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CRANIAL NERVES Cavernous sinus

Lateral view of left cavernous sinus as a simplified box shape


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Olfactory nerve C R A N I A L NERVES Optic nerve

Olfactory nerve (I)


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Optic nerve (11)


Olfactory nerve C R A N I A L NERVES Optic nerve

O L F A C T O R Y N E R V E (I) plate of the ethmoid bone where they


From: Olfactory epithelium synapse in the olfactory bulb which lies on
To: Olfactory cortex its superior surface. The bulb leads poster-
Contains: Special sense (smell) iorly to the olfactory tract which lies in the
anterior cranial fossa on the inferior surface
The olfactory epithelium lines the superior of the frontal lobe and conveys fibres to the
surface of the superior concha, upper medial anterior olfactory nucleus (in the posterior
nasal septum and inferior surface of the aspect of the olfactory bulb), to the
cribriform plate of the ethmoid bone. The prepiriform cortex, anterior perforating
fibres of the olfactory cells run in the substance and septal areas.
submucosa to pass through the cribriform

OPTIC N E R V E (11) canal and runs forwards to pierce the dura


From: Retina around the nerve inferomedially about l cm
To: Lateral geniculate body behind the eyeball. The nerve continues
Contains: Special sense (sight) posteriorly at first lateral to, then superior
to, the sella turcica where it forms the optic
The ganglion cells of the retina pass fibres chiasma. Fibres from both eyes are distrib-
out of the globe of the eye via the optic disc uted to each optic tract with medial retina1
to enter the optic N which passes through the fibres (temporal visual fields) crossing to the
orbit within the dural sheath and within the opposite side. Each tract passes from the
cone of muscles. The nerve passes through posterolateral angle of the chiasma, lying
the optic canal in the body of the sphenoid lateral to the pituitary infundibulum, to run
bone into the middle cranial fossa where it lateral to the cerebral peduncle and medial
lies medial to the anterior clinoid process. to the uncus of the temporal lobe to reach the
The ophthalmic artery lies inferior to it in the lateral geniculate body.
Oculomotor nerve CRANIAL NERVES Trochlear nerve

Oculomotor nerve (Ill)

Trochlear nerve (W)


Oculornotor nerve CRANIAL NERVES Trochlear nerve

O C U L O M O T O R NERVE ( I l l ) nasociliary branch of the ophthalmic


From: Oculomotor nucleus (somatic motor) division of the trigeminal N. It then enters
and Edinger-Westphal nucleus (general the orbit through the superior orbital fissure
visceral motor), ventral to cranial part of within the tendinous ring having divided into
aqueduct in midbrain superior and inferior divisions at the anterior
To: Terminal brs end of the cavernous sinus. The superior
Contains: Somatic motor & general visceral division runs lateral to the optic N on the
motor inferior surface of the superior rectus,
passing through this muscle to terminate in
This nerve emerges medial to the cerebral levator palpebrae superioris. This division
peduncle in the interpeduncular fossa to carries sympathetic supply to this muscle
reach the middle cranial fossa. It runs for- from the internal carotid artery in the cavern-
ward in close lateral relation to the posterior ous sinus. The inferior division divides into
communicating artery below the margin of terminal branches shortly after passing
the tentorium cerebelli. It pierces the dura through the tendinous ring, the nerve to
lateral to the posterior clinoid process to inferior oblique carrying the general visceral
enter the roof of the cavernous sinus lying motor fibres (parasympathetic) to the ciliary
initially high in its lateral wall. It descends, ganglion. This lies posteriorly in the orbit
passing medially over the trochlear N and inferolateral to the optic N.

TROCHLEAR NERVE (IV) just above the superior border of the pons.
From: Trochlear nucleus in floor of aqueduct It runs below the edge of the tentorium
in dorsal midbrain, level with upper part cerebelli between the posterior cerebral and
of inferior colliculus the superior cerebellar arteries. It enters the
To: Terminal brs roof of the cavernous sinus then onto its
Contains: Somatic motor lateral wall where it is crossed medially by
the oculomotor N from above down before
The fibres decussate within the substance of entering the orbit through the superior
the midbrain to appear on the opposite side. orbital fissure superolateral to the tendinous
The nerve emerges dorsally and passes ring. It runs medially above levator
lateral to the superior cerebellar peduncle palpebrae superioris to terminate as it
then around the lateral aspect of the pierces superior oblique.
midbrain in the middle cranial fossa to lie
Trigeminal nerve (Va) CRANIAL NERVES

Trigeminal nerve-ophthalmic division (Va)


CRANIAL NERVES Trigeminal nerve (Va)

TRlGEMlNAL NERVE-OPHTHALMIC the lateral upper eyelid. In its course it carries


D I V I S I O N (Va) parasympathetic fibres from the zygomatico-
From: Terminal nuclei are chief sensory temporal branch of the maxillary N (Vb)to
(touch),mesencephalic (proprioception) the lacrimal gland and sympathetic fibres
and spinal (pain & temperature). They lie from the nearby lacrimal artery.
in pons, midbrain & medullahpper
cervical cord respectively Nasociliary N. Runs within the tendinous
To: Terminal brs ring between superior and inferior division
Contains: Somatic sensory of the oculomotor N, crossing superior to
the optic N to lie over the medial rectus. It
The sensory root of the trigeminal N emerges leaves the muscular cone giving terminal
from the ventral surface of the upper pons to branches before running through the
enter the middle cranial fossa from where it anterior ethmoidal foramen in the ethmoid
passes to the trigeminal ganglion which lies bone on the medial orbital wall as the
in Meckel's cave, a prolongation of dura at anterior ethmoidal N. It traverses the
the apex of the petrous temporal bone. The anterior ethmoid sinus to run through its
ophthalmic division leaves the trigeminal roof and onto the superior surface of the
ganglion and runs forward in the lateral wall cribriform plate beneath the dura of the
of the cavernous sinus below the trochlear N anterior cranial fossa. It passes through the
and is crossed medially by the oculomotor plate again lateral to the crista galli onto
N. It divides into three terminal branches the medial wall of the nose, first on the
which pass through the superior orbital perpendicular plate of the ethmoid and then
fissure separately. (Note: the mesencephalic on the inner surface of the nasal bone. It
nucleus is unusual in that it receives primary passes into the skin of the nose beneath the
neurones that do not have the cell bodies in inferior margin of the nasal bone as its
the ganglion but in the nucleus itself.) terminal branch-the external nasal N.

Frontal N. Runs superolateral to the tendin- Short ciliary Ns. Each of these 8-10 nerves
ous ring into the orbit where it continues emerges from the ciliary ganglion with a
forwards and medially above levator sensory component from the nasociliary N,
palpebrae superioris, to divide into terminal postganglionic parasympathetic fibres from
branches which leave the orbit over its the oculomotor N and sympathetic fibres
superior margin through similarly named which pass directly from the internal carotid
notches. artery in the cavernous sinus.

Lacrimal N. Runs lateral to the tendinous Long ciliary Ns. Each of the 2-3 nerves has
ring into the orbit. It passes laterally, close sensory fibres from the nasociliary N and
to the periosteum of the orbital plate of the sympathetic fibres for the dilator pupillae
frontal bone, to supply the lacrimal gland that are carried by the nasociliary N from
and adjoining conjunctiva. It then leaves the the internal carotid artery in the cavernous
orbit over its superolateral margin to supply sinus.
Trigeminal nerve (Vb) CRANIAL NERVES

Trigeminal nerve-maxillary division (Vb)


CRANIAL NERVES Trigeminal nerve (Vb)

T R l G E M l N A L NERVE-MAXILLARY groove in the orbital surface of the maxilla.


D I V I S I O N (Vb) It terminates in branches in the skin of the
From: Terminal nuclei are chief sensory face having passed through the infra-
(touch),mesencephalic (proprioception) orbital foramen which is the completed
and spinal (pain & temperature). They lie continuation of the infra-orbital groove.
in pons, midbrain & medullahpper
cervical cord respectively Zygomatic N. Passes superiorly out of the
To: Terminal brs pterygopalatine fossa through the inferior
Contains: Somatic sensory orbital fissure to run in the lateral orbit
outside the cone of muscles. It terminates on
(See ophthalmic division for course to the the lateral orbital wall as facial and temporal
trigeminal ganglion.) The nerve leaves the branches which pass through unnamed
ganglion to run low down in the lateral wall canals in the zygomatic bone to reach the
of the cavernous sinus before passing onto skin over the zygomatic bone and hairless
the floor of the middle cranial fossa and it temple respectively.
then exits through the foramen rotundum
in the greater wing of the sphenoid bone. It Nasopalatine (previously sphenopalatine) N.
runs into the upper pterygopalatine fossa, Passes through the sphenopalatine foramen
giving branches via the pterygopalatine to enter the posterior upper nasal cavity to
ganglion before passing into the orbit via the end as terminal branches.
inferior orbital fissure to become the infra-
orbital N. The pterygopalatine ganglion is Pharyngeal N. A few fine branches of this
suspended from the maxillary N by one or nerve pass from the pterygopalatine ganglion
two roots and receives parasympathetic into the orbit via the inferior orbital fissure
fibres from the greater petrosal N in the to supply sensation and secretomotor fibres
pterygopalatine fossa which are distributed to the sphenoidal and ethmoidal sinuses.
with the terminal branches as shown.
Note: Other branches pass through foramina
Infra-orbital N. Passes laterally across the as indicated. Sympathetics have been
posterior aspect of the palatine bone and omitted from the distribution of the
maxilla to pass through the inferior orbital pterygopalatine ganglion to avoid
fissure and to run into the infra-orbital complicating the diagram.
Trigeminal nerve (VC) CRANIAL NERVES

Trigeminal nerve-mandibular division (VC)


CRANIAL NERVES Trigeminal nerve (VC)

T R l G E M l N A L NERVE-MANDIBULAR Posterior division


D I V I S I O N (VC) Auriculotemporal N. Passes posteriorly,
From: Terminal nuclei are chief sensory briefly dividing to encircle the middle
(touch), mesencephalic (proprioception) meningeal artery, before running between
and spinal (pain & temperature). They lie the neck of the mandible and the spheno-
in pons, midbrain & medullahpper mandibular ligament. It winds around the
cervical cord respectively. Motor nucleus neck of the mandible to pass laterally then
(branchial muscles) is in upper pons superiorly lying between the temporo-
To: Terminal brs mandibular joint and the external auditory
Contains: Somatic sensory & special visceral meatus deep to the parotid gland. It
motor terminates at the upper border of the gland
as branches. The nerve receives general
(See ophthalmic division for course to the visceral motor fibres (parasympathetic) from
trigeminal ganglion.) The smaller motor root the lesser petrosal N via the otic ganglion
leaves the ventral pons anteromedial to the which lies suspended from the nerve to
sensory root. The sensory root leaves the tensor tympani near the foramen ovale.
ganglion from its lateral part and passes, after
a short course over the greater wing of the Lingual N. Passes forward and inferiorly to
sphenoid bone, through the foramen ovale. lie between lateral pterygoid and tensor veli
The motor root passes under the ganglion palatini, then between medial pterygoid
and unites with the sensory root just beyond and the ramus of the mandible. It lies just
the foramen ovale. The nerve that is so beneath the mucous membrane of the mouth
formed passes into the infratemporal fossa posteromedial to the third molar tooth. It
between tensor veli palatini and lateral passes lateral to styloglossus and hyoglossus
pterygoid. It has a short course of 3-4mm and runs at first lateral, then inferior and
before dividing into anterior and posterior then medial to the submandibular duct.
divisions which provide terminal branches. It terminates over the lateral aspect of the
anterior two-thirds of the tongue. It is joined
Anterior division 2cm anterior and inferior to the foramen
Deep temporal Ns. Usually two, run above ovale by general visceral motor and special
the lateral pterygoid, over the infratemporal visceral sensory fibres of the chorda tympani
crest and on the squamous temporal and which relay in the submandibular ganglion.
greater wing of the sphenoid bones deep to This ganglion which is suspended from the
temporalis to supply it. They lie with their nerve by two roots lies on hyoglossus above
associated vessels deeply in the temporal the submandibular gland.
fossa.
Inferior alveolar N. Passes deep to lateral
Lateral pterygoid Ns. Pierce the muscle pterygoid to lie between the spheno-
directly to supply it. mandibular ligament and the rarnus of the
mandible before entering the mandible via
Masseter N. Runs laterally over the lateral the inferior alveolar foramen. It terminates
pterygoid and over the mandibular notch as cutaneous branches reappearing through
to pierce the deep surface of the muscle to the mental foramen in the anterior body of
supply it and the temporomandibular joint. the mandible. The N to mylohyoid arises just
before it enters the inferior alveolar foramen
Buccal N. Runs forward over lateral and pierces the sphenomandibular ligament
pterygoid and lies deep to temporalis, the to run in a groove on the medial surface of
mandible and masseter. It runs through the body of the mandible below mylohyoid.
buccinator to supply a small area of
overlying skin. The nerve is sensory only.
Abducent nerve (VI) C R A N I A L NERVES

Abducent nerve (W)


CRANIAL NERVES Abducent nerve (Vl)
P P-

A B D U C E N T N E R V E (VI) sellae. It arches forward directly over the


From: Abducent nucleus in sup part of floor ridge of the petrous temporal bone passing
of 4th ventricle in lower pons through the medial wall of the inferior
To: Terminal brs petrosal sinus under the petroclinoid
Contains: Somatic motor ligament and runs into the cavernous sinus.
Here it lies directly lateral to the internal
The fibres leave the pons at its lower border carotid artery before passing into the orbit
above the pyramid of the medulla. It through the superior orbital fissure within
traverses the pontine basal cistern running the tendinous ring. It passes forward and
forwards and superiorly to pierce the dura laterally to sink into the medial surface of the
over the clivus inferolateral to the dorsum lateral rectus muscle.
Facial nerve (VII) C R A N I A L NERVES

Facial nerve (W)


C R A N I A L NERVES Facial nerve (VII)

FACIAL N E R V E (VII) which leave just medial to the anterior


From: Facial motor nucleus deep to reticular border of the gland.
formation in lower pons. Sup salivary
nucleus (general visceral motor) distal to Greater petrosal N. Arises from the main
motor nucleus. Gustatory nucleus (taste) nerve at the geniculate ganglion and passes
in superior end of nucleus solitarius in medially through the petrous temporal bone
medulla. Sensory nucleus of V (see to lie in a groove on its anterior surface
trigeminal N ) beneath the temporal lobe and dura of the
To: Terminal brs middle cranial fossa. It runs beneath the
Contains: Somatic sensory, special visceral trigeminal ganglion and then passes
sensory & motor, general visceral motor anteromedially but lying anterolateral to
the internal carotid artery as this vessel
It leaves the pons at the cerebellopontine emerges across the upper end of foramen
angle medial to the vestibulocochlear N lacerum. It is joined by the deep petrosal
(VIII)as two nerve roots-the facial motor N (sympathetic) off the artery and this
root and the nervus intermedius. The nervus combined nerve (the N of the pterygoid
intermedius contains special visceral canal or Vidian's N ) passes into the same
sensory, general visceral motor and somatic named canal which commences a short
sensory fibres which connect with gustatory, way into the anterior wall of the foramen
superior salivary and sensory trigeminal lacerum at the root of the pterygoid process
nuclei respectively. These two roots pass of the sphenoid. This canal exits into the
across the subarachnoid space together to pterygopalatine fossa where the nerve enters
enter the internal auditory meatus and pass the posterior aspect of the pterygopalatine
laterally along it to reach and enter the facial ganglion and distributes its fibres with
canal. The two roots then unite and pass branches of the maxillary division (Vb) of
laterally onto the medial wall of the middle the trigeminal N.
ear before turning 90 degrees posteriorly
at the geniculate ganglion. It continues Chorda tympani. Arises from the facial nerve
posteriorly running above the promontory in the facial canal during its descent from the
and oval window and below the lateral medial wall of the middle ear. It runs back
semicircular canal. Finally the nerve turns 90 into the middle ear on the posterior wall
degrees inferiorly to run down in the medial before passing anteriorly between the two
wall of the aditus of the mastoid antrum. It layers of the flaccid part of the tympanic
leaves the middle ear via the stylomastoid membrane and over the handle of the
foramen to pass between the mastoid pro- malleus. It leaves the middle ear by passing
cess and the tympanic ring before passing into the petrous temporal bone and emerges
between the deep and superficial portions via the petrotympanic fissure to pass into the
of the parotid gland. Within the gland it infratemporal fossa medial to the spine of
lies superficial to the styloid process, the sphenoid bone which it grooves. It runs
retromandibular vein and external carotid antero-inferiorly, deep to lateral pterygoid,
artery before dividing into terminal branches to join the lingual branch of the mandibular
division (VC)2cm below the skull.
Vestibulocochlear nerve (VIII) C R A N I A L NERVES Glossopharyngeal nerve (IX)

Vestibulocochlear nerve (V111)


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Glossopharyngeal nerve (IX)


Vestibulocochlear nerve (VIII) CRANIAL NERVES Glossopharyngeal nerve (IX)

VESTIBULOCOCHLEAR NERVE ( V I I I ) pierces the temporal bone in its antero-


From: 4 Vestibular & 2 cochlear nuclei in inferior quadrant. The vestibular element
floor of 4th ventricle in pons divides into upper and lower divisions to
To: Inner ear pierce the temporal bone in its postero-
Contains: Special sense (hearing, balance) superior and postero-inferior quadrants. The
cochlear N runs in the cochlear modiolus to
It emerges at the cerebellopontine angle as a end in terminal connections. The upper
single nerve and traverses the subarachnoid vestibular division runs to supply the semi-
space to enter the internal auditory meatus circular canals and the utricle, the lower
where the cochlear element separates and division the saccule.

GLOSSOPHARYNGEAL NERVE (IX) and terminates in lingual and pharyngeal


From: Sensory nucleus of V (common branches.
sensation-see trigeminal N). Nucleus
solitarius (taste-medulla). Nucleus Carotid N. Arises just below the ganglia and
ambiguus (motor to branchial muscle- runs down closely adherent to the internal
medulla). Inf salivary nucleus carotid artery within the carotid sheath to
(secretomotor-lower pons) reach the carotid sinus and carotid body.
To: Terminal brs
Contains: Somatic sensory, general & special Lesser petrosal N. The tympanic branch
visceral motor, special visceral sensory (Jacobson's N) of the glossopharyngeal N
arises just below the ganglia to pass via the
The fibres leave the medulla as three or four petrous temporal bone into the middle ear.
rootlets lying posterior to the olive. They It mingles with parasympathetic fibres of the
rapidly fuse into one nerve which passes facial N (VII)and sympathetics from the
anterolaterally into the anterior compart- internal carotid artery over the promontory
ment of the jugular foramen (between on the medial wall to form the lesser petrosal
petrous temporal and occipital bones). N. This nerve then leaves the middle ear
It passes lateral to the inferior petrosal via the medial side of the roof and passes
sinus which separates it from the vagus and through the petrous temporal bone into the
accessory Ns and runs anteriorly out of the middle cranial fossa. Here it lies beneath the
compartment. It forms the glossopharyngeal dura to run forward before passing through
ganglia below the compartment as it passes the foramen ovale and synapsing below in
between internal jugular vein and internal the otic ganglion in the infratemporal fossa.
carotid artery. It passes inferolaterally From here it is distributed with the auriculo-
looping around the upper border of temporal branch of the mandibular division
stylopharyngeus, runs deep to hyoglossus (VC)to the parotid gland.
Vagus nerve (X) C R A N I A L NERVES

Vagus nerve (X)


C R A N I A L NERVES Vagus nerve (X)

VAGUS N E R V E (X) mucous membrane of the vallecula and


From: Dorsal motor nucleus of vagus larynx down to the vocal folds.
(general visceral motor-lower medulla).
Nucleus ambiguus (branchial motor- External branch. Runs down over the
medulla). Nucleus solitarius (taste & inferior constrictor accompanied by the
general visceral sensory-medulla). superior thyroid artery to reach the
Sensory nucleus of V (common sensation- cricothyroid muscle.
see trigeminal N )
To: Terminal brs Recurrent laryngeal N. In the neck the two
Contains: Somatic sensory, general & special sides follow the same course ascending in
visceral sensory, general & special visceral the tracheo-oesophageal groove. As the
motor nerve passes medial to the lateral lobe of the
thyroid gland it is intimately related to the
The fibres emerge from the medulla as a inferior thyroid artery. It passes beneath the
series of rootlets posterior to the olive inferior border of cricopharyngeus (inferior
between the glossopharyngeal and cranial constrictor) to terminate within the sub-
accessory rootlets. These form into a single mucosa of the larynx. The nerve on the right
nerve that passes into the middle compart- originates from the vagus anterior to the
ment of the jugular foramen. Below the subclavian artery around which it hooks
foramen it forms superior and inferior posteriorly before running medially to
ganglia before being joined by the cranial ascend in the tracheo-oesophageal groove.
part of the accessory N. It passes vertically The nerve on the left originates from the
down within the carotid sheath closely vagus inferolateral to the arch of the aorta
related to the internal carotid artery and passing inferior to the arch and posterior to
lying between it and the internal jugular the ligamentum arteriosum. It runs to the
vein. right of the arch as it passes posteriorly over
the left side of the trachea to reach the
Pharyngeal branch. Passes from the vagus tracheo-oesophageal groove.
at the inferior ganglion running between
internal and external carotid arteries to Cardiac Ns. The upper branch arises below
reach the lateral wall of the pharynx. These the inferior ganglion and the lower branch
fibres are mostly from the cranial part of the arises in the root of the neck. On the right
accessory N. they pass down anterior to the brachio-
cephalic artery and on the left over the aortic
Superior laryngeal N. Passes from the arch to terminate in the cardiac plexuses.
inferior ganglion running steeply down
anteriorly, lying posterior and then medial Note: General visceral motor (para-
to the internal carotid artery. It pierces the sympathetic) and general visceral sensory
carotid sheath to run on the wall of the fibres in the vagus to and from the thorax
pharynx to the level of the greater cornu of and abdomen ariselend in the dorsal motor
the hyoid bone where it divides. nucleus of vagus and nucleus solitarius
respectively.
Internal branch. Runs down anteriorly onto All branchial motor (special visceral
the thyrohyoid membrane which it pierces motor) fibres in the vagus which supply
at the level of the vallecula, and is then muscles arise in the nucleus ambiguus but
distributed as terminal branches to the the majority, if not all, are supplied to the
vagus by the cranial accessory (XI).
Accessory nerve (XI) C R A N I A L NERVES Hypoglossal nerve (XiI)

Accessory newe (XI)

Hypoglossal newe (XII)


Accessory nerve (XI) CRANIAL NERVES Hypoglossal nerve (XII)

A C C E S S O R Y N E R V E (XI) posterior to the vagus and anterior to the


From: Cranial root from nucleus ambiguus internal jugular vein. Inferior to the foramen
(branchial motor-medulla). Spinal root the cranial element passes inferomedially
from spinal nuclei (Cl-CS) to fuse with the vagus to which it adds its
To: Terminal brs complement of special visceral motor fibres.
Contains: Somatic motor (spinal), special
visceral motor (cranial) Spinal root. Passes posterolaterally, usually
posterior to the internal jugular vein, over
The fibres of the cranial root emerge from the lateral mass of the atlas ( C l )and deep to
the medulla as four to six rootlets posterior the occipital artery to enter the deep surface
to the olive immediately below those of the of sternocleidomastoid. It traverses the
vagus to fuse into a single nerve. They are posterior triangle of the neck from one-third
joined by the spinal root as it ascends via of the way down the posterior border of
the foramen magnum (see cervical plexus, sternocleidomastoid to one-third of the way
pp. 112-1 13). The nerve passes out of the up the anterior border of trapezius where it
posterior cranial fossa through the middle terminates.
compartment of the jugular foramen

.............................

H Y P O G L O S S A L N E R V E (XII) fuse. The nerve runs out of the canal anteri-


From: Hypoglossal nucleus in floor of 4th orly, lateral to the occipital, internal carotid,
ventricle in medulla external carotid and lingual arteries before
To: Terminal brs passing over the apex of the greater corm
Contains: Somatic motor of the hyoid bone. It then runs anteriorly,
looping lateral to hyoglossus, deep to
Its fibres pass out of the anterolateral sur- mylohyoid, to end in terminal branches
face of the medulla between the olive and beneath the submandibular gland.
pyramid as a series of 10-15 rootlets. These
fuse to form two roots which pass posterior Note: C1 fibres join the hypoglossal N (pp.
to the vertebral artery as they run into the 112-1 13). This is not shown in this diagram
hypoglossal canal where they themselves but they are seen leaving it.
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Cervical plexus (C1,2,3,4,5) 112 Sacral plexus (L4,S,S1,2,3,4,5) 132
Brachial plexus (C5,6,7,8,Tl) 1l 4 Sciatic nerve (L4,5,S1,2,3) 134
Radial nerve (C5,6,7,8,Tl) 1l 6 Tibial nerve (L4,5,S1,2,3) 136
Musculocutaneous nerve (C5,6,7) 118 Common peroneal (fibular)nerve
Median nerve (C6,7,8,T1) 120 (L4,5,S1,2) 138
Ulnar nerve (C8,Tl) 122 Superficial peroneal (fibular)nerve
Phrenic nerve (C3,4,5) 124 (LS,S1,2) 138
Intercostal nerve (typical) 124 Deep peroneal nerve (L4,5,S1,2) 138
Lumbar plexus (T12,L1,2,3,4,5) 126 Lateral plantar nerve (S1,2) 140
Femoral nerve (L2,3,4) 128 Medial plantar nerve (L4,S) 140
Obturator nerve (L2,3,4) 130
Cervical plexus PERIPHERAL NERVES

Cervical plexus (C 1,2,3,4,5)


PERIPHERAL NERVES Cervical plexus

C E R V I C A L P L E X U S ( C 1,2,3,4,5) membrane between obliquus capitis superior


From: C1,2,3,4,5 Ns and rectus capitis posterior major to
To: Ns as shown terminate in muscular branches in the
suboccipital triangle.
It arises mostly from the anterior primary
rami deep between scalenus medius and Greater occipital N (posterior primary rami
scalenus anterior at the level of Cl-C4 of C2, and a small contribution from C3).
vertebrae and is covered by prevertebral Emerges from the posterior spinal dura at
fascia lying deep to sternocleidomastoid. The the intervertebral foramen and passes
cutaneous branches pierce the prevertebral posteriorly over the transverse process of
fascia and run into the posterior triangle of the axis (C2)below obliquus capitis inferior.
the neck where they pierce the investing layer It then winds around this muscle to ascend
of the deep cervical fascia to terminate in deep to semispinalis piercing it and trapezius
subcutaneous Ns. near to their insertions into the superior
nuchal line. It terminates as cutaneous
Ansa cervicalis (Cl-C3). Superior root branches running in the scalp with the
(anterior primary rami C1)-passes directly occipital artery.
to the hypoglossal N (XII)between rectus
capitis anterior and lateralis. It leaves the Spinal accessory N (XIS)(lateral roots
hypoglossal N lateral to the occipital artery Cl-C5) is formed from the unique lateral
and runs anterior to the internal and roots of Cl-C5 and ascends within the
common carotid arteries where it joins the subarachnoid space lateral to the cord and
inferior root. Inferior root (anterior primary posterior to the denticulate ligament, to pass
rami C2,3)-passes laterally around the through the foramen magnum posterior to
internal jugular vein having pierced the the vertebral artery to meet with the cranial
prevertebral fascia at the level of C213. It root.
runs forwards and anteriorly as a long loop
to meet with the superior root anterior to the Phrenic N (see pp. 124-125).
common carotid artery.
Great auricular N (C2,3). Supplies skin over
Suboccipital N (posterior primary ramus parotid gland and angle of jaw (this is the
of Cl). Emerges through the dura to run only area of the face that is not supplied by a
beneath the vertebral artery closely applied cranial nerve), lower lateral auricle below
to the posterior arch of the atlas ( C l ) .It external auditory meatus, and whole of
pierces the posterior atlanto-occipital posterior (medial)auricle.
Brachial plexus PERIPHERAL NERVES

Brachial plexus (C5,6,7,8,T I )


PERIPHERAL NERVES Brachial plexus

BRACHIAL P L E X U S (C5,6,7,8,TI) neck of the humerus running laterally to end


From: Ant primary rami of C5,6,7,8,Tl in anterior and posterior divisions deep to
To: Musculocutaneous, median, ulnar & deltoid.
radial Ns
Upper lateral cutaneous N of arm. Is a
It emerges as five roots lying anterior to continuation of the posterior branch of the
scalenus medius and posterior to scalenus axillary N and supplies skin over the lower
anterior. The trunks lie in the base of the lateral deltoid. Damage to the axillary N
posterior triangle of the neck, where they are (and hence this nerve) gives a 'regimental
palpable, and pass over the 1st rib posterior badge' area of sensory loss.
to the third part of subclavian artery to
descend to lie behind the clavicle. The Thoracodorsal N (C5,6,7). Runs with the
divisions form behind the middle third of the subscapular artery down the medial scapular
clavicle lying on the upper fibres of serratus border over teres major and into latissimus
anterior and around the axillary artery, as dorsi.
they form the cords. The cords lie in the
axilla related to the second part of the Long thoracic N of Bell (C5,6,7). Descends
axillary artery lying medial, lateral and posterior to the trunks of the plexus and the
posterior as their names indicate and first part of the axillary artery to lie on the
posterior to pectoralis minor. Terminal lateral aspect of serratus anterior on the
nerves are formed around the third part of medial axillary wall.
the axillary artery posterior to the lower
fibres of pectoralis major. Suprascapular N (C5,6). Arises in the
posterior triangle of the neck, passes
Axillary N (C5,6). Arises posterior to the posterolaterally deep to trapezius and
third part of axillary artery. It runs omohyoid and runs through the supra-
posteriorly on subscapularis to pass through scapular notch into the supraspinous fossa.
the quadrangular space with the posterior It descends laterally around the scapular
circumflex humeral artery. It is intimately spine into the infraspinous fossa.
related to the medial aspect of the surgical
Radial nerve PERIPHERAL NERVES

Radial nerve (C5,6,7,8,T I)


PERIPHERAL NERVES Radial nerve

R A D I A L NERVE (C5,6,7,8,T I ) divides into terminal branches over the


From: Post cord of brachial plexus lateral epicondyle.
To: Terminal brs
Superficial terminal branch. Runs over
It arises as the continuation of the posterior supinator, pronator teres and flexor
cord and descends posterior to the axillary digitorum superficialis and lies under
and brachial arteries passing inferior to the brachioradialis running with the radial
tendons of latissimus dorsi and teres major artery on its medial aspect from one-third of
to run with the profunda brachii artery the way down the forearm. It passes
between the long and medial heads of triceps posteriorly, emerging from under the tendon
and through the lateral triangular space. It of brachioradialis proximal to the radial
gives off the posterior cutaneous N of arm styloid and then passes over the tendons of
before leaving the axilla. It then runs over the the snuff box where it terminates as cuta-
spiral line of the humerus between medial neous branches to the dorsum of the hand.
and lateral heads of triceps giving muscular
and cutaneous branches, and pierces the Posterior interosseous N. Passes between the
lateral intermuscular septum at the mid two heads of supinator three fingers' breadth
point of the humerus to reach the anterior below radial head passing into the posterior
compartment. Here it lies deep to the upper compartment where it breaks up into
fibres of brachialis then brachioradialis, terminal muscular branches in the plane
before entering the lateral cubital fossa. It between the deep and superficial muscles in
this compartment.
Musculocutaneous nerve PERIPHERAL NERVES

Musculocutaneous n e w e (C5,6,7)
PERIPHERAL NERVES Musculocutaneousnerve

M U S C U L O C U T A N E O U S NERVE brachialis, usually adherent to the deep


(C5,6,7) surface of biceps. The terminal branch is the
From:Lat cord lateral cutaneous N of forearm.
To: Terminal brs
Lateral cutaneous N of forearm. Emerges
It arises obliquely behind the lower fibres of lateral to the tendon of biceps in the cubital
pectoralis minor lying lateral to the axillary fossa, piercing the deep fascia just below the
artery and passes laterally between the two elbow and descends over the lateral aspect of
conjoined heads of coracobrachialis. It runs the forearm to terminate in the skin over the
laterally downwards between biceps and radial artery at the wrist.
Median nerve PERIPHERAL NERVES

Median nerve (C6,7,8,T I )


PERIPHERAL NERVES Median nerve

M E D I A N NERVE ( C 6 , 7 , 8 , T I ) superficialis about 5 cm proximal to the


From: Med & lat cords wrist where it gives its palmar cutaneous
To: Terminal brs branch and then passes deep to the flexor
retinaculum between the tendons of flexor
It is formed in the lower axilla by two roots digitorum superficialis and flexor carpi
(heads)which clasp the axillary artery. The radialis. In the carpal tunnel it divides into
nerve initially lies anterior to the axillary terminal branches-recurrent (muscular)
artery and then lateral to it and subsequently branch and palmar digital Ns.
lateral to the brachial artery. The median N
then crosses the brachial artery, usually Anterior interosseous N. Arises just below
anteriorly, at the level of the mid humerus, the two heads of pronator teres to run on
to lie medial to the artery in the cubital fossa. the interosseous membrane between and
It lies first on coracobrachialis and then covered by flexor digitorum profundus and
brachialis. It passes beneath the bicipital flexor pollicis longus ending beneath
aponeurosis at the elbow leaving the cubital pronator quadratus.
fossa between the two heads of pronator
teres before crossing superficial to the ulnar Recurrent branch of median N. Runs out of
artery and giving its anterior interosseous the carpal tunnel over the distal border of the
branch below this. It lies applied to the deep flexor retinaculum onto flexor pollicis brevis
surface of flexor digitorum superficialis on to terminate by passing into the thenar
flexor digitorum profundus. It emerges eminence.
from the lateral side of flexor digitorum
Ulnar nerve PERIPHERAL NERVES

Ulnar nerve (C8,T I)


PERIPHERAL NERVES Ulnar nerve

ULNAR NERVE (C8,TI) lateral side from one-third of the way down
From: Med cord of brachial plexus the forearm. It lies lateral to the tendon of
To: Terminal brs flexor carpi ulnaris at the wrist and then
passes superficial to the flexor retinaculum to
It arises medial to the axillary artery and divide into terminal branches at the pisiform
continues medial to the brachial artery lying bone.
on coracobrachialis to the mid point of the Superficialterminal branch-lies super-
humerus where it leaves the anterior com- ficial in the palm terminating as digital Ns.
partment by passing posteriorly through It also supplies palmaris brevis if present.
the medial intermuscular septum with the Deep terminal branch-passes through the
superior ulnar collateral artery. It lies hypothenar eminence between flexor digiti
between the intermuscular septum and the minimi and abductor digiti minimi grooving
medial head of triceps passing posterior to the hook of the hamate and runs with the
the medial humeral epicondyle and enters deep palmar arch, deep to the flexor tendons
the forearm between the two heads of flexor to terminate in adductor pollicis.
carpi ulnaris. It then lies medial to the Dorsal cutaneous branch-arises Scm
coronoid process of the ulna, runs deep to proximal to the wrist, passes deep to flexor
flexor carpi ulnaris and on flexor digitorum carpi ulnaris onto the medial aspect of the
profundus, with the ulnar artery on its dorsum of the hand where it terminates as
cutaneous Ns.
Phrenic nerve PERIPHERAL NERVES Intercostal nerve

Phrenic nerve (C3,4,5)

Intercostal nerve
Phrenic nerve P E R I P H E R A L NERVES Intercostal nerve

P H R E N I C N E R V E (C3,4,5) right atrium and inferior vena cava, lying


From:Ant primary rami of C3,4,5 within the fibrous pericardium. It passes
To: Terminal brs anterior to the hilum of the lung before
traversing the diaphragm via the caval
It arises deep between scalenus medius and orifice. Left-descends usually anterior to the
scalenus anterior and runs over the lateral left internal thoracic artery lying lateral to
border of scalenus anterior behind the the left common carotid artery. It runs down
prevertebral fascia. It runs on scalenus over the aortic arch crossing anterior to the
anterior from lateral to medial edges lying left vagus before running anterior to the left
lateral to the ascending cervical artery and pulmonary artery and thus anterior to the
it passes behind the suprascapular and hilum of the lung. It then runs lateral to
transverse cervical arteries as it does so. It the left auricle and left ventricle within
runs over the anterior part of the dome of the fibrous pericardium to traverse the
the pleura to enter the mediastinum post- diaphragm in isolation via the muscular
erior to the subclavian vein and anterior to portion of the diaphragm to the left of the
subclavian artery where right and left central tendon.
nerves take different courses. Right- An accessory phrenic N (CS)arising from
spirals forwards to lie lateral to the right the N to subclavius may join the phrenic N
brachiocephalic vein and continues on the near the 1st rib.
lateral surface of the superior vena cava,

INTERCOSTAL NERVE (TYPICAL) T1. Has no lateral or anterior cutaneous


From: Ant primary rami of thoracic N branches.
To: Terminal brs
T7-11. Run behind the costal margins in
It emerges from the intervertebral foramen their anterior course to lie in the same muscle
(giving off the posterior primary ramus as it plane in the abdomen. At their anterior limit
does so) to pass between the pleura and the they pass deep to rectus abdominis in the
inner muscle layer anterior to the transverse rectus sheath and pierce both of these struc-
process where it connects via the grey and tures to give terminal anterior cutaneous
white rami communicantes with the thoracic branches. These also supply rectus
sympathetic chain. It passes posterior to the abdominis.
intercostal artery to lie below it as it runs in
the subcostal groove in the plane between T12. Passes below the 12th rib as the sub-
internal and innermost muscle layers. The costal N having similar branches to those
muscular collateral branch arises before the above. It emerges from behind the lateral
posterior angle of the rib and runs in the arcuate ligament of the diaphragm.
same plane but lies at the level of the upper
border of the rib below.
Lumbar plexus P E R I P H E R A L NERVES

Lumbar plexus (T I 2,L 1,2,3,4,5)


PERIPHERAL NERVES Lumbar plexus

LUMBAR P L E X U S (T I 2 , L 1,2,3,4,5) passes over iliacus obliquely lying posterior


From: Ant primary rami of Tl2,Ll,2,3,4,S to the caecum on the right and descending
To: Ns as shown colon on the left. It runs forward to the
anterior superior iliac spine where it
The plexus is formed within the substance penetrates the inguinal ligament at irs
of psoas major anterior to the transverse attachment to pass into the subcutaneous
processes of L2-5 from the anterior primary tissue of the lateral thigh.
rami as they emerge from the intervertebral
foramina. Genitofemoral N (L1,2). Emerges onto the
anteromedial surface of psoas lying posterior
Iliohypogastric N (Ll).This main nerve to the ureter, gonadal and iliocolic vessels on
emerges lateral to psoas on the lumbar fascia the right and ureter, gonadal and lower left
at the level of L2 to pass posterior to the colic vessels on the left. It divides into genital
lower pole of the kidney and over quadratus and femoral branches on the anterior aspect
lumborum. It passes above the iliac crest, of psoas.
between transversus and internal oblique
abdominis to pierce the latter above the Genital branch. Crosses the external iliac
anterior superior iliac spine. It supplies both artery, passes through the deep inguinal ring
muscles before becoming cutaneous. into the inguinal canal and through the
superficial inguinal ring to terminate in the
Ilio-inguinal N (Ll).This collateral branch spermatic cord in the male and labium majus
emerges lateral to psoas on the lumbar in the female. It may also supply a small area
fascia, passes posterior to the lower pole of of scrotal/labial skin.
the kidney, over quadratus lumborum and
penetrates transversus and internal oblique Femoral branch. Continues down lateral to
abdominis above the anterior superior iliac the external iliac artery, under the inguinal
spine. It supplies the lowest fibres of these ligament and into the femoral sheath which
muscles and the conjoint tendon. Its terminal it penetrates anteriorly to become
branch enters the inguinal canal from above subcutaneous.
to pass through the superficial inguinal ring
before piercing the external spermatic fascia Lumbosacral trunk (L4,5). Emerges deep
to become subcutaneous. from the medial aspect of psoas to pass over
the pelvic brim to form the upper fibres of
Lateral femoral cutaneous N (L2,3). the sciatic N.
Emerges lateral to psoas below the iliac crest,
Femoral nerve PERIPHERAL NERVES

Femoral nerve (L2,3,4)


PERIPHERAL NERVES Femoral nerve

F E M O R A L N E R V E (L2,3,4) medialis running lateral to the femoral artery


From: Post div of ant primary rami of L2,3,4 as far as the upper part of the adductor
To: Terminal brs (Hunter's) canal before entering the muscle.

It is formed within psoas major and emerges Saphenous N (post division). Descends in the
from its lateral border low down in the iliac femoral triangle to reach the adductor canal
fossa to lie in the groove between psoas and where it spirals over the femoral artery to
iliacus. It reaches the thigh beneath the lie medial to it. It pierces the deep fascia
inguinal ligament lateral to the femoral through the apex of the canal and emerges
artery lying on the tendon of iliacus and posterior to sartorius and anterior to gracilis
psoas. In the femoral triangle it splits into to continue with the long saphenous vein. It
anterior and posterior divisions which passes over the subcutaneous surface of the
straddle the lateral circumflex femoral tibia and anterior to the medial malleolus
artery. There are usually four short super- where it is palpable, closely related to the
ficial branches. The deep branches continue long saphenous vein. It terminates in
down the femoral triangle, the N to vastus branches over the medial side of the foot.
Obturator nerve PERIPHERAL NERVES

Obturator newe (L2,3,4)


PERIPHERAL NERVES Obturator nerve

O B T U R A T O R N E R V E (L2,3,4) and posterior divisions which straddle


From: Ant div of ant primary rami of L2,3,4 adductor brevis. The posterior division
To:Terminal brs pierces a few fibres of obturator externus
and runs deep to adductor brevis on
This nerve is formed within psoas major and adductor magnus. The anterior division runs
emerges from the medial aspect of the muscle on the anterior aspect of adductor brevis
on the ala of the sacrum to pass behind the deep to pectineus and then deep to adductor
common iliac vessels. It runs over the pelvic longus to end by contributing, together with
brim on the lateral wall of the pelvis and over the saphenous and medial femoral cutaneous
the upper fibres of obturator internus to pass N, to the subsartorial plexus which supplies
through the upper anterior aspect of the the skin over the medial thigh.
obturator foramen. It divides into anterior
Sacral plexus P E R I P H E R A L NERVES

Sacral plexus (L4,5,S 1,2,3,4,5)


P E R I P H E R A L NERVES Sacral plexus

S A C R A L P L E X U S (L4,5,S 1,2,3,4,5) inferior to gluteus maximus to become sub-


From: Lumbosacral trunk (L4,5) & ant cutaneous in the buttock. It supplies that
primary rami from S1,2,3,4,5 part of the buttocks which touch when
To:Definitive Ns standing and part when sitting.

Lies on piriformis on the posterior wall of Pudendal N (S2,3,4). Passes out of the pelvis
the pelvis deep to the internal iliac vessels over the sacrospinous ligament close to the
(and the sigmoid vessels on the left) and is ischial spine through the greater, and re-
protected by a sheet of pelvic fascia overlying entering through the lesser, sciatic foramina.
it. Its roots are characteristically related to It runs on the medial surface of the lower
arteries which pass between them as shown. fibres of obturator internus in the pudendal
(Alcock's) canal. It passes forwards in the
Superior gluteal N (L4,5,Sl). Emerges from lateral wall of the ischio-anal fossa where it
the upper roots of the sciatic N and passes gives off its inferior rectal branch. It passes
out of the pelvis above piriformis through into the perineum and gives its terminal
the greater sciatic foramen. It runs between branches, the perinea1 N being superficial to
gluteus medius and minimus over the middle the urogenital diaphragm and the dorsal N
gluteal line on the outer surface of the ilium deep to it.
to terminate in muscular branches.
It helps to remember that all six branches
Inferior gluteal N (L5,S1,2). Emerges from leaving sacral roots before anterior and
the middle roots of the sciatic N and passes posterior divisions begin with the letter 'P':
out of the pelvis below piriformis through N to Piriformis S1,2 (remains in pelvis to
the greater sciatic foramen to enter gluteus supply this muscle)
maximus. Posterior femoral cutaneous N S1,2,3 (leaves
pelvis via greater sciatic foramen)
Posterior femoral cutaneous N (S1,2,3). Perforating cutaneous N S2,3 (leaves pelvis
Passes out of the pelvis below piriformis via greater sciatic foramen)
through the greater sciatic foramen. It runs Pudendal N S2,3,4 (leaves pelvis via greater
on the sciatic N, over the long head of biceps sciatic foramen)
femoris to become subcutaneous extending Pelvic splanchnics (parasympathetic) S2,3,4
as far as the popliteal fossa. (remain in pelvis to supply pelvic organs)
Perinea1 branch of S4 (remains in pelvis to
Perforating cutaneous N (S2,3). Passes supply levator ani)
through the sacrotuberous ligament and
Sciatic nerve PERIPHERAL NERVES

Sciatic nerve (L4,5,S 1,2,3)


PERIPHERAL NERVES Sciatic nerve

S C I A T I C N E R V E (L4,5,S 1,2,3) N to quadratus femoris (L4,5,S1). Arises


From:Ant primary rami of L4,S,Sl,2,3 from the anterior surface of the sciatic N
To: Tibial & common peroneal (fibular) Ns in the pelvis and leaves the pelvis in this
position through the greater sciatic foramen,
It is formed in the upper sacral plexus and lying between the sciatic N and the ischium.
passes out of the greater sciatic foramen Running deep to the tendon of obturator
below piriformis. In the buttock and thigh it internus and the gemelli it supplies gemellus
lies initially deep to gluteus maximus lying inferior before passing into quadratus
on gemellus superior, obturator internus femoris from above.
tendon and gemellus inferior and then on
quadratus femoris and adductor magnus. It N to obturator internus (LS,S1,2). Arises
passes out of the cover of gluteus maximus from the anterior surface of the sciatic N in
and for a short distance it is covered by only the pelvis and leaves the pelvis through the
deep fascia, before it passes deep to the two greater sciatic foramen below piriformis and
heads of biceps femoris. It runs vertically medial to the sciatic N. It passes medially
down in the midline of the posterior com- over the ischial spine (lateral to the pudendal
partment of the thigh and terminates by neurovascular bundle) and sends a branch to
dividing into common peroneal (fibular) and gemellus superior before turning forward to
tibial Ns usually two-thirds of the way down pass through the lesser sciatic foramen,
the thigh. In its course over the gemelli it is a penetrating and supplying obturator
close posterior relation of the ischium and internus as it does so.
posterior rim of the acetabulum.
Tibial nerve PERIPHERAL NERVES

Tibial newe (L4,5,S 1,2,3)


PERIPHERAL NERVES Tibial nerve

T I B I A L N E R V E (L4,5,S 1,2,3) down the calf. It slopes gently medially in


From: Sciatic N the lower calf passing behind the medial
To: Med & lat plantar Ns malleolus of the lower tibia between the
posterior tibial artery anterornedially
It arises in the lower third of the thigh above and the tendon of flexor hallucis longus
the apex of the popliteal fossa as the larger posterolaterally. It runs under the flexor
terminal branch of the sciatic N, and passes retinaculum where it divides into terminal
down in the midline into the fossa between branches.
semitendinosus and biceps femoris, lying
deep to them. It lies markedly lateral to the Sural N. Arises in the popliteal fossa, passing
popliteal artery on entry to the popliteal out posteriorly over the 'V' behind the two
fossa but then the artery crosses deep to the heads of gastrocnemius and is joined by the
N to lie lateral to it. The tibial N and the sural communicating N from the common
popliteal artery remain separated by the peroneal (fibular) N. It pierces the deep
popliteal veins. The nerve leaves the fossa fascia to become subcutaneous. It runs down
deep to the two heads of gastrocnemius by laterally accompanied by the short
passing deep to the fibrous arch of soleus. It saphenous vein to pass behind the lateral
then runs deep to soleus on tibialis posterior malleolus over the superior peroneal
in the midline, crossing over the posterior (fibular) retinaculum to end in terminal
tibial artery from medial to lateral half way branches on the lateral side of the foot.
Peroneal (fibular) nerves PERIPHERAL NERVES

Common, superficial and deep peroneal (fibular) nerves


Note: the common peroneal (fibular) nerve is viewed f r o m behind b u t t h e superficial and deep
nerves are viewed f r o m in front
P E R I P H E R A L NERVES Peroneal (fibular) nerves

C O M M O N PERONEAL [FIBULAR] subcutaneous. It runs downwards superficial


N E R V E (L4,5,S 1,2) to the superior and inferior extensor retin-
From: Sciatic N acula to end as terminal branches over them.
To: Superficial & deep peroneal (fibular) Ns

It arises in the lower third of the thigh above DEEP PERONEAL [FIBULAR] NERVE
the apex of the popliteal fossa as the smaller (L495,S 1,2)
terminal branch of the sciatic N. It passes From: Common peroneal (fibular) N
into the popliteal fossa along the upper To: Terminal brs
lateral boundary just beneath the edge of
biceps femoris and runs over plantaris, the It arises deep to peroneus longus and passes
lateral head of gastrocnemius and the forwards deep to the muscle to wind around
posterior capsule of the knee joint. It runs the fibula and to pass through the anterior
over the fibular attachment of soleus to wind intermuscular septum. It continues deep
around the neck of the fibula from posterior to extensor digitorum longus to appear
to lateral. It passes into peroneus longus between it and tibialis anterior lying on the
where it divides. interosseous membrane in the upper quarter
of the anterior compartment. It runs down
the interosseous membrane with the anterior
SUPERFICIAL PERONEAL [FIBULAR] tibial vessels, coming to lie between extensor
N E R V E (L5,S 1,2) hallucis longus and tibialis anterior in the
From: Common peroneal (fibular) N lower three-quarters of the compartment. It
To: Terminal brs passes anterior to the tibia at the ankle joint
between the anterior tibial artery medially
It arises deep to peroneus longus and passes and the tendon of extensor digitorum longus
forwards and downwards to lie over the laterally, running beneath the superior and
lateral surface of the fibula between peron- inferior extensor retinacula. It breaks up into
eus longus and brevis. It pierces the deep terminal branches on the dorsum of the foot.
fascia half way down the leg to become (Articular branch to ankle joint not shown.)
Lateral plantar nerve PERIPHERAL NERVES Medial plantar nerve

Lateral plantar nerve (S 1,2)

Medial plantar nerve (L4,5)


Lateral plantar nerve P E R I P H E R A L NERVES Medial plantar nerve

LATERAL PLANTAR NERVE (S 1,2) over the origin of flexor digitorum access-
From: Tibial N orius beneath flexor digitorum brevis, and its
To: Terminal brs superficial terminal branches appear more
superficially between flexor digitorurn brevis
It arises beneath the flexor retinaculum and and abductor digiti minimi. Its deep terminal
runs forward with the lateral plantar artery branches run medially beneath the long
around the sustentaculum tali of the cal- flexor tendons and across the metatarsa1
caneus deep to abductor hallucis. It runs shafts to end in muscular branches.

MEDIAL PLANTAR NERVE (L4,5) to abductor hallucis. It pierces the plantar


From: Tibial N fascia in so doing and runs forward over the
To: Terminal brs tendon of flexor digitorurn longus to appear
more superficially again between abductor
It arises beneath the flexor retinaculum and hallucis and flexor digitorum brevis in the
runs with the medial plantar artery around sole of the foot.
the sustentaculum tali of the calcaneus deep
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DERMATOMES AND CUTANEOUS NERVE DISTRIBUTION

Dermatomes: head and neck


DERMATOMES AND CUTANEOUS NERVE DISTRIBUTION

Cutaneous nerves: head and neck


DERMATOMES AND CUTANEOUS NERVE DISTRIBUTION

Dermatomes: upper limb


DERMATOMES AND CUTANEOUS NERVE DISTRIBUTION

Cutaneous nerves: upper limb


DERMATOMES AND CUTANEOUS NERVE DISTRIBUTION

Dermatomes: lower limb


DERMATOMES AND CUTANEOUS NERVE DISTRIBUTION

Cutaneous nerves: lower limb


DERMATOMES AND CUTANEOUS NERVE DISTRIBUTION

Dermatomes: thorax and abdomen


Abductor digiti minimi (foot) 154 Extensor hallucis longus 1 58
Abductor digiti minimi (hand) 154 Extensor indicis 158
Abductor hallucis 154 Extensor pollicis brevis 159
Abductor pollicis brevis 154 Extensor pollicis longus 159
Abductor pollicis longus 154 External oblique a bdominis 159
Adductor brevis 154 Flexor carpi radialis 159
Adductor hallucis 154 Flexor carpi ulnaris 159
Adductor longus 154 Flexor digiti minimi brevis (foot) 159
Adductor magnus 154 Flexor digiti minimi brevis (hand) 159
Adductor pollicis 155 Flexor digitorum accessorius (quadratus
Anconeus 155 plantae) (foot) 159
Articularis cubiti (subanconeus) 155 Flexor digitorum brevis (foot) 159
Articularis genu 155 Flexor digitorum longus (foot) 160
Aryepiglotticus 155 Flexor digitorum profundus (hand) 160
Auricularis 155 Flexor digitorum superficialis (hand) 160
Biceps brachii 155 Flexor hallucis brevis 160
Biceps femoris 155 Flexor hallucis longus 160
Brachialis 155 Flexor pollicis brevis 160
Brachioradialis 155 Flexor pollicis longus 160
Buccinator l 5 6 Gastrocnemius 161
Bulbospongiosus l 5 6 Gemellus inferior 161
Constrictor of pharynx-inferior 156 Gemellus superior 161
Constrictor of pharynx-middle 156 Genioglossus 1 61
Constrictor of pharynx-superior 1.56 Geniohyoid 161
Coracobrachialis 156 Gluteus maximus 161
Corrugator supercilii 156 Gluteus medius 161
Cremaster 156 Gluteus minimus 161
Cricothyroid 157 Gracilis 161
Dartos 157 Hyoglossus (&chondroglossus) 161
Deep transverse perinei 157 Iliacus 162
Deltoid 157 Inferior oblique (see also obliquus capitis
Depressor anguli oris 157 inferior) l 6 2
Depressor labii inferioris 157 Inferior rectus l 6 2
Diaphragm 157 Infraspinatus l 6 2
Digastric 157 Intercostals external 162
Erector spinae-iliocostocervicalis 157 Intercostals innermost 162
Erector spinae-longissimus 157 Intercostals internal 162
Erector spinae-spinalis 1 58 Internal oblique abdominis l 6 2
Extensor carpi radialis brevis 158 Interossei-dorsal of foot (4) 163
Extensor carpi radialis longus 158 Interossei-dorsal of hand (4) l 6 3
Extensor carpi ulnaris 158 Interossei-palmar of hand (3) 163
Extensor digiti minimi (hand) 158 Interossei-plantar of foot (3) 163
Extensor digitorum (hand) 1 58 Interspinales 163
Extensor digitorum brevis (foot) 158 Intertransversarii l 6 3
Extensor digitorum longus (foot) 158 Intrinsic muscle of tongue 163
MUSCLES

Ischiocavernosus l 6 3 Plantaris 168


Lateral cricoarytenoid 163 Platysma 168
Lateral pterygoid 163 Popliteus 169
Lateral rectus l 6 4 Posterior cricoarytenoid l 6 9
Latissimus dorsi l 6 4 Procerus 169
Levator anguli oris l 6 4 Pronator quadratus 169
Levator ani-coccygeus l 6 4 Pronator teres 169
Levator ani-iliococcygeus l 6 4 Psoas major 169
Levator ani-pubococcygeus l64 Psoas minor l 6 9
Levator ani-puborectalis l64 Pyramidalis 169
Levator ani-pubovaginalis (levator Quadratus femoris l 6 9
prostatae) 164 Quadratus lumborum 169
Levator la bii superioris l 6 4 Quadratus plantae (see flexor digitorum
Levator labii superioris alaeque nasi 164 accessorius)
Levator palpebrae superioris 164 Rectus abdominis 170
Levator scapulae 165 Rectus capitis anterior 170
Levator veli palatini 165 Rectus capitis lateralis 170
Levatores costarum 165 Rectus capitis posterior major 170
Longus capitis 165 Rectus capitis posterior minor 170
Longus colli l 6 5 Rectus femoris (quadriceps
Lumbricals of foot (4) 165 femoris l ) 170
Lumbricals of hand (4) 165 Rhomboid major 170
Masseter 165 Rhomboid minor 170
Medial pterygoid l 6 5 Risorius 170
Medial rectus l 6 5 Salpingopharyngeus 170
Mentalis 166 Sartorius 170
Musculus uvulae 166 Scalenus anterior 171
Mylohyoid 166 Scalenus medius 171
Nasalis (compressor & dilator) 166 Scalenus minimus 171
Oblique arytenoid 166 Scalenus posterior 171
Obliquus capitis inferior 166 Semimembranosus 171
Obliquus capitis superior 166 Semitendinosus 171
Obturator externus 166 Serratus anterior 171
Obturator internus 166 Serratus posterior inferior 171
Occipitofrontalis 166 Serratus posterior superior 171
Omohyoid 167 Soleus 171
Opponens digiti minimi (hand) 167 Sphincter ani (external) 172
Opponens pollicis l 6 7 Sphincter urethrae 172
Orbicularis oculi 167 Splenius capitis 172
Orbicuiaris oris l 6 7 Splenius cervicis 172
Palatoglossus l 6 7 Stapedius 172
Palatopharyngeus 167 Sternocleidomastoid 172
Palmaris brevis 167 Sternohyoid 172
Palmaris longus l 6 7 Sternothyroid 172
Pectineus 168 Styloglossus 172
Pectoralis major 168 Stylohyoid 172
Pectoralis minor 168 Stylopharyngeus 172
Peroneus brevis 168 Su bclavius 172
Peroneus longus 168 Su bcostalis 173
Peroneus tertius 168 Subscapularis 173
Piriformis 168 Superficial transverse perinei 173
MUSCLES
- P P-

Superior oblique (see also o bliquus capitis Tibialis posterior 175


superior) 173 Transverse arytenoid 175
Superior rectus 173 Transversospinalis-multifidus 175
Supinator 173 Transversospinalis-rotatores 175
Supraspinatus 173 Transversospinalis-semispinalis 175
Temporalis 173 Transversus abdominis 175
Temporoparietalis 174 Transversus thoracis (sternocostalis) 175
Tensor fasciae iatae 174 Trapezius 175
Tensor tympani 174 Triceps 176
Tensor veli palatini 174 Vastus intermedius (quadriceps
Teres major 174 femoris 2) 176
Teres minor 174 Vastus lateralis (quadriceps femoris 3) 176
Thyro-arytenoid & vocalis 174 Vastus medialis (quadriceps femoris 4 ) 176
Thyro-epiglotticus 174 Zygomaticus major 176
Thyrohyoid 174 Zygomaticus minor 176
Tibialis anterior 174
Abductor digiti minimi MUSCLES Adductor magnus

ABDUCTOR D I G I T 1 MINIM1 (foot) Action Abducts & extends thumb at CMC


Arises Med & lat processes of post jnt
calcaneal tuberosity Newe Post interosseous N (C7,8)
lnserts Lat side of base of prox phalanx of Notes Forms radial side of snuff box
5th toe & 5th MT
Action Flexes & abducts 5th toe. Supports
lat longitudinal arch A D D U C T O R BREVIS
Nerve Lat plantar N (S2,3) Arises Inf ramus & body of pubis
lnserts Upper third of linea aspera
Action Adducts hip
ABDUCTOR DIGIT1 MINIM1 (hand) Nerve Ant div of obturator N (L2,3)
Arises Pisiform bone & pisohamate lig
lnserts Ulnar side of base of prox phalanx
of little finger & extensor expansion A D D U C T O R HALLUCIS
(+ sesamoid) Arises Oblique head: base of 2,3,4 MTs.
Action Abducts little finger at MCP jnt Transverse head: plantar MT ligs & deep
Newe Deep br of ulnar N (C8,Tl) transverse lig
lnserts Lat side of base of prox phalanx of
big toe & lat sesamoid
ABDUCTOR HALLUCIS Action Adducts & flexes MTP jnt of big
Arises Med process of post calcaneal toe. Supports transverse arch
tuberosity & flexor retinaculum Newe Deep br of lat plantar N (S2,3)
lnserts Med aspect of base of prox phalanx Notes If muscle fibres are attached to 1st
of big toe via med sesamoid M T it can be regarded as opponens
Action Flexes & abducts big toe. Supports hallucis
med longitudinal arch
Nerve Med plantar N (S1,2)
A D D U C T O R LONGUS
Arises Body of pubis inf & med to pubic
ABDUCTOR POLLlClS BREVIS tubercle
Arises Tubercle of scaphoid & flexor lnserts Lower two-thirds of med linea
retinaculum aspera
lnserts Radial sesamoid of prox phalanx Action Adducts hip
of thumb & tendon of extensor pollicis Nerve Ant div of obturator N (L2,3,4)
longus
Action Abducts thumb at MCP & CMC
jnts ADDUCTOR MAGNUS
Newe Recurrent (muscular)br of median Arises Adductor portion: ischiopubic
N (C8,Tl) ramus. Hamstring portion: lower outer
Notes As this muscle is supplied only by quadrant of post surface of ischial
median N, its action is used as a test for tuberosity
this N in hand lnserts Adductor portion: lower gluteal line
& linea aspera. Hamstring portion:
adductor tubercle
ABDUCTOR POLLlClS LONGUS Action Adductor portion: adducts hip.
Arises Upper post surface of ulna & middle Hamstring portion: extends hip
third of post surface of radius & Nerve Adductor portion: post div of
interosseous membrane between obturator N (L2,3,4). Hamstring portion:
lnserts Over tendons of radial extensors & tibial portion of sciatic (L4)
brachioradialis to base of 1st MC &
trapezium
Adductor pollicis MUSCLES Brachioradialis

A D D U C T O R POLLlClS BICEPS B R A C H l l
Arises Oblique head: base of 2nd & 3rd Arises Long head: supraglenoid tubercle of
MCs, trapezoid & capitate. Transverse scapula. Short head: coracoid process of
head: palmar border & shaft of 3rd MC scapula with coracobrachialis
lnserts Ulnar sesamoid then ulnar side of lnserts Post border of bicipital tuberosity
base of prox phalanx & tendon of of radius (over bursa) & bicipital
extensor pollicis longus aponeurosis to deep fascia &
Action Adducts CMC jnt of thumb subcutaneous ulna
Newe Deep br of ulnar N (C8,Tl) Action Supinates forearm, flexes elbow,
weakly flexes shoulder
Newe Musculocutaneous N (C5,6) (from
ANCONEUS lat cord)
Arises Smooth surface at lower extremity Notes Supinates most effectively when
of post aspect of lat epicondyle of humerus elbow flexed
lnserts Lat side of olecranon
Action Weak extensor of elbow. Moves
(abducts) ulna in pronation BICEPS FEMORIS
Newe Radial N (C7,8) Arises Long head: upper inner quadrant of
post surface of ischial tuberosity. Short
head: middle third of linea aspera, lat
A R T l C U L A R l S C U B I T 1 (subanconeus) supracondylar ridge of femur
Arises Deep distal surface of med head of lnserts Styloid process of head of fibula, lat
triceps collateral lig & lat tibial condyle
lnserts Post capsule of elbow jnt Action Flexes & lat rotates knee. Long head
Action Lifts capsule away from jnt extends hip
Newe Radial (C6,7,8) Nerve Long head: tibial portion of sciatic
N. Short head: common peroneal portion
of sciatic N (both LS,S1,2)
ARTlCULARlS GENU
Arises Two slips from ant femur below
vastus intermedius BRACHlALlS
lnserts Apex of suprapatellar bursa Arises Ant lower half of humerus & med &
Action Retracts bursa as knee extends lat intermuscular septa
Newe Post div of femoral N (L2,3,4) Inserts Coronoid process & tuberosity of
ulna
Action Flexes elbow
ARYEPIGLOTTICUS Nerve Musculocutaneous N (C5,6) (from
Arises Apex of arytenoid cartilage lat cord). Also small supply from radial N
lnserts Lat border of epiglottis (c71
Action Aids closure of additus of larynx
Newe Recurrent laryngeal br of vagus N
(X) BRACHlORADlALlS
Note It is an extension of oblique arytenoid Arises Upper two-thirds of lat
supracondylar ridge of humerus & lat
intermuscular septum
AURlCULARlS lnserts Base of styloid process of radius
Arises Cartilage of auricle Action Flexes arm at elbow & brings
lnserts Galeal aponeurosis forearm into midprone position
Action Adjusts position of ear Newe Radial N (C5,6)
Newe Temporal & posterior auricular brs Notes Overlies radial N & art as they lie on
of facial N (VII) supinator
Buccinator MUSCLES Cremaster

BUCCINATOR Action Aids swallowing


Arises Ext alveolar margins of maxilla & Nerve Pharyngeal plexus (IX, X &
mandible by molar teeth, to maxillary sympathetic) via pharyngeal br of X with
tubercle & pterygoid hamulus & post its motor fibres from cranial accessory N
mylohyoid line respectively, then via (XI)
pterygomandibular raphe between bones
lnserts Decussates at modiolus of mouth &
interdigitates with opposite side CONSTRICTOR O F PHARYNX-
Action Aids mastication by emptying SUPERIOR
vestibule, tenses cheeks in blowing & Arises Lower two-thirds of med pterygoid
whistling, aids closure of mouth plate, pterygomandibular raphe & post
Nerve Buccal br of facial N (VII) end of mylohyoid line on mandible
lnserts Upper midline pharyngeal raphe &
pharyngeal tubercle of occiput
BULBOSPONGIOSUS Action Aids swallowing
Arises Perineal body (&midline raphe over Nerve Pharyngeal plexus (IX, X &
corpus spongiosum in male) sympathetic) via pharyngeal br of X with
lnserts Superficial perinea1 membrane & its motor fibres from cranial accessory
dorsal penilelclitoral aponeurosis (XI)
Action Male: aids emptying of urine &
ejaculate from urethra. Female: closes
vaginal introitus CORACOBRACHIALIS
Newe Perineal br of pudendal N (S2,3,4) Arises Coracoid process of scapula with
biceps brachii
lnserts Middle third of med border of
CONSTRICTOR O F PHARYNX- humerus
INFERIOR Action Flexes & weakly adducts arm
Arises Cricopharyngeus: lat aspect of arch Newe Musculocutaneous N (C5,6,7)
of cricoid cartilage. Thyropharyngeus: (from lat cord)
oblique line on laminar of thyroid Notes Ligament of Struthers as embryo-
cartilage & fibrous cricothyroid arch logical 3rd head. Musculocutaneous N
lnserts Cricopharyngeus: continuous with runs through muscle
muscle of opposite side, behind pharynx.
Thyropharyngeus: lower pharyngeal
raphe C O R R U G A T O R SUPERClLll
Action Aids swallowing. Cricopharyngeus Arises Med superciliary arch
acts as upper oesophageal sphincter lnserts Skin of med forehead
Newe Pharyngeal plexus (IX, X & Action Wrinkles forehead
sympathetic) via pharyngeal br of X with Nerve Temporal br of facial N (VII)
its motor fibres from cranial accessory
(XI)
Notes Killian's dehiscence is between the CREMASTER
two parts post Arises Lower border of internal oblique &
transversus abdominis in inguinal canal
lnserts Loops around spermatic cord &
CONSTRICTOR O F PHARYNX- tunica vaginalis & some fibres return to
MIDDLE attach to pubic tubercle
Arises Lower third of stylohyoid lig, lesser Action Retracts testis
cornu & sup border of greater cornu of Nerve Sympathetic & somatic fibres in
hyoid bone genital br (L2)of genitofemoral N (L1,2)
lnserts Middle portion of pharyngeal raphe
Cricothyroid MUSCLES Erector spinae-longissimus

CRICOTHYROID DEPRESSOR L A B l l I N F E R I O R I S
Arises Anterolateral aspect of cricoid Arises Outer surface of mandible
cartilage inferomedial to mental foramen
lnserts Inf cornu & lower laminar of lnserts Skin of lower lip
thyroid cartilage Action Depresses & draws lower lip laterally
Action Lengthens & tenses vocal cords by Nerve Mandibular br of facial N (VII)
tilting thyroid cartilage forwards
Nerve Ext br of sup laryngeal br of vagus N
(X) DIAPHRAGM
Arises Vertebral: crura from bodies of L1,2
(left),L1-3 (right),together giving median
DARTOS arcuate lig. Costal: med & lat arcuate ligs,
Arises Subcutaneous tissue of scrotum, inner aspect of lower six ribs and costal
superficial to superficial fascia (Colles) cartilages
lnserts Skin & midline fibrous septum of Sternal: two slips from post aspect of
scrotum xiphoid
Action Corrugates scrotal skin lnserts Trefoil central tendon
Nerve Sympathetic fibres in genital br (L2) Action Inspiration & assists in raising
of genitofemoral N (L1,2) intra-abdominal pressure
Nerve Phrenic N (motor) (C3,4,5).
Sensory: phrenic, intercostals (6-12) &
DEEP TRANSVERSE PERlNEl upper two lumbar N roots
Arises Med aspect of ischiopublic ramus &
body of ischium within deep perineal
pouch DlGASTRlC
lnserts Midline raphe & perineal body Arises Ant belly: digastric fossa on post
Action Fixes perineal body & supports surface of symphysis menti. Post belly:
pelvic viscera base of med aspect of mastoid process
Nerve Perinea1 br of pudendal N (S2,3,4) lnserts Fibrous loop to lesser cornu of
hyoid bone
Action Elevates hyoid bone. Aids
DELTOID swallowing & depresses mandible
Arises Lat third of clavicle, acromion, spine Nerve Ant belly: mylohyoid N (VC).Post
of scapula to deltoid tubercle belly: facial N (VII)before it enters parotid
lnserts Middle of lat surface of humerus gland
(deltoid tuberosity)
Action Abducts arm, ant fibres flex & med
rotate, post fibres extend & lat rotate E R E C T O R SPINAE-
Nerve Axillary N (CS,6) (from post cord) ILIOCOSTOCERVICALIS
Arises Post angles of ribs
lnserts Transverse processes above & below
DEPRESSOR A N G U L I ORlS Action Extends & lat flexes spine
Arises Outer surface of mandible inf to Nerve Post primary rami
mental foramen Notes Divided into iliocostalis-lumborum,
lnserts Modiolus at angle of mouth thoracis & cervicalis
Action Depresses & draws angle of mouth
laterally
Nerve Mandibular br of facial N (VII) ERECTOR SPINAE-LONGISSIMUS
Arises Transverse processes
lnserts Transverse processes several levels
above
Erector spinae--spinalis MUSCLES Extensor indicis

Action Extends spine E X T E N S O R D l G l T O R U M (hand)


Newe Post primary rami Arises Common extensor origin on ant
Notes Divided into longissimus-thoracis, aspect of 1at epicondyle of humerus
cervicis & capitis lnserts Extensor expansion to all phalanges
of four fingers by four tendons. Tendons
3 & 4 usually fuse & little finger just
ERECTOR SPINAE-SPINALIS receives a slip
Arises Spinous processes Action Extends all jnts of fingers
lnserts Spinous processes six levels above Newe Post interosseous N (C7,8)
Action Lat flexion of spine
Nerve Post primary rami
Notes Divided into spinalis-thoracis, EXTENSOR DlGlTORUM
cervicis & capitis B R E V I S (foot)
Arises Sup surface of ant calcaneus
lnserts Four tendons into prox phalanx of
E X T E N S O R CARPI R A D l A L l S BREVIS big toe & long extensor tendons to toes 2,
Arises Common extensor origin on ant 3 and 4
aspect of lat epicondyle of humerus Action Extends toes when foot fully
lnserts Post base of 3rd MC dorsiflexed
Action Extends & abducts hand at wrist Nerve Deep peroneal N (L5,Sl)
Newe Post interosseous N (C7,8) Notes Med one of four tendons could be
regarded as extensor hallucis brevis

EXTENSOR CARPI RADlALlS


LONGUS EXTENSOR DlGlTORUM
Arises Lower third of lat supracondylar L O N G U S (foot)
ridge of humerus & lat intermuscular Arises Upper two-thirds of ant shaft of
septum fibula, interosseous membrane & sup
lnserts Post base of 2nd MC tibiofibular jnt
Action Extends & abducts hand at wrist lnserts Extensor expansion of lat four toes
Nerve Radial N (C6,7) Action Extends toes & extends foot at
ankle
Nerve Deep peroneal N (L5,Sl)
EXTENSOR CARPI ULNARIS
Arises Common extensor origin on ant
aspect of lat epicondyle of humerus EXTENSOR HALLUCIS LONGUS
lnserts Base of 5th MC via groove by ulnar Arises Middle half of ant shaft of fibula
styloid lnserts Dorsal base of distal phalanx of
Action Extends & adducts hand at wrist great toe
Newe Post interosseous N (C7,8) Action Extends big toe & foot. Inverts foot
& tightens subtalar jnts
Nerve Deep peroneal N (L5,Sl)
E X T E N S O R D I G I T 1 M I N I M 1 (hand)
Arises Common extensor origin on ant
aspect of lat epicondyle of humerus EXTENSOR INDlClS
lnserts Extensor expansion of little Arises Lower post shaft of ulna (below
finger-usually two tendons which are extensor pollicis longus) & adjacent
joined by a slip from extensor digitorum at interosseous membrane
MCP jnt lnserts Extensor expansion of index finger
Action Extends all jnts of little finger (tendon lies on ulnar side of extensor
Nerve Post interosseous N (C7,8) digitorum tendon)
Extensor pollicis brevis MUSCLES Flexor digitorurn brevis

Action Extends all jnts of index finger FLEXOR CARPI ULNARIS


Nerve Post interosseous N (C7,8) Arises Humeral head: common flexor
origin of med epicondyle. Ulnar head:
aponeurosis from med olecranon & upper
E X T E N S O R POLLlClS BREVIS three-quarters subcutaneous border of
Arises Lower third of post shaft of radius & ulna
adjacent interosseous membrane lnserts Pisiform, hook of hamate, base of
lnserts Over tendons of radial extensors & 5th MC via pisohamate & pisometacarpal
brachioradialis to base of prox phalanx of ligs
thumb Action Flexes & adducts wrist. Fixes
Action Extends MCP jnt of thumb pisiform during action of hypothenar
Nerve Post interosseous N (C7,8) muscles
Notes Forms radial side of snuff box Nerve Ulnar N (C7,8,T1) (by
communication from lat cord)
Notes Ulnar N passes between two heads
EXTENSOR POLLlClS LONGUS
Arises Middle third of post ulna (below
abductor pollicis longus) & adjacent F L E X O R D I G I T 1 M I N I M 1 BREVIS (foot)
interosseous membrane Arises Base of 5th MT & sheath of
lnserts Base of distal phalanx of thumb peroneus longus
via Lister's tubercle (dorsal tubercle of lnserts Lat side of base of prox phalanx of
radius) little toe
Action Extends IP & MCP jnts of thumb Action Flexes MTP jnt of little toe
Nerve Post interosseous N (C7,8) Nerve Superficial br of lat plantar N (S2,3)
Notes Forms ulnar side of snuff box Notes A few muscle fibres to distal half of
plantar surface of 5th M T represent
opponens digiti minimi
EXTERNAL OBLIQUE ABDOMlNlS
Arises Ant angles of lower eight ribs
lnserts Outer ant half of iliac crest, inguinal F L E X O R D I G I T 1 M I N I M 1 B R E V I S (hand)
lig, pubic tubercle & crest, & aponeurosis Arises Flexor retinaculum & hook of
of ant rectus sheath, linea alba & hamate
xiphisternum lnserts Ulnar side of base of prox phalanx
Action Supports abdominal wall, assists of little finger
forced expiration, aids raising intra- Action Flexes MCP jnt of little finger
abdominal pressure &, with muscles of Nerve Deep br of ulnar N (C8,Tl)
opposite side, abducts & rotates trunk
Nerve Ant primary rami (T7-12)
Notes Interdigitates with four slips of FLEXOR DlGlTORUM ACCESSORIUS
serratus anterior & four of latissimus ( Q U A D R A T U S P L A N T A E ) (foot)
dorsi Arises Med & lat sides of calcaneus
lnserts Tendons of flexor digitorum longus
Action Assists flexor digitorum longus to
FLEXOR CARPI RADIALIS flex lat four toes, especially when ankle is
Arises Common flexor origin of med plantar flexed
epicondyle of humerus Nerve Lat plantar N (S2,3)
lnserts Bases of 2nd & 3rd MCs via groove
in trapezium
Action Flexes & abducts wrist F L E X O R D l G l T O R U M BREVIS (foot)
Nerve Median N (C6,7) (from med & lat Arises Med process of post calcaneal
cords) tuberosity
Flexor digitorurn longus MUSCLES Flexor pollicis longus

lnserts Four tendons to four lat toes to both Action Flexes prox IP jnts & secondarily
sides of middle phalanx. Tendons of flexor MCP jnts & wrist
digitorum longus pass through them Nerve Median N (C7,8,T1) (from med &
Action Flexes lat four toes. Supports rned & lat cords)
lat longitudinal arches Notes Median N applied to under surface
Nerve Med plantar N (S1,2) of muscle

F L E X O R D l G l T O R U M L O N G U S (foot) F L E X O R H A L L U C I S BREVIS
Arises Post shaft of tibia below soleal line Arises Cuboid, lat cuneiform & tibialis
& by broad aponeurosis from fibula posterior insertion over the two remaining
lnserts Base of distal phalanges of lat four cuneiforms
toes lnserts Med tendon to rned side of base of
Action Flexes distal phalanges of lat four prox phalanx of big toe. Lat tendon to lat
toes & foot at ankle. Supports lat side of same, both via sesamoids
longitudinal arch Action Flexes MTP jnt of big toe. Supports
Nerve Tibial N (S2,3) rned longitudinal arch
Notes Med two tendons receive slips from Nerve Med plantar N (S1,2)
flexor hallucis longus & all four receive
insertion of flexor accessorius & each
gives a lumbrical FLEXOR HALLUCIS LONGUS
Arises Lower two-thirds of post fibula
between median crest & post border,
FLEXOR DlGlTORUM lower intermuscular septum & inter-
P R O F U N D U S (hand) osseous membrane
Arises Upper three-quarters of ant & rned lnserts Base of distal phalanx of big toe &
surface of ulna as far round as subcutane- slips to rned two tendons of flexor
ous border & narrow strip of interosseous digitorum longus
membrane Action Flexes distal phalanx of big toe,
lnserts Distal phalanges of rned four flexes foot at ankle, supports rned
fingers. Tendon to index finger separates logitudinal arch
early Nerve Tibial N (S2,3)
Action Flexes distal IP jnts, then
secondarily flexes prox IP & MCP jnts &
wrist F L E X O R POLLlClS BREVIS
Newe Median N (ant interosseous) Arises Superficial head: flexor retinaculum
(C8,Tl) ulnar N (C8,Tl) & tubercle of trapezium. Deep head:
Notes Nerve supply as above in 60%. In capitate & trapezoid
40% it is a 3: 1ratio either way lnserts Base of prox phalanx of thumb (via
radial sesamoid)
Action Flexes MCP jnt of thumb
FLEXOR DlGlTORUM Newe Recurrent (muscular)br of median
S U P E R F I C I A L I S (hand) N (C8,Tl) (may also be from deep br of
Arises Humeral head: common flexor ulnar N (C8,Tl))
origin of rned epicondyle of humerus, rned
lig of elbow. Ulnar head: sublime tubercle
(med border of coronoid process) & FLEXOR POLLlClS LONGUS
fibrous arch. Radial head: whole length of Arises Ant surface of radius below ant
ant oblique line oblique line & adjacent interosseous
lnserts Tendons split to insert onto sides of membrane
middle phalanges of rned four fingers lnserts Base of distal phalanx of thumb
Gastrocnemius MUSCLES Hyoglossus (81chondroglossus)

Action Flexes distal phalanx of thumb GLUTEUS MAXIMUS


Nerve Ant interosseous N (C7,8) Arises Outer surface of ilium behind post
gluteal line & post third of iliac crest,
lumbar fascia, lat mass of sacrum,
GASTROCNEMIUS sacrotuberous lig & coccyx
Arises Lat head: post surface of lat condyle lnserts Deepest quarter into gluteal
of femur & highest of three facets on lat tuberosity of femur, remaining three-
condyle. Med head: post surface of femur quarters into iliotibial tract (ant surface of
above rned condyle lat condyle of tibia)
lnserts Tendo calcaneus to middle of three Action Extends & lat rotates hip.
facets on post aspect of calcaneus Maintains knee extended via iliotibial
Action Plantar flexes foot. Flexes knee tract
Newe Tibial N (S1,2) Nerve Inf gluteal N (LS,Sl,2)
Notes Main propulsive force for jumping Notes Largest muscle in body

GEMELLUS INFERIOR GLUTEUS MEDIUS


Arises Upper border of ischial tuberosity Arises Outer surface of ilium between post
lnserts Middle part of rned aspect of greater & ant gluteal lines
trochanter of femur lnserts Posterolateral surface of greater
Action Lat rotates & stabilises hip trochanter of femur
Nerve N to quadratus femoris (L4,5,S1) Action Abducts & rned rotates hip. Tilts
pelvis on walking
Nerve Sup gluteal N (L4,5,Sl)
GEMELLUS SUPERIOR
Arises Spine of ischium
lnserts Middle part of rned aspect of greater GLUTEUS MINIMUS
trochanter of femur Arises Outer surface of ilium between ant
Action Lat rotates & stabilises hip & inf gluteal lines
Nerve N to obturator internus (L5,S1,2) lnserts Ant surface of greater trochanter of
femur
Action Abducts & rned rotates hip. Tilts
GENIOGLOSSUS pelvis on walking
Arises Sup mental spine on post surface of Nerve Sup gluteal N (L4,5,S1)
symphysis menti
lnserts Central mass of tongue & mucous
membrane GRAClLlS
Action Protracts tongue Arises Outer surface of ischiopubic
Newe Hypoglossal N (XII) ramus
lnserts Upper rned shaft of tibia behind
sartorius
GENlOHYOlD Action Adducts hip. Flexes knee & rned
Arises Inf mental spine on post surface of rotates flexed knee
symphysis menti Nerve Ant div of obturator N (L2,3)
lnserts Sup border of body of hyoid bone
Action Elevates & protracts hyoid bone.
Depresses mandible HYOGLOSSUS
Nerve C1 fibres carried by hypoglossal N (& C H O N D R O G L O S S U S )
Arises Sup border of greater cornu of hyoid
bone
lnserts Lat side of tongue
lliacus MUSCLES Internal oblique abdominis

Action Depresses tongue Action Fix intercostal spaces during


Nerve Hypoglossal N (XII) respiration. Aids forced respiration by
elevating ribs
Nerve Muscular collateral brs of intercostal
ILIACUS Ns
Arises Iliac fossa within abdomen
lnserts Lowermost surface of lesser
trochanter of femur INTERCOSTALS INNERMOST
Action Flexes hip Arises Int lat aspect of ribs above & below
Nerve Femoral N in abdomen (L2,3) lnserts Int aspect of ribs above & below
Action Fix intercostal spaces during
respiration
I N F E R I O R O B L I Q U E (see also obliquus Nerve Muscular collateral brs of intercostal
capitis inferior) Ns
Arises Orbital surface of maxilla behind Notes Innermost intercostals are one of
orbital margin on med side three muscles that make up inner layer
lnserts Post/inf quadrant of sclera behind of thoracic wall muscles. Others are
equator of eyeball on lat side transversus thoracis (ant)& subcostalis
Action Elevates eye in adduction. Extorts (post)
eye in abduction
Nerve Inf div of oculomotor N (111)
INTERCOSTALS INTERNAL
Arises Inf border of ribs as far back as post
INFERIOR RECTUS angles. Beyond this is post (int)intercostal
Arises Inf tendinous ring within orbit membrane
lnserts Inf sclera ant to equator of eyeball lnserts Sup border of ribs below, passing
Action Depresses eye. Extorts eye in obliquely downwards & backwards
adduction Action Fix intercostal spaces during
Nerve Inf div of oculomotor N (111) respiration. Aids forced inspiration by
elevating ribs
Nerve Muscular collateral brs of intercostal
INFRASPINATUS Ns
Arises Med three-quarters of infraspinous
fossa of scapula & fibrous intermuscular
septa INTERNAL OBLIQUE ABDOMlNlS
lnserts Middle facet of greater tuberosity Arises Lumbar fascia, ant two-thirds of
of humerus & capsule of shoulder jnt iliac crest & lat two-thirds of inguinal lig
Action Lat rotates arm & stabilises lnserts Costal margin (ribs & costal
shoulder jnt cartilages), aponeurosis of rectus sheath
Nerve Suprascapular N (C5,6) (from upper (ant & post), conjoint tendon to pubic
trunk) crest & pectineal line
Notes Bursa under tendon over glenoid Action Supports abdominal wall, assists
angle. Tendon forms part of rotator cuff forced respiration, aids raising intra-
abdominal pressure &, with muscles of
other side, abducts & rotates trunk.
INTERCOSTALS EXTERNAL Conjoint tendon supports post wall of
Arises Inf border of ribs as far forwards as inguinal canal
costochondral junctions. Beyond this is Nerve Ant primary rami (T7-12) (conjoint
ant (ext)intercostal membrane tendon ilio-inguinal N ( L l ))
lnserts Sup border of ribs below, passing
obliquely downwards & forwards
Interossei-dorsal of foot MUSCLES Lateral pterygoid

INTEROSSEI-DORSAL O F F O O T (4) Action Extension of spine


Arises Bipennate from inner aspects of Nerve Post primary rami
shafts of all MTs
lnserts Bases of prox phalanges & dorsal
extensor expansions of med side of 2nd INTERTRANSVERSARII
toe & lat sides of 2nd, 3rd & 4th toes Arises Transverse processes
Action Abduct 2nd, 3rd & 4th toes from lnserts Transverse processes one above
axis of 2nd toe. Assist lumbricals in Action Lat flexes spine
extending IP jnts whilst flexing MTP jnts Nerve Post primary rami
Nerve Lat plantar N (1-3: deep br; 4:
superficial br) (S2,3)
INTRINSIC MUSCLE O F T O N G U E
Arises Sup & inf longitudinal, transverse &
INTEROSSEI-DORSAL O F H A N D (4)
vertical elements
Arises Bipennate from inner aspects of
lnserts Mucous membrane, septum &
shafts of all MCs
other muscles of tongue
lnserts Prox phalanges & dorsal extensor
Action Alter shape of tongue & so aid
expansion on radial side of index &
mastication, speech & swallowing
middle fingers & ulnar side of middle &
Nerve Hypoglossal N (XII)
ring fingers
Action Abduct index, middle & ring fingers
from axis of middle finger. Flex MCP jnt
ISCHIOCAVERNOSUS
whilst extending IP jnts
Arises Med aspect of ischium &
Nerve Deep br of ulnar N (C8,Tl)
ischiopubic ramus
lnserts Inferolateral aponeurosis over crura
INTEROSSEI-PALMAR O F H A N D (3) of penis/clitoris
Arises Ant shafts of 2 , 4 , 5 MCs Action Stabilises erect penis
(unipennate) Nerve Perinea1 br of pudendal N (S2,3,4)
lnserts Prox phalanges & dorsal extensor
expansion on ulnar side of index & radial
side of ring & little fingers LATERAL CRICOARYTENOID
Action Adduct index, ring & little fingers to Arises Lat aspect of arch of cricoid cartilage
axis of middle finger. Flex MCP jnt whilst lnserts Muscular process of arytenoid
extending IP jnts cartilage
Nerve Deep br of ulnar N (C8,Tl) Action Adducts & med rotates arytenoid
cartilage (closes rima glottidis)
Nerve Recurrent laryngeal br of vagus N
INTEROSSEI-PLANTAR O F F O O T (3)
Arises Inferomedial shafts of 3rd, 4th & (X)
5th MTs (single heads)
lnserts Med sides of bases of prox
LATERAL PTERYGOID
phalanges with slips to dorsal extensor
Arises Upper head: infratemporal surface
expansions of 3rd, 4th & 5th toes
of sphenoid bone. Lower head: lat surface
Action Adduct 3rd, 4th & 5th toes to axis
of lat pterygoid plate
of 2nd toe. Assist lumbricals in extending
Inserts Pterygoid fovea below condylar
IP jnts whilst flexing MTP jnts
process of mandible & intra-articular disc
Nerve Deep br of lat plantar N (S2,3)
& capsule of temporomandibular jnt
Action Protrudes mandible & opens mouth
INTERSPINALES by pulling condyle & disc forwards
Arises Spinous processes Nerve Ns to lat pterygoid (ant div of
lnserts Spinous processes one above mandibular N (VC))
Lateral rectus MUSCLES Levator palpebrae superioris

LATERAL RECTUS LEVATOR ANI-PUBOCOCCYGEUS


Arises Lat tendinous ring within orbit Arises Post surface of pubis & ant half of
lnserts Lat sclera ant to equator of eyeball fascial line over obturator internus
Action Abducts eye lnserts Anococcygeal body
Nerve Abducent N (VI) Action Supports pelvic viscera
Nerve Ant primary rami (perineal brs) of
S3,4
L A T l S S l M U S DORSl
Arises All thoracic spines & supraspinous
ligs from T7 downwards & lumbar & L E V A T O R ANI-PUBORECTALIS
sacral spines via lumbar fascia, post third Arises Post surface of pubis
iliac crest, last four ribs (interdigitating lnserts Midline sling post to rectum
with ext oblique abdominis) & inf angle Action Supports & aids continence of
of scapula rectum by maintaining anorectal angle
lnserts Floor of bicipital groove of Nerve Ant primary rami (perineal brs) of
humerus after spiraling around teres S3,4
major
Action Extends, adducts & med rotates
arm. Costal attachment helps with deep LEVATOR ANI-PUBOVAGINALIS
inspiration & forced expiration ( L E V A T O R PROSTATAE)
Nerve Thoracodorsal N (C6,7,8) (from Arises Post surface of pubis
post cord) lnserts Midline raphe post to
vaginalprostate
Action Supports ant pelvic viscera
L E V A T O R A N G U L I ORlS Nerve Ant primary rami (perineal brs) of
Arises Ant surface of maxilla below infra- S3,4
orbital foramen
lnserts Outer end of upper lip &
modiolus L E V A T O R LAB11 SUPERlORlS
Action Elevates angle of mouth Arises Med infra-orbital margin
Nerve Buccal br of facial N (VII) lnserts Skin & muscle of upper lip
Action Elevates & everts upper lip
Nerve Buccal br of facial N (VII)
L E V A T O R ANI-COCCYGEUS
Arises Sacrospinous lig & ischial spine
lnserts Anococcygeal body & coccyx L E V A T O R L A B l l SUPERlORlS
Action Supports pelvic viscera ALAEQUE NASl
Nerve Ant primary rami (perineal brs) of Arises Upper frontal process of maxilla
S4,S lnserts Skin of lat nostril & upper lip
Action Dilates nostril & elevates upper lip
Nerve Buccal br of facial N (VII)
LEVATOR ANI-ILIOCOCCYGEUS
Arises Post half of fascial line over
obturator internus & ischial spine L E V A T O R PALPEBRAE SUPERlORlS
lnserts Anococcygeal body Arises Inf aspect of lesser wing of sphenoid
Action Supports pelvic viscera bone just above tendinous ring
Nerve Ant primary rami (perineal brs) of lnserts Sup tarsal plate & skin of upper
S3,4 eyelid
Action Elevates & retracts upper eyelid
Nerve Sup div of oculomotor N (111)&
sympathetic to smooth muscle portion
Levator scapulae MUSCLES Medial rectus

LEVATOR SCAPULAE digitorum longus. Med 1:unipennate


Arises Post tubercles of transverse origin from rned aspect of 1st tendon
processes of Cl-4 lnserts Dorsal extensor expansion
lnserts Upper part of rned border of scapula Action Extend toes at IP jnts & flex MTP
Action Raises rned border of scapula jnts
Nerve Ant primary rami of C3 & C4 & Nerve First: rned plantar N (S2,3).2-4:
dorsal scapular N (CS) deep br of lat plantar N (S2,3)

LEVATOR VELl P A L A T l N l LUMBRICALS O F H A N D (4)


Arises Within pharynx at apex of inf Arises Four tendons of flexor digitorum
surface of petrous temporal bone & rned profundus. Radial 2: radial side only
rim of auditory tube (unipennate). Ulnar 2: cleft between
Inserts Palatine aponeurosis tendons (bipennate)
Action Elevates, retracts & lat deviates soft lnserts Extensor expansion (dorsum of
palate. May open auditory tube on prox phalanx) of fingers 2-5 radial side
swallowing Action Flex MCP jnts & extend IP jnts of
Nerve Pharyngeal plexus (IX, X, sympath- fingers
etic) via pharyngeal br of vagus N (X)with Newe Lat 2: median N (C8,Tl). Med 2:
its motor fibres from cranial accessory N deep br of ulnar N (C8,Tl)
(XI) Notes 60% have nerve supply as above.
40% have 3:1 or l : 3

LEVATORES COSTARUM
Arises Transverse processes C7 to T11 MASSETER
lnserts Post surface & angle of rib below Arises Ant two-thirds of zygomatic arch &
Action Elevates ribs zygomatic process of maxilla
Newe Post primary rami lnserts Lat surface of angle & lower ramus
of mandible
Action Elevates mandible (enables forced
LONGUS CAPITIS closure of mouth)
Arises Ant tubercles of transverse processes Newe Ant div of mandibular N (VC)
of C3-6
lnserts Ant basilar occipital bone
Action Flexes cervical spine & atlanto- MEDIAL PTERYGOID
occipital jnt Arises Deep head. Med side of lat pterygoid
Nerve Ant primary rami of Cl-3 plate & fossa between rned & lat plates.
Superficialhead: tuberosity of maxilla &
pyramidal process of palatine bone
LONGUS COLLl lnserts Med aspect of angle of mandible
Arises Ant body of T1-3, ant tubercles of Action Elevates, protracts & lat displaces
transverse processes of C3-7 mandible to opposite side for chewing
lnserts Ant arch of atlas ( C l )& bodies of Nerve N to medial pterygoid (main trunk
C2-4 of mandibular N (VC))
Action Flexes & rotates cervical spine
Nerve Ant primary rami of C2-6
MEDIAL RECTUS
Arises Med tendinous ring within orbit
LUMBRICALS O F F O O T (4) lnserts Med sclera ant to equator of eyeball
Arises Lat 3: bipennate origin from cleft Action Adducts eye
between the four tendons of flexor Newe Inf div of oculomotor N (111)
Mentalis MUSCLES Occipitofrontalis

MENTALIS Nerve Recurrent laryngeal br of vagus N


Arises Incisive fossa on ant aspect of (X)
mandible Notex It extends into aryepiglottic fold as
lnserts Skin of chin aryepiglotticus
Action Elevates & wrinkles skin of chin &
protrudes lower lip
Nerve Mandibular br of facial N (VII) OBLIQUUS CAPlTlS INFERIOR
Arises Spinous process of axis (C2)
lnserts Lat mass of atlas ( C l )
MUSCULUS UVULAE Action Rotates atlanto-axial jnt
Arises Post border of hard palate Nerve Suboccipital N (post primary ramus
lnserts Palatine aponeurosis of C l )
Action Shapes uvula
Nerve Pharyngeal plexus (IX, X, sympath-
etic) via pharyngeal br of vagus N (X)with OBLIQUUS CAPlTlS SUPERIOR
its motor fibres from cranial accessory Arises Lat mass of atlas ( C l )
N (XI) lnserts Lat half inf nuchal line
Action Lat flexes atlanto-occipital jnt
Nerve Suboccipital N (post primary ramus
MYLOHYOID of C l )
Arises Mylohyoid line on int aspect of
mandible
lnserts Ant three-quarters: midline raphe. OBTURATOR EXTERNUS
Post quarter: sup border of body of hyoid Arises Outer obturator membrane, rim of
bone pubis & ischium bordering it
Action Elevates hyoid bone, supports & lnserts Trochanteric fossa on med surface
raises floor of mouth. Aids in mastication of greater trochanter
& swallowing Action Lat rotates hip
Nerve Mylohyoid N (VC) Nerve Post div of obturator N (L3,4)

NASALIS (COMPRESSOR & OBTURATOR INTERNUS


DILATOR) Arises Inner surface of obturator
Arises Frontal process of maxilla membrane & rim of pubis & ischium
lnserts Nasal aponeurosis bordering membrane
Action Opens & closes nostrils, lnserts Middle part of med aspect of greater
particularly in forced respiration trochanter of femur
Nerve Buccal br of facial N (VII) Action Lat rotates & stabilises hip
Notes Part of dilator nasalis is depressor Nerve N to obturator internus (LS,S1,2)
septi from maxilla above central incisor to
mobile part of nasal septum
OCCIPITOFRONTALIS
Arises Occipital: highest nuchal line &
OBLIQUE ARYTENOID mastoid process. Frontal: sup fibres of
Arises Muscular process of arytenoid upper facial muscles
cartilage lnserts Galeal aponeurosis
lnserts Sup pole of opposite arytenoid Action Wrinkles forehead & fixes galeal
cartilage aponeurosis
Action Adducts arytenoid cartilages (closes Nerve Post auricular & temporal brs of
rima glottidis) facial N (VII)
Omohyoid MUSCLES Palmaris longus

OMOHYOID Notes Accessory parts are incisivus labii


Arises Suprascapular lig & adjacent superioris & inferioris
scapula
lnserts Inf border of body of hyoid bone
Action Depresses hyoid bone & hence PALATOGLOSSUS
larynx Arises Palatine aponeurosis
Nerve Ansa cervicalis N (C1,2,3) lnserts Posterolateral tongue
Notes Tendon between two bellies through Action Elevates post tongue & closes
sling behind sternocleidomastoid oropharyngeal isthmus & aids initiation
of swallowing
Nerve Pharyngeal plexus (IX, X, sympath-
O P P O N E N S D I G I T 1 M I N I M 1 (hand) etic) via pharyngeal br of vagus N (X)
Arises Flexor retinaculum & hook of with its motor fibres from cranial
hamate accessory N (XI)
lnserts Ulnar border of shaft of 5th MC Notes Forms palatoglossal arch
Action Opposes (flexes & lat rotates) CMC
jnt of little finger
Nerve Deep br of ulnar N (C8,Tl) PALATOPHARYNGEUS
Arises Palatine aponeurosis & post margin
of hard palate
OPPONENS POLLlClS lnserts Upper border of thyroid cartilage &
Arises Flexor retinaculum & tubercle of blends with constrictor fibres. Upper fibres
trapezium interdigitate with opposite side to give
lnserts Whole of radial border of 1st MC Passavant's ridge
Action Opposes (med rotates & flexes) Action Elevates pharynx & larynx.
CMC jnt of thumb Passavant's muscle closes nasopharyngeal
Nerve Recurrent (muscular)br of median isthmus in swallowing
N (C8,Tl) (may also be from deep br of Nerve Pharyngeal plexus (IX, X, sympath-
ulnar N (C8,Tl) ) etic) via pharyngeal br of vagus N (X)
with its motor fibres from cranial
accessory N (XI)
ORBlCULARlS O C U L l Notes Forms palatoglopharyngeal arch
Arises Med orbital margin & lacrimal
fascia behind lacrimal sac (orbital,
palpebral & lacrimal parts) PALMARIS BREVIS
lnserts Lat palpebral raphe Arises Flexor retinaculum & palmar
Action Closes eyelids, aids passage & aponeurosis
drainage of tears lnserts Skin of palm into dermis
Nerve Temporal & zygomatic brs of facial Action Steadies & corrugates skin of palm
N (W to help with grip
Nerve Superficial br of ulnar N (C8,Tl)
Notes Only muscle supplied by this br of
ORBlCULARlS ORlS ulnar N
Arises Near midline on ant surface of maxilla
& mandible & modiolus at angle of mouth
lnserts Mucous membrane of margin of PALMARIS L O N G U S
lips & raphe with buccinator at modiolus Arises Common flexor origin of med
Action Narrows orifice of mouth, purses epicondyle of humerus
lips & puckers lip edges lnserts Flexor retinaculum & palmar
Nerve Buccal br of facial N (VII) aponeurosis
Pectineus MUSCLES Platysma

Action Flexes wrist & tenses palmar PERONEUS BREVIS


aponeurosis Arises Lower two-thirds lat shaft of fibula
Nerve Median N (C7,8) (from rned & lat lnserts Tuberosity of base of 5th MT
cords) Action Plantar flexes & everts foot.
Notes Absent in 13% Supports lat longitudinal arch
Nerve Superficial peroneal N (L5,Sl)

PECTINEUS
Arises Pectineal line of pubis & narrow PERONEUS LONGUS
area of sup pubic ramus below it Arises Upper two-thirds of lat shaft of
lnserts A vertical line between spiral line & fibula, head of fibula & sup tibiofibular jnt
gluteal crest below lesser trochanter of lnserts Plantar aspect of base of 1st MT &
femur rned cuneiform, passing deep to long
Action Flexes & adducts hip plantar lig
Nerve Ant div of femoral N (L2,3). Action Plantar flexes & everts foot. Sup-
Occasional twig from obturator N (ant ports lat longitudinal & transverse arches
div-L2,3) Nerve Superficial peroneal N (L5,Sl)

PECTORALIS MAJOR PERONEUS TERTIUS


Arises Clavicular head-med half clavicle. Arises Third quarter of ant shaft of fibula
Sternocostal head-lat manubrium & lnserts Dorsal shaft & base of 5th MT
sternum, six upper costal cartilages & ext Action Extends & everts foot
oblique aponeurosis Nerve Deep peroneal N (L5,Sl)
lnserts Lat lip of bicipital groove of
humerus and ant lip of deltoid tuberosity
Action Clavicular head: flexes & adducts PlRlFORMlS
arm. Sternal head: adducts & rned rotates Arises 2,3,4 costotransverse bars of ant
arm. Accessory for inspiration sacrum between sacral foramina
Nerve Med pectoral N (from rned cord) & lnserts Ant part of rned aspect of greater
lat pectoral N (from lat cord) (C6,7,8) trochanter of femur
Notes Muscle folds on itself so that Action Lat rotates & stabilises hip
clavicular fibres insert lowest. Sternal Nerve Ant primary rami of S1,2
fibres are highest inserting into capsule of Notes Passes lat through greater sciatic
shoulder joint foramen

PECTORALIS MINOR PLANTARIS


Arises Ant aspect of 3 , 4 , 5 ribs Arises Lat supracondylar ridge of femur
lnserts Med & upper surface of coracoid above lat head of gastrocnemius
process of scapula lnserts Tendo calcaneus (med side, deep to
Action Elevates ribs if scapula fixed, gastrocnemius tendon)
protracts scapula (assists serratus Action Plantar flexes foot & flexes knee
anterior) Nerve Tibial N (S1,2)
Nerve Med & lat pectoral Ns (C6,7,8)
(from rned & lat cords)
Notes Landmark for axillary art & cords of PLATYSMA
brachial plexus Arises Skin over lower neck & upper lat
chest
lnserts Inf border of mandible & skin over
lower face & angle of mouth
Popliteus MUSCLES Quadratus lumborum

Action Depresses & wrinkles skin of lower lnserts Just post to most prominent part of
face & mouth. Aids forced depression of lat convexity of radius
mandible Action Pronates forearm & flexes elbow
Nerve Cervical br of facial N (VII) Newe Median N (C6,7) (from lat & rned
cords)
Notes Median N passes between its two
POPLITEUS heads
Arises Post shaft of tibia above soleal line
& below tibial condyles
lnserts A facet on lat surface of lat condyle PSOAS MAJOR
of femur postero-inferior to epicondyle. Arises Transverse processes of L1-5, bodies
Tendon passes into capsule of knee and a of Tl2-L5 & intervertebral discs below
few fibres attach to lat meniscus bodies of T12-L4
Action Unlocks extended knee by lat lnserts Middle surface of lesser trochanter
rotation of femur on tibia. Pulls back lat of femur
meniscus Action Flexes hip
Newe Tibial N (L4,5,S1) Nerve Ant primary rami of L1,2
Notes Popliteus bursa lies deep to tendon

PSOAS M I N O R
POSTERIOR CRICOARYTENOID Arises Bodies of T12 & L1 & intervening
Arises Post aspect of cricoid cartilage intervertebral disc
lnserts Muscular process of arytenoid lnserts Pectineal line of pubis & fascia over
cartilage iliopsoas
Action Abducts & lat rotates arytenoid Action Weak flexor of trunk
cartilage (opens rima glottidis) Nerve Ant primary rami of L1
Nerve Recurrent laryngeal br of vagus N (X)

PYRAMIDALIS
PROCERUS Arises Public crest ant to origin of rectus
Arises Nasal bone & cartilages abdominis
lnserts Skin of rned forehead lnserts Lower linea alba
Action Wrinkles & 'frowns' forehead Action Reinforces lower rectus sheath
Nerve Temporal br of facial N (VII) Nerve Subcostal N (T12)

PRONATOR QUADRATUS QUADRATUS FEMORIS


Arises Lower quarter of anteromedial shaft Arises Lat border of ischial tuberosity
of ulna lnserts Quadrate tubercle of femur & a
lnserts Lower quarter of anterolateral shaft vertical line below this to the level of lesser
of radius & some interosseous membrane trochanter
Action Pronates forearm & maintains ulna Action Lat rotates & stabilises hip
& radius opposed Nerve N to quadratus femoris (L4,5,S1)
Nerve Ant interosseous N (C8,Tl)

QUADRATUS LUMBORUM
P R O N A T O R TERES Arises Inf border of 12th rib
Arises Humeral head: rned epicondyle, rned lnserts Apices of transverse processes of
supracondylar ridge & rned intermuscular L1-4, iliolumbar lig & post third of iliac
septum. Ulnar head: rned border of crest
coronoid process
Rectus abdominis MUSCLES Sartorius

Action Fixes 12th rib during respiration & lnserts Quadriceps tendon to patella, via
lat flexes trunk ligamentum patellae into tubercle of tibia
Nerve Ant primary rami (T12-L3) Action Extends leg at knee. Flexes thigh at
hip
Nerve Post div of femoral N (L2,3,4)
RECTUS ABDOMlNlS
Arises Pubic crest & pubic symphysis
lnserts 5 , 6 , 7 costal cartilages, med inf RHOMBOID MAJOR
costal margin & post aspect of xiphoid Arises Spines of T2-T5 & supraspinous ligs
Action Flexes trunk, aids forced expiration lnserts Lower half of posteromedial border
& raises intra-abdominal pressure of scapula, from angle to upper part of
Nerve Ant primary rami (T7-12) triangular area at base of scapular spine
Action Retracts scapula. Rotates scapula to
rest position
RECTUS CAPlTlS ANTERIOR Nerve Dorsal scapular N (CS) (from root)
Arises Lat mass of atlas ( C l )
lnserts Basilar occipital bone ant to
occipital condyle RHOMBOID MINOR
Action Flexes atlanto-occipital jnt Arises Lower ligamentum nuchae, spines of
Nerve Ant primary rami of C1 C7 & T1
lnserts Small area of posteromedial border
of scapula at level of spine, below levator
RECTUS CAPlTlS LATERALIS scapulae
Arises Lat mass of atlas ( C l ) Action Retracts scapula. Rotates scapula to
lnserts Jugular process of occipital bone rest position
Action Lat flexes atlanto-occipital jnt Nerve Dorsal scapular N (CS) (from root)
Nerve Ant primary rami of C1

RlSORlUS
RECTUS CAPlTlS POSTERIOR MAJOR Arises Deep fascia of face & parotid
Arises Spinous process of axis (C2) lnserts Modiolus & skin at angle of mouth
lnserts Lat half of inf nuchal line Action Retracts angle of mouth
Action Extends & rotates atlanto-occipital Nerve Buccal br of facial N (VII)
jnt
Nerve Suboccipital N (post primary ramus
Cl) SALPINGOPHARYNGEUS
Arises Inf cartilage & mucosa of
pharyngeal orifice of auditory tube
RECTUS CAPlTlS POSTERIOR lnserts Upper border of thyroid cartilage &
MINOR inf constrictor muscle fibres
Arises Post process of atlas ( C l ) Action Elevates pharynx & larynx & aids
lnserts Med half of inf nuchal line swallowing. Opens auditory tube during
Action Extends atlanto-occipital jnt swallowing
Nerve Suboccipital N (post primary ramus Nerve Pharyngeal plexus (IX, X,
c1 sympathetic) via pharyngeal br of vagus
N (X)with its motor fibres from cranial
accessory N (XI)
RECTUS FEMORIS (QUADRICEPS
F E M O R I S I)
Arises Straight head: ant inf iliac spine. SARTORIUS
Reflected head: ilium above acetabulum Arises Immediately below ant sup iliac spine
Scalenus anterior MUSCLES Soleus

lnserts Upper rned surface of shaft of tibia SEMITENDINOSUS


Action Flexes, abducts, lat rotates thigh at Arises Upper inner quadrant of post surface
hip. Flexes, rned rotates leg at knee of ischial tuberosity
Newe Ant div of femoral N (L2,3) lnserts Upper rned shaft of tibia behind
gracilis
Action Flexes & rned rotates knee. Extends
SCALENUS ANTERIOR hip
Arises Ant tubercles of transverse processes Nerve Tibial portion of sciatic N (L5,S1,2)
of C3-6
lnserts Scalene tubercle on sup aspect of 1st
rib SERRATUS ANTERIOR
Action Accessory to inspiration. Lat flexion Arises Upper eight ribs & ant intercostal
of neck when 1st rib fixed membranes from midclavicular line.
Newe Ant primary rami of C5,6 Lower four interdigitating with external
oblique
lnserts Inner rned border scapula. 1 & 2:
SCALENUS MEDIUS upper angle; 3 & 4: length of costal
Arises Post tubercles of transverse surface; 5-8: inf angle
processes of C2-7 Action Lat rotates & protracts scapula
lnserts Sup aspect of 1st rib, ant to its Newe Long thoracic N of Bell (CS,6,7)
tubercle (from roots) slips from ribs 1 & 2: CS; 3 &
Action Accessory to inspiration 4: C6; 5-8: C7
Nerve Ant primary rami of C3-8

SERRATUS POSTERIOR INFERIOR


SCALENUS MINIMUS Arises Spinous processes & supraspinous
Arises Ant tubercle of transverse process of ligs of T11-L2
C7 lnserts Post aspect of ribs 9-12
lnserts Suprapleural membrane (Sibson's Action Assists forced expiration
fascia) Newe Ant primary rami (T9-12)
Action Supports suprapleural membrane
Nerve Ant primary rami of C7
SERRATUS POSTERIOR SUPERIOR
Arises Spinous processes & supraspinous
SCALENUS POSTERIOR lig of C7-T2
Arises Post tubercles of transverse lnserts Post aspect of ribs 2-5
processes C4 - 6 Action Assists forced inspiration
lnserts Posterolateral surface of 2nd rib Newe Ant primary rami (T2-5)
Action Accessory to inspiration
Nerve Ant primary rami of C6-8
SOLEUS
Arises Soleal line & middle third of post
SEMIMEMBRANOSUS border of tibia & upper quarter of post
Arises Upper outer quadrant of post shaft of fibula including neck
surface of ischial tuberosity lnserts Tendo calcaneus to middle of three
lnserts Med condyle of tibia below facets on post surface of calcaneus
articular margin, fascia over popliteus & Action Plantar flexes foot (aids venous
oblique popliteal lig return)
Action Flexes & rned rotates knee. Extends Nerve Tibial N (S1,2)
hip Notes Main propulsive force for walking &
Newe Tibial portion of sciatic N (LS,S1,2) running
Sphincter ani MUSCLES Subclavius

SPHINCTER AN I (external) Nerve Spinal root of accessory N (XI)


Arises Circular anatomical sphincter (lat roots Cl-5)
lnserts Deep, superficial & subcutaneous Notes Effectively four separate muscles
portions
Action Maintains continence of faeces
Nerve Inf rectal br of pudendal N (S2,3,4) STERNOHYOID
Arises Sup lat post aspect of manubrium
lnserts Inf border of body of hyoid bone
SPHINCTER URETHRAE Action Depresses hyoid bone & hence
Arises Circular anatomical sphincter larynx
lnserts Fuses with deep transverse perinei Nerve Ansa cervicalis N (C1,2,3)
Action Maintains continence of urine
Nerve Perinea1 br of pudendal N (S2,3,4)
STERNOTHYROID
Arises Med post aspect of manubrium
SPLENIUS CAPITIS lnserts Oblique line of lamina of thyroid
Arises Lower lig nuchae, spinous processes cartilage
& supraspinous ligs C7-T3 Action Depresses larynx
lnserts Lat occiput between sup & inf Nerve Ansa cervicalis N (C1,2,3)
nuchal lines
Action Extends & rotates cervical spine
Newe Post primary rami of C3,4 STYLOGLOSSUS
Arises Ant surface & apex of styloid
process & upper quarter of stylohyoid lig
SPLENIUS CERVlClS lnserts Superolateral sides of tongue
Arises Spinous processes & supraspinous Action Retracts & elevates tongue, aids
ligs of T3-6 initiation of swallowing
lnserts Post tubercles of transverse Nerve Hypoglossal N (XII)
processes of Cl-3
Action Extends & rotates cervical spine
Nerve Post primary rami of C5,6 STYLOHYOID
Arises Base of styloid process
lnserts Base of greater cornu of hyoid bone
STAPEDIUS Action Elevates & retracts hyoid bone.
Arises The pyramid (post wall of middle ear) Aids swallowing & elevates larynx
lnserts Neck of stapes Nerve Facial N (VII)before it enters
Action Protects & critically damps parotid gland
ossicular chain
Newe Facial N (VII),in middle ear
STYLOPHARYNGEUS
Arises Med aspect of styloid process
STERNOCLEIDOMASTOID lnserts Posterolateral border of thyroid
Arises Ant & sup manubrium & cartilage
superomedial third of clavicle Action Elevates larynx & pharynx. Aids
lnserts Lat aspect of mastoid process & ant swallowing
half of sup nuchal line Nerve Muscular br of glossopharyngeal N
Action Acting alone it laterally flexes (W
cervical spine & rotates head on neck to
bring ipsilateral ear to ipsilateral shoulder.
Acting together they protrude head & if SUBCLAVIUS
head is fixed, aid respiration Arises Costochondral junction of 1st rib
Subcostalis MUSCLES Temporalis

lnserts Subclavian groove on inf surface of Notes Passes around trochlear sling on
middle third of clavicle frontal bone
Action Depresses clavicle & steadies it
during shoulder movements
Nerve N to subclavius (C5,6, upper trunk) SUPERIOR RECTUS
Arises Sup tendinous ring within orbit
lnserts Sup sclera ant to equator of eyeball
SUBCOSTALIS Action Elevates eye. Intorts eye in
Arises Int post aspects of lower six ribs adduction
Inserts Int aspects of ribs two to three levels Newe Sup div of oculomotor N (111)
below
Action Depresses lower ribs
Nerve Muscular collateral brs of intercostal SUPINATOR
Ns Arises Deep part (horizontal): supinator
Notes Subcostalis is one of three muscles crest & fossa of ulna. Superficial part
that make up inner layer of thoracic wall (downwards):lat epicondyle & lat lig of
muscles. Others are innermost intercostals elbow & annular lig
(lat) & transversus thoracis (ant) lnserts Neck & shaft of radius, between ant
& post oblique lines
Action Supinates forearm. Only acts alone
SUBSCAPULARIS when elbow extended
Arises Med two-thirds of subscapular Nerve Post interosseous N (C6,7)
fossa Notes Post interosseous N passes between
lnserts Lesser tuberosity of humerus, upper its two heads
med lip of bicipital groove, capsule of
shoulder jnt
Action Med rotates arm & stabilises SUPRASPINATUS
shoulder jnt Arises Med three-quarters of supraspinous
Nerve Upper & lower subscapular Ns fossa of scapula, upper surface of spine
(C5,6) (from post cord) (bipennate)
Notes Subscapular bursa beneath tendon, lnserts Sup facet on greater tuberosity of
usually connected with jnt. Tendon forms humerus & capsule of shoulder jnt
part of rotator cuff Action Abducts arm & stabilises shoulder
jnt
Newe Suprascapular N (C5,6) (from upper
SUPERFICIAL TRANSVERSE PERlNEl trunk)
Arises Body of ischium Notes Subacromial bursa lies above its
lnserts Perineal body tendon. Tendon forms part of rotator cuff
Action Fixes perinea1 body
Newe Perineal br of pudendal N (S2,3,4)
TEMPORALIS
Arises Temporal fossa between inf
S U P E R I O R O B L I Q U E (see also obliquus temporal line & infratemporal crest
capitis superior) lnserts Med & ant aspects of coronoid
Arises Body of sphenoid superomedial to process of mandible
tendinous ring Action Elevates mandible & post fibres
lnserts Postlsup quadrant of sclera behind retract it
equator of eyeball on lat side Nerve Deep temporal brs from ant div of
Action Depresses eye in adduction. Intorts mandibular N (VC)
eye in abduction
Nerve Trochlear N (IV)
Temporoparietalis MUSCLES Tibialis anterior

TEMPOROPARIETALIS TERES M I N O R
Arises Aponeurosis above ear Arises Middle third lat border of scapula
lnserts Galeal aponeurosis above teres major
Action Fixes galeaI aponeurosis lnserts Inf facet of greater tuberosity of
Nerve Temporal br of facial N (VII) humerus (below infraspinatus) & capsule
of shoulder jnt
Action Lat rotates arm & stabilises
T E N S O R FASCIAE L A T A E shoulder jnt
Arises Outer surface of ant iliac crest Nerve Axillary N (C5,6) (from post cord)
between tubercle of the iliac crest & ant Notes Functionally part of infraspinatus.
sup iliac spine Tendon forms part of rotator cuff
lnserts Iliotibial tract (ant surface of lat
condyle of tibia)
Action Maintains knee extended (assists THYRO-ARYTENOID & VOCALIS
gluteus maximus) & abducts hip Arises Lower post surface of angle between
Nerve Sup gluteal N (L4,5,S1) laminae of thyroid cartilage
lnserts Vocal process of arytenoid
cartilage
TENSOR T Y M P A N I Action Shortens & relaxes vocal cords by
Arises Cartilaginous & bony margins of approximating arytenoid cartilage to
auditory tube thyroid cartilage
lnserts Handle of malleus (via processus Nerve Recurrent laryngeal br of vagus N
trochleariformis) (X)
Action Protects & critically damps Notes Vocalis is that part of thyro-
ossicular chain arytenoid that inserts into vocal cord itself
Nerve Off N to med pterygoid (main trunk
of mandibular N (VC))
THYRO-EPIGLOTTICUS
Arises Lower post surface of thyroid
T E N S O R VELl P A L A T l N l cartilage
Arises Scaphoid fossa, med aspect of spine lnserts Lat border of epiglottis
of sphenoid bone & lat cartilage of Action Widens additus of larynx
auditory tube Nerve Recurrent laryngeal br of vagus N
lnserts Palatine aponeurosis (via pulley of (X)
pterygoid hamulus)
Action Tenses soft palate prior to elevation.
Opens auditory tube on swallowing THYROHYOID
Nerve Off N to med pterygoid (main trunk Arises Oblique line on lamina of thyroid
of mandibular N (VC)) cartilage
lnserts Inf border of body of hyoid bone
Action Elevates larynx or depresses hyoid
TERES M A J O R bone
Arises Oval area (lower third) of lat side of Nerve C1 fibres carried by hypoglossal N
inf angle of scapula below teres minor (XII)
lnserts Med lip of bicipital groove of
humerus
Action Med rotates & adducts arm. TlBlALlS ANTERIOR
Stabilises shoulder jnt Arises Upper half of lat shaft of tibia &
Nerve Lower subscapular N (C5,6,7) (from interosseous membrane
post cord) lnserts Inferomedial aspect of med
Notes Functionally part of subscapularis cuneiform & base of 1st MT
Tibialis posterior MUSCLES Trapezius

Action Extends & inverts foot at ankle. TRANSVERSOSPINALIS-


Holds up med longitudinal arch of foot SEMlSPlNALlS
Nerve Deep peroneal N (L4,S) Arises Transverse processes
Notes Inversion is at subtalar & mid tarsal lnserts Spinous processes six levels above
joints Action Extends & lat flexes spine
Newe Post primary rami
Notes Three types-thoracis, cervicis &
TlBlALlS POSTERIOR capitis
Arises Upper half of post shaft of tibia &
upper half of fibula between median crest
& interosseous border, & interosseous TRANSVERSUS ABDOMlNlS
membrane Arises Costal margin (ribs & costal
lnserts Tuberosity of navicular bone & all cartilages), lumbar fascia, ant two-thirds
tarsal bones (except talus) & bases of of iliac crest & lat half of inguinal lig
metatarsals 2-4 lnserts Aponeurosis of post & ant rectus
Action Plantar flexes & inverts foot. sheath & conjoint tendon to pubic crest &
Supports med longitudinal arch of foot pectineal line
Nerve Tibial N (L4,S) Action Supports abdominal wall, aids
forced expiration & raising intra-
abdominal pressure. Conjoint tendon
TRANSVERSE A R Y T E N O I D supports post wall of inguinal canal
Arises Post surface & muscular process of Newe Ant primary rami (T7-12). Conjoint
arytenoid cartilage tendon: ilio-inguinal N (L1)
lnserts Corresponding surfaces of opposite
cartilage
Action Adducts arytenoid cartilages (closes TRANSVERSUS THORACIS
rima glottidis) (STERNOCOSTALIS)
Nerve Recurrent laryngeal branch of vagus Arises Lower third of inner aspect of
N (X) sternum & lower three costosternal
junctions
lnserts Second to sixth costal cartilages
TRANSVERSOSPINALIS- Action Depresses upper ribs
MULTlFlDUS Nerve Muscular collateral brs of intercostal
Arises Laminae of vertebra from sacrum to Ns
C2 Notes Transversus thoracis is one of three
lnserts Spinous processes two to three muscles that make up inner layer of thor-
levels above acic wall muscles. Others are innermost
Action Extends spine intercostals (lat) & subcostals (post)
Nerve Post primary rami

TRAPEZIUS
TRANSVERSOSPINALIS- Arises Med third sup nuchal line, lig
ROTATORES nuchae, spinous processes & supraspinous
Arises Transverse processes ligs to T12
lnserts Spinous processes one above lnserts Upper fibres to lat third of post
Action Rotates spine border of clavicle; med acromion & lat
Nerve Post primary rami spine of scapula. Lower fibres to med end
Notes Two types-thoracis & cervicis et of spine of scapula as far as deltoid tubercle
lumborum Action Elevates & retracts scapula. Rotates
it during abduction of arm. If scapula is
fixed, extends & lat flexes neck
Triceps MUSCLES Zygomaticus minor

Nerve Spinal root of accessory N (XI) (lat supracondylar ridge & lat intermuscular
roots, Cl-5) (spinal nerves C3 & C4 for septum
proprioception) lnserts Lat quadriceps tendon to patella,
via ligamentum patellae into tubercle of
tibia
TRICEPS Action Extends knee
Arises Long head: infraglenoid tubercle of Nerve Post div of femoral N (L2,3,4)
scapula. Lat head: upper half post
humerus (linear origin). Med head: lower
half post humerus inferomedial to spiral V A S T U S MEDIALIS (QUADRICEPS
groove & both intermuscular septa F E M O R I S 4)
lnserts Post part of upper surface of Arises Lower intertrochanteric line, spiral
olecranon process of ulna & post capsule line, med linea aspera & med
Action Extends elbow. Long head stabilises intermuscular septum
shoulder jnt. Med head retracts capsule of lnserts Med quadriceps tendon to patella
elbow jnt on extension & directly into med patella, via
Nerve Radial N (C6,7,8) (from post cord), ligamentum patellae into tubercle of tibia
four brs Action Extends knee. Stabilises patella
Nerve Post div of femoral N (L2,3,4)

VASTUS INTERMEDIUS
( Q U A D R I C E P S F E M O R I S 2) ZYGOMATICUS MAJOR
Arises Ant & lat shaft of femur to one Arises Ant surface of zygomatic bone
hand's breadth above condyles lnserts Modiolus at angle of mouth
lnserts Quadriceps tendon to patella, via Action Elevates & draws angle of mouth
ligamentum patellae into tubercle of tibia laterally
Action Extends knee Nerve Buccal br of facial N (VII)
Nerve Post div of femoral N (L2,3,4)

ZYGOMATICUS MINOR
VASTUS LATERALIS (QUADRICEPS Arises Lat infra-orbital margin
F E M O R I S 3) lnserts Skin & muscle of upper lip
Arises Upper intertrochanteric line, base of Action Elevates & everts upper lip
greater trochanter, !at linea aspera, lat Nerve Buccal br of facial N (VII)

Aide memoir for nerve supply of groups of muscles in head and neck

All muscles o f Supplied by: Except: Which is supplied by:

Pharynx Pharyngeal plexus (IX, X, sympathetic) Stylopharyngeus Glossopharyngeal(IX)

Palate Pharyngealplexus (IX, X, sympathetic) Tensor palati Off N t o med pterygoid (VC)

Tongue Hypoglossal (XII) Palatoglossus Pharyngeal plexus (IX, X,


sympathetic)

Mastication Mandibular (VC) Buccinator Facial (V11)

Larynx Recurrent laryngeal (X) Cricothyroid Ext br of superior laryngeal (X)

Facial expression Facial (VII)


& buccinator
Classification of joints Jointswith double cavities
separated by intra-articular
Fibrous Fibrous tissue between bones
ligaments-not fibrocartilaginous
Primary cartilaginous Hyaline cartilage
discs
between bones
Secondary cartilaginous As for primary Costovertebral (ribs 2-10)
but fibrocartilage between the layers of Sternochondral(2nd rib)
hyaline cartilage (symphysis)
Synovial Joint cavity with synovial fluid.
Joints classified by type
Hyaline cartilage on surface of bones.
Articular disc can be present Fibrous joints
Atypical synovial Joint cavity with synovial Arytenocorniculate (can be synovial)
fluid. Fibrocartilage on surface of bones. Costotransverse (ribs 11and 12)
Articular disc can be present Cuboideonavicular (can be synovial)
Gomphosis (teeth)
Radio-ulnar (interosseous membrane)
Types of synovial joint
Skull sutures
Plane Sliding only Tibiofibular (inferior)
Hinge (ginglymus) One plane of Tibiofibular (interosseous membrane)
movement
Modified hinge (bicondylar) One plane of Primary cartilaginous joints
movement + rotation Costochondral
Condyloid (ellipsoid) Two planes of Sternochondral(1st rib)
movement (circumduction) Spheno-occipital
Saddle condyloid (sella) Two planes of
movement + controlled rotation Secondary cartilaginous joints
Pivot (trochoid) Rotation only. One plane Intervertebral
of movement Manubriosternal
Ball and socket (spheroidal) Multi-axial. Sacrococcygeal
Three planes of movement Symphysis pubis
Xiphisternal
Joints with interarticular
Atypical synovial joints
fibrocartilaginous discs
Acromioclavicular
Acromioclavicular (usually incomplete) Sternochondral (ribs 2-7)
Femorotibial (knee) (incomplete-menisci) Sternoclavicular
Radiocarpal (wrist) Temporomandibular
Sternoclavicular
Temporomandibular Typical synovial
Acetabulofemoral (hip)
Atlanto-axial (dens & facets)
Atlanto-occipital
Calcaneocuboid
Carpometacarpal
Costotransverse (ribs 1-10)
JOINTS

Costovertebral Cuneocuboid (see intertarsal)


Crico-arytenoid Cuneonavicular (see intertarsal)
Crico-thyroid Elbow (see humero-ulnar, humeroradial &
Cuneocu boid superior radio-ulnar) 181
Cuneonavicular Facet (vertebral articulations) (see
Femorotibial (knee) zygapophyseal)
Glenohumeral (shoulder) Femorotibial (knee) 181
Humeroradial (elbow) Glenohumeral (shoulder) 181
Humero-ulnar (elbow) Gomphosis (dento-alveolar) 181
Intercarpal Hip (see acetabulofemoral)
Interchondral (cartilages 6-10) Humeroradial (elbow) 181
Intercuneiform Humero-ulnar (elbow) 181
Intermetacarpal Intercarpal (midcarpal) (see also
Intermetatarsal pisotriquetral)
Interphalangeal Interchondral 181
Metacarpophalangeal Intercuneiform (see intertarsal)
Metatarsophalangeal Intermetacarpal (see carpometacarpal-
Pisotriquetral fingers 2-5)
Radiocarpal (wrist) Intermetatarsal 181
Radio-ulnar (superior & inferior) Interphalangeal (fingers & toes) 181
Talocalcaneal Intertarsal-cuboideonavicular 181
Talocalcaneonavicular Intertarsal-cuneocuboid 181
Tarsometatarsal Intertarsal-cuneonavicular 182
Tibiofibular (superior) Intertarsal-intercuneiform l82
Tibiotalal (ankle) Intervertebral 182
Zygapophyseal (intervertebral facet) Intervertebral facets
(see zygapophyseal)
Intervertebral joints of Luschka
Unclassified
(neurocentral or uncovertebral) l 8 2
Intervertebral joints of Luschka Knee (see femorotibial)
Manubriosternal l 8 2
Metacarpophalangeal 182
Named joints
Metatarsophalangeal 182
Acetabulofemoral (hip) 180 Midcarpal (see intercarpal)
Acromioclavicular 180 Midtarsal (see calcaneocuboid &
Ankle (see tibiotalal) talonavicular part of
Arytenocorniculate (larynx) 180 talocalcaneonavicular )
Atlanto-axial-lateral 180 Pelvic (see sacro-iliac & symphysis
Atlanto-axialmedian 180 pubis)
Atlanto-occipital 180 Pisotriquetral 182
Calcaneocuboid (midtarsal) 180 Radiocarpal (wrist) l 8 2
Carpometacarpal-fingers 2 -5 (including Radio-ulnar-inferior l82
intermetacarpal) 180 Radio-ulnar-interosseous membrane &
Carpometacarpal-thumb 180 oblique cord 182
Costochondral 180 Radio-ulnar-superior 182
Costotransverse-ribs 1-10 180 Sacrococcygeal 182
Costotransverse-ribs 11,12 180 Sacro-iliac l 8 2
Costovertebral 180 Shoulder (see glenohumeral)
Crico-arytenoid (larynx) 180 Skull sutures l 8 3
Cricothyroid (larynx) 181 Spheno-occipital 183
Cuboideonavicular (see intertarsal) Sternochondral (sternocostal) l 8 3
JOINTS

Sternoclavicular (manubrioclavicular) 183 Tibiotalal (ankle) l 8 3


Sternocostal (see sternochondral) Vertebral (see intervertebral)
Subtalar (see talocalcanean & talocalcaneal Wrist (see radiocarpal & interarticular disc
part of talocalcaneonavicular) of inferior radio-ulnar)
Symphysis pubis l 8 3 Xiphisternal 184
Talocalcaneal (subtalar) (see Zygapophyseal (intervertebral facet) 184
talocalcaneonavicular)
Talocalcanean (subtalar) 183 All joints are paired except the following
Talocalcaneonavicular 183 which are single midline joints:
Talonavicular (midtarsal) (see Median atlanto-axial
talocalcaneonavicular) Intervertebral
Tarsometatarsal l 8 3 Manubriosternal
Temporomandibular 183 Spheno-occipital
Tibiofibular-inferior 183 Symphysis pubis
Ti biofibular-interosseous membrane l 8 3 Xiphisternal
Tibiofibular-superior 183
Acetabulofemoral JOINTS Crico-arytenoid

ACETABULOFEMORAL (hip) CARPOMETACARPAL-FINGERS 2-5


Classification Synovial (including intermetacarpal)
Type Ball & socket Classification Synovial
Articulation Acetabulum with femur Type Plane
Articulation Carpal bones with MCs &
between MCs
ACROMIOCLAVICULAR Notes Usually continuous cavity between
Classification Atypical synovial CMC, intermetacarpal & intercarpal jnts
Type Plane
Articulation Acromion with clavicle
Notes Often an articular disc in upper part CARPOMETACARPAL-THUMB
of jnt, usually incomplete Classification Synovial
Type Saddle condyloid
Articulation Trapezium with 1st MC
ANKLE (see tibiotalal) Notes Joint is separate from others in hand

ARYTENOCORNICULATE (larynx) COSTOCHONDRAL


Classification Fibrous or synovial Classification Primary cartilaginous
Articulation Arytenoid cartilage with Articulation Bony rib with costal cartilage
corniculate cartilage

COSTOTRANSVERSE-RIBS 1-1 0
ATLANTO-AXIAL-LATERAL Classification Synovial
Classification Synovial Type Plane
Type Plane Articulation Med facet of tubercle of rib
Articulation Articular facets of atlas with with transverse process of own vertebra
axis

COSTOTRANSVERSE-RIBS I I , 12
ATLANTO-AXIAL-MEDIAN Classification Fibrous (ligamentous)
Classification Synovial Articulation Tubercle of rib with
Type Pivot transverse process of own vertebra
Articulation Dens of axis with atlas
Notes Second cavity (bursa) posteriorly
COSTOVERTEBRAL
Classification Synovial
ATLANTO-OCCIPITAL Type Plane
Classification Synovial Articulation Head of rib with vertebral
Type Condyloid body
Articulation Atlas with occipital bone Notes 1st rib articulates with T1 vertebra
only (single cavity jnt). Ribs 2-10 with
own vertebra & one above (double cavity
CALCANEOCUBOID (midtarsal) jnts separated by intra-articular lig). Ribs
Classification Synovial 11& 12 with own vertebra only (single
Type Saddle condyloid cavity jnts)
Articulation Calcaneus with cuboid
Notes This is one part of midtarsal jnt.
Other is talonavicular part of CRICO-ARYTENOID (larynx)
talocalcaneonavicular Classification Synovial
Type Features of ball & socket
Cricothyroid JOINTS Intertarsal-cuneocuboid

Articulation Cricoid cartilage with Articulation Trochlea of humerus with


arytenoid cartilage ulnar trochlear notch
Notes Jnt cavity is shared with
humeroradial & sup radio-ulnar jnts
C R I C O T H Y R O I D (larynx)
Classification Synovial
Type Plane (rotational).Two together give INTERCARPAL (MIDCARPAL)
hinge movement (see also pisotriquetral)
Articulation Facet on side of cricoid Classification Synovial
cartilage with inf horn of thyroid Type Plane individually but together give
cartilage effective mixture of condyloid, saddle
condyloid & ball & socket
Articulation Between scaphoid, lunate,
ELBOW (see humeroradial & humero-ulnar) triquetral, hamate, capitate, trapezoid &
trapezium
Notes Single cavity between the seven
FEMOROTIBIAL (knee) bones usually communicating also with
Classification Synovial CMC & intercarpal jnts of fingers 2-5
Type Modified hinge
Articulation Femur with tibia
Notes Menisci are incomplete discs of INTERCHONDRAL
fibrocartilage Classification Synovial
Type Plane
Articulation Between costal cartilages 617,
G L E N O H U MERAL (shoulder) 7/8,8/9,9/10
Classification Synovial
Type Ball & socket
Articulation Glenoid fossa of scapula with INTERMETATARSAL
humerus Classification Synovial
Type Plane
Articulation Between MTs
G 0 M P H 0SlS (dento-alveolar)
Classification Fibrous
Articulation Tooth with bone of jaw INTERPHALANGEAL (fingers &toes)
Classification Synovial
Type Hinge
H I P (see acetabulofemoral) Articulation Between phalanges

HUMERORADIAL (elbow) INTERTARSAL-


Classification Synovial CUBOIDEONAVICULAR
Type Hinge Classification Fibrous (can be synovial)
Articulation Capitulum of humerus with Articulation Cuboid with navicular
radial head
Notes Jnt cavity is shared with humero-
ulnar & sup radio-ulnar jnts INTERTARSAL-CUNEOCUBOID
Classification Synovial
Type Plane
HUMERO-ULNAR (elbow) Articulation Lat cuneiform with cuboid
Classification Synovial Notes Cuneocuboid shares cavity with
Type Hinge cuneonavicular & intercuneiform jnts
Intertarsal-cuneonavicular JOINTS Sacro-iliac

INTERTARSAL-CUNEONAVICULAR Type Condyloid


Classification Synovial Articulation MTs with phalanges
Type Plane
Articulation Cuneiforms with navicular
Notes Cuneonavicular shares cavity with M l D T A R S A L (see both talonavicular part of
cuneocuboid and intercuneiform jnts talocalcaneonavicular and calcaneocuboid)

INTERTARSAL-INTERCUNEIFORM PISOTRIQUETRAL
Classification Synovial Classification Synovial
Type Plane Type Plane
Articulation Between cuneiforms Articulation Pisiform with triquetral
Notes Intercuneiform jnts share cavity with
cuneonavicular & cuneocuboid jnts
R A D I O C A R P A L (wrist)
Classification Synovial
INTERVERTEBRAL Type Condyloid
Classification Secondary cartilaginous Articulation Radius & triangular
Articulation Between vertebral bodies fibrocartilaginous articular disc with
scaphoid, lunate & triquetral

INTERVERTEBRAL J O I N T S O F
L U S C H K A (neurocentral o r RADIO-ULNAR-INFERIOR
uncovertebral) Classification Synovial
Classification Unclassified Type Pivot
Type Unclassified Articulation Radius with ulna
Articulation Lateral lip of upper surface of Notes Cavity separated from cavity of wrist
C3-7 & T1 vertebrae with adjacent by triangular fibrocartilaginous disc
vertebral body above
Notes Often small cavity which is
degenerative (not synovial) RADIO-ULNAR-INTEROSSEOUS
MEMBRANE & OBLIQUE C O R D
Classification Fibrous
K N E E (see femorotibial) Articulation Radius with ulna

MANUBRIOSTERNAL RADIO-ULNAR-SUPERIOR
Classification Secondary cartilaginous Classification Synovial
Articulation Manubrium with sternum Type Pivot
Notes May cavitate to give appearance of Articulation Radius with ulna
synovial jnt Notes Cavity is continuous with humero-
ulnar & humeroradial jnts

METACARPOPHALANGEAL
Classification Synovial SACROCOCCYGEAL
Type Condyloid Classification Secondary cartilaginous
Articulation MCs with phalanges Articulation Sacrum with coccyx

METATARSOPHALANGEAL SACRO-ILIAC
Classification Synovial Classification Synovial
Shoulder JOINTS Tibiotalal

Type Plane Notes This is a posterior, separate jnt that is


Articulation Sacrum with iliac bone one-half of subtalar jnt

S H 0 U L D E R (see glenohumeral) TALOCALCANEONAVICULAR


Classification Synovial
Type Features of ball & socket
SKULL SUTURES Articulation Talus with calcaneus &
Classification Fibrous navicular
Articulation Between diploae of skull Notes This is a two part jnt. Talocalcaneal
part (two facets) is part of subtalar jnt,
other being talocalcanean. Talonavicular
SPHENO-OCCIPITAL part (one facet) is part of midtarsal jnt,
Classification Primary cartilaginous other being calcaneocuboid.
Articulation Sphenoid with basi-occiput

TARSOMETATARSAL
S T E R N O C H O N D R A L (sternocostal) Classification Synovial
Classification 1st: primary cartilaginous; Type Plane
2nd-7th: atypical synovial Articulation Tarsal bones with MTs
Type 2nd-7th: plane
Articulation 1st rib with manubrium.
3rd-7th ribs with sternum. 2nd with TEMPOROMANDIBULAR
both Classification Atypical synovial
Notes 2nd jnt has two cavities separated by Type Condyloid
intra-articular lig Articulation Temporal bone with mandible
Notes Separated into two cavities by
fibrocartilaginous disc
STERNOCLAVICULAR
(manubrioclavicular)
Classification Atypical synovial TIBlOFlBULAR-INFERIOR
Type Features of ball & socket Classification Fibrous
Articulation Clavicle with manubrium Articulation Tibia with fibula
Notes Separated into two cavities by
fibrocartilaginous disc
TIBIOFIBULAR-INTEROSSEOUS
MEMBRANE
S U B T A L A R (see both talocalcanean & Classification Fibrous
talocalcaneal part of talocalcaneonavicular) Articulation Tibia with fibula

SYMPHYSIS PUBIS TIBIOFIBULAR-SUPERIOR


Classification Secondary cartilaginous Classification Synovial
Articulation Between pubic bones Type Plane
Notes May cavitate Articulation Tibia with fibula

T A L O C A L C A N E A N (subtalar) T l B I O T A L A L (ankle)
Classification Synovial Classification Synovial
Type Plane (effectivelyball & socket) Type Hinge
Articulation Talus with calcaneus Articulation Tibia with talus
Wrist JOINTS Zygapophyseal

W R I S T (see radiocarpal & interarticular disc Z Y G A P 0 P H Y S E A L (intervertebral facet)


o f inferior radio-ulnar) Classification Synovial
Type Plane
Articulation Between intervertebral facets
XIPHISTERNAL
Classification Secondary cartilaginous
Articulation Xiphoid with sternum
Ossificationtimes

Centre appears at:


Bones Forms in Centres
(number if membrane (M) primary (P) o r Gestation After
unpaired) o r cartilage (C) secondary (S) Site (weekslrnonths) birth Fused by

Mandible ( l ) Near mental forarnen (each side) Symphysis menti 1-3 Y

Hyoid ( l ) Greater cornu (each side)


Body (2 centres)
Lesser cornu (each side) Puberty

Occiput ( I ) Squamous (each side)


Lateral (each side)
Basilar

Sphenoid (I) Approximately 14 centres

Temporal Squamous
Tympanic
Petromastoid (several centres)

Parietal Near tuberosity (2 centres)

Frontal (2 3 I) Near each tuberosity (2 centres, one each Metopic suture 2 Y


side)

Ethrnoid ( l ) Labyrinth (one each side)


Perpendicular platelcrista galli

lnf concha

Lacrimal

Nasal

Vomer ( I ) (2 centres)

Maxilla (3 centres)

Palatine Perpendicular plate


Zygomatic M P 8 W
Ear ossicles C P Stapes 4M
C P Malleus 4M
C P lncus 4M
Scapula C P Body 8 W
C S Coracoid process IY 15Y
C S Subcoracoid Puberty 20 Y
C S Medial border Puberty 20 Y
C S Glenoid (lower rim) Puberty 20 Y
C S Acromion (2 centres) Puberty 20 Y
C S Inferior angle Puberty 20 Y
Clavicle M P Medial & lateral (2 centres) 5 W
M S Sterna1end Late teens 20 Y
Humerus (upper C P Shaft 8 W
end is growing end) C S Head 6M Upper epiphysis 18-20 Y
C S Greater tuberosity 2Y
C S Lesser tuberosity 5Y
C S Capitulum & lat ridge of trochlea IY
C S Medial trochlea IOY
C S Medial epicondyle 5Y Lower epiphysis 14-1 6 Y
C S Lateral epicondyle 12Y
Radius (lower C P Shaft 8 W
end is growing end) C S Head 4Y 14-17Y
C S Distal end IY 17-19Y
Ulna (lower end C P Shaft 8 W
is growing end) C S Olecranon (2 centres) 9Y 14-16Y
C S Distal end 5Y 17-18Y
Carpus C P Capitate 2M
C P Hamate 3M
C P Triquetral 3Y
C P Lunate 4Y

continued on p . I88
Ossification times continued

Centre appears at:


Bones Forms in Centres
(number if membrane (M) primary (P) or Gestation After
unpaired) or cartilage (C) secondary (S) Site (weekslmonths) birth Fused by

Scaphoid
Trapezium
Trapezoid
Pisiform

Metacarpal ( l st) Shaft


Base

Metacarpals (2nd-5th) Shaft


Head

Phalanges (hand) Shaft


Base

lnnominate Pubis (superior ramus)


lschium (body)
Ilium (above greater sciatic notch)
lliac crest (2 centres) Puberty
Acetabulum (2 centres) Puberty
Anterior superior iliac spine Puberty
lschial tuberosity Puberty
Pubic symphysis Puberty

Femur (lower end Shaft


is growing end) Greater trochanter
Lesser trochanter
Head
Distal end

Patella (Several centres) Puberty


Superolaterally Puberty
( Tibia (upper end is C P Shaft
growing end) Plateau
Distal end
Tuberosity

Fibula (upper end is Shaft


growing end) Distal end
Head

Talus

Calcaneus

Navicular

Cuneiform lateral

Cuneiform medial (May have 2 centres)

Cuneiform intermediate

Cuboid

Metatarsal ( lst) Shaft


Base

Metatarsals (2nd-5th) Shaft


Head

Phalanges (foot) Shaft


Base

continuedon p. 190
Closure of skull sutures
Ant fontinelle: closes 18 M; post fontinelle: closes 6 M-l Y
Notes: ( I ) All bones are paired unless otherwise stated. (2) Single centre of ossification unless specified otherwise. (3) Variability of ossification usually a sex difference, females
appearing and uniting earlier. (4) Fusion times for epiphyses are given if clinically relevant
O S S I F I C A T I O N TIMES

Ossification times continued-eruption of teeth

Eruption of teeth
Incisor Canine Premolar Molar

(upper) (lower)
First dentition (months) 7,8 6 9 18

Second dentition* (years) 7,8 7,8 II 9, 10 6, 12, 18

* Lower teeth erupt slightly earlier


Aqueduct of the vestibule 192 Mastoid foramen 194
Carotid canal 192 Mental foramen 194
Condylar canal 192 Nasolacrimal canal 194
Cribriform foramina 192 Optic canal 194
Facial canal 192 Palatovaginal canal 194
Foramen caecum (unpaired) 192 Petrosquamous fissure 194
Foramen lacerum 192 Petrotympanic fissure 194
Foramen magnum (unpaired) 192 Pterygoid canal 194
Foramen ovale 192 Pterygomaxillary fissure 194
Foramen rotundum 192 Sphenoidal foramen 194
Foramen spinosum 192 Sphenopalatine foramen 194
Foramen transversarium 192 Squamotympanic fissure 194
Greater palatine foramen 192 Stylomastoid foramen 195
Hypoglossal canal 193 Superior orbital fissure 195
Incisive canal 193 Supra-orbital foramen 195
Incisive foramen 193 Vertebral foramen (unpaired) 195
Incisive fossa (unpaired) 193 Vomerovaginal canal 195
Inferior orbital fissure 193 Zygomaticofacial foramen 195
Infra-orbital canal 193 Zygomatico-orbital foramen 195
Infra-orbital foramen 193 Zygomaticotemporal foramen 195
Internal acoustic meatus 193
Intervertebral foramen 193 Notes: (1) Most smaller emissary veins and
Jugular foramen 193 meningeal arterial supplies have been
Lesser palatine foramina 193 omitted. (2) All structures are paired unless
Mandibular canal (inferior alveolar otherwise indicated.
canal) 193
Mandibular foramen (inferior alveolar
foramen) 193
Aqueduct of the vestibule FORAM I NA-SKU LL A N D SPl NE Greater palatine forarnen

A Q U E D U C T O F T H E VESTIBULE temporal & basilar occipital bones in


Site In post aspect of petrous temporal bone middle cranial fossa
in post cranial fossa, 1cm post to int Contains Int carotid art enters behind &
acoustic meatus exits above. Greater petrosal N enters
Contains Endolymphatic duct & sac, small behindlabove & leaves ant as N of the
art & V pterygoid canal

CAROTID CANAL FORAMEN M A G N U M (unpaired)


Site In inf surface of petrous temporal bone Site In occipital bone in post cranial fossa
in middle cranial fossa Contains Medulla oblongata, meninges,
Contains Int carotid art enters with sym- vertebral arts, ant & post spinal arts,
pathetic plexus on it. Int carotid venous spinal roots of accessory Ns (XI),
plexus connecting cavernous sinus & int sympathetic plexus on vertebral art,
jugular vein apical ligament of dens, tectorial
membrane

CONDYLAR CANAL
Site In lower sigmoid groove in occipital FORAMEN OVALE
bone in post cranial fossa. Exits at con- Site In greater wing of sphenoid bone in
dylar fossa behind condyle (not always middle cranial fossa
present) Contains Mandibular N (VC),lesser
Contains Emissary V connecting sigmoid petrosal N, accessory meningeal art
sinus & occipital Vs. Meningeal br of
occipital art
FORAMEN R O T U N D U M
Site In greater wing of sphenoid bone in
CRlBRlFORM F O R A M I N A middle cranial fossa
Site In cribriform plate of ethmoid bone in Contains Maxillary N (Vb)
ant cranial fossa
Contains Olfactory filaments & ant
ethmoidal N & vessels FORAMEN SPINOSUM
Site In greater wing of sphenoid bone in
middle cranial fossa
FACIAL CANAL Contains Middle meningeal vessels,
Site In petrous temporal bone leading from meningeal br of mandibular N (VC)
int acoustic meatus to stylomastoid
foramen
Contains Facial N (VII) FORAMEN TRANSVERSARIUM
Site In pedicle of cervical vertebrae
bordered by-lat: intertubercular lamella
FORAMEN C A E C U M (unpaired) (costotransverse bar), med: body of
Site Between frontal crest of frontal bone & vertebra
crista galli of ethmoid bone in ant cranial Contains Vertebral art & V in Cl-6. Vein
fossa only in C7
Contains Emissary Vs connecting nose &
sup sagittal sinus
GREATER P A L A T I N E FORAMEN
Site Between maxilla & palatine bone at lat
FORAMEN LACERUM edge of hard palate
Site Between sphenoid, apex of petrous Contains Greater palatine N & vessels
Hypoglossal canal FORAMINA-SKULL A N D SPINE Mandibular foramen

HYPOGLOSSAL CANAL Contains Facial N (VII),nervus


Site In occipital bone above condyle in post intermedius, vestibulocochlear N (VIII),
cranial fossa labyrinthine art
Contains Hypoglossal N (XII) &
meningeal br of ascending pharyngeal art
INTERVERTEBRAL FORAMEN
Site Between vertebrae, bordered by-sup
INCISIVE CANAL & inf: pedicles of vertebrae, ant: vertebral
Site In ant maxilla extending from nose to bodies & intervertebral disc, post: lig
incisive foramina flavum covering sup & inf articular
Contains Nasopalatine N, greater palatine processes
vessels Contains Spinal art & V, dorsal root
ganglion, spinal N. Nerves Cl-7 emerge
via foramen above same numbered
INCISIVE FORAMEN vertebra; nerve C8 exits below C7
Site Midline, in ant hard palate. Openings vertebra & below this all nerves emerge
of incisive canals into incisive fossa via foramen below the same numbered
Contains Nasopalatine N, greater palatine vertebra
vessels

JUGULAR FORAMEN
I N C I S I V E F O S S A (unpaired) Site Between jugular fossa of petrous
Site Median, in ant hard palate leading temporal bone & occipital bone in post
upwards to incisive foramina cranial fossa
Contains Nasopalatine Ns, greater palatine Contains Glossopharyngeal N (IX),vagus
vessels (X), accessory N (XI), inf petrosal &
sigmoid sinuses enters it, int jugular V
emerges below
INFERIOR O R B I T A L FISSURE
Site Between greater wing of sphenoid bone
& maxilla LESSER P A L A T I N E F O R A M I N A
Contains Infra-orbital & zygomatic brs of Site Two or three foramina in med & inf
maxillary N (Vb),infra-orbital vessels, inf aspects of pyramidal process of palatine
ophthalmic Vs, orbital brs of bone
pterygopalatine ganglion Contains Lesser palatine Ns & vessels

INFRA-ORBITAL C A N A L M A N D I B U L A R C A N A L (INFERIOR
Site Within orbital aspect of maxilla ALVEOLAR CANAL)
Contains Infra-orbital N & vessels Site In body & ramus of mandible between
mandibular & mental foramina
Contains Inf alveolar N & vessels
INFRA-ORBITAL FORAMEN
Site Below infra-orbital margin in maxilla.
Ant opening of infra-orbital canal M A N D I B U L A R FORAMEN (INFERIOR
Contains Infra-orbital N & vessels ALVEOLAR FORAMEN)
Site Med aspect of ramus of mandible,
overlapped anteromedially by lingula
INTERNAL ACOUSTIC MEATUS Contains Inf alveolar N & vessels
Site In post surface of petrous temporal
bone in post cranial fossa
Mastoid foramen FORAMINA-SKULL A N D SPINE Squamotympanic fissure

M A S T O I D FORAMEN Contains Chorda tympani, ant lig of


Site In petrous temporal bone in post malleus, ant tympanic br of maxillary art
cranial fossa, post to sigmoid groove.
Exits behind mastoid process
Contains Emissary V connecting sigmoid PTERYGOID C A N A L
sinus & occipital Vs, meningeal br of Site In pterygoid process of sphenoid bone
occipital art connecting ant wall of foramen lacerum to
pterygopalatine fossa
Contains N & art of pterygoid canal
M E N T A L FORAMEN
Site Outer aspect of ant ramus of mandible
by second premolar tooth, leading from P T E R Y G O M A X I L L A R Y FISSURE
mandibular (inf alveolar) canal Site Between lat pterygoid plate & post
Contains Mental N & vessels surface of maxilla connecting infra-
temporal & pterygopalatine fossae,
continuous above with post end of inf
NASOLACRIMAL C A N A L orbital fissure
Site Between lacrimal bone & maxilla at Contains Terminal brs of maxillary art,
antlinflmed corner of orbit passing in, post sup alveolar Ns passing
Contains Nasolacrimal duct out

OPTIC CANAL SPHENOIDAL FORAMEN


Site In body of sphenoid bone in middle Site In greater wing of sphenoid in middle
cranial fossa between body & two roots of cranial fossa med to foramen ovale (40%
lesser wing of skulls) (venous foramen of Vesalius)
Contains Optic N (H),dural sheath, Contains Emissary V connecting cavernous
ophthalmic art sinus & pterygoid plexus

PALATOVAGINAL CANAL SPHENOPALATINE FORAMEN


Site Between upper surface of sphenoidal Site Between body of sphenoid bone &
process of palatine bone & lower surface sphenopalatine notch of palatine bone
of vaginal process of root of med ptery- (sup border of perpendicular plate &
goid plate in base of skull orbital & sphenoidal processes). In med
Contains Pharyngeal Ns from maxillary wall of pterygopalatine fossa
(Vb)and pterygopalatine ganglion & Contains Sphenopalatine art, nasopalatine
pharyngeal br of maxillary art & sup nasal Ns from pterygopalatine
fossa

P E T R O S Q U A M O U S FISSURE
Site Between squamous temporal bone & S Q U A M O T Y M P A N I C FISSURE
tegmen tympani (petrous temporal bone) Site Between tympanic part (plate)of
Contains No structures temporal bone & mandibular fossa
(squamous temporal bone) in base of
skull. It is divided by tegmen tympani
P E T R O T Y M P A N I C FISSURE (petrous temporal bone) into petro-
Site Between tympanic part (plate) of tympanic and petrosquamous fissures
temporal bone & tegmen tympani (also Contains Deep auricular br of maxillary
part of temporal bone) in base of skull artery
Stylomastoid foramen FORAMINA-SKULL A N D SPINE Zygomaticotemporal

STYLOMASTOID FORAMEN Contains Spinal cordlcauda equina, dura,


Site Between styloid & mastoid processes archnoid & pia mater, cerebrospinal fluid,
of temporal bone in base of skull internal vertebral venous plexus & spinal
Contains Facial N (VII) & stylomastoid br arts
of post auricular art

VOMEROVAGINAL C A N A L
SUPERIOR ORBITAL FISSURE Site Between lower aspect of ala of vomer
Site Between body & lesser & greater wings & upper aspect of vaginal process of root
of sphenoid bone in middle cranial fossa of med pterygoid plate in base of skull
Contains Ophthalmic N (Va)(lacrimal, (not always present)
frontal, nasociliary brs), ophthalmic Vs, Contains Pharyngeal br of sphenopalatine
oculomotor N (sup & inf divs) (111), art
trochlear N (IV),abducent N (VI),
sympathetic fibres, brs of middle
meningeal & lacrimal arts ZYGOMATICOFACJAL FORAMEN
Site In lat surface of zygomatic bone
Contains Zygomaticofacial N & vessels
SUPRA-ORBITAL FORAMEN
Site In supra-orbital margin of frontal
bone, 2cm from midline ZYGOM.ATIC0-ORBITAL FORAMEN
Contains Supra-orbital N & vessels Site In orbital surface of zygomatic bone
Contains Zygomatic br of maxillary N (Vb)

VERTEBRAL FORAMEN (unpaired)


Site Bordered by-ant: body of vertebra, ZYGOMATICOTEMPORAL FORAMEN
post: laminae, lat: pedicles & articular Site In posteromedial surface of zygomatic
processes. Collectively making the spinal bone
canal Contains Zygomaticotemporal N & vessels
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Adductor (Hunter's/subsartorial) Lesser sciatic foramen 199
canal 198 Medial triangular space 199
Anterior triangle of neck 198 Obturator canal 199
Cubital fossa 198 Popliteal fossa 199
Deep inguinal ring 198 Posterior triangle of neck 200
Epiploic foramen of Winslow (aditus to Pudendal (Alcock's) canal 200
lesser sac) (unpaired) l 9 8 Quadrangular space 200
Femoral ring & canal 198 Snuff box 200
Femoral triangle l 9 8 Superficial inguinal ring 200
Greater sciatic foramen l 9 8 Urogenital triangle 200
Inguinal canal 199
Inguinal (Hasselbach's) triangle 199 Notes: (1) Including fossae, spaces, rings,
Ischio-anal (ischiorectal)fossa 199 canals, triangles, sacs and foramina. (2)All
Lateral triangular space 199 paired unless otherwise indicated.
Lesser sac (omental bursa) (unpaired) 199
Adductor canal SPACES OTHER T H A N SKULL A N D S P I N E Greater sciatic

A D D U C T O R (HUNTER'S1 DEEP INGUINAL RlNG


SUBSARTORIAL) C A N A L Site A defect in transversalis fascia in lower
Site A groove in thigh extending from apex abdominal wall above mid point of
of femoral triangle to hiatus in adductor inguinal lig. Borders-sup & lat: curved
magnus. Bordered by-lat: vastus medialis, fibres of transversus abdominis. Inf:
med: adductor longus & magnus, roof: inguinal lig. Med: transversalis fascia &
fascia in which lies the subsartorial plexus inf epigastric vessels. Int spermatic fascia
& on which lies sartorius attached to its edges
Contains Femoral art & vein; saphenous N; Contains Vas deferens; testicular, vasal,
N to vastus medialis cremasteric arts & Vs; obliterated
processus vaginalis; genital br of
genitofemoral N; autonomic Ns;
ANTERIOR TRIANGLE O F NECK lymphatics
Site Borders-inf border of mandible,
midline & ant border of
sternocleidomastoid. Subdivided into EPlPLOlC FORAMEN O F W I N S L O W
carotid, digastric, submental & muscular ( A D I T U S T O L E S S E R S A C ) (unpaired)
triangles Site In upper abdomen. Borders-ant:
Contains Muscles: digastric, stylohyoid, portal V, bile duct & hepatic art in free
mylohyoid, geniohyoid, sternohyoid, edge of lesser omentum, post: inf vena
omohyoid, thyrohyoid, sternothyroid, cava, inf: first part of duodenum,
platysma. Hyoid bone, larynx, thyroid & sup: caudate lobe of liver
parathyroid glands, trachea, oesophagus, Contains Nil
submandibular gland, lymph nodes.
Arteries: common, int & ext carotids; brs
of ext carotid: sup thyroid, ascending FEMORAL RlNG & CANAL
pharyngeal, lingual, facial (submental). Site In lower abdomen. Femoral ring is
Mylohyoid art (maxillary via inf alveolar). upper end of femoral canal. Borders-ant:
Veins: int & ant jugular. Nerves: hypo- inguinal lig, med: lacunar lig, post:
glossal, ansa cervicalis, vagus & its int, ext pectineal lig & pectineus, lat: femoral V
& recurrent laryngeal & pharyngeal brs, Contains Cloquet's node; lymphatics
mylohyoid N from VCvia inf alveolar N

FEMORAL TRIANGLE
CUBITAL FOSSA Site In ant thigh. Borders-med: rned border
Site Triangular space in ant aspect of arm. of adductor longus, lat: rned border of
Borders-sup: intercondylar line, med: lat sartorius, sup: inguinal lig, floor: adductor
border of pronator teres, lat: rned border longus, pectineus, iliacus & psoas, roof:
of brachioradialis, floor: brachialis, fascia lata
supinator, roof: fascia (see below for what Contains Femoral N, art, V & their brs;
lies in it) deep inguinal lymph nodes
Contains From rned to lat: median N,
brachial art & its accompanying Vs,
biceps tendon, radial & post interosseous GREATER SCIATIC FORAMEN
Ns seen under edge of brachioradialis. Site In pelvis between greater sciatic notch
Roof: bicipital aponeurosis, median of ischium/ilium & both sacrotuberous &
basilic & cephalic Vs, rned & lat sacrospinous ligs
cutaneous Ns of forearm Contains From above downwards: sup
gluteal N & vessels, piriformis, inf gluteal
N & vessels, int pudendal art, pudendal
N, sciatic N, post femoral cutaneous N,
lnguinal canal SPACES O T H E R T H A N SKULL A N D S P I N E Popliteal fossa

perforating cutaneous N, N to obturator LESSER SAC ( O M E N T A L BURSA)


internus, N to quadratus femoris (unpaired)
Site Diverticulum from general peritonea1
cavity in upper abdomen opening via
INGUINAL CANAL epiploic foramen of Winslow
Site In lower abdomen between deep & Contains Its peritoneal lining lies against-
superficial inguinal rings. Borders-ant: ant (from above down): post surface of
external oblique abdominis & a small liver; lesser omentum; body & fundus of
portion of internal oblique abdominis, stomach; greater omentum. Inf: transverse
post: transversalis fascia, inf epigastric colon. Post: inf vena cava; first 2.5cm of
vessels & conjoint tendon, sup: curved duodenum; aorta; coeliac trunk & brs;
fibres of internal oblique & transversus body of pancreas; left suprarenal gland;
abdominis, inf: inguinal lig upper pole left kidney; sup: caudate lobe
Contains Vas deferenslround lig of uterus; of liver; med (right): opening of sac with
testicular, cremasteric & vasal arts & inf vena cava in post edge; portal V,
Vs; obliterated processus vaginalis; hepatic art & bile duct in ant free edge; lat
ilio-inguinal, genital br of genitofemoral (left): gastrosplenic & lienorenal ligs with
& autonomic Ns; lymphatics; int spleen between them
spermatic & cremasteric fasciae

LESSER S C I A T I C FORAMEN
I N G U I N A L (HASSELBACH'S) Site In pelvis between lesser sciatic notch of
TRIANGLE ischium & both sacrotuberous &
Site Post aspect of ant abdominal wall in sacrospinous ligs
inguinal region. Borders-lat: inf epigastric Contains Passing out: tendon of obturator
art, med: lat edge of rectus a bdominis, internus & int. pudendal V. Passing in: N
inf: inguinal lig, floor: transversalis fascia, to obturator internus, int pudendal art,
conjoint tendon & post wall of inguinal pudendal N
canal
Contains Nil. Site of direct inguinal
herniation M E D I A L T R I A N G U L A R SPACE
Site In post wall of axilla. Borders-
suplmed: subscapularis (teres minor
I S C H I O - A N A L (ISCHIORECTAL) viewed from behind), infllat: teres major,
FOSSA lat: long head of triceps
Site Wedge-shaped area lat to anal canal. Contains Circumflex scapular art
Borders-med: anal canal & levator ani,
lat: obturator internus & ischial
tuberosity, inf (floorlbase): post aspect of OBTURATOR CANAL
perinea1 body, urogenital diaphragm, Site In ant aspect of obturator foramen in
sacrotuberous lig & gluteus maximus lat wall of true pelvis. Borders-ant: post
Contains Fat; pudendal canal containing public ramus, suplinflmed: obturator int
pudendal N & int pudendal vessels; inf & its fascia
rectal N & vessels as brs of above Contains Obturator N & vessels

LATERAL T R I A N G U L A R SPACE POPLITEAL FOSSA


Site In post wall of axilla. Borders- Site Diamond shaped, behind knee.
suplmed: teres major, inflmed: long head Borders-supllat: biceps femoris,
of triceps, lat: med shaft of humerus suplmed: semitendinosus &
Contains Radial N; profunda brachii vessels semimembranosus, inflmed & infllat:
Posterior triangle SPACES OTHER T H A N SKULL A N D SPINE Urogenital triangle

heads of gastrocnemius, floor: post distal Contains Axillary N; post circumflex


femur, post capsule of knee & popliteus, humeral art & V
roof: fascia
Contains Plantaris; popliteal art & V &
brs; tibial, common peroneal, sural & SNUFF B O X
sural communicating Ns; lymph nodes & Site A triangular depression on dorsolateral
fat. Short saphenous V & post femoral side of hand formed by tendons of
cutaneous N in fascia of roof extensor pollicis longus (ulnar side) &
extensor pollicis brevis & abductor
pollicis longus (radial side)
POSTERIOR T R I A N G L E O F N E C K Contains Scaphoid, trapezium, radial art;
Site Between post border of terminal brs of radial N pass over it
sternocleidomastoid, ant border of
trapezius & middle third of clavicle. Floor:
prevertebral fascia over semispinalis SUPERFICIAL I N G U I N A L R I N G
capitis, splenius capitis, levator scapulae, Site In lower abdominal wall at med end of
scalenus medius & ant. Roof: investing inguinal canal as a V-shaped opening of
layer of deep fascia ext oblique aponeurosis. Ext spermatic
Contains Occipital, transverse cervical, fascia is attached to its edges
suprascapular & third part of subclavian Contains In female: ilio-inguinal N &
arts; transverse cervical, suprascapular & round lig of uterus. In males: ilio-inguinal
ext jugular Vs; muscular & cutaneous N & spermatic cord (vas deferens;
brs of cervical plexus (lesser occipital, testicular, cremasteric & vasal arts & Vs;
great auricular, transverse cervical, obliterated processus vaginalis; genital br
supraclavicular);three trunks of brachial of genitofemoral & autonomic Ns;
plexus; spinal root of accessory N; inf lymphatics; int spermatic & cremasteric
belly of omohyoid; superficial cervical fasciae)
lymph nodes

UROGENITAL TRIANGLE
P U D E N D A L (ALCOCK'S) C A N A L Site In perineum. Borders-lat: ischiopubic
Site Lies within a fascial sheath in lat wall rami, ant: post aspect of symphysis pubis,
of ischio-anal fossa between lesser sciatic post: transverse line at level of perineal
notch & deep perineal pouch. Borders- body & ischial tuberosities
lat: obturator internus & ischial tuber- Contains Deep perineal pouch (space)
osity, med: fat within sup & inf fascial layers of the
Contains Pudendal N; int pudendal vessels urogenital diaphragm perforated by
urethra with surrounding ext sphincter;
deep transverse perinei; brs of int
Q U A D R A N G U L A R SPACE pudendal vessels & pudendal N. In male
Site In post wall of axilla. Borders-sup: diaphragm contains bulbo-urethral glands
subscapularis (teres minor viewed from & supports penis, scrotum & superficial
behind), inf: teres major, med: long head transverse perinei from its inf surface. In
of triceps, lat: med shaft of humerus female it is perforated by vagina
Notes: (1)Al(ob1ique stroke) between two End of arch of aorta
levels indicates that the structure lies at a Azygos vein enters superior vena
level between these two vertebrae. (2)A - cava
(dash)between two levels indicates that the
structure occupies the equivalent level to Manubriosternal angle of Louis
these vertebrae inclusively. Bifurcation of trachea
Start of arch of aorta
Spinal root of accessory nerve crosses
transverse process of atlas Thoracic duct crosses midline
Open mouth and dens
Sternum
Superior cervical ganglion
Upper border of liver
Body of hyoid bone
Inferior angle of scapula
Upper border of thyroid cartilage Accessory hemiazygos vein crosses
Bifurcation of common carotid midline to azygos vein
arteries
Caval opening in diaphragm
Cricoid cartilage Inferior vena cava
Larynx becomes trachea Right phrenic nerve
Pharynx becomes oesophagus Left phrenic nerve pierces diaphragm
Middle cervical ganglion lat to central tendon
Vertebral artery enters foramen Hemiazygos vein crosses to right to
transversarium of C6 vertebra join azygos vein
Carotid tubercle of Chassaignac
Inferior thyroid artery crosses to Sternoxiphisternal joint
thyroid gland
Superior epigastic vessels traverse
First clearly palpable spinous process diaphragm
(vertebra prominens) Xiphoid
Stellatelinferior cervical ganglion
Oesophageal opening in diaphragm
Superior border of scapula Oesophagus
Brs of left gastric vessels
Suprasternal notch Anterior and posterior vagi

Medial end of spine of scapula Aortic 'opening' in diaphragm


End of oblique fissure of lung posterior to median arcuate lig
posteriorly at spine of T3 Aorta
Azygos & hemiazygos veins
Top of arch of aorta Thoracic duct
Origin of coeliac axis (lower border
Manubrium sterni of T12)
POSITION OF STRUCTURES ACCORDING T O VERTEBRAL LEVELS

Splanchnic nerves pierce crura of L2 Subcostal plane


diaphragm Formation of azygos and
Sympathetic trunk passes posterior hemiazygos veins
to medial arcuate ligament Duodenojejunal flexure, ligament
Subcostal neurovascular bundle of Treitz (upper border of L2)
passes posterior to lateral arcuate
lig L3 Origin of inferior mesenteric artery

L1 Transpyloric plane of Addison (half L314 Umbilicus


way between suprasternal notch
and symphysis pubis) L4 Supracristal plane (iliaccrests)
Fundus of gallbladder Bifurcation of aorta
Hila of kidneys
Second part of duodenum L5 Formation of inferior vena cava
Neck of pancreas
Origin of superior mesenteric S2 Sacral dimple
artery Mid point of sacro-iliac joint
Origin of portal vein Post superior iliac spine
Pylorus Dural sac ends
Attachment of transverse
mesocolon S3 Start of rectum
Hilum of spleen (spleen on ribs 9,
10,ll) S4 Sacral hiatus
Tip of 9th costal cartilage End of vertebral canal

L112 Origin of renal arteries Col Filum terminale inserts


Spinal cord ends in adults
Pharyngealderivatives
Pharyngeal derivatives

Arch derivatives Lateral pouch derivatives Artery Nerve

Mesoderm Endoderm Endoderm Ectoderm

Cartilages, bones, Muscles


Arch ligaments

I 'Mandibular' arch lncus Masseter Mucous membrane Auditory tube External acoustic Part of maxillary Mandibular
cartilage = Malleus Temporalis & glands of Inner layer of meatus artery division of
Meckel's Anterior lig of Pterygoids anterior 213 of tympanic Outer layer of trigeminal (VC)
malleus Mylohyoid tongue membrane tympanic
Sphenomandibular lig Anterior belly of (Part of middle ear) membrane
(Lingula) digastric (Mastoid antrum) (Tragus of ear)
(Mandible*) Tensor veli palatini (Skin of lower face)
Tensor tympani

2 'Hyoid' arch Upper body & lesser Stapedius Supratonsillar fossa Overgrowth of Stapedial artery Facial (VII)
cartilage = cornu of hyoid Stylohyoid Tonsillar crypts ectoderm over
Reichert's Stylohyoid ligament Posterior belly of Surface epithelium arches 3,4 & 6
Styloid process digastric of tonsil*
Stapes Muscles of facial (Part of middle ear)
expression
includingbuccinator
& platysma
3 'Thyrohyoid' arch Inferior body & Stylopharyngeus Mucous membrane Ventral: epithelia1 Internal carotid Glossopharyngeal
greater cornu of & glands of cells of thymus*" artery (including (IX)
hyoid posterior 1 l3 of Dorsal: inferior carotid sinus)
tongue parathyroid

4 Thyroid cartilage Palatoglossus Valleculae & Ventral: ultirno- Right: part of right Vagus (X)
Palatopharyngeus anterior branchial bodiest subclavian Pharyngeal &
Salpingopharyngeus epiglottis Dorsal: superior artery superior
Cricothyroid parathyroid Left: aortic arch laryngeal
Levator veli palatini branches
Striated of oesophagus
Pharyngeal
constrictors

Cricoid cartilage Cricopharyngeus Lung buds Ventral: pulmonary Vagus (X)


Vocal ligs All intrinsic muscles of artery Recurrent
Arytenoid, larynx Dorsal: ductus laryngeal
corniculate & arteriosus branch
cuneiform
cartilages

*The mandible forms in membrane around the ventral aspect of the first arch cartilage.
*The lymphoid tissue of the tonsil and thymus arises from the surrounding mesenchyme and is not arch derivative.
t Ultimobranchial bodies develop from ventral parts of fourth (and possibly fifth) pouch and fuse with the developingthyroid t o give parafollicular(C) cells which produce
calcitonin.
Notes: ( I ) The thyroid gland arises from between the first and second arch as a diverticulum (thyroglossal duct) which grows downwards leaving the foramen caecum at its
origin. (2) The epiglottis comes from the inferior part of the hypobranchial eminence and is thus not a true arch derivative. (3) Bracketed information is of additional interest