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Volume II
Inderbir Singh's
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TEXTBOOK OF
ANATOMY
Sixth Edition
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VOLUME I
Section 1 ................................................................................................................ General Anatomy
Section 2 ................................................................................................................ Upper Limb
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VOLUME II
Section 4 ................................................................................................................ Thorax
Section 5 ................................................................................................................ Abdomen and Pelvis
VOLUME III
Section 6 ................................................................................................................ Head and Neck
Section 7 ................................................................................................................ Neuroanatomy
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Volume II
Inderbir Singh's
TEXTBOOK OF
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ANATOMY
Sixth Edition
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Chennai
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owners. The publisher is not associated with any product or vendor mentioned in this book.
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Textbook of Anatomy
First Edition : 1996
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(1930–2014)
Tribute to a Legend
Professor Inderbir Singh, a legendary anatomist, is renowned for being a pillar in the education of
generations of medical graduates across the globe. He was one of the greatest teachers of his times. He
was a passionate writer who poured his soul into his work. His eagle's eye for details and meticulous
way of writing made his books immensely popular amongst students. He managed to become
enmeshed in millions of hearts in his lifetime. He was conferred the title of Professor Emeritus by
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Preface
Castles of all medical wisdom are anchored to the knowledge of anatomy. Both the learning and the teaching of anatomy
have undergone masterly changes. Though the limits of human anatomy appear to be confined to the boundaries of the
human body, newer frontiers have constantly appeared due to two primary factors—one, expanding basic medical and
clinical research and two, larger understanding of hitherto unexplained areas.
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The preparation of a textbook on Anatomy should have the scope to adequately accommodate the growing changes.
At the same time, it also cannot become disproportionately large, considering the time span within which an average
undergraduate medical student would have to acquire this knowledge.
This edition of Inderbir Singh’s Textbook of Anatomy has been prepared keeping the twin factors of the restructuring
of medical curriculum and the knowledge expansion in mind. Many of the chapters have been completely revised and
rewritten. Clinical Correlation has been clearly laid out. Embryological and Histological details have been added so as
to give the reader a comprehensive picture. Newer features like Multiple Choice Questions and Clinical Problem-solving
have been appended to each chapter in order to provide the reader with the opportunity of self-assessment.
A student entering the medical curriculum is faced with a completely new atmosphere. In an attempt to familiarize
the student not only with Anatomy but also with the nuances of the medical world, new sections on General Anatomy
and Genetics have been added. Professor Inderbir Singh’s eye for details and meticulous writing style have always been
popular amongst generations of medical students. Though many areas of the book have been revisited, the basic spirit
and nature of the book have been retained. Additional features like Added Information and Clinical Correlation in any
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chapter will be of much help not only to the undergraduate students but also to the postgraduates.
At this juncture, I would like to place on record my appreciation and gratitude to Dr Hannah Sugirthabai Rajila Rajendran,
Professor, Department of Anatomy, Chettinad Hospital and Research Institute, Kanchipuram District, Tamil Nadu, India;
Dr M Nirmaladevi, Associate Professor, PSGIMS & R, Coimbatore, Tamil Nadu, India and Dr J Sreevidya, Assistant
Professor-cum-Civil Surgeon, Madras Medical College, Chennai, Tamil Nadu, India for their painstaking editorial
assistance. I would like to thank Dr Indumathi. S, Professor and HOD, Department of Anatomy, Chettinad Hospital
and Research Institute, Dr T Anitha, Dr Elamathi Bose and Dr Bhuvaneswari, Assistant Professors of Anatomy, Madras
Medical College, Chennai for their help during the preparation and review of the manuscripts and formulation of
chapters.
I would be failing in my duty if I do not acknowledge the contributions of Dr Lakshmi, Dr Kanagavalli, Dr Arrchana,
Assistant Professors, Department of Anatomy, Madras Medical College, Chennai and Dr Dharani, Assistant Professor,
Villupuram Government Medical College, Villupuram, Tamil Nadu, India towards the completion of this edition. Shri
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RAC Mathews, Shri Ranganathan and Shri Sashikumar were instrumental in providing the necessary assistance, and
Shri E Senthilkumar provided some of the illustrations for the book and I would like to extend my thanks to each of them.
Special thanks to Shri Jitendar P Vij (Group Chairman) and Mr Ankit Vij (Group President), Jaypee Brothers Medical
Publishers (P) Ltd., without whom this edition would not have seen the light of the day. I am extremely thankful to
them for reposing their confidence in me and providing the opportunity to revise Inderbir Singh’s Textbook of Anatomy.
Dr Sakshi Arora (Director, Content and Strategy) has been the driving force behind all efforts and deserves a very special
thanks. She has provided insights and innovative ideas which have gone a long way in consolidating this book to best
meet the needs of the taught and the teacher alike. We are thankful to her entire Development and Content Strategy
team consisting of Ms Nitasha Arora (Project Manager), Mr Bunty Kashyap, Mr Phool Kumar, Mr Puneet Kumar Das,
Mr Vikas Kumar, Mr Neeraj Choudhary, Mr Sanjeev Kumar and Mr Sandeep Kumar (Designers and Operators), and
Ms Ankita Singh, Ms Sonal Jain, Ms Neelam Kakariya, Mr Prashant Soni (Editorial) for their constant technical support
throughout the project.
This book is the combined effort of a number of people who have contributed in myriad ways and it may not be
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humanly possible to list down the many; however, I take this opportunity to extend my thanks to all of them.
Sudha Seshayyan
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Contents
Section 4 Thorax
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19. Blood Vessels of Stomach, Intestines, Liver, Pancreas and Spleen . ..................................................................................... 250
20. Kidney, Ureter and Suprarenal Gland.............................................................................................................................................. 259
21. Posterior Abdominal Wall and Related Structures . ................................................................................................................... 271
22. Walls of Pelvis........................................................................................................................................................................................... 287
23. Pelvic Viscera—I: Viscera of Digestive System, Urinary System and Male Reproductive System .............................. 296
24. Pelvic Viscera—II: Viscera of Female Reproductive System. ................................................................................................... 320
25. Lymphatics and Autonomic Nerves of Abdomen and Pelvis . ............................................................................................... 332
26. Cross-Sectional, Radiological and Surface Anatomy of Abdomen and Pelvis . ............................................................... 343
Appendix 357
Index
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367
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Section 4
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Thorax
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Chapter 1
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Overview of Thorax
Enumerate three of the landmark lines of thorax and trace greatest in the lateral sagittal plane.
their levels of occurrence.
Anteroposterior flattening of the thorax, backward
curving of the ribs and dorsal placement of scapulae are
INTRODUCTION anatomical features, which are associated with the erect
posture of humans and have functional significance. The
Thorax (Greek.thoresso=chest) is the region between the most important of these is the backward curving of the
neck and the abdomen. The thorax has a large cavity, ribs. The projecting spines of the vertebral column are thus
called the thoracic cavity, contained within its walls; submerged into an osseo-musculo-ligamentous gutter
within this cavity, it contains important viscera like the and the back attains a flatter surface. Hence, a human can
heart and the lungs. The structures passing from the neck comfortably lie on the back, while a quadruped (examples
to the abdomen also traverse through the thorax. like a dog or a cow) cannot.
The bones of the thorax form the thoracic cage or the The two terms ‘thorax’ and ‘chest’ are not synonymous
bony thorax. Twelve thoracic vertebrae, twelve pairs of ribs and equivalent. The ‘chest’ is more a term to indicate the
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(including costal cartilages) and sternum together form upper part of the trunk in a general outlook. This part
the thoracic cage. of the trunk is broadest superiorly, with the side to side
The thorax has a superior aperture that connects it to diameter being measured from shoulder to shoulder.
the neck and an inferior aperture that connects it to the Chest includes the pectoral girdle and the pectoral and
abdomen. The superior aperture is formed by the body scapular musculature, which anatomically belong to the
of the first thoracic vertebra posteriorly, the first rib and upper limb.
costal cartilage on each side and the upper part of the The ‘thorax’ is a domed cage (shape of a bird cage with
manubrium sterni anteriorly. It is kidney shaped; the a dome) and is narrowest superiorly. The circumference
anteroposterior diameter is 5 to 6 cm and the side to side increases inferiorly and the maximum circumference and
diameter is 10 to 13 cm. The inferior aperture is formed size of the thoracic cage is reached at the junction of it
by the body of the twelfth vertebra posteriorly, the twelfth with the abdominal part of the trunk. However, external
rib and the lower six costal cartilages on each side and the appearance gives an exaggerated picture. The inferior
xiphoid process anteriorly. Due to the obliquity of the ribs, thoracic wall (or the floor of the thoracic cavity) formed
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the joining of some of the lower costal cartilages to each by the diaphragm is deeply invaginated into the thoracic
other and the presence of floating ribs, the shape of the cavity. It is pushed upward by the abdominal viscera. As
aperture is ill-defined. a result, the lower part of the thoracic wall surrounds the
The cavity of the thorax is also kidney shaped on abdominal cavity and abdominal viscera.
transverse section. The vertebral bodies appear to be The thorax is an extremely dynamic region of the body.
pushed forward into the cavity. The ribs, starting from the The walls and components are constantly in motion. Most
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Section 4 Thorax
Protects the internal organs from external forces; The thorax is part of the human trunk which encloses
Resists the negative internal pressures generated during the body cavity called the coelom. The coelomic cavity of
respiratory movements; the trunk is subdivided into that part which is within the
Provides for attachment and support of the upper limbs; thorax and the other within the abdomen. The thoracic
Provides for attachments of muscles and support to part of the coelomic cavity is the thoracic cavity and the
various body regions like the neck, abdomen and back; one within the abdomen is the abdominal cavity. There
and are several organs and structures occupying parts of these
Aerates the blood circulating in the lungs by expanding cavities. To give protection to the internal structures and
and contracting like bellows. to keep the body contour intact, the walls of thorax and
The thoracic cavity has three primary compartments. abdomen (without being mere flaps of skin) have bones,
These are the central mediastinum (regio mediastinale), muscles, connective tissue, vessels and nerves.
and the right and left pulmonary cavities (regiones The thoracic wall includes the thoracic cage (bone)
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cavitates pulmonale). The most important content of the and muscles which extend between the ribs (muscles).
mediastinum is the heart; the pulmonary cavities contain The skin, fascia and muscles covering the anterior and
the lungs. lateral aspects of the thoracic cage are also parts of thorax.
The skin, fascia and muscles covering the posterior aspects
Added Information of the thoracic cage are not customarily included in thorax
but are considered parts of the ‘back’. On the anterior aspect
Thoracic outlet: The superior aperture of the thorax had too, the pectoral region and the mammary gland, though
been called the thoracic inlet in olden times. It was so
called, because the aperture appears to be the passage
topographically related to the chest wall, are functionally
into the thoracic cavity. However, it has been noted that related to the upper limb.
through this passage emerge important vessels and nerves The thoracic cavity is subdivided into three parts: a
from within the thoracic cavity to reach the neck and upper central mediastinum and the right and left pleural
limbs. Hence, the term has been modified and the aperture cavities. The mediastinum contains the heart and organs
is called the ‘thoracic outlet’. It is the opening through related to transport of blood, air and food. The pleural
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may be compressed causing pain and other related symptoms. or spaces of importance on the transverse aspect) and
Nerve compression may lead to muscular wasting and vascular longitudes (lines or spaces of importance on the vertical
compression may compromise blood supply to the upper limb. aspect). The latitudes are provided by ribs and intercostal
The condition is called thoracic outlet syndrome since the spaces (spaces or gaps between the ribs). An internal
various structures present in the thoracic outlet are responsible structure can be described to be present ‘at the level of nth
for the compression.
rib’ or ‘at the level of nth intercostal space’.
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The longitudes are provided by several imaginary lines. Posterior axillary line: This is the vertical line drawn
The following lines are important: along the posterior axillary fold and continued down
Midsternal line: As the name indicates, this is the the chest wall.
midline of the body on the anterior chest wall; it can Midaxillary line: This is the line drawn from the
be defined as the intersection of the midsagittal plane deepest part of the axillary fossa down the chest wall,
with the anterior chest wall; it is otherwise called the parallel to the anterior axillary line.
anterior median line. Midvertebral line: This is the line drawn along the
Midclavicular line: This is the vertical line drawn from spines of vertebra and is the midline of the body on the
the midpoint of clavicle down the anterior chest wall. posterior aspect; it is also called the posterior median
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ANSWERS
1. a 2. b 3. c 4. b 5. b
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Clinical Problem-solving
Case Study 1: When you visited your friend, you happened to see his brother lying supine on the floor as part of his exercise routine.
Your friend commented that ‘lying supine’ is essentially a human feature.
Do you agree with your friend?
If so, what is your reason for such a comment?
What are the additional modifications in relation to this particular feature?
Case Study 2: A 42-year-old man had pain down his upper limb and also some neurovascular symptoms. He was diagnosed to be
having ‘thoracic outlet syndrome’.
What do you understand by the term?
What are the boundaries of the thoracic outlet?
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Chapter 2
General Characteristics of
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Vertebral Column
(d) Disc prolapse. as they have to progressively bear more weight. Lower to
Give an account of the vertebral column and its curvatures.
the lumbar region is the sacrum, which is the composite
Discuss the structure and functions of nucleus pulposus.
bone of the sacral region formed of five sacral vertebrae.
The most inferior part of the vertebral column is formed by
INTRODUCTION the coccygeal region that comprises the coccyx, which is a
The vertebral column, otherwise called the spinal column composite bone formed of four coccygeal vertebrae.
or the spine, is a flexible, curved structure consisting of From a lateral view, the vertebral column can be seen
several irregular bones called the vertebrae (singular. to have four normal curvatures. These are the cervical,
vertebra; plural. vertebrae). Extending from the skull to the thoracic, lumbar and the sacral curvatures. The cervical and
pelvis, it forms the axial support and the weight-bearing the lumbar curvatures are concave posteriorly while the
system of the body. The vertebral column also surrounds thoracic and sacral are convex posteriorly. The curvatures
and protects the spinal cord; it gives attachment to are functionally important because they increase the
several muscles of the neck and back; it provides points of resilience of the vertebral column and allow to function
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attachments to the ribs, thus contributing to the formation with adequate elasticity. The vertebral column should be
of a bony thoracic cage. like a spring and not like a rigid rod. The curvatures render
In the foetus and young infant, the vertebral column is elasticity for the spring action to take effect.
made up of 33 separate vertebrae, but the lower nine later
fuse to form two composite bones, namely the sacrum GENERAL STRUCTURE OF A TYPICAL VERTEBRA
and the coccyx. The upper 24 remain as individual bones
separated by the intervertebral discs. It can well be understood that the size, shape and
The sheer length of the vertebral column makes it characteristics of the vertebrae will vary according to the
necessary for several other structures to support the region of the vertebral column. However, most of them
column. The various ligaments of the back and the muscles share certain common features. These features can be
of the trunk provide this support. fitted into an imaginary typical vertebra.
A typical vertebra will have two main parts called the
REGIONS AND CURVATURES body and the vertebral arch. The body is that part which
is anterior and appears like a thick disc. The vertebral arch
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A B C D
Figs 2.1A to D: Vertebral column and its five regions A. Anterior view B. Lateral view C. Posterior view D. Bisected view
with the vertebral column in situ
The body is also called the centrum. It is disc-shaped, two other pairs of processes. One pair projects superiorly
varies in size in different regions and bears the body and the other inferiorly. These are the superior and inferior
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weight. Intervertebral discs lie between the bodies of articular processes respectively. The superior articular
successive vertebrae. processes have articular facets on their posteromedial
From the posterior aspect of the body, two projections, aspects and the inferior articular processes on their
one on either edge, run backward. These projections are anterolateral aspects. The superior articular processes
the pedicles. From the posterior ends of each pedicle, a of each vertebra form joints with the inferior articular
plate of bone stretches towards the midline and unites processes of the vertebra which is above it.
with the fellow of the opposite side. This plate of bone is The pedicles have notches on their superior and inferior
the lamina. The two pedicles and the two laminae together borders. Thus, when successive vertebrae are placed one
form the vertebral arch. over the other, the notch of the inferior border of the
A total of seven processes project from each vertebral preceding vertebra and the notch of the superior border
arch. At the junction of the two laminae is the spinous of the succeeding vertebra together form a foramen called
process (or simply the spine). It is a single, midline the intervertebral foramen. The spinal nerves given out by
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projection that points posteriorly (or posteroinferiorly). the spinal cord pass through the intervertebral foramina.
At the junction of the pedicle of each side with its
corresponding lamina is the transverse process. Two
INTERVERTEBRAL DISCS
transverse processes, one from each side, therefore, project
laterally from each vertebra. From the pedicle-lamina Each intervertebral disc is a cushion-like pad that lies
junctions, but medial to the transverse processes, project between the bodies of two consecutive vertebrae. It has
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Section 4 Thorax
MOVEMENTS OF THE VERTEBRAL COLUMN ‘thrown back’ in order to preserve the line of gravity.
Lumbar vertebrae experience heavy load and compression,
Various movements occur at different levels of the because the weight of the upper body plus the weight of
vertebral column. These movements are flexion (anterior the objects the individual lifts with the upper body will have
or forward bending), extension (posterior or backward to be borne by the lumbar region. Since the lumbar region
straightening), lateral flexion (bending to the right or the has maximum compression, disc herniation is more in this
region.
left) and rotation (around a vertical axis) (Figs 2.2A to C).
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A B
A B C D E
Figs 2.4A to E: Lateral and posterior view of abnormalities of spinal curvatures A. Normal B. Kyphosis C. Lordosis D. Normal E. Scoliosis
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Fig. 2.5: Age changes and development of vertebral curvatures during foetalhood and infancy, only the primary curvatures are seen.
The secondary curvatures develop during growth 9
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Section 4 Thorax
Added Information
The weight bearing part of a vertebra is its body which can be compared to a long bone. The body is constricted a little in its
midportion (comparable to the shaft) with slight enlargements at the upper and lower ends (the two ends). The two ends are
articular; the midportion has a primary centre of ossification (diaphysial primary centre) and the two ends have secondary centres.
The articular processes (except those of the atlas and the axis) generally do not bear or transmit weight. However, in certain
specialised conditions like rising from the stooping position, the articular processes also bear weight.
The size of a weight-bearing surface depends upon the weight it supports. The lumbar vertebrae, hence, are large and have larger
surfaces on the superior and inferior aspects than the thoracic and cervical vertebrae. The first piece of sacrum has a large superior
surface. The surfaces then decrease till the tip of coccyx. This is because the body weight which is borne by the presacral vertebral
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column is transferred from the first three pieces of sacrum to the ilia (through the sacroiliac joints) and then to the femora.
The lower sacrum and coccyx do not, therefore, take part in weight-bearing or transmission.
In prenatal life, the vertebral column is uniformly curved with a ventral concavity. The basic curvature is retained in the thoracic
and sacral regions. The cervical curvature appears by about three months of age when the child holds the head erect and learns to
direct vision forward. The lumbar curvature appears when the child starts walking which, is around 18 months of age. The thoracic
and sacral curvatures which are IN continuation of the prenatal curvature are called the primary curvatures. The cervical and
lumbar curvatures, which are acquired postnatally, are called secondary curvatures (Fig. 2.5).
between:
ANSWERS
1. c 2. a 3. a 4. d 5. b
Clinical Problem-solving
Case Study 1: A 54-year-old man suffers from L3-L4 disc prolapse.
Give the anatomical basis of any disc prolapse.
What symptoms due to expect in the above mentioned individual and why?
Why is lumbar disc prolapse more common than others?
Case Study 2: A 27-year-old pregnant woman has a prominent lumbar lordosis.
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Chapter 3
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Bones of Thorax
special features.
Discuss the atypical thoracic vertebrae.
Write notes on (a) Typical rib, (b) First rib, (c) Manubrium
sterni, (d) Xiphisternum
Discuss the various parts of the sternum.
having flat upper and lower surfaces. The upper and lower
surfaces are attached to those of the adjoining vertebrae
through the intervertebral discs.
Projecting backwards and a little laterally from the
right and left aspects of the posterior part of the body are
two short bars of bone. These bars are called the pedicles Fig. 3.2: Typical vertebra seen from above
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Section 4 Thorax
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Fig. 3.3: Typical vertebra seen from behind Fig. 3.4: Typical vertebrae seen from the lateral side (costal facets,
for ribs, are shown on the bodies and transverses processes
they are present only in the thoracic region)
(Latin.pediculus=small feet). Thus, every vertebra has two from the sides), one above and another below the pedicle.
pedicles, the right and the left. Projecting posteromedially The one above, called the superior vertebral notch, is
from each pedicle is a plate of bone called the lamina shallow. The inferior vertebral notch is large and deep.
(Latin.lamina=plate). The two laminae meet at the When the adjoining vertebrae are placed one above the
midline. The right and the left pedicles and the right and other, the inferior notch of the preceding vertebra and the
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the left laminae together constitute a bony arch which is superior notch of the succeeding vertebra complement
called the vertebral arch. Passing backwards and a little each other and form a foramen called the intervertebral
downwards from the junction of the two laminae, is the foramen. Between any two vertebrae are two intervertebral
spine (or spinous process) of the vertebra. foramina, one on the right and the other on the left.
From the junction, of each pedicle with its corresponding The vertebral foramen of each vertebra is a short segment
lamina, projects another bar of bone. This bar, that passes of the vertebral canal that runs through the whole length of
backwards and a little laterally, is called the transverse the vertebral column and transmits the spinal cord. As the
process (Fig. 3.3). spinal nerves emerge out of the spinal cord, the right and
Apart from the various parts, a vertebra also exhibits the left spinal nerves of a particular spinal segment pass
certain special and unique features. As the vertebral arch through the right and the left intervertebral foramina.
curves around, an opening is formed on the posterior
aspect of the vertebra. This large opening, which is THORACIC VERTEBRAE
bounded anteriorly by the posterior aspect of the body, The thoracic vertebrae are twelve in number and form part
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laterally by the pedicles and posteriorly by the laminae, is of the skeleton of the thorax. All of them do not have the
called the vertebral foramen. same features. The second to the ninth thoracic vertebrae
From the junction of a pedicle and its corresponding possess features characteristic of a thoracic vertebra and
lamina (medial to the root of the transverse process)
hence are examples of a typical thoracic vertebra. The
projecting upwards is the superior articular process and
first, tenth, eleventh and twelfth thoracic vertebrae have
projecting downwards is the inferior articular process. Each
features which do not confirm to those of a typical thoracic
process bears a smooth articular facet. The superior articular
vertebra, but distinguish the particular vertebra. These are
facet on the superior articular process is directed posteriorly
and the inferior articular facet on the inferior process is called the atypical thoracic vertebrae.
directed anteriorly. Thus there are two superior facets (right
Typical Thoracic Vertebrae
and left) and two inferior facets (right and left) in each
vertebra. The superior facets of a vertebra articulate with the The thoracic vertebrae have features which make them
inferior facets of the preceding vertebra (vertebra above). rib-bearing and hence suitable for formation of the
thoracic cage. The bodies of the thoracic vertebrae in the
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On each side of the body and close to the root of pedicle succeeding spine, thus contributing to the stability of the
are a pair of articular facets, one on the upper border and thoracic vertebral column.
the other on the lower border. These facets are not complete The superior articular facets face posterolaterally
in the sense that the head of the rib which articulates with and the inferior facets face anteromedially. The superior
one of these facets will also articulate with a similar facet vertebral notches are practically absent and the inferior
on the vertebra above or below. These facets, therefore, are notches are deep and large.
called demifacets (or costal demifacets; Latin.costa=rib).
The upper facet is larger than the lower and articulates Atypical Thoracic Vertebrae
First Thoracic Vertebra – T1
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Fig. 3.7: First thoracic vertebra seen from above Fig. 3.8: First thoracic vertebra seen from the lateral side 13
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Section 4 Thorax
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tubercles (superior, inferior and lateral). Fig. 3.10: Tenth, eleventh and twelfth thoracic vertebrae
The 11th and 12th vertebrae can be distinguished from from the sides
each other by examining the inferior articular facets. These
are of the thoracic type (facing posterolaterally) in the 11th Development contd…
vertebra, but are of the lumbar type (facing laterally) in the development. Somites of cervical and trunk regions show
12th vertebra (Fig. 3.9). typical development. Vertebrae and associated structures
develop from this.
Ninth Thoracic Vertebra Each somite differentiates into three portions—a dorsal
The ninth thoracic vertebra has all features of a typical superficial portion called dermatome; a lateral portion called
thoracic vertebra. However, it very often does not articulate the myotome; a medial portion called the sclerotome.
with the tenth ribs and so, the inferior demifacets are It should be remembered that the notochord is already
absent (or very small). in the midline. Scterotomic cells from both the sides
migrate medially and surround the notochord. By the 5th
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Development contd…
of the corresponding myotomes. This cranially relocated dense portion differentiates further into the intervertebral disc and intervertebral
ligaments (Fig. 3.11).
Movement of the dense portion of the sclerotomic mass splits the less condensed portion into cranial and caudal subparts. The
caudal subpart of one segmental mass unites with the cranial subpart of the succeeding segmental mass and forms the vertebral
body and the transverse processes.
At subsequent stages, a pair of chondrification centres appear in the body portion (centrum) and fuse to form the precartilaginous
vertebral body; chondrification centres appear in each half of the neural arch, grows around dorsally and fuses with the opposite
fellow around the neural tube; the body centres and neural arch centres unite and also extend laterally to form the transverse
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processes.
Ossification centres will later appear in the same pattern and complete the formation of vertebrae; but this process takes place
much later, resulting in complete vertebral formation only after birth.
The notochord which gets trapped in the centrum postion (dense sclerotome) degenerates completely. In the intervertebral
regions, it enlarges and forms the nucleus pulposus. The (less dense) sclerotomic tissue that surrounds the notochord in the
intervertebral regions forms the rest of the intervertebral discs and the intervertebral ligaments.
Added Information
Among the spines of the twelve thoracic vertebrae, four
lie above the level of the pericardium, four behind it and
four below it. The spines which are behind the pericardium
(5th, 6th, 7th and 8th) are almost vertical and overlap the
succeeding spine. Their tips are at the level of the lower
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flat and above the tips; they are absent in the 11th and 12th
vertebrae. almost flat and about 15 to 20 cm in length (Fig. 3.12). It
The vertebral foramina of the thoracic region are circular extends from the root of the neck to the upper level of the
and small. However, in the upper and lower two thoracic anterior abdominal wall. Though generally spoken of as
levels, they become triangular. a single bone, it has three parts, namely, the manubrium
sterni, the corpus sterni and the xiphisternum. Since it is
Dissection flat, it has anterior and posterior surfaces. The sternum can
Take samples of different ribs. Keep them adjacent to each be felt through the skin in its whole length and articulates
other and study their features. Note the differences. Try to on each side with the clavicle and upper seven costal
identify the various ribs. cartilages.
Study the sternum and vertebrae.
See the way all these bones are placed in an articulated Manubrium Sterni
thoracic cage. Attempt to study the ribs and sternum in a thin
Otherwise called episternum. If the entire ster-
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Section 4 Thorax
Development
Ribs and Sternum
Fig. 3.12: Sternum and costal cartilages seen from front At about the same time, chondrification is happening in
the axial sclerotomic tube, chondrification also occurs
in the membranous areas of the future costae along the
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2.5 cm at its superior border, the body widens to reach typical symphysis, the joint disappears in old age and
about 4 cm at the 4th segment and then tapers rapidly the xiphoid process and the body of the sternum become
to the inferior border. Similar to the manubrium, two united by bone. The junction of the first costal cartilage
surfaces, the anterior and the posterior and four borders, with the manubrium is a synchondrosis. The other
the superior, the inferior and the two lateral, can be defined. sternocostal joints usually have a joint cavity (i.e., they are
The anterior surface is rough and has three transverse synovial joints).
16
m
Aspect of the Sternum (Fig. 3.13) The sternocostalis arises from the lower one-third of
Sternal head of sternocleidomastoid arises from the the posterior surface of the body, and of the xiphoid
upper part of the manubrium; process (and also from the adjoining parts of the costal
Pectoralis major arises from the corresponding half cartilages);
of the manubrium and of the body of the sternum. The Sternal slips of the diaphragm arise from the back of the
origin extends onto the costal cartilages (Figs 3.14A to C); xiphoid process.
m
m
A B C
Figs 3.14A to C: Sternum and its parts–attachments of costal cartilages and the costal notches are shown; the relationship of the sternum to
the vertebral column are also shown
17
m
Section 4 Thorax
Relations RIBS
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As the sternum forms the part of the anterior wall of the Ribs are curved long bones that form the side-walls of
thorax, it has very important relations on its posterior the thorax. There are twelve ribs on either side. They
aspect. The posterior aspect of the manubrium is related vary considerably in length. The seventh rib is the longest,
to the arch of the aorta and its branches, and to the left those above and below it becoming progressively shorter.
brachiocephalic vein. Its lateral part is related to lungs and Adjacent ribs are separated by intercostal spaces. The
pleura. The body of the sternum is also related to lungs and ribs are attached behind to the thoracic vertebrae. The
pleura and to pericardium. The xiphoid process is related anterior ends of the upper seven ribs are attached to bars
to the liver. of cartilage (costal cartilages) through which they gain
attachment to the sternum. They are called true ribs or
Ossification vertebrosternal ribs or costae verae. The anterior ends
The number of centres of ossification appearing in of the eighth, ninth and tenth ribs also end in costal
different segments of the sternum is variable; 1 to 3 in the cartilages. However, these cartilages do not reach the
sternum, but end by gaining attachment to the next higher
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Added Information
Typical Rib
The first costal cartilage unites the first rib to the manubrium
in the same way as an epiphyseal cartilage unites an A typical rib (usually 3rd to 9th ribs) can be described to
epiphysis and the diaphysis. It is a synchondrosis. have the following parts—vertebral end, body and sternal
end (Fig. 3.16).
contd…
18
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The tubercle has a medial articular part that bears a facet for rib to rib. These muscles include the serratus anterior,
articulation with the costal facet on the transverse process of the pectoralis minor, the latissimus dorsi, the external
the corresponding vertebra. The lateral part of the tubercle oblique muscle of the abdomen, the levatores costae, and
is rough for attachment of ligaments. the iliocostalis cervicis (part of erector spinae).
Body
Important Relations of Typical Ribs
The part of the rib between the anterior and posterior ends
Intercostal vessels and nerve (of an intercostal space) lie
is the ‘body’; it is also called the shaft. Curved like the letter
in relation to the costal groove, but are separated from the
‘C’, anterior three-fourths of the shaft is also flattened. Thus
floor of the groove by the internal intercostal muscle. The
it has inner (internal) and outer (external) surfaces; and
sympathetic trunk descends vertically across the anterior
superior (upper) and inferior (lower) borders.
aspect of the heads of lower ribs. The internal surfaces of
The upper border is rounded and the lower border is
the ribs are covered by costal pleura.
sharp. The internal surface is concave. Just above the lower
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Tuo häntä suututti, kun hän oli niin arka, ettei uskaltanut tuota
tunnettaan tytölle selvästi näyttää, sanomisesta puhettakaan.
Mutta monesti sattui niin, kun hän oli hevosille kaivosta vettä
noutamassa, että tyttökin sattui olemaan kaivon kannella, toisinaan
lehmille vettä vinttaamassa, toisinaan sisälle noutamassa. Silloin hän
otti tytön kädestä kaivon salon ja täytti tytön ämpärinkin. Silloinkin,
sellaisissa tilaisuuksissa, olisi sopinut puhua tytölle asiat selväksi,
mutta kun ei uskaltanut.
Ei hän tuota miksikään huomannut, kun nuo veden noutoretket
rupesivat sattumaan niin ihmeen useasti heillä yhtä aikaa. Melkein
vaikkapa milloin Kalle kaivolle tuli, niin siellä oli tyttökin, tai jos ei ollut
niin sattui tulemaan. Jos hän tuon huomasi, niin ei uskaltanut
kuitenkaan ajatella, että tyttökin haluaisi samaa kuin hänkin, olla
yhdessä kaivolla, sisällä ja kaikkialla. Ettäkö tyttökin tuntisi tuollaista!
— Älä tee sitä! Anna noiden keskenään asiansa hoitaa. Kyllä siitä
tosi tulee. Anna on ylpeä, jos hän kuulee jotain, niin se pian siihen
jää. Saahan niistä pari tulla, kun kumpikin näyttävät sitä tahtovan.
Odotetaan! Onhan tuota niin mukava syrjästä katsoa, jutteli emäntä.
— Niin, kyllähän Annakin osaa huolen siitä pitää, että saapi Kallen
kosimaan, vaikka itse sen alkuun panisi — — —
Navetassa oli Anna ja toinen piika. Anna piteli vasikkaa, jota eri
karsinassa pidettiin ruokkimista varten. Kun Kalle tuli kirves kädessä
heidän luo, sanoi toinen tyttö:
Tyttö lehahti punaseksi. Nyt hän tunsi tuon kauvan odotetun asian
tulevan.
Siihen jäi Kalle karsinan viereen. Mikä juutas sen nyt pani irti
repimään, mietti hän harmistuneena. Hän lähti kanssa tuonne
toiseen päähän navettaa. Hän korjasi perän, jolla sonni oli ollut kiinni
ja kun tuo otus ei tahtonut rauhassa pysyä, mätki hän kirvesvarrella
sitä pitkin selkää.
Pahalla tuulella tuli Kalle pirttiin. Hän huomasi kuinka isä iski äidille
silmää. Hän arvasi, että hänestä he tuohon aihetta saivat. Mutta ei
ymmärtänyt minkä vuoksi. Petoako he nauravat, mietti hän
kiukustuneena.
Nukuttiin.
Hänellä itsellään oli kirjaston alku, jonka hän oli saanut hankituksi
ja myötäänsä hän koetti omaa kirjastoaan lisätä. Hänellä olikin suuri
osa suomenkielellä ilmestyneistä teoksista.
Mutta sentään toivoi hän parasta. Hän uskoi voivansa saada asiat
mielensä mukaan järjestetyiksi.
IV.
Hän säpsähti. Ensi kertaa eläissään oli hän nyt tyttösten kanssa
leikkisille ruvennut. Hän hämääntyi. Mutta nuo nauravat olennot
näyttivät hänestä niin vietteleviltä, ja varsinkin Anna.
— Mistäpä sen tietää kuka ensi vuoden esimies on, sanoi Kalle.
Hän katsoi saliin. Minne hän silmänsä loi, näki hän nuoruutta,
ilosta loistavia kasvoja. Tuolla etempänä istui tyttöjä, pitkä rivi. Heillä
näytti olevan jotain erikoisempaa. Annakin oli heidän joukossaan.
Mistä ihmeestä he aina nauramisen aihetta saivat? mietti Kalle. Eivät
he muuta osaa tehdäkään, aina vaan nauravat. Tuo alituinen nauru
kävi kyllästyttäväksi. Hän tunsi kuin olisi puukolla rintaan pistetty.
Hän kadehti noita nauravia ja samalla he suututtivat häntä.
— Ei, ei ole muita sellaisia. Mikset sinä voi olla niinkuin tähänkin
asti; eihän sinulla mitään estettä ole, jonka tähden et voisi olla, kuului
salista.
— Olkoon sitten niin tällä kertaa, sanoi Kalle ja sen jälkeen valittiin
seuralle muut virkailijat ja johtokunta.
Kun ääni hänen viulustaan vingahti, niin silloin tuli eloa saliin. Oli
kuin sähkövirta olisi johdettu lattiaa pitkin. Tyttösten jalat alkoivat
soiton mukaan elää, silmät paloivat ja povet kohoilivat, puoliavoimet
huulet päästivät lävitseen kuumia henkäyksiä.
Kalle istui salin seinän vierellä ja katseli tanssia. Hän ajatteli lähteä
pois, mutta ei vaan saanut päätetyksi: nyt lähden. — Aina hetken
perästä meni siitä Anna sivu. Hän ei näyttänyt mitään tietävän tästä
maailmasta. Vihloi niin kipeästi Kallen sisässä, kun Anna siitä sivu
meni, käsi toisen olalla ja tuon toisen käsi Annan vyötäröillä. Kalle
toivoi, ettei hän näkisi Annaa eikä tuota toista ollenkaan, mutta
kuitenkaan ei hän tahtonut päästää heitä pois näkyvistään aina hän
odotti, kun he tuolta toisen kautta tulivat näkösälle ja taasen katsoi
niin kauvan heidän jälkeensä, kun he taasen katosivat toiselle
suunnalle. — Hän kadehti heitä kaikkia ja melkein vihasi itseään, kun
ei ollut opetellut tanssimaan. Mutta kerkeäisihän vieläkin. Lempo
tuohon myllyyn lähteköön, en minä, mietti hän. Ei, en voi yrittääkään,
vaikka mitä tehtäisiin. — Taasen tuli Anna tuon toisen kainalossa.
Kallen sydäntä vihlasi niin kipeästi. Hän vihasi tyttöä. Tuollainen tyttö
menee kenen syliin kerkeää. Hän olisi mielellään tahtonut jotain
tehdä, jotain sellaista, mikä olisi kiduttanut tyttöä, kiduttanut hirveästi,
samalla tavalla kuin häntä itseään. Siinä hän istui ja kärsi. Eikä vaan
saanut päätetyksi lähteä pois.