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Anatomy 303 OSCE
Landmark
About
Ligaments
Muscles
To palpate
• prominent bony ridge located on the superior
portion of the ilium
• very superficial & easy to palpate
• part of the hip bone w ischium & pubis
• runs A to P- anterior ASIS & posterior PSIS
• landmark for L4
• internal surface of ilium= fossa
• posterior= SI joint
• anterior= viscera
• superior= abdominal walls
• lateral= greater trochanter
• iliolumbar ligament
(posterior)
• thoracolumbar
fascia
• ASIS- inguinal
ligament
•
•
•
•
Quadradus Lumborum
Gluteus Maximus
Latissimus Dorsi
Erectors- Iliocostalis &
longissimus
• External/internal
abdominal obliques
• Transverse Abdominus
• ASIS- Tensor Fascia Latae
* activate QL with
a hip hike
* do it sidelying
ASIS
anterior
superior iliac
spine
• boney projection on the anterior portion of the
iliac crest
• easily palpated & helps form the hip bone
• inferior= AIIS
• superior= iliac crest
• lateral/posterior= iliac crest/ PSIS
• medial= abdominals/viscera
• internal=fossa
• inguinal ligament
(ASIS to pubic
symphysis)
• Sartorius
• Tensor Fascia Latae
• internal abdominal oblique
to inguinal ligament &
transverse abdominis
• activate
sartorius- hip
flexion w
external rotation
• supine
AIIS
anterior inferior
iliac spine
• bony projection on the anterior portion of the
ilium
• helps form the hip bone
• superior= ASIS & iliac crest
• inferior=ischium & pubis
• lateral= greater trochanter
• medial=pubis & lower abdomen & iliac fossa
* Rectus Femoris
* Iliacus on internal surface
of ilium
* activate Rectus
Femoris- hip
flexion w knees
bent?
* supine
PSIS
posterior
superior iliac
spine
• bony projection on the posterior aspect of the
iliac crest
• easily palpated & helps from the hip bone
• creates the dimples in the low back
• inferior= PIIS
• superior= iliac crest, spine, posterior abdominal
wall
• medial= SI joint
• lateral= ilium & greater trochanter
• sacrotuberous
ligament
• Mulitifdus
(transverospinalis group)
* prone
Ischial
Tuberosity
• roughened bony projection known as the sits
bone
• posterior/inferior portion of the ischium thats a
site of many muscle attachments
• most exposed in a squat position
• lateral=greater trochanter
• superior= ischial spine
• medial= coccyx & pelvic floor
• inferior=femur
• sacrotuberous
ligaments • hamstrings- bicep femoris,
semimembranousus,
semitendinosus)
• posterior head of adductor
magnus
• quadratus femoris &
inferior gemelli
• superficial= gluteus
maximums
• Urogenital diaphragm:
Ischiocavernosus &
Superficial transverse
Perineal muscle
• use palm first,
prone
• activate
hamstrings w
resisting hip
extension
Ischial Spine
• thin pointed triangular eminence that projects
from the ischium
• part of the pelvis
• superior/medial to ischial tuberosity
• divides greater and lesser sciatic notch w the
ligament attachment
• lateral= greater trochanter
• medial= coccyx & sacrum
• inferior= ischial tuberosity
• superior= PSIS, ilium
• sacrospinus
ligament (from
ischial spine to
coccyx)
• superior gemelli
• Pelvic floor: levator ani ) &
coccygeus
• prone
• fine ischial
tuberositycome superior/
medial
Iliac Crest
“hip bone”
Landmark
About
Ligaments
Muscles
To palpate
triangular, irregular shaped bone
part of the spine- 5 fused vertebrae
posterior roughened for mm attachment
internal surface smooth for viscera
spinal cord becomes cauda equina @ L2 & exits
at the sacral hiatus
fused bilaterally to the ilium to create the
sacroiliac joint (SIJ)
middle of sacrum is median sacral crest
lateral- lateral sacral crest
intermediate sacral crest
foramen for nerve & blood supply
superior= L5
inferior=coccyx
lateral= ilium
• sacroiliac ligament
• sacrotuberous
ligament
• sacrospinous
ligament
• anterior/posterior
longitudinal
ligament
•
•
•
•
Gluteus Maximus
Latissimus Dorsi
Piriformis
Erectors- Iliocostalis &
longissiumus
• multifidus
(transversospinalis group)
• Coccygeus
• prone
• iliac crest
landmark @ L4
• find L5 come
inferior to find
sacrum
• use palm
• then fingerspalpate all sides
and inferior
corners
Coccyx
• small irregular bone located on most distal spine
• 4 undeveloped bones
• articulates w the apex of the sacrum to form
sacrococcygeal joint
• provides attachment for filum terminale (end of
the spinal cord)
• posterior is roughened and internal is smooth
• moves for child labour & defication
• superior=sacrum
• inferior=pelvic floor
• lateral= ischial tuberosity
• sacrotuberous
ligament
• sacrcoccygeal joint
(interosseous
ligament)
• Gluteus Maximus
• Pelvic floor: Levator Ani &
Coccygeus
• prone
• use palm to find
sacrum
• fingers to come
inferior off
sacrum to
coccyx
Sacrotuberous
Ligament
• ligament on posterior pelvis
• from PSIS/PIIS, lower 1/2 sacrum, lateral margin of coccyx to the ischial
tuberosity
• defines the medial border of the greater sciatic foramen
• prevents tilting of the sacrum during wt bearing
• anterior= sacrospinous ligament
• posterior= deep 6, gluteals
• gluteus maximus
• piriformis
• biceps femoris
• palm ischial
tuberosity
• use hypothenar
to draw a line
coming medial
to PSIS
Sacrospinous
Ligament
•
•
•
•
ligament on posterior pelvis
attachments from lower 1/2 sacrum, coccyx to ischial spine
prevents tilt of sacrum during wt bearing
helps create greater & lesser foramen with greater & lesser sciatic
notches
• anterior to large sacrotuberous ligament
• posterior= deep 6 & gluteal group
• located posterior are deep
6 & gluteal group
• prone-palm
ischial
tuberosity
• superior/medial
to fine ischial
spine- connect
to sacrum
Manubrium
•
•
•
•
• sternoclavicular
ligament
• interclavicular
ligament
• Sternocleidomastoid
(SCM)
• Sternohyoid
• Sternothyroid
• Pectoralis Major
• costal cartilages of ribs 1 &
2
• internal intercostals
• supine
• start at sternal
notch
• move laterally
to clavivles
• can pop up pect
major
• radiate sternocostal
ligament (rib to
sternum)
• Intra-articular
ligament (2nd rib &
sternum)
• Pectoralis Major
• transverse thoracic
• internal intercostals
* find sternal
notch of
manubriumcome inferior
* activate pect
major
Sacrum
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Sternum
(Body)
located on anterior trunk
most superior portion of the sternum
flat bone that becomes less mobile as we age
articulates bilaterally w clavicles to form
sternoclavicular joint (SCJ)
articulates with ribs 1 & 2
superior= neck musculature
inferior=sternal body
lateral=clavicles
posterior=heart & lungs
• bone located on anterior trunk
• moves with respiration
• articulates with ribs 2-7- sternocostal joints
(laterally)
• articulates w manubrium @ angle of lewis
(superior) - manubrium-sternal joint
• articulates w xipoid process (inferior)xiphisternal joint- symphysis
Landmark
About
Ligaments
Muscles
To palpate
Xipoid
Process
• inferior portion of the sternum- on anterior trunk
• triangular & at level of T9
• superior forms Xiphosternal joint, a symphysis,
ossifies by age 40
• inferior= viscera & abdominals
• lateral= rib cage
• costoxiphoid
ligament (7th costal
cartilage & xiphoid)
• radiate ligament
• diaphragm
• transverse thoracic
• rectus abdominis
* supine- locate
sternal notch and
come inferior to
fine
Costal
Cartilage
• flat bars of hyaline cartilage
• connection btw ribs & sternum
• forms part of the rib cage & ossifies w age
• aids in respiration- allows for mobility & elasticity
• upper 7-own cartilage
• 8-10 common cartilage
• 11 & 12- have free ends
• 1-7 increase in length then decrease to 12th rib
• convex on both sides to fit into notch
• sternalcostal joints- costal cartilage to sternum
• costochondral- ribs to costal cartilage
• radiate ligament
• internal intercostals
• transverse thoracic (ribs
4-7)
• diaphragm (ribs 7-12)
• rectus abdominis
• pectoralis major
• transverse abdominis
• supine- start at
the sternal notch
and come to
sternum- palpate
laterally to costal
cartilage
Rib 1
• most curved/shortest rib which is broad and flat
• head is small & round w circulate facet that
articulates wi T1 (neck/tubercle- costotransverse)
• articulates with manubirum anteriorly (via costal
cartilage)
• moves with inspiration and expiration (pumphandle)
• superior border 2 shallow grooves- subclavian
vein/artery
• no costal muscles pulling on top of it
• radiate ligament
• costotransverse joint
to T1
• no intra-articular
• costocorporgeal
• anterior/middle scalene
• subclavius
• erectors- iliocostalis
• levators costarum
• external/internal
intercostals
• serratus anterior
• supine
• find clavicle/ fall
onto 1st rib
• goes under first
rib
Rib 2
• twice the length of rib 1
• has a tubercle- articulates with T2/T3
• articulates with manubrium/sternum via costal
cartilages- costochondral joints)
• inferior=rib 3
• superior= rib 1
• medial= costal cartilage
• radiate ligament
• intra-articular
ligament (2nd rib &
sternum)
• serratus anterior
• posterior scalene
• external/internal
intercostals
• serratus posterior superior
• levatores costarum
• iliocostalis
• supine then
prone to cover
a/p
• T1- across for
prone
Rib 3-9
(typical ribs)
• enclose & protect thoracic contents
• have a shaft, elastic bony arches, costal end
(small concave for cartilage: forms costochondral
joint which can dislocate)
• vertebral end- has head, neck, tubercle
• 2 facets to attach onto 2 vertebrae
• tubercle articulates w the TVP of vertebrae to
make costotransverse joint
• costocorporeal joint articulates w demifacet &
margin of T/S bodies and IVD
* radiate ligament
* costotransverse
ligament
• erectors- iliocostalis,
longissimus
• rectus abdominis, external/
internal abdominal obliques
• transverse abdominis
• internal/external
intercostals
• diaphragm
• serratus posterior superior,
serratus posterior inferior,
serratus anterior
• levatores costarum
• subcostales
• pectoralis minor
• anteriorsternum to rib
• prone find SP to
rib
Rib 10
• enclosed & protect thoracic contents
• articulates anteriorly with common costal
cartilage
• posteriorly only with T10- only has single facet
(no demifacets)
• radiate ligament
• erectors- iliocostalis,
longissimus
• external/internal abdominal
oblique
• external/internal
intercostals
• diaphragm
• serratus posterior inferior
• levatores costarum
• subcostales
• landmark T7come down to
T10- palpate out
• anterior to costal
cartilages
Landmark
About
Ligaments
Muscles
To palpate
Rib 11 & 12
• most inferior rib- enclosing & protecting thoracic
contents
• false/floating rib- has hyaline cartilage at endembeded in soft tissue
• atypical- only articulates w corresponding T/S
• single large articular facet
• no tubercle, no neck
• no costotransverse joint
• helps in respiration
• inferior= iliac crest
• radiate ligamentposteriorly only
• quadratus lumborum (12)
• erectors- iliocostalis,
longissimus
• external/internal abdominal
obliques
• external/internal
intercostals
• diaphragm
• serratus posterior inferior
• levatores costarum
• subcostales
• side lying- find
iliac crest &
palpate up to 12th
rib
C7
• vertebrae prominens (SP very prominent)
• no bifid
• SP thick & almost horizontal
• large transverse processes
• where a cervical rib would originate
• last bone in C/S
• inferior=T1 & ribs
• lateral= ribs & neck musculature
• simple zygopophyseal joints in C/S
• vertebral foremen- large & triangular in C/S
• transverse foramen- vertebral artery in C/S
• bodies= small, broad
• C7 at level of cartilage below the 1st cricoid ring
• ligamentum nuchae
• anterior longitudinal
ligament
• posterior
longitudinal ligament
• ligamentum flavum
(lamina to lamina)
• start of
Supraspinous
ligament
• poorly developed
interspinous
ligament
• intertransverse
ligament
• erectors- iliocostalis,
longissimus, spinalis
• transversospinalissemispinalis, rotatores,
multifidus
• splenis capitis
• trapezius
• levatores costarum
• intertransversarii
• interspinalis
• serratus posterior superior
• prone- lift head
to find C7
• shoulder hikeupper traps
• neck extensionerectors
• extension/
rotationtransversospinal
is group
T/S
• increase in size caudally
• upper T/S: change from C/S to T/S
• upper 3 resemble cervical
• upper 4 left side flattened for aorta
• lower T/S: change from T/S to L/S
• T4 heart shaped
• all bodies have costal cartilages- articulates with
ribs
• some have demifacets
• love rotation
• pedicles overlap
• anterior longitudinal
ligament
• posterior
longitudinal ligament
• ligamentum flavum
• supraspinous
ligament
• interspinous
ligament
• intertransverse
ligament
• erectors- longissimus,
spinalis
• semispinalis, multifidus,
rotatores
• interspinalis,
intertransversarii
• splenius cervicis (T3-T6)
• splenius capitis
• serratus posterior superior/
inferior
• levatores costarum
• prone- find level
• T2- superior
angle of scap
• T7- inferior
angle of scap
• T12- iliac crest
and up
• T1- lift head if
on C7
T1
• articulates with 1& 1/2 ribs
• shows circular upper costal facets articulating w
the whole facet of 1st costal head
• inferior costal facet is smaller & semilunar
• articulate w demifacet of costal head
• SP is thick, long. horizontal
• rib 1 level of SP of T1
• if rib 1/5 cm above= cervical rib
• erectors- longissimus
• semispinalis, multifidus,
rotatores
• interspinalis,
intertransversarii
• splenius capitis
• serratus posterior superior
• levatores costarum
T9
• often fails to articulate with 10th rib- demifacet
absent
T10
• articulates only w 10th rib- therefore demifacet is
absent
• TP may or may not be facetted for 10th rib
• costocorporeal joints
(rib/demifacet/T/S/
IVD)
• radiate ligament
• intra-articular
ligament (costal
articular facet to
IVD)- absent in
T1,10,11,12)
• costotransverse joint
(costal tubercle to
TVP)- absent in
11& 12
• intertransverse
ligament (TP to TP)
* no costotransverse
ligament
* no intra-articular
ligaments
• semispinalis, multifidus,
rotatores
• longissimus
• levatores costarum
* semispinalis, multifidus,
rotatores
* longissimus
* intertransversarii
* levatores costarum
• activate erectors
w back
extension
ligament (TP to TP)
Landmark
About
T11
• articulates only w the heads of the 11 ribs
• has circular facets that are close to the upper
border of the body
• they have small TPs that lack costal facets (ribs
attach to the body- not TVP)
T12
• articulates w the heads of the 12th ribs by
circular facets that are just below the upper
border of the body
• large body
• small TPs replaces by 2 small tubercles
L/S
• large in size, box shaped
• surfaces are kidney shaped- flat/smooth
• built for wt bearing
• wider transversely & deeper in front
• upper/lower borders of bodies give attachments
to anterior/posterior longitudinal ligaments
• attachment of crura of diaphragm (L1-L3)
• superior= T/S
• inferior= sacrum/ SIJ
• pedicles do not overlap (T/S)
• lamina broad - project from each pedicle and
fuse to form roof of neural arch
• vertebral foramen- formed by neural arch/back of
body- triangular
• SP- quadrangular/ same level as body
• TVP- flat, irregular, long, in line with own body
(L1-3 increase in length, L5 is shorter)
• neural arch= 2 lamina, 2 pedicles- aka vertebral
foramen
• intervertebral foramen- allows spinal nerve to exit
• most convexity at level of L4/L5, L5/S1- sitting
anterior on sacrum
L5
L5
• most inferior vertebra of the spine
• spinal cord becomes cauda equina at level
above (L4)
• superior=L4
• inferior=sacrum
• L4/5, L5/S1 where L/S is most convex- sitting
anterior on sacrum
Rectus Sheath
Ligaments
* no costotransverse
ligament
* no intra-articular
ligaments
Muscles
To palpate
• erectors- longissimus,
spinalis
• multifidus, rotatores
• interspinalis,
intertransversarii
• serratus posterior inferior
• levatores costarum
• erectors- longissimus,
spinalis
• mutlifidus rotatores
• interspinalis,
intertransversarii
• psoas minor
• serratus posterior inferior
• zygoapophyseal
joint (complex
synovial in L/Slocking of inferior
articular process w
superior articular
process)- resist
sliding/twisting
• anterior/posterior
longitudinal
ligaments
• ligamentum flavum
(thickes in L/S)
• supraspinous
ligament (thick/
broad in L/S)
• interspinous
ligament
• intertransverse
ligament
• iliolumbar ligament
(5 parts- prevents
rotation L5/S1 and
L5 from slipping off
S1)
• erectors- longissimus
• multifidus, rotatores
• interspinalies,
intertransversarii
• quadradus lumborum
• psoas minor
• psoas major
• diaphragm
• thoracolumbar fascia
• prone- find level
of SP
• iliac crest level
with L4
• palpate SP
• activate QL w
hip hike
• activate erectors
w extension
• erectors- longissimus,
• mutilifdus, rotatores
• interspinalis,
intertransversarii
• thoracolumbar fascia
• prone- find L4 in
line with iliac
crest
• down one
• activate erectors
with back
extension
• a sheath of muscular fascia- part of anterior abdominal wall
• the midline aponeuroses of the external/internal abdominal obliques, and transverse abdominis muscles
come together to form the rectus sheath
• rectus abdominis is enclosed within the rectus sheath
• midline of rectus sheath is the linea alba
• 3 fibrous bands called tendinous inscriptions transect the rectus abdominis- divides them into boxes- 8pack
muscle
• can compress the abdominal contents
• supine- palpate
• activate rect
abdomimis w
crunch