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Muscles of thorax and abdomen. Muscle groups of the back. Vessels and nerves of the abdominal wall • Ivo Klepáček muscles inguina mm. epaxiales hypaxiales autochtonní heterochtonní autochtonic heterochtonic Ep Hyp muscles inguina Thoracic muscles muscles inguina • M.pectoralis major n.pectoralis lat.+med. • M.pectoralis minor n.pectoralis med. • M.subclavius n.subclavius • M.serratus anterior n.thoracicus longus • Mm.intercostales externi, interni, intimi nn.intercostales I-XI • M.transversus thoracis nn.intercostales • Musculus diaphragma n.phrenicus M.pectoralis major muscles inguina Clavicular part Sternal part Abdominal part adduction, rotation, accessory inspiratory muscle Muscles of the anterior axillar fold Thoracohumeral system Innervation: pectoral nerves C5-Th1 muscles inguina M.pectoralis minor What compress subclavian or axillary artery A) Costa cervicalis B) mm. scaleni (m.scalenus minimus) C) Tumor inside spatium costoclaviculare D) Insertion of the m.pectoralis minor Intercostal muscles muscles inguina external intercostal m. M. intercostalis externus membrana intercostalis externa fascia thoracica superficialis (externa) internal intercostal m. M. intercostalis internus membrana intercostalis interna innermost intercostal m. M. intercostalis intimus fascia intercostalis interna (endothoracica) Transverse thoracic m. M. transversus thoracis fascia intercostalis interna (endothoracica) Internal intercostal muscles + transversus ventral thoracic wall (dorsal view) muscles inguina m. transversus thoracis Internal and external intercostal muscles dorsal thoracic wall muscles inguina Angulus costae (II) Intercostalis externus Intercostalis internus Membrana intercostalis interna Mm. intercostalis externus, internus, intimus a transversus (transversalis) muscles inguina IE muscles inguina II Mm. intercostalis externus, internus, intimus transversus (transversalis) thoracis et fasciae muscles inguina muscles inguina Intercostal aa. et vv. muscles inguina muscles inguina Vein, Artery, Nerve, nerve, artery Spatium intercostale obsah muscles inguina Punctio Punction Vessels and nerves of the dorsal thoracic wall muscles inguina Superior intercostal vein v. intercostalis superior Azygos vein v. azygos Sympathetic trunk Truncus sympathicus Thoracic duct Ductus thoracicus Splanchnic nerves nn. splanchnici Ao v. jugularis Ductus thoracicus muscles inguina v. subclavia v.cava superior v.hemiazygos accesoria v.azygos v.hemiazygos Vena cava inferior Žilní systém trupu v.lumbalis ascendens Venous system of the trunk Lymphatic vessels of the trunk muscles inguina Preparace a. et v. thoracica interna muscles inguina Dissection of the internal thoracic a. and v. Muscles of anterior abdominal wall muscles inguina Function: Flexion Lateroflexion Rotation Increase of intraabdominal pressure Forced expiration innervation: intercostal nerves, iliohypogastric, ilioinguinal muscles inguina Superficial mm. (ventral abdominal wall) mm. obliquus externus, internus, transversus external oblique, internal transverse abdominal muscles OE OI T muscles inguina M.rectus abdominis hluboké svaly břicha deep abdominal muscle group (iliopsoas, quadratus lumborum mm.) m. rectus abdominis muscles inguina vagina musculorum rectorum rectus abdominis muscle and its sheath muscles inguina Linea arcuata Douglas line (arcuate line) Linea semilunaris Spiegel line Semilunar line Vagina musculorum rectorum Rectus sheath, vagina James Douglas 1675-1742 Engl. anatomist Adrian van den Spieghel /Adrianus Spigelius) 1578-1625 Belgian anatomist muscles inguina muscles inguina Hlavní funkce břišních svalů Main function of the abdominal muscles Abdominal wall – ventral view muscles inguina • • • Skin Fascia abdominalis subcutanea et superficialis Muscles Antonio Scarpa (1752 – 1832) Italian anatomist Petrus Camper (17221789), Dutch Anthropologist muscles inguina Caput Medusae muscles inguina muscles inguina Abdominal wall - dorsal view • • • Peritoneum Fascia transversalis (endoabdominalis) Muscles muscles inguina muscles inguina Canalis inguinalis Inguinal canal Stěny Walls ???? ???? Inguinal canal muscles inguina (Canalis inguinalis – latin) weakness of the abdominal wall 4 -5 cm long tube-like gap in the lower margin of the anterior abdominal wall above inguinal (groin) ligament It is the passage connecting inner and outer surface of the muscular layers of the anterior abdominal wall It serves as communicating canal between subcutaneous and intra-abdominal structures female muscles inguina c male muscles inguina Transverse section muscles inguina Anulus inguinalis profundus Internal inguinal ring c Anulus inguinalis superficialis External inguinal ring muscles inguina APONEUROSIS c Přední stěna Ventral wall muscles inguina Dolní okraje plochých šlach OI aT Distal margine of OI and T aponeuroses Tříselný kanál Canalis inguinalis Groin canal, inguinal canal 2.vrstva 2nd layer Strop dno Roof bottom FASCIA TRANSVERSALIS muscles inguina c Tříselný kanál Canalis inguinalis Groin canal, inguinal canal 3.vrstva 3rd layer Zadní stěna Dorsal wall muscles inguina muscles inguina Zadní stěna tříselného kanálu Dorsal wall of the inguinal canal (intraabdominal view) muscles inguina Ligamentum interfoveolare Aponeurosis m.transv.abdom. m.transversus abdominalis Inferior epigastric vessels Vasa testicularia Falx inguinalis Trigonum Hesselbachi Ligamentum inguinale n. femoralis a. femoralis v. femoralis Ductus deferentialis vas deferens muscles inguina Fascia transversalis „fascia“ cremasterica aa. testicularis, cremasterica, deferentialis Plexus pampiniformis Ductus deferens muscles inguina c muscles inguina muscles inguina Anulus inguinalis superficialis canalis inguinalis – příčný řez 1- fossa supravesicals 2- fossa medialis inguinalis 3- fossa lateralis inguinalis Přímá hernie HERNIA DIRECTA muscles inguina Nepřímá hernie HERNIA INDIRECTA Fascia transversalis peritoneum TA IOA EOA Superficial abd.fascia cremaster Fascia spermatica externa Ifascia spermatica interna muscles inguina Diaphragma structure muscles inguina Vertebral part – from ligaments which surround deep abdominal muscles (arcuate mediale, laterale and mediana ligg.). Lumbar part – right side - from first three lumbar vertebrae Lumbar part – left side - from first two lumbar vertebrae Sternal part - from xiphoid process and from false ribs muscles inguina Diaphragm phren formation muscles inguina Inferior view muscles inguina muscles inguina Diaphragm openings Aortic hiatus (aorta a ductus) Esophageal hiatus (jícen a vagus) Hiatus venae cava inferioris (vein and right phrenic nerve) Arcades (muscles and splanchnic nerves and connections between ascending lumbar veins and azygos and hemiazygos veins) muscles inguina Superior view Sternocostal triangle Lumbocostal triangle (Bochdaleki) Hiatus esophageus Medial arcuate lig. Lig. arcuatum medianum Lateral arcuate lig. PM Crus dextrum et sin QL Hiatus aorticus muscles inguina 4 5 muscles inguina Diaphragm - innervation Nerves – motor fibres from phrenic nerves (C3,4,5). Sensitive fibers supply parietal and visceral pleurae + middle part is supplied from the sensitive fibers of phrenic nerve sensoric fibers are from the intercostal nerve. muscles inguina Diaphragm and its function Muscle of abdominal straining: The diaphragm contraction aids that of the muscles of the anterior abdominal wall in raising the intra-abdominal pressure to evacuate the pelvic contents (micturition, defecation, parturition). Weight-lifting muscle: The diaphragm contraction support the vertebral column and prevent flexion. It assists the postvertebral muscles in the lifting of heavy weights. Thoracoabdominal pump: The descent of the diaphragm decreases the intrathoracic pressure and increases the intra-abdominal pressure. This pressures change compresses the blood in the inferior vena cava and forces it upward into the right atrium of the heart. Lymph can be passed faster to the thoracic duct, too. Diaphragma Diaphragm - absorbér peritoneální tekutiny muscles inguina - absorber of the peritoneal fluid muscles inguina Diaphragma - herniation Hernia congenitalis Proniká skrze congenital herniation – penetrates through: Canalis pleuroparietalis (častěji vlevo; v důsledku nespojení septum transversum s pleuroperitoneální řasou Pleuroperitoneal canal (more on left side, because of non fusion between pleuroperitoneal fold and septum transversum Hernia traumatica traumatic herniation – Proniká skrze penetrates through: hiatus oesophageus - para-esophageální typ oesophageal opening - paraesophageal type muscles inguina muscles inguina muscles inguina Svaly zad Musculi dorsi Back muscles muscles inguina muscles inguina Zádové svaly Back muscles Superficial layer Middle layer Deep layer Spinotransversal system Spinospinal system Transversospinal system Suboccipital muscles muscles inguina Mm. intermediales Intermediate muscles muscles inguina spinocostal system • Serratus posterior superior • Serratus posterior inferior • Levatores costarum muscles inguina mm. serrati serratus superior serratus inferior Mm. dorsales profundi Deep back muscles (erector trunci systems) muscles inguina • Superficial and obliquely directed • Erector spinae (trunci): iliocostalis, longissimus and spinalis parts Its separated continuation – splenius capitis and cervicis • Intermediate and obliquely directed Transversospinalis: semispinalis, multifidi and mm.rotatores • • Deeply arranged Mm. interspinales, intertransversarii muscles inguina muscles inguina Superficial and obliquely directed Spino-transversal system Derivatives of the Fascia thoracolumbalis+ Fascia nuchae arrangement muscles inguina m.splenius m.iliocostalis m.longissimus muscles inguina m.longissimus capitis, cervicis, thoracis L m.iliocostalis I cervicis, thoracis et lumborum Vertically directed muscles inguina Spino-spinal system mm.interspinales m.spinalis Intermediate and obliquely directed muscles inguina Transverso-spinal system mm.rotatores breves et longi m.multifidus m.semispinalis Mm. prevertebrales Prevertebral muscles muscles inguina mm. longus capitis et colli mm. rectus capitis et lateralis Spinospinální m.spinalis - extension Spinotransversální m.iliocostalis , m.longissimus, m.splenius –rotation to the same side Transversospinální m.semispinalis, mm.rotatores, m multifidus - rotation to the oposite side muscles inguina hluboké svaly zádové Inervace: Dorsální větve nn.spinales Innervation: dorsal branches of spinal nn. M.serratus M.latissimus post. sup. dorsi M.trapezius Petrovický lecture muscles inguina Fascia thoracolumbalis • It is between iliac crest and crista 12th • Outer layer: aponeurosis m. latissimus dorsi • Inner layer: Laterally proceeds to mm. transversi a obliqui interni Medially is splitted into three layers(lamellae): posterior lamella – covers deep muscles media lamella– dorsally from m. quadratus lumborum anterior lamella– ventrally from m. quadratus lumborum muscles inguina muscles inguina Movements in the regions • Thoracic region – rotation is produced by the semispinalis and rotatores muscles and less by the oblique abdominal muscles • Lumbar region – flexion is produced by the rectus abdominis and psoas muscles Lateral flexion is produced by the postvertebral muscles, the quadratus lumborum and the oblique abdominal muscles Rotation is produced by the rotatores muscles and by the oblique abdominal muscles muscles inguina muscles inguina Hernia lumbalis Lateroventrally Costa XII. Trigonum lumbale Petiti anulus superficialis PETIT Jean Louis 1674-1760 GRYNFELT Kazimierz 1840-1913 KRAUSE Wilhelm 1833-1909 Tetragonum Krausei (Trigonum Grynfelti - spatium tendineum Anulus profundus lumbale) muscles inguina muscles inguina muscles inguina muscles inguina Trigonum suboccipitale muscles inguina Where you can get more information muscles inguina R.S.Snell : Clinical Anatomy for Medical Students Lippincott, Williams & Wilkins, 6th edition pp.: 46-55; 57-58; 59-72 A.Dykes : Anatomy Mosby Publications pp.: 41-47 A.M.R.Agur and M.J.Lee : Grant`s Atlas of Anatomy Williams & Wilkins pp.: 2-28 K.L.Moore and A.M.R.Agur : Essential Clinical Anatomy Williams & Wilkins pp.: 32-47 Own archive