Download inguinal ligament

Dr. Nabil Khouri MD. Ph.D
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
The abdomen is the region of the body that is located between the
diaphragm above and the pelvic inlet below.
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Dermatoms
s

Abdominal regions.

The abdomen can be divided to 9 regions by four imaginary lines.
The Rt. And Lt. vertical lines extending from the midclavicular point superiorly to
midinguinal point inferiorly.


1.
2.

Two transverse lines
The lower plain
INTERTUBERCULAR
plain extends between the
Rt. And Lt. iliac tubercles
The upper subcostal plain
extends between the
lowest point of the costal
edge.
Or TRANSPYLORIC
plane that pass through
L1 or the midway
between the jugular notch
and the pubic symphysis.
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And Deep fascia
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

Skin
Superficial fascia.
Superficial fatty layer (CAMPER’S FASCIA).
It’s continuous with superficial fat over the rest of the body.
In the scrotum is modified as a thin smooth muscular layer called
DARTOS MUSCLE.
2.
Deep membranous layer.(SCARPA’S FASCIA).
Its thin and fades out superiorly and laterally where it
becomes continuous with the superficial fascia of the back
and the thorax.
Inferiorly passes on to the front of the thigh and fuses with the
deep fascia of the thigh about 2.5 cm bellow the inguinal
ligament.
In the midline inferiorly. It form a tubular sheath for the penis
(or clitoris) so it doesn’t attach to the pubis.
1.
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

Bellow the perineum
Inters the wall of the
scrotum. From here it
passes to be attached on
each side to the pubic arch
and there its referred as
COLLES FASCIA.
The Deep fascia.
Is a thin layer of
connective tissue covering
the muscles, it lies
immediately deep to the
membranous layer of
superficial fascia.
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Muscles of the anterior abdominal wall.
It connects the thoracic cage to the hip bones as a
three large flat sheets and a wide vertical
muscle.
1. External oblique.
2. Internal oblique.
3. Transversus abdominal.
4. Rectus abdominis.

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
External Oblique
The external oblique muscle is
a broad, thin, muscular sheet
that ARISES from the outer
surfaces of the lower eight ribs
and
fans out to be INSERTED into
1.
The xiphoid process.
2.
The linea alba.
3.
The pubic crest.
4.
The pubic tubercle.
5.
The anterior half of the iliac
crest.
6.
Forms the inguinal ligament
by its folding

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
Internal Oblique
lies deep to the external oblique; most of
its fibers run at right angles to those of
the external oblique.
It arises from
1.
The lumbar fascia,
2.
The anterior two thirds of the iliac
crest,
3.
The lateral two thirds of the inguinal
ligament.
 The muscle fibers radiate as they pass
upward and forward.
It inserts into
1.
The lower borders of the lower three
ribs and their costal cartilages.
2.
The xiphoid process.
3.
The linea alba.
4.
The symphysis pubis.

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The Transversus muscle


1.
2.
3.
4.
is a thin sheet of muscle that
lies deep to the internal
oblique, and its fibers run
horizontally forward
It arises from the
Deep surface of the lower
six costal cartilages and
margins
The lumbar fascia (posterior
aponeurosis)
The anterior two thirds of
the iliac crest,
The lateral third of the
inguinal ligament.
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
Rectus Abdominis

The rectus abdominis is a long strap muscle that extends along the
whole length of the anterior abdominal wall.
It is broader above and lies close to the midline, being separated
from its fellow by the linea alba.
It arises by two heads
from the front of the symphysis pubis.
from the pubic crest.
It inserts
into the fifth, sixth, and seventh costal cartilages and
the xiphoid process .
When it contracts, its lateral margin forms a curved ridge that can
be palpated and often seen and is termed the LINEA
SEMILUNARIS, this extends from the tip of the ninth costal
cartilage to the pubic tubercle.


1.
2.

1.
2.

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 The rectus abdominis
muscle is divided
into distinct
segments by three
transverse tendinous
intersections: at the
level of the
1. xiphoid process.
2. umbilicus.
3. halfway between
these two.
These intersections are
strongly attached to
the anterior wall of
the rectus sheath.
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
Pyramidalis

The pyramidalis muscle
is often absent.
It arises by its base from
the anterior surface of
the pubis.
it inserts into the linea
alba. It lies in front of the
lower part of the rectus
abdominis.


NOT:
The posterior border of the external oblique muscle is free,
whereas the posterior borders of the internal oblique and
transversus muscles are attached to the lumbar vertebrae by
the lumbar fascia
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1.
Above the costal margin, the anterior wall is formed by the
aponeurosis of the external oblique. The posterior
wall is formed by the thoracic wall—that is, the fifth,
sixth, and seventh costal cartilages and the intercostal
spaces.
2.
Between the costal margin and the level of the anterior
superior iliac spine, the aponeurosis of the internal oblique
splits to enclose the rectus muscle; the external oblique
aponeurosis is directed in front of the muscle, and the
transversus aponeurosis is directed behind the muscle.
Between the level of the anterosuperior iliac spine and the
pubis, the aponeuroses of all three muscles form the
anterior wall. The posterior wall is absent, and the rectus
muscle lies in contact with the fascia transversalis.
3.
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At the site where the aponeuroses forming the
posterior wall pass in front of the rectus at the
level of the anterior superior iliac spine, the
posterior wall has a free, curved lower border
called the arcuate line
 At this site, the inferior epigastric vessels enter
the rectus sheath and pass upward to
anastomose with the superior epigastric
vessels.

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
The rectus abdominis is enclosed between the aponeuroses of the
external oblique, internal oblique, and transversus muscles
which form the rectus sheath
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
Rectus Sheath

The rectus sheath is a long fibrous sheath that encloses the rectus
abdominis muscle and pyramidalis muscle (if present)
and contains
rectus abdominis muscle and pyramidalis muscle (if present)
the anterior rami of the lower six thoracic nerves and
the superior and inferior epigastric vessels
and lymph vessels.

1.
2.
3.
4.
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
Between the anterior superior iliac spine and the pubic
tubercle, the lower border of the external oblique muscle
aponeurosis is folded backward on itself, forming the
inguinal legament Inguinal ligament.
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
It extend from the ASIP to the symphesis pubis to from the medial end
of the ligament, the lacunar ligament that extends backward and
upward into the pectineal line on the superior ramus of the pubis

The inferior rounded border of the inguinal ligament is attached the
deep fascia of the thigh, the FASCIA LATA

The lateral part of the posterior edge of the INGUINAL
LIGAMENT gives origin to:
Part of the internal oblique
The transversus abdominis muscles.
1.
2.

Its sharp, free crescentic edge forms the medial margin of the
FEMORAL RING
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


The internal oblique has a
lower free border that arches
over the spermatic cord (or
round ligament of the uterus)
and then descends behind it
to be attached to the pubic
crest and the pectineal line.
Near their insertion, the
lowest tendinous fibers are
joined by similar fibers from
the transversus abdominis to
form the conjoint tendon.
The conjoint tendon is
attached medially to the
linea alba.
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Conjoint tendon
Superficial inguinal ring is a triangular-shaped defect in the
external oblique aponeurosis lies immediately above and medial to
the pubic tubercle.
 Its margins are referred as crura. At and beyond the apex of the
triangle 2 crura are united by intercrural fibers
 The spermatic cord (or round ligament of the uterus) passes
through this opening and carries the external spermatic fascia (or
the external covering of the round ligament of the uterus) from the
margins of the ring
 As the spermatic cord (or round ligament of the uterus) passes
under the lower border of the internal oblique, it carries with it
some of the muscle fibers that are called the
Cremaster muscle (fibers).

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Superficial inguinal ring
Lateral
Medial
Floor
Here are the anterior wall (which has
the SUPERFICIAL inguinal ring
situated medially), and the roof.
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Deep inguinal
ring
An oval opening in
the fascia
transversalis
situated 1.2 cm
above the
midinguinal point,
and immediately
lateral to the stem
of the inferior
epigastric artery
Deep
inguinal ring
Medial
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Floor
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Inguinal Canal
Location
Lateral
Floor
Inferior part of the
anterolateral abdominal wall
It is about 4cm(1.5 inches)
long, and is directed
downwards, forwards and
medially
The inguinal canal extends
from the deep inguinal ring to
the superficial inguinal ring

THE ANTERIOR WALL
1.In its whole extent
a. Skin
b. Superficial fascia
c. External oblique aponeurosis
2.In its lateral one-third
The fleshy fibres of the internal oblique muscle.
The ROOF : It is formed by the arched fibres of the internal oblique and
transverse abdominis muscles.
The posterior wall is formed by transversalis fascia (orange)
throughout and the conjoint tendon mdially. The wall is particularly
weak over the deep inguinal ring
1.In its whole extent
a. The fascia transversalis
b. The extra peritoneal tissue
c. The parietal peritoneum.
2.In its medial two-thirds a. The conjoint tendon b. At its medial end by the
reflected part of the inguinal ligament.
Deep inguinal ring
Posterior wall
Conjoint tendon medially
Lateral
Medial
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Content
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Nerve Supply of Anterior Abdominal Wall Muscles
The oblique and transversus abdominis muscles are supplied by the
lower six thoracic nerves and the iliohypogastric and ilioinguinal nerves
(L1).
The rectus muscle is supplied by the lower six thoracic nerves.
The pyramidalis is supplied by the 12th thoracic nerve.
The nerves of the anterior abdominal wall are the anterior rami of the
lower six thoracic and the first lumbar nerves.
The thoracic nerves are the lower five intercostal nerves and the
subcostal nerves and the first lumbar nerve is represented by the
iliohypogastric and ilioinguinal nerves, branches of the lumbar plexus.
They supply the skin of the anterior abdominal wall, the muscles, and
the parietal peritoneum.
The lower six thoracic nerves pierce the posterior wall of the rectus
sheath to supply the rectus muscle and the pyramidalis (T12 only).
They terminate by piercing the anterior wall of the sheath and
supplying the skin.
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The first lumbar nerve has a similar course,
but it does not enter the rectus sheath.
 It is represented by the iliohypogastric nerve,
which pierces the external oblique aponeurosis
above the superficial inguinal ring,
 and by the ilioinguinal nerve, which emerges
through the ring.
 They end by supplying the skin just above the
inguinal ligament and symphysis pubis.

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