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Important
Pelvis
Bony aspect is known as the pelvic girdle
Os coxae: term for the fusion of these three bones in the pelvis
ischium and pubis form the obturator foramen which is a The Pelvis
hole for passage of VAN
pubic symphysis adjoins both sides of the pelvic• girdle
Comprised of three fused bones: The ilium
Ilium ischium, and pubis
Found in the superior region of the pelvic girdle
Landmarks and important structures include: • Ilium: Superior region;important structur
iliac crest, anterior/posterior superior ilia
Iliac crest: placement of hands on hips=iliac crest
Auricular surface: articulates with the sacrumanterior/posterior inferior iliac spines.
anterior superior iliac spine
inguinal ligament
• Ischium:Posteroinferior region;ischial spin
tensor fasciae latae ischial tuberosity;lesser sciatic notch.
Sartorius • Pubis:Superior/inferior rami, pubic symph
posterior superior iliac spine
pubic arch;forms obturator foramen(isch.
anterior inferior iliac spine
rectus femoris attachment site
iliofemoral ligament attachment site
posterior inferior iliac spine
Ischium
Most posterior-inferior aspect of pelvis
Landmarks and important structures include
Ischial spines:
Symmetric ischial spines with the pubic symphysis forms the Urogenital
Triangle or UG triangle
Symmetrical ischial spines with the coccyx forms the Anal Triangle
Ischial tuberosity: portion of the pelvis which bears the weight of your body when
in the seated position
Lesser sciatic notch
Ischium and pubis form the obturator foramen
Pubis
Superior/inferior rami: superior rami contributes to
a part of the area adjoining at pubic symphysis
Rami means branch
Pubic symphysis
Fibrocartilage adjoins both halves of the pelvic girdle
usually rigid unless during parturition when it becomes more
pliable
“a great point of reference”
Pubic arch/subpubic angle
Differs in gender
Male subpubic angle=90’
Female subpubic angle >90’
Reason for this is parturition requires more room to pass
fetus
Ischium and pubis form the obturator foramen
True Pelvis
Portion of the pelvis inferior to the pelvic brim or inferior
to the vicinity of pubic tubercle
Forms deep bowl containing the bladder, reproductive organs
and rectum
False Pelvis
Portion of the pelvis superior to the pelvic brim or superior to vicinity of
pubic tubercle
Hands on hips is false pelvic placement
Muscles of pelvic floor
Levator ani group
Pubococcygeus:
origin at pubic and insertion in coccyx
Iliococcygeus:
origin in ilium and insertion in coccyx
Sphincter urethrae/Urogenital diaphragm
Skeletal muscle which allows for voiding of urinary bladder; voluntarily after training
the muscle during younger years
Ischiocavernosus
Bulbospongiosus
Pelvic inlet
Superior portion and entrance into pelvis
Pelvic outlet
Inferior portion and exit of pelvis
Occluded by muscles that form the pelvic floor
Levator ani group, sphincter urethrae, bulbus spongiosus,
and ischiocavernosus
SURGICAL CORRELATE: Episiotomy/perineotomy
During parturition, a tear can occur in the vagina due to the of muscles of vaginal
wall not being pliable; this correlates with the shape of the newborn’s head
The pubococcygeus muscle surrounding the vagina and rectum can be incised in
order to allow for more room during parturition
Arteries of the pelvis
Bifurcates of the abdominal aorta
RT/LT common iliac
Found in vicinity of abdominopelvic cavity
Common iliacs bifurcate into internal
and external iliac arteries
Internal iliac
Bifurcate of the common iliac
Supplies blood to the urinary bladder,
int/ext walls of the pelvis, and genitalia
External iliac
Continues inferiorly giving rise to the femoral artery
Provides blood to the pelvic limbs
Urinary system
Urinary bladder
Urachus
fibrous remnant of fetal shunt located at the apex of the bladder which allowed
fetus to empty bladder through the umbilical cord
obliterated after birth
MEDIAN umbilical ligament/Xander’s ligament in adults: extends from apex of
bladder to naval; anchors the urinary bladder to the anterior abdominal wall
Medial umbilical ligaments
Remnants of umbilical arteries in fetus
Cut when the umbilical cord is cut after
Results in vestiges of these arteries which become the medial umbilical
ligaments
Rugae
Folds found in the stomach and urinary bladder
Rugae are present and superficial layer of urothelium is dome shaped when UB is
empty
Rugae are absent and superficial urothelium is flattened when bladder is
distended
Ureteric openings and Internal urethra opening (trigone)
Two ureteral openings where ureters empty kidney contents
One internal urethra opening which allows for emptying of bladder outside of
body
CLINICALLY SIGNIFICANT: Trigone formed by these three openings is the target
site for clinicians to obtain culture samples to test for UTI
Histology
Deep to superficial
Lumen mucosasubmucosa inner longitudinal muscularis middle
circular muscularis outer longitudinal muscularis adventitia
Musculature cohesively known as the Detrusor muscle
Urethra
Thin walled muscular tube
Mostly stratified columnar epithelium
Male urethra
18-20 cm long
3x longer than female urethra
Three divisions
Prostatic
Membranous
Shortest section of urethra surrounded by the UG diaphragm/sphincter
urethrae
Penile/Spongy
Uterus
Fundus
Expansive portion of uterus responsible for implantation of zygote
Ectopic pregnancy if implantation occurs elsewhere
Uterine wall composed of
Myometrium (90%)
Smooth muscle contractile layer which contracts and elicits the cramping
effect during menses
Contracts and expels fetus during parturition
Endometrium (10%)
Inner lining of the uterus
Two layers
Stratum functionalis: proliferates, thickens, and sloughs off during
menses
Stratum basale: responsible regeneration of the endometrium
CLINICAL
Anterograde flow: Ovary uterine tube uterine cavity vagina
Retrograde flow: uterine cavity uterine tube ovary
Endometrial cells can leak out of the uterine cavity through the uterine
tube fimbriae which can lead to a condition known as endometriosis
Suspensory ligament of the ovary
Homologue of the male spermatic cord due to the contents of VAN
External Genitalia
Labia majora and minora
Homologues of the scrotal sac
Clitoris
Homologue of the penis
More specifically, homologue of the corpus cavernosum since can become erect and
does not surround a urethra
Additionally, the suspensory ligament connects to from the pubic symphysis to the
clitoris in females as it does in the males with the corpus cavernosum
Female androgen injections can lead to an enlarged clitoris
Bartholin’s/Vestibular glands
Serve mainly for lubrication of the vagina during coitus/intercourse
Skene’s/periurethral glands
Involved in female’s capacity to ejaculate
Homologue of male prostate
mdplz password
Lower limb
Femur
Largest, longest, and strongest bone of the body
Articulates with the acetabulum
Acetabulum formed by the fusion of the 3 pelvic bones
Length is .25xPerson’s height
Fovea capitis
Site of attachment of ligamentum teres femoris
Depression in the head of the femur that
reinforces it into the acetabulum
Head
Portion of femur that articulates with the acetabulum
Iliofemoral ligament/ Y-Ligament of Bigelow: surrounds
and anchors the head of the femur into the acetabulum
Neck
Weakest portion
CLINICAL
Broken hip is a misnomer since most often
a fracture in the neck of the femur occurs
Most likely to break if affected by osteoporosis
Greater and lesser trochanters
Psoas and iliacus insertion at lesser trochanter
(EXTRA)
Linea aspera
Ridge or elevation in the shaft of the femur
which is the site of attachment for some adductor
muscles
Lateral and medial condyles
Projections from the distal end of the femur
which form the upper half of the knee joint
Also found in tibia
Epicondyles
Superior to the LM condyles
Lateral epicondyle origin for Lateral Collateral Ligament
Medial epicondyle origin for Medial Collateral Ligament
Patellar surface
Portion of the femur that articulates with the patella
Patella
Articulates with the patellar surface of the femur
Patellar tendon/quadriceps tendon attach at the base of the patella
Patellar ligament attaches to the base of the patella
Articular surface on the posterior aspect of the patella is made of hyaline cartilage
Anterior cruciates and medial cruciates cross over in between the space of the
bones
Tibia
2nd largest, longest, and strongest bone in the body
medial and lateral condyles
make up lower half of the knee joint
medial condyle is insertion for medial
collateral ligament
medial and lateral menisci are sandwiched in between
lateral and medial condyles of tibia
menisci made of fibrocartilage and acts as shock
absorbers
intercondylar eminence
located in between the condyles
eminence with tubercles are the attachment site
for the cruciates ligament
Tibial tuberosity
Anterior crest
Medial malleolus
Distal aspect of the tibia
Fibula
Stick like bone with slightly expanded ends
Head
Insertion for the Lateral collateral ligament
lateral malleolus
Lower end/distal aspect of fibula
Crural interosseous membrane
Membrane found in between the tibia and fibula
Knee injury
Ligaments
Lateral collateral ligament
Origin at lateral epicondyle of the femur and insertion at head of fibula
Medial collateral ligament
Origin at medial epicondyle of femur and insertion at medial condyle of tibia
Injury to lateral aspect of knee will result in tears of the
1. Medial collateral ligament
2. Meniscus
3. Cruciates
Foot
Tarsal bones
Talus
transmits weight of body from tibia towards toes
2nd largest foot bone
calcaneus
largest of tarsal bones
cuboid bones and the posterior surface of calcaneus
attaches calcaneal/Achilles tendon
heel bone
Cuboid bone
Navicular
Cuneiforms
Medial
Intermediate
Lateral
Metatarsals
5 mini long bones
1st metatarsal supports weight of body
phalanges
14 long bones organized anatomically
Distal, middle, and proximal phalanges
hallux/big toe
hallux only digit without middle phalanx
demipointe: “tippy toes” not really because foot
is actually being placed entirely on distal phalanx
of the hallux and spread to the other toes
en pointe: weight is placed entirely on the distal
phalanx of the hallux as seen in ballerinas
Leg movement
Anterior thigh compartment - Extensors of the leg
Rectus femoris
Origin at anterior inferior iliac spine
Vastus
Lateralis
Medialis
Intermedius
Visualization possible through
removal of rectus femoris muscles
Posterior thigh compartment – flexors of the leg/hamstrings
Biceps femoris
Short head
Long head
Semitendinosus
Semimembranosus
Lateral to medial
1. Short head biceps femoris
2. Longhead biceps femoris
3. Semitendinosus
4. Semimembranosus
Foot and Toe Movement
Anterior compartment
Tibialis anterior
Extensor digitorum longus
Extensor hallucis
Lateral compartment
Peroneus/Fibularis longus
Peroneus/Fibularis brevis
Posterior compartment
Gastrocnemius
Soleus
Gastrocnemius and soleus form the calcaneal/Achilles tendon
When removed, deeper muscle visualized
1. Flexor hallucis longus
2. Tibialis posterior Medial to Lateral – Posterior view
3. Flexor digitorum longus
Arteries of the leg and thigh
Femoral
Deep femoral
Femoral artery branch
Popliteal
Continuous with femoral artery
Posterior tibial
Gives rise to the peroneal/fibular, medial, and lateral plantar arteries
Anterior tibial
Gives rise to dorsalis pedis
Peroneal
Supplies medial
Arteries of the foot
Dorsalis pedis
Medial plantar
Lateral plantar
Forms the plantar arch
Systemic veins – Pelvic limb venous drainage
Plantar & dorsal venous arch
Anterior & posterior tibial
Peroneal
Popliteal
Femoral
Great & small saphenous
Great saphenous is the largest vein in the body
External iliac
Great saphenous External iliac common iliac IVC
Nerves
Lumbar plexus T12- L4 with most contributions from L1-L4
Arises from 1st four lumbar spinal nerves and lies within the psoas major muscle
L1-L4 comprise the main part of plexus by divisions of the 1st four lumbar spinal
nerves
L1: iliohypogastric and ilioinguinal nerves
These two contribute to formation of genitofemoral nerve
L2: contributes to formation of genitofemoral nerve
Iliohypogastric
Ilioinguinal
Genitofemoral
Lateral femoral cutaneous
Femoral
Obturator
Sacral Plexus L4-S4
Larger branches
Sciatic
Largest nerve in the body
Common fibular and tibial divisions
Tibialis
Common peroneal
Deep peroneal
Superficial peroneal
Smaller branches
Superior gluteal
Inferior gluteal
Posterior femoral cutaneous
CLINICAL
Borders of femoral triangle: inguinal ligament, adductor longus, and Sartorius
Femoral Vein, Femoral Artery, and Femoral nerve found in this triangle
Injury to this area likely to be fatal
Also known as triangle of death
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Back
Vertebral column
Comprised of 26 irregular bones
Axial support of the trunk
VC protects the Spinal cord found in vertebral foramen
Point of attachment for the ribs and back muscles
Divisions
Cervical
7 Cervical Vertebrae
Thoracic
12 Thoracic Vertebrae
Lumbar
5 Lumbar Vertebrae
Sacrococcygeal
1 sacrum
1 coccyx
Primary curvature
Thoracic and Sacral
Pertains to fetal development
C-Shaped VC in womb
Out of the womb, baby on bed begins
to prop head and raise the neck forming
the primary curvature
Secondary curvature
Cervical and Lumbar
once bipedal, lumbar and cervical curvature develop
Irregular curvatures
Kyphosis “Hunchback”
Exaggerated thoracic curvature
Lordosis “Swayback”
Exaggerated lumbar curvature
Develops in third trimester pregnancies
Scoliosis
Lateral curvature of the VC
Lateral deviation results in angled shoulders and pelvis
Vertebrae Structure
Body
Vertebral arch
Lamina and pedicles
Vertebral foramen
Body + Vertebral arch(Lamina + Pedicles) = Vertebral foramen
Spinous process
Transverse process
Superior articular process/facets
Inferior articular process/facets
Superior and Inferior articular facets face each other
forming a joint
Intervertebral foramina
Exit for the spinal nerves
CLINICAL
Laminectomy: To expose the spinal cord, a surgeon
will cut through the lamina and remove it to create space
in the case of a herniated disc
Cervical Vertebrae
C1: Atlas
No body
No spinous process
Articular facets facing the skull allow for articulation in the vertical
plane; i.e. neck flexion and extension; nod yes
Openings in the transverse process= transverse foramina
housing the cerebral artery
C2: Axis
Body
Spinous process
Dens/odontoid process
Articulates with the atlas and forms a pivot which allows for lateral
rotation of the head i.e. nods no
CLINICAL: Hangman’s fracture occurs by fractures in the pedicles of C-2
forcing the odontoid process into the spinal cord
Reinforced by the transverse ligament
Thoracic Vertebrae
Increase in size from T1 T12
Heart shaped body
Circular vertebral foramen
Costal facets on the transverse processes
T-Vertebrae are the only vertebrae with costal facets
articulating with the ribs; exclusions to the rule are cervical ribs
Direct of articular facets in the T-Vertebrae
Superior articular process faces posterior
Inferior articular process faces anterior
This combination allows for twisting movement in the area of the thoracic
vertebrae
Lumbar vertebrae
Large bodies
Short lamina and pedicles
Short and flat spinous process
Superior/inferior articular processes
modified to lock to prevent rotation of the lumbar spine
In the lumbar vertebrae, the superior facets face medial and inferior facets face
laterally as opposed to the thoracic facets; by doing this, it prevents over-
rotation in the lumbar region
Sacrum
Formed by 5 fused vertebrae in adults
Sacroiliac joint/Auricular surface
Auricular surface articulates with the ilium of the pelvis forming the sacro-iliac
joint
Shapes the posterior wall of the pelvis
Two wing like alae
Sacral promontory
Transverse lines/ridges
Fusion points of sacral vertebrae
Sacral foramina
Cauda equina nerves exit through sacral foramina
Median and lateral sacral crests
Median sacral crest equivalent to the lumbar spinous process
Lateral sacral crest equivalent to lumbar transverse process
Sacral canal and hiatus
Parts of the sacrum
Canal is point of entry for the cauda equina (horse tail)
Cauda equina: mesh of nerves that come off the end of the spinal cord
Hiatus
Extensions of the dura matter, coccygeal ligament, and the filum terminale
(extension of the innermost layer of spinal cord) exit through the hiatus and
attach to the last coccygeal vertebrae=coccyx
CLINICAL: interest for caudal epidural, palpate the sacral cornu to pinpoint
hiatus for the epidural
Coccyx
Vestigial tail bone
Attachment site for ligaments and sphincter muscles
Four or five fused vertebrae (completed in late adulthood)
Gender different
Male curves more
Female is more vertical due to need for space during parturition
Spinal Meninges
Three layers from superficial to deep
All three layers are continuous with cranial meninges
Dura matter (superficial)
Fibrous CT
Outermost covering of the spinal cord and brain
Fuses at margins of the foramen magnum
Merges with components of filum terminale
This merger along with the coccygeal ligaments insert at caudal most aspect
of the coccyx
Arachnoid
Middle meningeal layer
Simple squamous epithelium
Subarachnoid space composed of arachnoid trabeculae which are made of
collagen and elastin fibers
Pia matter (deep)
Innermost layer
Close proximity to anterior and posterior spinal arteries
Astrocytes: glia or neuroglia are the supportive component of pia matter which
function to reinforce
Lateral extensions of pia matter= denticulate ligament
Caudal extension of pia matter=filum terminale
Cerebrospinal fluid
Circulates in subarachnoid space which is target region for LP
Epidural space
In the vertebral foramen of this space, adipose tissue can be found outside of the
dura matter