Myology 1

федеральное государственное бюджетное образовательное
учреждение высшего образования

«Оренбургский государственный медицинский университет»
Министерства здравоохранения Российской Федерации
Кафедра анатомии человека
МИОЛОГИЯ
Учебное пособие предназначено для иностранных студентов

31.05.01 Лечебное дело (факультет иностранных студентов)
Оренбург, 2019
УДК 611.73(075.8)=111
ББК 28.706я73=432.1
М99
Рецензенты:
УдочкинаЛ.А., д.м.н., профессор, зав. кафедрой анатомии Астраханского ГМУ;
Фатеев И.Н., д.м.н., доцент, профессор кафедры оперативной хирургии и клинической
анатомии им. С.С. Михайлова ОрГМУ
Авторы:
Лященко Д.Н., д.м.н., доцент, зав. кафедрой анатомии человека ОрГМУ
Шаликова Л.О., к.м.н., доцент кафедры анатомии человека ОрГМУ
Титов В.Г., к.м.н. доцент кафедры анатомии человека ОрГМУ
Гулина Ю.В., ассистент кафедры анатомии человека ОрГМУ
Серединова Т.С., ассистент кафедры анатомии человека ОрГМУ
Данное учебное пособие является практическим курсом по формированию знаний по

скелетной мускулатуре человека для иностранных студентов. Пособие содержит материал
для изучения анатомии мышц, а также основных топографических образований с
использованием латинских, греческих, русских терминов, а также эпонимов. Большое
количество тестовых заданий и ситуационных задач способствует формированию у
студентов клинического мышления. Указания позволяют организовать и унифицировать
самостоятельную работу студентов по изучению раздела анатомии «Миология» как в
учебное, так и внеучебное время, а также подготовиться к экзамену. Пособие предназначено
для иностранных студентов, обучающихся на английском языке.
Пособие составлено с учетом требований федерального государственного

образовательного стандарта 31.05.01. Лечебное дело.
УДК 611.73(075.8)=111
ББК 28.706я73=432.1
М99
2
Federal State Educational Institution
of Higher Education
Orenburg State Medical University
of the Ministry of Health of the Russian Federation
The Department of Human Anatomy
MYOLOGY
Study guide for foreign students

31.05.01 Therapy (Department of foreign students)
Orenburg, 2019
3
УДК 611.73(075.8)=111
ББК 28.706я73=432.1
М99
Reviewers:
Udochkina L.A., MD, Professor, Head of the Department of Anatomy, ASMU
Fateev I.N., MD, Professor of the Department of the operative surgery and clinical anatomy of
S.S. Mikhailov, OrSMU
Authors:
Lyashenko D.N., MD, Professor, Head of the Department of Human anatomy of OrSMU
Shalikova L.O., PhD, Associate Professor of the Department of Human anatomy of OrSMU
Titov V.G., PhD, Associate Professor of the Department of Human anatomy of OrSMU
Gulina U.V., assistant of the Department of Human anatomy of OrSMU
Seredinova T.S., assistant of the Department of Human anatomy of OrSMU
Study guide is a practical course on the knowledge formation of the human skeletal muscles
for English-speaking students. The manual contains material for the study of the muscles anatomy,
as well as main topographic structures using Latin, Greek, Russian terms and eponyms. A large
number of test tasks and clinical cases contributes to the formation of the clinical thinking on
students . These instructions allow to organize and unify the independent work of students to study
the part of anatomy "Myology" in both academic and extracurricular time, as well as prepare for the
exam. Study guide is intended for English-speaking students of foreign faculty.
Study guide is written according to the Federal State Educational Standard requirements
(31.05.01 Therapy).
УДК 611.73(075.8)=111
ББК 28.706я73=432.1
М99
4
CONTENTS
№/№ Theme Pages

1. Introduction 6
2. Lesson 1. Muscles of the neck. Masticatory and facial expression muscles. 7
Fasciae of the head and neck. Topography of the neck
3 Lesson 2. Muscles of the back. Chest and abdominal muscles. Inguinal canal. 20
Diaphragm
4. Lesson 3. Muscles and topography of the upper limb 31
5. Lesson 4. Muscles and topography of the lower limb 43
6. Control questions of the final test «Myology» 54
7. Keys to the tests 62
8. Keys to the clinical cases 62
9 List of the recommended literature 64
5
INTRODUCTION
The muscular system is the active part of skeletal system of the body. It affects the joints of
the body and provide movements of the human. The muscular system functioning correlates with
the condition of nervous system and joints. The skeletal muscle contraction provide the work of
respiratory, digestive, genitourinary systems, that’s why knowledge of structure and functions of
skeletal muscles is necessary for studying the other chapters of anatomy (arthrosyndesmology,
splanchnology, neurology) and clinical subjects.
Teaching anatomy students in medical universities is based on the continuity of knowledge,
skills and competencies obtained in the course of anatomy of secondary school, as well as
knowledge of biology, chemistry, physics, foreign languages.
The list of formed elements of competencies:
CC-1: the ability to abstract thinking, analysis, synthesis
PC-1: the readiness to solve standard tasks of professional activities after use bibliographic
resources, medical and biological terminology, information and communication technologies and
the integration of information security requirements
PC-9: the ability to assess morphological, physiological conditions and pathological
processes in the human body for solving professional tasks.
6
Topic of the practical lesson №1:
MUSCES OF THE NECK. MASTICATORY AND FACIAL EXPRESSION MUSCLES.
FASCIAE OF THE HEAD AND NECK. TOPOGRAPHY OF THE NECK.
Items for discussion

Muscles of neck, their classification. Superficial, middle and deep muscles of neck, their
description. Fascia of neck. Interfascial spaces of neck. Neck topography: regions and triangles.
Muscles of the head. Classification. Masticatory and facial expression muscles, their characteristics.
Anatomical peculiarities of facial expression muscles. Fascia of head.
Actuality
Neck muscles provide various functions: take part in movements of head and neck, temporo-
mandibular joint, form oral diaphragm, tense the deep plate of proper cervical fascia, participate in
breath, form the neck triangles, where the large blood vessels, nerves and some organs are located.
Neck muscles are surrounded by fascia, which reflect the neck organs topography and form
interfacial spaces, some of which communicate with mediastinum. Knowledge of neck muscles and
fascia help in most favorable surgery approach.
Control questions
1. Division of the neck muscles on the groups on topography and developmental origin.
2.Anatomical features and function of the superficial muscles of the neck (platysma,
sternocleidomastoid).
3. Anatomic features and function of the middle group muscles of the neck (suprahyoid muscles –
digastric, stylohyoid, mylohyoid, geniohyoid)
4. Anatomical features and function of the muscles of the middle group neck (infrahyoid muscles -
sternohyoid, omohyoid, sternothyroid, thyrohyoid)
5. Deep muscles of the neck (lateral group- anterior scalene, middle scalene, posterior scalene;
prevertebral group - longus colli, longus capitis rectus capitis anterior, rectus capitis lateralis) ,
their origin, insertion, function.
6. Neck topography: regions andmain triangles, their boundaries and value.
7. Characteristic of the neck fascia according V.M.Shevkunenko, topographical relationships with
the muscles, organs and vessels.
8. Interfascial spaces of the neck and their communication with the mediastinum.
9. Division of the head muscles by origin and location.
7
10.Masticatory muscles (masseter, temporalis, lateral pterygoid, medial pterygoid), their origin,
insertion, mechanism of action of the mandibular joint.
11. Anatomical peculiarities of the facial expression muscles.
12. Facialmuscles around the eye (orbicularis oculi, procerus, corrugatorsupercilii), their origin,
function.
13. Muscles around the nose (nasalis, depressor septinasi), their origin, function.
14. Muscle around the mouth, their origin, function.
15. The muscles of the cranial vault, origin,insertion, function.
16. Characteristic of the fasciae of the masticatory muscles.
Set of the natural preparations, models and tables

1. The human skeleton
2. The skull with mandible.
3. The cadaver with the prefilled muscles of the head and neck
4. Set of the tables «Musles of the neck», «Musles of the head», «Regions and triangles of the
neck», «Fasciae of the neck».
The student should know:

 development of neck muscles;
 classification, shape, origin, insertion and functions of neck muscles;
 neck regions, their boundaries, triangles;
 neck fascia, their characteristic;
 intermuscular and interfascial spaces and their content;
 classification of head muscles;
 peculiarities of facial expression muscles;
 arrangement and function of facial expression muscles;
 origin, insertion and function of muscles of mastication;
 head fascia.
The student should be able to name and show:

1. Superficial muscles of the neck
 platysma
 sternocleidomastoid
2. Suprahyoid muscles
 digastric
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 stylohyoid
 mylohyoid
 geniohyoid
3. Infrahyoid muscles
 sternohyoid
 omohyoid
 sternothyroid
 thyrohyoid
4. Deep muscles of the neck (lateral group)
 anterior scalene
 middle scalene
 posterior scalene
5. Deep muscles of the neck (prevertebral group)
 longus colli,
 longus capitis
 rectus capitis anterior
 rectus capitis lateral
6. Neck regions,their boundaries
 posterior
 anterior
 lateral
 sterno-cleido-mastoid
7. Main neck triangles and fossae
 omotrapezoid triangle
 omoclavicular triangle
 submandibular triangle
 Pirogov’s triangle.
 carotid triangle
 omotracheal triangle
 retromandibular fossa
8. Neck fasciae
 superficial cervical fascia
 superficial layer of the deep cervical fasciae.
 deep layer of the deep cervical fasciae, Riche’s aponeurosis.
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 endocervical fascia
 prevertebral fascia.
9. Interfascial spaces of the neck
 suprasternal interaponeurotic space
 Grooberi’s Blind cervical sac
 pretracheal space (previsceral space)
 retrovisceral space
10. Masticatory muscles
 masseter
 temporalis
 lateral pterygoid
 medial pterygoid
11. Facial muscles around the eye
 orbicularis oculi (orbital, palpebral and lacrimal parts)
 procerus
 corrugator supercilii
12. Muscles around the nose
 nasalis
 depressor septi nasi
13. Muscle around the mouth
 levator labii superioris
 zygomaticus major and minor
 risorius
 levator angulioris
 depressor angulioris
 levator labii superioris
 depressor labii inferioris
 mentalis
 buccinator
 orbicularis oris
14. Muscles of the cranial vault
 epicranius
15. Fasciae of the head
 Temporal fascia
10
 masseteric fascia
 parotid fascia
 buccopharyngeal fascia
Draw in copybook and denote:

1. Scheme of neck regions and triangles
2. Fasciae of the neck (according to V.N Shevkunenko)
TOPOGRAPHY OF THE NECK

The borders of the neck are:
Superior - from the mental tuber (tuber mentale) (chin) along the lower side of mandible
to its angle, then to the apex of mastoid processes, along the superior nuchal line to the external
occipital protuberance.
Inferior — from the incisure of the sternum, clavicles, acromions and then the imagine
line, which connects it with the spinal process of the C7 vertebra.
Regions of the neck:

1. POSTERIOR CERVICAL REGION. It is a space on the side of the neck situated
posteriorly to the external border of a trapezoid muscle.
2. STERNOCLEIDOMASTOID REGION. Its border equal to the sternocleidomastoid
muscle. This region separates medial and lateral triangle of the neck.
3. LATERAL CERVICAL REGION (LATERAL TRIANGLE). Itis a space on the side
of the neck situated externally to the sternocleidomastoid muscle.Boundaries:Anterior-posterior
border of sternocleidomastoid muscle., posterior-anterior border of trapezoid muscle, inferior –
clavicle, apex lies on the superior nuchal line where the trapezoid and sternocleidomastoid muscles
meet.Posterior belly of the omohyoid muscle divides the lateral carotid triangle into a large upper
part, called the omotrapezoid triangle and a smaller lower part, called the omoclavicular triangle.
Omotrapezoid triangle
Boundaries:
anterior- posterior side of sternocleidomastoid muscle,
inferior- posterior belly of omohyoid muscle,
posterior- posterior side of trapezoid muscle.
Omoclavicular triangle
Boundaries:
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anterior - posterior side of the sternocleidomastoid muscle,
posterior - the inferior belly of the omohyoid muscle,
inferior - clavicle.
4. ANTERIOR CERVICAL REGION.

It is a space on the side of the neck situated anteriorly to the sternocleidomastoid muscle.
Boundaries:
anterior - middle line of the neck,
posterior - anterior border of the sternocleidomastoid muscle,
superior -the margin of a mandible.
Submandibular triangle
The submandibular triangle is bordered by two bellies of the digastric muscle and the lower
border of the mandible. The contents of the triangle include the greater part of the submandibular
gland.
In cases when we need to legate the lingual artery it is difficult to find it in the bottom of the
mouth, that is why Pirogov suggested to find it in the submandibular triangle,usually it passes
through the small triangle which we call Pirogov’s triangle. The borders of it are: superiorly —
hypoglossal nerve, anteriorly — the site of the mylohyoid muscle, inferiorly — the tendon of the
digastrics bellies
Carotid triangle
It is a vascular area bounded by the superior belly of the omohyoid, the posterior belly of the
digastrics and the anterior border of the sternocleidomastoid muscles. It includes the common
carotid artery, the internal jugular vein, and the vagus nerve.
Omotracheal triangle
It is bounded by the superior belly of the omohyoid, the anterior border of the
sternocleidomastoid muscles and middle line.
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Fig.1 Regions and triangles of the neck
I -omoclavicular triangle, II -omotrapezoid triangle, III -carotid triangle,IV- omotracheal
triangle, V - submandibular triangle, VI - retromandibular fossa,
1- sternocleidomastoid m., 2-digastric m., 3- omohyoid m., 4- trapezoid m.
Fasciae of the neck

There are several classifications of the cervical fasciae. Shevkunenko’s classification the
most exactly corresponds to the surgical construction of the neck. According to this classification
we determine 5 fascial layers on the neck.
The first layer is superficial cervical fascia. It is thin and lies between the skin and
proprial fascia. It covers neck all around, and it has no borders. It contains the platysma, small
amount of fat, cutaneus nerves, blood and lymphatic vessels.
The second layer is the superficial layer of the deep cervical fasciae. It is the most
superficial layer of the deep fascia, surrounding the entire neck like a collar. Only apexes of the
spinal processes are uncovered with it.
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The fascia is thin and it is splitted into two parts to enclose the sternocleidomastoid and
trapezoid muscles, and submandibular gland forming their sheath. Superiorly this fascia attaches
to the superior nuchal line of the occipital bone, mastoid processes of the temporal bones, inferior
border of the mandible, and to the chin. Inferiorly the superficial layer of fascia attaches to the
manumbrium of the sternum and clavicles along their external surface, acromions and spines
of scapula to the spinous process of C7 vertebra and then turns to attach to transversal vertebral
processes.
On this layer the external jugular vein, branches of the cervical plexus and spinal accessory
nerve (XI pear) are situated:
The third layer is deep layer of the deep cervical fasciae, Riche’s aponeurosis.
It is limited to the anterior part of the neck. It extends inferiorly from the hyoid bone to the
manumbrium of the sternum and clavicles, to their internal surface. The lateral borders of this fascia
are omohyoid muscles because it forms the sheath for them. And it forms the sheath for the
sternohyoid, sternohyroid and thyrohyoid muscles.
The fourth layer is endocervical fascia. It consists of two layers: parietal and visceral
laminas. Parietal lamina surrounds all organs of the neck in common and forms the sheath for the
general neurovascular bundle-carotid sheath. This bundle includes the common carotid artery, the
internal jugular vein and the vagus nerve, some deep cervical lymph nodes. It communicates with
the anterior mediastinum inferiorly and parapharyngeal space and cranial cavity superiorly.
The visceral lamina encloses the thyroid gland, trachea, larynx, esophagus, and forms the
personal capsule for every organ.
The fifth layer is prevertebral fascia. It extends inferiorly from the cranial base and fuses
with the anterior longitudinal ligament and is attached to the body of the Th 3-4 thoracic vertebra.
It lies in front of the prevertebral muscles and forms the floor of the lateral triangle of the neck.
Laterally it is attached to transverse processes of the vertebra.
It covers long muscles of cervix and long muscles of the head and anterior, media and
posterior scalene muscles.
It forms the sheath for the deep neurovascular bundle, which consists of the subclavian
artery, subclavian vein and brachial plexus. This sheath is named axillary sheath because it extends
into the axilla.
The prevertebral fascia provides a fixed base for the movements of the pharynx, the
esophagus and the carotid sheath during movements of the neck and during swallowing.
14
Fig.2 Fasciae of the neck
1- superficial cervical fascia, 2- superficial layer of the deep cervical fasciae, 3- deep layer
of the deep cervical fasciae, 4- endocervical fascia, 4a- parietal layer, 4b-visceral layer, 5-
prevertebral fascia.
I –suprasternal intraaponeurotic space, II –pretracheal space, III –retropharyngeal space
Interfascial fat spaces
There are several fat spaces on the neck. They are formed by the fasciae and contain fat
tissues, vessels, nerves and organs. They are very important spaces, which defend the neck
structures. But they can serve as a place of infection localization. The fascial planes determine the
direction in which an infection in the neck may spread.
The fat spaces may be reserved and connecting.
1.Suprasternalinteraponeurotic space is formed by the second and third fascias above the
manumbrium of the sternum. It encloses the inferior angles of the anterior jugular vein, which
forms the jugular venous arch, fat and a few deep lymph nodes. In a healthy body, it is a reserved
space,but if the pathological process appears in this space, it will be connected with the neighbor
space, which is named Gruberi’s blind cervical sac (saccuscoeccusretrosternocleidomastoideus).
15
2.Grooberi’s Blind cervical sac is arranged between second and third fascias above the
clavicle, behind sternocleidomastoid muscle. It includes only various amount of fat and some lymph
nodes. It becomes connecting space only during the pathological process. The abscess spread to the
interaponeurotic space.
3.Thepretracheal space (previsceral space) is arranged between parietal and visceral
sheets of the endocervical fascia. It is extended from the hyoid bone to the manumbrium of the
sternum. It encloses the thyroid gland, the inferior thyroid veins, in childhood, it includes
brachiocephalic trunkand in 30%, it may be the lowest thyroid artery. This space is communicated
with the anterior mediastinum.
4.Theretrovisceral space is formed by the forth endocervical fascia. It extends from the
cranial base to the posterior mediastinum. It consists of two spaces: retropharyngeal-upper and
retroesophageal-lower. Both these spaces are communicated with each other and with posterior
mediastinal fat.
The retropharyngeal space is the largest and most important interfascial space on the neck
because it is the major pathway for the spread of infection. It is a connectional space that consists
of loose connective tissue.
5.The prevertebral space is formed by the prevertebral fascia and anterior surface
of vertebra. It is a tubular fascial space that extends along the superior surface of the vertebra.
It contains the fat, long muscles of the neck and long muscles of the head.
It is reserved that is why the infections extend upper and lower along the surface of the
vertebra not going out of the borders of the space.
Neck infection behind the prevertebral fascia arises usually from tuberculosis of the cervical
vertebra. It is called «the cold tuberculous abscess».
Deep intermuscular spaces
These spaces are arranged between the prevertebral fascia and deep cervical muscles:
anterior, medial and posterior scalenus muscles. There are spaces: antescalenal space and
interscalenal space.
1. Antescalenal space is a narrow cleft (fissure) between the prevertebral fascia and anterior
scalenus muscle. It contents the phrenic nerve, which is situated on the anterior surface of the
anterior scalenus muscle. The ascending cervical artery (from the thyrocervical trunk) passes near
this nerve. In the lower part of this space, the bulb and terminal part of the internal jugular vein are
situated. The terminal part of this vein is united with subclavian vein and the Pirogov’s venal angle
is formed.
16
2. Interscalenal space is arranged between medial and posterior scalenus muscle.
It contains the axillary sheath. Really, the interscalenal space is a deep layer of the omoclavicle
triangle.
TEST TASK
Choose one correct answer.
1. THE MUSCLES ARE CLASSIFIED ACCORDING TO THE SHAPE INTO

1 romboid, trapezoid, quadrate
2 oblique, transverse
3 great, small
4 biceps, triceps
2. MUSCLES HAVING CIRCULAR FIBERS ARE NAMED

1 flexors
2 extensors
3 sphincters
4 multiarticular
3. MUSCLES HAVING OPPOSITE FUNCTION ARE CALLED

1 antagonists
2 synergists
3 abductors
4 rotators
4. DEVELOPMENT OF THE FACIAL EXPRESSION MUSCLES IS FROM

1 I visceral arch
2 II visceral arch
3 III visceral arch
4 IV visceral arch
5. GROUP OF MASTICATORY MUSCLES INCLUDES

1 m.temporalis
2 m.zygomaticus minor
3 m.orbicularisoris
4 m.buccinator
6. WRINKLING OF THE FOREHEAD SKIN IS FUNCTION OF THE

1 m.temporalis
2 m.epicranial
3 m.occipitofrontal
4 m.procerus
7. DEVELOPMENT OF THE MASTICATORY MUSCLES IS FROM

1 I visceral arch
2 II visceral arch
3 III visceral arch
4 IV visceral arch
8 ONE OF THE MASTICATORY MUSCLES IS

17
1 m.buccinator
2 m.lateral pterygoid
3 m.orbicularisoris
4 m.levatorangulioris
9. LATERAL MOVEMENTS OF THE MANDIBLE ARE PROVIDED BY

1 m.medial pterygoid
2 m. lateral pterygoid
3 m.temporalis (anterior bundles)
4 m.masseteric
10. THE DUCT OF THE PAROTID GLAND PASSES THROUGH

1 m.levatorangulioris
2 m. zygomatic major
3 m.buccinator
4 m. zygomatic minor
11. SUPERFICIAL MUSCLES OF THE NECK

1 m.omohyoid, m.digastrics
2 m.platysma, m.sternocleidomastoid
3 m.platysma, m.mylohyoid
4 m.digastric, m.sternocleidomastoid
12. SUPRAHYOID GROUP OF THE NECK MUSCLES INCLUDES

1 m.sternohyoid
2 m.geniohyoid muscle
3 m.sternothyroidmuscle
4 m.omohyoid
13. INFRAHYOID MUSCLES ARE

1 anterior scalene, middle scalene, posterior scalene
2 sternohyoid, sternothyroid, thyrohyoid, omohyoid
3 stylohyoid, geniohyoid, omohyoid, thyrohyoid
4 long muscle of neck, sternohyoid, sternothyroid, digastrics
14. INFRAHYOID GROUP OF THE NECK MUSCLES INCLUDES

1 m.thyrohyoid
2 m.geniohyoid
3 m. mylohyoid
4 m.stylohyoid
15. DEEP GROUP OF THE NECK MUSCLES INCLUDES

1 m.digastric
2 m.scalene
3 m.sternocleidomastoid
4 m.sternothyroid
16. MUSCLES OF THE NECK ATTACHED TO RIBS

1 long muscle of neck, a long muscle of a head
3 digastric, long muscle of a neck
4 anterior scalene, long muscle of a neck
18
17. PREVERTEBRAL MUSCLES OF THE NECK
1 long muscle of a neck, a long muscle of a head, a anterior rectus capitis muscle, a lateral rectus
capitis muscle
3 sternocleidomastoid, long muscle of a head, long muscle of a neck
4 omohyoid, long muscle of a neck, digastric, lateral rectus capitis muscle
18. BORDERS OF THE CAROTID TRIANGLE

1 anterior and middle scalene muscles, clavicle
2 body of the mandible, anterior and posterior bellies of the digastric muscle
3 sternocleidomastoid muscle, superior belly of the omohyoid, posterior belly of the digastric
muscle
4 sternocleidomastoid muscle, inferior belly of omohyoid, a clavicle
19. BORDERS OF THE PIROGOV’S TRIANGLE

1 mylohyoid muscle, posterior belly of the digastric muscle, hypoglossal nerve
2 sternocleidomastoid, trapezoid muscles, clavicle
3 anterior bellies of the digastric muscle, hyoid bone
4 anterior and posterior bellies of the digastric muscle, mandible
20. PREVISCERAL SPACE IS CONNECTED WITH

1 retrovisceral space
2 anterior mediastinum
3 posterior mediastinum
4 suprasternal space
CLINICAL CASES:
1. The abscess is detected in the posterior wall of a pharynx in the patient after the
examination. What is the most probable way the process spreading?
2. During the examination of a facial expression the following is detected: the patient cannot
round the lips and whistle, oral fissure stretches to the sides (a transversal smile). An atrophy of
what muscle the symptoms look to?
3. 5 years old child suffers of a neck deformation. The following symptoms were detected
during the clinical examination: the evident inclination of a head to the left, turning of the face to
the right,
passive movements of a head to the right are limited. What muscle shortening takes place?
4. The patient cannot lift the lowered mandible. What muscles cannot perform the function?
5. The patient W., 37 years old, had the cough and then the asphyxia as a result a foreign
body in respiratory tract. The tracheotomy was performed in a region of a neck bounded by the
superior belly of omohyoid muscle sternocleidomastoid muscle and a median line of a neck. What
is the triangle of a neck where the surgery was carried out?
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MUSCLES OF THE BACK. CHEST AND ABDOMINAL MUSCLES.
INGUINAL CANAL.DIAPHRAGM.
Muscles of the back: superficial and deep, their characteristic (the origin, insertion,
function). Classification of muscles of the chest on topography and developmental origin. Muscles
of thoracic cage: superficial, deep, their characteristic. Thoracic fascia: an endothoracic fascia.
Clavipectoral fascia. Diaphragm: structure, function, foramens (their contents),
triangles.Diaphragmatic hernias concept.The muscles of abdomen: muscles of the anterior, lateral
and posterior abdominal walls, their characteristics. The rectus abdominis muscle sheath. The
fascias of abdomen.Topography of abdomen regions. The white line.Theumbilicalring.The inguinal
canal (orifices, walls, content, age and sex differences.Concept of umbilical and inguinal hernias.
Actuality
Muscles of the back have various developmental origin (autochthonous, visceral,

trunkopetal), are arranged in 2 layers (superficial and deep) and carry out various functions: 1)
cause to move bones of shoulder girdle and upper extremity; 2) move the trunk to fixed lower
limbs; 3) provide movement of vertebral column and head; 4) take part in respiration. They are
surrounded with fascias, and deep muscles are incorporated in the closed osteofibrous sheath.
Therefore the knowledge of back muscles is necessary for traumatologists, surgeons and doctors of
other specialities for correct and complete treatment of patients.
Muscles of the chest are divided on superficial and deep, thus performing various functions.
The basic functions of superficial muscles of the chest are influences on shoulder joint directly (the
major pectoral muscle) or indirectly through bones of shoulder girdle (a minor pectoral muscle),
and participation in forced inspiration (the major and minor pectoral muscles, anterior serratus and
subclavial). Autochthonous muscles are only respiratory muscles.
Diaphragm formed by the thin muscular plate carries out only respiratory function, actively
working in abdominal type of breathing.
20
The knowledge of muscles of these groups is necessary for correct comprehension of
biomechanics of joints of shoulder girdle, and also for comprehension of briefing act (slow and
forced) and are used in clinic by doctors of various specialities.
The abdomen muscles occupy the space between lower circumference of chest and upper
pelvic brim, forming the walls of pelvic cavity. They are devoted to autochthonic ventral muscles of
this region and perform various functions: provide movements in the lumbar region, participate in
breath action, form the abdominal pressure, thus participating in fixing the organs of abdominal
cavity, in defecation, micturition (urination) and parturition (childbirth).
The lateral abdomen muscles end with broad aponeurosis which move to median line
towards each other and form the so called white line which is poor with blood vessels. That feature
is used in surgery for the broad opening of abdominal cavity. The aponeurosis of lateral abdominal
muscles form the sheath for the rectus abdominis muscle, thus strengthening the anterior abdominal
wall. The lower edges of the lateral abdominal muscles and the ending of the external oblique
abdominal muscle form the passage that was called the inguinal canal. Normally, it is filled with the
spermatic cord which ends farther with a testicle in males and the round ligament of the uterus in
female. In pathologic cases the straight and oblique hernias exit through the deep and superficial
inguinal rings.
Knowledge of this topic is useful studying the course in topographic anatomy, in surgery
and therapeutic clinic for successful patients’ treatment.
Control questions:
1. General description of the back muscles, their division into layers and groups
2. Superficial muscles of the back(latissimus dorsi, trapezius, levator scapulae,
rhomboids,serratus posterior superior, serratus posterior inferior), their origin, insertion,
function.
3. Deep muscles of the back: the splenius (splenius capitis, splenius cervicis), erector spinae (its
parts -iliocostalis, longissimus, spinalis), transversospinalis group (multifidus, rotators,
semispinalis, rectus capitis posterior major, rectus capitis posterior minor, obliquus capitis
superior, obliquus capitis inferior),origin, insertion, function.
4. General characteristic of the chest muscles. Division into groups.
5. Superficial chest muscles (the pectoralis major,pectoralis minor, serratus anterior and
subclavius). Their origin, insertion, function.
6. Deep chest muscles (external intercostals, internal intercostals, transversus thoracis), their origin,
insertion, function.
7. Diaphragm: parts, openings, functions.
21
8. Muscles of the respiration, their functions.
9. General description of the muscles of the abdominal wall, anterior, posterior and lateral groups.
10. Lateral group – wide abdominal muscles (external oblique, internal oblique and transversus
abdominis), their origin, insertion, function.
11.Anterior group – rectus abdominis, pyramidalis.Origin, insertion, function.
12. Posterior group - quadratus lumborum.Origin, insertion, function.
13. Linea alba of the abdomen, its practical value in surgery.
14. Rectus sheath. Features of its structure above and below the umbilical ring.
15. Inguinal canal, its walls, rings,contents in the male and female body.
16. Abdominal regions.

2. The cadaver with the prefilled muscles of the back, chest and abdomen
3. Set of the tables «Musles of the back «Musles of the chest and abdomen»
4. Model of the diaphragm

 classification of back muscles on development;
 classification of back muscles on location and shape;
 back muscles: their name, origin, insertion, functions;
 fascia of the back;
 chest muscles attaching to bones of upper limb: their structure and function;
 proper chest muscles: origin, insertion, functions;
 fascia of the thorax;
 structure and function of diaphragm.
 abdominal muscles characteristics according to the standard scheme;
 the white line structure, the inguinal ring, the rectus abdominis muscle sheath;
 the formation, contents and structure of the inguinal canal and it’s orifices;
 folds and weak places of peritoneum on the internal surface of the anterior abdominal wall.
1. Superficial muscles of the back

 latissimus dorsi
 trapezius
22
 levator scapulae
 rhomboids
 serratus posterior superior
 serratus posterior inferior
2. Deep muscles of the back
o splenius
 splenius capitis
 splenius cervicis
o erector spinae
 iliocostalis,
 longissimus
 spinalis
o transversospinalis group
 multifidus
 rotators
 semispinalis
 rectus capitis posterior major
 rectus capitis posterior minor
 obliquus capitis superior
 obliquus capitis inferior
3. Chest muscles attaching to bones of upper limb
 pectoralis major
 pectoralis minor
 serratus anterior
 subclavius
4. Proper chest muscles
 external intercostal
 internal intercostal
 transversus thoracis
 subcostales
5. Diaphragm
 central tendon
 lumbar part
 right crus and left crus
23
 aortic hiatus
 esophageal hiatus
 costal part
 sternal part
 sternocostal triangle
 lumbocostal triangle
 caval opening
6. Abdominal muscles
o lateral group
 external oblique
 internal oblique
 transversus abdominis
o anterior group
 rectus abdominis,
 pyramidalis
o posterior group
 quadratus lumborum
7. Inguinal canal
8. Linea alba of the abdomen
9. Umbilical folds and fossae
 lateral umbilical fold
 medial umbilical fold
 median umbilical fold
 medial inguinal fossa
 lateral inguinal fossa
 supravesical inguinal fossa
TOPOGRAPHY OF THE ABDOMEN
The linea alba

The linea alba (Latin, white line) is a fibrous structure that runs down the midline of the
abdomen in humans and other vertebrates. In humans linea alba runs from the xiphoid process
to the pubic symphysis. The name means white line and the linea alba is indeed white, being
composed mostly of collagen connective tissue.
24
It is formed by the fusion of the aponeuroses of the abdominal muscles, and it separates the
left and right rectus abdominis muscles. In muscular individuals its presence can be seen on the
skin, forming the depression between the left and right halves of a "six pack." Just below the
middle of the linea alba is an opening called the umbilical ring where the umbilical cord entered
the fetus.
Because it consists of mostly connective tissue, and doesn't contain any primary nerves or
blood vessels, a median incision through the linea alba is a common surgical approach.
The alba line has various structure above and below an umbilical ring. It is wide and thin
above umbilical ring and it is narrow and thick-below umbilical ring. That’s why hernia of the
line alba is more frequent above ring (Fig.3)
Fig.3 Linea alba of the anterior abdominal wall
The rectus sheath

The rectus sheath encloses the rectus abdominis and pyramidalis muscles and forms an
important component of the anterior abdominal wall.
The rectus sheath is composed of the aponeuroses of transversus abdominis, external
oblique and internal oblique muscles, which form anterior and posterior layers of the sheath that
fuse laterally at the linea semilunaris and in the midline at the linea alba.
Only the middle segment of the rectus abdominis is completely enclosed. The anterior layer passes
anterior to the rectus abdominis and is formed by the fusion of the external oblique and anterior
layer of the internal oblique aponeuroses. The posterior layer passes posterior to the rectus
abdominis and is formed by the fusion of the posterior layer of the internal oblique and transversus
aponeuroses. The posterior sheath is lacking in parts of the above and below this middle segment:
 superior to the costal margin the aponeuroses are deficient because they either do not extend
that far superiorly (internal and external oblique muscles) or attach to the costal margin
(transversus abdominis)
25
 inferior to the arcuate line, the internal oblique aponeurosis passes anterior to the rectus
abdominis and since the other two aponeurosis are fused to it, the posterior surface of rectus
abdominis is in contact with the transversalis fascia
Fig.4 Rectus sheath

A-above arcuate line. B-below arcuate line.
1-transverse fascia, 2 (2a) - aponeurosis of the transverse abdominal muscle, 3 (3a)-
aponeurosis of the internal oblique muscle, 4 (4a) - aponeurosis of the external oblique
muscle, 5-rectus muscle, 6-peritoneum
Inguinal canal
The inguinal canal is a passage in the anterior (toward the front of the body) abdominal
wall which contains the spermatic cord in men and the round ligament in women. The inguinal
canal is larger and more prominent in men. This canal is present in normal, as a men, as a
women.
Each person has two canals: on the left and right sides of the abdomen.
The inguinal canal is situated just above the medial half of the inguinal ligament. The canal
is approximately 3,5 to 4 cm long, angled anteroinferiorly and medially. It is superior and parallel to
the inguinal ligament.
Canal has 4 walls:

The anterior wall is formed by the aponeurosis of the external oblique muscle of abdomen.
The posterior wall is formed by the transversalis fascia.
The roof is formed by the transversalis fascia, internal oblique and transversus abdominis muscles.
26
The floor is formed by the inguinal ligament and thickened medially by the lacunar ligament.
The two openings to the inguinal canal are known as rings.
- The deep (internal) ring is found above the midpoint of the inguinal ligament, which is
situated laterally to the epigastric vessels. The ring is created by the transversalis fascia, which
invaginates to form a covering of the contents of the inguinal canal.
- The superficial (external) ring marks the end of the inguinal canal, and lies just superior to
the pubic tubercle. It is a triangle shaped opening, formed by the invagination of the aponeurosis of
the abdomenexternal oblique muscle, which forms another covering of the inguinal canal contents.
This opening contains intercruralfibres, which run perpendicular to the aponeurosis of the external
oblique muscle and prevent the ring from widening.
The inguinal canal acts as a pathway by which structures can pass from the abdominal wall
to the external genitalia. The inguinal canal also has clinical importance. It is a potential weakness
in the abdominal wall, and therefore a common site of herniation.
During development, the testes establish in the posterior abdominal wall, and descend into
the scrotum. A fibrous cord of tissue called the gubernaculum attaches the inferior portion of the
gonad to the future scrotum, and guides them during their descent.
The inguinal canal is the pathway by which the testes are able to leave the abdominal cavity
and enter the scrotum. In the embryological stage, the canal is flanked by an outpocketing of the
peritoneum, and the abdominal musculature. This outpocketing, the processus vaginalis, normally
degenerates, but a failure to do so can result in an indirect inguinal hernia.
In women, there is also a gubernaculum, this attaches the ovaries to the uterus and future
labia majora. Because the ovaries are attached to the uterus by the gubernaculum, they are
prevented from descending as far as the testes, instead moving into the pelvic cavity. The
gubernaculum then becomes the ovarian ligament, and round ligament of uterus.
Clinical significance
Abdominal contents (potentially including intestine) can be abnormally displaced from the
abdominal cavity. Where these contents exit through the inguinal canal the condition is known as an
indirect or oblique inguinal hernia. This can also cause infertility. This condition is far more
common in men than in women, owing to the inguinal canal's small size in women.

27
 canal
Fig.5 Inguinal
TEST TASK
1. MUSCLES OF THE BACK CAN BE DIVIDED INTO

1 superior and inferior
2 anterior and posterior
3 superficial and deep
4 external and internal
2. ONE OF THE SUPERFICIAL MUSCLES OF THE BACK IS

1 m. splenius cervicis
2 lateral tract
3 m.latissimusdorsi
4 medial tract
3. ONE OF THE DEEP MUSCLES OF THE BACK IS

1 medial tract
2 m. levator scapulae
3 m.rhomboid major
4 m.trapezius
4. SUPERFICIAL MUSCLES OF THE BACK ATTACHED TO THE SHOULDER GIRDLE

AND BRACHIUM
1 trapezoid, rhomboid, inferior posterior serratus muscle
2 trapezoid, latissimus dorsi, spinal muscle
3 superior posterior serratus muscle, inferior posterior serratus muscle
4 trapezoid, latissimus dorsi, rhomboid, levator scapula
5. PARTS OF THE ERECTOR SPINAE MUSCLE ARE

1 iliocostal muscle, longissimus muscle, spinalis muscle
2 multifidi muscle, splenius muscle of head, suboccipital muscle
28
3 iliocostal muscle, multifidi muscle, spinalis muscle
4 semispinal muscle, longissimus muscle, spinalis muscle
6. MAIN RESPIRATORY MUSCLES INCLUDE

1 m.pectoralis minor
2 m.pectoralis major
3 external intercostal muscles
4 m. serratus anterior
7. DEEP (PROPER) MUSCLES OF THE CHEST

1 external intercostal, subclavian, internal intercostal muscles
2 anterior serratus, internal intercostal, subcostal, lesser pectoral muscles
3 transverse muscle of thorax, subclavian, levator costae muscles
4 external intercostal, internal intercostal, subcostal, transverse muscle of a thorax
8. PARTS OF THE DIAPHRAGM

1 thoracic and abdominal
2 vertebral and costal
3 sternal, costal and lumbar
4 right and left
9. «WEAK» POINT OF THE DIAPHRAGM IS

1 caval opening
2 aortic hiatus
3 esophageal hiatus
4 central tendon
10. THE FOLLOWING APONEUROSIS DOESN’T TAKE PART IN THE FORMATION OF

THE LINEA ALBA
1 aponeurosis of the rectus abdominis muscle
2 aponeurosis of the m.external oblique
3 aponeurosis of the m.internal oblique
4 aponeurosis of the m. transversus abdominis
11. INGUINAL LIGAMENT IS:

1 aponeurosis of the external oblique muscle
2 aponeurosis of the internal oblique muscle
3 aponeurosis of the transverse muscle
4 transverse fascia
12. POSTERIOR WALL OF THE RECTUS ABDOMINIS MUSCLE SHEATH SUPERIORLY

TO THE NAVEL IS:
1 aponeurosis of external oblique abdominis muscle
2 aponeurosis of internal oblique muscle, transverse fascia
3 aponeurosis of transverse abdominal muscle, internal layer of aponeurosis of internal oblique
muscle
4 internal layer of internal oblique muscle
13. POSTERIOR WALL OF THE RECTUS ABDOMINIS MUSCLE SHEATH INFERIORLY

TO THE NAVEL:
1 internal layer of internal oblique muscle
2 aponeurosis of transverse muscle, aponeurosis of internal oblique muscle
29
3 aponeurosis of internal oblique muscle
4 transverse fascia
14. SUPERIOR WALL OF THE INGUINAL CANAL IS FORMED BY:

2 inferior margins of the m. internal oblique and m.transversus abdominis
3 transverse fascia
4 inguinal ligament
15. ANTERIOR WALL OF THE INGUINAL CANAL IS:

3 transverse fascia
4 inguinal ligament
16. POSTERIOR WALL OF THE INGUINAL CANAL IS:

3 transverse fascia
4 inguinal ligament
17. INFERIOR WALL OF THE INGUINAL CANAL IS FORMED BY:

1 the aponeurosis of the external oblique abdominal muscles
2 the lower edge of the internal oblique and transverse abdominal muscles
3 transverse fascia
4 inguinal ligament
18. INGUINAL CANAL CONTAINS IN MALES:

1 femoral artery
2 obturator nerve
3 spermatic cord
4 inguinal ligament
19. INGUINAL CANAL CONTAINS IN FEMALES:

1 round ligament of the uterus
2 uterine artery
3 inguinal ligament
4 obturator nerve
20. MEDIAL UMBILICAL FOLD IS FORMED BY:

1 urachus
2 inferior epigastric artery
3 umbilical artery
4 umbilical vein
CLINICAL CASES:
1. The revision of an abdominal cavity is necessary. The surgeon will perform the operative
approach trough the anterior abdominal wall. In what part of an abdominal wall the most bloodless
approach is possible to perform?
30
2. The effects of paralysis of some muscles of a back have developed after a cerebral stroke
in a patient. Thus the function of extension of vertebral column in the lumbar part was broken.
What muscle have suffered after a cerebral stroke?
3. The diagnosis of diaphragmatic hernia has been put to the patient. What are the weak
spots distinguished in a diaphragm?
4.What is the sequence of anterior abdominal wall muscles layers opened during the
approach for appendectomy?

MUSCLES AND TOPOGRAPHY OF THE UPPER LIMB
Muscles of the upper limb, their classification. The muscles of shoulder girdle, their
classification, description. The arm, the forearm, the hand muscles, their classification,
description.Fascia of the upper limb.The axillary fossa and cavity, its topography, triangles,
foramen tri- and quadrilaterum.Fissures on the anterior surface of forearm. Bony-fibrous canals,
flexor and extensor retinaculums. Wrist canals, synovial sheaths of the flexor tendons.Synovial
bursa.
Actuality
Muscles of the arm and the forearm affect the joints of the upper limbs, providing
functioning as organ of labor. Muscles of the arm are located on the anterior and posterior surface
of the arm, insert onto the bones of forearm, and affect the elbow joint, making movements around
frontal axis. Forearm muscles are also divided into twogrous - anterior and posterior, flexing and
extensing hand and digits, pronating and supinating hand. Fascias of the arm and forearm provide
isolation of anterior and posterior groups of muscles, localizing to some extend the pathologic
process spreading when the latter appears. Hand muscles are located on the palmar surface of hand
between carpal bones. They are short, insert to proximal digital falangs, and provide delicate
movements of fingers, that is very useful in human’s everyday work. Between the muscles of the
pectoral girdle and upper limb the holes, canals and fissures exist for the blood vessels and nerves
passage. Besides, muscles of the pectoral girdle and upper limb form the walls of axillary and
cubital fossa. Fascias surround every muscle separately and group of muscles in general, isolating
with septals anterior and posterior surfaces. Besides, the fascia of forearm thickens in its distal part,
31
pass above the bones of forearm posteriorly and carpal bones anteriorly and form bony-fibrous
canal in the wrist region for vessels and synovial sheaths of forearm muscle tendons.
Thus, knowledge of fasciasand topography of the upper limb is necessary for course in
topographic anatomy and traumatology for prevention of purulent processes spreading.
Control questions:
1.Muscles of the shoulder girdle - posterior group (deltoid, supraspinatus infraspinatus, teres minor,
teres major, subscapularis). Origin, insertion, functionof each muscle.
2. Muscles of the shoulder girdle -anterior group (coracobrachialis,pectoralismajor,pectoralis
minor). Tell about origin, insertion, function of each muscle.
3. Muscles of the anterior (biceps brachii, brachialis) and posterior (triceps brachii, anconeus)
groups of the arm; their origin, insertion and function.
4. Muscles of the 1-st surface layer of the anterior forearm (pronatorteres, flexor carpi radialis,
palmaris longus, flexor carpi ulnaris), their origin, insertion function.
5. Muscle of the 2-nd layer of the anterior forearm (flexor digitorumsuperficialis), its origin,
insertion function.
6. Muscles of the 3-d layer of the anterior forearm (flexor digitorumprofundus,flexorpollicis
longus), their origin, insertion function.
7. Muscle of the 4-th layer of the anterior forearm (pronator quadratus), its origin, insertion
function.
8. Muscles of the superficial layer of the posterior forearm (brachioradialis, extensor carpiradialis
longus, extensor carpi radialis brevis, extensor digitorum, extensor digitiminimi, extensor carpi
ulnaris), their origin, insertion function.
9. Muscles of the deep layer of the posterior forearm (supinator, abductor pollicis longus, extensor
pollicis brevis, extensor pollicis longus, extensorindicis), their origin, insertion function.
10. Muscles of the thenar group of the hand (abductor pollicis brevis, flexor pollicis brevis,
opponenspollicis, adductor pollicis, their origin, insertion function.
11. Hypothenar group of the hand (palmaris brevis, abductor digitiminimi, flexor digitiminimi
brevis, opponensdigitiminimi), their origin, insertion function.
12. Midpalmar group of the hand (lumbricals, dorsal interossei, palmar interossei), their origin,
insertion function.
13.Fasciae of the upper limb.
14.Axillary fossa and cavity, its topography, triangles, foramen tri- and quadrilaterum.
15.Topography of the arm: the medial bicipital and lateral bicipital grooves humeromuscularis
(canalis spiralis) canal, their contents.
32
16. Topography of the cubital fossa and grooves of the forearm.
17. Anatomic snuffbox
18. Bony-fibrous canals, flexor and extensor retinaculums.
19.Synovial sheaths of the flexor tendons. Synovial bursa.

2. Bones of upper limb
3. The cadaver with the prefilled muscles of the upper limb
4. The model of shoulder girdle muscles

 classification of shoulder girdle muscles;
 classification of arm and forearm muscles;
 description of arm and forearm muscles (name, origin, insertion, function);
 classification of hand muscles;
 hand muscles: name, origin, insertion, function;
 fascias of the upper limb, their structure, peculiarities;
 axillary and cubital fossas, their content;
 grooves and canals of the upper limb.

1. Muscles of the shoulder girdle - posterior group
 deltoid
 supraspinatus
 infraspinatus
 teres minor
 teres major
 subscapularis
2.Muscles of the shoulder girdle - anterior group
 coracobrachialis
 pectoralis major
 pectoralis minor
3.Muscles of the anterior group of the arm;
33
 biceps brachii
 brachialis
4.Muscles of the posterior group of the arm;
 triceps brachii
 anconeus
5.Muscles of the 1-st surface layer of the anterior forearm
 pronator teres
 flexor carpi radialis
 palmaris longus
 flexor carpi ulnaris
6.Muscle of the 2-nd layer of the anterior forearm
 flexor digitorum superficialis
7.Muscles of the 3-d layer of the anterior forearm
 flexor digitorum profundus
 flexor pollicis longus
8.Muscle of the 4-th layer of the anterior forearm
 pronator quadratus
9.Muscles of the superficial layer of the posterior forearm
 brachioradialis
 extensor carpi radialis longus
 extensor carpi radialis brevis
 extensor digitorum
 extensor digitiminimi
 extensor carpi ulnaris
10. Muscles of the deep layer of the posterior forearm
 supinator
 abductor pollicis longus
 extensor pollicis brevis
 extensor pollicis longus
 extensor indicis
11.Muscles of the thenar group of the hand
 abductor pollicis brevis
 flexor pollicis brevis
 opponens pollicis
34
 adductor pollicis
12. Hypothenar group of the hand
 palmaris brevis
 abductor digiti minimi
 flexor digiti minimi brevis
 opponens digiti minimi
13.Midpalmar group of the hand
 lumbricals
 dorsal interossei (4)
 palmar interosse (3)
14.Fasciae, bony-fibrous canals, retinaculums, synovial sheaths of the upper limb
 deltoid fascia
 brachial fascia and its septa
 antebrachial fasciaits septa
 extensor retinaculum
 6 bony-fibrous canals of dorsal muscles
 palmar aponeurosis
 flexor retinaculum
 3 canals under flexor retinaculum
15.Topography of the upper limb
 axillary fossa
 axillary cavity, its walls
 triangles (clavipectoral, pectoral, subpectoral)
 foramen tri- and quadrilaterum
 the medial bicipital and lateral bicipital grooves
 humeromuscular (spiral) canal
 cubital fossa
 radial groove of the forearm
 median groove of the forearm
 ulnar groove of the forearm
 anatomic snuffbox

1. Scheme of axillary cavity
35
2. Scheme of synovial sheaths of the palm
TOPOGRAPHY OF THE PECTORAL GIRDLE AND UPPER LIMB
1) The axillary fossa (axilla, armpit) is a concave fossa of skin under the shoulder joint. It
containes nerves, axillary blood vessels, and a lot of adipose tissue and lymph nodes.
If the fascia together with the skin is removed, we have an axillary cavity. It has a pyramidal
between the upper part of the chest wall and the medial side of the arm.
The axilla has the apeх, base and 4 walls.
The anterior wall is formed by the major pectoralis, minor pectoralis and clavipectoral
fascia.
The posterior wall consists of the subscapularis m. superiorly and the major teres m. with the
latissimus dorsi m. iferiorly.
The medial wall is formed by the first four ribs with their corresponding intercostal muscles
and the upper part of the serratus anterior m..
The lateral wall is formed by the intertubercular groove of the humerus, the two heads of
biceps m. and the coracobrachialis m.
The anterior wall of the axillary cavity is traditionally divided into three triangles:
- The upper triangle – clavipectoral trigonum– is formed by the clavicle and the superior
border of the smaller pectoral muscle m.
- The middle triangle – pectoral trigonum– corresponds to the smaller pectoral muscle.
- The lower triangle – subpectoral trigonum – is bounded by the inferior border of the
smaller pectoral muscle, the inferior border of the greater pectoral muscle and the deltoid
muscle.
On the posterior wall of the axillary cavity:
The triangular space is formed by the surgical neck of the humerus (laterally), the major teres
muscle (inferiorly) and the subscapular muscle (superiorly). This space is divided into two
openings (foramina) vertically by the long head of the triceps m.
Quadrangular foramen (lateral) is formed by the subscapularis, the major teres m., humerus
and the long head of triceps m. It transmits the axillary nerve and the posterior humeral circumflex
vessels.
Triangular foramen (medial) is formed by the subscapularis m., the major teres and the long
head of triceps m. It transmits the circumflex scapular vessels.
36
Fig.6 Posterior wall of the axillary cavity
2) The medial bicipital and lateral bicipital grooves are located on the anterior surface of
the arm, limited by shoulder flexors and extensors mm. The brachial artery and the median nerve
are in the medial groove. The medial groove has a clinical value because the brachial artery
becomes subcutaneous along the medial groove, and its pulse may be detected there. This region is
clinically important in measuring blood pressure.
3) The humeromuscular (spiral) canal on the posterior surface of the upper third of the
shoulder for the passage of deep brachial artery and radial nerve.
4) The cubital fossa on the anterior surface of the elbow joint. It is a shallow depression on
the anterior surface of the elbow region. It is bounded superiorly by the humeral epicondyles,
medially by the lateral border of the pronator teres m. and laterally by the medial border of the
brachioradialis m. The floor of the cubital fossa is formed by the brachial muscle. It contains the
median cubital v., which is used as a place for phlebotomy. The cubital fossa is a usual place for
venipuncture (removal of blood from a vein).
5) Three grooves between the forearm muscles on the anterior surface of the forearm:
 the medial, ulnar groove, lies between brachioradialis m.(laterally) and flexor carpi ulnaris
m. (medially). The ulnar nerve, artery and veins pass through it.
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 The lateral, radial groove, lies between brachioradialis m. (laterally) and flexor carpi
radialis m. (medially). It is for passage of the radial nerve, artery and veins.
 The median groove lies between the flexor carpi radialis m. (laterally) and flexor digitorum
superficial m. It is for passage of the median nerve.
6) Anatomical snuffbox. It has triangular shape. The tendons of the extensor pollicis brevis,
abductor pollicis longus and extensor pollicis longus muscles form its boundaries. It is place for
palpation of the radial artery pulse.
7) Three canals in the region of the wrist joint. They are formed by the retinaculum
flexorum m. The carpal bones form the arch which is convex on the dorsal side of the hand and
concave on the palmar side. The groove on the palmar side, the carpal groove, is covered by the
flexor retinaculum, a sheath of tough connective tissue, thus forming the carpal tunnel. The flexor
retinaculum is attached radially to the scaphoid tubercle and the ridge of trapezium and to the
pisiform and hook of hamate on the ulnar side. Then the flexor retinaculum separate to the ulnar and
radial sides and form the radial carpal canal, the ulnar carpal canal (Guyon’s canal) and the
carpal tunnel:
 The ulnar nerves and vessels pass through the ulnar carpal canal
 The tendon of the flexor carpi radialis muscle lies in the radial carpal canal.
 The median nerve and nine flexor tendons pass through the carpal tunnel:
-flexor digitorum profundus m. (four tendons)
-flexor digitorum superficialis m. (four tendons)
-flexor pollicis longus m. (one tendon)
The median nerve may be compressed in this location resulting in carpal tunnel
syndrome.
8) Two synovial sheaths in the carpal canal:
1- the common synovial sheath of the flexor tendons, for the tendons of flexor digitorum
profundus m. and flexor digitorum superficialis m. It is a large sac. Superiorly, it protrudes 1-2 cm
proximally of the flexor retinaculum, inferiorly – to the middle of the palm. The sheath is continued
on the tendon of the flexor digiti minimi longus m. before the base of its distal phalanx.
2- the synovial sheath of the flexor pollicis longus m. - for the tendon of flexor pollicis longus m.
This long narrow canal superiorly also protrudes 1-2cm proximally of the flexor retinaculum,
inferiorly it extends to the distal phalanx of the pollicis.
The remaining three fingers have separated synovial sheaths, which is extended from the
metacarpophalangeal joints to the base of the distal phalanges.
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N.B! Similar structure of the synovial sheaths of flexor tendons on a wrist has a great clinical
value because the inflammation can be extended from the wrist to the forearm through these
synovial sheaths of the first and fifth fingers.
Fig.7. Synovial sheaths of flexor tendons of the wrist
TEST TASK
1. MUSCLES OF THE SHOULDER GIRDLE ARE

1 brachial, biceps, triceps, coracobrachial, anconeus
2 deltoid, supraspinatus, infraspinatus, subscapular, teres major
3 subclavian, anterior serratus muscle, pectoral
4 trapezoid, rhomboid, serratus, levator scapula muscle
2. THE DELTOID MUSCLE ORIGINATES FROM

1 coracoid process of a scapula, clavicle
2 superior angle of a scapula, spine of scapula
3 lateral third of the clavicle, acromion and spine of scapula
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4 coracoid process and acromion of scapula
3. FUNCTIONS OF THE DELTOID MUSCLE

1 flexion, extension and abduction of the arm
2 flexion, pronation and supination of the arm
3 extension and supination of the forearm
4 adduction and rotation of the hand
4. THE CANAL OF THE RADIAL NERVE IS LOCATED

1 on the anterior surface of the forearm between flexor carpi radialis muscle and flexor digitorum
superficialis muscle
2 on the anterior surface of the humerus, between biceps and brachial muscles
3 on the anterior surface of the forearm between a brachioradial muscle and flexor carpi radialis
muscle
4 on the posterior surface of the humerus, between the bone and the triceps muscle
5. ANTERIOR WALL OF AN AXILLARY FOSSA IS FORMED BY

1 m.anterior serratus
2 m.deltoid
3 biceps and coracobrachial muscles
4 major and minor pectoral muscles
6. POSTERIOR WALL OF THE AXILLARY FOSSA IS FORMED BY

1 latissimus dorsi, teres major and minor muscles
2 longissimus muscle of a back, rhomboid muscles
3 triceps and coracobrachial muscles
4 biceps and coracobrachial muscles
7. LATERAL BOUNDARY OF THE QUADRILATERUM FORAMEN IS

1 surgical neck of the humerus
2 m.teres minor
3 m.pectoralis major
4 long head of the m. triceps
8. INFERIOR BOUNDARY OF THE QUADRILATERUM FORAMEN IS

1 long head of the m.tricepsbrachii
2 m.latissimusdorsi
3 m. subscapularis
4 m.teres major
9. SUPERIOR BORDER OF THE TRILATERUM FORAMEN IS

1 m. subscapularis
2 m.teres major
3 long head of the m.tricepsbrachii
4 surgical neck of the humerus
10. TENDON OF THIS MUSCLE PASSES THROUGH THE SHOULDER JOINT

1 triceps brachii muscle
2 long head of the biceps brachii muscle
3 brachialis muscle
4 long head of the triceps brachii muscle
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11. ANTERIOR GROUP OF THE ARM MUSCLES INCLUDES
1 m. biceps brachii
2 m.tricepsbrachii
3 m. anconeus
4 m. deltoid
12.POSTERIOR GROUP OF THE ARM MUSCLES INCLUDES

1 m.subscapularis
2 m.bicepsbrachii
3 m.coracobrachialis
4 m.anconeus
13. CANAL OF THE ARM IS

1 median
2 humeromuscular
3 ulnar
4 middle
14. IN THE FORMATION OF THE SPIRAL CANAL ( CANAL OF RADIAL NERVE) IS

INVOLVED
1 m.brachialis
2 m. anconeus
3 m. triceps brachii
4 m.bicepsbrachii
15. ANTERIOR GROUP OF THE FOREARM MUSCLES

1 m. flexor pollicis brevis
2 m. extensor carpi radialis
3 m. flexor digitorumsuperficialis
4 m.supinator
16. POSTERIOR GROUP OF THE FOREARM MUSCLES INCLUDES

1 m. palmaris longus
2 m. extensor digitorum
3 m. flexor pollicis longus
4 m. pronator teres
17. FUNCTIONS OF THE LUMBRICAL MUSCLES OF THE HAND

1 adduction of the fingers to the midline of a palm
2 abduction of fingers from the midline
3 flexion of proximal and extension of distal and middle phalanges of fingers (except for thumb)
4 tense the palmar aponeurosis
18. BOUNDARIES OF THE RADIAL SULCUS OF THE FOREARM

1 brachioradial muscle, flexor carpi radialis
2 flexor carpi radialis, flexor digitorumsuperficialis
3. brachioradial muscle, brachial muscle
4 pronator teres, brachial muscle
19. BOUNDARIES OF THE MEDIAN SULCUS OF THE FOREARM

1 flexor digitorumsuperficialis, flexor carpi ulnaris
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2 flexor carpi radialis, flexor digitorumsuperficialis
3 flexor carpi radialis, brachioradial muscle
4 brachioradial muscle
20. MUSCLES OF THE THENAR ARE

1 m.palmaris brevis
2 mm. lumbricals
3 m. flexor pollicis brevis
4 mm. dorsal interossei
CLINICAL CASES:
1. The patient cannot abduct the upper limb. What muscle does not carry out the function?
2. The victim has an open fracture of the forearm bones because of falling. The anterior group
muscles of a forearm are damaged by the bone splinters. What disturbances will arise in the
functions of a radiocarpal joint because of breaking the group of muscles function?
3. The function of posterior group of muscles of the upper arm was broken in the victim as a result
of a trauma. What disturbances will arise in the functions of an elbow joint?
4. The patient cannot extend the arm in an elbow joint after a trauma. What basic muscle function
disturbance can cause it?

MUSCLES AND TOPOGRAPHY OF THE PELVIS AND LOWER LIMB

Muscles of pelvis and lower limb, classification and characteristics. Fascias of lower
extremity. Lacuna vasorum and musculorum, their topography and content. Femoral triangle.
Hiatus saphenus. Femoral canal (walls, rings, content). Femoral hernia. The grooves on the anterior
surface of thigh. Canalis abductorius. The popliteal fossa. The leg canals: cruropoliteal, superior
and inferior musculo-peroneus canals. The extensors and flexors retinaculums, fibular muscles
retinaculums.Synovial bursa and synovial sheaths of lower limb muscles.
Actuality
The muscles of the lower limb include the muscles of the lower limb girdle (pelvic), and
free lower limb (thigh, leg and foot). There’s no special muscles of the pelvic girdle, because it’s
fixed immobile. Muscles of the hip region pass from pelvic girdle to femur and provide movements
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in hip joint around all its three axis, that’s why they are located from three sides and fulfill all kinds
of movements.
Muscles of thigh participate in straight gait and maintenance of posture, moving long bony
levers. Muscles of the hip region and thigh affect the hip joint and knee joint so, knowledge of the
fixing points and direction of these muscles explain biomechanics of mentioned joints, that is
necessary to traumatologists to keep in mind during surgery on these areas.
Muscles of leg move the distal part of the lower extremity – foot, and fit for maintenance of
posture and straight gait. Muscles of foot are short, mostly located on the sole. Their structure and
function remind that one of the hand but they have no fine specialization and differentiation and
their main function is strengthening the plantar arches. Knowledge of their structure and points of
insertion is necessary for understanding the biomechanics of the ankle joint.
The foramens, canals and fissures for vessels passage exist between the muscles of the hip
region and moving lower extremity. The fascias covering the lower limb muscles create anatomical
peculiarities that causes the formation of the femoral canal and canals in the ankle region. These
data are necessary studying the topographic anatomy course, for surgeons operating the hip joint
and free lower limb.
Control questions:
1. Muscles of the anterior group of the pelvis (iliopsoas - psoas major, iliacus; psoas minor), origin,
2. Muscles of the posterior group of the pelvis (gluteus maximus, gluteus medius and gluteus
minimus; tensor fasciae latae, piriformis, obturator internus, gemelli superior and inferior,
quadratus femoris obturator externus).Origin, insertion, functionof each muscle.
3. Muscles of the anterior thigh (sartorius, quadriceps femoris- rectus femoris, vastus lateralis,
vastus intermedius, vastus medialis,) their origin, insertion, function.
4. Muscles of the posterior thigh (biceps femoris, semimembranosus, semitendinosus, popliteus),
their origin, insertion, function.
5. Muscles of the middle group of the thigh (pectineus, adductor brevis, adductor longus, adductor
magnus, gracilis) their origin, insertion, function.
6. Anterior group of muscles of the leg (tibialis anterior, extensor digitorum longus, peroneus
tertius, extensor hallucis longus).Origin, insertion, function.
7. Muscles of the lateral group of the leg (fibularis longus, fibularis brevis), their origin, insertion,
function.
8. Muscles of the superficial layer of the posterior group of the leg (triceps surae – gastrocnemius
and soleus; plantaris), their origin, insertion, function.
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9. Muscles of the deep layer of the posterior group of the leg (tibialis posterior, flexor digitorum
longus, flexorhallucis longus), their origin, insertion, function.
10. Muscles of the foot. Dorsal surface - extensor hallucis brevis, extensor digitorum brevis.Plantar
surface - abductor hallucis, flexor hallucis, adductor hallucis, abductor digitiminimi, flexor
digitiminimi brevis, flexor digitorum brevis, quadratus plantae, lumbricals, dorsal interossei,
plantar interossei. Tell about origin, insertion, function of each muscle.
11. Topography of the pelvic area (suprapiriforme foramen and infrapiriforme foramen,
canalisobturatorius).
12. Topography of the space under an inguinal ligament.Lacunamusculorum, lacuna vasorum,
their contents.
13. Femoral canal, practical value.
14. Topography of the anterior thigh area : femoral triangle (scarpa’s triangle), iliopectineus groove,
anterior femoralis groove, canalisadductorius(hunter's canal).
15. Popliteal fossa, boundaries, contents.
16. Cruropoliteal canal (Gruber’s canal).
17. Superior and inferior musculoperoneus canals
18. Medial and lateral plantar grooves of the foot.

2. Bones of lower limb
3. The cadaver with the prefilled muscles of the lower limb
4. The model of pelvic girdle muscles
5. Set of the tables «Musles and topography of the lower limbs»
6. The models of the inguinal and femoral canals

 classification, attachment points and functions of hip joint area muscles
 classification, anatomical peculiarities, attachment points and functions of thigh muscles
 classification of leg and foot muscles
 characteristics of leg and foot muscles
 fascias and topography of lower limb
 biomechanics of the lower limb muscles, hip joint, knee and ankle joints

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1.Muscles of the anterior group of the pelvis
 iliopsoas- psoas major, iliacus
 psoas minor
2.Muscles of the posterior group of the pelvis
 gluteus maximus
 gluteus medius
 and gluteus minimus
 tensor fasciae latae
 piriformis
 obturator internus
 gemelli superior and inferior
 quadratus femoris
 obturator externus
3.Muscles of the anterior thigh
 sartorius
 quadriceps femoris
 rectus femoris
 vastus lateralis
 vastus intermedius
 vastus medialis
4. Muscles of the posterior thigh
 biceps femoris
 semimembranosus
 semitendinosus
 popliteus
5.Muscles of the middle group of the thigh
 pectineus
 adductor brevis
 adductor longus
 adductor magnus
 gracilis
6.Anterior group of muscles of the leg
 tibialis anterior
 extensor digitorum longus
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 peroneus tertius
 extensor hallucis longus
7. Muscles of the lateral group of the leg
 fibularis longus
 fibularis brevis
8. Muscles of the superficial layer of the posterior group of the leg
 triceps surae – gastrocnemius and soleus
 plantaris
9.Muscles of the deep layer of the posterior group of the leg
 tibialis posterior
 flexor digitorum longus
 flexor hallucis longus
10.Muscles of the dorsal surface foot
 extensor hallucis brevis
 extensor digitorum brevis
11. Muscles of the plantar surface foot
 abductor hallucis
 flexor hallucis
 adductor hallucis
 abductor digitiminimi
 flexor digitiminimi brevis
 flexor digitorum brevis
 quadratus plantae
 lumbricals
 dorsal interossei
 plantar interossei
12.Topography of the pelvic area
 suprapiriforme foramen
 infrapiriforme foramen
 obturator canal
13. Topography of the space under the inguinal ligament
 lacuna musculorum
 lacuna vasorum
14. Topography of the thigh
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 femoral canal, their holes
 femoral triangle (Scarpa’s triangle)
 iliopectineus groove
 anterior femoral groove
 adductor canal (Hunter's canal)
 popliteal fossa, boundaries, contents
15. Topography of the leg
 cruropoliteal canal (Gruber’s canal)
 superior musculoperoneal canal
 inferior musculoperoneal canal
16. Topography of the foot
 medial plantar groove
 lateral plantar groove
17.Fasciae and their derivates
 iliac fascia
 superficial layer of the fascia lata
 deep layer of the fascia lata
 iliotibial tract
 superficial and deep layers of the leg fascia
 inferior and superior extensor retinaculum and their fibrous canals
 flexor retinaculum and its bony-fibrous and fibrous canals
 superior and inferior fibular retinaculums;
 plantar aponeurosis

1. Scheme of topography under inguinal ligament
TOPOGRAPHY OF THE PELVIC GIRDLE AND LOWER LIMB
The pelvis has exits on the hip region and on the gluteal area.
On the posterior surface of the pelvis: the piriform muscle passes through the greater sciatic
foramen and devides it on above and below which narrow openings – suprapiriformis foramen
and infrapiriformis foramen –passage of the gluteal vessels and nerves.
On the anterior surface:
47
1) The obturator sulcus of the pubic bone is supplemented below by the obturator
membrane and is thus converted to the canal- obturator canal - providing passage for the
obturator vessels and nerves.
2) Femoral triangle (Scarpa’s triangle).
The borders of the triangle:
superior - inguinal ligament
lateral - sartorius muscle
medial - adductor longus muscle
Its floor is formed by iliopsoas muscle (laterally) and pectineus muscle (medially), roof is
formed by fascia lata.
It contains femoral vein, femoral artery, femoral nerve (VA N - from medial side to lateral)
Fig.8 Femoral triangle

3) The space under the inguinal ligament. The inguinal ligament is the thickened, sprained
and tense border of an aponeurosis of an abdomen external oblique muscle. It stretches between the
superior anterior iliac spine and the pubic tubercle. The part of thickened band of iliac fascia
between the inguinal ligament and the iliopubic eminence is distinguished artificially as an
iliopectineal arch.
Iliopectineal arch divides the entire space below the inguinal ligament into 2 parts: a lateral –
muscular part (lacuna musculorum) and a medial – vascular part (lacuna vasorum). Muscular part
(lacuna musculorum) contains the iliopsoas muscle and the femoral nerve. Vascular part (lacuna
vasorum) contains the femoral artery (lateral position) and femoral vein (medial position). The
medial angle of this lacuna is filled with fatty tissue and contains a lymph node (Pirogov-
Rozenmuller’s node)
The vessels pass to the thigh, leg and foot from lacuna vasorum. The vessels and nerves pass
in grooves, which are converted to canals and then again opened to form grooves. According to the
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passage of the vessels and nerves, the following grooves and canals (sulci) on the lower limb are
distinguished:
 Iliopectineus groove (sulcus) lies between the iliopsoas (laterally) and the pectineal
(medially) muscles.
 Anterior femoral groove (sulcus) is formed by the vastus medialis (laterally) and the
adductor longus and magnus (medially) muscles.
Both sulci are in the femoral triangle.
4) At the inferior apex of the triangle, anterior femoral sulcus transforms into adductor canal
(Hunter's canal). This canal connects the lower third of the thigh with the popliteal fossa. It is the
musculo-fascial canal, it contains the large neurovascular bundle of the anterior thigh.
Boundaries are:
anterior– the tendinous lamina (lamina vastoadductoria);
lateral - vastus medialis m.;
medially - adductor longus m. and adductor magnus m.
Hunter's canal contains the femoral artery and vein, the saphenous nerve
5) Popliteal fossa. It has a rhomboid shape. The popliteal fossa is the shallow depression on
the posterior surface of the knee.
Boundaries are:
superomedial- tendons of semimembranosus and semitendinosus mm.,
superolateral - tendon of biceps femoris m.,
inferior - medial and lateral heads of the gastrocnemius m.
The floor of the fossa is formed by popliteal surface of the femur and the posterior wall of the
knee joint.
Popliteal fossa contains fatty tissue, popliteal lymph node, and the popliteal artery and vein,
sciatic nerve (NeVA- nerve, vein, artery, from the superficial to deep structures).
The popliteal fossa is continuous into cruropoliteus canal
6) Cruropoliteus canal (Gruber’s canal). This canal extends between the superficial and
deep layers of the posterior leg muscles and mainly is formed by the tibialis posterior (anteriorly)
and the soleus (posteriorly) muscles. It provides passage for the tibial nerve and the posterior tibial
artery and vein.
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7) Inferior musculoperoneus canal. It starts in the middle third of the leg on the lateral side
as continuation of the cruropopliteuscanal. This canal contains the peroneal artery. This canal is
limited by the flexor hallucis longus and posterior tibial muscles.
8) Superior musculoperoneus canal. It is the independent canal in the upper third of the leg.
It is located between the fibula and the peroneus longus muscle, it contains superficial peroneal
nerve.
9) Medial and lateral plantar grooves of the foot, which are situated at the edges of the
brevis flexor digitorum muscle. This grooves contain plantar vessels and nerves.
10) Femoral canal. It is not present normally, but there are anatomical prerequisites for its
emergence at femoral hernia.
The femoral sheath is the extension of transversalis and iliopsoas fascia that encloses the
proximal parts of the femoral vessels 3-4 cm inferiorly to the inguinal ligament. The sheath is
subdivided into 3 compartments: lateral (femoral artery), intermediate (femoral vein), and medial
(femoral canal, site of femoral hernias).
Femoral canal is a vertical passage of 1.25 cm long and 1.25 cm wide that travels from
femoral ring above to the saphenous opening below and occupies the most medial (inside)
compartment of the femoral sheath (A band of fibrous tissue located in the upper thigh, through
which pass the main femoral artery, vein, and lymph vessels). The contents of femoral canal include
lymphatic vessels, lymph nodes and fat.
This term denotes the path that runs from the hip femoral hernia ring to the subcutaneous gap.
The channel length of 0.5 – 1 cm to 3 cm has the shape of a triangular prism.
Between the femoral vein and lacunar ligament in the vascular lacuna is a space filled with
fiber and lymph node Pirogov-Rosenmüller. This space is a deep ring (entrance) femoral canal,
unlike the channel is normal in each individual weak point is the anterior abdominal wall.
Femoral ring (ring femoralis) drawn into the pelvic cavity and the inguinal ligament limited
front, rear – comb ligament (Cooper's ligament), medial – lacunar ligament, laterally – femoral
vein. On the inner surface of the abdominal wall is covered with transverse fascia ring having here
the type of perforated plates – femoral septum (partition femorale).
Subcutaneous (surface) ring (output) corresponds to the femoral canal subcutaneous gap
(space saphenus). It is covered with a grid fascia (fascia ethmoid).
The femoral canal is bordered:

anterosuperiorly by the inguinal ligament
posteriorly by the pectineal ligament lying anterior to the superior pubic ramus
medially by the lacunar ligament
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laterally by the femoral vein.
Hip width of the ring (the distance between the femoral vein and lacunar ligament) is for men
an average of 1.2 cm for women – 1.8 cm large size of the femoral ring predispose to the fact that
the femoral hernias are more common in women.
Femoral hernias are relatively more common in women.
TESTTASK
1. MUSCLE PROVIDES FLEXION OF THE THIGH

1 m. biceps femoris
2 m. sartorius
3 m. rectus abdominis
4 m. iliopsoas
2. ANTERIOR GROUP OF THE THIGH MUSCLES INCLUDES

1 m. gracilis
2 m. sartorius
3 m. adductor magnus
4 m. biceps femoris
3. MEDIAL GROUP OF THE THIGH MUSCLES INCLUDES

1 m. semitendinosus
2 m.pectineus
3 m.piriformis
4 m. sartorius
4. POSTERIOR GROUP OF THE THIGH MUSCLES INCLUDES

1 m. quadriceps femoris
2 m.tensor fasciae latae
3 m.semimembranosus
4 m. pectineus
5. FUNCTION OF THE ILIOPSOAS MUSCLE

1 flexion of the thigh
2 extension of the thigh
3 abduction of the thigh
4 rotation of the thigh
6. MUSCULAR LACUNA INCLUDES

1 femoral nerve
2 femoral artery
3 internal pudendal nerve
4 femoral vein
7. VASCULAR LACUNA INCLUDES

1 femoral vein
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2 femoral nerve
3 lateral cutaneous nerve of the thigh
4 great saphenus vein
8. MEDIAL BORDER OF THE FEMORAL TRIANGLE

1 m. sartorius
2 m. gracilis
3 m. adductor longus
4 inguinal ligament
9. THE DEEP FEMORAL RING IS FORMED BY

1 saphenous opening
2 layers of the broad fascia
3 fissure in the medial angle of vascular lacuna
4 fibers of aponeurosis of the external oblique muscle
10. LATERAL WALL OF THE FEMORAL CANAL IS

1 cribriform fascia
2 pirogov’s lymphatic node
3 falciform margin of the broad fascia of the thigh
4 femoral vein
11. INLET OF THE ADDUCTOR’S CANAL IS SITUATED

1 on the medial surface of the thigh
2 on the anterior surface of the thigh
3 in popliteal fossa
4 on the posterior surface of the thigh
12. ANTERIOR WALL OF THE ADDUCTOR’S CANAL IS

1 m. rectus femoris
2 m. vastus medialis
3 lamina vastoadductoria
4 m. Sartorius
13. BORDERS OF THE ADDUCTOR’S CANAL ARE

1 rectus muscle of thigh, great adductor muscle and aponeurotic membrane between them
2 medial vastus muscle, great adductor muscle and aponeurotic membrane
3 rectus muscle of thigh, medial vastus muscle, adductor magnus muscle
4 medial vastus muscle, adductor magnus muscle, and aponeurotic membrane
14. MUSCLES ADDUCT THE THIGH

1 adductor magnus, longus and brevis, obturator externus
2 adductor magnus, longus and brevis, gracilis, piriformis
3 adductor magnus, longus and brevis, gracilis, pectineus
4 quadriceps femoris
15. MUSCLES ROTATE THE THIGH MEDIALLY

1 gluteus maximus, medius and minimus
2 gluteus medius and minimus
3 sartorius and piriformis
4 piriformis, obturators
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16. ANTERIOR GROUP OF THE MUSCLES OF THE CRUS INCLUDES
1 m. plantaris
2 m. popliteus
3 m. extensor hallucis longus
4 m. flexor hallucis longus
17. CANALS OF THE LEG ARE

1 cruro-popliteal, anterior and posterior musculoperoneus
2 cruro-popliteal, musculoperoneus, maleolar
3 adductor, cruro-popliteal
4 cruro-popliteal, superior and inferior musculoperoneus
18. SUPERIOR MUSCULOPERONEUS CANAL IS FORMED BY

1 tibia, triceps surae muscle
2 fibula, fibularis longus muscle
3 fibula, flexor hallucis longus muscle
4 interosseus membrane of the leg, triceps surae muscle
19. INFERIOR MUSCULOPERONEUS CANAL IS FORMED BY

1 fibula, flexor hallucis longus muscle
2 fibula, fibularis longus muscle
3 interosseus membrane of the leg, triceps surae muscle
4 tibia, flexor hallucis longus muscle
20. MUSCLES ATTACH TO THE CALCANEAL TUBEROSITY

1 posterior tibial muscle, long flexor of big toe
2 posterior tibial muscle, long flexor of toes
3 triceps surae muscle, plantar muscle
4 triceps surae muscle, popliteal muscle
CLINICAL CASES:
1. The patient is complaining of impossibility of extension a leg in a knee joint after the falling.
What are the injured muscles?
2. The patient cannot perform the abduction of a thigh because of hurt of gluteal region. What is the
muscle has suffered because of hurt?
3. A function of the flexion a thigh in a hip joint was broken during the closed trauma of the
abdominal cavity. What are the muscles have suffered because of the trauma?
4. The female patient has the deep cut wound on a dorsum of the foot by the edge of a fallen pane.
What muscles' tendons can be suffered because of the trauma?
5. The female patient 30 years old has the swelling and a pain in a region of a femoral triangle have
appeared after a raising of a heavy subject. What hernia formation can you think about?
6. The sportsman has the rupture of Achilles' tendon. Define, what is damaged muscle?
53
CONTROL QUESTIONS OF THE FINAL TEST «MYOLOGY»
Anatomy:
1. Division of muscles in the head by origin and location.

2. The masticatory muscles, their origin, insertion, mechanism of action of the mandibular joint.
3. Anatomical peculiarities of facial expression muscles.
4. The muscles of the cranial vault: origin, insertion, function.
5. Facial muscles around the eye, their origin, insertion, function.
6. Muscles circumference of the nose, their origin, insertion, function.
7. Muscles circumference of the mouth, their origin, insertion, function.
8. General description of back muscles, their division into layers and groups.
9. The superficial muscles of the back, their origin, insertion, function.
10. Deep muscles of the back: the splenius, erector spinae, transversospinalis groups,origin,
11. General characteristic of the chest muscles. Division into groups.
12. The chest muscles, related to top of the upper limb. Their origin, insertion, function.
13. The own (deep) chest muscles, their origin, insertion, function.
14. The diaphragm: parts, openings, functions.
15. The muscles of respiration, their functions.
16. General description of the muscles of the abdominal wall, dividing them on the anterior,
posterior and lateral groups.
17. The lateral group of the abdominal wall muscles: their origin, insertion, function.
18. The anterior group of the abdominal wall muscles: origin, insertion, function.
19. The posterior group of the abdominal wall muscles: origin, insertion, function.
20. Muscles of the shoulder girdle - posterior group : origin, insertion, function of each muscle.
21. Muscles of the shoulder girdle – anterior: origin, insertion, function of each muscle.
22. Muscles of the anterior (biceps brachii, brachialis) and posterior (triceps brachii, anconeus)
groups of the arm; their origin, insertion and function.
23. Muscles of the 1-st surface layer of the anterior forearm (pronator teres, flexor carpi radialis,
palmaris longus, flexor carpi ulnaris), their origin, insertion function.
24. Muscle of the 2-nd layer of the anterior forearm (flexor digitorum superficialis), its origin,
insertion function.
25. Muscles of the 3-d layer of the anterior forearm (flexor digitorum profundus, flexor pollicis
longus), their origin, insertion function.
54
26. Muscle of the 4-th layer of the anterior forearm (pronator quadratus), its origin, insertion
function.
27. Muscles of the surface layer of the posterior forearm (brachioradialis, extensor carpi radialis
longus, extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor
carpi ulnaris), their origin, insertion function.
28. Muscles of the deep layer of the posterior forearm (supinator, abductor pollicis longus,
extensor pollicis brevis, extensor pollicis longus, extensor indicis), their origin, insertion
function.
29. Muscles of the thenar group of the hand, their origin, insertion function.
30. The hypothenar group of the hand, their origin, insertion function.
31. The midpalmar group of the hand (lumbricals, dorsal interossei, palmar interossei), their
origin, insertion function.
32. Muscles of the anterior group of the pelvis, origin, insertion, function.
33. Muscles of the posterior group of the pelvis: origin, insertion, function of each muscle.
34. The muscles of the anterior surface of the thigh, their origin, insertion, function.
35. The muscles of the posterior surface of the thigh, their origin, insertion, function.
36. The muscles of the middle group of the thigh, their origin, insertion, function.
37. The anterior group of muscles of the leg: origin, insertion, function of each muscle.
38. Muscles of the lateral group of the leg, their origin, insertion, function.
39. Muscles of the superficial layer of the posterior group of the leg, their origin, insertion,
function.
40. The muscles of the deep layer of the posterior group of the leg, their origin, insertion,
function.
41. Muscles groups of the of the foot. Muscles of the dorsal surface of the foot (extensor hallucis
brevis, extensor digitorum brevis): origin, insertion, function of each muscle.
42. Muscles of the plantar surface of the foot: origin, insertion, function of each muscle.
Topography:
1. Neck topography: regions and main triangles, their boundaries and value.
2. The characteristic of fascia of the neck according V.M.Shevkunenko, disassemble them
topographical relationships with the muscles, organs and vessels.
3. Characterized closed and communicating interfascial spaces of the neck and their
communication with the mediastinum.
4. The alba line of the abdomen, its structure and a practical value in surgery.
5. The rectus muscle sheath. Features of its structure above and below the umbilical ring.
55
6. The inguinal canal, its walls, rings. The length of the inguinal canal and its contents in the
male and female body. Clinical value.
7. The anterior abdominal wall regions.
8. The axillary fossa and cavity, its topography, triangles, foramen tri- and quadrilaterum.
9. Topography of the arm: the medial bicipital and lateral bicipital grooves humeromuscularis
(canalis spiralis) canal, their contents.
10. Topography of the cubital fossa and grooves of the forearm.
11. Anatomic snuffbox.
12. Bony-fibrous canals, flexor and extensor retinaculums.
13. Synovial sheaths of the flexor tendons. Synovial bursa.
14. Topography of the pelvic area (suprapiriforme foramen and infrapiriforme foramen, canalis
obturatorius).
15. Topography of the space under an inguinal ligament. Lacuna musculorum, lacuna vasorum,
their contents.
16. The femoral canal: walls, rings, contens, practical value.
17. Topography of the anterior thigh area: femoral triangle (scarpa’s triangle), iliopectineus
groove, anterior femoralis groove, canalis adductorius (hunter's canal).
18. Popliteal fossa, boundaries, contents.
19. Cruropoliteus canal (gruberov canal).
20. Superior and inferior musculoperoneus canals.
21. Medial and lateral plantar grooves of the foot.
To show on the preparations:

1. masseter m.
2. temporalis m.
3. lateral pterygoid m.
4. medial pterygoid m.
5. epicranius m.
6. epicranial aponeurosis
7. orbicularis oculi m.
8. procerus m.
9. corrugator supercilii m.
10. nasalis m.
11. depressor septi nasi m.
12. orbicularis oris m.
56
13. depressor anguli oris m.
14. risorius m.
15. zygomaticus major m.
16. zygomaticus minor m.
17. levator labii superioris m.
18. depressor labii inferioris m.
19. levator anguli oris m.
20. buccinators m.
21. mentalis m.
22. platysma m.
23. sternocleidomastoid m.
24. digastrics m.
25. stylohyoid m.
26. mylohyoid m.
27. geniohyoid m.
28. sternohyoid m.
29. thyrohyoid m.
30. anterior scalene m.
31. middle scalene m.
32. posterior scalene m.
33. longus colli m.
34. longus capitis m.
35. rectus capitis anterior m.
36. rectus capitis lateralis m.
37. latissimus dorsi m.
38. trapezius m.
39. levator scapulae m.
40. rhomboids m.
41. serratus posterior superior m.
42. serratus posterior inferior m.
43. splenius capitis m.
44. splenius cervicis m.
45. erector spinae m. (its parts -iliocostalis, longissimus, spinalis)
46. transversospinalis m. (its parts - multifidus, rotators, semispinalis)
47. rectus capitis posterior major m.
57
48. rectus capitis posterior minor m.
49. obliquus capitis superior m.
50. obliquus capitis inferior m.
51. pectoralis major m.
52. pectoralis minor m.
53. serratus anterior m.
54. subclavius m.
55. external intercostals m.
56. internal intercostals m.
57. transversus thoracis m.
58. diaphragm
59. external oblique m.
60. internal oblique m.
61. transversus abdominis m.
62. rectus abdominis m.
63. pyramidalis m.
64. quadratus lumborum m.
65. linea alba
66. inguinal canal
67. deltoid m.
68. supraspinatus m.
69. infraspinatus m.
70. teres minor m.
71. teres major m.
72. subscapularis m.
73. coracobrachialis m.
74. pectoralis major m.
75. pectoralis minor m.
76. biceps brachii m.
77. brachialis m.
78. triceps brachii m.
79. anconeus m.
80. pronator teres m.
81. flexor carpi radialis m.
82. palmaris longus m.
58
83. flexor carpi ulnaris m.
84. flexor digitorum superficialis m.
85. flexor digitorum profundus m.
86. flexor pollicis longus m.
87. pronator quadrates m.
88. brachioradialis m.
89. extensor carpi radialis longus m.
90. extensor carpi radialis brevis m.
91. extensor digitorum m.
92. extensor digiti minimi m.
93. extensor carpi ulnaris m.
94. supinator m.
95. abductor pollicis longus m.
96. extensor pollicis brevis m.
97. extensor pollicis longus m.
98. extensor indicis m.
99. abductor pollicis brevis m.
100.flexor pollicis brevis m.
101.opponens pollicis m.
102.adductor pollicis m.
103.palmaris brevis m.
104.abductor digiti minimi m.
105.flexor digiti minimi brevis m.
106.opponens digiti minimi m.
107.palmar lumbricals m. m.
108.dorsal interossei m. m.
109.palmar interossei m. m.
110. axillary cavity
111. cubital fossa
112. аnatomic snuffbox
113. iliopsoas m.
114. psoas major m.
115. iliacus m.
116. psoas minor m.
117. gluteus maximus m.
59
118. gluteus medius m.
119. gluteus minimus m.
120. tensor fasciae latae m.
121. piriformis m.
122. obturator internus m.
123. gemelli superior m.
124. gemelli inferior m.
125. quadratus femoris m.
126. obturator externus m.
127. sartorius m.
128. quadriceps femoris m.
129. rectus femoris m.
130. vastus lateralis m.
131. vastus intermedius m.
132. vastus medialis m.
133. biceps femoris m.
134. semimembranosus m.
135. semitendinosus m.
136. pectineus m.
137. adductor brevis m.
138. adductor longus m.
139. adductor magnus m.
140. gracilis m.
141. tibialis anterior m.
142. extensor digitorum longus m.
143. extensor hallucis longus m.
144. fibularis longus m.
145. fibularis brevis m.
146. popliteus m.
147. triceps surae m.
148. gastrocnemius m.
149. soleus m.
150. plantaris m.
151. tibialis posterior m.
152. flexor digitorum longus m.
60
153. flexor hallucis longus m.
154. extensor hallucis brevis m.
155. extensor digitorum brevis m.
156. abductor hallucis m.
157. flexor hallucis m.
158. adductor hallucis m.
159. abductor digiti minimi m.
160. flexor digiti minimi brevis m.
161. flexor digitorum brevis m.
162. quadratus plantae m.
163. plantar lumbricals m. m.
164. dorsal interossei m. m.
165. plantar interossei m. m.
166. suprapiriforme foramen
167. infrapiriforme foramen
168. canalis obturatorius
169. lacuna musculorum
170. lacuna vasorum
171. femoral canal
172. femoral triangle
173. iliopectineus groove
174. anterior femoralis groove
175. canalis adductorius
176. popliteal fossa
177. cruropoliteus canal
178. superior musculoperoneus canals
179. medial and lateral plantar grooves
61
KEYS TO THE TESTS
Practical Practical Practical Practical

lesson 1 lesson 2 lesson 3 lesson 4
1-2 1-3 1-1 1-4
2-3 2-3 2-3 2-2
3-1 3-1 3-1 3-2
4-4 4-4 4-2 4-3
5-4 5-3 5-1 5-1
6-4 6-3 6-1 6-1
7-1 7-4 7-1 7-1
8-2 8-3 8-4 8-3
9-2 9-3 9-1 9-3
10-3 10-1 10-2 10-4
11-2 11-1 11-1 11-1
12-2 12-3 12-4 12-3
13-2 13-4 13-2 13-4
14-1 14-2 14-3 14-3
15-2 15-1 15-3 15-2
16-2 16-3 16-2 16-3
17-1 17-4 17-3 17-4
18-3 18-3 18-1 18-2
19-1 19-1 19-2 19-1
20-2 20-3 20-3 20-3
KEYS TO THE CLINICAL CASES
Practical lesson1
1. Through the retrovisceral space to the posterior mediastinum
2. M. zygomaticus major
3.Sternocleidomastoid muscle and sternohyoid muscle
4. Masticatory group
5. Omotracheal triangle
Practical lesson2
1 Linea alba
2. Erector spinae muscle
3. Sternocostal and lumbocostal triangles, opening for esophagus
62
4. External oblique abdominal muscle, internal oblique abdominal muscle, transverse muscle of
abdomen
Practical lesson3
1. Deltoid
2. Flexion of the hand
3. Extension
4. Triceps brachii muscle
Practical lesson4
1. Quadriceps femoris muscle
2. Gluteus minimus and medius muscles
3. Iliopsoas muscle
4. Extensor digitorum longus and brevis muscles
5. Femoral
6. Triceps surae muscle
63
LIST OF RECOMMENDED LITERATURE
BASIC LITERATURE:
1. Prives M., Lysenkov N. Bushkovich V. Anatomy / M.Prives –Moscow,MIR

PUBLISHERS,2010.-T.1-2.
2. Netter Frank . Atlas of Human Anatomy. - 5th IE/ Saunders,
3. Gray`s anatomy. – 38 Edition. - Churchill Livingstone, Edinburg, London, New-York,
Philadelphia, Sidney, Toronto, 1995. – 2092 P.
4.Gray`s Anatomy for students. – 30 Ed/Churchill Livingstone, 2015.
5. M. R.Sapin, L.L. Kolesnikov, D.B. Nikitjuk Textbook of human anatomy: In 2 volumes. / M.R.
Sapin. – First Ed/ Moscow: New Wave Publisher Ltd, 2005.
ADDITIONAL LITERATURE
1. Moore Keith L., Daily Arthur F. Clinically oriented anatomy. – 4 Edition. - Lippincott Williams
& Wilkins, Canada, - 1999. – 1168 P.
2. Krishna Garg, PS Mittal, Mrudula Chandrupatla. Human Anatomy: In 3 volumes. / Garg. –
Sixth Ed/ CBS Publishers&Distributors Pvt Ltd, 2013.
3. Romanes G. J. Cunningham’s manual of practical anatomy. 3 volumes. – V edition. - Oxford,
New York, Tokyo: Oxford University press, 1999.
4. Rohen W., Johannes Chihiro Yokochi, Eike Lutjen-Drecoll. Colour atlas of anatomy (a
photographic study of the human body with 1111 figures, 947 in colour). IV Edition. –
Germany: Williams &: Wilkins, 1999. – 486 P.
5. Zadipryany I. V., Makejeva A.A. Dictionary. Anatomical terminology, terminologia anatomica,
анатомическая терминология (in three languages: english - latinum – русский). -
Simpheropol: Printed CSMU. – 2004. – 320 P.
6. Saladin K.S. Anatomy and physiology. The Unity of Form and Function. III Edition.. – McGraw
Hill. – 2004. – 1120 p.
7. Agur Anne M. R. Grant’s atlas of anatomy. – 9 Edition. – USA, 1991. – 650 P.
64

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федеральное государственное бюджетное образовательное

учреждение высшего образования

Кафедра анатомии человека

Учебное пособие предназначено для иностранных студентов

Данное учебное пособие является практическим курсом по формированию знаний по

Пособие составлено с учетом требований федерального государственного

The Department of Human Anatomy

Study guide for foreign students

№/№ Theme Pages

Items for discussion

Set of the natural preparations, models and tables

The student should know:

The student should be able to name and show:

Draw in copybook and denote:

TOPOGRAPHY OF THE NECK

Regions of the neck:

4. ANTERIOR CERVICAL REGION.

Fasciae of the neck

Interfascial fat spaces

Deep intermuscular spaces

1. THE MUSCLES ARE CLASSIFIED ACCORDING TO THE SHAPE INTO

2. MUSCLES HAVING CIRCULAR FIBERS ARE NAMED

3. MUSCLES HAVING OPPOSITE FUNCTION ARE CALLED

4. DEVELOPMENT OF THE FACIAL EXPRESSION MUSCLES IS FROM

5. GROUP OF MASTICATORY MUSCLES INCLUDES

6. WRINKLING OF THE FOREHEAD SKIN IS FUNCTION OF THE

7. DEVELOPMENT OF THE MASTICATORY MUSCLES IS FROM

8 ONE OF THE MASTICATORY MUSCLES IS

9. LATERAL MOVEMENTS OF THE MANDIBLE ARE PROVIDED BY

10. THE DUCT OF THE PAROTID GLAND PASSES THROUGH

11. SUPERFICIAL MUSCLES OF THE NECK

12. SUPRAHYOID GROUP OF THE NECK MUSCLES INCLUDES

13. INFRAHYOID MUSCLES ARE

14. INFRAHYOID GROUP OF THE NECK MUSCLES INCLUDES

15. DEEP GROUP OF THE NECK MUSCLES INCLUDES

16. MUSCLES OF THE NECK ATTACHED TO RIBS

18. BORDERS OF THE CAROTID TRIANGLE

19. BORDERS OF THE PIROGOV’S TRIANGLE

20. PREVISCERAL SPACE IS CONNECTED WITH

Items for discussion

Muscles of the back have various developmental origin (autochthonous, visceral,

Set of the natural preparations, models and tables

The student should know:

The student should be able to name and show:

1. Superficial muscles of the back

TOPOGRAPHY OF THE ABDOMEN

The linea alba

Fig.3 Linea alba of the anterior abdominal wall

The rectus sheath

Fig.4 Rectus sheath

Canal has 4 walls:

1. MUSCLES OF THE BACK CAN BE DIVIDED INTO

2. ONE OF THE SUPERFICIAL MUSCLES OF THE BACK IS

3. ONE OF THE DEEP MUSCLES OF THE BACK IS

4. SUPERFICIAL MUSCLES OF THE BACK ATTACHED TO THE SHOULDER GIRDLE

5. PARTS OF THE ERECTOR SPINAE MUSCLE ARE

6. MAIN RESPIRATORY MUSCLES INCLUDE

7. DEEP (PROPER) MUSCLES OF THE CHEST

8. PARTS OF THE DIAPHRAGM

9. «WEAK» POINT OF THE DIAPHRAGM IS

10. THE FOLLOWING APONEUROSIS DOESN’T TAKE PART IN THE FORMATION OF

11. INGUINAL LIGAMENT IS: