FA2-5+ABD&PELVIS
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FA2-5+ABD&PELVIS

Course Number: ANAT 314102, Fall 2009

College/University: Allan Hancock College

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1 LECTURE 05 ABDOMEN, PELVIS, & SACRUM MUSCLES OF ABDOMEN---HYPAXIAL MUSCULATURE Ventral--------rectus abdominis (Williams and Warwick, 1980) Fig 5.38 for TS). Laterals-------3 flank muscles and quadratus lumborum, Prevertebral---psoas VENTRAL GROUP - rectus abdominis. Due to the presence of the sternum it is present only in the abdomen, and extends from the 5th, 6th & 7th costal cartilages above to the...

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LECTURE 1 05 ABDOMEN, PELVIS, & SACRUM MUSCLES OF ABDOMEN---HYPAXIAL MUSCULATURE Ventral--------rectus abdominis (Williams and Warwick, 1980) Fig 5.38 for TS). Laterals-------3 flank muscles and quadratus lumborum, Prevertebral---psoas VENTRAL GROUP - rectus abdominis. Due to the presence of the sternum it is present only in the abdomen, and extends from the 5th, 6th & 7th costal cartilages above to the pubis below. The portions from each side of the trunk are separated by a tendinous area, the vertical linea alba or white line. There are also thin transverse bands of connective tissue, or inscriptions which may indicate the segmental origin of the muscle. It is contained in a sheath, which receives contributions from all three flank muscles. It acts to flex the thoracic and lumbar vertebrae. (Pyramidalis lies in front of the lower part of rectus abdominis, and extends up to 1/2 way to umbilicus). SHEATH of rectus femoris: Above costal margin and below ASIS, only an anterior sheath is present (above: EO; below, all 3). SKETCH rectus sheath TS (Williams and Warwick, 1980) Fig. 5.53 A&B LATERAL GROUP The lateral group or flank muscles are generally present in three layers, and they are found both in the abdomen and in the thorax. In the abdomen we have: external oblique superficial internal oblique intermediate transverse deep quadratus lumborum To some extent these 3 layers of the lateral musculature are also found in the thorax, but modified as the intercostal muscles: external oblique -> external intercostals internal oblique -> internal intercostals 2 EXTERNAL OBLIQUE sketch external oblique Origin from the external surface and lower borders of the lower 8 ribs, where it interdigitates with the digitations of serratus anterior. The fibres run downwards towards the midline---the same direction as the fingers if you put your hands in your pockets. As it reaches the edge of rectus abdominis, it becomes an aponeurosis which helps to form the front of the rectus sheath (cf (Williams and Warwick, 1980) fig. 5.53). Lower border is the iliac crest laterally, but medially, between the anterior superior iliac spine (ASIS) and the pubic symphysis, it is free. In fact it is folded back on itself, so that it in cross section it looks like so: sketch to form the inguinal ligament. Above the medial part of the inguinal ligament is a gap in the aponeurosis of the external oblique, above the pubic tubercle. This is the superficial inguinal ring, which is the external opening of the inguinal canal, carrying the spermatic cord in men, the round ligament of the uterus in women, and the ilioinguinal nerve. (The deep inguinal ring lies about 1cm above the inguinal lig, halfway between the ASIS and pubic symphysis. It is an opening in transverses fascia, just lateral to femoral sheat)> Innervation T7-T12. 3 INTERNAL OBLIQUE sketch cf (Williams and Warwick, 1980) fig 5.47 The fibres of this muscle run at right angles to those of the external oblique: i.e. they run upwards towards the midline. The muscle arises from the anterior half of the iliac crest and from the lateral 2/3 of the grooved upper surface of the inguinal ligament. It runs diagonally up to the lower 3 or 4 ribs, (where it is continuous with the internal intercostals) and across to the midline, where its aponeurosis splits to contribute to the anterior and posterior sheath of the rectus. In the lower part of the muscle, the fibres arch downwards around the superficial inguinal ring, helping to form the conjoint tendon with fibres of transversus abdominis. Innervation T7-L1. TRANSVERSUS ABDOMINIS sketch Arises laterally from the lateral 1/3 of the inguinal ligament, from the iliac crest, the thoracolumbar fascia, and from the lower 6 costal cartilages. Medially the aponeurosis runs behind the rectus to help form its sheath. Innervation T7-L1 Inguinal canal- in standing, IO and TA contract to close off the canal. Same in coughing or straining. Openings in EO, IO and TA are staggered to allow this (Grant and Basmajian, 1980). QUADRATUS LUMBORUM (last of the lateral group) Has attachments below to the iliac crest and iliolumbar lig, medially to the 1st 4 lumbar transverse processes and above to the 12th rib: 4 sketch or slide GM10 fig. 15.12 It may help to laterally flex the lumbar vertebral column--(cf Basmajian). Innervation T12-L3. PSOAS (dorsomedial or prevertebral group) There is a psoas major and a psoas minor, the major being the only important one. It arises anteriorly from the transverse processes of all the lumbar vertebrae (and from their bodies and discs). It passes behind the inguinal ligament and in front of the hip joint capsule, attaching to the lesser trochanter of the femur. With the iliacus it flexes the thigh on the pelvis, and also the lumbar vertebrae on the pelvis. The lumbar plexus (L1,L2,L3 & most of L4) is located within the muscle and innervates it. Actions of the three flank muscles They play an active role in movements of the trunk, but also have an effect on the viscera and contribute more or less passively to the stability of the vertebral column. 1) Active movements: the important muscles here are the rectus and obliques; the transversus has little effect on the vertebral column. The two obliques of one side will cause lateral flexion of the trunk to that side. The external oblique on the right and the internal oblique on the left (whose fibres are parallel) will cause flexion and rotation of the trunk so that the right shoulder is brought towards the left iliac crest. All four obliques acting together will cause flexion. When supine, flexion of the trunk is brought about mainly by the rectus if the head is raised, but by the rectus and obliques if the legs are raised (Basmajian and De Luca, 1985) p391. 2) Viscera: pressure in the abdominal cavity is raised by activity in the obliques and the transversus (Cresswell et al., 1992), but not the rectus (Basmajian and De Luca, 1985) pp 391-2, and the viscera are compressed. This assists in emptying the viscera, as in urination, defecation and giving birth: but it may also risk squeezing the viscera out of gaps in the abdominal wall, such as 5 the inguinal canal. If this happens we have an inguinal hernia. But fortunately the action of the muscles not only raises abdominal pressure, but also tends to close the inguinal canal. In fact in quiet standing all the abdominal muscles are generally silent, except the part of the internal oblique and transversus abdominis around the inguinal canal , i.e. conjoint tendon(Basmajian and De Luca, 1985) p391, 395). In addition the abdominal muscles, again the obliques and transverse mm, are the most important and only indisputable muscles of expiration (Basmajian and De Luca, 1985) p397. 3) Stability of vertebral column: as we shall see later, the abdominal cavity acts as a pressurised bag, which helps to resist and control flexion of the vertebral column. INNERVATION OF THORAX AND ABDOMEN The dorsal rami are smaller than the ventral ones. They run posteriorly to supply epaxial musculature and most of the skin of the back (cf Grey 35 fig 7.196). The ventral rami we have seen already in the cervical region, contributing to the cervical and brachial plexus. In the thoracic region, they innervate hypaxial musculature, but in this region there are no dorsomedial (prevertebral) muscles, and no ventral ones---so we have only the lateral group, i.e. the intercostals, to deal with. Each thoracic nerve emerges from the intervertebral foramen below the corresponding vertebra and rib: i.e. the first thoracic nerve emerges below T1 and R1. They innervate not only the intercostal muscles but also the skin on the lateral and anterior aspects of the chest and abdomen. The first 6 thoracic nerves (except T1, brachial plexus) are confined to the first 6 intercostal spaces, but the last 6 (T7 - T12) continue anteriorly into the abdominal wall, whose muscles they supply. The skin of the abdomen is also supplied by these nerves, with dermatomes arranged like so: sketch (Williams and Warwick, 1980) Fig 7.221 1) Sacrum 2) Pelvis 3) Sacroiliac joint 6 SACRUM SLIDE EA1 2-3, EA1 3-2 The sacrum is formed of 5 fused vertebrae, like inserted a wedge between the two innominate bones. At each end of the sacrum is an intervertebral disc: the upper one, between L5 and the base of the sacrum is the thickest of all the intervertebral discs and allows a relatively large amount of movement. The lower one articulates with the coccyx. The sacrum encloses the sacral canal, which carries cauda equina and filum terminale; the spinal cord itself terminates at the L1/L2 junction. Intervertebral foramina: The lateral wall of the canal has 4 intervertebral foramina, but these are hidden: what one can see are the dorsal and pelvic sacral foramina. Pelvic and dorsal foramina: Note two sets of foramina, the 4 dorsal sacral foramina, through which the posterior primary rami exit, and the 4 pelvic sacral foramina, which transmit the anterior primary rami of the 1st 4 sacral spinal nerves. sketch posterior aspect sacrum 7 POSTERIOR ASPECT OF SACRUM There are 3 ridges or crests: the median sacral crest, which carries 4 spinous tubercles, representing the spinous processes. Lateral to this and just medial to the dorsal sacral foramina is the intermediate sacral crest, which represents the fused articular processes. Lateral to the dorsal sacral foramina is the lateral sacral crest, which represents the fused transverse processes. At the caudal end of the sacral canal is an inverted U-shaped gap, the sacral hiatus. This is due to the failure of the laminae of S5 to meet in the median plane; anaesthetics can be injected through the sacral hiatus; this spreads extradurally and acts directly on the spinal nerves. Muscles attaching to the posterior aspect of the sacrum include gluteus maximus and erector spinae. Lumbarization and sacralization In sacralization of L5, it is fused with the sacrum (usually incomplete; cf McMinn p81). In lumbarization of S1, which is rarer, S1 is only incompletely fused with the remainder of the sacrum. Male and female. The sacrum is shorter and wider in the female than the male, and the concavity is deeper. ANTERIOR ASPECT OF SACRUM Sketch, powerpoint Promontory of the sacrum; attachment of piriformis muscle. LATERAL ASPECT OF SACRUM Auricular facets The sides of the upper 3 fused vertebrae of the sacrum form a large auricular (ear shaped) facet, which articulates with a corresponding auricular facet on the ilium of each side to form the sacroiliac joints. auricular facet, powerpoint So the weight of the body is transferred from L5 to the sacrum, the sacroiliac joints, and to the acetabulum and femur (if standing) or the ischial tuberosities (if sitting). 8 INNOMINATE BONE Remember the lateral view of the hip bone-its proper name is the innominate bone, made up of the ilium above and the pubis and ischium below. sketch SLIDE Lateral view of hip Grey 35 Fig 3.171 Note that the junction of the three bones passes through the acetabulum, the socket for the head of the femur. This junction is known as the triradiate cartilage, and does not complete ossification until late adolescence. ILIUM From the lateral aspect, note the iliac crest, which ends anteriorly as the anterior superior iliac spine (ASIS) and posteriorly as the posterior superior iliac spine (PSIS). in between is the iliac tubercle. Remember that the ASIS is at one end of the inguinal ligament (and sartorius): the PSIS is usually marked by skin dimples, at the level of S2 and the centre of the sacroiliac joint. Note also the AIIS (upper end of iliofemoral lig., straight head of rectus femoris), and the PIIS at the lower end of the sacroiliac joint. Note the anterior and posterior gluteal lines, dividing the gluteal surface of the ilium into areas of attachment for gluteus maximus, medius, and minimus. On the medial aspect, note the arcuate line from the convexity of the auricular facet, and continuous with the pectineal line of the pubis. Together these form the linea terminalis which separates the true pelvis below from the false pelvis above. Note also the auricular surface for the sacroiliac joint. ISCHIUM Note the ischial tuberosity on which you sit, and the ischial spine these give attachments to the sacrotuberous ligament and the sacrospinous ligament. PUBIS Note the superior and inferior pubic rami above and below the obturator foramen, the pubic crest connecting the pubic tubercles on each side, and the pubic symphysis. 9 NOTCHES & FORAMINA As well as these bony projections, note the notches and holes: the obturator foramen, the greater sciatic notch and the lesser sciatic notch, separated by the ischial spine. The obturator foramen is normally closed or obturated by a membrane, which gives the foramen its name. The membrane provides the origin for the two obturator muscles. There is a groove in the foramen in the anterior/superior angle; this marks the point where there is a gap in the membrane, through which pass the obturator nerve and vessels. Fractures of pelvis. Since the pelvis is a relatively rigid ring, at least in the adult, the pelvis usually breaks in two places, rather than one. If a single fracture is found a second should be looked for carefully. SACROILIAC JOINT This is a synovial joint, although here the range of movement has been sacrificed for the sake of stability. The articular surfaces have irregular depressions and elevations which fit into one another, contributing strength but limiting movement. The articular surfaces are mainly covered with hyaline cartilage, although there is some fibrocartilage on the articular surface of the ilium (GGO 4 p446). In the elderly, fibrous adhesions and synostosis often occur. It most likely functions as a shock absorber (Wilder et al 1980 Spine 5 575-579). The zone of instant centres of rotation lie close to the pubic symphysis, i.e. at some distance from the joint itself, indicating that most movement at the joint is translation rather than rotation (Lavignolle et al 1983, p175).But there is wide variation on this and some disagreement (Grieve, p 52) When the trunk is upright, the line of gravity of the trunk passes anterior to the axis of rotation of the joint, so that the sacrum tends to be rotated such that the vertebral column tips forwards: sketch sacrum from side GM10 fig.17-19 10 Furthermore, the sacrum is wedge shaped, so that the ilia tend to be forced apart: sketch anterior or post. view of pelvis with sacrum Both of these tendencies are resisted by ligaments. LIGAMENTS The ligaments of the sacroiliac joint can all be seen on the posterior surface: SLIDE Grey 35 f.4.57 GM10 f.17-21 1) sacroiliac interosseous dorsal ventral sacrum to ilium directly behind the joint overlies dorsal rami of sacral spinal nn. thickening of jt. capsule to ischial spine to ischial tuberosity transverse process of L5 to iliac crest 2) sacrospinous 3) sacrotuberous 4) iliolumbar Sacroiliac is the chief ligament and helps to prevent the ilia from being wedged apart. It consists of 3 components: the interosseous sacroiliac, which is the main part, located directly behind the joint itself. In addition there is a ventral sacroiliac (on the pelvic surface) and a dorsal sacroiliac ligament. 11 Sacrospinous and sacrotuberous ligaments together convert the greater and lesser sciatic notches into foramina. Both have similar functions in preventing the sacrum from rotating, and the vertebral column from tipping forwards, since they attach below the sacrum: SLIDE GM10 fig. 17-19 Iliolumbar ligament is not present at birth, develops gradually in the first 20 years. It is present in primates which walk erect such as the rhesus monkey, but not in quadrupeds (Pun et al, 1987). References Basmajian, J.V., and De Luca, C.J. (1985). "Muscles alive : their functions revealed by electromyography." Williams & Wilkins, Baltimore. Cresswell, A.G., Grundstrom, H., and Thorstensson, A., (1992). Observations on intraabdominal pressure and patterns of abdominal intra-muscular activity in man. Acta Physiol Scand 144, 409-418. Grant, J.C.B., and Basmajian, J.V. (1980). "Grant's Method of anatomy : by regions, descriptive and deductive." Williams & Wilkins, Baltimore. Williams, P.L., and Warwick, R. (1980). "Gray's Anatomy." Churchill Livingstone, Edinburgh.

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UNSWSchool of Electrical Engineering and Telecommunications1Switch structures and fabricsKeshav Chapter 8Lecturer: Dr. Tim MoorsCopyright 2002-2003UNSWSchool of Electrical Engineering and Telecommunications2Announcements Tutorials
Allan Hancock College - TELE - 4363
12Announcements The groupings for assignment 2 are now online at http:/alpha400.ee.unsw.edu.au/tele4363/ass2groupings.html . Please check that you are included in a group, and email tele4363lecturer AT ee.unsw.edu.au if you are not included in a
Allan Hancock College - CS - 4211
Outline!IntroductiontoDNA !Adlemans experiment !CuttingEdgeTechnologies !ProsandCons !ConclusionDNA ComputationHiroshi HiguchiWhatisDNA?"DNAstandsforDeoxyribonucleicAcid "DNArepresentsthegeneticblueprintofliving creatures "DNAcontains instruct
Allan Hancock College - COMP - 4600
A Printing Z and Object-Z L TEX documentsPaul King Department of Computer Science University of Queensland Australia, 4072 king@batserver.cs.uq.oz.au May 29, 19901IntroductionA This note describes a package of L TEX macros for printing Z and
Allan Hancock College - AGSM - 0212
Organisational Learning, Transformational Leadership and Implementation of Continuous Quality Improvement in Canadian HospitalsbyRolland LeBrasseur Robert Whissell Abhoy Ojha *Abstract: Implementing continuous quality improvement (CQI) in acut
Allan Hancock College - AGSM - 0108
9Can the Political System Sustain the Strategic Conversations Australia Needs?by Ian MarshAustralian Journal of Management, Vol. 26, Special Issue, August 2001, The Australian Graduate School of Management 153 AUSTRALIAN JOURNAL OF MANAGEMEN
Allan Hancock College - AGSM - 9206
COUNTERPOINT- 119 -AUSTRALIAN JOURNAL OF MANAGEMENTJune 1992- 120 -Vol.17, No.1Carter: DETERMINING INDUSTRY POLICYDetermining Industry Policyby Colin Carter 1. IntroductionOn 24 January 1992, the editorial writer of The Australia
Allan Hancock College - AGSM - 0309
Firm Size, Book-to-Market Equity and Security Returns: Evidence from the Shanghai Stock ExchangebyMichael E. Drew Tony Naughton Madhu Veeraraghavan Abstract:Capital market theory is concerned with the equilibrium relationship between risk and
Allan Hancock College - AGSM - 9306
4The Compliance Costs of Taxation in Australia and Tax Simplication: The Issuesby Jeff Pope Abstract: This paper identies six phases in the development of the compliance costs of taxation, in an Australian context. Estimates of the compliance cost
Allan Hancock College - AGSM - 9806
4The Pricing of Australian Index Futures Contracts with Taxes and Transaction CostsbyGarry J. Twite Abstract: This paper examines the pricing behaviour of the Australian share price index futures contracts, incorporating taxes and transaction c
East Los Angeles College - SOCM - 024
Statistical Modelling Week 5 Lab Session Logistic regression II: fitting nested models with interactions; obtaining and plotting predicted probabilities In this class we will be comparing the fit of nested logistic regression models using the Block s
East Los Angeles College - SOCM - 024
SOCM024 PRINCIPLES OF STATISTICAL MODELLING CONVENOR: DR NICK ALLUM, 38 AD 03 MODULE OUTLINE AUTUMN 2007 Fridays: Lectures - 10.00AM 10.50AM, tba; Lab sessions - 11.00AM 11.50AM, 40 AD 03 Week 4 Lecture topics Introduction to the course: Aims and O
Allan Hancock College - IAU - 221
Star Formation at High Angular Resolution ASP Conference Series, Vol. S-221, 2003 M.G. Burton, R. Jayawardhana & T.L. BourkeStarburst galaxies with NAOS-CONICA (adaptive optics at VLT)Damien Gratadour LESIA, Observatoire de Paris-Meudon, UMR 8109