pec major attach to costal cartilage, sternum, clavical insert to humerus

pec major, clavical, and deltoid make deltopectoral triangle w/ cephalic vein running in it useful for clinical purposes

(more medial) Lateral Pectoral N. branch off lateral cord of BP

get name b/c branch off medial cord of BP

pec minor attach ribs 345 attach to coracoid of scap

axillary a. start from subsclav go under clavical turn to axillary artery after go beyond first rib divided to 3 regions when pec minor in place

first branch is sup thoracic a. give blood to throacic wall (not always present or higher)

thoracoacromial a. very short quick split to branches (acromial deltoid pectoral clavicular) will likely be cut: know the stump and pectoral lateral thoracic (small) go to axilla and thoracic wall and lateral mammary portion next is large branch subscapular a split to circumflex scapular a. and thoracodorsal a. curcumflex scapular a. wrap around scap and go thru triangular space and get to posterior aspect of scap

thoracodorsal artery travel with thoracodrosal N. travel together to Lat dorsi

lat cord lateral axillary artery medial cord medial to ax a. with pectoral nerves coming off respectively

medial cord also give nerves medial cutaneous arm and forarm

posterior cord behind a lot give off axillary N. and Radial N. also supscapular nerves w/ thoracodorsal running b/w (lower is distal) and both subscapular go to subscapularis m.

thoracodorsal N+artery together to lat dorsi

shiny muscle tendon latissimus dorsi attachment to humerus inch wide

axillary a. change its name to brachial artery after pass inferior border teres Major then 2 come off on medial side

biceps brachii 2 heads medial Is short head goes to coracoid process long head lateral go to intertubercular groove into joint capsule

flip over biceps short head to see on medial side is coracobrachialis

coracobrachialis also origin coracoid insert to humerus musculocutaneous goes thru it

brachialis m

musculocutaneous N. innervate all 3 muscles

musculocutaneous continue b/w biceps (above) and brachialis m. deep musculocutaneous then emerge lateral to insertion of biceps and go cutaneous lateral cutaneous N. of forearm (muscular then cutaneous.)

Median N. travel w/ brachial a. on lateral side and ulnar N. travel with them on medial side till the medial epicondyle where it goes in to posterior

at cubital fossa brachial artery divides to radial and ulnar arteries

Need to know 2 kinds superificial structures 1. veins: cephalic and basilic and medial cubital 2. lateral and medial cutaneous N Here is a superficial vein running on radial side outside muscle = cephalic

muscles arise on lat epidondyle = post forearm muscle group

boundary b/w ant -post is radial a (off brachial in cubital fossa)

radial artery can be used for bipass

muscles arise on medial epicondyle (common tendon) travel distally in ant forearm 8 muscles 4 layers flex elbow and wrist joint palmerus longus small muscle with small muscle belly long tendon go into hand blend with flexor retinaculum continue to palmer aponeurosis and to fingertips (expose claws) palmerus longus can also be used for surgery replace other tendons

push flexor carpi ulnaris aside medially can see ulner artery and ulnar nerve which travel underneath esp distal

push aside 4 first layer muscles see deeper flexor digitorum superficialis (4 muscle tendons distal) under that is flexor digitorum 4 muscle tendons between FDS and FDP is Median N. (maybe attach to FDS) On radial side of FDP is FPL obvious muscle tendon last one is in distal forearm square shape muscle

around pronator quadratus proximal is anterior interosseus a. and N. deep to them is interosseus mem

ulner a. branch to common interosseus a continue to ant interosseus a. post. interosseus a.

brachial a. to ulnar and radial a. they are continous/anastamosis by superficial palmer arch

hand has 3 layer. after remove skin and fascia is triangle palmer aponeurosis. then superficial palmer space (then deep palmer space) ulnar a. (+ulnar N. on medial side) travel into superficial palmer space thru guyons canal (b/w pisiform and hook of hamate) then under palmaris brevis

Palmaris brevis
ulnar a. go to superficial palmer arch which give off common then proper palmer digital a. nerve (Ulnar 1.5 and Median 3.5) also travel w/ these

carpal tunnel (FDS on top then median N. then FDP) carpal tunnel is under flexor retinaculum b/w thenar and hyppthenar muscles

coming off FDP tendons to radial side are lumbricals (innervated 2 ulnar, 2 median) make Z/L movement

Thenar and Hypothenar muscles FPB innervated by both ulnar and median N. Median nerve give off recurrent branch to this and other thenar muscles

Abductor pollicis brevis Flexor pollicis brevis Opponens pollicis Abductor digiti minimi Flexor digiti minimi brevis Opponens digiti minimi

have to push APB and FPB out of way to see OP b/c its under them

nerve that runs on top of hypothenar muscles is superficial branch of ulner nerve going to pinky

recurrent branch of medial N.from medial N. goes into thenar muscles

deep palmer arch and deep branch of ulnar nerve in there

to get to deep palmer space cut FDP and FDS and flip distal. (move median N out of carpal tunnel).

Adductor pollicis

more deep inside can see AP and Dabs/Pads

coming off FDP tendons to radial side are lumbricals (innervated 2 ulnar, 2 median) make Z/L lasteral epicondyle movement most forearm extensors originate. (brachioradialis and ECRL originate at epicondylar ridge) all innervated by radial N.

APL and EPB travel over ECRL and ECRB. but under extensor reteinaculum (share sheath)

ECRL go to metacarpal base ECRB go to 3rd metacarpal base

2nd

APL insert to base 1st metacarpal. EPB go to base 1st phalynx EPL go to base distal phalynx

snuff box tip is end of first metacarpal base is extensor retinaculum and styloid process and bordered by EPL and EPB. has radial artery travel thru. and first metacarpal articulate with trapezium. (can feel scaphoid to side)

radial a. travel under ligaments (APL, EPB) thru anatomical snuff box give off branch to form dorsal palmer arch (give common and proper dorsal digital arteries) . radial artery continue go under EPL then travel thru 1st dorsal interosseus m. come to palmer side form deep palmer archDeep palmer arch mainly from radial a. (anastamosis ulnar a.) also has 2 branches before dive thru to become deep palmer arch give off to index (radial indices) and thumb (princeps pollicis)

ED extend muscles 2-5 muscle next to it is EDM. extra tendons (for pinky/index) always on ulnar side.

last one on ulnar side is ECU

push muscle tendons apart go deep find 2 muscle tendons. EPL, and on ulnar side is Extensor Indicies. ( on dorsum of hand it is also on ulnar side of ED)

supinator very deep. arise lateral epicondyle and go to radius. undereath brachialis, ECRL, ECRB, ED)

also on dorsum of hand is DABs

radial nerve originate psot cord BP travel thru axilla get to arm wrap around radius from behind in lateral groove to lateral aspect of elbow joint (lateral epicondyle) it start to emerge b/w brachialis (arm) and brachioradialis (forearm)

then radial nerve split to 2 branches: a superficial branch run under brachioradialis. deep branch go thru supinator and emerge in posterior compartment as post interosseus N.

Post interosseus N. also has post interosseus a. with it which came from ulnar artery common interosseus a. ant/post interosseus a.

Trap shrugelevated retract depress scapula innervated by Spinal accessory N Lat Dorssi exend adduct humerus innervated throacodorsal N. (and thoracodorsal artery traveling with it) triangle of auscutation b/w scap, lat dorssi and trap

found in area b/w levator scapula and rhomboids traveling underneath all and innervates all 3

muscle deep to lat dorsi traveling b/w lat dorsi and thoracic wall going toward scapula from front

arise lateral aspect of ribs coming over to scapula go underneath and insert along medial border under rhomboid

supraspinatus m. arise superspinus fossa, go laterally under acromion insert G. tubercle of humerus. it abduct arm esp first 15 degrees (then deltoid help it

spine of scapula separate supraspinatus, infraspinatus w/ teres minor running lateral w/ teres minor bigger running underneath minor and more lateral

services by superascap N. + a.

deltoid has to be reflected to see them b/c it attaches to spine of scapula (so does trapezius)

cut deltoid from spine of scapula and acromion and flip anterior-laterally see Axillary N. and anterior and posterior circumflex humoral arteries

arm abducted a bit see posterior arm w/ trapezius. lateral head doesnt go beyond shoulder joint attach to humerus. long head go to scapula infraglenoid tubercle. medial head dont need to worry about its somewhere.

long head of triceps travel underneath teres minor and on top teres Major w/ humerus above making a anatomical relationship w/ spaces

axillary N (go deltoid + infraspinatus) +post circumflex humeral a.

circumflex scap a

post cordradial N and brachial a deep artery arm

axillary a. subscapular a. circ. scap a. from give blood post scap region

to see suprascap N.+a. cut supraspinatus m. and flip it. along superior edge of scapula lateral see transverse scap ligament bridge over suprascapular notch. artery go above, nerve go below thru hole. they supply (supraspinatus fossa) supraspinatus m. then they both go thru glenohumeral notch into infraspinatus m.

inferior artery, nerve vain go glut max, med, min TFL

arise from sacrum sacrotuberus ligament, iliac bone, diagnal insert to illiotibial track and gluteal tuberosity on femur

Gluteus maximus Tensor fascia lata Gluteus med+min

piriformis m. arise ant. sacrum travel thru G. sciatic foramen insert to G. trochanteric fossa. VAN above = sup, VAN below=inf inf gluteal a/N supply glut med/min+TFL (dont inject too medial or hit inf gluteal N =trendelenburg sign

pudendal N. + internal a/V exits pelvic cavity thru G. sciatic foramen, curves around the sacrospinous lig to enter the perineum thru L. sciatic foramen to anogenital triangle

(piriformis) Gemellus superior Obturator internus Gemellus inferior Quadratus femoris

deep to sciatic N. is lateral rotaters 4 muscles under piriformis b/w G. trochanter femur and ischial tuberosity

bursas to prevent rubbing muscle on bones

obturator interus weird muscle arise at obturator membrane exit thru lesser sciatic foramen bending 3 hamstring muscles common insertion to ischial tuberosity

1.Biceps femoris 2.Semimembranosus 3.Semitendinosus

tendinous on top membranous on bottom insert med aspect tibia biceps femoris 2 heads one from ischial tuberosity other from lateral lip linea aspera. heads blend then insert to head of fibula

Sciatic Nerve (Tibial N. medially + Common Fibular N. laterally)Sural N

sciatic N. 2 nerves in one. when split one lateral is tibial N. one that continues into popliteal fossa is Tibial N.one that diverge out is common fibular (later split to deep and sup fibular N.) tibial and common fibular nerves also give off branches that combine to make sural N. which is superficial give sensation

Popliteal Artery Popliteal vein

huge blood vessels traveling thru = popliteal artery and vein. from femoral artery and vein travel thru adductor canal thru adductor hiatus to popliteal area. they are in a sheath. relationship that vein is on top, artery on bottom. if got stabbed in the back of the knee would injury vein first. Travel thru popliteal fossa together w/ tibial N. then after exit politeal fossa split to ant/post tibial a. While in politeal fossa artery give off genicular branches which anastamose extensively. (bend leg = no ischemia) one more muscle popliteus deep to artery and vein behind joint capsule. dense connective tissue fascia lata

great saphenous vein originate foot all the way medial aspect to saphenous opening drain to femoral vein

vein on medial

NAVEL

femoral hernia

iliotibial track is thickening of fascia muscle fiber TFL tenses illiotibial track innervated sup gluteal N. (1foot balance)

Femoral a. give off Sup epigastric sup circumflex iliac sup+deep external pudendal. Deep artery of the thigh run parallel but deep medial and lateral circumflex femoral arteries perforating arteries to post compartment Femoral a. and Femoral V travel together on medial aspect of leg under sartorius till they enter adductor canal exit become popliteal

S=sartorius F=femoral N.

G=gracilis O=obturator

T=semitendinosus N. S=sciatic N

sartorius longest m. in body arise ASIS insert to medial aspect tibia

Iliopsoas Pectineus Sartorius Rectus femoris Vastus lateralis Vastus intermedius Vastus medialis

quadriceps femoris from AIIS (4 heads) blend together make patellar tendon wrap around patella, then distal to patella = patella lig insert to tibial tuberosity

femoral N. give off lot of branches to ant compartment but one branch travel beyond knee joint its saphenous N. become superficial to innervate skin medial calf

Obturator externus (deep to pectineus) Pectineus Adductor longus Adductor brevis Adductor magnus (hamstring part) Adductor magnus (adductor part) Gracilis
adductor longus easiest to see find pectineus above. below longus is adductor brevis

cut and flip adductor longus see adductor brevis w/ superficial branch of obturator nerve running b/w (then goes to gracilis)

Obturator nerve L2-L4 (innervate med = adductors) superficial branch is in between adductor longus and brevis into gracilis deep branch is deep to adductor brevis on top of adductor magnus

under adductor brevis is adductor magnus and deep branch of obturator nerve sandwiched b/w

Tibialis Anterior
Extensor Digitorum Longus

(Fibularis Tertius)

Extensor Hallucis Longus

1artery1Nerve: ant tibular a. (branch from popliteal a) and deep fibular N. (branch from fibular N) find them betwee TA and EDL go under extensor retinaculum change name to dorsalis pedis a. (deep fibular N. keep name.) find these lateral to EHL (palpate)

lateral to tibia is ant compartment leg w/ muscular septum dividing (septum continuous w/ crural fascia and periosteum fibula) cloest tibia is tibialis ant goes under extensor retinaculum to first metatarsal. next to it is extensor digitorum longus under extensor retinaculum send tendons to 4 digits. 3rd muscle is deeper between them its extensor hallucis longuss

deep to Extensor digitorum longus have intrinsic muscles HB and EDB

dorsal interossei m. b/w metatarsal bones

lateral compartment fibularis longus and brevis muscle tendon wrap around lateral malleolus

Fibularis Longus

Fibularis Brevis

superficial fibular N. run b/w

sciatic common fibular N +tibial N. then common fibular N. tightly wrap around head of fibula. after head of fibula it splits to superficial and deep. b/c common fibular run so superficial it is in risk of dmg then have problems dorsiflex foot

superficial structures small saphenous vein and sural N.

find tibial N, common fibular N (lateral side) deep to these is popliteal vein and artery. come from ant compartment of thigh thru adductor hiatus (adductor magnus)

the vessels run lateral to each other in start of popliteal fossa but then quickly switch to having vein run on top. (so if got hurt in back of knee would hit vein first). popliteal a. giving off genicular arteries (lateral, medial, sup, mid,inf)

post compartment leg muscles 6 muscles 2 layers. superficial: gastroc, soleus, plantaris gastroc has 2 head originate from femur condyles. span knee+ankle joints and flex knee joint plantaris small muscle arise lateral condyle femur running down small muscle belly long tendon. live b/w gastroc and soleus soleus is below gastroc. and its shiny.

tibial N. and 2 arteries (post tib a. and fib a.) running b/w superficial and deep layers

politeal give off a. tibial artery go penetrate interossues mem and go to ant compartment. politeal also give off post tib a which split to 2 branch. lateral side is fibular a. medial branch is still called post tib a.. fibular a. go to ankle joint. post tibial a. go further wrap around medial malleolus go to plantar med+lat plantar arteries

posterior to joint capsule deep to all nerve and artery in popliteal fossa is small muscle running from superior lateral (lateral condyle of femur) to inferior medial (medial aspect tibia) its popliteus

Flexor Digitorum Longus

Tibialis Posterior

Flexor Hallucis Longus

ONLY behind medial malleoulus!

Tom, Dick and bloody nervous Harry corresponding to Tibialis posterior, flexor Digitorum, tibial vessels, nerve and FHL

adductor halicis+planter interossei muscles