Sobotta Atlas vol-1

M u sculo skele ta l system Vessels and nerves Im aging te ch n iq u e s -► In te g u m e n ta ry system

Skin

Fig. 1.57 Skin layers, In teg u m en tu m com m un e; (hairy skin); Figs. 1.58a to d Hairy skin (a and c, back of finger) and hairless
C: cutis, com posed o f epiderm is (E) and derm is (D); SC: subcutis; Fs: skin (b and d, finger tip);
superficial fascia; Fm: m uscle fascia; M : m uscle; rc: R etinaculum cutis; E: epiderm is; P: papillae; pD and rD: papillary and reticular derm is; RR:
ES: eccrine s w e a t glands. HE-staining, m agnification: 22-fold. [2] rete ridges; ES: eccrine sw e a t glands; SgD: sw e a t gland e ffe re n t duct.
The skin (cutis) is com posed o f th e ep iderm is and underlying derm is The d o tte d lines indicate th e m argins b e tw een the derm al layers (Stra­
(fibro-elastic connective tissue w ith capillary plexus, specialized recep­ tum papillare and Stratum reticulare). HE-staining. M agnification: 45-
tors, nerves, im m une cells, m elatonin-producing cells, sw eat glands, fold, inset 100-fold, (c, d [2])
hair follicles, sebaceous glands, sm o oth m uscle cells; thickn ess varies The top panel show s scanning electron m icroscopy images of the sur­
depending on the body region). Beneath the derm is lies the subcutis face o f the derm al Stratum papillare after the epiderm is has been di­
(subcutaneous fa t tissue).The skin is th e largest organ o f th e body (ap­ gested and rem oved. The bo ttom panel show s th e corresponding his­
prox. 2 m2) and serves many functions: it protects against mechanical tological schem atic overview images of sagittal sections through epi­
injury, is a therm oregulator and a sensory organ, and prevents exces­ derm is and derm is. The insert on the le ft image displays a tangential
sive fluid loss. c u t through th e epiderm is (purple) and th e papillary derm is (pink).

j- Clinical Remarks------------------------------------ tio n of blisters (Bullae) and, in som e cases, involve large detach­
m ent of the epiderm is. Detachm ent of epiderm is can also be caused
The derm o-epiderm al connection is ensured by a num ber o f diffe r­ by auto-antibodies against com ponents o f adhesive structures (bul­
ent proteins and structures w hich are responsible fo r the adhesion lous pemphigoid, pemphigus).
m echanism s betw een these tw o zones. Genetic defects o f some
o f these proteins and structures lead to injuries inflicted by shear
forces resulting in cracks w h ic h may be associated w ith th e fo rm a ­

Surface anatomy O rie n ta tio n on the b o d y -♦ In te g u m e n ta ry system

Hair shafts

S w eat gland glands

D e rm is

s Hair ro o t w ith
hair papilla

• S ubcutis

G alea
a p o n e u ro tic a

Hair papillae derm al, or fibrous sheath

Fig. 1.59 Hairs, Pili; longitudinal section through th e human scalp [24] a medulla (follicles reach into th e subcutis); it co n stitu te s th e hair o f
Hairs are the products o f keratinization of the epiderm is. They originate th e head, eye brow s, pubic region, arm pits, and beard (in men). The
from invaginations of the epiderm is w hich form follicles that contain body distribution o f term inal hair differs am ong ethnic groups.
m itotically active cells (m atrix cells) at the base. Hair protects from UV-light and cold and serves to convey sensations of
M atrix cells differentiate to becom e keratinized cells w hich form the touch.
sh a ft o f th e hair. Postnatally, w e distinguish tw o type s o f hair:
• Vellus hair (flu ffy hair) is soft, short, thin, largely w ith o u t pigm en­

tation, and does n o t contain a medulla (follicles are located in the
derm is); sim ilar to fetal lanugo hair, vellus hair covers m o st o f the
body in children and wom en.
Term inal hair (long hair) is firm , long, thick, pigm ented, and contains

Fig. 1.60 S tructure o f a hair follicle; longitudinal section. [25]
Hair originates fro m hair follicles w hich are cylindrical invaginations of
the epiderm is into the derm is or subcutis. The hair follicular body
consists o f a hair bulb and th e hair papilla. Each hair follicle receives a
tu ft o f blood vessels to sustain its g ro w th and is associated w ith a se­
baceous gland (hair-sebaceous gland unit) and a sm ooth m uscle (M .
arrector pili). The latter is responsible fo r the erection o f the hair (sym­
pathetic activation) by indenting the epiderm is to form small pits (goose
bumps).
The fo llo w in g stru cture s can be iden tified in a hair:
• a fully keratinized hair shaft w ith the epithelial inner and outer root

sheaths
• non-keratinized hair root separated by the keratogenous zone (hair

cells keratinizing) fro m the keratinized hair shaft
hair bulb w ith its expanded base contains m itotically active matrix
cells (regenerative part o f th e hair)
• dermal hair papilla, the cell- and blood vessel-rich dermal part w hich
invaginates into the hair bulb fro m beneath
hair infundibulum represents the surface opening of the follicle
and contains th e pilosebaceous canal of the hair-sebaceous gland
unit
• epith elial root sheath o f th e hair w h ich is divided into an inner and
outer root sheath: cellular layers o f the inner root sheath are (from
hair medulla outw ard): cuticle, HUXLEY's and HENLE's layers; the
ou ter root sheath is com posed o f m ultiple layers o f bright, non-
keratinized cells w h ich begin to keratinize in th e infundibular region
o f the hair and integrate into th e epiderm is.

Genetic predisposition and pigm entation (melanin content) determ ine
the hair colour. Once th e production o f melanin ceases, th e hair turns
from grey to w hite.

Trunk

Surface A n a to m y ............................. 42
D evelopment ..................................... 44
Skeleton .............................................. 46
I m a g in g ................................................ 68
Muscles .............................................. 74
Vessels and Nerves .......................... 96
Topography, Back ............................. 104
Female B re a s t..................................... 114
Topography, Abdomen and
A bdom inal W a l l ................................. 118

Ventral and Dorsal
Body Wall

It has becom e com m on practise and is also logic, to stud y the w alls the extrem ities). According to th e ir location and function, the muscles
(Paries) o f th e tru nk (Truncus) separately fro m th e con tent o f th e cavity, of the w all of the trunk form four major groups: the autochthonous
the internal organs, since both parts fo llo w different structural m uscles of th e back, m uscles of the lateral and ventral w all of the trunk,
principles. m uscles of the diaphragm, and m uscles of the pelvic floor.
If one takes the v ie w that the body w all is a structure com posed of The autochthonous muscles of the back, w hich consists of nu­
bones and m uscles w hich surround the internal organs, then it consists m erous single muscles, are located to both sides o f the vertebral
o f che st (Thorax), A bdom en, and Pelvis. A ccording to th is definition, colum n. Arranged in tw o pow erful m uscle strands, these m uscles are
th e shoulder girdle (-» p. 135) is not part o f th e Thorax, since it is only oriented in a predom inantly craniocaudal direction fro m the occiput to
resting on th e thoracic w alls, w h ereas th e pelvic girdle (-» p. 264) is an the pelvic girdle via th e neck, thorax and loins. W ith the back extended,
integral and definite part o f the trunk, as it holds and protects the or­ th e se m uscles are particularly visible in th e lum bar region. Overall,
gans of the low er abdomen. th e se m uscles are e ffe ctive in facilitatin g an erected spine posture,
hence the y are called M . erector spinae. The adjective "autochtho­
Skeleton no us" means "ro o te d or native" - during ontogenesis, all voluntary
m uscles o f the body em erge bilaterally to the vertebral column, pre­
The trunk (and th e neck) is supported by the vertebral colum n (Colum- cisely th e region o f th e autochthonous m uscles o f th e back in adults.
na vertebralis). The vertebral colum n is com posed o f single vertebrae The m uscular progenitor (precursor) cells (m yogenic progenitor cells) of
and continues throughout the entire length of the trunk. Its m ost caudal all other m uscles m igrate fro m th is region across the ventral side o f the
section, the coccyx (Os coccygis), consists o f a variable num ber (4-7) trunk tow ards the extrem ities. Thus, one should name these "alloch-
o f rudim entary vertebrae. The tip o f the tail piece o f the coccyx points tho nou s" muscles, since they arise from cells "com ing from outside".
to w a rd s th e po sterior w all o f th e R ectum . In th e pelvic region, five large The muscles of the lateral and ventral w all of the trunk exist as
single vertebrae are fu se d by synostosis, resulting in a very rigid verte­ m ultilayered intercostal m uscles (M m . intercostales) of the thorax.
bral colum n seg m ent. In contrast, th e fiv e lum bar vertebrae (Vertebrae They assist in respiration. The flanks o f the Abdom en (Regiones latera­
lumbales) enable flexion, extension, and lateral rotation o f the vertebral l s ) contain flat, likew ise m ultilayered muscles, w hich are also known
colum n. The tw elve thoracic vertebrae (Vertebrae thoracicae), w hich as lateral abdominal m uscles (M m . obliqui and M . transversus). The
articulate w ith th e tw e lv e rib pairs, are notably less m obile. anterior abdominal w all is form ed by tough tendons (aponeuroses) o f
The superior ten rib pairs (Costae verae et spuriae) are connected to these lateral muscles. The straight abdominal m uscle (M. rectus abdo­
th e Sternum , the tw o inferior pairs (Costae fluctuantes) do not extend minis) extending longitudinally fro m the sym physis to the chest is en-
to the Sternum . Ribs, thoracic vertebrae, and sternum fo rm the bony sheathed in these aponeuroses ("six-pack belly"). Together, these m us­
tho rax o r rib cage (Thorax). The ribs are easily palpable on both sides of cles rotate and flex the trunk. Beyond this, these m uscles also control
th e Sternum. Starting fro m the top of the rib cage, the firs t rib (Costa the tension o f the abdominal w all, assist in expiration as w e ll as in vo­
prim a) is n o t palpable because it is hidden under th e clavicle (Clavicula). calization fo r speech and singing, and increase abdominal pressure.
The second rib (Costa secunda), however, is palpable. Counting the The diaphragm (Diaphragma), the m ost im portant m uscle of respira­
ribs, alongside w ith th e use o f auxiliary reference lines, helps identify tion, is voluntary, even though one is not aw are o f its actions. The dia­
specific locations on the Thorax. For instance, in an imaginary sagittal phragm is located in th e inte rior o f th e trunk, arises fro m th e m argins of
line passing through th e m iddle of th e clavicle and th e fifth intercostal the inferior thoracic aperture (see above) and form s a large thin-walled
space th a t is b e lo w th e fifth rib, th e beat o f the cardiac apex is palpable. dom e w ith the apex pointing tow ards th e thoracic cavity. During con­
This is w here the apex o f the heart is "kno cking" on the chest wall traction, the dom e flattens and th is leads to an increased volum e o f the
fro m the inside. thoracic cavity facilitating inhalation.
The cartilaginous costal arch (Arcus costalis), w hich connects the The muscles of th e pelvic foor (Diaphragma pelvis and urogenitale)
seventh to te n th rib w ith th e S ternum in an arch-shaped fashion, is also are also voluntary (pelvic floor exercise). They bear th e w e ig h t of the
w e ll palpable. It is the landmark fo r the inferior thoracic aperture, w hich visceral organs (caudally the bony pelvis is open). These m uscles orig­
constitutes a w ide opening of the Thorax tow ards the Abdom en. The inate fro m the inner low er margins of the bony pelvis to form a funnel
tho racic cavity is partitioned by th e dome-shaped, steep and upward th a t tapers do w n to w a rd s th e caudal end (-* p. 196 and 214).
projecting diaphragm (see below). Abdom inal organs, such as stomach,
liver, spleen, and others, are located below to the diaphragm and "b e ­ Breast (Mamma)
neath th e cartilage" (Regiones hypochondriacae). The pulsation of the
Aorta abdominalis is palpable in the Regio epigastrica betw een the car­ The breasts (Mammae) are located on the fem ale thorax - m ore pre­
tilaginous rib arches and im m ediately inferior to the xiphoid process cisely: th e y ride on top o f the M. pectoralis major, a m uscle o f the
(Proc. xiphoideus sterni). shoulder girdle. Their m ajor com pone nt is subcutaneous adipose tissue
and only a small part consists of glandular tissue (Glandulae m am m a-
Muscles riae). Each m a m m ary gland com prises 10 to 20 single glands (Lobi) and
each gland sends its o w n e ffe re n t d u ct to th e m am m illa (Papilla m am -
The m uscles of the abdominal w all are voluntary, like those o f the ex­ maria). O nly during breastfeeding (lactation period) - o r in th e presence
trem ities. M uscles are classified into tw o major groups: m uscles acting of a m alignant breast tum our - the glandular tissue proliferates, w hich
exclusively on th e abdominal w all and m uscles of th e extrem ities should only serve the production of milk. M en also have tiny rudim en­
(arising fro m the abdominal wall and acting on the shoulder girdle and tary m am m ary glands. They can also accum ulate abundant adipose tis­
sue in th e breast region on to p o f th e M. pectoralis (gynecom astia).

40

-C linical Rem arks---------------------------------

A nom alies in th e region o f th e thoracic w all (e.g. Pectus excava-
tum [funnel chest], Pectus carinatum [pigeon chest or carinate
chest]) as w e ll as congenital anomalies and deform ities of the
m am m a (e.g. am astia, aplasia, athelia, polythelia, polym astia,
m am m ary hypertrophy) may occur.
The fem inization o f the male chest (gynecom astia) can have dif­
ferent underlying causes.
Stenosis of th e aortic isthm us causes the form ation of arterial
circulatory bypasses w hich involve arteries of the ventral wall of
th e tru n k (Aa. thoracica interna, epigastricae superior and inferi­
or). This leads to an increased arterial diam eter and pulsatile force
resulting in th e form atio n o f erosions at th e caudal aspect o f the
ribs in th e v icinity o f th e dilated intercostal arteries.
Hernias are a com m on disease in the region o f the ventral
abdom inal w all. A t a breach point in th e ventral abdom inal w all
(hernial canal), a hernial sac can fo rm in w h ic h abdom inal viscera
can protrude and be trapped (hernial content). M en usually have
congenital or acquired inguinal hernias.
The constriction or blockage of the upper or low er Vena cava
leads to the form ation of cavocaval anastom oses via superficial
and deep veins o f the abdominal w all w ith visible enlargem ent of
the epifascial veins.
Deviations fro m th e scrotal position o f th e te s tis can occur in
cases of maldescensus testis.

— ► Dissection Link
A fte r preparation of the skin, the M m . trapezius and latissim us dorsi as
w e ll as th e Fascia thoracolum balis are exposed. The M . trapezius is
separated at its origin; the M. latissim us dorsi is separated in an arch­
shaped m anner near its origin. A fte r dissection o f blood and nerve ves­
sels of the muscles, the M m . levator scapulae and rhom boidei are ex­
posed and the Trigonum lumbale fibrosum is defined. Following the
removal o f the origin o f the M . latissim us dorsi, the structures passing
through the axillary gaps are exposed. The M m . serrati posteriores are
exposed after removal of th e M m . rhom boidei at their origin. Subse­
quently, dissection of the M. erector spinae and the deep (internal)
neck region occurs. Upon com pletion, the M am m ae on th e ventral side
of the body are dissected and removed, the epifascial pathways are
traced to thigh and upper arm, and the dissection of the axilla and
M O H R EN H EIM 's fossa is com pleted. A fte r removal o f the M . pectora-
lis major, the Claviculae are exarticulated, the abdominal m uscles are
opened, the inguinal canal and the structure of the sperm atic cord are
exposed, the rectus sheath and the scrotum are opened and the tes­
ticular fasciae are displayed. In w o m e n , th e inguinal canal is located
along w ith the Lig. teres uteri.

EXAM CHECK LIST

• C olum na vertebralis: d e ve lo p m e n t and skeletal com pone nts •
Vertebra p rom ine ns • stru cture o f a vertebra • Os sacrum • Os
coccygis • vertebral connections • a u tochth ono us m uscles o f the
back • nerves and bloo d vessels: locatio n o f spinal ganglia and
s p in a l ne rves, in n e rv a tio n re g io n o f Rr. d o rs a le s , N. o c c ip ita lis
m ajor, A. vertebralis, and Plexus venosi vertebrales • surface
a n atom y • palpable skeletal prom ine nces • MICHAELIS' rh om bo id
• organization o f the layers o f the neck • Trigonu m sub occipitale •
m o rp h o lo g ica l basis o f lu m b a r pu ncture and ep id u ra l anaesthesia
• basic d e ve lo p m e n t o f the th o ra x • A n g u lu s sterni • m edioclavicu-
lar lin e • a n te rio r and p o s te rio r a x illa ry lines • sca p u la r lin e «veins
o f the skin and lym ph atic drainage • skeletal com pone nts and
con nection s • th o ra x • M m . intercostales • d iap hra gm • intercostal
nerves and bloo d vessels • A. tho racica interna • collateral
circu la to ry routes as a result o f aortic stenosis • Vv. thoracicae
internae • Vv. tho raco epiga stricae • cavocaval anastom oses •
m a m m a • basic d e ve lo p m e n t o f th e u m b ilic u s • ab dom in al
m uscles • segm ental nerves and bloo d vessels • N. subcostalis •
Plexus lu m b a lis • Nn. ilio h yp o g a stricu s, ilio in g u in a lis, and
g e n ito fe m o ra lis • Vasa epigastrica • Canalis ing u in a lis • external
genital organs

41

Trunk S urface a n a to m y -► D e ve lo p m e n t -► Skeleton -► Im a g in g -► M uscles

Back

M. trapezius

Vertebra prom inens

Spina scapulae 1 M. deltoideus
Scapula, A ngulus inferior •
11 1i 11 — M . trapezius
M. erector spinae 1 -------M . te re s m a jo r
S pina iliaca posterior superior -
V erte b ra lu m b a lis V, P roc. s p in o s u s - { I\ , M. latissimus dorsi
1
1 M. gluteus m axim us
1

Fig. 2.1 Back, D orsum , surface relief of th e back. ney). Bony landm arks are th e Proc. spinosus o f th e 7th cervical vertebra
The contours of the back provide useful landmarks to determ ine diff­ (Vertebra prom inens), the acromion, the Spina scapulae, the Angulus
erent regions of the vertebral colum n, muscles, th e approxim ate posi­ inferior scapulae, and th e Proc. spinosus o f th e 5th lum bar vertebra.
tion o f the end o f the spinal cord, and the position o f organs (e.g. kid­

Fig. 2.2 Regions and orientation lines of the back. scapularis, infrascapularis, deltoidea, lumbalis, sacralis, and glutealis.
The back and neck region have the follow ing distinct topographic re- Useful orientation lines of the back include the Linea mediana posteri-
gions: Regio cervicalis posterior (Regio nuchalis), Regiones vertebralis, or, paravertebralis, scapularis, and axillaris posterior.

Vessels and nerves -> Topography, back -> Female breast -► Topography, abdom en and abdom inal w all

Thoracic and abdominal wall

A rticulatio sternoclavicularis Incisura jugularis
Clavicula, C orpus

Angulus sterni

A rc u s c o s ta l is A nguius infrasternalis
S pina iliaca anterior superior A nulus um bilicalis

Fig. 2.3 Surface relief of th e chest and th e ab do m in al w a ll o f a e.g. the costal arch (Arcus costalis), the um bilicus (Anulus umbilicalis),
young woman. and the Spina iliaca anterior superior.
Landm arks assist in th e orientation at th e ventral side o f th e trunk, like Additional landmarks are shown.

Fig. 2.4 Surface relief of th e chest and th e abdom inal w all of a
young man.
Landmarks on the ventral side of the trunk.

Trunk S urface a n a to m y -► D e ve lo p m e n t -► Skeleton -► Im a g in g -► M uscles

D e ve lo pm e n t

D erm atom e S clerotom e
Neural tube
C horda dorsalis

A o rta

Fig. 2.5 D evelopm ent of th e w alls of th e trunk: organization of derm. A t w eek 4, a ventrom edial section of each som ite differentiates
th e som ites a t w e e k 4. [21 ] to becom e a sclerotome. M igrating cells of the sclerotom es on both
All elem ents of the supportive and muscular system s of the ventral and sides of the neural tube and the notocord (Chorda dorsalis) m eet to
dorsal trunk originate exclusively fro m the m iddle germ layer (M eso­ form prim itive vertebrae. Derivatives of the lateral section of each so­
derm ). The m esoderm condenses on both sides of th e Chorda dorsalis m ite are the m yotom e and the derm atom e w hich contribute cells for
and the neural tube to form som ites and unsegm ented lateral meso­ the developm ent of the m uscles and skin, respectively.

Week • Epim ere W

M yotom e Neural tube F le x o rs Week 7
Derm atom e C horda dorsalis
A o rta N. spinalis,
Hypom ere R. dorsalis

A u to c h th o n o u s
m uscles o f the back

N. spinalis,
R. ventralis

3 Layers
abdom inal m uscles

M . rectus abdom inis

Figs. 2.6a to c D evelopm ent of th e w alls of th e trunk: ratus lum borum , pelvic floor muscles, and sphincter m uscles of the
d ifferen tiatio n o f ep im ere and hypo m ere fro m m yotom es. [21] anus and urethra. The autochthonous m uscles of the back (M. erector
The striated skeletal m uscles of the trunk originate from derm ato- spinae) derive fro m th e epim ere. In th e region o f th e abdom inal wall,
m yo to m e s in th e lateral section o f th e s o m ite s and starts diffe ren tiating the hypom ere differentiates into the oblique and rectus abdominal
at w eek 4. During w eek 5, a larger ventral group of m esenchym al cells, m uscles at w eek 7; th e epim ere form s part of the autochtho­
the hypom ere, separates fro m a sm aller dorsal cell population, the epi­ nous back m uscles. Epimere and hypom ere receive separate nerve in­
mere. The hypom ere is the origin o f the M m . scaleni, prevertebral neck nervation: th e se are th e Rr. ventrales and Rr. dorsales o f th e spinal
muscles, infrahyoid muscles, M m . intercostales, subcostales, transver- nerves fo r th e hypom ere and epim ere, respectively.
sus thoracis, oblique abdominal muscles, M m . rectus abdominis, quad-

i- Clinical Remarks------------------------------------ The prun e-b elly syndrom e, w h ich is very rare, presents a com plete
lack o f abdominal m uscles and the organs are palpable through the
The absence o f individual m uscles is often w ith o u t clinical rele­ entire skin. Larger m uscle de fe cts in th e abdom inal w all are associ­
vance. Varying degrees o f severity of m ovem ent disorders are asso­ ated w ith the form ation of hernias.
ciated w ith uni- or bilateral absence of the M. pectoralis or the M m .
trapezius and serratus anterior.

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a ll

D e ve lo pm e n t

Week 6

N ucleus pulposus i i Anulus fibrosus

spinalis, R. ventralis

vein
Interseg m ental artery
N. spinalis, R. ventralis

Fig. 2.7 D evelopm ent of th e w all of th e trunk: Nuclei pulposi as W eek 10
rem n an ts o f th e Chorda dorsalis in th e ad u lt ve rtebral colum n.
[2 1 ] N ucleus
From the beginning of w eek 4 of developm ent, migrating cells from the p u lp o s u s
scerotom e assem ble around the neural tube. A fraction of cells encir­ Vertebral body
cles the Chorda dorsalis and differentiates to become the vertebral
body. The Chorda regresses to becom e th e sm all jelly-like Nucleus pul- Anulus fibrosus
posus in th e centre o f th e intervertebral discs.
Intersegm ental
The s te rn a l b a rs fuse blood vessel
c ra n io c a u d a lly
N. spinalis

Figs. 2.8a and b D eve lo p m e n t of th e ribs and th e stern um . [21 ] Fig. 2.9a and b D evelopm ent of vertebral bodies from tw o
The sternum develops fro m tw o sternal bars w hich derive fro m parallel adjacent sclerotom es. [21]
condensations o f m esenchym al cells in th e ventrolateral body w all (a) Sclerotom es divide into a cranial and caudal section. A m yo tom e is as­
and fuse cranio-caudally in th e m edian plane (b). O ssification o f the sociated w ith a sclerotom e and receives innervation by a spinal nerve.
Proc. xiphoideus occurs late at 2 0 -2 5 years o f age. The ribs in th e re­ In b e tw e e n th e sclero tom e s and th e m yo to m e s course th e interseg-
gion of the thoracic vertebral colum n and the Procc. costales of the m ental blood vessels (w ee k 6, a). The individual vertebrae are fo rm e d
neck and lumbar vertebrae derive from sclerotom e cells that have mig­ by the fusion of a caudal w ith a neighbouring cranial sclerotom e sec­
rated ventrolaterally. Dorsally they are connected w ith the vertebrae tion. Each spinal nerve associated w ith a m yotom e becom es sand­
and ventrally th e y con nect in part w ith th e S ternum (ribs I to VII; tru e w iched during the fusion of the cranial and caudal sclerotom e sections
ribs, Costae verae). The ribs VIII. to X fuse ventrally and connect to the and exits through a Foramen intervertebrale. Intervertebral discs
sternum in an arch via th e ir o w n cartilage (false ribs. Costae spuriae). develop b e tw e e n th e prim ordial vertebrae (b). M uscles derived fro m a
Ribs XI and XII are exclusively connected w ith th e vertebrae and end single m yo to m e (e.g. M . ro tator brevis, -» Fig. 2.78) can m ove tw o
freely (Costae fluctuantes) in the ventral chest wall. neighbouring vertebrae into opposite directions. The functional unit of
all stru cture s participating in th e m otion o f tw o neighbouring vertebrae
is called a m otion segm ent.

r- Clinical Remarks------------------------------------ bral disc creates a block vertebra. Failure of fusion of th e lateral
sternal bands often results in a gap form ation in the Corpus sterni or
A spina bifida represents a cle ft dorsal vertebral colum n as a result the Proc. xiphoideus. Clinically, such gaps or holes are insignificant.
o f failed fusion of a single or m ultiple vertebral arches. A com bina­ Accessory ribs are com m on in th e cervical and lum bar region (cervi­
tion of incom plete closure of vertebral arches and exposure o f under­ cal and lum bar ribs). In th e lum bar region, accessory ribs are usually
lying neural fo ld s is called rachischisis. Paralysis occurs if th e spinal clinically insignificant, how ever, in th e neck region th e y m ay lead to
cord is also affected. If the cleft in the vertebral arches is covered a com pression o f th e Plexus brachialis o r th e A. subclavia (-♦ p. 47
w ith skin, it is called spina bifida occulta. A w ed ge-sh aped vertebra and p. 54).
(hemivertebra) results if a vertebra lacks one o f the tw o ossification
centres. Fusion o f tw o vertebrae and degeneration of th e interverte-

45

Trunk S urface A n a to m y -*• D e ve lo p m e n t -► S keleton Im a g in g -► M uscle

Skeleton of the trunk

A tla s -
A x is

A pertura tho ra c is superior V erte b ra ce rv ic a lis VII
[prom inens] (Proc. spinosus)
Angulus s tern i* S te rn u m
C artilago C ostae verae
A rtic u la tio n e s c o s ta lis (C ostae l-VII)
s te rn o c o s ta le s
A rcus costalis C o s ta e spuriae
A rtic u la tio n e s (C ostae V III-X II)
c o s to c h o n d ra le s

C a rtila g o

A rtic u la tio n e s
in te r c h o n d ra le s

A p e rtu ra thoracis
inferio r

P rom ontorium Cingulum pelvicum A rticu latio
A rticulatio lum bosacralis
s a c ro iiia c a Sym physis pubica O s coccygis
O s sacrum Os coxae
Os 2.11
O s coccygis A rticulatio
sacrococcygea
2.10

Fig. 2.10 and Fig. 2.11 Bones and cartilages o f th e skeletal trunk; The rhomboid-shaped connection form ed by the Proc. spinosus o f the
ventral v ie w s (-» Fig. 2.10) and dorsal v ie w (-* Fig. 2.11).The bones of fourth lum bar vertebra w ith the Spinae iliacae posteriores superiores
the thorax (Ossa thoracis) as w ell as the bones of the vertebral colum n and th e superior part o f th e Crena ani at th e backside o f a w o m a n is
(Columna vertebralis) and the pelvic girdle (Cingulum pelvicum) are nam ed th e M IC H A ELIS' rhom boid. In m en, th e sacral triangle (con­
shown. nection betw een Spinae iliacae posteriores superiores and the superior
A lthough all ribs articulate w ith th e vertebral colum n, only th e firs t part o f th e Crena ani) is visible.
seven ribs are directly connected to the sternum via the ir cartilage
processes (Cartilago costalis). They are named tru e ribs (Costae verae). * clinical term : angle of LUDW IG (LUDOVICUS)
The rem aining five pairs o f ribs are false ribs (Costae spuriae); ribs XI * * Costae fluctu ante s (Costae XI—XII)
and XII fail to con nect w ith th e cartilaginous arch (Costae fluctuantes).

i- Clinical Remarks------------------------------------ gated transverse axis, w hereas w ith scoliosis the pelvis becomes
asym m etrical. The Proc. spinosus o f th e 4th lu m b ar ve rtebra lies
During physical exam ination th e w ell palpable Angulus sterni (Ang­ at the sam e level as the iliac crests. It serves as a reference point
le o f LUDW IG) is an im portant landmark fo r orientation on the tho­ fo r lum bar puncture and fo r intrathecal or epidural (peridural) anaes­
rax. It is located at th e level o f th e second rib. The sacral triangle in thesia.
m en and th e M IC H A E LIS ' rhom boid (lum bo-rhom boid) in w o m e n -
provide inform ation about the shape of th e pelvis. Rickets (vitamin
D deficiency) fo r exam ple can cause a pelvis deform ation w ith elon-

46

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a ll

Ribs

C aput costae Tuberculum m usculi Sulcus venae subclaviae
Collum costae scaleni anterioris

S ulcus arteriae
s u b c la v ia e

C ollum costae, Corpus costae
C rista colli costae T u b e rc u lu m
c o s ta e

Angulus costae

C aput costae T uberositas m usculi
C ollum co stae serrati anterioris

Facies articularis
tuberculi costae
Tuberculum costae

A ngulus co stae C orpus costae

Facies articularis capitis costae
C ollum co stae

Tuberculum co stae

Sulcus co stae

Fig. 2.12 Ribs, Costae; ribs I to III: cranial v ie w ; rib VIII: caudal Ribs I, II, X I, and X II deviate fro m th e typical rib stru cture .R ib I is
view. stum py, broad, and show s the strongest curving; the head has only one
Ribs III to X are typically shaped. The head o f th e rib (Caput costae) is articular surface. Rib II displays o n ly an outline o f a Sulcus costae and a
wedge-shaped and possesses tw o articular surfaces (Facies articulares Tuberositas m usculi serrati anterioris marks the origin o f the M . serra-
capitis costae). The Tuberculum costae has one surface (Facies articu­ tus anterior. The heads o f ribs XI and XII contain only one articular sur­
laris tub ercu li costae). The V., A., and N. intercostalis run in close prox­ face. These tw o ribs fail to contact w ith th e costal arch, sho w pointed
im ity to the Sulcus costae. An invagination at the ventral end of the ventral ends, and have no Tuberculum costae.
body o f the rib (Corpus costae) facilitates contact w ith the rib cartilage.

i- Clinical Rem arks------------------------------------

Rib anom alies are com m on: Tw o-headed ribs arise fro m tw o partially fused ribs,
• A cervical rib is observed in approxim ately 1% o f th e popula­ o In bifid ribs th e an terior part o f th e rib divides into tw o parts.
• W idening o f the intercostal arteries in the Sulcus costae during
tion. The rib prim ordial at th e 7th cervical vertebra (C7) is enlarged.
A part fro m isolated enlargem ent o f the Proc. transversus, uni- or stenosis o f th e aortic isthm us results in pressure atrophy o f the
bilaterally, additional ribs may be present w hich can be connected rib bone w h ich is called erosions (usures) o f th e rib.
to the sternum . The pressure of a cervical rib on the low er roots
of the Plexus brachialis can cause sensory loss and m otor deficits
in th e innervation region o f th e N. ulnaris.

47

Trunk S urface a n a to m y -► D e ve lo p m e n t -► S keleton -► Im a g in g -► M uscles

Vertebral column

V e rte b ra e
c e rv ic a le s

l-V II

V e rte b ra e
th o racicae

l-X II

V e rte b ra e
lum bales

l-V

Os sacrum
Os coccygis

Fig. 2.13 and Fig. 2.14 Vertebral colum n, Colum na vertebralis; synostotic parts, th e sacral (Os sacrum) and the coccygeal bone (Os
ventral (-* Fig. 2.13) and dorsal (-* Fig. 2.14) view s. coccygis). The thoracic vertebrae connect w ith the tw e lv e rib pairs, the
The vertebral colum n accounts for 40% o f the height of a human, a sacrum articulates w ith th e Ossa coxae. In th e upright position, the
quarter thereof being due to the intervertebral discs. The vertebral physical force increases fro m cranial to caudal along the vertebral
colum n is com posed o f 24 presacral vertebrae (seven cervical verte­ co lu m n .
brae, tw elve thoracic vertebrae, five lumbar vertebrae) as w ell as tw o

i- Clinical Remarks------------------------------------ sacral vertebrae. W hen th e sacrum has five vertebrae, the re is an
additional sacralization of th e firs t coccygeal vertebra. Fusion of the
S acralization re fers to th e fusio n o f th e 5th lum bar vertebra w ith firs t cervical vertebra (Atlas) w ith th e skull is called assim ilation of
the Os sacrum (only 23 presacral vertebrae remaining). W hen the the atlas.
top sacral vertebra remains separated from the rem ainder of the Os
sacrum (25 presacral vertebrae), th e condition is called lum baliza-
tion. Radiograph examination reveals six lumbar vertebrae and four

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a ll

Vertebral column

A tlas

C e rvic al lordosis
V ertebra prom inens

T h o r a c ic k y p h o s i s ----------------
D isci intervertebrales

Foram ina intervertebralia

L u m b a r lordosis

Prom ontorium

S ac ral kyphosis

Fig. 2.15 V erteb ral co lum n, C olum na vertebralis; v ie w fro m the firs t fe w m o nths a fte r birth, all sections o f the vertebral colum n sh o w a
le ft side. W hen view ed in th e sagittal plane the vertebral colum n has a dorsal convex bend. The cervical lordosis develops w ith the ability to sit
characteristic curvature: upright and the lum bar lordosis form s w hen learning to walk.
• cervical lordosis (ventral convex curvature) The vertebral curvatures form only after the pelvis has tilted forw ard as
• thoracic kyphosis (dorsal convex curvature) a result o f the bipedal w alk learned a t the age o f 1-2 years. Prior to this
• lum bar lordosis (ventral convex curvature) ability to w a lk upright, all sections o f th e vertebral colum n sh o w a dor­
• sacral kyphosis (dorsal convex curvature) sal convex curvature.
Lordosis and kyphosis are the medical term s fo r ventrally and dorsally
directed convex curvatures o f th e vertebral colum n, respectively. In the

j- Clinical Remarks------------------------------------ liosis is one o f the oldest know n orthopedic conditions. D espite in­
tense scientific and clinical efforts, to this day many of the problem s
Excessive curvature o f th e spine in th e frontal plane (scoliosis) is al­ associated w ith scoliosis are not resolved satisfactorily. Due to un­
w ays pathologic. This g ro w th d e fo rm ity o f th e spine results in fixed equal leg length, the m ajority of the population has a m ild scoliosis.
lateral curvature, torsion, and rotation of the vertebral colum n which
cannot be straightened physiologically by the use of muscles. Sco­

49

Trunk S urface a n a to m y -► D e ve lo p m e n t -► Skeleton -► Im a g in g -► M uscles

Atlas and axis

C ondylus occipitalis Tuberculum anterius a n te rio r atlantis
Foram en m agnum Foramen vertebrale
Facies articularis
(C rista occipitalis s u p e rio r Sulcus a rteriae
externa) v ertebralis
Proc. Arcus po sterio r
transversus a tla n tis

Foram en
tra n s v e rs a riu m

Tuberculum posterius

Fig. 2.16 Base of occipital bone, Os occipitale, region of the Fig. 2.17 1st Cervical ve rtebra. Atlas; cranial view .
Foramen m agnum and th e occipital condyles for th e upper head The atlas does not possess a vertebral body. During developm ent, the
joint; caudal view. latter fused w ith th e axis to form the Dens. The anterior vertebral arch
The occipital condyles are located bilaterally to the Foramen magnum. (Arcus anterior atlantis) is positioned anterior to and articulates w ith the
dens. A t th e po sterior vertebral arch (Arcus po sterior atlantis), th e Proc.
spinosus is replaced by a sm all Tuberculum posterius. The upper articu­
lar facets o f the atlas are frequently separated into tw o sections. Com­
pared to other vertebrae, the atlas has a slightly longer transverse pro­
cess.

* variant: Canalis arteriae vertebralis

M assa lateralis Tuberculum anterius D ens axis Facies articularis superior
a tla n tis A rcus a n te rio r atlantis M assa lateralis atlantis
M assa lateralis atlantis F a c ie s A rcus posterior atlantis
Facies articularis inferior a rtic u la ris

an terio r

Fovea
d e n tis

P roc. a rticularis
s u p e rio r

Proc. C o rp u s Proc. spinosus
transversus vertebrae
Foramen A rcus vertebrae
v e rte b ra le Foram en Foram en
tra n s v e rs a riu m tra n s v e rs a riu m Proc. articularis inferior
Tuberculum posterius
A rcus p o s te rio r atlantis transversus

Fig. 2.18 1st Cervical ve rtebra. Atlas; caudal v ie w . Fig. 2.19 1st and 2nd cervical ve rtebrae. A tlas and Axis; median
The Fovea dentis articulates w ith the Dens axis and is located on the section; view from the le ft side.
inside o f the Arcus anterior atlantis. The Facies articulares inferiores are The median section perm its the inspection of the vertebral canal. Atlas
shallow, concave, and tilte d in a 30° angle to the transverse plane. The and axis articulate via the Fovea dentis and the Facies articularis anteri­
Foramen transversarium is typical fo r cervical vertebrae and facilitates or in th e A rticulatio atlanto-axialis mediana. The A rcus po sterior atlantis
the passage of the A. vertebralis. is considerably sm aller in relation to th e A rcus vertebrae o f th e axis.

r- Clinical Remarks------------------------------------ Isolated fractures of the atlantal arches occur especially as a re­
sult o f m otor vehicle accidents. The incidence declined in recent
Degenerative changes of th e cervical vertebrae are com m on w ith years due to im proved safe ty m easures in vehicles (air bag). Frac­
advanced age and present as Osteochondrosis intervertebra- tures m u st be distinguished fro m A tlas variants. In contrast to varia­
lis w ith dorsal spondylophytes w h ic h can lead to narrow ing of tions such as the occurrence of a Canalis arteriae vertebralis or ab­
th e vertebral canal w ith resulting com pression of th e spinal cord. norm alities like the assim ilation of th e A tlas (fusion w ith the cranial
A rthrosis in th e zygapophyseal jo in ts and th e uncovertebral gaps base), cleft fo rm atio n s in th e region of th e vertebral arches are
(-* Fig. 2.24) w ith form atio n o f oste oph ytes results in narrow ing com m on (-» p. 54).
of the Foramen intervertebrale and/or the Foramen transversarium
w ith s y m p to m s resem bling spinal nerve com pression as w e ll as in
pressure on the A. vertebralis and the sym pathetic nerve plexus.

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a

Cervical vertebrae

Facies articularis an terio r Proc. articularis A pex dentis
Proc. articularis superior Facies a rticularis p o sterio r
C orpus vertebrae
Proc. transversus Tuberculum anterius Foramen transversarium

Proc. Foram en Foramen vertebrale
articularis inferior jb erculum posterius tra n s ve rsa riu m v e rte b ra e
P roc. spinosus
C orpus vertebrae A rcus vertebrae Proc. articularis inferior
Proc. spinosus
2.20

Fig. 2.20 and Fig. 2.21 2nd cervical ve rtebra. Axis; ventral the Procc. articulares inferiores are positioned in an oblique angle to the
(—> Fig. 2.20) and dorsocranial (-» Fig. 2.21) view s. frontal plane. Starting w ith th e 3rd cervical vertebra, th e articular facets
A distinct feature th a t sets the axis apart fro m the other cervical verte­ o f th e Procc. articulares superiores also assum e an oblique position in
brae is the dens. The fro n t and rear side o f the dens are covered w ith relation to th e frontal plane. The transverse process o f th e axis (Proc.
articular face ts (Facies articulares anterior e t posterior). The articular transversus) is short and the spinous process (Proc. spinosus) is fre­
facets of the Procc. articulares superiores are sloped to the outside and qu e n tly sp lit in tw o .

U ncus corporis C orpus vertebrae, C orpus vertebrae, U nci corporis
[P roc. uncinatus] Facies intervertebralis Epiphysis anularis [P ro cc. uncinati]
T u b e rc u lu m
a n te riu s Foram en transversarium Fora m e n P ediculus arcus
T u b e rc u lu m Sulcus nervi tra n s v e rs a riu m vertebrae
p o s te riu s s p in a lis Lam ina arcus
transversus vertebrae
Proc. articularis Foram en vertebrale
s u p e rio r Proc. articularis
A rc u s s u p e rio r
A rcus vertebrae
Proc. spinosus
P ro c. spinosus

Fig. 2.22 5th cervical ve rtebrae. V erteb ra cervicalis V; cranial view . Fig. 2.23 7th cervical ve rtebra. V ertebra cervicalis VII; cranial view .
The 5th cervical vertebra exe m plifies th e typical stru ctu re o f th e 3rd to The 7th cervical vertebra has a long transverse process w ith a Tubercu­
6th cervical vertebrae. W ith th e exception o f th e 7th cervical vertebra, lum posterius only and a long and undivided spinous process.
th e Proc. spinosus has tw o pointed ends. The Proc. transversus is
short, has a Foram en transversarium and ends laterally in a Tuberculum
anterius and in a Tuberculum posterius, w ith th e Sulcus nervi spinalis
located betw een them . The Foramen vertebrale is large and triangular.
The vertebral body is longer in th e transverse axis than in the sagittal
axis and sim ilarly w id e at the fro n t and back.

i- Clinical Rem arks-----------------------------------------------------------------------------------------------------

The o d on toid fracture o r th e fra cture o f th e Pars interarticularis accidents. An odontoid fra cture can also a ffe ct sm all children and is
(the so-called hanged m an's fracture) presents the risk o f cervical d ifficu lt to diagnose,
cord com pression and is m o s tly seen as a result o f m o to r vehicle

Trunk S urface a n a to m y -► D e ve lo p m e n t -► S keleton -► Im a g in g -► M uscles

Cervical vertebrae

Proc. T u b e rc u lu m
transversus anterius

T u b e rc u lu m C orpus vertebrae
p o s te riu s

Foramen transversarium S ym physis in te rve rte b ralis
S ulcus nervi spinalis

U n c i c o rp o ris [P ro cc. uncinati]

Fig. 2.24 2nd to 7th cervical ve rtebrae. V erteb rae cervicales II—VII; The Unci corporis are also nam ed Procc. uncinati and articulate in the
ventral view. Articulatio (Hemiarthrosis) uncovertebralis w ith the lateral and caudal
The 3rd to 6th cervical vertebrae have a typical stru cture , w hereas the parts of the Corpus vertebrae of the above vertebra.
1st, 2nd, and 7th cervical vertebrae deviate fro m th is stru cture . The upper
surfaces display a lip projecting upward at either side (Unci corporis). * so-called uncovertebral gaps

Dens axis

A tla s
A x is

A rticulatio zygapophysialis Proc. articularis inferior
Proc. articularis superior

V ertebra prom inens

Proc. spinosus

Fig. 2.25 1st to 7th cervical ve rtebrae. V erteb rae cervicales I—VII; 1st thoracic vertebra w h ich has an even m ore pronounced spinous pro­
lateral dorsal view. cess. The articular facets (Facies articularis superior or inferior) o f a ver­
The long and undivided spinous process o f th e 7th cervical vertebra can tebral process (Proc. articularis superior or inferior) articulate w ith the
be easily palpated in the neck and is the refo re also named Vertebra corresponding partner in th e A rticulatio zygapophysialis.
prom inens. However, this cervical vertebra can be confused w ith the

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a ll

Thoracic vertebrae

C o rp u s ve rteb ra e, F a cie s in te rve rte b ra lis

Epiphysis anularis*

A rticu latio cap itis co stae

Fovea costalis superior Caput costae Fovea costalis superior Proc. articularis superior

P ediculus arcus C ollum costae C orpus vertebrae Proc. transversus
v e rte b ra e
Foramen costotransversarium Fovea costalis
Foramen vertebrale processus transversi

Proc. articularis C o s ta
[Zygapophysis] superior Tuberculum costae

Fovea costalis Fovea costalis
processus transversi
Incisura vertebralis inferior

P roc- articularis inferior
Proc.

Proc. transversus A rtic u latio c o sto tran sversaria

v e rte b ra e

Proc. spinosus

Fig. 2.26 Vertebra: exam p le detailing th e structure of th e 5th Fig. 2.27 6th thoracic ve rtebra. V erteb ra thoracica V I; v ie w fro m
thoracic vertebra; cranial view . the left side.
The vertebral arch (Arcus vertebrae) is divided in the Pediculus arcus V iew of the articular facets fo r the costal heads (Foveae costales supe­
vertebrae and the Lamina arcus vertebrae. Coming o ff the arch are bi­ rior and inferior), the articular facets o f the zygapophyseal joints posi­
laterally the Procc. transversi and dorsally the Proc. spinosus. Articular tioned alm ost in the frontal plane (Procc. articulares superior and inferi­
facets are located cranially and caudally and participate in the form ation or), the facets (Foveae costales) fo r the articulation w ith the Tuberculum
of th e vertebral joints (zygapophyseal joints). The lateral cranial and cau­ costae of th e ribs, the Incisura vertebralis inferior and th e Proc. spino­
dal aspects of the vertebral body each possess a fovea for the articula­ sus pointing sharply downwards.
tion o f th e costal head (Fovae costales superior and inferior). In th e A r­
ticulatio costotransversaria at the Proc. transversus, the Fovea costalis
articulates w ith the facet of the Tuberculum costae of the corresponding

* also: annular rim

Procc. articulares
superiores

C orpus vertebrae Proc. transversus

A rcus vertebrae

P ro c. spinosus

Fig. 2.28 10th thoracic vertebra. V erteb ra thoracica X ; ventral Fig. 2.29 12th thoracic ve rtebra, V erteb ra thoracica XII; v ie w fro m
vie w onto the vertebral body w ith superior and inferior intervertebral the left side.
surface. The 12th thoracic vertebra has a singular bilateral Fovea costalis and
The articular facets of the Procc. articulares extend beyond the verte­ displays structural sim ilarities to a lumbar vertebra: the inferior articular
bral body cranially and caudally. processes p o in t laterally. In addition, th is vertebra possesses Procc.
mamillares and accessorii.

* area of the vertebral arch betw een th e upper and low er articular
process (so-called isthm us = interarticular portion)

53

Trunk surface a n a to m y -► D e ve lo p m e n t -► S keleton -► Im a g in g - * M uscles

Thoracic and lumbar vertebrae

Fovea costalis superior P roc. a rticularis su p erio r
Fovea costalis processus transversi
Incisura vertebralis inferior
Incisura vertebralis Proc. spinosus
A rticulatio zygapophysialis
P roc. a ccesso riu s

Foram en intervertebrale

Proc. costalis Proc. m am illaris
P roc. accessoriu s

P roc. articu la ris inferio r

Fig. 2.30 10th to 12th thoracic ve rtebrae. V erteb rae thoracicae w ard. The arches o f the lum bar vertebrae are the origin o f the Procc.
X -X II, and 1st to 2nd lu m b ar ve rtebrae. V erteb rae lum bales I—II; left costales (derived from the primordial ribs fused w ith the vertebrae), the
dorsal view. variably large Procc. accessorii, the Procc. articulares superiores (sup­
The lumbar vertebrae are larger and structurally m ore com pact to w ith ­ porting th e upper articular facets, Facies articulares), the Procc. mamil-
stand the increased com pression forces imposed by the body w eight. lares (rem nants o f the Proc. transversus), and the Procc. articulares in­
The Procc. spinosi are short, podgy, and point alm ost straight back- feriores w ith th e low er articular facets (Facies articulares).

i- Clinical Remarks------------------------------------ Cleavage of th e lateral vertebral arch causes separation of the
Procc. articulares inferiores w ith the posterior part of the arch and
• Posterolateral disc herniations or osteophytes caused by osteo- the Proc. spinosus from th e rem ainder o f the vertebra (known as
arthritic-m ediated degeneration o f vertebral jo in ts can lead to the spondylolysis).
narrowing of the Foramen intervertebrale and to compression • The bony separation o f th e isthm us (-» Fig. 2.29) can cause verte­
of the spinal nerve roots w ith resulting deficits. bral slippage (spondylolisthesis).

• Lum bar ribs can cause pain due to th e ir close topographic rela­
tionship to the kidneys.

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a ll

Lumbar vertebrae

P ediculus arcus v erteb rae

C orpus vertebrae

L am ina a rcu s v erte b ra e Proc. spinosus

★

Fig. 2.31 3rd lu m b ar ve rtebra. V erteb ra lum balis III, o f an elderly and articulate w ith the inferior articular processes of th e adjacent higher
person; m edian section; vie w from the left side. vertebra.
The articular facets o f the Procc. articulares superiores are facing each
o th e r (that is th e reason w h y th e y are not clearly visible fro m th e side) * ossification of ligam entous attachm ents

E piphysis anularis Corpus vertebrae, Facies intervertebralis
s u p e rio r*
P ediculus arcus vertebrae
Proc. costalis Foram en v erteb rale
Proc. articularis superior P roc. accessoriu s
L am ina arcus
Proc. m am illaris
2.32 Proc. spinosus

Proc. articularis superior Facies intervertebralis s u p e rio r*

C orpus vertebrae Proc. costalis
Facies a rticularis inferio r Facies intervertebralis in fe rio r**
Proc. articularis inferior
2.33

Fig. 2.32 and Fig. 2.33 4th lu m b ar vertebra. V erteb ra lum balis IV; bra has a massive body (Corpus vertebrae) w ith pronounced upper and
cranial (-> Fig. 2.32) and ventral (-* Fig. 2.33) view s. low er intervertebral surfaces (Facies intervertebrales superior and infe­
The Pediculus arcus vertebrae is proportionally very large in com pari­ rior). The articular facets o f th e zygapophyseal joint extend beyond the
son to the size o f the lum bar vertebra. A t the lateral aspect of the arch, cranial and caudal part of the vertebral body.
the diffe ren t processus are visible (Procc. costales, accessorii, mamil-
lares, and articulares superiores and inferiores) and posterior the strong * also: superior vertebral end plate
Proc. spinosus. W hen view ed from the ventral side, the lumbar verte­ * * also: inferior vertebral end plate

55

Trunk S urface a n a to m y -► D e ve lo p m e n t -► Skeleton -► Im a g in g -► M uscles

Sacrum

Proc. articularis superior C analis sacralis
Facies auricularis Tuberositas ossis sacri
C ris ta sacralis latera lis (interm edia)
C rista sacralis m ed ian a C ris ta s ac ralis m edialis
Foram ina s ac ralia posteriora
H iatus sacralis
Cornu sacrale

2.34 A pex ossis sacri

A la ossis sacri
P rom ontorium

Lineae transversae F oram ina sacralia
a n terio ra

Figs. 2.34 to 2.36 Sacrum , Os sacrum; dorsal (-» Fig. 2.34), ventral Apex ossis sacri
(-» Fig. 2.35), and cranial (-* Fig. 2.36) view s.
The dorsal surface (Facies dorsalis) displays five longitudinal crests of P rom ontorium
different intensity form ed by the fusion of the corresponding vertebral
processes. The Crista sacralis m ediana results from the fusion o f the Pars
Procc. spinosi, the Crista sacralis m edialis corresponds to the fusion lateralis
of the Procc. articulares, and the Crista sacralis lateralis represents
the fusion of the rudim entary lateral processes. The Crista sacralis m e­ Proc. articularis superior C rista sacralis medialis
diana term inates above th e Hiatus sacralis w hich represents the caudal (inte rm e dia)
opening o f th e vertebral canal. In children, th is opening is utilized fo r 2 2g C analis sacralis
sacral anaesthesia. C rista sacralis mediana
The pelvic surface (Facies pelvina) displays the fused margins of the
sacral vertebrae (Linae transversae) and th e paired Foramina sacralia
anteriora, w here th e branches o f th e spinal nerves exit. The Pars latera­
lis o f the Os sacrum is located lateral to the Foramina sacralia anteriora.
V isible fro m th e top, th e Basis ossis sacri is th e co n ta ct surface fo r the
intervertebral disc w ith th e 5th lum bar vertebra. This intervertebra I disc
extends farthest into the pelvis and, tog ethe r w ith the anterior rim of
th e Basis ossis sacri, is nam ed the P ro m o nto rium . Lateral to th e Basis
ossi sacri, the Alae ossis sacri extend as cranial portion o f the Partes
laterales. Located posterior to th e base is the triangular sacral canal and
laterally thereof are the Procc. articulares superiores fo r articulation
w ith th e 5th lum bar vertebra.

56

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a ll

Sacrum and coccyx

Fig. 2.37 S acrum , Os sacrum; v ie w fro m th e righ t side.Fig. 2.38 Sacrum , Os sacrum; m edian section; v ie w fro m th e right

The lateral v ie w show s the Facies articularis, w hich is part o f the joint side.

w ith th e Os coxae (A rticulatio sacroiliaca). The Tuberositas ossis sacri is * In adults, rem nants o f th e intervertebral discs can rem ain. In

located at its dorsal aspect and serves as an insertion region fo r liga- addition, incom plete fusions of sacral vertebrae are frequently

m e nts. found.

Fig. 2.39 Sacrum , Os sacrum; diffe ren ces in sex. Fig. 2.40 Sacrum , Os sacrum; differences in sex.
M en have a slightly longer and narrow er sacrum than w om en. The The male sacrum is bent m ore than the fem ale sacrum,
shape of the sacrum fem ale contributes to the w ider shape of the fe­
male pelvis w hich is advantageous during parturition.

Fig. 2.41 Coccyx, Os coccygis; ventral cranial view . Fig. 2.42 Coccyx, Os coccygis; dorsal caudal view.
The coccyx is fo rm e d fro m three to fo u r vertebrae b u t can also be The size o f the coccygeal vertebrae decreases fro m cranial to caudal,
m ade up o f fiv e rudim entary vertebrae as is s ho w n here. The coccyx is O f all coccygeal vertebrae, o n ly th e 1st coccygeal vertebra resem bles a
connected to the Os sacrum via the Cornua coccygea and the rudim en- typical vertebral structure,
tary vertebral body.

57

Trunk S urface a n a to m y -► D e ve lo p m e n t -► Skeleton -► Im a g in g -► M uscles

Sternum Incisura jugularis

Incisura clavicularis M anubrium sterni M anubrium sterni Incisura clavicularis
Incisura costalis I
Incisura costalis I Angulus s tern i*
Incisura c o s ta lis II Incisura c o s ta lis II
S ym physis Incisura c o s ta lis III
Incisu ra c o s ta lis III [S ynchondrosis] m an u b rio stern alis
Incisu ra c o s ta lis IV
Incisura c o s ta lis IV C orpus sterni Incisura costalis V
Incisura costalis V
Incisura c o s ta lis VI
Incisura costalis VI Incisura c o s ta lis VII
Incisura c o s ta lis VII

S ym physis xip h o stern alis P roc. xiph oid eus
P ro c. xiph oid eus

Fig. 2.43 and Fig. 2.44 S ternu m ; ventral (-» Fig. 2.43) and lateral the ribs I to VII via the Incisurae costales. M anubrium and Corpus sterni
(-» Fig. 2.44) view s. are connected by the Sym physis [Synchondrosis] m anubriosterna­
The Sternum is com posed o f the M anubrium and th e Corpus sterni, lis, w hereas the Corpus sterni and Proc. xiphoideus articulate through
and o f the Proc. xiphoideus. Its upper end fo rm s the Incisura jugularis the Sym physis xiphosternalis. The Proc. xiphoideus can be divided.
w hich is the ventral upper margin o f the upper thoracic aperture and
articulates w ith the clavicles through the Incisurae claviculares and w ith * angle of LUDWIG (LUDOVICUS)

Clinical Remarks------------------------------------ o f th e ribs II and III. The region o f th e costosternal connections and
the low er tw o-thirds of the Corpus sterni are excluded from sternal
Bone m arrow biopsies can be obtained fro m the sternum , the pelvis, puncture due to possible presence o f synchondroses and potential
and the iliac crest. The application of sternal puncture fo r diagnostic Fissura sterni congenita (opening in th e sternum ) as a result of
biopsy of bone m arrow has becom e rare and has been replaced by incom plete fusio n o f th e paired sternal bands. Needle puncture in
iliac crest puncture. Sternal puncture serves to evaluate bone mar­ th e se areas could lead to injury o f th e heart (—> p. 45).
ro w cells in haem atopoietic diseases. The puncture site is located
in th e m edian line o f th e Corpus sterni b e tw een th e attachm ents

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a ll

Sternum

Synchondrosis costae I

Cartilago costalis I M anubrium sterni
C a rtila g o c o s ta lis III
mm S ym physis [S ynchondrosis] m an u b rio stern alis

Lig. sternocostale intraarticulare

Cartilago costalis V Articulationes sternocostales
C a rtila g o c o s ta lis VII
Fig. 2.45 Sternum and origin of cartilaginous parts of th e ribs,
Cartilagines costales; frontal section.
Only part of the costosternal insertions are true joints. Synchondroses
are com m on (ribs I, VI and VII).

Clavicula Lig. in terclaviculare
A rticu latio stern oclavicularis, Lig. co sto cla vic u lare
Lig. ste rn o cla vic u lare anterius
Discus articularis
Lig. costoclaviculare Lig. s te rn o co s ta le radiatum
C a rtila g o c o s ta lis II
Capsula articularis
C a rtila g o c o s ta lis I; S yn ch o n d ro sis c o s ta e I

M anubrium sterni

S ym physis [S ynchon drosis] m an u b rio stern alis

Fig. 2.46 S ternoclavicular joints, A rticulationes sternoclavicula- al m o bility and very diverse m echanical stresses during d iffe re n t joint
res; ventral view ; right frontal section through the joint. positions. Because th e discus is able to absorb high shear forces, the
The sternoclavicular jo in t is a functional ball and socket jo in t w ith articular facets can be kept small. The Ligg. sternoclavicularia anterius
three degrees o f freedom in m ovem ent. It contains a Discus articula­ and posterius, interclaviculare and costoclaviculare strengthen the joint
ris of fibrous cartilage, dividing the jo in t into tw o chambers (dithalam ic capsule.
joint). The shape o f th is jo in t is a re flection o f th e dem ands o f m ultiaxi-

59

2 Trunk su rfa c e a n a to m y -► D e v e lo p m e n t -► S k e le to n -► Im a g in g - * M u s c le s

Ligaments of the vertebral column

Lig. c o s to - Fovea costalis inferior
tra n s v e rs a riu m Fovea costalis superior
P ediculus arcus vertebrae
C o s ta
A rcus vertebrae
D is c u s
in te rv e rte b ra lis Lig. longitudinale
p o s te riu s
Lig. lo n g itu d in a le V erte b ra th o ra c ic a XII,
a n te riu s C orpus vertebrae
D is c u s
Lig. capitis in te rv e rte b ra lis
co stae radiatum

Fig. 2.47 Ligam ents of th e vertebral colum n using th e exam ple Fig. 2.48 Ligam ents of th e ve rtebral colum n using th e exam ple
of the low er thoracic vertebral column; ventral view. of the low er thoracic and upper lum bar vertebral column; dorsal
The anterior longitudinal ligam ent (Lig. longitudinale anterius) ranges view.
fro m the Tuberculum anterius o f the Atlas to the Os sacrum. It is fixed The po sterior longitudinal ligam ent (Lig. lo ngitud inale posterius) is a
to the anterior surface of the vertebral bodies and to the intervertebral continuation o f th e M em brana tectoria and exte nds to th e Canalis sa-
discs (Disci intervertebrales). This ligam ent increases th e stability of the cralis. It is fixed to the intervertebral discs and the rim s o f the interver-
vertebral colum n during extension. tebral surfaces and secures the intervertebral discs (Disci intervertebra-
les). This ligam ent increases the stability o f the vertebral colum n during
flexion.

60

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a

Ligaments of the vertebral column

Lig. c ap itis c o s ta e radiatum Proc. articularis superior
A rticulatio capitis costae Lig. c o sto tra n sv ers a riu m
A rtic u latio c o sto tran sversaria
Lig. c o sto tran sversariu m C o s ta
C o llu m
Proc. transversus
Tuberculum costae
Ligg. flava
Lig. co sto tra n sv ers a riu m latera le

Fig. 2.49 C ostovertebral joints, A rticu latio nes costovertebrales; intervertebral disc is fixed to th e Crista capitis costae. In addition, the
transverse section through the low er part of the costovertebral joint; rib articulates w ith th e Proc. transversus o f th e cranial vertebra in th e
cranial view . A rticu latio costotransversaria (exception are ribs XI and XII). This in­
The costal heads articulate w ith th e thoracic vertebra/vertebrae in the volves the Facies articularis tuberculi costae of th e rib and the Fovea
A rticu latio capitis costae. W ith th e exception o f th e ribs I, XI and XII, costalis processus transversi of the vertebral transverse process. The
this is a tw o-cham bered jo in t (dithalam ic joint). Each costal head articu­ weak joint capsules are strengthened by different ligaments
lates w ith the upper and low er rim of tw o adjacent vertebrae and, ( - Fig. 2.50).
through a ligam ent (Lig. capitis costae intraarticulare; not visible), the

Lig. c o sto tra n sv ers a riu m Fovea costalis processus
la te ra le tra n s v e rs i
Ligg. flava
Lig. c o sto tra n sv ers a riu m
Capsula articularis
Lam ina arcus vertebrae

C o s ta P ediculus arcus vertebrae

Fig. 2.50 Connections o f th e vertebral arches; ventral view . ramina intervertebralia. The Ligg. flava are always under tension and
In b e tw e e n th e vertebral arches stre tch th e segm ental Ligg. flava (yel­ support the m uscles of the back w hen erecting the vertebral colum n
lo w colour results from the high content of elastic fibres oriented per­ fro m all flexe d positions.
pendicular to each other). They fo rm th e dorsal dem arcation o f th e Fo­

Trunk S urface a n a to m y -► D e ve lo p m e n t -► Skeleton -► Im a g in g -► M uscles

Ligaments of the vertebral column Proc. articularis superior
Fovea co sta lis processus transversi
Fovea costalis superior Foramen costotransversarium
C orpus vertebrae

Lig. co sto tra n sv ers a riu m latera le

Lig. longitu d in ale anterius Lig. c o sto tra n sv ers a riu m superius
D iscus intervertebralis Lig. intertran sversariu m
Lig. capitis co stae ra d ia tu m

Fig. 2.51 Ligam ents of th e vertebral colum n and th e costoverte­ by the Ligg. capitis costae radiata; the joint capsules o f the Articulatio­
bral joints, Articulationes costovertebrales; view fro m th e le ft side; nes costotransversariae are supported by the Ligg. costotransversaria
lateral parts of the anterior longitudinal ligam ent removed. (Lig. costotransversarium laterale and Lig. costotransversarium
The jo in t capsules of th e Articulationes capitis costae are strengthened superius).

A rcus vertebrae

Ligg. intertran sversaria

Proc. spinosus C o s ta e

Lam ina arcus vertebrae Lig. flavum
Lig. c o sto tra n sv ers a riu m superius

Lig. co sto tra n sv ers a riu m latera le Proc. transversus
Lig. intertran sversariu m Proc. articularis inferior

Lig. s u p ras p in ale *

Fig. 2.52 Ligam ents of th e vertebral colum n and th e costoverte- * The Lig. supraspinale is th e m edian part o f th e Fascia thora-
bral joints, Articulationes costovertebrales; dorsal view . colum balis.
The dorsal part o f the joint capsules of the Articulationes transversariae
is strengthened by the Ligg. costotransversaria laterales and superiora.
The Ligg. intertransversaria guarantee additional stability.

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a ll

Motion segment

Epiphysis anularis* Proc. articularis superior
Foramen intervertebrale Lig. flavum
Lig. longitu d in ale anterius Lig. supraspinale
Lig. interspinale
Facies intervertebralis
Fascia th o raco lu m b alis
D is c u s Anulus fibrosus
in te rv e rte b ra lis Nucleus pulposus

(Foram en venae basivertebralis) Proc. spinosus
P ediculus arcus vertebrae Lam ina arcus vertebrae

Lig. lo n g itu d in a le p o sterius

Proc. articularis inferior

Fig. 2.53 Lum bar m o tio n elem ent; m edian section; v ie w fro m the although w eake r, fixation is provided by the Lig. longitudinale anterius.
le ft side. A Discus intervertebralis acting as Symphysis intervertebralis connects
The intervertebral disc (Discus intervertebralis) is com posed o f a central tw o neighbouring vertebrae. The Ligg. flava interspinale and supra-
gelatinous nucleus (Nucleus pulposus), a rem nant o f the Chorda dorsa­ spinale provide th e connection b e tw een th e vertebral arches. In the
lis, and a ligam entous ring (Anulus fibrosus), w h ic h surrounds th e Nu­ thoracolum bar region, the Lig. interspinale projects into the Fascia tho­
cleus pulposus. The Anulus fibrosus is the non-ossified rem nant o f the ra c o lu m b a lis.
epiphysis o f th e vertebral body (*). Its m ain attachm e nt is to th e Corpus
vertebrae at the bony rim and the hyaline cartilaginous lining (**) o f the * annular rim
intervertebral surface and the Lig. longitudinale posterius. Additional, * * hyaline cartilaginous lining o f the intervertebral surface

I- Clinical Remarks------------------------------------ cases o n ly th e sacro-iliac jo in ts are affected . D espite th e lim itation in
flexing m otions, the outline o f the back seem s normal initially. H ow ­
The inherited (HLA-B27 positive) ankylosing spondylitis ever, progression o f the disease coincides w ith the back becoming
(BEKHTEREV's disease) involves a progressive ossification o f the flattened like a board. In addition, the re is a significa nt re striction of
Anulus fibrosus of the intervertebral discs, th e vertebral joints, the chest w all excursions along w ith restrictions in respiratory capacity.
Ligg. capitum costarum radiata and costotransversaria and Ligg. lon­
gitudinale anterius and interspinalia. In th e early stages, in m ost

63

Trunk S urface a n a to m y -► D e ve lo p m e n t -► Skeleton -► Im a g in g -► M uscles

Sulcus sinus sigm oidei Os o ccipitale, Clivus
O s occipitale
A rticulatio atlantooccipitalis,
Capsula articularis A tlas
M em bran a tectoria
A rticu latio atlantoaxialis lateralis,
Capsula articularis V erte b ra ce rv ic a lis III

Fig. 2.54 Cervico-occipital joints w ith deep ligam ents; dorsal Articulatio atlanto-axialis mediana (not visible). Lateral betw een Os oc­
vie w . cipitale and Atlas the jo in t capsule of the A rticulatio atlantooccipitalis
The M em b ran a tectoria is the cranial extension o f the Lig. longitudi- and betw een Atlas and Axis the joint capsule of the Articulatio atlanto­
nale posterius and covers the ligam ents and the joint capsule of the axialis lateralis are visible.

O s occipitale, Pars basilaris D ura m a te r cranialis

M e m b ran a a tlan to o ccip italis an terio r Lig. apicis dentis
Atlas, Arcus anterior
Dura m ater spinalis
A rticu latio atlan to ax ialis m ed ian a a n te rio r M em b ran a tectoria
A rticu latio atlan to ax ialis m ed ian a
Fasciculi longitudinales Lig. cruciform e
Lig. longitudinale anterius Lig. transversum atlantis a tla n tis
Dens axis
Fasciculi longitudinales
D iscus intervertebralis
V erte b ra ce rv ic a lis III, C o rp u s Squam a occipitalis

M e m b ra n a a tlan to o cc ip ita lis p o sterio r

A rcus posterior

Proc. spinosus

Nn. cervicales, Radices

Fig. 2.55 Cervico-occipital transitional region w ith interm ediate brana atlantooccipitalis anterior and the upper part o f the Lig. longi­
atlanto-axial jo int and corresponding ligam ents; sagittal section tudinale superius, respectively. On the posterior side of the dens, the
through the median plane; view fro m the left side. jo in t capsule is stre ngth ene d by th e Fasciculi longitudinales and th e Lig.
A section through the articular connection betw een Dens axis and an­ transversum atlantis (jointly named Lig. cruciform e atlantis) as w ell as
te rio r arch o f th e A tlas is sho w n . This is part o f th e so-called lo w e r head the M em brana tectoria w hich covers the Lig. cruciform e atlantis. The
joint com posed of the A rticulationes atlantoaxiales laterales and the M em brana tectoria is covered by the Dura m ater spinalis. The M e m ­
Articulatio atlantoaxialis mediana as opposed to the upper head joint brana atlantooccipitalis posterior extends betw een the Os occipitale
w hich consists o f th e A rticulationes atlantooccipitales. Above and and Atlas at the dorsal aspect o f the vertebral canal.
below the Atlas, the joint capsule receives support through the M em -

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a ll

Cervico-occipital joints

Fasciculi longitudinales Os occipitale, Pars basilaris
Ligg. alaria Canalis nervi hypoglossi
S ulcus sinus sigm oidei
Capsula articularis A rticu latio a tlantooccipitalis

Lig. c ru cifo rm e atlantis Lig. transversum £ A rcus posterior
F a s c ic u li A rtic u latio atlan to ax ialis lateralis

Fig. 2.56 C ervico-ocipital jo in ts w ith deep ligam ents; dorsal view ; nate fro m th e tip and th e lateral surface o f th e D ens axis (-* Fig. 2.57);
after removal of the Membrana tectoria. they project upwards in an oblique angle. On the le ft side, the joint
Centrally located is th e Lig. cruciform e atlan tis com posed o f th e Lig. capsule of the Articulatio atlantooccipitalis and the Articulatio atlantoaxi­
transversum atlantis and th e tw o Fasciculi longitudinales. Behind this alis are show n. On th e right side, the jo in t capsules have been removed
ligam ent the Ligg. alaria (winged ligaments) are located w hich origi­ and th e jo in t cavity is visible.

Os occipitale Ligg. alaria
Lig. a picis dentis Dens axis

C apsulae articu lares

Fig. 2.57 Cervico-occipital jo in ts w ith deep ligam ents; dorsal One can see th e Ligg. alaria (-* Fig. 2.56) w h ich fre q u e n tly project to
view ; a fte r removal o f the M em brana tectoria and Lig. cruciatum the Massae laterales o f the Atlas and the thin Lig. apicis dentis.
atlantis.

i- Clinical Rem arks------------------------------------

Rupture o f the Lig. transversum atlantis and/or the Lig. cruci­ tures (broken neck). The nerve centres fo r respiration and blood
fo rm e atlantis can lead to th e dislocation o f th e D ens axis into circulation are destroyed, w hich w ill result in im m ediate death.
the vertebral canal and, thus, into the Medulla oblongata. This Occasionally, a m issing Dens axis or incom plete form ation of the
w ill result in spinal cord contusion or transsection o f th e struc- odontoid may cause an atlanto-axial subluxation.

65

Trunk S urface a n a to m y -► D e ve lo p m e n t -► Skeleton -► Im a g in g -► M uscles

Cervico-occipital joints

Os o ccipitale, Pars basilaris M e m b ra n a a tlan to o cc ip ita lis an terio r
O s occipitale, Pars lateralis
O s o ccipita le , Pars lateralis
A rticu latio atlan to o cc ip ita lis Capsula articularis

A tlas Lig. longitudinale anterius
A rticu latio atlan to ax ialis lateralis D iscus intervertebralis

A x is V erte b ra ce rvica lis III, C o rp u s ve rte b ra e

V erte b ra ce rv ic a lis III

Fig. 2.58 Cervico-occipital joints w ith ligam ents and upper brana atlantooccipitalis anterior extends from the occipital bone to
cervical vertebral column; ventral view. the Atlas. The jo in t capsule o f th e Articulatio atlantooccipitalis is shown
The Lig. lo ngitud inale anterius is located in th e m idline. The M e m - on the ride side and removed on the contralateral side.

M e m b ran a a tlan to o cc ip ita lis p o sterio r

A tlas, M assa lateralis Lig. a tlantooccipitale laterale
S ulcus arteriae vertebralis
A rticu latio atlan to ax ialis lateralis Tuberculum posterius

A rticu latio atlan to ax ialis lateralis,
Capsula articularis

A xis, Arcus vertebrae

Fig. 2.59 Cervico-occipital joints; dorsal view . terior atlantis. The jo in t capsule of the Articulatio atlantoaxialis lateralis
Dorsal vie w onto the M em brana atlantooccipitalis posterior and the Lig. b e tw e e n A tlas and Axis is sho w n on th e ride side and rem oved on the
atlantooccipitale laterale betw een the Os occipitale and the Arcus pos- contralateral side.

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a ll

Intervertebral discs

N u c leu s d u Id o s u s

★* Corpus vertebrae

U ncus co rp o ris E piphysis anularis
[Proc. uncinatus] Anulus fibrosus
Epiphysis anularis
Anulus fibrosus N ucleus pulposus

P ediculus arcus vertebrae * Lig. longitudinale
C orpus vertebrae p o s te riu s
C orpus vertebrae
N. spinalis,
G anglion sensorium

nervi spinalis

A. v e rte b ra lis

Figs. 2.60a and b In terverteb ral discs. Disci intervertebrales. thus, can im pa ct negatively on neck m o bility (-» Clinical Remarks),
a Cervical intervertebral discs, Disci intervertebrales cervicales; frontal b Lumbar intervertebral disc, Discus intervertebralis lumbalis; median

section; ventral view. section (-» Fig. 2.53); v ie w fro m th e left.
In th e lateral areas o f th e cervical intervertebral discs so-called uncover-
tebral gaps (**) start form ing already during the first decade o f life. * hyaline cartilaginous lining o f the intervertebral surface as part of
Betw een 5 to 10 years o f age, the gaps becom e m anifest and assume the non-ossified portion of the vertebral epiphyses
a joint-like character, hence their name uncovertebral joints. W hile pro­
viding increased flexibility o f the cervical vertebral colum n at a younger * * so-called uncovertebral gap
age, later on these uncovertebral joints may rupture com pletely and,

Lig. longitudinale anterius

Anulus fibrosus

D is c u s
in te rv e rte b ra lis

Nucleus pulposus

Lig. longitudinale posterius N. spinalis

Fig. 2.61 Lum bar in terverteb ral disc. Discus in terverteb ralis The intervertebral disc (Discus intervertebralis) is com posed o f a central
lumbalis; cranial view . jelly-like nucleus (Nucleus pulposus), a rem nant o f the Chorda dorsalis,
and a fibrous ring (Anulus fibrosus) surrounding the Nucleus pulposus.

i- Clinical Remarks------------------------------------ tebral canal resulting in com pression o f th e spinal nerve roots (spi­
nal radicular syndrom e). M o st often, the segm ents S1, L5 and L4
Degenerative alterations of the intervertebral disc occur m ost are affected. In th e cervical vertebral colum n, a slipped disc may
fre q u e n tly in th e lum bar and th e cervical regions o f th e vertebral occur upon rupture o f the Discus intervertebralis, emanating from
colum n. This can result in disc protrusion or disc prolapse (slipped the uncovertebral gaps.
disc, herniated Nucleus pulposus). The disc tissue shifts usually to
the posterior and lateral side, rarely posterom edially, into the ver­

67

Trunk surface a n a to m y -► D e ve lo p m e n t -► S keleton -► Im a g in g - * M uscles

Cervical region of the vertebral column, radiography

Proc. mastoideus

O s occipitale

Atlas, A rcus anterior Atlas, A rcus posterior
A xis, Dens Atlas, Tuberculum posterius
A xis, Proc. spinosus

A xis, C orpus vertebrae Incisura vertebralis inferior
Incisura vertebralis superior
Angulus m andibulae
Lingua A rticu latio zygapophysialis
Proc. articularis inferior
V erte b ra c e rvica lis III, Proc. articularis superior
C orpus vertebrae Proc. spinosus
P ediculus arcus vertebrae
E p ig lo ttis Foramen intervertebrale

Os hyoideum

Discus intervertebralis
Cartilago cricoidea, Lam ina

Facies intervertebraies
V erte b ra ce rv ic a lis VII,

Corpus vertebrae

Fig. 2.62 Cervical vertebrae. Vertebrae cervicales; lateral
radiograph o f the cervical part of th e vertebral colum n; upright
position; th e central beam is directed on to th e 3rd cervical vertebra;
shoulders are pulled downw ards.

i- Clinical Remarks------------------------------------

Kyphosis is defined as a vertebral colum n curved dorsally convex. [SCHEUERMANN'S disease]; in adults through loss o f elasticity and
In th e tho racic vertebral colum n, this slight curvature is physiologi­ disc degeneration as senile kyphosis). Congenital kyphosis usually
cal, how ever, in th e cervical and lum bar vertebral colum n it is al­ results from hemi- or fused vertebrae. A strong non-physiological
w ays pathologic. A pronounced kyphosis leads to hum p form ation lordosis is called hyperlordosis and occurs particularly in the lumbar
(gibbus) and is present in various fo rm s (e.g. in early childhood as vertebral column.
humpback; in adolescence as juvenile or adolescent kyphosis

68

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a ll

Thoracic region of the vertebral column, radiography

Fig. 2.63 Thoracic vertebrae. Vertebrae thoracicae; anterior-poste-
rior (AP) radiograph o f th e thoracic part o f th e vertebral colum n; upright
position w ith Thorax in inspiration; central beam is directed on to th e 6th
thoracic vertebra.

* intervertebral disc space

i- Clinical Rem arks------------------------------------ m inor strain leads to collapse of vertebrae. O ften vertebral frag­
m ents enter the vertebral canal or the intervertebral foram ina and
Due to the dense capillary netw ork w ithin a vertebra, the vertebral result in injuries and com pression o f the spinal cord and the spinal
colum n is frequently a location for m etastases o f m alignant tu ­ nerves.
m ours. The normal bone m atrix o f affected vertebrae is destroyed
and the mechanical bone properties have vanished. Therefore, even

69

Trunk S urface a n a to m y -► D e ve lo p m e n t -► Skeleton -► Im a g in g -► M uscles

Lumbar region of the vertebral column, radiography

V erte b ra lu m b a lis I, C o rp u s ve rte b ra e Foram ina intervertebralia
C o sta XII*
A rcus vertebrae,
Facies intervertebrales P ediculus arcus vertebrae
Incisura vertebralis inferior

Incisura vertebralis superior

Proc. spinosus
Proc. articularis inferior
Proc. articularis superior

O s ilium , C rista iliaca

A rticu latio zygapophysialis

Basis ossis sacri C rista sacralis m ediana

P rom ontorium
Os sacrum

Fig. 2.64 Lum bar vertebrae. Vertebrae lumbales; lateral radiograph * intervertebral disc space
of the lum bar part o f the vertebral colum n; upright position; central * * region of the vertebral arch betw een the superior and inferior
beam is directed on to th e 2nd lum bar vertebra. The anterior edges of
the low er lum bar vertebrae are oblique as an initial sign of degenerative articular processes (isthm us = interarticular portion)
changes and pathological alterations. * * * T h e term inal points indicate th e position o f th e XII. rib, w h ich is

poorly visible in this copy o f the radiograph.

i- Clinical Remarks------------------------------------ tivity, malnutrition, and unfavourable estrogen levels contribute to
the developm ent of osteoporosis. As a result of the weakened bone
O steoporosis is a m etabolic bone disease (osteopathy) w h ich structure, fractures such as vertebral fractures, distal radius frac­
is characterized by localized or universal reduction o f bone tissue tures, and fem oral neck fractures occur frequently.
w ith o u t changing th e external shape o f th e bone. The etio lo gy is
m ostly unknown. This condition m ostly affects w om en over 55 and
men over 70 years o f age. G enetic predisposition, low physical ac-

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a ll

Lumbar region of the vertebral column, radiography

C o s ta XII Procc. costales
V erte b ra lu m b a lis I, C o rp u s ve rteb ra e

Proc. articularis superior
A rticu latio zygapophysialis

Proc. articularis inferior

Pediculus arcus vertebrae Procc. spinosi
Facies intervertebrales

Proc. costalis

O s coxae; O s ilium

A rticu latio sacroiliaca

Foramina sacralia anteriora

Proc. articularis superior Fig. 2.65 Lum bar vertebrae. Vertebrae lumbales, and sacrum, Os
sacrum; AP-radiograph o f the lum bar part o f the vertebral colum n and
sacrum ; upright position; central beam is directed on to th e 2nd lum bar
vertebra.

* intervertebral disc space

Fig. 2.66 Lum bar vertebrae. V ertebrae lumbales; radiograph w ith
beam in an oblique angle; upright position. [8]
The experienced radiologist can recognize a dog-like figure ("S cotty
d o g ", dotted lines) in th is oblique radiograph image. The central part
represents the interarticular portion. The clinical term refers to the
superior and inferior articular facets of the zygapophyseal joints
( - Fig. 2.29).

interarticular portion

P e d ic u lu s

Clinical Remarks the cranial vertebra shifts over the caudal vertebra as a result of con­
genital or degenerative changes o f the position o f the articular facet.
Fractures in th e region o f th e in terarticu lar portion (isthm us) A ll th e above-m entioned conditions (including a fra cture o f th e Pars
lead to a change in th e S cotty dog figure, such as dog collar, caused interarticularis) are term ed spondylolisthesis (vertebral slippage).
by a zone o f lysis. M o stly as a result o f sport injuries, damage occurs
particularly to th e Pars interarticularis at th e level o f L4 and L5 (isth­
m us). In th e absence o f a fra cture o f th e ventral Pars interarticularis,

71

2 Trunk S u rfa c e a n a to m y -► D e v e lo p m e n t -► S k e le to n -► Im a g in g -► M u s c le s

Vertebral colum n, CT

Larynx

Corpus vertebrae Cartilago thyroidea

T u b e rc u lu m M. sternocleido-
anterius m a sto id e u s
V erte b ra ce rv ic a lis V,
Proc. trans­ Fora m e n C orpus vertebrae
versus transversaru Uncus corporis
Proc. transversus,
Tuberculum Tuberculum anterius
p o s te riu s Discus intervertebralis

Foramen vertebrale N. spinalis
Pediculus arcus vertebrae
Proc. articularis inferior
V erte b ra ce rv ic a lis VI,
Lam ina arcus vertebrae Corpus vertebrae
Proc. articularis
Lig. flavum Lam ina arcus vertebrae
Proc. spinosus, Tubercula
Proc. spinosus

Fig. 2.67 Cervical part of th e vertebral colum n; com puted tom o­ Fig. 2.68 Cervical pa rt of th e ve rtebral colum n; com pute d to m o ­
graphic (CT) cross-section at th e level o f th e intervertebral disc bet­ graphic (CT) cross-section at th e level o f th e 5th cervical vertebra.
w e e n th e 4th and 5th cervical vertebrae.

endotracheal tube and endoscopic instrum ent

A orta, Pars abdom inalis V. c a v a in fe rio r
V. c a v a in fe rio r Aorta, Pars abdom inalis

D iscus intervertebralis ■ Corpus vertebrae
M. psoas m ajor
Ren ■ M. psoas major

Foramen intervertebrale P ediculus arcus vertebrae
Lig. flavum
Proc. articularis superior P roc. c o s ta l is
Proc. articularis inferior
A rticulatio zygapophysialis Proc. articularis superior
Lig. interspinale
Proc. articularis inferior Mm. dorsi
Fascia thoracolum balis
Proc. m am illaris
Mm. dorsi

Proc. spinosus

Fascia thoracolum balis •

Fig. 2.69 Lum bar part of th e vertebral colum n; com puted tom o­ Fig. 2.70 Lum bar pa rt of th e vertebral colum n; com puted to m o ­
graphic (CT) cross-section at th e level o f th e 2nd and 3rd lum bar verte­ graphic (CT) cross-section at th e level o f th e pediculi o f th e 3rd lum bar
brae. vertebra.

i- Clinical Remarks------------------------------------

S om e ge netic diseases are associated w ith diffe re n ce s in vertebrae genital elevation o f scapula due to spinal fusion. Spina bifida, low er
count. The KLIPPEL-FEIL syndrom e is a hereditary disorder o f the placem ent of ears, and abnorm alities of heart and other organs ac­
cervical spine w ith spinal fusion (generally o f atlas and axis or of com pany this disease.
th e 5th and 6th cervical vertebrae) during th e early em bryonic stage. A vertebra tha t em erges from only one side o f the associated scle­
Characteristic features are a decreased neck length and often a con­ ro to m e is te rm e d a hem ivertebra.

72

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a ll

Vertebral column, MRI

V erte b ra lu m b a lis I, Fascia thoracolum balis
Corpus vertebrae Proc. spinosus

D iscu s in te rve rte b ra lis Spatium epidurale
Canalis vertebralis;
C auda equina Fig. 2.71 Lum bar pa rt of th e vertebral colum n; m agnetic resonance
V erte b ra lu m b a lis V, tom ographic image (MRI) of the thoracic and lumbar part of the
Corpus vertebrae vertebral colum n and the sacrum.
Canalis sacralis MRI is a suitable imaging technique to v ie w intervertebra I discs, the
spinal cord, and the epidural space (Spatium epidurale).
Canalis vertebralis with
cerebrospinal fluid and C auda equina

D isc prolapse A rticular facet

V ertebra lu m b alis IV D isc prolapse

Fig. 2.72 M edial disc prolapse; T2-w eighted magnetic resonance Fig. 2.73 M edial disc prolapse; T2-w eighted m agnetic resonance
tom ographic sagittal image (MRI) in th e lum bar part o f th e vertebral tom ographic axial im age (MRI) in th e lum bar part o f th e vertebral co­
colum n. [8] lum n. [8]

Clinical Remarks------------------------------------ bodies. On radiographic images, th e sclerotic process is reflected
by an increase in radiation de nsity (osteochondrosis). Further, it
Aging decreases the ability of th e Anulus fibrosus and Nucleus pul­ results in the form ation o f osteophytes (bony spurs) at the vertebral
posus to retain w a te r w h ic h leads to form atio n o f sm all cracks in th e bodies, w h ich are also visible in radiographs. W ith th e radial cracks
A nulus fibrosus (chondrosis). N otable are radiographic reduction in in th e Anulus fibrosus increasing, intervertebra I disc tissue can leave
height and pathologic instability w ith increased m o bility in th e m o­ th e intervertebral space (disc prolapse; -» Figs. 2.72 and 2.73).
tion segm ent. Gradual height reduction o f the disc and the resulting
reduction in m echanical b u ffe r fun ction lead to increased strain on
adjacent superior and inferior intervertebral surfaces of the vertebral

73

Trunk S urface a n a to m y -► D e ve lo p m e n t -► Skeleton -► Im a g in g -» M uscles -*•

Superficial layer of muscles of the back

Protuberantia occipitalis externa
M. sternocleidom astoideus

Pars descendens
M . tra p e ziu s Pars transversa

S pina scapulae Acrom ion
Fascia deltoidea
Vertebra prom inens,
Proc. spinosus

M . te res m ajor S capula, Angulus inferior
M . latissim us dorsi
M . infraspinatus,
Fascia infraspinata

M. rhom boideus m ajor

M . obliquus externus abdom inis V erte b ra th o ra c ic a XII,
Trigonum lum bale Proc. spinosus
M. latissim us dorsi
Fascia thoracolu m b alis
C rista iliaca
O s sacrum , Facies dorsalis

Fig. 2.74 Superficial layer of th e trunk-arm and trunk-shoulder The M . latissim us dorsi is th e largest m uscle o f th e hum an body w ith
girdle muscles; dorsal view. respect to the surface area. It low ers the elevated arm, adducts the
The M m . trapezius and latissim us dorsi represent the largest part of the arm, can move the arm fro m an adducted position m edially and back­
superficial layer of m uscles of the back. The M . trapezius secures the w ards, rotates the arm inward, and assists in expiration. M. latissim us
scapula and thus the shoulder girdle and can move the scapula and dorsi and M . teres m ajor develop at the same tim e. The latter pulls the
clavicle backwards m edially tow ards the vertebral colum n. The Partes arm medially and backwards, supports adduction, and inward rotation
descendens and ascendens turn th e Angulus inferior of the scapula of the arm.
medially. The Pars descendens acts as an adductor and supports the
M . serratus anterior in th e elevation o f th e shoulder. - » T 27, 28

Clinical Remarks

A portion of the M . latissimus dorsi can be used to cover defects pedicle flap, on w h ich th e A. and V. thoracodorsalis are segm ented
of the w all of the trunk as w ell as to reconstruct the mammary and transferred, is prepared. The M . pectoralis m ajor (ventral trunk
after resection of m am m ary carcinoma. For this purpose a suitable wall) is often used as pedicle flap graft to cover facial defects.

dissection link

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a

Superficial layer of muscles of the back

tra p e z iu s
M . sternocleidom astoideus

M . splenius capitis

M . levator scapulae

Fascia deltoidea M. trapezius
M. teres major
M . s erratu s p o sterio r M . rhom boideus m a jo r
s u p e rio r M. infraspinatus,
C o s ta e Fascia infraspinata
Scapula, Angulus inferior
M . latissim us dorsi erector spinae
M. serratus anterior
M. latissim us dorsi
M . s erratu s p o s te rio r inferio r
M. obliquus externus abdom inis Fascia thoracolu m b alis

(Trigonum lum bale superius) M. obliquus externus abdom inis
M. o b liqu u s internus abdom inis
M. o bliquus internus abdom inis;
(Trigonum lu m b ale inferius)
C rista iliaca

Fig. 2.75 Deep layer of th e trunk-arm and trunk-shoulder girdle The Fascia th oraco lum balis co n stitu te s a dense aponeurosis. This
muscles; dorsal view. tough fibrous structure surrounds the autochthonous (intrinsic) erector
A fte r removal of the M. trapezius, the M m . levator scapulae, rhom ­ spinae m uscles of the back and form s an osteofibrous tube together
boideus m inor and rhom boideus major are visible on the right side. The w ith the vertebral colum n and the dorsal side o f the ribs. Its superficial
M . levator scapulae can lift the scapula and sim ultaneously turns the lamina serves as origin fo r the M. latissim us dorsi and the M . serratus
Angulus inferior of the scapula medially. posterior. This lamina is firm ly attached to th e tendon o f th e M . erector
M . rhom boideus m inor and M . rhom boideus m ajor fix the scapula to spinae. It separates the M. splenius cervicis fro m the M . trapezius and
the thorax and pull it tow a rds the spine. th e M m . rhom boidei in its cranial section and m erges w ith th e Fascia
A fte r the removal o f the three m uscles and the M . latissim us dorsi the nuchae. The deep lamina is show n in -* Fig. 2.76.
M m . serrati posteriores superior and inferior becom e visible. The The areas o f th e Trigonum lum b ale superius (GRYNFELT's triangle in
M. serratus posterior superior lifts the upper ribs upwards and supports TA) and th e Trigonum lum b ale inferius (PETIT's triangle) are th e sites
inspiration. The M . serratus posterior inferior broadens the low er tho­ fo r GRYNFELT's and PETIT's lum bar hernias.
racic aperture and stabilizes the low er ribs during the contraction o f the
Pars costalis o f th e diaphragm . Thus, th is m uscle also supports inspira­ —»T 2 7 , 28
tion.

dissection link

Trunk S urface a n a to m y -► D e ve lo p m e n t -► Skeleton -► Im a g in g -» M uscles -*•

Deep layer of muscles of the back

M . sem ispinalis capitis Lig. nuchae
M . splenius cap itis M . splenius capitis

M . longissim us capitis M . sternocleidom astoideus
M . splenius cervicis splenius cervicis
M . scalenus posterior

M. levator scapulae M. trapezius
M . longissim us cervicis M. teres m ajor
M. serratus posterior superior
M. sem ispinalis cervicis M. rhom boideus m ajor
M . iliocostalis cervicis M . iliocostalis th o ra c is
M . latissim us dorsi
M. infraspinatus, M . longissim us thoracis
Fascia infraspinata M. serratus anterior
M . serratus posterior inferior
M . spin alis th o ra c is
M . iliocostalis thoracis Fascia thoracolum balis
M . longissim us thoracis M . e re c to r spinae

M . iliocostalis lum borum
M . obiiquus externus abdom inis

M . obiiquus internus abdom inis

Fig. 2.76 Superficial layer of th e deep (autochthonous) muscles extends from the sacrum to the occipital bone. The abdominal muscles
of the back; dorsal view. and the M . erector spinae together act as a functional unit (bow-tendon
The autochthonous m uscles of the back are collectively named M. principle).
erector spinae. It is divided into a medial and a lateral tract. Each tract
is com posed o f d iffe re n t sy s te m s (-* Fig. 2.77). The M. ere cto r spinae —»T 18

dissection link

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a ll

Deep layer of muscles of the back, schem atic diagram

Tract E rector system O b liq u e system Tract

M. longissim us M. splenius*
-c a p itis -c a p itis
-c e rv ic is
-c e rv ic is
-th o ra c is M . sem ispinalis** m e d ia l
-c a p itis
M. iliocostalis -c e rv ic is
-c e rv ic is
-th o ra c is M. m u ltifid us** m e d ia l
-c e rv ic is
-lum borum -th o ra c is
-lum borum
M. spinalis
-c a p itis Mm. rotatores lo n g i**
-c e rv ic is
-c e rv ic is -th o ra c is
-th o ra c is -lum borum

Mm . inter- Mm. rotatores breves** m e d ia l
transversarii -c e rv ic is
-th o ra c is
p o s te rio re s -lum borum

M m . interspinales
-c e rv ic is
-th o ra c is

-lum borum

Fascia
thoracolum balis

Fig. 2.77 Deep (autochthonous) m uscles of th e back; diagram of • The spinotransverse system acts as a stabilizer according to the
the diffe ren t m uscle groups. bow-tendon principle and, together w ith the short neck muscles,
The autochthonous m uscles of the back, collectively named M . erector supports all m o ve m e n ts generated in th e jo in ts o f th e cervical spine
spinae, can be divided into a longitudinal erector system and an oblique and head.
system , as w ell as in a lateral and medial tract.
The lateral tract divides into an intertransversal system (M m . intertrans- The m edial tract divides into a spinal system (M m . interspinales, M.
versarii), a sacrospinal system (M. iliocostalis, M. longissimus), and a spinalis) and a transversospinal system (M m . rotatores breves, M m .
spinotransverse system (M. splenius cervicis, M . splenius capitis): rotatores longi, M . m ultifidus, M . semispinalis). Functionally, the spinal
• The intertransversal system serves as stabilizer, facilitates bending system is im portant fo r extension and torsion; the transversospinal
system stabilizes and rotates to the contralateral side.
sideways and extension am ong transverse processes of the verte­
brae. * spinotransverse
• The sacrospinal system erects the spine, causes extension, and * * transversospinal
facilitates side-bending and rotational m ovem ents of the trunk on
the ipsilateral side.

77

Trunk S urface a n a to m y -► D e ve lo p m e n t -► Skeleton -» Im a g in g M uscles ->

Deep layer of muscles of the back

M. sem ispinalis capitis M . obliquus capitis superior
M . rectu s cap itis po sterio r m inor M. splenius capitis
M . rectu s c ap itis p o sterio r M. longissim us capitis
M. digastricus, Venter posterior
Atlas, Tuberculum posterius M m . intertransversarii posteriores cervicis
Atlas, Proc. transversus
Ligg. intertransversaria
M . obliquus capitis inferio r Ligg. interspinalia; Lig. supraspinale
M. sem ispinalis capitis Mm. rotatores thoracis breves
M m . m ultifidi M m . intertransversarii thoracis
M. sem ispinalis cervicis
M m . rotatores thoracis longi
Mm . interspinales cervicis Lig. costotransversarium superius
M. spinalis capitis Lig. intertransversarium

M m . levatores costarum breves M em brana intercostalis interna

M. sem ispinalis thoracis M. q ua dratu s lum borum , Fascia
Mm . intertransversarii m ediales lum borum
M m . intercostales externi, Fascia M. transversus abdom inis
M m . interspinales lum borum
M m . levatores costarum breves
Ligg. intertransversaria
M m . lev a to re s c o staru m longi Lig. iliolum bale
M m . intertransversarii thoracis
C o s ta XII Spina iliaca posterior superior
Fascia thoracolum balis Lig. sacrotuberale
M. o bliquus internus abdom inis
M m . intertransversarii laterales
lum borum
Fascia transversalis

M. obliquus externus abdom inis

M m . m ultifidi

Fig. 2.78 Muscles of th e back. M m . dorsi, and muscles of th e by Rr. ventrales o f th e spinal nerves. C ontraction o f these m uscles re­
neck. M m . suboccipitales; dorsal view. sults in rotation o f the contralateral side and side-bending m ovem ents
Upon removal of the M m . splenius capitis and sem ispinalis capitis, the on th e ipsilateral side. Some authors also discuss a role of this m uscle
short neck m uscles (M m . rectus capitis posterior minor, rectus capitis group in inspiration. For th e organization o f th e o th e r sho w n au tochth o­
posterior major, obliquus capitis superior, obliquus capitis inferior) be­ nous m uscles o f th e back see -» Fig. 2.77.
com e visible.
Also depicted here are the M m . levatores costarum w hich are not part -►T 18
of the autochthonous m uscles of th e back because the y are innervated

dissection link

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a

Deep layer of muscles of the back

Lig. costotransversarium Lig. intertransversarium

M. levator costae C o s ta IX
M . levator costae brevis
M m . rotatores thoracis M m . m ultifidi

V erte b ra lu m b a lis I, Lig. intertransversarium
A rcus vertebrae
Ligg. flava Costa XII
Vertebrae lum bales,
Mm . intertransversarii P rocc. costales
m ediales lum borum M m . intertransversarii
laterales lum borum
Vertebrae lum bales, Fascia thoracolu m b alis
Procc. spinosi (Lam ina profunda)

M m . m ultifidi
M . e re c to r spinae

Fascia th o raco lu m b alis
(Lam ina superficialis)

Fig. 2.79 Deep layer of th e m uscles of th e back. M m . dorsi, in and are located medially, together w ith the superficial and deep leaf of
the region of the thoracic and lum bar part of the vertebral th e Fascia thoracolum balis. On th e le ft side o f th e body, th e M m . rota­
column; dorsal view. tores thoracis are visible.
On the right side, a cross-section through the caudal region of the M.
ere cto r spinae is sho w n . The M m . m u ltifid i belong to the m edial tract - ♦ T 18

Lig. longitudinale anterius C auda equina
Ren P ediculus arcus vertebrae'! A rcus

M. psoas major f vertebrae
Lam ina arcus ve rte b ra e j
Plexus lum balis
Proc. costalis Mm . transversospinales**

M . quadratus lum borum M. erector spinae*
C o s ta XII
(Lam ina
obliquus externus abdom inis p ro fu n d a )
M . latissim us dorsi
Proc. spinosus F a s c ia
th o raco lu m b alis

— (Lamina
s u p e rfic ia lis )

Fig. 2.80 A utoch tho no us m uscles of th e back; transverse section m uscles of the back are divided into a lateral tract (*) and a medial tract
at th e level o f th e 2nd lum bar vertebra; caudal view . (**).
The autochthonous m uscles o f th e back are located in an osteofibrous
tube w hich is form ed by the dorsal parts o f the vertebrae at the inside T 18
and the Fascia thoracolum balis on the outside. The autochthonous

dissection link

Trunk S urface a n a to m y -► D e ve lo p m e n t -► S keleton -» Im a g in g -► M uscles ->

Neck muscles

M . obliquus capitis Fig. 2.81 S ho rt muscles of th e neck. M m . suboccipitales; vie w
s u p e rio r from an oblique dorsal angle.
The M m . rectus capitis posterior major, obliquus capitis superior, and
M . rectus capitis obliquus capitis inferior create a triangle (vertebralis triangle). The M.
po sterio r m inor rectus capitis posterior m inor is located m edially to the M. rectus capi­
tis posterior major. Functionally, the fo u r m uscles direct precise m ove­
M . rectu s capitis m ents of the head joints (Articulationes atlantooccipitalis and atlantoaxi-
po sterio r m ajor alis) and pe rform m inu te ad ju stm en ts o f th e head in th e atlanto-occipital
and atlanto-axial joints.
Atlas, A rcus posterior
—►T 18
M . obliquus capitis
inferio r

M . rectu s cap itis po sterio r m inor M . trapezius
M. sem ispinalis capitis
M . splenius capitis M . rectu s cap itis p o s te rio r m ajor
M . obliquus capitis superior
M. splenius cervicis M . splenius capitis
M . longissim us capitis
M . sem ispinalis capitis Atlas, A rcus posterior
Atlas, Tuberculum posterius
A xis, Proc. spinosus M . splenius cervicis

Proc. mastoideus
M. longissim us capitis
M . digastricus, Venter posterior
Proc. styloideus
M . obliquus capitis inferio r
M. longissim us capitis

M. sem ispinalis capitis

Mm . interspinales cervicis M m . m ultifidi

M. sem ispinalis cervicis

M. longissim us cervicis

M. iliocostalis cervicis

Lig. supraspinale

M. sem ispinalis thoracis

Fig. 2.82 Muscles of th e back. M m . dorsi, and muscles of th e nuchalis inferior. The M. obliquus capitis superior originates at th e Proc.
neck. M m . suboccipitales; dorsal view. transversus of the Atlas and inserts above and laterally to the M . rectus
To vie w the short m uscles of the neck, the M m . splenius capitis and capitis posterior major. The M. obliquus capitis inferior has its origin at
sem ispinalis capitis on the right side w ere removed. The M. rectus ca­ the Proc. spinosus o f the Axis and inserts at the Proc. transversus of
pitis posterior m inor has its origin at the Tuberculum posterius o f the the Atlas.
Atlas and inserts m edially at the Linea nuchalis inferior. The M. rectus
capitis posterior m ajor originates at the Proc. spinosus of the Axis and -►T 18
inserts laterally to the M. rectus capitis posterior m inor at th e Linea

dissection link

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a

Neck muscles

M. sem ispinalis capitis M . rectu s capitis po sterio r m inor
M . rectu s cap itis po sterio r m ajor
M . splenius capitis M em brana atlantooccipitalis posterior

M . obliquus capitis superior A . v e rte b ra lis , Pars atlantica
Proc. transversus
M. longissim us capitis
M . digastricus, Venter posterior M . obliquus capitis inferio r
M . splenius cervicis
M. rectus ca p itis lateralis
Proc. styloideus Mm. m ultifidi

M. o bliquus capitis inferior
M. longissim us cervicis

M. intertransversarius p o ste rio r cervicis
A xis, Proc. transversus
M. splenius cervicis

M . sem ispinalis capitis

Fig. 2.83 M uscles of th e neck. M m . suboccipitales; dorsal view . I = Tuberculum po sterius o f th e Atlas

The M m . rectus capitis posterior major, obliquus capitis superior, and II = Proc. spinosus o f th e Axis

obliquus capitis inferior create the margins of the vertebralis triangle

(Trigonum arteriae vertebralis). A t the base of this triangle the A.

vertebralis crosses the Arcus posterior atlantis.

M. splenius capitis Fig. 2.84 Muscles of th e back, M m . dorsi, and muscles of the
M . longissim us capitis neck. M m . colli; v ie w fro m th e le ft side.
Upon dissection of the M . splenius capitis (rest displaced cranially), the
lateral view of the neck reveals fro m anterior to posterior the M m . sca-
leni medius and posterior as w ell as autochthonous m uscles o f the
back w ith the lateral (M m . iliocostalis cervicis, longissim us cervicis,
splenius cervicis, longissim us capitis) and medial (M m . sem ispinalis
thoracis, sem ispinalis capitis) tracts. W ith the removal o f the superficial
m uscles o f th e back in th e neck region th e Lig. nuchae and parts o f th e
M . trapezius becom e visible at the midline.

M . s e m is p in a lis c a p i t i s -------- I l I I M N I M »ft----------- L ig . n u c h a e

M . splenius M . trapezius
M. levator scapulae
M . longissim us Vertebra prom inens, Proc. spinosus
M . s calen u s m edius M . iliocostalis cervicis
M . scalenus M . sem ispinalis th o ra c is
Costa I

dissection link

Trunk S urface a n a to m y -► D e ve lo p m e n t -► Skeleton -► Im a g in g -» M uscles -*•

Muscles of the thoracic and abdominal wall

M m . sternocleidom astoidei (Trigonum c lavipectorale)
Platysm a
Fascia brachii
Fascia clavipectoralis Fascia axillaris
V. c ep h a lica M . p e c to ra lis m ajo r, Pars clavicularis

M. deltoideus

M . serratus M . p e cto ralis m ajor, Pars sternocostalis
M . latissim us dorsi
Ligg. costoxiphoidea M . p ectoralis major, Pars abdom inalis

M . obliquus e xtern u s abdom inis Linea alba

Anulus um bilicalis V agina m usculi re cti abdom inis,
Spina iliaca anterior superior L am ina an terio r
Tela subcutanea; P anniculus adiposus
M. o bliquus externus abdom inis, Fibrae intercrurales
C rus m ed iale
A p o n e u ro s is M. crem aster
Lig. reflexum
Funiculus sperm aticu s Lig. suspensoriu m penis
Lig. fu n d ifo rm e penis

Fig. 2.85 Muscles of th e thoracic and abdom inal w all. M m . In th e abdom inal region, the rectus sheath is fo rm e d by the aponeuro­
thoracis and M m . abdom inis, superficial layer; ventral view . ses of the oblique abdominal muscles. The ou tm ost oblique abdominal
The V. cephalica runs b e tw een th e m argins o f th e M . deltoideus and M. m uscle, M . obliquus externus abdom inis, sends its aponeurosis into
pectoralis m ajor to the Trigonum clavipectorale (M O HRENHEIM 's fos­ the outer layer of the rectus sheath.
sa) w h e re it goes deep to join th e V. axillaris. The lo w e r margin o f the In th e m idline, th e aponeuroses join in th e Linea alba. The caudal sus­
M. pectoralis m ajor constitutes the anterior axillary fold, the anterior pensory ligam ents fo r the penis, Ligg. fundiform e and suspensorium
margin of the M. latissim us dorsi creates the posterior axillary fold; the penis, are shown. Lateral thereof the Funiculus sperm aticus and con-
M. serratus anterior fo rm s the floo r o f the axilla. tralaterally the Anulus inguinalis superficialis w ith Crus mediale, Fibrae
The M . pectoralis m ajor functionally participates in the anteversion (= intercrurales, and Lig. reflexum are visible.
flexion) o f th e arm in th e shoulder jo in t and is a strong adductor and
m edial rotator. In addition, th is m uscle can pull th e shoulder forw ard —►T 15, 24, 25, 28
and d o w n w ard w ith th e arm in a fixed position and assists in inspira­
tion.

dissection link

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a ll

Muscles of the thoracic and abdominal wall

M. trapezius C lavicula
Spina scapulae
M . infraspinatus M. p ectoralis major, Pars sternocostalis
M. teres minor
M. teres m ajor Corpus mammae,
Lobi glandulae m amm ariae
M. deltoideus
M . tric e p s b ra chii (I SC aappUu !t !la°tnte9raulren; Papilla m am m aria
M . s erratu s an terio r
M. brachialis M. p ectoralis major, Pars abdom inalis
M. b icep s brachii
M . latissim us dorsi A rcus costalis
M . obliquus e xtern u s abdom inis
Fascia thoracolum balis Anulus um bilicalis
(Trigonum lumbale)
V agina m usculi recti abdom inis,
S pina iliaca posterior superior Lam ina a n te rio r
(Fascia glutea) M . obliquus externus abdom inis,
A p o n e u ro s is
M . gluteus m axim us S pina iliaca anterior superior

M . te n s o r fasciae latae

M . sartorius

Fig. 2.86 Muscles of th e thoracic and abdom inal w all, M m . lo w e r ribs run alm o st vertical to th e Labium exte rnu m o f th e Crista ilia­
thoracis and M m . abdominis; view from the right side. ca. The remaining m uscle fibres enter into a sheet-like aponeurosis
The lateral v ie w dem onstrates th e fem ale breast (M amma) riding on w h ich participates in th e form atio n o f th e rectus sheath (Vagina m uscu­
the M. pectoralis major. The lateral abdominal w all displays the serrated li recti abdom inis). A t th e thigh, th e Fascia glutea and th e M m . gluteus
interposition of the m uscular origins of the M . obliquus externus abdo­ m axim us and tensor fasciae latae radiating into the Tractus iliotibialis
m inis w ith those of the M . serratus anterior. The M . latissimus dorsi are visible.
covers these m uscular serrations from dorsal.
The M . obliquus externus abdom inis extends from lateral posterior - f T 24, 25, 27, 28
cranial to medial anterior caudal. The m uscle fibres com ing fro m the

83

Trunk S urface a n a to m y -► D e ve lo p m e n t -► Skeleton -» Im a g in g M uscles ->

Muscles of the thoracic and abdominal wall (M . ste rn alis, Var.)
M. subclavius
M. sternocleidom astoideus, Tendo V. a xilla ris
M. p ectoralis major, Pars clavicularis M. pectoralis m inor

M. intercostalis internus Plexus brachialis,
M. deltoideus Pars infraclavicularis
M . coracobrachialis

M . biceps brachii, C aput breve

M. pectoralis m ajor A. axillaris

M . pectoralis m inor M. serratus anterior

C o s ta III
M. latissim us dorsi

M. serratus anterior

M . p e cto ralis m ajo r, Pars sternocostalis

o bliquus externus abdom inis

M. p ectoralis major, Pars abdom inalis

Fig. 2.87 Muscles of th e thoracic w all; M m . thoracis; ventral view. th e Proc. coracoideus. The M. pectoralis m inor originates fro m ribs III
The M . pectorals m ajor w as rem oved on both sides, and the M. pecto­ to V and participates in depression and rotation o f th e scapula. The very
ralis m ino r w a s also rem oved on th e le ft side. On th e righ t side o f the variable M. sternalis is a not infrequent variant located on top o f the M.
body, the course o f the neurovascular bundle is visible be lo w the M. pectoralis major.
pectoralis m inor. A lthough the M . pectoralis m inor is considered a
m uscle of the shoulder it does not insert at the upper extrem ity but at —►T 13, 15, 24

M. serratus anterior C o s ta VIII
M . s erratu s anterior, Fascia V. in te rco s ta lis p o s te rio r
A . in terco stalis p o sterio r
M. intercostalis N. in terco stalis (T8)
internus
P ulm o
M. intercostalis P le u ra v is c era lis [pulm onalis]
e x te rn u s P leura p arietalis, P ars costalis;
Fascia endothoracica
C o s ta IX
Fascia th o ra c ic a interna
C utis; Tela
Fascia th o racica P leura p arietalis,
externa Pars diaphragm atica
Pars costalis diaphragm atis
Costa X
Hepar

Peritoneum viscerale
Peritoneum parietale
Recessus costodiaphragm aticus

Fig. 2.88 Muscles of th e thoracic w all; M m . thoracis; frontal tures always are conducted at th e upper margin of the rib because the
section through tw o intercostal spaces. neurovascular stru cture s (V., A., N. intercostalis) run be lo w th e rib.
The follow ing structures are penetrated during pleural puncture: Cutis/
Subcutis, Fascia m usculi serrati, M . serratus anterior, Fascia thoracica * position of the needle during pleural puncture
externa, M. intercostalis externus, M . intercostalis internus, Fascia in­ —►T 13
tercostalis interna, Fascia endothoracica, Pleura parietalis. Pleural punc-

dissection link

Vessels and nerves -► T opog ra p hy, back -> Fem ale breast -► Topograp hy, a b dom en and a b d o m in a l w a ll

Muscles of the thoracic and abdominal wall

M. scalenus posterior Tuberculum anterius [caroticum ]
M. scalenus m edius (V ertebra ce rv ic a lis VI)
M. scalenus anterior
M. scalenus anterior
M em brana intercostalis interna M . longus colli

M m . intercostales interni M em brana intercostalis interna
Lig. longitudinale anterius M m . intercostales externi

M m . intercostales interni

Fig. 2.89 Posterior w a ll o f th e thoracic cavity, C avea thoracis; visible). They act during expiration by depressing th e ribs. An excep­
ventral view. tion are the muscular parts located betw een the cartilaginous parts of
The M m . intercostales externi project fro m posterior cranial to anteri­ the ribs (M m . intercartilaginei) w hich support inspiration. Not shown
or caudal. They initiate at the Tubercula costarum and reach forw ard to are the m uscular elem ents of the M m . intercostales interni stretching
the parasternal cartilage (not visible). These m uscles act in concert w ith across m ultiple segments, known as M m . subcostales, w hich serve
the M m . intercartilaginei (not shown) by elevating th e ribs during in­ the same function as the M m . intercostales interni.
spiration.
The M m . intercostales interni project from posterior caudal to anterior
cranial. They initiate at the Angulus costae and reach th e sternum (not

M . sternohyoideus M. sternothyroideus
Cartilago costalis I
Corpus sterni
M anubrium sterni
M m . intercostales interni Diaphragm a,
M . transversus thoracis C entrum tendineum

Foramen venae cavae
Mm . intercostales interni
Proc. xiphoideus

Fig. 2.90 A n terio r w a ll o f th e thoracic cavity, Cavea thoracis; xiphoideus and insert on th e inside of the costal cartilages 2 to 6. The
dorsal view. M . transversus thoracis supports expiration.
The vie w onto the inner side of the anterior thoracic w all displays the The posterior side o f the M anubrium sterni serves as origin fo r the M.
sternum and the muscular bundles of the M . transversus thoracis. sternothyroideus and M . sternohyoideus.
They originate at th e lateral side o f th e sternum and o f th e Proc.
—»T 13

85

Trunk S urface a n a to m y -► D e ve lo p m e n t -► Skeleton -► Im a g in g -» M uscles -*•

Abdominal muscles Ligg. costoxiphoidea

M . serratus anterior M . p e c to ra lis major,
Pars sternocostalis

Vagina m usculi recti abdom inis, M. p ectoralis major,
Lam ina anterior Pars abdom inalis

M . obliquus externus abdom inis

M. rectus abdom inis, Mm . intercostales interni
Intersectio tendinea M . rectus abdom inis

M . rectu s abdom inis

M . obliquus e xtern u s ab d o m in is M. o bliquus internus abdom inis,
Anulus um bilicalis A p o n e u ro s is

Linea alba M . o bliquus externus abdom inis
S pina iliaca anterior superior
M . obliquus internus abdom inis

M. o bliquus externus abdom inis,
A p o n e u ro s is

Fibrae intercrurales Funiculus sperm aticus; M . crem aster

...................... ...... C ru s laterale Lig. reflexum
Anulus inguinalis I

superficialis | C rusm ediale

Fig. 2.91 Superficial and m iddle layer of th e abdom inal muscles. On the left side, the M . obliquus externus abdom inis has been de­
M m . abdominis; ventral view. tached and folded m edially across the rectus sheath. The larger part of
On the right side, the superficial leaf (Lamina anterior) of the rectus this m uscle ends in an aponeurosis w hich contributes to the superficial
sheath (Vagina m usculi recti abdom inis) has been opened and the M. leaf (Lamina anterior) of the rectus sheath. Functionally, this m uscle
rectus abdom inis becom es visible. This m uscle is separated into participates in th e fo rw a rd and side-bending m o ve m e n ts it lateral rota­
three to four Intersectiones tendineae w hich create the so-called tion o f the upper torso. It is an elem ent o f th e oblique and transverse
six pack contour w hen exercised properly. The M. rectus abdominis m uscular abdominal girdle, and creates a functional unit w ith th e mus­
serves to bend the trunk forward and sideways. cles of the opposite side as w ell as the M m . obliqui interni and transver-
The caudal part of the rectus sheath contains the small triangular M. si abdom inis.
pyram idalis w hich originates fro m the Os pubis and projects into the
Linea alba. The M . pyramidalis is a rudim entary pouch m uscle (from a —►T 13-15, 24
com parative anatom ical standpoint, the kangaroo possesses a strongly
developped M . pyramidalis).

8 6 dissection link