Superficial Muscles of the Back; Muscle Chart PLATE 373
Superior fibers External occipital protuberance
Sternocleidomastoid muscle
Trapezius muscle Middle fibers Splenius capitis
muscle
Inferior fibers
Acromion
Spine of scapula Spinous process of
vertebra prominens
Deltoid muscle
and fascia
Teres major muscle Inferior angle of the scapula
Latissimus dorsi muscle
Infraspinatus
muscle and fascia Spinous process of 12th
thoracic vertebra
Rhomboid major muscle
Thoracolumbar fascia
External abdominal oblique muscle Iliac crest
Lumbar triangle Dorsal surface of the sacrum
Latissimus dorsi muscle
FIGURE 373 The Superficial Muscles of the Back: Trapezius and Latissimus Dorsi
NOTE that although the trapezius and latissimus dorsi are superficial muscles of the back, they both insert onto pectoral girdle bones—that is, the
scapula and the humerus.
SUPERFICIAL MUSCLES OF THE BACK
Muscle Origin Insertion Innervation Action
Trapezius Middle third of the superior Lateral third of the Motor fibers from Assists serratus anterior in rotating
nuchal line; external clavicle; medial spinal part of the the scapula during abduction of the
occipital protuberance; margin of acromion; accessory nerve (XI); humerus between 90 and 180 degrees;
ligamentum nuchae; spinous spine of the scapula sensory fibers from upper fibers elevate the scapula;
processes of C7 and T1 to C3, C4 lower fibers depress the scapula; middle
T12 vertebrae fibers adduct the scapula; occipital
fibers draw the head laterally
Latissimus dorsi Thoracolumbar fascia; Floor of the Thoracodorsal nerve
spinous processes of lower intertubercular sulcus from the posterior Extends, adducts, and medially rotates
six thoracic vertebrae and of the humerus cord of the brachial humerus; with insertion fixed, it
five lumbar vertebrae and plexus (C6, C7, C8) elevates the trunk to the arms, as in
the sacrum; iliac crest; climbing
lower three or four ribs
Chapter 5 The Back, Vertebral Column, and Spinal Cord
PLATE 374 Intermediate Back Muscles and the Latissimus Dorsi
Rhomboid minor Trapezius muscle
muscle Sternocleidomastoid muscle
Splenius capitis muscle
Rhomboid major muscle
Splenius cervicis Levator scapulae muscle
muscle Rhomboid minor
muscle
Deltoid fascia
and muscle Trapezius muscle
Teres major muscle
Serratus posterior Infraspinatus muscle,
superior muscle infraspinous fascia
Scapula, inferior angle
Ribs Erector spinae muscles
Latissimus dorsi muscle Latissimus dorsi muscle
Serratus anterior muscle Thoracolumbar fascia
Serratus posterior External oblique muscle
inferior muscle Inferior lumbar triangle
External oblique muscle Iliac crest
Internal oblique muscle
FIGURE 374 Superficial and Intermediate Back Muscles (Posterior View)
NOTE: (1) On the right side, the trapezius has been removed to reveal the rhomboid muscles, the levator scapulae, and the splenius capitis. The
latissimus dorsi and the thoracolumbar fascia are still intact.
(2) On the left side, the trapezius, the latissimus dorsi, and the rhomboid muscles have been removed to expose the serratus posterior superior,
the serratus posterior inferior, and several ribs.
(3) The erector spinae muscle and its overlying fascia (labeled on the right and shown extensively on the left but not labeled) extends longitudi-
nally and considered the strongest and most important deep back muscle (see Fig. 375).
Chapter 5 The Back, Vertebral Column, and Spinal Cord
Erector Spinae and Semispinalis Muscles PLATE 375
Semispinalis capitis muscle Ligamentum nuchae (nuchal ligament)
Splenius capitis muscle Semispinalis capitis muscle
Longissimus capitis muscle Sternocleidomastoid muscle
Splenius cervicis muscle
Splenius cervicis muscle
Scalenus posterior muscle Levator scapulae
(posterior scalene) muscle
Levator scapulae muscle Deltoid muscle
Longissimus cervicis muscle and fascia
Semispinalis cervicis muscle Teres major muscle
Trapezius muscle
Iliocostalis cervicis muscle Serratus posterior superior muscle
Infraspinatus muscle, Rhomboid major muscle
infraspinous fascia Iliocostalis thoracis muscle
Latissimus dorsi muscle
Spinalis thoracis muscle Longissimus thoracis muscle
Iliocostalis thoracis muscle Serratus anterior muscle
Spinalis thoracis muscle
Longissimus thoracis muscle Serratus posterior inferior muscle
Iliocostalis lumborum muscle
External oblique muscle
External oblique muscle Thoracolumbar fascia
Lumbar vertebrae,
Erector spinae muscles
spinous processes muscle
Internal oblique muscle
FIGURE 375 Erector Spinae Muscles and Semispinalis Capitis Muscles
NOTE: (1) The trapezius and latissimus dorsi muscles have been removed, as have the rhomboid muscles and the serratus posterior (superior
and inferior) muscles.
(2) The erector spinae muscle is seen intact on the right side, while its iliocostalis, longissimus, and spinalis columns have been separated on the
left side. This muscle is a strong extensor and lateral flexor of the vertebral column (and head).
(3) The two semispinalis capitis muscles superiorly following the removal of the splenius capitis muscles. Observe the tendinous intersections that
are characteristic of this muscle.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
PLATE 376 The Back: Intermediate and Deep Back Muscles
Semispinalis capitis muscle, lateral part Semispinalis capitis muscle, medial part
Nuchal ligament
Semispinalis capitis muscle, lateral part
Splenius capitis muscle
Splenius capitis muscle
Masseter muscle Levator scapulae muscle
Levator scapulae muscle Splenius cervicis muscle
Splenius cervicis muscle Middle and posterior scalene muscles
Omohyoid muscle
Rhomboid minor muscle Clavicle
1st rib
Trapezius muscle Omohyoid muscle
Supraspinatus muscle
Deltoid Acromion
muscle Infraspinatus muscle
Teres minor muscle
Triceps muscle
6
Teres major and 9 Rhomboid minor
minor muscles 12 muscle
Rhomboid major
Rhomboid major muscle
muscle Serratus posterior
superior muscle
Serratus anterior muscle Latissimus dorsi
muscle
Thoracic part, Serratus anterior muscle
thoracolumbar fascia Longissimus thoracis
muscle
Serratus posterior Spinalis thoracis muscle
inferior muscle Iliocostalis thoracis muscle
External oblique muscle Erector spinae muscle
Aponeurosis, Lumbar part of
latissimus dorsi muscle thoracolumbar fascia
Lumbar triangle; Internal oblique muscle
internal oblique muscle
Gluteal fascia
Gluteus maximus muscle
FIGURE 376 Muscles of the Back: Intermediate Layer (Left), Deep Layer (Right)
NOTE: (1) On the left side, the superficial back muscles (trapezius and latissimus dorsi) have been cut, as have the rhomboids, which attach the
vertebral border of the scapula to the vertebral column. Observe the underlying serratus posterior superior and inferior muscles.
(2) On the right side, the serratus posterior muscles and the thoracolumbar fascia have been removed, exposing the erector spinae muscle (for-
merly called sacrospinalis muscle).
(3) In the neck, the splenius cervicis, splenius capitis, and semispinalis capitis underlie the trapezius.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
The Back: Erector Spinae Muscle PLATE 377
Splenius capitis muscle Semispinalis capitis muscle
(medial fascicle)
Semispinalis capitis muscle 2 Semispinalis capitis muscle
(lateral fascicle)
Nuchal ligament Longissimus cervicis muscle
Longissimus capitis muscle
Longissimus capitis muscle Spinalis cervicis and capitis muscles
Splenius cervicis muscle Iliocostalis cervicis muscle
Levator scapulae muscle
Longissimus cervicis muscle Iliocostalis thoracis muscle
Iliocostalis cervicis muscle Longissimus thoracis muscle
Scalenus posterior muscle Spinalis thoracis muscle
Semispinalis capitis muscle
Serratus posterior superior muscle
Longissimus cervicis muscle 3
Levator costae muscle 4
5
Longissimus thoracis muscle
External intercostal muscles 6
Semispinalis thoracis 7
and cervicis muscles 8
9
Iliocostalis thoracis muscle
Levatores costarum muscles
Serratus 10
posterior inferior muscle
11 Iliocostalis lumborum muscle
Spinalis thoracis muscle
Semispinalis thoracis muscle 12
Longissimus thoracis
muscle
Latissimus dorsi muscles
External oblique muscle Longissimus muscle
Serratus
Red Iliocostalis lumborum
posterior inferior muscle Black Iliocostalis thoracis
Iliocostalis lumborum muscle Blue Iliocostalis cervicis
Green
Internal oblique muscle Longissimus thoracis
Longissimus cervicis
Tendon of origin, Longissimus capitis
latissimus dorsi muscle
Spinalis thoracis
Gluteal fascia Spinalis cervicis
Spinalis capitis
Lumbar part of
thoracolumbar fascia Semispinalis capitis
Erector spinae muscle (medial and lateral
fasciculi)
Gluteus maximus muscle
FIGURE 377 Deep Muscles of the Back and Neck: Erector Spinae Muscle
NOTE: (1) On the left, the erector spinae (sacrospinalis) muscle is separated into iliocostalis, longissimus, and spinalis parts. In the neck, observe
the semispinalis capitis, which has both medial and lateral fascicles. The semispinalis cervicis and thoracis extend inferiorly from above and lie
deep to the sacrospinalis layer of musculature.
(2) On the right, all of the muscles have been removed and their attachments have been diagrammed by means of colored lines and arrows.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
PLATE 378 The Back: Transversospinal Groups of Muscles
Semispinalis capitis muscle I Obliquus capitis superior muscle
Rectus capitis posterior minor muscles II Splenius capitis muscle
III Longissimus capitis muscle
Obliquus capitis superior muscle
Splenius capitis muscle VII Intertransversarius cervicis muscle
1 Capsules of intervertebral joints
Rectus capitis posterior major muscles
Transverse process of atlas Intertransversarii
Posterior tubercle of atlas cervicis (posterior) muscles
Obliquus capitis inferior muscle Intertransverse ligaments
Semispinalis capitis muscle Interspinal ligament
Multifidus muscles Rotatores thoracis muscles
Semispinalis cervicis muscle
Scalenus posterior muscle
Interspinalis cervicis muscles
Spinalis capitis muscle
Levatores 6 Intertransversarii thoracis muscles
costarum breves muscles 11 External intercostal muscle
Semispinalis thoracis muscle
Rotatores thoracis muscles
External
intercostal fascia Intertransverse ligament
Internal intercostal membrane
Levatores Intercostal nerve,
costarum breves muscles artery and vein;
internal intercostal muscle
Rotatores thoracis muscles
Internal intercostal membrane
Levatores 12 Internal intercostal muscle
costarum longi muscles
External intercostal muscle
Intertransversarii
thoracis muscles I
12th rib (periosteum Internal oblique muscle
partly removed)
Transversalis fascia
Lumbar part of overlying quadratus lumborum muscle
thoracolumbar fascia
Internal oblique muscle Intertransversarii
lumborum muscles (medial)
Intertransversarii
lumborum muscles (lateral) Transversus abdominis muscle
Transversalis fascia Interspinalis
lumborum muscles
Tendon of external V Iliolumbar ligament
oblique muscle
Intertransverse
ligaments
Multifidus muscles Posterior
superior iliac spine
Gluteus maximus muscle; Sacrotuberous ligament
posterior superior iliac spine
FIGURE 378 Deep Muscles of the Back and Neck: Transversospinal Group
NOTE: (1) The transversospinal groups of muscles lie deep to the erector spinae, and they extend between the transverse processes of the verte-
brae and the spinous processes of higher vertebrae. These muscles are extensors of the vertebral column or acting individually and on one side,
they bend and rotate the vertebrae of that side.
(2) Within this group of muscles are the semispinalis (thoracis, cervicis, and capitis), the multifidus, the rotatores (lumborum, thoracis, cervi-
cis), the interspinales (lumborum, thoracis, cervicis), and the intertransversarii.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
Chart of Intermediate and Deep Back Muscles PLATE 379
INTERMEDIATE MUSCLES OF THE BACK
Muscle Origin Insertion Innervation Action
Rhomboid major Spinous processes of T2 Medial border of scapula Dorsal scapular nerve Adducts the scapula by pulling
to T5 thoracic vertebrae between the scapular spine (C5) it medially toward the vertebral
and inferior angle column; rotates the scapula by
depressing the lateral angle; helps
Rhomboid minor Spinous process of C7 Medial border of scapula Dorsal scapular nerve fix scapula to thoracic wall
and T1 vertebrae at the level of the spine of (C5) Assists the rhomboid major muscle
the scapula
Elevates superior border of scapula;
Levator scapulae Transverse processes of Superior angle and upper C3 and C4 nerves and rotates scapula laterally thereby
atlas and axis and the medial border of scapula the dorsal scapular tilting the glenoid cavity downward
Serratus posterior posterior tubercles of nerve (C5)
superior the transverse processes
Serratus posterior of C3 and C4 vertebrae Onto the upper borders of Ventral primary rami Elevates the second to fifth ribs
inferior the second, third, fourth, of T1 to T4 spinal
Spinous processes of C7 and fifth ribs nerves Draws the lower four ribs downward
and T1 to T3 thoracic and backward
vertebrae Onto the inferior border of Ventral primary rami
the lower four ribs of T9, T10, T11, and
Spinous processes of T12 spinal nerves
T11, T12, and upper
three lumbar vertebrae
DEEP MUSCLES OF THE BACK
Muscle Origin Insertion Innervation Action
ERECTOR SPINAE MUSCLES By six or seven muscle Dorsal primary rami Extends, laterally flexes,
fascicles onto the inferior of lower thoracic and and assists in rotation of
ILIOCOSTALIS MUSCLE (Lateral Column) borders of the lower six or upper lumbar nerves the vertebral column; can
seven ribs at their angles depress the ribs
Iliocostalis Posteromedial part of the iliac Upper borders of the first six Dorsal primary rami of Extends, laterally flexes, and
lumborum crest and from the most lateral ribs at their angles and on the C8 and upper six assists in rotation of the
part of the common tendon of the transverse process of the thoracic spinal nerves thoracic vertebrae
the erector spinae muscle seventh cervical vertebra
Posterior tubercles of Dorsal primary rami of Extends, laterally flexes, and
Iliocostalis Upper borders of the lower six transverse processes of the lower cervical and assists in rotation of lower
thoracis ribs at their angles fourth, fifth, and sixth upper thoracic spinal cervical and upper thoracic
cervical vertebrae nerves vertebrae
Iliocostalis Angles of the third, fourth,
cervicis fifth, and sixth ribs Onto the tips of transverse Dorsal primary rami Extends and laterally flexes
processes of all thoracic of the thoracic and the vertebral column; also
LONGISSIMUS MUSCLE (Intermediate Column) vertebrae; onto the lower lumbar spinal nerves able to depress the ribs
9 or 10 ribs between their
Longissimus Intermediate continuation tubercles and angles Dorsal primary rami Extends vertebral column
thoracis of the erector spinae muscle; Posterior tubercles of of upper thoracic and and bends it to one side
transverse processes of the transverse processes of C2 to lower cervical spinal
lumbar vertebrae C6 cervical vertebrae nerves Extends the head; muscle of
Dorsal primary rami one side bends head to the
Longissimus Tips of transverse processes of middle and lower same side and turns face to
cervicis of upper four or five thoracic cervical spinal nerves that side
muscle vertebrae
Dorsal primary rami of Extends vertebral column
Longissimus From transverse processes of Posterior margin of the thoracic spinal nerves
capitis upper four or five thoracic verte- mastoid process of the Extends the cervical
brae; articular processes of lower temporal bone Dorsal primary rami of vertebrae
three or four cervical vertebrae lower cervical spinal
Spinous processes of upper nerves Extends the head
SPINALIS MUSCLE (Medial Column) four to eight thoracic Dorsal primary rami of
vertebrae upper cervical spinal
Spinalis From spinous processes of T11, Spinous process of the axis nerves
thoracis T12, L1, and L2 vertebrae and those of the C3 and C4
Spinalis Spinous processes of C7, Inserts with the semispinalis
cervicis T1, and T2 vertebrae and capitis muscle between the
ligamentum nuchae superior and inferior nuchal
Spinalis lines of the occipital bone
capitis Spinous processes of lower
cervical and upper thoracic
vertebrae
Chapter 5 The Back, Vertebral Column, and Spinal Cord
PLATE 380 Semispinalis, Multifidus, and Rotator Deep Back Muscles: Chart; Figure
DEEP MUSCLES OF THE BACK (Continued)
Muscle Origin Insertion Innervation Action
TRANSVERSOSPINALIS GROUP OF MUSCLES Spinous processes of C7, Dorsal primary rami Extends vertebral column
C8, and upper four thoracic of lower cervical and and rotates it to the
SEMISPINALIS MUSCLES vertebrae upper thoracic spinal opposite side
nerves
Semispinalis Transverse processes of the 6th Dorsal primary rami Extends cervical spinal
thoracis to 10th thoracic vertebrae of the middle cervical column; rotates vertebrae
spinal nerves to opposite side
Semispinalis Transverse processes of upper Spinous processes of the axis Dorsal primary rami Extends the head and
cervicis five or six thoracic vertebrae and third, fourth, and fifth of the cervical spinal rotates it such that the
cervical vertebrae nerves face is turned to the
Semispinalis Tips of transverse processes of opposite side
capitis the C7 and upper six or seven Between the superior and Supplied segmentally
thoracic vertebrae inferior nuchal lines on the by dorsal primary rami Bends or laterally flexes
occipital bone of the lumbar, thoracic the vertebral column and
spinal nerves rotates it to the opposite
MULTIFIDUS MUSCLES side; both multifidi columns
Dorsal primary rami acting together extend the
Lumborum From the back of the sacrum; Onto the spinous processes of the thoracic spinal vertebral column
thoracis cervicis mamillary processes of lumbar of higher vertebrae; each nerves
vertebrae; transverse processes multifidus muscle spans two Dorsal primary rami of Extend the vertebral
of all thoracic vertebrae; to four vertebrae cervical spinal nerves column and bend it
articular processes of lower toward the opposite side
four cervical vertebrae On the base of the spine of Dorsal primary rami of Extend cervical vertebrae
thoracic vertebra above the lumbar spinal nerves and bend them to the
ROTATORES MUSCLES origin or the one above that opposite side
To the base of the spines
Rotatores From transverse processes of of the cervical vertebra Extend lumbar vertebrae
thoracis thoracic vertebrae deep to the immediately above and bend them to the
multifidus muscles opposite side
To the base of the spines
Rotatores From the articular processes of of the lumbar vertebra
cervicis (These the cervical vertebrae immediately above
are less well
defined.)
Rotatores From the mamillary processes
lumborum of the lumbar vertebrae
(These are less
well defined.)
Levator costae brevis muscle 8th rib
Costotransverse ligament Intertransverse ligament
Rotatores thoracis muscles Multifidus muscles
Levator costae longus muscle
Intertransverse ligament
Vertebral arch, 1st lumbar vertebra
Ligamenta flava 12th rib
Transverse processes, lumbar vertebrae
Medial lumbar intertransverse muscles Lateral lumbar intertransverse muscles
Thoracolumbar fascia,
Spinous processes, lumbar vertebrae anterior (deep) layer
Multifidus muscles
Erector spinae muscle
FIGURE 380 Multifidus, Rotator, Levator Costae, and Intertransverse Muscles of the Deep Back
NOTE: The erector spinae and semispinalis muscles have been removed.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
Posterior Neck Muscles; Suboccipital Triangle PLATE 381
Rectus capitis posterior minor muscles Trapezius muscle
Semispinalis capitis muscle
Rectus capitis posterior major muscle
Obliquus capitis superior muscle
Splenius capitis muscle
Splenius capitis muscle Posterior arch of atlas
Spenius cervicis muscle
Splenius cervicis muscle Mastoid process of temporal bone
Longissimus capitis muscle Longissimus capitis muscle
Semispinalis capitis muscle Posterior belly of digastric muscle
Styloid process (of temporal bone)
Posterior tubercle of atlas Obliquus capitis inferior muscle
Spinous process of axis Longissimus capitis muscle
Interspinalis cervicis muscles Semispinalis capitis muscle
Multifidus muscles
Longissimus cervicis muscle
Iliocostalis cervicis muscle Semispinalis cervicis muscle
Supraspinous ligament
Semispinalis capitis muscle
Semispinalis thoracis muscle
FIGURE 381.1 The Semispinalis Capitis Muscle (Left) and Suboccipital Triangle (Right)
NOTE that the semispinalis capitis is a strong extensor of the head, and at the same time, it rotates the head so that the face turns to the opposite
side.
Obliquus capitis
superior muscle
Rectus capitis posterior
minor muscle
M. rectus capitis FIGURE 381.2 Left Suboccipital Triangle
posterior major
NOTE that the suboccipital triangle is bounded by the obliquus capitis superior and
Atlas, arcus posterior inferior and the rectus capitis posterior major muscles.
Obliquus capitis Chapter 5 The Back, Vertebral Column, and Spinal Cord
inferior muscle
PLATE 382 The Back: Superficial Vessels and Nerves
Greater occipital nerve Occipital belly of occipitofrontalis muscle
Occipital artery
Occipital artery and vein Greater occipital nerve
Occipital vein
Posterior auricular vein
Mastoid branch Lesser occipital nerve
Occipital artery
Descending branch Occipital branch of
posterior auricular artery
Semispinalis capitis muscle Great auricular nerve
Lesser occipital nerve Splenius capitis muscle
Sternocleidomastoid muscle
Longissimus capitis muscle External jugular vein
Accessory nerve Medial cutaneous branches of posterior rami,
cervical and thoracic spinal nerves
Splenius capitis muscle
Levator scapulae muscle Trapezius muscle
Dorsal scapular nerve
Dorsal scapular artery
Dorsal scapular vein
Rhomboid major muscle
Deltoid
muscle
Trapezius
muscle
Teres major
muscle
Rhomboid minor
muscle
Latissimus dorsi
muscle
Lateral cutaneous
branches of
posterior rami,
thoracic nerves
FIGURE 382 Nerves and Vessels of the Superficial and Intermediate Muscle Layers of the Upper Back
and Posterior Neck
NOTE: (1) The cutaneous branches of the posterior primary rami of the cervical and thoracic spinal nerves supplying the posterior neck and
back segmentally. Observe the accessory nerve (XI) as it descends to supply the trapezius and sternocleidomastoid muscles.
(2) The greater occipital nerve, a sensory nerve from the posterior primary ramus of the C2 spinal nerve. It is accompanied by the occipital ves-
sels. Also observe the lesser occipital nerve, which courses to the skin of the lateral posterior scalp and arises from the anterior primary ramus
of C2.
(3) The dorsal scapular nerve and vessels that course beneath the levator scapulae and rhomboid muscles.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
The Back: Deep Vessels and Nerves; Suboccipital Region PLATE 383
External occipital protuberance ++ Occipital belly, occipitofrontal muscle
Greater occipital nerve
Semispinalis capitis muscle II
I Semispinalis capitis muscle
Rectus capitis posterior
major muscle Muscular branch,
vertebral artery
Occipital artery
Vertebral artery
Suboccipital nerve (C1)
Posterior auricular vein
Mastoid branch, Mastoid branch,
occipital artery occipital vein
Occipital vein
Descending branch, Vertebral vein
occipital artery Occipital artery
I = Multifidus muscle ++
II = Semispinalis Spinous
process
cervicis muscle of axis
Obliquus capitis Splenius
superior muscle capitis
muscle
Splenius capitis
muscle Posterior arch
of atlas
Longissimus capitis
muscle Communicating
nerve between
Vertebral artery C2 and C3
Obliquus capitis inferior
Deep cervical artery
muscle
Greater occipital nerve (C2) Deep cervical vein
Muscular branch, vertebral artery
Dorsal scapular nerve
Semispinalis capitis muscle
3rd cervical nerve Accessory nerve
Deep cervical artery Rhomboid major
Accessory nerve and minor muscles
Superficial branch
of transverse Trapezius muscle
cervical artery
Nerve to
levator
scapulae
muscle
Deep branch of Dorsal Rhomboid major Medial cutaneous branch of posterior primary ramus,
transverse scapular and minor muscles T5 nerve
cervical artery nerve
FIGURE 383 Deep Vessels and Nerves of the Suboccipital Region and Upper Back; Suboccipital Triangle
NOTE: (1) The suboccipital triangle lies deep to the semispinalis muscle and is bounded by the rectus capitis posterior major, obliquus capitis
superior, and obliquus capitis inferior.
(2) The vertebral artery crosses the base of the suboccipital triangle, while the suboccipital nerve (posterior primary ramus of C1) courses
through the triangle to supply motor innervation to the three muscles that bound the triangle as well as to the rectus capitis posterior minor
and the overlying semispinalis capitis muscle.
(3) The greater occipital nerve (posterior primary ramus of C2), a sensory nerve, emerges below the obliquus capitis inferior and then courses
medially and superiorly to become subcutaneous just lateral to and below the external occipital protuberance.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
PLATE 384 Suboccipital Region: Muscles, Vessels, and Nerves
Semispinalis capitis muscle Rectus capitis posterior
minor muscle
Splenius capitis muscle Rectus capitis
posterior major muscle
Obliquus Posterior
capitis superior muscle atlantooccipital membrane
Vertebral artery
Longissimus capitis muscle
Obliquus capitis inferior muscle
Posterior belly of digastric muscle Splenius cervicis muscle
Rectus capitis lateralis muscle; Articular capsule, intervertebral joint
styloid process of temporal bone Multifidus muscles
Transverse process of atlas Middle scalene muscle
Obliquus capitis inferior muscle
Longissimus cervicis muscle
Posterior cervical intertransverse muscle
Transverse process of axis
Longissimis cervicis muscle
Splenius cervicis muscle
Multifidus muscle I = Posterior tubercle of atlas
Semispinalis capitis muscle II = Spinous process of axis
FIGURE 384.1 Muscles of the Suboccipital Triangle
NOTE: (1) The obliquus capitis inferior, obliquus capitis superior, and rectus capitis posterior major muscles outline the suboccipital
triangle.
(2) The vertebral artery crosses the floor of the triangle and penetrates the posterior atlantooccipital membrane to enter the foramen magnum.
There the two vertebral arteries join to form the basilar artery on the ventral aspect of the brainstem.
Superior sagittal sinus Foramen magnum
Transverse sinus Suboccipital nerve
Cerebellomedullary cistern
Transverse process
Cranial arachnoid mater; of atlas
cerebellum Vertebral artery
Spinal arachnoid mater Greater occipital nerve
Spinal dura mater Third occipital nerve
Spinal nerve, posterior
Spinal arachnoid mater ramus
Denticulate ligament
Scalenus medius
(middle scalene) Spinal nerve, anterior ramus
5th cervical vertebra (C V), Spinal nerve, spinal ganglion
transverse process Vertebral artery
Cervical nerve (C7),
posterior rootlets
Spinal cord
FIGURE 384.2 Suboccipital Region: Vertebral Artery and Occipital Nerves
NOTE: The assent and 90-degree turn medially taken by the vertebral arteries along the superior border of the atlas to achieve the ventral surface
of the medulla oblongata.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
Greater occipital Suboccipital Region: Nerves and Muscle Chart PLATE 385
nerve
3rd occipital
Semispinalis capitis nerve
muscle
Rectus capitis
Obliquus capitis posterior minor
superior muscle muscle
Rectus capitis Mastoid process,
posterior major temporal bone
muscle Suboccipital nerve (C1)
Posterior arch of atlas
Vertebral artery
Obliquus capitis inferior muscle
Suboccipital nerve (C1) Vertebral artery
Obliquus capitis inferior Rectus capitis posterior
muscle major muscle
Posterior primary ramus (C2) Cervical interspinous muscles
(greater occipital nerve)
3rd occipital nerve
Cervical plexus
FIGURE 385 Nerves of the Suboccipital Region
NOTE: (1) The suboccipital nerve (C1), primarily a motor nerve, emerges from the spinal cord above the atlas, courses through the suboccipital
triangle, and supplies motor innervation to all four suboccipital muscles.
(2) The greater occipital (C2) and third occipital (C3) nerves branch from the posterior primary rami of those segments. After passing through
the deep muscles of the back, they become purely sensory to supply the skin on the posterior scalp and neck.
MUSCLES OF THE SUBOCCIPITAL REGION
Muscle Origin Insertion Innervation Action
Suboccipital nerve Extends the head and
Rectus capitis Spinous process of axis Lateral part of inferior (dorsal ramus of C1) rotates it to the same side
posterior major nuchal line of occipital
bone Suboccipital nerve Extends the head
Rectus capitis Tubercle on the posterior (dorsal ramus of C1)
posterior minor arch of the atlas Medial part of inferior Extends the head and
nuchal line of occipital Suboccipital nerve bends it laterally
Obliquus capitis Upper surface of transverse bone (dorsal ramus of C1)
superior process of the atlas Rotates the atlas and
Onto occipital bone Suboccipital nerve thereby turns the face
Obliquus capitis Apex of spinous process of between superior and (dorsal ramus of C1) toward the same side
inferior axis inferior nuchal lines
Inferior and dorsal part of
transverse process of the
atlas
Chapter 5 The Back, Vertebral Column, and Spinal Cord
PLATE 386 The Back: Primary Rami of Spinal Nerves; Cross Section of Back
Sympathetic trunk and ganglion Vertebral body
Spinal cord
Ramus communicans
Anterior root
Meningeal branch
Dorsal root ganglion Intervertebral foramen
Trunk of spinal nerve Posterior root
Vertebral canal
Posterior primary ramus Vertebral arch
Anterior primary ramus Spinous process
(intercostal nerve) Deep back muscles
Rib
Lateral branch of posterior
primary ramus
Medial branch of posterior
primary ramus
Lateral cutaneous branch
Medial cutaneous branch
FIGURE 386.1 Branching of a Typical Spinal Nerve
NOTE: (1) Fibers from both dorsal and ventral roots join to form a spinal nerve. That nerve soon divides into a posterior and an anterior
primary ramus. The posterior primary ramus courses dorsally to innervate the muscles and skin of the back. The anterior primary ramus
courses anteriorly around the body to innervate the rest of the segment.
(2) The posterior primary rami of typical spinal nerves are smaller than the anterior rami, and each usually divides into medial and lateral
branches, which contain both motor and sensory fibers innervating back structures.
(3) Unlike anterior primary rami, which join to form the cervical, brachial, and lumbosacral plexuses, the peripheral nerves derived from the
posterior rami do not intercommunicate and form plexuses. There is, however, some segmental overlap of peripheral sensory fields, as seen
with the anterior rami.
Anterior longitudinal Cauda equina
ligament
Kidney Pedicle Vertebral
Lamina arch
Psoas major muscle
Transversospinal
Lumbar nerves muscles
Transverse process Erector spinae muscles
Quadratus lumborum Anterior
muscle layer
12th rib (deep)
Internal oblique Thoracolumbar
muscle fascia
Latissimus dorsi Posterior
muscle layer
(superficial)
Spinous process
FIGURE 386.2 Cross Section at the L2 Vertebral Level: Deep Back Muscles and Thoracolumbar Fascia
NOTE: (1) This cross section of the deep back shows the lumbar part of the thoracolumbar fascia as it encloses the divisions of the erector spinae
and transversospinal muscles. The fascia is formed by a posterior (superficial) layer and an anterior (deep) layer.
(2) Medially, the layers of the thoracolumbar fascia attach to the spinous and transverse processes of the lumbar vertebrae, and laterally, they
become continuous with the aponeuroses and fascias of the latissimus dorsi and anterior abdominal muscles.
(3) The quadratus lumborum and psoas major muscles located deep to the erector spinae. Observe the relationship of the kidneys anterior to the
quadratus lumborum muscles.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
Vertebral Column and the Pectoral and Pelvic Girdles PLATE 387
7th cervical vertebra Clavicle 6th cervical vertebra
(vertebra prominens) 7th cervical vertebra
Humerus (vertebra prominens)
Vertebral canal 2nd rib 1st thoracic vertebra
Clavicle, Scapula
sternal
end
Manubrium
of sternum
Body of
sternum
Costal margin
11th rib
11th rib 12th rib
12th rib 1st lumbar vertebra
3rd lumbar vertebra
Anterior superior Ilium
iliac spine Femur
Promontory
Ischial Symphysial surface Sacrum
spine Coccyx
Ischial tuberosity
Ischial tuberosity FIGURE 387.2 Left Lateral Surface of the
Vertebral Column Sectioned in the Median Plane
FIGURE 387.1 Left Medial Surface of the Vertebral
Column Sectioned in the Median Plane NOTE: The scapula does not articulate with the vertebral col-
umn, whereas the pelvis articulates with the sacrum to form the
NOTE: (1) The sectioned vertebral column is shown from vertebra sacroiliac joint.
C5 inferiorly to the tip of the coccyx.
(2) The vertebral canal within which descends the spinal cord from
the medulla oblongata of the brain.
(3) The C7 vertebra has a spinous process that is usually longer
than the other cervical vertebrae and, therefore, is often called
the vertebra prominens.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
PLATE 388 Cervical Vertebrae
Posterior arch Posterior tubercle Posterior arch Posterior tubercle
Transverse foramen
Groove for Transverse Vertebral
vertebral artery foramen foramen
Transverse
process
Lateral mass Superior Transverse process Fovea for dens
articular facet Lateral mass Anterior tubercle
Vertebral foramen
Anterior arch Inferior articular facet
Anterior arch
Anterior tubercle
FIGURE 388.1 Atlas, Viewed from Above FIGURE 388.2 Atlas (Caudal View)
NOTE: The superior articular facets are the sites of the occipito- NOTE: The inferior articular facets on the inferior surface of
atlantal joints behind which are the grooves for the vertebral arteries. the lateral mass articulate with the axis below.
Superior articular process Odontoid process (dens) Apex of dens Anterior articular surface
Transverse process Odontoid process (dens)
Posterior articular surface Superior articular
Body of axis Transverse process process
Transverse Anterior
foramen tubercle
Transverse foramen Vertebral foramen
Inferior articular process Arch of axis Inferior Posterior
articular process tubercle
Spinous process (bifid)
Body of axis Arch of axis
FIGURE 388.3 Posterior View of the Axis
Spinous process (bifid)
NOTE: The large body and the odontoid process of the axis and
the posterior articular facet articulates with the anterior arch of the FIGURE 388.4 Anterior View of the Axis
atlas.
NOTE: The articular facet on the anterior surface of the odontoid
process behind (posterior) extends the transverse ligament of the
atlas.
Spinous process
Vertebral foramen Vertebral arch Lamina of vertebral arch Spinous process
Superior articular
Sulcus for process Pedicle of Vertebral arch
spinal nerve vertebral arch
Posterior Superior articular
tubercle process
Transverse foramen Vertebral foramen Transverse
process
Anterior
tubercle Transverse
foramen
Uncus of vertebral body
Body of vertebra Uncus of vertebral body Body of vertebra
FIGURE 388.5 Fifth Cervical Vertebra (from Above) FIGURE 388.6 Seventh Cervical Vertebra
(from Above)
NOTE: The fifth cervical vertebra is typical of third, fourth, and sixth
cervical vertebrae, and different from the first (atlas), second (axis), NOTE: The seventh cervical vertebra, being transitional between
and seventh, which present special features. Also note the delicate cervical and thoracic vertebrae, has a transverse foramen similar
structure of this vertebra. to the cervical and a large spinous process similar to the thoracic.
The latter gives it the name vertebra prominens.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
Cervical Vertebrae and the Atlantooccipital Membranes PLATE 389
Dens of axis
Groove for
vertebral artery
Atlas Posterior Transverse process
Body of axis tubercle Body of vertebra
Axis Anterior
tubercle
3rd cervical Transverse Anterior
vertebra foramen tubercles
4th cervical Transverse Sulcus for
vertebra process spinal nerve
5th cervical
vertebra
6th cervical
vertebra
7th cervical vertebra Uncus of vertebral body
(vertebra prominens)
FIGURE 389.2 Cervical Vertebrae (Ventral View)
Spinous process
NOTE: Only a small part of the second to seventh cervical vertebrae
FIGURE 389.1 Cervical Spinal Column (Dorsal) is shown above and below the convex anterior surfaces of the bodies
of the third to sixth vertebrae.
NOTE: While flexion and extension of the head are performed at
the atlantooccipital joint, turning of the head to the left or right
is the result of rotation of the atlas on the axis.
Occipital bone Posterior > FIGURE 389.3 Atlantooccipital and
atlantooccipital Atlantoaxial Joints (Posterior View)
Lateral mass membrane
of atlas NOTE: From the posterior margin of the foramen
Lateral atlantooccipital ligament magnum to the upper border of the posterior arch
of the atlas stretches the posterior atlantooccipital
membrane.
Sulcus for Posterior tubercle Occipital bone, lateral part
vertebral Capsule of lateral
artery atlantoaxial joint Anterior
atlantooccipital
Vertebral arch Occipital bone, lateral part membrane
of axis
Occipital
bone
Atlantooccipital joint Articular capsule
FIGURE 389.4 Articulations of Occipital N Atlas Anterior longitudinal
Bone and First Three Vertebrae ligament
(Anterior View) Lateral atlantoaxial
joint Intervertebral disc
NOTE: Extending between the occipital bone and the Axis
anterior arch of the atlas is the anterior atlantooccipi- Body of 3rd cervical
tal membrane, which continues laterally to join the ar- C3 vertebra vertebra
ticular capsules. Also observe the anterior longitudinal
ligament.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
PLATE 390 Craniovertebral Joints and Ligaments
Sulcus for Occipital bone > FIGURE 390.1 Tectorial Membrane (Dorsal View)
sigmoid sinus Atlas
NOTE: The tectorial membrane is a broadened upward exten-
Atlantooccipital joint sion of the posterior longitudinal ligament and attaches the axis
(articular capsule) to the occipital bone (see also, Fig. 391.1). It covers the posterior
surface of the odontoid process and lies dorsal to the cruciform
Lateral atlantoaxial joint ligament, covering it as well.
(articular capsule)
Tectorial membrane
Transverse process,
3rd cervical vertebra Axis
3rd cervical vertebra
Cruciform ligament Basilar part of occipital > FIGURE 390.2 Atlantooccipital and Atlantoaxial
(superior longitudinal part) bone Joints Showing the Cruciform Ligament
(Posterior View)
Alar ligaments Hypoglossal
canal NOTE: The posterior arches to the atlas and axis have been
Articular capsule Sulcus for removed, and the cruciform ligament is seen from this poste-
sigmoid sinus rior view. It consists of the transverse ligament (see Fig. 390.4)
Cruciform ligament and the longitudinal fascicles that extend superiorly and
(transverse part) Atlantooccipital inferiorly.
joint
Cruciform ligament
(inferior Posterior arch of atlas
Lateral atlantoaxial
longitudinal part) joint
Axis
Alar ligaments > FIGURE 390.3 Alar and Apical Ligaments
(Posterior View)
Occipital bone
NOTE: This figure is oriented the same as Figure 390.2. The
Apical cruciform ligament has been removed to reveal the odontoid
ligament of process of the axis. This is attached superiorly to the occipital
bone by the two alar ligaments and the apical ligament of the
dens dens. These ligaments tend to limit lateral rotation of the skull.
Articular
capsules
Odontoid process (dens)
Body of axis
Spinous process of axis Posterior articular > FIGURE 390.4 Median Atlantoaxial Joint
surface of dens (from Above)
Ligamentum flavum
(atlantoaxial joint) Superior articular NOTE: The odontoid process of the axis articulates with the an-
facet of atlas terior arch of the atlas, thereby forming the median atlantoaxial
joint, and the thick and strong transverse ligament (part of the
cruciform) of the atlas retains the dens on its posterior surface.
Transverse Dens of atlas
ligament of atlas Fovea for dens
Anterior articular surface of dens
Chapter 5 The Back, Vertebral Column, and Spinal Cord
Craniovertebral Joints and Ligaments; X-Ray of Atlas and Axis PLATE 391
Basilar part of occipital bone Apical ligament of dens
Anterior atlantooccipital membrane Dura mater
Tectorial membrane
Anterior arch of atlas Cruciform ligament (superior longitudinal part)
ANTERIOR Anterior articular surface of dens Cruciform ligament (transverse part) POSTERIOR
Dens of axis Cruciform ligament (inferior longitudinal part)
Rootlets of cervical nerves
Posterior atlantooccipital membrane
Posterior articular surface of dens
Squama of occipital bone
1st intervertebral disc Posterior arch of atlas
Body of 3rd cervical vertebra
Spinous process of axis
FIGURE 391.1 Median Sagittal Section of Atlantooccipital and Atlantoaxial Regions
NOTE: The relationships from anterior to posterior of the following structures: the anterior arch of the atlas, the joint between the atlas and
the odontoid process (median atlantoaxial joint), the “joint” between the odontoid process and the transverse ligament of the atlas, the tectorial
membrane, and finally, the dura mater covering the spinal cord.
8 9 11
6 2 10 1. Odontoid process of axis
4 1 4 2. Anterior arch of atlas (inferior margin)
3. Posterior arch of atlas (inferior margin)
3 4. Lateral atlantoaxial joints
5. Spinous process of axis (bifid)
5 6. Transverse process of atlas
7. Inferior dental arch
8. Superior dental arch
9. Styloid process of temporal bone
10. Coronoid process of mandible
11. Condylar process of mandible
7
FIGURE 391.2 Radiograph of the Odontoid Process and the Atlantoaxial Joints
NOTE: This is an anteroposterior projection taken through the oral cavity as shown in the diagram.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
PLATE 392 Vertebral Column Atlas
Axis
Cervical
vertebrae Vertebra
prominens
Thoracic
vertebrae Intervertebral
foramina
Lumbar
vertebrae
Sacrum
Promontory
Coccyx FIGURE 392.2 Posterior View FIGURE 392.3 Left Lateral View
FIGURE 392.1 Anterior View
FIGURE 392.1–392.3 Vertebral Column, Including the Sacrum and Coccyx
NOTE: (1) The vertebral column normally consists of 7 cervical, 12 thoracic, and 5 lumbar vertebrae and the sacrum and coccyx. Its principal
functions are to assist in the maintenance of the erect posture in humans, to encase and protect the spinal cord, and to allow attachments of
the musculature important for movements of the head and trunk.
(2) From a dorsal or ventral view, the normal spinal column is straight. When viewed from the side, the vertebral column presents two ventrally
convex curvatures (cervical and lumbar) and two dorsally convex curvatures (thoracic and sacral).
Chapter 5 The Back, Vertebral Column, and Spinal Cord
Thoracic Vertebrae; Costovertebral Joints PLATE 393
Spinous process
Superior articular processes
Lamina Transverse process
Transverse
costal facet
Vertebral arch
Pedicle Superior articular Body of
process vertebra
Superior costal facet Transverse
process
Body of Intervertebral Lamina of vertebral arch
vertebra surface
Annular Spinous process
apophysis
Vertebral foramen
FIGURE 393.1 Sixth Thoracic Vertebra (from Above) FIGURE 393.2 Tenth Thoracic Vertebra
(Ventral View)
Superior costal facet Superior articular process Accessory process Superior articular process
Vertebral arch
Transverse process with Mamillary process
transverse costal facet
Spinous
process
Inferior costal facet Body of vertebra Costal facet
Inferior vertebral notch
Inferior articular process Inferior articular process
Spinous process
FIGURE 393.4 Twelfth Thoracic Vertebra
FIGURE 393.3 Sixth Thoracic Vertebra (from Left (Lateral View)
Lateral Side)
Rib Ligamentum flavum Spinous process Transverse process
Superior articular process Lateral costotransverse ligament
Costotransverse joint Tubercle of rib
Costotransverse ligament
Pedicle Neck of rib
Vertebral foramen Costotransverse ligament
Body of vertebra Head of rib articulation (joint)
Radiate ligament of head of rib
FIGURE 393.5 Costovertebral Joints, Transverse Section as Seen from Above
NOTE: Each rib articulates with the thoracic vertebrae at two places: (a) the head of the rib with the vertebral body and (b) the tubercle on the
neck of the rib with the transverse process of the vertebra.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
PLATE 394 Costovertebral Joints and Ligaments 1 Intertransverse ligaments
Ribs
Vertebral arch
Spinous process
Lateral costotransverse ligaments Ligamentum flavum
Superior costotransverse ligaments
Lateral costotransverse ligaments Transverse process
Intertransverse ligaments Inferior articular process
Articular capsule
Lamina of vertebral arch Supraspinous ligament
FIGURE 394.1 Lower Costovertebral Joints (Posterior View)
NOTE: (1) Five pairs of costovertebral joints, viewed from behind, show to advantage the articulations between the necks and the tubercles of the
ribs and the transverse processes of the thoracic vertebrae.
(2) The ligaments that connect these gliding joints are the costotransverse, lateral costotransverse, and superior costotransverse.
(3) The costotransverse joints (neck of rib with transverse process) are not to be confused with the joints between the heads of the ribs and the
bodies of the vertebrae.
Superior costal facet Superior articular process
Body of vertebrae
Transverse costal facet
Costotransverse foramen
Superior costotransverse ligaments
Lateral costotransverse ligament
Anterior longitudinal ligament Ribs
Intervertebral discs
Intertransverse ligament
Radiate ligament of head of rib
FIGURE 394.2 Costovertebral Joints (Lateral View Showing the Radiate Ligaments of the Heads of the Ribs)
Chapter 5 The Back, Vertebral Column, and Spinal Cord
Body of vertebra Costovertebral Joints and Ligaments 2 PLATE 395
Anterior longitudinal ligament
Intra-articular ligament at head of rib
Intervertebral disc Intervertebral foramen
Superior costotransverse ligament
Lateral costotransverse ligament
Head of rib articulation (joint)
Tubercle of rib
Head of rib
FIGURE 395.1 Sagittal Section through the Spinal Column Showing the Costovertebral Joints
NOTE: The following important structures are shown: the intervertebral disks, the intra-articular and costotransverse ligaments, and the inter-
vertebral foramina, which transmit the spinal nerves and their accompanying vessels.
FIGURE 395.2 Anterior Longitudinal Ligament N Costotransverse
(Ventral View) ligaments
NOTE: The anterior longitudinal ligament extends from the axis Ribs
to the sacrum along the anterior aspect of the bodies of the vertebrae
and the intervertebral disks to which it is firmly attached. Its fibers are
white and glistening and can readily be identified.
Intervertebral disc
Anterior
longitudinal ligament
Radiate ligament
of head of rib
Costotransverse Transverse
ligaments costal facets
Costotransverse Ligamenta
ligament flava
Ribs Articular
capsule
Lamina of > FIGURE 395.3 Ligamenta Flava (Anterior View)
vertebral
arch NOTE: The bodies of the thoracic vertebrae have been re-
moved, revealing from within the vertebral foramina the
Pedicle ligamenta flava interconnecting the laminae of the dorsal
vertebral arches. The pedicles have been cut, and on the left,
the ribs have been removed. The ligamenta flava are formed
by yellow, elastic tissue.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
PLATE 396 Lumbar Vertebrae
Vertebral arch (lamina) Spinous process Superior costal facet Superior articular process
Mamillary process T10 Transverse costal facet
Vertebral arch (lamina) T11
T12 Spinous
Superior articular processes
process Accessory process
Accessory Transverse process
process Pedicle
Vertebral foramen
Body of vertebra L1
FIGURE 396.1 Lumbar Vertebra (Cranial View)
Superior articular processes
Transverse process Mamillary process
(costal process) L2
Body of
vertebra
Transverse process Inferior articular process
Accessory process
Inferior articular facet
Inferior articular processes FIGURE 396.3 Last Three Thoracic and First Two
Lumbar Vertebrae (Lateral View)
FIGURE 396.2 Lumbar Vertebra (Anterior View)
Transverse process Zygapophyseal joint (articular capsule)
Ligamentum flavum
Superior articular process
Inferior articular process
Lamina of vertebral arch
Spinous process
FIGURE 396.4 Zygapophyseal Joints and Ligamenta Flava between Adjacent Lumbar Vertebrae
NOTE: (1) In this posterior view, the articular capsule of the zygapophyseal joint (between the articular processes) and the ligamentum flavum
have been removed on the left side.
(2) Each ligamentum flavum is attached to the anterior surface of the lamina above and to the posterior surface of the lamina below. They are
elastic and permit separation of the laminae during flexion of the spine, and they inhibit abrupt and extreme movements of the vertebral
column, thus protecting the intervertebral disks (see also, Fig. 395.3).
Chapter 5 The Back, Vertebral Column, and Spinal Cord
Cervical and Lumbar Vertebrae: Intervertebral Disks and Ligaments PLATE 397
Uncinate process of vertebral body Superior articular process
Intervertebral foramen
Intervertebral surface Zygapophyseal joint and joint capsule
Ligamentum flavum
Annular epiphysis;
Rim of vertebral body Interspinous ligament
Vertebral body
Anterior longitudinal ligament
Intervertebral surface
Hyaline cartilage
Intervertebral Anulus
disc fibrosus
Nucleus
pulposus
Ligamentum nuchae
Foramen for basivertebral vein Inferior Spinous
articular process process
Annular epiphysis; Lamina of vertebral arch
Rim of vertebral body
Pedicle of vertebral arch
Posterior longitudinal ligament
FIGURE 397.1 Cervical Intervertebral Joints: Median Sagittal Section
NOTE: (1) The long spinous processes of the cervical vertebrae and the strong interspinous ligaments. Observe the blending of fibers of the
interspinous ligaments with the ligamentum nuchae of the dorsal cervical region.
(2) The intervertebral disk between the bodies of the two cervical vertebrae is shown; also note the nucleus pulposus surrounded by the annulus
fibrosis.
(3) The anterior and posterior longitudinal ligaments and the foramina for the basivertebral veins.
Annular apophysis of vertebral body Intervertebral foramen Superior articular process
Ligamentum flavum
Anterior longitudinal ligament Interspinous ligament
Supraspinous ligament
Intervertebral surface
Outer zone of collagenous fibers Thoracolumbar fascia
of intervertebral disc
Intervertebral Annulus fibrosus
disc Nucleus pulposus
Foramen for basivertebral vein
Posterior longitudinal ligament Spinous process
Pedicle of vertebral arch Inferior articular process
Lamina of vertebral arch
FIGURE 397.2 Median Sagittal Section through Two Lumbar Vertebrae and an Intervertebral Disk
NOTE: (1) The anterior and posterior longitudinal ligaments ventral and dorsal to the bodies of the lumbar vertebrae.
(2) The ligamentum flavum forms an important ligamentous connection between the laminae of adjacent vertebral arches on the dorsal aspect
of the vertebral canal.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
PLATE 398 Intervertebral Disks
Hyaline cartilage Nucleus pulposus
Uncovertebral clefts
Hyaline cartilage Vertebral Posterior
Uncus of corpus body longitudinal
(uncinate process)
ligament
Annulus fibrosus
Pedicle of Annular epiphysis
vertebral arch
Annulus fibrosus
Vertebral body Annular epiphysis
Nucleus pulposus
Uncovertebral clefts
Hyaline cartilage
Sensory
spinal ganglion Vertebral body
Vertebral artery FIGURE 398.2 Median Sagittal Section through a Lumbar
Intervertebral Disk
FIGURE 398.1 Two Cervical Intervertebral
Disks: Frontal Section through the Centers NOTE: (1) The nucleus pulposus that forms the inner core is soft and gelati-
of the Vertebral Bodies nous in early years and consists of mucoid material and a few cells.
NOTE: (1) The intervertebral disks are located between (2) After 10 or 12 years of age the mucoid material is gradually replaced by
the bodies of adjacent vertebrae (in this case cervical fibrocartilage, and the center of the disk becomes more like the annulus
vertebrae). that surrounds it. (See notes for Fig. 398.3.)
(2) Hyaline cartilage covers the end plates of the verte-
bral bodies and lies adjacent to the annulus fibrosus.
Intervertebral Nucleus Anterior longitudinal ligament
disc pulposus
Annulus Thoracolumbar fascia
fibrosus Vertebral body of L1
Posterior Spinal nerve Spinous process
longitudinal Intervertebral disc
ligament
Vertebral canal;
FIGURE 398.3 Photograph of a Lumbar cauda equina
Intervertebral Disk (Viewed from Above)
Epidural space
NOTE: (1) The annulus fibrosus consists of a thin band of
collagenous fibers and a thicker band of fibrocartilage. Vertebral body of L5
(2) In later adolescence and in the young adult, the inter- Sacral canal
vertebral disks are strong and can withstand most verti-
cal forces that impinge on the vertebral column, such as FIGURE 398.4 Magnetic Resonance Image of the Lumbar
jumping or sitting upright. Vertebrae (Median Sagittal Section)
(3) After several decades, some degeneration may occur that NOTE: (1) The spinous processes and the bodies of the lumbar vertebrae.
weakens the annulus fibrosus. These changes may account (2) The intervertebral disks arranged sequentially between the vertebral
for the fact that in the elderly there may be a displacement
of the nucleus pulposus (after even a mild strain) into or bodies.
through the annulus, resulting in pain. (3) The so-called disk problem that results from displacement of disk mate-
rial is most likely to occur in the cervical or lumbar regions and espe-
cially between the L4-L5 vertebral body.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
Sacrum and Coccyx PLATE 399
Superior articular process
Base of sacrum Lateral part Lateral part of sacrum
Sacral tuberosity
Anterior aspect
of sacral wings Median
sacral crest
(ala)
Promontory Anterior sacral Sacral horn Auricular surface
foramina Coccygeal horn of sacrum
of sacrum
1st coccygeal vertebra
Transverse
lines (ridges)
Apex of sacrum Coccyx
FIGURE 399.1 Sacrum, Anterior or Pelvic Surface FIGURE 399.2 Sacrum and Coccyx
(Lateral View)
NOTE: (1) The sacrum is a large triangular bone formed by the fusion of five
sacral vertebrae, and it is wedged between the two hip bones, with which it NOTE: The auricular (ear-shaped) surface of the sa-
articulates laterally. crum articulates with the iliac portion of the pelvis.
Inferiorly, the sacral apex joins the coccyx.
(2) Superiorly, the sacrum articulates with the fifth lumbar vertebra, and infe-
riorly with the coccyx.
(3) The anterior (pelvic) surface of the sacrum is concave and shows four pelvic
foramina on each side. These transmit the ventral rami of the upper four
sacral nerves.
Superior articular Sacral tuberosity
process Lateral sacral crest
Sacral canal 1st coccygeal
vertebra
Auricular
surface
Median sacral crest
Intermediate sacral crest Coccygeal horn
Dorsal sacral foramina
Sacral hiatus
Sacral horn 2nd, 3rd, and 4th
coccygeal vertebrae
Apex of sacrum
FIGURE 399.4 Coccyx (Dorsal View)
FIGURE 399.3 Sacrum (Posterior Surface)
NOTE: This coccyx has four segments, but in
NOTE: On the dorsal surface of the sacrum, the foramina transmit the dorsal rami of many people there are three or five.
the sacral nerves. The dorsal laminae of the fifth sacral vertebra fail to fuse, thereby
leaving a midline opening into the sacral canal called the sacral hiatus.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
PLATE 400 Radiographs: Cervical Spine (Lateral View); Thoracic Spine (Anteroposterior View)
1 12
2 11
5
6
78
1 10
9
2 10
3
11
12
4
13
14 15 3
4 9
5
6
FIGURE 400.1 Cervical Spinal Column (Lateral View) 8
1. Body of axis 7
2. Transverse process of C3 vertebra
3. Body of C3 vertebra FIGURE 400.2 Spinal Column, Thoracic Region
4. Lamina of cricoid cartilage (Anteroposterior Projection)
5. Anterior arch of atlas
6. Odontoid process of axis 1. Neck of first rib
7. Transverse process of axis 2. First rib
8. Posterior arch of atlas 3. Spinous process
9. Inferior articular process 4. Inferior articular process
10. Spinous process 5. Superior articular process
11. Superior articular process 6. Pedicle of vertebral arch
12. Inferior articular process 7. Twelfth thoracic vertebra
13. Spinous process 8. Twelfth rib
14. Intervertebral articulation 9. Diaphragm
15. Spinous process, vertebra prominens (C7) 10. Left contour of the heart
11. Clavicle
(From Wicke, 6th ed.) 12. T1 vertebra
(From Wicke, 6th ed.)
Chapter 5 The Back, Vertebral Column, and Spinal Cord
Radiographs: Lumbar Spine (Anterior and Lateral Views) PLATE 401
T12
5
L1
1 L1 6 L2 10
2 L2 7 9
L3 8
3 L4 89 L3 7
4 L5 1
10
11 L4 6
L5 5
2
4
3
FIGURE 401.1 Spinal Column, Lumbar Region FIGURE 401.2 Spinal Column, Lumbar
Region (Lateral Projection)
(Anteroposterior Projection)
1. Intervertebral disk space
1. Body of L3 vertebra 2. Lumbosacral joint
2. Posterior margin of L3 vertebra 3. Promontory
3. Anterior margin of L4 vertebra 4. Sacrum
4. Spinous process of L3 5. Iliac crest
5. Twelfth rib 6. Superior articular process of L4 vertebra
6. Superior articular process 7. Inferior articular process of L3 vertebra
7. Intervertebral articulation (zygapophyseal joint) 8. Spinous process of L2 vertebra
8. Pedicle of vertebral arch 9. Intervertebral foramen
9. Costal process 10. Costal process
10. Lamina of vertebral arch
11. Inferior articular process (From Wicke, 6th ed.)
(From Wicke, 6th ed.) Chapter 5 The Back, Vertebral Column, and Spinal Cord
PLATE 402 Spinal Cord (Infant); Spinal Nerves (Adult, Diagram)
Medulla oblongata Cerebral hemisphere
Occipital bone
Cerebellum
2nd cervical spinal ganglion
Spinal cord (cervical enlargement)
Spinal ganglia
Dorsal roots of Intercostal nerves
thoracic spinal nerves Dorsal roots
Posterior primary rami
Thoracic spinal cord
Conus medullaris
Ribs Lumbar spinal ganglia
Right kidney
Spinal cord Ilium of pelvis
(lumbar enlargement)
Cauda equina
Sacral spinal ganglia
FIGURE 402.1 Spinal Cord and Brain of a Newborn Child FIGURE 402.2 Emerging Spinal
(Posterior View) Nerves and Segments in the Adult
NOTE: (1) The central nervous system has been exposed by the removal of the dorsal Yellow: Cervical segments (C1–C8)
part of the spinal column and of the dorsal cranium. The spinal ganglia have been Red: Thoracic segments (T1–T12)
dissected, as have their corresponding spinal nerves. Blue: Lumbar segments (L1–L5)
Black: Sacral segments (S1–S5)
(2) Although in this dissection it appears as though the substance of the spinal cord ter- White: Coccygeal segments (C0)
minates at about L1, it is more usual in the newborn for the cord to end at about L3
or L4, thereby filling the spinal canal more completely than in the adult. NOTE: Many spinal nerves travel long dis-
tances before they leave the vertebral canal in
(3) The dorsal root ganglion of the first cervical nerve may be very small and often absent the adult.
(see small ganglion above that of C2). Both anterior and posterior primary rami of
C1 are principally motor, although from time to time C1 will have a small cutaneous
branch.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
Spinal Cord (Dorsal and Ventral Views) PLATE 403
Glossopharyngeal and Brain stem Pons
vagus nerves Atlas Medulla oblongata
Hypoglossal nerve Cervical spinal ganglia Hypoglossal nerve (XII) Accessory nerve (XI)
1 7th cervical vertebra Decussation of pyramids
1st thoracic vertebra Cervical segments Anterior median fissure
2 3rd rib of spinal cord Anterolateral sulcus
Cervical nerves 3 4th rib Cervical enlargement
4 Dura mater
5 12th thoracic vertebra
6 1st lumbar vertebra
7
8
1
2
3
4
5
6 Thoracic segments Dura mater
7 of spinal cord
Thoracic nerves
8
9
10
11
12 Lumbar enlargement
1 Lumbar segments
of spinal cord
2 Lumbar spinal ganglion
3
Lumbar nerves Conus medullaris
4 5th lumbar vertebra Filum terminale
5
1 Filum terminale
(surrounded by dura mater)
Sacral nerves 2 Sacrum
3 FIGURE 403.2 Spinal Cord (Ventral View)
Filum terminale
4 (surrounded by NOTE: (1) The origin of the spinal portion of the ac-
dura mater) cessory nerve (XI) arising from the cervical spinal
5 Coccyx cord and ascending to join the bulbar portion of that
Coccygeal nerve nerve.
FIGURE 403.1 Spinal Cord within the Vertebral (2) The alignment of the rootlets of the hypoglossal nerve
(XII) with the ventral roots of the spinal cord.
Canal (Dorsal View)
(3) The anterior median fissure is located in the longitu-
NOTE: (1) The first cervical nerve emerges above the first dinal midline of the spinal cord. Within this fissure
vertebra and the eighth cervical nerve emerges below the courses the anterior spinal artery (see Fig. 404.1).
seventh vertebra.
(4) The cervical and lumbar enlargements caused by the
(2) The cervical spinal cord is continuous above with the me- large numbers of sensory and motor neurons located
dulla oblongata of the brainstem. in these regions that are required to supply innerva-
tion to the upper and lower limbs.
(3) Each spinal nerve is formed by the union of the dorsal and
ventral roots of that segment, and it emerges between the Chapter 5 The Back, Vertebral Column, and Spinal Cord
two adjacent vertebrae through the intervertebral foramen.
PLATE 404 Spinal Cord: Arterial Supply and Spinal Roots
Basilar artery Pons Posterior median sulcus Anterior median fissure
Vertebral artery Occipital bone Posterolateral sulcus Dura mater
Atlas Dorsal root filaments Denticulate ligament
Spinal branches
(to cervical cord) Aortic arch Arachnoid Spinal ganglia
Anterior
spinal artery
Ascending cervical
artery
Vertebral artery
Ascending aorta
Spinal branch (from Descending aorta Dura mater (meningeal)
intercostal artery)
Intercostal artery Posterior intercostal FIGURE 404.2 Spinal Cord with Dura Mater
arteries Dissected Open (Dorsal View)
Anterior spinal artery
NOTE: Extensions of the pia mater to the meningeal dura mater be-
Anterior root tween the roots of the spinal nerves are called denticulate ligaments.
(spinal nerve) The arachnoid sends fine attachments to both the pia and the dura.
Spinal ganglion Dura mater
A Cervical
Mixed spinal nerve
Great radicular artery
(of Adamkiewicz)
Cauda equina Dura mater
B Thoracic
Dura
mater
FIGURE 404.1 Anterior Spinal Artery C Lumbar
NOTE: The anterior spinal artery is formed by vessels from the FIGURE 404.3A–C Relationship of the Dorsal and
vertebral arteries. It receives anastomotic branches from certain Ventral Roots to the Dura Mater (Various Spinal
cervical, thoracic, and lumbar segmental arteries along the spinal Levels)
roots. An especially large branch (artery of Adamkiewicz) arises
in the lower thoracic or upper lumbar region.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
2nd lumbar vertebra, lamina Spinal Cord: Cauda Equina PLATE 405
Epidural space
Ligamentum flavum
Spinal ganglion Quadratus lumborum muscle
Posterior internal vertebral venous plexus Superior articular process
Posterior ramus Posterior spinal artery
Subdural space
Spinal arachnoid mater Lateral lumbar
Subarachnoid space intertransversarii
Spinal pia mater Iliolumbar ligament
Spinal dura mater
Cauda equina
Trunk of spinal nerve
Spinal nerve, anterior root
Spinal nerve, posterior root
▲ FIGURE 405.1 Dorsal View of the Vertebral Canal from the
Second to the Fifth Lumbar Vertebral Level
Anterior Spinal ganglia NOTE: (1) The vertebral arches have been removed to show the vertebral canal
median fissure Lumbar spinal nerves below the conus medullaris.
Dura mater (2) The anterior (ventral) and posterior (dorsal) roots coursing together through
Cauda equina the intervertebral foramina in the lumbar region.
(3) The dorsal root ganglia at each segmental lumbar level.
(4) The formation of spinal roots below the conus medullaris (L2 level of the
spinal cord) is often called the cauda equina (horse’s tail).
Conus medullaris
Filum terminale
Dura mater
Coccygeal nerve > FIGURE 405.2 Conus Medullaris and Cauda Equina (Ventral)
NOTE: (1) The termination of the neural part of the spinal cord at the conus med-
ullaris. Its membranous continuation as the filum terminale measures about
20 cm and extends as far as the coccyx.
(2) The cauda equina refers to the roots of the spinal nerves below the conus, and
these are seen to surround the filum.
(3) Prolongations of the dura continue to cover the spinal nerves for some dis-
tance as they enter the intervertebral foramen.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
PLATE 406 Spinal Cord: Cross Section; Spinal Arteries
Arachnoid Periosteal layer of dura mater
Pia mater Epidural space;
venous plexus
Dorsal spinal root Meningeal layer of dura mater
Subarachnoid space
Dura mater Spinal ganglion
Spinal ganglion
Posterior primary ramus,
spinal nerve
Transition of dura mater
and epineurium
Anterior ramus, spinal nerve
Rami communicantes
(with sympathetic trunk)
Denticulate ligament Ventral spinal root
FIGURE 406.1 Meninges of the Spinal Cord Shown at Cervical Level (Transverse Section)
NOTE: (1) The meningeal dura mater (inner layer of yellow) surrounds the spinal cord and continues along the spinal nerve through the in-
tervertebral foramen. Its outer periosteal layer is formed of connective tissue that closely adheres to the bone of the vertebrae forming the
vertebral canal.
(2) The delicate filmlike arachnoid, which lies between the meningeal layer of the dura mater and the vascularized pia mater, which is closely
applied to the cord.
Posterior spinal artery
Anterior spinal artery
Spinal branch (posterior
intercostal artery)
FIGURE 406.2 Spinal Arteries and Their Sulcal Branches
NOTE: (1) As the anterior spinal artery descends in the anterior median sulcus, it gives off sulcal branches that penetrate the spinal cord.
(2) These sulcal branches usually arise singly, and each turns to the right or left to supply that half of the spinal cord. When each branch is given
off it does not bifurcate to supply both sides.
(3) Each sulcal branch turns to one side of the cord, and the next branch turns to the other. This alternating pattern (as shown in this figure) occurs
along the length of the spinal cord.
(4) Each of the two posterior spinal arteries supplies its respective side of the cord.
(5) The spinal arteries anastomose with the spinal branches of the segmental arteries (especially those from the intercostal and lumbar arteries).
Chapter 5 The Back, Vertebral Column, and Spinal Cord
Vertebral Veins; Cross Section, Third Lumbar Level PLATE 407
Basivertebral vein Anterior external vertebral
Anterior internal vertebral plexus plexus
Posterior longitudinal
ligament
Posterior internal vertebral plexus Ascending lumbar vein
Intervertebral vein
Posterior external vertebral
plexus
FIGURE 407.1 Veins of the Vertebral Column
NOTE: (1) The veins drain blood from the vertebrae, and the contents of the spinal canal form plexuses that extend the entire length of the spinal
column (Batson’s veins).
(2) The plexuses are grouped according to whether they lie external to or within the vertebral canal. Thus, they include external vertebral,
internal vertebral, basivertebral, intervertebral, and veins of the spinal cord.
(3) The basivertebral veins drain the bodies of the vertebrae and may flow into anterior external or anterior internal vertebral plexuses.
Periosteal layer of dura mater Ligamentum flavum
Epidural space Subarachnoid space
Pia mater
Dura mater (meningeal layer) Medial branch (dorsal primary ramus)
Subdural space Lateral branch (dorsal primary ramus)
Spinal nerve (dorsal primary ramus)
Arachnoid mater
Posterior root of spinal nerve
Spinal ganglion Spinal nerve (ventral primary
Anterior root of spinal nerve ramus)
Ramus communicans
Sympathetic ganglion
Cauda equina Recurrent meningeal branch
Filum terminale of spinal nerve
Anterior internal vertebral plexus
Posterior longitudinal ligament
FIGURE 407.2 Cross Section of the Cauda Equina within the Vertebral Canal
NOTE: (1) This cross section is at the level of the third lumbar vertebra, one segment or more below the site where the spinal cord ends.
(2) Specimens of cerebrospinal fluid may be obtained by performing lumbar punctures between the laminae or spines of the third and fourth or
fourth and fifth lumbar vertebrae.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
PLATE 408 Lumbar and Sacral Puncture into the Spinal Cord
L3 lumbar vertebra
Iliac crest
FIGURE 408.1 Position of Patient for Lumbar Puncture
NOTE that the patient is sitting and bent forward as far as possible in order to increase the space between the vertebrae. For orientation, observe
that the junction between the L3 and L4 vertebrae is at the level of the iliac crest.
Internal posterior vertebral Cauda equina
venous plexus Arachnoid mater of the meninges
Dura mater
L3 spinous process Ligamentum flavum
Interspinous ligament Vertebral arch (lamina)
FIGURE 408.2 Lumbar Injection into the Cauda Equina
NOTE that the needle is inserted just below the spinous process of the L3 vertebra, and realize that the spinal cord becomes the nonneural conus
medularis just below the L2 vertebra.
FIGURE 408.3 Sacral Puncture into the Cauda Equina
NOTE that the needle is inserted into the sacral hiatus in order to produce a caudal epidural anesthesia. This method can be used to anesthetize
the lower sacral and coccygeal nerves.
Chapter 5 The Back, Vertebral Column, and Spinal Cord
6C H A P T E R The Lower Limb
Plates
409 Lower Limb: Photographs (Anterior and Posterior Views) 433 Gluteal Region: Deep Vessels and Nerves (Dissection 4)
410 Lower Limb: Surface Anatomy and Peripheral Nerve Fields 434 Chart of Gluteal Muscles; Safe Zone for Gluteal Injections
(Anterior View)
435 The Gluteal Muscles; Safe Gluteal Quadrant
411 Lower Limb: Cutaneous Nerves (Anterior and Posterior Views)
436 Posterior Thigh: Sciatic Nerve and Popliteal Vessels (Dissection 1)
412 Bones and Joints of the Lower Extremity
437 Lower Extremity: Posterior Thigh Muscles (Dissection 2)
413 Lower Extremity: Arteries and Bones
438 Lower Extremity: Posterior Thigh, Deep Muscles (Dissection 3)
414 Muscles and Fasciae on the Anterior Aspect of the Lower
Limb 439 Posterior Thigh and Gluteal Region: Deep Vessels and Nerves
(Dissection 4)
415 Muscles and Fasciae on the Posterior Aspect of the Lower
Limb 440 Anterior and Medial Nerves of the Lower Limb
416 Lower Limb: Anterior Thigh, Superficial Vessels and Nerves 441 Posterior Nerves of the Lower Limb
(Dissection 1)
442 Popliteal Fossa, Vessels and Nerves (Dissections 1, 2)
417 Superficial and Deep Inguinal Lymph Nodes; Saphenous
Opening 443 Knee Region: Medial and Posterior Aspects (Dissection 3)
418 Lower Extremity: Anterior Thigh Muscles, Superficial View 444 Lower Extremity: Popliteal Fossa, Deep Arteries (Dissection 4)
(Dissection 2)
445 Lower Extremity: Popliteal Fossa, Femoral–Popliteal–Tibial
419 Individual Muscles of the Anterior Thigh (Dissection 3) Arteriogram
420 Lower Extremity: Anterior Thigh Muscles (Dissection 4) 446 Anterior Leg, Superficial Vessels and Nerves (Dissection 1)
421 Anterior and Medial Thigh Muscles, Intermediate Layer 447 Anterior Leg, Investing Fascia and Muscles (Dissections 2, 3)
(Dissection 5)
448 Compartments of Leg; Muscle Chart, Anterior and Lateral
422 Arteries of the Hip Region; Deep Femoral and Circumflex Iliac Compartments
Arteries
449 Anterior Compartment of the Leg: Vessels, Lymphatics, and
423 Lower Extremity: Femoral Vessels and Nerves; Adductor Canal Muscles
(Dissection 6)
450 Anterior and Lateral Leg: Deep Arteries and Nerves
424 Anterior and Medial Thigh Muscles, Deep Layer (Dissection 7) (Dissection 4)
425 Anterior and Medial Thigh, Deep Vessels and Nerves 451 Anterior and Lateral Compartments: Deep Muscles
(Dissection 8) (Dissection 5)
426 Lower Extremity: Anterior Thigh, Movements and Muscle 452 Lower Extremity: Lateral Compartment of the Leg
Chart (Dissection 6)
427 Lower Extremity: Chart of Thigh Muscles 453 Fibular Nerves; Ankle and Foot Movements
428 Gluteal Region and Thigh: Superficial Vessels and Nerves 454 Dorsum of the Foot: Superficial Vessels and Nerves
(Dissection 1) (Dissection 1)
429 Lower Extremity: Muscles of the Thigh (Lateral View) 455 Dorsum of the Foot: Superficial Muscles and Tendon Sheaths
(Dissection 2)
430 Lower Extremity: Gluteus Maximus (Dissection 2)
456 Dorsum and Malleolar Regions of the Foot: Tendons and
431 Gluteal Region: Gluteal Muscles (Superficial and Deep) Tendon Sheaths
432 Gluteal Region: Gluteus Medius and Lateral Rotators 457 Dorsum of the Foot: Muscles and Tendons (Dissection 3)
(Dissection 3)
458 Dorsum of the Foot: Muscles and Tendons (Dissection 4)
CHAPTER 6 The Lower Limb
459 Dorsum of the Foot: Deep Vessels and Nerves (Dissection 5) 486 Right Knee Joint (Frontal Section); Tibial Collateral Ligament
460 Posterior Leg; Superficial Vessels and Nerves (Dissection 1) 487 Knee Joint (Posterior Superficial View); Internal Ligaments
461 Posterior Leg, Crural Fascia; Superficial Muscles (Dissections 488 Knee Joint: Transverse and Sagittal Sections
2, 3)
489 Four Magnetic Resonance Images (MRIs) of the Knee Joint
462 Knee, Calf, and Foot: Muscles and Tendons (Medial View)
490 Arthrogram of the Right Knee
463 Posterior Leg: Soleus and Plantaris Muscles (Dissection 4)
491 Arthroscopic Images of the Knee Joint
464 Posterior Compartment of the Leg: Soleus Muscle Level
(Dissection 5) 492 Knee Joint: Synovial Cavity and Bursae
465 Posterior Leg: Arteries and Nerves, Deep to Soleus Muscle 493 Radiographs of Knee Joint
(Dissection 6)
494 Knee Joint: Synovial Membranes (Bursae): Movements at
466 Posterior Compartment of the Leg: Deep Muscle Group Joint
(Dissection 7)
495 Joints of the Lower Limb: Knee Joint, the Menisci; Patella
467 Posterior Compartment of the Leg: Deep Vessels and Nerves
(Dissection 8) 496 Bones and Joints of the Lower Limb: Tibia and Tibiofibular
Joints
468 Posterior Compartment of the Leg: Attachments of Muscles;
Muscle Chart 497 Bones and Joints of the Lower Limb: Tibia and Fibula
469 Posterior Leg: Tibialis Posterior and Flexor Hallucis Longus 498 Joints of Lower Limb: Talocrural (Ankle) Joint: X-Ray
(Dissection 9) (Coronal Section)
470 Plantar Foot: Aponeurosis, Vessels and Nerves (Dissections 1, 2) 499 Talocrural (Ankle) Joint: Articular Surface (Posterior View)
471 Plantar Aspect of the Foot: First Layer of Muscles (Dissection 3) 500 Bones of the Foot and Muscle Attachments (Dorsal View)
472 Plantar Aspect of the Foot: Second Layer of Muscles 501 Bones of the Foot and Muscle Attachments (Plantar View)
(Dissection 4)
502 Bones and Ligaments of the Right Foot (Lateral View)
473 Plantar Aspect of the Foot: Plantar Arteries and Nerves
(Dissection 5) 503 Bones and Ligaments of the Right Foot (Medial View)
474 Plantar Aspect of the Foot: Deep Vessels and Nerves 504 Talocrural Joint: Sagittal Section of the Foot; Medial
(Dissection 6) Ligaments
475 Plantar Aspect of the Foot: Third Layer of Plantar Muscles 505 Talocalcaneonavicular, Intertarsal, and Tarsometatarsal
(Dissection 7) Joints
476 Plantar Aspect of the Foot: Diagram of Arteries; Interosseous 506 Joints of Lower Limb: Ligaments on the Plantar Surface of
Muscles the Foot
477 Plantar Aspect of the Foot: Chart of Plantar Muscles 507 Talocrural Joint: Sagittal Section; Tarsal and Metatarsal
Joints
478 Bones of Lower Limb: Muscle Attachments; Femur (Anterior View)
508 Radiograph and MRI of Ankle, Subtalar, and
479 Bones of Lower Limb: Muscle Attachments; Femur (Posterior Talocalcaneonavicular Joints
View)
509 Longitudinal Arches of the Foot
480 Joints of Lower Limb: Hip Joint, Ligaments and Frontal
Section 510 High Cross Section of the Right Thigh through the Neck of
the Femur
481 Joints of Lower Limb: Hip Joint, Frontal Section and Opened
Socket 511 Cross Section and MRI through the Middle of the Right Thigh
482 The Hip Joint and the Head of the Femur 512 Cross Section and MRI through the Distal End of the Right Femur
483 Blood Supply to Upper Femur; Radiograph of Hip Joint 513 Cross Section and MRI through the Middle of the Right Leg
484 Joints of the Lower Limb: Knee Joint, Patellar Structures; 514 Cross Sections: Lower Right Leg and Proximal Right Foot
Anteroposterior X-Ray
515 Cross Section and MRI of the Foot through the Metatarsal
485 Knee Joint: Synovial Folds and Cruciate Ligaments (Anterior Bones
View)
516 Compartments of the Right Foot: Frontal Section,
Midmetatarsal Level
Lower Limb: Photographs (Anterior and Posterior Views) PLATE 409
Anterior superior iliac spine Sacrum
Tensor fasciae latae muscle Anal sulcus
Gluteal region;
Inguinal ligament gluteus maximus muscle
Greater trochanter
Greater trochanter Gluteal crease
Anterior femoral region
Posterior femoral
Sartorius muscle region
Quadriceps Posterior knee region;
femoris muscle popliteal fossa
Head of the fibula
Anterior knee region; patella
Head of the fibula Gastrocnemius
Tibial tuberosity Posterior crural region
Anterior crural region
Anterior margin of the tibia
Medial malleolus (tibia) Medial malleolus (tibia)
Lateral malleolus (fibula) Lateral malleolus (fibula)
Dorsum of the foot Dorsum of the foot
Small toe (5th digit)
Calcaneal tuberosity
4th digit
FIGURE 409.2 Photograph of the Posterior Surface
3rd digit Plantar surface of the Lower Limb
2nd digit of foot
NOTE: (1) The following bony landmarks are shown:
Large toe (hallux) (a) Sacrum
(b) Greater trochanter
FIGURE 409.1 Photograph of the Anterior Surface (c) Head of the fibula
(d) Medial and lateral malleoli
of the Lower Limb (e) Calcaneal tuberosity
NOTE: (1) The following bony landmarks are shown: (2) The gluteal crease. Midway between the greater trochanter later-
(a) Anterior superior iliac spine ally and the ischial tuberosity medially and deep to this crease is
(b) Greater trochanter found the large sciatic nerve descending in the posterior thigh.
(c) Patella The nerve is vulnerable at this site because only skin and super-
(d) Head of the fibula ficial fascia overlie it.
(e) Tibial tuberosity
(f) Anterior margin of the tibia (3) The popliteal fossa located behind the knee joint. Deep to the
(g) Medial and lateral malleoli skin at this site are found the tibial and fibular divisions of the
sciatic nerve and the popliteal artery and vein.
(2) The inguinal ligament, which forms the lower anterior boundary
of the abdominal wall, separating it from the anterior thigh infe- (4) The calcaneal tuberosity into which inserts the calcaneus tendon
riorly. formed as the common tendon of the gastrocnemius, soleus, and
plantaris muscles.
(3) Deep to the surface areas shown in this figure course branches of
the cutaneous nerves that supply the anterior and lateral aspects
of the thigh and leg and the dorsum of the foot. These branches
are shown in Figure 411.1.
Chapter 6 The Lower Limb
PLATE 410 Lower Limb: Surface Anatomy and Peripheral Nerve Fields (Anterior View)
Anterior superior Pectineus muscle T12 S2
iliac spine L1
Adductor L2
Tensor fasciae longus muscle
latae muscle L3
Vastus medialis
Sartorius muscle muscle L4
L5
Rectus femoris muscle Patella
Vastus lateralis muscle Patellar
ligament
Lateral epicondyle
of femur Medial head of
gastrocnemius muscle
Fibularis longus Tibialis anterior
muscle muscle
Soleus muscle
Lateral malleolus Medial malleolus
Great saphenous vein
S1
FIGURE 410.1 Surface Anatomy of the Right Lower FIGURE 410.2 Segmental Cutaneous Innervation of
Limb (Anterior View) the Right Lower Extremity (Dermatomes: Anterior
View)
NOTE: (1) The pectineus and adductor longus muscles forming the
floor of the femoral triangle. Also observe the sartorius muscle NOTE: (1) As a rule, the lumbar segments of the spinal cord supply
coursing inferomedially and the tensor fasciae latae that shapes cutaneous innervation to the anterior aspect of the lower limb,
the rounded upper lateral contour of the thigh. and the dermatomes are segmentally arranged in order from L1
to L5.
(2) The leg is shaped laterally by the fibularis muscles, anteriorly
by the tibialis anterior, and medially by the gastrocnemius and (2) The first sacral segment supplies the skin over the medial mal-
soleus muscles. leolus and the dorsolateral aspect of the foot.
Chapter 6 The Lower Limb
Lower Limb: Cutaneous Nerves (Anterior and Posterior Views) PLATE 411
Iliohypogastric nerve
Lateral femoral Superior cluneal Iliohypogastric nerve
cutaneous nerve nerves: (L1, L2, L3; (iliopubic nerve),
lateral cutaneous
posterior rami) branch
Genitofemoral Femoral Iliohypogastric nerve Lateral
nerve branch (anterior cutaneous cutaneous
branch) nerve of thigh
Genital (lateral femoral
branch Middle cluneal cutaneous
nerves (S1, S2, S3; nerve)
posterior rami)
Anterior scrotal Inferior cluneal
branches (from nerves (from
ilioinguinal nerve)
posterior femoral
cutaneous nerve)
Femoral nerve Obturator nerve, Posterior femoral
(anterior cutaneous cutaneous branch cutaneous nerve
branches) (S1, S2, S3)
Obturator nerve,
cutaneous branch
Infrapatellar branch Saphenous nerve Common fibular
of the saphenous nerve (medial crural nerve (common
(from the femoral nerve) peroneal nerve),
cutaneous nerve) lateral sural
cutaneous nerve
(sciatic nerve)
Lateral sural cutaneous Saphenous nerve
nerve (from common (from femoral nerve)
fibular nerve)
Sural nerve (lateral dorsal Sural nerve,
cutaneous nerve) (sciatic nerve)
Intermediate dorsal FIGURE 411.2 Cutaneous Nerve Branches
cutaneous nerve (from (Posterior Surface)
superficial fibular nerve)
NOTE: (1) Cutaneous innervation of the gluteal region:
Medial dorsal (a) Lateral branch of iliohypogastric nerve (anterior ramus: L1)
cutaneous branch (from (b) Superior cluneal nerves (posterior rami: L1–L3)
(c) Middle cluneal nerves (posterior rami: S1–S3)
superficial fibular nerve) (d) Inferior cluneal nerves (S1–S3)
Medial dorsal cutaneous (2) Skin of posterior thigh supplied by the posterior and lateral fem-
branch (from deep oral cutaneous nerves and obturator nerve.
fibular nerve)
(3) Skin of posterior leg supplied the saphenous, sural, and lateral
FIGURE 411.1 Cutaneous Nerve Branches sural nerves.
Chapter 6 The Lower Limb
(Anterior Surface)
NOTE: (1) Cutaneous branches of the femoral nerve supply the skin
of the anteromedial thigh, and the saphenous nerve supplies the
anteromedial and posteromedial leg.
(2) The lateral sural branch of the common fibular nerve supplies
the anterolateral and posterolateral leg skin.
(3) The fields supplied by the superficial and deep fibular nerves on
the anterior leg and foot dorsum.
(4) The knowledge of the course of these nerves is important in ad-
ministering local anesthesia.
PLATE 412 Bones and Joints of the Lower Extremity
Pelvis (Hip bone) Sacroiliac joint
Hip Hip joint
Femur
Femur
Knee Patella Femoropatellar joint
Leg Knee joint Meniscofemoral joint
Fibula
Tibia Meniscotibial joint
Tibiofibular joint
Tibiofibular syndesmosis
Talocrural joint
Calcaneocuboid joint
Tarsal bones Subtalar joint Talotarsal joint
Metatarsal Talocalcaneonavicular joint
bones Cuneonavicular joint
Foot Cuneocuboid joint
Intercuneoform joints
Bones of the toes:
Proximal phalanx Tarsometatarsal joints
Middle phalanx Metatarsophalangeal joints
Distal phalanx Interphalangeal joints
FIGURE 412 Bones and Joints of the Lower Limb
NOTE the following joints: hip, knee, tibiofibular, ankle (talocrural), tarsal, tarsometatarsal, metatarsophalangeal, and
interphalangeal joints.
Chapter 6 The Lower Limb
Lower Extremity: Arteries and Bones PLATE 413
Femoral artery Inferior
gluteal artery
Medial femoral
Lateral circumflex artery
femoral Deep femoral artery
circumflex
1st, 2nd, 3rd 1st, 2nd, 3rd Superior lateral
artery perforating arteries perforating genicular artery
Ascending arteries Sural artery
Descending Middle genicular artery
branch genicular artery Popliteal artery
Descending Inferior lateral
Saphenous artery Superior medial genicular artery
branch genicular artery Posterior tibial
Articular branch recurrent artery
Superior lateral Sural artery
genicular artery Superior medial Inferior medial Anterior tibial artery
genicular artery genicular artery
Inferior lateral Articular network Posterior tibial artery Fibular artery
genicular artery
Inferior medial
Anterior tibial genicular artery
recurrent artery
Anterior tibial
artery
Perforating branch, Anterior medial Medial malleolar Communicating branch
fibular artery malleolar artery artery
Medial tarsal artery Lateral malleolar artery
Anterior lateral malleolar artery Medial plantar Lateral plantar artery
Dorsalis pedis artery artery Plantar arch
Lateral tarsal artery
Arcuate artery Dorsal metatarsal
arteries
FIGURE 413.1 Arteries and Bones of the Lower FIGURE 413.2 Arteries and Bones of the Lower
Limb (Anterior View) Limb (Posterior View)
NOTE: The anastomoses in the hip and knee regions, and the NOTE: The branches of the popliteal artery at the knee and its
perforating branches of the deep femoral artery. In the anterior continuation as the posterior tibial artery. In the foot this vessel
leg, the anterior tibial artery descends between the tibia and the divides to form the medial and lateral plantar arteries, which
fibula to achieve the malleolar region and the foot dorsum. then anastomose to form the plantar arch.
Chapter 6 The Lower Limb
PLATE 414 Muscles and Fasciae on the Anterior Aspect of the Lower Limb
Iliopsoas Iliacus muscle Anterior superior Inguinal ligament
muscle iliac spine
Psoas major Spermatic cord
muscle Tensor fasciae
lata muscle Saphenous hiatus
Falciform Great saphenous vein
margin
Openings for
Tensor fascia lata perforating veins
muscle
Tendon of quadriceps
Sartorius muscle Pectineus Iliotibial tract femoris muscle
muscle Fascia lata
Patella
Vastus lateralis muscle Adductor Subcutaneous
Rectus femoris muscle longus prepatellar bursa
Vastus medialis muscle muscle Patellar ligament
Subcutaneous
Gracilis infrapatellar bursa
muscle
Crural fascia
Lateral patellar Anterior margin
retinaculum of the tibia
Head of the fibula Medial surface
of the tibia
Fibularis longus muscle Crural fascia Tendon of the tibialis
(peroneus logus muscle) anterior muscle
Gastrocnemius
Tibialis anterior muscle muscle Inferior extensor
(medial head) retinaculum
Extensor digitorum muscle Extensor hallucis
Soleus muscle brevis muscle
Extensor hallucis muscle Tendon of extensor
Superior extensor hallucis longus muscle
retinaculum Dorsalis pedis fascia
Tendons, extensor
digitorum longus muscle
FIGURE 414.1 Muscles of the Lower Limb FIGURE 414.2 The Deep Fasciae of the Anterior
and Medial Thigh (Fascia Lata) and the Crural
NOTE the anterior and medial thigh muscles and also the Fascia of the Leg
anterior and lateral muscles of the leg.
NOTE the great saphenous vein, the saphenous hiatus, and the
fascia lata of the anterior thigh. Observe the closely investing cru-
ral fascia over the anterior and lateral compartment muscles of
the leg.
Chapter 6 The Lower Limb
Muscles and Fasciae on the Posterior Aspect of the Lower Limb PLATE 415
Iliac crest
Gluteus medius Gluteal fascia
muscle
Tensor fascia
Gluteus maximus lata muscle
muscle Gluteal sulcus
Iliotibial tract
Semitendinosus Biceps femoris
muscle muscle Fascia lata
Semimembranosus
muscle
Popliteal fossa Popliteal fascia
Gastrocnemius Crural fascia
muscle
Tendon of the
Gastrocnemius gastrocnemius muscle
muscle Calcaneal tendon
Soleus muscle Medial malleolus
Calcaneal tendon FIGURE 415.2 Fascia of the Gluteal Region
and the Fascia Lata of the Posterior Thigh
FIGURE 415.1 Muscles of the Lower Limb: Posterior and Crural Fascia of the Posterior Leg
Aspect of Thigh and Leg
NOTE the iliac crest, gluteal sulcus, iliotibial band, and the
NOTE the hamstring muscles of the posterior thigh and the gastrocne- crural fascia below the knee.
mius and soleus muscles of the posterior leg.
Chapter 6 The Lower Limb
PLATE 416 Lower Limb: Anterior Thigh, Superficial Vessels and Nerves (Dissection 1)
Femoral artery
Femoral vein Iliohypogastric nerve
Anterior cutaneous branches of T12
Superficial epigastric artery and vein Ilioinguinal nerve
Superficial external pudendal artery and vein
Lateral femoral cutaneous nerve
Anterior femoral vein
Femoral branch of genitofemoral
nerve
Superficial circumflex iliac
vessels
Great saphenous vein
Anterior cutaneous branches of
femoral nerve
Cutaneous branches of obturator nerve
Patellar network of vessels Descending genicular artery
Infrapatellar branch of saphenous nerve
FIGURE 416 Superficial Nerves and Blood Vessels of the Anterior Thigh
NOTE: (1) The great saphenous vein as it ascends the anterior and medial aspect of the thigh. Just below (1½ in.) the inguinal ligament, it pen-
etrates the deep fascia through the saphenous opening to enter the femoral vein.
(2) The superficial branches of the femoral artery and the superficial veins drain into the great saphenous vein. These include the: (a) superficial
epigastric, (b) external pudendal, and (c) superficial circumflex iliac arteries and veins.
(3) The principal cutaneous nerves of the anterior thigh. Compare these with those shown in Figure 411.1.
Chapter 6 The Lower Limb
Superficial and Deep Inguinal Lymph Nodes; Saphenous Opening PLATE 417
N FIGURE 417.1 Superficial Inguinal Lymph Nodes
Inguinal Superficial epigastric NOTE: (1) The superficial tissues of the genitalia, lower anterior
ligament vein abdominal wall, inguinal region, and anterior thigh drain
into the superficial inguinal lymphatic nodes.
Superficial Superficial inguinal
circumflex nodes (2) These nodes are located around the femoral vessels just in-
ferior to the inguinal ligament and usually number between
iliac vein 10 and 15. In turn, these nodes drain into the external iliac
nodes within the pelvis.
Great
saphenous Spermatic cord
vein Superficial external
pudendal veins
Accessory
saphenous vein
Great saphenous
vein
Adductor longus
Iliacus muscle Psoas major
muscle
FIGURE 417.2 Saphenous Opening in the N Inguinal ligament
Fascia Lata Tendon of psoas
minor muscle
NOTE: (1) The femoral sheath (dense connective tissue Fascia lata
that surrounds the femoral artery and vein) has been Iliopectineal arch
removed in this dissection, revealing the sharply de- Falciform Superior
fined falciform margin of the saphenous opening. margin horn Femoral artery and vein
Medial lacunar lymph node
(2) The great saphenous vein receives its superficial Inferior (of Rosenmüller)
tributaries before it enters the saphenous opening. horn Lacunar ligament
Superficial circumflex iliac vein
Superior pubic ligament
Superficial epigastric
vein
Fascia lata
Superficial external
pudendal veins
Great
saphenous
vein
Psoas major muscle Internal iliac lymphatic nodes
Internal iliac artery and vein
External iliac lymphatic nodes Rectum
(lateral group)
Ovary
External iliac lymphatic nodes Uterus
(medial group)
Bladder
External iliac artery and vein Deep inguinal lymphatic nodes
Superficial inguinal lymphatic nodes Superficial inguinal lymphatic
(superolateral group) nodes (inferior group)
Inguinal ligament
Superficial inguinal lymphatic nodes
(superomedial group)
Saphenous opening
FIGURE 417.3 Superficial and Deep Inguinal Lymphatic Nodes
NOTE: The directions of flow (arrows) of lymph from adjacent tissues into the superficial and deep inguinal nodes. The superficial nodes are
divided into superolateral, superomedial, and inferomedial groups, while the deep nodes are closest to the femoral vessels.
Chapter 6 The Lower Limb
PLATE 418 Lower Extremity: Anterior Thigh Muscles, Superficial View (Dissection 2)
Iliopsoas muscle 5th lumbar vertebra
Anterior superior iliac spine Promontory
Tensor fasciae latae muscle Piriformis muscle
Inguinal ligament
Sartorius muscle Obturator internus muscle
Pecten pubis
Rectus femoris muscle Pubic tubercle
Vastus lateralis muscle Pectineus muscle
Adductor longus muscle
Quadriceps femoris muscle
Fascia lata Gracilis muscle
Adductor magnus muscle
Tendon of rectus femoris muscle
Patella Sartorius muscle
Patellar ligament Vastus medialis muscle
Medial condyle of femur
FIGURE 418 Anterior Muscles of the Thigh: Superficial View (Right)
NOTE: (1) The long narrow sartorius muscle, which arises on the anterior superior iliac spine and passes obliquely across the anterior femoral
muscles to insert on the medial aspect of the body of the tibia. The sartorius flexes, abducts, and rotates the thigh laterally at the hip joint, and
it flexes and rotates the leg medially at the knee joint.
(2) The quadriceps femoris muscle forms the bulk of the anterior femoral muscles, and both the sartorius and quadriceps muscles are innervated
by the femoral nerve.
(3) Above and medial to the sartorius muscle are visible, in order, the iliopsoas, pectineus, adductor longus, adductor magnus, and gracilis
muscles.
Chapter 6 The Lower Limb
Individual Muscles of the Anterior Thigh (Dissection 3) PLATE 419
Tensor fascia lata muscle Rectus femoris muscle
Vastus medialis muscle
Sartorius muscle Vastus intermedius muscle
Iliotibial tract Vastus lateralis muscle
FIGURE 419.1 The Tensor Fascia Patellar ligament
Lata and Sartorius Muscles
FIGURE 419.2 The Quadriceps
Femoris Muscle
Psoas major muscle
Pectineus muscle Iliacus muscle
Adductor brevis muscle
Adductor longus muscle
Adductor magnus muscle
Gracilis muscle
FIGURE 419.4 The Iliopsoas Muscle
FIGURE 419.3 The Adductor Muscles and the
Pectineus and Gracilis Muscles
Chapter 6 The Lower Limb
PLATE 420 Lower Extremity: Anterior Thigh Muscles (Dissection 4)
Iliopsoas muscle Psoas major muscle
Sartorius muscle Promontory
Piriformis muscle
Tensor fasciae latae muscle Sacrospinous ligament
Iliacus muscle Pecten of pubis
Superior pubic ligament
Gluteus medius muscle
Rectus femoris muscle Pectineus muscle
Adductor longus muscle
Iliopsoas muscle Gracilis muscle
Adductor canal; femoral vessels
Rectus femoris muscle Tendinous wall of adductor canal
Vastus lateralis muscle
Quadriceps femoris muscle
Fascia lata Sartorius muscle
Tendon of rectus femoris Vastus medialis muscle
Patella Medial condyle of femur
Patellar ligament
FIGURE 420 Quadriceps Femoris, Iliopsoas, and Pectineus Muscles
NOTE: (1) The quadriceps femoris muscle consists of the rectus femoris and the three vastus muscles (lateralis, intermedius, and medialis) as
it converges inferiorly to form a powerful tendon that encases the patella and inserts onto the tuberosity of the tibia. The entire quadriceps
extends the leg at the knee, while the rectus femoris also flexes the thigh at the hip.
(2) The iliopsoas muscle is the most powerful flexor of the thigh at the hip joint, and it inserts on the lesser trochanter.
(3) The quadrangular and flat pectineus muscle medial to the iliopsoas. Sometimes called the key to the femoral triangle, this muscle is normally
supplied by the femoral nerve, but in slightly over 10% of cases it also receives a branch from one of the obturator nerves.
Chapter 6 The Lower Limb
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