Anatomy Flashcards
Omohyoid
The omohyoid muscle is a muscle that depresses the hyoid. It is located at the front of the neck and consists of two bellies separated by an intermediate tendon. Its superior belly serves as the most lateral member of the infrahyoid muscles, located lateral to both the sternothyroid and thyrohyoid muscles. [1] Its name derives from the Greek "omos" meaning shoulder, giving one of its attachments, and "hyoid", giving the other attachment - the hyoid bone. Contents [hide] 1 Structure 2 Variations 3 Examination of Neck 4 Innervation 5 Additional images 6 References 7 External links Structure[edit]
It arises from the upper border of the scapula, and occasionally from the superior transverse scapular ligament which crosses the scapular notch, its extent of attachment to the scapula varying from a few millimetres to 2.5 cm.
This muscle has two separate bellies: superior and inferior.[1]
From this origin, the inferior belly forms a flat, narrow fasciculus, which inclines forward and slightly upward across the lower part of the neck, being bound down to the clavicle by a fibrous expansion; it then passes behind the sternocleidomastoid, becomes tendinous and changes its direction, forming an obtuse angle.
It ends in the superior belly, which passes almost vertically upward, close to the lateral border of the sternohyoid, to be inserted into the lower border of the body of the hyoid bone, lateral to the insertion of the sternohyoid.
The central tendon of this muscle varies much in length and form, and is held in position by a process of the deep cervical fascia, which sheaths it, and is prolonged down to be attached to the clavicle and first rib; it is by this means that the angular form of the muscle is maintained.
Variations[edit]
Doubling; absence; origin from clavicle; absence or doubling of either belly.
Examination of Neck[edit]
The inferior belly of the omohyoid divides the posterior triangle of the neck into an upper or occipital triangle and a lower or subclavian triangle. Its superior belly divides the anterior triangle into an upper or carotid triangle and a lower or muscular triangle.[2]
The Omohyoid muscle is proximally attached to the scapula and distally attached to the hyoid bone.
Innervation[edit]
The omohyoid is innervated by a branch of the cervical plexus, the ansa cervicalis, and mostly acts to stabilise the hyoid bone. Although the inferior belly of the omohyoid is innervated by branches of all three cervical rami (C1-C3) that make up the ansa cervicalis, the superior belly is innervated by the superior root of ansa cervicalis which contains only fibers from the first cervical spinal nerves (C1).
quadrangular space or quadrilateral space
The quadrangular space (or quadrilateral space [of Velpeau] or Foramen Humerotricipitale) is an axillary space in the arm. This is a clinically important anatomic space in the arm. In the quadrangular space, the axillary nerve and posterior circumflex humeral artery can be compressed or damaged due to space-occupying lesions or disruption in the anatomy due to trauma. Symptoms include axillary nerve related weakness of the deltoid muscle in the case of any significant mass lesions in the quadrangular space. Contents [hide] 1 Boundaries 2 Contents 3 See also 4 Additional images 5 References 6 External links Boundaries[edit]
It is bounded by:[1]
above/superior: the subscapularis and teres minor. Some sources exclude the teres minor.[2]
below/inferior: the teres major
medially: the long head of the triceps brachii
laterally: the surgical neck of the humerus
Contents[edit]
It transmits the axillary nerve and posterior humeral circumflex artery.
See also[edit]
Triangular space
Thyrocervical trunk
Distal to vertebral off subclavian
Inferior thyroid
Dorsal scapular
Suprascapular
Costocervical trunk
Ascending cervical
Supreme intercostal
Cervical plexus
The cervical plexus has two types of branches: cutaneous and muscular.
Cutaneous (4 branches):
Lesser occipital nerve - innervates lateral part of occipital region (C2 ONLY)
Great auricular nerve - innervates skin near concha auricle (outer ear) and external acoustic meatus (ear canal) (C2&C3)
Transverse cervical nerve - innervates anterior region of neck (C2&C3)
Supraclavicular nerves - innervate region of supraspinatus, shoulder, and upper thoracic region (C3,C4)
Muscular
Ansa cervicalis (loop formed from C1-C3), etc. (geniohyoid (C1 only), thyrohyoid (C1 only), sternothyroid, sternohyoid, omohyoid)
Phrenic (C3-C5 (primarily C4))-innervates diaphragm and the pericardium
Segmental branches (C1-C4)- innervates anterior and middle scalenes
Sub occipital triangle
The suboccipital triangle is a region of the neck bounded by the following three muscles of the suboccipital group of muscles:
Rectus capitis posterior major - above and medially
Obliquus capitis superior - above and laterally
Obliquus capitis inferior - below and laterally
(Rectus capitus posterior minor is also in this region but does not form part of the triangle)
It is covered by a layer of dense fibro-fatty tissue, situated beneath the Semispinalis capitis.
The floor is formed by the posterior occipito-atlantal membrane, and the posterior arch of the atlas.
In the deep groove on the upper surface of the posterior arch of the atlas are the vertebral artery and the first cervical or suboccipital nerve.
The vertebral artery is accessed here in order to conduct angiography of the circle of Willis.
Contents [hide]
1 Contents of the suboccipital triangle
2 Additional images
3 References
4 See also
5 External links
Contents of the suboccipital triangle[edit]
1) Third part of vertebral artery
2) Dorsal ramus of nerve C1-suboccipital nerve
3) Suboccipital venous plexus
The purpose of these muscles is to provide fine motor function in movements of the head. The actions of trapezius, sternocleidomastoid and other larger muscles that move the head are refined by the relatively small suboccipital triangle muscles.
LON
The lesser occipital nerve is one of the four cutaneous branches of the cervical plexus. It arises from the lateral branch of the ventral ramus of the second cervical nerve, sometimes also from the third; it curves around and ascends along the posterior border of the Sternocleidomastoideus.
Near the cranium it perforates the deep fascia, and is continued upward along the side of the head behind the auricula, supplying the skin and communicating with the greater occipital, the great auricular, and the posterior auricular branch of the facial.
The smaller occipital varies in size, and is sometimes duplicated.
It gives off an auricular branch, which supplies the skin of the upper and back part of the auricula, communicating with the mastoid branch of the great auricular.
This branch is occasionally derived from the greater occipital nerve.
GON
Greater occipital nerve
Posterior primary divisions of the upper three cervical nerves. (Great occipital nerve labeled at center top.)
Innervates semispinalis capitis, scalp
From C2
The greater occipital nerve is a spinal nerve, specifically the medial branch of the dorsal primary ramus of cervical spinal nerve 2. This nerve arises from between the first and second cervical vertebrae, along with the lesser occipital nerve. It ascends after emerging from below the suboccipital triangle beneath the obliquus capitis inferior muscle. It then passes through the trapezius muscle and ascends to innervate the skin along the posterior part of the scalp to the vertex. It innervates the scalp at the top of the head, over the ear and over the parotid glands.
spinal anatomy
7 cervical, first rib on T1 C7 vertebra prominens C6 first anterior tubercule T12 last rib vertebral artery enters at C6 or C7 in 7%
Shoulder testing
Physical Examination Info
ANKLE PHYSICAL EXAMINATION | KNEE PHYSICAL EXAMINATION | SHOULDER PHYSICAL EXAMINATION
Shoulder Physical Examination
Anthony Luke MD, MPH
Examination
The glenohumeral joint is the most mobile joint in the body, but the large multi-directional range of motion is a trade-off for joint stability. The lack of stability makes the shoulder more susceptible to a large spectrum of injuries, especially with overhead activities involved in sports such as baseball, volleyball, swimming and weight lifting. The shoulder girdle is important because is serves as the connecting joint between the arm and the axial skeleton. It serves as the base of support for movements occurring at the elbow, wrist and hand.
During an examination, taking a thorough history is as important as the physical exam itself. The clinician should inquire about the patient’s hand dominance, as well as their occupation and recreational activities. It is also important to establish their chief complaint, which may include pain, instability, weakness, or loss of range of motion. Complaints of numbness and tingling may be associated with neurovascular disorders, and stiffness may suggest adhesive capsulitis and/or arthritis. Furthermore, any crepitus may indicate bursa, osteoarthritis or rotator cuff pathology. It is also important to have patients try and establish an approximate timeline for when the injury occurred and what event or mechanism, if any, lead to the injury or onset of symptoms. For patients who report a dislocation, it should be asked what position the arm was in at the time of the dislocation, and what the frequency of dislocations or subluxations were. Finally it is important to establish what type of activities of daily living the patient can and cannot perform. Such activities include simple everyday tasks like getting dressed, lifting an object overhead, sleeping on the shoulder, brushing your teeth, combing your hair, putting on shoes, and carrying or lifting objects like groceries.
Paplation
There are several important bony and soft tissue structures that need to be palpated during the shoulder physical exam. Bony structures should include: the sternoclavicular joint, the clavicle, the acromioclaviular joint, the coracoid process, the borders of the scapula, and the greater and lesser tuberosities of the humerus. Soft tissue landmarks should include: the subacromial bursae, the supraclavicular fossa, the long head of the biceps tendon, the trapezius, and other associated muscles and tendons.
Range of Motion
Active range of motion performed by the patient is typically assessed first, and can be affected by both pain and motor function. The patient can be either seated or standing during the assessment, and movements to be tested should include forward flexion, extension, internal/external rotation, and abduction/adduction.
Active Range of Motion: Forward Flexion and External Rotation
Active Range of Motion: Internal Rotation
Passive range of motion is performed by the clinician with the patient seated or supine in the same planes previously stated. This is used to isolate motion for an accurate evaluation of soft tissue.
Passive Range of Motion: Horizontal Adduction
Normal motion for forward flexion is considered to be 0° to 170-180°, while normal extension is said to be 60°. For internal and external rotation, the arm should be abducted to 90° for an accurate measurement. Normal internal rotation is said to be 90°, while normal external rotation is around 60-70°. It is important to keep in mind that these values can vary greatly with patients who are overhead athletes, such as baseball or softball players. For adduction, the assessment is normally limited due to the trunk, but typically 30° is considered normal. Abduction motion can range from 0° to 180°
An example of limited passive range of motion can be seen in cases of frozen shoulder.
Frozen Shoulder: External Rotation
To improve range of motion, special exercises such as Codman’s Pendulum can be performed to help relax the muscles around the shoulder, reduce pain, and increase motion.
Codman’s Pendulum
Have the patient standing in a relaxed position, and tell them to swing their weak arm in a circular motion while keeping their shoulder nice and relaxed. Be sure they swing their arm in both the clockwise and counterclockwise directions.
Rotator Cuff Strength Testing:
Empty Can Test
Description: The empty can test is used to evaluate the strength and integrity of the supraspinatus muscle and tendon.
Maneuver: Have the patient stand with their shoulder abducted to 90° and horizontally adducted forward 30° with the thumbs pointing down towards the floor, as if they are pouring out a can. Ask the patient to maintain this position. Proceed to apply downward resistance to the patient’s forearm. A variation of this test can be done at 30° abduction instead of 90°, where the supraspinatus should function in relative isolation.
Positive findings: Decreased strength or pain on resisted testing.
External Rotation
Description: The external rotation test examines the strength of the infraspinatus and teres minor.
Maneuver: With the patient’s arms at their side, externally rotated 45° and elbow flexed to 90°, the examiner applies an internal rotation moment to assess the strength of the external rotators.
Positive Findings: Decreased strength or pain on resisted testing. Significant weakness of the infraspinatus may be indicative of suprascapular nerve palsy, where the infraspinatus become denervated. This can be due to trauma, ganglion cyst or illness.
Subscapularis Lift-Off Test
Description: The lift off test evaluates the muscular strength of the subscapularis.
Maneuver: With the patient seated or standing, have them internally rotate their arm behind their back. Then ask the patient to lift the back of their hand off their lower back. If they are unable to complete this task, apply resistance to the palm to assess the strength of the subscapularis.
Positive findings: Inability to lift the dorsum of hand off the back.
Impingement/Rotator Cuff Special Tests:
Neer’s Impingement
Description: The Neer impingement test assesses the presence of impingement of the rotator cuff, primarily the supraspinatus, as it passes under the subacromial arch during forward flexion.
Maneuver: Stabilize the scapula with one hand while applying passive forced flexion of the arm.
Positive findings: Pain in the anterior shoulder or reproduction of the patient’s symptoms.
Hawkin’s Kennedy Impingement Test
Description: The Hawkin’s test is used to evaluate impingement of rotator cuff and subacromial bursa.
Maneuver: The patient is seated or standing and with their arm forward flexed to 90°and their elbow bent to 90°. Stabilize the top of he shoulder while internally rotating the arm at the forearm.
Tip: Stand at the side of the patient with one hand on top of the shoulder and keep the patient from elevating the shoulder. The other hand should be positioned close to the elbow with the thumb down, making it more comfortable for the examiner to internally rotate the arm. The test should not be done with the arm abducted.
Positive Findings:Pain in the anterior shoulder or reproduction of the patient’s symptoms with the test.
Instability Special Tests:
Load and Shift Test
Description: The Load and Shift test examines integrity of shoulder stability in the anterior and posterior directions.
Maneuver: Have the patient seated or supine with their arm relaxed and resting at their side. Grasp the head of the humerus with thumb and fingers and apply an anterior and posterior glide from the resting position.
Positive Findings: Excessive gliding of the humeral head is considered to be a positive test. The degree of stability can be graded based on the following: Grade 0 is no gliding from the center of the glenoid, Grade 1 equals translation to the glenoid rim, Grade 2 translation of the head over the glenoid rim but no locking, and Grade 3 results in the head of the humerus locking over the glenoid rim.
Apprehension Relocation
Description: The apprehension test, described by Row and Zarin, tests for anterior instability of the shoulder. The relocation test, described by Jobe, is used in conjunction with the apprehension test to distinguish between anterior instability and primary impingement of the shoulder.
Maneuver: : To perform the apprehension test, have the patient supine, with their arm abducted and elbow flexed to 90°. Gently externally rotate the arm. Once the patient becomes apprehensive or complains of pain, proceed with the relocation and surprise test by applying a posterior force to the humeral head.
Positive Findings: For the apprehension test, the patient may complain of pain or be apprehensive that their arm may dislocate as it is externally rotated. The relocation test is positive if the symptoms of apprehension reduce, or if the clinician is able to externally rotate the shoulder further without any increase in pain or apprehension. If the symptoms persist following the posterior directed force, the pain is associated with primary impingement and not anterior shoulder instability.
Sulcus Sign
Description: The sulcus sign tests for inferior instability caused by laxity of the inferior glenohumeral ligament complex.
Maneuver: : Have the patient seated with their arm resting at their side. Grasp the patient’s upper arm and apply a distal force to it.
Positive Findings: Increased inferior movement of the humeral head or the visible development of a sulcus at the glenohumeral joint are positive findings. A positive test can often suggest that the patient has multidirectional instability, espeically if there are other signs of join instability.
Labral Special Tests:
O’Brien’s Test
Description: This test examines the integrity of the glenoid labrum and the acromioclavicular joint.
Maneuver: With the patient seated or standing, instruct the patient to raise their arm into 90° of forward flexion with their elbow extended, and then adduct their arm 10-15°. Have the patient internally rotate their arm and point their thumb down to the ground. Apply a downward force to the arm. Then instruct the patient to externally rotate their arm and point their thumb towards the ceiling. Again, apply a downward force.
Alternate View:
Positive Findings: Positive findings for labral pathology occur when the first test reproduces pain, while the second test decreases or eliminates pain. The pain associated with labral tears is described as being deep in the shoulder. Pain situated over the acromioclavicular joint is associated with acromioclavicular joint pathology such as osteoarthritis or a shoulder separation, rather than labral pathology. Pain in the AC joint is usually equal with the palm down or the palm up.
pelvis - muscles
Adductor Magnus
Origin Inferior Ramus Of The Pubis, Ramus Of Ischium, Ischial Tuberosity
Insertion Linea Aspera And Adductor Tubercle
Actions Adduct Hip, Medially Rotate Hip, Assist Hip Flexion
Posterior Fibers Also Extend The Hip
Adductor Longus
Origin Pubic Tubercle
Insertion Medial Lip Of Linea Aspera
Actions Adduct Hip, Medially Rotate Hip, Assist Hip Flexion
Adductor Brevis
Origin Inferior Ramus Of Pubix
Insertion Pectineal Line And Medial Lip Of Linea Aspera
Actions Adduct Hip, Medially Rotate Hip, Assist Hip Flexion
Pectineus
Origin Superior Ramus Of Pubis
Insertion Pectineal Line Of Femur
Actions Adduct Hip, Medially Rotate Hip, Assist Hip Flexion
Gracilis
Origin Inferior Ramus Of Pubis And Ramus Of Ischium
Insertion Proximal, Medial Shaft Of Tibia At Pes Anserius Tendon
Actions Adduct Hip, Medially Rotate Hip, Assist Hip Flexion
Also Flexes And Medially Rotates The Knee
Gluteus Maximus
Origin Coccyx, Posterior Sacrum, Posterior Iliac Crest, Sacrotuberus And Sacroiliac Ligaments
Insertion Gluteal Tuberosity (Upper Fibers), Iliotibial Tract (Lower Fibers)
Actions Extends, Laterally Rotates, And Abducts The Hip; Lower Fibers, Adduct the Hip
Gluteus Medius
Origin External Surface Of The Ilium Between The Iliac Crest And Posterior And Anterior Gluteal Lines
Insertion Greater Trochanter
Actions Abducts, Flexes, Extends And Laterally And Medially, Rotates Hip
Gluteus Minimus
Origin External Surface Of The Ilium Between Anterior And Inferior Gluteal Lines
Insertion Anterior Border Of Greater Trochanter
Actions Abducts, Flexes, And Medially Rotates Hip
Biceps Femoris
Origin Long Head: Ischial Tuberosity
Short Head: Lateral Lip Of Linea Aspera
Insertion Head Of The Fibula
Actions Flex Knee, Extend Hip, Tilt Pelvis Posteriorly, Also Laterally Rotate Hip And Flexed Knee
Semitendinosus
Origin Ischial Tuberosity
Insertion Proximal, Medial Shaft Of The Tibia
Actions Flex Knee, Extend Hip, Tilt Pelvis Posteriorly, Also Medially Rotate Hip And Flexed Knee
Semimembranosus
Origin Ischial Tuberosity
Insertion Posterior Aspect Of medial Condyle Of Tibia
Actions Flex Knee, Extend Hip, Tilt Pelvis Posteriorly, Also Medially Rotate Hip And Flexed Knee
Psoas Major
Origin Bodies And Transverse Processes Of Lumbar Vertebrae
Insertion Lesser Trochanter Of Femur
Actions Flexes, Adducts And Laterally Rotates Hip
Iliacus
Origin Iliac Fossa
Insertion Lesser Trochanter Of Femur
Actions Flexes, Adducts And Laterally Rotates Hip
Piriformis
Origin Anterior Surface Of Sacrum
Insertion Greater Trochanter
Actions Laterally Rotate Hip, Abduct Thigh When Hip Is Flexed
Quadratus Femoris
Origin Lateral Border Of Ischial Tuberosity
Insertion Posterior Surface Of Femur Between Greater And Lesser Trochanter
Actions Laterally Rotates Hip
Obdurator Internus
Origin Obdurator Membrane And Pelvic Surface
Insertion Medial Surface Of Greater Trochanter
Actions Laterally Rotates Hip
Obdurator Externus
Origin Superior And Inferior Rami Of Pubis
Insertion Trochanteric Fossa Of Femur
Actions Laterally Rotates Hip
Gemellus Inferior
Origin Ischial Tuberosity
Insertion Upper Border Of Greater Trochanter
Actions Laterally Rotates Hip
Gemellus Superior
Origin Spine Of The Ischium
Insertion Upper Border Of Greater Trochanter
Actions Laterally Rotates Hip
Rectus Femoris
Origin Anterior Inferior Iliac Spine (AIIS)
Insertion Tibial Tuberosity
Actions Extend Knee, Flex Hip
Vastus Medialis
Origin Medial Lip Of Linea Aspera
Insertion Tibial Tuberosity
Actions Extend Knee
Vastus Lateralis
Origin Lateral Lip Of Linea Aspera, Gluteal Tuberosity
Insertion Tibial Tuberosity
Actions Extend Knee
Vastus Intermedius
Origin Anterior And Lateral Shaft Of Femur
Insertion Tibial Tuberosity
Actions Extend Knee
Sartorius
Origin Anterior Superior Iliac Spine (ASIS)
Insertion Proximal, Medial Shaft Of Tibia
Actions Flex, Abduct And Laterally Rotate Hip, Flex Knee, Medially Rotate Flexed Knee
Tensor Fascia Latae
Origin Iliac Crest, Posterior To ASIS
Insertion Iliotibial Tract
Actions Flex, Abduct And Medially Rotate Hip
pelvic nerves
coccygeus m., n. to sacral plexus (brs. of the ventral primary rami of spinal nerves S3-S4) no named branches coccygeus m., levator ani m. none nerve to coccygeus enters the muscle on its pelvic surface
hypogastric n. superior hypogastric plexus inferior hypogastric plexus supplies vascular smooth muscle of the pelvic viscera pain from the pelvic viscera paired; hypogastric n. lies inferior to the common iliac vessels; it contains postganglionic sympathetic axons
hypogastric plexus, inferior hypogastric nn. and sacral splanchnic nn. (postganglionic sympathetic axons); pelvic splanchnic nn. (preganglionic parasympathetic axons from the ventral primary rami of spinal nerves S2-S4) contributes branches to: uterine/vaginal plexus, vesical plexus, prostatic plexus sympathetic: supplies vascular smooth muscle of vessels supplying the pelvic viscera; parasympathetic: supplies smooth muscle of the pelvic viscera pain from the pelvic viscera; general visceral afferent from the pelvic viscera inferior hypogastric plexus lies between the pelvic viscera and the pelvic wall
hypogastric plexus, superior intermesenteric plexus and lumbar splanchnic nn. (postganglionic sympathetic axons) hypogastric nn. (right and left) vascular smooth muscle of the pelvic viscera (sympathetic) pain from the pelvic viscera; general visceral afferent from the pelvic viscera superior hypogastric plexus is the continuation of the intermesenteric plexus; it crosses the pelvic brim
pelvic splanchnic n. ventral primary rami of spinal nerves S2-S4 (cell bodies are located in the lateral horn gray of the sacral spinal cord) unnamed branches contribute to the pelvic plexus (inferior hypogastric) plexus smooth muscle and glands of the gut distal to the left colic flexure; smooth muscle and glands of all pelvic viscera none parasympathetic nerves; these contain preganglionic parasympathetic axons
prostatic plexus inferior hypogastric (pelvic) plexus is continuous with the rectal and vesical plexuses sympathetic: vascular smooth muscle of the pelvic viscera, especially the urethra, prostate gland and ejaculatory ducts; parasympathetic: smooth muscle and glands of the pelvic viscera, especially the urethra, prostate gland, and ejaculatory ducts pain from the pelvic viscera listed at left the autonomic nerve plexuses of the pelvis (prostatic, rectal and vesical in the male; rectal and uterovaginal in the female) are in communication with each other
pudendal n. ventral primary rami of spinal nerves S2-S4 (sacral plexus) inferior rectal n., perineal n., dorsal n. of the clitoris/penis its branches supply: external anal sphincter, bulbospongiosus m., ischiocavernosus m., superficial & deep transverse perineus mm., sphincter urethrae m., sphincter urethrovaginalis, compressor urethrae its bhes supply: skin of the anus, posterior scrotum/labium majus, clitoris/penis pudendal n. passes through the pudendal canal formed by fascia on the medial surface of the obturator internus m.
rectal plexus inferior hypogastric (pelvic) plexus, posterior part no named branches sympathetic: vascular smooth muscle of the pelvic viscera, especially the rectum; parasympathetic: smooth muscle and glands of the pelvic viscera, especially the rectum pain and general sensation from the rectum rectal plexus is continuous with the vesical plexus in the male, uterovaginal plexus in the female
sacral splanchnic n. sacral sympathetic ganglia unnamed branches contribute to the pelvic plexus (inferior hypogastric) plexus vascular smooth muscle of the pelvic viscera pain from the pelvic viscera sacral splanchnic nn. contain both preganglionic and postganglionic sympathetic nerve fibers with postganglionic fibers predominating in number
sympathetic chain ganglia preganglionic sympathetic fibers arrive via white rami communicantes of ventral primary rami of spinal nerves T1-L2 postganglionic sympathetic fibers depart via gray rami communicantes to all spinal nn.; internal & external carotid nn.; cervical cardiac brs.; thoracic direct visceral brs.; greater, lesser & least thoracic splanchnic nn.; lumbar splanchnic nn.; sacral splanchnic nn. dilator pupillae, vascular smooth muscle, arrector pili muscles, sweat glands, suprarenal medulla, heart, lungs and gut pain from viscera located lateral to the vertebral bodies in the neck, thorax & abdominopelvic cavity; the ganglia plus their interconnecting fibers are also known as the sympathetic trunk; preganglionic cell bodies are located in the intermediolateral gray matter of spinal cord levels T1-L2
uterovaginal plexus inferior hypogastric plexus continuous with the rectal plexus sympathetic: vascular smooth muscle of the pelvic viscera, especially the uterus, uterine tubes and vagina; parasympathetic: smooth muscle and glands of pelvic viscera, especially uterus, uterine tubes and vagina pain from the pelvic viscera listed at left the uterovaginal plexus is a subsidiary plexus of the inferior hypogastric plexus
vesical plexus inferior hypogastric plexus continuous with the prostatic plexus sympathetic: vascular smooth muscle of the pelvic viscera, especially the urinary bladder, seminal vesicle, ductus deferens and ejaculatory duct; parasympathetic: smooth muscle and glands of the pelvic viscera, especially the urinary bladder, seminal vesicle, ductus deferens and ejaculatory duct pain and general sensation from the bladder, seminal vesicle and ductus deferens vesical plexus is continuous with the other autonomic nerve plexuses in the pelvis and cannot be distinguished from them
posterior femoral cutaneous n. sacral plexus (ventral primary rami of spinal nerves S1-S3) inferior cluneal nn.; perineal br. sympathetic motor innervation to skin skin of the lower buttock & posterior thigh cutaneous nn. carry postganglionic sympathetic axons to skin
gluteal, inferior sacral plexus (ventral primary rami of spinal nerves L5, S1-S2) no named branches gluteus maximus m. none inferior gluteal n. passes through the greater sciatic foramen inferior to the piriformis m.
gluteal, superior sacral plexus (ventral primary rami of spinal nerves L4-L5, S1) superior & inferior brs. gluteus medius m., gluteus minimus m., tensor fasciae latae m. none superior gluteal n. passes through the greater sciatic foramen superior to the piriformis m.
lumbar plexus ventral primary rami of spinal nerves L1-L4 branches of the lumbar plexus: iliohypogastric n., ilioinguinal n., genitofemoral n., lateral femoral cutaneous n., femoral n., obturator n., lumbosacral trunk (considered to be part of sacral plexus), brs. to the psoas major and minor mm., branches to the quadratus lumborum m. muscles of the lower abdominal wall; cremaster m., psoas major and minor mm., quadratus lumborum m., iliacus m.; muscles of the anterior and medial thigh and hip skin of the lower abdominal wall, skin of the anterior scrotum/labium majus, skin of the anterior and medial thigh and lateral hip lumbar plexus is noted for its variable branching pattern of nerves that supply the abdominal wall
lumbosacral plexus ventral primary rami of spinal nerves L4-S4 branches of the lumbosacral plexus: iliohypogastric n., ilioinguinal n., genitofemoral n., lateral femoral cutaneous n., femoral n., obturator n., lumbosacral trunk (considered to be part of sacral plexus), brs. to the psoas major and minor mm., branches to the quadratus lumborum m., superior & inferior gluteal nn., n. to the obturator internus m., n. to the quadratus femoris m., sciatic n., n. to the piriformis m., posterior femoral cutaneous n., pudendal n., n. to the pelvic diaphragm, pelvic splanchnic nn. muscles of the lower abdominal wall; cremaster m., psoas major and minor mm., quadratus lumborum m., iliacus m.; muscles of the anterior and medial thigh and hip, muscles of the pelvic & urogenital diaphragm, posterior hip, posterior thigh, leg and foot skin of the lower abdominal wall, skin of the anterior scrotum/labium majus, skin of the anterior and medial thigh and lateral hip’ skin of the perineum, posterior thigh, leg and foot also known as: lumbar & sacral plexuses
lumbosacral trunk part of the ventral primary ramus of L4 united with the ventral primary ramus of L5 no named branches; it contributes to the formation of the sacral plexus muscles of the hip and posterior thigh see sacral plexus the lumbosacral trunk is not considered to be part of the lumbar plexus
obturator n. lumbar plexus (ventral primary rami of spinal nerves L2-L4) anterior and posterior brs. muscles of the medial thigh: adductor longus m., adductor brevis m. and adductor magnus m., gracilis m., obturator externus m. skin of the lower medial thigh obturator n. passes through the obturator canal
obturator internus m., n. to sacral plexus (ventral primary rami of spinal nerves L5-S2 ) n. to the superior gemellus m. obturator internus m., superior gemellus m. none nerve to obturator internus m. crosses the ischial spine and enters the ischioanal fossa by passing through the lesser sciatic foramen
quadratus femoris m., n. to sacral plexus (ventral primary rami of spinal nerves L4-L5, S1) n. to the inferior gemellus m. quadratus femoris m., inferior gemellus m. none nerve to the quadratus femoris m. passes anterior to the obturator internus tendon
sacral plexus lumbosacral trunk (ventral primary rami of spinal nerves L4-L5), ventral primary rami of spinal nerves S1-S4 superior & inferior gluteal nn., n. to obturator internus m., n. to quadratus femoris m., sciatic n., n. to piriformis, posterior femoral cutaneous n., pudendal n., n. to pelvic diaphragm, pelvic splanchnic nn. muscles of the pelvic diaphragm; muscles of the urogenital diaphragm; muscles of the posterior hip, posterior thigh, leg and foot skin of the perineum, posterior thigh, leg and foot (excluding the medial side of the leg and foot) the sacral plexus is often grouped with the lumbar plexus as the “lumbosacral plexus”
sciatic n. sacral plexus (ventral primary rami of spinal nerves L4-L5 and S1-S3) tibial n., common fibular (peroneal) n. semitendinosus m., semimembranosus m., biceps femoris m., ischioconylar part of the adductor magnus m.; its branches supply all muscles of the leg and foot its branches supply the skin of the leg and foot (excluding the medial side of leg & foot) sciatic n. is composed of tibial and common fibular divisions; branches to muscles come from one of the two divisions, so that the sciatic n. is considered to have no direct muscular brs., only 2 terminal brs.
foramen transversum
Starts C7, C6 starts vertebral artery
anterior tubercule
C6, not C7
