Exam 3 (weeks 5 and 6) Flashcards
Boundaries of the anterior abdominal wall
Superior: R/L costal margins and the xiphoid process.
inferior: line in either side between ASIS and pubic symphysis
Lateral: lines from the ASIS up
Posterior: lumbar paravertebral musculature
Subcostal plane
Most inferior parts of the costal cartilages (10th costal cartilage) and thru the body of L3
Transtubecular plane
lines through iliac tubercles at L5
Transpyloric plane (AKA)
“Addison’s Plane”
L1
halfway bettered the sternal notch and the pubic symphysis
through the pyloris and tips of the 9th costal cartilages and border of L1
Names of the 9 quadrants
right and left hypochondriac epigastric right and left lumbar umbilical right and left inguinal hypogastric
What two planes divide into 4 quadrants
transumbilical plane and the median plane
list the fascia and tissue in order from superficial to deep
Skin, Campers fascia (fatty fascia), Scarpa’s Fascia (membrenous), EO, IO, TA, Transversalis Fascia (endo-abdominal fascia), extraperitoneal fascia, parietal fascia
what is scarps fascia continuous with
the fascia lata of the thigh
External Oblique OINA and the fibers run…
fibers run medially and inferiorly
O: external surface ribs 5-12
I: linea alba, pubic crest, iliac crest, pubic symphysis
N: inferior 5 t-nerves, subcostal, iliohypogastric
A: flex and rotate the trunk, laterally rotate the trunk and compress the contents
Internal Oblique OINA and the fibers run…
fibers run superiorly and inferiorly
O: thoracolumbar fascia, anterior iliac crest and lateral 1/2 of the inguinal ligament
I: linea alba, pubic crest, inferior surface of ribs T10-12
N: inferior 5 t-nerves, subcostal, iliohypogastric
A: flex and rotate the trunk, laterally rotate the trunk and compress the contents
Transversus Abdominus OINA and the fibers run
fibers run horizontally and medially to the midline
O: thoracolumbar fascia, iliac crest, lateral 1/3 inguinal ligament, internal surfaces of costal cartilages 7-12
I: linea alba, pubic crest and pubic symphysis
N: inferior 5 t-nerves, subcostal, iliohypogastric
A: compress and support the abdominal viscera (and the IST complex)
Rectus abdominus OINA
-is the O+I superior or inferior
the origin is inferior, insertion is superior
O: pubic symphysis and crest
I: xiphoid process and costal cartilages 5-7
N: inferior 5 t-nerves, subcostal, iliohypogastric
A: flex the trunk and tense the abdominal wall
Does the EO or the IO rotate contralaterally or ipsilaterally
The EO rotates contralaterally and the IO rotates ipsilaterally
what gives you a six pack
the tendinous interdigitations of the RA
what supplies most of the anterior abdominal wall (blood)
superior epigastric artery
what is the posterior rectus sheath. what lives here
runs behind, posteriorly to the RA. this is where the superior epigastric artery lives
what happens at the arcuate line
all 3 aponeurosis are anterior to the Ra
the arcuate line is at the level of…
umbilicus
Above vs below the arcuate line
Above:
Anteriorly, all aponeurosis of the EO and 1/2 aponeurosis IO
Posteriorly, 1/2 aponeurosis of the IO and all the TA aponeurosis
Below:
Anteriorly, all three layers of the aponeurosis
posteriorly, thin fascia remains which prevents the RA from rubbing against the abdominal contents
linea alba
where the posterior and anterior walls meet and fuse
what is one of the functions of the abdominal wall
stability of the spine
Describe the abdominal and lateral raphe complex
the abdominal muscles contract and pull on the lateral raphe (because they are attached here). this pulls the multifidus and the erector spinae and will compress the compartment, which will have an amplifying effect on the compression
what is the innervation of the anterior abdominal wall
ventral primary rami of the inferior 5 t-nerves (T6-T11)
subcostal (T12)
iliohypogastric (L1)
ilioinguinal (L1)
What are these landmarks
T10
T7
L1
T10: umbilical
T7: xiphoid
L1: pubic
thoracoabdominal nerve
T7-T11
other names for the inguinal ligament
“Poupart’s Ligament”
“suspender of the abdominal wall”
the superior epigastric comes from the _____ and the inferior epigastric comes from the _____. They enter the rectus sheath ___ to the RA and go to what muscle
the superior comes from the internal thoracic artery and the inferior comes from the external iliac artery
the enter the sheath posterior to the RA and go to the RA
When the external iliac artery goes under the ___ it becomes the ____ artery
inguinal ligament becomes the femoral artery
the superficial inferior epigastric goes under the ___ from the anterior abdominal wall and is a branch of…
inguinal ligament
from the external iliac
the superior circumflex artery is off of the ___ artery. why?
this is off of the femoral artery because it arises from the artery underneath the inguinal ligament
what is caput medusae
distended and engorged superficial epigastric veins (palm tree sign)
also the thoracoepigastric vein
portal hypertension (the dilated para vertebral veins, which usually bring blood from mom to baby) this usually closes within 1 week of birth
the inguinal canal is formed by folds of…
EO aponeurosis
what is the function of the inguinal canal
a passageway for contents from the abdominal wall to the leg
the ligament runs from the
ASIS to the pubic tubercle
what is the content of the inguinal canal
spermatic cord, round ligament of the uterus inguinal nerve and blood and lymph
below the arcuate line on the posterior wall, the posterior sheath disappears and becomes the
transversalis fascia
what is the semilunar line
where is it visible
the semilunar line is where the muscle becomes aponeurosis. its only in the posterior rectus sheath, when you dissect away the IO and EO
the genitofemoral nerve travels on the
spermatic cord
the lacunar ligament is where the inguinal ligaments attaches to the
pubic symphysis
the ___ muscle is around the spermatic cord
the cremaster
under the inguinal ligament there is the iliopectineal arch. what is under there?
a neural packet for the iliopsoas and the femoral nerve
what are some other names for the inguinal triangle
Hesselbach’s, or the medial inguinal fossa
what are the boundaries of the inguinal triangle
superior lateral margin; inferior epigastric artery and vein
lateral margin; rectus sheath
inferior border: inguinal ligament
whats a good pneumonic to remember the boundaries of the inguinal triangle
RIP
Rectus sheath
inferior epigastric arteries and veins
Poupart’s ligament (inguinal)
where do inguinal hernias happen (what happens during this)
in the inguinal triangle
pieces of the small intestine from the abdominal wall pop through
direct vs indirect hernias
direct (acquired): weakness int he floor of the inguinal canal, men over 40, small intestine loops through and exits the deep and superficial inguinal ring
indirect (congenital): through the natural weakness of the internal inguinal ring. development of vas deferens and descent of testes in utero while it develops. piece of bowel herniates (usually small intestine ends up in the cremaster muscle)
posterior abdominal wall bones
the lumbar vertebrate, wings of the ilium and the lower ribs
posterior abdominal wall muscles
diaphragm, iliacus, posts major and minor and the QL
the pelvic girdle is comprised of
2 os coxae (hip bones- each wth an ilium, ischium and pubis), and the sacrum
where does fusion of the os coxae happen
the femur (acetabulum)
where do each os coxae articulate
they articulate together at the pubic symphysis and sacrum and they also articulate with the femur.
Ischial Tuberosuity attachment sites
the semimembranosis muscle
semitendinosis and the LH biceps femoris .
sacrotuberous ligament
adductor Magnus
the articulate surface of the acetabulum is called the
lunate surface
is the acetabulum a complete socket
no, it is open inferiorly
the Ala of the sacrum are the “___”
“wings”
what attaches to the ASIS
the inguinal ligament and the sartorius
what attaches to the ischial spine
the sacrospinous ligament
what does the sacrotuberous ligament attach
the sacrum to the ischial tuberosity
what does the sacrospinous ligament attach
the sacrum with the ischial spine
what attached to the AIIS
the rectus femoris
psoas major OINA
O: TP bodies and IVD of T12-L5
I: lesser trochanter (with iliacus)
N: Ventral primary rami L2-L4
A: flexion of the thigh, lateral flexion of the trunk and trunk flexion
psoas monir OINA
O: bodies of T12-L1 and the disc in between
I: pubic bone
N: vernal primary rami of L1
A: flexion of the pelvis and vertebral column
Iliacus OINA
O: iliac fossa
I: lessen trochanter (with the psoas major)
N: femoral nerve (which passes in front of this muscle, and behind the psoas major)
A: flex the thigh
Quadratus Lumborum OINA
O: iliac crest, iliolumbar ligament, TP of the lower L-vertebrates
I: rib 12, TP of upper L-vert
N: subcostal and upper L-vert ventral primary rami
A: lateral flexion of the trunk, extension of the vertebral column, elevate the hip and stabilize the 12th rib (really its a stabilizer muscle)
what root does the iliohypogastric come from
L1
ilioinguinal
L1
genitofemoral
L1-2
Lateral femoral cutaneous nerve
L2-3
Femoral nerve
L2-4
Obturator nerve
L2-4
what is the lumbosacral trunk
the ventral primary rami of L4 and L5 join with the sacral plexus (S1-S4)
superior gluteal
L4-S1
inferior gluteal
L5-S2
Sciatic nerve
L4-S3
common perineal (L4-S2)
tibial (L4-S3)
Pudendal nerve
S2-S4
Twigs to the Pirifromis
S1-S2 (S4)
N to obturator internus
also supplies superior gemmelus
L5-S2
N to quadratus femoris
also supplies inferior gemmelus
L4-S1
where does the pudendal nerve travel
out of the greater sciatic nerve and in through the lesser sciatic nerve
the genitofemoral nerve is what in relation to the psoas
on top of, sits superficially to.
the descending thoracic aorta becomes the ___ after passing through the diaphragm
abdominal aorta
the abdominal aorta will split at spinal level ____ and become right and left
at L4, right and left common iliac arteries
the common iliac artery will divide into
the external and internal iliac artery
what does the internal iliac artery supply
the viscera in the pelvic cavity
what happens to the external iliac artery? where does it go? what does it become?
it goes under he inguinal ligament to become the femoral artery that supplies the anterior thigh compartment
the inferior epigastric artery arises from the ____ before it enters the….
what does it supply
from the external iliac before it enters the anterior thigh. supplies the inferior aspect of the abdominal wall
what is a triple A
an abdominal aorta aneurism. usually happens by the inferior mesenteric artery. This is when the abdominal aorta becomes distended and bursts
from what areas of the body does the IVC return blood from
the lower extremities, and the abdominal wall and abdominal viscera.
where does the IVC arise (from the union of what two vessels)
from the common iliac veins at the level of L5
the diaphragm separates what two cavities
the thoracic and abdominal
what is the boomerang portion of the diaphragm called
the central tendon (where peripheral muscles attach)
what are the 3 peripheral muscle portions
the sternal, costal and the lumbar
where does the sternal part of the diaphragm extend
the xiphoid process to the central tendon
where does the costal part extend
from the internal surface of the lower 6 ribs and costal cartilage and lateral and medial arcuate lines
where does the lumbar part extend
from the L-vert in the form of a right and left crus
Right crus- L-vert 1-3 and IVD
Left crus- L-vert 1-2 and IVD
looking at the diaphragm from anterior to posterior, what are the openings (from anterior superior to posterior inferior
anterior opening is the sternocostal part
the anterior superior opening is the IVC
the middle part is the esophagus
the lower part is the aorta
what passes through the sternocostal hiatus
the superior epigastric artery (which comes from the internal thoracic artery (and supplies the anterior abdominal wall) and lymph
what passes through the Foramen for the IVC
the IVC and the Right phrenic nerve
what passes through the esophageal opening
the esophagus and the vagal trunks
what passes through the aortic opening
the aorta and the thoracic ducts
what is the nerve supply of the diaphragm
the phrenic nerve
right: goes long the heart to supply the superior diaphragm
the left: along the left side of the heart and goes through the esophageal opening and supplies the underside of the diaphragm
the pelvis is comprised of
2 os coxa, the sacrum, coccyx and the pubic symphysis
what are the boundaries for the pelvis
the superior opening is the inlet, and the inferior opening (enclosed by the diaphragm) is the outlet.
the anterior pelvic wall is the bodies of he public rami and the pubic symphysis
the lateral wall are the hip bones and the obturator interns
and the posterior pelvic wall is the sacrum, coccyx and the SI joint and ligaments
what is the greater (_____) pelivs
AKA the false pelvis, above the inlet, which is housed within the ilium bones and has the lower abdominal wall
what is the lesser (_____) pelvis
true pelvis between the inlet and the outlet
male vs female pelvis
the male pelvis has more of a heart shape inlet and is thicker and heavier. it also have a more narrow arch and the acetabulum is larger. For female, more oval shaped, larger outlet, has a wider arch (child birth)
Pelvic floor is formed by the (which has what parts)
pelvic diaphragm (levator ani and coccygeus
what are the boundaries of the pelvic floor
the pubic symphysis anteriorly to the coccyx posteriorly and laterally, the walls of the pelvis
what are the components of the levator ani
the pubococcygeus, puborectalis and the iliococcygeus
the coccygeus is ___ to the sacrospinous ligament
deep (superior too?)
the piriformis comes from the ___ surface of the sacrum and out of the ____
anterior
grater sciatic foramen
the fascia over the obturator internus acts as a…
sling to keep things in
from posterior to anterior, what are the muscles of the pelvic diaphragm
you have the piriformis, then the coccygeus, then the iliococcygeus then the pubococcygeus and then the puborectalis.
what are the OINA for the levator ani
O: body of the pubis, obturator fascia, ischial spine
I: coccyx
N: nerve to levator ani ( S3-4)
A: muscular sling to support abdominopelvic viscera, holds pelvic viscera in place and helps the abdominal cavity compress (during coughing, sneezing and vomiting)
Coccygeus OINA
O: ischial spine
I: sacrum
N: N to levator ani (S3-4)
A: support pelvic viscera and for part of the pelvic diaphragm
list the following in order, from superficial to deep
sacrotuberous
coccygeus
sacrospinous
superficial: sacrotuberous
sacrospinous
coccygeus
what happens at the perineal body
where the criss cross happens
what is the anorectal angle
usually about 80 degrees. the puborectalis is contracted when at rest, and forms a sling. when you need to poop this muscle relaxes. think squatty potty.
what is the difference between rectocele and cystocele
rectocele is when the anus and rectum form a pocket for feces to collect and stay
cystocele is when the bladder falls through
what is the main blood supply to the pelvic region
the internal iliac artery
what are the two divisions of the internal iliac artery. what are their components
the anterior and posterior anterior: -obturator artery -pudendal artery -inferior gluteal artery (inferior to the piriformis) posterior: -superior gluteal artery (superior to piriformis) -iliolumbar artery -lateral sacral artery
what does the inferior gluteal artery supply. where does it exit to supply what region
the main supplier of blood to the muscles of the pelvic diaphragm. exits through the greater sciatic foramen to supply the gluteal region
what bones make up the lower leg
femur, tibia, fibula, and patella
what are the boundaries of the femoral triangle
superior: inguinal ligament (ASIS to pubic symphysis)
lateral: sartorius (the medial side of this muscle)
medial: adductor longus
roof: fascia lata
floor: iliopsoas and pectinous
what are the contents of the femoral triangle?
the lateral femoral cutaneous nerve
the femoral nerve
femoral artery, and vein (in the sheath)
profunda femoris artery
what does the profound femoris artery give rise to…
what do they supply
the lateral and medial femoral circumflex arteries
they wrap and wind around the neck of the femur to supply the neck and the grater and lesser trochanter and the intertrochenteric notch
what is the main blood supplier of the thigh
the profunda femoris artery
what is the main blood supplier of the head and neck of the femur
the lateral and medial femoral circumflex artery
the femoral nerve is just _____ to the femoral sheath (which houses…?)
it innervates what compartment
the femoral nerve is just lateral to the femoral sheath, which houses the femoral artery and vein and lymph. It supplies the anterior thigh compartment
what is another name for the adductor canal
Hunters canal
where does the adductor canal begin and end
begins where the sartorius passes over the adductor longus
ends at the adductor hiatus (the opening in the adductor Magnus)
what are the contents of the adductor canal
the femoral artery and vein (when they leave they become the popliteal artery and vein)
the great saphenous nerve (a branch off the femoral nerve)
also the nerve to the vests medialis
what divides the thigh into compartments
the intramuscular septa (of the extensions of the deep fascia lata)
what supplies the following?
- anterior compartment
- medial compartment
- posterior compartment
anterior: femoral nerve
medial; obturator
posterior: sciatic
cutaneous innervation supplied by the subcostal nerve
lateral aspect of the thigh, anterior to the greater trochanter
cutaneous innervation supplied by the iliohypogastric nerve
the lateral part supplies to the superior and lateral part of the butt
the anterior branch supplies the skin superior to the pubis
cutaneous innervation supplied by the ilioinguinal nerve
through the superficial inguinal ring, inferior to the pelvis, also the proximal medial aspect of the thigh
cutaneous innervation supplied by the genitofemoral nerve
branches extend to the pelvis. innervates the skin of the thigh inferior to the inguinal ligament on the medial aspect
cutaneous innervation supplied by the lateral femoral cutaneous nerve
lateral and anterior portions of the thigh (passes under the lateral aspect of the inguinal ligament, and goes distally from the greater trochanter to the knee)
cutaneous innervation supplied by the femoral nerve
skin of the anterior and medial thigh
cutaneous innervation supplied by the anterior femoral cutaneous nerve
from the femoral nerve, runs along the path of the sartorius and innervates the skin of the anterior and medial thigh
does the RF attach to the femur
no, goes from he AIIS to the quad tendon
Rectus femoris OINA
O: AIIS and the rim of the acetabulum
I: tibial tuberosity via the patellar lig.
N: femoral
A: flex the thigh and extend the leg
vastus Intermedius OINA
O: anterior femur
I: tibial tuberosity via the patellar lig.
N: femoral
A: extend the leg
Vastus Lateralis OINA
O: lateral femur
I: tibial tuberosity via the patellar lig.
N: femoral
A: extend the leg
Vastus Medialis OINA
O: medial femur and the tendon of adductor Magnus
I: tibial tuberosity via the patellar lig.
N: femoral
A: extend the leg
what controls tracking of the patella
the VM, which pulls the patella medially
sartorius OINA
O: ASIS
I: superior end of the medial surface of the tibia (pos anserine)
N: femoral
A: flex and laterally rotate the thigh, weak leg flexor and weak ABD
Iliopsoas OINA
O: combo of the iliacus (iliac fossa) and the psoas major (TP, bodies and IVD of T12-L5)
I: lesser trochanter
N: femoral
A:
pectineus OINA
O: pectineal line superior to the rams pubis
I: pectineal line of the femur
N: femoral and obturator
A: flex and adduct the thigh
adductor longus OINA
O: body of the pubis
I: distal 2/3 linea aspera
N: obturator
A: ADD and flexion of the thigh
Adductor Magnus OINA
O: tubercle and ramus of the ischium
I: linea aspera and adductor tubercle
N: obturator nerve and tibial portion of the sciatic
A: ADD and flex the thigh, and extend the thigh
Adductor Brevis OINA
O: inferior ramus of the pubis
I: femur
N: obturator
A: ADD and flex the thigh
Gracilis OINA
O: inferior ramus of the pubis
I: medial surface of the tibia inferior to the condyle (pos anserine)
N: obturator
A: ADD the thigh and flex the leg
how can you tell the difference between the adductor and hamstring part of the adductor Magnus
the adductor part has all the holes and the hamstring part is a little more straight (up and down)
the perforations in the adductor Magnus are for the passing of..
the profunda femoral arteries
the adductor hiatus is formed by which two muscles
really the adductor and the hamstring part of the adductor Magnus muscle
what attaches at the pos anserine? whats another name? how do you remember the order
the sartorius, gracilis and semitendinosis (SGT)
also Called the gooses foot
the external iliac artery gives off
the superior epigastric artery
under the inguinal ligament, the external iliac becomes the…
what does it give off
femoral artery gives off... -superficial external iliac arteries -deep and superficial external pudendal arteries - profunda femoris artery
under the adductor hiatus, the femoral artery becomes the…
popliteal artery
the profunda femoris artery gives off ___ perforating arteries and goes into the ___ artery
4
popliteal
the femoral artery is first visible when it goes behind the ___ and in front of the ____ (really, its in between these two)
behind the psoas major and in front of the iliacus
what do the anterior and posterior divisions of the femoral nerve do
the anterior division is cutaneous innervation of the anterior and medial thigh
the posterior division is the nerve to innervate the muscles of the anterior thigh
the obturator nerve supplies what compartment and travels through what muscle
the medial
through the obturator externus
what parts of the adductors are supplied by the posterior and anterior branches of the obturator nerve
the posterior branches supply the Magnus, and the anterior branches supply the braves and longus
what are the boundaries of the gluteal region
superior: crest of the ilium
medial: sacrum and coccyx
inferior; sacrotuberous ligament and ischial tuberosity
laterally: greater trochanter
where does the cutaneous innervation of the gluteal region come from
the superior cluneals (dorsal primary rami first 3L N)
the middle cluneals (DPR first 3 sacral N)
the inferior cluneals (from the posterior femoral cutaneous)
branches of the subcostal (T12), iliohypogastric (L1) and the lateral femoral cutaneous (L2-3)
where does the sacrotuberous ligament go
from the PIIS, sacrum and coccyx to the ischial tuberosity
where does the sacrospinous ligament go
from the sacrum and coccyx to the ischial spine
which is more anterior to the other
the sacrospinous is more anterior to the sacrotuberous
the sacrospinous and sacrotuberous ligaments make the.
greater and lesser foramina
Gluteus Maximus OINA
O: ilium (posterior to the gluteal line), sacrum, sacrotuberous ligament, and the coccyx
I: gluteal tuberosity and the ITB
N: inferior gluteal
A: extend thigh (run and climb), sit to stand and laterally rotate the hip
Piriformis OINA
O: pelvic surface of the sacrum
I: greater trochanter
N: N. to piriformis (s1-2)
A: laterally rotate and extend the thigh
Gluteus Medius OINA
O: ilium between the iliac crest and superior gluteal line
I: greater trochanter
N: SUPERIOR GLUTEAL
A: ABD and medially rotate
Obturator Internus OINA:
O: obturator membrane
I: greater trochanter
N: n. to obturator internus
A: laterally rotate and extend the thigh
why are the obturators external rotators
because they attach posteriorly to the trochanter
superior gemellus OINA
O: ischial spine
I: greater trochanter
N: N t obturator internus
A: laterally rotate and extend thigh
inferior gemellus OINA
O: ischial tuberosity
I: greater trochanter
N: N to quadratus femoris
A: laterally rotate and extend thigh
quadrates femoris OINA
O: ischial tuberosity
I: intertrochenteric crest
N: N to quad femoris
A: laterally rotate and extend thigh
Gluteus Minimus OINA
O: ilium between superior and inferior gluteal lines
I: greater trochanter
N: superior gluteal nerve
ABD and medially rotate thigh
Obturator Externus OINA:
O: obturator membrane
I: trochenteric fossa
N: obturator N
A: ADD and laterally rotate thigh
TFL OINA
O: iliac crest
I: ITB
N: superior gluteal
A: ABD and flex the thigh
a trendelenburg tests what muscles
the gluteus medius
when you stand on one leg the gluteus medius contracts to…
ABD the hip and keep you level
if you have a weak gluteus medius, you have a hip drop on which side
the contralateral side
how might a compensated trendelenburg look
bring the trunk over the hip /leg
what is the purpose of the TFL and ITB
to support the lateral hip and knee
what causes snapping hip syndrome
the ITB rubbing over the greater trochanter
the superior gluteal nerves and vessels pass ___ to the piriformis. has branches to what
superiorly
to the gluteus max, and passes between the med and min to get to the TFL
the inferior gluteal nerves and vessels pass ___ to the piriformis. has branches to what
inferiorly
the deep surface of the gluteus Maximus
the sciatic nerve passes through the ____ foramen, ___ to the piriformis
greater sciatic foramen
inferior
the sciatic nerve descends ___ to the obturator internus, gemelli, and QF
posteriorly
the posterior femoral cutaneous nerve passes __ to the sciatic nerve
medially
what are the two portions of the sciatic nerve
the common fibular (peroneal) and the tibial
sciatic alternatives
87% normal (under the piriformis)
12% (thru the piriformis, (the common peroneal component)
.5% over the piriformis (common peroneal) and the tibial inferior to the piriformis
the pudendal nerve exits what foramen and enter what. How does it pass in relation to the QF, obturator internus and gemelli
exits the greater sciatic, enters the lesser sciatic,. passes just anteriorly to the QF (deep to the obturator internus and gemelli)
the superficial and deep branches of the superior gluteal artery and vein
(above piriformis)
superficial: top half of the gluteal max
deep: between the medius and minimus
the medial femoral circumflex artery passes ___ to the head of the femur, and the lateral femoral circumflex artery passes ___ to the head
medial (posterior)
lateral (anterior)
