Transcript MUSCULI THORACIS

MUSCULI THORACIS
Institute of Anatomy 2nd and 1st Medical Faculty
R. Druga
The muscles of the thorax
• They are all concerned in the movements of
the ribs and hence with respiration
• The intercostales
• Transversus thoracis
• Levatores costarum
• Pectorales
Mm. pectorales
M. Pectoralis
major
Origo :
Sulcus
deltoideopectoralis
Clavicula,
sternum
Vagina m.
rectorum
Clavipectoral
triangle
Trigonum
clavipectorale
Anterior wall
of the axilla
Insertio : crista
tuberculi
majoris
Clavipectoral
fascia
Relations of the pectoralis minor to axillary vessels and brachial plexus
CLAVIPECTORAL FASCIA
M. serratus ant.
Origo : 1. – 9. Rib
Insertio : medial
margin of the
scapula.
N. Thoracicus
longus
Mm.
Intercostales
interni (11)
Internal
intercostal
membrane
(depression of
the ribs)
Exspiratory
muscles
From posterior
costal angles to
the sternum
Mm.intercostales
externi (11)
Inspiratory muscles
(elevation of ribs)
From the tubercles of
the ribs to the cartilage
of the ribs in front
Mm. Intercostales
externi
External intercostal
membrane
Spatium intercostale
Intercostal space and layers of thoracic wall
The intercostales intimi
Poorly developed in upper spaces,
More extensive in lower spaces
Separate intyercostal vessels and
nerve from the pleura
Action : like the intercostales interni
Spatium
intercostale
Puncture of the pleural cavity
Punkce cavum pleurae
DIAPHRAGMA
THE DIAPHRAGM
A dome- shaped muscle which separates the thoracic from the
abdominal cavity.
Its periphery consists of muscular fibres attached to the central
tendon (aponeurotic).
LUMBAR PART
COSTAL PART
STERNAL PART
The diaphragmatic aperturtes :
Aortic
Oesophageal
Vena caval
Main inspiratory muscle
DIAPHRAGMA
• Hranice mezi dutinou hrudní a břišní
Diaphragma
Crus mediale L1 –
L3
Crus laterale L 1 – L2
Lumbocostal
arches
Medial and lateral
N. Phrenicus (C 4)
Inferior phrenic
artery
Phrenic nerve
Diaphragmatic part of the pericard
Relations of the diaphragm
• The upper surface is in relation with the pleura
(right and left diaphragmatic pleura) and with the
pericardium
• Lower surface is covered by peritoneum
Right dome
Left dome
4th intercostal
space
5th
intercostal
space
Upper surface
and
diaphragmatic
apertures
Diaphragma - actions
• Principal muscle of inspiration
• During inspiration muscular fibres contract
and the central tendon and domes move
downwards (volume of the thoracic cavity
increases)
Inspiration
• Elevation of ribs (external intercostal
muscles)
• Depression of the diaphragm
• In quiet inspiration the principal muscle is the diaphragm
• In forced inspiration additional muscles are called into
action (pectoral, scalenic)
Expiration
• Relaxation of the diaphragm
• Contraction of the intercostales interni
MUSCULI ABDOMINIS
Institute of Anatomy
2nd and 1st Medical Faculty
M. Obliquus ext.
5th – 12th rib
(8 slips)
Vagina m. rectus abd.
Linea alba
Inguinal lig.
Inguinal
ligament
M. Obliquus
internus
Iliac crest,
lumbodorsal
fascia
9th –12th rib
Linea alba,
vagina m.
rectus abd.
M. Rectus abd.
ribs,
pubis
M.
Transversus
abd.
7th – 12th
rib, iliac
crest,
inguinal lig.
Linea alba,
vagina mm.
rectorum
Vagina of the rectus muscles
Vasa
epigastrica
inf.
M.
cremaster
INGUINAL CANAL
CANALIS INGUINALIS
Lentgh 4 – 5 cm, from anulus inguinalis
profundus (deep inguinal ring, entrance)
to anulus inguinalis superficialis
(superficial inguinal ring, exit)
4 walls
Contens : funiculus spermaticus
(spermatic cord, lig. teres uteri)
Presence of canal appear to weaken the
anterior abdominal wall
Canalis inguinalis
• Délka 4 – 5 cm
• Anulus inguinalis profundus – anulus inguinalis
superficialis
• 4 stěny
• Obsah – funiculus spermaticus, lig. teres uteri
• Zeslabené místo přední stěny břišní
• Hernie !!!
Walls of the inguinal canal
• Anterior wall –aponeurosis of the External oblique
(superficial ring)
• Posterior wall – transversal fascia (deep ring)
• Lower wall – inguinal ligament
• Upper wall - Internal oblique and Transversal (lower
margins)
Stěny canalis inguinalis
•
•
•
•
Přední stěna : aponeurosa m. obliquus externus
Zadní stěna : fascia transversalis
Dolní stěna : ligamentum inguinale
Horní stěna : m. obliquus internus a m. transversus
abdominis
Anterior wall
Canalis
inguinalis
(superficial
ring)
Inguinal canal
Posterior wall
Falx
inguinalis
Interfoveolar
lig.
Inguinal
triangle
Posterior wall from
behind
Inguinal
canal- sagittal
section
Cremaster muscle
Posterior wall of the inguinal canal =
transversal fascia
Falx inguinalis, lig. interfoveolare
Posterior wall of the inguinal canal – ligamentous
bands
• Falx inguinalis (inguinal falx, the conjoint tendon) – is
formed by the lower part of the aponeurosis of the
transversus and is inserted medially to the pubis
• Interfoveolar ligament – laterally to falx, from lower
margin of the transversus to pubis. Covers inferior
epigastric vessels. Laterally to interfoveolar ligament is
deep inguinal ring.
• Between falx and interfoveolar ligament – inguinal
triangle
Peritoneal
folds
Peritoneální
řasy a jamky
Hernial sac
Indirect
hernia
Kýlní vak,
Hernia
indirecta
Inguinal hernia I (indirect, oblique)
• The viscus is protruded through the inguinal region
(canal)
• Indirect (oblique) hernia – intestine is protruded inside
of peritoneal sac - through
• the lateral inguinal fossa (peritoneum)
• Enters the inguinal canal at the deep inguinal ring
• Pass along the inguinal canal
• Enters the superficial inguinal ring
• Lastly descends into the scrotum
• Very frequently acquired variety, less frequently
congenital
Inguinal hernia II (direct)
•
•
•
•
•
•
•
Protrusion makes its way through –
Medial inguinal fossa (peritoneum)
Inguinal triangle
Superficial inguinal ring (exit of the hernia)
Is much less frequent than oblique hernia
Occurs more often in men than in women
Is always of acquired variety
Hernia inguinalis, Tříselná kýla
Vychlípený peritoneální vak
Uvnitř vaku je kýlní obsah (klička střevní, omentum,
močový měchýř)
Vak prochází (protlačuje se) zeslabenými místy stěny
břišní (může dojít k ruptuře transversální fascie)
Herniae inguinales
Hernia ing. directa :
Vnitřní branka – trig. inguinale
Zevní branka – anulus ing. superf.
Získaná hernie
Hernia ing. indirecta :
Vnitřní branka – anulus ing. profundus
Zevní branka – anulus ing. Superficialis
Většinou získaná, vzácně vrozená hernie