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

Sulcus deltoideo-pectoralis

Clavipectoral triangle

Trigonum clavipectorale

Anterior wall of the axilla

M. Pectoralis major

Origo :

Clavicula, sternum

Vagina m. rectorum

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 DIAPHRAGMA 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

4th intercostal space

Left dome

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

Canalis inguinalis

Inguinal canal

Anterior wall

(superficial ring)

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