svaly ii
DESCRIPTION
Svaly II. Muscles II. Thorax & back. Muscles of thorax – Musculi thoracis. thoracohumeral m. pectoralis major m. pectoralis minor m. subclavius m. serratus anterior proper thoracic mm. intercostales (externi, interni, intimi) mm. subcostales mm. levatores costarum - PowerPoint PPT PresentationTRANSCRIPT
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Svaly II. Muscles II.
Thorax &back
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Muscles of thorax Musculi thoracisthoracohumeralm. pectoralis majorm. pectoralis minorm. subclaviusm. serratus anteriorproper thoracic mm. intercostales (externi, interni, intimi)mm. subcostalesmm. levatores costarumm. transversus thoracisdiaphragma
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Leonardo
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Thoracohumeral muscles m. pectoralis majorpars clavicularispars sternocostalispars abdominalisRotation of insertion tendon 180
m. pectoralis minorfascia clavipectoralis
nn. pectorales (med.+lat.)
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Leonardo
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Thoracohumeral muscles m. serratus anteriorthoracoscapular musclen. thoracicus longus
m. subclaviusfascia clavipectoralisn. subclavius
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Thoracic fasciaefascia pectoralis covering m. pectoralis majorfascia clavipectoraliscovering m. subclavius and m. pectoralis minorfossa ovalis infraclavicularis Mohrenheimi (for v. cephalica)fascia thoracica superficial fascia of all intercostal spacesfascia endothoracica (f. thoracis parietalis)lining the thoracic cavity
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Fascia clavipectoralis
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Developmental defectsPolland syndrom
absence of m. pectoralis majorlength reduction of fingers or syndactylia (obviously a defect of induction)3x more in
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Breast implants
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Proper thoracic muscles mm. intercostales externifrom tuberculum costae to cartilago costalisthen membrana intercostalis externa as far as sternuminspiration
mm. intercostales interni from sternum to angulus costaethen membrana intercostalis interna as far as vertebral columnmm. intercostales intimisimilar to interni, weakerinsertion internally to sulcus costae
expiration
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Proper thoracic musclesm. transversus thoracis internal side of sternumexpirationinervation: nn. intercostales 1-6
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Proper thoracic musclesmm. subcostales frequently rudimental at anguli costarum deep to mm. intercostales intimi inervation: nn. intercostales
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Proper thoracic musclesmm. levatores costarum longi et brevebreves 12 x longi 4 (kaudal) inervation: rr. dorsales ramorum posteriorum nn. spinalium T1-12 !!!
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Intercostal spacePunctionat superior margin of rib = at inferior margin of intercostal space
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Diaphragma (phren in Greek)mammalia, crocodiles3-5 mm thickmuscular-tendinous membrane separates thoracic and abdominal cavitymain inspiration muscle: 6080% of labormaintain stabilization of thoraco-lumbar transition of vertebral column
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Diaphragma developmentWeek 5-12: 4 sourcesseptum transversumorigin cranial to cardiogenic zone
pleuroperitoneal membrans (= primitive diaphragm)1+2 fuses in centrum tendineum
mesoesophageum dorsale crura diaphragmatis
ingrowth of mesenchyme from thedorsolateral body wall future muscles of dorsolateral part
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Diaphragma inervation, shapeseptum transversum descensus n. phrenicus C3-5
firstly: frontal plane postitionlater: by growth of lungs and formation of pleural cavities (recessus costodiaphragmatici) typical cupular shape
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Diaphragm vaults
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right and left diaphragmatic vault 4th athd 5. intercostal space)centrum tendineumpars lumbaliscrus dextrum et sinistrumpars costalispars sternalis trigonum lumbocostale Bochdalekitrigonum sternocostale Morgagni s. Larreyimain inspiration muscleactive in exspiration, tooDiaphragma
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Diaphragm vaultslig. arcuatum medianum (aortic arcade) unpairedhiatus aorticus
lig. arcuatum mediale (psoatic arcade) pairedfor m. psoas major
lig. arcuatum laterale (quadratic arcade) pairedfor m. quadratus lumborum
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Level of diaphragmatic openingsforamen venae cavae T8hiatus oesophageus T10hiatus aorticus T12
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Structures passing via diaphragm
pars lumbalis (crus sin. et dx.) truncus sympathicus, nn. splanchnici,(sometimes v. azygos et hemiazygos)hiatus aorticus (between crura diaphragmatis, border with lig. arcuatum medianum)aorta thoracica/abdominalis, ductus thoracicus (sometimes v. azygos et hemiazygos)hiatus oesophageus (within crura diaphragmatis)oesophagus, truncus vagalis ant.et post. (+ rr. gastrici), rr. oesophageales a. et v. gastricae sin.foramen venae cavae (within centrum tendineum)v. cava inf., rr. phrenicoabdominales n. phrenici dx.trigonum strenocostalenothingventrally to m. transversus thoracis: vasa thoracica interna vasa epigastrica superioratrionum lumbocostalenothing
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Diaphragmatic herniaehiatus oesophageus sliding hiatus (hiatal) herniafalse hernia (without peritoneal cover) contains abdominal part of oesophagus, stomach, intestinepara-oesophageal hiatus (hiatal) herniatrue hernia sac appears between the wall of hiatus oesophageus and oesophageus trigonum lumbocostale (rarely)inborn failure of diaphragm parts fusionacquiredtrigonum sternocostale (rarely)
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Diaphragmatic herniaesliding hiatus herniapara-oesophageal hiatus hernia
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Diaphragmatic herniae
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Hernia diaphragmatica posterolateralis congenitalis Bochdaleki
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1801 Skipov 1883 LitomiceVincenz AlexanderBochdalek
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Giovanni Battista Morgagni1682 1771Italyfounder of pathology
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Break 5 minutes
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Muscles of backMusculi dorsi
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Vertebral columnColumna vertebralis
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Developmentepaxial muscules = autochthonous deep dorsal musculesmyoseptum horizontale fish lamina media fasciae thoracolumbalishypaxial muscules = heterochthonous all other muscles:limbs, head, neck, thorax, abdomen + 3 superficial layer dorsal muscules
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Development
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CTlaminamediafasciaethoraco- lumbalisepaxialmuscles
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Muscles of back (Musculi dorsi)4 layers:superficial (first) = spinohumeral musclessecond layer= spinoscapular musclesthird layer= spinocostal musclesfourth layer= deep (proper) dorsal muscles = epaxial muscles
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Superficial (first) layerm. trapeziuspars descendenspars transversapars ascendensspeculum rhomboideum C7n. accessorius + C3-C4
m. latissimus dorsin. thoracodorsalisinsertion tendon inverted (180)
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Second layerm. levator scapulae C3,4 + n. dorsalis scapulae (C5)
m. rhomboideus minorm. rhomboideus majorn. dorsalis scapulae
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Third layerm. serratus posterior superiornn. intercostales 2-5
m. serratus posterior inferiornn. intercostales 9-11 + n. subcostalis
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Deep (fourth) layerproper muscles of back
epaxial muscles derivates of somites segmental organization + inervation
inervation: rami posteriores nervorum spinalium
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Somites42-44
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ramiposterioresnervorumspinalium
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Rami posteriores nervorum spinaliumsegmental arrangementno plexusesmixed nervesmotor deep muscles of backsensory skin medially to vertebral column
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Deep (fourth) layerMusculi dorsi proprii3 systema due direct fibres:spinotransversal (form V)spinospinal (form I)transversospinal (form A)
short dorsal mmmm. interspinalesmm. intertransversarii
deep neck muscules
ANATOMICAL DEFINATEDMUSCULES
IVA
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M. SPINALIS (shape I)thoracis, cervicis, capitisM. LONGISSIMUS (shape V)thoracis (pars lumbalis), cervicis, capitisM. ILIOCOSTALIS (shape V)lumborum (pars lumbalis, thoracica), cervicis
function: bilateral erection (extension) of vertebral column retroflexion of headunilateral lateroflexion and ipsilateral rotation of vertebral columnM. ERECTOR SPINAE
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M. SPLENIUS (shape V)cervicis, capitis
function: retroflexion, rotationMM. SPINOSTRANSVERSALES
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MM. TRANSVERSOSPINALESM. SEMISPINALIS (shape A)thoracis, cervicis, capitis
function: bilateral erection (extension) of vertebral column retroflexion of headunilateral lateroflexion of vertebral column and head and contralateral rotation
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MM. TRANSVERSOSPINALES 2.MM. MULTIFIDI (shape A)lumborum, thoracis, cervicis
function: bilateral erection (extension) of vertebral column retroflexion of headunilateral lateroflexion of vertebral column and head and contralateral rotation
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MM. ROTATORESLONGIBREVES(form A)lumborum, thoracis, cervicis
MM. TRANSVERSOSPINALESfunction:bilateral erection (extension)of vertebral column retroflexion of headunilateral lateroflexion of vertebral column and head and contralateral rotation
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Deep and short muscles
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MM. INTERTRANSVERSARIIMM. INTERSPINALES
function:small muscles contributing to lateroflexion and retroflexion
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Suboccipital musclesm. rectus capitis posterior majorm. rectus capitis posterior minorm. obliquus capitis superiorm. obliquus capitis inferior
balance movements of head and C1, C2trigonum suboccipitale (trigonum a. vertebralis)
innervation: n. suboccipitalis (rmaus posterior nervi spinalis C1)
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Trigonum suboccipitalecontent:
a. vertebralis (pars atlantica) - running in depth
n. suboccipitalis - emerging
n. occipitalis major passes superficially
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Fascia thoracolumbalis3 layerslamina anteriorlamina media = (original myoseptum horizontale in fish)lamina posteriorcovers deep back muscles in lumbar region3 laminae merge laterallyorigin site for 2 (out of 3) lateral abdominal muscles + m. latissimus dorsi
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Michaelis rhomboid Rhombus; Rhomboid; Quadrilateral; Sacral quadrangleGustav Adolf Michaelis(1798-1848)German obstetrician
regular rhomboid shape marks correct pelvic proportions and same length of both limbs
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Michaelis rhomboid
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Topography
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Trigonum auscultationiscranially: m. trapeziuscaudally: m. latissimus dorsi laterally: margo medialis scapulae floor: m. rhomboideus major (partially)
6th+7th rib (in protraction of scapulae = anteflexion of vertebral column + crossed hand on chest- project of apex of inferior lobe of lungs- possible point for auscultation
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Trigonum lumbale inferius Petiticaudally: crista iliaca (cca 2-3 cm) medially: m. latissimus dorsi laterally: m. obliquus externus abd. floor: m. obliquus internus abd.
inferior lumbal hernia
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Trigonum lumbale superius Grynfeltti s. Lesshafticranially: m. serratus post. inf. (sometimes costa XII.) medially:m. iliocostalis lumborum laterally: m. obliquus internus abd. floor: aponeuross m. transversi abd. ceiling: m. latissimus dorsi resp. laterocranially: costa duodecima tetragonum Krausei
n. et vasa subcostalia emergen. iliohypogastricus superior lumbal hernia
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Lumbal herniaBleichner herniain lumbar regionattention! danger of confusion with herniation of intervertebral discPetit herniavia Petit triangle (trigonum lumbale inferius) 5%Jean Louis Petit (16741750) French surgeon
Grynfeltt herniavia Grynfeltt-Lesshaft triangle (trigonum lumbale superius) 95 %Joseph Casimir Grynfeltt (18401913) French physicianPjotr Lesshaft Russian physician
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Grynfeltt hernia
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Petit hernia
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Clinical notesbackache vertebrogenic disordersupper crossed syndromelower crossed syndrome
trigger points in muscle contractureslumbar herniaespondylosurgery
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Case report, 32 years
year pyrosis (heartburn)last month gastro-oesophageal refluxlast week vomiting after drnking alcohol
normal blood testsnormal size of liver
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Case reportdiagnosis:hiatus hernia
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Thank you for your attentionDavid Kachlk, Praha 2012AlbinusVesalius
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