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Prevertebral Muscles (A, B) Scalene Muscles (A, B)

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Prevertebral Muscles (A, B) Scalene Muscles (A, B) 80 Trunk Prevertebral Muscles (A, B) lift the first two pairs of ribs and thus the superior part of the thorax. Their action is The prevertebral muscles include the rec- increased when the head is bent backward. tus capitis anterior, longus capitis, and lon- Unilateral contraction tilts the cervical gus colli. column to one side. Occasionally there is a The rectus capitis anterior (1) extends scalenus minimus which arises from the from the lateral mass of the atlas (2) to the seventh cervical vertebra and joins the basal part of the occipital bone (3). It helps scalenus medius. It is attached to the apex to flex the head. of the pleura. Nerve supply: cervical plexus (C1). The scalenus anterior (17) arises from the The longus capitis (4) arises from the ante- anterior tubercles of the transverse Trunk rior tubercles of the transverse processes of processes of the (third) fourth to sixth cervi- the third to sixth cervical vertebrae (5). It cal vertebrae (18) and is inserted on the runs upward and is attached to the basal anterior scalene tubercle (19) of the first rib. part of the occipital bone (6). The two longi Nerve supply: brachial plexus (C5 –C7). capitis muscles bend the head forward. The scalenus medius (20) arises from the pos- Unilateral action of the muscle helps to tilt terior tubercles of the transverse processes the head sideways. of the (first) second to seventh cervical Nerve supply: cervical plexus (C1 –C4). vertebrae (21). It is inserted into the 1st rib The longus colli (7) is roughly triangular in behind the subclavian artery groove and shape because it consists of three groups of into the external intercostal membrane of fibers. The superior oblique fibers (8) arise the 1st intercostal space (22). In this way it from the anterior tubercles on the trans- can reach the 2nd rib. The attachment at verse processes of the fifth to second cervical the 1st rib is located behind the groove for vertebrae (9) and are inserted on the ante- the subclavian artery. rior tubercle of the atlas (10). The inferior Nerve supply: cervical and brachial plexus oblique fibers (11) run from the bodies of the (C4 –C8). first to third thoracic vertebrae (12) to the The scalenus posterior (23) runs from the anterior tubercle on the transverse process posterior tubercles on the transverse of the sixth cervical vertebra (13). The me- processes of the fifth to seventh cervical dial fibers (14) extend from the bodies of the vertebrae (24) to the 2nd (3rd) rib (25). It upper thoracic and lower cervical vertebrae can be absent. (15) to the bodies of the upper cervical Nerve supply: brachial plexus (C7 –C8). vertebrae (16). Unilateral contraction of the A scalenus minimus muscle may be present in muscle bends and turns the cervical verte- about one-third of cases. It arises from the ante- bral column to the side. Together, both rior tubercle of the transverse process of the longi colli muscles bend the cervical spine seventh cervical vertebra and reaches the fibrous forward. Electromyographic studies have vault of the pleura and the 1st rib. If the muscle is shown that the homolateral muscle is also absent, a transverse cupular ligament (Hayek) re- involved in lateral flexion and rotation of places it. the cervical vertebral column. Nerve supply: brachial plexus (C8). Nerve supply: cervical and brachial plexus (C2 –C8). Clinical tip: Between the scalenus anterior and scalenus medius lies the scalene opening (26), Scalene Muscles (A, B) through which pass the brachial plexus (see p. 360 and vol. 3) and the subclavian artery. The scalene muscles represent the cranial Retroversion of the arm may occlude the sub- continuation of the intercostal muscles. clavian artery between the rib and the clavicle. They arise from the vestigial ribs of the cer- Together with the longus colli, the scalenus vical vertebrae. They are the most impor- anterior forms the medial wall of the scal- tant muscles for quiet inhalation, as they enovertebral triangle (27; see p. 366). Prevertebral and Scalene Muscles 81 4 1 8 4 Trunk 7 A Prevertebral and scalene muscles 14 7 20 17 23 11 27 19 26 22 3 6 2 10 II 21 9 16 5 18 V 24 VI 13 VII 15 B Diagram of origin, course, and insertion of muscles 12 25 19 128 Upper Limb: Bones, Ligaments, Joints Bones of the Metacarpus and Digits The base of the distal phalanx also bears a ridge. At the distal end there is a rough pal- (A–C) mar surface for insertion of the tendon of The five metacarpals of the hand each have the flexor digitorum profundus as well as a a head (1), a shaft (2), and a base (3). On all palmar-facing roughened, spade-shaped of these there are articular facets at one plate (11) at its terminus, the tuberosity of end (base) for articulation with the carpals distal phalanx. and at the other (head) for the phalanges. The palmar surface is slightly concave and Sesamoid bones are regularly found in the the dorsal surface slightly convex. The dor- joints between the metacarpals and the sal surface exhibits a characteristic tri- proximal phalanx of the thumb, one lying angular configuration toward the head. medially and the other laterally. Sesamoid The proximal articular facet of the first bones are also found in variable numbers metacarpal is saddle-shaped; the second in the other fingers. metacarpal has a notched base proximally Upper Limb for articulation with the carpus, and on the Ossification: In both the metacarpals and the medial side with the third metacarpal. On phalanges there is only one epiphysial center of the dorso-radial side of the base of the third ossification in addition to the perichondral di- metacarpal is a styloid process (4) and aphysis (3rd intrauterine month). In the meta- carpals the distal epiphysial centers develop in radially an articular facet for the second the 2nd year of life, except for the 1st metacarpal, metacarpal. Proximally, for junction with in whose proximal end the center appears in the the carpus, there is one articular facet, and 2nd– 3rd year. In the phalanges epiphysial ossifi- on the ulnar side there are two articular cation centers occur only proximally. facets for articulation with the fourth meta- carpal. The fourth metacarpal has two artic- Clinical tip: Pseudoepiphyses may develop in the ular facets radially but only one on its ulnar metacarpal bones. In radiographs they may be side for articulation with the fifth metacar- distinguished from true epiphyses, as they are pal. attached to the diaphysis by a piece of bone. The 1st metacarpal bone may have a pseudo- epiphysis at its distal end, but all other meta- The bones of the digits: Each digit (i.e., the carpal bones have them at the proximal end: index, middle, ring and little finger) con- they must be distinguished from fractures. sists of more than one bone, namely, a Pseudoepiphyses are found more commonly in proximal (5), a medial (6), and a distal phalanx certain diseases. (7). The sole exception is the thumb, which has only two phalanges. Each proximal phalanx has a flattened pal- mar surface, dorsally and transversally it is convex and has roughened sharpened borders for the attachment of the fibrous tendon sheaths of the flexor muscles. It has a shaft (8), a distal phalangeal head (also called a “trochlea”) (9), and a proximal base (10). The base has a transverse oval socket, an articular facet for the metacarpals. The base of the middle phalanx has two con- vex facets separated by a smooth ridge to conform to the shape of the head of the proximal phalanx. Bones of the Metacarpus and Digits 129 11 3rd i.u.m. 7 3rd i.u.m. 6 2nd year 9 3rd i.u.m. 8 2nd3rd 5 years C Ossification of Upper Limb metacarpal bones and phalangeal 10 bones 1 2 3 A Dorsal view of right metacarpals and digits 4 B Articular facets of metacarpals on their opposing surfaces 272 Lower Limb: Muscles, Fascias, and Special Features Muscles of the Sole of the Foot The abductor digiti minimi (18) is the largest and longest of the muscles of the Muscles of the Great Toe, continued little toe. In the main it actually forms the (A–C) lateral margin of the foot. It arises from the The adductor hallucis (1) has two heads.It lateral process of the tuber calcanei (19), only becomes visible after the flexor digi- from the lower surface of the calcaneus (20), torum longus and the flexor digitorum the tuberosity of the fifth metatarsal (21) brevis (2) have been removed (A). The and the plantar aponeurosis and extends to strong oblique head (3) arises from the the proximal phalanx (22) of the fifth digit. cuboid (4) and lateral cuneiform (5) bones, Like the other muscles it supports the arch and from the bases of the second and third of the foot. In addition it plantar flexes the metatarsals (6). Other surfaces of origin fifth digit and, to a small extent, it acts also may include the fourth metatarsal, the as an abductor. plantar calcaneocuboidal ligament, the Nerve supply: lateral plantar nerve (S1– long plantar ligament (7), and the plantar S 2). tendinous sheath (8) of the peroneus lon- gus. The transverse head (9) arises from the 23 Quadratus plantae capsular ligaments of the metatarso- Lower Limb phalangeal joints of the third–fifth digits (10) and also from the deep transverse metatarsal ligament. Both heads are inserted into the lateral sesamoid bone (11) of the great toe. The muscle acts especially as a tensor of the plantar arches.
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