Svaly Hrudníku , Přehled Zádových Svalů

Muscles of thorax and abdomen. Muscle groups of the back. Vessels and nerves of the abdominal wall • Ivo Klepáček muscles inguina mm. epaxiales hypaxiales autochtonní heterochtonní musclesautochtonic heterochtonic Ep inguina Hyp Thoracic muscles • M.pectoralis major n.pectoralismuscles lat.+med. • M.pectoralis minor n.pectoralis med. • M.subclavius n.subclavius • M.serratus anterior n.thoracicus longus • Mm.intercostalesinguina externi, interni, intimi nn.intercostales I-XI • M.transversus thoracis nn.intercostales • Musculus diaphragma n.phrenicus M.pectoralis major Clavicular part Innervation: Sternal part pectoral nerves C5-Th1 Abdominalmuscles part adduction, rotation,

accessory inspiratoryinguina muscle

Muscles of the anterior axillar fold Thoracohumeral system M.pectoralis musclesminor inguina What compress subclavian or axillary artery A) Costa cervicalis B) mm. scaleni (m.scalenus minimus) C) Tumor inside spatium costoclaviculare D) Insertion of the m.pectoralis minor Intercostal muscles

 external intercostal m. M. intercostalis externus membrana intercostalis externa fascia thoracicamuscles superficialis (externa)  internal intercostal m. M. intercostalis internus membrana intercostalis interna  innermost intercostal m. M. intercostalis intimus fascia intercostalisinguina interna (endothoracica)  Transverse thoracic m. M. transversus thoracis fascia intercostalis interna (endothoracica) Internal intercostal muscles + transversus ventral thoracic wall (dorsal view) muscles inguina m. transversus thoracis Internal and external intercostal muscles dorsal thoracic wall musclesAngulus costae (II)

Intercostalis externus inguinaIntercostalis internus

Membrana intercostalis interna Mm. intercostalis externus, internus, intimus musclesa transversus (transversalis) inguina IE muscles II inguina Mm. intercostalis externus, internus, intimus transversusmuscles (transversalis) thoracis et fasciae inguina muscles inguina Intercostal aa. et vv. muscles inguina Vein, Artery, Nerve, nerve, artery

Spatium musclesintercostale - obsah inguina Punctio Punction muscles inguina Vessels and nerves of the dorsal thoracic wall Ao Superior intercostal vein v. intercostalismuscles superior Azygos vein v. azygos

Sympathetic trunk Truncus sympathicus

Thoracic duct Ductusinguina thoracicus

Splanchnic nerves nn. splanchnici v. jugularis Ductus thoracicus v. subclavia v.cava superior

v.hemiazygos accesoria v.azygos musclesv.hemiazygos

v.lumbalis Vena cavainguina inferior ascendens

Žilní systém Venous system trupu of the trunk Lymphatic vessels of the trunk muscles inguina Preparace a. et v. thoracica interna

Dissection of the internal thoracic a. musclesand v. inguina Muscles of anterior abdominal wall muscles

Function: Flexion Lateroflexion Rotation inguinaIncrease of intraabdominal pressure Forced expiration

innervation: intercostal nerves, iliohypogastric, ilioinguinal Superficial mm. (ventral abdominal wall) mm. obliquus externus, internus, transversus external oblique, internal transverse abdominal muscles OE musclesOI T inguina M.rectus musclesabdominis hluboké svaly břicha deep abdominal inguinamuscle group

(iliopsoas, quadratus lumborum mm.) m. rectus abdominis vagina musculorum rectorum rectus abdominis muscle musclesand its sheath inguina Linea arcuata

Douglas line muscles(arcuate line)

Linea inguinasemilunaris Spiegel line Semilunar line

James Douglas 1675-1742 Engl. anatomist Vagina musculorum rectorum Adrian van den Spieghel /Adrianus Rectus sheath, vagina Spigelius) 1578-1625 Belgian anatomist muscles inguina Hlavní funkce břišních svalů Mainmuscles function of the abdominal muscles inguina Abdominal wall – ventral view muscles• Skin • Fascia abdominalis subcutanea et superficialis inguina• Muscles

Antonio Scarpa (1752 – Petrus Camper (1722- 1832) Italian anatomist 1789), Dutch Anthropologist Caput Medusae muscles inguina muscles inguina Abdominal wall - dorsal musclesview

• Peritoneum • Fascia transversalis (endoabdominalis) inguina• Muscles muscles inguina Canalis inguinalis Inguinal canal

Stěnymuscles ???? Walls ???? inguina Inguinal canal

(Canalis inguinalis – latin) musclesweakness of the abdominal wall 4 -5 cm long tube-like gap in the lower margin of the anterior abdominal wall above inguinal (groin) ligament It is the passage connecting inner and outer surfaceinguina of the muscular layers of the anterior abdominal wall

It serves as communicating canal between subcutaneous and intra-abdominal structures female muscles inguinac

male muscles inguina Transverse section Anulus inguinalis profundus Internalmuscles inguinal ring

inguinac

Anulus inguinalis superficialis External inguinal ring APONEUROSIS muscles inguinac

Přední stěna Ventral wall muscles

Dolní okraje plochých šlach OI aT inguinaDistal margine of OI and T aponeuroses Tříselný kanál Canalis inguinalis

Groin canal, inguinal canal Strop dno 2.vrstva 2nd layer Roof bottom FASCIA TRANSVERSALIS muscles

inguinac

Tříselný kanál Canalis inguinalis Groin canal, inguinal canal Zadní stěna 3.vrstva 3rd layer Dorsal wall muscles inguina muscles inguina Zadní stěna tříselného kanálu Dorsal wall of the inguinal canal (intraabdominal view) Ligamentum

interfoveolare Aponeurosis m.transv.abdom.

m.transversus musclesabdominalis

Vasa Inferior epigastric testicularia vessels Falx inguinalis Trigonum inguinaHesselbachi n. femoralis Ligamentum a. femoralis inguinale v. femoralis

Ductus deferentialis vas deferens muscles inguina

Fascia transversalis „fascia“ cremasterica aa. testicularis, cremasterica, deferentialis Plexus pampiniformis Ductus deferens muscles inguinac muscles inguina muscles

Anulus inguinalis inguina superficialis

1- fossa supravesicals canalis inguinalis – příčný řez 2- fossa medialis inguinalis 3- fossa lateralis inguinalis Nepřímá hernie HERNIA INDIRECTA Přímá hernie HERNIA DIRECTA

Fascia transversalis TA peritoneum IOA EOA muscles Superficial abd.fascia cremasteringuina

Fascia Ifascia spermatica interna spermatica externa muscles inguina Diaphragma structure Vertebral part – from ligaments which surround deep abdominalmuscles muscles (arcuate mediale, laterale and mediana ligg.).

Lumbar part – right side - from first three lumbar vertebraeinguina Lumbar part – left side - from first two lumbar vertebrae Sternal part - from xiphoid process and from false ribs Diaphragm phrenmuscles formation inguina Inferior view muscles inguina muscles inguina Diaphragm musclesopenings Aortic hiatus (aorta a ductus)

Esophageal hiatus (jícen a vagus) Hiatus venae cava inferioris (vein and right phrenicinguina nerve) Arcades (muscles and splanchnic nerves and connections between ascending lumbar veins and azygos and hemiazygos veins) Superior view Sternocostalmuscles triangle

Hiatus Lumbocostal triangle Medial esophageus (Bochdaleki) arcuate Lig. arcuatum medianum inguinalig. Lateral arcuate lig.

QL PM

Crus dextrum et sin Hiatus aorticus muscles4 5 inguina Diaphragm - innervation Nerves – motor fibres from phrenic nerves (C3,4,5).

Sensitive fibers supply parietal and visceral pleuraemuscles + middle part is supplied from the sensitive fibers of phrenic nerve sensoric fibers are from the intercostal nerve. inguina Diaphragm and its function

Muscle of abdominal straining: The diaphragm contraction aids that of the muscles of the anterior abdominal wall in raisingmuscles the intra-abdominal pressure to evacuate the pelvic contents (micturition, defecation, parturition).

Weight-lifting muscle: The diaphragm contraction support the vertebral column and prevent flexion. It assists the postvertebralinguina muscles in the lifting of heavy weights. Thoracoabdominal pump: The descent of the diaphragm decreases the intrathoracic pressure and increases the intra-abdominal pressure. This pressures change compresses the blood in the inferior vena cava and forces it upward into the right atrium of the heart. Lymph can be passed faster to the thoracic duct, too. Diaphragma Diaphragm - absorbér peritoneální tekutiny -musclesabsorber of the peritoneal fluid inguina Diaphragma - herniation Hernia congenitalis congenital herniation – Pronikámuscles skrze penetrates through: Canalis pleuroparietalis (častěji vlevo; v důsledku nespojení septum transversum s pleuroperitoneální řasou Pleuroperitoneal canal (more on left side, because of non fusion between pleuroperitoneal fold and septum transversum

Herniainguina traumatica traumatic herniation – Proniká skrze penetrates through: hiatus oesophageus - para-esophageální typ oesophageal opening - paraesophageal type muscles inguina muscles inguina Svaly zad Musculimuscles dorsi Back muscles inguina muscles inguina Zádové svaly Back muscles Superficial layer

musclesMiddle layer Deep layer Spinotransversal system

Spinospinal system inguinaTransversospinal system

Suboccipital muscles muscles inguina Mm. intermediales Intermediate muscles musclesspinocostal system inguina • Serratus posterior superior • Serratus posterior inferior • Levatores costarum musclesmm. serrati

serratus inguinasuperior serratus inferior Mm. dorsales profundi Deep back muscles (erector trunci systems) • Superficial and obliquely directed muscles• Erector spinae (trunci): iliocostalis, longissimus and spinalis parts Its separated continuation – splenius capitis and cervicis

• Intermediate and obliquely directed inguinaTransversospinalis: semispinalis, multifidi and mm.rotatores

• Deeply arranged • Mm. interspinales, intertransversarii muscles inguina Superficial and obliquely directed musclesSpino-transversal system Derivatives inguinaof the Fascia thoracolumbalis+ Fascia nuchae arrangement m.splenius musclesm.iliocostalis m.longissimus inguina m.longissimus capitis, cervicis, musclesthoracis

L m.iliocostalis inguinaI cervicis, thoracis et lumborum Vertically directed Spino-spinal system

mm.interspinales musclesm.spinalis inguina Intermediate and obliquely directed Transverso-spinal system musclesmm.rotatores breves et longi m.multifidus inguinam.semispinalis Mm. prevertebrales Prevertebral muscles muscles inguina

mm. longus capitis et colli mm. rectus capitis et lateralis Spinospinální m.spinalis - extension Spinotransversální m.iliocostalis , m.longissimus, m.splenius –rotation to the same side Transversospinální m.semispinalis, mm.rotatores, m multifidus - rotation to the oposite side muscleshluboké svaly zádové inguina

M.serratus M.latissimus post. sup. dorsi Inervace: Dorsální větve nn.spinales M.trapezius Innervation: dorsal branches of spinal nn. Petrovický lecture Fascia thoracolumbalis • It is between iliac crest and crista 12th • Outermuscles layer: aponeurosis m. latissimus dorsi • Inner layer: Laterally proceeds to mm. transversi a obliqui interni

Medially is splitted into three layers(lamellae): posterior lamella – covers deep muscles mediainguina lamella– dorsally from m. quadratus lumborum anterior lamella– ventrally from m. quadratus lumborum muscles inguina Movements in the regions

• Thoracic region – rotation is produced by the semispinalismuscles and rotatores muscles and less by the oblique abdominal muscles

• Lumbar region – flexion is produced by the rectus abdominis and psoas muscles Lateral flexion is produced by the postvertebral muscles,inguina the quadratus lumborum and the oblique abdominal muscles Rotation is produced by the rotatores muscles and by the oblique abdominal muscles muscles inguina Hernia lumbalis

Latero- muscles ventrally

Costa XII.

Trigonum lumbale Petitiinguina anulus superficialis

PETIT Jean Louis 1674-1760 Tetragonum Krausei (Trigonum GRYNFELT Kazimierz 1840-1913 Grynfelti - spatium tendineum Anulus KRAUSE Wilhelm 1833-1909 lumbale) profundus muscles inguina muscles inguina muscles inguina Trigonum musclessuboccipitale inguina muscles inguina Where you can get more information R.S.Snell : Clinical Anatomy for Medical Students Lippincott, Williams & Wilkins, 6th edition musclespp.: 46-55; 57-58; 59-72 A.Dykes : Anatomy Mosby Publications pp.: 41-47 A.M.R.Agur and M.J.Lee : Grant`s Atlas of Anatomy Williams & Wilkins pp.: 2-28 inguinaK.L.Moore and A.M.R.Agur : Essential Clinical Anatomy Williams & Wilkins pp.: 32-47

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