VIPCRO)I
`Human
`BVPLOL
`
`IPR2021-00208
`
`Frank H. Netter, M.D.
`
`rl he!
`
`Third Edition
`
`Masimo Ex. 2010
`Apple v. Masimo
`
`
`
`- 1 -
`
`Masimo Ex. 2010
`Apple v. Masimo
`IPR2021-00208
`
`

`

`as o
`
`uman
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`na om
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`- 2 -
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`

`

`Atlas
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`Human
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`- 3 -
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`

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`Third Edition
`
`
`
`by Frank H. Netter, M.D.
`
`John T. Hansen, Ph.D., Consulting Editor
`
`
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`
`
`University of Rochester School of Medicine and Dentistry
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`Rochester, New York
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`Icon Learning Systems · Teterboro, New Jersey
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`- 4 -
`
`

`

`lffiN
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`LEAR NIN G
`S Y ST E M S
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`Copyright© 2003, 1997, 1989, ICON Learning Systems, LLC, a subsidiary of MediMedia USA, Inc.
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`First Edition, 1989
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`Second Edition, 1997
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`Third Edition, 2003
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`All rights reserved. No part of this book may be reproduced in any form or by any electronic
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`or mechanical means, including information storage and retrieval systems, without permission
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`in writing from the publisher. Requests for permission should be addressed to Permissions
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`Editor, Icon Learning Systems, 295 North Street, Teterboro NJ 07608; or may be made
`at www.netterart.com/request_start.asp
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`NOTICE
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`Every effort has been taken to confirm the accuracy of the information presented.
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`Neither the publisher nor the authors can be held responsible for errors or for any
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`consequences arising from the use of the information contained herein, and make
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`no warranty, expressed or implied, with respect to the contents of the publication.
`
`Paul Kelly
`Executive Editor:
`
`Greg Otis
`
`Editorial Director:
`
`Jennifer Surich
`
`Managing Editor:
`Erika Gehringer
`Art Director:
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`Mary Ellen Curry
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`Print Production Manager:
`
`10 9 8 7 6 5 4 3 2
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`ISBN 1-929007-11-6 (paperback)
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`
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`ISBN 1-929007-15-9 (paperback/CD Combo)
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`ISBN 1-929007-21-3 (case bound/CD Combo)
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`
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`Library of Congress Control No: 2002110663
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`
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`Printed and bound in USA by RR Donnelley
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`100M·0703·RRO
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`- 5 -
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`

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`To my dear wife, Vera
`To my dear wife, Vera
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`- 6 -
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`

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`PREFACE TO THE FIRST EDITION
`
`I have often said that my career as a medical artist for almost 50 years has been a sort of
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`"command performance" in the sense that it has grown in response to the desires and
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`of the medical profession. Over these many years, I have produced almost 4,000
`requests
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`Illustrations Collection illustrations, mostly for The CIBA (now Netter) of Medical but also
`for Clinical Symposia.
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`These pictures have been concerned with the varied subdivisions of
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`medical knowledge such as gross anatomy,
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`histology, embryology, physiology, pathology,
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`diagnostic modalities, surgical and therapeutic techniques and clinical manifestations of a
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`multitude of diseases. As the years went by, however, there were more and more requests
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`for me to produce an atlas purely of gross anatomy. Thus,
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`from physicians and students
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`this atlas has come about, not through any inspiration on my part but rather, like most
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`of my previous works, as a fulfillment of the desires of the medical professi
`.on.
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`I had made over so many years, It involved going back over all the illustrations
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`selecting those pertinent to gross anatomy, classifying them and organizing them by system
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`and region, adapting them to page size and space and arranging them in logical sequence.
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`Anatomy of course does not change, but our understanding of anatomy and its clinical
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`significance does change, as do anatomical terminology and nomenclature. This therefore
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`required much updating of many of the older pictures and even revision of a number of
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`them in order to make them more pertinent to today's ever-expanding scope of medical
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`of medical and surgical practice. In addition, I found that there were gaps in the portrayal
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`knowledge as pictorialized in the illustrations I had previously done, and this necessitated
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`my making a number of new pictures that are included in this volume.
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`In creating an atlas such as this, it is important to achieve a happy medium between
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`complexity and simplification. If the pictures are too complex, they may be difficult and
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`confusing to read; if oversimplified, they may not be adequately definitive or may even
`the clutter
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`be misleading. I have therefore striven for a middle course of realism without
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`of confusing minutiae. I hope that the students and members of the medical and allied
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`professions will find the illustrations readily understandable, yet instructive and useful.
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`At one point, the publisher and I thought it might be nice to include a foreword by
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`a truly outstanding and renowned anatomist, but there are so many in that category
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`that we could not make a choice. We did think of men like Vesalius, Leonardo da Vinci,
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`
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`William Hunter and Henry Gray, who of course are unfortunately unavailable, but I do
`wonder what their comments might have been about this atlas.
`
`Frank H. Netter, M.D.
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`(1906-1991)
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`- 7 -
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`

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`——
`Pe i hl Pia iad
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`|
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`
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`PHOTOGRAPH BY JAMES L CLAYTON
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`PHOTOGRAPHBy JAMES L. CLAYTON
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`»
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`al
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`7=
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`- 8 -
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`

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`=
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`be Phase Ho Neve a
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`Qa
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`- 9 -
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`FOREWORD
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`"The release in 1989 of the first edition of Or. Frank Netter's 'personal Sistine Chapel'-the
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`Atlas of Human Anatomy-was a major event in the history of the teaching and lea.ming
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`the Atlas of Human Anatomy became the top-selling of anatomy. Almost instantly,
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`choice universally." anatomical atlas in the world and clearly became the students'
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`of the Atlas of Human Anatomy still resonates
`This quotation from the second edition
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`today as the beautifully conceived and rendered artwork of Dr. Netter continues to
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`capture the admiration of students and healthcare professionals.
`The skillful editing and publishing teamwork of Novartis Medical Education, in
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`consultation with many of the 20th century's outstanding anatomists and physicians,
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`have made the first and second editions of the Atlas the standard against which all other
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`atlases are compared. This third edition owes much to the Consulting Editors of the
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`earlier editions, Ors. Sharon Colacino (Oberg) (first edition) and Arthur F. Dalley II
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`(second edition), who shepherded their editions with great skill and uncompromising
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`professionalism and thus made my task significantly easier. I am honored to serve as the
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`Consulting Editor of the third edition and to continue the Netter tradition in partnership
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`with Icon Learning Systems as the Atlas of Human Anatomy enters the new century.
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`Perceptive student and faculty response to the earlier editions
`prompted greater
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`attention to several concepts that are critical to the anatomical basis of clinical practice.
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`Notably, each regional section now begins with a surface anatomy plate, skillfully drawn
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`by Carlos A.G. Machado, M.D. These surface anatomy plates remind us of the value of
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`careful observation in clinical medicine and draw attention to surface features that por­
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`tend the underlying anatomy.
`We also have included a significant number of normal radiographic images in
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`this edition, reflecting the importance of diagnostic imaging in clinical anatomy and
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`medicine. These new images are not meant to be comprehensive of the radiographic
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`knowledge available to today's clinicians, but rather are starting points for further
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`exploration into the richness of anatomical detail that imaging can provide. I am grateful
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`to Matthew Cham, M.D., and John Wandtke, M.D., of our Department of Radiology for
`selecting
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`these images and permitting us to use them in this edition.
`
`- 10 -
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`

`

`We balanced the addition of new surface and radiographic anatomy plates largely
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`of the Atlas. Several
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`little to the quality by eliminating several plates that contributed
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`/1/ustrations plates from The Netter (formerly CIBA) Collection of Medical were added
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`and several plates were altered slightly to correct anatomical errors consistent with our
`current
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`
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`knowledge. In sum, the third edition has grown by 30 images. Finally, the
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`References and the Index have been updated.
`The anatomical terminology is consistent throughout the Atlas and conforms to
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`(Terminologia Anatomica)
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`the International Anatomical Terminology
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`approved in 1998
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`by the International Federation of Associations of Anatomists. Common eponyms are
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`retained parenthetically, and the leader lines and labels have been checked and, where
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`necessary, corrected to ensure their accuracy. For reviewing this material I thank
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`Wojciech Pawlina, M.D., Leonard J. Cleary, Ph.D., Daniel 0. Graney, Ph.D., and Brian R.
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`MacPherson, Ph.D. Their meticulous examination of each plate has greatly enhanced
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`the accuracy of this atlas.
`For the proofreading, editing and designing, I am indebted to Jennifer Surich,
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`Erika Gehringer and Greg Otis at Icon Learning Systems; their keen eyesight, dedication
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`and professionalism buoyed me when I began to drift. A special thank you is reserved
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`for Paul Kelly, Executive Editor, who continues to listen patiently and is a true believer in
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`the power of the visual image to teach.
`To all students, past, present and future, the legacy of Dr. Netter's artwork lives in
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`you; his unique ability to "clarify rather than intimidate" is his gift to you. I am both privi­
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`leged and humbled to have the opportunity to carry forward this tradition of excellence
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`and to contribute to your understanding of human anatomy.
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`Finally, to my wife, Paula, thank you for giving me the freedom to write and the
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`support to sustain me-in those respects, this book was co-edited.
`
`John T. Hansen, Ph.D.
`
`
`Professor of Neurobiology and Anatomy
`
`
`
`University of Rochester School of Medicine and Dentistry
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`Rochester, New York
`
`- 11 -
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`

`

`CONTENTS
`
`
`
`Section I HEAD AND NECK
`
`
`
`SURFACE ANATOMY
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`BONES AND LIGAMENTS
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`SUPERFICIAL FACE
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`NECK
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`NASAL REGION
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`ORAL REGION
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`PHARYNX
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`THYROID GLAND AND LARYNX
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`ORBIT AND CONTENTS
`
`EAR
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`MENINGES AND BRAIN
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`CRANIAL AND CERVICAL NERVES
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`
`
`Plate 1
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`Plates 2-18
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`Plates 19-22
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`Plates 23-31
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`Plates 32-46
`
`Plates 47-58
`
`Plates
`59-69
`Plates 70-76
`Plates 77-86
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`Plates 87-93
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`Plates 94-109
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`Plates 1 10-129
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`CEREBRAL VASCULATURE
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`REGIONAL SCANS
`
`Plates 130-141
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`Plates 142-144
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`Section II BACK AND SPINAL CORD
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`SURFACE ANATOMY
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`BONES AND LIGAMENTS
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`SPINAL CORD
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`MUSCLES AND NERVES
`
`Plate 145
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`Plates 146-152
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`Plates 153-766
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`Plates 167-173
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`Section Ill THORAX
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`SURFACE ANATOMY
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`MAMMARY GLAND
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`BODY WALL
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`LUNGS
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`HEART
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`MEDIASTINUM
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`REGIONAL SCANS
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`.. nlV ABDOMEN
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`SURFACE ANATOMY
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`BODY WALL
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`PERITONEAL CAVITY
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`VISCERA (GUT)
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`VISCERA (ACCESSORY ORGANS)
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`VISCERAL VASCULATURE
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`Plate 174
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`Plates 175-177
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`Plates 178-791
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`Plates 192-206
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`Plates 207-225
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`Plates 226-237
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`Plate 238
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`Plate 239
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`Plates 240-259
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`Plates 260-266
`Plates 267-277
`Plates 278-289
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`Plates 290-307
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`INNERVATION
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`
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`Plates 308-318
`KIDNEYS AND SUPRARENAL GLANDS Plates 3 79-334
`Plates 335-33 7
`ABDOMINAL SECTIONS
`Plate 338
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`REGIONAL SCANS
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`- 12 -
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`

`

`Section V
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`PELVIS AND PERINEUM
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`SURFACE ANATOMY
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`BONES AND LIGAMENTS
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`PELVIC FLOOR AND CONTENTS
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`FEMALE STRUCTURES
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`MALE STRUCTURES
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`RECTUM
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`VASCULATURE
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`INNERVATION
`
`HOMOLOGUES OF GENITALIA
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`REGIONAL SCANS
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`UPPER LIMB
`
`Section VI
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`SURFACE ANATOMY
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`
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`SHOULDER AND AXILLA
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`ARM
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`ELBOW AND FOREARM
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`WRIST AND HAND
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`NEUROVASCULATURE
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`Section VII
`
`LOWER LIMB
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`SURFACE ANATOMY
`
`HIP AND THIGH
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`KNEE
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`LEG
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`ANKLE AND FOOT
`
`NEUROVASCULATURE
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`Plate 339
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`Plates 340-342
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`Plates 343-353
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`Plates 354-362
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`Plates 363-371
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`Plates 372-377
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`Plates 378-388
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`Plates 389-397
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`Plates 398-399
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`Plate 400
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`Plate 401
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`Plates 402-413
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`Plates 414-418
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`Plates 419-434
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`Plates 435-454
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`Plates 455-466
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`Plate 467
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`Plates 468-487
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`Plates 488-494
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`Plates 495-504
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`Plates 505-519
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`Plates 520-528
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`Section VI 11
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`
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`CROSS-SECTIONAL ANATOMY
`
`ICROSS-SECTION
`
`THORAX
`
`OVERVIEW
`
`ABDOMEN
`
`MALE PELVIS
`
`THORAX
`
`REFERENCES
`
`INDEX
`
`Plate 529
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`Plates 530-533
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`
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`Plates 534-539
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`Plate 540
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`Plates 541-542
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`- 13 -
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`

`

`
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`Section VI
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`UPPER
`
`LIMB
`
`SURFACE ANATOMY
`Plate 401
`401.Upper Limb
`
`ARM
`Plates 414-418
`414.Muscles of Arm: Anterior Views
`
`
`415.Muscles of Arm: Posterior Views
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`416.Brachia! Artery In Situ
`SHOULDER AND AXILLA
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`417.Brachia! Artery and Anastomoses
`Plates 402-413
`
`402.Clavicle and Sternoclavicular Joint
`Around Elbow
`
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`403.Humerus and Scapula: Anterior Views
`
`418.Arm: Serial Cross Sections
`404.Humerus and Scapula:
`
`Posterior Views
`ELBOW AND FOREARM
`405.Shoulder: Anteroposterior Radiograph
`
`
`Plates 419-434
`
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`406.Shoulder (Glenohumeral) Joint
`419.Bones of Elbow
`407.Muscles of Shoulder
`420.Elbow: Radiographs
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`408.Muscles of Rotator Cuff
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`421.Ligaments of Elbow
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`409.Scapulohumeral Dissection
`422.Bones of Forearm
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`410.Axillary Artery and
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`423. Individual Muscles of Forearm:
`
`Rotators of Radius
`
`Anastomoses Around Scapula
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`424.Individual Muscles of Forearm:
`
`411.Pectoral, Clavipectoral
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`Extensors of Wrist and Digits
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`and Axillary Fasciae
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`
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`412.Axilla (Dissection): Anterior View
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`425.Individual Muscles of Forearm:
`
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`413.Brachia! Plexus: Schema
`Flexors of Wrist
`
`ATLAS OF HUMAN ANATOMY
`
`- 14 -
`
`

`

`SECTION VI: UPPER LIMB
`
`426.Individual Muscles of Forearm:
`
`446.Lumbrical Muscles and Bursae,
`
`
`Spaces and Sheaths: Schema
`
`Flexors of Digits
`
`447.Flexor and Extensor Tendons
`427.Muscles of Forearm (Superficial
`
`
`Layer): Posterior View
`in Fingers
`428.Muscles of Forearm (Deep Layer):
`
`448.Intrinsic Muscles of Hand
`View
`Posterior
`
`449.Arteries and Nerves of Hand:
`429.Muscles of Forearm (Superficial
`Palmar Views
`Anterior
`
`
`Layer): View
`430.Muscles of Forearm (Intermediate
`Dissection
`
`
`Layer): Anterior View
`
`431.Muscles of Forearm (Deep Layer):
`Dissection
`
`Anterior View
`452.Wrist and Hand: Deep Dorsal
`
`
`432.Forearm: Serial Cross Sections
`Dissection
`
`433.Attachments of Muscles of
`
`453.Extensor Tendons at Wrist
`
`
`Forearm: Anterior View
`454.Fingers
`
`434.Attachments of Muscles of
`
`
`Forearm: Posterior View
`
`450.Wrist and Hand: Superficial Radial
`
`451.Wrist and Hand: Superficial Dorsal
`
`455. Cutaneous Innervation of Wrist
`
`NEUROVASCULATURE
`
`Plates 455-466
`
`
`WRIST AND HAND
`and Hand
`
`Plates 435-454
`435.Carpal Bones
`
`456.Arteries and Nerves of Upper Limb
`436.Movements of Wrist
`
`457.Musculocutaneous Nerve
`
`43 7. Ligaments of Wrist
`458.Median Nerve
`
`438.Ligaments of Wrist (continued)
`459.Ulnar Nerve
`439.Bones of Wrist and Hand
`
`460.Radial Nerve in Arm and Nerves of
`440.Wrist and Hand:
`
`Posterior Shoulder
`
`Anteroposterior Radiograph
`461.Radial Nerve in Forearm
`
`441.Metacarpophalangeal and
`
`462.Cutaneous Nerves and Superficial
`
`lnterphalangeal Ligaments
`
`Veins of Shoulder and Arm
`442.Wrist and Hand: Superficial
`
`463.Cutaneous Nerves and Superficial
`Palmar Dissections
`Veins of Forearm
`443.Wrist and Hand: Deeper
`
`
`464.Cutaneous Innervation of Upper Limb
`Palmar Dissections
`
`465.Dermatomes of Upper Limb
`
`
`444.Flexor Tendons, Arteries and Nerves
`
`466.Lymph Vessels and Nodes
`at Wrist
`of Upper Limb
`
`445.Bursae, Spaces and Tendon Sheaths
`of Hand
`
`ATLAS OF HUMAN ANATOMY
`
`- 15 -
`
`

`

`Upper limb
`
`
`
`Trapezius muscle
`
`Anterior
`view
`
`Clavicle
`
`Acromion
`
`
`
`Deltoid muscle
`
`
`
`Cephalic vein
`
`X
`
`muscle
`
`Biceps brachii
`
`
`
`Cubital fossa
`
`
`
`Cephalic vein
`
`""--..,;;- - Pectoralis major
`
`muscle
`
`Posterior view
`
`Flexor carpi
`
`
`radialis tendon
`
`Triceps brachii
`
`muscle (long head)
`
`Intermediate (medial)
`
`antebrachial vein
`Triceps
`
`brachii muscle
`Long head
`.:..-� '-- - flexor digitorum
`
`Lateral head
`
`superficialis tendons
`
`
`Flexor carpi ulnaris tendon
`
`
`
`
`
`Hypothenar eminence
`Brachioradialis
`and extensor
`Proximal palmar crease
`carpi radialis
`
`longus muscles
`
`
`
`
`
`Proximal digital crease
`
`
`
`Radial
`longitudinal
`crease
`
`Middle digital crease
`
`carpi Distal digital crease Extensor
`
`
`radialis brevis
`muscle -- - �
`
`::.
`
`Common name
`of digits
`
`I Thumb
`21ndex
`3 Middle
`4 Ring
`5 Little
`
`Extensor pollicis
`
`
`longus tendon
`
`
`
`Flexor carpi ulnaris muscle
`
`
`
`
`
`
`
`Extensor carpi ulnaris muscle
`
`
`
`Cephalic vein
`
`
`
`
`
`Extensor digitorum tendons
`
`Site of proximal
`
`inlerphalangeal (PIP) joint
`
`J�l--t""t- - -Site of distal
`
`interphalangeal (DIP) joint
`
`Ct4f�
`
`C119N
`�-.·;:. :;
`
`SURFACE ANATOMY
`
`PLATE401
`
`- 16 -
`
`

`

`and Sternoclavicular
`Joint
`Clavicle
`
`Right clavicle
`
`surface
`Superior
`
`Shaft body
`
`surface
`Inferior
`
`,&.nteti:.:o�r ____ _
`
`Conoid tubercle
`muscle
`Trapezius
`
`groove
`Subclavian
`muscle)
`(for subclavius
`
`-
`
`facet
`Sternal
`
`-
`-
`-
`
`Muscle origins
`Muscle insertions
`attachments
`Ligament
`
`Sternocleidomastoid muscle
`
`major muscle
`Pectoralis
`-�
`major muscle
`Pectoralis
`ligament
`Costoclavicular
`
`surface
`Inferior
`
`Anterior
`Posterior
`muscle
`Subclavius
`
`�
`Coracoclavicular
`ligament { Conoid ligament
`
`muscle
`S ternohyoid
`
`sternoclavicular
`ligament
`Anterior
`
`Sternoclavicular
`joint
`
`muscle
`Subclavius
`
`cavities
`of
`Articular
`sternoclavicular
`joint
`
`Costa! cartilages
`2nd rib,....-<
`ligament
`sternocostal
`Radiate
`
`PLATE402
`
`UPPER LIMB
`
`- 17 -
`
`

`

`
`
`
`
`Humerus and Scapula: Anterior Views
`
`SEE ALSO PLATE 178
`
`
`
`Lesser tubercle
`
`
`Surgical neck
`
`Crest of
`
`lesser tubercle _,,-,,-1
`
`Deltoid tuberosity/ l
`Medial
`supracondylar ridge
`Lateral
`supracon
`::�::,\
`Coracobrachialis muscle
`
`Condyles
`and /4
`
`Pecto,alis majoc m"sde�
`Lateral
`
`
`Biceps brachii muscle
`Radial
`
`(short head)
`fossa----�-;--
`Lateral / ,,...._,..,...._
`epicondyle
`
`Latissimus dorsi muscle
`Capitulum
`
`Teres major muscle
`
`Deltoid muscle
`
`Coronoid fossa
`
`Medial epicondyle Brachioradialis muscle
`
`
`
`Extensor carpi radialis longus muscle
`
`Common extensor tendon
`
`
`
`(extensor carpi radialis brevis, extensor
`
`
`
`digitorum with extensor digiti minimi
`
`
`and extensor carpi ulnaris muscles)
`
`Brachialis muscle
`
`Supinator muscle
`
`ld
`
`Subscapulari
`s
`muscle
`
`Serratus
`anterior
`muscle
`
`Muscle attachments
`-
`Origins
`-
`Insertions
`
`Pronator teres muscle (humeral head)
`
`
`
`Common flexor tendon
`
`
`
`(flexor carpi radialis, palmaris longus,
`
`
`flexor carpi ulnaris and flexor digitorum
`
`
`superficialis lhumeroulnar head) muscles)
`
`
`
`Flexor digitorum superficialis muscle
`
`(humeroulnar head)
`
`
`Pronator teres muscle (ulnar head)
`
`
`
`
`ti-- Flexor pollicis longus muscle (ulnar head)
`
`
`
`SHOULDER AND AXILLA
`
`PLATE 403
`
`Acromial angle Acromion Coracoid
`proce� Clavicle (cue)
`
`/ Superior angle
`
`
`__ --2r----Superior border
`1----Medial border
`
`Subscapular fossa
`
`lnfraglenoid tubercle
`
`Trapezius muscle
`
`Pectoralis minor muscle
`
`Humerus
`
`
`
`Deltoid muscle
`
`- 18 -
`
`

`

`
`
`
`
`Humerus and Scapula: Posterior Views
`
`SEE ALSO PLATE 778
`
`
`
`Suprascapular notch
`
`
`
`Superior border
`
`
`
`Medial border---
`
`
`
`Inferior angle
`
`t,&> --- Acromial angle
`
`�-r�--Notch connecting
`
`supraspinous and
`
`infraspinous fossae
`
`
`
`Greater tubercle
`
`Head of humerus
`
`
`
`Anatomical neck
`
`
`
`Surgical neck
`
`
`
`lnfraglenoid tubercle
`
`
`
`Deltoid tuberosity
`
`
`
`Supraspinatus muscle
`
`Scapula
`
`
`
`Radial groove
`
`Levator
`scapulae
`muscle
`
`minor
`muscle
`
`major
`muscle
`
`- ....---Supraspinatus muscle
`
`
`
`lnfraspinatus muscle
`
`Teres minor muscle
`
`- - - Triceps brachii muscle
`
`
`(lateral head)
`
`Triceps
`brachii
`muscle
`(long head)
`
`
`
`Olecranon fossa
`
`
`
`Lateral epicondyle
`
`Teres minor
`muscle
`
`Latissimus dorsi
`
`muscle (small
`slip of origin)
`
`Teres major
`muscle
`
`
`
`Deltoid muscle
`
`Groove for ulnar nerve
`
`
`Medial epicondyle
`Brachialis muscle
`
`Triceps brachii muscle
`
`
`
`(medial head)
`
`Muscle attachments
`-
`Origins
`-
`Insertions
`
`
`
`
`
`Triceps brachii muscle
`
`Common 0exor tendon-- --1u
`
`
`
`Common extensor tendon
`
`
`
`Anconeus muscle
`
`PLATE 404
`
`UPPER LIMB
`
`- 19 -
`
`

`

`
`
`Shoulder: Anteroposterior Radiograph
`
`
`
`SEE ALSO PLATE 403
`
`A Acromion
`
`
`AN Anatomical neck of humerus
`C Clavicle
`CP Coracoid process
`
`
`G Glenoid cavity of scapula
`
`GT Greater tubercle
`
`H Humerus
`HH Head of humerus
`
`s Scapula (lateral border)
`
`
`Surgical neck of humerus
`SN
`ss Spine of scapula
`
`
`
`SHOULDER AND AXILLA
`
`PLATE 405
`
`- 20 -
`
`

`

`
`
`
`
`Shoulder (Glenohumera/) Joint
`
`
`
`Anterior view
`
`'-:::><;
`
`----7"�..=:__!!
`
`Acromioclavicular joint capsule
`
`
`
`(incorporating acromioclavicular ligament)
`.-
`--.
`Acromion
`�
`
`Coracoacromial ligament---::.__
`
`Supraspinatus tendon (cul)
`
`Coracohumeral ligament
`
`
`Greater tubercle and
`
`Lesser tubercle
`of humerus
`
`
`Transverse humeral ligament---+-­
`lntertubercular tendon sheath----4;-'t::ll!a
`
`
`
`(communicates with synovia( cavity)
`
`Subscapularis tendon (cut)
`
`
`
`Biceps brachii tendon (long head) -----T
`
`Anterior
`view
`
`Deltoid
`muscle
`
`(reflected)
`
`Acromion
`
`Supraspinatus tendon
`
`(fused to capsule)
`
`Subdeltoid bursa ---­
`
`lnfraspinatus tendon
`
`(fused to capsule)
`
`
`Glenoid cavity (cartilage)
`Teres minor tendon
`
`(fused to capsule)----"'
`
`
`
`Synovial membrane (cut edge)
`
`Openings of subtendinous
`bursa of subscapularis
`
`
`
`
`
`Joint opened: lateral view
`
`---::::::::.----- Clavicle
`Trapezoid
`ligament
`} Coraco-
`clavicular
`Conoid
`ligament
`ligament
`
`Superior transverse
`
`
`scapular ligament and
`
`suprascapular notch
`
`Coracoid process
`
`���
`tf OlfiiN
`
`1•.·:.•:
`:,
`
`
`
`Axillary recess
`
`
`
`
`
`Coronal section through joint
`
`
`
`Capsular
`ligaments
`��- --Subdeltoid bursa fused with
`
`
`subacromial bursa
`
`Subdehoid bursa
`
`Supraspinatus tendon
`
`Capsular ligament
`
`Synovial membrane
`Acromion
`Deltoid
`Acromioclavicular
`muscle
`joint
`Coracoacromial ligament
`
`
`Coracoid process
`
`Coracohumeral ligament
`
`Biceps brachii tendon
`(long head)
`
`Superior glenohumeral
`ligament
`
`Subscapularis tendon
`
`(fused to capsule)
`Middle glenohumeral
`ligament
`Glenoid
`
`Inferior glenohumeral
`labrum
`ligament
`
`PLATE 406
`
`UPPER LIMB
`
`- 21 -
`
`

`

`
`
`Muscles of Shoulder
`
`SEE ALSO PLATES 23, 167, 182, 183, 785, 186
`
`Semispinalis
`capitis
`muscle } Not connected
`S I . . • 1
`to upper limb
`
`p emus cap1t1s muse e
`
`
`Spinous process of C7 vertebra
`
`
`Levator scapulae muscle
`minor muscle
`Rhomboid
`Acromion
`
`Supraspinatus muscle
`
`lnfraspinatus muscle
`
`Latissimus dorsi muscle
`
`Long head } Triceps
`brachii
`head muscle
`Lateral
`
`
`Spinous process of
`Tl 2 vertebra
`
`Omohyoid muscle and
`
`investing layer of
`
`deep cervical fascia
`
`Clavicular
`head
`
`Pectoral is
`� ---Sternocostal
`major
`head
`muscle
`Abdominal
`part
`
`view
`Posterior
`
`Trapezius muscle
`
`Deltoid
`muscle
`lnfraspinatus
`fascia----
`
`
`
`Triangle of auscultation
`
`Deltopectoral triangle
`
`
`Deltoid muscle
`Dehoid branch of
`thoracoacromial artery
`
`Cephalic vein
`Biceps
`Long head
`brachii
`l
`muscle Shon head
`
`
`Triceps brachii muscle
`
`(lateral head) ___ ,
`
`Latissimus dorsi muscle
`
`
`Serratus anterior muscle
`
`
`External oblique muscle
`
`
`
`SHOULDER AND AXILLA
`
`PLATE 407
`
`- 22 -
`
`

`

`
`
`
`
`Muscles of Rotator Cuff
`
`
`
`Superior view
`
`{ Trapezoid ligament
`
`
`Coracoclavicular ligament
`Conoid ligament
`
`Coracoid process
`
`
`Subscapularis tendon
`
`Coracoacromial ligament
`
`Acromioclavicular joint
`
`lnfraspinatus
`tendon
`Teres minor
`tendon
`
`
`
`lnfraspinatus muscle
`
`Supraspinatus muscle
`
`Superior border of scapula
`
`
`muscle
`Subscapularis
`
`Coracoacromial ligament
`
`Coracoid process
`transverse
`Superior
`
`
`scapular ligament and
`suprascapular notch
`
`Supraspinatus muscle
`
`Spine of scapula
`
`Teres
`minor
`muscle
`
`
`
`Axillary nerve
`
`
`
`Anterior view
`
`
`
`Posterior view
`
`PLATE 408
`
`UPPER LIMB
`
`- 23 -
`
`

`

`
`
`lnterlubercular tendon sheath
`
`Axillary nerve and
`
`
`posterior circumnex
`
`humeral artery----
`
`
`
`Quadrangular space
`
`
`
`Coracobrachialis muscle
`
`
`
`Latissimus dorsi muscle
`
`
`
`Posterior view
`
`Superior transverse scapular
`
`
`
`ligament and suprascapular
`notch ________ __.
`
`
`
`Supraspinatus muscle (cul)
`
`Spine of scapula
`
`Triangular space with
`
`
`
`circumflex scapular artery
`deep to space------
`
`
`
`Scapulohumeral Dissection
`
`SEE ALSO PLATE 460
`
`Superior transverse scapular
`
`
`
`ligament and suprascapular
`notch
`
`
`
`Pectoralis minor tendon (cut)
`
`Biceps brachii tendon
`
`
`
`(short head) (cul) and
`
`coracobrachialis tendon
`(cut)
`
`
`
`Subscapularis muscle
`
`
`
`Subscapular artery
`
`Lower subscapular nerve
`
`(to teres major muscle)
`
`
`
`
`
`Circumnex scapular artery
`
`Thoracodorsal artery and
`
`
`
`nerve (to latissimus dorsi
`muscle)
`
`
`
`Subscapularis muscle
`
`Teres major muscle
`
`
`
`
`
`Suprascapular artery and nerve
`
`Quadrangular space
`
`
`transmitting axillary
`nerve and posterior
`
`
`circumnex humeral artery
`
`Superior lateral
`
`
`cutaneous nerve of arm
`
`Deep artery of arm and
`
`
`Radial nerve
`shown between
`
`Lateral head and
`Long head of
`
`
`triceps brachii muscle
`
`
`
`SHOULDER AND AXILLA
`
`PLATE 409
`
`- 24 -
`
`

`

`
`
`Around Scapula Axillary Artery and Anastomoses
`
`
`
`SEE ALSO PLATES 29, 417
`
`
`
`
`
`Ascending cervical artery
`
`
`
`Anterior view
`
`
`
`
`
`Transverse cervical artery
`
`
`
`
`
`�IIP- --- Inferior thyroid artery
`
`
`
`Suprascapular artery
`
`
`
`Thyrocervical trunk
`
`Acromion and
`
`
`
`acromial anastomosis -- 4!:. c,-
`
`
`
`Coracoid process
`
`Anterior circumflex
`
`
`humeral artery
`
`Posterior circumflex
`
`
`humeral artery
`
`artery
`Subscapular
`
`Circumflex
`
`scapular artery
`
`
`
`Brachia! artery
`
`
`
`Thoracodorsal artery
`
`�-�-=��-------Superior thoracic
`
`artery
`
`
`
`Thoracoacromial artery
`
`
`
`Clavicular branch
`
`
`
`Acromial branch
`
`
`
`Deltoid branch
`
`
`
`Pectoral branch
`
`1, 2, 3 indicate 1st,
`
`2nd and 3rd parts of
`
`axillary artery
`
`
`
`
`
`Lateral thoracic artery
`
`
`
`
`
`Levator scapular muscle
`
`
`
`
`
`Dorsal scapular artery
`
`
`
`Supraspinatus muscle (cul}
`
`Superior transverse
`
`
`scapular ligament
`
`and suprascapular notch
`
`Spine of scapula
`
`
`
`I nfraspinatus muscle (cul}
`
`Teres minor muscle (cul)
`
`Teres major muscle
`
`Acromion and
`
`
`acromial plexus
`
`�...;::: �� ---lnfraspinous
`branch of
`suprascapular
`artery
`
`� il!:!IA- -�-- Posterior
`circumflex
`humeral
`
`artery (in
`quadrangular
`space)and
`
`ascending and
`descending
`branches
`
`Circumflex
`
`scapular artery
`
`l Triceps
`
`brachii
`muscle
`
`Posterior
`view
`
`C:J/� _,,,,�.
`ClfiiN
`t�·-·.•.::
`
`PLATE 410
`
`UPPER LIMB
`
`- 25 -
`
`

`

`
`
`Pectoral Clavipectoral and Axillary Fasciae
`
`
`
`Thoracoacromial artery
`
`
`Coracoid process
`
`Cephalic vein
`Deltoid
`muscle---,-
`Pectoralis
`major
`muscle (cut)
`Biceps
`brachii
`muscle
`Short head
`Long head
`
`Brachia! fascia
`
`(cut edge) over
`coracobrachialis
`
`and biceps brachii
`muscles
`
`SEE ALSO PLATE 182
`
`Omohyoid muscle invested by
`
`
`
`
`fascia of infrahyoid muscles
`Clavicle
`
`Fascia investing
`
`subclavius muscle'
`
`Fascia investing pectoralis
`
`
`minor muscle
`
`
`Suspensory ligament of axilla*
`
`Pectoralis major muscle and
`
`
`pectoral fascia (superficial
`and deep layers)
`
`Latissimus dorsi fascia
`
`
`Serratus anterior fascia
`1£..-----Axillary fascia
`
`(anterior part)
`
`
`
`Anterior view
`
`
`
`
`
`Oblique parasagittal section of axilla
`
`
`
`
`Trapezius muscle
`
`plexus l Supraspinatus Brachia! muscle -----"'"'-<"".'"'-l:
`
`� Spine
`Scapula
`i Body
`
`lnfraspinatus muscle -----r,,
`
`Subscapularis muscle ---��-r
`Teres minor muscle-- -....:..:�� :\
`Teres major muscle-- --- -+l,;.)(1.,-.J
`
`Latissimus dorsi muscle --
`{ Central
`
`Axillary lymph nodes Pectoral
`(anterior)
`
`'::!'
`
`---.:i-�
`---
`
`(fenestrated)
`
`•components of clavipectoral fascia
`
`
`
`SHOULDER AND AXILLA
`
`PLATE 411
`
`Omohyoid muscle
`
`
`Subclavius muscle and fascia*
`
`Costocoracoid ligament•
`
`
`vein-�.._,,,;;���-\'�,---Thoracoacromial artery and cephalic
`
`
`Lateral pectoral nerve
`
`
`Axillary artery and vein
`
`Pectoralis major muscle and fascia
`
`Pectoralis minor muscle and fascia*
`
`Medial pectoral nerve
`
`
`Suspensory ligament of axilla
`
`Axillary fascia
`
`
`
`- 26 -
`
`

`

`
`Thoracoacromial artery Trapezius
`
`Pectoralis minor tendon (cut)
`
`Acromial branch muscle
`
`
`Deltoid branch
`
`Clavicular branch
`
`Pectoral branch
`
`
`
`Suprascapular artery and nerve
`
`
`
`
`
`Dorsal scapular artery and nerve
`
`
`
`Axillary artery
`
`Clavicle and
`
`subclavius
`muscle
`(cul)
`
`
`
`
`
`Axil/a (Dissection): Anterior View
`
`
`
`
`
`
`
`Coracoid process
`
`
`
`Cephalic vein
`
`
`
`Musculoculaneous nerve
`
`
`
`
`
`Anterior circumflex humeral artery
`
`
`
`Axillary nerve and posterior
`
`
`
`circumflex humeral artery
`
`
`
`Pectoralis major muscle (cut)
`
`
`
`Coracobrachialis muscle
`
`Musculocuta-
`
`Brachialis
`muscle
`
`Medial cutaneous
`nerve of arm
`
`nerve
`
`Circumflex
`
`scapular artery
`
`Lower sub­
`
`scapular nerve
`
`Deep
`artery
`of arm
`
`
`
`Radial nerve
`
`Triceps
`brachii
`muscle
`
`
`
`Brachia! veins
`
`Ulnar nerve
`
`Median nerve
`
`
`
`Brachia! artery
`
`
`
`latissimus dorsi muscle
`
`
`
`
`Medial cutaneous nerve
`of the forearm
`
`
`
`Upper subscapular nerve
`
`
`
`Thoracodorsal artery and nerve
`
`
`
`Basilic vein
`
`
`
`
`
`Serratus anterior muscle
`
`Subclavian
`
`artery and vein
`
`1st rib
`
`
`
`Brachia! plexus
`
`
`
`
`
`Superior thoracic artery
`
`
`
`lateral pectoral nerve
`
`
`
`Lateral thoracic artery and long thoracic nerve
`
`
`
`
`
`
`
`
`
`nerve Pectoralis minor muscle (cut) Medial pectoral
`
`
`
`PLATE 412
`
`UPPER LIMB
`
`- 27 -
`
`

`

`Note: Usual composition shown.
`
`
`
`Prefixed plexus has large C4
`
`contribution but lacks Tl.
`
`
`Postfixed plexus lacks CS but
`has T2 contribution
`
`Musculocutaneous
`nerve (CS, 6, 7)�
`
`Axillary
`nerve (CS, 6)
`
`Median nerve
`(CS, 6, 7, 8, Tl)
`Ulnar nerv�
`(C7, 8, Tl)
`
`
`
`Inconstant contribution
`
`
`
`Brachia/ Plexus: Schema
`
`Suprascapular
`nerve (CS, 6)
`
`\
`
`To longus co/Ii
`
`and scalene
`muscles
`(CS, 6, 7, 8)
`Long thoracic
`nerve (CS, 6, 7)
`
`Medial cutaneous nerve of arm (Tl)
`
`
`
`
`
`Medial cutaneous nerve of forearm (CB, Tl)
`
`Upper subscapular nerve (CS, 6)
`
`
`
`Thoracodorsal (middle subscapular) nerve (C6, 7, 8)
`
`Lower subscapular nerve (CS, 6)
`
`
`
`SHOULDER AND AXILLA
`
`PLATE 413
`
`- 28 -
`
`

`

`
`
`Muscles of Arm: Anterior Views
`
`
`
`�-�� ---- -- --- -Acromion
`�.- -.-Coracoid process
`
`Pectoralis minor tendon (cut)
`
`
`Subscapu laris muscle
`-----Musculocutaneous nerve (cut)
`
`Coracobrachialis muscle
`
`
`
`Circumflex scapular artery (cut)
`Teres major muscle
`
`Latissimus dorsi muscle
`
`Biceps brachii
`
`
`tendons (cut)
`Short head
`Long head
`
`Coracobrachialis muscle
`
`Musculocutaneous nerve
`
`SEE ALSO PLATE 457
`
`
`
`Coracoacromial ligament
`
`�--_,...
`
`------..r.­
`Greater tubercle,
`
`tubercle- -----
`Lesser
`of humerus
`lntertubercular
`tendon sheath
`
`(reflected)
`
`Pectoralis major
`
`muscle
`
`Anterior circumflex
`
`humeral artery
`
`Biceps Long head
`brachii
`l
`muscle Short head
`
`
`Brachia! artery (cut)
`Median nerve (cul)
`
`Brachialis muscle
`
`Lateral cutaneous
`nerve of forearm
`
`Bicipital aponeurosis
`
`
`Biceps brachii tendon
`
`Brachioradialis muscle
`
`Flexor carpi
`
`
`radialis muscle---- -=:::;_:�.:....:;. �
`
`
`
`Superficial layer
`
`Lateral intermuscular septum---....:
`
`
`
`
`Lateral epicondyle of humerus--{_
`
`
`Lateral cutaneous nerve of forearm
`Head of radius
`
`
`Biceps brachii tendon
`
`Radial tuberosity---.i___
`
`-"
`
`Deep layer
`
`
`
`Brachialis muscle
`
`
`
`Tuberosity of ulna
`
`PLATE 414
`
`UPPER LIMB
`
`- 29 -
`
`

`

`
`
`Muscles of Arm: Posterior Views
`
`SEE ALSO PLATE 460
`
`
`Superficial layer
`'1"."'::-- ---Supraspinatus muscle
`� ..... ----Greater
`tubercle of humerus
`,.._- ---lnfraspinatus muscle
`'IJ.:.:?�ra---Teres minor muscle
`
`Axillary nerve and posterior
`
`
`circumflex humeral artery
`
`Deltoid muscle (cut and reflected)
`
`
`
`Superior lateral cutaneous nerve of arm
`
`Long head l
`
`
`
`Tendon
`
`
`
`Lateral head Triceps brachii muscle
`
`Posterior cutaneous
`
`nerve of arm
`
`(from radial nerve)
`Medial inter­
`
`muscular septum
`
`Teres
`major
`muscle
`
`Medial epicondyle
`of humerus- ---- -..-
`
`Olecranon of ulna ---
`
`Flexor carpi
`
`ulnaris muscle ----7
`
`Anconeus muscle
`
`Extensor carpi
`
`
`radialis longus muscle
`
`
`Extensor carpi ulnaris muscle
`
`Posterior cutaneous
`nerve of forearm
`
`(from radial nerve)
`
`
`Extensor digitorum muscle
`
`carpi radialis brevis
`muscle
`Extensor
`Medial head of
`
`
`triceps brachii muscle
`Medial epicondyle
`of humerus- ---- tl
`Ulnar nerve
`
`Olecranon of ulna
`
`Anconeus muscle
`Deep layer
`
`Long head of
`
`
`triceps brachii muscle
`
`
`
`Capsule of shoulder joint
`
`
`
`
`
`Axillary nerve
`
`Posterior circumflex
`
`
`humeral artery
`
`� � � - --superior lateral
`
`cutaneous nerve of arm
`
`
`
`Middle collateral artery
`
`
`
`
`
`Radial collateral artery
`
`Inferior lateral cutaneous
`
`
`nerve of arm
`
`Nerve to anconeus and
`
`
`lateral head of
`
`
`triceps brachii muscle
`
`�,li� ... t"'T --Posterior
`
`cutaneous nerve
`of forearm
`
`Lateral epicondyle
`
`of humerus
`
`ARM
`
`PLATE 415
`
`- 30 -
`
`

`

`
`
`Brachia/ Artery In Situ
`
`Coracoid process----
`
`
`Deltoid muscle---
`
`Anterior circumOex
`
`humeral artery-__ _
`
`major
`Pectoralis
`muscle and tendon (cut)
`Biceps
`l brachii
`muscle .
`
`Coracobrachialis muscle
`
`Brachia! artery
`
`:
`....
`
`.. ..
`. . .
`
`" ;
`t
`
`branch----
`Muscular
`
`
`Biceps brachii muscle-----
`
`Brachialis muscle
`
`
`Radial recurrent