Outline

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Outline

• Superficial Back
• Joints
• Pectoral/Breast
• Abdominal Wall musculature
• Inguinal canal-structure

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Joints

• A joint, or articulation, is the place where two
  bones come together. There are three types of
  joints classified by the amount of movement they
  allow immovable, slightly movable, and freely
  movable.
• Immovable joints are synarthroses. In this type
  of joint, the bones are in very close contact and
  are separated only by a thin layer of fibrous
  connective tissue. An example of a synarthrosis
  is the suture in the skull between skull bones.
• Slightly movable joints are called
  amphiarthroses. This type of joint is
  characterized by bones that are connected by
  hyaline cartilage (fibro cartilage). The ribs
  that connect to the sternum are an example of an
  amphiarthrosis joint.
• Most of the joints in the adult human body are
  freely movable joints. This type of joint is
  called a diarthrosis joint. There are six types
  of diarthroses joints.

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There are six types of diarthroses joints.

• Ball-and-Socket The ball-shaped end of one bone
  fits into a cup shaped socket on the other bone
  allowing the widest range of motion including
  rotation. Examples include the shoulder and hip.
• Condyloid Allowing angular motion but not
  rotation. This occurs between the metacarpals
  (bones in the palm of the hand) and phalanges
  (fingers) and between the metatarsals (foot bones
  excluding heel) and phalanges (toes).
• Saddle This type of joint occurs when the
  touching surfaces of two bones have both concave
  and convex regions with the shapes of the two
  bones complementing one other and allowing a wide
  range of movement. The only saddle joint in the
  body is in the thumb.
• Pivot Rounded or conical surfaces of one bone
  fit into a ring of another one thereby allowing
  rotation. An example is the joint between the
  ulna and radius.
• Hinge A convex projection on one bone fits into
  a concave depression in another permitting only
  flexion and extension as in the elbow and knee
  joints.
• Gliding Flat or slightly flat surfaces move
  against each other allowing sliding or twisting
  without any circular movement. This happens in
  the carpals in the wrist and the tarsals in the
  ankle.

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Clavicle

• Clavicle to sternum joint is a saddle joint that
  acts like a ball and socket joint.

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Clavicle

• The clavicle forms the anterior portion of the
  shoulder girdle. It is a long bone, placed nearly
  horizontally at the upper and anterior part of
  the thorax, immediately above the first rib.
• It articulates medially with the manubrium
  sterni, and laterally with the acromion of the
  scapula. It presents a double curvature, the
  convexity being directed forward at the sternal
  end, and the concavity at the scapular end.
• Its lateral third is flattened from above
  downward, while its medial two-thirds is of a
  rounded or prismatic form.   1 Lateral Third.The
  lateral third has two surfaces, an upper and a
  lower and two borders, an anterior and a
  posterior.   2 Surface.The upper surface is
  flat, rough, and marked by impressions for the
  attachments of the Deltoideus in front, and the
  Trapezius behind
• between these impressions a small portion of the
  bone is subcutaneous. The under surface is flat.
  At its posterior border, near the point where the
  prismatic joins with the flattened portion, is a
  rough eminence, the coracoid tuberosity (conoid
  tubercle) this, in the natural position of the
  bone, surmounts the coracoid process of the
  scapula, and gives attachment to the conoid
  ligament. From this tuberosity an oblique ridge,
  the oblique or trapezoid ridge, runs forward and
  lateralward, and afford attachment to the
  trapezoid ligament.

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• Left clavicle. Top view and bottom view

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Scapula

• (Shoulder Blade)The scapula forms the posterior
  part of the shoulder girdle. It is a flat,
  triangular bone, with two surfaces, three
  borders, and three angles.   
• Surfaces.The costal or ventral surface presents
  a broad concavity, the subscapular fossa.
• At the upper part of the fossa is a transverse
  depression, where the bone appears to be bent on
  itself along a line at right angles to and
  passing through the center of the glenoid cavity,
  forming a considerable angle, called the
  subscapular angle this gives greater strength to
  the body of the bone by its arched form, while
  the summit of the arch serves to support the
  spine and acromion.  
• The dorsal surface is arched from above downward,
  and is subdivided into two unequal parts by the
  spine the portion above the spine is called the
  supraspinatous fossa, and that below it the
  infraspinatous fossa.   
• The supraspinatous fossa, the smaller of the two,
  is concave, smooth, and broader at its vertebral
  than at its humeral end its medial two-thirds
  give origin to the Supraspinatus.  

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Superficial back

• Fascia
• subcutaneous tissue or superficial fascia -
  allows movement of skin on deeper structures
• investing or deep fascia - encloses regions,
  muscles, forms compartments - named
  specializations. Surrounds entire muscle group.
• Muscle and muscular fascia surround individual
  muscles
• Loose connective tissue between muscles and
  organs
• allows movement of parts and contains
  neurovascular elements
• It can be site of fat storage
• Neurovascular bundles- arteries, veins, nerves.

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• The infraspinatous fossa is much larger
• The medial two-thirds of the fossa give origin to
  the Infraspinatus the lateral third is covered
  by this muscle. 
• The surface between the ridge and the axillary
  border is narrow in the upper two-thirds of its
  extent, and is crossed near its center by a
  groove for the passage of the scapular circumflex
  vessels
• It affords attachment to the Teres minor. Its
  lower third presents a broader, somewhat
  triangular surface, which gives origin to the
  Teres major, and over which the Latissimus dorsi
  glides
• The Spine (spina scapulæ).The spine is a
  prominent plate of bone, which crosses obliquely
  the medial four-fifths of the dorsal surface of
  the scapula at its upper part, and separates the
  supra- from the infraspinatous fossa.
• It begins at the vertical border by a smooth,
  triangular area over which the tendon of
  insertion of the lower part of the Trapezius
  glides, and, gradually becoming more elevated,
  ends in the acromion, which overhangs the
  shoulder-joint.

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• The spine is triangular, and flattened from above
  downward, its apex being directed toward the
  vertebral border. It presents two surfaces and
  three borders.
• The Acromion.The acromion forms the summit of
  the shoulder, and is a large, somewhat triangular
  or oblong process, flattened from behind forward,
  projecting at first lateralward, and then curving
  forward and upward, so as to overhang the glenoid
  cavity.
• Its superior surface, directed upward, backward,
  and lateralward, is convex, rough, and gives
  attachment to some fibers of the Deltoideus, and
  in the rest of its extent is subcutaneous. Its
  inferior surface is smooth and concave. Its
  lateral border is thick and irregular, and
  presents three or four tubercles for the
  tendinous origins of the Deltoideus. Its medial
  border, shorter than the lateral, is concave,
  gives attachment to a portion of the Trapezius,
  and presents about its center a small, oval
  surface for articulation with the acromial end of
  the clavicle.

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Humerus

• The humerus is the longest and largest bone of
  the upper extremity it is divisible into a body
  and two extremities. 
•  Upper Extremity.The upper extremity consists of
  a large rounded head joined to the body by a
  constricted portion called the neck, and two
  eminences, the greater and lesser tubercles. 
• The Head - The head, nearly hemispherical in
  form, is directed upward, medialward, and a
  little backward, and articulates with the glenoid
  cavity of the scapula. The circumference of its
  articular surface is slightly constricted and is
  termed the anatomical neck, in contradistinction
  to a constriction below the tubercles called the
  surgical neck which is frequently the seat of
  fracture. Fracture of the anatomical neck rarely
  occurs.  
• The Anatomical Neck is obliquely directed,
  forming an obtuse angle with the body.
• The Greater Tubercle - The greater tubercle is
  situated lateral to the head and lesser tubercle.
  Its upper surface is rounded and marked by three
  flat impressions the highest of these gives
  insertion to the Supraspinatus the middle to the
  Infraspinatus the lowest one, and the body of
  the bone for about 2.5 cm. below it, to the Teres
  minor.
• The lateral surface of the greater tubercle is
  convex, rough, and continuous with the lateral
  surface of the body. 
•  The Lesser Tubercle-The lesser tubercle,
  although smaller, is more prominent than the
  greater it is situated in front, and is directed
  medialward and forward. Above and in front it
  presents an impression for the insertion of the
  tendon of the Subscapularis. 
• The tubercles are separated from each other by a
  deep groove, the intertubercular groove
  (bicipital groove), which lodges the long tendon
  of the Biceps brachii and transmits a branch of
  the anterior humeral circumflex artery to the
  shoulder-joint. It runs obliquely downward, and
  ends near the junction of the upper with the
  middle third of the bone.

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Back continued

• Superficial back muscles
• Trapezius-spinal root of accessory nerve and C3,
  C4
• latissimus dorsi-thoracodorsal n.(C6,C7,C8)
• levator scapulae-dorsal scapular(C5) and C3, C4
• rhomboideus major-dorsal scapular
• rhomboideus minor-dorsal scapular
• triangles
• Ausculation-6th intercostal space. Formed by
  trapezius and latissimus dorsi. Listen to lungs
  here.
• Lumbar-formed by abdominal obliques and
  latissimus dorsi. Hernia can happen here.

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Back continued.

• Nerves
• spinal accessory n. (Cranial Nerve XI) - motor to
  trapezius
• C3, C4 (sensory from trapezius) and subtrapezial
  plexus
• dorsal scapular n (C5)
• thoracodorsal n (C5, 6)
• cutaneous nn. of back
• distinction between cutaneous vs sensory nerves,
  muscular vs motor nerves
• origin - dorsal primary rami (DPR) of spinal
  nerves
• distribution
• greater occipital n. - from DPR of C2

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More back

• Vessels
• transverse cervical artery and vein-trapezius
• dorsal scapular artery and vein
• thoracodorsal artery and veins
• Deep branch of transverse cervical runs with
  dorsal scapular n.
• Superficial branch of transverse cervical runs
  with CN XI.

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Pectoral region and breast

• Muscles
• pectoralis major
• pectoralis minor
• serratus anterior
• Subclavius
• Clavicle-fracture so your left with medial 2/3rd
  and lateral 1/3rd.
• Know the Coracoclavicular ligaments-trapezoid and
  conoid

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• Nerves
• medial pectoral nerve - pierces pectoralis minor
  innervates both muscles
• lateral pectoral nerve - runs w/ thoracoacromial
  artery innervates pectoralis major
• Nerve to subclavius
• Long thoracic nerve-winged scapula

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• Blood Supply
• thoracoacromial artery - through clavipectoral
  fascia. All of except serratus anterior
• Lateral thoracic arttery-serratus anterior and
  pec minor
• Side note know the different fascias and
  costocoracoid membrane and suspensory lig of
  axilla.

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• READ THIS ON YOUR OWN TIME
• Pectoral Fascia.The pectoral fascia is a thin
  lamina, covering the surface of the Pectoralis
  major, and sending numerous prolongations between
  its fasciculi it is attached, in the middle
  line, to the front of the sternum above, to the
  clavicle laterally and below it is continuous
  with the fascia of the shoulder, axilla, and
  thorax. It is very thin over the upper part of
  the Pectoralis major, but thicker in the interval
  between it and the Latissimus dorsi, where it
  closes in the axillary space and forms the
  axillary fascia it divides at the lateral margin
  of the Latissimus dorsi into two layers, one of
  which passes in front of, and the other behind
  it these proceed as far as the spinous processes
  of the thoracic vertebræ, to which they are
  attached. As the fascia leaves the lower edge of
  the Pectoralis major to cross the floor of the
  axilla it sends a layer upward under cover of the
  muscle this lamina splits to envelop the
  Pectoralis minor, at the upper edge of which it
  is continuous with the coracoclavicular fascia.
  The hollow of the armpit, seen when the arm is
  abducted, is produced mainly by the traction of
  this fascia on the axillary floor, and hence the
  lamina is sometimes named the suspensory ligament
  of the axilla. At the lower part of the thoracic
  region the deep fascia is well-developed, and is
  continuous with the fibrous sheaths of the Recti
  abdominis.

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Clinical Correlations

• Winged scapula-long thoracic nerve damage
• Shoulder separation-acromioclavicular joint is
  disrupted
• Peau d'Orange From the French term, orange skin,
  this identifies a malignant obstruction of the
  superficial lymphatic channels.
• Skin Retraction Skin or Cooper's ligament pulled
  in by a malignant lesion.
• Nipple Inversion Inward retraction of the nipple
  by a malignant ductal lesion.

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Basic Breast Outline

• Breast Structure
• gland in subcutaneous tissue
• 15-20 lobes with lactiferous ducts and sinuses
  opening directly onto nipple
• Neurovascular Supply
• Internal thoracic, Lateral thoracic, and Superior
  thoracic arterys
• Lymphatic Drainage
• Clinical Significance predicting the metastasis
  of carcinoma of the breast!
• 75 to axillary nodes (via pectoral group)
• remaining to parasternal and abdominal wall nodes
  

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Breast Lymphatics

• The anatomy of the axilla or the axillary basin
  is important to all oncologic surgeons as it
  represents the principal lymphatic drainage
  region of the breast.
• Lymphatic metastasis from a malignant breast
  lesion will most often occur in this region. For
  inner quadrant lesions, it can occur in the
  internal mammary chain.
• Lymphatic metastasis can also be present in the
  supraclavicular nodes.

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• THE BREAST
• The Breast Parenchyma The breast is the
  specialized human tissue located on the chest
  between the pectoralis muscle, i.e. the
  superficial fascia and the subcutaneous tissue,
  i.e. right beneath the skin.
• The Retromammary Space The breast rests on a
  rich vascular and lymphatic network within the
  pectoralis fascia. This represents the
  retromammary space which is positioned between
  the deep pectoralis fascia and the superficial
  pectoralis fascia. If this is invaded it is bad
  news
• The Nipple-Areolar Complex The Nipple-Areolar
  complex is the center of the breast. It is the
  end portion of the largest lactiferous duct.

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• The Lobules The lobules, also called the lobular
  units, are responsible for the production of
  milk.
• The Ductal System The milk is collected by
  distal lactiferous ducts or acini which merge
  into minor and then major lactiferous ducts. In
  most instances, these empty into the major duct
  or sinus which ends in the nipple. The ductal
  system has a ductal epithelium surrounded by a
  myo-epithelium. This ductal epithelium is
  responsible for the propulsion of milk through
  the ductal system as it has contractile
  capabilities. This ductal system is sealed and
  surrounded by an uninterrupted basement membrane.
  
• The Stroma This interlobular tissue, also
  referred to as connective tissue, contains
  capillaries and other specialized cells.
• Cooper's Ligaments These are dense strands of
  fascia found throughout the entire breast which
  end on the skin itself.

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Abdominal Wall

• Boundaries of the Abdomen
• Superior Boundary The diaphragm Fifth
  intercostal space.
• Posterior Boundary Lumbar Vertebrae and
  Quadratus Lumborum mm.
• Anterolateral Borders The muscles of abdominal
  wall.
• Inferior Borders The Pelvic Brim. Anterior
  Superior Iliac Spine (ASIS) The anterior most
  feature on the iliac crest.Pubic Tubercle
  Lateral edge of pubic bone.
• Inguinal Ligament Extends between the ASIS and
  the pubic tubercle.UMBILICUS Usually between L3
  and L4 in physically fit persons.

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• Layers of Anterior abdominal Wall
• Skin
• Superficial fascia Fatty (Camper's) and
  Membranous (Scarpa's)
• Deep fascia
• Muscles
• lateral (flank)
• external oblique the aponeurosis forms the
  inguinal ligament and the superficial inguinal
  ring. Superficial Inguinal Ring allows passage of
  the spermatic cord (male) or round ligament
  (female) and is made up of two components,
  lateral crus and medial crus. Intercrural fibers
  separate the two.
• internal oblique
• transversus abdomins
• anterior rectus abdominis, pyramidalis

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Fascial Layers

• The Superficial Fascia.The superficial fascia of
  the abdomen consists of a single layer containing
  a variable amount of fat but near the groin it
  is easily divisible into two layers, between
  which are found the superficial vessels and
  nerves and the superficial inguinal lymph
  glands. 
• The superficial layer (fascia of Camper) is
  thick, areolar in texture, and contains adipose
  tissue. Below, it passes over the inguinal
  ligament, and is continuous with the superficial
  fascia of the thigh. In the male, Campers fascia
  is continued over the penis and outer surface of
  the spermatic cord to the scrotum, where it helps
  to form the dartos.
• As it passes to the scrotum it changes its
  characteristics, becoming thin, destitute of
  adipose tissue, and of a pale reddish color, and
  in the scrotum it acquires some involuntary
  muscular fibers. From the scrotum it may be
  traced backward into continuity with the
  superficial fascia of the perineum.
• In the female, Campers fascia is continued from
  the abdomen into the labia majora. 
• The deep layer (fascia of Scarpa) is thinner and
  more membranous in character than the
  superficial, and contains elastic fibers. It is
  loosely connected by areolar tissue to the
  aponeurosis of the Obliquus externus abdominis,
  but in the middle line it is more intimately
  adherent to the linea alba and to the symphysis
  pubis
• it is continued over the penis and spermatic cord
  to the scrotum, where it helps to form the
  dartos. From the scrotum it may be traced
  backward into continuity with the deep layer of
  the superficial fascia of the perineum (fascia of
  Colles). In the female, it is continued into the
  labia majora and thence to the fascia of Colles.

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Muscles

• External Abdominal Oblique-intercostal nerves
  7-11, subcostal, iliohypogastric and ilioinguinal
  nerves. the external spermatic fascia is the
  external abdominal oblique muscle's contribution
  to the coverings of the testis and spermatic cord
  
• Internal Abdominal Oblique-the cremaster muscle
  and fascia is the internal abdominal oblique
  muscle's contribution to the coverings of the
  testis and spermatic cord
• Transversus Abdominus
• Rectus Abdominus-rectus sheath contains rectus
  abdominis and is formed by the aponeuroses of
  external and internal oblique and transversus
  abdominis mm.

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• Innervation
• thoracoabdominal nerves (branches of the VPR of
  T7-T11) travel anteroinferiorly between the
  internal oblique and transverse abdominal muscles
  (remember the analogous situation in the thorax).
  Supplies motor (to the muscles) and sensory
  (cutaneous) fibers. Distribution is as follows
• T7-T9 - superior to umbilicus
• T10 - at level of umbilicus
• T11 (along with subcostal, iliohypogastric, and
  ilioinguinal nerves) - inferior to umbilicus.
• subcostal nerves (T12) travel anteroinferiorly
  between the internal oblique and transverse
  abdominal muscles (remember the analogous
  situation in the thorax) to innervate the wall
  inferior to the umbilicus. Supplies motor (to the
  muscles) and sensory (cutaneous) fibers.
• iliohypogastric nerves (L1) path is somewhat
  similar to thoracoabdominal nerves and subcostal
  nerves, that is, anteroinferiorly between the
  internal oblique and transverse abdominal muscles
  for part of the way. However, the iliohypogastric
  nerves and ilioinguinal nerves are different in
  that they pierce the internal abdominal oblique
  at the anterior superior iliac spine to travel
  superficial to it and deep to the external
  abdominal oblique. Supplies motor (to the
  muscles) and sensory (cutaneous) fibers to the
  wall inferior to the umbilicus.
• ilioinguinal nerves (L1) supplies motor (to the
  muscles) and sensory (cutaneous) fibers to the
  wall inferior to the umbilicus. Sometimes
  considered separate from the iliohypogastric
  nerves because ilioinguinal nerves also innervate
  the scrotum or labia by sending branches through
  the inguinal canal. The iliohypogastric nerves
  and ilioinguinal nerves are different in that
  they pierce the internal abdominal oblique at the
  anterior superior iliac spine to travel
  superficial to it and deep to the external
  abdominal oblique.

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• Blood Supply
• superior epigastric arteries continuation of the
  internal thoracic arteries. They run inferiorly
  in the rectus sheath, deep to the rectus
  abdominis muscle. The superior epigastric
  arteries anastomose with the inferior epigastric
  arteries within the rectus sheath.
• inferior epigastric arteries branches of the
  external iliac arteries. They run superiorly in
  the rectus sheath, deep to the rectus abdominis.
  The inferior epigastric arteries anastomose with
  the superior epigastric artery within the rectus
  sheath.
• deep circumflex iliac arteries branches of the
  external iliac arteries. They run deep in the
  abdominal wall, parallel to the inguinal
  ligament.
• superficial circumflex iliac arteries branches
  of the femoral arteries. They run superficially
  in the abdominal wall, parallel to the inguinal
  ligament.
• superficial epigastric arteries branches of the
  femoral arteries. They run superficially,
  superiorly toward the umbilicus.

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• Vessels (anastamosis)
• Superficial epigastric art.
• Superficial external pudendal art.
• Superficial circumflex iliac art.
• Deeper vessels
• Superior and inferior epigastric (inside rectus
  sheath)
• Intercostal
• Deep circumflex iliac
• Rectus sheath Arcuate Line The line that
  divides the upper 3/4 of abdomen wall from lower
  1/4, by the differences in the aponeurotic
  layers.

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• Lymphatic drainage
• superficial lymphatic vessels accompany
  superficial arteries. Most of them above the
  umbilicus ultimately drain into the axillary
  lymph nodes. Below the umbilicus, the vessels
  drain into the superficial inguinal lymph nodes.
• deep lymphatic vessels drain to the external
  iliac, common iliac, and lumbar lymph nodes,
  eventually reaching the cisterna chyli and
  thoracic duct.
• Note The deep inguinal lymph nodes receive most
  of the drainage from the lower extremity.
  Efferent vessels from them drain into the
  external iliac, common iliac, and lumbar lymph
  nodes, eventually reaching the cisterna chyli and
  thoracic duct.

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• Linea Alba fused midline layers of the sheath
  between the 2 recti. The best place to make a
  surgical cut and not hit any nerves.
• Layers above and below arcuate line

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• Inguinal Canal a diagonal passage formed by the
  aponeuroses of the three flat abdominal muscles.
  Contents of Inguinal Canal
• Spermatic Cord (male) or Round Ligament (female)
• Ilioinguinal Nerve
• Boundaries
• Superficial inguinal ring triangular defect in
  the ext. oblique aponeurosis
• Deep inguinal ring in the transversalis fascia.
• Anterior wall int.oblique muscle (laterally) and
  external oblique aponeurosis (medially).
• Roof falx inguinalis (arching inferior fibers of
  internal oblique muscle)
• Floor inguinal ligament and lacunar ligament
  (medially)
• Posterior wall transversalis fascia (weak
  fascia) laterally and conjoint tendon (medially)

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• inguinal ligament-the inguinal ligament is a
  specialization of the inferior border of the
  external abdominal oblique aponeurosis it is the
  site of origin for a part of the internal
  abdominal oblique muscle and for a part of the
  transversus abdominis muscle also known as
  Poupart's ligament
• lacunar ligament-the lacunar ligament is a
  flattened portion of the aponeurosis of the
  external abdominal oblique m. that projects
  posteriorly from the pubic tubercle
• pectineal ligament-the pectineal ligament looks
  like an extension of the lacunar ligament along
  the surface of the pectineal line
• falx inguinalis-also known as conjoint tendon

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Internal oblique aponeurosis 2Inguinal ligament
(inturned lower edge of external oblique
aponeurosis) 3Superficial epigastric vein
4Rectus abdominis 5Transversalis fascia
6Anterior surface of rectus sheath 7Anterior
superior iliac spine 8Superficial inguinal ring
9Pubic tubercle
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• Abdominal Wall Hernias
• Inguinal hernia passes through the inguinal
  canal for a variable distance and exits through
  the ext.inguinal ring.
• Indirect
• Congenital through patent processus vaginalis
• Acquired passes through deep inguinal ring
  initially, i.e lateral to the inferior epigastric
  artery and exits through the superficial ring.
• Direct passes medial to the inferior epigastric
  artery (in the inguinal triangle) and may pass
  through the superficial inguinal ring.

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Candy Questions

• Which rami of the spinal nerves innervate the
  thoracolumbar fascia?

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Practice Questions

• 1. Distinguish between the fatty layer and the
  membranous layer of the subcutaneous tissue.
• The fatty layer is the superfical layer, also
  known as Camper's fascia, lies just below the
  skin. This is a big depot for fat (spare tire,
  beer belly). The membranous layer, also known as
  Scarpa's fascia, is deeper. It is well-defined
  below the umbilicus.
• 2. What is the extent of the membranous layer of
  the subcutaneous tissue?
• This layer continues inferiorly as the
  superficial perineal fascia (Colles fascia) in
  the scrotum and labia majora, and also extends to
  the posterior border of the urogenital triangle
  (a line drawn between the two ischial
  tuberosities). It is attached to the iliac crest,
  the fascia lata of the thigh, and the pubic
  symphysis. The layer ends 1-2 cm into the thigh,
  below the inguinal region.
• 3. What does the superficial inguinal ring
  transmit in the female? In the male?
• Both ilioinguinal nerve
• Female round ligament of the uterus
• Male spermatic cord, covered by cremaster muscle
  and fascia, and internal spermatic fascia

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More questions

• 4. How do you differentiate the external
  abdominal oblique from the internal abdominal
  oblique?
• The fibers of the external abdominal oblique
  originate on the lower ribs, running
  inferomedially towards the linea alba (like hands
  in your pockets). This is the same direction as
  the external intercostal muscles. The fibers of
  the internal abdominal oblique originate more
  laterally, on the iliac crest and thoracolumbar
  fascia, and run superomedially, like the internal
  intercostals.
• 5. Where do the iliohypogastric and ilioinguinal
  nerves pierce the internal and external abdominal
  oblique muscles? To where do they distribute?
• Both nerves begin their journey between the
  internal abdominal oblique and transversus
  abdominis muscles, but at the anterior superior
  iliac spine they jump out a layer and lie between
  the external abdominal oblique aponeurosis and
  the internal abdominal oblique muscle. Both
  nerves supply the skin and muscles of the
  anterior abdominal wall. Think about their names
  to determine distribution. Iliohypogastric gets
  the hypogastric regions of the abdomen.
  Ilioinguinal goes through the inguinal canal to
  become the anterior scrotal or anterior labial
  nerve as it passes through the superficial ring.

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More questions

• 6. Locate superior and inferior epigastric
  arteries. What are their sources? Do they
  anastomose?
• The superior epigastric artery comes from
  internal thoracic artery (the other branch of the
  internal thoracic is the musculophrenic artery).
  The inferior epigastric artery comes from
  external iliac artery. They run inside the rectus
  sheath, and yes, they anastomose.
• 7. At what level (relative to the umbilicus) do
  you find the arcuate line? Is it distinct?
• The arcuate line is a transverse line halfway
  between umbilicus and pubic symphysis. It is
  usually distinct, but occasionally it is a
  gradual transition.
• 8. What tissue is left on the posterior side of
  the rectus muscle caudal to this line?
• Only the transversalis fascia, extraperitoneal
  connective tissue and peritoneum are left.