Anatomy notes

Written by abdelrafi

Parasympathetic ganglion

1. Ciliary ganglion
-neculus edinger west phal neuclus ,located lateral to optic nerve
-pre gang para symp through oculuomotr nerve
-post gang para symp through short ciliary nerve
Targit organ and action
-sphincter pupilae (constriction )
-ciliary muscle (accumodaton )

There sympathetic fiber run through internal carotid plexus

-supply dilator pupilae (dilatation ) and tarsal muscle .

2. Ptergopalatine ganglion
Neculus =superior salivery neculus
Pre gang para symp through facial nerve , greater petrosal nerve and nerve
to ptergoid canal
Post gang para through maxillary nerve
Target organ lacrimal gland ,palate ,nose (secretomotor )

There is sympathetic run through ganglion without synapse through internal

carotic plexus .

3. Submandibular ganglion
Nuclus SSN

Pre gang para symp by branch from facial nerve as chorda tempani . the chorda
tempani join lingual nerne before synapse in the gland

Post gang parasymp travel through lingual nerve some said run direct

Target organ sub mandibular sub lingual and lingual glands( SECRETION)
Notes sympathetic run through plexus of facial artery ( Reduce secretion )

4.otic ganglion in the infratepmoral fossa below foramen ovale

-Pre gang parasymp run with glossophargneal nerve through tympanic nerve ,
and lessor petrosal nerve .

- post gang para symp run though auriculotepmoral nerve

Target organ parotid gland (secretomotor )

Notes sympathetic run on plexus of middle meningeal artery

……………………………………………………………………………………………………..

DORAL ROOT GANGLION CONTAIN 1. GSA 2. GVA

SYMPATHETIC CHAIN CONTAIN

 Post gang sympathetic

 Pre gang symp (GVE)
 GVA

White rami contain: . 1. GVA 2. GVE (pre gang sympathetic )

Gray rami contain: post ganglionic sympathetic .

___________________________________________________________________

Lesion of auriculotemporal nerve damage postganglionic para symp

secretomotor to the parotid gland and damage of post ganglionic sympatheic to
the sweat gland when nerve is severed the fiber can regenerate along each others
and onnervate the sweat gland resulting in freys syndrome which produce flushin
and sweating instead of salivation response to taste f the food .

Lesion of chorda tepmni = result in loss of salivary secretion from submandibular

ganglion and loss pf the taste of ant 2/3 of the tongue

Crocodile tears syndrome is sponteous lacrimation during eating caused by lesion

of facial nerve proximal to geniculate ganglion its due miss direction of regenerate
parasympathetic fiber which formely innervate salivary (submandibular and sub
lingual gland) to lacrimal glands.

Danger zone of the scalp =loose connective tissue highly vascular (emissary vein)
between apneurosis and perostium.

Above the vocal cord is innervated by internal laryngeal nerve which is branch of
superior largngeal nerve

Superior largngeal nerve divided into internal and external laryngeal nerve

Below vocal cord is supply by recurrent laryngeal nerve.

Common tendinous ring surround the optic canal and medial part of the superior
orpital fissure .

1.Is site of origin of 4 rectus eyes muscle

2.transimt oculomotor,nasociliary,abducent ,all in superior orpital fissure (SOF)

3.optic nerve ,ophthalmic artery and central artery of retina all in optic canal

4. superior ophthalmic vein trochlear frontal and lacrimal nerve all in SOF

NOTES

External laryngeal nerve supply circothyroid m and inferior pharyngeal constrictor

Muscle of tongue

Styloglossus 12 retract and elevate

Hyoglossus 12 depress and retract

Genioglossus 12 protrude and depress

Palatoglossus 10 elevate the tongue .

…………………………………………….
Diffuse swelling of blood which may extend to eye lid anterioly and to superior
nucheal line . this diffuse swelling in the subaponeurotic.

Local swelling overlying one bone and limited by suture of the skull =
subperiosteal .

Oblique arytenoids m and aryepiglottic m close the larynx and prevent the food
from entering the larynx and trachea .

Cricopharyngus m and inferior pharyngeal constrictor m prevent air from

entering oesophagus .

Styloid process attach all following muscle

 Stylohoid(facial n) 2. Stlyoglossus(hypoglossal n ) 3.Stylopharyngus

(glossopharyngeal n).

Nasal septum are formed by 1.vomer 2.ethmoid bone 3.septal cartilage

All of the following open into middle meatus

*Maxillary sinus * frontal sinus *anterior ethmoid sinus * middle ethmoid sinus

Posterior etmoid sinus open into superior meatus alone

Nasolacrimal duct open into inferior meatus .

Danger space is space between anterior alar part and posterior layer of
prevetebral fascia .

Retrophayngeal space is space between prevertebral fascia and buccopharyngeal

fascia .

Eagle~s syndrome is elongation of the styloid process or calcification , the pain is

due to compression of glossopharyngeal nerve or compress of the internal or
external carotid artery .

Ttt by stylectomy .

Torticolus chin is pointed to opposite site , injury to accessory nerve , congenital.

Structure pierce the dural roof of cavernous sinus between ant and middle clinoid
process = internal carotid artery.

Reflex

1.optic nerve mediate afferent limb of papillary reflex ,whereas parasympathetic

fiber in the oculomtornerve mediate efferent limb .

2.opthamic nerve mediate afferent of corneal relex (blink) by way of nasocillary

branch whereas the the facial mediate efferent reflex .

3.maxillary nerve mediate the afferent of sneeze and vagus mediate the efferent

4.mandibular nerve mediate afferent and efferent of jaw jerk reflex

5.facial nerve mediate effent of corneal reflec , and afferent by trigeminal .

6.glossopharyngeal nerve mediate afferent of gag reflex and efferent by vagus.

7.vagus mediate afferent and efferent of cough reflex , (also vagus mediate
efferent of gag and efferent of sneeze reflex ).

8.SVA for taste of ant 2/3 of tongue by chorda tempani of facial nerve.and
general senation by ligual nerve

9.SVA for taste of post 1/3 of tongue by and general senation BY

glossopharyngeal nerve.

10. taste sensation from palate by facial nerve through its greater petrosal nerve .

11.taste sensation of epiglottis carry by internal laryngeal branch of superior

laryngeal nerve which is branch from vagus .

…………………………………………………………………………………………………………………………..

Head and neck muscle innervations.

 All infrahyoid muscle innervated by ansa cervicalis except thyrohoid m

which innervated by c1 through hypoglossal nerve .
  For suprahyoid m *(DM tested by Serum GLUCOSE ) Stylohyoid and
diagastric posterior belly by facial ,mylohoid and diagastric anterior belly by
trigeminal ,geniohyoid by c1 through hypoglossal .
 All muscle of tongue by hypoglossal except palatoglossal by 10
 All muscle of palate innervated by 10 except tensor veli palatini by 5
 All muscle of pharynex by 10 except stylopharyngeus by 9
 All muscle of larynex by recurrent laryngeal nerve except cricothyroid m
innervated by externa laryngeal nerve .

Spina bifida occulta : failure of vertebral arch to fuse (only bony defect with
small tuft of hair over affected skin.

Meningocele : protrusion of the meninges through the unfused arh of vertebrae

(also called spina bifida cystic).

Meningomyelocele : protrusion of the spinal cord and meninges .

Myeloschisis :rachischitis =defect spinal cord due to failure of neural fold to close

Any fetus suspected spina bifida should delivered by c/s

Monosynaptic reflex

o Knee jerk – ankle jerk – biceps jerk – supinator reflex

Very important notes ‫حفظ‬

Cuneate nucleus ---upper limb

Gracile neuclus -----lower limb

Mesonephric (wolfian) in male lead to

1.efferent ductule of testis

2.epidydimis

3.seminal vesicle

4.uretric bud
5.trigone of the bladder .

6.vas deferens .

Mesonephric in female lead to :1. epoophoron , 2.paraophoron , 3.trigone of

bladder , 4.gartner duct

Pronephron =degenerate

Metaanephron =adult kidney

Metenephric develop from uretric bud and uretric bud develop from mesnephric.

Uretric bud will form all of the following

o Ureter ,renal pelvis ,major and minor calyces , collecting tubule

Metanephric mesoderm form nephron of the adult kidney ,glomerulus ,pct loop .

Paramesonephric duct lead to

o Uterine tube
o Uterus
o Cervix
o Upper part of vagina.

Pharyngeal tonsil=adenoid tonsil

All ligmanet of knee joint inside the capsule and out side the synovial except
lateral collateral lig .

Anterior axillary fold = pectoralis majorand minor ,subclavius ,clavipectoral fascia

Post axillary fold = latissimus dorsi , sub scapularis , teres major.

Anastomosis around hip joint

 First perforating aretery

 Inferior gluteal artery
 Medial femoral circumflex artery
  Lateral femoral circumflex artery

All of the following at level of sternal angle

 Bufircation of trachea
 Begin and end of aortic arch
 End of ascending and bigin of decending aorta
 Interior margin of superior mediastium

Median nerve innervate

 FDS
 Pronator teres
 Palamris longus
 Flexor carpi radialis
 Lateral 2lumbricle

Recurrent of median nerve innervate thenar m

 Oppoenus
 Flexor pollics brevis
 Abd pollicis brevis

Anterior interossius nerve of median innervate

 Lateral half of FDP

 Flexor pollicis longus
 Pronator quadrates

Stenson duct =parotid = open into upper 2 molor tooth

Wharton duct =submandibular gland – open on the side of freulum in floor of

mouth.

Collateral circulation around the knee

 Anterior tibial recurrent artery

 Decending branch of lateral femoral circumflex artery
  Medial inferior genicular arery
 Lateral superior genicular artery

Corocoid gives origin of 3 muscle

 Coracobrachilis
 Short head of biceps
 Peonator teres

Most common dislocation of shoulder join

Ant 90% injury axillary nerve.

Clavipectoral fascia surround subclavius and pectoraslis minor

Its pierced by * cephalic vein *lateral pectoral nerve *lymphatics

Port hepatis ‫مهمة‬

 Hepatic duct
 Hepatic artery
 Branches from portal vein
 Hepatic nerve
 Lymphatics vessels

Left umbilical vein ======‫======مهمة‬round ligament =ligentum teres ‫مهمة‬

Rt umbilical cein =obliterated

Umbilical artery ==============medial umbilical lig .

Ductus venosus ==============ligamentum venosus

Ductus arteriosus =============ligamentum arteriosus

Paraumbilical vein ===========ligamentum teres

Lateral umbilical fold======== contain inferior epigastric vessel

Medial umbilical fold =========obliterated umbilical artery

Median umbilical fold ====urachus ===allantois.

Between median and medial umbilical fold ====supravesical fossa

Between medial and lateral umbilical fold ==== medial inguinal fossa for direct
inguinal hernia .‫مهمة‬

Lateral to lateral umbilical fold lateral inguinal fossa .=indirect hernia ‫مهمة‬

Curved line along lateral border of rectus abdominis ==linea semilunaris

Ceresnt line marking the inferior limit of posterior layer of rectus sheath = linea
semicircularis.

Apneurosis of internal oblique and transverse abdominal muscle = conjoid tendon

=(falx inguinalis ) .‫مهمة‬

Superficial inguinal ring = opening in apneurosis of external oblique muscle

Deep inguinal ring lies in transversalis fascia just lateral to inferior epigastric
vessel.

Ligamentum teritz =supensory lig of doudenum‫سؤال لوكال‬

 Origin from right crus of diaphragm to doudenojejunal flexure , arise at

origin of celiac trunk and sup mesenteric artry .
 Is apoint where retroperitenal small intestine become intra peritoneum
 Its fold of peritoneum

LAYERS OF ABDOMINAL WALL and contuniation

Skin become ====== skin in scrotum

Superficial (fatty )layer of superficial fascia (camper fascial) continue as over

pubis and perineum as superficial layer of superficial perineal fascia . Also
continue over Inguinal lig as superficial fascia of the thigh .

Deep (membranous )layer of superficial fascia(scarpa)attached to fascia latta

below inguinal lig, continue over pubis and perineum as membranus layer colles
fascia of superficial perineal fascia., continue over penis as superficial fascia of
the penis and continue over scrotum as dartus which contain smooth muscle .and
may contain extravasated urine during rupture of spongy urethra.

Process vaginalis

 Is peritoneum and form visceral and parietal layer of tunica vaginalis testis
 If persist lead to congenital indirect hernia
 If it occulded cause fluid accumulation =congenital hydrocele.‫سؤال لوكال‬
12/2016

Gebernaculum

 Is homologus to ovarian lig and round lig

 Pulls the testis down during migration

Pancreas

 Ventral bud give rise to head and unicate process

 Dorsal bud give rise to all remaing of pancreas

Aganglionic megacolon due to abscense of enteric ganglia (post gang para

sympathetic)

Mynteric (auerbach )between longitual muscle and circular muscle .

Meissner(submucosal)

Heister valve occlude cystic artery

Common variation of common hepatic artery its branch from superior mesenteric
artery .

Left gasro epipolic artery branch from splenic artery

Rt gastro epipolic artery branch from gastodoudenal a

Duct of luscka its accessory biliary duct can lead to peritonitis

Superior pancreatico duodenal artery branch from gastodoudenal branch of
common hepatic .

Inferior pancreatico duodenal artery is branch from superior mesenteric artery.

Kerh sign pain felt in left soulder in rupture spleen

Mittelschmerz sign pain durning rupture of graafine follicle during mid cycle .

Rovsing sign gall bladder pain radiate to rt shoulder

Portal hypertension treated by 2ways ‫مهمة‬

1.potocaval shunt between portal vein and ivc

2.spenorenal shunt (warren shunt )between splenic vein and left renal vein ‫مهمة‬

Failure of spongy urethra to fuse = epispadius

Posterior intercostals artery 1-2 from superior intercostals artery branch of

costocervical trunk.

Remaing lower posterior intercostals artery from descending aorta

Anterior intercostals artery upper 6 from internal thoraxic artery

Internal thoraxic artery divided into musculocutaneous and superior epigastric

Paucinian==================== vibration

Rafini ======================pressure

Meissener============velocity

Merkel ===================== location

Brown sequard syndrome

 1. Ipsi lateral spastic paralysis below level of lesion
2. Ipsilatearal prorioception ,loss of 2point discrimination (dorsal column
tract).
3. Contralateral pain senation and temperature and crude touch (1 or 2
segment below lesion due to anteriolateral spinothalamic tract

Loss of circadian rhythm === suprachiasmatic

Vision === lateral geniculate

Hearing===== medial geniculate

Frontal lobe ==confusion

Rapid eye movement == pons

Thalamic lesion hyperathesia

Precentral cortex ======motor pri

Post cerntral cortex ==== sensory pri

Post inf gyrus of frontal lobe brochs area =expressive =motor aphasia

Post sup gyrus of temporal lobe werniks area

Lateral rototar of hip

*piriformis*obturator internus * quadrates femoris* gluteus maximus

Abductuction and medially rotate hip

*gluteaus medius * minimus

Location of the gallbladder intersection between lina semilunaris with 9 costal

cartilage .

Morgangni hernia between xiphiod process and costal margin.

Posterior intercostals veins ‫سؤال لوكال‬

on th rt ---------------------------------------------------------on the left
On the rt On the left
1st drain into rt braciocehalic vein Lt drain into lt brachiocephalic vein.
2,3,4 uinute to form superior intercostals vein 2,3,4uniute to form superior intercostals vein
which drain into azygus . which drain into lt brchiocephaic vein
5,6,7,8,9 ,10,11 &subcostal vein all drain into azygus 5,6,7,8form accessory hemiazygus then drain
into azygus
9,10 ,11 & subcostal form hemiazygus drain
into azygus vein
Accumulation of fluid in male in rectovesical pouch up right position

Accumulation of fluid in female in douglas pouch in upright position

Appendix pain sensation t8-t10 and cell body doral root ganglia

Sweat gland

para symp ===== sweating

symp===== copios sweating

heart

para symp====== by vagus

symp by t1 ---- t5

lung

para symp by vagus (bronchoconstriction and sti,ulate gland secretion)

symp t2 –t7

git para symp by vagus (lower 2/3 oseohagus stomach small intestine liver
gallbladder ,pancreas ascending colon and transverse colon )lead to contract
lumen increase secretion .

para symp by pelvic splanchnic nerve ( descending colon rectosegmoid )

Adductor canal transmit

  Femoral vessel
 Nerve to vastus medialis
 Saphenous nerve

Superior to body of pancreas

 Common hepatic a
 Cystic artery and vein

Inferior to the head of pancreas inferior mesenteric artery

Posterior to neck of pancreas

 Portal vein is formed by join of superior mesenteric v and splenic v

 Superior mesentric artery

Lesion at junction of posterior cerebral artery and posterior communicating arety

will affect oculomotor nerve so para symp affected so constriction of eye will
affect so the pt will presnt by dilated eyes .

Lie between flax cerebri and tentorium cerebelli is straittum sinus .

Incomplete separation of cloaca by urorectal septum == anal agenesis

Dorsal deviaton of urorectal septum anal stenosis .

Failure od anal membrane to perforate ==imperforated anus =failure of

proctoderm to develop = imperforated anus.

Note: caudal end of hind gut join allantois to form cloaca , the cloaca is divided by
urogenital septum into rectum and anal canal dorsally ,and urogenital sinus
ventrally which form urinary bladder .

Abnormal partition of cloaca =anorectal agenesis .

Great cardiac vein run with anterior interventricular artery.

Middle cardiac vein run with post interventricular artery

Small cardiac run with marginal artery

Note : oblique and great cardiac vein open into the right side of coronary sinus

And middle and small cardiac vein open to the left side of the sinus .

Aortic arches‫مهمة حفظ‬

1-2 dissapear

3 – common carotid ,

-and proximal part of internal carotid artery

4 - aortic arch on the left

- brchiocephalic artery on rt ,

-and proximal part of subclavian artery on rt

5. disappear

6- proximal pulmonary artery

- Ductu arterosus

Sub clavian artery branches

1. Vertebral

2. thyrocervical –gives -i. inferior thyroid a

- ii. transverse cervical a gives –superficial cervical and

-Dorsal scapular artery

- iii. suprascapular a

3. internal thoracix a

4. costocervical gives – deep cervical and superior intercostals artery

5. dorsal scapular a

Axillary artery :
  is continuation of sub clavian artery . extend from outer border of 1st rib to
the inferior border of teres major
 is divided into 3 part by pectoralis minor.
 Branches
1.superior thoracix artery
2. thoracoacromial artery and lateral thoracix artery
3. i. subsapular artery ( divide into thoracodorsal and circumflex scapular
artery ).
ii. ant humoral circumflex artery
iii.post humoral circumflex artery

blocked of subclavian artery or axillary artery can be by pass by anastomosis

between thyrocervical and subscapular artery .

 Transeverse cervical
 Suprascapular off the thyrocervical trunk
 Subscapular branch of 3rd part of axillary
 Circumflex scapular off subscapular

Superior mediastinum contain :

 1.svc 2.brachiocephic vein 3. Arch of the aorta

 4.thorcix duct 5. Trachea 6.oseophagus
 7.vagus 8.lt recurrent laryngeal nerve 9.phrenic nerve
 11. Thymus .

Anterior mediastinum

 Remenant of thymus gland

 Lymphnode
 Fat & connective tissue

Middle mediastinum

*heart and pericardium * phrenic nerve * roots of great vessel *

aorta , and pulmonary artery ,vein and vena cava * arch of the azygus
 * main bronchi

Posterior mediastium

1.Oseohagus 2. Thoracix aorta 3. Azygus vein

4.Hemiazygus 5. Thorcix duct 6. Vagus nerve

7. sympathetic trunk 8.spalnchnic nerve

AICA (ANT INF CEREBELLAR ARTERY ) compress facial nerve .

Pica ( POST INF CERBELLAR ARTERY ) compress trigeminal root .

Innervations :

Heart para by vagus symp by t1 – t5

Lung para vagus ---( bronchoconstriction and stimulate gland secretion )

Lung symp t2 –t7

Git para by vagus (lower oseog=hagus stomach small intestine liver gall bladder
pancreas ascending colon transerverse colon ) =contract lumen ,and increase
secretion .

Git para by pelvic spalnchnic nerve (descending colon rectosigmoid )

Git sympathetic upper part by t5 –t9 till ligament of treitz

Git sympathetic middle part by t10 – t11 from lig of treitz till splenic flexure .

Git sympathetic lower part from splenic till down by t12 –L2

Symp in git lead to decrease secretion , decrease motility , decrease digestion

Bladder wall parasymp by pelvic splanchnic n (contract wall ,relax sphincter ).

BLADDER symp by t 11 – L2 (relax wall contract sphincter )

Penis para erect

Penis symp ejactlation by t11 – L2

Kidney para vagus

Kidney symp by t10 –t11 (constrict afferent arteriole )

Ureter para upper by vagus lower pelvic splanchnic n (s2 s3 s4 )

Ureter symp upper part t10 –t 11 lower part t12- L1

LIVER para vagus symp by t10 –t11

Uterus body and cervix

Para by splanchnic relax body constrict cervix

Symp t10 – L2 constrict body relax cervix

Thorcix vertebrae :

Have costal facet . sup facet articulate with head of correspond rib

Inf facet articulate subjacent rib below

Transeverse process articulate with tubercle of corresponding rib.

Have typical vertebrae t2-t 8 .

Carpel tunnel transmit

 Median nerve . flexor pollicis longus , FDP , FDS

Thenar space contain flexor pollicis longus and othe flexor of index finger

Mid palmar space contain flexor tendon of medial 3 digit .

Ulnar bursa contain both FDP and FDS tendon .

Radial bursa contain tendon of flexor pollicis longus muscle.

75% off breast lymphnode to ant pectoral node .

Musculocutaneous nerve supply BBC ( biceps brachii , brachilis , coracobrachilis ).

Erbs palsy( upper trunck palsy ) ,loss of abduction, loss of flexion and lateral
rotation of the arm producing waiter tip hand. In which the arm tend to be
medialy rotate resulting from loss of lator rotators .

Lower trunck palsy (klumple ) may difficult breach delivery or by cervical rib r by
abnormal insertion of ant or middle scalnus muscle cause claw hand.

Rotator cuff muscle supraspinatus innervation suprascapular n

Infraspinatus innervations by suprascapular n

Subscapularis innervated by upper or lower subscapualr nerve

Teres minor by axillary nerve .

Quadriangular space is bounded superioly by teres minor and subscapularis m

Inferioly by teres major medially by long head of triceps , and lat by surgical neck
of humoerus .

Transmit the axillary nerve and posterior humeral circumflex vessels .

Upper triangular space :

Is bounded sup by teres minor inf by teres major and laterally by long head of
triceps .

Contain circumflex scapular vessels .

Lower triangular space :

Is formed by sup by teres major m medi by long head of triceps and lat by medial
head of triceps .

Contain radial nerve and profunda brachii artery .

Triangle of auscultation is bounded by upper border of latissmus dorsi ,lateral of

trapezes ,and medial border of sapula , floor is formed by rhomboid major muscle

Injury of long thoracic nerve (c5 6 7):

  Run on external surface of serratus anterior and supply it
 Result in paralysis of seratus anterior .
 In ability to elevate the the arm above horizontal line .‫مهمة‬
 Winged scapula(medial border of scapula protrude away from the thorax)

Anatomic snuff box

Bounded medially by ext pollicis longus .

Laterally by ext pollicis brevis and abd pollicis longus .

Floor by scaphoid trapezium and crossed by radial artery .

Unhappy traid is injury of all of following

 Ant cruciate lig

 Tibial collateral lig
 Medial meniscus

Hallux varus is deviation of big toe toward medial side

Hallux valgus is deviation of big toe toward lateral side

Genu valgum the tibia is twised or bended laterally

Genu varus tibia bended or twisted medially

Pes anserinus muscle are sartoris , gracilis and semitendinous.

Coxa valga = the angle made by axis of femoral neck to axis of the femoral shaft is
more than 135

Coxa vara angle is less than 135 .

Lateral fibular lig is separated from lateral minscus by popliteal muscle ‫مهمة‬

Example of ball and socket joint are

1.shoulder 2. Hip 3. Tallocalcaneunavicular joint

Structure passes posterior to Tarsal tunnel ( flexor retinaculum ).

Mnemonic (tall doctor are never hunger )or tom dick and harry )

1. Tibialis posterior
2. Flexor digitorum longus .
3. Posterior tibial artery and vein
4. Tibial nerve
5. Flexor hallucis lomgus .

Achilles tendon are insertion of ticeps surae ( gastrocemius and soleus ).

Medial longitudinal arch ‫مهم حفظ‬

- Is formed by tallus , calcaneus , navicular cuneiform , and 3 medial metatarsal

bones .

-key stone head of tallus .

- supported by spring ligament and the tendon of flexor hallucis longus .

Lateral lig arch

 - Is formed by calcaneus ,cuboid and lateral 2metatarsal bones

-Key stone cuboid .

- Is supported by peroneus longus tendon and short planter ligament

- is support the body in erect position and act as spring locomotion .

Transverse arch proximal

- Is formed by navicular bone 3 cuneform bone cuboid , and base of five

metatarsal bone of foot .

Is supported by peroneus longus .

Transverse arch distal

-Is formed by heads of five metatarsal bones

-is maintain by transverse head of adductor longus .

Epispadius is due to failure of spong urethra on dorsum.

Hypospadius is due to failure of two urethral fold to fuse .

Culdocentesis is aspiration of fluid from douglas pouch by needle puncture

through posterior vagina fornix .

Superficial peineal pouch ‫حفظ‬

 Lies between inferior fascia of urogenital diaphragm (perineal

membrane) and the membranous layer of superficial perineal fascia
(colles fascia).
 Contain :
 Perineal membrane
 Ischiocavernous muscle
 Bulbospongiosus muscle
 Superficial transverse perineal muscle
  Perineal body
 Greater vestibular gland (bartholin gland)

Deep peineal pouch

 Lies between superior and inferior fascia of urogenital diaphragm

 Contain:
 Deep perineal muscle
 Sphincter urethrae m
 Urogenital diaphragm
 Bulbourethral gland (cowper gland )

Support of uterus by

1. Levator ani muscle (most)

2. .cardinal ligament less than levator ani

Spring ligament ‫ مهم‬.

o Support head of the talus and medial longituanal lig

o Is support by tendon of tibialis posterior .

Damage to common preoneal nerve

 Occur commonly fracture of neck of fibula lead to

 Foot drop (loss of dorsiflexion ).
 Loss of sensation on dorsum of the foot and lateral aspect of leg .
 Causes paralysis of all muscle of ant and lat compartment (loss of
dorsifexion and evertor of the foot ).

Damage to superficial peoneal nerve

 No foot drop
 There is loss of eversion of foot
Damage to deep peoneal nerve

 Foot drop(loss of dorsifexion)

 High stepping gait (charaterstic)

Tibial nerve damage

 Loss of palnter fexion of the foot

 Impaired inversion (due paralysis of tibials post )causes difficulty of getting
the heal off the ground and shuffling gait
 There is characterstic claw of the toes and sensory loss on the sole of the
foot affecting posture and locomotion.

Sciatica is pressure on sciatic nerve by pririforms muscle.

Very important notes

Superficial muscle of the back are innervated by ventral primary rami .

Deep muscle of the back are innervated by dorsal primary rami

Cauda equina:

is formed by dorsal and ventral roots of lumber and sacral spinal verves .

Denticulate lig :

lateral extension of the pia matter ,HELP to hold TO SPINAL CORD IN POSTION

Film terminalae (internum )

Is prolongation of pia mater from tip of spinal cord at level of L2 .

Film externum :

Is film of dura mater of coccygeal ligament whict attach to dorsum of coccyx.