GALGOTIAS UNIVERSITY

DEPARTMENT OF PHYSIOTHERAPY

LAB MANUAL
ANATOMY LAB- I

L3UA108L

I Semester

PREPARED BY:
Dr. NEHA CHAUHAN (PT)
CONTENTS

Practical 1. To study the structure and compositions of human skeleton.

Practical 2. To study the osteology and muscle attachments of Clavicle bone.
Practical 3. To study the osteology and muscle attachments of Scapula bone
Practical 4. To study the osteology and muscle attachments of Humerus bone.
Practical 5. To study the osteology and muscle attachments of Radius bone.
Practical 6. To study the osteology and muscle attachments of Ulna bone.
Practical 7. To study the osteology and muscle attachments of Carpals bones
Practical 8. To study the osteology and muscle attachments of Metacarpals and phalanges.
Practical 9. To study the osteology and muscle attachments of Sternum bone.
Practical 10. To study the osteology and muscle attachments of Ribs.
Practical 11. To study the muscle forming the Thoracic cage.
Practical 12. To study the muscle of respiration.
Practical 13. To study the muscle forming the Abdominal wall.
Practical 14. To study the muscle forming the Pelvic floor.
Practical 15. To study the typical thoracic vertebral column and its attachments to Ribs.
PRACTICAL-1
To study the structure and compositions of human skeleton.

In adults, the skeletal system includes 206 bones, many of which are shown in Figure 1,2
Bones are organs made of dense connective tissues, mainly the tough protein collagen.
Bones contain

blood vessels, nerves, and other tissues. Bones are hard and rigid due to deposits of calcium and other
mineral salts within their living tissues. Locations, where two or more bones meet, are called joints. Many
joints allow bones to move like levers. For example, your elbow is a joint that allows you to bend and
straighten your arm.
Some of the 206 bones are labeled on the adult human skeleton.

Besides bones, the skeletal system includes cartilage and ligaments.

 Cartilage is a type of dense connective tissue, made of tough protein

fibers. It is strong but flexible and very smooth. It covers the ends of bones at joints, providing
a smooth surface for bones to move over.
 Ligaments are bands of fibrous connective tissue that hold bones together. They keep the bones
of the skeleton in place.

Axial and Appendicular Skeletons

The skeleton is traditionally divided into two major parts: the axial skeleton

and the appendicular skeleton, both of which are pictured in Figure

 The axial skeleton
forms the axis of the body. It includes the skull, vertebral column (spine), and rib cage.
The bones of the axial skeleton, along with ligaments and muscles, allow the human body to
maintain its upright posture. The axial skeleton also transmits weight from the head, trunk, and
upper extremities down the back to the lower extremities. In addition, the bones protect
the brain and organs in the chest.
 The appendicular skeleton forms the appendages and their attachments to the axial skeleton. It
includes the bones of the arms and legs, hands and feet, and shoulder and pelvic girdles. The
bones of the
appendicular skeleton make possible locomotion and other movements of the appendages. They
also protect the major organs of digestion, excretion, and reproduction.
 Figure 1
Axial skeleton
 Figure 2

Appendicular skeleton
Functions of the Skeletal System

The skeletal system has many different functions that are necessary for human survival.
Some of the functions, such as supporting the body, are relatively obvious. Other
functions are less obvious but no less important. For example, three tiny bones
(hammer, anvil, and stirrup) inside the middle ear transfer sound waves into the
inner ear.

Support, Shape, and Protection

The skeleton supports the body and gives it shape. Without the rigid bones of the skeletal
system, the human body would be just a bag of soft tissues, as described above. The bones of
the skeleton are very hard and provide protection to the delicate tissues of internal organs. For
example, the skull encloses and protects the soft tissues of the brain, and the vertebral
column protects the nervous tissues of the spinal cord. The vertebral column, ribs, and
sternum (breast bone) protect the heart, lungs, and major blood vessels. Providing protection
to these latter internal organs requires the bones to be able to expand and contract. The ribs
and the cartilage that connects them to the sternum and vertebrae are capable of small shifts
that allow breathing and other internal organ movements.
Practical- 2

Aim: To study the osteology and muscle attachments of Clavicle bone

CLAVICLE BONE
 Side Determination 
- The bone has a cylindrical part called shaft & two ends- medial andlateral.
- Lateral end is flat & medial end is large and quadrilateral.
- Shaft is slightly curved, convex forwards in its medial 2/3rd, concave forward in its lateral1/3rd.
 Peculiarities: 
- It is the only long bone that lies horizontally & first bone that startsossifying.
- It is Subcutaneous throughout.
- It is the only long bone that ossifies in membrane.
- It has two primary centers of ossifying.
 Features: 
Shaft: is divisible into lateral 1/3rd& medial 2/3rd
- Lateral 1/3rd- is flattened from above downwards, has two borders anterior and posterior.
- Medial 2/3rd- is rounded & has four surfaces; anterior, posterior, superiorand
inferior. Surfaces: it has two surfaces.
- Superior- is subcutaneous
- Inferior surface- presents an elevation known as Conoid tubercle& a ridge known as trapezoid
ridge. Ends: has two ends, lateral & medial.
- Lateral (acromial) end is flattened from above downwards. It bears a facet for articulation with
acromion process of scapula to form acromio-clavicular joint.
- Medial (sterna) end is quadrangular & articulates with clavicular notch of manubrium sterni toform
sterno-clavicular joint.
 Muscle attachments on the clavicle 
1. At the lateral end the margin of the articular surface for the acromioclavicular joint gives
attachment to the joint capsule.
2. At the medial end the margin of the articular
surface for the sternum gives attachment to:
(a) the fibrous capsule all round;
(b) the articular disc posterosuperiorly and
(c) the interclavicular ligament superiorly.
3. At the lateral end the margin of the articular surface
for the acromioclavicular joint givesattachment to
the joint capsule.
4. At the medial end the margin of the articular
surface for the sternum gives attachment to:
(a) the fibrous capsule all round;
(b) the articular disc posterosuperiorly and
(c) the interclavicular ligament superiorly.
5. Lateral one-third of shaft:
a) Anterior border gives origin to the deltoid
 b) Posterior border provides insertion to the trapezius.
c) Conoid tubercle and trapezoid ridge gives attachment to the conoid and trapezoid parts of
the coracoclavicular ligament.
6. Medial two-third of the shaft:
a) The anterior surface gives origin to the clavicular head of the sternocleidomastoid.
b) The rough superior surface gives origin to the clavicular head ofthe
sternocleidomastoid.
c) The oval impression on the inferior surface at the medial end gives attachment to the
costoclavicular ligament.
d) The subclavian groove gives insertion to the subclavius muscle

Practical 3.
AIM: To study the osteology and muscle attachments of Scapula bone
SCAPULA BONE

 Features: 
- It is a thin bone present on the postero-lateral aspect of thoracic cage.
- It has 2 surfaces, 3 borders, 3 angles& 3 processes.
 Side determination: The lateral or glenoid angle is large & bears glenoidcavity.
 Surfaces: 
1. The dorsal surface is convex & is divided by triangularspine into superior & inferior spinous fossa.
2. The costal surface or subscapular fossa is concave, directed medially & forward. It is marked
by 3 longitudinal ridges that act as lever for anterior serratus anterior during overhead
abduction of arm.
 Borders: 
1. Superior border is thin & short, presents with suprascapular notch near the rootof coracoid
process.
2. Lateral border is thick & presents with infraglenoid tubercle at the upperend.
3. Medial border is thin & extends from superior angle to inferior angle.
 Angles: 
1. Superior angle is covered by Trapezius muscle.
2. Inferior angle is covered by Latissimus dorsi muscle.
3. Lateral/glenoid angle is broad & bears the glenoidcavity/fossa.
 Processes: 
1. The spine/spinous process is a triangular plate of bone with three borders & two surfaces.It
dividesdorsal surface of scapula into two. Its posterior border is called ‘crest of spine’.
2. The acromion process has two borders- medial & lateral and two surfaces- superior & inferior.
3. The coracoid process is directed forwards & slightly laterally.
 Muscle attachments: 
1. The multipennate subscapularis arises from the medial two-third of the subscapular fossa.
2. The supraspinatus arise from the medial two-third of the supraspinatus fossa including the
uppersurface of the spine.
3. The infrasspinatus arise from the
medial two-third of the
infraspinatus fossa, including the
lower surface of the spine.
4. The Deltoid arises from the lower
border of the crest of the spine and
 from the lateral border of the
acromion.
5. The trapezius is inserted into
theupperborder of the crest of the
spine and into the medial border of
the acromion.
6. The serratus anterior is inserted
along the medial border of the costal
surface; one digitation from
thesuperior angle to the root of
spine, two digitation to the medial
border and five digitations to the
inferior angle.
7. The long head of the biceps brachii arise from the supraglenoid tubercle; and short head from
lateralpart of the tip of the coracoid process.
8. Coracobrachialis arise from the medial part of the tip of the coracoidprocess.
9. The pectoralis minor is inserted into the medial border and superior surface of the
coracoidprocess.
10. The long head of the triceps arise from the infraglenoidtubercle.
11. The teres minor arise from the upper two-third of the rough strip on the dorsal surface
along thelateral border.
12. The teres major arise from the lower one-third of the rough strip on the dorsal aspect of the
lateralborder.
13. Levator scapulae is inserted along the dorsal aspect of the medial border.
14. Rhomboideus minor is inserted into the medial border opposite the root of thespine.
15. Rhomboideus major is inserted into the medial border between the root of the spine
and theinferior angle.
 Clinical anatomy 
- Paralysis of the serratus anterior causes 'winging of scapula'. The medial border of the bone
becomeunduly prominent, and the arm cannot be abducted beyond 90 degrees.
- In a developmental anomaly called scaphoid scapula, the medial border isconcave.

Practical 4.
AIM: To study the osteology and muscle attachments of
Humerus bone
 Features: 
- It is the bone of arm.
- It is the longest bone of upper limb.
- It has an upper end, a shaft & a lowerend.
- It ossifies from 1 primary center & 7 secondary centers.
 Upper end: 
- The head is directed medially, backwards & upwards. It articulates with the glenoid cavity of
scapulato form shoulder joint.
- The line separating the head from the rest of upper end is called Anatomicalneck.
- Lesser tubercle is an elevation on the anterior aspect of upperend.
- Greater tubercle is an elevation that forms the lateral part of upper end.
- Intertubercular sulcus / bicipital groove separate lesser tubercle medially from the anterior
part ofgreater tubercle.
 Shaft: 
 - It is rounded in the upper half & triangular in the lowerhalf.
- It has three borders & three surfaces.
- The upper 1/3rdof anterior border forms lateral lip of intertubercular sulcus, middle part
forms theanterior margin of deltoid tuberosity.
- The lateral border is prominent only at lower end when it form lateral supracondylarridge.
- The upper part of medial border forms the medial lip of intertubercular sulcus.
- The antero-lateralsurface lies between anterior & lateral borders; upper half of this
surfaceiscovered by deltoid muscle.
- The anteromedial surface lies between anterior & medial borders; upper 1/3rd is narrow
& formsthe floor of intertubercular sulcus.
- The posterior surface lies between medial & lateral borders.
 Lower end: 
- It forms condyles which is expanded from side-to-side & has articular and non-articularparts.
- Articular parts
- Capitulum is rounded projection which articulates with head ofradius.
- Trochlea is a pulley shaped surface that articulates with the trochlear notch of ulna.
- Non-articular
- Medial epicondyle is a prominent bony projection on the medial side of lowerend.
- Lateral Condyle is smaller than medial epicondyle.
- Lateral supracondylar ridge is the sharp lateral margin above the lowerend.
- Medial supracondylar ridge is smaller ridge on medial side.
- Coronoid fossa is depression just above anterior aspect of thetrochlea.
- Radial fossa is a depression just above the anterior aspect ofcapitulum.
- Olecranon fossa lies above the posterior aspect of trochlea.
 Muscle attachments 
1. Multipennate subscapularis is inserted into the lesser tubercle.
2. Supraspinatus is inserted into the uppermost impression on the greater tubercle.
3. Infraspinatus is inserted into the middle impression on the greatertubercle.
4. Teres minor is inserted into the lower impression on the greatertubercle.
5. Pectoralis major is inserted into the lateral lip of the intertubercular sulcus.
6. Latissimus dorsi is inserted into the floor of the intertubercular sulcus.
7. Teres major is inserted into the medial lip of the intertubercular sulcus.
8. Contents of the intertubercular sulcus are:
(a) The tendon of the long head of biceps, and its synovial sheath; and
(b) ascending branch of the anterior circumflex humeral artery.
9. Deltoid is inserted into the deltoid tuberosity.
10. Coracobrachialis is inserted into the rough area on the middle of the medial border.
11. Brachialis arise from the lower halves of the anteromedial and anterolateral surfaces
oftheshaft.
12. Brachioradialis rise from the upper two-thirds of the lateral supracondylar ridge.
13. Extensor carpi radialis longus arise from the lower one-third of the lateral supracondylar ridge.
14. Pronator teres arise from the lower one-third of the medial supracondylar ridge.
15. Superficial flexor muscles of forearm arise by a common origin from the anterior aspect
of themedial epicondyle.
16. Superficial extensor muscles of the forearm have a common origin from the lateral epicondyle.
17. Anconeus arise from the posterior surface of the leteral epicondyle.
18. Lateral head of triceps brachii arise from oblique ridge on the upper part of pasterior
surface above the radial groove, while its medial head arise from posterior surface below
the radial groove.
Practical 5.
To study the osteology and muscle attachments of Radius bone.

RADIUS BONE
 Features: 
- It is the lateral bone of forearm.
- It is homologous to tibia of lower limb.
- It has upper end, shaft & lower end.
- The shaft ossifies from primary center.
 Upper end: 
- The head is disk shaped & covered with hyaline cartilage.
- It has superior (concave) surface which articulates with capitulum of humerus to form elbowjoint.
- The neck is enclosed by narrow lower margin of annular ligament.
- Tuberosity lies just below the medial part of neck.
 Shaft: 
- It has 3 borders & 3 surfaces.
- Anterior border extends from anterior margin of radial tuberosity to styloid process.
- Posterior border is clearly defined in its middle 1/3rd.
- Medial/interosseous border is the sharpest of the three borders.
- Anterior surface lies between anterior & interosseous borders.
- Posterior surface lies between poaterior & interosseous borders.
- Lateral surface lies between anterior & posterior borders.
 Lower end: 
- The anterior surface is in the form of thick prominent ridge; radial artery is palpated againstit.
- The posterior surface presents wit 4 grooves for extensor tendons.
- The medial surface is occupied by ulnar notch.
- The lateral surface is prolonged downwards to form
styloid process.
- The inferior surface bears a triangular area for scaphoid
bone & medial quadrangular area for lunate bone.
 Muscle attachments 
1. Biceps brachii is inserted into the rough posterior part
of the redial tuberosity.
2. Supinator inserted into the upper part of the lateral
surface.
3. Pronator teres is inserted into the middle ofthe
lateral surface.
4. Brachioradialis is inserted into the lowest part ofthe
lateral surface just above the styloid process.
5. Radial head of the flexor digitorum superficialis takes
origin from the anterior oblique line or the upper part
of anterior border.
6. Flexor pollicis longus takes origin from the upper two-
thirds of the anterior surface.
7. Pronator quadratus is inserted into the lower part of
the anterior surface and into the triangular area on the
medial side of the lower end.
8. Abductor pollicis longus and extensor pollicis brevis
from the posterior surface.
Practical 6.
To study the osteology and muscle attachments of Ulna bone
ULNA BONE

 Features: 
- It is the medial bone of forearm.
- It has upper end, shaft & lower end.
- The shaft & most of the upper end ossifies from a primary center which appears during 8th week of
development.
 Upper end: 
- The olecranon process projects upwards from the shaft& has anterior, posterior, medial, lateraland
superior surfaces.
Anterior surface- is articular& forms upper part of trochlear notch.
Posterior surface- forms triangular subcutaneous area which is separated from skin by
bursa. Medial surface- is continuous inferiorly with medial surface of shaft.
Lateral surface- is smooth & continues with the posterior surface of shaft.
Superior surface- shows a roughened area in its posterior part.
- The Coronoid process projects forwards from shaft just below the olecranon & has 4 surfaces-
superior, anterior, medial & lateral.
Superior surface- forms lower part of trochlear
notch. Anterior surface- is triangular & rough.
Lateral surface- has radial notch for head of radius in its upper part.
Medial surface is continuous with medial surface of shaft.
- Trochlear notch forms an articular surface that articulates with trochlea of humerus to form elbow
joint.
 - Radial notch articulates with head of radius to form superior radio-ulnar joint.
 Shaft: 
- It has 3 borders & 3 surfaces.
- Interosseous/lateralborder is sharpest in its middle two-fourths.
- Anterior border is thick & rounded.
- Posterior border is subcutaneous.
- Anterior surface lies between anterior & interosseous border.
- Medial surface lies between anterior & posterior borders.
- Posterior surface lies between posterior &interosseous borders.
 Lower End: 
- It is made of head & styloid process.
- Head articulates with ulnar notch of radius to form inferior radio-ulnar joint.
- Styloid process projects downwards to form posteromedial side of lower end of ulna.
 Muscle attachments 
1. Triceps is inserted into the posterior part of the superior surface of the olecranon.
2. Brachialis is inserted into the anterior surface of the coronoid process including the tuberosity of
the ulna.
3. Supinator arises from the supinator crest and from the triangular area in front of thecrest.
4. Ulnar head of the flexor digitorum superficialis arise from a tubercle at the upper end of the
medial margin of the coronoid process.
5. Ulnar head of pronator teres arise from the medial margin of the coronoidprocess.
6. Flexor digitorum profundus arises from:
(a) the upper three-fourths of the anterior and medial surfaces of the shaft;
(b)the medial surfaces of the coronoid and olecranon processes;
(c)the posterior of the shaft through an aponeurosis which border of the shaft through an
aponeurosis which also gives origin to the flexor carpi ulnaris and the the extensor carpi ulnaris.
7. Pronator quadratus takes origin from the oblique ridge on the lower part of the anterior surface.
8. Flexor carpi ulnaris arises from the medial side of the olecranon process and from theposterior
border.
9. Extensor carpi ulnaris arises from the posterior border.
10. Anconeus is inserted into the lateral aspect of the olecranon process and theupper one-fourth
of the posterior surface.
11. Lateral part of the posterior surface gives origin from above downwards to the abductor polllicis
longus, the extensor pollicis longus, and the extensorindicis.
Practical- 7
AIM: To study the osteology and muscle attachments of
Carpals bones

CARPAL BONES
- Made up of 8 bones, which are
arranged inrows:
- The proximal row contains:
I. The scaphoid,
II. The lunate,
III. The triquetral,
IV. The pisiform.
- The distal row contains in the same order:
I. The trapizium,
II. The trapezoid,
III. the capitate,
IV. The hamate.
 Side Determination
1. Proximal row is convex proximally and concave distally.
2. Distal row is convex proximally and flat distally.
3. Each bone has 6 surfaces.
I. Palmer and dorsal surface are non- articular, except for the triquetral and pisiform.
II. Lateral surfaces of the two lateral bones are non- articular.(scaphoid and
trapezium).
III. Medial surfaces of the three medial bones are non-articular.( triquetral,
pisiform andhamate).
4. Dorsal non- articular surface is always larger than the palmar non-articular surfaces,
except for thelunate.
 Muscle attachments
There are four bony pillars at the four
corners ofthe carpus:
1. Tubercle of the scaphoid
gives attchmentto:
a) flexor retinaculum; and
b) few fibres of the
abductor pollicisbrevis.
2. Pisiform gives attachment to:
a) flexor carpi ulnaris;
b) flexor retinaculum;
c) abductor digiti minimi;
d) Extensor retinaculum.
3. Trapezium has the
followingattachments:
 a) the crest gives origin to the abductor
pollicis brevis, flexor pollicis brevis, and
opponens pollicis.
b) Edgesof the groove give attachment to the two layers of the flexorretinaculum.
c) Lateral surface gives attchments to the lateral ligament of the wristjoint.d) Groove lodgesthe
tendon of the flexor carpi radialis.
4. Hamate.
a) Tip of the hook gives attchment to the flexor retinaculum;
b) Medial side of the hook gives attachment to the flexor digit minimi and the opponens digiti minimi.

PRACTICAL 8
AIM: To study the osteology and muscle attachments of Metacarpals and
phalanges.

The bones of the hand provide support and flexibility to the soft tissues. They can be divided
into three categories:

 Carpal bones (Proximal) – A set of eight irregularly shaped bones. These are located in the wrist area.
 Metacarpals – There are five metacarpals, each one related to a digit
 Phalanges (Distal) – The bones of the fingers. Each finger has three phalanges, except for the thumb,
which has two.

In this article, we shall look at the anatomical features of the bones of the hand.

Fig 1 – Overview of the bones of the hand.

Carpal Bones
The carpal bones are a group of eight, irregularly shaped bones. They are organised into two rows:
proximal and distal.

Proximal Row (lateral to medial) Distal Row (lateral to medial)

Scaphoid Trapezium
Lunate Trapezoid
Triquetrum Capitate
Pisiform (a sesamoid bone, formed within Hamate (has a projection on its palmar
the tendon of the flexor carpi ulnaris) surface, known as the ‘hook of hamate’

Collectively, the carpal bones form an arch in the coronal plane. A membranous band, the flexor
retinaculum, spans between the medial and lateral edges of the arch, forming the carpal tunnel.

Proximally, the scaphoid and lunate articulate with the radius to form the wrist joint (also known as the
‘radio-carpal joint’). In the distal row, all of the carpal bones articulate with the metacarpals.

Fig 2 – Palmar view of the carpal bones of the left hand.

Fig 3 – Transverse section of the carpal tunnel.

Clinical Relevance: Scaphoid Fracture

The scaphoid bone of the hand is the most commonly fractured carpal bone – typically
by falling on an outstretched hand (FOOSH).
In a fracture of the scaphoid, the characteristic clinical feature is pain and tenderness in
the anatomical snuffbox.
The scaphoid is at particular risk of avascular necrosis after fracture because of its so-
called ‘retrograde blood supply’ which enters at its distal end. This means that a fracture
to the middle (or ‘waist’) of the scaphoid may interrupt the blood supply to the proximal
part of the scaphoid bone rendering it avascular.
Patients with a missed scaphoid fracture are likely to develop osteoarthritis of the wrist
in later life
 Practical 9.
AIM: To study the osteology and muscle attachments of
Sternum bone.
The sternum (or breastbone) is a flat bone located at the anterior aspect of the
thorax. It lies in the midline of the chest and has a ‘T’ shape.

As part of the bony thoracic wall, the sternum helps protect the internal thoracic
viscera – such as the heart, lungs and oesophagus.

In this article, we shall look at the osteology of the sternum – its constituent parts,
articulations, and clinical correlations.

Parts of the Sternum

The sternum can be divided into three parts; the manubrium, body and xiphoid
process. In children, these elements are joined by cartilage. The cartilage ossifies
to bone during adulthood.

Manubrium

The manubrium is the most superior portion of the sternum. It is trapezoid in

shape.

The superior aspect of the manubrium is concave, producing a depression known

as the jugular notch – this is visible underneath the skin. Either side of the jugular
notch, there is a large fossa lined with cartilage. These fossae articulate with the
medial ends of the clavicles, forming the sternoclavicular joints.

On the lateral edges of the manubrium, there is a facet (cartilage lined depression
in the bone), for articulation with the costal cartilage of the 1st rib, and a demifacet
(half-facet) for articulation with part of the costal cartilage of the 2nd rib.

Inferiorly, the manubrium articulates with the body of the sternum, forming the
sternal angle. This can be felt as a transverse ridge of bone on the anterior aspect
of the sternum. The sternal angle is commonly used as an aid to count ribs, as it
marks the level of the 2nd costal cartilage.
Body

The body is flat and elongated – the largest part of the sternum. It articulates with
the manubrium superiorly (manubriosternal joint) and the xiphoid process
inferiorly (xiphisternal joint).

The lateral edges of the body are marked by numerous articular facets (cartilage
lined depressions in the bone). These articular facets articulate with the costal
cartilages of ribs 3-6. There are smaller facets for articulation with parts of the
second and seventh ribs – known as demifacets.
Xiphoid Process

The xiphoid process is the most inferior and smallest part of the sternum. It is variable in shape and
size, with its tip located at the level of the T10 vertebrae. The xiphoid process is largely cartilaginous in
structure, and completely ossifies late in life – around the age of 40.

In some individuals, the xiphoid process articulates with part of the costal cartilage of the seventh rib.

By Anatomography [CC-BY-SA-2.1-jp], via Wikimedia Commons

Fig 1 – Anatomical position of the sternum in the body thorax.

Fig 2 – The articulations and parts of the sternum.

Clinical Relevance: Fractures of the Sternum

Sternal fractures are associated with severe blunt trauma to the chest, such
as in a vehicular accident. They are relatively uncommon.

Typically, the sternum will break into several pieces – this type of fracture
is classified as a comminuted fracture. The most common site of fracture
is the manubriosternal joint – where the manubrium meets the body of the
sternum. Despite the degree of damage to the sternum, the fragments are
not usually displaced due to the attachment of the pectoralis muscles.

Sternal fractures have a high mortality rate (25-45%). This is not due to
the fracture itself, but usually as a result of heart and lung injuries, which
are likely to occur simultaneously with the primary trauma. Because of
this, it is crucial to check patients with sternal fractures for visceral injury.
X-ray, CT and ultrasound are common investigations.
Practical 10.
To study the osteology and muscle attachments of
Ribs

The ribs are a set of twelve paired bones which form the protective ‘cage’ of
the thorax. They articulate with the vertebral column posteriorly, and terminate
anteriorly as cartilage (known as costal cartilage).

As part of the bony thorax, the ribs protect the internal thoracic organs. They also
have a role in ventilation; moving during chest expansion to enable lung inflation.

In this article, we shall look at the anatomy of the ribs – their bony landmarks,
articulations and clinical correlations.

Fig 1 – Overview of the ribs and costal cartilage.

Fig 2 – The bony landmarks of a typical rib.

Rib Structure
There are two classifications of ribs – atypical and typical. The typical ribs
have a generalised structure, while the atypical ribs have variations on this
structure.

Typical Ribs

The typical rib consists of a head, neck and body:

The head is wedge shaped, and has two articular facets separated by a wedge
of bone. One facet articulates with the numerically corresponding vertebra,
and the other articulates with the vertebra above.

The neck contains no bony prominences, but simply connects the head with
the body. Where the neck meets the body there is a roughed tubercle, with a
facet for articulation with the transverse process of the corresponding
vertebra.
 The body, or shaft of the rib is flat and curved. The internal surface of the
shaft has a groove for the neurovascular supply of the thorax, protecting the
vessels and nerves from damage.

Atypical Ribs

Ribs 1, 2, 10 11 and 12 can be described as ‘atypical’ – they have features

that are not common to all the ribs.

Rib 1 is shorter and wider than the other ribs. It only has one facet on its
head for articulation with its corresponding vertebra (there isn’t a thoracic
vertebra above it). The superior surface is marked by two grooves, which
make way for the subclavian vessels.

Rib 2 is thinner and longer than rib 1, and has two articular facets on the
head as normal. It has a roughened area on its upper surface, from which the
serratus anterior muscle originates.

Rib 10 only has one facet – for articulation with its numerically
corresponding vertebra.

Ribs 11 and 12 have no neck, and only contain one facet, which is for
articulation with their corresponding vertebra.

Articulations
The majority of the ribs have an anterior and posterior articulation.

Posterior

All the twelve ribs articulate posteriorly with the vertebra of the spine. Each rib forms
two joints:

 Costotransverse joint – Between the tubercle of the rib, and the transverse costal
facet of the corresponding vertebra.

 Costovertebral joint – Between the head of the rib, superior costal facet of the
corresponding vertebra, and the inferior costal facet of the vertebra above.
 Fig 3 – Posterior articulations between a typical rib and its numerically
corresponding vertebra.
Anterior
The anterior attachment of the ribs vary:

 Ribs 1-7 attach independently to the sternum.

 Ribs 8 – 10 attach to the costal cartilages superior to them.
 Ribs 11 and 12 do not have an anterior attachment and end in the abdominal
musculature. Because of this, they are sometimes called ‘floating ribs’.

Clinical Relevance: Rib Fractures

Rib fractures most commonly occur in the middle ribs, as a consequence of crushing
injuries or direct trauma. A common complication of a rib fracture is further soft
tissue injury from the broken fragments. Structures most at risk of damage are the
lungs, spleen or diaphragm.

If two or more fractures occur in two or more adjacent ribs, the affected area is no
longer under control of the thoracic muscles. It displays a paradoxical movement
during lung inflation and deflation. This condition is known as flail chest. It impairs
full expansion of the ribcage, thus affecting the oxygen content of the blood. Flail
chest is treated by fixing the affected ribs, preventing their paradoxical movement.
 Practical 11.
AIM: To study the muscle forming the Thoracic
cage.

There are five muscles that make up the thoracic cage; the intercostals (external,
internal and innermost), subcostals, and transversus thoracis. These muscles act
to change the volume of the thoracic cavity during respiration.

There are some other muscles that do not comprise the thoracic wall, but
do attach to it. These include the pectoralis major, minor, serratus anterior and the
scalene muscles.
Intercostals
The intercostal muscles lie in the intercostal spaces between ribs. They are
organised into three layers.

External Intercostals

There are 11 pairs of external intercostal muscles. They run inferoanteriorly from the
rib above to the rib below, and are continuous with the external oblique of the
abdomen.

 Attachments: Originate at the lower border of the rib, inserting into the superior
border of the rib below.

 Actions: Elevates the ribs, increasing the thoracic volume.

 Innervation: Intercostal nerves (T1-T11).

 Fig 1 – The external and internal intercostals of the thoracic wall.
Internal Intercostals

These flat muscles lie deep to the external intercostals. Like the external
intercostals, they run from the rib above to the one below, but in an opposite direction
(inferoposteriorly). They are continuous with the internal oblique muscle of the
abdominal wall.

 Attachments: Originates from the lateral edge of the costal groove and inserts into
the superior surface of the rib below.

 Actions: The interosseous part reduces the thoracic volume by depressing the
ribcage, and the interchondral part elevates the ribs.

 Innervation: Intercostal nerves (T1-T11).

Innermost Intercostals

These muscles are the deepest of the intercostal muscles, and are similar in
structure to the internal intercostals.

They are separated from the internal intercostals by the intercostal neurovascular
bundle and are found in the most lateral portion of the intercostal spaces.

 Attachments: Originates from the medial edge of the costal groove and inserts into
the superior surface of the rib below.

 Actions: The interosseous part reduces the thoracic volume by depressing the
ribcage, and the interchondral part elevates the ribs.
 Innervation: Intercostal nerves (T1-T11) 

Transversus Thoracis
These muscles of the thoracic cage are continuous with transversus abdominis
inferiorly.

 Attachments: From the posterior surface of the inferior sternum to the internal
surface of costal cartilages 2-6.

 Actions: Weakly depress the ribs.

 Innervation: Intercostal nerves (T2-T6).

Fig 2 – View of the internal aspect of the thoracic wall. The internal intercostal and
transverse thoracis muscles are visible.
Subcostals
The subcostal muscles are found in the inferior portion of the thoracic wall. They
comprise of thin slips of muscle, which run from the internal surface of one rib, to
second and third ribs below. The direction of the fibres parallels that of the innermost
intercostal.

 Attachments: These originate from the inferior surface of the lower ribs, near the
angle of the rib. They then attach to the superior border of the rib 2 or 3 below.
 Actions: Share the action of the internal intercostals
 Innervation: Intercostal nerves

Practical 12.
AIM: To study the muscle of respiration.

Primary Muscles
The primary inspiratory muscles are the diaphragm and external
intercostals. Relaxed normal expiration is a passive process, happens because of
the elastic recoil of the lungs and surface tension. However, there are a few
muscles that help in forceful expiration and include the internal intercostals,
intercostalis intimi, subcostals and the abdominal muscles.

The muscles of inspiration elevate the ribs and sternum, and the muscles of
expiration depress them.

Accessory Muscles
The accessory inspiratory muscles are the sternocleidomastoid,
the scalenus anterior, medius, and posterior, the pectoralis major and minor, the
inferior fibres of serratus anterior and latissimus dorsi, the serratus posterior
superior may help in inspiration also the iliocostalis cervicis. Technically any
muscle attached to the upper limb and the thoracic cage can act as an accessory
muscle of inspiration through reverse muscle action (muscle work from distal to
proximal) [2]

The accessory expiratory muscles are the abdominal muscles: rectus

abdominis, external oblique, internal oblique, and transversus abdominis.
And in the thoracolumbar region the lowest fibres of iliocostalis and longissimus,
the serratus posterior inferior and quadratus lumborum. The accessory muscles
are recruited during times of exercising because of the increased metabolic need
and also during dysfunction in the respiratory system

Diaphragm
It's a double-domed musculotendinous sheet of internal skeletal muscle located at
the inferior-most aspect of the rib cage that separates the thoracic cavity from the
abdominal cavity.
It serves two main functions:

-Separates the thoracic cavity from the abdominal cavity

-Undergoes contraction and relaxation, altering the volume of the thoracic cavity
and the lungs, producing inspiration and expiration. [8]

Diaphragm(inferior view)

 Origin: Xiphoid process (posterior surface), lower six ribs and their costal
cartilage (inner surface) and upper three lumbar vertebrae as right crus and
upper two lumbar vertebrae as left crus.
 Insertion: central tendon
 Nerve Supply: Motor nerve supply by Phrenic nerve (C3 C4 C5) and sensory
supply by phrenic nerve to central tendon and lower 6 or 7 intercostal nerve
to peripheral parts.
 Blood supply: inferior phrenic arteries deliver the majority of blood supply
and the remaining supply is delivered via superior phrenic, musculophrenic
and pericardiacophrenic arteries.
 Action: diaphragm is the main inspiratory muscle, during inspiration it
contracts and moves in an inferior direction that increases the vertical
diameter of the thoracic cavity and produces lung expansion, in turn, the air
is drawn in.
Intercostal muscles
They are three types: External intercostal muscles (the most superficial muscle of
intercostal muscles), internal intercostal muscles, and innermost intercostal
muscles.

External intercostal muscles

 Origin: inferior border of rib above and

 Insertion: superior border of rib below

Internal intercostal muscles

 Origin: from the costal groove (lower part of inner surface of rib near the
inferior border) of the rib above and

 Insertion: upper border of rib below

Innermost intercostal muscles:

It is an incomplete muscle layer and crosses more than one intercostal space.
These muscles assist in the function of external and internal intercostal muscles.

 Origin: from the costal groove of the rib above and

 Insertion: the superior border of rib below
  Nerve supply: all the intercostal muscles are supplied by their respective
intercostal nerves.
 Blood supply: all three muscles receive blood supply from anterior and
posterior intercostal arteries, in addition to internal thoracic and
musculophrenic arteries; costocervical trunk for internal and innermost
intercostal muscles.

Practical 13.
AIM:To study the muscle forming the Abdominal
wall.

Structure and Function

The abdominal muscles are more extensive than those listed above, and are be
divided broadly into: Anterolateral; and Posterior walls. Anterolateral
Abdominal Wall Muscles: consists of

 2 vertical muscles located on the midline (bisected by linea alba): Rectus

abdominis; and pyramidalis
 3 flat muscles on the anterolateral side arranged from superficial to deep;
external abdominal oblique, internal abdominal oblique, transversus
abdominis.
 Muscles of the Abdomen Posterior

Posterior Wall Muscles

1. Quadratus: One of the functions of QL is lateral flexion and extension of the

vertebral column and during the inhalation assist with the diaphragm and
fixes the 12th rib.
2. Psoas major
3. Psoas minor,
4. Iliacus,
5. Diaphragm, the posterior aspect of the diaphragm.

The abdominal wall encloses the abdominal cavity and can be divided into
anterolateral and posterior sections. The abdominal wall:

 Forms a firm, yet flexible boundary which keeps the abdominal viscera in
the abdominal cavity and assists the viscera in maintaining their anatomical
position against gravity.
 Protects the abdominal viscera from injury.
 Assists in forceful expiration by pushing the abdominal viscera upwards.
 Is involved in any action (coughing, vomiting, defecation) that increases intra-
abdominal pressure.

The anterolateral abdominal wall consists of four main layers (external to

internal): skin, superficial fascia, muscles and associated fascia, and parietal
peritoneum.

In this article, we shall look at the anatomy of the anterolateral abdominal wall –
its musculature, surface anatomy and clinical correlations.

Superficial Fascia
 The superficial fascia is connective tissue. The composition of this layer depends
on its location:

• Above the umbilicus – a single sheet of connective tissue. It is continuous

with the superficial fascia in other regions of the body.

• Below the umbilicus – divided into two layers; the fatty superficial layer
(Camper’s fascia) and the membranous deep layer (Scarpa’s fascia).

The superficial vessels and nerves run between these two layers of fascia

Fig 1 – The layers of the anterolateral abdominal wall. Below the umbilicus, there are two layers of
superficial fascia – Camper’s and Scarpa’s.

Muscles of the Abdominal Wall

The muscles of the anterolateral abdominal wall can be divided into two main
groups:
 Flat muscles – three flat muscles, situated laterally on either side of the abdomen.
 Vertical muscles – two vertical muscles, situated near the mid-line of the body.

Flat Muscles

There are three flat muscles located laterally in the abdominal wall, stacked upon one another.
Their fibres run in differing directions and cross each other – strengthening the wall and
decreasing the risk of abdominal contents herniating through the wall.

In the anteromedial aspect of the abdominal wall, each flat muscle forms
an aponeurosis (a broad, flat tendon), which covers the vertical rectus
abdominis muscle. The aponeuroses of all the flat muscles become entwined in
the midline, forming the linea alba (a fibrous structure that extends from the
xiphoid process of the sternum to the pubic symphysis).

External Oblique

The external oblique is the largest and most superficial flat muscle in the
abdominal wall. Its fibres run inferomedially.

 Attachments: Originates from ribs 5-12 and inserts onto the iliac crest and pubic
tubercle.
 Actions: Contralateral rotation of the torso.
 Innervation: Thoracoabdominal nerves (T7-T11) and subcostal nerve (T12).

Internal Oblique

The internal oblique lies deep to the external oblique. It is smaller and thinner in
structure, with its fibres running superomedially (perpendicular to the fibres of
the external oblique).

 Attachments: Originates from the inguinal ligament, iliac crest and lumbodorsal
fascia. It inserts onto ribs 10-12.
 Actions: Bilateral contraction compresses the abdomen, while unilateral
contraction ipsilaterally rotates the torso.
 Innervation: Thoracoabdominal nerves (T7-T11), subcostal nerve (T12) and
branches of the lumbar plexus.
 Fig 2 – The muscles of the anterolateral abdominal wall. Note how the flat muscles form aponeuroses
medially.

Transversus Abdominis

The transversus abdominis is the deepest of the flat muscles, with transversely running
fibres. Deep to this muscle is a well-formed layer of fascia, known as the transversalis
fascia.

 Attachments: Originates from the inguinal ligament, costal cartilages 7-12, the iliac
crest and thoracolumbar fascia. It inserts onto the conjoint tendon, xiphoid process,
linea alba and the pubic crest.
 Actions: Compression of abdominal contents.
 Innervation: Thoracoabdominal nerves (T7-T11), subcostal nerve (T12) and branches
of the lumbar plexus.

Vertical Muscles

There are two vertical muscles located in the midline of the anterolateral abdominal wall
– the rectus abdominis and pyramidalis.
 Rectus Abdominis

The rectus abdominis is long, paired muscle, found either side of the midline in the
abdominal wall. It is split into two by the linea alba. The lateral borders of the muscles
create a surface marking known as the linea semilunaris.

At several places, the muscle is intersected by fibrous strips, known as tendinous

intersections. The tendinous intersections and the linea alba give rise to the ‘six pack’
seen in individuals with a well-developed rectus abdominis.

 Attachments: Originates from the crest of the pubis bone. It inserts onto the xiphoid
process of the sternum and the costal cartilage of ribs 5-7.
 Actions: As well as assisting the flat muscles in compressing the abdominal viscera,
the rectus abdominis also stabilises the pelvis during walking, and depresses the ribs.
 Innervation: Thoracoabdominal nerves (T7-T11).

Pyramidalis

This is a small triangular muscle, found superficially to the rectus abdominis. It is located
inferiorly, with its base on the pubis bone, and the apex of the triangle attached to the
linea alba.

 Attachments: Originates from the pubic crest and pubic symphysis before inserting
into the linea alba.
 Actions: Tenses the linea alba.
 Innervation: Subcostal nerve (T12).
Rectus Sheath

The rectus sheath is formed by the aponeuroses of the three flat muscles and
encloses the rectus abdominis and pyramidalis muscles. It has an anterior and
posterior wall for most of its length:

• Anterior wall – formed by the aponeuroses of the external oblique, and of

half of the internal oblique.

• Posterior wall – formed by the aponeuroses of half the internal oblique and
of the transversus abdominis.

Approximately midway between the umbilicus and the pubic symphysis, all the
aponeuroses move to the anterior wall of the rectus sheath. At this point, there is
no posterior wall to the sheath; the rectus abdominis is in direct contact with the
transversalis fascia.

The demarcation point where the posterior layer of the rectus sheath ends is the
arcuate line.
Practical- 14

Aim: To study the muscle forming the

Pelvic floor.

The pelvic viscera (bladder, rectum, pelvic genital organs and terminal
part of the urethra) reside within the pelvic cavity (or the true pelvis). This
cavity is located within the lesser part of the pelvis, beneath the pelvic
brim.

A number of muscles help make up the walls of the cavity – the lateral walls
include the obturator internus and the piriformis muscle, with the latter also
forming the posterior wall

In this article, we shall look at the anatomy of the muscles that make up the inferior
lining of the cavity – the pelvic floor muscles. The pelvic floor is also known as the
pelvic diaphragm.

We shall look at the individual roles of these muscles, their innervation and blood
supply, and any clinical correlations.
Fig 1 – An overview of the pelvic cavity and its walls. Note the funnel shape of the pelvic floor.

Note – some texts consider the pelvic floor to include the perineal membrane and deep perineal
pouch. We have considered these as a distinct and separate structures.

Pelvic Floor Structure

The pelvic floor is a funnel-shaped structure. It attaches to the walls of the lesser pelvis,
separating the pelvic cavity from the perineum inferiorly (region which includes the genitalia
and anus).

In order to allow for urination and defecation, there are a few gaps in the pelvic floor. There
are two ‘holes’ that have significance:

Urogenital hiatus – an anteriorly situated gap, which allows passage of the urethra (and the
vagina in females).

Rectal hiatus – a centrally positioned gap, which allows passage of the anal
canal.
Between the urogenital hiatus and the anal canal lies a fibrous node
known as the perineal body, which joins the pelvic floor to the perineum
(described further here).
Functions
As the floor of the pelvic cavity, these muscles have important roles to
play in the correct functioning of the pelvic and abdominal viscera.

The roles of the pelvic floor muscles are:

Support of abdominopelvic viscera – through their tonic contraction.

Resistance to increases in intra-pelvic/abdominal pressure – during
activities such as coughing or lifting heavy objects.
Urinary and faecal continence – the muscle fibres have a sphincter action
on the rectum and urethra. They relax to allow urination and defecation.
Muscles
When learning about the muscles of the pelvic floor, it is important to keep
in mind its funnel-shaped structure. There are three main components of
the pelvic floor:

Levator ani muscles (largest component).

Coccygeus muscle.
Fascia coverings of the muscles.
Fig 2 – Superior (bird’s eye) view of the pelvic floor. Note the pre-rectal
fibres of the puborectalis.
Levator Ani Muscles
The levator ani is a broad sheet of muscle. It is composed of three
separate paired muscles; pubococcygeus, puborectalis and
iliococcygeus.
Puborectalis
The puborectalis is the most important of the levator ani group for
maintaining faecal continence.

Attachments: Originates from the posterior surface of the pubis. It forms

a U-shaped sling around the anal canal, and attaches to the pubis on the
contralateral side.
Actions: Tonic contraction bends the anal canal anteriorly. This creates
the anorectal angle which contributes to faecal continence. It is voluntarily
inhibited during defecation.
Innervation: Nerve to levator ani and pudendal nerve.
Some fibres of the puborectalis muscle (pre-rectal fibres) form another U-
shaped sling that flank the urethra in the male and the urethra and vagina
in the female (in some textbooks they appear as pubovaginalis or
sphincter urethrae / vaginae). These fibres are very important in
preserving urinary continence, especially during abrupt increase of the
intra-abdominal pressure i.e. during sneezing.

Pubococcygeus

The pubococcygeus forms the bulk of the levator ani complex. It is located
between the puborectalis and iliococcygeus within the pelvic floor.

Attachments: Originates from the posterior surface of the pubis. It blends

with the contralateral muscle in the midline of the pelvic floor.
Actions: Stability and support of abdominal and pelvic organs.
Innervation: Nerve to levator ani and branches of the pudendal nerve.
Iliococcygeus
The iliococcygeus is a thin muscle which forms the posterolateral part of
the levator ani muscle group.

Attachments: Originates from the ischial spines and the posterior

tendinous arch of the internal obturator fascia. It inserts onto the coccyx,
perineal body and anococcygeal ligament. It also blends with the fibres of
the contralateral muscle in the midline of the pelvic floor.
Actions: Elevates the pelvic floor and anorectal canal.
Innervation: Nerve to levator ani and branches of the pudendal nerve.
Coccygeus
The coccygeus is a small triangular muscle located posterior to the
levator ani muscle group.
Attachments: Originates from the ischial spines and inserts onto the
inferior end of the sacrum and coccyx.
Actions: Supports the pelvic viscera and flexes the coccyx.
Innervation: Anterior rami of S4 and S5.
Blood supply: Inferior vesical, inferior gluteal and pudendal arteries.

Fig 3 – Sagittal cut through the pelvis, showing a lateral view of the pelvic floor
and walls.
Clinical Relevance: Pelvic Floor Dysfunction
Pelvic floor dysfunction refers to a range of signs and symptoms that related to
abnormal functioning of the pelvic floor muscles.
In women, the pelvic floor muscles support the urethra, vagina, and anal canal.
The weakening of these muscles can result in a loss of structural support to
these organs – presenting as:
Urinary incontinence
Faecal incontinence
Genitourinary prolapse
Pelvic pain
Sexual dysfunction
The causes of pelvic floor dysfunction are understood to be multifactorial and
include obstetric trauma, increasing age, obesity, and chronic straining.
Practical 15. To study the typical thoracic vertebral column
and its attachments to Ribs

The
thoracic cage protects the heart and lungs. It is composed of 12 pairs of ribs
with their costal cartilages and the sternum. The ribs are anchored
posteriorly to the 12 thoracic vertebrae. The sternum consists of the
manubrium, body, and xiphoid process. The manubrium and body are
joined at the sternal angle, which is also the site for attachment of the
second ribs.
Ribs are flattened, curved bones and are numbered 1–12. Posteriorly, the
head of the rib articulates with the costal facets located on the bodies of
thoracic vertebrae and the rib tubercle articulates with the facet located on
the vertebral transverse process. The angle of the ribs forms the most
posterior portion of the thoracic cage. The costal groove in the inferior
margin of each rib carries blood vessels and a nerve. Anteriorly, each rib
ends in a costal cartilage. True ribs (1–7) attach directly to the sternum via
their costal cartilage. The false ribs (8–12) either attach to the sternum
indirectly or not at all. Ribs 8–10 have their costal cartilages attached to
the cartilage of the next higher rib. The floating ribs (11–12) are short and
do not attach to the sternum or to another rib.