1. MUSCULI THORACIS Institute of Anatomy 2nd and 1st Medical Faculty R
MUSCULI THORACIS Institute of Anatomy 2nd and 1st Medical Faculty R. Druga

2. The muscles of the thorax
They are all concerned in the movements of the ribs and hence with respiration
The intercostales
Transversus thoracis
Levatores costarum
Pectorales

3. Sulcus deltoideo-pectoralis
Mm. pectorales
M. Pectoralis major
Origo :
Clavicula, sternum
Vagina m. rectorum
Insertio : crista tuberculi majoris
Sulcus deltoideo-pectoralis
Clavipectoral triangle
Trigonum clavipectorale
Anterior wall of the axilla

4. Clavipectoral fascia

7. Relations of the pectoralis minor to axillary vessels and brachial plexus

9. CLAVIPECTORAL FASCIA

10. M. serratus ant. Origo : 1. – 9. Rib
Insertio : medial margin of the scapula.
N. Thoracicus longus

12. Mm. Intercostales interni (11)
Internal intercostal membrane
(depression of the ribs)
Exspiratory muscles
From posterior costal angles to the sternum
Mm.intercostales externi (11)
Inspiratory muscles
(elevation of ribs)
From the tubercles of the ribs to the cartilage of the ribs in front

13. Mm. Intercostales externi
External intercostal membrane

14. Spatium intercostale
Intercostal space and layers of thoracic wall

15. The intercostales intimi
Poorly developed in upper spaces,
More extensive in lower spaces
Separate intyercostal vessels and nerve from the pleura
Action : like the intercostales interni

16. Puncture of the pleural cavity Punkce cavum pleurae
Spatium intercostale

17. DIAPHRAGMA THE DIAPHRAGM The diaphragmatic aperturtes : Aortic
A dome- shaped muscle which separates the thoracic from the abdominal cavity.
Its periphery consists of muscular fibres attached to the central tendon (aponeurotic).
LUMBAR PART
COSTAL PART
STERNAL PART
The diaphragmatic aperturtes :
Aortic
Oesophageal
Vena caval
Main inspiratory muscle

18. DIAPHRAGMA
Hranice mezi dutinou hrudní a břišní

19. Diaphragma
Crus mediale L1 – L3
Crus laterale L 1 – L2

22. Lumbocostal arches
Medial and lateral

23. N. Phrenicus (C 4)

24. Inferior phrenic artery
Phrenic nerve

25. Diaphragmatic part of the pericard

26. Relations of the diaphragm
The upper surface is in relation with the pleura (right and left diaphragmatic pleura) and with the pericardium
Lower surface is covered by peritoneum

27. Right dome
4th intercostal space
Left dome
5th intercostal space

28. Upper surface and diaphragmatic apertures

30. Diaphragma - actions
Principal muscle of inspiration
During inspiration muscular fibres contract and the central tendon and domes move downwards (volume of the thoracic cavity increases)

31. Inspiration Elevation of ribs (external intercostal muscles)
Depression of the diaphragm
In quiet inspiration the principal muscle is the diaphragm
In forced inspiration additional muscles are called into action (pectoral, scalenic)

32. Expiration Relaxation of the diaphragm
Contraction of the intercostales interni

33. MUSCULI ABDOMINIS Institute of Anatomy 2nd and 1st Medical Faculty

35. M. Obliquus ext.
5th – 12th rib
(8 slips)
Vagina m. rectus abd.
Linea alba
Inguinal lig.
Inguinal ligament

36. Iliac crest, lumbodorsal fascia
M. Obliquus internus
Iliac crest, lumbodorsal fascia
9th –12th rib
Linea alba, vagina m. rectus abd.
M. Rectus abd.
ribs,
pubis

37. 7th – 12th rib, iliac crest, inguinal lig.
M. Transversus abd.
7th – 12th rib, iliac crest, inguinal lig.
Linea alba, vagina mm. rectorum

39. Vagina of the rectus muscles

41. Vasa epigastrica inf.
M. cremaster

44. to anulus inguinalis superficialis (superficial inguinal ring, exit)
INGUINAL CANAL
CANALIS INGUINALIS
Lentgh 4 – 5 cm, from anulus inguinalis profundus (deep inguinal ring, entrance)
to anulus inguinalis superficialis (superficial inguinal ring, exit)
4 walls
Contens : funiculus spermaticus (spermatic cord, lig. teres uteri)
Presence of canal appear to weaken the anterior abdominal wall

45. Canalis inguinalis Délka 4 – 5 cm
Anulus inguinalis profundus – anulus inguinalis superficialis
4 stěny
Obsah – funiculus spermaticus, lig. teres uteri
Zeslabené místo přední stěny břišní
Hernie !!!

46. Walls of the inguinal canal
Anterior wall –aponeurosis of the External oblique (superficial ring)
Posterior wall – transversal fascia (deep ring)
Lower wall – inguinal ligament
Upper wall - Internal oblique and Transversal (lower margins)

47. Stěny canalis inguinalis
Přední stěna : aponeurosa m. obliquus externus
Zadní stěna : fascia transversalis
Dolní stěna : ligamentum inguinale
Horní stěna : m. obliquus internus a m. transversus abdominis

48. Canalis inguinalis Inguinal canal Posterior wall Falx inguinalis
Anterior wall
(superficial ring)
Posterior wall
Falx inguinalis
Interfoveolar lig.
Inguinal triangle

49. Posterior wall from behind
Inguinal canal- sagittal section

50. Cremaster muscle

51. Posterior wall of the inguinal canal = transversal fascia
Falx inguinalis, lig. interfoveolare

52. Posterior wall of the inguinal canal – ligamentous bands
Falx inguinalis (inguinal falx, the conjoint tendon) – is formed by the lower part of the aponeurosis of the transversus and is inserted medially to the pubis
Interfoveolar ligament – laterally to falx, from lower margin of the transversus to pubis. Covers inferior epigastric vessels. Laterally to interfoveolar ligament is deep inguinal ring.
Between falx and interfoveolar ligament – inguinal triangle

53. Peritoneal folds
Peritoneální řasy a jamky

54. Hernial sac
Indirect hernia
Kýlní vak, Hernia indirecta

55. Inguinal hernia I (indirect, oblique)
The viscus is protruded through the inguinal region (canal)
Indirect (oblique) hernia – intestine is protruded inside of peritoneal sac - through
the lateral inguinal fossa (peritoneum)
Enters the inguinal canal at the deep inguinal ring
Pass along the inguinal canal
Enters the superficial inguinal ring
Lastly descends into the scrotum
Very frequently acquired variety, less frequently congenital

56. Inguinal hernia II (direct)
Protrusion makes its way through –
Medial inguinal fossa (peritoneum)
Inguinal triangle
Superficial inguinal ring (exit of the hernia)
Is much less frequent than oblique hernia
Occurs more often in men than in women
Is always of acquired variety

57. Hernia inguinalis, Tříselná kýla
Vychlípený peritoneální vak
Uvnitř vaku je kýlní obsah (klička střevní, omentum, močový měchýř)
Vak prochází (protlačuje se) zeslabenými místy stěny břišní (může dojít k ruptuře transversální fascie)

58. Herniae inguinales Hernia ing. directa : Hernia ing. indirecta :
Vnitřní branka – trig. inguinale
Zevní branka – anulus ing. superf.
Získaná hernie
Hernia ing. indirecta :
Vnitřní branka – anulus ing. profundus
Zevní branka – anulus ing. Superficialis
Většinou získaná, vzácně vrozená hernie