Appendix. Useful Anatomical Data of Clinical Significance

Appendix Useful Anatomical Data of Clinical Significance

Appendix Outline Respiratory System 426 Table I. Important Airway Distances (Adult) 426 Table II. Important Data Concerning the Trachea 426 Musculoskeletal System 427 Table III. Summary of the Movements of the Shoulder Joint and the Muscles Producing Those Movements 427 Table IV. Summary of the Movements of the Elbow Joint and the Muscles Producing Those Movements 429 Table V. Summary of the Movements of the Wrist Joint and the Muscles Producing Those Movements 430 Table VI. Summary of the Movements of the Hip Joint and the Muscles Producing Those Movements 432 Table VII. Summary of the Movements of the Knee Joint and the Muscles Producing Those Movements 434 Table VIII. Summary of the Movements of the Ankle Joint and the Muscles Producing Those Movements 435 Digestive System 436 Table IX. Lengths and Capacities 436 Urinary System 436 Table X. Lengths and Capacities 436 Reproductive System 436 Table XI. Dimensions 436 Embryology 437 Table XII. The Size and Weight of the Developing Human Embryo and Fetus 437 Respiratory System Table I Important Airway Distances (Adult) a Table II Important Data Concerning the Trachea a Airway Incisor teeth to the vocal cords Incisor teeth to the carina External nares to the carina a Average figures given 1 2 cm. Distances (approx.) 5.9 in. (15 cm) 7.9 in. (20 cm) 11.8 in. (30 cm) Length (approx.) Diameter (approx.) Adults 4.5 in. (11.4 cm) 1 in. (2.5 cm) Infants 1.6 2 in. (4 5 cm) As small as 3 mm b a Extension of the head and neck, as when maintaining an airway in an anesthetized patient, may stretch the trachea and increase its length by 25%. In the adult, the carina may descend by as much as 3 cm on deep inspiration. At the carina, the right bronchus leaves the trachea at an angle of 25 from the vertical and the left bronchus leaves the trachea at an angle of 45 from the vertical. In children younger than 3 years, both bronchi arise from the trachea at equal angles. b As children grow, the diameter in millimeters corresponds approximately to their age in years.

Appendix 427 Musculoskeletal System Table III Summary of the Movements of the Shoulder Joint and the Muscles Producing Those Movements a Movements Muscles Origin Insertion Nerve Supply Nerve b Flexion Deltoid (anterior Clavicle Middle of lateral Axillary nerve C5, 6 fibers) surface of shaft Pectoralis major Clavicle Lateral lip bicipital Medial and lateral C5, 6 (clavicular groove pectoral nerves part) from brachial plexus Biceps brachii Long head Supraglenoid Tuberosity of Musculocutaneous C5, 6 tubercle of scapula radius, deep fascia nerve of forearm Short head Coracoid process of scapula Coraco- Coracoid process Medial aspect of Musculocutaneous C5, 6, 7 brachialis of scapula shaft nerve Extension Deltoid Spine of scapula Middle of lateral Axillary nerve C5, 6 (posterior surface of shaft fibers) Latissimus dorsi Iliac crest, lumbar Floor of bicipital Thoracodorsal C6, 7, 8 fascia, spines of groove of nerve lower six thoracic humerus vertebrae, lower three or four ribs, and inferior angle of scapula Teres major Lower third lateral Medial lip of Lower subscapular C6, 7 border of scapula bicipital groove nerve Abduction Middle fibers Acromion process Middle of lateral Axillary nerve C5, 6 of deltoid of scapula surface of shaft Supraspinatus Supraspinous fossa Greater tuberosity Suprascapular C4, 5, 6 of scapula nerve Adduction Pectoralis major Sternum and upper Lateral lip of Medial and lateral C7, 8; T1 (sternal part) six costal bicipital groove pectoral nerves cartilages Latissimus dorsi Iliac crest, lumbar Floor of bicipital Thoracodorsal C6, 7, 8 fascia, spines of groove nerve lower six thoracic vertebrae, lower three or four ribs, inferior angle of scapula

428 Appendix Table III (continued) Movements Muscles Origin Insertion Nerve Supply Nerve b Teres major Lower third lateral Medial lip of Lower subscapular C6, 7 border of scapula bicipital groove nerve Teres minor Upper two thirds Greater tuberosity Axillary nerve C5, 6 lateral border of scapula Lateral Infraspinatus Infraspinous fossa Greater tuberosity Suprascapular C5, 6 rotation of scapula nerve Teres minor Upper two thirds Greater tuberosity Axillary nerve C5, 6 lateral border of scapula Deltoid Spine of scapula Middle of lateral Axillary nerve C5, 6 (posterior surface of shaft fibers) Medial Subscapularis Subscapular fossa Lesser tuberosity Upper and lower C5, 6 rotation subscapular nerves Latissimus Iliac crest, lumbar Floor of bicipital Thoracodorsal C6, 7, 8 dorsi fascia, spines of groove of nerve lower three or humerus four ribs, inferior angle of scapula Teres major Lower third lateral Medial lip bicipital Lower subscapular C6, 7 border of groove of nerve scapula humerus Deltoid (anterior Clavicle Middle of lateral Axillary nerve C5, 6 fibers) surface of shaft a Circumduction is a combination of all the movements described. b The predominant segmental nerve supply is indicated by boldface type.

Table III. Musculoskeletal System Appendix 429 Table IV Summary of the Movements of the Elbow Joint and the Muscles Producing Those Movements Movements Muscles Origin Insertion Nerve Supply Nerve a Flexion Brachialis Front of lower Coronoid process Musculocutaneous C5, 6 half of ulna nerve Biceps brachii Long head Supraglenoid Tuberosity of Musculocutaneous C5, 6 tubercle of radius, deep nerve scapula fascia of forearm Short head Coracoid process of scapula Brachioradialis Lateral Styloid process Radial nerve C5, 6, 7 supracondylar of radius ridge Pronator teres Humeral head Medial epicondyle Lateral aspect of Median nerve C6, 7 shaft of radius Ulnar head Coronoid process of ulna Extension Triceps Long head Infraglenoid tubercle Olecranon Radial nerve C6, 7, 8 of scapula process of ulna Lateral head Posterior surface of Medial head shaft Lower half of posterior surface of shaft Anconeus Lateral epicondyle Olecranon Radial nerve C7, 8; T1 process of ulna a The predominant segmental nerve supply is indicated by boldface type.

430 Appendix Musculoskeletal System Table V Summary of the Movements of the Wrist Joint and the Muscles Producing Those Movements Movements Muscles Origin Insertion Nerve Supply Nerve a Flexion Flexor carpi Medial epicondyle Bases of second Median nerve C6, 7 radialis and third metacarpal bones Flexor carpi ulnaris Humeral head Medial epicondyle Pisiform bone, Ulnar nerve C7, 8 hook of hamate, base of fifth metacarpal bone Ulnar head Olecranon process, posterior border of ulna Palmaris longus Medial epicondyle Flexor Median nerve C7, 8 retinaculum, palmar aponeurosis Flexor digitorum superficialis Humeroulnar Medial epicondyle Middle phalanx Median nerve C7, 8; T1 head, of medial four Radial head coronoid process of ulna Oblique line anterior surface shaft of radius fingers Flexor digitorum Anterior surface Distal phalanx Ulnar half C8; T1 profundus shaft of ulna, of medial four ulnar nerve, interosseous fingers radial half membrane median nerve Flexor pollicis Anterior surface Distal phalanx Anterior C8; T1 longus shaft of radius of thumb interosseous branch of median nerve Extension Extensor carpi Lateral supracondylar Base of second Radial nerve C6, 7 radialis longus ridge metacarpal bone Extensor carpi Lateral epicondyle of Base of third Deep branch C7, 8 radialis brevis humerus metacarpal bone of radial nerve Extensor carpi Lateral epicondyle Base of fifth Deep branch C7, 8 ulnaris metacarpal bone of radial nerve Extensor Lateral epicondyle Middle and distal Deep branch of C7, 8 digitorum phalanges of radial nerve medial four fingers

Appendix 431 Table V (continued) Movements Muscles Origin Insertion Nerve Supply Nerve a Extensor indicis Shaft of ulna and Extensor Deep branch of C7, 8 interosseous expansion of radial nerve membrane index finger Extensor digiti Lateral epicondyle Extensor Deep branch of C7, 8 minimi expansion of radial nerve little finger Extensor pollicis Shaft of ulna and Base of distal Deep branch of C7, 8 longus interosseous phalanx of thumb radial nerve membrane Abduction Flexor carpi Medial epicondyle Bases of second Median nerve C6, 7 radialis and third metacarpal bones Extensor carpi Lateral Base of second Radial nerve C6, 7 radialis longus supracondylar metacarpal bone ridge Extensor carpi Lateral epicondyle Bases of third Deep branch of C7, 8 radialis brevis metacarpal bone radial nerve Abductor pollicis Shafts of radius Base of first Deep branch of C7, 8 longus and ulna metacarpal bone radial nerve Extensor pollicis Shaft of ulna and Base of distal Deep branch of C7, 8 longus interosseous phalanx of thumb radial nerve membrane Extensor pollicis Shaft of radius and Base of proximal Deep branch of C7, 8 brevis interosseous phalanx of thumb radial nerve membrane Adduction Flexor carpi ulnaris Humeral head Medial Pisiform bone, Ulnar nerve C7, 8 epicondyle of hook of humerus hamate, base of fifth metacarpal bone Ulnar head Olecranon process of ulna Extensor carpi Lateral epicondyle Base of fifth Deep branch of C7, 8 ulnaris metacarpal radial nerve bone a The predominant segmental nerve supply is indicated by boldface type.

432 Appendix Musculoskeletal System Table VI Summary of the Movements of the Hip Joint and the Muscles Producing Those Movements a Movements Muscles Origin Insertion Nerve Supply Nerve b Flexion Iliacus Iliac fossa Lesser trochanter Femoral nerve L2, 3 Psoas Body of twelfth Lesser trochanter Lumbar plexus L1, 2, 3 thoracic vertebra, transverse processes, bodies and intervertebral discs of the five lumbar vertebrae Rectus femoris Straight head Anterior inferior Patella Femoral nerve L2, 3, 4 iliac spine Reflected head Ilium above acetabulum Sartorius Anterior superior Upper medial Femoral nerve L2, 3 iliac spine surface of shaft of tibia Extension Gluteus Outer surface of Iliotibial tract, Inferior gluteal L5; S1, 2 (a posterior maximus ilium, sacrum, gluteal nerve movement coccyx, sacrotuber- tuberosity of of the flexed ous ligament femur thigh) Biceps femoris Long head: ischial Head of fibula Tibial nerve L5; S1, 2 tuberosity (sciatic nerve) Semitendinosus Ischial tuberosity Upper part of Tibial nerve L5; S1, 2 medial surface of (sciatic nerve) shaft of tibia Semimembra- Ischial tuberosity Medial condyle of Tibial nerve L5; S1, 2 nosus tibia (sciatic nerve) Adductor magnus Ischial tuberosity Adductor tubercle Tibial nerve L2, 3, 4 (sciatic nerve) Abduction Gluteus medius Outer surface of Greater Superior gluteal L5; S1 ilium trochanter of nerve femur Gluteus minimus Outer surface of Greater Superior L5; S1 ilium trochanter of gluteal nerve femur Sartorius Anterior superior Upper medial Femoral nerve L2, 3 iliac spine surface of shaft of tibia Tensor fasciae Iliac crest Iliotibial tract Superior gluteal L4, 5 latae nerve Piriformis Anterior surface of Greater Sacral plexus L5; S1, 2 sacrum trochanter of femur

Appendix 433 Table VI (continued) Movements Muscles Origin Insertion Nerve Supply Nerve a Adduction Adductor longus Body of pubis Posterior surface Obturator nerve L2, 3, 4 of shaft Adductor brevis Inferior ramus of Posterior surface Obturator nerve L2, 3, 4 pubis of shaft Adductor magnus Inferior ramus of Posterior surface Obturator nerve L2, 3, 4 (adductor fibers) pubis, ramus of of shaft, ischium, ischial adductor tubercle tuberosity Pectineus Superior ramus of Upper end of Femoral nerve L2, 3 pubis shaft Gracilis Inferior ramus of Upper part of Obturator nerve L2, 3 pubis, ramus of shaft of tibia on ischium medial surface Lateral Piriformis Anterior surface of Greater trochanter Sacral plexus L5; S1, 2 rotation sacrum Obturator Inner surface of Greater trochanter Sacral plexus L5; S1 internus obturator membrane Obturator Outer surface of Greater trochanter Obturator nerve L3, 4 externus obturator membrane Superior Spine of ischium Greater trochanter Sacral plexus L5; S1 gemellus Inferior gemellus Ischial tuberosity Greater trochanter Sacral plexus L5; S1 Quadratus Ischial tuberosity Quadrate tubercle Sacral plexus L5; S1 femoris on upper end of posterior surface Gluteus maximus Outer surface of Iliotibial tract, Inferior gluteal L5; S1, 2 ilium, sacrum, gluteal tuberosity nerve coccyx, sacrotuberous ligament Medial Gluteus medius Outer surface of Greater trochanter Superior gluteal L5; S1 rotation ilium nerve Gluteus Outer surface of ilium Greater trochanter Superior gluteal L5; S1 minimus nerve Tensor fasciae Iliac crest Iliotibial tract Superior L4, 5 latae gluteal nerve a Circumduction is a combination of all the movements described. b The predominant segmental nerve supply is indicated by boldface type.

434 Appendix Musculoskeletal System Table VII Summary of the Movements of the Knee Joint and the Muscles Producing Those Movements Movements Muscles Origin Insertion Nerve Supply Nerve a Flexion Extension Biceps femoris Long head Ischial tuberosity Head of fibula Tibial nerve L5; S1, 2 Short head Shaft Common peroneal nerve Semitendinosus Ischial tuberosity Upper part of Tibial nerve L5; S1, 2 medial surface of shaft of tibia Semimem- Ischial tuberosity Medial condyle of Tibial nerve L5; S1, 2 branosus tibia Gastrocnemius Medial, lateral Via Achilles tendon Tibial nerve S1, 2 condyles of into calcaneum femur Quadriceps femoris: rectus femoris Straight head Anterior inferior Patella Femoral nerve L2, 3, 4 iliac spine Reflected head Ilium above acetabulum Vastus lateralis Upper end and Patella Femoral nerve L2, 3, 4 shaft Vastus medialis Upper end and Patella Femoral nerve L2, 3, 4 shaft Vastus inter- Shaft Patella Femoral nerve L2, 3, 4 medius Medial Sartorius Anterior superior Upper medial Femoral nerve L2, 3 rotation iliac spine surface of shaft of tibia Gracilis Interior ramus of Upper part of shaft Obturator nerve L2, 3 Lateral pubis, ramus of ischium of tibia on medial surface Biceps femoris rotation Long head Ischial tuberosity Head of fibula Tibial nerve L5; S1, 2 Short head Shaft Common L5; S1, 2 peroneal nerve a The predominant segmental nerve supply is indicated by boldface type.

Appendix 435 Musculoskeletal System Table VIII Summary of the Movements of the Ankle Joint and the Muscles Producing Those Movements Nerve Movements Muscles Origin Insertion Supply Nerve a Dorsiflexion Tibialis anterior Shaft of tibia, Medial cuneiform, Deep peroneal L4,5 interosseous base of first nerve membrane metatarsal bone Extensor hallucis Shaft of fibula, Base of distal Deep peroneal L5, S1 longus interosseous phalanx of great nerve membrane toe Extensor digitorum Shaft of fibula, Dorsal extensor Deep peroneal L5, S1 longus interosseous expansion of nerve membrane lateral four toes Peroneus tertius Shaft of fibula, Base of fifth Deep peroneal L5, S1 interosseous metatarsal bone nerve membrane Plantar- Gastrocnemius Medial, lateral Via Achilles tendon Tibial nerve S1,2 flexion condyles of into calcaneum femur Soleus Shaft of tibia Via Achilles tendon Tibial nerve S1,2 and fibula into calcaneum Plantaria Lateral supra- Calcaneum Tibial nerve S1,2 condylar ridge Peroneus longus Shaft of fibula Base of first Superficial L5; S1,2 metatarsal and peroneal nerve medial cuneiform Peroneus brevis Shaft of fibula Base of fifth Superficial L5; S1,2 metatarsal bone peroneal nerve Tibialis posterior Shaft of tibia, Tuberosity of Tibial nerve L4,5 fibula, in- navicular terosseous membrane Flexor digitorum Shaft of tibia Distal phalanges Tibial nerve S2,3 longus of lateral four toes Flexor hallucis Shaft of fibula Base of distal Tibial nerve S2,3 longus phalanx of big toe a The predominant segmental nerve supply is indicated by boldface type.

436 Appendix Digestive System Table IX Lengths and Capacities Region (approx.) Lengths (approx.) Capacities (Approx.) Esophagus 10 in. (25 cm) Stomach a Lesser curvature 4.8 5.6 in. (12 14 cm) 1,500 ml Duodenum 10 in. (25 cm) Jejunum 8 ft (2.4 M) Ileum 12 ft (3.7 M) Appendix 3 5 in. (8 13 cm) Ascending colon 5 in. (13 cm) Transverse colon 15 in. (38 cm) Descending colon 10 in. (25 cm) Sigmoid colon 10 15 in. (25 38 cm) Rectum 5 in. (13 cm) Anal canal 1.5 in. (4 cm) Gallbladder 2.8 3.9 in. (7 10 cm) 30 50 ml Cystic duct 1.5 in. (3.8 cm) Bile duct 3 in. (8 cm) a The curved course taken by a nasogastric tube from the cardiac orifice to the pylorus is usually longer, 6 10 in. (15 25 cm). Urinary System Reproductive System Table X Lengths and Capacities Table XI Dimensions Capacity Organ Lengths (approx.) (approx.) Ureter 10 in. (25 cm) Bladder 500 ml Male urethra 8 in. (20 cm) Penile 6 in. (15.7 cm) Membranous 0.5 in. (1.25 cm) Prostatic 1.25 in. (3 cm) Female urethra 1.5 in. (3.8 cm) Organ Male Testis Vas deferens Penis (erect) Female Ovary Uterine tube Uterus Vagina Dimensions (approx.) 2 1 in. (5 2.5 cm) 18 in. (45 cm) 6 in. (15 cm) 1.5 0.75 in. (4 2 cm) 4 in. (10 cm) 3 2 1 in. (8 5 2.5 cm) 3 in. (8 cm)

Appendix 437 Embryology Table XII The Size and Weight of the Developing Human Embryo and Fetus Age of Conception Crown Rump (weeks) Length (mm) Weight (g) 4 5 0.02 5 8 8 23 1 12 56 14 16 112 105 20 160 310 24 203 640 28 242 1,080 32 277 1,670 36 313 2,400 Full term 350 3,300 Reprinted with permission, Arey 1966. CD Figure APP-1 Critical times in the maturation of the human fetus during which mutant genes, drugs, or environmental factors may alter normal development of specific structures.