Inguinal Region in the Male

Inguinal and femoral regions in the male (anterior aspect). On the right, the spermatic cord was dissected to display the ductus deferens

and the accompanying vessels and nerves. The fascia lata on the left side has been removed.

Layers of spermatic cord and types of hernias. Left: normal situation. Middle: location of acquired inguinal hernias:

A = indirect; B = direct inguinal hernia. Right: congenital indirect inguinal hernia (C); the vaginal process remained open.

I = median umbilical fold containing urachus chord.

II = medial umbilical fold with remnants of umbilical artery.

III = lateral umbilical fold with inferior epigastric artery and vein.

220 Inguinal Region in the Female

1 Aponeurosis of external abdominal

oblique muscle

2 Internal abdominal oblique muscle

(divided and reflected)

3 Transversus abdominis muscle

4 Superficial circumflex iliac artery and

vein

5 Superficial inguinal ring with fat pad

6 Medial and lateral crural fibers

7 Round ligament (ligamentum teres uteri)

8 Labium majus pudendi

9 Anterior layer of rectus sheath

10 Superficial epigastric artery and vein

11 Inguinal ligament

12 Cutaneous branch of ilio-inguinal nerve

13 Superficial inguinal lymph nodes

14 Entrance of round ligament into the

labium majus

15 External pudendal artery and vein

16 Position of deep inguinal ring

17 Ilio-inguinal nerve

18 Internal abdominal oblique muscle

19 Pubic branch of inferior epigastric

artery

20 Genital branch of genitofemoral nerve

21 Fat pad of inguinal canal

22 Ilio-inguinal nerve

23 Sheath of round ligament

(inguinal canal)

24 Transversalis fascia

Inguinal region in the female (anterior aspect). Left side: superficial layer;

right side: external and internal abdominal oblique muscle divided and reflected.

Inguinal canal of the female (anterior aspect, right side).

The external abdominal oblique muscle has been divided and

reflected, to display the ilio-inguinal nerve and the round

ligament.

Inguinal canal of the female (anterior aspect, right side).

The external and internal abdominal oblique muscle have been

divided and reflected to show the content of the inguinal canal.

Back: Muscles 221

Skeleton of the trunk (dorsal and lateral aspect).

The long muscles of the back [longissimus (1) and iliocostalis (2) muscles] originate at the sacrum and pelvis and insert at the spinous or

transverse processes of the vertebrae or at the ribs. There are also muscles that insert at the occipital bone.

The long muscles form the lateral tract, whereas muscles of the medial tract are situated within the groove between the spinous and

transverse processes of the vertebrae [transversospinal (3) and spinotransversal (4) muscles] or between the spinous processes [spinalis

muscles (5)] or between the transverse processes [intertransversarii muscles (6)] of the vertebrae.

222 Back: Muscles

Origin and insertion of iliocostalis

and longissimus muscles

(schematic drawing).

1 Rectus capitis posterior minor muscle

2 Rectus capitis posterior major muscle

3 Obliquus capitis inferior muscle

4 Spinous process of axis

5 Semispinalis cervicis muscle

6 Spinous process of seventh vertebra

7 Iliocostalis cervicis muscle

8 External intercostal muscles

9 Iliocostalis thoracis muscle

10 Longissimus thoracis muscle

11 Iliocostalis lumborum muscle

12 Internal abdominal oblique muscle

13 Semispinalis capitis muscle (divided)

14 Longissimus capitis muscle

15 Levator scapulae muscle

16 Longissimus cervicis muscle

17 Rhomboid major muscle

18 Spinalis thoracis muscle

19 Serratus posterior inferior muscle

(reflected)

20 Spinous process of second lumbar

vertebra

21 Iliac crest

22 Mastoid process

Muscles of the back. Dissection of the erector spinae muscle (lateral column of the

intrinsic back muscles).

223

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

Back: Muscles

1 Rectus capitis posterior minor muscle

2 Rectus capitis posterior major muscle

3 Obliquus capitis superior muscle

4 Obliquus capitis inferior muscle

5 Semispinalis cervicis muscle

6 Levator scapulae muscle

7 Rhomboideus major muscle

8 Scapula with infraspinatus muscle

9 Teres major muscle

10 Spinalis muscle

11 Latissimus dorsi muscle

12 Levatores costarum muscles

13 Spinous processes of lumbar vertebrae

14 Ribs (Th11, Th12)

15 Multifidus muscle

16 Longissimus and iliocostalis

muscles (cut)

17 Iliac crest (lumbar triangle)

18 Thoracolumbar fascia

19 Gluteus maximus muscle

20 Protuberantia occipitalis externa

21 Occipital artery and greater occipital

nerve (C2)

22 Posterior tubercle of atlas

23 Spinous process of axis

24 Spinous process of seventh cervical

vertebra (vertebra prominens)

25 Medial branches of dorsal branches

of spinal nerves

26 External intercostal muscles

27 Lateral branches of dorsal branches

of spinal nerves

28 Superior cluneal nerves

Muscles of the back. Dissection of the deeper layer of the intrinsic muscles of the

back (longissimus and iliocostalis muscles are cut).

224

1

2

3

4

5

6

10

1

11

13

12

3

7

6

8

8

9

10

Back: Muscles

1 Semispinalis cervicis muscle

2 Levator scapulae muscle

3 Levatores costarum muscles

4 Vertebral arches of lumbar vertebrae

5 Supraspinal ligaments

6 Intertransverse lumbar muscles

7 Lumbar rotator muscles

8 Cutaneous branches of spinal nerves

9 Lumbar interspinal muscles

10 Longissimus and iliocostalis muscle (cut)

11 Spinal muscle of the back

12 Multifidus muscle

13 Tenth rib (T10)

Muscles of the back. Deepest layer. Lumbar region (higher

magnification).

Muscles of the back. Deepest layer.

Back: Muscles 225

Medial column of intrinsic muscles of the

back. Transversospinal and intertransversal

system (schematic drawing).

1 Rectus capitis posterior minor muscle

2 Obliquus capitis superior muscle

3 Rectus capitis posterior major muscle

4 Obliquus capitis inferior muscle

5 Spinous process of axis

6 Longissimus capitis muscle

7 Trapezius muscle (reflected) and

accessory nerve (n. XI)

8 Spinous processes

9 Rhomboid major muscle

10 Transverse processes of thoracic

vertebrae

11 Teres major muscle

12 Intertransverse ligaments

13 Levatores costarum muscles

14 Rotatores muscles

15 Tendons of iliocostalis muscle

16 Intertransversarii lumborum muscles (lateral)

17 Iliac crest

18 Gluteus maximus muscle

19 Semispinalis capitis muscle

20 Semispinalis cervicis muscle

21 Semispinalis thoracis muscle

22 External intercostal muscles

23 Multifidus muscle

24 Posterior cervical intertransversarii muscles

25 Spinalis thoracis muscle

Muscles of the back. Transversospinal muscles, deepest layer on the right, where all

parts of semispinalis and multifidus muscles have been removed.

226 Back: Nerves

1 Occipital belly of occipitofrontalis muscle

2 Splenius capitis muscle

3 Trapezius muscle

4 Medial cutaneous branches of dorsal rami

of spinal nerves

5 Medial margin of scapula

6 Rhomboid major muscle

7 Latissimus dorsi muscle

8 Lateral cutaneous branches of dorsal rami

of spinal nerves

9 Thoracolumbar fascia

10 External abdominal oblique muscle

11 Iliac crest

12 Last coccygeal vertebra

13 Anus

14 Greater occipital nerve

15 Third occipital nerve

16 Lesser occipital nerve

17 Cutaneous branches of cervical plexus

18 Levator scapulae muscle

19 Deltoid muscle

20 Rhomboid major and minor muscles

21 Upper lateral cutaneous nerve of arm

(branch of axillary nerve)

22 Teres major muscle

23 Iliocostalis thoracis muscle

24 Serratus posterior inferior muscle

25 Superior cluneal nerves

26 Middle cluneal nerves

27 Inferior cluneal nerves

28 Posterior femoral cutaneous nerve

Innervation of the back. Superficial (left) and deeper (right) layers.

Right trapezius and latissimus dorsi muscles removed.

To page 227:

1 Trapezius muscle

2 Infraspinatus muscle

3 Left latissimus dorsi muscle

4 Thoracolumbar fascia

5 Splenius cervicis muscle

6 Serratus posterior superior muscle

7 Medial branches of dorsal rami

of thoracic spinal nerves

8 Lateral branches of dorsal rami

of thoracic spinal nerves

9 Iliocostalis muscle

10 Serratus posterior inferior muscle

11 Latissimus dorsi muscle (reflected)

Back: Nerves 227

Innervation of the back. Dissection of the dorsal branches of spinal nerves. On the right, longissimus thoracis muscle has

been removed and iliocostalis muscle laterally reflected.

228 Back: Nerves

Innervation of the back. Deeper layer (dorsal aspect).

1 Semispinalis capitis muscle

2 Left splenius capitis muscle

(cut and reflected)

3 Left splenius cervicis muscle

(cut and reflected)

4 Semispinalis thoracis muscle

5 Spinalis thoracis muscle

6 Latissimus dorsi muscle (reflected)

7 Iliac crest

8 Lesser occipital nerve

9 Splenius capitis muscle

10 Levator scapulae muscle

11 Splenius cervicis muscle

12 Serratus posterior superior muscle

13 Scapula

14 Medial branches of dorsal rami

of spinal nerves

15 Rib and external intercostal muscle

16 Iliocostalis thoracis muscle

17 Lateral branches of dorsal rami

of spinal nerves

18 Multifidus muscle

19 Superior cluneal nerves