Gray's Anatomy for Students

1 The body

What is anatomy? 4

How can gross anatomy be studied? 4

Important anatomical terms 4

Imaging 7

Diagnostic imaging techniques 7

Nuclear medicine imaging 10

Image interpretation 11

Plain radiography 12

Computed tomography 12

Magnetic resonance imaging 13

Nuclear medicine imaging 13

Safety in imaging 13

Body systems 14

Skeletal system 14

Cartilage 14

Bone 15

Joints 20

Skin and fascias 26

Skin 26

Fascia 26

Muscular system 27

Cardiovascular system 29

Lymphatic system 31

Lymphatic vessels 31

Lymph nodes 32

Lymphatic trunks and ducts 32

Nervous system 34

Central nervous system 34

Functional subdivisions of the CNS 34

Somatic part of the nervous system 35

Visceral part of the nervous system 41

Other systems 52

Clinical cases 53

2 Back

Conceptual overview 56

General description 56

Functions 57

Support 57

Movement 57

Protection of the nervous system 58

Component parts 58

Bones 58

Muscles 60

Vertebral canal 62

Spinal nerves 63

Relationship to other regions 64

Head 64

Thorax, abdomen, and pelvis 65

Limbs 65

Key features 65

Long vertebral column and short spinal cord 65

Intervertebral foramina and spinal nerves 66

Innervation of the back 66

Regional anatomy 67

Skeletal framework 67

Vertebrae 67

Intervertebral foramina 75

Posterior spaces between vertebral arches 75

Joints 79

Joints between vertebrae in the back 79

Ligaments 82

Anterior and posterior longitudinal ligaments 82

Ligamenta flava 82

Supraspinous ligament and ligamentum

nuchae 83

Interspinous ligaments 84

Back musculature 86

Superficial group of back muscles 86

Intermediate group of back muscles 92

Deep group of back muscles 93

Suboccipital muscles 99

Spinal cord 101

Vasculature 102

Meninges 104

Arrangement of structures in the vertebral

canal 106

Spinal nerves 107

Surface anatomy 112

Back surface anatomy 112

Absence of lateral curvatures 112

Primary and secondary curvatures in the sagittal

plane 112

Useful nonvertebral skeletal landmarks 112

How to identify specific vertebral spinous

processes 114

Visualizing the inferior ends of the spinal cord and

subarachnoid space 115

Identifying major muscles 116

Clinical cases 118

3 Thorax

Conceptual overview 124

General description 124

Functions 125

Breathing 125

Protection of vital organs 125

Conduit 125

Component parts 125

Thoracic wall 125

Superior thoracic aperture 126

Inferior thoracic aperture 126

Diaphragm 127

Mediastinum 128

Pleural cavities 128

Relationship to other regions 129

Neck 129

Upper limb 130

Abdomen 130

Breast 130

Key features 130

Vertebral level TIV/V 130

Venous shunts from left to right 132

Segmental neurovascular supply of thoracic

wall 132

Sympathetic system 134

Flexible wall and inferior thoracic aperture 134

Innervation of the diaphragm 134

Regional anatomy 137

Pectoral region 137

Breast 137

Muscles of the pectoral region 139

Thoracic wall 141

Skeletal framework 141

Intercostal spaces 147

Diaphragm 156

Venous drainage 158

Innervation 158

Movements of the thoracic wall and diaphragm

during breathing 158

Pleural cavities 159

Pleura 159

Lungs 163

Mediastinum 176

Middle mediastinum 177

Superior mediastinum 204

Posterior mediastinum 215

Anterior mediastinum 223

Surface anatomy 224

Thorax surface anatomy 224

How to count ribs 224

Surface anatomy of the breast in women 225

Visualizing structures at the TIV/V vertebral

level 226

Visualizing structures in the superior

mediastinum 227

Visualizing the margins of the heart 227

Where to listen for heart sounds 228

Visualizing the pleural cavities and lungs, pleural

recesses, and lung lobes and fissures 228

Where to listen for lung sounds 229

Clinical cases 233

44 Abdomen

Conceptual overview 246

General description 246

Functions 247

Houses and protects major viscera 247

Breathing 249

Changes in intra-abdominal pressure 249

Component parts 250

Wall 250

Abdominal cavity 251

Inferior thoracic aperture 253

Diaphragm 253

Pelvic inlet 254

Relationship to other regions 254

Thorax 254

Pelvis 254

Lower limb 255

Key features 256

Arrangement of abdominal viscera in the

adult 256

Skin and muscles of the anterior and lateral

abdominal wall and thoracic intercostal

nerves 259

The groin is a weak area in the anterior abdominal

wall 260

Verterbral Level L1 262

The gastrointestinal system and its derivatives are

supplied by three major arteries 262

Venous shunts from left to right 264

All venous drainage from the gastrointestinal

system passes through the liver 265

Abdominal viscera are supplied by a large

prevertebral plexus 266

Regional anatomy 268

Surface topography 268

Four-quadrant pattern 268

Nine-region pattern 269

Abdominal wall 270

Superficial fascia 270

Anterolateral muscles 272

Extraperitoneal fascia 278

Peritoneum 279

Innervation 279

Arterial supply and venous drainage 280

Lymphatic drainage 282

Groin 282

Inguinal canal 284

Inguinal hernias 288

Abdominal viscera 292

Peritoneum 292

Peritoneal cavity 293

Organs 297

Arterial supply 327

Venous drainage 337

Lymphatics 341

Innervation 341

Posterior abdominal region 348

Posterior abdominal wall 349

Viscera 355

Vasculature 366

Lymphatic system 372

Nervous system in the posterior abdominal

region 374

Sympathetic trunks and splanchnic nerves 374

Surface anatomy 382

Abdomen surface anatomy 382

Defining the surface projection of the

abdomen 383

How to find the superficial inguinal ring 384

How to determine lumbar vertebral levels 385

Visualizing structures at the L1 vertebral

level 386

Visualizing the position of major blood

vessels 387

Using abdominal quadrants to locate major

viscera 388

Defining surface regions to which pain from the gut

is referred 389

Where to find the kidneys 390

Where to find the spleen 390

Clinical cases 391

5 Pelvis and perineum

Conceptual overview 406

General description 406

Functions 406

Contain and support bladder, rectum, anal canal,

and reproductive tracts 406

Anchors the roots of the external genitalia 408

Component parts 408

Pelvic inlet 408

Pelvic walls 409

Pelvic outlet 409

Pelvic floor 411

Pelvic cavity 411

Perineum 412

Relationship to other regions 414

Abdomen 414

Lower limb 414

Key features 415

The pelvic cavity projects posteriorly 415

Important structures cross the ureters in the pelvic

cavity 415

The prostate is anterior to rectum 417

The perineum is innervated by sacral spinal cord

segments 417

Nerves are related to bone 418

Parasympathetic innervation from spinal cord levels

S2 to S4 controls erection 418

Muscles and fascia of the pelvic floor and perineum

intersect at the perineal body 419

Gender determines the course of the urethra 419

Regional anatomy 421

Pelvis 421

Bones 421

Joints 426

Orientation 428

Gender differences 428

True pelvis 429

Vicera 438

Fascia 458

Peritoneum 460

Nerves 462

Blood vessels 471

Lymphatics 477

Perineum 478

Borders and ceiling 478

Ischio-anal fossae and their anterior recesses 480

Anal triangle 480

Urogenital triangle 483

Somatic nerves 490

Visceral nerves 492

Blood vessels 492

Veins 494

Lymphatics 496

Surface anatomy 497

Surface anatomy of the pelvis and perineum 497

Orientation of the pelvis and perineum in the

anatomical position 497

How to define the margins of the perineum 497

Identification of structures in the anal triangle 499

Identification of structures in the urogenital triangle

of women 500

Identification of structures in the urogenital triangle

of men 501

Clinical cases 504

6 Lower limb

Conceptual overview 512

General introduction 512

Function 513

Support the body weight 513

Locomotion 515

Component parts 517

Bones and joints 517

Muscles 518

Relationship to other regions 520

Abdomen 520

Pelvis 521

Perineum 521

Key points 521

Innervation is by lumbar and sacral spinal

nerves 521

Nerves related to bone 525

Superficial veins 525

Regional anatomy 526

Bony pelvis 526

Proximal femur 529

Hip joint 532

Gateways to the lower limb 535

Nerves 537

Arteries 540

Veins 542

Lymphatics 542

Deep fascia and the saphenous opening 544

Femoral triangle 545

Gluteal region 547

Muscles 548

Nerves 551

Arteries 554

Veins 554

Lymphatics 554

Thigh 555

Bones 555

Muscles 561

Arteries 569

Veins 573

Nerves 573

Knee joint 575

Tibiofibular joint 584

Popliteal fossa 584

Leg 585

Bones 586

Joints 588

Posterior compartment of leg 588

Lateral compartment of leg 595

Anterior compartment of leg 596

Foot 600

Bones 600

Joints 605

Tarsal tunnel, retinacula, and arrangement of major

structures at the ankle 612

Arches of the foot 614

Plantar aponeurosis 615

Fibrous sheaths of toes 615

Extensor hoods 616

Intrinsic muscles 616

Arteries 622

Veins 624

Nerves 624

Surface anatomy 628

Lower limb surface anatomy 628

Avoiding the sciatic nerve 628

Finding the femoral artery in the femoral

triangle 630

Identifying structures around the knee 630

Visualizing the contents of the popliteal fossa 632

Finding the tarsal tunnel—the gateway to the

foot 633

Identifying tendons around the ankle and in the

foot 634

Finding the dorsalis pedis artery 635

Approximating the position of the plantar arterial

arch 635

Major superficial veins 636

Pulse points 637

Clinical cases 638

77 Upper limb

Conceptual overview 650

General description 650

Functions 651

Positioning the hand 651

The hand as a mechanical tool 651

The hand as a sensory tool 654

Component parts 654

Bones and joints 654

Muscles 655

Relationship to other regions 657

Neck 657

Back and thoracic wall 658

Key points 659

Innervation by cervical and upper thoracic

nerves 659

Nerves related to bone 663

Superficial veins 663

Orientation of the thumb 664

Regional anatomy 665

Shoulder 665

Bones 665

Joints 668

Muscles 675

Posterior scapular region 678

Muscles 678

Gateways to the posterior scapular region 680

Nerves 682

Arteries and veins 682

Axilla 684

Axillary inlet 685

Anterior wall 686

Medial wall 688

Lateral wall 690

Posterior wall 691

Gateways in the posterior wall 692

Floor 693

Contents of the axilla 693

Arm 710

Bones 712

Muscles 715

Arteries and veins 717

Nerves 720

Elbow joint 724

Cubital fossa 729

Forearm 731

Bones 732

Joints 734

Anterior compartment of the forearm 736

Muscles 736

Arteries and veins 742

Nerves 743

Posterior compartment of the forearm 745

Muscles 745

Arteries and veins 750

Nerves 751

Hand 751

Bones 752

Joints 754

Carpal tunnel and structures at the wrist 756

Palmar aponeurosis 758

Palmaris brevis 759

Anatomical snuffbox 759

Fibrous digital sheaths 759

Extensor hoods 760

Muscles 762

Arteries and veins 767

Nerves 770

Surface anatomy 775

Upper limb surface anatomy 775

Bony landmarks and muscles of the posterior

scapular region 775

Visualizing the axilla and locating contents and

related structures 777

Locating the brachial artery in the arm 779

The triceps brachii tendon and position of the radial

nerve 779

Cubital fossa (anterior view) 779

Identifying tendons and locating major vessels and

nerves in the distal forearm 781

Normal appearance of the hand 782

Position of the flexor retinaculum and the recurrent

branch of the median nerve 783

Motor function of the median and ulnar nerves in

the hand 783

Visualizing the positions of the superficial and deep

palmar arches 784

Pulse points 784

Clinical cases 786

8 Head and neck

Conceptual overview 796

General description 796

Head 796

Neck 798

Functions 799

Protection 799

Contains upper parts of respiratory and digestive

tracts 799

Communication 800

Positioning the head 800

Connects the upper and lower respiratory and

digestive tracts 800

Component parts 800

Skull 800

Cervical vertebrae 802

Hyoid bone 803

Soft palate 804

Muscles 804

Relationship to other regions 805

Thorax 805

Upper limbs 805

Key features 806

Vertebral levels CIII/IV and CV/VI 806

Airway in the neck 806

Cranial nerves 807

Cervical nerves 808

Functional separation of the digestive and

respiratory passages 808

Triangles of the neck 811

Regional anatomy 812

Skull 812

Anterior view 812

Lateral view 814

Posterior view 816

Superior view 818

Inferior view 819

Cranial cavity 822

Roof 822

Floor 823

Meninges 830

Cranial dura mater 830

Arachnoid mater 833

Pia mater 833

Arrangement of meninges and spaces 834

Brain and its blood supply 835

Brain 835

Blood supply 837

Venous drainage 842

Cranial nerves 848

Olfactory nerve [I] 849

Optic nerve [II] 850

Oculomotor nerve [III] 850

Trochlear nerve [IV] 850

Trigeminal nerve [V] 851

Ophthalmic nerve [V1] 852

Maxillary nerve [V2] 852

Mandibular nerve [V3] 852

Abducent nerve [VI] 852

Facial nerve [VII] 852

Vestibulocochlear nerve [VIII] 853

Glossopharyngeal nerve [IX] 853

Vagus nerve [X] 853

Accessory nerve [XI] 854

Hypoglossal nerve [XII] 854

Face 856

Muscles 857

Parotid gland 863

Innervation 865

Vessels 869

Scalp 873

Layers 873

Innervation 874

Vessels 876

Lymphatic drainage 877

Orbit 878

Bony orbit 878

Eyelids 879

Lacrimal apparatus 882

Sensory innervation 882

Fissures and foramina 885

Fascial specializations 886

Muscles 887

Vessels 892

Innervation 893

Eyeball 898

Ear 902

External ear 903

Middle ear 906

Internal ear 913

Temporal and infratemporal fossae 920

Bony framework 920

Temporomandibular joints 922

Masseter muscle 925

Temporal fossa 926

Infratemporal fossa 929

Pterygopalatine fossa 940

Skeletal framework 940

Gateways 941

Contents 942

Neck 947

Fascia 948

Superficial venous drainage 950

Anterior triangle of the neck 954

Posterior triangle of the neck 968

Root of the neck 976

Pharynx 985

Skeletal framework 986

Pharyngeal wall 987

Fascia 990

Gaps in the pharyngeal wall and structures passing

through them 990

Nasopharynx 991

Oropharynx 993

Laryngopharynx 993

Tonsils 993

Vessels 994

Nerves 996

Larynx 997

Laryngeal cartilages 998

Extrinsic ligaments 1000

Intrinsic ligaments 1001

Laryngeal joints 1002

Cavity of the larynx 1003

Intrinsic muscles 1005

Function of the larynx 1008

Vessels 1010

Nerves 1012

Nasal cavities 1013

Lateral wall 1014

Regions 1015

Innervation and blood supply 1016

Skeletal framework 1016

External nose 1018

Paranasal sinuses 1018

Walls, floor, and roof 1020

Nares 1024

Choanae 1024

Gateways 1024

Vessels 1026

Innervation 1028

Oral cavity 1030

Multiple nerves innervate the oral cavity 1031

Skeletal framework 1031

Walls: the cheeks 1034

Floor 1035

Tongue 1037

Salivary glands 1044

Roof—palate 1047

Oral fissure and lips 1055

Oropharyngeal isthmus 1055

Teeth and gingivae 1056

Surface anatomy 1061

Head and neck surface anatomy 1061

Anatomical position of the head and major

landmarks 1062

Visualizing structures at the CIII/CIV and CVI

vertebral levels 1063

How to outline the anterior and posterior triangles

of the neck 1063

How to locate the cricothyroid ligament 1064

How to find the thyroid gland 1065

Estimating the position of the middle meningeal

artery 1066

Major features of the face 1067

The eye and lacrimal apparatus 1068

External ear 1069

Pulse points 1070

Clinical cases 1071