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Appendix Useful Anatomical Data of

Clinical Significance

Appendix Outline

Respiratory System	426	Table VII. Summary of the Movements of the
Table I. Important Airway Distances (Adult)	426	Knee Joint and the Muscles Producing
Table I. Important Airway Distances (Adult)	426	Those Movements	434
Table II. Important Data Concerning the Trachea	426	Those Movements	434
Table II. Important Data Concerning the Trachea	426	Table VIII. Summary of the Movements of the Ankle
Musculoskeletal System	427	Table VIII. Summary of the Movements of the Ankle
Musculoskeletal System	427	Joint and the Muscles Producing Those
Table III. Summary of the Movements of the		Movements	435
Shoulder Joint and the Muscles Producing		Digestive System	436
Those Movements	427	Digestive System	436
Those Movements	427	Table IX. Lengths and Capacities	436
Table IV. Summary of the Movements of the		Table IX. Lengths and Capacities	436
Table IV. Summary of the Movements of the		Urinary System	436
Elbow Joint and the Muscles Producing		Urinary System	436
Those Movements	429	Table X. Lengths and Capacities	436
Table V. Summary of the Movements of the		Reproductive System	436
Wrist Joint and the Muscles Producing		Table XI. Dimensions	436
Those Movements	430	Table XI. Dimensions	436
Those Movements	430	Embryology	437
Table VI. Summary of the Movements of the		Embryology	437
Table VI. Summary of the Movements of the		Table XII. The Size and Weight of the Developing
Hip Joint and the Muscles Producing		Table XII. The Size and Weight of the Developing
Those Movements	432	Human Embryo and Fetus	437

Respiratory System

	Important Airway Distances
Table I	Important Airway Distances
Table I	(Adult)a

		Distances
Airway		(approx.)

Incisor teeth to the vocal cords		5.9 in. (15 cm)
Incisor teeth to the carina		7.9 in. (20 cm)
External nares to the carina		11.8 in. (30 cm)

a Average figures given 1–2 cm.

		Important Data Concerning
Table II		Important Data Concerning
Table II		the Tracheaa

	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 mmb

aExtension 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.

bAs children grow, the diameter in millimeters corresponds approximately to their age in years.

Appendix 427

Musculoskeletal System


		Summary of the Movements of the Shoulder Joint and the Muscles Producing
Table III
Table III		Those Movementsa
		Those Movementsa

						Segmental
Movements	Muscles		Origin	Insertion	Nerve Supply	Nerveb
Flexion	Deltoid (anterior		Clavicle	Middle of lateral	Axillary nerve	C5, 6
	fibers)			surface of shaft
				of humerus
	Pectoralis major		Clavicle	Lateral lip bicipital	Medial and lateral	C5, 6
	(clavicular			groove of humerus	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 of humerus	nerve
Extension	Deltoid		Spine of scapula	Middle of lateral	Axillary nerve	C5, 6
	(posterior			surface of shaft
	fibers)			of humerus
	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
				of humerus
Abduction	Middle fibers		Acromion process	Middle of lateral	Axillary nerve	C5, 6
	of deltoid		of scapula	surface of shaft
				of humerus
	Supraspinatus		Supraspinous fossa	Greater tuberosity	Suprascapular	C4, 5, 6
			of scapula	of humerus	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	of humerus
	Latissimus dorsi		Iliac crest, lumbar	Floor of bicipital	Thoracodorsal	C6, 7, 8
			fascia, spines of	groove of humerus	nerve
			lower six thoracic
			vertebrae, lower
			three or four ribs,
			inferior angle of
			scapula

428 Appendix


	Table III		(continued)

							Segmental
Movements		Muscles		Origin	Insertion	Nerve Supply	Nerveb
		Teres major		Lower third lateral	Medial lip of	Lower subscapular	C6, 7
				border of scapula	bicipital groove	nerve
					of humerus
		Teres minor		Upper two thirds	Greater tuberosity	Axillary nerve	C5, 6
				lateral border of	of humerus
				scapula
Lateral		Infraspinatus		Infraspinous fossa	Greater tuberosity	Suprascapular	C5, 6
	rotation			of scapula	of humerus	nerve
		Teres minor		Upper two thirds	Greater tuberosity	Axillary nerve	C5, 6
				lateral border of	of humerus
				scapula
		Deltoid		Spine of scapula	Middle of lateral	Axillary nerve	C5, 6
			(posterior		surface of shaft
			fibers)		of humerus
Medial		Subscapularis		Subscapular fossa	Lesser tuberosity	Upper and lower	C5, 6
	rotation				of humerus	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
					of humerus

aCircumduction is a combination of all the movements described.

bThe predominant segmental nerve supply is indicated by boldface type.

Appendix 429

MusculoskeletalTable IIISystem.

			Summary of the Movements of the Elbow Joint and the Muscles Producing
	Table IV
	Table IV		Those Movements

							Segmental
Movements		Muscles		Origin	Insertion	Nerve Supply	Nervea
Flexion		Brachialis		Front of lower	Coronoid process	Musculocutaneous	C5, 6
				half of humerus	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 of humerus
		Pronator teres
		Humeral head		Medial epicondyle	Lateral aspect of	Median nerve	C6, 7
				of humerus	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
				shaft of humerus
		Medial head		Lower half of
				posterior surface
				of shaft of humerus
		Anconeus		Lateral epicondyle	Olecranon	Radial nerve	C7, 8; T1
				of humerus	process of ulna

aThe predominant segmental nerve supply is indicated by boldface type.

430 Appendix

Musculoskeletal System


			Summary of the Movements of the Wrist Joint and the Muscles Producing Those
	Table V
	Table V		Movements

							Segmental
Movements		Muscles		Origin	Insertion	Nerve Supply	Nervea
Flexion		Flexor carpi		Medial epicondyle	Bases of second	Median nerve	C6, 7
		radialis		of humerus	and third
					metacarpal bones
		Flexor carpi
		ulnaris
		Humeral head		Medial epicondyle	Pisiform bone,	Ulnar nerve	C7, 8
				of humerus	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
				of humerus	retinaculum,
					palmar
					aponeurosis
		Flexor digitorum
			superficialis
		Humeroulnar		Medial epicondyle	Middle phalanx	Median nerve	C7, 8; T1
			head	of humerus,	of medial four
				coronoid process	fingers
				of ulna
		Radial head		Oblique line anterior
				surface shaft of
				radius
		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 of humerus	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	of humerus	metacarpal bone	of radial nerve
		Extensor		Lateral epicondyle	Middle and distal	Deep branch of	C7, 8
			digitorum	of humerus	phalanges of	radial nerve
					medial four
					fingers

Appendix 431


Table V		(continued)

						Segmental
Movements	Muscles		Origin	Insertion	Nerve Supply	Nervea
	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	of humerus	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	of humerus	and third
				metacarpal bones
	Extensor carpi		Lateral	Base of second	Radial nerve	C6, 7
		radialis longus	supracondylar	metacarpal bone
			ridge of humerus
	Extensor carpi		Lateral epicondyle	Bases of third	Deep branch of	C7, 8
		radialis brevis	of humerus	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	of humerus	metacarpal	radial nerve
				bone

a The predominant segmental nerve supply is indicated by boldface type.

432 Appendix

Musculoskeletal System


		Summary of the Movements of the Hip Joint and the Muscles Producing
	Table VI
	Table VI	Those Movementsa

						Segmental
Movements		Muscles	Origin	Insertion	Nerve Supply	Nerveb
Flexion		Iliacus	Iliac fossa	Lesser trochanter	Femoral nerve	L2, 3
				of femur
		Psoas	Body of twelfth	Lesser trochanter	Lumbar plexus	L1, 2, 3
			thoracic vertebra,	of femur
			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
				of femur	(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)

						Segmental
Movements	Muscles		Origin	Insertion	Nerve Supply	Nervea
Adduction	Adductor longus		Body of pubis	Posterior surface	Obturator nerve	L2, 3, 4
				of shaft of femur
	Adductor brevis		Inferior ramus of	Posterior surface	Obturator nerve	L2, 3, 4
			pubis	of shaft of femur
	Adductor magnus		Inferior ramus of	Posterior surface	Obturator nerve	L2, 3, 4
	(adductor fibers)		pubis, ramus of	of shaft of femur,
			ischium, ischial	adductor tubercle
			tuberosity	of femur
	Pectineus		Superior ramus of	Upper end of	Femoral nerve	L2, 3
			pubis	shaft of femur
	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	of femur
	Obturator		Inner surface of	Greater trochanter	Sacral plexus	L5; S1
	internus		obturator membrane	of femur
	Obturator		Outer surface of	Greater trochanter	Obturator nerve	L3, 4
	externus		obturator membrane	of femur
	Superior		Spine of ischium	Greater trochanter	Sacral plexus	L5; S1
	gemellus			of femur
	Inferior gemellus		Ischial tuberosity	Greater trochanter	Sacral plexus	L5; S1
				of femur
	Quadratus		Ischial tuberosity	Quadrate tubercle	Sacral plexus	L5; S1
	femoris			on upper end of
				posterior
				surface of femur
	Gluteus maximus		Outer surface of	Iliotibial tract,	Inferior gluteal	L5; S1, 2
			ilium, sacrum,	gluteal tuberosity	nerve
			coccyx,	of femur
			sacrotuberous
			ligament
Medial	Gluteus medius		Outer surface of	Greater trochanter	Superior gluteal	L5; S1
rotation			ilium	of femur	nerve
	Gluteus		Outer surface of ilium	Greater trochanter	Superior gluteal	L5; S1
	minimus			of femur	nerve
	Tensor fasciae		Iliac crest	Iliotibial tract	Superior	L4, 5
	latae				gluteal nerve

aCircumduction is a combination of all the movements described.

bThe predominant segmental nerve supply is indicated by boldface type.

434 Appendix

Musculoskeletal System

		Summary of the Movements of the Knee Joint and the Muscles
Table VII		Summary of the Movements of the Knee Joint and the Muscles
Table VII		Producing Those Movements
		Producing Those Movements

						Segmental
Movements	Muscles		Origin	Insertion	Nerve Supply	Nervea
Flexion	Biceps femoris
	Long head		Ischial tuberosity	Head of fibula	Tibial nerve	L5; S1, 2
	Short head		Shaft of femur		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
Extension	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 of femur
	Vastus medialis		Upper end and	Patella	Femoral nerve	L2, 3, 4
			shaft of femur
	Vastus inter-		Shaft of femur	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
			pubis, ramus	of tibia on medial
			of ischium	surface
Lateral	Biceps femoris
rotation		Long head	Ischial tuberosity	Head of fibula	Tibial nerve	L5; S1, 2
		Short head	Shaft of femur	—	Common	L5; S1, 2
					peroneal
					nerve

a The predominant segmental nerve supply is indicated by boldface type.

Appendix 435

Musculoskeletal System

	Summary of the Movements of the Ankle Joint and the Muscles Producing
Table VIII
Table VIII	Those Movements
	Those Movements

				Nerve	Segmental
Movements	Muscles	Origin	Insertion	Supply	Nervea
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
		of femur
	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)	—
Stomacha			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


	Lengths and Capacities
Table X	Lengths and Capacities

		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)	—



		Table XI	Dimensions

		Organ	Dimensions (approx.)

		Male
		Testis	2 1 in. (5 2.5 cm)
		Vas deferens	18 in. (45 cm)
		Penis (erect)	6 in. (15 cm)
		Female
		Ovary	1.5 0.75 in. (4 2 cm)
		Uterine tube	4 in. (10 cm)
		Uterus	3 2 1 in. (8 5 2.5 cm)
		Vagina	3 in. (8 cm)

Appendix 437

Embryology

		The Size and Weight of the
	Table XII	The Size and Weight of the
	Table XII	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.

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