ანატომია ზეპირი:

1. Frontal Bone – Borders 12 bones: ethmoid, sphenoid, 2 parietals, 2 nasals, 2 maxillae, 2 lacrimal, 2
zygomatic. Has 3 parts: squamous (forehead area, flat, zygomatic processes, contains frontal sinuses,
glabella), orbital, and nasal. Part of the eye orbit. Nasal notch connects to -?. Orbital plates. Foramen
cecum (here passes emissary vein from the nose to the superior sagittal sinus).
2. Anterior Cranial Fossa – formed by frontal, ethmoid and lesser wing of sphenoid bones. Frontal crest
– the median bony extension of frontal bone. Foramen cecum – important during fetal development,
insignificant postnatally. At the base of frontal bone. Emissary vein passes here. Has ethmoid bone in
middle, which contains cribriform plate and crista galli (triangular process, olfactory nerve (1) passes
here, responsible for smell).
3. Middle Cranial Fossa – butterfly shaped, lateral parts are depressed. Postero-inferior to anterior fossa.
Sphenoidal crests – separates frontal and middle cranial fossae laterally. Formed by lesser wing of
sphenoid bone. They end medially into clinoid processes. Optic nerve (2) passes through optic canal,
with artery and sympatric nerves. Hypophyseal fossa – for hypophysis. Foramen: spinosum, ovale,
lacerum. Hiatus of greater and lesser petrosal nerves.
4. Orbits – formed by bones: frontal, ethmoid, sphenoid lesser wing, zygomatic, maxilla, lacrimal,
palatine. Has superior and inferior orbital fissure. 5 nerves pass here: optical (2), oculomotor (3),
trochlear (4), ophthalmic (5), abducens (6).
5. Posterior Cranial Fossa – contains foramen magnum; internal occipital crest; Jugular foramen;
hypoglossal canal; internal acoustic meatus; clivus. Anterior margin, pharyngeal tubercle, floor is
mostly occipital bone which has foramen, hypoglossal foramen, others too I think. Sulcus =?. Carotic
artety comes in carotic artery, goes through ptergopalatic fossa, ends in middle crania fossa (which
foramen?).
6. Sphenoid Bone – cranial medial fossa base. Irregular bone, in contact with frontal, temporal and
occipital bones.
Body: anteriorly contributes with nasal cavity, laterally optic canal, superiorly Sella turcica,
hypophyseal fossa, and dorsum selle. Dorsum selle and sella turcica house pituitary gland.
2 greater wings: anteriorly, posterior aspect of lateral orbital wall, contain foramen ovale and foramen
spinosum that house mandibular nerve, meningeal vessels.
2 lesser wings: Superolaterally – optic canal, inferiorly – lateral margin of orbit, superiorly – cranial
cavity.
pterygoid processes: contain pterygoid canal (petrosal nerve and pharyngeal nerve (9).
2 paranasal sinuses. ქიაზმა ოპტიკ ნერვში and posterior clinoid process. Nerves: oculomotor (3),
trochlear (4), ophthalmic (5), abducens (6). Foramen: spinosum, ovale (mandibular branch of nerve 5),
lacerum. Hiatus of greater and lesser petrosal nerves.
7. Lateral Aspect of Cranium – The lateral aspect of the cranium is formed by both neurocranium and
Viscerocranium. The main features of the neurocranial part are the temporal fossa, the external
acoustic meatus opening, and the mastoid process of the temporal bone. The main features of the
viscerocranial part are the infratemporal fossa, zygomatic arch, and lateral aspects of the maxilla and
mandible. The temporal fossa is bounded superiorly and posteriorly by the superior and inferior
temporal lines, anteriorly by the frontal and zygomatic bones, and inferiorly by the zygomatic arch.
The superior border of this arch corresponds to the inferior limit of the cerebral hemisphere of the
brain. The zygomatic arch is formed by the union of the temporal process of the zygomatic bone and
the zygomatic process of the temporal bone. In the anterior part of the temporal fossa, superior to the
midpoint of the zygomatic arch, there is a clinically important area of bone junctions: the pterion. It is
usually indicated by an H-shaped formation of sutures that unite the frontal, parietal, sphenoid
(greater wing), and temporal bones. Less commonly, the frontal and temporal bones articulate.
Sometimes all four bones meet at a point. The external acoustic meatus opening (pore) is the entrance
to the external acoustic meatus (canal), which leads to the tympanic membrane (eardrum). The
mastoid process of the temporal bone is postero-inferior to the external acoustic meatus opening.
Anteromedial to the mastoid process is the styloid process of the temporal bone, a slender needle-like,
pointed projection. The infratemporal fossa is an irregular space inferior and deep to the zygomatic
arch and mandible and posterior to the maxilla.

zygomatic arch, and the upper and lower jaws. The zygomatic arch is formed jointly by the zygomatic
process of the temporal bone and the temporal process of the zygomatic bone. The shallow space
above the zygomatic arch is the temporal fossa.
8. Pterogopalatine Fossa – bilateral, extending from infratemporal fossa to nasal cavity. Between maxilla,
sphenoid and palatine bones. Maxillary artery, its branches, trigeminal nerve (5) with foramen
rotundum, emissary veins pass here.

9. Facial Aspect of the Scalp - scalp consists of skin (hair bearing) and subcutaneous tissue. Has 5 layers,
first 3 layers are connected and move together. Scalp is an acronym: S- skin; C – connective tissue; a –
aponeurosis; L – loose connective tissue; P – pericranium. Facial muscles are in subcutaneous tissue.
Gala aponeurosis, muscles, supraciliaic arch.
10. Facial Aspect of the Cranium, Maxillary Bone – facial bones are: 2 maxilla, 2 zygomatic, mandible, 2
nasal, 2 Palatine, 2 lacrimal, vomer, 2 inferior nasal conchae. Maxillary bone – pair bone, upper jaw,
gomphosis with teeths. Has body and 4 processes: frontal, zygomatic, palatine, alveolar. Foramen:
maxillary foramen.
11. Cervical Vertebrae (7)– C1=atlas, C2=axis; C7=vertebra prominens-palpable, long spinous processes.
Atlantoaxial joint – between C1 and C2. Has 3 synovial joints: lateral right, lateral left, and medial.
Lateral joints are plane-synovial, medial joint is pivot synovial. Ligaments: cruciform ligament (type is
cruciate ligament) of atlas (transverse ligament + longitudinal bands). Alar ligaments – from den of
atlas to foramen magnum. Tectorial membrane – continuation of posterior longitudinal ligament,
Den of atlas - a bony extension around which atlas rotates.
Cervical lordosis is 20–40 degrees. Has small vertebral bodies. Atlas – anterior and posterior arches
and tubercles. Transverse processes have foramens, where vertebral arteries pass (not in C7).
Intervertebral foramen is created with bodies, IV discs and superior & posterior notches.
12. Thoracic Vertebrae, Fracture and Dislocation of Atlas (12)– Atlantoaxial joint dislocation, most often
in adolescents. Thoracic kyphosis is 20-40 degrees. Special characteristic – rib binding with costal
cartilages. Each rib binds with 2 vertebrae with demifacets (same level vertebra and upper vertebra),
and transverse process of same level vertebrae with tubercle. Rib and vertebrae attach at
costovertebral joint.
13. Lumbar Vertebrae, Lumbar Spinal Stenosis (5) - stenosis means narrowing. This case, narrowing of
lumbar spinal canal. Can happen in any part, most often in lumbar area. Foramen openings narrow,
which compresses nerves. Can cause pain or numbness, access pressure on spinal canal.
Large vertebral bodies, short and thick spinous processes. Lumbar lordosis = 40 – 60 degrees.
14. Sacrum (S5) – below Lumbar vertebrae, connects backbone with pelvis with Sacroiliaic joint, forming
posterior pelvic wall. Sacral kyphosis = Sacrum fused in a kyphotic curve. Sacral hiatus – inferior side,
sacral verves and coccygeal nerves pass here. Ala – provides stability and aids in walking. Sacral canals
– for sacral nerves and blood vessels. Dorsal sacral foramina – posterior sacral nerves pass here. Apex
– articulates with coccyx. Superior articular facet connects with L5 vertebra in lumbosacral joint.
15. Scapula – has anterior and posterior parts; flat bone. Inferior angle, superior angle, lateral angle.
Medial border between superior and inferior angles. Lateral border between inferior angle and
glenoid cavity. Fossae: supraspinous, infraspinous, subscapular. Scapular notch - at the end of coracoid
process, superior border lateral notch. Arteries and nerves pass here. glenoid cavity - socket for
humerus, infraglenoid and supraglenoid tubercles. Coracoid process – horizontal, acromion – on top,
end of scapular spine.
16. Clavicle (collar bone) – Has shape of long bone, but isn’t. S shape, connects upper limb with truck.
Shaft of the clavicle – has double curve in horizontal lane. Sternal end is triangular and it articulates
with manubrium at the sternoclavicular joint. Lateral half has acromial end, which has flat ending
 where it articulates with acromion at acromioclavicular joint (here is acromioclavicular ligament).
Curves increase the resilience. Covers the first rib from injury.
Inferior surface: conoid tubercle – conoid ligament attaches, trapezoid line, subclavian groove.
17. Sternum – flat, elongated bone. Directly covers the central mediastinum. Middle part of anterior
thoracic cage. 3 parts: manubrium, body, xiphoid process. In adolescents and children these parts are
connected with cartilaginous joint (synchondrosis), which later undergoes ossification. Manubrium is
widest and thickest part. Superior border is jugular notch. Clavicular notches receive clavicles,
forming sternoclavicular joints. First rib synchondrosis– connects to manubrium. Manubriosternal
joint – secondary cartilaginous joint - symphysis, manubrium and sternum body joint. Same as sternal
angle. Second rib articulates at manubriosternal joint. Other ribs bind the body of sternum at costal
notches, up to 6th. The 7th rib binds sternum at Xiphisternal joint. Diaphragm binds xiphoid process
posterior surface. Xiphoid process is on T10 vertebra level.
18. Ribs – all originate (posteriorly) from thoracic vertebra (T1-T12), and insertion is at
vertebral bodies, IV discs and transverse processes (with tubercle). Curved, flat bones.
Each contains spongy, hematopoietic (red) bone marrow. Ribs elevate or depress around an
axis that traverses the head and neck of the rib. Intercostal space (11 in total) – space
between adjacent ribs. Separates ribs and their costal cartilages from other ribs, is filled
with muscles, membranes, blood vessels and nerves. Subcostal space – space between 12th
rib. In groove – intercostal vein, artery and nerve. External and internal sides, which
muscles attach. Costo-vertebral, capsular vertebra. Posterior tubercle parts. Has costal
angle, costal tubercle (articulating and nonarticulating parts, articulating part connects
transverse processes, nonarticulating parts connect). Radiate ligament – connects rib head
with backbone and stabilizes the joint.
Classification (1):
True ribs (vertebrosternal) – ribs from 1 to 7. Join to the sternum through the costal
colleges. Costochondral joint – between sternal end of true ribs and sternal cartilage.
False ribs (vertebrochondral) – ribs 8, 9, 10. Attach to the sternum by joining the cartilages
of ribs 6 and 7. Indirect connection with sternum. Interchondral joint – in ribs 7 to 10,
connects costal cartilages.
Floating ribs (vertebral, free) – ribs 11 and 12 (sometimes 10th rib too). Originate from
vertebra but don’t attach anywhere
classification (2):
Typical – ribs 3 to 9. They have: head, neck, tubercle (articular and nonarticular parts), and
body (contains costal groove, curves at costal angle, joins costal cartilage). Superior and
inferior facets that binds with vertebrae, between them - crest of the head. Neck connects
the head of the rib with the body. Tubercle: at the junction of neck and body. Articular part
articulates with transverse process of vertebra, nonarticular part provides attachment site
 for costotransverse ligament. Body: thin, flat, curved. Inner surface is concave, has costal
groove (protects costal nerve), which protects intercostal nerve and vessels.
Atypical – ribs 1, 2, 10, 11, 12. Rib 1 – one facet on head articulates with T1 only, shortest.
2 transverse grooves for subclavian vessels. On the level of third vertebra.
Rib 2 – longer than first rib, 2 facets for articulation with T1 and T2 vertebrae. Atypical
feature is tuberosity for serratus anterior (rough area on upper surface. On the level of 5th
vertebra. Rib 7 – largest, typical. 10th, 11th, and 12th ribs - short, no neck or tubercle, one
facet on their heads and articulate with single vertebra.
19. Humerus, Fractures of Humerus – has head, anatomical and surgical necks. Anatomical superiorly,
surgical inferiorly. Proximally has greater and lesser tubercles. On shaft, has intertubercular (bicipital)
groove. On middle part, has deltoid tuberosity (anterior surface) and radial groove (posterior surface).
Distally has olecranon, radial, and coronoid fossae. Has medial and lateral epicondyles. Has lateral and
medial supracondylar ridges.
20. Ulnar bone – medial. proximally has coronoid process, trochlear notch, olecranon process. Creates
hinge elbow joint, primary synovial cartilaginous joint. Olecranon is the fossa where humerus
epicondyles are placed. Distally has head, styloid process, radio-ulnar joint. Between ulna and radius
is interosseous membrane of forearm.
21. Radial Bone – proximal head is articular disc, then comes radial neck and radial tuberosity. Distally
has articular surface for carpal bone articulation. Distal end also has styloid process, and ulnar notch.
Wide head is towards carpal bones, where in wrist joint articulates with scaphoid, lunate, triquetral.
22. Bones of Hand – Carpal  metacarpal  proximal, intermediate (not in 5th finger), distal phalanges.
Carpal bones: scaphoid – connects with radius; lunate – connects radius and ulna, triquetrum –
proximal but lateral side; Hamate – distal, binds 4th and 5th metacarpals, has anchor; Capitate – distal,
binds 3rd metacarpal; trapezoid – distal, binds second metacarpal; trapezium – distal, binds first
metacarpal.

Carpometacarpal joint – synovial plane. Metacarpophalangeal joint – condyloid synovial.

23. Bones and Features of Pelvic Girdle – pelvic girdle – sacrum, coccyx, ilium, ischium, pubic. There are
true and false pelvis.
24. Hip Bone, Ilium – made of 2 parts: ala (wing) and body. Has 4 spines, anterior infero and superior,
posterior infero and superior. Iliac crest runs between anterior superior and posterior superior spines.
 Iliac tubercle – posterior to ASIS (anterior superior illiaic spine). Iliac fossa is formed medially on ala.
It is smooth depression for iliacus muscle attachment. Ilium creates superior third of acetabulum.
Posterior inferior illiaic spine is the superior end of greater sciatic notch. Articular surface – medial
posterior side of ilium, rough, auricular (ყურის ფორმის). Iliac tuberosity – even rougher surface
superior to articular surface, synovial and syndesmotic articulation with reciprocal surfaces of sacrum
at Sacroiliaic joint.
25. Hip Bone, Pubis - 3 main parts: body, superior ramus, inferior ramus. Pubic symphysis is articulation
between pubic bones, (secondary cartilaginous, has disc). superior-inferior ramus connection
(vertically). Iliopubic eminence – at proximal (near center) portion of the pubic bone, unites ilium
and pubis. With ischium creates obturator foramen. In this foramen passes obturator artery, obturator
vein, obturator nerve (In obturator canal). Pubic crest – created by pubic symphysis and antero-
superior surfaces of joined pubic bodies, attachment for abdominal muscles. Pubic tubercles – lateral
ends of pubic crest, they bind inguinal ligament. Lateral 1/3 of acetabulum.
26. Hip Bone, Ischium –Postero-inferior part of hip bone. Superior and inferior ramus and body. Forms
inferior third of acetabulum. Ischial ramus joints inferior ramus of pubic bone, forming ischiopubic
ramus. It is the inferomedial boundary of obturator foramen. Posterior part of ischium creates part of
greater sciatic notch. Ischial spine – triangular, separates greater and lesser sciatic notches. Ischial
tuberosity – bears the weight while sitting, is proximal attachment to posterior thigh muscles through
hamstring tendon.
27. Femur, Femoral Fractures – proximally has head (covered with fovea, which attaches ligamentum
teres), intertrochanteric crest, greater and lesser trochanters. Has anatomical and surgical necks (often
broken). On posterior shaft has linea aspera (muscle attachment point). Distally has lateral and medial
condyles, with intercondylar notch in between, covered with patellar surface. Ligament of femur
head (ligamentum teres) – no role in movement, artery passes through it which nurtures femur.
Iliofemoral, pubofemoral, Ischiofemoral ligaments are for movement. Femur neck is mostly structured
point, often in old women due to osteoporosis.
28. Tibia – larger and medial bone below femur. Proximally has medial and lateral condyles, and
intercondylar eminence. Tibial tuberosity close to proximal head. Articulates with fibula at axial and
distal tibiofibular joints (syndesmosis). The interosseus membrane covers the area between it and
fibula. At distal head has articular surface to articulate with talus. Between condyles is articular
surface for knee joint.
29. Fibula – smaller than tibia, on lateral side. Has proximal head, proximal and distal tibiofibular joints,
syndesmosis. Between it and tibia is interosseus membrane. Lateral collateral ligament connects it
with femur. Distal side, has calcaneofibular ligament, which connects it with calcaneus. Anterior and
posterior Talofibular ligaments connects it with talus. Tibiofibular ligament connects it with tibia.
30. Foot Bones – tarsus, metatarsals, phalanges (proximal, intermediate, distal. ცერა თითს - has 2
sesamoid processes, and doesn’t have intermediate phalanx).
31. Tibia - repeated
32. Tarsus – 7 bones: talus (ankle joint), calcaneus (has calcaneus tuberosity, connects Achilles tendon),
cuboid, cuneiform (medial, intermediate, lateral), navicular.

33. Craniovertebral Joints – Atlanto-axial joint. first two cervical vertebrae and occipital bone. Atlas –
anterior and posterior tubercles, transverse foramen. Ligaments: Atlanto occipital, transverse
ligament, nuchal ligament is not part of Atlanto-occipital joint.
34. Temporomandibular Joint – modified hinge synovial joint; temporal bone has mandibular fossa,
styloid process (Stylomandibular ligament origin) and articular tubercle. Then there is articular disc
between temporal and mandible bones. It separates superior and inferior articular surfaces, creating
superior or inferior synovial membrane.
Mandibular head has body, ramus, angle between them, mental foramen, coronoid process, condyloid
process (most superior part that articulates in joint). Insertion of this ligament is zygomatic process of
temporal bone. Postglenoid tubercle – with lateral ligament of TMJ, prevents dislocation of jaw.
Ligaments:
Temporomandibular ligament – condyloid process (mandible)  zygomatic process (temporal bone).
Lateral ligament of the TMJ – condyloid process (mandible)  zygomatic process (temporal bone).
Stylomandibular – from styloid process of temporal bone  mandible angle. Allows protruding.
Sphenomandibular – from sphenoid bone spine  lingula of mandible.
35. Joints of the Vertebral Bodies – secondary cartilaginous, symphysis. Articulating surfaces of hyaline
cartilage of vertebral bodies are connected by IV (made of annulus fibrosis and nucleus pulposus,
regulate movement by releasing water) and ligaments. Adjacent vertebrae connect with 2 superior
and 2 inferior cartilaginous processes, 2 IV disc (symphysis), and costovertebral joint (synovial plane).
36. Sternoclavicular Joint – saddle type synovial joint, but functions as ball-and-socket. Connects
sternum (manubrium- clavicular notch) with clavicle (sternal end). Divided in 2 compartments with
articular disc, which is attached to anterior and posterior sternoclavicular ligaments, joint capsule, and
interclavicular ligament. This disc absorbs shockwaves coming from upper limb. Because of this,
dislocation of clavicle is rare, but its fracture is more common. It’s the only articulation between axial
skeleton and upper limb.

37. Joints of thoracic wall

 Costochondral – between rib sternal end and costal cartilage lateral end.
Interchondral – synovial plane, between costal cartilages of 6th -7th-8th-9th ribs.
38. Glenohumeral Joint – most movable joint in body, ball-and-socket type, connects humerus head with
glenoid cavity of scapula. Hyaline cartilage covers both articular surfaces. Glenoid cavity is much
smaller than humerus head, thus rotator cuff muscles are essential for joint stabilization. Glenoid
labrum - fibrocartilaginous tissue within the glenoid cavity, for stability and shock absorption. Joint
allows extension, abduction-adduction, rotation (medial-lateral), circumduction, movement on 3 axes.
Ligaments: coracohumeral, transverse humeral, coraco-acromial, and glenohumeral (Superior, middle,
and inferior). Has joint capsule. Below it is infraglenoid tubercle.
39. Elbow joint, Ligaments of Elbow Joint – hinge type synovial, has joint capsule. Ligaments – radial
collateral (connects radius and humerus capitulum), ulnar collateral (3 branches, humerus medial
epicondyle to ulna coronoid tuberosity and olecranon), anular ligament (connects radius and ulna).
40. Elbow Joint, clinical notes – elbow joint can dislocate, due to hyperflexion. Ulnar collateral ligament
is often torn. Ulnar nerve might be damaged (posterior side of joint), which causes numbness in
middle finger, and weakness of flexion. If collateral ligaments are damaged, dislocation of femur from
olecranon of ulna can occur.
If anular ligament is damaged, radius proximal head might dislocate from the joint.
41. Wrist Joint – condyloid synovial. Ulna doesn’t participate. Distal end of radius and articular disc of
distal radio-ulnar joint articulate with proximal row of carpal bones (scaphoid, lunate, triquetrum)
except pisiform (sesamoid bone). Has joint capsule, which is strengthened by ulnar collateral and
radial collateral ligaments from lateral sides. There are also palmar radiocarpal and dorsal radiocarpal
ligaments (from radius to 2 rows of carpal bones). These 2 ligaments make sure hand follows the
radius during pronation of forearm.
42. Sacroiliaic Joint – Binds ilium and sacrum. Articular surface – medial posterior side of ilium, rough,
auricular (ყურის ფორმის). Iliac tuberosity – even rougher surface superior to articular surface,
synovial and syndesmotic articulation with reciprocal surfaces of sacrum at Sacroiliaic joint.
43. Ligaments of the pelvic floor – iliolumbar, Sacrotuberous, and sacrospinous.
44. Hip Joint – ball-and-socket type, between lower limb and pelvic girdle. Femur head is the ball,
acetabulum is the socket. Most movable joint after glenohumeral. Acetabulum is made of all 3 hip
bones, has lunate surface – articular area between acetabulum and femur, parabola shape. Acetabular
fossa – under lunate surface.
Ligaments: ligamentum teres (of femur head)– no role in movement, artery passes through which
nurtures femur. Iliofemoral: connects ilium and neck of femur, strongest ligament in the body.
Pubofemoral – connects pubic bone with femur neck. Function: extension and abduction of hip joint.
Ischiofemoral – connects ischium and femur neck. Transverse acetabular: acetabulum inferior border,
continuation of the acetabular labrum, bridges the acetabular notch. Fovea covers femur head.
45. Joint capsule of Hip Joint – strong fibrous capsule and internal synovial membrane enclose the joint.
Joint capsule (in general) defines the movement range of the joint. Hyaline cartilage lines synovial
joints except temporomandibular joint. Capsule interior is covered with synovial membrane, that
produces and secretes synovial fluid.
46. Knee Joint – hinge type synovial, allows flexion and extension. Between patella, femur and tibia,
Fibula is not involved. Has 3 articulations: femoropatellar, medial and lateral femorotibial. Patella is
sesamoid bone, for protection. Most important muscle involved is quadriceps femoris. Has typical
fibrous joint capsule, containing synovial membrane. Meniscus (ხრტილები)– medial (lunar shape)
and lateral (C shaped). Posteriorly is popliteal fossa. Cruciate ligaments – where they start, end, which
way they move.
 Clinical correlation – cruciate ligament can be torn.
47. Intra-Articular Ligaments of Knee Joint – knee joint has 4 main ligaments: anterior and posterior
cruciate ligaments, 2 collateral ligaments. Transverse ligaments (cruciate=?) – connect meniscus,
transverse each other. Meniscus hold tibia in joint, fibrous structures, connect with ligaments.
Extracapsular ligaments: patellar ligament, medial and lateral patellar retinacula, tibial (medial)
collateral ligament, fibular (lateral) collateral ligament, oblique popliteal ligament, arcuate popliteal
ligament, anterolateral ligament (ALL) Intracapsular ligaments: anterior cruciate ligament (ACL),
posterior cruciate ligament (PCL), medial meniscus, lateral meniscus.
48. Tibiofibular Joint – Superior: plane synovial, between fibular head and tibia lateral condyle. Has joint
capsule, strengthened by anterior and posterior ligaments of fibular head. Superiorly crossed by
popliteus. Innervated by fibular and popliteal nerves. Inferior – syndesmosis, fibrous. Anterior,
posterior tibiofibular and interosseous (continuation of membrane) ligaments inferiorly. Between
these joints stretches interosseus membrane.
49. Ankle Joint – talocrural articulation. Hinge type synovial. Between distal ends of tibia and fibula and
talus bone. Has joint capsule, supported by medial and lateral (collateral) ligaments. Interosseus
tibiofibular ligament. Deltoid ligament –
Lateral ligament of ankle: supports ankle joint, has 3 parts: anterior and posterior tibiofibular
ligaments, and calcaneofibular ligament.
Tibia and talus have 2 articulations: superior is synovial plane, inferior is syndesmosis fibrous.
Malleolar mortise – created by tibia and fibula inferior syndesmosis joint, articulates with the trochlea
of talus.
50. Foot Joints – involve tarsals, metatarsals, and phalanges. Important intertarsal joints are the subtalar
(talocalcaneal) joint and the transverse tarsal joint (calcaneocuboid and talonavicular joints). Inversion
(medially) and eversion (outside) of the foot are the main movements involving these joints. The
other intertarsal joints, the tarsometatarsal, and intermetatarsal joints are relatively small and tightly
joined by ligaments, only slight movement occurs. In the foot, flexion and extension occur in the
forefoot at the metatarsophalangeal and interphalangeal joints Inversion is augmented by flexion of
the toes (especially the great and 2nd toes), and eversion by their extension (especially of the lateral
toes). All bones of the foot proximal to the metatarsophalangeal joints are united by dorsal and plantar
ligaments. The bones of the metatarsophalangeal and interphalangeal joints are united by lateral and
medial collateral ligaments.
51. Cervical fascia -
52. Ligaments of the Vertebral Column: stabilize and prevent excessive movement of spine.

Ligamentum flavum (plural - flava) – yellow, attaches between the lamina of each vertebra.

Anterior longitudinal ligaments – From skull to sacrum. continuous ligaments that run from the to the
bottom of the vertebral column and prevent access movement.

posterior longitudinal ligaments – inside the vertebral canal. Weaker than anterior ligament, parallel to it.
Intertransverse ligament- stretch between the transverse processes of spine.

Interspinous ligament – thin membranous ligaments between spinous processes.

Supraspinous ligament – connect the tips of spinous processes. At 7th vertebra it is continuous with the
nuchal ligament which runs from 7th vertebra to the skull (external occipital protuberance).

Radial ligament – connects rib head with backbone

Intra-articular ligament – connects rib head with backbone (IV disc part).

Sacral ligaments – posterior sacral ligaments: sacroilliaic, sacrospinal, Sacrotuberous, iliolumbar. Cauda
equina - ზურგის ტვინი ლუმბარ 5 დონეზე მემგონი. ლ3 დან იწყებს ზურგის ტვინი განლევას.

53. Muscles of Face - located in subcutaneous tissue of anterior and posterior scalp, face, and neck.
Responsible for facial expression, by moving the skin. Epicranial aponeurosis – covers upper skull. All
facial nerves are innervated by facial nerve branches. They insert at subcutaneous tissue.
Occipitofrontalis – elevates eyebrows and wrinkles forehead. Has frontal and occipital bellies, both of
them insert to Epicranial (galea) aponeurosis and share same tendon. Frontalis (Frontal belly) – origin
is eyebrows, forehead muscles. Occipitalis (Occipital belly) – origin is superior nuchal line lateral 2/3.
Epicranial aponeurosis  skin, and forehead and eyebrow subcutaneous tissue.
Nasal group:
Nasalis muscle – paired, covers nose dorsum. Has 2 parts: alar and transverse. Widens nostrils.
Alar part: frontal process of maxilla  skin of ala; transverse part: maxilla  merges with counterpart.
Depressor septi nasi (mustache muscle) – incisive fossa of maxilla  nasal septum, nasalis muscle back
alar part. Connects lower part of nose with upper lip.
Procerus – on top of the nose, contraction pulls eyebrows downwards. Fascia aponeurosis covering
nasal bone and lateral nasal cartilage  inferior forehead skin between eyebrows.

Auricular muscles: posterior, anterior, and superior articular muscles.

54. Muscles of Orbital Opening:
Orbicularis oculi – orbital, palpebral and lacrimal parts. Circular muscle between 3 bones: frontal,
lacrimal and maxilla. Lacrimal part aids in draining tears. Orbital part attaches to frontal and maxilla
bones to tightly close the eyelid. Palpebral part binds medial palpebral ligament, gently closes eyelids.
Medial palpebral ligament, lacrimal bone, medial orbital margin  skin around the margin.
Corrugator supercilii – (წარბის კუნთი) supercillary arch of frontal bone  supercillary arch and
skin superiorly. Function – brings eyebrows together medio-inferiorly. Small, pyramidal muscle.
Moves Superolaterally to insertion point.
55. Muscles of Mouth – largest group of facial muscles.
Orbicularis oris – main circular muscle within lips. Controls entry/exit through oral fissure.
Medial points of maxilla and mandible  skin on lip lateral corners.
Buccinator muscle: paired muscle, forms muscular base of cheeks. Maxilla and mandible alveolar
processes  mouth angle, intersecting fibers with orbicularis oris. Closely related to buccal mucosa.
with orbicularis oris, keeps the food on posterior teeth during chewing. Also participates in forceful
expulsion of air from mouth (blowing bubble, playing trumpet).
Levator labii superioris alaque nasi: paired muscle. Maxilla frontal process  alar cartilage.
Contraction of this muscle helps depressor septi nasi and alar part of nasalis in flaring nostrils.
Levator labii superioris: infero-orbital margin of maxilla  upper lip. Contraction of this muscle
elevates upper lip.
Zygomaticus minor: zygomatic bone anterior aspect  upper lip skin. Contraction elevates upper lip.
Zygomaticus major: lateral to zygomaticus minor. Zygomatic bone lateral aspect  skin of mouth.
Contraction causes superolateral movement of mouth.
Levator anguli oris: under zygomaticus major. Maxilla infraorbital margin  skin of mouth.
Contraction elevates lip corners.
Mentalis: mandible anterior surface  chin skin. Contraction causes lower lip to protrude (stick out).
ტუჩსა და ლოყას შორის წერტილოვან ჩაღრმავებას აკეთებს სიცილის დროს.
Risorius: (variable attachment sites) buccal skin, parotid fascia angle of mouth (modiolus). Stretches
lips laterally, sometimes called smiling muscle.
Depressor labii inferioris: lies deep (under) to depressor anguli oris. Platysma, mandible infero-medial
anterior surface  skin of lower lip. Depresses lower lip.
Depressor anguli oris: mandible infero-lateral borders of anterior aspect  angle of mouth (modiolus).
Antagonist of levator anguli oris, pulls modiolus downward.
Platysma – paired, flat, superficial neck muscle. crosses and overlaps clavicle.
 Subcutaneous tissue of infra and supraclavicular regions  mandible base, skin of cheek, lower lip
and orbicularis oris. It has function in animals, not humans. Depresses mandible and tenses skin of
neck and inferior face.
56. Muscles of Mastication (chewing):
Temporalis: flat muscle on lateral side of skull, covers temporal bone. Temporal fossa, temporal fascia
that surrounds the muscle end is thick tendon that attaches mandible coronoid process. Contraction
elevates the jaw (lower mouth).
Masseter: most superficial muscle of mastication. Has superficial and deep parts. Both parts originate
from zygomatic arch, - superficial part: anterior 2/3 of zygomatic arch, deep part: posterior 1/3 of
zygomatic arch. They insert at inferior border of mandible ramus and mandible masseter tuberosity.
Medial pterygoid: inferior to lateral pterygoid. Deep and superficial parts. Inserts at mandibular fossa.
Lateral pterygoid: superior to medial pterygoid. Has 2 heads, inferior head is larger than superior
head. Originates from sphenoid bone. Only muscle that can open the oral cavity by depressing the
mandible. Inserts at temporomandibular joint. Infratemporal fossa (superior head), (inferior head)
pterygoid process lateral part  (superior part). Unilateral movement moves jaw in one direction.
57. Muscles in the lateral Cervical Region
58. Muscles in the anterior Cervical Region
59. Deep Cervical Fascia
60. Muscles of thoracic wall: Intercostal (external, internal, innermost), subcostal, transversus thoracis.
Intercostal muscles: all support rib cage, accessory respiratory muscles.
 External – 11 pairs from rib above to rib below, moves inferomedially. Anteriorly replaced with
external intercostal membrane. Most active during inhaling, forced inspiration.
 Internal – 11 pairs from rib above costal groove to rib below. Moves inferolaterally. Posteriorly,
between ribs, they are replaced with internal intercostal membranes. Weaker than external muscles,
most active during exhaling, forced expiration.
 Innermost – deep parts of internal muscles, also originates from costal groove. Separated from
internal muscles by intercostal nerves. Between the internal rib surfaces, on the lateralmost parts of
intercostal spaces.
Subcostal muscles – well developed in lower thoracic wall. Between internal surfaces of superior and
inferior ribs (might skip 2-3 ribs). In same direction as the internal intercostals.
 Subcostal muscles: transversus thoracis:
Transversus thoracic muscles – 3 origins: inferior posterior surface of sternum body, posterior xiphoid
process surface; sternal ends of costal cartilages of ribs 4-7. Insertion point is costal cartilage inner
surfaces of ribs 2-6. Supports thoracic cage and participates in forced exhaling by depressing ribs.
61. Muscles of Back, Deep Layer :
Semispinalis: superficial in group. Transverse processes  spinous processes of upper vertebrae.
multifidus: sacrum, iliac spine, transverse processes  spinous processes 2-4 upper vertebrae.
rotators brevis and longus – short muscles. transverse processes  spinous processes and laminae.
They stabilize, rotate and extend backbone. Most developed in thoracic region, longus skips few
vertebrae.
62. Deep Posterior Thoracoappendicular Muscles - ?
63. Intrinsic Back Muscles – Has superficial, intermediate and deep layers. Are innervated by the
posterior rami of spinal nerves and act to maintain posture and control movements of the vertebral
column. extend from the pelvis to the cranium, are enclosed by deep fascia that attaches medially to
the nuchal ligament, the tips of the spinous processes of the vertebrae, the supraspinous ligament, and
the median crest of the sacrum.
Superficial layer – splenius capitis and cervicis – flat and thick, on lateral and posterior aspects of
neck. They cover and hold the deep neck muscles in position. Begin on nuchal ligament and spinous
processes of C7-T6 vertebrae. Splenius capitis connects mastoid process of temporal bone. Splenius
cervicis inserts ant cervical vertebrae transverse processes.

Intermediate layer: erector spinae muscles - chief extensors of the vertebral column and are divided
into three columns: the iliocostalis forms the lateral column, the longissimus forms the intermediate
column, and the spinalis forms the medial column. Each column is divided regionally into three parts
according to the superior attachments (iliocostalis lumborum, iliocostalis thoracis, and iliocostalis
cervicis). The common origin of the three erector spinae columns is through a broad tendon. Lie in a
“groove” on each side of the vertebral column between the spinous processes centrally and the angles
of the ribs laterally.

Deep layer - short transversospinalis muscle group:

Semispinalis: superficial in group. Transverse processes  spinous processes of upper vertebrae.
multifidus: sacrum, iliac spine, transverse processes  spinous processes 2-4 upper vertebrae.
rotators brevis and longus – short muscles. transverse processes  spinous processes and laminae.
They stabilize, rotate and extend backbone. Most developed in thoracic region, longus skips few
vertebrae.
Levator costal muscles – Transverse processes of the C7 – T11  Superior border/external surface of
rib one level below origin.
64. Biceps Brachii Muscle - 2 heads: short head medially (coracoid process of scapula), long head –
laterally (supraglenoid tubercle of scapula)  Body (elbow side): both heads connect to radial
tuberosity of the radius. Second attachment for both is deep fascia of forearm. A single biceps tendon
forms distally and attaches primarily to the radius.
65. Brachialis, Coracobrachialis Muscles: innervated by musculocutaneous nerve.
 Brachialis – beneath lower half of biceps. Originates from distal half of anterior surfaces
humerus, and medial and lateral intermuscular septum. Distal attachment – ulna coronoid
process and ulnar tuberosity. Acts only on elbow joint, flexes forearm.
 Coracobrachialis – coracoid process of scapula  anteromedial surface of the humerus
shaft. For adduction and flexion of arm at shoulder joint.

66. Muscles of Hand:

Innervation: in all hand muscles: medial and ulnar nerves.
Thenar muscles (all participate in opposition): Opponens policis, abductor policis brevis,
flexor policis brevis (superficial and deep heads) adductor policis (oblique and transverse
heads).
Hypothenar muscles: Abductor digiti minimi, flexor digiti minimi, opponens digiti.
Dorsal and palmar interossei, lumbricals – finger abduction, assists in flexion of
metacarpophalangeal joints and in extension of interphalangeal joints.
Flexor retinaculum = intercarpal ligament. Palmar aponeurosis–covers carpometacarpal joint.
Palmar brevis – hypothenar muscle; medial side of hand and palmar aponeurosis. Innervation
– superficial ulnar nerve.

67. Muscles of Posterior Abdominal Wall - the diaphragm, psoas major, psoas minor, iliacus, and
quadratus lumborum.
Psoas major – long, thick. T12-L5 bodies, Lumbar transverse processes and IV discs  Passes
inferolaterally, under the inguinal ligament, binding to the tendon on the lesser trochanter of femur.
Thig flexor, vertebral column lateral flexion, truck balance.
 Psoas minor – T12, L1 and IV discs pectineal line and Iliopubic eminence on pelvis. Truck flexor.
Iliacus – large, triangular muscle. It has fibers that attach to psoas major. Together with psoas (major
and minor) creates the iliopsoas - thig flexor, hip joint stabilizator.
Quadratus lumborum – quadrilateral (4 heads), thick muscle. Connects iliac crest with L1-L4
transverse processes, 12th rib. Stabilizes pelvis and lumbar area. Innervation – subcostal nerve T12;
spinal nerves L1-L4.

68. External & Internal Oblique Muscles of the Abdomen – abdomen has 12 layers (all needed).
skin  subcutaneous tissue  external oblique  superficial fascia  internal oblique muscles 
transverse oblique deep investing fascia  rectus abdominis  transverse abdominis.
Lineal alba starts from xiphoid process and end on pubic symphysis. Rectus abdominis, pyramidalis,
external abdominal oblique, internal abdominal oblique, transversus abdominis.
69. Muscles of Anterior Abdominal Wall – (repeated 68)
70. Pelvic Floor - pubococcygeus, puborectalis and Iliococcygeus, their tendons, sacrococcygeus ligament.
Coccygeus is adjacent. Parietal body, obturator membrane.
71. Muscles in the Anterior Compartment of the Leg - tibialis anterior, extensor hallucis longus, extensor
digitorum longus, and fibularis tertius muscles. Innervation – deep peroneal nerve. Supplied by
anterior tibial artery.
72. Posterior Thigh Region Muscles - repeated (76)
73. Muscles of Gluteal Region - gluteus maximus, gluteus medius, gluteus minimus, piriformis, superior
and inferior gemelli (between them obturator internus), obturator externus, quadratus femoris, tensor
fasciae latae.
74. Hamstring Muscles - semitendinosus, semimembranosus, and biceps femoris muscles. All originate
from ischial tuberosity and end on tibia or fibula head (biceps femoris).

75. Rotator Cuff Muscles – SITS (Supraspinous, Infraspinous, Teres minor, and Subscapularis), teres major,
and deltoid. Deltoid: clavicle 1/3, acromion, scapula spine  deltoid tuberosity. Axillary nerve
innervates. Teres major - originates from inferior angle of scapula, insertion at crest of lesser
tubercle on humerus anteriorly. Function - rotation to medial side.
76. Posterior Thigh Muscles - biceps femoris long and short head, semitendinosus, and semimembranosus.
SAME AS 74.