Sectional Anatomy By MRI and CT

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The New Edition of this up-to-date comprehensive sectional anatomy atlas features all new images, demonstrating the latest in MRI technology. It provides carefully labeled MRIs for all body parts, as well as a schematic diagram and concise statements that explain the correlations between the bones and tissues. Three new editors present superior images for abdominal and other difficult areas and offer their expertise in their respective region. Plus, a bonus website containing digital quality images lets you create electronic presentations. View all body images in three standard planes, axial, coronal, and sagittal. Visualize the orientation of every image via schematic diagrams of each body region. Gain a complete understanding of the correlations between body structures. Consult all new state-of-the-art images-more than 2,320 in all-that can be downloaded for electronic presentations. Enhance your clinical acumen with a special chapter dedicated to the musculature of the shoulder girdle and chest wall and two new chapters on MR arthrography of the shoulder and the hip. Compare chest and abdomen images scanned with both MRI and MDCT. Broaden your perspective with insights from New Editors who provide fresh, state-of-the-art images for abdominal and other difficult areas. Get an unparalleled view of the ankle with a unique axial MRI sequence. Expand your knowledge with supplemental CTs that cover areas that MRs do not work well in. Cover Sectional Anatomy by MRI and CT THIRD EDITION Georges Y. El-Khoury, MD Professor Departments of Radiology and Orthopaedic Surgery University of Iowa College o Iowa City, Iowa William J. Montgomery, MD Associate Professor Department of Radiology University of Florida College of Medicine Gainesville, Florida Ronald A. Bergman, PhD Professor Emeritus Department of Anatomy University of Iowa College of Medicine Iowa City, Iowa 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 ISBN: 978-0-443- 06666-5 Copyright © 2007, 1995, 1990 by Churchill Livingston Library of Congress Cataloging-in-Publication Data El-Khoury, Georges Y. Sectional anatomy by MRI and CT / Georges Y. El-Khoury p . ; cm. Rev. ed. of: Sectional anatomy by MRI / Georges Y. El-Khoury, Ronald A. Bergma Montgomery. 1995. ISBN 0-443-06666-3 1. Human anatomy—Atlases. 2. Magnetic resonance imaging—Atlases. 3. T omogr I. Montgomery, William J. II. Bergman, Ronald A. (Ronald Arly). III. El-Kho [DNLM: 1. Anatomy, Regional—Atlases. 2. Magnetic Resonance Imaging—Atlases. QM25.E38 2007 611 ′ .90222–dc22 Acquisitions Editor: Rebecca Gaertner Developmental Editor: Kim Davis and S Project Manager: Amy Norwitz Design Direction: Lou Forgione Cover illustrations are by Leonardo da Vinci and were made available by The Ro Printed in the United States of America SECTIONAL ANATOMY BY MRI AND CT Notice The Publisher Last digit is the print number: 9 8 7 6 5 4 3 2 1 T o our wives, Salam, Phyllis, and Nancy. W ithout their love and support, this work would not have been possible. Associate Editors Carol A. Boles, MD Associate Professor Department of Radiology W ake-Forest University School of Medicine W inston-Salem, North Carolina Mark J. Kransdorf, MD Professor Department of Radiology Mayo Clinic Jacksonville J acksonville, Florida Brian F. Mullan, MD University of Iowa College of Medicine Iowa City, Iowa Alan H. Stolpen, MD, PhD Contributors T imothy Averion-Mahloch, MD Department of Radiology Lexington Clinic Lexington, Kentucky Carol A. Boles, MD Associate Professor Department of Radiology W ake-Forest University School of Medicine W inston-Salem, North Carolina K ousei Ishigami, MD Staff Radiologist Department of Radiology Abdominal Imaging Group K yushu U Mark J. Kransdorf, MD Professor Department of Radiology Mayo Clinic Jacksonville J acksonville, Florida Thomas P. Martin, MD X-Ray Associates of New Mexico Albuquerque, New Mexico W illiam J. Montgomery, MD University of Florida College of Medicine Gainesville, Florida Brian F. Mullan, MD Akihiro Nishie, MD V isiting Assistant Professor Department of Radiology University of Iowa College of Medicine Iowa City, Iowa Alan H. Stolpen, MD, PhD Associate Professor Department of Radiology University of Iowa College of Medicine Iowa City, Iowa Preface While anatomy is an enduring discipline in which lit tle or no changes occur, W e are excited about this edition, and we hope that for the next few years t Georges Y. El-Khoury, MD W illiam J. Montgomery, MD Ronald A. Bergman, PhD Acknowledgments Georges Y. El-Khoury, MD W illiam J. Montgomery, MD Ronald A. Bergman, PhD 1Chapter MRI of the Pectoral Girdle and Chest Wall Figure 1.1.3 Figure 1.1.4 Figure 1.1.5 Figure 1.1.6 Figure 1.1.9 Figure 1.2.6 Figure 1.2.18 Figure 1.3.4 MRI of the Shoulder MRI OF THE SHOULDER T able 1: Muscles of the Shoulder Pectoralis major Medial half of the anterior Crest of the greater tubercle Lateral and medial pectoral surface of the clavicle, side of the humerus, lateral lip of (C5 and C6 for the clavicular and front of the sternum as the intertubercular groove, part, and C7, C8, and T1 for far as the 6th costal cartilage, deltoid tubercle, and fibrous the sternocostal part) front and surfaces of the carti- periosteum of the lage of the 2nd through 6th intertubercular sulcus ribs, osseous ends of the 6th and 7th ribs, and aponeurosis of external abdo Pectoralis minor Aponeurotic slips from the Anterior half of the medial Medial and lateral pectoral 2nd through 5th ribs, near border and upper surface of (C6, C7, C8) costal cartilages the coracoid process of the scapula Subclavius First rib and its cartilage Inferior surface of the clavicle Nerve to subclavian (C5 or between the costal and C5 and C6) coracoid tuberosities Deltoid Lateral border and upper Deltoid tuberosity of the Axillary (C5, C6) surface of the lateral third of humerus the clavicle, the acromion, and the scapular spine Supraspinatus Supraspinous fossa and Shoulder capsule and superior Suprascapular (C4, C5, C6) investing fascia facet of the greater tubercle of the humerus Infraspinatus Infraspinous fossa, scapular Shoulder capsule and middle Suprascapular (C4, C5, C6) spine, investing (deep) fascia, facet of the greater tubercle of and adjacent aponeurotic septa the humerus T eres minor Upper two thirds of the Shoulder capsule and inferior Axillary (C4, C5, C6) axillary border of the scapula facet of the greater tubercle of the humerus Subscapularis Subscapularis fossa Shoulder capsule and lesser T wo or three subscapular tubercle of humerus and its branches from posterior cord shaft immediately below the and upper and lower sub- tubercle scapular (C5, C6, C7) T eres major Inferior angle of the scapula Medial lip of the intertubercular Lower subscapular (C6, C7) groove of the humerus Latissimus dorsi Spine and interspinous ligaments Muscle tendon inserts onto the Thoracodorsal (C6, C7, C8) of the lower five or six thoracic ventral side of the lesser tubercle vertebrae, upper lumbar of the humerus and onto the vertebrae, thoracodorsal fascia, floor of the intertubercular posterior third of the crest of groove ventral to the tendon the ilium, and the lateral surface of the teres major. The tendon and upper edge of the lower may extend to the greater three or four ribs tubercle of the humerus MR Arthrography of the Shoulder Figure 3.1.2 Figure 3.1.5 Figure 3.1.6 Figure 3.2.4 Figure 3.2.10 Figure 3.3.6 Figure 3.3.8 Figure 3.3.12 ABER * *ABER = abduction and external rotation Figure 3.4.4 Figure 3.4.8 Figure 3.4.10 MRI of the Arm MRI OF THE ARM T able 2: Muscles of the Arm Coracobrachialis Coracoid process Shaft of the humerus above the Musculocutaneous middle of the bone (C5, C6, C7) Biceps brachii Short head, coracoid process; T uberosity of the r adius and by Musculocut long head, supraglenoid aponeurotic expansion to tubercle; superior part of the fascia on the ulnar side of glenoid labrum the forearm Brachialis Distal half of anterior surface of Capsule of the elbow joint Musculocutane and ulnar tuberosity T riceps Long head, infraglenoid tube- Primary tendon inserts onto the R adial (C6, C rosity of the scapula; lateral head, olecranon process of the ulna from the posterior surface of the and laterally, by expansion humerus; medial head, from the over the anconeus, into the posterior surface of the humerus dorsal fascia of the forearm below the radial groove and dorsal surfaces of the medial and lateral intermuscular septa Figure 4.3.2 Figure 4.3.8 Figure 4.3.12 MRI of the Elbow Figure 5.1.2 Figure 5.1.6 *Data from Sassmannshausen G, Mair SD, Blazar PE. Rupture of a bifurcated d *Data from Sassmannshausen G, Mair SD, Blazar PE. Rupture of a bifurcated d Figure 5.1.10 Figure 5.1.14 Figure 5.1.20 Figure 5.3.2 Figure 5.3.6 Figure 5.3.8 MRI of the Forearm MRI OF THE FOREARM T able 3: Muscles of the Forearm Anconeus P osterior surface of the lateral Onto the radial side of the Nerve to ancon epicondyle, and adjacent part olecranon and adjacent part (C7, C8, T1) of the elbow joint capsular onto the shaft of the ulna ligament Brachioradialis Upper two thirds of the lateral Lateral side of the base of the Radial (C5 epicondylar ridge of the styloid process of the radius humerus and the anterior surface of the lateral intermuscular septum Extensor carpi radialis Lower third of the lateral Lateral part of the base epicondylar ridge, lateral second metacarpal intermuscular septum, and extensor tendons from the lateral epicondyle Extensor carpi radialis Common extensor tendon Back of the base of the t from the lateral epicondyle, metacarpal r ior interosseus) (C7, C8) intermuscular septa, and radial collateral ligament of the elbow joint Extensor digitorum Common extensor tendon D orsal digital fibrous expansion covering the dorsum of the interosseus) (C7, C8) proximal phalanx and sides of its base, base of the middle and distal phalanges Extensor digiti minimi Intermuscular septa, overlying Base of the proximal fascia, and common extensor of the little finger interosseus) (C7, C8) tendon Extensor carpi ulnaris T wo heads: (1) distal dorsal part O nto a tubercle proximal three fourths of the dorsal border of the ulna Supinator Dorsal aspect of the lateral Lateral surface of the radius Deep radial (po epicondyle, ulnar depression between the anterior and interosseous) (C5, C distal to the radial notch, and posterior oblique lines supinator crest Abductor pollicis longus Lateral edge of the proximal Radial side of the v ulna, adjacent interosseous metacarpal membrane, dorsal surface of the radius, and occasionally, the intermuscular septa Extensor pollicis brevis Distal end of the middle third Base of the proxim of the radius in its dorsal surfac e , the thumb or into the capsule of int occasionally, the ulna MRI OF THE FOREARM T able 3: Muscles of the Forearm—Cont’d Extensor pollicis longus Middle third of the dorsal Base of the distal pha surface of the ulna adjacent to the thumb interosseus) (C7, C8) the interosseous membrane Extensor indicis Proximal part of the distal Dorsal aponeurosis on the Deep radial (posterio third of the posterior surface ulnar side of the index finger, interosseus) of the ulna interosseous adjacent to the base of the membrane proximal phalanx Pronator teres T wo heads: (1) humeral head Onto the middle third of Median (C6, C7) (superior half of the ventral lateral surface of the radius surface of the medial epicondyle), and (2) ulnar head (medial border of the coronoid process) Flexor carpi radialis Medial epicondyle of the Base of the second metacarp humerus and usually, base of the third metacarpal Palmaris longus Medial epicondyle Flexor retinaculum and Median (C7, C8) palmar aponeurosis Flexor carpi ulnaris T wo heads: (1) medial Primarily onto the pisiform U epicondyle, and (2) medial side of the olecranon, upper two thirds of the dorsal border of the ulna Flexor digitorum T wo heads: (1) ulnar (medial V entral surface of the sha epicondyle, ventral surface of the middle phalanx of each the epicondyle, ulnar collateral finger ligament, ulnar tuberosity, medial border of coronoid process), and (2) radial (anterior oblique line and ventral border below the r adial oblique line) Flexor digitorum Proximal three fourths of the Bases of the distal phalange medial and anterior surface of of the second to fifth digits branch (C8, T1) the ulna and interosseous membrane Flexor pollicis longus V entral surface of the radius, Base of the distal oblique line, and adjacent the thumb branch (C8, T1) interosseus membrane Pronator quadratus Medial side, ventral surface of Distal quarter of the ve Figure 6.1.2 Figure 6.1.8 Figure 6.1.16 Figure 6.1.22 MRI of the Wrist Figure 7.1.2 Figure 7.1.4 Figure 7.1.6 Figure 7.1.7 Figure 7.1.12 Figure 7.1.16 Figure 7.1.18 Figure 7.2.4 Figure 7.3.2 Figure 7.3.6 Figure 7.3.8 MRI of the Hand MRI OF THE HAND T able 4: Muscles of the Hand Palmaris brevis Ulnar border of the palmar Deep surface of the skin along Superficial bran aponeurosis the ulnar border of the palm (C8, T1) Abductor pollicis brevis P almar surface of the flexor Radial side of the retinaculum, trapezium, and proximal phalanx of the (C8, T1) occasionall Opponens pollicis P almar surface of the flexor Lateral part of the palmar retinaculum and tubercle of surface of the shaft of the first (C8, T1) the trapezium the metacarpal Flexor pollicis brevis Superficial head: trapezium, Superficial head: late retinaculum, and tendon proximal phalanx; deep head: (C8, T1) sheath of the flexor carpi into a tendon of the superficial r adialis; deep head: trapezoid head and capitate Adductor pollicis brevis Carpal head: flexor retina- Ulnar side of the fron culum, capitate, bases of the base of the proximal phalanx (C8, T1) second and third metacarpals; of the thumb metacarpal head: palmar ridges of the third metacarpal and capsules of the second, third, and fourth metacarpo- phalangeal articulations Abductor digiti minimi Distal half of the pisiform, T wo tendons: (1) the pisihamate ligament, tendon of the base of the proximal (C8, T1) of the flexor carpi ulnaris, and phalanx of the little finger and frequently the flexor (2) the aponeurosis of the retinaculum extensor tendon of the little finger Flexor digiti minimi brevis Hook of the hamate and Ulnar side of the base adjacent parts of the flexor proximal phalanx of the little branch of ulna finger Opponens digiti minimi Distal border of the hook of Medial surface of the the hamate and adjacent flexor particularly onto the head of (C8, T1) re the fifth metacarpal Lumbrical T wo lateral lumbricals: radial Into the radial border of the Median, late and palmar sides of the first tendon of the extensor lumbricals; ulnar, de and second tendons of the digitorum on the back of the branch, medial one flexor digitorum profundus proximal phalanx lumbricals (C8, T1) T wo medial lumbricals: adjacent side of the second and third tendons, and the third and fourth tendons of the flexor digitorum profundus MRI OF THE HAND T able 4: Muscles of the Hand—Cont’d Interosseous P almar interosseous: anterior Into the expansion on the axial Deep palmar branch of ulnar border of the shaft of the first, side of the corresponding digit. (C8, T1) second, fourth, and fifth The first palmar interosseous is metacarpals. The first arises described frequently as a near the base and the others division of the flexor brevis or arise from three fourths of the adductor pollicis. The first shaft of the bone. Dorsal dorsal interosseous usually interosseous: adjacent sides of inserts onto the proximal the metacarpal bones in each phalanx. The other three insert metacarpal interspace into the extensor expansion and proximal phalanx Figure 8.1.4 Figure 8.1.6 Figure 8.1.7 Figure 8.1.8 Figure 8.1.10 Figure 8.1.12 Figure 8.1.14 Figure 8.2.1 Figure 8.2.2 Figure 8.2.4 Figure 8.2.18 MRI of the Hip MRI OF THE HIP T able 5: Muscles of the Hip Obturator internus P elvic surface of the pubic Medial side of the greater foramen, pelvic surface of the trochanteric fossa of the femur trunk, and f ischium between the foramen sacral and the greater sciatic notch, deep surface of the obturator internus fascia, fibrous arch that surrounds the foramen for obturator vessels and nerve, most of the pelvic surface of the obturator membrane except the lower part Obturator externus Lateral surface of the pubic T rochanteric fossa Obturator and ischial rami, where they surround the obturator membrane, lateral surface of the obturator membrane Gemellus superior Outer surface of the ischial After union with the tendon sciatic notch serts into the medial side of internus or branch of the the greater trochanter in front nerve to the quadratus of the trochanteric fossa femoris Gemellus inferior Upper part of the inner By union with the tendon of By the ischium, sacrotuberous the tendon onto the greater femoris ligament, and edge of the trochanter below the obturator lesser sciatic notch internus muscle Quadratus femoris Upper part of the outer border Onto the inferior dorsal of the tuberosity of the ischium of the greater trochanter sacral Psoas major By a series of thick fasciculi Inserts onto the lesser Branches from L1 (o from the intervertebral discs trochanter of the femur L3, and L4 and bodies between T12 and L5, from the bodies of L1 to L4, and from slender fascicles from the ventral surfaces of the transverse processes of the lumbar vertebrae Iliacus Iliac crest, iliolumbar ligament, Lateral surface of the psoas F emoral an iliac fossa, anterior sacroiliac tendon (above the inguinal ligaments, often from the ala ligament) onto the femur of the sacrum, and from the immediately distal to the lesser ventral border of the ilium trochanter; the lateral portion between the two anterior arises from the ventral border spines of the ilium and is attached to the tendon of the rectus femoris and the capsule of the hip joint MRI OF THE HIP T able 5: Muscles of the Hip — Cont’d T ensor fasciae latae Anterior superior iliac spine Muscle fibers pass dist and anterior part of the parallel array, unite with the external lip of the iliac crest tendon, and join the iliotibial tract about one third of the w ay down the thigh Gluteus medius V entral three fourths of the Onto the posterosuperior Superior gluteal (L iliac crest, outer surface of the angle and the external surface ilium between the anterior of the greater trochanter and posterior gluteal lines, and from the investing fascia Piriformis Lateral part of the ventral sur- Onto the anterior and inner S1 or S2 or fr face of S2, S3, and S4, post erior parts of the upper border of between S border of the greater sciatic the greater trochanter notch, from the sacrotuberous ligament near the sacrum Gluteus maximus Dorsal fifth of the outer lip of Into the iliotibial tract the posterior gluteal line, cent part of the tendinous plexus (separately thoracolumbar fascia between origin of the vastus lateralis united nerve) the posterior superior spine of the ilium and the side of the sacrum, lateral parts of S4, S5, and coccygeal vertebrae, and from the back of the sacrotuberous ligament Gluteus minimus Outer surface of the ilium Onto the anterior border of inferior gluteal lines, from the femur sor fasciae latae septum between the gluteus minimus and the gluteus medius near the anterior superior, iliac spine and the capsule of the hip joint Biceps femoris, Medial facet on the posterior By a tendon that extends to T ibial part of long head surface of the ischial tuberosity the lateral condyle of the and sacrotuberous ligament femur Semitendinosus Distal margin of the ischial By a triangular tendinous Sciatic or directly tuberosity and from the tendon expansion into the proximal lumbosacral ple common to it and the long part of the medial surface of nerves: from S1 an head of the biceps femoris the tibia behind and distal to from L5 and S1 the insertion of the gracilis Semimembranosus Lateral facet on the posterior P osterior aspect of the me surface of the ischial tuberosity tibial condyle the adductor magnus) MR Arthrography of the Hip Figure 10.1.3 Figure 10.3.10 Ilium Chapter MRI of the Thigh MRI OF THE THIGH T able 6: Muscles of the Thigh Sartorius Anterior superior iliac spine Medial surface of the tibia; F emoral and adjacent area below near the tuberosity and neighboring fascia Rectus femoris Straight head: anterior inferior Through the patellar ligament F emoral iliac spine; reflected head: to the tibial tuberosity posterosuperior surface of the rim of the acetabulum V astus lateralis Shaft of the femur along the Proximal border of the patella, F emoral anteroinferior margin of the front of the lateral condyle of greater trochanter, above the the tibia and fascia of the leg gluteal tuberosity, and the upper half of the linea aspera V astus medialis Medial lip of the linea aspera Upper two thirds of the F emoral and the distal half of the medial margin and proximal intertrochanteric line, and the margin of the patella, medial aponeurosis of the tendons condyle of the tibia, and of insertion of the adductor investing deep fascia of the muscles leg with the tendons of vastus intermedius, lateralis, and rectus, and through the patellar ligament onto the front of the tibial tuberosity V astus intermedius Distal half of the lateral margin Proximal margin and lateral bifurcation and from of the vastus lateralis, medially the anterolateral part of the and laterally to the tendons of shaft of the femur v astus medialis and lateralis, to the patellar ligament and onto the tibial tuberosity Gracilis Medial margin of inferior By an expanded tendinous Anterior division of th r amus of the pubis and the process onto the tibia below obturator pubic end of the inferior the medial condyle r amus of the ischium Pectineus Pectineal line, pectineal Upper half of the pectineal F emora the obturator sulcus, and obturator from the pubofemoral ligament Adductor longus Pubic tubercle to symphysis Middle third of the linea An pubis aspera obturator, also occasionally, branch from the femoral Adductor brevis Medial part of the outer Distal two thirds of the Anterior (or posterior) surface of the inferior ramus pectineal line and the upper of the obturato of the pubis one third of the linea aspera MRI OF THE THIGH T able 6: Muscles of the Thigh— Cont’d Adductor magnus Inferior ramus of the pubis Medial side of the gluteal ridg and the superior part of the r ator and a branch from the linea aspera by a tendon from sciatic the distal three fourths of the linea aspera and the adductor tubercle at the distal end of the medial supracondylar ridge Biceps femoris F rom the lateral lip of the linea Head of the fibula in front of P eronea aspera of the femur, from the the apex, partially onto the middle of the shaft to the lateral condyle of the tibia, and bifurcation of the linea aspera, into the fascia of the leg proximal two thirds of the supracondylar ridge, and lateral intermuscular septum Figure 11.2.4 Femur Figure 11.2.9 Femur Figure 11.2.10 Sartorius m Figure 11.2.14 Femoral a Figure 11.2.15 Femoral v Figure 11.2.17 Pubis Figure 11.3.4 Iliopsoas m Figure 11.3.5 Iliopsoas m MRI of the Knee Figure 12.1.14 Figure 12.2.1 Vastus Figure 12.2.2 Figure 12.3.5 Vastus Figure 12.3.18 MRI of the Leg T able 7: Muscles of the Leg Tibialis anterior Distal part of the lateral condyle Medial surface of the first Branch from of the tibia, lateral surface of the cuneiform and the base of peroneal an proximal half of the shaft of the the first metatarsal the deep peroneal tibia, adjacent interosseous membrane, overlying fascia near the condyle of the tibia, and intermuscular septum between it and the extensor digitorum longus Extensor digitorum Lateral condyle of the tibia, Each tendon, located on th anterior crest of the fibula, dorsal surface of the toe to peroneal intermuscular membrane which it goes, divides into between it and the tibialis three fasciculi: the intermed- anterior, lateral margin of the iate, attached to the dorsum interosseous membrane, the of the base of the middle septum between it and the phalanx; and two lateral, which peroneus longus, and fascia of converge to the dorsum of the the leg near the tibial origin base on the distal phalanx. The margins of each tendon are bound to the sides of the back of the proximal phalanx Peroneus tertius Distal one third of the anterior O nto the base of the fifth The more dista surface of the fibula, metatarsal and often onto extensor digitorum suppli neighboring interosseous the base of the fourth this muscle (deep peroneal) membrane, anterior intermuscular septum Extensor hallucis Middle half of the anterior At the base of the dorsal surface of the fibula near aspect of the great toe the interosseous crest, and distal half of the interosseous membrane Peroneus longus Proximal two thirds of the Inferior surface of the first Usually, the comm lateral surface of the fibula cuneiform and on the adjacent peroneal, some part of the inferolateral by superficial peroneal border and the base of the first metatarsal Peroneus brevis Middle one third of the lateral Dorsal aspect of the Superficial peroneal surface of the fibula, from tuberosity of the fifth branch to peroneus long the septum that separate it metatarsal from the anterior and posterior groups of muscles MRI OF THE LEG T able 7: Muscles of the Leg—Cont’d Popliteus F acet at the anterior end of the Proximal lip of the popliteal T ibial: groove on the lateral aspect line of the tibia and the shaft arises indep of the femoral condyle of the tibia proximal to with the nerve to the this line posterior tibial muscle Flexor digitorum P opliteal line, medial side of Onto the bases of the T the second quarter of the terminal phalanges of the nerves to other muscles dorsal surface of the tibia, second to fourth toes of this group fibrous septum between the muscle and the tibialis fascia posterior, and the covering its proximal extremity Flexor hallucis Distal two thirds of the Onto the base of the T ibial: often in company longus posterior surface of the f ibula, terminal phalanx of the with the nerve to the septa between it and the great toe digitorum longus or other tibialis posterior, and peroneal muscles of this group muscles Tibialis posterior Lateral half of the popliteal The tendon divides into t middle one third of the attached primarily to the of this group posterior surface of the tibia, tubercle of the navicular bone, medial side of the head and and usually to the first part of the body of the fibula cuneiform; the superficial part next to the in terosseous attaches to the third cuneiform membrane in the proximal and the base of the fourth two thirds, the entire proximal metatarsal, and also, in part, and lateral portion of the to the second cuneiform, to lateral part of the posterior the capsule of the naviculo- surface of the interosseous cuneiform joint, to the sulcus of membrane, and the septum the cuboid, and usually also between its proximal portion to the origin of the short flexor and the long flexor muscles of the big toe and base of the second metatarsal; slip may extend to other structures Gastrocnemius Medial head: posterior V ia the Achilles tendon Sciatic, tibial part surface of the medial onto the posterior surface condyle of the femur of the calcaneus above the articular surface; lateral head: a facet on the proximal part of the posterolateral surface of the lateral condyle of the femur Continued Soleus By a fibular head from the V i a the calcaneal tendon Sciatic, tibial part back of the head and the onto the posterior surface proximal one third of the o f the calcaneus posterior surface of the shaft of the fibula; intermuscular septum between it and the peroneus longus, by a tibial head from the popliteal line and the middle one third of the medial border of the tibia Plantaris Distal part of the lateral line V ia a flat narrow tendon Sciatic, tibial part of the bifurcation of the linea running along the medial aspera, in close association with edge of the Achilles tendon the lateral head of the to the posterior surface of gastrocnemius the calcaneus SAGITTAL Figure 13.2.1 Figure 13.3.3 Figure 13.3.9 MRI of the Ankle Figure 14.1.1 Figure 14.1.3 Figure 14.1.6 Figure 14.1.14 OBLIQUE AXIAL Figure 14.2.1 Figure 14.2.3 Figure 14.3.3 CORONAL MRI of the Foot T able 8: Muscles of the Foot Extensor digitorum Distal part of the lateral As the fiber bundles extend and superior surfaces of the distally, they become grouped calcaneus and the apex of the into four bellies. Those fibers inferior extensor retinaculum of the most medial and largest belly are known as extensor hallucis brevis. The tendon of this muscle inserts onto the base of the first metatarsal. The remaining fiber bundles are not so distinctly isolated as described for the great toe, and their insertions are variable. The second toe inserts mainly onto the middle of the back of the base of the proximal phalanx and is often united with the tendon of the long extensor. The remaining three tendons are usually fused with the lateral margins of the corresponding tendons of the long extensor near the bases of the three middle phalanges and usually to the bases of proximal phalanges the of the corresponding toe Flexor digitorum Medial process of the tuber T endons of the short (brevi the plantar aponeurosis, and of the long flexor into the medial and later osteofibrous canals on the intermuscular septa flexor surface of the digits. On the proximal phalanx of each toe, the tendon of the short flexor divides and forms an opening through which the tendon of the long fl exor passes. The tendons of the short flexor insert onto the base of the middle phalanx Quadratus plantae T wo heads: a small lateral and The two heads are separ head arises from an elongated triangular space. The heads obliquely across tendon from the lateral fuse to form a single belly, superficial surface o process of the tuberosity of but the fiber bundles of each the muscle, par the calcaneus, and from the head are separately inserted. with the tendon lateral margin of the long F rom the lateral head, the flexor digitorum lo plantar ligament. (2) Medial fibers insert into the lateral head originates from margin of the flexor tendon. the medial surface of The medial head inserts as an the calcaneus in front aponeurosis into the deep of the tuberosity and surface of the flexor tendon from adjacent ligaments MRI OF THE FOOT T able 8: Muscles of the Foot—Cont’d Lumbricals Three lateral lumbricals arise Fiber bundles of each muscle Three lateral from the adjacent sides of the converge on both sides of a usually supplie digital tendons of the flexor tendon that becomes free of the deep ramus o digitorum longus. The first near the metatarsophalangeal lateral plantar n lumbrical arises on the medial joint and is inserted onto lumbrical is sup margin of the second toe the medial side of the proximal first common plant phalanx of the appropriate branch of the medial toe. A tendinous expansion is plantar nerve. This nerve may inserted into the aponeurosis supply the two more medial of the extensor muscle muscles, or the medial muscles may receive a double nerve supply Abductor hallucis Medial border of the medial Along with the tendon of the flexor retinaculum, and plantar onto the base of the proximal aponeurosis phalanx of the great toe Flexor hallucis F rom the plantar surface of the The medial and lateral sides Branch from brevis lateral cuneiform and cuboid of the base of the proximal plantar or first pl bones phalanx of the great toe digital. Rarely, the lateral body may receive a branch from the lateral plantar Adductor hallucis, T uberosity of the cuboid and By a flat tendon that in sheath of the tendon of the i n c o mmon with that of r amus of the lat peroneus longus, the plantar the flexor brevis onto the plantar calcaneo third cuneiform, bases of the surface of the base of the second and third metatarsals proximal phalanx, and by a slip into the aponeurosis of the long extensor muscle on the back of the great toe Adductor hallucis, J oint capsules of the third, By a common tendon that phalangeal joints and the deep of the tendon of the oblique plantar tran sheath on the tendon of the long flexor of the great toe Abductor digiti Lateral and medial processes Onto the lateral surface of the Lateral plant minimi of the tuber calcanei and proximal phalanx of the little lateral and plantar surfaces of toe and the metatarsophalangeal the body of the bone in front capsule of these, lateral intermuscular septum, deep surface of the lateral plantar fascia, and fibrous band extending from the calcaneus to the lateral side of the base of the fifth metatarsal Continued Flexor digiti Sheath of the peroneus longus, By short tendinous bands onto Branch from t minimi brevis tuberosity of the cuboid, the base of the proximal r amus of the lateral p and base of the fifth phalanx of the little toe, the metatarsal capsule of the corresponding joint, and the aponeurosis on the dorsal surface of the toe Opponens digiti An inconstant muscle, it Onto the lateral surface Branc may arise from the sheath of the fifth metatarsal flexor brevis and the of the peroneus longus and superficial ramus of the the tuberosity of the cuboid lateral plantar by a thin tendon that passes over the tuberosity of the fifth metatarsal Interosseous, Each of the three lateral The first and second Deep branch of the lateral dorsal dorsal interosseous muscles interosseous muscles onto each plantar. The in arises from the sides of the side of the base of the muscles of the fourt shaft and the plantar surface proximal phalanx of the interspace are usua of the bases of the metatarsals, second toe; the third and supplied by a b bounding the space fourth onto the lateral side of the superficial ramus o in which each lies, from the the bases of the proximal lateral plantar fascia covering it dorsally, phalanges of the third and and from the fibrous fourth toes. Each tendon prolongations from the long adheres to the capsule of plantar ligament. The first the adjacent joint (medial) has a similar origin, except that its medial origin is by a tendinous slip from the peroneus longus tendon and, occasionally, by fiber bundles from the medial side of the proximal end of the first metatarsal Interosseous, The plantar interosseous Onto a tubercle on the Lateral plantar plantar muscle arises from the medial side of the base proximal third of the of the proximal phalanx medial plantar surface of the digit to which it of the shaft, from the goes base of the metatarsal on which it lies, and from the fascial expansions of the long plantar ligament Figure 15.1.4 Second metatarsal head Third metatarsal head Lateral sesamoid Medial sesamoid Fourth metatarsal head Flexor digitorum longus tt Fifth metatarsal head Fifth metatarsal Flexor digiti minimi m Abductor digiti minimi m Flexor hallucis longus t Flexor digitorum longus tt Base of fifth metatarsal Peroneus brevis t Flexor digitorum brevis m Quadratus plantae m Figure 15.1.11 MRI of the Thoracic Spine MRI OF THE THORACIC SPINE: AXIAL MRI OF THE THORACIC SPINE: AXIAL MRI OF THE THORACIC SPINE: SAGITTAL MRI of the Lumbar Spine Figure 17.1.8 MRI OF THE LUMBAR SPINE: SAGITTAL Figure 17.2.4 CT of the Thorax Figure 18.2.1A Figure 18.2.1B Figure 18.3.3A Figure 18.3.3B Figure 18.3.6A Figure 18.3.6B Figure 18.3.7A Figure 18.3.7B MRI of the Heart Figure 19.1.2 Figure 19.1.3 Figure 19.1.6 MRI OF THE HEART: SAGITTAL MRI OF THE HEART: CORONAL Figure 19.3.4 CT of the Abdomen Figure 20.1.2 Figure 20.1.11 Figure 20.2.7 Figure 20.3.7 MRI of the Abdomen Figure 21.1.1 Sternum Figure 21.3.4 CT of the Male Pelvis Figure 22.1.2 Figure 22.1.5 Cecum Figure 22.1.9 CT OF THE MALE PELVIS: SAGITTAL Figure 22.3.10 CT of the Female Pelvis CT OF THE FEMALE PELVIS: SAGITTAL MRI of the Male Pelvis Figure 24.1.4 Figure 24.1.8 Figure 24.1.9 Figure 24.1.10 Figure 24.1.12 Figure 24.2.6 Figure 24.3.1 Figure 24.3.10 MRI of the Female Pelvis Figure 25.1.6