recursal/Fanatic-Fandom huggingface dataset:
Beanz Mainz Heinz

Beanz Mainz Heinz is a parody of 1. FSV Mainz 05. The club is currently competing in the first tier Germazing league Bundesliga.

## Debut

The club first appeared when Bayern Munchausen's comedian Thomasshole Muller missed a penalty against this team but they won 3-0 away.

## Former players

Lolis Krapius

Yougurn Klopp (also manager)
Brevic Wisdom

The people of Brevoy are known for their somewhat pessimistic (they would say “realistic”) view of life, summed up in the many expressions on the lips of every farmer, trader, traveler, and tavern regular. Common Brevic sayings include:

“When the wolf shows you his teeth, he’s not smiling.”

“Riders at night carry no glad tidings.”

“Winter always follows spring.”

“As the stars see me” (a common oath asserting the truth) and “The stars see all.”

“The dragon has two heads” (referring to both the crest of the Conqueror and the duplicity of the nobility).

“The temple is close, but the night is cold. The tavern is far, but I have a cloak.”

“Fire is everyone’s ally, but no one’s friend.”

“Pharasma makes cradles for us all.”

“No man dies wishing he had worked more.”

"And the wolves are sated, and the sheep are whole" (referring to a win-win situation)

"Don't piss in the well - you might need to drink from it later"

"It is better to be poor and healthy, than rich and sick" (often parodied tongue-in-cheek as "It is better to be rich and healthy, than poor and sick")

"A thread from all the world, and the poor one shall have their shirt" (referring to gradual, patient accumulation of resources)

"One that burned themselves on milk, blows on water" (referring to people being overly cautious following past bad experiences. Often a justification for withholding trust)

"Ye who hath lied once - who shall believe you now?" (a common admonishment at oathbreakers)

"But the bear's advice disappeared in vain" (a quote from a folk fable, essentially meaning "I told you so")

"I ran across a bridge, and snatched up a clover's leaf" (anther quote from a popular folk tale, referring to a person so busy with running around (typically doing work), that they barely have time to eat.

"And if there's something I desire, than I shall drink to it, of course" (a quote from a popular comedic song

"other than face-beatings, I offer no miracles" another quote from aforementioned song

"When I am drunk, and I am drunk at all times..."

"Pound the metal while it is hot" (meaning to get on a task while you have the initiative)

"The only thing that's free is bait in a trap"

"Ready your sleigh in summer, and your wagon in winter."
Choroid plexus

Choroid plexus

* Secretory epithelium that produces cerebrospinal fluid (CSF)
* Choroid plexus forms where tela choroidea contacts ependymal lining of ventricles: Roof of third ventricle, body & temporal horn of lateral ventricle via choroidal fissure, inferior roof of fourth ventricle
* CSF flows from lateral ventricles through foramen of Monro into third ventricle, through cerebral aqueduct into fourth ventricle; exits through foramina of Luschka & Magendie to SAS
* Bulk of CSF resorption through arachnoid granulations in region of superior sagittal sinus
Infratemporal fossa:Mandibular n. & branches

Mandibular nerve is one of the branches of the trigeminal ganglion.

Course:

* exits the cranial fossa via the foramen ovale
* lies deep to the upper head of the lateral pterygoid, between it and the tensor palati muscle
* divides into a small anterior motor branch and large posterior sensory branch

Meningeal branch: nervus spinosus, re-enters the middle cranial fossa via the foramen spinosum to supply the meninges of the middle cranial fossa.

Nerve to medial pterygoid: runs forwards to the muscle and gives a branch which passes through the otic ganglion without synapse to supply the two tensor muscles, tensor palati and tensor tympani.

   Anterior branches: an entirely motor division except the buccal nerve (sensory)

* **deep temporal branches to temporalis:** passes above the upper border of the lateral pterygoid muscles
* **masseteric nerve:** passes above the upper border of the lateral pterygoid and emerges through the mandibular notch to enter the deep surface of the massseter.
* **nerve to lateral pterygoid** runs with the buccal nerve and supplies both heads of the muscle.
* **buccal nerve:** all sensory fibres of the common sensation in the anterior division of the mandibular nerve. It emerges between the two heads of the lateral pterygoid and courses downwards and forwards on the buccinator and gives branches to skin over the cheek.

Posterior branches: all sensory except the mylohyoid nerve

* **auriculotemporal nerve:** pass backwards between neck of the mandible and the sphenomandibular ligament, lying on the maxillary vessels. It supplies:
	+ the temporomandibular joint and ascends over the lateral aspect of the zygomatic arch behind the superficial temporal vessels.
	+ The auricular part innervate skin to the tragus, upper part of the lateral surface of the pinna, the external acoustic meatus and outer surface of the tympanic membrane.
	+ The temporal part supplies skin of the temple.
	+ Supplies parotid gland with postganglionic secretomotor fibres from the otic ganglion.
* **inferior alveolar nerve:** emerges from below the lower head of the lateral pterygoid and curves down superficial to the medial pterygoid. It enters the mandibular foramen with the corresponding vessels.
	+ supplies the three molar and two premolar.
* **mylohyoid nerve:** splits from the inferior alveolar nerve prior to the mandibular foramen and runs forward on the superficial surface of the mylohyioid and the anterior belly of the digastric.
	+ supplies the mylohyoid
* **lingual nerve:** pass deep to the lateral pterygoid forwards and downwards superficial to medial pterygoid. It then runs deep to the mylohyoid, crosses the submandibular duct and runs forward to the tongue.
	+ a side branch supplies all the lingual gum and mucous membrane of the mouth.
	+ sensation of anterior 2/3 of the tongue
Anatomy of the Spine & Back

Anatomy

Thoracic vertebrae
Lumbar vertebrae
Sacrum
Coccyx
Features of vertebrae (body, pedicle, facets etc)
Intervertebral foramina
Intervertebral discs
Zygapophyseal (facet) joints
Sacroiliac joints
Costovertebral and costotransverse joints
Sacrococcygeal joint
Transverse ligament of atlas
Apical and alar ligaments
Cruciform ligament
Intertransverse ligaments
Ligamentum nuchae (nuchal ligament)
Tectorial membrane
Anterior and posterior atlantooccipital membranes
Intrinsic back muscles
Splenius capitis and cervicis
Erector spinae group
Transversospinalis group
Multifidus
Suboccipital muscles
Longissimus
Iliocostalis
Semispinalis muscles
Rotatores
Dura mater and dural sleeves
Subarachnoid space including lumbar cistern
Epidural space
Artery of Adamkiewicz
Batson vertebral plexus
Grey matter nuclei (non-cranial nerve):

The **basal ganglia** are a group of subcortical nuclei in the inferior hemisphere of the brain that is interconnected with the cerebral cortex, thalami and brainstem. It is involved in motivation, controlling movement.

Structure:

* Lentiform nucleus: Putamen and globus pallidus (PG)
* Corpus striatum: Caudate nucleus and the lentiform nucleus

Relations:

* Anterior limb of internal capsule separates caudate head from putamen, GP
* Posterior limb separates thalamus from basal ganglia

Caudate nucleus:

A paired "C-shaped" curved nucleus with large head, tapered body, down-curving tail

* Head forms floor/lateral wall of anterior horn of lateral ventricle
* Body borders, parallels lateral ventricle
* Tail follows curve of inferior horn, lies in ventricular roof
* The tail ends in the amygdaloid nucleus
* Deep groove (sulcus terminalis) separates caudate from thalamus; its stria terminalis lies deep to ependyma, helps form choroid fissure
* Caudate nucleus is continuous anteriorly with inferior putamen via strands of grey matter through the anterior limb.

Putamen:

 The putamen lies lateral to the globus pallidus and medially to the external capsule. It is connected to the substantia nigra and globus pallidus. The main function of the putamen is to regulate movements and influence various types of learning. It employs dopamine to perform its functions.

Globus pallidus:

A subcortical nuclei in the lentiform nucleus and lies medial to the putamen.

* Lateral (external), medial (internal) segments separated by internal medullary lamina
* Higher myelin content than putamen

Vascular Supply

* medial and lateral lenticulostriate arteries (from ACA and MCA respectively)
Middle DCF:Buccopharyngeal fascia

Buccopharyngeal fascia is a facial layer that invests the constrictor muscles of the pharynx and is continued forward from the superior pharyngeal constrictor on to the buccinator. It is attached to the prevertebral fascia via loose connective tissue and can be distended easily (the space is the retropharyngeal space).
Bone:Metacarpals & phalanges:Epiphyses (sites, dates of appearance/fusion)

METACARPALS

Each metacarpal ossifies from a primary centre for the shaft and a secondary centre in the base of the 1st metacarpal and at the heads of the other four. It begins ossification of the midshaft in the ninth week.
The ossification centres unite at 18 years

PHALANGES

Phalanges are ossified from a primary centre in the shaft and a proximal epiphyseal centre.
Distal phalanges begin in 8th week, proximal in 10th week and middle in 11th week.
All epiphyses unite in 15th / 18th year
Muscle/Group:Forearm: Deep fasciaExtensor retinaculum

Extensor retinaculum

* Dorsum of distal forearm and wrist
* Origin: Distal radius
* Insertion: Ulnar styloid, triquetrum, pisiform
* Has deep slips that form the 6 extensor tendon compartments of distal forearm and wrist
	+ 1st extensor compartment: Abductor pollicis longus, extensor pollicis brevis
	+ 2nd extensor compartment: Extensor carpi radialis longus and brevis
	+ 3rd extensor compartment: Extensor pollicis longus
	+ 4th extensor compartment: Extensor digitorum, extensor indicis
	+ 5th extensor compartment: Extensor digiti minimi
	+ 6th extensor compartment: Extensor carpi ulnaris
* Prevents bowstringing of extensor tendons
Intracranial cavity (extra axial): Middle cranial fossa:Temporal bone & apex

Petrous bone: Pyramid-shaped, medial portion of temporal bone (T-bone); not a separate bone

* Contains inner ear, internal auditory canal (IAC), labyrinthine segment, and anterior genu facial nerve canal (FNC) and PA

* Petrous apex: Portion of petrous bone that is anteromedial to inner ear and IAC

Relations

* Lateral portion
	+ Fuses with squamous & mastoid portions of T-bone
* Medial portion: foramen lacerum, clivus
* Anterior portion: greater wing of sphenoid
	+ Forms posterior wall of middle cranial fossa floor
	+ Continuous laterally with inner surface of squamous T-bone
* Posterior portion: occpital bone
	+ Forms anterior wall of posterior fossa
	+ Continuous with inner surface of mastoid T-bone
* Inferior portion: nasopharynx
	+ Forms part of skull base
Muscle:Pelvis:Levator ani and coccygeus (pelvic floor)

Pelvic floor is the bottom of the pelvis formed by the levator ani and coccygeus (paired structures). it is a gutter-shaped sheet of muscle slung around the midline viscera (urethra, anal canal and vagina in females).

Function:

* Primary support for pelvic organs
* Critical for maintaining continence, as well as normal micturition and defecation

Relations

* Posterior wall: Sacrum, coccyx, and piriformis, coccygeus muscles
* Lateral wall: Ilium, ischium and piriformis, obturator internus, levator ani muscles
* Anterior wall: Symphysis pubis, anterior portion of obturator internus muscle, levator ani muscle

The **levator ani**, also known as the **muscular** **pelvic diaphragm**, is the musculotendinous sheet that forms the majority of the pelvic floor, supports the pelvic viscera, and aids in urinary and fecal evacuation as well as maintaining continence.

The levator ani has two main components, each of which is paired. The fibres pass from the body of the pubis to the ischal spine across the obturator fascia, along the tendinous arch laterally.

* **Pubococcygeal muscle -** arise from the anterior half of the tendinuous arch, and from the posterior surface of the pubic body. Sweeps backwards and the paired muscle meet in the midline forming tendinous plate and insert into the coccyx. The pubococcygeus runs from the inner surface of the pubis and obturator fascia with fibres fusing medially at the perineal body and musculature of the prostate/vagina.The muscle can be subdivided further into:
	+ Pubovaginalis: medial fibres that sling around the posterior wall of the vagina
	+ Pubourethralis/puboprostaticus: in male, these most medial fibres, pass backwards alongside the prostate and urethra and decussate across midline behind the urethra
	+ Puborectalis: part of the pubococcygeal muscle. Fibres from the body of the pubis lying more anterior and medially to the true pubococcygeal muscle, wrap around the anorectal junction like a U-shaped sling.
	+ True pubococcygeal muscle

* **Iliococcygeus muscle -** arise from the posterior half of the tendinous arch and pelvic surface of the ischial spine, and insert into the sides of the coccyx and anococcygeal raphe.

The **coccygeus** (ischiococcygeus) is a triangular muscle with its base attaching to the lateral aspect of the inferior sacrum and inner tip of the coccyx and apex attached to the ischial spine with fibres along the tendinous arch. It forms the posterosuperior part of the levator ani. It flexes the coccyx anteriorly and partially fuses with the sacrospinous ligament which lies on its posterior aspect. It lies edge to edge with the lower border of he piriformis.

Blood supply

* Pubococcygeal and iliococcygeus: internal pudendal artery
* ischiococcygeus: inferior gluteal artery

Nerve supply

* pelvic surface: sacral plexus by branches of S3 and S4
* perineal surface: perineal branch of S4 and inferior rectal branch of the pudendal nerve

Variant anatomy

* thinning or aplasia of one or both sides is common (~50%)
Muscle/Group:Forearm:Extensor compartment deep layer:Abductor pollicis longus

**Abductor pollicis longus**

* Origin: Posterior surfaces of radius, ulna, and interosseous membrane
* Insertion: Posterior surface of base of 1st metacarpal
* Innervation: Posterior interosseous nerve
* Action: Abducts and extends thumb at metacarpophalangeal joint
* Distal tendon forms anterior (volar) aspect of anatomic snuff box of wrist
Joints:Knee Joint:Fibrous capsule & deficiencies

The **knee capsule** is a dual-layered structure that surrounds the knee joint. It is relatively thin anteriorly and posteriorly, thickened laterally by the collateral ligaments.

Gross anatomy

The outer layer of the knee capsuleconsists of fibrous connective tissue to hold the joint in place, whereas the inner layer consists of a synovial membrane which secretes synovial fluid and provides lubrication.

Boundaries

The femoral aspect of the capsule is demarcated by:

* the proximal femoral condyles and intercondylar fossa posteriorly
* patellar retinaculum anteriorly
* articular margin of the femur medially
* the femur just proximal to the groove for the popliteus tendon laterally

There is no capsule above the patella, allowing the suprapatellar bursa to communicate with the joint.

The tibial aspect of the capsule is demarcated by:

* the tibial condyles posteriorly and medially
* patellar retinaculum and tibial tuberosity anteriorly
* head of the fibula laterally

There is also an aperture for the popliteus tendon at the lateral tibial condyle.

The fibrous capsule also has a deep component with a thickening on the medial aspect being part of the medial collateral ligament. The deep component also attaches weakly to the menisci, where they are known as the coronary ligaments 1.
12. Lymphatics

**Lymphatics of posterior abdominal wall**

* Major lymphatic vessels and nodal chains lie along major blood vessels (aorta, IVC, iliac) and have same names (e.g., common iliac nodes)
* Lymph from alimentary tract, liver, spleen and pancreas passes along celiac, superior mesenteric chains to nodes with similar names (e.g., **celiac nodes**)
	+ Efferent vessels from alimentary nodes form **intestinal lymphatic trunks.** This merges with lumbar lymphatic trunks to form the cisterna chyli. Continues as the **thoracic duct** at the L1-2 level.

**Thoracic duct**

* Ascends through **aortic hiatus** in diaphragm to enter posterior mediastinum
* Ends by entering junction of **left subclavian** and **internal jugular veins**

* Lymphatic system drains surplus fluid from extracellular spaces and returns it to bloodstream
	+ Has important function in defense against infection, inflammation and tumor via lymphoid tissue that is present in lymph nodes, wall of gut, spleen and thymus
	+ Absorbs and transports dietary lipids from intestine to thoracic duct and bloodstream
Arterial structure:Radial & Ulnar:Radial

Radial artery is a terminal branch of the brachial artery. The division occurs half way down the fossa at level of the neck of the radius.

Course:

* Passes distally medial to the biceps tendon and into to forearm under the cover of brachioradialis.
* Cross over pronator teres, FDS, flexor pollicis longus and insertion of pronator quadratus.
* Moves laterally in the forearm and passes below the tendons of abductor pollicis longus and extensor pollicis brevis into the snuffbox.
* Terminate in the deep palmar arch of the hand.

Branches:

* Radial recurrent artery
	+ Runs proximally along lateral side of elbow to form anastomosis with branches of deep brachial artery
* Muscular branches to lateral side of forearm
* Superficial palmar branch: continues superficial to FR; passes through thenar eminence muscle to anastomose with ulnar artery to form superficial palmar arch at metacarpal base level.
* Dorsal carpal branch: at level of dorsal scaphoid waist joins dorsal carpal branch of ulnar artery and anterior interosseous artery to create dorsal carpal (intercarpal) arch.
* Main radial artery continues distally around the wrist, gives off branch which splits into princeps pollicis and radialis indicis arteries. Dives deep in interspace between 1st and 2nd metacarpal, passes between heads of 1st dorsal interosseous muscle to enter palm, joining ulnar artery, deep palmar branch, to form deep palmar arch.
Cranial nerve systems:Olfactory bulb & tract

The **olfactory nerve (CN I)** is visceral afferent system providing sense of smell

* Olfactory nerve segments
	+ End receptor in olfactory epithelium in nasal vault
	+ Transethmoidal segment through cribriform plate
	+ Intracranial olfactory bulb, tract and cortex

Course:

* **Nasal segment:** Bipolar cell is the first-order sensory neuron located in the roof of the nose, immediately inferior to the cribiform plate of the ethmoid bone.
* **Transethmoidal segment:** their central processes form filaments (approximately 20) which pass through the cribiform plate, pierce the dura mater and relay in the olfactory bulb.
* **Intracranial segment:** the second-order neurons forms the olfactory nerve which passes posteriorly within the olfactory grooves of the anterior cranial fossa and then in-between the gyrus rectus medially and medial orbital gyrus laterally.

* Anterior to the anterior perforated substance, they form medial and lateral olfactory striae.
	+ The lateral olfactory striae project to the uncus (olfactory cortex)
	+ The medial olfactory striae ultimately project to the hypothalamus and brainstem nuclei.
10. Viscera

**Perineum**

* Space inferior to levator ani
* Central tendon of perineum (perineal body) formed in midline behind the vagina in females and behind urethra in males

* Diamond-shaped area bordered by pubic symphysis, ischial tuberosities and coccy
	+ Subdivided into 2 spaces (urogenital and anal triangles) by line drawn slightly anterior to ischial tuberosities, along superficial transverse perineus muscle
* Urogenital triangle contains urethra and external genitalia
	+ Muscle development greater in male
		- Paired muscles: Superficial and deep transverse perineus, bulbocavernosus and ischiocavernosus
	+ Urogenital diaphragm: Deep transverse perineus muscle and fascia, urethral sphincter
	+ Female: Bartholin glands (greater vestibular glands) and vestibular bulbs
	+ Male: Penile bulb
* Anal triangle contains anus
	+ Identical in both sexes
	+ Circular external anal sphincter surrounds anus and maintains continence
		- 3 muscle components: Subcutaneous, superficial and deep
		- Fibers extend posteriorly to form anococcygeal ligament
	+ Ischiorectal fossa located in posterior and lateral portion of triangle
		- Filled with fat
		- Communicates posteriorly, forming U-shape around levator ani and anus
		- Bounded posteriorly by sacrotuberous ligament and gluteus maximus
Key gyri:Operculum

The **insular cortex** lies deep to the lateral surface of the brain. The operculum is the parts of frontal, temporal, parietal lobes that overhang/enclose insula.

The insular cortex lies within the lateral sulcus which separates the temporal lobe and the parietal lobe dorsally.

The insular cortex is considered to be a part of a number of structures according to different authorities:

* a separate lobe of the telencephalon
* part of the temporal lobe
* grouped with limbic structures
3. Ligaments

Ligament that typically unite two typical vertebrate:

* Anterior longitudinal ligament: fibrous band on ventral surface of spine from skull to sacrum
	+ Firmly attached at ends of each vertebral body
	+ Loosely attached at midsection of disc
	+ 3 sets of fibers: Deep span 1 disc; intermediate 2-3 discs; superficial 4-5 levels
* Posterior longitudinal ligament: Dorsal surface of bodies from skull to sacrum
	+ Attached at discs, margins of vertebral bodies
	+ Cervical/thoracic: Broad, uniform
	+ Lumbar: Narrow at body, broad at disc level
* Ligamentum flavum
	+ Largest elastic ligament in body
	+ Connects adjacent lamina from C2 to lumbosacral junction
	+ Extends from capsule of apophyseal joint to junction of lamina with spinous process
	+ Thin, broad in cervical region, thicker in lumbar
* Interspinous ligaments: Connect adjoining spinous processes
	+ Between ligamentum flavum, supraspinous ligaments
	+ Strongest in lumbar spine
* intertransverse ligaments: join transverse processes along adjacent borders, relatively weak fibrous tissue
	+ Cervical: Sparse or absent
	+ Thoracic: Stronger associated with muscles
* Supraspinous ligaments: Extend from tips of spinous processes from C7 to sacrum
	+ Fused with dorsal margin of interspinous ligament
	+ Broader, thicker in lumbar spine
	+ Merges with ligamentum nuchae in cervical spine
	+ Ligamentum nuchae extends from external occipital protuberance to C7
Muscle/Group:Shoulder (Pectoral):Brachialis

Brachialis muscle

* Origin: Distal half of anterior humeral shaft and two intermuscular septae
* Insertion: Tuberosity of ulna and anterior surface of coronoid process
* Nerve supply: Musculocutaneous nerve plus branch of radial nerve
* Blood supply: Brachial artery, muscular branches and recurrent radial artery
* Action: Flexes forearm
* Covers anterior aspect of elbow joint
* Variants: Doubled; slips to supinator, pronator teres, biceps, lacertus fibrosus or radius
Intracranial cavity (extra axial): Middle cranial fossa:Foramen ovale

**Foramen ovale** is an oval shaped opening in the middle cranial fossa located at the posterior base of the greater wing of the sphenoid bone, lateral to the lingula.

Content:

* **O:**otic ganglion (inferior)
* **V:**V3 cranial nerve (mandibular division of trigeminal nerve)
* **A:**accessory meningeal artery
* **L:**lesser petrosal nerve
* **E:**emissary veins
Abdomen:Arterial:Lumbar arteries

The **lumbar arteries** are arteries located in the lower back or lumbar region. The lumbar arteries are in parallel with the intercostals.

- They are usually four in number on either side, and arise from the back of the aorta, opposite the bodies of the upper four lumbar vertebrae.

- A fifth pair, small in size, is occasionally present: they arise from the middle sacral artery.

Course:

- They run laterally and backward on the bodies of the lumbar vertebrae, behind the sympathetic trunk, to the intervals between the adjacent transverse processes, and are then continued into the abdominal wall.

- The arteries of the right side pass behind the inferior vena cava, and the upper two on each side run behind the corresponding crus of the diaphragm.

- The arteries of both sides pass beneath the tendinous arches which give origin to the psoas major, and are then continued behind this muscle and the lumbar plexus.

- They cross the quadratus lumborum, the upper three arteries running behind, the last usually in front of the muscle.

- At the lateral border of the quadratus lumborum they pierce the posterior aponeurosis of the transversus abdominis and are carried forward between this muscle and the internal oblique.

- They anastomose with the lower intercostal, the subcostal, the iliolumbar, the deep iliac circumflex, and the inferior epigastric arteries.
Intracranial cavity (extra axial): Middle cranial fossa:Foramen rotundum

The **foramen rotundum**is located in the middle cranial fossa, inferomedial to the superior orbital fissure at the base of greater wing of sphenoid.

Its medial border is formed by lateral wall of sphenoid sinus. It runs downwards and laterally in an oblique path and joins the middle cranial fossa with the pterygopalatine fossa.

It transmits maxillary nerve branch of trigeminal nerve, artery of foramen rotundum and emissary veins.
Intracranial cavity (extra axial): Middle cranial fossa:Carotid canal

The **carotid canal**is a passage within the petrous temporal bone and transmits the internal carotid artery and sympathetic plexus.

Its inferior opening is called the carotid foramen and is situated anteriorly to the jugular fossa and medially to the tympanic plate. The carotid canal is initially directed superiorly, then turns anteromedially to reach up to the petrous apex. It runs approximately 2cm within the petrous bone and opens into the middle cranial fossa superior to the foramen lacerum.
Infrahyoid muscles (sternothyroid, thyrohyoid, sternohyoid, omohyoid)

Sternhyoid

* **origin:**posterior surface of manubrium sterni and the sternoclavicular joint
* **insertion:**lower body of the hyoid bone
* **innervation:**anterior rami of C1-C3 spinal nerves through the ansa cervicalis of the cervical plexus
* **blood supply:** superior thyroid artery
* **action:**
	+ depresses and fixes the hyoid bone
	+ draws the hyoid bone and underlying larynx downwards in phonation and the terminal phase of swallowing

Relations: superficial to sternothyroid and thyrohyoid and medial to the superior belly of omohyoid on the hyoid bone.

Thyrohyoid

* **origin:**oblique line of the thyroid cartilage
* **insertion:**greater horn of the hyoid bone
* **innervation:**branch from anterior rami of C1 spinal nerve
* **blood supply:** superior thyroid artery
* **action:** depresses and fixes the hyoid bone and larynx; when hyoid is fixed thyrohyoid raises the larynx

Relations: deep to the superior belly of the omohyoid and sternohyoid. Originate end to end on the oblique line of thyroid cartilage with sternothyoid muscle.

This muscle is continuous with geniohyoid so geniohyoid have the same innervation.

Sternothyroid

* **origin:**posterior surface of manubrium sterni
* **insertion:**oblique line on the lamina of the thyroid cartilage
* **blood supply:** superior thyroid arteries
* **innervation:**anterior rami of C1-C3 spinal nerves through the ansa cervicalis
* **action:**depresses and fixes the hyoid bone

Omohyoid

Paired flat strap muscles made up of superior and inferior bellies joined by intermediate tendon.

* **origin:**transverse scapula ligament and superior border of scapula medial to the suprascapular notch
* **insertion:**lateral and inferior border of the hyoid bone
* **innervation:**anterior rami of C1 – C3 spinal nerves from the cervical plexus. The superior and inferior bellies are innervated by separate nerves of the ansa cervicalis.
* **action:**
	+ depresses and fixes the hyoid bone
	+ draws the hyoid bone and underlying larynx downwards in phonation and the terminal phase of swallowing
	+ intermediate tendon of the muscle tenses overlying cervical fascia and maintains patency of the internal jugular vein

Variants:

Omohyoid: doubled, absent, origin from clavicle

Sternothyroid: doubled; absent; accessory slips to thyrohyoid, inferior constrictor and carotid sheath

Sternohyoid: doubled, accessory slips , absent
Muscle/Group:Forearm:Extensor compartment deep layer:Extensor pollicis longus

**Extensor pollicis longus**

* Origin: Posterior surface of ulna and interosseous membrane
* Insertion: Posterior surface of base of 1st distal phalanx
* Innervation: Posterior interosseous nerve
* Action: Extends interphalangeal joint of thumb and 1st metacarpophalangeal joint
* Distal tendon forms posterior (dorsal) aspect of anatomic snuff box of wrist
Arterial:Femoral:Lateral & medial plantar arteries

Arteries of the foot derived from posterior tibial artery.

- tibial artery divide under the cover of the flexor retinaculum

- the plantar arteries passes between the first and second layer.

MEDIAL PLANTAR

- supplies the big toe. Does not form part of the plantar arch

LATERAL PLANTAR

- crosses the sole obliquely toward the base of the fifth metatarsal.

- forms the plantar arch which curves convexly forward and across the bases of the fourth, third, and second metatarsal.

- joined at the first intermetatarsal space by the dorsalis pedis from the dorsum.
Cranial nerve systems:Trigeminal nuclei, ganglion & roots

Trigeminal nerve is a mixed nerve arising from the pons, governing the motor of masticator muscles and the sensory of the face.

Origin: four nuclei (3 sensory, 1 motor)

* Distributed across the brainstem from pons to upper cervical cord.
	+ Mesencephalic nucleus CN5
		- Slender column of cells projecting cephalad from pons to level of inferior colliculus
		- Afferent fibers for facial proprioception (teeth, hard palate and temporomandibular joint)
	+ Main sensory nucleus CN5
		- Nucleus lies lateral to entering trigeminal root
		- Provides facial tactile sensation
	+ Motor nucleus CN5
		- Supplies muscles of mastication (medial/lateral pterygoids, masseter, temporalis), tensor palatine/tensor tympani, mylohyoid and anterior belly of digastric
	+ Spinal nucleus CN5
		- Extends from principal sensory root in pons into upper cervical cord (between C2 to C4 level)
		- Conveys facial pain, temperature

Cisternal (Preganglionic) Segment

* Two roots: Smaller motor, larger sensory
* Emerges from lateral pons and courses anterosuperiorly through prepontine cistern
* Enters middle cranial fossa by passing beneath tentorium at apex of petrous temporal bone
* Passes through an opening in dura matter called porus trigeminus to enter Meckel cave

Interdural Segment

* Meckel cave formed by meningeal layer of dura lined by arachnoid
	+ Cave is filled with cerebrospinal fluid (CSF) (90%) and continuous with prepontine subarachnoid space
* Preganglionic CN5 ends at trigeminal ganglion (TG)
	+ TG located in inferior aspect of Meckel cave

* Divisions (Post-Ganglionic) of CN5
	+ **Ophthalmic nerve**
		- Courses in lateral cavernous sinus wall below CN4
		- Exits skull through superior orbital fissure
		- Enters orbit, divides into lacrimal, frontal and nasociliary nerves
			* Sensory innervation scalp, forehead, nose, globe
	+ **Maxillary nerve**
		- Courses in cavernous sinus lateral wall below CNV1
		- Exits skull through foramen rotundum
		- Traverses roof of pterygopalatine fossa
		- Continues as infraorbital nerve in floor of orbit
		- Exits orbit through infraorbital foramen
			* Sensory to cheek and upper teeth
	+ **Mandibular nerve**
		- Does not pass through cavernous sinus
		- Exits directly from Meckel cave, passing inferiorly through foramen ovale into masticator space
		- Carries both motor and sensory fibers
			* Motor root bypasses TG, joins V3 as it exits throughforamen ovale
			* Divides into masticator (muscles of mastication) and mylohyoid nerves (mylohyoid and anterior belly of digastric muscles)
			* Masticator nerve takeoff just below skull base
			* Mylohyoid nerve takeoff at mandibular foramen
		- Main sensory branches include inferior alveolar, lingual and auriculotemporal nerves
Anatomy of the Lower Limb

**Anatomy**

Bony features
Articular surfaces
Epiphyses(sites, dates of appearances) | Attachments of muscles
Bony features
Articular surfaces
Attachments of ligaments
Talus & calcaneus
Accessory bones and sesamoids | Navicular & cuboid
Metatarsals
Phalanges | Cuneiforms
Ossification
Fibrous capsule and retinacular fibres
Acetabular labrum |  | Bursae
Fibrous capsule & deficiencies
Menisci (medial & lateral) | Synovial membrane
Bursae: suprapatellar, prepatellar, semimembranosus
Tarsometatarsal & intermetatarsal joints
Ligament of head of femur | Pubofemoral ligament
Collateral ligaments (medial & lateral)
Cruciate ligaments (anterior & posterior) | Oblique popliteal
Intermeniscal ligaments
Patellar retinacula | Arcuate popliteal, transverse
Coronary
Spring ligament
Bifurcate ligament
Cervical ligament
Psoas major (& minor)
Gluteus medius
Gluteus minimus
 Obturator internus
 Quadratus femoris | Tensor fascia lata
Superior gemellus
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
Adductor longus
Adductor brevis
Adductor magnus
Semimembranosus
Tibialis anterior
Extensor hallucis
Extensor digitorum
Peroneus tertius
 **Lateral compartment**
Peroneus longus
Gastrocnemius
Soleus
Flexor digitorum longus
Flexor hallucis longus
Plantar aponeurosis
Synovial sheaths | Peroneal retinacula
Peroneal tendons
Extensor digitorum (& hallucis)
brevis
**Intrinsic muscles of sole**
Flexor hallucis brevis
Adductor hallucis
Dorsal interossei | **Intrinsic muscles of sole**
Abductor hallucis
Flexor digitorum brevis
Abductor digiti minimi
Flexor accessorius
Four lumbricals
Flexor digiti
Minimi brevis
Dorsalis pedis | Medial & lateral circumflex femoral arteries
Popliteal
Posterior tibial
Anterior tibial
Peroneal | Perforating arteries
Genicular arteries
Plantar vascular arches
Lateral & medial plantar arteries
Obturator nerve
Superficial peroneal nerve
Deep peroneal nerveTibial nerve | Sural nerve
Medial plantar nerve
Lateral plantar nerve
Ligament:Pelvis:Sacrotuberous ligament

The **sacrotuberous ligament** (**STL**) is a stabiliser of the sacro-iliac joint and connects the bony pelvis to the vertebral column.

The STL has broad fan-like origin

* origin: sacrum, coccyx, ilium (posterior between PSIS and PIIS) and sacro-iliac joint capsule.
* insertion: the fibres converge to course caudally to insert into the medial ischial tuberosity and fibres (known as the **falciform process**) extend to the ischial ramus under the pudendal canal.

It forms a boundary of the greater and lesser sciatic foramen. Many of its fibres blend with other musculotendinous structures

* provides extensive insertion for the gluteus maximus muscle
* distal fibres partially blend with the proximal tendon of the long head of biceps femoris
* sacrospinous ligament
* posterior sacro-iliac ligment

The sacrotuberous ligament is pierced by coccygeal branches of the inferior gluteal artery and the perforating cutaneous nerve and branches of the coccygeal plexus.
Lateral ventricles

The **lateral ventricles** are a paired C shaped structure and part of the ventricular system in the brain. They are lined with ependyma, and consists of the body with three horns that project into the lobe after which they are named:

* anterior/frontal horn: frontal lobe
* posterior/occipital horn: occipital lobe
* inferior/temporal horn: temporal lobe

On the medial wall of the ventricular body and inferior horn, mass of blood capillaries enter and invaginating the pia mater and ependyma forming the choroid plexus. CSF is produced in the choroid plexus. It exits along the interventricular foramen (of Monro) to the third ventricle. The central part of lateral ventricle is called the cella media.

The grey matter of the parahippocampal, calcarine and collateral sulci, thalamus and caudate nucleus indents the cavity of the lateral ventricle.The curvature of the caudate nucleus closely follows that of the lateral ventricle.

**Anterior horn:** part of the lateral ventricle that extends anteriorly into the frontal lobe from the interventricular foramina.

* anteriorly: fibres of the genu of the corpus callosum (forceps minor)
* posteriorly: interventricular foramen
* floor: rostrum of the corpus callosum and bulbous end of the caudate nucleus
* medially: septum pellucidum
* laterally: head of the caudate nucleus

**Body:** arches downwards and forwards into the temporal lobe as the inferior horn and backwards into the occipital lobe as the posterior horn.

* floor: dorsal thalamus and caudate nucleus, choroid plexus,
* roof: corpus callosum, medially the body and crus of the fornix
* medially: septum pellucidum, fornix
* laterally: body, tail of caudate nucleus

**Posterior horn:**

* floor: collateral eminence
* roof: tapetum of corpus callosum (fibres of the body)
* medially: bulb of the posterior horn formed by fibres of the splenium of the corpus callosum (forceps major) and calcar avis (calcarine sulcus).
* laterally: tapetum

**Inferior horn:** largest of the horns

* floor: hippocampus medially and collateral eminence laterally.
* roof: tail of the caudate nulceus
* laterally: tapetum, optic radiation, and arcuate fasciculus

* medial: hippocampus
Ligament:Pelvis:Sacrospinous ligament

The **sacrospinous ligament** is a stabiliser of the sacro-iliac joint and connects the bony pelvis to the vertebral column.

The sacrospinous ligament is a triangular-shaped structure, with its base attached to the anterior sacrum (S2-S4) and coccyx and apex attached to the ischial spine. It forms a boundary of the greater and lesser sciatic foramen.

It lies on the posterior aspect of the sacrotuberous ligament.

The coccygeus muscle lie on the pelvic surface of the ligament.
Abdomen:Radiological spaces:Inguinal canal

The **inguinal canal** is an oblique passage in the anterior abdominal wall that transmits structures from the pelvis to the perineum.

The inguinal canal is 4 cm in length and has two openings:

1. **deep inguinal ring** - a round opening in the transversalis fascia found 1 cm superior to the inguinal ligament and 1 cm lateral to the inferior epigastric arteries.
2. **superficial inguinal ring** - a V-shaped opening in the external oblique aponeurosis that is superior and medial to the pubic tubercle. It lie anterior to the conjoint tendon.

Boundaries

The following structures contribute to the walls of the inguinal canal (MALT)

* superior wall (roof) - internal oblique muscle; transversus abdominis muscle (**M**uscle)
* anterior wall - external oblique aponeurosis; internal oblique aponeurosis laterally (**A**poneurosis).
* inferior wall (floor) - inguinal ligament and lacunar ligament medially (**L**igament).
* posterior wall - tranversalis fascia; conjoint tendon medially (**T**endon).

Contents

* Males - spermatic cord (vas deferens, its artery, testicular artery and vein, obliterated remains of the processus vaginalis, genital branch of the genitofemoral nerve, autonomic nerves and lymphatics); ilioinguinal nerve
* Females - round ligament; ilioinguinal nerve
* The ilioinguinal nerve does not enter the canal, despite being a content, but pierce the internal oblique muscle, i.e. it slips into the sides. The nerve pass anterior to the cord, leaves canal through the superficial ring to supply skin of the inguinal region, upper part o the thigh and anterior third of the scrotum.
Basal CSF cisterns:Ambient cistern

The **ambient cistern** is part of the subarachnoid cisterns. It is a thin, sheet-like extension of the quadrigeminal cistern that extends laterally around the midbrain. It acts as the connection between the quadrigeminal cistern and the interpeduncular cistern.

The term "ambient cistern" may be used to refer the these connections and the quadrigeminal cistern as a whole.
Intracranial cavity (extra axial): Middle cranial fossa:Middle meningeal artery

The **middle meningeal artery** the third branch of the first part (retromandibular part) of the maxillary artery that supply the dura mater (the outermost meninges) and the calvaria.

The middle meningeal artery is the largest of the three (paired) arteries that supply the meninges, the others being the anterior meningeal artery and the posterior meningeal artery

Course:

* Branching off the maxillary artery in the infratemporal fossa
* Runs vertically between sphenomandibular ligament and lateral pterygoid muscle, through the roots of the auricotemporal nerve (whcih wraps around the artery) and enters the middle cranial fossa via the foramen spinosum
* Here it runs forward on the in a groove on the greater win and gives off two branches - superior tympanic branch and ganglionic branch - before dividing into anterior and posterior divisions.
* The **anterior division of the middle meningeal artery** runs anterolaterally through the middle cranial fossa on the greater wing of sphenoid before coursing superiorly, often grooving the bone, and passes under the pterion before giving its terminal branches over the upper parietal bone.
* The **posterior division of the middle meningeal artery** runs horizontally posteriorly over the squamous part of the temporal bone to gives its terminal branches over the lower parietal bone.
* The branches of the middle meningeal artery are distributed partly to the dura mater, but chiefly to the bones; they anastomose with the arteries of the opposite side, and with the anterior and posterior meningeal arteries. The very smallest distal branches anastomose through the skull with small arterioles from the scalp.

Branches:

1. Numerous small vessels supply the semilunar ganglion and the dura mater
2. Superficial petrosal branch enters the hiatus of the facial canal, supplies the facial nerve, and anastomoses with the stylomastoid branch of the posterior auricular artery.
3. Superior tympanic artery runs in the canal of the tensor tympani muscle, and supplies this muscle and the lining of the canal.
4. Orbital branches pass through the superior orbital fissure or through separate canals in the great wing of the sphenoid, to anastomose with the lacrimal or other branches of the ophthalmic artery.
5. Temporal branches pass through foramina in the great wing of the sphenoid, and anastomose in the temporal fossa with the deep temporal arteries.

Variation

* In 50% it branches into an accessory meningeal artery.
* ophthalmic artery may arise as a branch of the middle meningeal artery.
* The middle meningeal artery may arise not only from the maxillary artery but also from the ophthalmic artery, or lacrimal artery.
* Arise from a persistent stapedius artery
Muscle:Pelvis:Piriformis

The **piriformis muscle** is a muscle in the gluteal region of the lower limb. The piriformis is a flat muscle, pyramidal in shape, lying almost parallel with the posterior margin of the gluteus medius and deep to gluteus maximus. The muscle passes out of the pelvis through the upper part of the greater sciatic foramen into the gluteal region. It is situated partly within the pelvis against its posterior wall, and partly at the back of the hip joint. It function is abduction and lateral rotation of the thigh

Origin: Anterior part of the sacrum by three fleshy digitations, and from the superior margin of the greater sciatic notch, and to a lesser extent the sacroiliac joint capsule and the sacrotuberous ligament.

Insertion: upper part of the greater trochanter of the femur. Its tendon often joins with the superior gemellus, inferior gemellus and obturator internus muscles prior to insertion.

Relations

Structures also passing through the greater sciatic foramen pass either above of below piriformis. At its origin, the emerging sacral nerves and plexus lie on the muscles.

* passing superiorly: superior gluteal nerve and vessels
* passing inferiorly: inferior gluteal nerve and vessels; sciatic nerve; internal pudendal artery; pudendal nerve; posterior femoral cutaneous nerve; nerve to obturator internus; nerve to quadratus femoris

Arterial supply

* superior gluteal artery
* inferior gluteal artery
* lateral sacral artery

Innervation: nerve to piriformis (L5, S1and S2 nerve roots)

Variant anatomy

* may be fused or partially fused with gluteus medius, gluteus minimus or superior gemellus
* may have only one or two sacral attachments at its origin
* may be inserted into the capsule of the hip joint
* when the sciatic nerve bifurcates prior to exiting the greater sciatic foramen, the piriformis is frequently pierced by the common peroneal (fibular) nerve
Joints: Knee Joint: Articular surfaces (patello-femoral & femoro-tibial)

Femoral
articular surfaces (distal)

Both
condyles are more flat anteriorly, and more rounded posteriorly, allowing both stability
when locked in extension and mobility when in flexion, respectively. The
lateral femoral condyle extends more superior than the medial, and has a
prominent lateral groove (compared to the smaller medial groove).

Patella
articular surfaces

The
posterior aspect has a longitudinal groove corresponding to the patellar
surface of the femur, with a larger lateral aspect and a smaller medial aspect.

Tibial
articular surfaces (proximal)

Slightly
concave condyles, articulate with menisci. Medial is more oval (long AP
diameter), lateral is smaller and more circular. Seperated by intercondylar
eminence. The articulation surface is deepened by the

menisci, which allow
dynamic articulation in different positions. The lateral meniscus is more
circular (4/5 of a circle), attached to popliteus, and more mobile. The medial
meniscus is more semicircular and attached to the medial collateral ligament.

Patello-femoral
articulation

Saddle
joint. The patella slides superiorly and inferiorly along the anterior aspect
of the patella surface of the femur. The quadriceps tend to pull the patella
laterally, but the larger lateral groove, the quadriceps bulk, and the
medial/lateral retinaculae prevent this. The medial facet is free in extension,
but articulates with the medial condyle in extension.

Femoro-tibial
articulation.

Modified
hinge joint. Deepened by menisci. Flexion/extension with a little rotation in flexion
only. Locks in extension, but action of popliteus helps to unlock knee
(internally rotates tibia and flexes knee). Collateral ligaments are taught when
knee is in extension.