Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. We post anatomical, medical or surgical terms, their meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.

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A Moment in History

Andreas Vesalius Bruxellensis (1514- 1564)

A Flemish anatomist and surgeon, Andreas Vesalius was born on December 31, 1514 in Brussels, Belgium. He is considered to be the father of the science of Anatomy. Up until his studies and publications human anatomy studies consisted only on the confirmation of the old doctrines of Galen of Pergamon (129AD - 200AD). Anatomy professors would read to the students from Galen's work and a demonstrator would point in a body to the area being described, if a body was used at all. The reasoning was that there was no need to dissect since all that was needed to know was already written in Galen's books. Vesalius, Fallopius, and others started the change by describing what they actually saw in a dissection as opposed to what was supposed to be there. 

Vesalius had a notorious career, both as an anatomist and as a surgeon. His revolutionary book "De Humani Corporis Fabrica: Libri Septem" was published in May 26, 1543. One of the most famous anatomical images is his plate 22 of the book, called sometimes "The Hamlet". You can see this image if you hover over Vesalius' only known portrait which accompanies this article. Sir William Osler said of this book "... it is the greatest book ever printed, from which modern medicine dates" 

After the original 1543 printing, the Fabrica was reprinted in 1555. It was re-reprinted and translated in many languages, although many of these printings were low-quality copies with no respect for copyright or authorship.

The story of the wood blocks with the carved images used for the original printing extends into the 20th century. In 1934 these original wood blocks were used to print 617 copies of the book "Iconaes Anatomica". This book is rare and no more can be printed because, sadly, during a 1943 WWII bombing raid over Munich all the wood blocks were burnt.

One interesting aspect of the book was the landscape panorama in some of his most famous woodcuts which was only "discovered" until 1903.

Vesalius was controversial in life and he still is in death. We know that he died on his way back from a pilgrimage to Jerusalem, but how he died, and exactly where he died is lost in controversy. We do know he was alive when he set foot on the port of Zakynthos in the island of the same name in Greece. He is said to have suddenly collapsed and die at the gates of the city, presumably as a consequence of scurvy. Records show that he was interred in the cemetery of the Church of Santa Maria delle Grazie, but the city and the church were destroyed by an earthquake and Vesalius' grave lost to history. Modern researchers are looking into finding the lost grave and have identified the location of the cemetery. This story has not ended yet.

For a detailed biography of Andreas Vesalius CLICK HERE.

Personal note: To commemorate Andrea Vesalius' 500th birthday in 2014, there were many scientific meetings throughout the world, one of them was the "Vesalius Continuum" anatomical meeting on the island of Zakynthos, Greece on September 4-8, 2014. This is the island where Vesalius died in 1564. I had the opportunity to attend and there are several articles in this website on the presence of Andreas Vesalius on Zakynthos island. During 2015 I also attended a symposium on "Vesalius and the Invention of the Modern Body" at the St. Louis University. At this symposium I had the honor of meeting of Drs. Garrison and Hast, authors of the "New Fabrica". Dr. Miranda


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Brachialis

Brachialis muscle - Image modified from the original. Public domain
Brachialis muscle.
Click on the image for a larger depiction

UPDATED: The brachialis muscle is a skeletal muscle attached proximally to the anterior surface of the humerus and distally to the coronoid process and tuberosity of the ulna. It is one of the three muscles in the anterior compartment of the arm (flexor compartment), the other two being the biceps brachii and the coracobrachialis.

It is a strong flexor of the elbow found deep to the biceps brachii. Because it does not attach to the radius, the brachialis muscle does not participate in the pronation and supination of the forearm.

The brachialis is supplied by branches of the brachial artery and by the recurrent radial artery.

The innervation of the brachialis muscle is a point to be discussed. Most modern books of anatomy state that this muscle is innervated by the musculocutaneous nerve (C5, C6, and C7). Older and more detailed books state that this muscle has a dual innervation. A 2011 research paper published in Spanish (see Sources #6) describes this dual innervation. The proximal portion of the muscles is indeed innervated by the musculocutaneous nerve, but the distal portion (in 90% of the cases) is innervated by muscular branches that arise off the radial nerve. The radial nerve (C5, C6, C7, C8 & T1) is a branch of the brachial plexus.

Following is an excerpt from the "Trail Guide to the Body" by Andrew Biel: "Ironically, (because it is deep to the biceps) the brachialis girth only helps the biceps brachii to bulge further from the arm, making the brachialis the biceps' "best friend"

Personal note: The research paper that describes the double innervation of the brachialis muscle was done at my alma mater, the University of Chile, and the authors' listing includes two of the contributors to this blog, Professors Claudio Molina and Cristian Uribe. Dr. Miranda

Sources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 42nd British Ed. Churchill Livingstone 2021
4. “An Illustrated Atlas of the Skeletal Muscles” Bowden, B. 4th Ed. Morton Publishing. 2015
5. "Trail Guide to The Body" 4th. Ed. Biel, A. Books of Discovery. 2010
6. "Doble Innervacion del Musculo Brachial en la Poblacion Chilena" Claudio Molina; Cristián Uribe; Álvaro Heras; Cristián Astorga;Jorge Lemus & Alberto Rodríguez. Int. J. Morphol, 2011. 29(4):1207-1211. A PDF copy of this paper is available here.

Note: The side image modified from the original by Anatomography, CC BY-SA 2.1 JP <https://creativecommons.org/licenses/by-sa/2.1/jp/deed.en>, via Wikimedia Commons following Creative Commons attributes.


Biceps brachii

Biceps brachii muscle - Image modified from the original, Wikimedia Commons. Public domain
Biceps brachii muscle.
Click on the image for a larger depiction

The musculus biceps brachii is a long muscle found in the anterior, aspect of the arm and is one of the three muscles contained in the anterior compartment (flexor compartment) of the arm, the other two being the brachialis and coracobrachialis muscles.  It is composed by two muscular heads, one long (lateral) , and one short (medial) that originate superiorly from separate tendons that attach to the scapula. These two heads join to  form a single long, oval-shaped belly with a single tendon that crosses the elbow joint and attaches to the radius. 

The short tendon of the biceps brachii passes anteromedial to the shoulder joint and attaches to the coracoid process of the scapula by way of a tendon that mixes with the tendon of the coracobrachialis muscle.

The long cylindrical tendon of the biceps brachii is found in the intertubercular (bicipital) groove (Lat: sulcus intertubercularis) of the humerus, and passes between the greater and lesser tubercles of the humerus, entering the articular cavity of shoulder joint, and continues superiorly to insert in the supraglenoid tubercle of the scapula.

The distal, common tendon of the biceps brachii courses inferiorly and attaches to the radial (bicipital) tuberosity of the radius. There is a well-defined bursa between the radial tuberosity and the biceps brachii tendon that allows for movement of the tendon.

Also, a flat, fascial extension of the tendon, known as the bicipital aponeurosis extends inferomedially to blend with the antebrachial aponeurosis that covers the epitrochlear muscles of the forearm (pronator teres, flexor carpi radialis muscles). The brachial artery passes between the tendon of the biceps brachii and the bicipital aponeurosis in the anterior aspect of the elbow joint.

The biceps brachii crosses both the shoulder and the elbow join. As such, its functions will depend on which joint is fixed and which one is not. This muscle flexes the elbow, supinates the forearm, and flexes the shoulder.

It is innervated by the musculocutaneous nerve (C5,D6) which is a branch of the brachial plexus. It receives arterial supply by way of muscular branches that arise from the brachial artery.

The name of the muscle literally means "two heads" as the prefix "bi" means "two" and the Latin term "-ceps" means "head".

Note: Because the long and the short head of the biceps brachii attach to different locations of the scapula, some authors and Internet websites say that there are 18 muscles that attach to the scapula. I do not agree, as the biceps brachii is a single muscle that happens to have to separate attachments to the scapula. It would be different if this article was titled "Name the 18 separate muscular attachment points of the scapula". Dr. Miranda

The image is modified from the original via Wikimedia. Public domain. Animated image below by Wikimedia Commons - Anatomography [CC BY-SA 2.1 following Creative Commons attributes.

Niwadare, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia CommonsSources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 42nd British Ed. Churchill Livingstone 2021
4. “An Illustrated Atlas of the Skeletal Muscles” Bowden, B. 4th Ed. Morton Publishing. 2015
5. "Trail Guide to The Body" 4th. Ed. Biel, A. Books of Discovery. 2010


Pectoralis minor

Pectoralis minor muscle (26) - Testut & Latarjet 1931. Public domain
Pectoralis minor muscle (26)
Click on the image for a larger depiction

The pectoralis minor muscle is a small triangular muscle found deep to the pectoralis major in the anterior aspect of the thorax.

This muscle originates from three fleshy bellies that insert into the superior border and anterior surface of the third, fourth and fifth ribs. The muscle fibers converge superolaterally to insert into the inferomedial aspect of the coracoid process, of the scapula, where the tendon of the pectoralis minor intermingles and fuses with the tendon of the coracobrachialis muscle.

The pectoralis minor lies immediately anterior and covers some of the structures of the axillary region, the axillary artery and vein and some of the components of the brachial plexus. In fact, the pectoralis minor muscle is the landmark that divides the axillary artery into its three components: proximal (between the first rib and the medial border of the pectoralis minor). middle (deep to the pectoralis minor), and distal (between the lateral border of the pectoralis major and the inferior border of the teres major muscle). Thus defined the pectoralis major forms part of the anterior wall of the axilla.

In conjunction with other muscles, the pectoralis minor helps to maintain the scapular and shoulder joint in position. If the scapula is fixed, the pectoralis major assists to elevate the anterior thoracic wall during forced inhalation. The pectoralis minor also works as a depressor of the scapula and shoulder joint, abducts the scapula, and rotates the scapula.

The pectoralis minor is innervated by the medial pectoral nerve (C8.T1), a branch of the brachial plexus. Some of the fibers of the medial pectoral nerve perforate the pectoralis minor to provide nerve supply to a portion of the pectoralis major. The pectoralis minor is one of the 17 muscles that attach to the scapula.

Sources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 42nd British Ed. Churchill Livingstone 2021
4. “An Illustrated Atlas of the Skeletal Muscles” Bowden, B. 4th Ed. Morton Publishing. 2015
5. "Trail Guide to The Body" 4th. Ed. Biel, A. Books of Discovery. 2010


Pectoralis major

Pectoralis major muscle
Click for a larger image

UPDATED: The pectoralis major muscle is the largest muscle in the anterior aspect of the thorax. It is thick and fan-shaped.  It attaches superiorly to the medial 2/3rds of the clavicle, and medially to the anterior aspect of the sternum and cartilages of the first to sixth or seventh ribs, extending inferiorly to attach to the aponeurosis of the external oblique muscle. Laterally, this muscle attaches to the lateral lip of the intertubercular groove (bicipital groove) of the humerus by a two-layered quadrilateral tendon which inserts each of the two heads of the muscle.

The superficial tendon attaches the clavicular head (red in the accompanying image), which extends between the intertubercular groove of the humerus and the clavicle. The deep tendon attaches the sternocostal head (purple in the accompanying image), which extends between the humeral intertubercular groove and the attachments in the sternum, costal cartilages, and the aponeurosis of the external oblique muscle. There is usually a well-defined interval between the two heads of the pectoralis major.

The pectoralis major is innervated by the medial pectoral nerve (C8-T1) and lateral pectoral nerve (C5-C7).

This muscle is covered by the pectoral fascia. An extension of this fascia is the clavipectoral fascia. In both male and female, the mammary gland is situated anterior to and anchors to the pectoral fascia by a number of fascial ligaments known as "Cooper's ligaments"

Pectoralis major muscle - Direction of the muscular fibers. Public domain
Click for a larger image

When both pectoral heads contract as a unit, the muscle adducts. flexes, and medially rotates the shoulder joint and humerus, such as when swimming doing and Australian crawl. Testut & Latarjet (1931) describe three separate muscular segments to this muscle, a clavicular component, a superior sternocostal component, and an inferior sternocostal component. They state that the clavicular components is quite evident, but the other two, although difficult to see, are separate. The clavicular head draws the humerus forward, upward, and medially, such as when you reach for something in front and above you. The sternocostal head draws the humerus down, forward, and medially.

The second image in this article is from Testut & Latarjet (1931) and shows the direction of muscular fibers of the three segments of the pectoralis major.

The word pectoral arises from the Latin term "pectum" meaning "chest, breast". In its true meaning, pectoral or pectoralis refers to a "chest plate" or an "adornment of the chest".

Sources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 38th British Ed. Churchill Livingstone 1995
4. “An Illustrated Atlas of the Skeletal Muscles” Bowden, B. 4th Ed. Morton Publishing. 2015
First image modified from the original by Henry VanDyke Carter, MD. Public domain. Second image from Testut & Latarjet. Public domain 


Latissimus dorsi

Latissimus dorsi muscle (1) - Testut & Latarjet 1931. Public domain
Latissimus dorsi muscle
Click on the image for a larger depiction

The latissimus dorsi muscle is a large, wide, flat muscle on the posteroinferior aspect of the back. It has the shape of a triangle that has a base at the thoracolumbar spine and its apex in the axillary region.

This muscle has a wide origin by tendons that attach to the spinous processes of the lower six or seven thoracic vertebrae as well as those of the lumbar vertebrae, the sacral crest, and the posterior aspect of the external lip of the iliac crest. This created a wide fibrotendinous lamina known as the thoracolumbar fascia. The muscle also attaches to the external surface of the three or four inferiormost ribs and the inferior angle of the scapula.

From here, the muscle fibers converge superolaterally and twist anterosuperiorly to form a quadrilateral tendon that inserts deep into the bicipital groove (Lat: sulcus intertubercularis) of the humerus as shown by number 5 in the accompanying figure. There is sometimes a tendinous extension to the humeral lesser tubercle.

The latissimus dorsi extends, adducts, and medially rotates the shoulder joint, also known as the glenohumeral joint. Along with the teres major muscle they are known as the “handcuff muscles”, as this is the action of these muscles as the hands are brought together towards the back. The latissimus dorsi is innervated by the thoracodorsal (or long subscapular) nerve (C6, C7, and C8).

The Terminologia Anatomica 2 proper name is “musculus latissimus dorsi”. The plural form is “musculi latissimi dorsi”. The name of the muscle is derived from Latin. Since “latum” means “wide”, “musculus latissimus dorsi” means the “widest muscle of the back”, quite a proper name. In other languages this is more evident. In Spanish, the name for the muscle is [músculo dorsal ancho] meaning the “wide muscle of the back”.

The latissimus dorsi is one of the 17 muscles that attach to the scapula. It also forms one of the borders of the lumbar triangle of Petit, potential site for a lumbar hernia.

Sources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 42nd British Ed. Churchill Livingstone 2021
4. “An Illustrated Atlas of the Skeletal Muscles” Bowden, B. 4th Ed. Morton Publishing. 2015
5. "Trail Guide to The Body" 4th. Ed. Biel, A. Books of Discovery. 2010


Name the 17 muscles that attach to the scapula

Anterior view of the left scapula.  Image in Public Domain, by Henry Vandyke Carter, MD - Gray's Anatomy
Anterior view of the left scapula.


UPDATED:
The scapula is a flat, triangular bone that forms the posterior portion of the shoulder girdle. It is described with two surfaces, three borders, and three angles. The scapula attaches to the clavicle by way of the acromioclavicular joint and ligaments. . Seventeen muscles attach to the scapula and are listed here alphabetically:

1. Biceps brachii
2. Coracobrachialis 
3. Deltoid  
4. Infraspinatus 
5. Latissimus dorsi
6. Levator scapulae 
7. Omohyoid (inferior belly)
8. Pectoralis minor 
9. Rhomboid major 
10. Rhomboid minor 
11. Serratus anterior 
12. Subscapularis 
13. Supraspinatus 
14. Teres major 
15. Teres minor 
16. Trapezius
17. Triceps brachii (long head)

By surfaces, borders, and structures, these muscles group and attach as follows:

Posterior surface:
1. Supraspinatus
2. Infraspinatus
3. Teres major
4. Teres minor

Scapular spine and acromion:
5. Trapezius
6. Deltoid

Anterior surface:
7. Subscapularis
8. Serratus anterior

Medial border:
8. Serratus anterior
9. Rhomboid major
10. Rhomboid minor
11. Levator scapulae


Superior border:

12. Omohyoid (inferior belly)

Medial border:
13. Triceps brachii (long head)

External angle:
14. Biceps brachii (long head)

Coracoid process:
14. Biceps brachii (short head)
15. Coracobrachialis
16. Pectoralis minor

Inferior angle:

17. Latissimus dorsi

Note: Because the long and the short head of the biceps brachii attach to different locations of the scapula, some authors and Internet websites say that there are 18 muscles that attach to the scapula. I do not agree, as the biceps brachii is a single muscle that happens to have two separate attachments to the scapula. It would be different if this article was titled "Name the 18 separate muscular attachment points of the scapula". Dr. Miranda 

Sources:
1. "Tratado de Anatomia Humana" Testut et Latarjet 8 Ed. 1931 Salvat Editores, Spain
2. "Gray's Anatomy" 38th British Ed. Churchill Livingstone 1995
Image in the Public Domain, by Henry Vandyke Carter - Gray's Anatomy