Anterior abdominal muscles

1. ANTERIOR ABDOMINAL MUSCLES
(Complete Info. & Presentation)(Complete Info. & Presentation)
By- Dr. Armaan SinghBy- Dr. Armaan Singh

2. Anterior Abdominal Wall
• The muscles of the anterior
abdominal wall play a major role in
movements of the trunk
• Protecting the abdominal organs
• Increase the intra-abdominal
pressure, aid in expiration and all
straining activities such as
micturition, coughing and vomiting
• Supplied by lower five intercostal
and subcostal nerves

3. Anterior Abdominal Muscles
• Strong abdominals are important in
helping to stabilise the trunk
• Support the spine
• They flex and rotate the trunk
• Acting with the adductors and
abductors of the hip
• They help to stabilise the pelvis during
walking and running

4. Anterior Abdominal Wall
• Superficial fatty layer
• Membranous layer of superficial
fascia
• Below umbilicus
• Continuous with Colles’ fascia in
the perineum

5. Skin of Anterior Abdominal
Wall
• Lower five intercostal nerves
• Subcostal nerve T12
• 10th
intercostal nerve is at the
level of the umbilicus
• Iliohypogastric nerve L1
• Ilioinguinal nerve L1

6. Blood Supply and
Lymphatics
• Intercostal vessels
• Skin above umbilicus
superficial veins and
lymphatics drain to axilla
• Skin below umbilicus
superficial veins and
lymphatics drain to long
saphenous vein
• Superficial inguinal glands

7. Inguinal Glands
• Proximal group parallel to
inguinal ligament
• Enlarged tender inguinal
glands
• Part of a generalised
lymphadenopathy
• Secondaries

8. Inguinal Glands
• Proximal group
• Lesions in local structures
• Skin of lower anterior abdominal
wall
• Gluteal region
• Skin of scrotum or labia
Distal superficial glands
• Skin of leg area drained by long
saphenous vein
• All drain to deep inguinal glands
along femoral vein

9. Abdominal Muscles
• External oblique
• Internal oblique
• Transversus
• Rectus abdominus
• Pyramidalis
• Nerves and vessels
• Lie between internal oblique and
transversus

10. External Oblique
• Origin
• Outer surfaces lower borders
lower eight ribs
• Interdigitating with serratus
anterior and latissimus dorsi
• Fibres pass medially and
inferiorly

11. External Oblique Insertion
• Inserted into anterior half of
anterior two thirds outer lip of
iliac crest
• Aponeurosis in the inguinal
region passes anterior to
rectus muscle
• Forms the inguinal ligament
• Lacunar ligament
• Reflected portion of inguinal
ligament

12. Inguinal and Lacunar
Ligaments
• Inguinal ligament
aponeurosis is folded
back from anterior
superior iliac spine to
pubic tubercle to form
inguinal ligament
• Lacunar ligament
triangular, attached to
pectineal line. lateral
free border medial
margin of femoral ring

13. Insertion External Oblique
• Pubic crest
• Gap for superficial
inguinal ring
• Pubic bone
• Linea alba
• Anterior wall of the
rectus sheath
• Zyphoid process

14. External Oblique
• Acting separately
• The external oblique flexes the
vertebral column laterally and
rotates it to the opposite side
• If the thorax is fixed by contracting
both external obliques, you can tilt
the symphysis pubis superiorly and
flex the trunk, posterior pelvic tilt
• Movement of the iliac crests
determines the direction of the tilt

15. Internal Oblique
• Muscular origin lateral two
thirds of inguinal ligament
• Anterior two thirds
intermediate lip of iliac crest
• Lumbar fascia
• Muscular fibres arch over
contents of inguinal canal
anterior to rectus muscle
• Fibres pass medially and
superiorly

16. Insertion Internal Oblique
• Into coastal margin, upper three as
fleshy fibres
• Next three as aponeurotic
• Inserted into linea alba
• Between zyphoid and half way
between umbilicus and pubic
symphysis aponeurosis splits
• Anterior layer fuses with external
oblique
• Posterior layer fuses with
transversus

17. Internal Oblique Conjoint
Tendon
• Half way between umbilicus
and pubic symphysis
• Aponeurosis of the internal
oblique and transversus fuse
to form conjoint tendon
• Anterior portion of rectus
sheath
• Inserted into pectineal line
behind superficial inguinal ring

18. Internal Oblique
• The right side of the muscle twists
to the right and the left side twists
to the left
• The lower six intercostals nerve
• Subcostal nerve
• Iliohypogastric nerves

19. Transversus Abdominus
• Origin
• Lateral one third of inguinal
ligament
• Anterior two thirds of inner lip of
iliac crest
• Lumbar fascia
• Lower border and inner surfaces
lower six ribs interdigitating with
diaphragm

20. Insertion Transversus
Abdominus
• Into zyphoid, linea alba
• Half way between umbilicus and
pubic symphysis
• Fuses with posterior lamella of
internal oblique
• Below forms conjoint tendon
• Inserted into pectineal line behind
superficial inguinal ring

21. Transversus Abdominus
• The transversus abdominus helps
to support the abdominal viscera
• Maintain intra-abdominal pressure
• Stabilises the lumbar spine
• It is supplied by the lower six
intercostals nerves
• Subcostal nerves
• Iliohypogastric nerves

22. Rectus Abdominus
• Segmental muscle
• Two heads
• Anterior pubic symphysis
• Pubic crest
• Inserted anterior aspect of 5, 6, 7th
costal
cartilages
• Adhesions anterior surface
• Segmental blood and nerve
supply from Intercostals
• The rectus abdominus flexes the trunk

23. Rectus Abdominus
• The rectus muscles (recti)
are the most powerful
flexors of the vertebral
column
• When raising the head from
a supine position
• A movement often used to
strengthen the abdominals
• It is the recti that contract first
• When the shoulders start to rise upwards, the obliques
start to contract
MOB TCD

24. Rectus Sheath
• Above zyphoid
• Anterior wall is the external
oblique
• Posterior, costal cartilages
• From ziphoid and half way
between umbilicus and pubic
symphysis
• Anterior is external oblique and
anterior lamella of internal oblique
• Posterior lamella internal oblique
and transversus

25. Rectus Sheath
• Below half way between
umbilicus and pubic symphysis
• The aponeurosis of the
external oblique, internal
oblique and transversus
(conjoint tendon) pass anterior
to the rectus
• Posterior lies the transversalis
fascia

26. Rectus Sheath
• Contents
• Rectus muscle
• Pyramidalis
• Superior and inferior epigastric
vessels
• Lower five intercostal vessels and
nerves

27. Transversalis Fascia
• Lines deep aspect of
transversus abdominus
• Fuses with inguinal ligament
• Continuous with iliac fascia
• Except in the region of the
femoral vessels
• Forms anterior wall of femoral
sheath

28. Extraperitoneal Tissue
• Extraperitoneal connective
tissue
• If fatty, it separates the
transversalis fascia from
the peritoneum
• If thin, they are in close contact
with one another

29. Peritoneal Pouches
• Peritoneal pouches are
found in the region of the
deep inguinal ring
• Medial portion of the
posterior wall
Posterior aspect anterior
abdominal wall

30. Inguinal Canal
• Intra muscular canal
• Lower portion of anterior
abdominal wall
From
• Deep inguinal ring
• Superficial inguinal ring
• Transmits spermatic cord in
male
• Round ligament in female

31. Superficial Inguinal Ring
• Triangular opening in
aponeurosis of external
oblique
• Base, pubic crest
• Superior crus attached to
the pubic crest
• Inferior attached to pubic
tubercle
• External spermatic fascia
arises from its margins

32. Deep Inguinal Ring
• Oval opening 2.5 cm
• Above the middle of inguinal
ligament
• Inferior epigastric artery passes
medial to the deep ring

33. Interfoveolar Ligament
• The interfoveolar ligament is
an inconstant band
• Medial to deep inguinal ring
• Anterior to inferior epigastric
vessels
• From lower margin of
transversus abdominus
• To pectineal line
McVay & Anson, 1949

34. Inguinal Canal
• Anterior Wall
• External oblique forms
• Whole anterior wall
• Internal oblique forms
• Lateral half only

35. Inguinal Canal
• Posterior Wall
• Transversalis fascia
• Whole of wall
• Medial half conjoint tendon
• Medial quarter reflected portion
of inguinal ligament

36. Roof of Inguinal Canal
• Roof
• Arching fibres of internal oblique
• Transversus as they both arise
from the inguinal ligament

37. Floor of Inguinal Canal
• Floor
• Inguinal ligament
forms whole of floor
• Medial half by the
lacunar ligament
• Reflected part of
inguinal ligament
forms medial quarter

38. Passing Through Deep Ring
Male
• Vas Deferens
• Testicular artery
• Pampiniform plexus of veins
• Remains of processus vaginalis
• Genital branch of genitofemoral
nerve
• Lymphatics from testes
• Cremaster artery

39. Passing through
Superficial Ring Male
• Everything that went through deep
ring
• Plus
• Ilioinguinal nerve
• Internal spermatic fascia from
margins of the deep ring
• Cremaster muscle and fascia

40. Passing through
Deep Ring Female
• Round ligament of uterus
• Remains of processus vaginalis
• Genital branch of genitofemoral
nerve
• Lymphatics from uterus, region of
cornu

41. Passing through
Superficial Ring Female
• Everything that went through
deep ring
• Plus ilioinguinal nerve

42. Inguinal Canal
• Contraction of the
abdominal muscles
increases the obliquity of
the inguinal canal
• Protecting the two rings
Lytle, 1945

43. Increase in Intra-Abdominal
Pressure
• Pain aggravated by an
increase in intra- abdominal
pressure
• Hernia
• Inguinal or femoral hernia
• Entrapment of the
ilioinguinal nerve

44. Hernia
• Chronic pain in the groin in an
athlete may be due to a hernia or
a potential hernia

45. Inguinal Hernia
• Sudden severe pain in
lower abdomen
• Associated with lifting a
heavy object
• Common history of a direct
inguinal hernia

46. Indirect Inguinal Hernia
• Passes through
• Deep inguinal ring
• May extend to pass through
the superficial ring into the
scrotum
• Congenital or acquired
• Congenital inside the tunica
vaginalis (serous
membrane, covers part
of testes)
• Acquired outside

47. Direct Inguinal Hernia
• Enters through posterior wall of
the inguinal canal
• Leaves through superficial
inguinal ring
• Above and medial to the pubic
tubercle

48. Inguinal Hernia

49. Inguinal Versus Femoral Hernia
• Inguinal hernia above and
medial to pubic tubercle
• Femoral hernia below and
lateral to the tubercle
• More common in females
and more likely to
strangulate

50. Femoral Ring

51. Femoral Hernia
• Enters through femoral ring
• Enters femoral canal
• Medial compartment of femoral
sheath
• More common in women

52. Femoral Hernia

53. Saphenous Varix
• Swelling is soft and
diffuse
• Empties on minimal
pressure
• Refills on release
• Cough impulse is
present

54. Gilmore’s Groin
• Common cause of chronic groin
pain in field sports
• Particularly soccer players
• Pain on any sudden change of
movement, sneezing, coughing

55. Gilmore’s Groin
• Trying to sprint
• Will increase the pain
• Pain is worse getting out of bed
• The day after a match or a
training session

56. Gilmore’s Groin
• Pain is increased by
external rotation
• Or hyperextension of hip
• Pain is localised to lower
anterior abdominal wall
• Adductor or perineal region

57. Gilmore’s Groin
• Torn external oblique
aponeurosis
• Torn conjoint tendon
• A dehiscence between conjoint
tendon and the inguinal ligament
• The absence of a hernial sac
• Superficial inguinal ring on the
affected side is dilated and
tender
• Cough impulse

58. Gilmore’s Groin Surgery
• Treatment is surgical
• 90% return to sport
• Strengthen lower abdominal
muscles
1.Plication of the transversalis
fascia in “Shouldice hernia
repair”
2.Repair of torn conjoint tendon

59. Gilmore’s Groin Surgery
3. Approximation of conjoint
tendon to the inguinal
ligament
4. Repair of the external oblique
5. Reconstitution of the
superficial inguinal ring