BONUS PLATES BP1 Degenerative Changes in the Cervical Vertebrae BP2 Atlanto-occipital Junction BP3 Muscles of Facial Expression: Anterior View BP4 Subclavian Artery BP5 Sympathetic Nervous System: General Topography BP6 Parasympathetic Nervous System: General Topography BP7 Cholinergic and Adrenergic Synapses: Schema BP8 Spinal Cord Cross Sections: Fiber Tracts BP9 Cervical Ribs and Related Anomalies BP10 Muscles of Respiration BP11 Pulmonary Arteries and Veins BP12 Coronary Arteries and Cardiac Veins: Variations BP13 Arteries of Esophagus: Variations BP14 Intrinsic Nerves and Variations in Nerves of Esophagus BP15 Lumbar Vertebrae: Radiographs BP16 Thorax: Tracheal Bifurcation, Left Atrium (Coronal Section: Midaxillary Line) BP17 Inguinal and Femoral Regions BP18 Indirect Inguinal Hernia BP19 Variations in Position and Contour of Stomach in Relation to Body Habitus BP20 Some Variation in Posterior Peritoneal Attachment of Cecum BP21 Sigmoid Colon: Variations in Position BP22 Topography of Liver BP23 Variations in Form of Liver BP24 Liver Segments and Lobes: Vessel and Duct Distribution BP25 Variations in Cystic, Hepatic, and Pancreatic Ducts BP26 Variations in Pancreatic Duct BP27 Variations in Hepatic Arteries BP28 Variations in Cystic Arteries BP29 Variations in Celiac Trunk BP30 Variations in Colic Arteries – Part I BP31 Variations in Colic Arteries – Part II BP32 Variations and Anomalies of Hepatic Portal Vein BP33 Lymph Vessels and Nodes of Liver BP34 Variations in Renal Artery and Vein BP35 Abdomen Cross Section: Illeocecal Junction BP36 Abdomen Cross Section: Sacral Promontory BP37 Female Urethra BP38 Ligaments of Wrist BP39 Ovary, Ova, and Follicles BP40 Variations in Hymen BP41 Nephron and Collecting Tubule: Schema BP42 Blood Vessels in Parenchyma of Kidney: Schema BP43 Schematic Cross Section of Abdomen at Middle T12 BP44 Vertebral Veins: Detail Showing Venous Communications BP45 Vertebral Ligaments BP46 Tympanic Cavity BP47 Cross Section through Prostate BP48 Muscle Attachments of Ribs BP49 Coronary Arteries: Right Anterior Oblique Views BP50 Male and Female Cystourethrograms BP51 Layers of Duodenal Wall BP52 Arteries of Upper Limb BP53 Arteries of Lower Limb BP54 Leg: Serial Cross Sections Bonus Plates Atlas of Human Anatomy Sixth Edition Frank H. Netter, MD 1600 John F. Kennedy Blvd. Ste. 1800 Philadelphia, PA 19103-2899 ATLAS OF HUMAN ANATOMY Standard Edition: 978-1-4557-0418-7 SIXTH EDITION International Edition: 978-0-8089-2451-7 Professional Edition: 978-1-4557-5888-3 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency can be found at our website: www.elsevier.com/ permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Permission for Netter Art fgures may be sought directly from Elsevier’s Health Science Licensing Department in Philadelphia, PA: phone 1-800-523-1649, ext. 3276, or (215) 239-3276; or email Consulting Editors John T. Hansen, Ph.D. Lead Editor Associate Dean for Admissions Professor of Neurobiology and Anatomy University of Rochester Medical Center Rochester, New York Brion Benninger, MD, MS Professor, Chair Medical Anatomical Sciences, Family Medicine, and Neuromuscular Medicine College of Dental Medicine, Western University of Health Sciences Lebanon, Oregon; Orthopaedic and General Surgery Residency Program Samaritan Hospital Corvallis, Oregon; Surgery, Orthopedics & Rehabilitation, and Oral Maxillofacial Surgery Oregon Health & Science University Portland, Oregon Jennifer Brueckner-Collins, PhD Professor and Vice Chair of Educational Programs Anatomical Sciences and Neurobiology University of Louisville School of Medicine Louisville, Kentucky Todd M. Hoagland, PhD Associate Professor Department of Cell Biology, Neurobiology, and Anatomy Medical College of Wisconsin Milwaukee, Wisconsin R. Shane Tubbs, MS, PA-C, PhD Pediatric Neurosurgery Children’s Hospital of Alabama Birmingham, Alabama Professor of Anatomy Department of Anatomical Sciences, St. George’s University, Grenada Centre of Anatomy and Human Identifcation, Dundee University, United Kingdom Contributing Medical Illustrator Carlos A. G. Machado, MD Editors of Previous Editions First Edition Fourth Edition Fifth Edition Sharon Colacino, PhD John T. Hansen, PhD John T. Hansen, PhD Jennifer K. Brueckner, PhD Brion Benninger, MD, MS Second Edition Stephen W. Carmichael, PhD, Jennifer K. Brueckner, PhD Arthur F. Dalley II, PhD DSc Stephen W. Carmichael, PhD, Thomas R. Gest, PhD DSc Third Edition Noelle A. Granger, PhD Noelle A. Granger, PhD John T. Hansen, PhD Anil H. Waljii, MD, PhD R. Shane Tubbs, MS, PA-C, PhD International Advisory Board Sadakazu Aiso, MD, PhD Victor J. Götzens, PhD Thazhumpal C. Mathew, MSc, Professor Professor of Human Anatomy and PhD, FRCPath Department of Anatomy Embryology Professor Keio University School of Medicine Department of Pathology and Vice Dean for Research Training and Tokyo, Japan Experimental Therapeutics Consultation Faculty of Medicine Faculty of Allied Health Sciences, Nihal Apaydin, MD University of Barcelona Health Sciences Centre Associate Professor Barcelona, Spain Kuwait University Department of Anatomy Kuwait City, Kuwait Ankara University Faculty of Medicine Sung-Tsang Hsieh, MD, PhD Ankara, Turkey Departments of Anatomy and Cell Janusz Morys´, MD, PhD Biology and Neurology Professor Col. Rajan Bhatnagar, MD Institute of Brain and Mind Sciences Department of Anatomy and Armed Forces Medical College National Taiwan University Neurobiology Wanowrie, Pune, India Taipei, Taiwan Medical University of Gdansk Gdansk, Poland Lucio Cocco, MD Tang Jun Min, MD Professor and Head Professor Eduardo Cotecchia Ribeiro, Cellular Signaling Laboratory Department of Anatomy, Histology, MS, PhD Department of Biomedical Sciences and Embryology Associate Professor of Descriptive and University of Bologna Peking University Health Science Topographic Anatomy Bologna, Italy Center Department of Morphology and Beijing, China Genetics Yu Enhua, MD, PhD Federal University of Sao Paulo Professor Rachel Koshi, MBBS, MS, PhD School of Medicine Department of Anatomy, Histology, Professor of Anatomy in Cell and Sao Paulo, Brazil and Embryology Developmental Biology Peking University Health Science Weill Cornell Medical College in Qatar Jean-Pierre Richer, MD, PhD Center Doha, Qatar Professeur d’Anatomie Beijing, China Chirurgien des Hôpitaux Marios Loukas, MD, PhD Université de Poitiers Quentin A. Fogg, PhD Professor and Chair Poitiers, France William Hunter Senior Lecturer in Department of Anatomical Sciences Anatomy Dean of Research, School of Medicine Andreas H. Weiglein, MD School of Life Sciences St. George’s University Professor University of Glasgow Grenada, West Indies Vice Chair, Institute of Anatomy Glasgow, UK Medical University of Graz Lucia Manzoli, MD Graz, Austria Professor, Department of Anatomical Sciences University of Bologna Bologna, Italy Netter’s Atlas of Human Anatomy – Celebrating 25 Years “Anatomy, of course, does not change, but our understand- and perspectives that elucidate complex anatomic relation- ing of anatomy and its clinical signifcance does.” ships. This edition also includes the illustrations from older – Frank H. Netter, MD editions of the Atlas, like Dr. Netter’s depictions of common anatomic variations (in electronic editions and print+electronic th Whether you’re using this 6 edition of Atlas of Human packages) as bonus plates to help provide more comprehen- Anatomy in print, as an e-Book, online, or in the Netter’s sive coverage that dissection lab hours may not allow. For the Anatomy Atlas for iPad app—Dr. Netter’s paintings of the frst time, the Atlas incorporates muscle tables as quick intricacies of the human form remain as relevant today as look-up appendices at the end of each section for the conve- th at frst launch. The publication of the 6 edition marks the nience of the clinician, student, or educator with little time. silver anniversary of the frst release of Frank H. Netter’s StudentConsult.com and NetterReference.com electronic Atlas of Human Anatomy—when its vibrant colors and resources include some 3D models extracted from Netter’s unique clinical perspective made it a must-have companion 3D Interactive Anatomy, dissection video selections from Net- in anatomy classes, dissection labs, and clinical professional ter’s Online Dissection Modules by UNC at Chapel Hill, and offces worldwide—solidifying his legacy to so many as one other supporting resources. In addition, all text throughout of the world’s most infuential medical educators. the Atlas has been meticulously updated to be in line with the Anatomy remains a cornerstone of healthcare educa- most recent version of Terminologia Anatomica by the tion. It is often one of the frst topics taught in medical or Federal International Program for Anatomical Terminology healthcare curricula. Anatomy is also central to so much in (FIPAT) of the International Federation of Associations of clinical practice, from physical examination and radiologic Anatomists (IFAA). imaging to surgery and physical rehabilitation. However, The unique visual perspective of Frank H. Netter is changes in anatomy education and its clinical application unsurpassed. Dr. Netter brought the hand of a master medical over these past 25 years have been signifcant. Medical and illustrator, the brain of a physician, and the soul of an artist th healthcare curricula increasingly integrate anatomy through- to his depictions of the human body. This 25 anniversary out and dedicated gross-anatomy hours have decreased. edition celebrates the lasting impact of his work that contin- Some programs have discontinued full-body dissection. ues to teach and inspire. Advances in imaging technology have provided increasingly We want to hear from you—about the history clearer views of living anatomy, and 3D models of anatomy and future of anatomy education and medicine and the continue to evolve. Likewise, the Atlas has evolved. Thanks Netter legacy and invite you to share your thoughts, inspira- to the tremendous guidance of leading clinical anatomists tions, memories, tributes, and feedback with us through and expert anatomy educators, as well as the contributions email: Frank H. Netter, MD Photograph by James L. Clayton