GrayA'nsa tomfyo rS tudents, 3'Edd ition witShT UDENCTO NSULOTn liAncec ess DrakeV,a g&i M itchell 2014I.S BN9:7 8-700-20-5131-9 Gray's AnaftoorSm tyu dents FlasCha rds3',Ed d ition witShT UDENCTO NSULOTn liAncec ess DrakeV,a g&i M itchell 2014I.S BN9:7 8-1-4557-5898-2 GrayA'tsl aosfA natomy, 2•E•d ition witShT UDENCTO NSULOTn liAncec ess Drakeet a/. 2014I.S BN9:7 8-1-4557-4802-0 GrayA'nsa tomRye view Laukaest a/. 2009I.S BN9 78-0-443-06938-3 GrayC'lsi niPchaolt ographic Clinical Photographic Dissecotfot rh eH umanB ody Dissecotfot rh e witShT UDENCTO NSULOTn liAncec ess iJ\i LaukaBse,n ning&e Tru bbs 2013I.S BN9:7 8-1-4377-2417-2 GrayB'ass iAcn atomy witShT UDENCTO NSULOTn liAncec ess DrakeV,a g&i M itchell 2013I.S BN9:7 8-1-4557-1078-2 GrayA'nsa tomy, 401Ehd ition ExpeCrotn sulOtn-liannedP rint Standring 2009I.S BN9:7 8-0-443-06684-9 Thipsa gei ntentiolneaftbl llayn k ....A..n.. .. atom fors tudents RichaL.rD dr akPeh,DF ,A AA DirecotfoA rn atomy ProfesosfoS ru rgery ClevelaCnldi nLiecr neCro lleogfeM edicine CaseW esterRne serUvnei versity ClevelaOnhdi,o A.W aynVeo glPh,D F,A AA ProfesosfoA rn atomayn dC elBli ology DepartmeonfCt e llualnadrP hysioloSgciiceanlc es FaculotfyM edicine UniversoifBt ryi tCioslhu mbia VancouvBerri,t Cioslhu mbiCaa,n ada AdamW .M .M itchMeBl BlSF,,R CSF,R CR ConsultRaandti ologist Chelsaenad W estminsHtoesrp ital HonoraSreyn ioLre cturIemrp eriCaoll lege LondonU,n iteKdi ngdom Illustrabtyi ons RichaTridb biatntdPs a uRli chardson Photograbpyh s AnseHlolr n THIRD EDITION ELSEVIER CHURCHILL LIVINGSTONE ELSEVIER 160J0o hn KennedByl vd. F. Ste1.8 00 PhiladelpPhAi1 a9,1 03-2899 GRAY'SA NATOMYF ORS TUDENTST,H IRDE DITION ISBN9: 78-0-7020-5131-9 InternatiEodniatli on ISBN9: 78-0-7020-5132-6 Copyrig2h0t1©52 ,0 102,0 0b5y C hurchLiilvli ngsatnio mnper,i onfEt l sevIinecr. No parotf t hipsu blicatmiaoybn e r eproduocret dr ansmititnae ndy f ormo rb ya nym eanse,l ectroonrmi ecc hanical, includpihnogt ocopyriencgo,r dionrag n,y i nformatsitoonr aagned r etriesvyaslt ewmi,t houpte rmissiinow nr itifnrgo m thep ublishDeert.a iolnsh owt os eepke rmissifounr,t hienrf ormataiboonu tth eP ublishpeerr'msi ssipoonlsi cainedso ur arrangemewnittsho rganizatsiuocnhas s t heC opyrigChlte aranCceen tearn dt heC opyrigLhitc ensiAngge nc,cy anb e founadt o urw ebsitwew:w .elsevie/rp.ecrommiss.i ons Thibso oka ndt hei ndividcuoanlt ributcioonntsa inienid ta rep rotecutnedde cro pyribgyht th eP ublish(eort htehra na s mayb en otehde rein). Notices Knowledagned b esptr actiicnte h ifise ladr ec onstancthlayn ginAgs.n ewr esearacnhd e xperiebnrcoea deonu r understandcihnagn,g eisnr esearmceht hodpsr,o fessipornaaclt iocrem se,d ictarle atmemnaty b ecomnee cess.a ry Practitiaonnder ress earchmeurssta lwayrse loyn t heiorw ne xperieanncdek nowledignee valuatainndgu sinagn y informatmieotnh,o dcso,m poundosr,e xperimednetssc rihbeerde iInn.u sinsgu chi nformatoirmo ent hodtsh esyh ould bem indfouflt heiorw ns afeatnyd t hes afeotfyo therisn,c ludpianrgt ifeoswr h om thehya vea professional responsi.b ility Withr espetcota nyd rugo rp harmaceutpircoadlu citdse ntifrieeadd,ea rrsea dvisteodc hectkh em ostc urrent informatpiroonv id(eido) n p rocedufreeast uroer(d i biy)t hem anufactuorfee ra chp rodutcotb ea dministetrove edr,i fy ther ecommenddeods oer f ormultah,em ethoadn dd uratioofna dministraatnidoc no,n traindicaIttii sto hnes . responsiboifpl riatcyt itiorneelrysio,nn gt heiorw ne xperieanncdek nowledogfet heipra tienttoms a,k ed iagnosteos , determidnoes agaensd t heb esttr eatmefnoter a chi ndividpuaatli eanntd,t ot akael alp proprisaatfeep trye cautions. Tot hef ulleexstte notft hel awn,e ithtehreP ublisnhoerrt hea uthorcso,n tributoorer dsi,t oarsss,u maen yl iabifloirt y anyi njuarnyd o/r d amagteo p ersoonrsp roperatsay matteorfp roducltisa bi,nl eigtlyigeonrco et herwiosref ,r oma ny useo ro peratioofa nn ym ethodpsr,o ducitnss,t ructoiroi ndse,ac so ntainientd h em aterial herein. ISBN9: 78-0-7020-5131-9 VPG loMbeadli Ecdaulc aCtoinotnMea ndtel:e Hnyed e SenMiaonra gCeor.n tent DeRvebeelcocGarp umleionwt : PubliSsehrivnMigac neasgP aetrr:iT cainan ian SenPiroorj Meacnta gJoehrnC: a sey DesiDginr ecLtouiF oorng:i one PrintiendC anada Lasdti giistt hep rinntu mber:9 8 7 6 5 4 3 2 l Acknowledgments Firwsewt o,u lldit koce olcltievtehlaytn hko wsheoa greed DrM.u rrMaoyr orniDs,r J.o nanMe atsubDarBr.ra i,a n toe xamienaer ldirearfo tfts h beoo k-anatoemdiusts,W estbeerrLga,u Hraal aln,Jd i nCguf io,cr o ntributing catsoa,rn sdt udmeenmtb eorfts h eed itroerviiabelorw ad imagfeotsrh ceh apotnet rhh ee aadn nde ck. forma routnhdwe o rYlodu.r input was invaDlrBu.ra ubCclreea .w faonrLddo gLaenfe o,r help with images We'dal sot otl hikaReni kc hTairbdb aintPdta suR li ch fotrh seu rfaancaet oomfty h uep pleirm b. ardsfoonr tshkeiiilntrl u rnoiunvrgi suiadlei ansta o PreosfsEolri zaAbkeestshao nndD rD.o nna fFoorr d, realtihtaiytsn o otn layf oundaftotirho aenc quisitiont hoeefin rt husiastaincvd asluupacpbroliuretet is q. anatomkincoawll ebdugatel ,si bose autiful. DrS.a mW isemafnoc,ro ntrisbuurtgiainncgdoa tlh er Thanmkuss atl sgoot oM adelHeyndeBe i,Sl hclm i,t t imagients h e abdohmeenaa dna ndne dcc kh aepr.ts ReebccGar uliJoowhC,na seayn,ad l tlh tee aamtE lsevier A.W aynVeo gl fogru iduistn hgr otuhgpehr eparoaftt hibioosno k. DrS.ah aNra ss(eesrnii sopre ciraelgiissftto rhrae rl)p We'da lsloit koet haPnrko feRsiscohrAa .rB du cking witthh iem agaenstd e axtna dd dicnrgi taincaally sis hamo ft hAeb rahLaimn cSoclhnoo ofMl e dicUinniev,e r onm odeirmna nggi. sitoyfI llifnootrih pser oviosfFi iogn8.. 11 4B.F inya,l l Dr.sJ .H eya,lJ .L eeG,.R aejswrareRn.,P earacned beucsawee w orkseeadp rayt,de ilstabnyic,nse odem c ases, B.R oberftoornt heisru ppoarntdc onsttirvuec thousoafmn idslst,e h earreve a ripoeuosp leg awvlheoo c al criitsimc. supporwth,o m we wotuoml adk el imkeeon fit nidoinv idu Threa diosltoaagftCyf h seelaan Wde stmiHnosstpeirt al allWye.' gvrea utlellfyi sttheedhm e re: and FTohret Ciluisn ic. DrL.e onaErpdpD ,r C.a rMlo rgaDnrR,.o beSrhte llInp articMurl.Aa nrd,r eWwi lliFaRmCsS,,w h ose hamearn,Dd r R.o beCratr delplr owfhooui nndfllyu relenatnluden sfsl agsguipnphgoa rbste einn valuable encmeydc raeearsa s cieanntadin se td ucator. (anhdem endmeydl e.g !) RichLa.Dr radk e AdaWm M.M itchell DrS.y dnFeryi edDmraE.nl ,Ri oa viaonlDdar ,C. h arles Slocnkeefro,tr h eiinrs piraantdsi uopnp aonrdft o r instiilnml eai p nags sfioorn d tihsec iopfAl niantyeo. m Dedications Tom yw ifCeh,e rwyhloh, a ssu ppomreta;en dmd y p arteswn,h oh avgeu idmeed. -RichLa.rD dra ke Tom yf amitlomy y,p reosfsicoonlalle aangrduo emlseo de,al nstdo m ys tudentbso-otikhfs io ysro u. -A.W aynVeo gl ToC aty,Mh ax,a nEdl sa -AdamW M.M itchell vii Thipsa gei ntentiolneaftbl llayn k Preface The3 dre ditoifGo rnya 'Asn atofmoSyrt udebnutisol nd ss ummaritzhileno tgci aofnuc,nt i,ao nndd istriobfu tion thpea satn ldo otkosw atrhdfe tu ure. eacchr anniearlhv aebs e eand dedh,a asan se wfi gure Imta inttahigeno saa lnsod b jecttihv1eets as n 2odf nd summarihzoiwnm gaoj rs trucst,iu nrcelucdrianngi al editwihoinalstte h sea me ctoinmtei ntuoii nncgo rpornaetreevse ,n taenrdl eatvhece r anciaavliW teya .l shoa ve inpfruotm o urre adaenradsd u jstitnhcgeo ntteoan lti gni ncluand eewd figiulrleu sttrhcaelt iinniigmpc oarlt ance witthh eev olveidnugc ateinovniarlo nment. ofv ascusltarru citnau nrader so utnhdce r anciaav.li ty Oneo ft hmea ojrf ocuosfoe usar t tenatswi eop nr e Anothneerw feiantt uhrieesd itrieolnat tore esv iew partehd3e dr e ditwiaoscn l inciocnatlTe hnert e.a sfoonr mataelr.Wsi hitlhee ussee sfutlua diyhd asv e ableweany s thiisst halte arniincn ogn theaxbste coamne imporatvaanitlo anSb tlued Ceonsntu alst oannl ine rients hoiusr ce, themneo otn liynm ediecdaulc abtuiiton na natomiecdailt tihoaenp proprreivaimteaewt erfioearla scc hh apter scieendcuecsa gteinoelnlr Wyae.d eawlitt thh cel inicaarllei sattte hdbe eg innoiftn hgac th apTtheiirsn. f ormation contiennt two w ayFsi.r wsetr ,e evalaunadut pedda teidn cluadnoe nsl iannea toamnyde mbryosleolgfy- study th"enI t hcel iicnb"o exsc,l inmiactaelri inta hlbe o ydo f courmseed,i cal ccals,iep nhsiycsaitlch aelr calpiyn ical thtee ,xc tlinicaatlt hecena ds teohscfe h aptaenirdnst he cas,se es-lafsseensqtsu meisot,na snmdo re. onlirnees coeusra,n di nt hseu rfaancaet yo smectionW.e b elitehvaweti tthh ecshea ntghe3esdr e ditoifo n Secowneda ,d dedc nleiwn icals otm haattther erae idaelr G ray'Asn atofmoSyrt udeinasmt us cihm provveseridoo nf wouhladv uep -toe-xdaamtperl eelsa atniantgo miincfaolrt h2en d edainthdio optneh atthb eo owki cloln titnobu ee matitoocn l insiicttauinlaos . av alualbelaer rniensrgoc ufeo srt ud.e nts Ina ddittiouo pnd atainndgr evistihnecg l inical contetnhstee, c toinoc nr anniearlvh easbs e esni gnifi RichLa.Dr rda ke cantelxaypn deUdn.d ersttahnedisimpeno gar ntcto mpo A.W aynVeo gl nenotfst hnee rvosuyss tiescm r itfiocsrat lu deantt s AdaW.m M.M itchell evelreyv Teolf .a cilsittuadtleeen atr nai nnegwfi gure Decem2b0 e1r3 ix