Muscles of the Abdominal Wall

In medical vernacular, the abdominal wall most commonly refers to the layers composing the anterior abdominal wall which, in addition to the layers mentioned above, includes the three layers of muscle: the transversus abdominis (transverse abdominal muscle), the internal (obliquus internus) and the external oblique (obliquus externus). The rectus abdominis muscle, also known as "abs" or a "six pack", is a paired muscle running vertically on each side of the anterior wall of the human abdomen (and in some other animals). There are two parallel muscles, separated by a midline band of connective tissue called the linea alba (white line). It extends from the pubic symphysis, pubic crest and pubic tubercle inferiorly to the xiphoid process and costal cartilages of ribs superiorly. The rectus abdominis is an important postural muscle. It is responsible for flexing the lumbar spine, as when doing a "crunch". The rib cage is brought up to where the pelvis is when the pelvis is fixed, or the pelvis can be brought towards the rib cage (posterior pelvic tilt) when the rib cage is fixed, such as in a leg-hip raise. The two can also be brought together simultaneously when neither is fixed in space. The rectus abdominis assists with breathing and plays an important role in respiration when forcefully exhaling, as seen after exercise as well as in conditions where exhalation is difficult such as emphysema. It also helps in keeping the internal organs intact and in creating intra-abdominal pressure, such as when exercising or lifting heavy weights, during forceful defecation or parturition (childbirth). The external oblique is situated on the lateral and anterior parts of the abdomen. It is broad, thin, and irregularly quadrilateral, its muscular portion occupying the side, its aponeurosis the anterior wall of the abdomen. In most humans (especially females), the oblique is not visible, due to subcutaneous fat deposits and the small size of the muscle. It arises from eight fleshy digitations, each from the external surfaces and inferior borders of the fifth to twelfth ribs. These digitations are arranged in an oblique line which runs inferiorly and anteriorly, with the upper digitations being attached close to the cartilages of the corresponding ribs, the lowest to the apex of the cartilage of the last rib, the intermediate ones to the ribs at some distance from their cartilages. The five superior serrations increase in size from above downward, and are received between corresponding processes of the serratus anterior muscle; the three lower ones diminish in size from above downward and receive between them corresponding processes from the latissimus dorsi. From these attachments the fleshy fibers proceed in various directions. Those from the lowest ribs pass nearly vertically downward, and are inserted into the anterior half of the outer lip of the iliac crest; the middle and upper fibers, directed downward (inferiorly) and forward (anteriorly), become aponeurotic at approximately the midclavicular line. This aponeurosis formed from fibres from either side of the external oblique decussates at the linea alba. The aponeurosis of the external oblique muscle forms the inguinal ligament. The muscle also contributes to the inguinal canal. The external oblique functions to pull the chest downwards and compress the abdominal cavity, which increases the intra-abdominal pressure as in a valsalva maneuver. It also has limited actions in both flexion and rotation of the vertebral column. One side of the obliques contracting can create lateral flexion. It also contributes in compression of abdomen. Its fibers run perpendicular to the external oblique muscle, beginning in the thoracolumbar fascia of the lower back, the anterior 2/3 of the iliac crest (upper part of hip bone) and the lateral half of the inguinal ligament. The muscle fibers run from these point superiomedially (up and towards midline) to the muscle's insertions on the inferior borders of the 10th through 12th ribs and the linea alba (abdominal midline seam). In males, the cremaster muscle is also attached to the internal oblique. The internal oblique performs two major functions. First, it acts as an antagonist (opponent) to the diaphragm, helping to reduce the volume of the thoracic (chest) cavity during exhalation. When the diaphragm contracts, it pulls the lower wall of the chest cavity down, increasing the volume of the lungs which then fill with air. Conversely, when the internal obliques contract they compress the organs of the abdomen, pushing them up into the diaphragm which intrudes back into the chest cavity reducing the volume of the air filled lungs, producing an exhalation. Secondly, its contraction rotates and side-bends the trunk by pulling the rib cage and midline towards the hip and lower back, of the same side. It acts with the external oblique muscle of the opposite side to achieve this torsional movement of the trunk. For example, the right internal oblique and the left external oblique contract as the torso flexes and rotates to bring the left shoulder towards the right hip. For this reason, the internal obliques are referred to as "same side rotators''. The transversus abdominis, so called for the direction of its fibers, is the innermost of the flat muscles of the abdomen, being placed immediately beneath the internal oblique muscle. The transversus abdominis (TVA) helps to compress the ribs and viscera, providing thoracic and pelvic stability. This is explained further here. The transversus abdominis also helps pregnant women deliver their child.

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