Rectus abdominis muscle
The rectus abdominius muscle is one of four muscles of the anterior abdominal wall. It acts as a flexor of the spine and an accessory muscle of respiration. In those with low body fat, is clearly visible beneath the skin. In this article we will discuss the gross and functional anatomy of the rectus abdominis muscle. We will also discuss the clinical relevance of the structure, and provide a summary of key points at the end of the article. We will finally conclude with some review questions to test the reader’s understanding of the article content.
The rectus abdominis muscle is paired muscle that runs vertically, either side of the linea alba, on the anterior surface of the abdominal wall. The linea alba is a band of connective tissue that divides the two halves of the muscle vertically. The linea semilunaris is the tendinous intersection that separates the lateral edge of the muscle from the external oblique and internal oblique muscles that lie on the lateral surface of the anterior abdominal wall, it usually extends from tip of the ninth costal cartilage to pubic tubercle. The rectus abdominis muscle is attached superiorly to the xiphoid process and costal margins of 5th, 6th and 7th ribs (principally the fibers of the 5th rib), inferiorly it is attached by two tendons, the larger is attached to the pubic crest, pubic tubercle to the pectineal line and small medial tendon is attached to the pubic symphysis. There are three tendinous intersections in the rectus abdominis muscle. One of these horizontal intersections is present at the level of umbilicus, another at the level of xiphoid process and third mid way between them. These fibrous bands divide the muscle into segments, resulting in a grid iron ‘six pack’ shape in those with low body fat. The intersections are believed as representation of myosepta which delineate the muscle forming myotomes.
The rectus sheath
The rectus abdominis muscle itself lies within the rectus sheath, which is formed by the merging of the aponeurosis of transversus abdominis, external and internal oblique abdominal muscles. External oblique is the most superficial muscle of the anterior abdominal wall. The transversus abdominis is the deepest of the three muscles and its fibers run in a horizontal direction. The internal oblique aponeurosis divides into two. The anterior part of the internal oblique aponeurosis passes in front of the rectus abdominis muscle with the external oblique aponeurosis. The posterior division of the internal oblique aponeurosis passes behind the rectus abdominis muscle with the transversus abdominis aponeurosis. However, below the arcuate line (which lies one third of the way from the umbilicus to the pubic crest), all three of the muscular aponeuroses pass anterior to the rectus abdominis, and the posterior surface of the muscle is covered only by transversalis fascia, and parietal peritoneum.
The muscle itself is a flexor of the spine, and also acts as an accessory muscle of respiration. It compressed the abdomen, which raises the diaphragm further due to superior displacement of the abdominal contents, which allows for more air to be released during exhalation.
The blood supply to the rectus abdominius muscle arises from a number of vessels. The inferior epigastric artery and vein arise from the external iliac artery and vein respectively. They run along the posterior surface of the muscle, and enter the rectus sheath at the level of the arcuate line. The superior epigastric is another vessel that supplies the rectus abdominius muscle, and is a branch of the internal thoracic (internal mammary) artery. The internal thoracic is a branch of the subclavian artery near its origin. In addition small terminal branches of the lower three posterior intercostal arteries, subcostal and deep circumflex artery also provide some contribution.
The rectus abdominius muscle is innervated by the thoracoabdominal nerves, which enter the rectus sheath by piercing its anterior surface. They pass between the transversus abdominis and internal oblique muscle layers, and pierce the sheath of the rectus abdominis muscle. The nerves are simply the anterior divisions of the 7th to 11th lower intercostal nerves, that continue to supply the abdominal wall after the intercostal spaces they supplied end medially.