Anatomy at A Glance

ANATOMY
AT A
GLANCE
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ANATOMY
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Sibani Mazumdar
Professor of Anatomy
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Calcutta National Medical College, Kolkata, India
IPGME & R (Institute of Postgraduate Medical Education and Research), Kolkata, India
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Ex Associate Professor of Anatomy
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North Bengal Medical College, Darjeeling, India
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Calcutta Medical College, Kolkata, India
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Nil Ratan Sarkar Medical College, Kolkata, India
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Anatomy at a Glance
© 2009, Sibani Mazumdar
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any
form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission
of the author and the publisher.
This book has been published in good faith that the material provided by author is original. Every effort is made to
ensure accuracy of material, but the publisher, printer and author will not be held responsible for any inadvertent
error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition: 2009

ISBN 978-81-8448-454-0
Typeset at JPBMP typesetting unit
Printed at
Dedicated to
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• All categories of students (Medical, dental, paramedical and nursing) —
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whose respect for teachers and eagerness to know the subject, inspired
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me to write this book.
• My only son Avishek—whose help in processing the book inspired me.
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• My husband—Dr Ardhendu Mazumdar, who unveiled me in the greater field
of life.
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• My mother—Asha Rani Biswas, whose blessings inspired me a lot.
• Professor Samar Deb—Professor and Head of the Department of Anatomy
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(NBMC), whose knowledge, devotion, and love for the subject gave me
inspiration.
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• Pupils all over the world.
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MESSAGE
To my beloved students
• Though it is a small book, yet it is charged with new found force.
• This book has been written in a simple, lucid and communicative style.
• Remember “Read and Repeat” is an important key for effective learning.
• The overall objectives of this book is to develop, the integrated skills in
listening, speaking, reading, writing and also to develop interest in Anatomy.
• Above all, it is the time to build-up your character. It is that power with
which human can win victory even after loosing battles.
PREFACE
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There is a change in existing system of Anatomy—in teaching; in question pattern; as well as, in
duration. No doubt it is a vast subject. There are many textbooks, but I feel it is impossible for the
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student to memorise, and revise the subject before examination. For this reason I was inspired by the
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students to write this book Anatomy at a Glance. Every chapter of this book is provided with
understandable, appropriate diagrams. The beauty of this book is that diagrams are more than
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written pages, and most of the diagrams are on the same page along the writing material, which
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would be helpful to the students for visual impression. Most of the chapter is purposefully written in
tabulated form. This book will help the medical, paramedical and nursing students. It would also be
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helpful to PG students for quick revision of Anatomy. It is written in simple language. In glossary, I
have given meanings of various medical terminology. At the beginning of each chapter I have given
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necessary terminology. In Window Dissection Chapter, student can quickly learn Anatomy point by
point, unnecessary details in Anatomy have been omitted here. In each chapter I have tried to give
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the functional anatomy. There may be unknowing errors in writing or printing of this book. If my
colleagues or students focus me I shall be highly obliged. Any suggestion regarding improvement
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are always welcome.
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Sibani Mazumdar
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ACKNOWLEDGEMENTS
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1. Jaypee Brothers Medical Publishers (P) Ltd.—who gave me a scope to publish this book.
2. All the staffs of Jaypee Brothers, Kolkata who helped me in processing the book.
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3. The heads of the Departments of Anatomy Prof. Rita Roy (Calcutta National Medical College),
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Prof. Asis Dutta, Prof. Debabrata Kar (Institute of Postgraduate Medical Education and Research),
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Prof. Sumita Sarkar (KPC Medical College), Prof. Anjan Sen (Calcutta Medical College), Prof.
Samar Deb (Principal of Katihar Medical College)—the trees, under which this sapling was born.
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4. All the teachers and staffs in the Department of Anatomy CNMC (IPGME & R) North Bengal
Medical College, Calcutta Medical College, and Nil Ratan Sarkar Medical College for their
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congenial environment.
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5. Dr Narayan Jyoti (dental surgeon), Dr Karabi Baral, Dr Viswa Prakash Das, Sandip (paramedical
student), Debanjan (MBBS student), Gargi Biswas (Computer technologist) and Sudipto Das
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(Computer teacher), who extended their helping hands towards me.
6. The librarian and staffs of North Bengal Medical College, Calcutta Medical College (IPGME & R)
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and Calcutta National Medical College—whose help cannot be expressed in language.
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7. I express my regards to the authors of different medical books who enriched my knowledge through
their valuable writings.
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8. My gratitude to Prof. P Dev (Dean of UBMES and Head of the Department of Radiology) and
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Dr Sohini Sengupta—Assistant Professor (Radiology IPGME & R) for incorporating radiological
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pictures in this book.
CONTENTS
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1. Introduction ...................................................................................................................................... 1
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2. Skeletal System ............................................................................................................................... 5
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3. Joints ................................................................................................................................................ 48
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4. Muscular System ........................................................................................................................... 67
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5. Nervous System ............................................................................................................................. 95
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6. Heart and Arterial System ......................................................................................................... 119
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7. Veins .............................................................................................................................................. 135
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8. Lymphatic System ....................................................................................................................... 148
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9. Viscera ........................................................................................................................................... 153
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10. Embryology ................................................................................................................................... 203
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11. Window Dissections that Come in Examination ................................................................... 223
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12. Histology ....................................................................................................................................... 272
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13. Radiology (Imaging Technique) ............................................................................................... 286
14. Surface Anatomy ......................................................................................................................... 296
Appendix ......................................................................................................................................... 307
Glossary .......................................................................................................................................... 309
Index ............................................................................................................................................... 313

Introduction
DEFINITION OF ANATOMY
Anatomy is a science that deals with the structure
and functions of the body.
Branches are:
• Gross anatomy—which is visible in naked eye.
• Microanatomy or histology—(which is visible
with the aid of microscope).
• Clinical anatomy—it is the practical application
of anatomical knowledge to diagnosis and
treatment.
• Developmental anatomy or embryology—it is
structural changes of an individual from
fertilization up to full-term baby.
• Radiological anatomy—study of anatomical
structure by radio photo.
• Surface anatomy—study of surface projection
of a structure (like heart, stomach, etc).
Positioning (Body Posture) (Fig. 1.1)

Anatomical position: It is that position in which a
person is standing erect, with eyes looking towards
horizon, arm is by the side of the trunk, palm faces
forwards.
Supine position: The subject is lying on the back
with faces up.
Prone position: The subject is lying with faces
down and belly, on the table.
Lateral position: Position in which, the side of the
subject is adjacent to the film.
Lithotomy position: The subject is lying in supine
position with flexed hip and knee. It is useful in
dissection of perineum and during delivery. Fig. 1.1: Positioning
2 Anatomy at a Glance
Anatomical Terms (Figs 1.2A to D)

• Superior or cephalic towards the head or upper
part of a structure, e.g. the head is superior to
the neck.
• Inferior or caudal away from the head. Navel is
inferior to the chest.
• Anterior or ventral towards the front part of the
body.
• Posterior or dorsal towards the back part of the
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body.
• Towards the midline of body.
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• Proximal closer to the origin (closest to the
trunk). C
• Distal away from the origin (away from trunk).
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• Superficial towards the body surface (skin is
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superficial).
• Deep away from the surface (muscles are deep).
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Figs 1.2A to D: Anatomical terms
Introduction 3
Terminology Used in Description of Bones • Lips: Elevated mergin of a crest (outer and inner
(Fig. 1.3) lips of iliac crest).
• Meatus: A narrow passage (e.g. middle meatus
• Ala: Wing-like process (e.g. alar of sacrum).
of nose).
• Canal: A bony tunnel (e.g. vertebral canal).
• Process: Any localized projection is known as
• Condyles: Smooth and articular projection (e.g.
process (e.g. olecranon process of ulna).
condyles of femur).
• Ridge: A linear elevation on surface of bone.
• Crest: A ridge with certain breadth (e.g. iliac • Spine: A pointed bony process (e.g. spine of
crest of hip bone). vertebra).
• Epicondyles: Nonarticular bony projection • Squama: Flat scale-like appearance of a bone
situated above the condyle (e.g. lateral and (e.g. squamous part of occipital).
medial epicondyle of femur). • Sulcus: A groove on surface of bone (e.g.
• Facet: Small, smooth articular surface (e.g. intertubercular sulcus of humerus).
costal facet). • Trochanters: Large nonarticular projection of
• Fossa: It is a depression on the surface of the varying shape and size (greater and lesser
bone (e.g. coronoid and olecranon fossa of trochanters of femur).
lower end of humerus). • Trochlea: Pulley-shaped articular surface (e.g.
• Foramen: An opening in the bone (e.g. nutrient trochlea of lower end of humerus).
foramen of a long bone). • Tubercle or tuberosity: Localized rounded
• Hamulus: A hook-like process (e.g. pterygoid thickening on the surface of bone; size is smaller
hamulus). than trochanter (e.g. greater and lesser tubercle
• Hiatus: A gap in the general outline of a bone of humerus).
(e.g. sacral hiatus).
• Incisura: A notch in the general outline. Regional Terms for Specific Body Areas
(Fig. 1.4)
• Lingula: A tongue-shaped projection (e.g.
lingula of mandible). Anterior
• Linea: A line-like elevation (e.g. linea aspara of • Frontal (Forehead)
femur). • Orbital (Eye)
Fig. 1.3: Terminology used for description of bones

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Fig. 1.4: Regions of body
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• Nasal (Nose) • Tarsal (Ankle)
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• Buccal (Cheek) • Digital (Toes)
• Oral (Mouth) • Hallux (Great toe).
• Mental (Chin)
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• Cervical (Neck) Posterior
• Acromial (Point of shoulder) • Cephalic (Head)
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• Axillary (Armpit) • Otic (Ear)
• Sternal (Breast bone) • Occipital (Back of head)
• Thoracic (Chest) • Vertebral (Spine)
• Mammary (Breast) • Scapular (Shoulder blade)
• Abdominal (Belly) • Brachial (Arm)
• Umbilical (Navel) • Antebrachial (Forearm)
• Pelvic (Pelvis) • Lumbar (Loin)
• Inguinal (Groin) • Sacral (Between hips)
• Coxal (Hip) • Gluteal (Buttock)
• Femoral (Thigh) • Popliteal (Back of knee)
• Patellar (Anterior knee) • Sural (Calf)
• Peroneal (Side of leg) • Calcaneal (Heel)
• Crural (Leg) • Plantar (Sole).
Skeletal System
SKELETON (FIG. 2.1)
Fig. 2.1: Adult skeleton (Total bones—206)

SCLEROUS TISSUE (specialized connective tissue). It is of two types—cartilage and bones.
Difference between cartilage and bones

Cartilage Bones
• Gives strength as well as resiliency. • Gives strength as well as form skeletal framework of
body.
• Least vascular. • Highly vascular.
• Grows both by appositional and interstitial method. • Grows by appositional method.
• Nonnervous. • Has nerve supply.
Hyaline cartilage (e.g. articular, costal,

Cartilage (3 types)
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Elastic cartilage (e.g. epiglottis, Fibrocartilage (intervertebral disk)
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respiratory) (Fig. 2.2) pinna) (Fig. 2.2) (Fig. 2.2)
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• Ground glass appearance of matrix. • Presence of abundant • Most compressible cartilage.
elastic fibers in matrix.
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• Collagen fibers present. • More flexible than • Resist stretch.
hyaline cartilage.
• In old age, segmental degeneration of • No change in old age. • In old age, intervertebral disk
cartilage. becomes thin.
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Fig. 2.2: Different varieties of cartilage
Skeletal System 7
Classification of Bones According 3. Flat bone: It consist of two thin plates of

to Shape (Fig. 2.3) compact bone, enclosing a dipole (spongy bone
1. Long bone: Here length is greater than breadth. layer), e.g. skull bone sternum. In adult,
It is composed of a diaphysis and two hemopoietic tissue is found within the dipole.
epiphyses. The epiphysis contains spongy bone. 4. Irregular bone: Irregular in shape, e.g. hip bone,
The medullary cavity of long bone contains red vertebrae.
Fig. 2.3: Classification of bones according to shape
marrow for hemopoiesis; but in adults, it is 5. Sesamoid bone: Seed-like. Develops within a
replaced by yellow marrow. Periosteum covers tendon of muscle, having no periosteum and
the diaphysis. Endosteum lines the medullary harvesian system (e.g. patella in a quadriceps
cavity. Muscles are attached to periosteum (e.g. femoris and pisiform in flexor carpi ulnaris
femur, tibia, humerus). Long bones continue tendon).
to grow until adolescence. 6. Pneumatic bone: Pneuma means air. A bone
2. Short bone: Cubical in shape. Out of six contains air-filled cavity, e.g. maxilla.
surfaces usually four surfaces are articular (e.g. 7. Accessory bone: Extra-bone particularly seen
carpal and tarsal bone). in seventh cervical and first lumbar vertebra. It
is due to separation of costal element from
transverse process.
Bones of Superior Extremity
Names Comments Important features Anatomical positions

Clavicle Modified long Two ends: 1. Sternal: Quadrangular • Place medial 2/3rd
(Collar bone; horizo- 2. Acromial: Flat convexity in front.
bone) ntally placed, Shaft: Subclavian groove on
(Figs 2.4A shape like ‘f’. 1. Medial 2/3rd (convex in front) has 4 surfaces: inferior surface.
and B) a. Anterior surface: origin of calvicular head of • Sternal end lies more in
pectoralis major. anterior plane.
b. Posterior surface: origin of sternohyoid.
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c. Superior surface: near sternal end few fibers
of sternocleidomastoid.
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d. Inferior surface:
i. A rough area medially.
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ii. A subclavian groove laterally gives
attachment to clavipectoral fascia (in
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Fig. 2.4A: Figure of 8 anterior and posterior margins) insertion of
bandage in fracture clavicle subclavius muscle.
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2. Lateral 1/3rd (concave in front) has
a. Two borders:
i. Anterior—concave, gives attachment of
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deltoid.
ii. Posterior—rough, convex gives attachment
of trapezius.
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b. Two surfaces:
i. Superior, subcutaneous (palpable).
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ii. Inferior, present conoid tubercle and
Fig. 2.4B: Clavicle trapezoid ridge.
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Scapula Flat Two surfaces: • Superior border with
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(shoulder triangular; a. Ventral—hollow out subscapularis is attached suprascapular notch
blade) lies in back b. Dorsal—marked by spine which divides the above.
(Fig. 2.5) opposite surface —two fossae: • Spine in on dorsal
second to i. Supraspinous—supraspinatus attached. surface.
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seventh rib. ii. Infraspinous—infraspinatus attached. It has • Tip of the coracoid
head or glenoid, neck and body. process directed
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Three borders: forwards and slightly
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a. Superior—shortest; marked medially by laterally.
suprascapular notch. • Glenoid looks laterally
b. Medial or vertebral—largest; in the: ventral and upwards.
aspect—gives attachment of serratus anterior.
dorsal aspect—from above downwards: gives
attachment to levator scapulae, rhomboidus minor
and major.
c. Lateral or axillary—thickest border, in the:
i. ventral aspect—gives attachment of
subscapularis.
ii. dorsal aspect—from above downwards: Teres
major and minor.
Contd...
Skeletal System 9
Fig. 2.5: Scapula

Three angles:
a. Superior—meeting of superior and medial
borders—obscured by muscle.
b. Inferior angle—meeting of lateral and medial
borders—over lies seventh rib.
c. Lateral angle or glenoid—provide a shallow-
socket for head of humerus—forming gleno-
humeral or shoulder joint—synovial ball and
socket joint.
Three processes:
a. Spinous process—dorsal border or crest of spine
—deltoid is attached at lower lip, trapezius is
attached at upper lip.
b. Coracoid process—it is atavistic type of
epiphysis—gives attachment of pectoralis minor,
short head of biceps, coracobrachialis and
coracoclavicular ligament.
c. Acromial process—projecting forwards from
spine.Acromian angle (junction of lateral and
inferior border) gives
attachment of deltoid—lateral border.
attachment of trapezius—medial border.
It has upper end, lower end and shaft.
Humerus Longest and Upper end presents • Place globular head

(arm bone) largest bone Head—globular, articular, forms shoulder joint. It is above.
(Figs 2.6A of upper directed upwards, medially, and slightly backwards. • Place bicipital grooves
and B) limb. Neck-anatomical—constriction adjoining head, coronoid and radial
capsular ligament is attached here. fossa in front.
Morphological—junction between epiphysis and
diaphysis (epiphyseal line).
Contd...
Surgical—it is the most constricted portion, in the • Place greater tubercle

upper part of shaft - vulnerable to trauma. on lateral aspect.
Tubercles—greater–lies in lateral part; covered by
deltoid, produces rounded contour of shoulder. There
are three impressions for attachment of supra-
spinatus, infraspinatus and teres minor muscles.
Lesser—separated from greater tubercle by bicipital
groove; gives attachment to subscapularis.
Shaft
Three borders—anterior, medial and lateral lower
part of lateral and medial border is prominent and
known as lateral supracondylar line.
Three surfaces
a. Anteromedial surface: marked by bicipital groove.
It presents two lips:
i. Pectoralis major—is attached in lateral lip,
ii. teres major—at medial lip. In floor lies
latissimus dorsi.
b. Anterolateral surface: in the middle rough
impression—deltoid tuberosity. Deltoid is
inserted.
c. Posterior surface: in the middle third. There is
shallow spiral groove (lodges radial nerve and
arteria profunda brachii.
Lower 1/3rd is flat. Gives origin to medial head of
triceps, linear origin of lateral head of triceps above
spiral groove.
Fig. 2.6A: Humerus Lower end Fig. 2.6B: Humerus
Articular part—Pulley-shaped articular surface
Abbreviation medially (trochlea), rounded articular surface
FDH–Flexon digtorum laterally (capitulum).
superficialis Nonarticular part—coronoid fossa, radial fossa in
FPL–Flexor pollicis longus front and olecranon fossa behind capsular ligament
FDS–Flexor digitorum of elbow joint attached at the margin of articular area
superficialis and it includes three fossae.
EPL–Extensor pollicis longus i. Medial epicondyle gives common origin of flexor
EPB–Extensor pollicis brevis muscle.
ii. Ulnar nerve lies behind the medial condyle and
behind lateral epicondyle common extensor of
forearm arises.
Radius Lateral bone of Upper end • Place dorsal tubercle

(Figs 2.6C forearm. It has Head—cup-shaped upper surface forms joint with posteriorly.
and D) upper end, shaft capitulum of humerus—forms part of elbow joint. • Disk like head should
and lower end. Neck—constricts part below head. be placed above.
Forms elbow Tuberosity—rough projection below and medial side • Styloid process should
joint, wrist of neck—gives attachment to biceps brachii. be on lateral aspect.
joint, superior, Shaft—three borders:
middle, and a. Anterior border—upper part form anterior oblique
inferior radio- line. Flexon digitorum superficialils is attached.
ulnar joint.
Contd...
Skeletal System 11

b. Posterior border—upper part form posterior
oblique line.
c. Interosseous border—sharp; starts from radial
tuberosity. Interosseous membrane is attached
Three surfaces:
a. Anterior—hollow out in upper part-flexor pollicis
longus, pronator quadratus is attached (in the
lower part).
b. Posterior—supinator, abductor pollicis longus,
extensor pollicis brevis is attached.
c. Lateral—pronator teres, supinator is inserted.
Lower end—enlarged; presents five surfaces:
a. Anterior surfaces—concave.
b. Posterior surfaces—marked by ridges and
grooves; dorsal tubercle is present. From lateral
to medial-abductor pollicis longus, extensor
pollicis brevis, extensor carpii radialis longus and
brevis, extensor digitorum is related.
c. Medial surfaces—there is a notch present.
d. Lateral surfaces—forms styloid process-insertion
of brachioradialis.
e. Inferior surfaces—articular; lateral triangular Fig. 2.6D: Radius and
impression articulate with scaphoid, medial one ulna
Fig. 2.6C: Radius and ulna to lunate.
Abbreviations
FDH–Flexure digotorum super-
ficialis FPL–Flexor pollicis
longus, FDS–Flexor digitorum
superficialis, EPL–Extensor
pollicis longus, EPB–Extensor
pollicis brevis, EI–Extensor
indicis
Ulna Medial bone of Upper end—hook-like—two processes: • Place more expanded

forearm. Forms a. Coronoid process—lateral surface present radial end with olecranon
elbow joint; superior, notch. Anterior surface present rough ulnar process and coronoid
middle and inferior tuberosity gives—attachment to brachialis. process above.
radioulnar joint. b. Olecranon process—superior surface gives— • Head with styloid
attachment of triceps, capsular ligament. process below.
Shaft—three borders— • Place trochlear notch
a. Anterior anteriorly. Sharp
b. Posterior—palpable; common aponeurotic origin interosseous border is
of flexor and extensor carpi ulnaris. lateral.
c. Interosseous—attachment of interosseous
membrane.
Three surfaces:
a. Anteriors—nutrient foramen present here. Gives
attachment to flexor digitorum profundus,
pronator quadratus and supinator.
b. Posterior—divided into:
i. Upper oval area—anconeus is inserted.
ii. Lower large area—origin of abductor pollicis
longus, extensor pollicis longus and extensor
indicis.
Classification of Bones in General C. According to Position

A. According to Shape 1. Axial bones : Skull 29
1. Long bones—three types Vertebral 26
a. Long long bone, e.g. Humerus Ribs and sternum 25
b. Short long bone, e.g. Metacarpal 2. Appendicular bones:
c. Modified long bone, e.g. Clavicle Bones of upper limb 64
2. Short bones (Cubical in shape), e.g. Bones of lower limb 62
Carpals and tarsals Articulated Skeleton of Hand (Fig. 2.7)
3. Flat bones: Sternum
4. Irregular bones: Hip bone It comprises of 8 marble size short bones of carpals
5. Sessamoid bones: Patella closely united by ligaments, 5 metacarpals
(numbered from thumb to little finger as 1 to 5)
6. Pneumatic bones: Maxilla
and phalanges (comprising of 14 bones), 3 in each
7. Accessory bones: Cervical ribs
(2 to 5 finger) except first (consists of 2 phalanges).
B. According to Development
Gliding movements occur between the carpal
1. Membranous: Parietal bone
bones. So it is flexible (can be assessed during
2. Cartilaginous: Femur bone wearing of short bangles inside the hand). The
3. Membrano-cartilaginous: Clavicle carpal bones are arranged into two rows:
Fig. 2.7: Skeleton of hand

Skeletal System 13
Proximal row (from lateral to medial side)— trapezoid (boot shaped), capitate (longest carpal
scaphoid (boat shaped), lunate (crescentic moon bone with a head), hammate (hammer-like with
like), triquetral (triangular), pisiform (pea seed hook).
like). Applied Anatomy of Bones (In General)
Distal row (from lateral to medial side)— FRACTURE—break in the normal outline of bone
trapezium (distal articular surface saddle shaped), (Fig. 2.8).
Fracture type Description Comments
Simple Bone break clearly but does not Sometimes called closed
penetrate the skin. fracture.
Compound Broken end of bone protrudes More serious than simple
through soft tissue and skin. fracture.
Comminuted Broken fragments into many Common in aged whose
pieces. bones are more brittle.
Bones break incompletely, much Common in children whose
Green stick
like green twigs break. bones are more flexible.
Derpessed Broken bone portions are Typical in skull fracture.
pressed inward.
Fig. 2.8: Types of fracture
Osteoporosis: A diminution of bone mass; particularly in elderly fellow.

Injury of upper limb bone
Bone involved Comments

Fracture of clavicle It is common, particularly in children and young adults, due to fall of outstretched
hand. Fracture is usually in mid-shaft region in children.
Fracture of scapula Fracture in the body of scapula is due to direct blow. Fracture in the neck of
scapula is due to fall on shoulder.
Fracture of surgical It can occur with a fall on, the outstretched hand, particularly in the elderly woman.
neck of humerus
Fracture of shaft of It is produced when a fall is accompanied by twisting injury. It may involve the
humerus radial nerve and there is wrist drop.
Supracondylar fracture It is common injury to children and adolescents due to fall on the outstretched
hand. The structures at risk are brachial artery and median nerve.
Forearm fracture These fractures interfere with pronation and supination.
Colles’ fracture Fracture in the lower end of the radius with or without ‘dinner fork’ deformity
due to fall on the outstretched hand.
Scaphoid fracture Above 70% of carpal fractures, only the scaphoid is broken, due to fall on the
outstretched hand. Palpation of anatomical snuffbox is more painful. High rate of
non-union and avascular necrosis (in proximal part) is common.
First metacarpal Also known as Bennet’s fracture, occurs at the base of the thumb.
Fracture
The Vertebral Column (Figs 2.9, 2.10A and B) the secondary curvatures or compensatory
curvatures (that develop after birth, when
It includes 26 irregular vertebrae (7 cervical, 12 baby can hold its head upright and when
thoracic, 5 lumbar, sacrum and coccyx) connected start to sit and walk) are cervical and lumbar
in such a way that a flexible curved structure curvatures.
results. It supports the axial structure of trunk and Curvature increases spine flexibility. Normal
transmits the weight of the trunk to lower limb. movement of vertebral column are flexion,
In the fetus and infant the vertebral column extension, lateral bending. Abnormal curvatures
typically consists of 33 separate pieces of bone. are scoliosis (lateral bending), kyphosis (dorsally
The fibrocartilaginous intervertebral disk acts exaggerated thoracic curvature), lordosis
as shock absorber and provides flexibility of (accentuated lumbar curvature). In all cases of
vertebral column. When somebody views the abnormal curvatures back pain is common.
vertebral column from side; four curvatures are In old age, the height of the vertebral column
seen. The primary curvature (curvature present diminishes due to diminished thickness of inter-
during developing fetus) are thoracic, and sacral; vertebral disk mainly.
Skeletal System 15
Fig. 2.9: The vertebral column add-its different

curvatures (in children adult) Fig. 2.10A: Movements of vertebral column
Fig. 2.10B: Abnormal vertebral curvatures (comparing with normal)

Regional Characteristics of Cervical, Thoracic

and Lumbar Vertebrae (Typical) (Fig. 2.11)
Characteristic Typical cervical (3—6) Typical thoracic (2,3 to 9th) Typical lumbar (1—4)
Body Small,wide side to side. Larger than cervical, heart- Massive, kidney shaped
Transverse diameter > shaped. Transverse and (i.e., indentation on
antero-posterior diameter. antero-posterior diameters posterior part of body).
are equal Transverse > Antero-
posterior diameter.
Spinous process Short, bifid, projects Long, sharp, projects Short, project horizontal
directly backwards. downwards. backwards.
Vertebral forearm Triangular in shape. Circular in shape. Triangular in shape.
Transverse process. Contain foramina Club shaped bear facets for Thin. Slender and close to
(foramina transversarium). ribs. tip bears a vertical ridge
for attachment of lumbar
fascia.
Superior and inferior Fused to form articular Thin articular process supe- Superior articular process
articular process pillar. rior facet looks, backward and has concave facet directed
interior facet looks forward. postero-medially. Interior
articular process has vertical
convex articular facets
facing posteromedially.
Movements allowed Flexion, extension, lateral Rotation, lateral flexion possible Flexion and extension
bending and rotation. This but limited by ribs. Flexion and some lateral flexion,
vertebral region has greatest extension prevented. rotation prevented
range of movement.
Fig. 2.11: Movements of vertebral column

Abbreviations: SAP—Superior articular process, SP—Spinous process, VF—Vertebral foramen, TP—
Transverse process, B—Body, IAP—Interior articular process
Skeletal System 17
ATYPICAL CERVICAL VERTEBRAE (Fig. 2.12A)
Fig. 2.12A: Atypical cervical vertebrae (Atlas)
Atlas Support globe of head; ring (1) No body (2) No lamina and • Anterior arch which
(First cervical) like. Forms atlanto-occipital spine (3) Presents anterior and has a circular face on
and atlanto-axial joint. posterior arches and two lateral posterior aspect place
masses (4) Tip of the transverse in front.
process is palpable between
angle of mandible and mastoid
temporal bone (5) Superior
articular process has kidney-
shaped facet (6) Inferior
articular process has oval facet.
Axis Allow rotation of head and (1) Odontoid (dens) process • Groove presents on the
(Second cervical) atlas around the dens. Named projects from upper part of the upper surface of
so because of prominent body—Apical ligament and posterior arch, should
adontoid process. alar (cheek) ligament is be placed above.
attached. (2) Lamina is thick. • Odontoid process
(3) Spine is thick and bifid. (4) marked by oval facet in
Transverse process is small and front should be placed
no costo-transverse bar. anteriorly.
Vertebra (1) Spine—not bifid, long and • Convex superior

prominence horizontal. (2) No facet in body articular facet should
(Seventh cervical) by which one can separate it be placed superiorly
from first thoracic. (3) Absence • Place body with
of costotransverse bar in neurocentral lip
transverse process. upwards.
• Strong horizontal
spinous process
should be placed
backward
ATYPICAL THORACIC VERTEBRAE (Fig. 2.12B)
Fig. 2.12B: 7th cervical (V. prominens)

First All thoracic vertebrae except (1) Body cervical, type, i.e. • Place body anteriorly
thoracic tenth, eleventh and twelfth transverse diameter is greater and superior articular
vertebrae h ave upper and than anteroposterior diameter. facet above.
lower facet. Upper one (2) Upper facet is circular for
articulates with numerically first rib. (3) Lower half facet
corresponding rib and lower (demifacet)—for upper facet
one with upper facet of rib of second ribs. (4) Spine
below. directed horizontal like
cervical.
Tenth thoracic Same as first thoracic, but body (1) Body is larger, only • Place semilunar costal
is gradually larger and attains superior semilunar facet if facet in the upper part.
lumbar shape (kidney shape). present for tenth rib. (2) • Place body anteriorly
Body is lumbar type. Thoracic Inferior demifacet is absent.
aorta becomes abdominal at (3) The transverse process
the lower border of T12. may or may not present facet
for tenth rib tubercle. (4) Ob-
liquity of spine diminishes.
Contd...
Skeletal System 19

Eleventh (1) Full costal facet in the • Place body anteriorly
thoracic body for eleventh rib. (2) with single facet
No costal facet in transverse above.
process. (3) Facet for • Place body anteriorly
inferior articular process is with single facet
flat and looks forward. (4) above.
Spine is triangular with
blunt apex.
Twelfth (1) Full costal facet in the • Shaft (Inner surface)

thoracic body, enchroaching on the should be directed
pedicle. No facet in the upwards and laterally
lower part. (2) No facet in
transverse process. (3) Facet
of inferior articular process
is convex and looks
upwards. (4) Presence of
mamillary and accessory
process like lumbar. (5)
Spine is triangular with blunt
apex.
Fig. 2.12C: Atypical thoracic vertebra
Other Atypical Vertebrae

Fifth lumbar Inferior vena cava is formed Massive body—(1) Anterior • Place body with thick-
(Figs 2.12C in front and right side of body. part of the body is more thicker. ened anterior part in
and D) (2) Short and thick transverse front and spine in
process projects from the behind.
pedicle. (3) Distance between
the two superior articular
process is equal or less than the
distance between the two
inferior articular process. (4)
Spine quadrilateral and down
turned.
Fig. 2.12D: Atypical lumbar vertebra

Contd...

Sacrum (wedge Formed by fusion of fifth Ventral surface: It is marked • Broad base is directed
shaped bone) sacral vertebra. by four transverse ridges. upwards.
(Figs 2.13A and B) Lateral to it lies four ventral • Tapered apex directed
foramina; sympathetic trunk downwards.
descends medial to ventral • Pelvic surface is
sacral foramina ventral surface; directed forwards and
gives E-shaped origin of tilted downwards as if
pyriformis muscle. sacrum is pickling
Dorsal surface: (1) Marked by something from ground.
medial sacral crest (formed by • Dorsal surface is
fusion of spinous process), recognized by sacral
intermediate (fusion of articular crests.
process) and lateral sacral crest
(fusion of transverse process).
(2) Presence of four dorsal
sacral foramina—transmit
dorsal rami of sacral nerves.
(3) Sacral hiatus (U shaped)—
transmit S5, coccygeal nerve
Fig. 2.13A: Sacrum (Dorsal surface) and filam terminale.
Base—broad; formed by first
sacral vertebra. Lower part of
body projecting downwards and
forwards—sacral promontory
(anteroposterior diameter of
inlet of pelvis is measured).
Sympathetic trunk, lumbosacral
trunk, obturator nerve lies in
front alar (wing-like) process.
Apex—lower part of sacrum,
articular with coccyx.
Lateral surface—Upper
part—presence of ear-like
articular surface–form sacro-
Fig. 2.13B: Sacrum (Ventral surface) illiac joint with hip bone.
Lower part—gluteus maximus
is attached.
Coccyx Formed by fusion of four Base—formed by first coccy- • Base identified by oval
(triangular small rudimentary coccygeal verte- geal vertebra. From its postero- facet directed upwards.
bone) (Fig. brae superior aspect coccygeal • Dorsal surfaces will be
2.13C) cornua project. identified by coccygeal
Apex—Formed by fourth cornu.
coccygeal vertebra.
Pelvic surface—attachment of
coccygeus and levator ani.
Dorsal surface—attachment of
filum terminale (second
piece)—gives origin to gluteus
maximus, external anal
sphincter (last piece).
Fig. 2.13C: Coccyx
Skeletal System 21
Applied Anatomy (Vertebrae)

Spondylosis (misnomer spondylitis): It is a margin of the vertebral body near the intervertebral
degenerated condition, characterized by disk. Abscess (pus) formation is common and can
degeneration of intervertebral disks, and formation form paraspinal abscess. It may track down through
of osteophytes (bony overgrowth). the psoas sheath producing psoas abscess.
Spondylolisthesis: It is congenital (present from Coccydynia: It refers to any painful condition in
birth) the vertebral body and arch are not fused. the region of coccyx.
All the diseases describe above produces pain Prolapsed disk: It means a herniated disk; mainly
in the spine (vertebral column). nucleus pulposus herniated out, through annulus
Tuberculosis: Most common source of vertebral pulposus. It is also known as slipped disk. It is
infection; the infection begins at the anterior most commonly seen in lower lumbar region.
Ribs and Sternum

Sternum Flat bone: consists of two Three parts: • If three parts are joined
(breast bone) compact bone layers and 1. Manubrium (cranial part) together, then place
(Fig. 2.14) spongy bone in between. 2. Body (middle part) triangular manubrium
3. Xiphoid process (caudalpart). above.
MANUBRIUM • Anterior surface is very
1. Concavo-convex anterior surface– rough and convex.
sternocleidomastoid (in upper part) and • If only body is present,
pectoralis major (in lower part) are then, upper and lower
attached. end is identified by
2. Concave posterior surface—gives distance between arti-
attachment to sterno-hyoid above and cular facets. Upper part
sterothyroid below. It is related with distance is more and
arch of aorta with three branches. lower part distance is
a. Superior border—in the center lies less.
jugular notch, gives attachment to • Lower end of the bone
two layers of deep cervical fascia should be placed for-
enclosing space of Burn. wards and upper end
b. Lateral border—has two costal backwards.
facet for cartilage (cartilaginous
joint), of first rib and second rib
(synovial joint).
c. Inferior border—oval area;
articulate with upper part of body
forming manubrio- sternal joint, also
known as sternal angle (important for
surface marking and counting of
ribs).
BODY: Two surfaces, two borders.
1. Anterior surface—it is marked by
promi-nent transverse ridge (three in
number)—indicate fusion of four
sternebrae, on either side of midline—
Fig. 2.14: Sternum pectoralis major is attached.
Contd...

It contains red bone 2. Posterior surface—it is flat, faint
marrow throughout life, transverse ridges; related to anterior
and forms anterior border of two lungs with pleura. The
boundary of superior and left part of lower, two pieces of
inferior medias-tinum. sternebrae are direct contact with heart
and pericardium.
Lower end—joins with xiphoid, which
unites at 40 years of age. Lateral border—
has six facets on either side—first and last
are half facet. The distance between the two
adjacent central facets are gradually
diminishing from above downwards.
XIPHOID PROCESS—small part. Its size
and shape vary. At the tip, linea alba is
attached.
1. On anterior surface—external oblique
apo-neurosis and rectus abdominis is
attached.
2. Posterior surface—Gives transverse
attachment abdominis and gives
attachment of diaphragm.
Ribs
12 pairs, classified into typical and atypical ribs
Typical Ribs

Typical Elastic arches of Anterior end—cup-shaped depression for • It should place in pen
Rib bone, present costal cartilage. holding fashion with
(third to anterior end and Posterior end—present head, neck and cup-shaped anterior
ninth) posterior end and tubercle. end lies below the
(Fig. 2.15) body or shaft. 1. Head—present two facets; lower large posterior end.
facet articulates with the same number of • Posterior end above.
thoracic vertebra. Upper facet articulates • Thick and rounded
superior border is
with the lower facet of vertebra above.
above.
2. Neck—it has elevated upper border is • Sharp inferior border
known as crest of neck. below.
3. Tubercle—lateral nonarticular part • Costal groove should
present a medial facet of articulation with be on internal surface.
facet of transverse process of same
number of vertebrae.
Shaft or body—has thick upper border
gives insertion of external intercostals,
internal intercostals and intercostalis intimus.
Sharp lower border—gives origin to
external intercostals.
Costal groove (which is faint in anterior
aspect) gives origin to internal intercostals.
Ridge above the groove gives origin to
intercostalis intimi.
Contd...
Skeletal System 23
Fig. 2.15: Typical and atypical ribs

Atypical Ribs

First Rib Brodest, shortest, most Single facet at head. Inspite of external • It should be placed ob-
(Vertebrosternal) curved rib; form and internal surface (as in other ribs) it liquely so that anterior
lateral boundary of has rough superior surface marked by end is nearly 4 cm
inlet of thorax. two grooves. The anterior groove below the posterior
lodges subclavian vein. The posterior end.
groove lodges subclavian artery. • Rough superior surface
Inferior surface—smooth with two prominent
Inner border—it has a tubercle in the grooves should be
middle (scalene tubercle)—scalenus above.
anterior muscle is attached. Whole
border gives attachment to suprapleural
membrane.
Outer border—convex; thick behind
and thin in front.
Second Rib Twice the length of Double facet at head.The shaft is flat • It should be placed in
(Vertebrosternal) first. Shaft is not with external rough surface looking pen holding fashion
twisted like first. So upwards; and internal smooth surface with cup-shaped ante-
when it is placed on a downwards and inwards, external rior end below and
plane surface, both the surface gives attachment to first posterior end above.
ends touch the surface. external intercostals, serratus anterior • Thick and rounded supe-
rior border is above.
Contd...
Atypical Ribs
(first and second digitations). Internal • Sharp inferior border

surface gives origin to second external below.
intercostals near its outer border and • Costal groove should
related to second posterior intercostals be on internal surface.
nerve, artery, and vein.
Tenth Rib Vertebrochondral rib. Single facet in head. • Same as typical.

Facet present in tubercle. Other
features like typical ribs.
Eleventh Rib Vertebral. Single facet in head. • Place in horizontally,

No facet in tubercle. Slight angle, slight i.e. anterior end and
tubercle, shallow central groove. posterior end in the
same line.
Twelfth Rib Vertebral (very short Single facet in head. No angle, no • Horizontal in position
ribs) tubercle, no costal groove. Lower with the head directed
border is sharper than upper border. medially.
Upper border is slopping downwards, • Tip directed laterally
towards the tip—gives attachment to • Anterior surface looks
last external intercostals. Lower forwards and upwards.
border—middle layer of thoracolumbar
fascia is attached. Anterior surface—
quadratus lumborum muscle is
attached.
Applied Anatomy inspiration and driving out during expiration

(paradoxical respiration).
Single rib fracture: due to compression force. Pain
Cervical rib: When the costal element in the
is experienced at the site of fracture during
seventh cervical vertebra grows and separates out,
respiration.
it is called cervical rib. Common anomaly—it
Frail chest: As a result of crushing injury (motor
presses the brachial plexus and sometimes
vehicle accident) produces comminuted (multiple)
subclavian artery producing symptoms
fracture of a number of ribs The frail segment (a
number of fractured ribs) sucked in, during Bones of Inferior Extremity

Hip bone Irregular bone formed THREE PARTS • Place elevated iliac
(coxal bone) by fusion of ILIUM, 1. ILIUM (superior portion of hip crest above and ante-
(Figs 2.16A and ISCHIUM and bone)—It has three borders rior superior iliac spi-
B) PUBIS, and cup-like a. Superior border–It is also known ne and pubic tubercle
acetabulum occurs at as Iliac crest gives attachment to in same vertical plane.
the point of fusion. fascia lata, external oblique, • Posterior superior
Form symphyseal transversus abdominis and gluteus iliac spine lies above
joint with opposite hip maximus muscles (near its 5 cm away from mid-
posterior part). line.
Contd...
Skeletal System 25

bone, sacroiliac joint b. Anterior border—It has two • Acetabulum is on
with sacrum. spines and a notch: lateral aspect.
• Anterior Superior Iliac
Spine—palpable attachment of
inguinal ligament and sartorius
muscle.
• Anterior Inferior Iliac Spine—
stem of iliac femoral ligament
and rectus femoris muscle
(straight head) is attached.
c. Posterior border—Presents two
spine and a notch:
• posterior superior iliac spine—
represents in the living body by
a dimple in the buttock—gives
attachment to sacrotuberous
ligament (also attached at
• posteroinferior iliac spine)
• presence of greater sciatic notch.
d. Medial border—forms iliac part of
arcuate line.
Fig. 2.16A: IIiac crest (viewed from above)
Contd...
Fig. 2.16B: Hip bone, surfaces

Three Surfaces:
1. Gluteal Surface—Presents three
gluteal lines—anterior, posterior,
and inferior. Area behind the
posterior gluteal lines gives
attachment to gluteus maximus.
Between posterior and anterior
gluteal lines gluteus medius is
attached; below inferior gluteal line
gluteus minimus is attached.
2. Sacropelvic Surface—it has
auricular impression, articulate
with auricular surface of sacrum;
rough iliac tuberosity gives
attachment to interosseous sacro-
iliac ligament.
Contd...
Skeletal System 27

3. Pelvic surface is smooth, marked
by preauricular sulcus (more
prominent in female).
a. Iliac Fossa—gives origin of
iliacus muscle; right fossa lodges
caecum with appendix. Left
fossa lodges part of desending
colon.
ISCHIUM—It has a ramus and a body.
Body presents three surfaces:
i. Femoral Surface—Quadratus
femoris is attached.
ii. Dorsal Surface—Lower part form
ischial tuberosity (we sit on it) gives
attachment to hamstring muscles
(semitendinosus, semi-membra-
nesus, adductor magnus, long head
of biceps).
Fig. 2.17: Comparision between male iii.Pelvic Surface—lies pudendal
and female pelvis canal, with internal pudendal
vessels and pudendal nerve.
Comparison between male and female pelvis RAMUS—presents external surface
(Fig. 2.17) and internal surface.
Male Female PUBIS—V-shaped bone; articulates
Sub pubic Narrower wider with opposite pubis. It has a both form
angle symphyseal joint .
Lesser pelvis Less spaceous More spaceous BODY
Bony More marked Less marked 1. Anterior Surface—Presence of
prominance pubic crest. Lateral end of pubic
Preauricular Not prominent Prominent crest is known as Pubic tubercle
sulcus a. where medial end of inguinal
Acetabula Larger, closer Smaller and ligament is attached;
further apart b. guide for identifying inguinal
and femoral hernia.
c. gives attachment to adductor
longus muscle .
2. Posterior Surface—Smooth,
related to urinary bladder. Gives
attachment of levator ani and
obturator internus along the
obturator foramen.
Superior Ramus—Run upwards and
laterally. (1) Gives attachment to
pectineus muscle (2) Vas deferens is
in relation (in male).
Inferior Ramus—Unite at 8 years with
ramus of ischium, forms common
ischiopubic rami. It gives attachment
Contd...
Fig. 2.18: Different views of femur

Femur Largest, longest and to obturator externus, adductor • Globular head above.
(Thigh bone) strongest bone in the magnus, adductor brevis, gracilis • Linea aspara and
(Fig. 2.18) body. Its length is muscle on the external surface and condyles are behind.
roughly 1/8th of a perineal muscle on internal surface. • Greater trochanter is
person’s height. It has an UPPER END behind.
upper end, shaft and 1. Head—Globular, directed upwards
lower end. It takes part and medially; articulate with
in formation of hip joint acetabulum forming hip joint. A pit
and knee joint. in the head-fovea capitis-ligamen-
tum teres femoris is attached.
Contd...
Skeletal System 29
Femur (Contd...) 2. Neck—long and constricted on the

middle.
Anterior surface—of the neck
marked by a rough line inter-
trochanteric line; capsular ligament
of hip joint is attached here.
Posterior surface—near its junction
with shaft, an elevated ridge is
present known as intertrochanteric
crest—in the middle of which,
quadratus femoris muscle is attached.
1 cm above the crest, the capsular
ligament fits as tight collar.
3. Greater Trochanter—Quadrilateral
eminence; pyriformis, gluteus
medius, gluteus minimus and,
obturator internus is attached.
4. Lesser Trochanter—Iliacus and
psoas muscle are inserted.
SHAFT
Three Borders
1. Lateral
2. Medial border which is rounded.
3. Posterior border (linea aspara) vastus
medialis, medial intermuscular
septum, adductor brevis above,
adductor longus below; and adductor
magnus is attached to it.
Three Surfaces
1. Anterior,
2. Medial and
3. Lateral surface.
Anterior surface—origin of vastus
intermedius, vastus medialis and vastus
lateralis.
LOWER END
Two Condyles:
1. Medial Condyle—convex medial
surface easily palpable. Presence of
adductor tubercle;gives insertion to
adductor magnus.
2. Lateral Condyle—lateral surface is
flat and less prominent. Presence of
oblong groove for attachment of
popliteus. Presence of epicondyle
(Lateral). Lateral collateral ligament
is attached.
3. Intercondyler Fossa—separates two
condyle behind.
Contd...

4. Intercondylar Line—attachment • Broader upper end
of capsular ligament of knee joint. should placed above.
Attachment of anterior cruciate • Tibial tuberosity and
ligament at the posterior part of shin facing forwards.
medial surface of lateral condyle. • Medial malleolus
Posterior cruciate ligament is should be situated on
attached at the anterior part of the medial aspect.
medial surface of lateral condyle.
Tibia Larger medial bone of UPPER END
(Fig. 2.19A) leg; consists of upper Two Condyles
end, shaft and lower 1. Medial—larger than lateral; in its
end. It forms knee posterior aspect groove for
joint, superior, middle semimem-branous present.
and inferior tibio fibu- 2. Lateral condyle—oval facet in
lar joint. front; for attachment of iliotibial
tract. In posterior aspect a facet for
articulation with head of fibula.
A tuberosity—palpable tibial tubero-
sity. Upper smooth part gives attach-
ment to ligamentum patellae.
SHAFT
Three Borders
1. Medial border—attachment of
medial collateral ligament. Soleus
is attached in middle 1/3rd of
medial border.
2. Lateral border (interosseous
border)—interosseous membrane is
attached.
3. Anterior border (shin)—palpable;
gives attach-ment to deep fasca of
leg and superior extensor
retinaculum (in lower part).
Three Surfaces
1. Medial surface—Subcutaneous,
Fig. 2.19A: Tibia and fibula with except in upper part. Upper part
attachments gives insertion to sartorius, gracilis
and semitendinosus.
2. Lateral surface—in its proximal
3/4th it is transversely concave.
Gives attachment to tibialis anterior
muscle.
3. Posterior surface—divided by
oblique soleal line into upper
popliteal surface and lower surface,
(which is again divided by vertical
ridge into medial and lateral part).
It gives attachment of popliteus,
soleus, flexor digitorum longus.
Contd...
Skeletal System 31

LOWER END—projected medial part
is known as medial malleolus—gives
attachment to deltoid ligament. It has
anterior, posterior, medial, lateral and
inferior surfaces.
1. Lateral surface—lower part forms
fibular notch, articulates with lower
end of fibula.
2. Anterior surface—structure in
relation (from medial to lateral)—
Tendons of tibialis anterior,
extensor hallucis longus, anterior
tibial vessels, extensor digitorum
longus.
3. Posterior surface—related with
tendon of tibialis posterior, flexor
digitorum longus, posterior tibial
vessels, tibial nerve and flexor
hallucis longus.
4. Inferior surface—articulates with
superior, medial, and inferior
surface of talus.
Fibula (Lateral Stick like; has upper UPPER END—prominent head lies 2 • Hold the bone by
bone of leg) (Fig. end, shaft and lower cm below knee joint. Present articular pressing the thumb at
2.19B) end.It forms superior, facet at upper end for articulation with malleoler fossa so that
middle and inferior tibia.Junction between head and shaft fossa lies below and
tibiofibular joint and is known as neck. behind.
ankle joint. Shaft: Three Borders
1. Anterior border—begins from
below, from the apex of a
subcutaneous triangular area the
lateral surface and ends is neck.
2. Posterior border—prominent in
lower part, ascends upwards from
posterior groove of lateral
malleolus and fades upwards.
The interosseous border is medial to
anterior border and in the upper part it
is placed in close proximity with this
border.
Three Surfaces
1. Lateral surface (peroneal)—
between anterior and posterior
border—gives attachment to
peroneus longus above and
peroneus brevis below.
Fig. 2.19B: General feature of 2. Medial (extensor) surface—
tibia and fibula between anterior and interosseous
Contd...

border—extensor digitorum longus,
extensor hallucis longus and
peroneus tetrius arises from the
surfaces.
3. Posterior (flexor) surface—
between posterior and interosseous
border—soleus and flexor hallucis
longus and tibialis posterior is
attached to it.
Patella Largest sessamoid bone LOWER END—it is known as lateral • Place rough anterior
(Fig. 2.20) having no periosteum and malleolus—subcutaneous bony surface in front.
haversian system. projection; in it, medial aspect there is • Place articular area of
a facet in front and a groove behind posterior surface
(malleolar fossa). above medial border
It has broad base, (directed above), present a vertical
pointed apex (directed below). Rough facet behind.
anterior surface in front and upper part
of the posterior surface is occupied by
articular smooth area. It has medial
border and lateral border. Base gives
attachment of quadratus femories, apex
ligamentum patellae.
Fig. 2.20: The patella (Anterior and posterior aspects)
Talus (Ankle Important tarsal bone that Presents globular head, constricted • Head is directed
bone) (Fig. 2.21) overrides calcaneum and neck and body. forwards.
it is depressed during HEAD—articulates with navicular. • Trochlear surface of
transmission of body NECK—gives attachment to capsular body is above.
weight in standing posi- ligament. Long axis make angle of long • Place complete trian-
tion. gular facet on lateral
axis of body—about 140°. In infant the
Talocalcaneal, talocal- aspect.
caneonavicular joint are angle is larger. In its plantar aspect deep
contributed by this bone. groove is present known as sulcus tali.
Contd...
Skeletal System 33

BODY
Presents five surfaces.
1. Superior or dorsal surface—
articular, pully-like surface
articulate with inferior articular
surface—of tibia and fibula,
forming ankle joint.
2. Inferior or plantar surface—
marked by oval facet—articulate
with calcan-eum forming subtalar
joint.
3. Medial surface
a. Upper part—occupied by
comma-shaped facet articulate
with medial malleolus of tibia.
b. Lower non-articular part—
rough for deltoid ligament (deep
part).
Fig. 2.21: Talus 4. Lateral surface—occupied by
triangular facet—articulates with
facet on medial aspect of lateral
malleolus.
5. Posterior surface—marked by
medial and lateral tubercle
(posterior tubercle) at the lower
part.
CALCANEUM Largest tarsal bone, Superior surface (dorsal)—Presence • Facet for cuboid
(heal bone) forming heel having of an articular facet in front— should lie in front.
(Fig. 2.22) six surfaces. articulates with a facet in the The sulcus calcanei
undersurface of head of talus. are above.
A deep groove—sulcus calcanei, form
sinus tarsi with sulcus tali. A big middle
Contd...
Fig. 2.22: Calcaneum (largest tarsal bone)


calcaneal facet articulates with facet in • Sustenticulum tali
inferior surface of talus. should place media-
Inferior surface (planter)—Rough lly.
and marked by calcaneal tuberosity in • Anterior part is in
posterior part. higher position than
Anterior surface—Occupied by posterior part.
concavo-convex articular facet;
articulates with cuboid, forms calcano-
cuboid joint.
Medial surface—Presence of shelf-
like projection—sustenticulum tali
produces which is a palpable bony
marking.
Lateral surface—Rough, marked by a
tubercle (peroneal tubercle) in the middle.
Articulated Skeleton of Foot

navicular, on medial aspect (boat-shaped bone with
(Figs 2.23 and 2.24)
a tuberosity on plantar aspect) and cuboid (cube
It includes tarsal bone (seven in number), like, with a crest and groove on plantar surface)
matatarsals (five numbered from great toe to little on the lateral aspect. Medial (largest of three
toe as 1st–5th) and the phalanges (same as hand). cuneiform); Intermediate (shortest of three, distal
Tarsal bones form the posterior half of the foot. surface is occupied by a triangular facet which does
Body weight is carried primarily by two largest not cover this surface wholely) and lateral (distal
and most posterior tarsal bones—the talus surface occupied by a triangular facet which
calcaneum. The intermediate row comprising of completely occupies that surface) cuneiform bones.
Fig. 2.23: Skeleton of foot

Skeletal System 35
Difference between Matatarsal and Matacarpal
Matacarpals Matatarsal
• Head is larger than base, except first metacarpal. • Base is larger than head, except first metatarsal.
• Dorsal surface has flat triangular area. • No such marking.
• First metacarpal has a shaddle-shaped facet at the • First metatarsal has kidney-shaped facet at the base.
base to articulate with trapezium.
Matacarpals Matatarsal
Fig. 2.24: Difference between metacarpal and metatarsal
Differences between Pectoral Girdle and Pelvic Girdle (Figs 2.25 and 2.26)
Pectoral girdle Pelvic girdle

• Two components—clavicle and scapula which • Three components—ilium, ischium and pubis which
remains separate. fuse at the age of 25 to becomes a single hip bone.
• Comparatively lightly built for mobility. • Strong and heavily built for resistance to stress.
Contd...
Fig. 2.25: Pectoral girdle Fig. 2.26: Pelvic girdle

Pectoral girdle Pelvic girdle

• No articulation with vertebral column. • Articulates with sacrum (auricular articular surface).
• No direct ventral articulation (clavicles are connected • Direct ventral articulation at symphysis pubis.
by interclavicular ligament). • Articulation of hip bone with axial skeleton (sacrum)
• Articulations of clavicle with axial skeleton are relatively are relatively large, less mobile and dorsal.
small (Manubrium sterni) mobile and ventral. • Deep joint with limb with limited range of
• Shallow joint with limbs which allows free mobility. movement.
• Stability is less. • More stable.
Injury of Lower Limb Bones (Figs 2.27 and 2.28)
Bone involved (Fig. 2.22) Comment

• Fractured neck of femur are of two Intracapsular fracture, may interfere with the blood supply of head,
types —intracapsular and extracapsular due to damage of retinacular blood vessels–avascular necrosis of
head occurs.Extracapsular fracture occur outside the capsules and
damage of blood supply is little. So satisfactory union is there.
• Supracondylar fracture of femur Accompanied by pain, swelling and inability to make the movement
of leg (occur due to direct trauma).
• Patellar fractures May be transverse or stellate. Transverse fracture is due to indirect
violence of quadriceps and stellate fracture is due to direct blow
over patella.
• Fracture of tibial condyles Are relatively common and may be articular or nonarticular. The
lateral condyle is most frequently involved.
• Combined fracture of tibia and fibula It is a common injury to men due to accident.
(in shaft region)
Contd...
Fig. 2.27: Different types of fractures (femur)

Skeletal System 37
Fig. 2.28: Different types of fracture of leg bones
Bone involved (Fig. 2.22) Comment

• March fracture It is also known as stress fracture of metatarsal. Traditionally seen in
military recruits. It is a fatigue fracture occurring with the repetitive
stress after prolonged period of rest. Pain felt during palpation of the
metatarsal which is involved.
Cranial Bones
Bones Comments Important marking Anatomical positions

Frontal Forms forehead, roof • It has squamous part and orbital part. • Orbital surface will
(Fig. 2.29) of orbit and anterior • Presence of nasal notch and ethmoidal face downwards
cranial fossa. It notch > nasal notch (articular from medial • Orbital plate will be
contains two unequal to lateral) nasal bone, frontal process of horizontal.
fron-tal air sinuses. maxilla and lacrimal bone is articulated. • Concave cerebral sur-
• It has supraorbital foramina (or notch) face of squama facing
which allows the supraorbital vessels and posteriorly.
nerve to pass.
• Squamous part—it has
(a) External surface—convex
(b) Internal surface—concave.
• External surface present Glabella—
meeting point of two superciliary arches.
Supercilary arch—it is formed due to the
projection of frontal air sinus. Eyebrows
lies super-ficial to it. Frontal tuberosity—
bulge over each orbit.
• Supraorbital margin—arched ridge just
below the eyebrows.
Parietal Form most of superior • Presence of four angles—arterosuperior • Inferior border is

(Figs 2.30A and lateral aspect of Occupied by unossified membrane bevelled on the mid-
and B) the skull. (fontanellae) at the time of birth. Antero dle at the expense of
inferior angle pointed and inferiorly. external surface
Contd...
Fig. 2.29: Frontal bone Fig. 2.30A: Parietal bone
Bones Comments Important marking Anatomical positions

During birth un- placed. Postero superior angle (lambda),
obssibial memb- porture inferior angle (marked an
rane present which internal surface by sigmoid sulcus).
helps in moulding of • Four borders • Pointed anterior
foetal head. 1. Anterior 2. Posterior 3. Superior inferior angle (marked
4. Inferior border articulates with, (from internally by groove
before backward) sphenoid (greater for middle meningeal
wing) squamous and mastoid part of vessels) placed down-
temporal bone. wards and anteriorly.
• Two surfaces • Smooth convex exter-
1. External surface marked by superior nal surface with parie-
and inferior temporal lines—inferior tal tuberosity should
temporal line gives attachment to be placed laterally.
temporails muscle.
2. Internal surface marked by grooves
and sulcus—criddle meningeal
groove, sagittal sulcus and sigmoid
sulcus (on postero inferior angle).
Fig. 2.30B: Fontanellae • Parietal eminence: Most prominent part;
biparietal diameter is measured here.
Ossification centre starts from here.
Contd...
Skeletal System 39

Occipital Forms posterior as- • External surface of squamous part • Foramen magnum
(Fig. 2.31) pect and most of the presents prominent tubercle known as must be horizontal.
base of the skull It external occipital protuberance (convex) • Apex of squamous
has squamous, con- and three nuchal lines (a) highest, (b) part face upwards,
dylar, and basilar superior, (c) inferior. Superior nuchal occipital condyle face
part. line gives attachment to trapezius, downwards.
sternocloidomastoid, (d) inferior nuchal • Basilar part directed
lines. upwards and forwards.
• External occipital crest—ligamentum
nuche is attached.
• Internal surface—concave; marked by
four fossae and three sulcus. (1) Upper
fossae—lodges occipital poles—of
brain. (2) Lower fossae—lodges
cerebellar hemisphere. Sulcuses are—
(1) Superior sagittal sulcus—from
internal occipital protruberance to
superior angle. (2) Two transverse
sulci—on either side of internal occipital
protrubrance.
• Foramen magnum—(1) gives passage to
lower part of medulla with meninges,
two vertebral arteries, sympathetic nerve
and venous plexus. (2) Spinal root of
accessory nerve and one anterior and
two posterior spinal arteries.
• Hypoglossal canal: Allow passage of
hypoglossal nerve (twelfth cranial
Fig. 2.31: Occipital bone nerve).
• Occipital condyles: Articulates with
superior articular process of atlas
forming atlanto-occipital joint.
movements of this joint are Flexion,
Extension, Lateral bending.
Temporal Forms inferolateral Temporal bone has three processes—zygo • Squamous part
(Fig. 2.32) aspects of skull and matic, mastoid, and styloid process· directed upwards and
contributes to the • Zygomatic process—helps to form the styloid process
middle cranial fossa. zygomatic arch which forms the pointed downwards.)
It has squamous, prominence of cheek. • Apex of petrous part
mastoid, tympanic • Styloid process—Deeply situated, gives looks forward and
and petrous part. attachment to stylohyoid ligament, medially.
Important foramina styloglossus, stylopharyngeous and • Zygomatic process
of this bone are stylohyoid muscles. directed forwards and
stylomastoid F, inte- • Mastoid process—Palpable behind the medially.
rnal acoustic meatus. auricle; gives attachment to sterno- • External auditory
cleidomastoid, posterior belly of digastric meatus lies on the
and other neck muscles. lateral aspect.
Contd...
Stylomastoid foramen—allows facial

nerve (seventh cranial) to pass. Jugular
foramen–allows passage to internal
jugular vein, nineth, tenth, eleventh,
cranial nerves. Internal acoustic
meatus—allows passage of seventh and
eighth cranial nerves and auditory
vessels. Carotid canal—S-shaped
channel in petrous part, transmits
internal carotid artery.
Mandibular fossa—oval shaped
depression, anterior to external auditory
meatus, form socket for head of mandible
forming temporo-mandibular junction.
Squamous part—in scale like has
smooth external surface, form temporal
fossa and rough internal surface.
Petrous part—wedge-shaped, it houses
middle and internal ear. Mastoid part—
It lies posterior to external auditory
Fig. 2.32: Temporal bone meatus. Rough lower projected part
produce mastoid process; contains
mastoid air cells. At the junction of
mastoid and squamous part lies external
auditary meatus. Triangular area above
the meatus is known as suprameatal
triangle; deep to which lies mastoid
antrum.
• Basilar part (basiocciput)—fuses with
basi sphenoid and form clivus (slope).
It lodges brain stem.
• Condylar part—It has articular and
non-articular arm.
Sphenoid (bird Single bone, situated in 1. Sella turcica (hypophyseal fossa)— • Pterygoid looks
like with wings the middle of base of present in superior surface; lodges downwards.
stretched skull.It has two wings— pituitary gland • Jugum sphenolae
outwards) 1. Lesser wing· 2. Optic foramen—gives passage to second and sphenodal air
(Figs 2.33A to C) Greater wing—has (optic) cranial nerve and ophthalmic sinus facing
two surfaces: lateral, artery. forwards.
cerebral. 3. Super-ior orbital fissure—allows passage
2. A body with six to cranial nerves—third, fourth, sixth and
sufaces— ophthalmic division of fifth cranial nerve.
a. Superior 4. Foramen rotandum—gives passage to
b. Inferior maxillary division of trigeminal nerve.
c. Anterior 5. Foramen ovale—it transmits sensory part
d. Posterior of mandibular nerve, motor root of
trigeminal nerve, anterior division of
middle meningeal sinus, lesser superficial
petrosal nerve.
-Contd...
Skeletal System 41
Two lateral. Two ptery- 6. Foramen spinosum–middle menin-

goid process geal artery and posterior division of
• Two air filled cavi- middle meningeal sinus.
ties in the center part 7. Foramen lacerum—Opening at the
of body (sphenoidal junction of the sphenoid, temporal and
air sinus). occipital bone. It transmits a branch of
ascending pharyngeal artery.
Fig. 2.33A: Sphenoid
Fig. 2.33B: Mandible

Fig. 2.33C: Age changes of mandible
Mandible
Names Important features Anatomical positions
Mandible Parts Forms lower jaw (immovable). It is the strongest and largest bone • Place the mandible in
(Fig. 2.33B) of the face.Mandible has (1) C-shaped body, (2) two rami (right such a way that the
and left); (3) three processes—(a) pointed coronoid process, (2) coronoid, condyoloid
rounded condyloid process (also known as head) and (3) alveolar process, and alveolar
process contains socket for teeth. process should be
a. External surface 1. Body: It has two surfaces, convex external and concave looked upwards.
internal.External surface near the midline lies a ridge known as • Convex external sur-
symphysis menti indicates the mandible develops in two halves. face should be placed
In the lower part on either side of symphysis menti is mental outwards.
tubercles. On each side a faint ridge extends upwards and
backwards from mental tubercle (oblique line). Main muscles
arise from external surface, they are buccinator (opposite three
molar teeth). From the lower border (also known as base); anterior
belly of digastic arises.
b. Internal surface Presence of mylohyoid line in internal (extends from third molar
tooth to symphysis menti) and this line demarcates two fossa upper
sublingual; lower submandibular fossa lodging the salivary glands.
Behind the symphysis menti lies two pairs of tubercle. Upper genial
tubercle gives the attachment to genioglossus lower one to geniohyoid.
2. Ramus: It has outer and inner surface. At outer surface masseter
is attached. Internal surface near the angle of mandible medial
pterygoid is attached.Neck gives the attachment to lateral
pterygoid.
3. Coronoid process: Sharp coronoid process gives insertion of
temporalis.
4. Condyloid process: Also known as head. Articulates with
atricular fossa of mandible forming a temporomandibular
(synovial) joint.
Age changes of At birth the bone presents two halves. 1 year after birth it becomes
mandible a single bone. The coronoid process projects at a higher level
(Fig. 2.33C) than condyloid process. The mental foramen is at the lower border
of the body (Fig. 2.33C). In adult—
1. Teeth (sixteen in number) have errupted.
Contd...
Skeletal System 43
Names Important funcitons Anatomical positions

2. Condyloid process is higher than coronoid process.
3. Mental foramen is situated at midposition of the body.
In old age—
1. Absorption of the alveolar process.
2. Mental foramen is close to alveolar process
Applied Fracture (#) of mandible single or multiple, is common. Forward
dislocation of mandible even during yawning displaces the TM
joint.
Maxilla
Bones Comments Important features Anatomical positions

Maxilla Second largest bone of Body—(pyramidal shape) contains • Frontal process
(Fig. 2.34) face forming upper maxillary air sinus. should be directed
jaw, part of hard Four surfaces presents— upwards from body.
palate, orbits and nasal 1. Anterior surface, • Alveolar process
cavity. It is a pneu- 2. Infratemporal or posterior directed downward.
matic, quadrangular surface, • Zygomatic process
bone. From cheek and 3. Orbital surface, projects laterally.
part of orbit. 4. Nasal surface (medial) it presents • Palatine process
maxillary hiatus). directed postero-
Processes— medially.
1. Frontal—articulates with frontal • Like posterosuperior
bone, border placed post-
2. Zygomatic— articulates with erior superiorly.
zygomatic bone, • Temporal process
3. Alveolar—contains sixteen teeth in project backward.
adult,
Contd...
Fig. 2.34: Maxilla


4. Palatine—forms anterior 2/3rd of
hard palate.
Anterior surfaces of body have:
1. Incisive fossa,
2. Canine eminence,
3. Infraorbital foramen (just below
the orbital margin—infraorbital
vessels and nerve come out),
4. Nasal notch—separates the
anterior surfaces from medial
surface.
Infratemporal surface (posterior
surfaces)—lateral part forms
infratemporal fossa. Medial part forms
pterygopalatine fossa. Maxillary
tuberosity lies at the lower and poste-
rior part of this surface. Sometimes
this tuberisity is damaged during
removal of upper 3rd molar teeth.
Orbital surface—forms the floor of
orbit. Posterior border forms anterior
boundary of inferior orbital fissure
(greater wings of sphenoid forms
posterior border). It transmits
maxillary nerve and its zygomatic
branch, inferior ophthalmic vein and
sympathetic nerve.
Nasal (medial) surface—identified
by large maxillary hiatus which is
partially reduced in size by processes
from inferior nasal chonchae, palatine
and lacrimal bones.
Zygomatic Three surfaces— • Lateral surface

(or Japonicum) 1. lateral, 2. temporal 3. orbital convex with zygo-
(Fig. 2.35) Five borders— matic facial foramen.
1. anterosuperior, • Convex anterior
2. anteroinferior, surface place
3. posterosuperior, anteriorly. Lesser
4. postero-inferior, cornu directed
5. posteromedial. upwards. Tip of
Three processes— greater cornu
1. frontal, 2. temporal, 3. maxillary. directed backwards.
At the upper part of the body—
thyrohyoid membrane, hyoepiglottic
ligament and genioglossus is attached.
At the anterior surface of the body
geniohyoid, hyoglossus, mylohyoid,
sternohyoid and omohyoid is attached.
Contd...
Skeletal System 45
Fig. 2.35: Zygomatic bone

Hyoid Lies in front of neck; At greater cornu—origin of middle
(Fig. 2.36) U-shaped bone. constri-ctor. Attachment of
thyrohyoid membrane. Lesser
cornu—origin of middle constrictor
and stylohyoid ligament.
Important Landmarks in Cranium (Figs 2.37 and 2.38)
Fig. 2.36: Hyoid bone Fig. 2.37: Important landmarks in cranium

Bony landmarks Location Importance
Pterion Junction of greater wing of sphenoid, (1) Position of anterior division of middle meningeal
(Fig. 2.37) squamous temporal, frontal and artery and sinus.
anteroinferior angle of parietal bone. (2) Position of stem of lateral sulcus of brain.
(3) Insula lies deep to it.
(4) Broca’s area of speech is situated here.
Asterion Meeting point of three bones— post- Position of sigmoid sinus.

eroinferior angle of parietal, squamous
part of occipital and mastoid part of
temporal.
Bregma Point of calvaria at the junction of Occupied by anterior fontanelle (unossified

coronal and sagittal suture. membrane) at the time of birth. It ossifies at eighteen
months of age.
Lambda Point on calvaria (skull cap) at the Occupied by posterior fontanelle which ossify six
junction of sagittal and lamboid months after the birth of the baby.
sutures.
Nasion Junction of nasal and frontal bones. Length of the skull is measured from here.
(L.nose)
Inion Most prominent point of external Length of the skull is measured from here.
(Situated at back occipital protuberance.
of head)
Vertex (L.whorl) Superior point of neurocranium in the Used for measurement of height.
midline, in anatomical plane.
Foranina at the Base of and their Contents

(Fig. 2.38)
Foramina Contents (structures come through)
Anterior cranial fossa Nasal emissary vein connecting superior sagittal sinus with
Foramen caecum, anterior and posterior ethmoidal veins of nose. Anterior and posterior ethmoidal vessels and
foramina nerve.
Foramina in cribriform plate of ethmoid Rootlets of olfactory nerve.
Middle cranial fossa Optic nerve and ophthalmic arteries.

optic canals
Superior orbital fissure Inferior ophthalmic vein, ophthalmic nerve and occulomotor,
troclear, abducent nerve and sympathetic nerve fibers.
Foramen rotandum Maxillary nerve.
Foramen ovale Mandibular division of trigeminal nerve and accessory

meningeal artery and lessser superficial petrosal nerve.
Contd...
Skeletal System 47
Foranina in Cranial Fossa and their Contents (Fig. 2.38)
Fig. 2.38: Base of skull
Foramina Contents (structures come through)

Foramen spinosum Middle meningeal artery and vein and a branch of mandibular
nerve.
Foramen lacerum Structure actually lies across, are, internal carotid artery and
its accompanying sympathetic and venous plexuses.
Posterior cranial fossa Medulla with its covering meninges, vertebral arteries, spinal
Foramen magnum(magna—large) root of accessory, anterior and posterior spinal arteries several
dural veins.
Jugular foramen Glossopharyngeal (IX), Vagus (X), Accessory (XI) nerves,

sigmoid sinus continued as superior bulb of internal jugular
vein, inferior petrosal sinus and meningeal branch of
ascending pharyngeal artery.
Hypoglossal canal Hypoglossal nerve.
Internal auditors meatus Passes seventh and eighth cranial nerve.

Joints
Joints—Joints are the junction between two or more bones, bones with cartilage or cartilage with cartilage.
JOINTS [Functional Classification] (Figs 3.1 to 3.3)
Synarthrosis Darthrosis [joint with

[joints without cavity], e.g. fibrous joint cavity], e.g. synovial joint
Fibrous joints Cartilaginous joints slight

No movement permissible movement permissible
Sutures, e.g. sagittal Syndesmosis, e.g. Gomphosis, e.g. joints of teeth

suture of skull inferior tibio-fibular Joint with mandible and maxilla
Primary cartilaginous Secondary cartilaginous [sym-

[synchondroses], e.g. junction of physis], e.g. any midline joint of
epiphysis and diaphysis body; such as symphysis pubis
According to number of According to axis

articulating bones of movement
Simple, e.g. inter- Compound, e.g. ankle Complex, e.g. knee and
phalanges joint of finger and wrist joint sterno-clavicular
Uniaxial, e.g. elbow and Biaxial, e.g. radiocarpal and Polyaxial, e.g. hip joint
knee joint carpometacarpal joint and shoulder joint
Joints 49
Fig. 3.1: Classification of hip joints (function)
Important Joints of Whole Body at a Glance (Skip it in Case of Beginner)
Joints Articulating bones Structural type Movements allowed

Temporo-mandibular Mandibular fossa of temporal bone and Type – synovial Elevation, depression,
joint condyles of mandible. Subtype – condyloid protraction, retraction and
slight lateral movement.
Atlanto-occipital Condylar process of occipital with Type – synovial Flexion, extention, lateral
superior kidney shaped articular process Subtype – condyloid bending and circum-duction.
of atlas.
Atlanto-axial Atlas (c-1) with axis (c-2) Type – synovial Uniaxial joint.
Subtype – pivot Rotation of head.
Intervertebral Between adjacent vertebral bodies Type – secondary Gliding movement

cartilaginous
Subtype – symphysis
Contd...
Fig. 3.2: Joints of upper limb and sternum
Fig. 3.3: Joints of lower limb

Joints 51
Name Comment Important features Anatomical position

Costo-vertebral joint Vertebrae and ribs Type—synovial Gliding movement
Sub type—plain
Sterno-clavicular Sternum and clavicle Type—synovial Gliding movement

joint Sub type—saddle
Sterno-costal joint Sternum and first rib Synchondrosis (primary No movement

cartilaginous joint)
Other sterno-costal Sternum and second to seventh rib Type—synovial Gliding movement
joint Subtype—double plane
Acromioclavicular Acromion of scapula and lateral end of Type—synovial Gliding, elevation, depres-
joint clavicle Subtype—plane sion, protraction and retrac-
tions
Shoulder joint Glenoid cavity of scapula with head of Type—synovial Multiaxial joint. Movements
humerus Subtype—ball and socket are—flexion, extension, ab-
joint duction, adduction, circum-
duction and rotation.
Elbow joint Lower end of humerus with upper end Type—synovial Uniaxial joint. Movements
of ulna and radius Subtype—hinge are—flexion and extension.
Radioulnar joint (pro- Radius and ulna Type—synovial Uniaxial, rotation.

ximal and distal, both) Subtype—pivot
Wrist joint Lower end of radius with proximal Type—synovial Biaxial joint. Movements
(radio-carpal) carpals, i.e. scaphoid and lunate. Subtype—condyloid are—flexion, extension,
abduction, aduction and
circumduction.
Sacroiliac joint Articular surface of sacrum and Type—synovial Slight gliding possible
articular surface of hip bone Subtype—plane
Hip joint (coxal joint) Acetabulum of hip bone and head of Type—synovial Multiaxial joint. Movements
femur Subtype—ball and socket are—flexion, extension,
type abduction, adduction and
some degree of rotation.
Tibio-fibular joint Proximal part of tibia and fibula Type—synovial Gliding

Proximal Subtype—plane
Distal Distal end of tibia and fibula. Type—fibrous Slight movement during
Subtype—syndesmosis dorsiflexion of foot.
Ankle joint Articular surface of lower end of tibia Type—synovial Dorsiflexion (extention)
and fibula with superior, medial and Subtype—hinge Planter flexion of foot
lateral articular surface of talus
Subtalar joint Inferior articular surface of body of Type—plane Inversion and eversion of
talus with superior surface of foot.
calcaneum.
Ta l o - c a l c a n o n a v i - Head of talus articulate with calcaneum Talonavicular part—ball Gliding and rotarory
cular joint and navicular and socket type movement
Calcanocuboid joint Anterior articular surface of calcaneum Type—plane Inversion and eversion of
foot.
Important Joints of Superior Extremity
52
Name of joints and Important Movements Muscle involved Nerve supply Stability Closed packed Loose packed
bones concerned ligments position position
Shoulder joint Capsular 1. Flexion 1(a) Deltoid • Axillary Unstable joint. Abduction Semi-
or ligaments (bending) (anterior fibers), • Supras- Stability is and lateral abduction.
Glenohumeral Glenohumeral Pectoralis major capular maintained by rotation In loose
(polyaxial, ball and ligaments (clavicular part) • Lateral – rotator cuff packed
socket type) bones (thickening part (b) Biceps brachi pectoral muscles (e.g. position.
concerned – of capsule) (long and short supraspinatus, All
• Glenoid fossa of head) infraspinatus, movements
scapula (c) Coraco- subscapularis) are free.
Anatomy at a Glance
• Articular surface brachialis and teres minor

of head of 2. Extension 2. Posterior fibers
humerus (straightening) of deltoid,
(Figs 3.4A and latissimus dorsi
B) and teres major.
3. Abduction 3. Middle fibers of
(move away deltoid, suprasp-
from midline) inatus.
4. Adduction 4. Supraspinatus,
(move towards pectoralis major
the mid line) (sternal part)
latissimus dorsi.
5. Lateral Infraspinators,
rotation teres major,
deltoid (posterior
fibfer).
6. Medial Subscapulares,
rotation latissimus dorsi,
teres major.
Circumduction
(combination
of all move-
ments in
sequence)
Contd...
Joints 53
Fig. 3.4A: Shoulder joint and its interior
Fig. 3.4B: Movements of shoulder joint

Name of joints and Important Movements Muscle involved Nerve supply Stability Closed packed Loose packed
54
bones concerned ligments position position
Elbow joint • Capsular liga- 1) Flexion 1a) Brachialis • Musculocuta- Stable joint. Extension Semiflexion
(hinge, uniaxial ment 1b) Biceps–brachii neous, via its Stability is and and
variety) • Radial co-lateral 1c) Brachioradialis branch to brachi- maintained by semipro- supination.
(Figs 3.5A and B) ligament 1d) Pronator teres alis. – bony nation.
• Ulnar co-lateral • Radial, via nerve configuration
ligament 2a) Triceps brachii to anconeus. and
Bones concerned: 2b)Anconeus • Ulnar nerve ligaments.
Articular surface 2) Extension • Median nerve
of lower end of
humerus (i.e.
Anatomy at a Glance
trochle and
capitulum)
Wrist joint • Fibrous capsule. • Prime-mover: • Anterior intero- Maintained by Dorsiflexion Semiflexion
(biaxial condylar • Palmar radio- • Flexor carpi sseous nerve- configuration
variety) (Fig. 3.6) carpal ligament 1) Flexion ulnaris branch of median and ligaments.
Bones • Dorsal radio- • Flexor carpi nerve.
concerned: Articular carpal ligament radialis • Posterior intero-
surface of lower • Radial co-lateral Assisted by: sseous nerve –
end of radius, ligament • Flexor digitorum branch of radial
scaphoid and • Ulnar co-lateral superfacialis, nerve.
lunate. ligament • Flexor digitorum • Deep terminal
profulus, branch of ulnar
• Flexor pollicis nerve.
longus, and
Abductor pollicis
longus.
a) Extensor carpi
radialis, longus
2) Extension and brevis.
b) Extensor carpi
ulnaris.
c) Extensor
digitorum.
d) Extensor
indicis.
Contd...
Fig. 3.5B: Movements of elbow joint
Fig. 3.5A: Elbow joint and ligaments
Name of joints and Important Movements Muscle involved Nerve supply Stability Closed Loose
bones concerned ligments packed packed
e) Extensor digiti
minimi.
f) Extensor
pollicis longus.
3) Abduction a) Flexor carpi
radialis.
b) Extensor carpi
radialis, longus
and brevis.
c) Abductor
pollicis longus.
d) Extensor
pollicis brevis.
Joints
4) Adduction a) Flexor carpi

ulnaris. Fig. 3.6:
b) Extensor carpi
55
Radiocarpal or
ulnaris. wrist joint
Joints Involved in Pronation and Supination

Name and bones Ligments Movements Muscles producing Nerve supply Stability
concerned the movement
Superior (synovial, • Capsular Pronation and supina- Pronation – Giving • Musculo Maintained
uniaxial, • Annular tion in a vertical axis; something (king cutaneous by strong
pivot type) and • Capsular the axis passes through pronate) – done chiefly ligaments.
inferior radio-radio ligament the center of head of by pronator quadratus.
ulnar joint.Superior • Palmar radius, and through the Assisted by pronator • Median
– articular area of ligament ulnar attachment of teres (when the
head of radius with • Dorsal articular disk (lower). movement is rapid and
articular area of ligament against resistance).
ulna. • Lateral Supination—[more
Inferior radio-ulnar ligament powerful, antigravity • Radial
joint – head of ulna movement (begger nerves
with ulnar notch of supinate)] i.e. taking
radius (Fig. 3.7). something
• Supinator
• Biceps brachii.
Fig. 3.7: Radio-ulnar joints, movements and applied

Name and bones
Ligments Movements Muscle involved Nerve supply Stability Closed packed Loose packed
concerned
First carpometa- • Capsular ligament 1. Flexion a. Flexor pollicis brevis Digital branch Stable joint Full oppo- Neutral
carpal joint (poly b. Opponens pollicis of median nerve sition position of
- axial, saddle and assisted by flexor going to thumb. thumb
shaped) pollicis longus.
Distal articular • Palmar ligament 2. Extension a. Extensor pollicis-

surface of longus and brevis.
trapezium.
• Dorsal ligament 3. Abduction a. Abductor pollicis

longus.
b. Abductor pollicis
longus and abductor
pollicis brevis.
• Lateral ligament 4. Opposition Assisted by – extensor

pollicis brevis.
a. Flexor pollicis brevis.
b. Assisted by –
adductor pollicis.
Proximal saddle- 5. Circumduction All movements (in a

shaped articular sequence)
surface of first
metacarpal. 6. Adduction Adductor pollicis
(Fig. 3.8)
Joints
57
Fig. 3.8: Movements of 1st carpo metacarpal joint

Joints of Inferior Extremity
58
Name and bones Ligments Movements Muscle involved Nerve supply Stability Closed packed Loose packed
concerned position position
Hip Joint (poly- A. Capsular liga- 1. Flexion a. Iliacus By branches Stable due to Extension Semiflexion
axial, ball and ment (three (bending) b. Psoas from – lumbar bony configu- and medial
socket joint) parts) c. Rectus femoris plexus via – ration and liga- rotation
1. Iliofemoral d. Sartorius 1. Obturator ments.
ligament. nerve
2. Pubofemoral – 2. Nerve to
ligament rectus femoris
3. Ischiofemoral – 3. Accessory
ligament obturator
Anatomy at a Glance
Articular surface B. Ligamentum 2. Extension a. Gluteus maximus nerve.

of acetabulum of teres femoris. (straightening) b. Biceps femoris
hip bone. c. Semitendinous
d. Adductor magnus
(ischial fibres)
Articular surface C. Acetabular 3. Abduction a. Adductor longus
of head of femur. labrum. b. Adductor brevis
(Figs 3.9A and B) c. Adductor magnus
d. Gracilis
e. Pectineus
4. Lateral rotation a. Pyriformis
(external rotation) b. Obturator inte-
rnus and externus.
Contd...
Fig. 3.9A: Hip joint

Fig. 3.9B: Movement of hip joint
Joints
59
Joints of Inferior Extremity
60
Name and bones Ligments Movements Muscle involved Nerve supply Stability Closed packed Loose packed
concerned position position
D. Transverse c. Two-gamelii
acetabular d. Quadratus femoris
ligament. e. Gluteus maximus
5.Medial a. Gluteus medius

rotation b. Gluteus minimus
6.Circumduction c. Tensor fasciae
latae
KNEE JOINT • Capsular 1.Flexion Combination of all Obturator Maintained Full Semiflexion
Anatomy at a Glance
(modified hinge ligament. movements in nerve mainly by extension

joint) Bones • Tibial (medial) sequence. (posterior ligaments and
concerned— collateral a. Biceps femoris division) partially by
1.Articular area ligament. b. Semitendinous muscles.
of lower end • Fibular (lateral) c. emimembranous Genicular
of femur. collateral d. Gastrocnemius branches of
2.Articular area ligament. tibial and
on posterior • Oblique 2.Extension Quadriceps femoris common
surface of popliteal peroneal.
patella. ligament.
3.Articular area • Cruciate 3.Medial Satorius, gracilis.
of upper end ligament, rotation
of tibia (Figs medial and
3.10A and B) lateral menisci. 4.Lateral rotation Biceps femoris
ANKLE JOINT Capsular ligament 1.Dorsiflexion a. Tibialis anterior Deep peroneal Bony Dorsiflexion Neutral
(hinge; uniaxial) Deltoid (medial) (flexion) b. Extensor hallucis configuration position
(Fig. 3.11) Lateral ligament longus.
c. Extensor
digitorum longus.
d. Peroneus tertius.
2.Plantar flexion a. Gastrocnemius.
(extension) b. Soleus
c. Tibialis posterior
d. Flexor digitorum
longus
e. Flexor hallucis
longus.
Joints 61
Fig. 3.10A: Knee joint
Fig. 3.10B: Movement of knee joint Fig. 3.11: Ankle joint and its movements
Arches of Foot
Comments Factors maintaining the arch Applied

• It acts as an elastic platform 1. SHAPE OF BONES – Bones are faceted and • Flat foot (pes planus) – It
which helps to carry body shaped in such a way that they fit with each other. can be congenital or
weight efficiently and 2. INTERSEGMENTAL TIERS – They are the acquired (due to over-
economically. binders of bones (ligaments). weight) and prolong
• It helps in propagation, in Important tiers (ligaments) of medial arch are – standing.
plane or uneven surface, due SPRING LIGAMENT (plantar calcanonavicular • High arch (pes cavus) –
to segmental nature. ligament). For lateral arch – Long Plantar Ligament Height of arch is more.
• Foot has three arches, which Short Plantar Ligament for Transverse Arch – Deep • Talipes equinus – Heal
are also present at birth. The Transverse Ligament. raised; person walks on
arches are: 3. BOW STRING OR TIE — BEAM toes.
1. Medial longitudinal arch – ARRANGEMENT – two ends of the arch • Talipes calcaneus –
bones are: calcaneum, connected by muscles or ligaments. Person walks on heel.
talus, navicular, three FOR MEDIAL ARCH – Medial part of plantar • Talipes varus – Person
cuneiform bones, first aponeurosis. Abductor hallucis (muscle of sole). walks on lateral border of
three metatarsals. FOR LATERAL ARCH – lateral part of plantar foot.
2. Lateral longitudinal arch – aponeurosis and abductor digiti minimi (intrinsic • Talipes valgus – Person
bones are calcaneum, muscle of sole). walks on medial border of
cuboid, fourth and fifth FOR TRANSVERSE ARCH – Peroneus longus foot.
metatarsal bones. tendon and tibialis posterior • Talipes equinovarus –
3. Transverse arch. Bones 4. SLING ARRANGEMENT – Suspends arch from Most common combi-
are: bones of all metat- above. nation. It is also called
arsals and cuboid and three FOR MEDIAL ARCH – Suspended by flexure clubfoot.
cuneiform. hallucis longus. • Above all deformities
(Figs 3.12A to D) FOR LATERAL ARCH – Peroneus longus et brevis. produce impairment of
FOR TRANSVERSE ARCH – peroneus longus. movements and pain.
Fig. 3.12A: Arches of foot

Joints 63
Fig. 3.12B: Maintenance of arches
Fig. 3.12C: Imprints of different kinds of feet
Fig. 3.12D: Different deformities of foot

Joints of Head and Neck
Name and bones Ligaments Movements Muscle concerned Nerve supply

concerned
Temporo mandibular 1. Capsular 1. Protrusion 1. Lateral and medial Auriculotemporal

joint (TM Joint) ligament. pterygoid muscle. – from posterior
• Articular area of 2. Lateral 2. Retraction 2. Temporalis (posterior division of
head of mandible. temporo- fibre), assisted by – mandibular
• Articular area of mandibular Masseter, Digastric,
mandibular fossa of ligament. Geniohyoid. Masseteric
temporal bone and 3. Stylomandi- 3. Elevation 3. Temporalis Masseter. branch – from
its articular tubercle bular ligament. 4. Depression 4. Medial pterygoid. anterior division
(Fig. 3.13). Lateral pterygoid. of mandibular.
Digastric.
Geniohyoid.
Mylohyoid.
5. Side-to-side 5. Medial and lateral
chewing pterygoid of each side,
movement. acting alternately.
Contd...
Fig. 3.13: Tenporo mandibular joint

Joints 65
Name and bones Ligaments Movements Muscle concerned Nerve supply

concerned
Cranio-vertebral Joints Fibrous capsule. Flexion (main) Longus capitis. First cervical nerve.
Atlanto-occipital Joint Anterior with a little lateral Rectus capitis anterior.
(Synovial) Bones atlanto-occipital flexion and
Concerned: membrane. rotation.
Condyles of occipital Posterior
bone and reciprocally atlanto-occipital
curved superior membrane.
articular surface of first
cervical vertebra.
(Atlas) (Fig. 3.14).
ATLANTO-AXIAL 1. Atlantoaxial Simultaneous of Oblicus capitis inferior. Second cervicle

JOINT [synovial, ligament. all three joints. Rectus capitis posterior
uniaxial, pivot type] 2. Apical. Rotation of axis major.
BONE CONCERNED: 3. Alar ligament which are checked Splenius capitis.
Atlas and axis forms 4. Transverse by alar ligament. Contralateral (opposite
three synovial ligament. side).
joints – 5. Cruciform Sternomastoid
Lateral ligament.
Medial 6. Membrana
tectoria.
Fig. 3.14: Craniovertebral joints (atlanto to occipital and atlantoaxial)
Applied Anatomy [Joints]

Common Joint Injuries Cartilage Injuries
Sprain: The ligaments reinforcing a joint are • It is common in knee joint, particularly in case
stretched or torn. The lumbar region, the knee and of sportsman.
ankle are common sites of sprain. RICE; R – for • The avascular cartilage [medial menisci] is
rest; I – for ice, C – for compression and E – for unable to repair itself.
elevation, are the standard treatment for pulled • The patient is unable to fully extend the knee
muscle, stretched tendons or ligaments. and there is true locking.
Dislocation particularly in women.

• It involves displacement of articular surfaces of Weight bearing joints are mostly affected.
bones. • Rheumatoid arthritis:
• It is usually accompanied by sprains, Occurs in any age group [three times more in
inflammation, and joint immobilization, like female].
fracture, dislocation must be reduced [go back It is most crippling arthritis [due to auto-
to original position]. Shoulder joints, finger immune disease] involving severe inflammation
joints, thumb, patella and temporo-mandibular of joints.
joint is commonly dislocated. Small joint like joint of finger, wrist, ankle
• Sublaxation is the partial dislocation of a joint. and feet are affected in the same time [both
Shoulder joint is commonly sublaxated due to sides are involved].
loose capsule on inferomedial aspect. • Frozen shoulder:
• Temperomandibular joint is also dislocated due
It is a syndrome [combination of severe signs
to loose capsule; even a large yawning produce
and symptoms] characterized by a global
dislocation.
restriction of glenonumeral movement, pain and
Inflammation and degenerative disease of joint muscle wasting. Commonly affects the middle
[includes bursitis, tendinitis and various forms of aged and elderly persons.
arthritis] Spontaneous recovery occurs.
• Tennis elbow [lateral epicondylitis]:
• Osteoarthritis: This is a common over used condition
Most common degenerative joint disease [repeatitive rotation at the elbow].
accompanied by stiffness and pain. There is pain in the lateral epicondyle [common
Most common in aged [above 40 years] extensor origin].
Muscular System
INTRODUCTION abundant actin and myocin protein filament.

Muscle cells are known as myocytes. In man,
Muscle (mouse-like appearance) tissue has the muscle tissue constitutes 40 to 50% of body mass.
special property of contractility due to presence of There are three types of muscles.
Feature Skeletal (Fig. 4.1A) Cardiac (Fig. 4.1C) Smooth (Fig. 4.1B)
Fibers-shape • The fibers are Fibers are cylindrical and branched Fibers are fusiform or
cylindrical. (intercalated disc present at the spindle shaped.
junction).
Position of nuclei • Peripherally situated Single central nucleus. Single central nucleus.
multiple nuclei.
Cross striations • Numerous Cross striation may or may not be No such features.
prominent cross present (when it is faintly stained).
striation showing
light and dark band.
Situation • They are usually Present in heart musculature. Muscle of organs like
attached to body gastrointestinal tract,
skeleton. urinary tract, etc.
Function • Voluntary in Involuntary in function. Involuntary in function.

function.
Fig. 4.1A: Skeletal muscle Fig. 4.1B: Smooth muscle Fig. 4.1C: Cardiac muscle
(Terminology) Associated with Muscle by a thin strong sheet of fibrous tissue known
(Fig. 4.2) as aponeurosis, e.g. External oblique aponeu-
rosis.
• Origin: The attachment that moves least.
• Raphae: A raphae is interdigitation of tendinous
• Insertion: The attachment that moves more.
ends of fibers of flat muscle, e.g. Mylohyoid
• Tendon: The end of a muscle is connected to raphae.
cartilage by strong, rounded fibrous tissue are • Retinaculum: Condensation of white fibrous
known as tendon, e.g. tendoachills. tissue (deep fascia) around the joint. It stabilizes
• Aponeurosis: The flated muscles are attached the long tendons during movement of a joint.
Fig. 4.2: Terminology used in description of muscle
CLASSIFICATION OF VOLUNTARY Slow, oxidative (fatigue resistance) – red

MUSCLE muscle: Used in maintaining posture.
Intermediate fast oxidative (fatigue resistance):
The individual fiber of a voluntary muscle are
Used during walking. Most muscles contain a
arranged either parallel or oblique to the long axis
mixture of fibers types.
of a muscle. According to their arrangement of
fibers, they are classified below (Fig. 4.3).
Classification of Muscle According to Action
While resting, every skeletal muscle is in a
partial state of contraction. This is known as muscle • Prime movers (agonists): The muscles bear the
tone. In paralysis of skeletal muscle, tone is absent, chief responsibility for producing movement.
and flabby. In the long run, there is wasting of • Antagonist: The muscle that opposes the action
muscles. of another muscle.
There are three types of voluntary muscles • Synergists: Helps the prime movers by effecting
fibers–fast (glycolytic)–Tire quickly or white type the same action (by stabilizing joint or
(pale)–Used in powerful movement. preventing undesirable movements).
Muscular System 69
Fig. 4.3: Classification of voluntary muscle (according to shape and direction of muscle fibers)
• Fixator: Its function is to immobilize a bone or Naming of Muscle

a muscle from origin to allow the desirable
According to Shape
movement.
• Deltoid=(triangular), e.g. deltoid muscle of arm.
Bones and Muscles as Body Lever System • Quadratus = (square), e.g. quadratus lumborum
A lever is a bar that moves on fulcrum. When an of abdomen.
effort is applied to the lever, a load is moved. In • Rhomboid = (diamond shaped), e.g. rhomboids
the body bones are the levers, joints are the fulcrum major muscle of back.
and the effort is exerted by skeletal muscle. • Teres = (round), e.g. teres major of upper limb.
First class levers (effort – fulcrum – load) • Gracilis = (slender), e.g. gracilis muscle in thigh.
may operate at a mechanical advantage or • Rectus = (straight), e.g. rectus abdominis of
disadvantage, e.g. humero ulnar and part of elbow abdomen.
joint (Fig. 4.4A). • Lumbrical = (worm like), e.g. lumbricals of
Second class lever (fulcrum – load – effort) all hand and feet.
operate at a mechanical advantage, e.g. ankle joint
(Fig. 4.4B). According to Size
Third class lever (fulcrum – effort – load) always • Major = big, e.g. pectoralis major (muscle of
operate at a mechanical disadvantage, e.g. elbow thorax).
joint (Fig. 4.4C). • Minor = small, e.g. pectoralis minor (muscle of
thorax).
Fig. 4.4: Lever system
• Longus = long, e.g. adductor longus (of thigh). According to Number of Heads of Origin
• Brevis = short, e.g. adductor brevis (of thigh). • Biceps = Bi – two; ceps – head – e.g. biceps
brachii (front muscle of arm).
• Magnus = large, e.g. adductor magnus (of
• Triceps = Tri – three; Triceps brachii (back of
thigh).
arm).
• Latissimus = broadest, e.g. latissimus dorsi • Quadriceps = Quadri – four; Quadriceps femoris
(back muscle). (muscle of front thigh).
Often several criteria are combined in naming
• Maximus = largest, e.g. gluteus maximus (hip
of a muscle = For example, Extensor carpi
muscle). radialis brevis – tells us, extensor (muscle’s
• Minimus = smallest, e.g. gluteus minimus action), carpi (of wrist), radialis (of radial side,
(another hip muscle). i.e. on lateral side), brevis (short).
Muscular System 71
Applied 5. Muscle injury: Very common; formation of

hematoma (blood accumulated swelling) within
1. Effect of exercise on muscles
the muscle, e.g. hamstring, gastrocne-mius
• Regular aerobic exercise results in increase
hematoma.
efficiency endurance (tolerance), strength,
6. Wasting: Wasting due to disuse, and confine-
and resistant to fatigue of skeletal muscles.
ment in bed due to peripheral nerve injury.
• Resistance exercise causes skeletal muscle
7. Rotator cuff weakness: Supraspinatus, infra-
hypertrophy (increase in size) and gains in
spinatus teres minor, subcapularis form the
skeletal muscle strength.
rotator cuff. Most problems arise due to tear
2. Cramp: Sustained spasm of an entire muscle
(complete or partial) of supraspinatus. The
(lasts for a few seconds to several hours) causing
abduction is impaired and arm drop.
the muscle to become tough and painful;
8. Biceps and triceps tendinitis (tendon inflamma-
common in calf, thigh and hip muscle.
tion): Biceptial tendinitis causes pain in the
3. Spasm: A sudden involuntary muscle twitch
anterior aspect of elbow or in upper arm as a
(range from mere irritation to very painful) due
result of overuse or strain.
to chemical imbalance; common in eyelid, facial
Tricepital tendinitis causes posterior elbow
muscle.
pain and tenderness in the triceps insertion.
4. Muscle strain: Excessive stretching and
9. Quadriceps weakness: It occurs due to constant
forceable tearing (due to overuse and abuse) –
use of high heel or tear of few fibers of muscles
the injured muscle is painful and inflammed.
(due to over work) and due to prolonged immo-
Quadriceps and hamstring muscle strain is very
bilization. The patient gets tired early when
common in athlets.
walks on a staircase.
Muscle Connecting Upper Limb to Thoracic Wall (Fig. 4.5)
Muscle Origin Insertion Description Nerve supply Action

Pectoralis major Clavicle, sternum Lateral lip of Large, fan shaped Medial and Adductus arm
(Pectus – chest and upper six bicipital groove muscle, covering lateral and rotate it
Major – large) postal cartilages. of humerus. upper portion of pectoral medially.
chest, forms ant- nerves from Clavicular fiber
erior axillary fold. brachial also flex arm.
plexus.
Pectoralis minor Third, fourth and Coracoid process Flat, thin muscle Medial Depress point of
(minor – small) fifth ribs. of scapula. lies under cover of pectoral nerve. shoulder, when
pectoralis major. the scapula is
fixed. It elevates
the ribs from
insertion.
Subclavius (sub – First rib cartilage Clavicle Small, cylindrical Nerve to sub- Depresses the
beneath, clav – muscle extending clavius from clavicle.
clavicle) from first rib to upper trunk of Steadies clavicle
clavicle. b r a c h i a l during
plexus. movement of
shoulder girdle.
Serratus anterior Upper eight ribs. Entire anterior Lies deep to Long thoracic Move scapula
(serratus – saw surface of scapula, forms nerve. forward around
tooth like medial border medial wall of the thoracic wall;
(Boxer muscle) and inferior axilla, origins has rotates scapula
angle of scapula. saw tooth like and raises the
appearance. point of shoulder.

Fig. 4.5: Muscle connecting the upper limb to
thoracic wall
Muscle Connecting Upper Limb to Vertebral Column (Fig. 4.6)
Trapezius Occipital bone, A continuous ins- Most superficial Spinal part of Stabilize and rotates
ligamentum ertion along the muscle of back. Flat accessory scapula, upper fibers
nuchae. Muscle acromin and triangular in shape. nerve elevates the scapula,
arises also from spine of scapula Upper fibers run (eleventh middle fibers pull
spines of C7 and (upper border) downwards, middle cranial nerve) the spinel medially
all thoracic spines. and lateral third fibers run horizon- and lower fibers pull
of clavicle. tally and lower the medial
fibers pass upwards. border of scapula
downwards.
Latissimus From iliac crest, It winds around Broad, flat triangu- Thoracodorsal Extends, adduct and
dorsi lumbar fascia, the teres major lar muscle of nerve medially rotates the
(Latissimus – spines of lower six to insert in the lumbar region, arm. It is prominent
widest dorsi – thoracic vertebrae, floor of bicipital forms posterior wall during hammering,
on dorsal lower three or four groove of of axilla. rowing and
aspect) ribs and inferior humerus. swimming.
angle of scapula.
Rhomboid Second to fifth Medial border of Rectangular muscle Dorsal Raises medial border
major (Rhom - thoracic spine. scapula. lying deep to scapular of scapula upwards
boid –diam- trapezius. nerve and medially.
ond shaped)
Rhomboid Ligamentum Medial border of Rectangular muscle Dorsal Raises medial border
minor nuchae, spines of scapula. lying deep to scapular of scapula and
C7 and T1. trapezius and nerve stabilizes scapula.
inferior to levator
scapulae.
Contd...
Muscular System 73
Teres major Lower 3rd of Medial lip of Thick muscle, Lower Medially rotate and
[Rotator cuff lateral border of bicipital groove located inferior to subscapular adduct arm and
muscle] scapula. of humerus. teres minor, helps to nerve from stabilizes shoulder
form the posterior post cord of joint.
border of axilla. brachial
plexus
Teres minor Upper 2/3rd of Greater tubero- Small elongates Axillary nerve Laterally rotate the
(Rotator cuff lateral border of sity of humerus muscle lies inferior arm and stabilizez
muscle) scapula. (lower to infraspinatus and shoulder joint.
impression). may be inseparated
from the muscle.
Subscapularis Subscapular Lesser tuberosity Forms part of Upper and Chief medial rotator
(sub-under) fossa. of humerus. posterior of axilla. lower sub- of arm and stabilize
rotator cuff Tendon passes scapular shoulder joint.
muscle infront of shoulder nerve of post
joint. cord of
brachial
plexus
Fig. 4.6: Muscle connecting the upper limb to vertebral column

Muscles Connecting the Scapula to Humerus (Fig. 4.6)
Deltoid Lateral one In deltoid tubero- Thick, multipennete Axillary Abducts arm. Anterior
(Delta – triangular third of sity in middle of muscle, forming the nerve. fibers flex and medially
muscle) clavicle, lateral surface of roundness of shou- rotate the arm. Posterior
acromian, shaft of humerus. lder. A site comm- fiber extends and
spine of only used for intra- laterally rotate the arm.
scapula. muscular injection. Action in antagonist of
pectoralis major and
latissimus dorsi.
Supraspinatus Supraspinous Greater Lies deep to Supra - Abducts and stabilizes

(supra – above a fossa of tuberosity of trapezius and it is scapular shoulder joint. Prevent
muscle lies above scapula. humerus, a rotator cuff nerve. downward dislocation
the spine) [Rotate shoulder joint. muscle. of shoulder when
cuff muscle]. carries a heavy suitcase.
Infraspinatus (Infra Infraspinous Greater Partially covered Supra Laterally rotates the
–below– so a fossa of tuberosity of by deltoid and scapular arm and stabilizes
muscle below the scapula. humerus, trapezius. nerve. shoulder joint.
spine of scapula) shoulder joint.
[Rotator cuff
muscle].
MUSCLES OF ARM
Anterior Muscles (Fig. 4.7A)
Biceps Long head – from Tuberosity of Fusiform muscle. Musculo- Flexes elbow joint and
Brachii supraglenoid radius and Two head unite near cutaneous supinate the forearm.
(Biceps – tubercle of bicepital about the middle of nerve. Long head stabilize
two head) scapula.Short head – aponeurosis. arm. shoulder joint.
Coracoid process of
scapula.
Coraco- Coracoid process of Medial aspect of Small cylindrical Musculo- Flexes arm; weak
brachialis scapula. shaft of humerus. muscle. cutaneous adductor synergist of
(Coraco- nerve. pectoralis major.
coracoid
process
brachium-
arm)
Brachialis From anterolateral Coronoid process Strong muscle. Lies Musculo- Flexor of elbow joint.
and anteromedial of ulna. deep to biceps cutaneous
surface of lower end brachii on distal nerve.
of humerus. humerus.
Muscular System 75
Figs 4.7A and B: Muscles of arm
Posterior Muscles (Fig. 4.7B)

Triceps bra- Long head—Infrag- Superior surface Large fleshy belly, and Radial Extensor of
chii (Tri— lenoid tubercle of of olecranon pro- only muscle of post- nerve. elbow joint.
three scapula. cess of ulna. erior compartment of
ceps—head Lateral head – upper arm. Long and lateral
three half of posterior head lie superficial to
headed humerus. Medial head me-dial head
muscle) – Lower half of
posterior humerus,
below the radial
groove.
Muscles of Forearm (Figs 4.8A and B)

Eight muscle arranged in lateral to medial aspect
Pronator Humeral head – Lateral aspect of Two headed super- Median Pronation and
teres (Pro- Medial epicondyle of shaft of radius. ficial muscle located nerve. flexon of forearm.
nation– humerus. between brachiora-
position of Ulcer head – Medial dialis on its lateral
forearm to border of coronoid aspect and flexor carpi
give some- process of ulna. radialis on its medial
thing to aspect. Form medial
somebody). boundary of cubital
fossa.
Contd...

Flexor carpi Anterior surface of Bases of second and Runs obliquely Median Flexes and abducts
radialis medial epicondyle of third metacarpal. across the forearm. It nerve. hand at wrist joint.
humerus. has chord like tendon
at the region of wrist.
Palmaris Anterior surface of Flexor retinaculum Small muscle with a Median Weak wrist flexor.
longus medial epicondyle of and palmar apo- long tendon; often nerve.
humerus. neurosis. absent.
Flexor carpi Humeral head – Pisiform, hook of Medial most muscle Ulnar Flexes and adduct
ulnaris Anterior surface of hammate and base of of flexor group. Two nerve. the arm at wrist
medial epicondyle of fifth metacarpal headed ulnar nerve joint.
humerus. bone. lies lateral to its
Ulnar head – Medial tendon.
aspect of olecranon
process and posterior
border of ulna.
Flexor digi- Humero-ulnar head – By four tendon into Intermediate group Median Flexer middle,
torum super- Anterior surface of middle phalanges of of muscle, visible at nerve. phalanx of fingers
ficialis medial epicondyle of two to five fingers. the distal part of and assist in flexing
(digitorum – humerus; medial forearm. Median proximal phal-anx
concerned border of coronoid nerve is plastered and head.
with finger) process of ulna. behind this muscles
or toe super- Radial head – from
ficial – close anterior oblique line
to surface. of shaft of radius.
Fig. 4.8A: Superficial flexor muscles of forearm Fig. 4.8B: Arrangement of superficial flexors of
forearm (like 4 fingers in hand)
Muscular System 77
Deep Muscles
Flexor Anterior surface of shaft Distal phalanx of Lies side by side with Anterior Flexes distal
pollicis of radius. thumb. flexor digitorum. interosseous phalanx of
longus Profundus. branch of thumb.
Pollax – median
thumb. nerve.
So long
flexor of
thumb.
Flexor Anteromedial surface of Distal phalax of Extensive origin Medial half Only muscle
digitorum shaft of ulna. medial 4 fingers. covered by flexor by ulnar that can flex
profundus digitorum and lateral distal
(Profunda– superficialis. half by interphalangeal
deep) median. joint.
Pronator Pronator ridge on the Anterior surface Deepest muscle of Anterior Pronates
Quadratus anterior surface of lower of lower end of distal forearm. Only interosseous forearm along
(quodrate– end of ulna. shaft of radius. muscle that arise branch of with pronator
square solely from ulna and median teres.
shape). inserted solely in nerve.
radius.
Muscles of Posterior Compartment of Forearm

Superficial (Lateral to Medial) (Fig. 4.9)
Brachio- Lateral supracondylar Base of styloid Form lateral boundary Radial nerve. Rotates fore-
radialis ridge of humerus process of radius. of cubital fossa. arm to the mid
prone position.
Estensor Lateral supracondylar Posterior surface Parallel to brachio- Radial nerve. Extends and
carpi radialis ridge of humerus. of base of second radialis on lateral abducts hand
longus metacarpal bone. forearm and may blend at wrist joint.
(longus-long) with it.
Extensor Lateral epicondyle of Posterior surface Shorter than extensor Deep branch Extends and
carpi humerus. of base of third carpi radialis longus of radial abducts hand
radialis metacarpal bone. and lies deep to it. nerve. at wrist joint.
brevis (brevis
–short)
Extensor Lateral epicondyle of Middle and Lies medial to extensor Deep branch Extends little
digitorum humerus. distal phalanx of carpi ralialis brevis. of radial fingers and
medial four Four tendons at the nerve. hand.
fingers. wrist passes deep to
extensor retinaculum.
Contd...
Fig. 4.9: Superficial extensors of forearm
Extensor Posterior surface of lateral Extensor It is the detached Deep branch Extends
digiti epicondyle of humerus expansion of portion of extesor of radial metacarpo-
minimi little finger. digitorum. nerve phalangeal
(posterior joint of little
interosseous). finger.
Extensor Posterior surface of lateral Base of fifth Medial most muscle of Deep Extends and
carpi epicondyle of humerus. metacarpal. superficial compartment. branch of adduct hand
ulnaris It is long and slender radial at wrist joint.
in shape.
Anconeus Posterior surface of lateral Lateral surface Small, triangular (Posterior Extends and
epicondyle of humerus. of olecranon in muscle behind the interosseous). abduct ulna
a fan shaped cubital joint. It is Radial during
manner partially blended with nerve. pronation
triceps.
Muscular System 79
Deep Group

Supinator Lateral epicondyle of Neck and shaft of Deep muscles at Posterior Supination of
(turning humerus, annular radius. posterior aspect of interosseous forearm.
palm ligament. elbow largely nerve (deep
anteriorly) concealed by branch of
superficial muscle. radial).
Abductor Posterior surface of shaft Base of first It lies lateral and Posterior Abducts and
pollicis of radius. metacarpal parallel to extensor interosseous extends
longus bone. pollicis longus. nerve. thumb.
Extensor Posterior surface of shaft Brevis – base of Deep muscle pair with Posterior Brevis
pollicis of radius. proximal a common origin and interosseous extends
brevis and phalanx of action. nerve. metacarpo-
longus. thumb. phalangeal
Longus – base joint of thumb
of distal phalanx and longus –
of thumb. extends distal
phalanx.
Extensor Posterior surface of shaft Extensor Tiny muscle arising Posterior Extends
indicis of ulna. expansion of close to wrist. interosseous metacarpo-
index finger. nerve. phalangeal
joint of index
finger.
Muscles of Inferior Extremity (Fig. 4.10)

Muscle of Anterior Compartment (extensor group)
of thigh (seven muscles)

Sartorius Anterior superior iliac Inverted hockey Long, slender, super- Femoral Flexes, and
(sartor spine. stick like inser- ficial strap muscle, (anterior laterally
means tailor. tion in the upper descends downwards division) rotates thigh.
Tailor’s medial surface of and medially, crosses Weak flexor of
muscle) shaft of tibia. both hip and knee joint. knee. This
It forms lateral boun- position is
dary of femoral triangle. usually seen in
tailor which
uses their both
legs on the
machine.
Iliacus Iliac fossa of hip bone. With psoas into Large, fan-shaped Femoral Flexes hip.
lesser trochanter muscle, fibers covering nerve. Flexes trunk
of femur. downwards and passes and thigh as in
below the inguinal liga- sitting posture.
ment toward insertion.
Contd...
Fig. 4.10: Muscles of front of thigh (extensor compartment)

Poas major By fleshy slips from With iliac Longer, thicker, more Ventral rami • Prime mover
transverse processes, (together known medial muscle of the of L1-L3. of hip joint
bodies (upper and lower as ilio-psoas) into ilio-psoas pair; (flexion).
border) and disc of all lesser trochanter descends along the • Flexes trunk
lumbar vertebrae and T12. of femur. pelvic brim, below the on the thigh.
inguinal ligament and in • Important
front of hip joint, postural
towards insertion. muscle.
Pectenius Pecten pubis Upper end of Short, flat quadrilateral 1. Nerve to Flexes and
linea-aspara of muscle. It lies over pectenius adducts thigh.
shaft of femur. adductor brevis on (branch of
proximal thigh. femoral
nerve).
2. From
obturater.
Rectus Straight head – arises Through patella Superficial muscle of Femoral Extends knee
femoris from anterior inferior inserted to tibial extensor compartment (posterior and flexes thigh
(rectus – iliac spine.Reflected tuberosity via of thigh. Runs straight division) at hip joint.
straight) head – from ilium above ligamentum down in thigh. This is
acetabulum. patellae. the only muscle of
extensor group which
crosses the hip joint.
Vastus Greater trochanter, intert- Through patella Largest, bulky compo- Femoral Extends knee.
lateralis rochanteric line, linea inserted to tibial nent of quadriceps (posterior
division)
Contd...
Muscular System 81

aspara and lateral lip of tuberosity via femoris. It is a site for
gluteal tuberosity of ligamentum pate- intramuscular injection
femur. llae. particularly in infant.
Vastus Linea aspara, medial Through patella Forms inferomedial Femoral • Extends
medialis aspect of inter trochanteric inserted to tibial aspect of thigh. Fibers (posterior knee.
line medial supracon- tuberosity via pass downward and division) • Stabilizes
dylar line. ligamentum medially towards patella.
patellae. medial border of
patella.
Vastus inter From anterolateral and Through patella Obscured by rectus Femoral • Extends
medialis anteromedial surface of inserted to tibial femoris, intermediate in nerve knee
upper 2/3rd of femur. tuberosity via position on anterior
ligamentum thigh. It appears to be
patellae. inseparable from vastus
medialis.
Muscles of Medial Compartment of Thigh

(Adductor Group–Five Muscles)

Gracilis • By thin aponeurosis Upper part of Long, thin, superficial Obturator Adduct thigh,
(slender) from body of pubis. medial surface muscle broad above and nerve (Anterior flexes knee
• From ischiopubic rami. of shaft of tibia narrow below. division) and rotate it
posterior to medially.
sartorius.
Adductor Body of pubis as a C Linea aspara in Large, fan shaped Obturator • Adducts
Longus shaped tendon. the middle of muscle. Most anterior nerve (anterior thigh.
(longus – 1/3rd of femur. muscle among three division). • Flexes
long) adductors. medially
rotate thigh.
Adductor Body and inferior ramus Linea aspara Largely concealed by Obturator • Adducts
brevis of pubis. between adductor longus and nerve (anterior thigh.
(brevis – pectineous and pectineus. It is some division)
short) adductor longus. what triangular muscle sometimes
lies in contact with posterior
obturator externus. division.
Adductor • From ischiopubic rami. From medial A hybrid, triangular, Adductor • Adducts
magnus • Inferolateral aspect of margin of gluteal massive muscle with a portion. thigh.
(Magna – ischial tuberosity. tuberosity upto broad insertion. The Posterior • Hamstring
Large) adductor linear attachment of division of portion
tubercle of lower muscle is interrupted by obturator extends hip.
end of femur. a series of openings (for nerve.
four perforating arteries) Hamastring
portion by
sciatic nerve.
Muscles of Posterior Compartment of Thigh

(Flexor Group) (Fig. 4.11A)
They are called hamstring.
Group of muscle four in number.
Biceps femoris Long head – ischial Head of fibula. Most lateral muscles of Long head – tibial Extends hip
(Bi – two ceps tuberosity. Short hamstring group. In the portion of sciatic and flxes knee.
two headed), head – linea lower part it forms the nerve. Short head
e.g. two aspera, lateral lateral boundary of – common pero-
headed muscle supracon-dylar line popliteal fossa and neal part of sciatic
of shaft of femur. common peroneal nerve nerve
lies in its medial aspect.
Semiten- Ischial Medial aspect of It is quite fleshy and lies Tibial portion of Extends hip
dinosus (semi- tuberosity(upper upper tibial shaft. medial to biceps in sciatic nerve and flxes knee.
half, i.e. lower area). upper part. Lower third
half of it is of thigh it is replaced by
transformed a long tendon.
onto tendon)
Semimemb- Ischial tuberosity Medial condyle Deep semitendinosus Tibial portion of Extends hip
ranosus. (upper part) of tibia in a and posteromedial sciatic nerve and flxes knee
(nearly half of tubercle for aspect of thigh.
the muscle semimem-
flattened form, branosus.
i.e. me-mbrane
like)
Adductor magnus – Discussed in muscles of medial compartment of thigh.

Fig. 4.11A: Muscles of gluteal region
and posterior compartment of thigh
Muscular System 83
Muscles of Leg (Fig. 4.12A)

Anterior Compartment (Five in Number) of ankle and have a common innervation by deep
All muscles of anterior compartment are dorsiflexor peroneal nerve.
Tibialis Lateral surface of Inferior surface of Superficial muscle of Deep peroneal Dorsiflexion
anterior shaft of tibia medial cuneiform anterior leg, readily nerve. of ankle and
(upper 2/3rd) and and base of first palpable, lateral to tibia. invert foot.
from lateral metatarsal bone. In the lower 1/3rd of leg Maintain
condyle of tibia. the muscle belly is medial long-
replaced by tendon. itudinal arch.
Extensor • Lateral condyle Inserted into Lies lateral to tibialis Deep peroneal Dorsiflexor of
digitorum of tibia. distal phalanx of anterior muscle. nerve. foot and prime
longus • Proximal 3/4th 2-5 toes through In upper 1/3rd of leg mover in toes
of extensor dorsal digital anterior tibial vessel extension.
surface of fibula. expansion. and deep peroneal
• Interosseous nerve lies between it,
membrane. and tibialis anterior.
Peroneus • Lower 1/4th of Inserted on Small muscle, usually Deep peroneal Dorsiflexes
tertius extensor surface dorsum of fifth continuous and fused nerve. and evert
(Perone – of fibula. metatarsal, with distal part of foot.
fibula tertius – • Interosseous passing anterior extensor digitirum
third) membrane. to lateral longus. Not always
malleolus. present.
Extensor Arises from middle Inserted on distal It lies deep to extensor Deep peroneal Dorsiflexes
hallucis longus half of anterior phalanx of great digitorum longus and nerve foot and
(hallux – great surface of fibula. toe. tibialis anterior. It has extends great
toe) narrow origin. toe.
Fig. 4.12A: Muscles of anterior and

lateral compartment of leg
Fig. 4.12B: Muscles of back and lateral compartment of leg
Muscles of Lateral Compartment of Leg (Fig. 4.12B)
Peroneous Arises from head By a long tendon More superficial muscle Superficial Plantar flexor
longus and proximal 2/3rd which crosses the of the two. In the lower peroneal nerve. and evertor of
(longus– of lateral surface of sole obliquely and 1/3rd it ends in tendon foot.
long). shaft of fibula. inserted into base which passes behind the
of first metatarsal lateral mallesus and
and medial cunei- enter into sole.
form.
Peroneus Distal 2/3rd of Dorsal surface of Smaller than longus and Superficial Plantar flexor
brevis lateral surface of base of fifth lies deep to it. It ends in peroneal nerve. and evertor of
(brevis – fibula. metatarsal lateral a tendon which lies foot.
short) to peroneus behind the lateral
tertius. malleolus (brevis is
deep).
Muscular System 85
Muscles of Posterior Compartment (Back) of Leg

(Supplied by Tibial Nerve) (Fig. 4.12B)
Superficial Group
Gastrocnemius Medial, larger head

Via tendo- Paired superficial Tibial nerve. Plantar flexor
(most arises from a calcaneus muscle. Prominent of foot at ankle
superficial) depression behind (largest tendon bellies that form joint and flexes
adductor tubercle.in the body- prominence of calf. knee joint.
15 cm in length). Along with soleus it is
Lateral head from It is inserted into known as triceps
lateral surface of middle part of surae.
femur. posterior surface
of calcaneum.
Plantaris Lower part of lateral Posterior surface Generally very small Tibial nerve. Plantar flexor
supracondylar line of calcaneum. and feeble, but varies in of foot at ankle
of femur. size and extent, may be joint and flexes
absent. knee joint.
Soleus Soleal line middle 1/ Via tendo achills Lies deep to gastroc- Tibial nerve. Plantar flexor
3rd of medial border into posterior nemius; is a broad flat foot
of shaft of tibia, surface of muscle. Within it
upper 1/4th of fibula calcaneum. venous plexuses lies
which pump venous
blood upwards by
muscle action. So
soleus is known as
peripheral heart.
Deep Group
Popliteus Intracapsular but Posterior surface Thin, triangular muscle Tibial nerve. Flexes knee. Un-lock
extra–synovial, of shaft of tibia at posterior knees; knee joint by lateral
originates from above soleal line. passes downwards and rotation of femur on
groove on lateral medially in a fan shaped tibia and loose the
surface of lateral manner. It forms floor ligaments.
condyle of femur. of popliteal fossa.
Flexor Posterior surface of Bases of distal It is thin and pointed Tibial nerve. • Weak plantar
digitorum shaft of tibia below phalanges of proximally; runs medial flexor.
longus soleal line and lateral four toes. to tibialis posterior and • Flexes toes and
medial to vertical partly overlies posterior helps foot “to
ridge. on it. It is long and nar- grip” the ground.
row muscle. • Support medial
and lateral
longitudinal arch.
Contd...
Flexor Posterior surface of Base of distal Bipennate muscle. Tibial nerve. • Flexes distal
hallucis distal 2/3rd of phalanx of Bulckier than flexor phalanx of big toe.
longus fibula. hallux (great digitorum longus, and • Weak plantar
toe). laterally placed flexor of ankle.
• Support medial
longitudinal arch.
Tibialis Posterior surface of Tuberosity of Most deeply palced Tibial nerve Invert foot and
posterior shaft of tibia and navicular bone muscle of flexor group. weak plantar flexor.
fibula and and gives slips Support medial
interosseous mem- to other neigh- longitudinal arch
brane. bouring tarsal and transverse arch
bones, except of foot.
talus.
Muscles of Gluteal Region (Figs 4.11A and B)

Gluteus • From area behind 3/4th fiber in ilio Largest and more Inferior Extends and lateral
maximus the posterior tibial tract and superficial of gluteal gluteal nerve rotates the hip joint.
gluteal line of hip gluteal tuberosity muscle. From bulk of
bone. of femur. buttock; fibers are
• Outer sloping thick and course and
surface of dorsal runs downwards and
segment of iliac laterally.
crest.
Gluteus From outer ilium, Gluteal tube- Thick muscle; its Superior • Abducts thigh–
medius surface between rosity of femur. posterior 1/3rd is cove- gluteal nerve (acting from
anterior and post- red by gluteus maxi- pelvis) and rotate
erior gluteal lines. mus. It is superficial in it medially.
its anterior 2/3rd. Inter • Take an essential
muscular injection is part in maintaining
given in anterior part of the trunk upright
outer and upper part of when the foot of
hip region. the opposite site is
raised from the
ground.
Gluteus Between anterior Anterior surface Fan shaped smallest and Superior • Abducts thigh –
minimus and inferior gluteal of greater troch- deepest gluteal muscle. gluteal nerve (acting from pel-
line. anter of femur. vis) and rotate it
medially.
• Take an essential
part in maintaining
the trunk upright
when the foot of
the opposite site is
raised from the
ground.
Contd...
Muscular System 87
Fig. 4.11B: Insertion at the upper end of femur (muscle seen after
removal of gluteus maximus + gluteus medium)
Pyriformis From anterior Upper border of Pyramidal muscle; First and • Rotates thigh
surface of sacrum by greater troch- located on posterior second laterally
three steps: anter of femur. aspect of hip joint; sacral nerve • Assists abduction
comes out from pelvis (nerve to of thigh when hip
via greater sciatic pyriforms). is flexed
foramen. • Stabilizes hip joint
Obturator • Inner surface of Upper border of Surrounds their From sacral • Rotate thigh
internus obturator greater trochanter obturator foramen plexus. laterally.·
membrane. of femur. within pelvis. Leaves • Stabilizes hip
• Greater sciatic pelvis via greater joint.
notch and marg- sciatic foramen along
ins of obturator with two small gemelli
foramen. muscle.
Obturator • Medial 2/3rd of By a tendon into Flat, triangular muscle Obturator • Rotate thigh
externus the external trochanteric deep in upper medial nerve laterally.
surface of obtura- fossa. aspect of thigh. • Stabilizes hip
tor mem-brane. joint.
• From pubis and
ischium.
Tensor fasica From anterior 5 cm In iliotibial tract. Fibers run downwards Superior Extends knee and
lata of outer aspect of and backwards. gluteal nerve. laterally rotate the leg.
iliac crest.
Quadratus From femoral Quadratus Short, square muscle, Nerve of Lateral rotator of
femoris surface of body of tubercle of femur. lies between gemelli quadratus thigh.
(quadrate– ischium. above and upper border femoris.
square of adductor magnus
shaped) below in deeper plane.
Muscles of Abdomen (Fig. 4.13) abdominis. The three muscles blend and form a
There are four pairs of flat muscle in abdomen. broad sheat (aponeurosis). The aponeurosis in
They protect the anterior abdominal wall turn, encloses the fourth muscles rectus
from external injury as there is no bony support. abdominis in front like a sheath. This sheath is
The muscles are from outside inwards known as rectus sheath. They are the additional
external oblique, internal oblique, transverses muscles of expiration.
Fig. 4.13: Exposure of rectus sheath
External By fleshy slips from Most fibers It is most superficial By T7 to It compresses abdo-
oblique outer surface of lower inserted in linea muscle. Fibers run T12 minal wall and
(outer eight ribs. alba (white line) downwards and me- intercostal increases the intra-
layer) some into pubic dially and end in ap- nerve. abdominal pressure
crest, tubercle oneurosis, which (which helps in
and iliac crest. folds upon inferiorly micturition, defaeca-
and forms inguinal tion, sneezing, etc).
ligament along with the
muscles of back, it
helps in trunk
rotation and lateral
flexion.
Internal Arises from a Inserted in linea Fibers run upwards T7 – T12 Same as external
oblique thoracolumbar fascia, alba, pubic crest and forward at right intercostal oblique.
(Middle iliac crest, inguinal and last three angle to those of and L1
layer) ligament ribs. external oblique. nerves.
Contd...
Muscular System 89
Transeversus Arises from thoraco- In linea alba and Fibers run horizon- T7 – T2 Compresses abdo-
abdominis lumbar fascia, inguinal in pubic crest. tally and its deep intercostal minal contents.
(innermost ligament, cartilage of surfaces lined by nerve and L1
layer) last six ribs, iliac crest. transversalis fascia. spinal nerve.
Rectus Arises as tendon from Inserted in It is vertically placed T7 – T12 Flex and rotate the
abdominis public crest and xiphoid process straight muscle of intercostal lumbar region of
symphysis pubis (anterior sur- abdomen situated on nerves. vertebral column.
face) and 5–7 either side of midline
ribs (as fleshy intersected by tend-
fiber). inous intersection
Levator Transverse process of Located in the Medial border of Elevates the C3 and C4 spinal
scapulae first four cervical back and side of scapula. medial nerve and dorsal
(levator – vertebrae. neck, deep to border of scapular nerve.
elevator or trapezius. scapula.
raises)
Applied: Due to repeated childbirth in a woman, it is seen that the rectus muscle of abdomen is weak
and there is herniation between two recti. This is known as ventral hernia or abdominal hernia.
Muscles of Head (Fig. 4.14)

Muscles of scalp
Occipito- Epicranial Skin, superficial Bipartite muscle Facial nerve. Pull scalp forward.
frontalis has aponeurosis fascia of eyebrows. connected by
two parts: epicarnial aponeurosis
1. Frontalis (galea aponeurotica).
2. Occipitalis
From lateral 2/3rd Facial nerve. Move scalp
of superior nuchal backwards.
line of occipital and
from mastoid part of
temporal bones.
Fig. 4.14: Muscle of face

Muscles of Facial Expression
Orbicularis
occuli – two
parts
1. Palpebral Medial palpebral Lateral palpebral Thin, flat, circular Facial nerve. 1. Closes eyelid.
part ligament. raphe. muscle around eye. 2. Protects eye from
2. Orbital Frontal and Loops return to Paralysis lead to intense light and
part maxillary bones. origin. drooping of eyelid and injury.
G
spilling of tears.
Corrugator Superciliary arch. All muscles of Small muscle; actively Facial nerve. Draws eyebrows
R
superciliarils. face inserted in associated with together.Vertical
facial skin orbiculari occuli. wrinkling in
V
except masseter. forehead.
d
Orbicularis Maxilla, mandible Encircle oral Thin, flat muscle enc- Facial nerve. Compresses lips
oris and skin. orifice. ircling the oral aperture. together.
ti e
Other small muscles are, procerus (situated at root levator labii superioris, zygomaticus major,
of nose), dilator naris (dilates nostrils), compressor zygomaticus minor, levator anguli oris, risorius,
n
naris (reduces nostril), need not know in details. depressor anguli oris, depressor labii inferioris
and mentalis. They arise from bones and fascia
U
Dialator muscles of Lip around oral aperture and inserted into substance
-
They are levator labii superioris et alaequae nasi, of lip. They separate lips and supplied by facial
nerve.
Muscles of Mastication
9
ri 9
Masseter Zygomatic arch Angle and ramus Powerful muscle that Branch of Elevates mandible
of mandible. covers lateral aspect of mandibular and clenches teeth.
h
mandibular ramus. This nerve.
muscle is covered on its
a
lateral aspect by tough
t
masseteric fascia.
Temporalis Temporal fossa Coronoid process Fan shaped muscle. Its Branch of
(its top and contraction is easily felt mandibular
anterior border). during clenching of teeth.
teeth.
Medial • Medial surface of Medial surface of Thick, quadrilateral Mandibular • Synergist to

pterygoid lateral pterygoid mandible near its muscle with deep nerve. temporalis and
plate. angle. origin. The insertion of masseter in eleva-
• Tuberosity of the muscle makes the tion of mandible.
maxilla. mandible rugged upto • With lateral ptery-
mylohyoid line. goid it produces
side to side move-
ment.
Contd...
Muscular System 91
Lateral Infra temporal fossa Pterygoid fovea It is a short, thick muscle. Mandibular Pulls mandible
pterygoid of greater wing of at the neck of Maxillary artery either nerve. forward (protrudes
1.Upper sphenoid. mandible and crosses super-ficial or lower jaw) and
head articular disc. deep to the muscle. helps side to side
chewing movement.
2.Lower Lateral surface of

head lateral pterygoid
plate.
3.Buccinator Linear origin from The central fiber It is a thin, quadrilateral Buccal • Compresses
the region of molar decussate and muscle of cheek that branch of cheek against the
teeth of maxilla and upper and lower occupies the interval facial nerve. teeth and gums.
mandible. horizontal fiber between maxilla and
blends with orbi- mandible. A large mass
cularis oris. of fat separate it from
mandible. The muscle is
pierced by parotid duct.
Muscles of Neck (Fig. 4.15)

Muscles of Neck
Muscles of Anterior Muscles of Posterior

Triangle of Neck Triangle of Neck
Muscles of Anterior Triangle of Neck

Most important muscle is Sternocleidomastoid
which forms the posterior boundary of anterior
triangle. Fig. 4.15: Muscle of neck
Sternocleido • Anterior surface Mastoid process Two headed muscle, Accessory Both sided muscle
-mastoid manubrium of temporal bone. located deep to platy- nerve (11th acting together
sterni. sma on antero lateral cranial extend head and flex
• Medial 1/3rd of surface of neck. Key nerve) neck. Acting alone
cervicle. mascular landmark in one muscle, tilt head
neck. Spasm of this towards same side.
muscle cause wryneck.
Suprahyoid Group (Lies Superior to Hyoid Bone)
Digastric – Inserted Di – two; gaster – belly. • From • Elevate hyoid

two bellies intermediate The muscle arises as nerve to bone and steady
Anterior Impression on body tendon which is two bellies. Two bellies mylohyoid. it during
belly of mandible (lower held from hyoid from a V shaped area • From swallowing and
part). by a fascial ring. under the chin. facial speech.
nerve. • Depress
G
Posterior From deep groove mandible.
belly on the medial aspect
of mastoid process.
R
Stylohyoid Styloid process of Body of hyoid. Slender muscle below Facial nerve Elevates hyoid bone.
V
temporal bone. angle of mandible
parallel to posterior
d
body of digastric.
ti e
Mylohyoid Myloid line on the Body of hyoid Flat, triangular muscle Nerve to Elevates floor of
body of mandible. bone and fibrous just deep to disgastric; mylohyoid mouth and hyoid
raphae. this muscle pair form coming from bone in first stage of
n
the floor of anterior inferior alv- deglutition or
mouth. eolar nerve. depress mandible.
U
Geniohyoid Lower genial tuber- Body of hyoid. Narrow muscle, in First Elevates hyoid bone
-
cles contact with its fellow cervical and draws depress
on medial side, runs nerve. mandible.
from chin to hyoid.
9
Infrahyoid Group
ri 9
Sternohyoid • Upper part of Lower margin of Narrow, strap and med- Through • Depress hyoid
h
posterior surface body of hyoid ial most, muscles of ansa cervic- bone.
a
of manubrium bone. neck. Superficial muscle alis (slender • Plays a part in
t
sternal. except inferiorly where it nerve root of speech and masti-
• Medial end of is covered by sterno- cervical cation.
clavicle. cleidomastoid. plexus).
Sternothyroid From posterior Oblique line on Shorter and wider than Through Draw hyoid bone
surface of manu- lamina of thyroid sternohyoid lies deep ansa cervi- and the thyroid
brium inferior to cartilage. and partly medial to it. calis slender cartilage
origin of sterno- nerve root of (i.e. larynx)
hyoid known as cervical inferiorly.
details. plexus).
Thyrohyoid Oblique line on Lower border of Appear as a superior First cervical Depress hyoid bone
anterior surface of body of hyoid continuation of sterno- nerve via and elevates larynx.
lamina of thyroid bone. thyroid muscle; quadri- hypoglossal.
cartilage. lateral in shape.
Contd...
Muscular System 93
Omohyoid Lower border of Intermediate Thin, strap like muscle. Ansa Depress hyoid bone.
1. Superior body of hyoid. tendon is held to The inferior belly cervicalis.
belly clavicle and first divides the posterior
rib by a sling of triangle of neck into two
deep fascia. – upper occipital and
lower supraclavicular
triangle.
2. Inferior Upper border of –– Do ––
belly scapula near
scapular notch.
Muscles of Posterior Triangle of Neck (Fig. 4.15)
Sternocleido- Trapezius • A continuous Most superficial muscle Accessory • The upper fibers
mastoid • Medial 1/3rd of insertion of back of neck, and nerve. elevates the
superior nuchal along acromin thorax. Rhomboid in scapula.
line of occipital and spine of shape; upper fibers run • Middle fibers pull
bone. scapula (upper downwards and middle the scapula
• Ligamentus border of fibers run horizontally. medially.
nuchae. crest). Lower fibers runs • Lower fibers pull
• Spines of C7 and upwards and laterally. the medial border
all the thoracic of scapula
spine. downwards.
Scalenus Transverse process Scalene tubercle Located lateral neck Ventral rami • Elevates first rib
anterior of third to sixth of first rib. deep to sternocleido- of C4, C5, (and inspiration).·
(Though cervical vertebrae. mastoid.It is small C6. Bends the cervical
this is not in vertical muscle. • Portion vertebral
posterior column.
triangle – in
dissection it
is shown in
this region)
Scalenus
medius Transverse process First rib between The largest and longest Ventral rami • Bends cervical
of upper six cervical tubercle of rib of scalene. It is sepa- of C3 to C8th part of vertebral
transverse process and groove for rated from scalenus spinal nerves. column of same
(posterior tubercle). subclavian artery. anterior by the subcla- side.
vian artery, levator • Elevates first rib
scapulae and scalenus during active
posterior. inspiration.
Scalenus; Ventral
posterior Posterior tubercle of In second rib Smallest and most branches • Elevates second
4th, 5th and 6th deeply situated among from 6th, 7th rib.
cervical vertebrae the scalene. and 8th • Bends cervicle
cervical part of vertebral
nerve. column to the
same side.
Extrinsic Muscles of Tongue (Fig. 4.16)

Genio- Uppergenial Blends with Fan shaped muscle, Hypoglossal • Protrude tongue.
glossus tubercle of body of other muscle of forms part of tongue (12th cranial) • Acting bilaterally,
mandible. tongue. and lies on either side it depress the
of mid line. central part of
tongue.
Hyoglossus Body and greater Inferolateral Flat quadrilateral Hypoglossal • Depress tongue
G
cornu of hyoid aspect of tongue; muscle. (12th cranial and draws its
bone. blends with nerve) sides downwards.
other muscles
R
Styloglossus Styloid process of Inferolateral Slender muscle, Hypoglossal Draws tongue
V
temporal bone. aspect of tongue; running superiorly to (12th cranial upwards and
blends with hypoglossal nerve, nerve) backwards.
d
other muscle. shortest and smallest
of all muscles arising
ti e
from styloid process.
Chondro- Medial side and Blends with Sometimes described Hypoglossal Assists hyoglossus
glossus base of lesser cornu other muscles as part of hyoglossus; (12th cranial in depressing the
n
of hyoid. between sometimes separated nerve) tongue.
hyoglossus and from it by fibers of
genioglossus.
U
genioglossus.
Palato- Palatine Side of tongue. Form palatoglossal Pharyngeal Pulls root of the
-
glossus aponeurosis. fold of mucous plexus tongue upwards and
membrane; and backwards; narrows
anterior boundary of or opharyngeal
9
tonsillar fossa. isthmus.
ri 9
a h
t
Fig. 4.16: Muscles of tongue and
pharynx (lateral view)
Nervous System
INTRODUCTION the spinal cords. There are 31 pairs; 8 cervical, 12

thoracic, 5 lumbar, 5 sacral, 1 coccygeal. These
The nervous system is controlling and
communicating system of our body. Its main emerges through intervertebral foramina. Except
functions are to monitor, integrate, and response T2 – T12, all ventral rami join one another forming
to information on the environment. nerve plexuses. This plexuses occur in the cervical,
It is divided into two major parts: brachial, lumbar and sacral regions. The ventral
Central nervous system [including brain and rami of spinal nerves supply the limbs and the
spinal cord] and Peripheral nervous system [12 anterolateral aspect off the trunk.
pairs of cranial nerves, 31 pairs of spinal nerves
and their associated ganglia]. Cervical Plexus and its Branches
Functionally, the nervous system is again (Figs 5.1A to C)
divided into Somatic nervous system [which
controls voluntary function] and Autonomic The cervical plexus is formed by ventral rami of
nervous system [control involuntary function]. C1 – C4. It lies deep to the internal jugular vein,
Spinal Nerves: Spinal nerves are united ventral sternocleidomastoid, and anterior to scalenus
and dorsal roots, attached in a series, to the side of medius, levator scapulae. Its branches are:
Nerves Comments Structure served

Superficialis branches [cutaneous] Ascending (Figs 5.1A to C)
Lesser occipital nerve It is second cervical ventral ramus mainly. Skin on posterolateral aspect of
It hooks round the accessory nerves and neck.
ascends along the posterior border of
sternocleidomastoid.
Greater articular nerve It is the largest ascending branch encircles Skin of the ear over mastoid pro-
the posterior border of sternocleidomastoid. cess, and skin over parotid gland.
Transverse cutaneous Curves around the midpoint of the posterior Skin on anterior and lateral
[anterior] nerve border of sternocleidomastoid and runs aspect of neck.
horizontally deep to the external jugular
vein.
Contd...
Descending It arises as a common trunk, and later divides Skin of shoulder and anterior
Supraclavicular into medial, intermediate, and lateral aspect of the chest.
division at the posterior border of
sternocleido-mastoid.
Deep branches [motor] It lies over scalenus anterior muscle. Supplies diaphragm.
Phrenic nerve
Rectus capitis nerve
G
Anterior nerve
Rectus capitis nerve Very slender branch Supplies respective muscles.
Lateralis nerve
R
Longus capitis nerve
Longus coli nerve
V
Inferior root of ansa nerve
d
ti e
U n
-
9
ri 9
Fig. 5.1B: Cutaneous nerve supply of face,
scalp and neck
a h
t
Fig. 5.1A: Cervical plexus and its branches
Fig. 5.1C: Distribution of cutaneous nerves

Nervous System 97
Applied Anatomy Brachial Plexus and Its Branches (Fig. 5.2)

Lesion of the phrenic nerve – division of phrenic The large important brachial plexus is
nerve in neck during operation, procedures complete situated partly in the neck and partly in
paralysis of the diaphragm of that side identified the axilla. The plexus is formed by the ventral
during X-ray screening of chest. If accessory phrenic rami of the C5, C6, C7, C8 and the major part of
is present, complete paralysis will not occur. T1.
Branches from root

Dorsal scapular Arises from the root of brachial plexus, Rhomboids muscles.
pierce the scalenus medius.
Long thoracic Arises from the root of brachial plexus. Serratus anterior muscle.
Nerve to subclavius Arises from the trunk of brachial plexus. Subclavius muscle.
Very slender nerve.
Suprascapular nerve Arises from the trunk of brachial plexus. Shoulder joint; supraspinatous
Large branch. and infraspinatous muscle.
Branches from the lateral cord

Musculocutaneous Arises opposite lower border of pectoralis Biceps brachii, brachialis,
minor. coracobrachialis muscle and
elbow joint.
Lateral pectoral Small branches; pierces the clavipectoral Pectoralis major and minor.
fascia. Muscle of thumb to skin of lateral
2/3rd of palm.
Lateral root of median Discussed along with the medial root. The
two roots combine to form the median nerve.
Articular branches to elbow and wrist
Flexor carpi ulnaris and medial part

of flexor digitorum profundus
Branches from the medial cord

Medial pectoral Small branches, arise from medial cord, Pectoralis minor.
where it lies posterior to axillary artery.
Medial cutaneous nerve of arm Communication with intercostobrachial Supplies skin of upper and
nerve coming from T2. medial side of the arm.
Medial cutaneous branch of forearm The nerve situated medial to brachial artery. Supplies skin of upper and
medial side of the front of
forearm and skin over front of
arm.
Median nerve Arises as two roots from lateral and medial It gives no branch in arm.
cord of brachial plexus lies in front of or Muscular branches to pronator
slightly lateral to the axillary artery. teres, pronator quadratus, flexor
Contd...
carpi radialis, the palmaris longus

and flexor digitorum super-
ficialis, lateral half of flexor
digitorum profundus (i.e. most
deep muscle of flexor compart-
ment except flexor carpi ulnaris
and medial part of flexor
digitorum profundus.
G
Ulnar nerve It is the terminal branch of medial cord; run Flexor carpi ulnaris, medial half
along the medial aspect of arm and passes of flexor digitorum profundus
R
behind the medial epicondyle to enter most intrinsic muscle (about 20)
forearm. of hand, skin of medial 1/3rd of
hand (both palm and dorsum).
V
Branches from posterior cord
d
Upper subcapular It is a slender nerve, passes posteriorly and Subscapular muscle.
difficult to trace in axilla dissection; when
ti e
clavicle is present.
Thoracodorsal Arises between upper and lower subscapular, Latissimus dorsi.
n
runs inferolaterally.
Lower subscapular Passes inferolaterally deep to subscapular Inferior portion of subscapularis
U
artery and vein. and teres major.
-
Axillary Terminal branches, passes to posterior aspect Deltoid, teres minor, shoulder
of arm through quadrangular space, winds joint, skin over the inferior part
round the surgical neck of humerus. of deltoid.
9
Radial Terminal and largest branch; passes posterior Triceps, anconeus, brachio-
ri 9
to axillary artery enters radial groove with radialis and extensor muscles of
anteria profunda brachii. forearm. Skin of posterior aspect
of arm and forearm.
a h
t
Fig. 5.2: Brachial plexus

Nervous System 99
Lesion of Important Nerves of Brachial the neck but can be injured in penetrating injuries
Plexus (Fig. 5.3) (in war) can be avulsed (in birth trauma and motor
The brachial plexus is deeply placed in the root of cycle accident).
Names Site of injury Effect (Manifestation)

Suprascapular At the suprascapular notch, [entrapment Weakness of supraspinatous and infras-
nerve neuropathy] or trauma in this region. pinatous muscle and gradually muscle
wasting.
Long thoracic Blow in the posterior triangle of the neck or Paralysis of the serratus anterior, muscle. So
nerve (Fig. 5.3) during surgical procedure. there is difficulties in arising arm above
head. There is winging of scapula.
Upper lesion of In mortorbike accident when there is Supraspinatous, infraspinatous, subclavius,

brachial plexus or Erb abnormal separation of head and shoulder, biceps brachii and greater part of brachialis,
Duchenne palsy during delivery (the same cause), the region coracobrachialis and deltoid are paralysed.
[mainly C5 and partly of Erbs point (meeting of six nerve) is So the arms hang by the side of the trunk
C6 is involved] involved. and rotated medially, elbow extended and
(Fig. 5.4) forearm pronated, as if some body is taking
the tips. Movements of the wrist and fingers
are not lost.
Lower plexus paralysis It occurs in the lower part of the neck, and Progressive weakening of small muscles of
[klumpkee] involves axilla (upper part) by cancerous infiltration hand and wasting of muscle gradually.
C8 and T1 from apex of lung, of breast, cervical rib, Hypothenar emences become wasted. This
etc. is known as claw hand [due to hyperex-
tension of metacarpophalangeal joint and
flexion of interphalangeal joint].
Axillary NV lesion Fracture at the surgical neck of humerus Paralysis of deltoid with dropping of
shoulder as first initiator of abduction is lost
(deltoid).
Fig. 5.3: Winging of right scapula due to paralysis of Fig. 5.4: Erb-Duchenne paralysis (waiters tip)
long thoracic nerve which supplies serratus anterior
Important Nerves of Brachial Plexus (More

Details) Median Nerve (Figs 5.5, 5.6 and 5.7)
Origin Course Branches Applied
From lateral and It embraces the third part of Muscular to the super- Injury, above elbow, (as in the
medial cord of axillary artery in the axilla. In the ficial flexor muscles of supracondylar fracture) – produce
brachial plexus in arm it is lateral to brachial artery, forearm except the paralysis of all the flexor muscle
axilla. near the insertion of coraco- flexor carpi ulnaris. of forearm except, flexor carpi
brachialis it crosses in front of the Anterior interosseous ulnaris. In the hand, thenar muscle
G
artery and in cubital fossa it is branch, supplies flexor and first and second lumbricals are
medial to the artery. It enters the pollicis longus. Palmar paralysed. So forearm lies in the
R
forearm by passing between two cutaneous branch – supine position, hand is adducted;
heads of pronator teres, separated arises above the flexor flexion at interphalangeal joints of
from ulna art by deep head of retinaculum, supplies index and middle finger is lost.
V
pronator teres. In the forearm lies the skin of thenar When the patient tries to make a
d
deep to flexor digitorum eminence. It gives fist, the index and middle finger
superficialis and profundus. The articular to elbow joint, tend to remain straight. The
ti e
nerve enters the hand by passing the proximal radio-ulnar muscles of thenar eminence are
deep to flexor retinaculum (in the joint; vascular to radial paralysed and the eminence if
carpal tunnel) and it divides into and ulnar artery. flattened. The thumb is adducted
two, to supply the lateral 3½ and laterally rotated (ape-like
n
digits. hand). There is sensory loss of
lateral 3½ finger.
- U
9
ri 9
a h
t
Fig. 5.6: Sensory supply of hand
Fig. 5.5: Median nerve, ulnar nerve and

radial nerve in forearm
Fig. 5.7: Median nerve palsy
Nervous System 101
Ulnar Nerve (Figs 5.5 and 5.9)
It is the continu- In the axilla it runs downwards • Articular to elbow, Ulnar nerve paralysis commonly
ation of medial between axillary artery and vein; wrist. occurred behind the medial
cord of brachial then medial to brachial artery in • Muscular to flexor epicondyle of humerus.
plexus. the arm. At the middle of the arm carpi ulnaris and • There is impairment of power
the nerve pierces the medial flexor digitorum of adduction at the wrist due to
intermuscular septum, descends in profundus. paralysis of flexor carpi ulnaris
the back of arm up to medial • Superficial – sensory and medial ½ of flexor
epicondyle. Here nerve can be felt supply to medial 1½ digitorum profundus flattening
against the bone. The nerve enters digit and mascular to of medial side of forearm.
the forearm between two heads of palmaris brevis. • Paralysis of interosseous muscle
flexor carpiulnaris, runs between • Deep terminal branch produces claw hand (hyper
flexor digitorum profundus (on –muscular to adduc- extension of metacarpo-
medial aspect) and flexor tor pollicis, all palmar phalangeal joint and flexion of
digitorum superficialis (on medial and dorsal interossei interphalangeal joint).
aspect). The nerve enters the palm and third and fourth • Inability to adduct the thumb.
by passing superficial to flexor lumbricals • Wasting of hypothenar muscle.
retinaculum lateral to pisiform • Sensation is impaired in the
bone ulnar 1½ fingers on both palmar
and dorsal surfaces.
All muscles of hand are supplied by ulnar nerve except muscle of thenar eminence and first and second lumbricals (supplied
by median nerve).
Radial Nerve (Figs 5.5 and 5.8)

Arise from post In axilla it descends behind the Muscular: Radial nerve palsy commonly
cord; largest third part of axillary artery. In 1. Triceps occurs due to compression of
branch of between long and lateral head of 2. Anconeus nerve in axilla (malfitted crutchs
brachial plexus. triceps, it enters the spiral groove 3. Brachioradialis at armpit); arm thrown carelessly
with arteria profunda brachii. It 4. Brachialis (lateral by drunkers over a chair [Saturday
pierces the lateral intermuscular part) night palsy].
septum to enter the anterior 5. Extensor carpi • Elbow and wrist extension is
compartment. In front of lateral radialis longus impaired.
epicondyle it divides into posterior inteross- • So there is wrist drop,
superficial and deep branches. The eous nerve supplies. fingerdrop due to weakness of
superficial branch lies in front of 6. Supinator extensor tendon.
supinator muscle deep to 7. Extensor carpi • Sensory impairment in lower
brachioradialis and descends radialis brevis. part of arm, back of forearm,
lateral to radial artery. In the 8. Extensor digitorum lateral part of dorsum of hand.
middle third of arm the artery is 9. Exterior carpi Post interosseous palsy. This is
medially situated; it quits the ulnaris due to compression of nerve
artery about 7 cm above the styloid 10. Exterior pollicis within the extensor muscles.
process of radius. Deep terminal longus • No sensory impairment since
branch is known as posterior 11.Abductor pollicis the superficial branch arises
interosseous nerve. longus above this level.
Articular to radio carpal • There is weakness in finger
joint. and thumb (extensions and
abduction).
Fig. 5.8: Wrist drop due to radial nerve palsy Fig. 5.9: Ulnar nerve palsy
G
Musculocutaneous
R
V
Arises from lateral It runs down between the axillary • Muscular to biceps Rarely injured, as it is protected
cord of brachial artery and coracobrachialis, leaves brachii. by biceps brachii. If it is injured,
d
plexus at the level the axilla by piercing the cora- • Lateral half of it is injured high up in the arm.
of lower border of cobrachialis. It descends laterally brachialis. Biceps and coracobrachialis will
ti e
pectoralis minor. between biceps and brachial is to Cutaneous branch to be paralysed resulting in marked
the lateral side of the arm; just forearm weakness in elbow flexion.
below elbow it pierces the deep Sensory impairment on the
fascia, lateral to tendon of biceps, extensor aspect of forearm.
n
continued as lateral cutaneous
nerve of forearm.
U
Lumbar Plexus and its Branches
-
psoas major muscles anterior to lumbar transverse
The plexus is formed by union of ventral rami of processes. Branches come out from lateral border
L1, L2, L3 and L4. It lies in the posterior part of of psoas major (Figs 5.10A and B).
9
ri 9
Ilio hypogastric It comes out from upper part of psoas major, crosses obliquely Muscles of anterolateral abdo-
behind the lower pole of kidney, then it lies in front of quadratus minal wall (internal oblique and
transverses) abdominal skin of
h
lumborum; pierces internal and external oblique muscle near
iliac crest. lower abdomen, lower back and hip.
a
Ilio inguinal It comes out below and parallel to ilio hypogastric, cross Skin of the external genitalia and
t
obliquely the quadratus lumborum, pierces the roof of inguinal upper medial aspect of thigh and
canal and comes out through superficial inguinal ring. internal oblique muscle.
Lateral femoral Runs inferolaterally in front of iliacus muscle, enters thigh Skin of the lateral side of the
cutaneous behind the inguinal ligament, just medial to anterior superior thigh.
iliac spine. It may be compressed by inguinal ligament or
through fascia lata. There is tingling sensation in the area served
by this nerve.
Femoral Largest branch of lumbar plexus. Emerging low, from lateral Skin of the anterior and medial
(Fig. 5.11) border of psoas major, enters thigh behind the inguinal side of the thigh. Skin of the
ligament, lies in ilio psoas groove. Splits into anterior and medial side of the leg and foot. It
posterior divisions.Branches of anterior division-(a) Two also supplies hip joint, knee joint.
cutaneous (b) One muscular Branches of posterior division- Motor to quadriceps femoris,
(a) Four muscular – to vasti and rectus femoris. (b) One sartorius, pectineus and iliacus.
cutaneous – saphenous nerve.
Nervous System 103
Fig. 5.10A: Lumbar plexus and its branches
Branches comes out from medial border of psoas major (Figs 5.10B and 5.11)
Fig. 5.10B: Posterior abdominal wall (Right sided psoas

major is cut for better exposure of lumbar plexus
Fig. 5.11: Femoral nerve and its branches in thigh (right)

Branches Come Out from the Medial Border

of Psoas Major
Obturator It emerges near pelvic brim passes behind the common Motor to adductor longus,
(Fig. 5.11) iliac vessels. It enters in obturator canal and divides into adductor brevis, pubic fiber of
anterior and posterior division. adductor magnus, gracilis and
obturator externus. It supplies
articular branches to hip and knee
joint, cutaneous branch to the
G
skin of medial thigh.
Accessory obturator Not always present. When present it is very thin and small. It supplies pectineus muscle and
R
hip joint.
Lumbosacral trunk Thick nerve trunk descends in front of ala of sacrum and
V
(Fig. 5.11) joins with ventral rami of sacral nerve form.
d
Sacral Plexus and its Branches
ti e
It is formed by lumbosacral trunk (part of L4 and and part of the fourth sacral ventral rami. It lies in the
whole of L5), the first to third sacral ventral rami, posterior pelvic wall and in front of pyriformis muscle.
U n
-
9
ri 9
a h
Nerves
t Figs 5.12A and B: Sacral plexus and its branches
Comments Structure served

Superior gluteal Comes out through greater sciatic forearm It is motor to gluteus medius, minimus and
(Figs 5.12A and B) above pyriformis and immediately divide into tensor fascia lata.
superior and inferior branch.
Inferior gluteal Comes out through greater sciatic forearm Gluteus maximus.
below pyriformis and supply the gluteus
maximus from its deep surface
Contd...
Nervous System 105
Posterior femoral It descends under cover of gluteus maximus, Skin of buttock, posterior thigh, popliteal
cutaneous lying postero-medial to sciatic nerve. region.
Pudendal It leaves the pelvis via greater sciatic foramen Supplies the most of the skin and muscles
below pyriformis and lies over the tip of ischial of perineum and external anal sphincter.
spine along with the internal pudendal vessels
– re-enter pelvis through lesser sciatic foramen
runs in pudendal canal.
Sciatic nerve Broadest nerve of the body; comes out through Hamstrings muscles, gastrocnemeus, soleus,
A. Tibial component greater sciatic foramen below pyriformis. It lies plantaris, popliteus, deep muscles of poste-
(Figs 5.13A and B) in between ischial tuberosity and greater rior tibio-fibular region and muscles of sole
trochanter. It descends in the back of thigh and and foot.
divides into tibial and common peroneal com- To knee joint
ponent. In the popliteal fossa, this nerve supplies To skin of posterior surface of leg and foot.
to popliteal vessels and in the distal part of the
fossa, it is continued as tibial nerve of leg.
B. Common peroneal It is half the size of the tibial; situated at the medial Gives cutaneous branch to skin of anterior
component border of the biceps femoris in the popliteal fossa, surface of leg and dorsum of foot.
and at the neck of fibula it divides into superficial Motor to short head of biceps femoris, peron-
and deep peroneal branch. eal muscles, muscles of anterior compartment
of leg (tibialis anterior, extensor hallucis
longus, extensor digitorum longus and
peroneus tertius).
Fig. 5.13A: Sciatic nerve and hamstring muscle in Fig. 5.13B: Tibial nerve and muscles of right leg
back of thigh (right) (soleus and plantaris removed)
Applied Anatomy – Sciatic Nerve frequently injured during fracture of the neck
of fibula or a badly fitting leg plaster. Complete
1. Shooting pain along the distribution of sciatic
division produces paralysis of muscles of
nerve is known as sciatica. Injection Novocain
anterior and lateral compartment of leg and the
is given midway between ischial tuberosity and
short extensor of toes. The dorsiflexion and
greater trochanter of femur around the sciatic
eversion is lost, so there is foot drop and
nerve, to get relief from sciatica pain.
inversion.
2. Damage of the individual component of sciatic
nerve takes place by bullet wounds in the region
AUTONOMIC NERVOUS SYSTEM
of back of thigh. If tibial component is injured,
G
paralysis of the superficial and deep muscles It is the part of nervous system that controls
of calf and sole takes place. There is loss of automatic activity of our body (i.e. involuntary
R
plantar, flexion of the ankle joint and toes. So activity) like heart, smooth muscles and gland. It
the foot is held in calcano-valgus position and is divided into two parts sympathetic and
V
walking is difficult. parasympathetic and both parts have afferent and
3. The common peroneal component most efferent nerve fibers (Figs 5.14A and B).
d
ti e
U n
-
9
ri 9
a h
t
Fig. 5.14A: Autonomic nervous system (sympathetic division)

Nervous System 107
Characteristic Sympathetic Parasympathetic
Action It prepares body for emergency. Maintenance functions, i.e. conserves and
stores.
Origin (outflow) Arises from thoracolumbar outflow (lateral Craniosacral outflow (i.e. brainstem nuclei of
horn of grey matter of spinal chord). third, seventh, tenth cranial nerves and S2, S3,
S4 segments of spinal cord).
Preganglionic fiber Myelinated Myelinated.
Contd...
Fig. 5.14B: Autonomic nervous system (para sympathetic division)

Characteristic Sympathetic Parasympathetic
Location of ganglia Paravertebral (sympathetic trunk), preverte- Small ganglia close to viscera (e.g. otic,ciliary)
bral coeliac, superior mesenteric, inferior or ganglion cells in plexuses (cardiac and pul-
mesenteric. monary plexus).
Relative length of Short preganglionic, long postganglionic. Long preganglionic

preganglionic and Short postganglionic.
postganglionic fibers
G
Degree of branching Extensive Minimal
of preganglionic fibers
R
Neurotransmitters All preganglionic fiber release acetylcholine. All fibers release acetylcholine (cholinergic
V
Most postganglionic fibers liberate nore- fibers).
pinephrine (nor-adrenaline). So it is adre-
d
nergic except sweat glands (cholinergic).
ti e
Physiological • Reaction is mass response. • Reaction is localized.
• Increase heart rate, increase blood pressure, • Decrease heart rate
constriction of cutaneous arteries (increase • Increase glandular secretion.
n
blood supply of heart, muscle, brain), • Increase peristaltic activity of gut.
decrease peristaltic activity of gut.
U
All structures are supplied by post- All structured are supplied by postganglionic
-
ganglionic fiber except suprarenal medulla fibers.
(supplied by preganglionic as it is a
sympathochromaffin organ).
9
ri 9
Higher control Hypothalamus Hypothalamus
h
Sympathetic Trunk (Fig. 5.14A)
1. They may terminate in the ganglion they have
a
They lie on either side of vertebral column; extends entered. These postganglionic nerve fiber
t
from base of the skull to the coccyx. It looks like a (known as rami), now pass through the thoracic
knotted thread. There are three cervical ( superior, spinal nerve and supply the smooth muscle of
middle and inferior), eleven thoracic, four lumbar, blood vessels and sweat glands.
four sacral ganglia. The sympathetic ganglions are 2. The fibers may ascend high up and terminate in
structures where synapse (white rami) between pre cervical ganglia or lower fiber may descend
and postganglionic fiber takes place. The right and down in lower lumbar and sacral ganglia.
left trunk coverage medially and form ganglion 3. Some of the preganglionic fibers may pass
impar (unpaired) in front of coccyx. Most through the ganglia on thoracic part of
preganglionic fibers reach the sympathetic trunk, sympathetic trunk without synapsing. These
they have three types of termination: fibers form three splanchnic nerve.
Nervous System 109
• Greater splanchnic nerve – Arise from fifth • Hypertension (high blood pressure) – May result
to ninth thoracic ganglia pierces the from excessive sympathetic activity. It is known
diaphragm and synapses (neuro – neuronal as stress-induced hypertension.
junction) with coeliac plexus.
• Vaso-occlusive disease – They are Raynaud’s
• Lesser splanchnic nerve – Arise from tenth
disease affecting the upper limb, Buerger’s
and eleventh thoracic ganglia, pierces
disease affecting the lower limb. It is
diaphragm and synspses with lower part of
characterized by gradual cyanosis (bluish
plexus.
coloration), pain in the affected region in severe
• Least splanchnic nerve – Spinal nerve
correspond to the same segment of spinal cases gangrene (tissue death) may result. To treat
cord, but the sympathetic path ways do not severe cases, sympathectomy is done. The
correspond with the segment of spinal cord. involved vessels dilate, re-establishing adequate
• T1 segment – Passes up and goes to head blood delivery to the affected region.
region • Congenital megacolon (Hirschsprung’s disease)
• T2 segment – goes to neck. – In this condition, parasympathetic innervation
• T3 – T6 segment – into thorax of the distal part of colon fails to develop. As a
• T7 – T11 segment – for abdomen result, distal colon is immobile and dilated. The
• T12 – L2 segment – for leg. condition is corrected surgically.
Preganglionic fibers are cholinergic in both
• Achalasia (Not relaxed) – A condition where
sympathetic and parasympathetic; postganglionic
oesophagus is unable to propel food in the lower
sympathetic fiber are adrenergic except for sweat
gland and arrector pili muscle. Postganglionic part due to parasympathetic neuron deficiency.
neurone of parasympathetic is cholinergic. Para- The distal esophagus becomes dilated and
sympathetic are essential for life. vomiting is common.
• Horner’s syndrome – Results from an
Applied interruption of the sympathetic nerve supply to
Autonomic Nervous System is involved in every head and neck. The effected person exhibits
important process that goes in our body. Most contriction of pupil (myosis), slight drooping
autonomic disorders reflect, excess, or deficient of eye lid (ptosis), vasodilatation of skin
controls of smooth muscle activity. arterioles and loss of sweating (anhydrosis).
CRANIAL NERVES (12 pairs)
110
Name and Origin and

Function Clinical testing Applied
components course
Olfactory (special Olfactory nerve fibers arise from Smell from nasal mucosa of Person is asked to sniff the Fracture of ethmoid or
sensory) No. I olfactory receptor cells located on roof of each nasal cavity and aromatic substance like lesion of olfactory fibers
(Figs 5.15 and olfactory epithelium of nasal cavity and superior sides of nasal septum clove oil, vanilla, etc and to may result in partial or
5.16) pass through cribriform plate of ethmoid and superior concha. identify each. total loss of smell
and synapse in olfactory bulb. The bulb (anosmia).
end posteriorly as olfactory tract, which
runs beneath the frontal lobe and
terminate in the olfactory cortex.
Anatomy at a Glance
Optic Fibers arise from eye forms optic nerve, Vision from retina Acquity of vision and visual Damage leads to blindness
(special sensory) which passes through optic foramen of fields are determined with in eye served by the
No. II (Fig. 5.16) orbit; the nerve converge to form optic eye chart and by testing the nerves.
chiasma where the nasal fiber crosses point at which the person
over. The nerve continue and as optic first sees an object moving
tract – enters thalamus and synapses into the visual field.
there. Thalamic fibers run as optic
radiation to occipital cortex where visual
interpretation occurs.
Occulomotor Fibers arise from ventral aspect of Somatic motor to four Pupils are examined for In this nerve paralysis, eye
(somatic motor midbrain and junction of pons and pass intrinsic muscle of eye size, shape and equality. cannot move up, down or
and visceral through superior orbital fissure to eye. (superior, inferior, medial Papillary reflex is tested inward and at rest, eye
motor) recti, inferior oblique) with pencil torch. rotates laterally (external
No. III and levator (palpebral Convergence for near strabismus), drooping of
(Fig. superioris) elevates vision is tested (ability to upper eyelid. Person has
5.15) eyelid and accommo- follow object near the eye). double vision and trouble
dates eye. Parasy- on focusing near object.
mpathetic motor – to
constrict muscle of iris,
and to ciliary muscle (for
changing the shape of
lens).
Fig. 5.16: Optic nerve (C.N.2)
Contd...
Nervous System
Fig. 5.15: Base of brain and superficial origins of cranial nerves

111
Name and Origin and
Function Clinical testing Applied 112
components course
Trochlear (motor) Fibers emerge from dorsal midbrain and Motor to superior oblique Like cranial nerve III. Trauma or paralysis results
No. lV course ventrally around the midbrain, to that assist in turning eye in double vision and
(Figs 5.15 and enter orbit through superior orbital inferolaterally. reduced ability to rotate
5.17) fissure along with occulomotor nerve. eye inferolaterally.
Trigeminal Fibers arises from the junction of pons Convey sensory impulse from Corneal reflexes tested by Injury to terminal bran-
(largest cranial and middle cerebellar peduncle and enter skin of forehead, scalp, touching cornea by wisp of ches (particularly maxil-
nerve) No. V the face via superior orbital fissure. eyelid, cornea, mucosa of cotton – it elicit blinking. lary) in roof of maxillary
(mixed) nerve (Figs 5.15 and 5.18A) nasal cavity and para nasal sinus, pathologic process
three divisions: sinuses. affecting trigeminal nerve
Anatomy at a Glance
Ophthalmic – produce loss of pain and

division (sensory) touch sensation. Pares-
thesia of face; loss of
corneal reflex
Maxillary division Fibers run from pons to face via foramen Sensory impulse from nasal Sensation of pain, touch,
(sensory) rotundum. cavity, palate, upper teeth and temperature are tested by
(Fig. 5.18B) skin of cheek, upper lip and safety pin and by touching
lower eyelid. hot and cold objects.
Mandibular Fibers pass through foramen ovale. Convey sensory impulse from Motor activity can assessed Paralysis of masticatory
division (motor + out 2/3rd of tongue except by asking the person to muscles, derivation of
sensory). taste buds, lower teeth, skin clench his teeth, open mandible to the side of
(Fig. 5.18B) of temporal region of scalp, mouth against resistance lesion, when the mouth is
supplies motor fibers to and move jaw side to side. opened.
muscles of mastica-tion.
Abducent Fibers leave inferior aspect of pons and Lateral rectus muscle turns Patient is asked to rotate the Injury to base of brain or
No. VI pass through superior orbital fissure and eyeball laterally. eye laterally. Person can fracture involving caver-
Mainly motor supply lateral rectus muscle. move, if the nerve is all nous sinus or orbit. Cause
(Figs 5.15 and right. no movement of eyes on
5.17) lateral side and diplopia on
lateral grazing.
Contd...
Fig. 5.17: Distribution of 3rd, 4th and 6th NV. in the orbit
Nervous System
113
Fig. 5.18A: Different banches of trigeminal nerves Fig. 5.18B: Cutaneous distribution of
trigeminal nerve
Name and Origin and
Function Clinical testing Applied
114
components course
Facial (mixed) Fibers arise from pons just lateral to It is the chief motor nerves of Anterior 2/3rd of tongue is Laceration in parotid
nerve No. VII abducent nerves, enter temporal bone face have five major branches tested for ability to taste region produces paralysis
(Figs 5.19A to C) through internal auditory meatus and run – temporal, zygo-matic, sweet, salty, sour and bitter of facial nerve results in
within internal ear before emerging buccal, mandibular and substances. Symmetry of paralysis of facial muscles,
through stylomastoid foramen, nerve cervical. It also transmit face is checked. Subject is eye remains open, angle of
then passes to lateral aspect of face and parasympathetic motor asked to close eyes, smile, mouth droops, Bell’s palsy
supplies muscles of facial expression. impulse to lacrimal, nasal and whistle and so on. – characterized by paraly-
palatine glands. Convey sis of facial muscle, partial
sensory impulse from taste loss of taste sensation,
bud of anterior 2/3rd of may develop rapidly in
Anatomy at a Glance
tongue. Herpes Zoster infection.
Vestibulocochlear Fiber arises from hearing, organ of corti, Purely sensory.Cochlear Hearing (air and bone Lesions (due to infection)
No. VIII forms cochlear division and equilibrium division is responsible for conduction) is checked of cochlear nerve produce
(Sensory) (semicircular canals) from vestibular hearing and vestibular usually by tuning fork. nerve deafness. Where as
division apparatus located within internal division for sense of damage to vestibular
ear of temporal bone and pass through equilibrium. division produce tinnitus,
internal acoustic meatus and enter vertigo, nausea, vomiting.
brainstem at pontomedullary junction.
Glossopharyngeal Fibers emerge from medulla and leave Motor to stylopharyngeus Position of uvula is check- Injury or inflammation of
No. IX skull through jugular foramen. muscle (assists swallowing); ed. And swallowing refle- glossopharyngeal pain in
(Secretomotor, secteromotor to parotid gland. xes are checked. Subject is swallowing and taste is
parasympathetic It covers general sensation asked to speak and cough. lost (particularly bitter).
sensory) and taste sensation from Posterior 1/3rd of tongue
posterior 1/3rd of tongue. may be tested for taste.
Contd...
Fig. 5.19A: Distribution of facial nerve in face Fig. 5.19C: Bell's palsy
(like 5 fingers in hand)
Nervous System
115
Fig. 5.19B: Distribution of facial nerve (7th cranial)

Name and Origin and
Function Clinical testing Applied 116
components course
Vagus (mixed) The only cranial nerve that extends Mixed nerves; nearly all Like cranial nerve IX. Brainstem lesion or deep
No. X beyond head and neck region. Fibers motor fibers are sympathetic laceration of neck
(Figs 5.20A and emerge from medulla, pass through efferent, except muscles of produce sagging of soft
B) jugular foramen and descends through pharynx and larynx. Parasy- palate, deviation of uvula
neck region into thorax and abdomen. mpathetic motor supply to to unaffected side, hoarse-
heart, lungs and abdominal ness due to para-lysis of
viscera (from pharynx to vocal fold. Diffi-culty in
splenic flexure of colon, liver swallowing and speaking.
and kidneys).
Anatomy at a Glance
Accessory (cranial Cranial root emerges from lateral aspect Muscle of soft palate except Sternocleidomastoid and Laceration of neck pro-
root and spinal of medulla. Spinal root arises from tensor vele palatine; pharynx trapezius muscle are duces paralysis of sterno-
root) superior region of spinal cord enter skull (except stylopharyngeus). checked for strength by mastoid and superior
No. XI via foramen magnum and temporally Larynx (except cricothyroid) asking person to rotate head fibers of trapezius. There
Motor joins spinal root; the resulting nerve and sternocleidomastoid and and shrug shoulder against is drooping of shoulder.
(Figs 5.15 and comes out through jugular foramen, the trapezius. resistance.
5.21) cranial and spinal root diverge.
Cranial root fibers joins the vagus to
supply larynx and spinal root supplies
the sternomastoid and trapezius.
Hypoglossal Fibers arise by a series of rootlets from Supplies muscles of tongue Person is asked to protrude In lesion of hypoglossal
No. XII medulla and exit from skull via (except palao glossus) and tongue. Any deviation can nerve, protrude tongue
Motor hypoglossal canal and supplies tongue controls its shape and be noted. deviates toward affected
(Fig. 5.22) muscles. movement. side. It causes difficulty of
speech (moderate dysar-
thria).
Nervous System 117
Fig. 5.20A: Vagus nerve (branches arising in the head and neck)
Fig. 5.20B: Distribution of vagus nerve

Fig. 5.21: XI Accessory nerve: that spinal portion ascending into the cranium to
join the cranial portion before exiting the jugular foramen
Fig. 5.22: Distribution of hypoglossal nerve

Heart and Arterial System
TERMINOLOGY USED IN DESCRIPTION layer). It has four chambers – right atrium, right
OF BLOOD VESSELS ventricle, left atrium and left ventricle. The two
atria are separated from ventricle by an incomplete
• Angina pectoris – chest pain
c-shaped sulcus – atrioventricular groove. Right
• Artery – carries more oxygenated blood away
atrium receives poorly oxygenated blood through
from the heart.
• Embolous – plug. superior vena cava, inferior vena cava and coronary
• Infarction – virtually blood less area. sinus. Blood passes from atria to ventricle by right
• Ischemia – lacking adequate blood supply. atrioventricular orifice (tricuspid orifice) and
• Stenosis – narrowing. thence ejected to pulmonary trunk for oxygenation
• Vein – carries poorly oxygenated blood towards (pulmonary circulation). The left atrium receives
the heart. oxygen rich blood via four pulmonary veins. From
left atrium, blood passes to left ventricle and thence
INTRODUCTION ejected to ascending aorta for systemic circulation.
Total amount of blood in our body is 5.5 litres, but The heart wall is composed of (from inside
it has to do tremendous function (supply nutrient outwards) endocardium – (inner thin layer); middle
and O2) continuously from birth up to death, so thick myocardium (muscle coat) and outer thin
blood must circulate. The function of heart is to epicardium (visceral layer of serous pericardium).
circulate blood by pumping action. Its size is about
one’s close fist; situated in middle mediastinum, Heart (Figs 6.1A and B)
enclosed in a double sac of pericardium – outer It has three surface, three borders, an apex and a
fibrous and inner serous (parietal and visceral base.
Name Important points
• Apex Pointed, formed only by left ventricle, directed downwards, forwards and to the left 9 cm
away from midline (just below and medial to the left nipple). Apex beat (downmost and
outermost point of definite cardiac pulsation) is palpable here.
• Base (anatomical) Formed solely by two atria (right and left); directed upwards, backwards and towards right
Contd...
Fig. 6.1A: Heart with great vessels (Anterior view)
Fig. 6.1B: Heart with roots of great vessels (Posterior view)

Heart and Arterial System 121
Name Important points
• Base (clinical) Corresponds to parasternal part of right second intercostal space, examined by auscultation
• Sterno-costal Formed by left (1/3rd) and right ventricle (2/3 part), right atrium with auricle. The surface
surface is covered by lungs and plura, except the area of cardiac dullness. If there is excess fluid in
(Figs 6.1A and pericardium; it is drained through this area. Anterior interventricular groove is situated
6.2) here
1. lodges anterior interventricular branch of left coronary artery.
2. great cardiac vein (drains in coronary sinus).
• Diaphragmatic Formed by right (1/3 part) and left (2/3 part) ventricle – there is a flat surface rest on
surface diaphragm. This surface present posterior interventricular groove which lodges posterior
interventricular branch of right coronary artery and middle cardiac vein.
• Left surface Formed by left auricle and left ventricle
• Right border It extends from right side of superior vena cava to inferior vena cava, it correspond to
(separate sterno- sulcus terminalis outside.
costal from base)
• Left border It is formed mainly by left ventricle and partly by left auricle. Each borders formed angle
(separate sterno- with diaphragm called right and left cardiophrenic angle (in X- ray flim).
costal from left
surface)
• Inferior border It formed mainly by right ventricle and partly by left ventricle near its apex.Medial to the
(separate sterno- apex lies a notch (incisura apicis codis). At this border lies right marginal vessels.
costal from
diaphragmatic
surface)
Interior of right It has two parts – anterior rough part (where comb-like musculae pectinati present),
atrium (Fig. 6.2) – posterior smooth part. It is separated from rough part by a muscular ridge – crista-
terminalis. It receives superior vena cava, inferior vena cava (guarded by semiulnar
valve) and coronary sinus (guarded by semi-circular valve).
Right side of intra-atrial septum present
• Fossa ovalis – oval depression.
• Limbus fossa ovalis – crescentic margin, surrounding upper, anterior and posterior part
of fossa ovalis.
Interior of right It has inflowing rough part – in it, present ridges (supraventricular crest – an important
ventricle ridge which separates inflowing rough from outflowing smooth part) bridges, out of which
(Fig. 6.3A) septomarginal trabecula or moderator band is important. It extends from right side of
interventricular septum up to base of anterior papillary muscle.
Papillary muscles – finger like projections, three in number, anterior, posterior and septal
– attached to tricuspid valve by chordae tendineae. Anterior papillary muscle arises from
sternocostal surface, attached to anterior and posterior valve cusp. Posterior papillary muscle
arises from diaphragmatic surface, attached to posterior and septal cusp.Septal papillary
muscle – very small, often absent. If present, it is attached to septal and anterior cusp.
Fig. 6.2: Sternocostal surface of heart showing coronary arteries
Fig. 6.3A: Interior of right atrium and right ventricle

Artery Supply of Heart (Coronary Circulation)

(Fig. 6.3B)
Fig. 6.3B: Coronary arterial system
Name Begining Course Branches Area supplied
1. Right coronary Arises from It passes downwards in • Marginal Supplies all of the right
artery (smaller ascending aorta between the root of • Posterior ventricle, the variable
than left coro- from the anterior pulmonary trunk and the interventricular· part of diaphragmatic
nary artery) aortic sinus. right auricle, winds the Nodal (60% surface of left ventricle,
inferior border, passes case) post 1/3rd of intervent-
in the posterior part of ricular septum, the right
atrioventricular groove atrium part of left atrium
and terminate by and nodal tissue.
anastomosis with left
coronary artery.
2. Left coronary Arise from • Anterior inter- Supplies most of left

artery ascending aorta ventricular. ventricle, small area of
from left • Branch to right ventricle, anterior 2/
posterior aortic diaphragmatic 3rd of interventricular
sinus. surface of left septum, most of left
ventricle. atrium.
Applied Anatomy (Heart and Pericardium)

• Pericardial Effusion: When excess fluid is
• Angina Pectoris: It is an intermittent, transient,
accumulated (more than 300 c.c.), it is known
central chest pain. It is due to coronary artery
as pericardial effusion. There is compression
symptoms (cardiac temponade). The cardiac insufficiency.
output is reduced and heart beats in, abnormal • Valvular Disease: It is commonly seen in
rhythm; and eventually, cardiac arrest. To relive rheumatic fever, produces valvular incompe-
pain, a tapping is done through left costo- tence (incapability), seen most commonly in
xyphoid angle. mitral and aortic valves.
Heart Failure: When diastolic pressure of ventri Arterial Aneurysm: Abnormal dialation of a
increases (normal pressure 0) – there is gradual segment of main artery is known as aneurysm.
heart failure. Any one of the four chambers of heart Atherosclerosis: It is characterized by irregular
can fail separately, which increases back pressure. lipid deposit (fat) in the inner wall of large and
There is edema (accumulation of fluid) of feet and medium size artery. Common in middle, and old
breathlessness on exertion. aged group; produces partial ischemia, (less blood
Developmental Anomalis: Discussed in embryo- supply) of the region supplied.
logy chapter, i.e. Chapter 10.
Aorta and Major Arteries of Systemic
Circulation (Fig. 6.4)
Fig. 6.4: Major arteries of systemic circulation

Name Begining Termination Branches Area supplied

Ascending aorta Left ventricle of Sternal angle Right and left coronary Heart
heart arteries
Arch of aorta Sternal angle (right Sternal angle • Brachiocephalic Whole of superior
side) (left side) • Left common carotid extremity and head
• Left subclavian and neck region.
Brachiocephalic Arch of aorta Upper border of • Right subclavian. Right side of head
right. • Right common carotid and neck, right
Sternoclavicular and occasionally arteria superior extremity.
joint. thyroidemia.
Left common Arch of aorta Upper boarder of • Left external and left Left side of head and
carotid thyroid cartilage. internal carotid arteries. neck.
Descending Sternal angle on Continuous as • Parietal – posterior Supplies intercostal

thoracic aorta the left side abdominal aorta intercostal; superior muscles, spinal cord,
at the level of phrenic vertebrae, pleura,
T12 vertebra. • Visceral – mediastinal skin, posterior and
esophageal; bronc-hial, superior diaphragm.
pericardial.
Abdominal aorta Arises at the T12 Terminates at the → Coeliac Supplies whole of the
level, as a conti- level of L4 by Ventral → Superior mesenteric abdominal organs
nuation of thoracic dividing into → Inferior mesenteric and parietes.
aorta. right and left
common iliac → Interior phrenic
arteries. → Gonadal
Lateral
→ Suprarenal
→ Renal
Dorsal–4 lumbars
Left and right At L4 level At the level of • External iliac Mainly supplied
common iliac sacroiliac joint • Internal iliac pelvic structure and
inferior extremity.
Arteries of Superior Extremity (Fig. 6.5)
Subclavian Right from brachi- At the outer • Vertebral Neck and upper
(right and left) ocephalic and left border of first • Internal thoracic limb
from arch of aorta. rib, continues as • Thyrocervical
axillary artery. • Costacervical
• Dorsal scapular
(Total – 5 branches)
Contd...
Fig. 6.5: Arterial supply superior extremity (upper limb)
Axillary Outer border of At the lower • Superior thoracic – from Shoulder, axilla,
artery first rib border of teres first part. chest wall.
major. • Acromio thoracic – from
2nd
• Lateral thoracic. part
• Subscapular
• Anterior humeral circumflex.
• Posterior humeral circumflex
– from third part.

(Total – 6 branches)
Contd...
Brachial At the lower As ulnar and • Arteria profunda brachii. Supplies anterior
artery border of teres radial artery at • Nutrient artery to humerus. flexor muscles and
(Fig. 6.5) major the level of neck • Superior ulnar collateral posterior extensor
of radius. artery. muscle (triceps) of
• Interior ulnar collateral arm, by small
artery. branches; to elbow
(Total 4 branches) joint, by anasto-
mosis.
Radial artery At the level of neck At the fifth meta- • Radial recurrent arteries. Supplies lateral
of radius from carpal base, after • Muscular branches· muscles of forearm,
brachial artery. passing through • Palmar carpal branch· the wrist and the
first dorsal inter- • Superficial palmar branch· thumb and index
metecarpal and • Dorsal carpal branch· finger.
also through two • First dorsal metacarpal
heads of adduc- artery.
tor pollicis, form • Arteria princeps pollicis.·
deep palmar arch • Arteria radialis indicis
(Total 8 branches)
Ulnar artery At the neck of At the level of • Anterior ulnar recurrent Muscles of medial
radius from pisiform bone artery side of forearm
brachial artery • Posterior ulnar current three to fifth fingers
artery medial aspect of
• Common interosseous index finger, elbow
artery joint, wrist joint.
• Muscular
• Palmar carpal branch
• Dorsal carpal branch
• Deep palmar branch
• Superficial palmar arch.
Arteries of Thorax (Figs 6.6 and 6.7)
Fig. 6.6: Internal thoracic artery (posterior view)

Descending Arises from arch At the T12 • Pericardial. Thoracic wall

thoracic aorta of aorta at vertebra passing • Bronchial. diaphragm and
(Fig. 6.5) external angle through aortic • Esophageal. thoracic viscera
(lower border of opening of • Mediastinal. except mammary
fourth thoracic diaphragm. • Superior phrenic. gland.
vertebra). (2 cm above the • Posterior intercostals
transpyloric (except first two) (6
plane in the branches)
midline). • First two are the branches
of costo cervical trunk.
Internal From lower At the level of • Pericardio phrenic Thoracic wall,

thoracic border of first part sixth intercostal • Mediastinal. thoracic viscera,
artery of sub clavian space 1 cm from • Pericardial. diaphragm and
artery about 2 cm the lateral • Sternal. mammary gland.
above the sternal sternal border, it • Anterior intercostals
end of clavicle. ends by dividing • Perforating
into two • Musculo phrenic
branches. • Superior epigastric.
(8 branches)
Arteries of Abdomen
Abdominal Aorta and Its Branches (Fig. 6.7)
Fig. 6.7: Major arteries of thorax and abdomen

Ventral Branch

Coeliac trunk Wide, unpaired ventral Passes almost hori- 1. Left gastric Stomach, liver and
branch of abdominal zontally towards and 2. Common hepatic spleen.
aorta.It lies 1.25 cm slightly right, above 3. Splenic
above the transpyloric pancreas and splenic
plane slightly to the vein, dividing into
left of mid line. three branches.
Superior Unpaired ventral The artery crosses in 1. Inferior Whole of the small
mesenteric branch of abdominal front of inferior vena pancreati- intestine from
aorta, at the level of cava, right ureter and coduodenal. superior part of
first lumbar vertebra, psoas major, narrows 2. Jejunal and ileal. duodenum up to
just below the coeliac down and anastomoses 3. Middle colic. right 2/3rd and left
trunk. with its own ileo-colic 4. Right colic 1/3rd of transverse
branch. 5. Left colic. colon (large gut).
Inferior Unpaired Continues at superior S i g m o i d . S u p e r i o r Left 1/3rd of trans-

mesenteric Ventral branch arises rectal artery within rectal.(3 branches) verse colon and
at the level of third lesser pelvis. most of the rectum.
lumbar vertebra.
Lateral Branches (Paired)

Inferior At the level of T12 End by supplying the • Small branches to Under surface of
phrenic from aorta just inferior inferior surface of liver. diaphragm and sup-
artery to diaphragm. diaphragm. • To spleen. rarenal gland only.
• Superior supra-
renal.
Middle Paired small branches By supplying supra- No branch. Suprarenal gland.

suprarenal of abdominal aorta; renal gland.
artery arises at the level of
superior mesenteric
artery.
Renal artery Two large arteries arise Near the renal hilum, it • Inferior suprarenal Kidney,
slightly below the divides into four to five • Ureteric Suprarenal gland,
superior, mesenteric branches. • Muscular Upper part of ureter
artery (between L-1 and muscles of
and L-2). posterior abdomi-
nal wall.
Gonadal Paired, long slender End by supplying • Ureteric In case of males

artery artery;arises little gonads. supplies testis, peri-
below the renal renal fat, ureter and
arteries. iliac lymph nodes. In
case of females,
ovary, skin of labia
majora, inguinal
region.
Contd...

• Lumbar These are in series with Ends by supplying • Muscular branches These segmental
artery posterior intercostal muscles of lumbar region. arteries supply the
arises from lumbar posterior
region. abdominal wall.
• Common At the level of 4th At the level of 5th lumbo • Peritoneal

iliac lumbar vertebra as sacral disc (sacroiliac • Branch to psoas
terminal branch of joint) it terminate into major
abdominal aorta. two arteries: • Ureteric
1. Internal iliac artery • Loose aveolar tissue
2. External iliac artery
Branches from anterior
• Internal At the level of At the greater sciatic trunk
iliac artery sacroiliac joint from foramen by dividing into Superior vesical.
(right and common iliac. anterior trunk and Inferior vesical.
left) posterior trunk. Middle rectal.
Uterine.
Obturator.
Internal pudendal.
Muscular.
Inferior rectal.
Perineal.
Urethral.
Deep artery of penis.
Dorsal artery of penis.
Branches from posterior
trunk:
Iliolumbar.
Lateral sacral.
Superior gluteal
(total15 branches)
N.B. – The testicular artery is not the sole supply to the testis. It also receives some blood from branches of inferior
epigastric artery. Thus, injury to the artery high in the abdomen usually leaves the testis unharmed; whereas injury
in the region of spermatic cord involves both the vessel and leads to gangrene of testes.
Arteries of Inferior Extermity (Figs 6.8A and B)
Name Begining Course Branches Area supplied
Femoral Continuation of exter- At the fifth osseoaponeu- 1. Superior epigastric Muscle of thigh,
artery nal iliac at the level of rotic opening continued as 2. Superficial circumflex head and neck
inguinal ligament. popliteal artery. iliac region of femur.
3. Superficial external
pudendal
4. Muscular
5. Arterioprofunda
femoris (main
branch)
Contd...
Popliteal At the fifth osseoa- At the lower border of • Cutaneous branches. By arterial anas-
artery poneurotic opening popliteus by dividing into • Superior muscular tomsis, supplied
from femoral artery. anterior and posterior branches. knee joint.
tibial. • Superior genicular By terminal bran-
(medial and lateral). ches supplied to the
Contd...
Figs 6.8A and B: Arteries of lower limb (inferior extremity)

• Middle genicular (small muscles and joints

in size). of leg region.
• Inferior genicular
(medial and lateral).
Anterior At the lower border At the level of ankle • Posterior tibial External muscle of
tibial artery of popliteus from continued as dorsalis recurrent. anterior compar-
popliteal artery. pedis artery. • Anterior tibial recurr- tment of leg.
ent.
• Muscular.
• Arteria dorsalis pedis
Posterior Larger terminal At the ankle, midway • Peroneal largest branch Flexor and pero-
tibial artery branches of popliteal between medial tubercle • Circumflex fibular. neal muscles of leg,
artery, at the lower of calcaneum and medial • Nutrient artery to tibia. sole.
border of popliteus. malleolus, it end by • Muscular.
dividing into medial and • Medial malleolar.
lateral plantar arteries. • Calcaneal.
• Medial plantar.
• Lateral plantar
Dorsalis At the ankle beyond At the first intermetatarsal • Tarsal. Ankle joint,
pedis artery inferior extensor space. • Arcuate. dorsum of foot.
retinaculum, and • First dorsal
medial to the tendon metatarsal.
of extensor hallucis
longus.
Arteries of Head and Neck (Fig. 6.9)
Fig. 6.9: Arteries of head and neck

Right and Common carotid; In the substance of parotid • Superior thyroid. Thyroid, pharynx,
left external arteries at the upper gland behind the mandi- • Ascending tongue, face, occi-
carotid border of thyroid bular neck; terminates by pharyngeal. pital region behind
arteries cartilage. dividing into superficial • Lingual. the ear, temple,
temporal and maxillary • Facial. meninges of brain,
arteries. • Occipital. external ear (i.e.
• Posterior auricular. most tissue of head
• Superficial temporal. except orbit and
• Maxillary. brain).
Internal Larger than external At the medial end of base Cervical part – No Supplies orbit and
carotid artery carotid arises at the of lateral sulcus of brain. branch 80% of cerebral
(right and upper border of • Tympanic hemisphere.
left) thyroid cartilage. It is • Pterygoid
divided into four • Cavernous
parts, cervical, • Hypophyseal
petrous, cavernous • Meningeal
and cerebral. • Ophthalmic
• Anterior cerebral
• Middle cerebral
• Posterior
communication
• Anterior choroids
(Total 10 branches)
Vertebral From subclavian At the base of brain (near • Spinal branch Spinal cord
arteries (right arteries at the root of ponto-medullary • Muscular occipital lobes and
and left) the neck. junction) the two arteries • Meningeal part of (interior)
unite and form basilar • Posterior spinal temporal lobe of
arteries. • Anterior spinal cerebral
• Posterior interior hemisphere
cerebella
• Medullary arteries
(Total 7 branches)
Arterial Circle Of Wills: It is polygonal rather than Applied Anatomy

circular. It is bounded arterially by anterior cerebral Angiogram: Visualisation of arterial tree by radio-
arteries (from internal carotid) are joined by paque dye is known as angiogram. At the upper
anterior communicating artery. Posterior the basilar limb brachail artery (just above the cubital fossa)
artery divides into two posterior cerebral arteries, and radial artery (region where radial pulse is felt)
each joined to the same sided internal carotid by a are the common site, common carotid artery in neck
posterior communicating artery. (near its bifurcation) and femoral artery in lower
limb (just below the inguinal ligament) in the site
of choice for angiography. Various regions in the
body where arterial pulsations can be felt are shown
in Figure 6.10.
Fig. 6.10: Regions where arterial pulsation is felt (Peripheral arterial pulse)
Veins
INTRODUCTION
Veins are the channels that carry blood towards
the heart. Poorly oxygenated blood is carried by
all veins in the body except pulmonary veins which
carries oxygenated blood. It posses thin muscle
wall and are wider and numerous than the arteries.
It is formed from capillary tissue fluid (micro
molecular in nature). In human body four types of
venous system present 1) Caval system, 2) Portal
venous system, 3) Azygos venous system, 4) Para
vertebral veins.
The Venae Cavae (Figs 7.1 and 7.2)
Fig. 7.1: Venous drainage of

whole body (anterior aspect)
Fig. 7.2: Inferior vena cava along with aorta

Name Formation Termination Tributaries Area of drainage

Superior By union of two At the posterosuperior • Two brachiocephalic. Drains blood from all
vena cava brachio-cephalic vein aspect of right artrium. • Arch of azygos vein. areas superior to
at the lower border of diaphragm except
first right costal from the pulmo-nary
cartilage. circuit.
Inferior Formed by union of It terminates at the • Two common iliac (for- From all the
vena cava right and left common posteroinferior part of mative) tributary. structures of body
iliac vein at the level of right atrium just after • Lumbar veins. below dia-phragm.
L5 to the right of the passing through vena- • Ascending lumbar vein.
midline. caval opening of dia- • Gonadal (testicular in
phragm at the level of T8. male, and ovarian vein in
female)
• Renal
• Suprarenal
• Inferior phrenic
• Hepatic
External By union of posterior Passing super ficial to • Posterior division of Drain the supply
jugular division of retroman sternocleido mastoid, retromandibular region of head
dibular and posterior pierce the deep fascia and • Posterior auricular. (scalp and face)
auricular vein near drain into subclavian • Posterior external to some extent
mandibular angle. vein. jugular deepar part.
• Transeverse cervical.
• Supra scapular.
• Sometimes anterior
jugular.
(6 tributaries)
Vertebral Arises as a plexus in Drains into brachio- • Connected to sigmoid Drains from the
veins the suboccipital tri- cephalic veins of corres- sinus by a tributary. region of ****
angle and lies over the ponding side at the root • Occipital vein. vertebrae, the
posterior arch of atlas. of neck. • Veins from pre-vertebral spinal cord and
muscles. small neck
• Internal and exter-nal muscles.
vertebral plexus [Unlike vertebral
(4 tributaries) arteries the verte-
bral vein do not
much of the
branch).
Internal It begins at jugular Joined with subclavian • Inferior petrosal sinus. Drains from
jugular vein foramen cranial base as vein at the posterior end • Facial vein. region of skull
a continuation of of sternoclavicular joint • Lingual vein. (superficial part)
sigmoid sinus. of corresponding side • Pharyngeal vein face, and major
forming brachiocephalic • Superior and middle structures of
vein. thyroid vein. neck.
• Some times occipital
(6 tributaries)
Veins 137
Veins of Thorax (Fig 7.3A)

Brachio- By union of internal At the sternal end of right • Two brachio- Blood from
cephalic jugular and subclavian costal cartilage two cephalic whole of head
vein (inno- brachiocephalic vein • Left vertebral and neck and
minate) unites to form superior • Internal thoracic superior extre-
Devoid of vena cava. (internal mity and thorax.
valves mammary)
• Inferior thyroid
• Superior intercostal
• Thymic and
pericardial veins
(6 tributaries)
Azygos vein Arises in abdomen as It ends in superior vena • Right posterior inter- Right sided
lumbar aszygos vein, cava; at the junction of costal veins except parietes of
from inferior vena its intra and extra the first. thorax,
cava. pericardial part, at the • Right superior mediastinal
level of sternal angle. intercostal vein. structures and
• The hemiazygos. bronchus.
• Accessory
hemiazygos vein
• Esophageal
Superior Formed by union of It joins the azygos at the • Mediastinal Left upper part
hemiazyos fourth to eighth inter- level of T7 vertebra. • Pericardial of thorax and
vein. costal vein. • Bronchial (right) sometimes the
• Ascending lumber left bronchus.
• Subcostal.
• Four to eight
intercostal vein.
• Sometimes left
bronchial.
Inferior Formed by the union of At azygos vein at about • Lower three Lower parieties
hemiazygos left ascending lumbar T8 level. posterior intercostal of thorax,
vein. vein and left subcostal vein. structures of
vein. • Common trunk mediastinum.
formed by
ascending lumbar
and subcostal,
esophageal, and
mediastinal veins.
Fig. 7.3A: Venous drainage of posterior thoracic and abdominal wall
Cardiac Veins (Venous Drainage of Heart) (Fig. 7.3B)

Coronary sinus Formed behind the left Open in the right atrium • Great cardiac vein Whole heart.
atrium and left between the opening of (begin at cardiac
ventricle; 2-3 cm long. inferior vena cava and right apex, ascends in
atrioventricular orifice. anterior inter ventri-
cular sulcus).
• Small cardiac vein.
• Middle cardiac vein
(begin at cardiac
apex ascends in
posterior inter ven-
tricular groove).
• Posterior vein of the
left ventricle, obli-
que vein of left
atrium.
Fig. 7.3B: The cardiac veins

Thebesian vein Situated in sub- End in right atrium through Anterior part of
or inferior pericardial tissue. foramina venerum right ventricle.
cardiac vein minimerum.
Veins 139
Veins of Abdomen and Pelvis (Fig. 7.2) This is the direct route. But when this route is
blocked (by chirrosis of liver), other smaller
Veins from whole of abdomen and pelvis are
communication exists between the portal and
drained by inferior vena cava which has discussed
systemic system and bypass the blood from liver
previously. Here we discuss the portal vein.
and drains into systemic vein. These communica-
Portal Vein (Figs 7.4A, B and 7.5A) tion exists at:
1. Lower end of esophagus – Communication of
The hepatic portal system collect blood from esophageal branch of left gastric (portal system)
digestive tract, and are valve less. They form a with esophageal veins of azygos system
trunk – the portal vein, which enter into the liver (systemic). An abnormally large amount of
and breaks up again into capillaries. Thus, the blood passes through these channels forms
blood have to passed through capillaries in the gut esophageal varices. Channels may rupture and
wall, again passes through capillaries (sinusoids) produce severe hemorrhage.
in the liver. 2. In the distal part of anal canal – The superior
rectal vein (portal system) anastomoses between
Important Porto-systemic Anastomosis the middle and inferior rectal vein (systemic).
(Fig. 7.5A)
In portal hypertension these veins dilated and
Under normal condition portal blood passes protruded through mucosa and form internal
through the liver and drains in the inferior piles (hemorrhoids) which may rupture during
vena cava (systemic vein) by hepatic veins. passage of stool.
Fig. 7.4A: Tributaries of portal vein

Fig. 7.4B: The veins forming portal system and their tributaries
3. In umbilical region – The paraumbilical vein Circulation). In portal hypertension these veins
connect left branch of portal vein between the are enlarge and radiates around the umbilicus
superficial vein of abdomen (systemic and form caput medusae (Fig. 7.5B).
Veins 141
Fig. 7.5A: Important Proto-systemic anastomosis
Fig. 7.5B: Caput medusae in anterior abdominal wall


External Continuation of fem- At the corresponding • Inferior epigastric Lower part of
iliac oral vein from the sacroiliac joint by joining vein. anterior
level of inguinal with internal iliac. • Deep circumflex abdominal wall,
ligament. iliac vein. of pelvis.
• Pubic vein.
(3 tributaries)
Disease of external iliac artery may cause adherence with the external iliac vein. Dissection in this region therefore
produces severe venous hemorrhage which is difficult to control.
Internal Veins from different At the corresponding • Superior gluteal v. Gluteal region
iliac viscera of pelvis; sacroiliac joint it joins • Inferior gluteal v. and structure of
converge near the with internal iliac vein to • Middle rectal v. lesser pelvis and
region of greater form the common iliac • Internal pudendal v. external
sciatic foramen to form vein. • Obturator vein. genitalia.
the internal iliac vein. • Lateral sacral v.
• Vesical v.
• Uterine and vaginal
v (in case of female).
• Prostatic venous
plexus.
• Dorsal vein of penis.
(10 branches)
Lumbar Four pairs from lumbar At inferior vena cava • Lumbar. Lumbar muscles
vein muscles and skin. except the first one, • Abdominal. and skin, from
drains into ascending wall of
lumbar and lumbar abdomen.
azygos.
Gonadal or Emerge posteriorly The right vein ends in Veins from all the From gonads.
testicular from testis, as pamp- inferior vena cava, below structres of spermatic
veins iniform plexus and in renal vein, at an acute cord.
case of ovary from angle. Left one drain in
ovarian plexus. left renal vein at 90º
angle.
Renal vein Within renal sinus by Into inferior vena cava at Left receives left Drains the
(right 2.5 cm union of lobar veins. right angle just below the gonodal and left supra- kidney.
and left 7.5 origin of superior renal vein.
cm long) mesenteric artery.
Suprarenal Form from, numerous Right drain into inferior From supra-
(right and small veins from vena cava. Left into left renal glands.
left) supra-renal medulla renal vein.
and cortex.
Hepatic Within the substance Opens in inferior vena Cystic vein. Liver, gall-
veins (right of liver commences as cava in the groove on the bladder
and left) intra lobular veins. posterior surface of liver.
Veins 143
Venous Drainage of Inferior Extremity perforating veins in femoral region, adductor

canal, a little above knee, little below knee and
There are three types of veins in lower limb.
ankle perforation. The flow of blood is from
Superficial (lies in superficial fascia), deep (lies
superficial vein to deep vein. It is provided with
deep to deep fascia) and a connecting channel
valves.
known as perforating veins.
Deep Veins (It lies along the arteries)
Perforating Veins
Veins are drained from below upwards. Anterior
The perforating veins are those veins which tibial venae comitants, posterotibial venae
connects the superficial and deep vein. There are comitants, popliteal vein, femoral vein.
Superficial veins (Fig. 7.6)

Long saphe- Arises from medial It ends in femoral vein • From sole of foot by From superficial
nous vein marginal vein which is about 3 cm below the medial marginal vein. structures of
(longest vein the continuation of inguinal ligament. • Communicating vein whole of lower
in the body) medial part of dorsal from small saphenous limb except
venous network. It goes vein. back of leg.
upward accom-panied • Accessory saph-onous
by saphenous nerve, vein.
bends behind the medial • Superficial epigas-tric
condyle of femur; • Superficial circum-flex
ascends in the medial iliac.
side of thigh. • Superficial external
pudendal vein.
• Thorace epigastric vein
– It is a connec-ting
link between superior
and inferior vena cava.
Small saph- Arises from lateral It ascends upwards in the • Veins from back of leg. From superficial
onous vein border of foot as a back of by perforates • Communicating vein structures of
(word sap- continuation of lateral deep fascia on the back of with the great back of leg.
hes means end of dorsal venous knee and terminates in saphonous vein.
easily seen) network. popliteal vein between • From lateral part of the
the two heads of gastroc foot.
nemius.
Applied
1. Vene section—When patient is in collapse state (in shock), it is not easy to get superficial vein. Vene section is
done near the region or great saphenous veins (in front of ankle) for therapeutic (treatment) purpose.
2. Varicosity—Dilatation and tortuasity of veins is known as varicosity. Common sites of varicose veins are lower
limb veins (person with long standing habit, in pregnancy, etc.) superficial abdominal veins (in portat hypertension
—as in caput medisae), testicular vein (pampiniform plexus—dilatation known as varicocele).
3. Intravenous injection—Common site—(a) Median cubital vein in front of elbow, (b) Cephalic vein (near its
formation in hand), used as diagnostic purpose (Blood T.C, D.C, E.S.R., Sugar, Urea, etc.)
4. Therapeutic purpose—Fluid transfusion.
5. Spread of cancer by vein—Act as a vehicle for spread of cancer, e.g. cancer prostate spread from prostate to
vertebrae by veins of Batson.
Fig. 7.6: Superficial venous drainage of inferior extermity (lower limb)
Veins of Superior Extremity (Fig. 7.7) their companion arteries and have the same names.
Most are paired that lies by the side of the artery
The deep veins of upper limb follows the paths of
except longest one.

1. Cephlic It is formed over the It pierces the clavi- Many tributaries from Lateral and post-
vein—It is anatomical snuff box as a pectoral fascia, crosses the lateral and posterior erior surface of
used for continuation of lateral axillary artery and end in surface of limb. limb.
cardiac ca- part of dorsal venous axillary vein below the
theterisation network. clavicle.
2. Baisilic Continuation of medial Reaching the lower border • Medial cubital vein. Medial and post-
vein. part of dorsal venous of teres major, it is joined • Various tributaries on erior surface of
network. by venae comitantes of medial and posterior limb.
brachial artery and surface of limb.
continued as axillary
veins.
3. Medial Arises from palmar Terminate either in basilic • Numerous unnamed Palm and front of
veins of venous plexus. or cephalic vein or into tributaries. forearm.
forearm median cubital vein.
4. Median Communication bet-ween

cubital vein cephalic and basilic vein
just below the crease of
elbow. It is used in
intravenous injection,
blood trans-fusion.
Veins 145
Fig. 7.7: Venous drainage of superior extremity (right)
Veins of Head and Neck (Figs 7.8A and B)
Fig. 7.8A: Superficial veins of head and neck

Fig. 7.8B: Major veins of head and neck
Cranial Dural Venous Sinuses (Figs 7.9A to C)

sinus, anterior and posterior intercavernus sinus.
The dural venous sinuses are blood filled spaces Most of the veins of the brain drains into it. They
between the endosteal and meningeal layer of have no valves in their wall, and also devoid of
duramaters except straight sinus, inferior sagittal muscular tissue.
Fig. 7.9A: Duramater and venous sinuses Fig. 7.9B: Superior sagittal sinus
(lateral view) after removal of cranial vault
Fig. 7.9C: Venous sinus at

the base of skull
Veins 147
Name Situation Beginning End Tributaries

Superior It is situated at the Begin near the crysta gali At the internal occipital • Superior cerebral v.
saggital attached, or convex of ethmoid bone. protuberence, it is • Parietal emissary v.
sinus margin of falx cerebri continuous as right • Diploic and
(unpaired) transverse sinus. meningeal vein (3
tributaries)
Inferior In the posterior half At the anterior part of In straight sinus. • Veins from falx
sagittal sinus or 2/3rd of free lower folded part of cerebri.
(unpaired) margin of falx meningeal layer of dura • Sometimes from
cerebri. mater medial surface of
brain
(2 tributaries).
Straight Lies at the site of Union of inferior Normally it will • Great cerebral vein
sinus attachment falx sagittal sinus and the continued as left
(unpaired) cerebri, with great cerebral v. transverse sinuses.
tentorium cerebelli
Transverse It lies along the Begins at the internal Continued as sigmoid • Superior petrosal
sinus attached margin of occipital protuberance sinus at the postero- sinus.
(paired) tentorium cerebelli lateral part of temporal • Inferior cerebral v.
bone. • Inferior cerebellar v.
• Diploic v.
(4 tributaries)
Sigmoid It lies along the inner As a continuation of the It comes out at posterior • Mastoid
sinus surface of mastoid transverse sinus compartment of jugular • Chondylar emissary
(paired) angle of temporal foramen as superior vein.
bone. bulb of internal jugular
vein.
Occipital Smallest of the Begins near the foramen Straight sinuses. • Connects with
sinus sinuses situated at the magnum vertebral venous
(unpaired) attached margin of plexus.
tentorial cerebelli
Cavernus Situated at the sides Begins from superior At the apex of petrous • Spheno parietal
sinus of body of sphenoid orbital fissure part of temporal bone. sinus.
bone. • Superior ophthalmic
vein.
• A tributary of inferior
ophthalmic vein.
• Crntral vein of retina.
• Middle meningeal
sinus.
• Inferior cerebral
veins.
• Superficial middle
cerebral vein.
Lymphatic System
INTRODUCTION sometimes several. The lymph vessels have

numerous valves. The lymph vessels that carry
Apart from artery and vein, there exist another
lymph towards the LN is known as afferent vessel,
channel in our body, i.e. lymphatic system.
and that carries lymph away from LN is known as
Lymphatic system is accessory to venous system.
efferent vessel. The lymph reaches the blood stream
It also drains tissue fluid from the tissue spaces
at the root of the neck by large lymph vessels called
like veins, but the difference is that it carries protein
right lymphatic duct and thoracic duct. The thoracic
and fat macromolecules from tissue spaces. The
duct begins in the abdomen as a sac; cysterna chyli,
veins carries micromolecular substance from tissue
and enters the thorax through a opening (aortic
space. Lymphatic tissue is essential for
opening) of diaphragm. It ascends through thorax,
immunological defence of the body from bacteria
lies in front of thoracic vertebrae. It then ascends
and viruses.
into neck and drain into the angle, formed by left
Lymph is the name given to the tissue fluid, once
internal jugular and left subclavian vein.
it has entered a lymphatic vessel. Before lymph is
The right lymphatic duct drains lymph from the
drained into the blood stream, it passes at least one
body’s right upper quadrant (right side of head and
lymph node (small masses of lymphatic tissue),
neck, right upper limb and right half of thorax).
The thoracic duct drains lymph from remainder of
the body (Fig. 8.1).
The central nervous system, the eyeball; the
internal ear, the epidermis of skin, cartilage and
bone are devoid of lymphatic vessels.
Applied
1. Lymphangitis. It is the inflammation of lymph
vessel. When lymph vessels are severely
inflamed, the vasa vesorum (vessel supplying a
vessel) become congested with blood. As a
result the pathway of the associated lymphatics
become visible through skin as red line and
painful to touch.
Fig. 8.1: Lymphatic drainage of whole body
Lymphatic System 149
2. Lymphadenitis. It is the inflammation of lymph 4. Lymph nodes of mediastinum.

node. This two phenomenons may occur when 5. Lymph nodes of mesentery.
the lymphatic system is involved in the spread
of cancer cell. Lymph Nodes of Head and Neck
3. Lymphoedema. The accumulation of lymph in (Figs 8.2A and B)
tissue space. When lymph does not drain from It divides into two division, superficial (lies in the
an area of the body. It is seen in coastal region superficial fascia) and deep (lies beneath the deep
of Orissa, there is repeated attack by a bacteria. fascia). The members of superficial sets are
The lower limb is most commonly affected and arranged in circular chain along the base of
the condition is known as elephantiasis, edema mandible. They are named as follows:
of upper limb occurs due to removal of axillary 1. Occipital LN—One to 2 in number (in back of
lymph node after cancer of breast. head – often enlarged due to dandruff in the
The LN are bean shaped structures having a head).
hilum (depression) on one side. They are not so 2. Mastoid LN—Two to 3 in number (behind the
prominent in health, but during inflammation it is auricle – postauricular).
distinguishable. A numerous afferent lymphatics 3. Parotid LN—Three to 4 in number (in front of
enter the node from periphery. The single (usually) auricle – preauricular).
efferent vessel leaves the LN through helium. A 4. Buccal (facial) LN—Two to 3 in number lies
lymph vessel in its course passes through different along the facial vein.
sets of lymph nodes before it reaches the final 5. Submandibular LN—Eight to 10 in number,
destination. situated in the submandibular region – Enlarged
in tongue disease.
Regional Lymph Nodes
6. Submental LN—One to 2 in number, situated
The important regional lymph nodes are: below the chin (enlarged commonly in tongue
1. Lymph nodes of head and neck disease).
2. Lymph nodes of axilla (armpit) 7. Deep cervical LN—Twenty to 30 in number –
3. Lymph nodes of inguinal region. It is a long chain of LN situated along side the
Fig. 8.2A: Lymph nodes head and neck and their Fig. 8.2B: Lymph nodes of neck: Arrows indicate the
areas of drainage (superficial) lymphatic drainage of thyroid gland, larynx and
trachea
carotid sheath deep to sternocleido mastoid. (jugulo-digastric group) on both sides. Whereas
They form superior (jugulodigastric) and cancer from anterior part of tongue spread into
inferior (jugulo-omohyoid) groups. inferior deep cervical lymph nodes (jugulo-
omohyoid group). Cancer in the tip of tongue first
Lymphatic Drainage of Tongue (Fig. 8.3) spread into submental and submandibular group
of lymph nodes and in all cases nodes are enlarged
1. Lymphatics from the tip of tongue drains to
and feel stony hard.
submental lymph nodes (of both sides).
2. The right and left halves of remaining part of
Axillary Lymph Nodes (Fig. 8.4)
anterior 2/3rd of tongue drain to the sub
mandibular lymph node of the corresponding These nodes lie in axilla. They are divided in five
side. A few central lymphatics drain to the same groups.
nodes of both sides. 1. Anterior (pectoral) group—Three to 5 in
number – lying along the lower border of the
pectoralis minor.
2. Posterior (subscapular) group—Six to 7 in
number – lying in front of the subscapularis
muscle.
3. Lateral (humeral) group—Six to 7 in number –
lying along the medial side of axillary vein. These
nodes receives most of the lymphatics of upper
limb.
4. Central group—Three to 4 in number – Large
in size lying in the center of axilla wthin the
axillary fat.
5. Infra clavicular (delto pectoral) group—These
nodes are not strictly axillary nodes because they
are located outside.
6. Apical group—Lying at the apex of axilla. These
nodes receives efferent lymph vessels from all
Fig. 8.3: Lymphatic drainage of tongue (superior view) other axillary nodes.
3. The posterior 1/3rd of the tongue drains to the

jugulo-omohyoid nodes of both sides. As most
of the lymph from tongue lately drain into
jugulo-omohyoid nodes.
Applied
Tongue—The lymphatic drainage of tongue is of
clinical importance because cancer is common
here. Cancer affecting the posterior part of the
tongue spreads into superior deep cervical LN Fig. 8.4: Lymphatic drainage of breast
Lymphatic System 151
Lymphatic Drainage of Breast serratus anterior) and thoracodorsal nerve (supply

(Mammary Gland) latissimus dorsi) and to be carefully presented.
Lymphatic drainage of breast is clinically important
Inguinal Lymph Nodes
because cancer is common in this gland and
(Figs 8.6A and B)
usually, spread of cancer takes place through
lymphatics. For the anatomical location and They lie below the inguinal ligaments and divided
description of tumors, the surface ultimately drain into two groups—superficial and deep.
into jugulo-omohyoid nodes. • Superficial group—Lies in superficial fascia and
Lymph passes from nipple, areola and lobules around like letter T. It is divided into a horizontal
of the gland pass to the subareolar lymph plexus (lies below and parallel to inguinal ligament)
and from it most lymph (more than 75%) drains to and vertical group (lies along the upper part of
axillary LN Remaining (25%) lymph, mainly great saphenous vein).
pectoral, some also passes directly to detopectoral The superficial inguinal LN drain the following
group, supraclavicular particularly from medial area:
quadrant of breast, drains to parasternal nodes of
same side or opposite side. Lymph from lower
quadrant passes to the abdominal nodes (inferior
phrenic). Axillary tail drains directly into posterior
(subscapular) group of lymph node.
Applied
The axillary LN enlarge and become painful when
infection of upper limb occur. The lateral group is
the first one to be involved. Excision (cut) and
pathologic analysis is often necessary for treatment
of breast cancer. During the removal of node two
nerves are in danger; long thoracic nerve (supply
Fig. 8.6A: Distribution of inguinal lymph nodes
Fig. 8.6B: Relation of superficial and

Fig. 8.5: Lymph drainage of skin of trunk deed inguinal lymph nodes
a. Superficial lymphatics from skin and lymph nodes. The efferents from deep inguinal
subcutaneous tissue of lower limb (Fig. 8.5). LN draind into the external iliac lymph nodes
b. Gluteal region. (lies along the external iliac artery).
c. Anterior abdominal wall below the level of
umbilicus. Applied
d. Perineum and external genitalia except glans
penis. 1. Any infection in the foot, even sometimes tight
e. Vagina and lower part of anal canal. shoes produce (blister) enlargement of inguinal
• Deep inguinal lymph nodes—They are few L nodes (superficial group).
lymph nodes lying along the upper part of 2. In cancer of glans penis, deep inguinal lymph
femoral vein. All the vessels from superficial nodes are enlarged.
nodes drain into deep group; in addition they 3. In carcinoma of body of uterus superficial
receive deep lymphatics from the lower limb. inguinal lymph nodes (medial group) will be
The glans penis also drain into deep inguinal enlarged.
Viscera
THORAX (FIG. 9.1)

Lungs: They are essential organ in respiration;
conical in shape, covered by thin serous membrane
(visceral pleura), floats in water. It has following
presenting features:
Fig. 9.1: Lungs with pleura
Name Right lung Left lung

Apex Conical; lies above the impression of first rib; covered by Same
cervical pleura (part of parietal pleura) and Sibson’s fascia;
extends into anterior aspect of root of neck.
Base Concave, semilunar, related to liver separated by the Concavity is less, semilunar,
diaphragm. related to left lobe of liver, stomach
and spleen separated by
diaphragm.
Anterior Thin, descends from apex, downwards and medially upto Thin, descends from apex, down-
border sternal angle, then vertically downwards upto xiphisternal wards and medially upto sternal
junction slightly right of midline. angle (slightly left to midline). Then
descends vertically downwards
upto fourth space. It then deviates
towards left 3 to 4 cm away from
Contd...
midline producing cardiac notch

and lingula and end at left sixth
costal cartilage.
Posterior border Thick, rounded, extends from apex to base and fits in Same
para vertebral gutter.
Costal surface Identified by impression of ribs, covered by costal pleura Same

(part of parietal pleura).
Medial surface Identified by several impression. Impressions are: • Hilum – triangular nonpleural
(Mediastinal • Hilum - Triangular nonpleural impression in which impression through which the
surface + Ver- structures of lung root enter and leave the lung. These structures passes, related from
tebral part) are from above downwards bronchus, artery, above downwards are (pul-
(pulmonary) bronchus, vein (pulmonary vein). monary) artery, bronchus, vein
Mediastinal • Cardiac impression – lies below and infront of hilum. (pulmonary).
surface It is concave, related to sternocostal surface of heart. • Cardiac impression – lies below
(Figs 9.2 and • Groove for azygos vein – slender groove above the and in front of hilum more
9.3) hilum for terminal part of azygos vein. concave than right side, related
• Groove for superior vena cava – it is the upwards to sternocostal and left surface
continuation of cardiac impression, wide shallow of heart.
groove. • Groove for arch of aorta – a
(Fig. 9.3) • Groove for esophagus lies behind the hilum. deep impression arching above
• Impression of inferior vena cava – thumb like the hilum.
impression lies at the posteroinferior part of the • Groove for descending thoracic
cardiac groove. aorta behind the hilum – it is a
deep groove.
Contd...
Fig. 9.2: Medial surface of right lung

Viscera 155
Fig. 9.3: Medial surface of left lung
Fissures oblique Lined by visceral pleura, extends from above and behind Same as right lung but obliquity is
the hilum. Cuts the posterior border and descends more marked.
obliquely downwards and forwards; again it cuts the
inferior border, goes to medial surface and end below
and infront of hilum.
Transverse Lined by visceral pleura, extends from anterior border Not present.
fissure (at the fourth sternocostal junction) to oblique fissure in
mid axillary line.
Lobes 3 in number 2 in number
Bronchopul- 10 in number 10 in number

monary segment • In upper lobe • Upper lobe
Portion of lung 1. Apical, 2. Anterior, 3. Posterior 1. Apical, 2. Posterior,
areated by • Middle lobe 3. Anterior, 4. Superior lingular,
tertiary 1. Medial, 2. Lateral. 5. Inferior lingular.
bronchus • Lower lobe • Lower lobe
(Figs 9.4A and 1. Superior, 2. Anterior basal, 3. Posterior basal, 1. Superior, 2. Anterior,
B) 4. Medial basal, 5. Lateral basal. 3. Posterior, 4. Medial,
5. Lateral basal. Here medial
basal segment is suppressed.
Artery supply By one right brochial artery branch of third posterior By two brachial arteries branch of
intercostal artery. descending thoracic aorta.
Nerve supply Both lung by pulmonary plexus formed by, sympathetic (derived from T1–T4 ganglia),
parasympathetic from vagi.
The sympathetic efferent fibers produce bronchodilatation and vasoconstriction. The
parasympathetic efferent fibers produces, bronchoconstriction, vasodilatation and increase
glandular secretion.
Contd...

Anatomical • Conical apex should be placed above.
position / • Convex base should be placed below.
side • Thin anterior border should be placed anteriorly.
determination • Thick posterior border should be placed posteriorly.
• Medial surface with hilum should be placed medially.
Fig. 9.4A: Bronchi and its divisions (segmental bronchi)
Fig. 9.4B: Bronchopulmonary segments
Applied (dyspnea), wheezing and chest tightness,

partially relieved by antibiotics and broncho-
1. Pneumonia—Infective inflammation of lung; in dialators.
which fluid accumulated in the alveoli area. It 3. Tuberculosis (TB)—It is an infectious disease
is cured by proper antibiotics. caused by bacteria (mycobacterium tubercu-
2. Asthma—An obstructive condition, which is losis). Most common lung disease in our
characterized by coughing, difficult breathing country.
Viscera 157
4. Postural drainage—Excessive accumulation of Important Notes

fluid into a lobe or bronchopulmonary segments • In every case of lung disease respiration is
can interfere with breathing. To facilitate normal impaired.
drainage a medical person often advise to • Lung is divided functionally into conducting
change the posture of patient, so that gravity zone (upto terminal bronchiole, which filter,
assists in process of drainage. moisten and warm air) and respiratory zone,
5. Lung cancer—It is dangerous and spread rapidly (respiratory bronchioles to alveoli—where
It is known as bronchogenic carcinoma. gaseous exchange occur).
• Heart—written in chapter of arteries pg. 119.
Abdominal Viscera (Figs 9.5 and 9.6A to C)
Position of abdominal viscera in relation to regions of abdomen
Viscera Quadrants of abdomen

Liver Right and left hypochondrium and epigastrium.
Stomach Epigastrium, left hypochondrium and umbilical region.
Duodenum First part extends into epigastrium rest of the parts in umbilical region
plastered with the posterior abdominal wall.
Pancreas (Figs 9.6A and B) It is retroperitoneal and is situated in the epigastrium and left hypochondrium
Spleen Left hypochondrium and against the nineth, tenth and eleventh rib.
Caecum with appendix Right iliac fossa.
Transverse colon Right lumbar, umbilical and may extend upto hypogastrium, left lumbar,
left hypochondrium.
Rectum and anal canal Pelvic cavity
Fig. 9.5: Abdominal cavity (sagittal section) Fig. 9.6A: Regions of abdomen RH-right hypochon-
drium E–Epigastrium, LH–Left hypocondrium, RL–
Right lumbar, U–Umbilical, LL–Left lumbar, RE–Right
iliac, H–Hypogastrium, LI–Left iliac
Fig. 9.6B: Postions of viscera in different Fig. 9.6C: Abdominal incisions

quadrants of abdomen
Name Features
GI Tract stomach shape J shaped in normal built.
Capacity (in adult) and 1500 cc usually empties food after 3 hours capacity is 50 cc, that’s why infant requires
newborn more frequent meals.
Situation Epigastrium, umbilical, and left hypochondrium
Two orifices Deeply placed, lies 1 inch left of the median plane at the level of seventh costal
1. Cardiac orifice cartilage.Superficially situated; 1inch to the right of the median plane and on
2. Pyloric orifice transpyloric line.
Two borders Start from the right margin of esophagus, goes towards the right upto pylorus.
1. Lesser curvature • At the most dependent part there is an angular notch known as incisura angularis/
(right border) • Lesser omentum is attached here.
• Anastomosis of right and left gastric artery lies in this border.
2. Greater curvature Start from cardiac notch; ascends upwards, backwards and to the left upto left
(left border) fifth intercostal space, then runs downwards, forwards and to the right upto pylorus.
(Figs 9.7 and 9.8A) • From above downwards gastrophrenic, gastrosplenic and greater omentum is
attached.
Two surfaces Related to diaphragm, liver and anterior abdominal wall.

1. Anterosuperior Lies on following structures that constitute the stomach bed:
2. Posteroinferior 1. Left kidney
surface 2. Left suprarenal gland
(Fig. 9.8A) 3. Left crus of diaphragm.
4. Pancreas (body)
5. Left colic flexure
6. Transverse mesocolon.
7. Splenic artery.
Contd...
Viscera 159
Fig. 9.7: Sagittal section of abdomen showing peritoneal cavity and the folds of peritoneum
Fig. 9.8A: Stomach Fig. 9.8B: Arteries of stomach and spleen.

Name Features
Cavity of stomach
has three parts:
Fundus • It is the part above the horizontal line, from cardiac notch to greater curvature. Normally
it contains gas. In X-ray film it looks black.
Body • From fundus upto a line that extends from incisura angularis vertically downwards.
(Fig. 9.8A) Inside which, there are temporary fold (rugae) in mucous membrane which disappear
when stomach is full.
Pyloric part. • Extends from right side of body to pyloric (proximal part) constriction. Pyloric part is
further subdivided into pyloric autrum and pyloric canal (distal part).
Artery supply • Principal supply by left gastric – branch of coelic trunk.
(Fig. 9.8B) • Right gastric – branch of hepatic
• Short gastric – branch of splenic, supply the fundus of stomach
Venous drainage Correspond to arteries.

Nerve supply Autonomic nervous system – Sympathetic from celiac plexus (T6 segment). Parasympathetic
– From vagi via anterior and posterior gastric nerves.
Applied • Gastric ulcer – Breach (break in continuity) in mucus membrane occur along the lesser
curvature very common disease in case of low income groups.
• Malignancy (cancer) – Affects stomach, readily spread to surrounding viscera, i.e.
esophagus, pancreas due to profuse lymphatics.
• Gastric pain – It is felt in the epigastrium, due to same segmental supply. The sensation
of visceral pain is caused by the distention or spasmodic contraction of smooth muscle.
Anatomical position • Place stomach on left hand with lesser curvature facing towards right.
• Thin cardiac end should be above, and directed to left side.
• Thick pyloric end (occasionally bile stained) should be placed below and to the right of
the midline.
Duodenum, Jejunum and Ileum (Fig. 9.9 and 9.10)
Features Duodenum Jejunum Ileum

Situation In posterior abdominal wall. Between the outline of large gut. Between the outline of
large gut and in pelvis.
Shape C shaped and consists of four Proximal 2/5th (8 inches) is Distal 3/5th (12 inches)
parts – First (2 inches in length), jejunum. of small intestine is
Second (3 inches in length), ileum.
Third (4 inches in length) and
Fourth (1 inch in length).
Mesentery No mesentery, so less mobile. Present (highly mobile). Present (highly mobile)
Wall Thick Thicker Thin
Lumen, circular Abscent in first 1 inch of duo- Permanent, very thick and Permanent, thin and lies
folds denum. In the second part of closely placed and due to this at a distance from one
Contd...
Viscera 161
Fig. 9.9: Duodemum and pancreas Fig. 9.10: Interior of small intestine
Features Duodenum Jejunum Ileum
duodenum in postero medial reason it feels like two tubes another. Feeling of single
aspect there is a papilla (major on palpation. tube on palpation.
duodenal papilla) on which,
common bile duct and
pancreatic duct open, unitedly
or separately.
Peritoneal Not present Thinner near gut due to Thicker near gut due to
window and absence of fat. presence of fat.
vascularity • Arterial arcades are less (1 • Arterial arcades are
or 2 in number). more (5 or 6 in
• Vasa recti (long) number).
• Vasa recti (short).
Arterial supply Auperior and inferior pancre- Jejunal branch of superior Ileal branches of superior
atico duodenal. mesenteric. mesenteric.
Applied The first part of duodenum is Because of its extent and • Meckel’s diverticulum –
the common site for duodenal position traumatic injury is It is a diverticulum pre-
ulcer. In barium to med X-ray common here. Small penetra- sent in 2% of cases 2
first 1 inch of first part of ting injuries may self- healed feet away from ileo-
duodenum shows a triangular but in large bullet wound, caecal junction, 2 inches
white shadow called duodenal material leaks freely into the in length and lies in
cap. In duodenal ulcer there is peritoneal cavity. Small bowel antimesenteric border.
defective duodenal cap. content have nearly neutral • The payer’s patches get
pH and produce slight ulcerated in typhoid
irritation in the peritoneum. fever. There may be
perforation of intestine.
Important features There is no sharp demarcation between jejunum and ileum. The change from jejunum to
to note ileum is a gradual structural change.
Name and features Description
Pancreas (Fig. 9.9) It is a mixed gland, soft and lobulated, placed transversely along the posterior abdominal
wall. It occupies epigastrium and left hypochondriac region. It has four parts – flattened
globular head, small constricted neck, prismoid body (with three surfaces and three borders)
and a small tail. Important structures related to pancreas
1. Head – Lies in the concavity of duodenum. Anteriorly lies transverse colon; posteriorly
related with inferior vena cava.
2. Neck – Behind it lies portal vein.
3. Body – Presents three surfaces and three borders
a. Anterior surface - related to stomach and peritoneal.
b. Posterior surface – Nonperitoneal, related with abdominal aorta, left crus of
diaphragm, left psoas major muscle, left kidney.
c. Inferior surface – Peritoneal, related to duodeno jejunal flexure, coils of small
intestine.Three borders
a. Superior border – related to tortuous splenic artery.
b. Anterior border – transverse mesocolon is attached.
c. Inferior border – related to origin of superior mesenteric artery.Tail – lies within the
lienorenal ligament.
Exocrine part of Main pancreatic duct lies near its posterior surface, extends from left to right, receives
pancreatic ducts small tributaries (looks like fish bone pattern). Within the head of pancreas common bile
duct related to its right side. The two ducts, in the second part of duodenum, join and
open over the major duodenal papilla 8 to 10 cm away from pylorus.
Endocrine parts Consists of islets of Langerhans, secretes insulin (by β cells), glucagon (by α cells),
gastrin and somatostatin (by δ cells).
Arterial supply • Mainly by pancreatic branch of spelenic artery.

• Superior and inferior pancreatic duodenal arteries.
Applied 1. Inflammation of pancreas is known as pancreatitis, which produces pain referred to

back of abdomen.
2. Lack of insulin produces diabetes mellitus.
3. Deficiency of pancreatic juice produces digestive disturbances.
4. Carcinoma of the head of pancreas is quite common.
Anatomical position It is always lies along with duodenum and spleen.

• Hold the specimen in such a way that C shaped duodenum is on right hand and spleen
on left hand.
• If only pancreas is present then place globular head to right, triangular body in the
middle, and tail towards the left hand.
• Posterior surface, identified by splenic vein placed posteriorly.
Spleen It is soft, blood riched, pinapple colored, mobile and largest lymphoid organ in body,
(Fig. 9.11A) located just beneath the diaphragm.
Situation and size It is situated behind the stomach in the left hypochondrium. The size of the organ is 1inch
in thickness, 3 inches in breadth and 5 inches in length. It extends from left 9th rib to 11th
rib of which 10th rib is the axis.
Contd...
Viscera 163
Presenting parts It has 2 ends, 2 borders, 2 surfaces, 2 important ligaments and is completely covered by
peritoneum except hilum. Two ends; medial (smaller and rounded) directed medially and
upwards, lateral end is broader. Borders are
1. Superior – marked by notches anteriorly.
2. Inferior border – separates diaphragmatic surface from visceral surface. Diaphragmatic
surface smooth and related to diaphragm. Visceral surface is marked near its middle by
hilum which gives passage of splenic artery and vein. This surface is related to stomach
(above hilum), left kidney, below hilum and at the lateral end with left colic flexure.
Spleen is surrounded by splenic capsule which sends trabeculae inside the substance of
spleen. In it rounded areas consists of lymphocytes and reticular tissue is white pulp, red
pulp is the all other splenic tissues.
Applied • Enlargement of spleen is known as splenomegaly. It is due to chronic maleria, chronic

kalazar and leukemias (blood cancer).
• As the splenic capsule is relatively thin, a direct blow or fall on the ground during
playing may cause it, to rupture. The spleen is removed quickly and it is known as
splenectomy. Care should be taken during removal, to avoid tail of pancreas.
Anatomical position • Spleen should be placed on left hand with smooth convex surface lies over the palm.
• Superior border identified by notches should be placed above.
• Visceral surface (identified by hilum) should be placed above.
• Rounded medial end (smaller) should be directed above and medially.
• Large lateral end should be directed downwards and laterally.
LARGE INTESTINE Important features (Cardinal feature)

Large intestine (extends from caecum to anal 1. Presence of Tinea (longitudinal muscle
orifice – 5 feet long). aggrigation).
2. Sacculation (haustration).
3. Appendices epiploicae (peritoneal pocket
containing fat).

Caecum (A blind pouch) It is the commencement of large intestine, 6 cm long, 7 cm broad; lies in right iliac
(Fig 9.12A) fossa. Caecum has a large right pouch and small left pouch with appendix hanging
down from its posteromedial aspect. Ileum open in it through ileocaecal orifice, guarded
by ileocaecal valve. The valves are formed by duplication mucous membrane containing
submucous coat and circular muscle of ileum.
Applied Caecum is often infected by amoebiosis. Carcinomas of caecum are also common.
(Figs 9.12A and B)
Artery supply Anterior and posterior caecal arteries branches of iliocolic branch of superior mesenteric
artery.
Contd...
Fig. 9.11A: Large gut Fig. 9.11B: Spleen (visceral surface)
Appendix vermiform It is a blind diverticulum from the posterior medial aspect of caecum, 2 cm below the
(worm like) (Fig 9.12B) ileocaecal junction. Lengths 7 to 10 cm (average). It belongs to large gut, but without any
(Fig. 10.18 in haustration and appendices epiploicae. All the taenia coli starts from the base of appendix.
Embryology) Commonest position of appendix is retrocaecal. Second common position is pelvic. Other
position is splenic (tip directed towards the spleen) – When lie in front of terminal ileum
it is known as pre-ileal varity. This position is dangerous in appendicitis. Appendix has a
triangular fold of mesentry – mesoappendix, so it is highly mobile. It is supplied by
appendicular artery – branch of posterior caecal.
Appendicistis – Inflammation of appendix; which causes vague pain around the umbilicus
at first (due to same segmental supply [T10]) next severe pain on Mc Burney’s point,
where maximum tenderness is felt.
Anatomical position • Hold the viscera in such a way that cut end is above.
• Appendix should be placed below and posteomedial to ileo-caecal orifice.
Ascending colon 15 cm in length, wider than descending colon – It extend from ileocaecal orifice to right
(Fig. 9.11B) colic flexure, supplied by right colic artery – branch of superior mesenteric.
Transverse colon 50 cm in length; extends from right colic flexure (1 inch below the transpyloric plane and
(Figs 9.7 and 9.11B) 4 inches to the left of midline to left colic flexure. This flexure is 1 inch above the
transpyloric plane and 4 inches away from midline. Artery supply–middle colic (branch
of superior mesenteric).
Anatomical position • Transverse colon is identified by two mesenterics, i.e. greater omentum and transverse
nesocolon.
• Place the colon in such a way that right colic flexure (wider) should lies below the left
colic flexure (narrower).
• It has a mesentery– transverse mesocolon.
Descending colon • 25 cm in length, narrower than ascending colon.

• Extends from left colic flexure to sigmoid colon.
• Artery supply – Sigmoid arteries – branches of inferior mesenteric.
Contd...
Viscera 165
Sigmoid colon • 40 cm in length, extends upto third sacral vertebrae where it becomes rectum. It has a
triangular sigmoid mesocolon. It is supplied by sigmoidal arteries.
• Visualisation of interior of sigmoid colon by means of endoscope (an instrument) is
known as sigmoidoscopy.
Rectum
(Figs 9.12B, 9.13 and It begins at third sacral vertebra; passes downwards in the concavity of sacrum, and at the
9.14) level of coccyx, it is dialated and form ampulla. At about 3cm in front of the coccyx it
bends sharply backwards to become the anal canal. It has peritoneum of the upper third in
anterior and lateral aspect, and on the middle-third in its anterior surface. Inferior 1/3rd is
nonperitoneal.
• It is related anteriorly rectovesical pouch, (peritoneal pouch) base of bladder, prostate,
seminal vesicle and vas deferens in case of male, and pouch of Douglas (recto uterine
pouch), post wall of vagina, in case of female. The rectum has three lateral bends. The
highest and the lowest are concave to the left. Internally there are three horizontal
shelves (valves of Houston) of mucosa. The upper part of rectum serves as faecal
reservoir.
Contd...
Fig. 9.12A: Interior of caecum Fig. 9.12B Rectum and anal canal (sagittal section)
Fig. 9.13: Rectum and anal canal (coronal section)

Fig. 9.14: Per rectal examination
Artery supply
Applied 1. By superior rectal artery – branch of inferior mesenteric.
(Fig. 9.14) 2. By middle rectal – branch of internal iliac.
3. By inferior rectal – branch of internal pudendal.
Per-rectal examination (P/R) by means of finger is done to assess the anterior of rectum
as well as condition of the neighbouring structures specially the postrate in male, and
condition of genital tract in virgin women.To visualise the interior of rectum by mens of
an instrument is known as Proctoscopy.
Anatomical position • Place peritoneal surface (shiny) anteriorly.

• Nonperitoneal (dull) surface benind.
Anal canal. It is the last part of GI tract. It lies in the perineum, below the pelvic diaphragm 3.8 cm
(Figs 9.12B and 9.13) long.; the interior of anal canal is divisible into three parts:
1. The upper 15 mm is lined by columnar epithelium. It ends below at the pectinate line
(wavy line). This part of mucusa presents anal columns (longitudinal mucus folds).
The lower ends of anal column are united to each other by transverse fold of mucous
membrane; these folds are called anal valves. In between columns and valves there
lies a depression called anal sinus.
2. Next 15 mm is the middle part known as area pecten, lined by stratified squamous
epithelium. Rectal venous plexus is situated in between mucosa and muscle coat.
3. Lower part 8 mm long, linned by true skin, present hair follicle, sebaceous and sweat
glands.
Nerve supply Above pectinate line supplied by autonomic nerves which is insensitive to pain, touch.
Below the pectinate line supplied by somatic nerve which is sensitive to pain, touch,
temperature.
Contd...
Viscera 167
Applied 1. Piles (Hemorrhoids) – Internal pile (true) – painless. They bleed profusely during
straining due to passage of hard stool. The primary piles are seen in 3, 7, and 11
O’ clock.region (in lithotomy posture, formed by enlargement of superior rectal
vein).
Anatomical position 2. Fissure – It is due to tearing of one of the anal valves.
• Lower end (identified by black stained skin) should be placed below.
• Hold the specimen in such a way that upper part lies in the concavity of palm
and lower end should be below the level of finger, producing perineal flexure.
Liver The liver is the largest gland in the body, occupies mainly in the right hypochondrium,
(Fig. 9.15) epigastrium and partly into left hypochondrium. It has manifold activities. It
metabolises carbohydrate and protein after their absorption from intestine and secrete
bile which digest fats. In natural state it is reddish brown, very soft like a jelly. Its
weight is near about 1.5 kg and almost completely covered with peritoneum. In
formalin hardened specimen it composed of 5 surfaces (follows the role of 5), 5
fissures, 5 borders, 5 bare areas (not covered by peritoneum). The surfaces are
triangular (1) anterior (marked by saggitally placed falciform ligament – which
divide the liver into right and left lobe). (2) Posterior (marked by a groove for
inferior vena cava), (3) superior surface is convex (divided into two unequal lobes
by attachment of falciform ligament), (4) inferior surface is uneven and slopping
(most prominent surface) and (5) right lateral surface (forms the base and related to
7 to 11 ribs). The structure related to inferior surface from left to right side, stomach
(gastric impression), pyloric impression (on the right side of ligamentum teres),
duodenal impression (for 1st part of duodenum) in quadrate lobe. The fossa for the
gallbladder, lies to the right of quadrate lobe, colic impression for right colic flexure
Contd...
Fig. 9.15: Liver and applied

and the renal impression for right kidney. The 5 fissures are, fissures for ligamentum
venosum, ligamentum teres hepatis, groove for inferior vena cava, fossa for
gallbladder and porta hepatis (which is a gateway from where hepatic artery and
two division of portal vein goes in and two division of hepatic duct and lymphatics
comes out).
Out of 5 borders 3 are prominent, posterosuperior border, posteroinferior border

and inferior border (most prominent and sharp). It separates inferior surface from
anterior surface and right lateral surface. Out of 5 bare areas 3 are important (1)
The bare area (triangular), present on posterosuperior aspect of right lobe of liver,
demarcated by superior and inferior layer of coronary ligament; and groove for
inferior vena cava, (2) porta hepatis and fossa for gallbladder. Liver is broadly
subdivided into right and left lobe. Anatomical line of separation passes through
attachment of falciform ligament and behind by fissure for ligamentum venosum
and ligamentum teres. So, two other lobes quadrate and caudate lobes belongs to
right lobe anatomically. But for practical purpose physiological division has got
tremendous importance and physiologic line of demarcation passes through
cholecysto vena caval line (i.e. groove for inferior vena cava and fossa for
gallbladder). So, physiological left lobe possess caudate and quadrate lobe. The
ligaments of liver are peritoneal, and nonperitoneal. Peritoneal ligaments (false)
are falciform ligament, superior and inferior layer of coronary ligament, left and
right triangular ligament, lesser omentum. Non peritoneal (true) ligaments are
ligamentum teres hepatis and ligamentum venosum.
Arterial supply Hepatic artery branch of caeliac trunk. Nutrition is carried to the liver by portal
vein.Venous drainage – Hepatic veins (2 to 3 in number) pierces the groove for
inferior vena and drain immediately into inferior vena cava.
Applied 1. Normally liver is palpable under costal margin in case of children below three
years (because of huge size of the gland and small pelvic cavity).
2. Benign (not harmful) tumor of liver is known as hematoma.
3. Secondary metastasis (spread) of cancer cells are common.
4. Cirrhosis of liver – Detruction of liver tissue with haphazard degeneration (wear
out) and regenerations feature (growth). The liver is shrunken, and functions are
impaired.
5. Liver biopsy – Removal of small amount of liver tissue, from right lateral surface,
of liver, between 8th and 9th rib is known as liver biopsy.
Anatomical position Groove for inferior vena cava should be vertical. Inferior surface should be placed
downwards, backwards and to the left.
Viscera 169
Genito Urinary System (Figs 9.16 and 9.17)
Fig. 9.16: Structures around the kidney (after removal of duodenum and pancreas)
Fig. 9.17: Anterior surface of kidney with its relation

Kidney (Figs 9.18A and The kidneys are bean shaped retro peritoneal suructure, which remove waste products
B) (urea, uric acid, creatinine, etc) from the blood. It is highly vascular and has two surfaces,
two poles, two borders (follow the rule of 2). Average length of kidney is 10 cm, breadth
6 cm and thickness 3 cm and weight roughly 150 gm. Left kidney is at higher level than
right. It extends from T11 to L3 vertebra. The two kidneys are covered from inside
outwards:
1. Renal capsule (easily stripped out) – goes into renal sinus.
2. Peri renal fat (perinephric fat) – it goes into the renal sinus.
3. Renal fascia – It consists of anterior and posterior layer. Upper part fuses above
kidney and encloses suprarenal in separate compartment. The two layers remain
separated in lower part.
4. Para renal fat – situated by the side of kidney. It acts as packing material.
The presenting features Right Left

(Fig. 9.17)
Upper pole • Related to triangular right supra- Related to semilunar suprarenal
renal gland. (left) gland.
• Right lobe of liver, second part of Related to fundus of stomach,
duodenum, right colic flexure, coils spleen, left colic flexure and coils
of small intestine. of small intestine.
Posteriorly both kidneys are related with diaphragm. 12th rib, psoas major and quadratus lumborum muscles, sub
costal vessels and nerve, iliohypogastric vessels and nerve.
Coronal Section Coronal section of kidney presents two distinct area. Outer cortex and inner medulla
(Fig. 9.18A) and a space known as renal sinus. In medulla few conical structures are seen which are
renal pyramids. In apices of pyramid 16-20 duct of Bellini opens. The papilla is received
by a cup like tube known as calices minor. In between two pyramid there are cortical
Contd...
Fig. 9.18A: Coronal section of kidney Fig. 9.18B: Development of kidney

Viscera 171

tissue, known as renal column; over the base of pyramid the cortical tissue is known as
cortical arches. Several minor calices join and form major calyx. Two to three major
calyces join to form pelvis of ureter.
Blood supply 1. By renal artery (right and left) – Lateral branch of abdominal aorta.
2. Accessory renal arteries (30% case) – usually supplies the lower pole.
Applied In newborn/infant renal functions are weak. Similarly in old age due to destruction of
nephrons renal function is weak. So in these extreme ages drug should be administered
cautiously.
• Renal stone – very common
• Polycystic kidney
Anatomical position • Anterior surface of kidney should be identified by relation of structures at hilum.
Hold the kidney in such a way that long axis should be directed downwards and
laterally.
• Place right kidney at lower level than left.
Urinary bladder The urinary bladder is a muscular sac, which stores urine. It lies behind the symphysis
(Figs 9.19A to C) pubis, on the pelvic floor (formed by levator ani muscle). In male, rectum lies behind the
urinary bladder but in females, uterus lies in between rectum and bladder. In contracted
state, it presents three surfaces (superior, two inferolateral), an apex, base (posterior
surface) and a neck. In case of male, neck is surrounded by prostate gland.
Presenting parts 1. Superior surface—peritoneal, related to coils of small intestine.

2. Two inferolateral surface—Nonperitoneal, related in front with a space known as
space of retzius and loose areolar tissue. This space allows dilatation of urinary bladder.
3. Base of Posterior Surface—Situated behind, nonperitoneal. In male, this surface is
related to seminal vesicle and ampulla of vas. The two ureters open in this surface.
4. Apex—Pointed and median umbilical ligament is attached.
5. Interior of bladder—The interior of bladder has openings for both ureters and the
urethra. The smooth triangular region outlined by those three openings is the internal
trigone (trigon – triangular). The trigon is important clinically because infections
tend to persist in this region. The internal urethral opening is guarded by valve
Contd...
Fig. 9.19A: Urinary bladder

Fig. 9.19B: Male urinary bladder (posterior aspect) Fig. 9.19C: Interior of urinary bladder
(thickened detrusor muscle) – internal urethral sphincter is controlled involuntarily

when bladder is disteneded with urine (more than 300 cc) it is palpable above symphysis.
When it is more distended, it loses its different surfaces and ovoid in shape. At this
time, inferolateral surfaces become anterior surface and superior surface is posterior.
6. CAPACITY – The mean capacity of adult urinary bladder is 220 ml. Bladder capacity
and tone decreases with age leading to frequent micturation (emptying of bladder). In
newborn, bladder is small and further reason micturition is frequent.
Arterial supply Superior and inferior vesicle

Applied arteries.
(Fig. 9.20) • Urinary retention—
Bladder is unable to expel
its contained urine. It is
normal after general
anesthesia. Others causes
of retention are enlarged
prostate. Catheter must be
inserted through urethra
for drainage.
• Cystoscopy—Visualisa-
tion of interior of bladder
mucosa by a thin viewing
tube is known as
cystoscopy.
• Bladder cancer is also not
uncommon. It involves the
bladder mucosa.· Fig. 9.20: Urethral and supra pubic
catheterisation (sagittal section)
Viscera 173

Suprapubic cystostomy – When retention of urine is not relieved by catheter, suprapubic
cystostomy (a wound done above the symphysis pubis and catheter is introduced in
urinary bladder directly) is done
• Atonic bladder – It is a condition in which bladder is flaccid and overfills, due to
injury of spinal cord. It allows urine to dribble (to flow in drops) through sphincters
due to temporary loss of micturition reflex.
Anatomical position • In contracted specimen place two inferolateral surface over the palm (like when you
offering something to higher spirit).
• Posterior surface (identified by two seminal vesicle and ampulla of vas) should place
posteriorly.
• Place bladder neck below.
Female Reproductive System
Uterus (womb) Nourishes the fertilized egg up to full form fetus. It is pear shaped and has a fundus (no
(Figs 9.21, 9.22 and lumen inside), body (where future baby is grown up) and cervix. It is located in pelvis in
9.23) front of rectum, and postero superior to urinary bladder. In nulliparous woman (who do
not give birth to child), it is anteflexed (angle between long axis of body and long axis of
cervix) and anteverted (angle between long axis of uterus with that of vagina). The cavity
of cervix is known as cervical canal which is almost closed by leaf like arrangement
(arbor vitae uteri) of mucous membrane. The cervix communicates with the body by a
narrow opening (internal os) and with the vagina by external os (another narrow opening).
Cervical mucus also blocks the entry of sperms except at midcycle when the mucus thins
out.
Supports of uterus 1. Ligamentous –

(Figs 9.22A to C) • Lateral aspect – Above, by the peritoneal broad ligaments.
- Below, by Macken rod ligament (condensation of pelvic cellular tissue).
• In front – Pubocavical ligament (from cervix to symphysis pubis).
• Behind – Uterosacral ligament anchors uterus to sacrum.
2. Supports by pelvic floor muscles. The uterine wall is composed of outer serous lining
the perimetrium, middle muscle coat (myometrium) and inner endometrium (mucous
coat). The endometrium sloughs out periodically during reproductive period (extends
from 10 to 50 years).
3. Artery supply – By tortuous uterine artery – branch of anterior division of internal
iliac.
Applied 1. Uterine prolapse – Congenital weakness of pelvic floor muscle or tearing of muscles
and ligaments due to repeated child birth produce prolapse of uterus (descends down
of uterus through vagina).
2. Endometriosis – An inflammatory condition of endometrium characterised by abnormal
uterine bleeding and pelvic pain.
3. Cancer of cervix is common in female (of 30-50 years age group) which is diagnosec
by cervical smear test.
4. Hysterectomy – Surgical removal of uterus is known as hysterectomy.
Contd...
Uterus and vagina in coronal section Uterus and vagina in sagittal section
Fig. 9.21: Presenting parts of uterus
Fig. 9.22A: Supports of uterus (sagittal section)
Fig. 9.22B: Ligamentous support
Fig. 9.22C: Per vaginal examination (sagittal

section)
Viscera 175

5. Laparoscopy – Viewing of interior of abdomen and pelvis by means of instrumental
(laproscope) through anterior abdominal wall is known as laparoscopy.
6. PV Examination – Examination around the cervix (in married women) by passing two
fingers in vagina is known as PV examination.
Anatomical position • Place more convex anterior surface in front with a bend at the level of internal os.
• Place uterine tube over the thumb of two hands.
• Wider fundus is above.
• Narrow cervix is below.
Male Reproductive System
Testis Testis (1 inch in diameter, and 1½ inch in length) is male sex gland, one on each side, and
(Figs 9.23A to C) suspended by spermatic cord. It has three coverings – from outside inwards tunica
Vaginalis, tunica albugenia and tunica vasculosa. The tunica vaginalis is smooth and
shiny. The tunica albugenia is the fibrous capsule of testis. From the posterior part of it,
an incomplete partition extends into testis known as mediastinum testis. From mediastinum,
numerous partitions divide the testis into a number of lobules. Each lobule contains 1 to
3 tightly coiled seminiferous (sperm carrying) tubule. The seminiferous tubule of each
lobule converge and form rete (network) testis, located in the mediastinum testis. From
the rete testis, sperms ascend to epididymes through efferent ductules.
Arterial supply By paired testicular artery – it is a lateral branch of abdominal aorta.
Venous drainage By pampiniform plexus of veins – through testicular veins. Left testicular vein drain into
left renal vein at right angle and right one drain into inferior vena cava at acute angle.
Contd...
Fig. 9.23A: Male generative organ Fig. 9.23C: A semischematic diagram of testis to
show its arrangement of tubules and ducts
Fig. 9.23B: Testis and contents of spermatic cord

Applied • Varicocele–Dilation and tortuosity of pampiniform plexus due to lack of drainage is
known as varicocoele. Left sided varicocoele is more common. It results in elevation
of scrotal temperature, which intereferes with sperm development.
• Orchitis–Inflammation of testis is known as orchitis, commonly occur during mumps.
Carcinoma testes is very common known as seminoma.
Anatomical position • Place upper pole (identified by comma shaped epididymis) above.
• Place lateral surface (identified by sinus of epididymis) laterally.
• In this way you can determine the side also.
Viscera of Head and Neck

Tongue The tongue occupies the floor of the mouth and fills the oral cavity when mouth is closed.
(Fig. 9.24) It is a muscular (skeletal muscle) organ lined on both surfaces by mucous membrane.
Parts It has two parts, anterior 2/3 (oral part) and posterior 1/3 (pharyngeal part).
Features Tongue has dorsum, tip, inferior surface and a root.
Dorsum Dorsum is divided by V shaped sulcus (sulcus terminalis) into two parts, anterior 2/3 and
posterior 1/3, anterior 2/3 is roughened due to papillae of three types. In front of sulcus
terminalis, lies twelve vallate papillae (biggest than other two, containing taste buds),
Contd...
Viscera 177
Fig. 9.24: Tongue (Dorsal surface)
Filliform papillae are numerous pointed projection fills up the whole anterior part of
tongue and fugiform papillae (club shaped). Fugiform papillae appears as reddish spot
over the normal tongue (Fig. 9.24)
In posterior 1/3 there are smooth elevation due to lymphoid tissue known as lingual
tonsil.
Inferior surface The inferior surface is smooth and in the midline there is a fold of mucous membrane
(frenulum linguae) which attaches tongue to the floor of mouth. On either side of frenulum,
sublingual duct open over a papilla.
It has both extrinsic and intrinsic muscles. Intrinsic muscles mainly change the shape of
Muscle of tongue
tongue and there is no bony attachment. Extrinsic muscles change the shape as well as
alter position; and anchors the organ to the bone.
• Extrinsic muscles are discussed in chapter of muscles.
By lingual artery branch of external carotid.

Blood supply
Motor – All muscles of tongue (extrinsic and intrinsic) are supplied by hypoglossal (twelvth
Nerve supply cranial) nerve except palatoglossus which is innervated by cranial accessory (eleventh
cranial).
Sensory (General) – Anterior 2/3rd by lingual except vallate papillae, posterior 1/3rd by
glossopharyngeal including vallate papillae.
Special sense (taste sensation) – Anterior 2/3rd by corda tympani through lingual nerve
and posterior 1/3rd by glossopharyngeal.

Lymphatic drainage Discussed in lymphatic system.
Applied • Tongue tie – In tongue tie (ankyloglossia) frenulum is short due to developmental
defect. It affects speech depending upon the shortness of frenulum.
• Cancer of tongue is also common.
Anatomical position • Hold the specimen in such a way that rough superior surface (identified by papillae)
placed above.
• It is always associated with larynx and pharynx.
• Glossy inferior surface lies over the palm.
• Pharynx and larynx is directed below and behind.
Pharynx It is funnel shaped passage connecting nasal cavity to larynx and oral cavity to esophagus.
(Figs 9.25 and 9.26) It extends from base of skull up to sixth cervical vertebra.
Sub division It has three sub divisions – Nasopharynx, Oropharynx and Laryngopharynx.
Nasopharynx (lining It lies posterior to nasal cavity and superior to soft palate. It is most dilated part and most
epithelium is ciliated of its walls are immovable. On its lateral wall opens the pharyngotympanic tube (eustachian
pseudostratified tube). Behind it, there is elevation – due to cartilaginous part of pharyngo tympanic tube
columnar epithelium) (tubal elevation). In the roof and posterior wall of nasopharynx collection of lymphoid
tissue known as nasopharyngeal tonsil.
Fig. 9.25: Sagittal section of head and neck showing nasal cavity, pharynx and larynx
Viscera 179
Oropharynx (Epithelium Lies posterior to oral cavity; extends from soft palate to epiglottis. In its lateral wall lies
– stratified squamous palatine tonsil (the tonsil) in a fossa, known as tonsillar fossa. The fossa is between
epithelium) palatoglossal and palatopharyngeal fold.
Laryngopharynx (lined Lies behind the larynx and extends from epiglottis to cricoid cartilage. The lateral wall of
by stratified squamous laryngopharynx present pyriform fossa (bounded by aryepiglottic fold on its medial aspect,
epithelium) laterally by mucous membrane lining the lamina of thyroid cartilage.
Pharyngeal muscles There are 6 muscles, 3 constrictors (superior, middle and inferior constrictor) and
(Fig. 9.26) stylopharyngeus, palatopharyngeus and salpingopharyngeus.
The constrictors are circularly arranged and fits like three bucket where the superior one
is the innermost and inferior one is the outermost. There is overlapping of fibers. All
constrictors constrict pharynx and longitudinal muscle shortens the pharynx and propel
the food to esophagus.
Artery supply Ascending pharyngeal – branch of external carotid.

Also supplied by branches of facial artery.
Nerve supply – motor All pharyngeal muscles are supplied by cranial accessory through pharyngeal plexus except
stylopharyngeus which is supplied by glossopharyngeal.
Contd...
Fig. 9.26: Posterior view of pharynx with three constrictors

Applied Inflammation of nasopharyngeal tonsil is known as adenoids which blocks the airway
passage and leads mouth breathing. Common in children in the winter season.
Anatomical position • Hold the specimen in such a way that rough superior surface of tongue (identified by
papillae) placed above.
• Glossy inferior surface lies over the palm.
• Pharynx and larynx is directed below and behind.
Larynx (Voice box) Larynx extends from fourth to sixth cervical vertebra; 5 cm in length. It has a cartilaginous
(Figs 9.27 and 9.28) framework (epiglottis, thyroid, cricoid and a paired arytenoids cartilages). All cartilages
are hyaline except epiglottis (elastic cartilage).
Cavity The cavity of larynx (interior) is divided into three parts: (1) Vestibule (upper part), (2)
sinus of larynx (middle part) and (3) infraglottic (lower part) region.
• The laryngeal inlet is bounded by two folds (aryepiglottic fold) on either side, in front
by epiglottis and posteriorly by transverse fold between two arytenoid cartilages. The
vestibule is limited below by two vestibular fold. Between the vestibular fold (above)
and vocal fold (below) lies sinus of larynx. The gap between the two vestibular folds
is known as rima glottis or simply glottis. Anterior 3/5th of it is membranous (vocal
cord) and posterior 2/5th is cartilaginous (in between vocal process of arytenoids
cartilages). Vocal cord looks like pearly white when examined by indirect laryngoscopy.
Muscles The muscles of larynx alter the size and shape of laryngeal inlet and causes movement of
(Fig. 9.29) vocal ligament or changing the tension of vocal cord. There are 9 pairs of very thin
muscles which control the phonations and breathing. Alteration of shape of glottis is
done by abduction, adduction, tension and relaxation of vocal cord.
Abduction (separation) – done by posterior cricoarytenoid (safety muscles of larynx).
Adductor (approximation) – by lateral cricoarytenoid and transverse arytenoids.
Tension (elongation) – done by cricothyroid and vocalis.
Relaxation (shortening) – done by thyroarytenoid.
Nerve supply Sensory – Above the vocal fold, mucous membrane is supplied by internal laryngeal
branch of superior laryngeal and below the vocal by recurrent laryngeal nerve, branch of
vagus.
Motor – All intrinsic muscle of larynx is innervated by recurrent laryngeal nerve except
cricothyroid which is supplied by external laryngeal.
Applied • If there is damage of superior laryngeal (unilateral) during operation of thyroid,

cricothyroid muscle of the affected side is paralysed, there is temporary hoarsness of
voice.
• Bilateral damage of superior laryngeal nerve produces permanent hoarsness because
rima glottis cannot close properly. Sensation of vallecula, pyriform fossa and vestibule
of larynx is lost – therefore no cough reflex.
• In cutting of recurrent laryngeal nerve (unilateral) there is weakness of voice. Bilateral
cutting results in permanent hoarsness of voice and respiratory difficulty.
• When both superior and recurrent laryngeal nerve is damaged, then there is complete
paralysis of vocal cord called cadaveric position.
Anatomical position • As above (like tongue)

Contd...
Viscera 181
Fig. 9.27: Skeleton of larynx
Fig. 9.28: Interior of larynx Fig. 9.29: Laryngeal musculative (posterior view)
Nasal cavity The nasal cavity lies posterior to external nose. Air enters the nasal cavity through nostrils.
The cavity is divided into two by a midline nasal septum. The nasal cavity is continuous
behind with the nasopharynx by choanae (posterior nares).
Nasal septum The septum is formed anteriorly by hyaline cartilage (the saptal cartilage) and posteriorly
Boundary by perpendicular plate of ethmoid and vomer. The anteroinferior part of nasal septum is
(Figs 30A and B) highly vascular where septal branch of facial artery, a branch from long sphenopalatine,
and greater palatine artery anastomoses. It is known as ‘Little’s area of epitaxis’ which
produce bleeding in children (commonly due to pricking of nose).
The roof is bounded by ethmoid and sphenoid bone; floor is formed by palate (which
separates it from oral cavity), the lateral wall is by medial wall of maxilla mainly.
Parts of nasal cavity The portion of nasal cavity superior to the nostril is called vestibule, is lined by skin. Hair
is present for filtering of dust and bacteria from inspired air. Small slit-like area at the
roof is covered with olfactory mucosa (contains receptor for sense of smell). The rest of
the area is covered with respiratory mucosa (lined by pseudostratified ciliated columnar
epithelium). The paranasal air sinuses open into the respiratory region.
Nasal conchae Protruding medially from lateral wall of nasal cavity are three mucous-covered projection
(Fig. 9.31B) known as conchae. The superior and middle conchae are part of ethmoid bone and inferior
nasal conchae is a separate piece of bone. The space under the conchae are named superior,
middle and inferior meatus respectively.Openings that are situated on the lateral wall of
nasal cavity
(A) Superior meatus – Opening of posterior ethmoidal sinus.
(B) Middle meatus – 1. Contains ethmoidal bulla (elevation) – which contain middle
group of ethmoidal air cells and it opens on it. 2. Hiatus semilunaris where maxillary
sinus, frontonasal duct and anterior group of ethmoidal air cells open.
(C) Inferior meatuses-Nasolacrimal duct opens here.
Applied • Inflammation of nasal cavity is known as rhinitis.

Contd...
Fig. 9.30A: Nasal septum (sagittal section) Fig. 9.30B: Blood supply of nasal septum
Viscera 183
Fig. 9.31A: Relative position of air sinuses in face Fig. 9.31B: Paranasal air sinuses (coronal section)
• The nasal septum is not truly median. Excessive deviation of nasal septum is known
clinically as deflected nasal septum (DNS). Patients with DNS frequently suffer from
common cold and often, respiratory difficulty.
• Benign growth in the nasal cavity is commonly known as polyps.
• Lesion of olfactory nerve due to breakage of cribriform place (usually in motor car
accident) and CSF may dribble (drop by drop) through the breakage.
Paranasal air sinuses The nasal cavity is surrounded by a group of air sinuses known as paranasal air sinuses
(Figs 9.31A to C) (PNS). It makes the bone lighter and add moisture to the inspired air. Each sinus is lined
by ciliated columnar epithelium. The sinuses are located in frontal, ethmoid, sphenoid
and maxillary bones. The sinuses possess a sensory nerve supply and the mouth (ostium)
of the sinus is more sensitive
and other parts are relatively
insensitive.
Maxillary sinus – Largest
paired sinus whose floor is ½
inch deeper to floor of nasal
cavity. Its opening to the nasal
cavity is minimized by
lacrimal (in front), palatine
(from behind) uncinate
process of ethmoid from
above and a process of inferior
nasal concea from below.
Ethmoidal air sinus (cells) –
Lies within labyrinth of
ethmoid bone. They are
grouped into anterior, middle Fig. 9.31C: Paranasal air sinuses (in sagittal section)
and posterior groups.
Contd...
Frontal air sinuses – Paired, unequal size, more prominent in male. It produces more
prominent glabella and superciliary arch, in male and it is absent at birth. Sphenoidal air
sinus–Unpaired. Situated in middle, lies within the body of sphenoid. It is related to
pituitary above and cavernus sinus on both sides. It opens in sphenoethmoidal recesses.
Applied • Inflammation of sinus due to common cold virus is known as sinusitis. It produces
pain.
• Accumulation of infected material in maxillary sinus produces much pain due to poor
natural drainage (as the floor of the sinus is deep). Surgical drainage is done by breaking
the lateral wall of inferior meatus and middle meatus.
• Paranasal air sinuses are well visualized in X-ray skull (in occipito-mental view).
Parotid gland (Para – One of the salivary glands. Others are submandibular, sublingual. The large triangular
near; otid – ear) parotid gland lies in parotid mould; (fossa) between masseter muscle and skin. The fossa
(Fig. 9.32) So, gland is bounded anteriorly by mandible, behind by mastoid process, medially by styloid process
near the ear and above by zygomatic arch. The gland is covered on lateral aspect by thick
parotidomasseteric fascia.
Presenting parts The gland presents a tapering apex (placed downwards), a concave broad base (placed
below the external acoustic meatuses) and three surfaces (A)superficial (related to skin
and subcutaneous tissue), (B) anteromedial surface (deeply grooved by ramus of mandible)
and (C) posteromedial surfaces (large and related to mastoid process, styloid process,
transverse process of atlas, facial nerve and external carotid artery).Facial nerve divides
the gland into superficial and deep parts.
Parotid duct By parotid duct the gland pours its secretion in the vestibule of mouth opposite the crown
of upper second molar teeth. Length is 5 cm and can be palpable when teeth is clenched.
Contd...
Fig. 9.32: Parotid gland and its relations

Viscera 185
Artery supply By external carotid artery and its branches.
Nerve supply By autonomic nervous system. Parasympathetic secretomotor passes through

auriculotemporal nerve.
Applied • Viral infection of parotid gland is known as mumps; common in children.

• Inflammatory swelling of gland is very painful due to tough fascial covering.
• Mixed parotid tumor – slow growing, benign, painless tumor and of huge size.
Anatomical position • Placed concave broad base, above (often external auditory meatus attached with it).
• Tapering apex below.
• Anterior border (identified by the presence of parotid duct) and it should be hold by
other hand anteriorly.
• Lateral surface is smooth and place outside.
• Medial surface (identified by fossa and ridges) should be placed inside.
Thyroid gland Butterfly shaped largest endocrine gland situated in front of neck over trachea.
Parts (Fig. 9.33) It has two lobes connected by median tissue mass called isthmus. The lateral lobe presents
upper pole (extends up to oblique line of thyroid cartilage), lower pole (extends up to
sixth tracheal ring), three surfaces – superficial (muscular surface), posterior (vascular
surface) and medial (tubal surface) and three borders.
Muscular surface – is related to sternothyroid muscle.
Vascular surface – is related to carotid sheath with common carotid artery and internal
jugular vein.
Tubal surface – is related to two tubes:
• Lower part of larynx and upper part of trachea.
• Lower part of pharynx and upper part of esophagus.
Artery supply Highly vascular thyroid gland is supplied by superior thyroid (branch of external carotid)
and inferior thyroid (branch of thyrocervical trunk) arteries; occasionally by arteria
thyroidea ima.
Contd...
Fig. 9.33: Thyroid gland (anterior view)


Applied • Slight enlargement of thyroid gland during puberty is known as pubertal goiter.·
Non-inflammatory; non-neoplastic growth of thyroid gland is known as goiter.·
Cancer of thyroid is also common.
Anatomical position • Hold the butterfly shaped gland in such a way that tapering upper pole should
above.
• Flat superficial surface laterally.
Brain
The human brain is like a computer. The brain used in Anatomy are hardened by formalin. The
controls all the functions of our body. It is well- average adult male brain weights 1.6 kg and that
protected within cranial cavity by bones, meninges of a woman averages 1.45 kg. In terms of brain
and cerebrospinal fluid. The fresh brain is pinkish weight per kg body weight, however, males and
grey tissue and is extremely soft and specimens females have equivalent brain size.
Viscera 187
Name and presenting parts Description
Cerebral hemispheres It is the most superior part of brain. The two hemispheres are separated by a longitudinal
(Fig. 9.34A) fissure into which flax cerebri (a process of dura mater) projects. Almost entire surface
of cerebral hemisphere is marked by elevated ridges of tissue called gyri, separated by
shallow groove, the sulci. The gyri and sulci increase the surface area of brain.
It has three surfaces and Each cerabral hemisphere has three surfaces (Figs 9.34A to C): (1) convex superolateral
three borders surface, (2) the flat medial surface, (3) inferior surface which consists of anterior orbital
and posterior tentorial parts. Borders are: (1) Superomedial border separates convex
superolateral surface from flat medial surface. (2) Inferolateral border, which presents a
notch (preoccipital notch) and it separates superolateral surface from inferior surface.
(3) Inferomedial border – separates inferior surface from medial surface and is divided
into anterior medial orbital borders and posterior medial occipital borders.
Lobes/important sulci Three important sulci (central, lateral, parieto-occipital) and two imaginary line divides
and gyri on superolateral the cerebrum into four lobes: frontal, temporal, parietal and occipital. The important
surface (Fig. 9.34A) sulci on superolateral surfaces are central sulcus, pre-central sulci, post-central sulcus,
posterior rami (branch) of lateral sulcus and parieto-occipital sulcus (extends only about
½ cm in this surface).
1. Central sulcus The central sulcus is located 1 cm behind the half way between frontal and occipital
(Fig. 9.34A) pole and descends downwards and forwards and ends just above the posterior rami of
lateral sulcus. The surface topography of this sulcus is parallel and two fingers away of
coronal sulcus. This important sulcus is often difficult to identify. Pre-central sulcus
lies in front and almost parallel to it. Similarly, post-central sulcus lies behind it. The
gyri lies in front of central sulcus and limited by pre-frontal sulci is pre-central gyri
(known as Broadman area 4) located at front lobe. This region of brain mainly controls
all the motor activity of the contralateral body along with pre-motor cortex and frontal
eye field (area 6). The entire body is represented in the primary motor cortex upside
down; the head lies at the inferolateral part of prefrontal gyrus and toes at the superomedial
part. The gyrus lies behind the crntral sulcus is post-central gyrus. It is the sensory
cortex (areas 3,1,2), located in parietal lobe of brain. This area primarily concerned
with conscious awareness of sensation. Recent studies show both the motor and sensory
areas are not wholly motor or sensory. Some sensory fibers are located in motor area,
and some motor fibers are seen in sensory area (although very scanty in number). So
now-a-days, a new name is given sensory-motor cortex – where motor fiber is dominant
(as in motor area) Ms1 is named, where sensory fibers dominant Sm1 (sensory) is named
(capital M indicates Motor fiber predominate, capital S indicates sensory fiber
predominate). Similarly, here, body is represented upside down. The motor speech area
of broca (anterior) is on inferior frontal gyrus of left side. The posterior speech area of
Wernicke is in the posterior part of superior and middle temporal gyrus.
2. Lateral sulcus The complicated lateral sulcus starts from inferior surface (from valleculla) of cerebral
(Fig. 9.34A) hemisphere. It has a stem and three rami, anterior horizontal, anterior ascending and
posterior (largest) rami. The auditory area (areas 41, 42) is mostly lies in the floor of
lateral sulcus.
Important sulci and gyri The flat medial surface is connected by corpus callosum (commissural fibers). The fibers
and areas on medial of the brain act like electric wiring for connection, integration and execution of different
surface (Figs 9.34B and activities. In this surface lies callosal sulcus (just above the comma-shaped corpus
9.35A)
Contd...
Fig. 9.34A: Superolateral surface of cerebral hemisphere
Fig. 9.34B: Medial surface of cerebral hemisphere
Fig. 9.34C: Inferior surface of cerebral hemisphere

Viscera 189
callosum). During examination, corpus callosum is divided and the cerebral hemispheres
are separated. One finger breadth above the callosal sulcus lies cingulated sulcus. It
ends behind the paracentral lobule. In between two sulci lies cingulated gyrus and above
cingulated sulcus lies below medial frontal gyrus. The cingulated gyrus (anterior part)
is the part of limbic system (concerned with our emotions). In this surface, there is
oblique parieto-occipital sulcus (which extends up to superomedial border) separates
parietal lobe from occipital lobe. Another deep sulcus lies in posterior part of medial
surface – the calcarine sulcus. These two deep sulci converge anteriorly and meet behind
the posterior part (splenium) of corpus callosum. In between parieto-occipital and
calcarine sulcus, the wedge shaped tissue is known as cuneus. In front of cuneus lies
precuneus (limited in front by paracentral lobule). Paracentral lobule is the area brain
tissue around upper part of central sulcus. Both the motor and sensory area of lower
limb, perineum is located here. Along the lips of posterior part of calcarine sulcus,
visual area (17) is situated. The cortex is adjacent to area 17 on the medial and lateral
surfaces of cerebral hemisphere from the visual association area. This cortex receives
visual information from retina.
Important sulci, gyri on Inferior surface is divided by stem of lateral sulcus into anterior orbital and posterior
inferior surface tentorial part. From orbital surface a medial straight sulcus strips of brain tissue and
(Fig. 9.34C) formed gyri recti. Rest of the brain tissue is divided by irregular H-shaped sulci into
anterior, posterior, medial and lateral orbital gyri. The tentorial part is marked by some
anteroposteriorly oriented sulci named colateral sulcus (begins from the occipital pole
and extends anteriorly parallel to calcarine sulcus) and occipitotemporal sulcus (parallel
to collateral sulcus and lies lateral to it). The gyrus between collateral and calcarine is
lingual gyrus. The hook-shaped area in front of collateral sulcus is uncus. Medial to
collateral sulcus is parahippocampal gyrus. Uncus and parahippocampal gyrus is
concerned with emotions (belongs to limbic system).
Artery supply The two vertebral and two internal carotid arteries supplies the whole brain. The
(Fig 9.35B) superolateral surface of cerebral hemisphere is mainly supplied by middle cerebral artery,
Contd...
Fig. 9.35A: Main functional cortical areas of brain

branch of internal carotid.

The medial surface is
mainly supplied by anterior
cerebral (branch of internal
carotid) and main artery
supplies the inferior surface
is posterior cerebral (branch
of basilar).
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Applied • Microcephaly—It is a
congenital (present from
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Fig. 9.35B: Blood supply of brain
birth) condition
characterised by reduced skull size and the child is mentally and physically retarded.
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• Cerebrovascular accident (CVA)—It is very common, commonly known as stroke
results from lack of blood supply (e.g. atherosclerosis). If the person survives
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developed paralysis usually of one side of body.
• Head injuries—There may be subdural and subarachnoid hemorrhage. It is treated
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by surgery. Other types of injuries include contusion which results in much tissue
destruction.
• Alzheimer’s disease—It is a progressive degenerative disease of brain which results
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in dementia (forgetfulness).
• Encephalitis—Inflammation of brain tissue by virus or bacteria.
• Psychoses—It is a type of functional brain disorder where the affected individual is
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detached away from reality and exhibits odd behaviour.
• Cerebral palsy—Temporary lack of oxygen (as in difficult delivery) may lead to
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cerebral palsy. It is a neuromuscular disability where muscles are poorly controlled
or paralysed.
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Basal nuclei 1. Basal nuclei or corpus striatum includes the caudate nucleus, putamen and globus
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(Fig. 9.36) caudate pallidus.
nucleus putamen globus 2. These structures are primarily concerned with the control of posture and movements.
pallidus In clinical practice, it is known as extra-pyramidal motor system.
3. Tropographically, the putamen and globus pallidus constitute the lentiform nucleus
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(lens like).
4. Functionally, the caudate nucleus and putamen form a single entity – the neostriatum
a
(striatus), while the globus pallidus forms the paleostriatum or pallidum.
t
5. The caudate nucleus lies in the wall of lateral ventricle. It has a globular head, body
and tail.
6. The curved tapering tail of the caudate nucleus follows the curvature of lateral ventricle
into temporal lobe.
7. The putamen and globus pallidus lies lateral to the internal capsule deep to cortex
and insula.
8. The caudate nucleus and the putamen are the input regions of corpus striatum.
9. They receive afferents from cerebral cortex, intralaminar thalamic nuclei and substantia
nigra.
10. Efferent fibers are directed to the globus pallidus and parts reticulata of substatia
nigra.
11. The globus pallidus consists of two segments – medial and lateral.
12. The medial segment shares many similarities with the parts reticulata of substantia
nigra, these two structures are regarded as output regions of corpus striatum.
Contd...
Viscera 191
Fig. 9.36: Basal ganglia (horizontal section)
13. The globus pallidus receives afferent fibers from the stratum and the subthalamic
nucleus.
14. The medial part of globus pallidus projects primarily to the thalamus.
15. The thalamus in turn sends fibers to the motor areas of frontal lobe.
Applied • Unilateral basal ganglia lesions produce their effects on opposite sides of the body.
(Fig. 9.37) Basal ganglia dysfunction does not cause paralysis, sensory loss or ataxia but leads to
abnormal motor control, alteration of muscular tone, and there are abnormal, involuntary
movements (dyskinesias).
• Parkinson’s disease is a neurodegenerative disease (dopaminergic neurone is
degenerated) of substantia nigra, usually elderly group is affected of unknown cause.
It is characterized by short, suffling gait, a hypokinesia (less movement), tremor, and
rigidity of muscle.
• Hepatolenticular degeneration (Wilson’s disease)—It is an inherited disease of copper
metabolism. Basal ganglion changes to abnormal movement and progressive dementia
in childhood and youth.
Fig. 9.37: Disorder of basal ganglia

which connects the brain and spinal cord. The

White Matter of Cerebral Hemisphere
cerebral hemisphere receives and gives information
Fibers are classified on the basis of origin and to different regions of spinal cord through these
termination. These fibers are like electric wires fibers.
Association fibers These fibers link cortial region within the same hemisphere. Important fiber bundles
are superior longitudinal fasciculus, arcuate fasciculus, inferior longitudinal fasciculus
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Short Long and uncinate fasciculus.
Applied Carbon monoxide posisoning destroys the inferior longitudinal fasciculus bilaterally.
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In this case, the vision remains normal but cannot identify the individual faces or the
nature of object.
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Commissural fibers These fibers connect the corresponding region of the two hemispheres. The major
d
commissural fibers are the corpus callosum, the anterior commissure and the
hippocampal commissures.
ti e
Corpus callosum Largest commissure, 10 cm in length. Anterior end is 4 cm away from frontal pole and
(Figs 9.38A and B) posterior end is 6 cm away from occipital pole. It is divided into four parts; from
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anterior to posterior aspect they are rostrum, genu, body and splenium. As the corpus
callosum is shorter than cerebral hemisphere, the callosal fibers linking the frontal and
occipital poles curve forwards and backwards, and form forceps minor and major
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respectively. As the splenium interconnects the occipital cortex, it is concerned with
visual functions.
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Artery supply By anterior and posterior cerebral artery, artery of Heubner
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Applied Destruction of splenium of corpus callosum by stroke or tumor leads to posterior
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disconnections syndrome. Such individuals can speak and write but cannot understand
written material. Chronic epilepsy (fit) patients may be treated by section of corpus
callosum to control the fit. But the drawback is that the person cannot name objects.
Contd...
a h
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Figs 9.38A and B: Corpus callosum and its different parts
Viscera 193
Projection fibers These fibers connect between the cerebral cortex and various subcortical areas. These
fibers pass through corona radiata and internal capsule.
Internal capsule • It is the important projection fiber. Corona radiata fibers become concentrated in a
(Fig. 9.36) narrow area, and form internal capsule between thalamus and caudate nucleus medially
and the lentiform nucleus laterally. The internal capsule is angulated like boomerang
and has got anterior limb, genu, posterior limb, retrolentiform and sublentiform part.
Through anterior limb passes fiber from thalamus to prefrontal cortex, also fibers
from frontal cortex to pontine nucleus (pons). The posterior limb contains corticobulbar
and corticospinal motor fibers and thalamo cortical fiber to somatosensory cortex.
Through retrolenticular part passes optic radiation fiber to visual cortex through
submiddle cerebral.
Artery supply By lenticulostriate arteries – branch of anterior and middle cerebral artery. One of them is
large and known as charcoat artery, supply the lower limb region is frequently ruptured.
It is known as artery of cerebral hemorrhage.
Brain stem Brain stem comprises of midbrain, pons and medulla from above downwards. Each segment
(Fig. 9.39) is roughly one inch in length. Out of 12 pairs of cranial nerves, 10 pairs (except first and
second ) arise from brainstem. It controls automatic centers for our survival (like heart
beat, respiration, GI reflex).
Contd...
Fig. 9.40A: The mid-brain—level of the inferior

colliculus and decussation of the superior
cerebellar peduncle
Fig. 9.39: Brain stem (lateral view)
Fig. 9.40B: The mid brain—level of the superior

colliculus and the red nucleus

Mid brain • It lies between diencephalons and pons. A hollow tunnel (cerebral aqueduct ) passes
(Figs 9.40A and B) through it. An imaginary line passes through the aqueduct, divides the midbrain into
ventral cerebral peduncle (stalk) and dorsal tectum (roof).
Tectum • Tectum consists of two pairs of elevated masses, superior and inferior colliculi. They
are the reflex center. The superior colliculi is receives fibers from optic tract and inferior
colliculi receives fibers of auditory pathway (lateral lemniscus).
Cerebral peduncle • The ventral cerebral peduncle is divided by substantia nigra (dark pigmented area)
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into three parts; from ventral to dorsal aspect lies crus cerebri, substantia nigra and
tegmentum. The middle third of crus consists of pyramidal fibers (descending tract).
Substantia nigra • It is a dark pigmented area visible in necked eyes (section of midbrain). The substantia
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nigra has both afferent and efferent connection with basal nuclei (corpus striatum). It
is associated with extra-pyramidal system.
V
Tegmentum • It consist of ascending fibers (medial and lateral lemnisci) and discrete grey matter.
Third nerve nucleus lies in grey matter (ventral to aqueduct) at the level of superior
d
colliculi. At this level lies red nucleus (important motor nucleus of extrapyramidal
system), fourth nerve nucleus lies ventral to aqueduct at the level of inferior colliculi.
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Through out the tegmentum lies scattered masses of grey matter known as reticular
formation.
n
Applied Parkinson’s disease—It is characterized by tremor (involuntary fine movement of fingers),
rigidity (stiffness) due to degeneration of dopamine, (a neurotransmitter) producing cells
of substantia nigra.
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PONS – means bridge It is a bridge between midbrain above and medulla oblongata below. The fifth, sixth,
-
(Figs 9.41A and B) seventh and eighth cranial nerves are attached to it. It is situated in posterior cranial fossa
over the clivus. Functionally it is a conduction pathway between higher and lower brain
centers. It respiratory (pneumotaxic) nuclei, in addition with, medullary respiratory center
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Contd...
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a h
t
Fig. 9.41A: Cross section of pons (middle part) Fig. 9.41B: Brain stem showing pons
Abbreviations: SCP—Superior cerebellar peduncle, (anterior surface)
M—Middle cerebellar peduncle, PN—Pontine nuclei
Viscera 195
control rate and depth of respirations. A cross section of pons shows ventral basilar part
and dorsal tegmental part. Through the basilor part transversely running ponto cerebellar
fibre pass to opposite middle cerebellar peduncle. Also there are vertically running
pyramidal fiber scattered within these fibres are groups of pontine nuclei. The teg mentum
contain 5th, 6th, 7th, 8th nerve nuclei. There is a special bluish color locus ceruleus
nucleus.
Medulla oblongata It is 2.5 cm long; broad above, and narrow below. Four cranial nerves, ninth, tenth, eleventh,
(Fig. 9.42) twelveth cranial nerves are attached to it. The medulla ends below the foramen magnum—
where the first cervical nerve is attached. The lower part of pons and upper part of medulla
form ventral part of fourth ventricle. The dorsal wall of ventricle is formed by thin capillary
riched membrane—the choroids plexus. The medulla has several externally visible
landmarks. On the ventral aspects just by the side of anterior median sulcus lies pyramidal
(formed by large pyramidal tract) and by the side of pyramid, in the upper part, lies oval
shaped olive (formed by inferior olivary nucleus). In the mid line, we can see the cross
over of pyramidal fibers (75%) known as decussation of pyramid. The inferior cerebellar
peduncles are visible on dorso-lateral aspect of olive. The rootless of hypoglossal nerve
(twelveth cranial nerve) emerge between pyramid and olive. Inspite of its small size, and
apart from important nuclei and tracts, it also controls autonomic reflex involved in
maintaining the body homeostasis. They are the cardiovascular center, respiratory center,
vomiting and coughing centers.
Applied • As the vital centers situated in medulla, a lesion is usually fatal.

• Damaged to paramedian region produced medial medullary syndrome characterized
by paralysis of tongue on the same side, hemiplegia (paralysis of one-half of body) to
opposite side with the loss of touch and kinesthetic sense on opposite side.
Contd...
Fig. 9.42: Section (transverse) of medulla at the level of 4th ventricle with intact lower part
• Damage to dorsolateral aspect give rise to lateral medullary syndrome. It is characterized

by dysphonia (difficulty in speaking), dysphagia (difficulty in swallowing) due to
paralysis of laryngeal and palatal muscles on the same side. Loss of pain and temperature
sensation on the same side of the face, and opposite side of body. Involvement of
vestibular nuclei causes vertigo and nystagmus with nausea and vomiting.
Cerebellum situation • The cauliflower like cerebellum is the largest part of hind brain; situated in posterior
(Figs 9.43A to C) cranial fossa, overlapping mid brain. It lies below the tentorium cerebelli (a process of
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dura matter). Its weight is 150 gms in adult. It forms 1/8th part of cerebrum in adults
and 1/20th part of cerebrum in children. Cerebellum comprises of two cerebellar
hemisphere connected by vermis – superior and inferior vermis.
R
Parts • It is composed two surfaces, two borders, two fissures and two notches. It is connected
V
to brain stem by superior, middle and inferior cerebellar peduncles. The cerebellar
surface shows fine, parallel, plate like gyri known as folia. Deep fissures (like fissure
d
prima, horizontal fissure) subdivide each hemisphere into anterior, posterior and
flocculonodular lobes. The cerebellum processes and interpretes impulses from motor
ti e
cortex and sensory pathways. It co-ordinates motor activity so that smooth and well-
timed movement can occur.
Blood supply
n
• Superior surface by superior cerebellar artery. Inferior surface, in anterior part by
anteroinferior cerebellar artery and posterior part by posterior inferior cerebellar artery,
branch of vertebral artery.
U
Applied The lesion of cerebellum gives rise to following:
-
1. Hypotonia—Less tone of muscles.
2. Cerebellar ataxia—Sway gait.
3. Intention tremors—Tremor (fine involuntary movement) occur at the beginning of
9
any action.
ri 9
Contd...
a h
t
Figs 9.43A to C: (A) Superior surface (B) Inferior surface (C) Mid sagittal section through vermis
Viscera 197
4. Dysarthria—Difficulty in articulating speech.

5. Nystagmus—Jerky movements of the eyeball while looking at one side.
Anatomical position • Hold the cerebellum in such a way that superior vermis (elevated in the middle) should
be above.
• Inferior vermis (identified by a projection between two sulci) should be placed antero-
inferiorly.
• If pons and medulla is attached, it should lie on anterior aspect.
• If only cerebellum is present anterior aspect will be identified by presence of a large
notch.
Spinal cord introduction The spinal cord lies within the vertebral canal and bears the 31 pairs of spinal nerves
(Figs 9.44 to 9.47) through which it receives fibers from periphery and again sends fibers to periphery.
Length and extension It is 45 cm in length, cylindrical in shape. It begins at the upper border of first cervical
vertebra and ends at the lower border of first lumbar vertebra. In children, it extends up to
third lumbar vertebra. Lower part of spinal cord tapers out and forms conus medullaris. It
has an anterior longitudinal fissure and in posterior surface a shallow post median sulcus.
The cord is dialated in two regions, cervical and lumbar. Near the cord, spinal nerve
divides to form dorsal and ventral roots. The spinal cord consists of a central core of grey
matter containing nerve cell bodies and outer layer of white matter or nerve fibers. Within
the white matter run a number of ascending and descending tracts, which link the spinal
Contd...
Fig. 9.44: Spinal cord with meninges (at mid thoracic level)
cord with the brain like electric wires. The principal ascending tracts are the spinothalamic
and spinocerebellar tracts. The corticospinal tract is an important descending tract.
Blood supply By one anterior and two posterior spinal arteries. Also supped by radicular artery.
Applied • Lumbar puncture – withdrawal of cerebrospinal fluid from the subarachnoid space at
the level of L2 and L3 or L3 and L4 vertebral junction, is known as lumbar puncture.
It is used as diagnostic purpose as also for therapeautic purpose.
• The acute (sudden onset) injury of spinal cord due to accident, is catastrophic, and the
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individual is permanently disabled.
• Chronic compression of cord includes herniated intervertebral disc, infection of
vertebrae with TB and due to tumor in vertebrae. In both the cases, the earliest sign is
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pain and it is made worse by sneezing and coughing.
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Anatomical position Hold the spinal cord vertically so that:
1. Conical lower end with branches of spinal nerves should be placed inferiorly.
d
2. Prominent anterior median fissure should be placed anteriorly.
3. On upper end in naked eye, the rounded anterior horn is well-marked. That is also
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another point of identification of upper end from lower end.
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9
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a h
Fig. 9.45: Spinal cord with its membrane (posterior view)
Fig. 9.46: Layers pierced by lumbar puncture (LP) needle Fig. 9.47: Relationship of spinal cord, spinal
nerves and vertebral column
Viscera 199
Eyeball (Figs 9.48 to 9.51)
Name Description
Eyeball The eyeball or bulbus oculi is an organ of sight and its mechanism is like that of a camera.
(Fig. 9.48)
Situation It is situated in the anterior part of the orbit, not exactly spherical in size, enclosed by
Shape, Size fascial sheath. By thin facial sheath, it is separated from orbital muscle and fat. It is about
(Fig. 9.49) 2.5 cm in size.
Layers or Coats It has three coates—(1) Outer sclera; fibrous coat and cornea (2) Middle vascular layer or
(Fig. 9.48) uveal tract (i.e. choroids, ciliary’s body and iris) (3) Inner nervous tissue layer
1. Sclera It is the outer whitish coat covering the posterior 5/6th of eyeball and anterior 1/6th of it
is the transparent cornea (avascular). Outer coat maintains the shape of the eye and gives
attachment to the extraocular muscle. The optic nerve pierces the sclera at posterior part
3 mm. to the nasal side. At the junction of sclera and cornea, a minute canal present (canal
of shelmn) known as sinus venous sclere and it encircles the cornea. Sclera and inner
surface of eyelid are covered by the thin epithelial layer known as conjunctiva.
Contd...
Fig. 9.48: Right eyeball (Semi schematic)

Name Description
2. Uveal Tract It is the vascular coat situated between sclera and retina. It consists of, from behind
forwards, choroids, ciliary body and iris. The ciliary body is divided into an external part
the ciliary muscles and internal ciliary ridges. The ciliary body controls the curvature of
the lens.The iris is a perforated diaphragm of various colors (racial variation). The slit-
like perforated area is known as pupil and its diameter is regulated by two muscles,
sphincter pupillae, dilator pupillae.
3. Retina Inner photosensitive coat is retina. When it is traced towards anterior aspect it ends in
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saw-edged border ; the ora serrata. An instrument, opthalmoscope, can examine the inner
surface of the retina. It shows (i) a yellow spot the macula lutea; (ii) a depression in it
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(fovea centralis), and (iii) optic disc or blind spot, about 2 mm. medial to yellow spot.
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Interior of Eye The space between the cornea and lens is incompletely divided into anterior and posterior
chamber by lens. Anterior chamber filled with a transparent fluid aqueous humour, secreted
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by cilliary glands. This fluid gives nutrition to transparent structure like cornea, lens and
removes waste product from them. Behind the lens, the cavity of the eye is filled up by
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the transparent jelly-like substance vitreous humour.
Ocular Muscles They are six in number and voluntary in nature, are known as extrinsic muscles of the
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(Figs 9.49 and 9.50) eye. They are connected with the movements of the eyeball; medially, laterally, upwards
and downwards; and so on.
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a h
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Fig. 9.49: Boundary of right orbit
Viscera 201
Fig. 9.50: Muscles of eye superior aspect (horizontal section)
There are Four Rectus or Straight Muscles

and Two Oblique (Figs 9.50 and 9.51)
Name of the muscles Origin Insertion Action Nerve supply

Superior rectus Annulus tendinus 6 mm away from Elevation of the eyeball Oculomotor
communis of zinn. aclerocorneal junction (rotates it upwards). (3rd cranial)
Inferior rectus Annulus tendinus 6.5 mm away from Depression of the Oculomotor
communis of zinn. aclerocorneal junction eyeball (rotates it (3rd cranial)
downwards)
Lateral rectus Annulus tendinus 7 mm away from Rotates the eyeball Abducent
communis of zinn. aclerocorneal junction outwards (6th cranial)
Medial rectus Annulus tendinus 5.5 mm away from Rotates the eyeball Oculomotor
communis of zinn. aclerocorneal junction inwards (3rd cranial)
Superior oblique Roof of orbit, Upper and outer part Rotates the eyeball 4th cranial nerve
antero-medial to of sclera behind the downwards and (trochlear).
optic canal. equator. outwards.
Inferior oblique Orbital surface of Rotates the eyeball Oculomotor

maxilla. upwards and outwards (3rd cranial)
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Fig. 9.51: Muscles and nerves of right eye (after removal of eyeball)
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Name Description
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Applied • Inflammation of conjunctiva due to virus, allergen or due to welding spark light,
is known as conjunctivitis (which is very common). It produces redness of eye.
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• Due to vitamin A deficiency, there may be dryness of conjunctiva and produces
corneal ulcer and opacity.
• Corneal graft—Cornea of the one person ( from freshly donated dead body) can
be placed on the eye of another person with corneal opacity. In common language
h
it is called eye donation.
a
• Rise in the intraocular pressure (Glaucoma)—It is due to rise of the pressure of
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aqueous humour due to blockage of circulation.
• Retinal detachment—It is the condition where nervous layer (2 to 10) is detached
from pigmented layer due to developmental cause.
• Cataract—Opacity in lens is known as cataract. It may be present from birth or
develop in elderly.
• Defect of vision—
(a) Myopia or short sightedness—Image form, in front of retina due to excessive
growth of eyeball in the childhood. Corrected by biconcave lens (minus
power).
(b) Hypermetropia—Far sightedness- Image form, beyond retina. Corrected by
covex lens (plus power).
(c) Presbyopia—It develops in 36 to 40 age group, due to loss of elasticity of
lens. Convex (plus) lens are used for correction.
(d) Squint—It is a condition when one eye deviates always from a fixation point;
corrected by surgery.
Embryology
Nomenclature Used in Embryology Stages of General Embryology (Figs

10.1A to D)
1. Albicans (L) – white.
2. Albugenia (L) – whitish • Fertilization (male + female gamete) takes place
in the ampullary part of uterine tube.
3. Allantois (G) – elongated diverticulum
• The haploid gamete unites to form diploid zygote
(sausage shaped).
(contain 46 chromosome).
4. Annulus (L) – ring. • The large zygote cell divide by cleavage division
5. Branchial (L) – pertaining to gills to form morula (mass of cells), which travel
6. Caudal (L) – tail. from uterine tube to body of uterus.
7. Cephalic – head. • Fluid enters into morula and there are separation
8. Chorion (G) – skin or covering of cells. Morula is now called blastocyst. The
cells arrange in outer layer, known as trophoblast
9. Cloaca (L) – drain.
and inner layer form the inner cell mass.
10. Diverticulum – an offshoot from main tube
• Cells of blastocyst continue to divide and the
11. Ectopic (G) – out of place trophoblast implants the blastocyst in the uterine
12. Fetus – unborn offspring wall at 6 to 7 days after fertilazation. This is
13. Gamete (G) – spouse. interstitial (within) implantation.
14. Gonad (G) – seed; hence the sex glands • The inner cell mass multiplies rapidly and form
15. Gubernaculums – a rudder. circular embryonic disc. The division of labor
takes place in the inner cell mass. The outer
16. Infundibulum – a funnelshaped passage
aspect of the disc, form ectoderm and the inner
17. Lanugo – fine soft hair side form entoderm.
18. Notochord (G) – the cord of the back • Two cavities appear, one on ectodermal side,
19. Palcode (G) – thickened plate of ectoderm known as amniotic cavity and another on the
20. Proctodeum (G) – anus entodermal side, known as yolk sac cavity.
21. Stomodum (G) – mouth • The bilaminar disc become trilaminar due to the
growth of cells from primitive streak, at on day
22. Tunica (L) – a coat
15. The primitive streak develop in the caudal
23. Urachus (G) – a urine container aspect of entoderm. It is the primary organizer
24. Vas (L) – a vessel and initiates the formation of notochord and
25. Vitelline – related to yolk sac. intraembryonic mesoderm (in between ecto-
derm and endoderm). The disc shaped
R G
d V
ti e
U n
-
9
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Fig. 10.1A: Development of human being
Embryology 205
embryonic area become pyriform in shape on

day 19. The mesoderm does not insinuate in
the cephalic region known as, procordal plate,
later, form the buccopharyngeal membrane; and
in caudal aspect, bilaminer disc remain as
cloacal membrane.
• The cells of primitive streak multiply and form
rounded primitive node. Multiplication of cells
of primitive node gives rise to cells, which
migrate in the mid line to form a rod like
structure — the notochord.
Fig. 10.1C: Vertical section of placenta • Most of the notochord disappear. Its remnant in
adult is nucleus pulpous of inter vertebral disc.
Fig. 10.1B: Full term placenta showing maternal and fetal surface
R G
d V
ti e
n
Fig. 10.1D: Anomalies of placenta
- U
9
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Embryology 207
• A wide plate of ectoderm in the midline lies over fold coverge and incorporate midgut. The gut
the notochord thickened, and form neural plate. is closed cranially, by prochoradal plate
Groove appear in the middle of neural plate on (converted into buccopharyngeal membrane),
day 21, and subsequent closure of the groove and caudally limited by cloacal membrane.
produces neural tube. From here whole of the • The limb bud develop from lateral plate
central nervous system develop. mesoderm.
1. Concomitant to ectodermal development, • The septum transversum, consists of mass of
intraembryonic mesoderm shows three mesoderm lying on the cranial aspect of
subdivision by the appearance of a groove pericardial cavity. Fibrous pericardium and
on the medial aspect. The part medial to the diaphragm develop from it.
groove, mesoderm is cubical, known as
• Development of placenta: Placenta develops
paraxial mesoderm — later, forms somite.
from two sources — partly from embryo and
Age of the embryo can be determined as
partly from uterine wall known as decidua. Its
presomite stage, somite stage and post somite
function is to transport the nutrients, oxygen,
stage. The somite divides into: (i) sclerotome.
to fetus and for, removal of waste products.
ventromedially, forms, vertebrae and ribs. (ii)
the dermomyotome or the muscle plate dorso • Before implantation of blastocyst, there is
laterally. It produces the muscles of body formation of trophoblast, which gradually
wall and the dermis of skin. differentiate into inner cellular cytotrophoblast
and outer syncitiotrophoblast (no define cellular
2. The mesoderm in the lateral part of
outline). The trophoblast, first form villi (finger
embryonic disc is called lateral plate
like projection); the primary villi. They are made
mesoderm. Due to rapid growth there is
up of, central core of cytotrophoblast, covered
development of small cavities which unite
by syncytio-trophoblast. This is converted into
and form a single cavity – the intra embryonic
secondary villi, by insinuation (going inside) of
coelome or body caivity. It splits the
mesoderm. Next, tertiary villi is formed when
mesoderm into two layers—splancho-
mesoderm in changed into blood vessels. Villi
nopleure lies in contact of entoderm and,
are surrounded intervillous space, which
somatopleure, which lies in contact with
contain maternal blood. As the placenta enlarges
ectoderm. Intraembrynic coelome later form
septa grows within the intervillous space and
the pericardial, pleural and peritoneal cavities.
form placental lobes. The mature placenta is
3. The intermediate cell group is known as
about 6 inches in diameter; 500 gm in weight
intermediate cell mass. It project ventrally
and fetal surface is shinny where as maternal
between the other two strips. From lateral
surface is rough.
side of intermediate cell mass, develop
urinary system. Its medial portion, give rise
Applied
to genital system and cortex of suprarenal
gland. Trophoblast secretes human chorionic gonadotro-
• Folding of embryo: As a result of more rapid phin which is responsible for positive pregnancy
growth of the embryonic area, the trilaminar test in first week, after the missed period. It is
embryo under goes folding. The original yolk known as pregnancy test or Gravindex test.
sac is reduced, due to incorporation of yolk sac
Short Note on General Embryology
as gut. The cranial end folds and incorporate
part of the yolk sac as foregut; the caudal end • Spermatogenesis—It is a series of process by
folds and incorporate the hind gut; two lateral which spermatogonia are changed to
spermatozoa (sperms) (Figs 10.2A and B). The

spermatogenesis is divided into three phases—
Spermatocytosis, Meiosis and Spermiogenesis.
Primordial germ cells divide by mitosis
repeatedly to provide a continuous reserve of
sperm cells. Some of the spermatogonia are
specialised and form type B spermatogonia,
from where primary spermatocyte (contains
diploid chromosome) is derived by mitosis
G
division (spermatocytosis). The large primary
spermatocyte undergoes first meiotic division
R
and forms secondary spermatocyte with haploid
number of chromosome. After completion of
V
meiosis, one secondary spermatocyte gives rise
d
to four equal sized spermatids; out of which,
two bear the X chromosome and two bear the
ti e
Y chromosome. The change over of spermatids
to mature spermatozoa is known as
spermiogenesis. These changes include (1)
n
shadding of excess cytoplasm (which is engulfed
by Sertoli cells) (2) condensation of nucleus
U
(3) formation of acrosomes at the head, which
Fig. 10.2A: Transverse section of seminiferous tubule
contains a number of important enzymes (4)
-
showing different stages of maturation of male germ
formation of neck, middle piece and tail. In cells
9
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Fig. 10.2B: Spermiogenesis
Embryology 209
humans the time required for a spermatogonium Implantation on blastocyst in uterine body takes
to develop into a mature spermatozoon is place on sixth or seventh day after fertilisation.
approximately 64 days. In males, differentiation Implantation anywhere in the upper of uterine
of primordial germ cells begins at puberty. cavity is considered as normal. Sometimes
• Oogenesis—In female, the maturation of blastocyst is embedded in abnormal situation
primitive germ cells to mature gamete is known which may be extrauterine and intrauterine. If
as oogenesis (Fig. 10.3). Oogenesis starts in blastocyst is implanted in lower uterine segment,
prenatal life. It includes three processes: it gives rise to placenta praevia; and if occurs in
1. Repeated mitosis – produces a number of uterine tube, it is known as tubual pregnancy.
oogonia • Notochord—It is the forerunner of vertebral
2. Specialisation of some oogonia into primary column and extends from prochordal plate upto
oocyte (with diploid number of primitive tail end of embryo. It is formed by
chromosome). differentiation of head process. The notochordal
3. Meiotic division starts before birth of baby process undergo different changes that convert
and completed (formation of secondary it first into a canal and finally back into rodlike
oocyte), if there is fertilisation. solid structure. Most of the notochord
The oocyte with follicular cells surrounding disappears. In adults remnants persist as apical
them is known as primordial follicle. The ligament of odontoid process and nucleus
primary oocyte does not complete their first pulposus of intervertebral disc.
meiotic division and remains in diplotene stage • Chorion—Literally chorion means skin (outer
until puberty. With the onset of puberty, a covering) (Fig. 10.4). It is an important
number of follicles begin to mature, with each membrane, which surrounds embryo. It is
ovarian cycle, but only one of them reaches formed by parietal layer of extra embryonic
full maturity. During the process, one primary mesoderm and the trophoblast. The chorion
oocyte gives rise to one ovum (instead of four) plays an important role in child birth. It appears
and three polar bodies. Mature ovum with its in 24 days of development. It consists of chorion
follicular cells is known as graafian follicle, frondosum and chorion laeve.Chorionic
which lies at the surface of the ovary and can frondosum forms placenta and gives nutrition
be examined by laparoscope. to developing embryo. Abnormal growth of
• Blastocyst—It is derived from morula by chorion is known as hydatidiform mole with
accumulation of fluid inside it. It has two parts non-development of embryo.
– one is trophoblast and other embryoblast. • Allantois—It lies first within the body stalk and
later within umbilical cord. It is diverticulum
from developing hindgut. It appears on fifteenth
day of development. Vascularisation of embryo
starts first in this region. Allantois is vestigial
organ in human. Its remnant is known as
urachus. It’s abnormalities are, patent urachus,
urachal cyst and urachal fistula.
• Placental barrier—Placental barrier is the
membrane that separates fetal blood from
maternal blood. (Fig. 10.6) It is made up of
endothelium of fetal blood vessels, surrounding
Fig. 10.3: Oogenesis
mesoderm, syncyto-trophoblast and cytotropho-
blast. Interchanges of oxygen, nutrition,

respiration and waste product takes place
through this membrane. Maternal antibody
passes to fetus which protects the fetus from
certain infections. However, certain drugs like
thalidomide, tetracycline, etc. can pass through
the barrier and can damage the fetal tissue. So
one should take precaution about drug
administration during pregnancy.
• Umbilical cord—It connects abdominal wall of
fetus with the fetal side of placenta (Fig. 10.5).
At full term, it measures about 50 cm in length
and 2 cm in breadth. The cord is twisted and
presents false knots. Umbilical cord is formed
from body stalk (Fig. 10.5). It appears as fifth
week of intrauterine life and is a vascular
pathway between fetus with placenta. It
consists of two umbilical arteries and a vein. It
is cut off after birth. Too short cord or too long
cord may produce difficulty during birth of baby.
Fig. 10.4: End of the second month
Fig. 10.6: Placental barrier (membrane)
Fig. 10.5: Umbilical cord

Embryology 211
• Amnion—Encloses embryo and umbilical cord. • Mackel’s diverticulum—The extra embryonic

Amniotic sac is membranous sac, filled with part of yolk sac is connected with the midgut
amniotic fluid. It appears at the beginning of by vitelo intestinal duct. This part normally
second week. The membrane is known as disappears. But when it is present, the condition
amnion, the cavity it encloses is called amniotic is known as Mackel’s diverticulum. It is present
cavity – the fluid inside it is, amniotic fluid. With in 2% of cases, 2 inch in length, attached 2 feet
the floding of embryo, amniotic cavity enlarges away from ileiocaecal junction at antimesenteric
and encroaches on all aspects of embryo. The border. It is the site of development of peptic
amniotic fluid is secreted first by amniogenic ulcer.
cells, the fetal urine and slight secretion from • Twining—(Figs 10.7A and B) Usually, human
fetal tracheobronchial tree are added in its gives birth normally one offspring at a time.
volume. At the full term, the amniotic fluid Simultaneous development of two or more
measures about 1,500 to 2,000 cc. The amniotic embryos is known as twining or multiple birth.
fluid more than 2,000 cc is known as It occurs 1 in 80 birth (approximately). Twins
hydramnios and less than 1.000 cc is known as are of different varieties, e.g. uniovular or
oligohydramnios (oligo means scanty). Obstetri- monozygotic, binovular or dizygotic and
cian terminology of amnion is ‘the bag of conjoint twins. Monozygotic twin runs in family
waters’– which helps fetus maintaining a (hereditary character) and the two twins are of
constant hydrostatic environment and dilates same sex, and appearance. Dizygotic twin
cervix during the child birth. results from fertilization of two ova by two
separate sperms. The twins are usually not of
same sex and their appearance and character is
different. Conjoint twins are those monozygotic
twins which are joined with each other to a small
or large extent.
Fig. 10.7A: Twining
Fig. 10.7B: Conjoint twins

DEVELOPMENT OF CERTAIN IMPORTANT produces bending of heart tube. As a result of

ORGANS (SPECIAL EMBRYOLOGY) bending, the venous end is carried dorsally and in
cephalic position. The bulbus cordis tends to lose
Development of Heart
its identity and to merge with ventricle on one hand
Heart is a hollow muscular organ, which pumps and truncus arteriosus on other hand. The common
blood continuously throughout the body, till death. atrium is partitioned into primitive right and left
The development of heart takes place in cardiogenic atria by means of intra-atrial septum, and primitive
area below the stomodeum. Primitive angioblastic ventricle is divided by development of
tissues fuse together to form two paramedian heart interventricular septum (Fig. 10.9).
tube (Fig. 10.8). Two tubes fuse to form a single
heart tube. Single heart tube undergoes enormous
expansion and five chambered heart is formed. DEVELOPMENT OF INTERATRIAL
From caudal to cranial aspect, they are; sinus SEPTUM (FIG. 10.10)
venosus, primitive atrium, primitive ventricle, It is developed from three sources – septum
bulbus cordis and truncus arteriosus. Further primum, septum intermedium and septum
growth within this limited area (pericardial cavity) secondum. Atrium communicates with primitive
Fig. 10.8: The bending of heart tube within pericardial cavity
Fig. 10.9: Development of interatrial and inter ventricular septum in various stages
Embryology 213
Fig. 10.10: Stages of development of inter atrial septum
ventricle through atrioventricular opening. There secundum then is known as foramen ovale. After
is development of two swelling from the dorsal birth of baby, when the lungs begins to function,
and ventral aspect of atrioventricular orifice known the pressure of left atrium increases and forces
as ventral and dorsal endocardial cushion. The the primary septum against side of the secondary
cushion fuses to form a broad anteroposterior septum. They fuse and form the complete
partition– the septum intermedium. During the interatrial septum. The fossa ovalis is developed
same time from the roof and dorsal wall of primitive from septum primum and the limbous fossa ovalis
atrium septum primum (an endocardial fold) developed from septum secundum.
develops and it grows caudally. Its lower margin
is free and concave. The two ends of the septum Applied
fuses to the anterior and posterior ends of septum
intermedium and a foramen exists in the middle— • Common type of malformation is atrial septal
named ostium primum. Gradually, there is closure defect (ASD) (Fig. 10.11). In 25% of individuals
of ostium primum. As the function of fetal lung is small opening exists, known as probe patency
nil, there is disintegration of upper and posterior of foramen ovale. It is insignificant clinically.
part of septum primum and formation of ostium • When the defect is large, the left atrial blood
secundum. In the later part of fetal life, ostium passes to right atrium and 50% cases die. If the
secundum is guarded by a flap valve due to growth right atrial blood passes to the left, there is
of another fold – the septum spurium. Ostium cyanosis (bluish discoloration).
Fig. 10.11: Various anomalies of heart

DEVELOPMENT OF INTERVENTRICULAR Applied

SEPTUM (FIG. 10.12)
Persistent interventricular foramen– It is due to
It is developed from three sources: the defect in development of membranous
1. Ventricular septum proper—Develops from floor part. It may be associated with other cardiac
and ventral wall of primitive ventricle. It forms defect. Blood flow from left to right. Small
muscular part of interventricular septum. It does opening is asymptomatic. Large defect can shorten
not grow as far as septum intermedium. A life.
foramen exists in between them. Fallot’s tetrology (Fig. 10.11) – Here four cardiac
2. Proximal bulbar septum—This septum partially anomalies are seen– (1) Pulmonary stenosis, (2)
closes the upper part of ventricular foramen. Displacement of aortic orifice, (3) Ventricular
3. Septum intermedium—The area between septal defect (VSD), (4) Hypertrophy of right
ventricular septum proper and proximal bulbar ventricle.
septum is closed by growth of right edge of
septum intermedium. ALIMENTARY SYSTEM (FIGS 10.13A and B)
The alimentary system is developed from entoderm
of definitive yolk sac during folding of embryo.
The part within the head fold of embryo from
foregut, within the tail fold is the hindgut, in
between two lateral folds forms midgut (Figs
10.13A and B). The mucous mem-brane is formed
from entoderm, muscle coat and outer coat is
formed by invading mesoderm. The glandular
accessory organs (liver, pancreas, salivary glands
and gallbladder) are formed from outpocketing of
foregut entoderm.
Fig. 10.13A: Median sagittal section

Fig. 10.12: Formation of intra ventricular septum of the embryo (Early stage)
Embryology 215
Fig. 10.13B: Median sagittal section of the embryo (More advanced stage)
DEVELOPMENT OF FACE
(FIGS 10.13C and D)
Face is developed as a result of changes around
the stomodeum (oral) aperture. In the fifth week
of IUL, the stomodeum is deepened by the
appearance of 5 processes around it – the process
of elevations are the frontonasal process above,
the right and left maxillary process (arising from
first arch) from sides, and right and left mandibular
process below. Within the frontonasal process,
two swellings (olfactory) appear which divide the
process into one median nasal and two lateral nasal
processes. Median nasal process gives rise to
philtrum of upper lip, premaxilla with four incisor
teeth and nasal septum. The right and left
Fig. 10.13C: Different stages of development of
mandibular processes meet in the midline and form face (earlier stage)
lower lip and lower jaw. Fusion of frontonasal
process with right and laft maxillary process
Applied
forms upper lip. The cheeks are formed by fusion
of the posterior part of maxillary and mandibular Failure of fusion completely leads to various forms
process. of hare lip.
DEVELOPMENT OF PALATE (FIG. 10.14)

Palate is developed by fusion of right and left shelf
like palatine process which arises from maxillary
processes with premaxilla (developed from
frontonasal process). The two palatal processes
unite with each other and with nasal septum from
before backwards. Deficiency in fusion leads to
various forms of cleft palate. It may be partial or
complete. Arrest in union varies from uvula to gum.
In the later case, the cleft runs between lateral
incisor and canine teeth. Complete cleft palate
produces nasal regurgitation of milk and needs early
repair. The cleft palate is due to administration of
teratogen during seventh to eighth week of IUL.
BRANCHIAL (PHARYNGEAL) ARCHES

AND ITS DERIVATIVES
The secondary mesoderm of the neck region
Fig. 10.13D: Different stages of development of consists of only paraxial and lateral plate
face (anterior view) (in late stage) mesoderm. There is no intermediate mesoderm.
Fig. 10.14: Development of gum, lip and nose and their anomalies (ventral view)
Embryology 217
Derivatives (Fate) of 6 Branchial Arches (Fig. 10.15)
Nerves Skeletal derivative Muscular derivative Nerve Artery

First arch Meckel’s cartilage – from Muscles of mastica- 1. Mandibular Maxillary
which incus and malleus is tion, e.g. mylohyoid, 2. Chorda
developed. Anterior liga- anterior belly of diga- tympani
ment of malleus, spheno- stric, tensor veli pala-
mandibular ligament, body tine, tensor, tympani.
of mandible and maxilla also
developed
Applied Unilateral agenesis of mandible shows weakness of muscle of mastication and there is facial assemetry.
Second arch Stapes, styloid process, Muscles of facial Facial Stapedial artery
stylohyoid ligament lesser expression, stapedius,
cornu and superior part of stylohyoid, posterior
hyoid bone. belly of digastric.
Third arch Greater cornu and inferior Stylopharyngeous Glossopharyngeal Common carotid and
parts of body of hyoid bone muscle proximal part of
internal carotid.
Fourth arch Thyroid cartilage Cricothyroid muscle Superior laryngeal Left fourth arch forms
part of arch of atorta
and right fourth arch
form part of right
subclavian artery
Fifth arch Disappear No important remnant
Sixth arch Cricoid, epiglottics and All intrinsic muscles of Recurrent Ventral part both side
arytenoids cartilage. larynx except crico- laryngeal. of right and left form
thyroid. pulmonary artery.
Dorsal part form
ligamentum arterio-
sum. Dorsal part of
right disappear.
Lateral plate mesoderm has no cavity. A series of DERIVATIVES OF PHARYNGEAL POUCHES

condensed mesoderm forms six pairs of arches
There are five pharyngeal pouches on each side.
called branchial arches which pushes the peri-
Except for the first, each pouch has got ventral
cardial cavity downwards. In between the arches,
and dorsal positions:
there are gaps which have got only ectodermal
lining outside and entodermal lining within. Due
DEVELOPMENT OF TONGUE (FIG. 10.16)
to growth of mesodermal arches, 5 cleft develop
externally known as branchial cleft (one on each Tongue has composite origin. It is formed by
side), while entodermal furrows on the inner different element which do not appear
aspect forms 5 pairs of pharyngeal pouches. Each simultaneously. Ventral end of first branchial arch
branchial arch gives rise to skeletal element, are swollen and form the lingual swelling. Another
myotome, nerve of the arch, artery of the arch. swelling called tuberculum impar appears in the
Fig. 10.15: Fate of skeletal derivatives (bones +

cartilage) of branchial arches
floor of first pharyngeal pouch. These lingual

swelling and tuberculum impar fuse to form Fig. 10.16: Floor of primitive pharynx and
anterior 2/3rd of tongue. The posterior 1/3rd of development of tongue (coronal section)
tongue develops from a cranial part median
swelling called hypobranchial eminence (which is forms a big mass, which is separated from rest of
formed by fusion of mesederm of ventral ends of the mandibular process by formation of linguo-
second, third, and part of fourth branchial arches). gingival sulcus. Gradually, this sulcus deepens and
At first, the regions of tongue, teeth, and lip are makes the inferior surface free from floor of mouth
not demarcated from each other. Soon tongue in anterior part. Muscles are developed from
Name of pouch Derivatives

First–ventral Atrophy
Dorsal form Tubotympanic recess forming auditory tube, middle ear, mucous lining of tympanic
membrane.
Second–ventral Atropy
Dorsal form Palatine tonsil and along with first pouch form part of tubotympanic recess
Third–ventral Thymus
Dorsal form Parathyroid (lower)
Fourth–ventral Lateral lobe of thyroid

Dorsal form Parathyroid (upper).
Fifth–ventral Ultimobranchial body – forms parafollicular cells of thyroid.

Embryology 219
migrated occipital myotome, but some embryo- difficulty in speech according to the degree of
logist say muscles are developed from regional tie.
mesoderm. Taste buds are developed from nerve • Bifid tongue – A split in the anterior 2/3rd due
endings. to failure of fusion of two lingual swellings.
• Macroglossia – Large tongue, due to enlarge
Applied plexuses and tissue spaces. In all these cases,
there is difficulty in speech.
• Ankyloglossia or tongue tie – It is due to
deficiency in formation of alveolingual groove. Development of Individual Organ in Short
Here frenulum is short. There may be certain (Special Embryology)
Name Description
Esophagus It is developed from the part of foregut between pharynx and stomach. It is elongated during
the formation of neck and caudal migration of septum transversum. Upper 1/3rd musculature
is developed from musculature of branchial apparatus. That why upper 1/3rd musculature is
for voluntary type; rest are involuntary.
Applied • Tracheo esophageal fistula – It communicate with trachea due to failure of caudal growth of
tracheo esophgeal septum.
• Cardiospasm (achalasia)—It is due to neuromascular in coordination at cardio-esophageal
junction. As a result proximal part dialates and distal part narrows down.
Stomach It is developed from fusiform dilatation from lower part of foregut during fourth or fifth
week. It lies initially in the median plane. There is rapid growth of dorsal border which forms
the greater curvature. Due to differential growth, there is alteration in size and shape of
stomach. The original ventral border face upwards and to the left and becomes the antero
superior surface and left surface becomes the posteroinferior surface.
Applied Congenital hypertrophic pyloric stenosis. It is more common in male. Here the circular
muscular coat undergoes hypertrophy and there is also neuromuscular in coordination. The
child suffers from progressive vomiting. A mass is felt in the transpyloric line 1 cm right to
mid line.
Duodenum The part of duodenum above the orifice of bile duct is developed from foregut. The part
below it is developed from proximal part of midgut.
Jejunum and ilium Midgut loop has got two segment. Above the superior mesenteric artery is known as pre
arterial segment and below the artery is known as postarterial segment. The whole of jejunum
and most of the ilium have developed from pre arterial segment. The terminal part is developed
from postarterial segment near the caecal bud.
Caecum and Developed from caecal bud which is developed from postarterial segment of midgut within
appendix fifth to tenth week. In order to reach the right iliac fossa caecum and appendix undergoes 210°
rotation. Within the abdomen caecum and appendix pass successively through the left iliac
fossa, umbilical, subhepatic, right lumbar and finally reach the right iliac fossa.
Contd...
Name Description
Applied • According to shape adult caecum

(Fig. 10.17) are of four types (1) Fetal type
(2%) – caecum is conical and
appendix. (2) Infantile type (3%)
– The two saccules of caecum are
of equal in sizes, develops from
each side of base of appendix. (3)
Adult or normal type.- In this case
the right saccules enlarges more
that left one and appendix is
located 2 cm below the ileocaecal
junction. (4) Exaggrated type –
In this case the right saccules
enlarges and the left saccules
atrophies. The appendix lies close
to ileocaecal junction. Fig. 10.17: Normal and abnormal position of
• According to position (due to caecun with appendix
defect in the rotation of gut) - The
caecum with appendix may be in the following position (1) in the left hypochondrium, (2)
below the right lobe of liver and right iliac fossa due to reverse rotation of the gut.
Transverse colon It is developed from two sources. Right 2/3rd from caudal part of midgut loop and left 1/3rd
Right 2/3rd of from proximal part of hind gut loop.
transverse colon Endothelium of mucous membrane including the glands is developed from entoderm of the
midgut. Rest of the layers including the musculature is developed from splanchic mesoderm.
Left 1/3rd of Endothelium is developed from entoderm of hind gut. Rest of the layers including the
transverse colon musculature are developed from splanchinic mesoderm.
up to pelvic colon.
Rectum The caudal part of the gut is dialated to form the entodermal cloaca. The mesoderm between
gut and allantois in vaginated the wall of entodermal cloaca and divides into two parts (1)
Dorsal part forming rectum and anal canal, (2) ventral part with allantois. The preallantoic
part gives rise to rectum above the third Houston valve. Rest part of rectum including the
musculature are developed from the postallantoic part.
Anal canal 1. Part of the anal canal above pectinate line is developed from caudal part of dorsal portion
of the endodermal cloaca. Rest of the layers develop from splanchic mesoderm. So internal
and spincter is involuntary and supplied by the autonomic nerve.
2. It is developed from ectodermal cloaca. So lining membrane is skin (i.e. stratified squamous).
The rest of the layer including musculature is developed from somatic mesoderm. So
sphincter ani externus is innervated from the somatic nerve.
Applied • Agenesis of rectum and anal canal.

• Imperforate anus – Failure of rupture of colacal membrane, which is known as anal septum
in the fetal stage, leads to impertorate anus.
Contd...
Embryology 221
Name Description
Liver The liver is developed from two sources:

1. An entodermal diverticulum grows within the mesoderm of ventral mesogastrium, at the
junction of foregut and midgut. This form the parenchyma of liver.
2. The fibrous architecture of liver is developed from the mesenchyme of the septum
transversum.
Pancreas It develops in two parts:

1. Ventral pancreatic diverticulum—It develops from bile duct diverticulum. It forms the
lower part of head of pancreas and uncinate process.
2. Dorsal pancreatic diverticulum—It extends within dorsal mesentery of the gut from bile
duct diverticulum. This diverticulum form upper part of the head, whole of the neck, body
and tail of the pancreas.
Applied The original structure of ventral pancreatic bud sometimes failed to fuse to form single mass.
In this condition two lobes develop in opposite directions.
Accessory pancreatic tissue—Heterotrophic modules of pancreatic tissue may be found in
the deodenum, gallbladder and in Mackel’s diverticulum.
Kidney Three different sets of kidneys develop from intermediate cell mass. During the fourth week
(Fig. 10.18) of development pronephros appear (first tubular system). It degenerates gradually after the
development of second set. It is never functional and disappear completely by the sixth
week. The pronephric duct persist. It is utilised by second duct system that is mesonephros.
It utilizes the pronephric duct and now, known as mesonephric duct. The mesonephric
kidney disappear once again and finally third set; metanephros develops. It persists as adult
kidney along with ureteric bud. The ureteric buds push superiorly from the mesonephric
duct. The distal end of the bud produce renal pelvis collecting tubules; their unexpanted
Contd...
Fig. 10.18: Different stages of development of kidney

Name Description
proximal part become the ureter. As the kidneys develop in the pelvis it has to ascends to
reach their final position in abdomen. This metanephric kidney excreates urine by the third
month of development.
Applied • Horse shoe shaped kidney—When kidney ascends from pelvis, if the kidneys are very
close together, the lower pole fuse together in the midline forming a single horse shaped
kidney. This condition is usually asymptomatic.
• Polycistic kidney—It is inherited disease where the kidneys have many urine filled cyst. It
results from failure of communication of collecting tubule.
• Pelvic kidney—When the kidney fail to ascend. It remains in pelvis with normal functions.
Window Dissections that
Come in Examination
Before you start dissection you have to notice the The instruments require for dissection are:
following structures:—- 1.Forceps —→ Tooth
1.Skin Forceps —→ Untooth
• It has: two parts—epidermis (responsible for 2.Scalpel —→ Handle with changeable blade.
different coloration of skin) and 3.Scissors —→ Long pointed.
• dermis (collagen fiber in it, is responsible for Scissors —→ Blunt.
cleavege lines); 4.Chain with hook.
• two glands—sebaceous gland (secretes oily The cadaver (you dissect) is the best textbook
substance), and sweat gland of anatomy and always try to demonstrate
• two appendages—nail and hair follicle structures as clearly as possible.
• two thickenings—in palm and sole. Skin first applied (skin)
In the cadaver the skin feels more thick due • Boil—Infection hair follicle.
to preservative material. • Curbuncle—Infection of several hair
2.Superficial fascia (subcutaneous tissue)—Lies follicles.
below skin, adherent to dermis.Vessles, nerves • Paronychia—Infection beneath the nail fold.
run into it. Fat is deposited here in obese person • Sebaceous cyst—It is a cystic swelling found
(near abdomen, hip, waist). In non obese person, largely in head and neck and it is developed
it is maximally found in palm and sole. collection of sebum due to blockage of hair
3.Deep fascia—Lies deep to superficial fascia. It pores.
is present in limbs, neck; abscent in face and • Line of cleavage—Surgical incision along
abdomen. Beneath these one can get all the this langerhans line produces minimal scar.
structures like muscles, bones, vessels and • Burn—The depth of burn is the criterion of
nerves. skin healing. Superficial burn heals quickly
but that extends deeper the sweat gland, heals
slowly.
NB—Tissues heal faster and leave less scar in
young, than in aged
CLAVI PECTORAL FASCIA
224
Anatomy at a Glance
Fig. 11.1: Incision of clavipectoral fascia
Fig. 11.2: Deep dissection (Clavi pectoral fascia)

SUPERIOR EXTREMITY (FRONT)
NAME OF THE DISSECTION–CLAVI PECTORAL FASCIA
POSITION OF BODY–SUPINE, WITH UPPER LIMB IS AT RIGHT ANGLE TO THE BODY
Incision (Fig. 11.1) Comment Identification (Applied Anatomy)

• A transverse incision from It is a strong fascia, situated Clavipectoral fascia and • Cephalic vein catheterisa-
sternal notch along the deep to clavicular head of structure piercing it, i.e. tion
clavicle upto its acromial pectoralis major, and extends • Branches of Thoraco • Placement of space
end. from lower part of subclavius acromial artery a branch of –maker in infraclavicular
• A vertical incision from to upper border of pectoralis 2nd part of axillary artery. fossa.
sternoclavicular joint upto minor. Above it splits to • Caphalic vein drain the • Developmental anomalies of
Window Dissections that Come in Examination

4th costal cartilage. Trian- enclose the subclavius, below lateral side of hand. breast.
gular flap of skin reflected it splits again and cover the • lateral pectoral nerve– • Drainage of breast abscess.
lateraly and downward. pectoralis minor. It is then it Branch of lateral cord.
• Superficial fascia (Contai- blends with axillary fascia. • Muscles–Pectoralis major
ning fat) is exposed with Medially extends upto 1st rib. (Fig. 11.2)
cutaneous branches of Laterally extends upto
supraclavicular nerves coracoid process and coraco
(lateral, intermediate and clavicular ligament.
medial division). It is
reflected by similar incision.
• Upper part of pectoralis
major is exposed.
• Calvicular head of pectora-
lis major is cut and reflected
downwards laterally.
• Clavipectoral fasica is
exposed.
225
AXILLA
226
Anatomy at a Glance
Fig. 11.3: Incision (Axilla)
Fig. 11.4: Deep dissection

NAME OF THE DISSECTION–AXILLA
Incision (Fig. 11.3) Comment Identification (Fig. 11.4) (Applied Anatomy)

• A curved incision along the Axilla is a pyramidal space Contents of axilla • Paralysis of long thoracic
anterior border axilla from between lateral side of chest 1. Medial wall – nerve from its origin
the 4th space (ICS) exten- and arm. It has a apex directed • long thoracic nerve. produces winging of scapula.
ding upto junction of upper upwards and medically, a • lateral thoracic vessels. • Cervical rib syndrome
2. Lateral wall–from Medial
¼th of and lower ¾th of arm. base—directed downwards. • Erb’s palsy.
to lateral.
• Two transverse incisions are Anterior wall, is formed by • Medial cutaneous nerve • Klumke’s palsy
given from the ends of pectoralis major, minor, and of arm. • Saturday night palsy

curved incision upto the subscapularis post wall– • Axillary vein. • Crutch paralysis.
table latissimus dorsi and Teres • Medial cutaneous nerve • Carcinoma of breast.
• Skin with supeficial fascia is major. Medial wall–Serratus of forearm. • # Surgical neck–Produces
exposed. anterior in upper space, lateral • Ulnar nerve. axillary nerve paralysis.
In it lies the intercosto- wall–upper ¼th of humerus. • Axillary artery (3rd part)
brachial nerve. (branch of • Medial root of median
nerve crosses in front of
2nd Throracic NV.) axillary artery.
• Remove fat and lymph node • Median nerve.
carefully • Musculocutaneous nerve.
All the structures of the – it pierces the muscle-
axilla is exposed. coraco brachialis.
3. In posterior wall–Subs-
capular vessels (branch of
3rd part of axillary artery)
• Posterior-circumflex
humoral vessel
• Axillary nerve accompa-
nied by posterior
humeral circumflex
artery.
• Upper and lower subs-
capular nerve.
227
• Thoracodorsal nerve.
4. Axillary pad of fat.
CUBITAL FOSSA
228
Anatomy at a Glance
Fig. 11.5: Incision
Fig. 11.6: Superficial dissection

NAME OF THE DISSECTION–CUBITAL FOSSA

(Figs 11.6 and 11.7)
• Transverse incision one It is a fossa in the front of arm • Blood pressure is measured.
finger above the two forearm junction. It is bounded 1. Cephalic veins • Intravenous injection is
epicondyles • laterally–medial border of 2. Median cubital vein. given in medial cubital Vein
• Transverse incision at the brachioradialis 3. Bicipital aponeurosis. • Cubital tunnel syndrome,
junction of upper 1/3rd to • Medially–lateral border of 4. Brachioradialis. Pronator syndormes.
lower 2/3rd of the front of pronator teres 5. Pronator teres,
forearm. • apex–by meeting of 6. Supinator,

• Vertical incision from the brachioradialis and pronator 7. Brachialis
mid point of proximal to mid teres. 8. Tendon of biceps brachii
point of distal incision • Base–Imaginary like joining 9. Brachial artery and vein
• It is cut and reflected with the two epicondyles of 10. Radial blood vessels
skin. Deep fascia is exposed. humerus. 11. Ulnar artery and vein
It is cut in same way and Floor–by supinator and 12. Superficial and deep
muscles and vessels and brachialis. division of radial nerve.
exposed. 13. NV to pronator teres.
• Reflect the skin flap side
ways.
• Preserve the superficial vein
(cephalic and, basilic and
median cubital vein
• Superficial fascia is cut like
skin and reflected
• Deep fascia is exposed.
• It is cut and reflected like
skins.
• Boundaies and contents of
cubital fossa is exposed.
229
FRONT OF ARM
230
Anatomy at a Glance
Fig. 11.8: Incision

NAME OF THE DISSECTION–FRONT OF ARM

(Figs 11.9 and 11.10)
• One transverse incision at Muscles forming the fleshy • Cephalic vein in delto • Nerve injuries.
the junction of upper ¼th to belly (biceps) actually acts pectoral groove. • Supracondylar fracture.
lower ¾th of arm upon the forearm as flexor of • Basilic vein on medial side • Auto mobile accident.
• Another Transverse incision elbow joint and supinator of of the arm unites with • Amputation.
at the point of epicondyles forearm. You all familiar to brachial vein in the upper
of humerus. show this buldge to your ¼th of arm and form

• A longitudinal incision friends. Deep to biceps lies axillary vein .
along the midpoint of two another important flexor of • Biceps brachii (long head
transverse incisions. forearm is brachialis. and short head)
• Skin flaps is reflected. • Coraco brachialis
• Superficial fascia is exposed • Brachialis
• Brachial artery
• Musculocutaneous nerve–
continuation of lateral cord
of brachial plexus.
• Median nerve
• Ulnar nerve–continuation of
medial cord of brachial
plexus
• Radial nerve along with
arterial profunda brac-
hialis.
231
FRONT OF FOREARM
232
Anatomy at a Glance
Fig. 11.11: Incision
(left limb)

(right limb)
Fig. 11.12: Superficial dissection (left limb)

NAME OF THE DISSECTION–FRONT OF FOREARM
Incision Comment Identification (Applied Anatomy)

(Fig. 11.11) (Figs 11.12 and 11.13)
• Carpal tunnel syndrome
• Transverse incision at the of The extremities possess deep • Median cubital vein • Effect of nerve injury
elbow. fascia. So in front of forearm • Cephalic vein on lateral • Space of parona.
• Transverse incision at the there is superficial fascia. side.
wrist from ulnar styloid Deep fascia, preserving the • Basilic vein in the medial
process to radial styloid important veins like median side.
process. cubital veins in the middle, • Medial cutaneous NV of

• Mid line vertical incision basilic vein on the medial side forearm.
from proximal to distal part. of forearm. Superficial fascia • Pronator teres.
Reflect skin sideways. is reflected like skin. Deep • Flexor carpi radialis
fascia is exposed. It look like • Flexor digitorum super-
a tracing paper. It is incised ficialis
like skin and muscles of • Palmaris longus.
forearm and neurovascular • Flexor carpi ulnaris.
structures are exposed. • Flexor digitorum profun-
• Mind that all muscles of dus
forearm-are supplied by • Supinator
median nerve in forearm • Ulnar artery are separated
except flexor carpi ulnaris– from ulnar nerve by deep
supplied by ulner nerve. head of pronator teres
• Ulner nerve are separated
by deep head of pronator
teres
• Radial artery
• Radial nerve
• Median nerve is plastered
under flexor digitorum
superficialis.
233
PALM
234
Anatomy at a Glance

NAME OF THE DISSECTION–PLAM

(Fig. 11.14) (Figs 11.15 and 11.16)
• Transverse incision (proxi- The skin of the palm and sole • Palmar cutaneous branch of • Claw hand
mal incision) from radial are thick and known as median and ulnar nerve • Ape hand
styloid process to ulnar glabrous skin. It is devoid of • Palmaris brevis, which • Mid palmer space and thenar
stylod process. hair follicle, Sebaceous gland. increases the power of grip. space infection.
• Transverse incision along Palm of hand is very important. • Palmar aponeurosis • Ulnar tunnel syndrome
the distal part along the webs Lateral 3½ digit are innervated • Muscles of thenar emin- • Infection of pulp space of
of the finger. by median nerve medical 1½ ence, i.e. Abductor pollicis finger

• Vertical incision from mid digit are innervated by ulnar brevis. Flexor pollcis and • Dupuytren’s contracture.
point of tip of middle finger nerve. oppoens pollicis
upto middle of (1st proxi- Superficial fascia is reflected • Adductor pollicis
mal) incision like skins. Palmar aponeurosis • Muscle of hypothenar
• Another longitudinal inci- (shiny deep fascia) is exposed. eminence.
sion from the mid point of • Abductor digiti minimi
proximal incision upto base • Flexor digiti minimi
of thumb. • Opponens digiti minimi
• Skin flaps are reflected. • Superficial palmar arch–
Superficial fascia with cuta- formed mainly by super-
neous nerve and only sub- ficial branch of ulnar artery.
cutaneous muscle palmaris
brevis is exposed.
235
TRIANGULAR AND QUANDRANGULAR SPACE
236
Anatomy at a Glance
Fig. 11.17: Incisions (triangular; quadrangular space)
SUPERIOR EXTREMITY (BACK)
NAME OF THE DISSECTION–TRIANGULAR AND QUADRANGULAR SPACE
POSITION OF BODY–PRONE WITH ARM AT RIGHT ANGLE TO THE BODY
Incision (Fig. 11.17) Comment (Fig. 11.18) Identification (Fig. 11.18) (Applied Anatomy)
• Feel the spine of scapula. • The lower border of teres • Muscles, teres minor, long • Nailing of humeral surgical
• From the midpoint of spine minor is separated by a gap head of triceps. neck done through this
a vertical incision extend from the upper border of • Vessels space; care should be taken
upto inferior angle of major. This gap is divided • Posterior humeral circum- during nailing, as it may
scapula. and long head of triceps into flex vessels, circumflex, damage the axillary nerve.
• Oblique incision extends medial quadrangular and Scapular vessels, and

from above incision along lateral triangular space. • Nerves—axillary nerve and
the back of the spine upto Boundary of quadrangular its branches pseudo
acromion and the upper part space. ganglion over the nerve to
of arm. • Above–teres minor below – teres minor.
From it extends downwards Teres major medially–long-
towards the table. head of triceps.
• Oblique incision from Laterally–surgical neck of
inferior angle of scapula humerus
upwords and laterally upto • Contents: axillary nerve,
posterior axillary fold. posterior humeral circum-
flex artery.
• Triangular space—upper by
teres minor.
Lower–upper border of teres
major.
Laterally–By long head of
triceps.
237
BACK OF ARM
238
Anatomy at a Glance
Fig. 11.19A: Incision Fig. 11.19B: Muscles of back of arm
NAME OF THE DISSECTION–BACK OF ARM
POSITION OF BODY–PRONE WITH ARM REST OVER THE WOODEN SHEET AT RIGHT ANGLE TO BODY
Incision (Fig. 11.19A) Comment (Fig. 11.19B) Identification (Fig. 11.19B) (Applied Anatomy)
• Transverse incision at the There is only one large fleshy • long, lateral and medial Injury to radial nerve in spiral
upper ¼th of arm. muscle in the back, which head of triceps. groove.
• Transverse incision from cover the structures of radial • Insertion of triceps • Saturday night palsy
medial epicondyle to lateral groove. The muscle is triceps • Radial nerve. • Crutch paralysis
epicondyle. brachii which is a powerful • Arteria profuna brachii • Wrist drop.
• Midline vertical incision forearm extensor. Out of three
extends from upper to lower heads, long and lateral head

incision. lies superficial to medial head.
239
BACK OF FOREARM
240
Anatomy at a Glance
Fig. 11.20: Incision Fig. 11.21: Superficial dissection Fig. 11.22: Deep dissection
NAME OF THE DISSECTION–BACK OF FOREARM AND DORSUM OF HAND
POSITION OF BODY (PRONE WITH FOREARM FULLY PRONATED)
Incision (Fig. 11.20) Comment (Fig. 11.21) Identification (Fig. 11.22) (Applied Anatomy)
Back of forearm
• Transverse incisions from • Superficial fascia with • Extensor retinaculum • Wrist drop
medial epicondyle to lateral cephalic vein on lateral side • Abductor pollicis longus • Mallet finger
epicondyle. and basilic vein on medial and abductor pollicis
• Transverse incision extends side is exposed. brevis–out cropping
from radial styloid process • Remove superficial fasica muscles.
to ulnar styloid process (preserving the vein) and • Extensor pollicis longus
• Midline vertical incision deep fascia like similar • 4 tendons of extensor

connecting of the two incision as skin. digitorum.
transverse incision. • Muscles are exposed all the • Extensor carpi radialis
extension group arises from longus and brevis.
a common tendons from the • Extensor indicis
post surface of lateral • Extensor digiti minimi
condyle of humerus. • Extensor carpi ulnaris.
Dorsum of Hand The skin here is so thin that • Dorsal venous arch • Synovial cyst.
• Transverse incisions from you can visualise the • Tendon of extensor pollicies • Digital block
ulnar styloid process to superficial veins. Not only that brevis • Paresthesia
radial styloid process. you will get here Anatomical • Tendons of extensor pollicis
• Transverse incision along snuffbox (Bounded laterlly by longus
the roots of finger abductor pollicis longus and • 4 tendons of extensor
• Vertical incision extendes extensor pollicis brevis digitorum.
from proximal incision upto Medially by extensor pollicis • Extensor indicis
nail to middle finger. longus. • Extensor digiti minimi
Base formed by scaphoid, • Extersor digitorum brevis
trapezium and base 1st • Cutaneous branches of
(metacarpal) radial and ulnar nerve.
Realise all the tendon present
in dorsum by producing its
241
movement.
FEMORAL TRIANGLE
242
Anatomy at a Glance
(Right thigh) Fig. 11.26: Deep dissection
(left thigh)
Fig. 11.24: Structures in super Fig. 11.25: Deep fascia (Left thigh)
ficial fascia (Right thigh)
INFERIOR EXTREMITY (FRONT)
NAME OF THE DISSECTION–FEMORAL TRIANGLE
POSITION OF BODY–BODY SUPINE WITH THIGH ABDUCTED LATERALLY
Incision Comment (Fig. 11.26) Identification (Applied Anatomy)

(Fig. 11.23) (Figs 11.24 to 11.26)
• One oblique incision from The triangle is situated in front • Inguinal ligament. • Swelling of inguinal lymph
anterior superior iliac spine of the upper 3rd of thigh. • Great saphenous vein nodes.
to pubic tubercle along the Base (above) formed by • Femoral sheath (contents– • Psoas abscess
inguinal ligament. inguinal ligament. Femoral artery, femoral • Femoral hernia more
• One transverse incision at Apex (below) meeting of vein, femoral canal) common in female.

the junction of upper 1/3rd Sartorius and adductor longus • Femoral nerve in ilio psoas • Varicose veins.
and lower 2/3rd of front of Medial border–by medial groove • Meralgia paresthetica.
thigh. Which extends below border of adductor longus. • Lateral femoral cutaneous • Repair of femoral hernia.
anterior superior iliac spine. lateral border–by sartorius. nerve, below anterior • Spastic paralysis
No need of extension of Floor–From lateral to medial– superior iliac spine. • Riders bone
transverse incision away Iliacus, psoas, pectineus, • Inguinal lymph nodes. • Venous graft in caronary
from this level. abductor longus muscles. • Adductor longus surgery.
• A midline vertical incision • Pectineus
extending from mid ingui- • Iliacus.
nal point to lower trans- • Psoas
verse incision.
243
244
Anatomy at a Glance
Fig. 11.28: Abductor canal and front of
thigh
Fig. 11.27: Incision Fig. 11.29: Boundaries and

contents of adductor canal
NAME OF THE DISSECTION–ADDUCTOR CANAL
POSITION OF BODY (SUPINE WITH THIGH EXTENDED, AND ROTATED LATERALLY)

(Fig. 11.27) (Figs 11.28 and 11.29)
• One transverse incision at Adductor canal or Hunter’s • lateral and medial circum- • ligature of femoral artery
the lower 2/3rd of the front canal is exposed after removal flex femoral artery. done in this canal during
of thigh (extends upto the of deep fascia. • Deep division of femoral popliteal artery aneurysm
level of anterior superior Bounday–laterally–by media- nerve and its muscular • Stab injuries of thigh injuries
iliac spine) lis border of vastus medialis; branches. the structures of adductor
• Another transverse incision medially–above by adductor • Saphenous nerve (only canal.

at the level of lower 1/3rd of longus; below by adductor cutaneous branch of
thigh. magnus. roof-Formed by deep posteior division of femoral
• A midline vertical incision fascia. nerve)
from midpoint of proximal • Nerve to vastus medialis
and distal incisions • Vasti and adductor longus,
adductor brevis muscles.
NAME OF THE DISSECTION–FRONT OF THIGH

POSITION OF BODY–BODY SUPINE AND KNEE EXTENDED

(Fig. 11.28)
One transverse incision from Reflect the skins laterally and • The vastus medialis, • Quadriceps weakness. (due
head of flbula to tibia (upper medially lateralis, rectus femoris and to constant wearing of high
end) vastus intermedius heel shoes and also in
Other incision is given before. persons having long standing
duties
245
ANTERO LATERAL COMPARTMENT
246
Anatomy at a Glance
Fig. 11.30: Incision Fig. 11.32: Deep dissection
Fig. 11.31: Muscles of anterior and

lateral compartment of leg
NAME OF THE DISSECTION (ANTERIOR COMPARTMENT OF LEG)
POSITION OF BODY–SUPINE WITH THIGH ABDUCTED LATERALLY

(Fig. 11.30) (Figs 11.31 and 11.32)
• Transverse incision from Anterior compartment of leg is • Tibialis anterior • Anterior compartment of leg
tibial tuberosity to head of exposed. • Anterior tibial veins syndrome
fibula (proximal incision) Boundary–Medially by antero • Deep peroneal nerve in • Infiltration common pero-
• Distal in incision from mid lateral surface of shaft of tibia between tibialis anterior and neal nerve producing anes-
point between two malleoli laterally–by anterior inter- extensor digitorum longus. thesia.
upto lateral malleolus. muscular, septum. Anteriorly • Extensor hallucis longus.

• Vertical incisions from tibial by deep fascia of leg (fascia • Peroneous tertious
tubersity to distal incision. cruris)
• Reflect superficial and deep Posteriorly–by interosseous
fascia laterally membrane
247
DORSUM OF FOOT
248
Anatomy at a Glance
Fig. 11.33: Incision Fig. 11.34: Dorsal venous network Fig. 11.35: Deep dissection
NAME OF THE DISSECTION–DORSUM OF FOOT
POSITION OF BODY (Supine with Slight Planter Flexion of Foot)

(Fig. 11.33) (Figs 11.34 and 11.35)
• Proximal transverse incision The skin is thin, with minimum • Dorsal venous network, lies Palpation of
from medial malleoli to amount of subcutaneous tissue dorsal to tendons of • dorsalis pedis pulse.
lateral malleoli. so during movents of toes all extensor muscles. • Buerger disease.
• Distal curved incision along the tendons can visible through • Tendon of extensor hallucis • Venae section.
the roots of the toes. skins. longus. • Varicose vein
• 4 tendons of extensor • Football ankle.

digitorum longus.
• Peroneus tertius.
• Dorsalis pedis artery and
deep peroneal nerve in
between tendon of hallucis
and digitorum longus.
249
GLUTEAL REGION
250
Anatomy at a Glance
Fig. 11.36: Incisions
Fig. 11.38: Insertion at the upper end of femur

(muscle seen after removal of gluteus
maximus + gluteus medium)
INFERIOR EXTREMITY (BACK)
NAME OF THE DISSECTION–GLUTEAL REGION
POSITION OF BODY–Prone
(Fig. 11.36) (Figs 11.37 and 11.38)
• Curved incision from It is an extensive region • Gluteus maximus (coarse • Intramuscular injection
posterior superior iliac spine covered with plenty of fat. The fiber) • Muscle transplant
along the iliac crest towards region extends above upto iliac • Gluteal aponeurosis. • Weavers bottom
anterior superior iliac spine crest, below limited by gluteal • Structures under the gluteus • muscle weakness and
(as far as body will permit) fold. Anteriorly it extends upto maximus. paralysis

• From posterior superior iliac a line from anterior superior a. gluteus medius.
spine downwards and iliac spine upto greater b. pyriformis
medially upto coccyx. trochanter, posterior limit is • Above the pyriformis :
• From coccyx a curved natal fold. c. Superior gluteal vessels
incision downwards and and nerve.
laterally upto the junction of • Below the pyriformis
upper one fourth and lower d. Inferior gluteal vessels
3/4th of back of the thigh and nerve.
(below the gluteal fold) e. Sciatic nerve (widest
• Skin with superfical fascia is nerve in the body)
reflected laterally and f. Posterior femoral
downwards. cutaneous nerve.
g. Structures over ischial
spine
• Internal pudendal
vessels and nerve.
• Nerve to obturator
internus
251
POPLITEARL FOSSA
252
Anatomy at a Glance
11.41: Deep dissection
Fig. 11.40: Superficial Fig. 11.42: Boundary Fig. 11.43: Backer’s cyst
dissection of popliteal fossa
NAME OF THE DISSECTION–POPLITEAL FOSSA
POSITION OF BODY–PRONE WITH EXTENDED KNEE

(Fig. 11.39) (Fig. 11.42) (Figs 11.40 to 11.42) (Fig. 11.43)
• Transverse incision at the This fossa is situated at the • The muscles : both head of • Popliteal cyst.
junction of upper 2/3rd and back of knee bounded above gastrocnemius • Backer cyst.
lower 1/3rd of back of thigh. and medially by semimem- • Plantaris. • Popliteal artery aneurysm.
Another vertical incision branosus, semitendinosus • Semimembranosus
connecting the mid point of below and medially by medial • Semitedinosus
the proximal and distal head of gastrocnemius. • Popliteus.

incision. Above and laterally by biceps Vessels–popliteal artery with
• Transverse incision at the femoris. Below and laterally genicular and muscular
back of leg at the junction by lateral head of gastrocne- branches.
of upper 1/3rd and lower mius and plantaris floor of the Popliteal vein with its
2/3rd. fossa formed by (From above tributaries. Behind the middle
downwards) Popliteal surface of knee the relation of three
of femur, oblique pepliteal structures are (from super-
ligament, popliteus muscle. ficial to deep) tibial nerve,
Roof by deep fascia which is popliteal vein and artery.
pierced by small saphenous Nerves–Tibial nerve with its
vein. muscular branches and a
cutaneous branch in the
middle of the fossa.
• Common peroneal nerve
with its branches at the
medial border of biceps
femoris.
253
BACK OF THIGH
254
Anatomy at a Glance
Fig. 11.44: Incisions Fig. 11.45: Incisions
NAME OF THE DISSECTION–BACK OF THIGH
POSITION OF BODY–PRONE WITH EXTENDED KNEE

(see Fig. 11.44) (see Fig 11.45)
• Transverse incision in the Hamstring muscles are visible Muscles are : • Sciatica
back of thigh at the level of clearly. Criteria of this muscles Semitendinosus, semimem- • Safe site of injection
upper 2/3rd and lower 1/3rd. are : branosus, Ischial fibers of • Hamstrig Strain (Seen in
(Proximal) • They must arise from ischial adductor magnus and long athlet).
• Transverse incision at the tuberosity head of biceps femoris.
back of leg at the level of • Inserted in the bone beyond Vessels are: Perforating

upper 1/3 (distal) and lower femurs. vessels.
2/3rd of the back of leg. • Must be supplied by tibial Nerves : • Sciatic
• Vertical incision joining the component of sciatic nerve. • Posterior femoral
mid point of the two. • Flexors of knee and extensor cutaneous nerve.
of hip.
255
256
Anatomy at a Glance
Fig. 11.47: Structures in Fig. 11.48: Superficial
superficial fascia muscles
Fig. 11.46: Incision Fig. 11.49: Deep dissection

NAME OF THE DISSECTION–BACK OF LEG
POSITION OF BODY (Prone with Extended Knee)

(Fig. 11.46) (Figs 11.47 to 11.49)
• Proximal–Transrverse inci- This region is known as • Muscles : • Foot drop
sion at the level of fibular posterior compartment of leg. – Lateral and medial head • Tarsal tunnel syndrome.
head. The leg is divided into anterior, of gastrocnemius.
• Distal–between two malleal lateral and posterior compart- – Soleus.
at the back of ankle joint. ments by anterior and posterior – Tendocalcaneus.
• Midline vertical incision intermuscular septum again – Plantaris.

from proximal to distal the posterior compartment of – Popliteus
incisions. leg is divided into superficial, – Flexor digitorum longus
• Superficial fascia is exposed middle and deep part by on medial side.
and short saphenous vein is superficial and deep transverse – Flexor hallucis longus.
seen along with sural nerve. fascia. on the lateral side (more
bulkier than digitorum)
– Tibialis posterior lies in
between digitorum and
hallucis longus tendon.
• Vessels
– Posterior tibial art–
branch of popliteal
artery.
– Venae comitantes along
the artery.
• Nerve
– Tibial nerve in leg.
257
SOLE
258
Anatomy at a Glance
Fig. 11.50: Incision Fig. 11.51: Planter aponeurosis Fig. 11.52: Muscles of 1st layer
NAME OF THE DISSECTION–SOLE
POSITION OF BODY–PRONE OR LITHOTORMY POSITION

(Fig. 11.50) (Figs 11.51 and 11.52)
• Proximal–a curved incision Superficial fascia is exposed. • Subcutaneous thick faulty • Planter fascitis.
along the heel. It is very much thickened with tissue which form the • Different variety of club foot.
• Distal–curved incision at the fat particularly in the weight cushion of heel. • Police man heel
ball of the toes. bearing areas. This type of skin • Planter aponeurosis (Medial • Bunion.
• Mid line vertical incision is known as glabrous skin (It part).
from the tip of 2nd toe upto is devoid of hairs). Muscles are Planter aponeurosis

the midpoint of heel. in four layers but for examina- (Central part)
• Skin is reflected medially tion purpose only two super- Planter aponeurosis (lateral
and laterally. ficial layer is important. part)
After cutting planter aponeu-
rosis from proximal aspect 1st
layer muscles are exposed.
• Medial side–Abductor
hallucis
• Central–Flexor digitorum
brevis.
• Lateral side–Abductor digiti
minimi.
After cutting the flexor
digitorum, 2nd layer
structures are exposed.
• Flexor digitorum access-
orius muscle
• Lumbicales arises from
tendon of flexor digitorum
longus.
259
INGUINAL CANAL
260
Anatomy at a Glance
Fig. 11.53: Incision Fig. 11.54: Boundaries of the inguinal canal
ABDOMEN
NAME OF THE DISSECTION–INGUINAL CANAL
POSITION OF BODY (SUPINE WITH THIGH EXTENDED)
(Fig. 11.53) (Fig. 11.54) (Fig. 11.54)
• Transverse incision from This canal is 4 cm long and • Inguinal ligament. • Hernia direct
anterior superior iliac spine extends from deep ring to • External oblique muscle • Hernia indirect
upto midline. superficial inguinal ring. and aponeurosis. • Extravasation of urine
• Vertical incision from the Anterior wall– • Arched fibers of internal between two layers of
midline upto pubic tubercle. • Throughout its whole extent oblique and transversus superficial fascia during
Reflect the skin and super- formed by external oblique abdominis. ruptured urethra.

fical fascia downwards and aponeurosis. • Deep inguinal ring
laterals. • Anterolaterally re-emforced • Ilio inguinal nerve.
by internal oblique and • Spermatic cord in male and
transverses abdominis. round ligament of uterus in
Post wall–Throughout its female.
whole extent it is formed by
fasica transversalis. Medial
part of this wall is reinforced
by conjoint tendon.
Roof–formed by arched fibers
of internal oblique and
transversus abdominis
Floor–inguinal ligament.
261
RECTUS SHEATH
262
Anatomy at a Glance
Fig. 11.55: Incision Fig. 11.56: Exposure of rectus sheath
ASIS—Anterior superior iliac spine
NAME OF THE DISSECTION–RECTUS SHEATH
POSITION OF BODY (Supine with Thigh Extended)

(Fig. 11.55) (Fig. 11.56) (Fig. 11.56)
• Transverse incision from It is an aponeurotic sheath that • Rectus abdonimis muscle. • Hematoma within the muscle
xiploid process upto 4½” is present almost wholy around • Pyramidalis, if present due to injury.
(10 cm) laterally. the rectus abdominis muscle. • lower 7th to 12th thoracic • Divertication of recti.
• Another oblique incision Lower 1/3rd, it is deficient, nerve and iliohypogastric • Incisional hernia.
from anterior superior iliac where arcuate line is formed. and ilioinguinal nerve enters
spine upto pubic tubercle. Middle 2/3rd it is aponeurotic the muscle towards its

• Midline vertical incision and complete. After removing lateral aspect.
extending from the mid the anterior wall of sheath we • Free posterior part of
points of these two incisions. can see the transverse sheath.
• Skin along with superficial intersections.
fascia is exposed and
reflected sideways. Anterior
layer of rectus sheath is
exposed.
263
KIDNEY FROM BACK
264
Anatomy at a Glance
Fig. 11.57: Morris paralleogram (Dissection of kidney from back)
NAME OF THE DISSECTION–KIDNEY FROM BACK
POSITION OF BODY (PRONE)

(Fig. 11.57) (Fig. 11.57)
• Transverse incision extends The lower part of kidney is • Erector spinae. • Renal angle.
1” away from the level of T- easily found from this • Quadratus lumborum. • Nephrectomy in the lower
11 spine laterally upto 4” dissection. After skin incisions • Thoracolumbar fascia pole.
• Another transverse incision reflect superficial fascia • Nerves subcostal • Bimanual palpation of
1” away from L3 spine upto laterally, erector spinae muscle – Iliohypogastric kidney.
4” laterally is exposed. All muscles should – Ilioinguinal • Lumbar hernia through

• Connect this by vertical be retracted medially and • Lumbar triangle triangle.
incision closer to spine. fascia should be retracted • Lower pole of kidney
laterally. Retracted medially
posterior layer of thoraco-
lumbar fascia is exposed.
Retract the fascia laterally.
Quadratus lumborum is
exposed. It is retracted
medially. Middle layer of
thoracolumbar fascia is seen.
It is retracted laterally. Lower
pole is exposed. This way is
safer to expose as it kidney
does not posses the
peritoneum.
265
FACE
266
Anatomy at a Glance

HEAD AND NECK
NAME OF THE DISSECTION–FACE
POSITION OF BODY–SUPINE

(Fig. 11.58) (Fig. 11.59)
• Vertical incision extents It is the anterior part of head, • Muscles of facial expres- • Danger area of face
from nasion to chin; It must extents from one ear to other sion particularly. • Bells palsy
encircle the eyes, nostrils transversly; vertical extension - Orbicularis occuli. • Stone in porotid duct.
and orifice of mouth. from scalp to chin. - Zygomaticus major and • Accessory parotid gland.
• Transverse incision from It is contributed by facial bones minor

outer angle of eye to the whose architecture produce the - Levator anguli oris.
upper part of tragus. shape of face. This shape is - Orbicularis oris.
• Transverse incision from the also variable by muscles of - Buccinator
angle of the mouth to the facial expression muscles have - Masseter
lower part of tragus. got no bony origin but they are • Vessels
• Transverse incision from inserted in the skin. They - Facial artery (tortuous)
chin to angle of mandible. produce facial expression, facial vein (Straight) and
nonverbal communication. lies posterior to artery.
They lift the eyebrows, close • Branches of facial nerve.
and open the eyes, flare the • Parotid duct–cord like
nostinal, open and close the structure lies between upper
mouth. Its importance is very buccal and lower buccal
much observed when the nerve.
muscles are paralysed. • Superficial temporal.
vessels and auriculo-
temporal nerve.
267
268
Anatomy at a Glance
Fig. 11.60: Incisions Fig. 11.62: Deep dissection
Fig. 11.61: Subdivision of Fig. 11.63: Deep dissection (after

triangles of neck cutting of sternocleidomastoid)
NAME OF THE DISSECTION–ANTERIOR TRIANGLE OF NECK
POSITION OF BODY (SUPINE WITH NECK EXTENDED)

(Fig. 11.60) (Figs 11.61 to 11.63)
• Midline vertical incision The anterior triangle is Muscles : • Carorid pulse
from symphysis menti upto bounded anteriorly by arterior • Platysma • Branchial cyst.
the jugular notch of sternum. midline of neck, behind by • Sternocleidomastoid • Cannulation in internal
• Transverse incision extends anterior border of sternoc- • Anterior belly of diagastric Jugular vein.
from symphysis menti along leidomastoid. Base is above • Posterior belly of diagastric • Jugular venous pressure
the base of mandible, upto forms by mandible and apex is • Sternohyoid • Enlargement of thyroid

angle and then upto the directed below towards jugular • Sternothyroid • Stenosis of internal carotid
mastoid process. notch. • Omohyoid (Superior belly) artery.
• Flap of skin reflected It is subdivided into different Vessels : • lesion of cervical sympa-
downwards laterally triangles by two bellies of • Carotid sheath with its thetic nerve.
diagastric and superior bolly of contents.
omohyoid. • Common carotid artery,
internal jugular vein.
• Nerves
• Vagus nerve.
• Hypoglossal nerve.
• External carotid artery with
its superior thyroid branch,
lingual, and facial branches.
Thyroid gland.
269
POSTERIOR TRIANGLE OF NECK
270
Anatomy at a Glance
Fig. 11.64: Incision Fig. 11.65: Superficial dissection
11.66: Deep dissection

NAME OF THE DISSECTION–POSTERIOR TRIANGLE OF NECK
POSITION OF BODY (SUPINE WITH NECK TURNED TOWARDS OPPOSITE SIDE)

(Fig. 11.64) (Figs 11.65 and 11.66)
• Vertical incision along the • Boundary—Anterior poste- • Supraclavicular nerve. • Spasmodic torticolis
posterior border of sternoc- rior border of sternomastoid. • Transverse cutaneous nerve • Wry neck
leidomastoid. Posterior—by anterior of neck. • Subclavian vein puncture.
• Transverse incision from border of trapezius. • Lesser occipital nerve • Prominence of external
angle of mandible upto a Apex of triangle directed • Accessory nerve and Jugular.
furrow behind sternocleido- upwards formed by meeting branches from C2 and C3 • Severance of external jugular

mastoid and mastoid of trapezius and stenoclei- • Muscles like inferior belly vein.
process. domastoid. of omohyoid. • Nerve block in posterior
• Another transverse incision Base–by clavicle. • Scalenus medius. triangle
from sternocleidomastoid. Floor–by scalenus medius, • Levator scapulae • Injury to accessory nerve
(lower attachment) upto Levator scapulae, Splenius • Splenus capitis during surgery of posterior
anterior margin of trapezius. capitis, semispinalis capitis. • Semispinalis capitis triangle.
• Sternocleidomastoid, trape- • Air embolism in external
zius. jugular vein.
• Artery • Compression of subclavian
Transverse cervical artery. artery.
• Cold abscess.
271
Histology
Histology—study of different tissues of body by microscope is known as histology.

Histology 273
Fig. 12.1: Different types of epithelia
Fig. 12.2: Different varies of glands

Fig. 12.3A: Fungiform papilla of tongue Fig. 12.3B: Circumvallate papilla of

(HE stained) tongue (HE stained)
Fig. 12.4: TS of upper esophageal Fig. 12.5: TS of fundus of body of

wall (stained with HE) stomach (stained with HE)
Fig. 12.6: Section of deudenum (HE stained) Fig. 12.7: TS of small intestine (stained with HE)
Histology 275
NAME AND POINTS OF

IDENTIFICATIONS UNDER MICROSCOPE
Gastrointestinal System
Name Identifying points under microscope (stained with hematoxylin and Eosin)
• Tongue • From outside inwards presence of stratified squamous epithelium.
(Figs 12.3A and B) • Muscle coat is very thick and haphazard direction.
• Papillae present (filiform and fungiform) and sometimes circumvallate
• Esophagus • From inside outwards presence of stratified squamous epithelium.

(Fig. 12.4) • Presence of prominent muscularis mucosae.
• Presence of outer longitudinal and inner circular muscle layer.
• Stomach • From inside outwards presence of columnar epithelium with gastric glands.
(Fig. 12.5) • Presence of muscles are arranged in three layers:
(a) Inner oblique
(b) Middle circular
(c) Outer longitudinal.
• Duodenum • From inside outwards presence of columnar epithelium with villi.

(Fig. 12.6) • Submucous Bruner’s gland is present.
• Presence of outer longitudinal and inner circular layer.
• Jejunum and ileum • From inside outwards presence of brush border columnar epithelium, with intestinal
(Fig. 12.7) gland (crypts of Lieberikühn).
• presence of finger like villi is seen.
• We get serous coat, muscle arranged in outer longitudinal and inner circular; submucous
coat and mucous membrane.
Contd...
Fig. 12.8: TS of large intestine (stained with HE) Fig. 12.9: Vermiform appendix
Fig. 12.10: TS of liver (stained with HE) Fig. 12.11: Sectional view of pancreas
Fig. 12.12: Salivary gland parotid (HE stained)

Histology 277
• Large gut except • From inside outwards, it is lined by columnar epithelium with plenty of goblet cells.
appendix and anus • Tenae present (aggregation of longitudinal muscle fiber)
(Fig. 12.8)
• Appendix • Absence of intestinal villi

(Fig. 12.9) • Columnar epithelium with goblet cells.
• Promonent lymphoid tissue in submucous coat.
• Presence of gap in the muscular coat (hiatus muscularise).
• Liver • Presence of liver lobule (hexagonal in shape) with central vein.

(Fig. 12.10) • Presence of portal triad at the different corner of lobule.
• Pancreas • Connective tissue septa divides the gland into lobules.

(Fig. 12.11) • Darkly stained serous acini present.
• Discrete lightly stained islets of Langerhan present.
• Parotid gland • Connective tissue septa divides it into number of small lobules containing mainly serous
(Fig. 12.12) and mucous acini.
• No islets of Langerhan.
• Ducts are lined by pseudostratified columnar epithelium.
Fig. 12.13: Sectional view of trachea Fig. 12.14: Sectional view of lung (HE stained)
Fig. 12.15: TS of deep cortical area of kidney Fig. 12.16: TS of ureter (HE stained)
(stained with HE)
Fig. 12.17: A section of the wall of the urinary Fig. 12.18: Section of testis (HE stained)
bladder (HE stained)
Histology 279
Respiratory System
• Trachea • Lumen lined by pseudostratified columnar epithelium.

(Fig. 12.13) • Presence of hyaline cartilage (uniform blue color with chondrocyte present in lacunae).
• Presence of abundant glands and trachialis muscle.
• Lungs Presence of innumerable alveoli lined by pavement epithelium

(Fig. 12.14) • Presence of bronchus (identified by incomplete ring of hyaline cartilage).
• Presence of bronchiole (cartilage absent) and flower like appearance.
• Kidney • Section shows plenty of Bowman’s capsules with glomeruli.

(Fig. 12.15) • Different shapes of tubules (due to cut into different planes) are present
• Ureter • From within outwards lined by transitional epithelium (from which outwards)
(Fig. 12.16) • Lamina propla present
• Muscular coat – inner longitudinal and outer circular
• Outermost fibrous coat.
• Urinary bladder • From within outwards lined by transitional epithelium

(Fig. 12.17) • Muscles coat arragned in three layers which is indistincly differentiated
• Testis • A number of semin, ferrous tubule is present (in different shapes).

(Fig. 12.18) • Spermatogenic cells are arranged in different stages of maturation
• Tall columnar sertoli cells are present.
Fig. 12.19: A section of vas deferens (HE stained) Fig. 12.20: A section of prostate (HE stained)
Fig. 12.21: Section of ovary showing mature follicle Fig. 12.22: Section of the uterine tube
(high power) (HE stained)
Fig. 12.23: Section of the uterus (follicular phase)

Histology 281
Genito Urinary System
• Vas deferens (Fig. • From within outwards narrow irregular lumen.
12.19) • Muscular layer is the thickest coat – inner longitudinal; middle circular and other
longitudinal.
• Outer fibrous coat.
• Prostate • Fibromuscular capsule covers the fibromusculo-glandular storma.

(Fig. 12.20) • Amyloid bodies (prostatic concretion).
• Ovary • From outside inwards covered by cubical germinal epithelium.

(Fig. 12.21) • Outer border zone contains ovarian follicles in different state of maturation; atretic follicles
also present.
• Uterine tube • From inside outwards inner mucous membrane thrown into fold which branch and rebranch
(Fig. 12.22) in such a way that rarely a lumen is visible.
• Mucous folds do not anastomise.
• Outer longitudinal and inner circular muscle coat is present.
• Outer most serous coat (made up of mesothelium).
• Uterus • From inside outwards lined by simple columnar epithelium.

(Fig. 12.23) • Lamina propna composed of connective tissue contains uterine glands.
Fig. 12.24: Spongy bone Fig. 12.25: Compact bone
Fig. 12.26: Section of thyroid gland (HE stained) Fig. 12.27: Pituitary gland (high power)
Fig. 12.28: Lymph node (Panoramic view) Fig. 12.29: Section of thymus (hematoxylin stained)
(HE stained)
Histology 283
Others
• Bone (spongy) • Bony trabecular, contains irregular lamillar plate.
(Fig. 12.24) • Marrow spaces containing bone marrow.
• Bone (compact) • Presence of haversian system.

(Fig. 12.25) • Lacunae contain osteocytes.
• Thyroid gland • A number of follicles with different shapes and sizes present.
(Fig. 12.26) • Follicles contain homogeneous pink colored colloid.
• Pituitary gland • Pars anterior contains anastomising cords of chromophobe and chromophil cells.
(Fig. 12.27) • Pars posterior contains pituicyles and large number of nerve fibers.
• Lymph node • From outside inwards bean shaped.

(Fig. 12.28) • Subcapsular space is present.
• Cortex contains numerous germinal epithelium.
• Thymus • From outside inwards outer lobulated cortex covered by thin capsule.
(Fig. 12.29) • Cortex is dark stained.
• Inner medulla contains Hassall’s batch. Corpuscle.
• Spleen • From outside inwards presence of fibrous capsule.

(Fir. 12.30) • Send incomplete septa from fibrous capsule.
• Presence of red pulp and white pulp.
• White pulp presents eccentric arteriole.
Contd...
Fig. 12.30: Section of spleen (Panoramic view)

(HE stained)
Fig. 12.31: Section of palatine tonsil (HE stained) Fig. 12.32: Section of the cerebral cortex
Fig. 12.33: Section of cerebellum Fig. 12.34: Section of the spinal cord
Fig. 12.35: Sectional view of scalp Fig. 12.36: Sectional of suprarenal gland
Histology 285
• Palatine tonsil • Surface is covered by stratified squamous non keratinised epithelium.
(Fig. 12.31) • Crypts are present.
• Presence of partial capsule.
• Cerebrum Laminated appearance usually consists of 6 layers

(Fig. 12.32) • Molecular layer
• External granular layer
• External pyramidal layer
• Internal granular layer
• Internal pyramidal layer
• Multiform layer
Very large pyramidal shaped neurons (Beta cells) are present in internal pyramidal layer.
• Cerebellum • From outside inwards outer grey matter divided into three zones
(Fig. 12.33) – Molecular (outer) layer.
– Purkinje layer (intermediate).
– Inner granular (dark bluish violet stain).
• Inner white matter contains nerve fiber stained pink.
• Spinal cord • H shaped grey matter inside.

(Fig. 12.34) • Outer white matter.
• Anterior median fissure and posterior median sulcus present.
• Anterior horn is bulbous.
• Skin • From superficial to deep presence of stratified squamous keratinised epithelium.

(Fig. 12.35) • Hair follicle present.
• Suprarenal gland • Outer pale stained cortex which is divided into three zones – zona glomerulosa, zona
(Fig. 12.36) faciculata, zona reticularis.
• Inner dark blue medulla.
Radiology
(Imaging Technique)
RADIOLOGY structure is better visualized in this view, e.g.

AP view of hip joint, elbow joint, etc.
It is the study of structures of body by means of 2. Posteroanterior view (PA view) (Fig.
radiophoto. 13.1A)—Here the source of light is behind the
1. Conventional radiography (Fig. 13.1A)—The subject and the rays passing postero anteriorly
making of X-ray picture on photo film is known as the film is in front, e.g. PA view of the skull,
as radiography. It is excellent for high contrast chest.
structures like bones and lungs. Normally soft 3. Lateral view—This view is used to assess the
tissue with slight thickness are not visible. So, depth of structures. The position in this view is
the contrast media is used to identify soft at the right angle to AP and PA.
structures. Contrast media are of two different
Other Methods of Imaging Technique
types:
Translucent–(air, oxygen) 1. Angiographies—Visualisation of vascular tree
Opaque—e.g. barium sulphate, iodine by introducing iodinated contrast medium
compound. through catheter is known as angiography. It is
The rays when readily absorbed by a useful in visualising tumor vascularity and to
substance is known as radiolucent (like soft assess the position of arteries.
tissue). The tissue like bone is so dense that 2. Ultrasound (Fig. 13.1B)—It is inaudible sound
X-rays do not pass through it, is known as radio- with frequency of more than 20, 000 cycles/sec
opaque substance.
Advantages
1. To diagnose bony deformities and fractures.
2. To diagnose a congestion of soft tissue, or space
occupying the lesion (tumor, etc).
STANDARD POSITION USED IN

RADIOLOGY EXAMINATION
1. Anteroposterior view (AP view)—In this view
the source of light is in front of the subject and
the film lies behind the subject. Posterior Fig. 13.1A: Technique of X-ray of PA view
Radiology (Imaging Technique) 287
Fig. 13.1B: Technique for producing an abdominal ultrasound image
is passed to obtain the image or photograph of lesion and changes produced by it. The
an organ and tissue; it is known as procedure is safe and quick.
ultrasonography, or ultrasound in common 4. Magnetic Resonance Imaging (MRI) – Here
language. Ultrasound is difficult in very obese magnetic property of H-Nucleus is excited by
person. radio frequency radiation and photograph is
3. Computerized Topography (CT) (Fig. taken. MRI is safe and structures are more
13.1C)—It permits the study of tissue in slices, clearly visualized than CT scan.
by which we can clearly localised the area of
Fig. 13.1C: Technique of abdominal CT scan

Here are few conventional X-ray plates which often come in examination:
SUPERIOR EXTREMITY
Fig. 13.2: AP view of shoulder joint Fig. 13.3: Shoulder joint

Showing: 1. Aeromian 2. Head of humerus My beloved student: Outline the different
3. Acromio-clavicular joint space 4. Glenoid cavity structures by probe and practise
5. Coracoid process 6. Clavicle 7. Superior angle
(scapula) 8. Lateral border of scapula
9. Soft tissue shadow 10. Anatomical neck of
humerus
ELBOW JOINT
Fig. 13.4: AP view of elbow joint Fig. 13.5: Lateral view of elbow joint
Showing: 1. Olecranon and coronoid fossae Showing: 1. Two epicondyles of humerus
2. Medial epicondyle 3. Olecranon process 2. Olecranon 3. Elbow joint space 4. Compact
4. Elbow joint space 5. Lateral epicondyle (flatter bone 5. Supracondylar ridge 6. Coronoid
appearance) 6. Head and tuberosity of radius process 7. Tuberosity of radius 8. Medullary
7. Soft tissue shadow cavity 9. Soft tissue shadow 10. Head of radius
POSTERO-ANTERIOR VIEW OF WRIST JOINT AND HAND
Fig. 13.6: PA view of wrist and hand Fig. 13.7: PA of wrist and hand outline the different
structures by probe and practise
Showing: 1. Styloid process of radius 2. Scaphoid
3. Trapezium 4. Trapezoid 5. 1st metacarpal
6. Ulnar styloid process 7. Lunate 8. Triquitral and
pisiform 9. Capitate 10. Hammate with hook
CHEST
Fig. 13.8: Postero anterior view of thorax

Showing: 1. Lateral border of scapula 2. Hialar shadow due to lympho-glandular vascular components
3. Right border of mediastinal shadow 4. Right dome of diaphragm 5. Gas in fundus of stomach 6. Left
dome of diaphragm 7. Costo-phrenic angle (left) 8. Cardio phrenic angle (left) 9. Left border of mediastinal
shadow 10. Aortic knuckle formed by arch of aorta 11. Thoracic inlet 12. Spine of vertebra visualized
through shadow of trachea 13. Shadow of trachea 14. 1st rib 15. Clavicle 16. Ribs
ABDOMEN
R G
d V
ti e
Fig. 13.9: Plain or straight X-ray of abdomen Fig. 13.10: Straight X-ray of abdomen
Showing: 1. Vertebral body 2. Intervertebral disc Please practice by probe
space 3. Ala of sacrum 4. Lower ribs 5. Spine of
n
vertebra 6. lliac crest 7. Sacral promontory 8.
Gas in large gut
U
CONTRAST RADIOGRAPHY
-
9
ri 9
a h
t
Fig. 13.11: Barium meal X-ray of stomach Fig. 13.12: Ba-meal X-ray of stomach
Showing: 1. Lesser curvature of stomach Please practice by probe
2. Fundic gas shadow 3. Rugae 4. Greater
curvature of stomach 5. Pyloric antrum 6. Pyloric
canal 7. Duodenal cap (due to barium in 1st one
inch of 1st part of duodeneum) 8. Feathery intestinal
mucosa 9. Gas shadow in colon 10. Shadow of
pedicle
ABDOMEN
Fig. 13.13: Barium meal X-ray of stomach and Fig. 13.14: Barium meal X-ray showing large gut
follow through intestine
Showing: 1. Ascending colon 2. Caecum
Showing: 1. Stomach 2. Feathery appearance of 3. Appendix 4. Small gut in pelvis 5. Transverse
small intestine (due to barium entangle between colon 6. Descending colon
mucous folds)
PYLOGRAM
Fig. 13.15: Descending (intravenous) pyelo gram Fig. 13.16: Descending pyelogram showing the
dye contentrated in urinary bladder student, must
Showing: 1. Minor calices 2. Double ureter on
outline the different shadows for practice
both side 3. Major calices 4. Pelvis of ureter 5.
Gas in descending colon
HEAD AND NECK
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Fig. 13.17: Antero posterior view of skull Fig. 13.18: Lateral view of skull
Showing: 1. Outer table 2. Inner table 3. Frontal Showing: 1. Pituitary fossa 2. Coronal suture
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air sinus 4. Petrous part of temporal bone 3. Orbital plate of frontal bone 4. Sphenoidal air
5. Maxillary air sinus 6. Ramus of mandible 7. Soft sinus 5. External auditory meatus 6. Petrous part
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tissue shadow of tongue 8. Nasal septum and of temporal bone 7. Outer table of parietal 8. Inner
turbinate table of parietal
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Fig. 13.19: Occipito meutal view for examination of PNS
(Para-nasal air sinuses)
Showing: 1. Frontal air sinus 2. Orbital cavity 3. Nasal
cavity 4. Maxillary air sinus 5. Foramen magnum 6. Axis
(adontoid process) 7. Ethmoidal air cells
HEAD AND NECK (Contd...)
Fig. 13.20: Lateral view of neck (slightly flexed) Fig. 13.21: Lateral view of neck (extended)
Showing: 1. Dens (odontoid process) 2. Inter Showing: 1. Anterior arch of atlas 2. Disc space
vertebral foramen 3. Spine (cervical) (intervertebral)
INFERIOR EXTREMITY
Fig. 13.22: Antero posterior (AP) view of hip joint

Showing: 1. Iliac crest 2. Acetabular magnum 3. Head of
femur 4. Neck of femur 5. Obturator foramen 6. Symphysis
pubis 7. Soft tissue shadow of external genitalia (by which you
can identify sex) 8. Upper curved line 9. Greater trochanter of
femur 10. Shenton’s line 11. Lesser trochanter of femur
INFERIOR EXTREMITY (Contd...)
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Fig. 13.23: Antero-posterior view of knee Fig. 13.24: AP view of knee
Student please practice with a probe
Showing: 1. Soft tissue shadow 2. Lower end of
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femur 3. Outline of patella 4. Lateral condyle of
femur 5. Knee joint space 6. Lateral and medial
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condyles of tibia 7. Head of fibula 8. Medial
condyle of femur
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Fig. 13.25: Lateral view of knee joint
Showing: 1. Soft tissue shadow 2. Lateral
condyle of femur 3. Patella 4. Tibial tuberosity
5. Head of fibula 6. Medial condyle of femur
Fig. 13.26: Dorso planter view of foot Fig. 13.27: Lateral view of foot
Showing: 1. Lower end of tibia 2. Ankle joint Showing: 1. Ankle joint space 2. Medial comma
space (line) 3. Medial malleolus 4. Talus 5. 2nd like articular surface of talus 3. Calcaneum
metatarsal 6. 1st metatarsal 7. Styloid process of 4. Calcaneal spur 5. Cuboid 6. Medial
5th metatarsal 8. Lateral malliolus 9. Trachlear cuneiform 7. Navicular 8. Head of talus 9. Neck
articular surface of talus 10. Epiphyseal line of talus 10. Trochlear articular area of talus
11. Tuberosity of 5th metatarsal (at base)
Fig. 13.28: Lateral view of foot

Showing: 1. Head of talus 2. Navicular 3. Base
of 2nd metatarsal 4. 1st metatarsal 5. Phalanx
6. 5th metatarsal 7. Lateral cuneiform 8. Styloid
process of 5th metatarsal 9. Cuboid 10. Calcaneal
tuberosity 11. Calcaneum 12. Sinus tarsi
Surface Anatomy
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Applied Importance (Surface Anatomy)
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SURFACE ANATOMY
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Study of anatomy in relation to body surface is 1. Physical examination of patient is the clinical
known as Surface Anatomy. Physical examination application of surface anatomy.
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of patient is the clinical application of surface 2. Determination of peripheral pulse reduces the
anatomy. For this carefully selected landmark is complication of vaso occlusive disease
used. There are: (Buerger’s disease)
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1. Visible landmark 3. Prominence of some veins help in diagnosis and
2. Palpable landmark. also therapeutic management of patient.
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4. Determination of certain diseases by palpating
Visible Landmark nerves (e.g. thickening of ulnar nerve in leprosy)
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as well as nerve injuries due to fracture of
Those landmarks are those which one can visible bones.
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with nacked eye. Majority of them are produced
by bones and cartilage, only nipple and umbilicus SUPERIOR EXTREMITY
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is soft tissue landmark identified by inspection.
Points
Palpable Landmarks (Fig. 14.1) 1. Angle of Acromian Process (Fig. 14.2): Forms
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a subcutaneous bony prominence. It can be
These land-marks are felt through skin, muscles
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defined by following, the lateral margin of
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and tendons. Artery pulsation is felt against bone acromion across the tip of the shoulder.
(e.g. radial pulse, femoral pulse, etc.). Nerves can 2. Pisiform Bone: Felt at the medial part of the
be rolled against bone (e.g. ulnar nerve, termination base of the hypothenar eminence.
of common peroneal nerve). Superfical tendon can 3. Head of the Radius: It lies in the depression
be felt by making the muscle prominent. Parotid below the lateral epicondyle and lateral to
duct and vas deferens can be felt through skin. olecranon process, which is felt during
During examination it is better to use white chalk pronation and supination.
powder for points as well as for lines (because it 4. Head of the Ulna: The wrist is flexed and
is more prominent) as white color can be used in forearm pronated - the head is seen and also
any type of drawings. In drawing an artery and a felt as a swelling.
vein, please put a lumen inside two lines. In case 5. Tip of Coracoid Process: 2 cm below the
of nerve one should draw a single line. junction of lateral 1/4th and medial 3/4th of the
Surface Anatomy 297
Fig. 14.1: Important visible points and palpable bony prominences used in surface marking
clavicle. It lives deep to anterior fibres of deltoid Lines

and felt by deep palpation.
Bifurcation of Brachial Artery or Beginning of
6. Styloid Process of Radius: It is traced from
Radial Artery (Fig. 14.3): 1.25 cm below the mid
the lower end of anterior border of radius. Tip
is felt in the floor of anatomical snuff box. It point of the line joining two epicondyles of
lies 1.5 cm. below the ulnar styloid process. humerus, medial to the tendon of biceps brachii.
7. Styloid Process of Ulna: It is felt in the It moves upward in the middle of cubical fossa
posteromedial aspect of wrist just the line of when the elbow is flexed.
wrist joint, 1.2 cm. above the level of styloid Left Axillary Artery (Fig. 14.3): Arm is abducted
process of radius. at right angles to the body. The points are:
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Fig. 14.2: Dark area palpable features of superior extremity
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i. At the lower border of midpoint of the clavicle.
Please identify the sternal end and then stress
acromial end of clavicle and then assess the
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midpoint of clavicle.
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ii. At the junction of anterior 2/3rd and posterior
1/3rd of the line joining the distal ends of anterior
and posterior axillary folds. (Anterior axillary
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fold is formed by pectoralis major and later by
teres major and latissimus dorsi).
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2 parallel lines joining the above points
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represents the axillary artery.
Brachial Artery (Fig. 14.3)

1. At the junction of anterior 2/3rd and posterior
1/3rd of the line joining the distal ends of anterior
and posterior axillary folds.
2. The point is 1 cm distal to the elbow joint at the
level of neck of radius. The point lies on the
medial aspect of tendon of biceps brachii.
Fig. 14.3: Axillary art, brachial artery (in arm) radial
2 parallel lines joining the above points artery, ulnar artery (in forearm) and superficial palmar
represents brachial artery. arch (in palm)
Surface Anatomy 299
i. Brachial artery is compressed on the medial

aspect of tendon of biceps during blood
pressure recording
Radial Artery in the Forearm (Fig. 14.3)

Points are:
1. A point 1 cm below the bent of elbow joint at
the level of medial side of neck of the radius.
2. In front of the wrist between flexor carpi radialis
and lower part of anterior border of radius,
where pulsation is felt. It is the most important
peripheral reflection of cardiac action.
Joint the 2 points by two = lines.
• It is the most important site of recording
pulse.
Ulnar Artery in Forearm (Fig. 14.3)

Fig. 14.4: Thenar and hypothenar eminences
Points are: and superficial palmar arch
1. The point is 1 cm distal to the elbow joint at the
level of medial side of neck of the radius. 2. Junction of upper and middle third of the line
2. At the base of pisiform bone. It has a very joining insertion of deltoid to lateral epicondyle.
superficial course in the forearm. Join the two points by a single line.
Join these 2 points with a lumen within.
Ulnar Nerve in Forearm
Superficial Palmar Arch (Figs 14.3 and 14.4) Points at:
Points are: i. Behind medial epicondyle of humerus
1. Lateral side of pisiform bone ii. Lateral to pisiform bone.
Join these 2 points with a single line.
2. Centre of thenar eminence
The points are joined by two curved line passing INFERIOR EXTREMITY
through middle of palm. The summit of the line
lies along the distal border of outstretched thumb. Points (Fig. 14.5)
• Due to superficial and deep palmer arch the palm 1. Tip of Medial Malleolus: Formed by lower
is more warmer than dorsum. projecting part of tibia.
2. Tip of Lateral Malleolus: Formed by lower
Radial Nerve in the Back of the Arm (Fig. 14.3) end of fibula. It is half cm. lower than the medial
Points are: malleolus.
1. At the termination of axillary artery, i.e. at the 3. Tubercle of Navicular Bone: 2 cm below the
junction of anterior 2/3rd and posterior 1/3rd tip of medial malleolus and 2 cm in front of it.
of the line joining the distal ends of anterior and 4. Adductor Tubercle: Thigh is abducted and
posterior axillary folds. laterally rotated, hip and knee are slightly flexed.
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Fig. 14.5: Palpable features of inferior extremity
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A small projection at the upper part of medial
condyle of femur is palpated by tracing the
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tendon of adductor magnus from above.
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• Importance:
- Insertion of adductor magnus
- Junction of epiphysis and diaphysis
Lines
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1. Popliteal Artery (Fig. 14.6)
Points at:
i. 2.5 cm medial to the midpoint of the back of
the thigh at the junction of middle and lower Fig. 14.6: Popliteal fossa (surface marking)
third of the thigh.
ii. Middle of the back of the leg at the level of i. Middle of the back of the leg opposite tibial
tibial tuberosity. tuberosity.
2 parallel line joining the above points ii. Midway between medial malleolus and
represent the popliteal artery. tendocalcaneus.
2. Posterior Tibial Artery 2 parallel line joining the above points
Points at: represent posterior tibial artery.
Surface Anatomy 301
Fig. 14.8: Arteria dorsalis pedis (surface marking)
Fig. 14.7: Surface marking of leg (anterior

tibial artery, deep peroneal nerve)
3. Anterior Tibial Artery (Fig. 14.7)

Points at:
i. 2.5 cm below the medial side of the head of
the fibula. Fig. 14.9: Relation of arteria dorsalis pedis with
ii. Midpoint between medial and lateral malleolus long tendons of dorsum
2 parallel line joining the above points
represent anterior tibial artery.
2. Transpyloric Plane (Fig. 14.10): Cuts the lower
4. Arteria Dorsalis Pedis (Figs 14.8 and 14.9)
border of L1 vertebra. One hand breadth below
Points at:
the xiphisternal joint of the individual.on which
i. Midpoint between medial and lateral malleolus
the surface marking is done.
ii. Point at the base of first intermetatarsal space
• Pylorus of stomach, hila of kidneys,
• These (posteria tibial artery and dosarlis
duodeno-jejunal flexure, neck of pancreas lies
pedis artery are important for recording
in this plane.
peripheral pulse
3. Transtubercular Plane (Fig. 14.10): Line
2 parallel lines joining the above points represents
joining the iliac tubercles represent this plane
anterior tibial artery.
—(5 cm behind the anterior superior iliac spine.)
ABDOMEN This plane lies at the level of L4 vertebra. It lies
slightly below the umbilicus.
Planes
Points
1. Right and Left Lateral Planes (Fig. 14.10):
Plane passing through midclavicular point to 1. Origin of Coeliac Artery: Point 1.5 cm. above
midinguinal point. transpyloric plane in the midline.
Points at:
i. Left 5th intercostals space 9 cm away from
the midline.
ii. At transpyloric plane in the midline
iii. Tip of 9th costal cartilage (right)
iv. 1.2 cm. below right costal margin, at the level
of tip of 10th costal cartilage.
The above points are joined to represent inferior
border of liver.
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• It is of great clinical value became liver is
enlarged by a number of diseases. Normally
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in child upto 3 yrs. of age the lower border
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exist below the costal margin.
2. Fundus of Stomach (Fig. 14.10):
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i. One line is drawn directed upward backward
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and to the left starting from the left border
of cardiac orifice.
ii. The summit of the curve is situated at the
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Fig. 14.10: Surface marking of abdomen level of left 5th intercostals space just below
the nipple.
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3. Lesser Curvature of Stomach (Fig. 14.10):
2. Origin of Superior Mesenteric Artery: A point
Put a point at cardiac orifice and also in pyloric
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just above the transpyloric plane in the midline.
orifice. The curvature is drawns starting from
3. Pyloric Orifice of Stomach (Fig. 14.10): At
the transpyloric plane 1.25 cm to the right of the right margin of cardiac orifice upto the left
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the midline. margin of pyloric orifice. Incisura angularis is
made in the mid line just below the transpyloric
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4. Tip of 9th Costal Cartilage (Fig. 14.10): At
the junction of transpyloric planes and lateral plane.
border of rectus abdomininis (It is prominent 4. Root of the Mesentery
h
in muscular body). Points are:
5. Fundus of Gallbladder (Fig. 14.10): Tip of 1st to draw transpyloric plane, transtubercular
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right 9th costal cartilage. It corresponds with and right lateral plane.
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an angle between right costal margin and line i. 1 cm below the transpyloric plane, 2.5 cm
semilunaris (lateral border of rectus muscle). to the left of the midline, it represents
6. Base of the Appendix (Fig. 14.10): 2 cm below duodeno jejunal flexure.
ileocecal orifice. ii. Junction of right lateral plane and transtuber-
7. Mc. Burney’s Point: At the junction between cular plane.
medial 2/3rd and lateral 1/3rd of spinoumbilical Join these two points by line with convexity
line (line joining umbilicus and anterior superior directed toward left.
iliac spine). 5. Kidney from the Back (Fig. 14.11):
(Morris’ parallelogram):
Lines i. Two transverse lines at the level of l1th
1. Inferior Border of Liver (Fig. 14.10): thoracic and 3rd lumber spine.
Surface Anatomy 303
ii. Point on the lower border of right 6th costal

cartilage at the level of xiphisternal joint.
iii. Point on the right 4th space 3.8 cm from
midline convex line Joining the above three
points represent right border of Heart.
2. Left Border of Heart (Fig. 14.14):
i. Point on lower border of left 2nd costal
cartilage 1.2 cm from lateral margin of
sternum.
ii. Point in the left 5th intercostals space 9 cm
away from the midline.(Where apexbeat in
felt)
Fig. 14.11: Morris paralleogram (Dissection of Line joining the above points convex upward
kidney from back) and to the left represents the border of heart.
3. Anterior Border of Left Lung (Fig. 14.12):
ii. Two vertical lines–2.5 cm away from the i. A point 2.5 cm above the midpoint of medial
mid line and 10 cm away from the midline third of left clavicle.
respectively. ii. A point on left sternoclavicular joint, a point
Kidney is drawn–upper pole 3.8 cm away from at sternal angle slightly to the left of midline.
midline, and lower pole 7.5 cm away from the iii. A point slightly to the left of the midline at
midlines on the respective side (right or left). the level of the 4th chondrosternal junction.
From the 4th point the line passes laterally
THORAX for 3.5 cm (from the midline), then down-
Points ward and medially in a curved manner to the
left 6th costal cartilage, about 4 cm. From
1. Bifurcation of Trachea (Fig. 14.11): It is a
the midline.
point to the slightly right of midpoint of sternal
angle.
2. Sternal Angle (Fig. 14.14): Junction of
manubrium with the body of sternum.
i. Importance of sternal angle
• Counting of ribs
• Junction of superior and inferior
mediastinum.
3. Apex of the Heart (Fig. 14.14): In the left 5th
intercostals space (ICS) 9 cm. away from
midline (i.e. below and medial to left nipple).
Lines
1. Right Border of Heart (Fig. 14.14)
i. Point at the upper border of right 3rd costal
cartilage 1.25 cm from the lateral border of Fig. 14.12: Surface marking of (1) anterior border
sternum. (2) Lower border of both lungs
4. Right Costomediastinal Pieural Reflection: 7. Superior Vena Cava (Fig. 14.12):

Points at: Points at:
i. Right sternoclavicular joint i. Lower border of sternal and of right Ist costal
ii. Sternal angle in the midline cartilage
iii. Level of right 4th sternochondral junction, ii. Upper border of the sternal end of the right
in the midline 3rd costal cartilage.
iv. Xiphisternal joint—just to the right of the Superior vena cava is repreented by 2 parallel
midline. lines 2 cm apart, coinciding with the above 2
(For costomediastinal reflection of pleura on the points.
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left side, 4th point is taken at the left extremely
of the xiphisternal joint) HEAD AND NECK
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5. Interior Border of Left Lung (Figs 14.12 and
14.13): Points
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Points at: 1. Isthmus of Thyroid Gland
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i. Left 6th costal cartilage 4 cm. Away from Put a point at the center of the isthmus.
midline Upper border: 1.2 cm below the lower border
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ii. Left 8th rib in midaxillary line of cricoid cartilage. Lower border 2 cm. below
iii. Left 10th rib in scapular line the upper border. Borders are 1.2 cm long. It
iv. 2 cm to the left of 10th thoracic spine line lies over 1st end and 3rd tracheal ring.
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joining the above points represent the inferior • Here tracheostomy is done by lifting the
border of left lung. isthmus.
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6. Arch of Aorta 2. Anterior Arch of Cricoid Cartilage
Points at:
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(Fig. 14.15):
i. Right end of sternal angle A point at the midline of anterior arch of cricoid,
ii. Centre of manubrium sternum most prominent part below the thyroid.
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iii. Left end of sternal angle
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The line joining the points represents, the convex
outer border of the arch of aorta.
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Fig. 14.13: Posterior chest wall: Fig. 14.14: Surface marking of heart (only give the
ribs, lungs and pleura linear diagram) (1) Right border, (2) Left border (3)
Inferior border
Surface Anatomy 305
3. Tip of Greater Cornu of Hyoid Bone 2. Duct of Parotid Gland (5 cm) (Fig. 14.15):
(Fig. 14.15): Points at:
Most upper and lateral bony point from the body i. Lower border of concha
of the hyoid, can be palpated between thumb ii. In between ala of the nose and red margin of
and the index finger. the upper lip.
4. Thyroid Eminence: Most prominent eminence Middle-third of the line joining these two points
in the mid line below the hyoid bone. More represents the parotid duct.
marked in male. • This is of clinical value as it can often felt by
5. Nasion (Fig. 14.15): Overlies the frontonasal clinician to diagnose stone.
suture, marked by the depression at the root of 3. Right Frontal Air Sinus (Fig. 14.15):
the nose. Points at:
i. The nasion
Lines ii. 2.5 cm above the nasion
iii. Junction of medial 1/3rd and lateral 2/3rd of
1. Right Lobe of Thyroid Gland supraorbital margin. The points are joined.
Points at: • Frontal air sinuses are unequal is size,
i. 1.2 cm below the lateral end of isthmus, the inflamed in sinusitis and point of tenderness
line is drawn downward and taken laterally is elicited in this region.
with a convexity downward for about 2 or 4. Spinal Accessory Nerve
2.5 cm. Points at:
ii. On the anterior border of sternomastoid at i. The lower and anterior point of tragus
the level of laryngeal prominence. The upper ii. Point opposite the tip of transverse process
pole is joined with the lateral end upper border of atlas.
of isthmus iii. Junction of upper 1/4th and lower 3/4th of
• Thyroid gland is frequently enlarged. In anterior border of sternomastoid.
female it is darged in puberty. Non- iv. Junction of upper 1/3rd and lower 2/3rd of
cancering growth of thyroid is known as posterior border of sternomastoid.
goiter. v. Anterior margin of trapezius of the posterior
trangle about 6 cm above the clavicle.
5. Right Common Carotid Artery (Fig. 14.15)
Point at:
i. Right sternoclavicular joint
ii. Anterior margin of sternomastoid opposite
the level of upper border of thyroid cartilage.
It is represented by two parallel lines joining
above two points.
• Palpation of common carotid pulse is very
important for cardiopulmonary resuscitation
6. Right Internal Carotid Artery (Fig. 14.15):
Point at:
i. Bifurcation of common carotid artery, i.e. a
Fig. 14.15: Surface marking of head and neck point at upper border of thyroid cartilage at
the level of anterior border of sternocleido- The first two points are joint by two zigzag
mastoid. line. 2nd and 3rd point are connected by two
ii. Posterior border of mandibular condyle. straight line.
• This artery has got great clinical importance
It is represented by two parallel lines joining
in plastic and cosmetic surgery.
above two points.
Bifurcation of Common Carotid Artery: A Tip of Seventh Cervical Spine: A point at lower
point at lower 1/3rd opposite upper border of end of nuchal furrow, a prominent bony elevation
thyroid cartilage at the anterior margin of in the midline felt when the head is bowed down.
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sternocleido-mastoid. 8. Internal Jugular Vein (Fig. 14.15):
7. Facial Artery in Face (Fig. 14.15): Points at:
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Points at: i. Louble of the ear.
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i. The base of the mandible at the anterior ii. Medial end of the clavicle.
border of masseter. (it is felt by pressing
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The points are joined by 2 parallel lines.
upper jaw with lower jaw).
• Internal jugular vein is canulated frequently
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ii. 1.25 cm lateral to the angle of mouth. to measure the central venous pressure as
iii. Medial angle of the eye. well as is dialysis of patient in kidney failure.
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Appendix
MEDICAL PREFIXES, SUFFIXES, AND COMBINING USED IN ANATOMY
Eu ..................................... Good Macro .............................. Large

Ex ..................................... Out Mast, masto .................... Breast
Exo ................................... Exterior, External Mega, megalo ................. Large
Extra ................................. Outside of Melano ............................ Black
Fibro ................................ Fiber Meso ............................... Middle
Form ................................. Shape Micro ............................... Small
Galact, galacto ................ Milk Mono ............................... Singular
Glosso .............................. Tongue Morpho ........................... Shape
Gluco ............................... Glucose Oculo ............................... Eye
Gnath, gnatho ................. Jaw Odonto ............................ Tooth
Granule ............................ Grain like Oligo ................................ Few
Graph ............................... A recording instrument Oo, oophoro .................... Ovary
Gyne, gyneco, gyno ....... Woman Orchi, orchio ................... Testis
Hemat, hemato ................ Blood Osseo, osteo ................... Bone
Hemi ................................. One half Ovi, ovo .......................... Egg
Hepat, hepato ................. Liver Pachy ............................... Thick
Histio, histo .................... Tissue Pan ................................... All
Hydro .............................. Water Patho, pathy .................... Disease
Hyper ............................... Excessive Penia ................................ Deficiency
Hypo ................................ Beneath Per .................................... Through
Hyster, hystero ............... Uterus Peri ................................... Around
Ileo ................................... The ileum Pexy ................................. Fixation
Infra ................................. Below Phaco ............................... Lens (eye)
Inter ................................. Between Phase, phagia, phago ..... Eating
Itis .................................... inflammation Phleb, phlebo .................. Vein
Intra ................................. Within Phono .............................. Sound
Irid, irido .......................... The iris Phos, photo .................... Light
Karyo ............................... Nucleus Phren, phrenco ............... Diaphragm
Kerat, kerato.................... Cornea Plagia ............................... Paralysis
Kinesio ............................ Motion Pluri .................................. More
Lact, lacto, lacti ............... Milk Pneuma, pneumato ......... Air
Lepto ............................... Light or slender Podo, podium .................. Foot
Leuco ............................... White Poly .................................. Multiplicity
Litho ................................ A stone Pre, pro ............................ Before
Procto .............................. Anus Spleno .............................. Spleen

Psyche ............................. Mind Steno ............................... Narrowness
Pylo .................................. Pelvis Stoma, stomato ............... Mouth
pyo ................................... Suppuration Sub ................................... Beneath
Re ..................................... Again Super ............................... In excess, in the upper part
Recto ............................... Rectum Sym, syn ......................... Together
Rhino ............................... Nose Thel, thela ....................... Nipple
Sclero ............................... Hardness Thermo ............................ Heat
Scope ............................... An instrument for viewing Thoraco ........................... Chest
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Semi ................................. One half Thromb, thrombo ............ Blood clot
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Sialo ................................. Saliva Tome, tomy ..................... Cutting
Somat, somato ................ Body Trans ............................... Across
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Spasmo ............................ Spasm Trichi ............................... Hair
Spermato, spermo ........... Semen spermatozoa Xanth, xantho ................. Yellow
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Splanchno ....................... Viscera Zym, zymo ....................... Fermentation
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9
ri 9
a h
t
Glossary 309
Glossary
MEDICAL PREFIXES, SUFFIXES, AND COMBINING USED IN ANATOMY
Abduct .................... To move away from midline Aspiration ............... The act of inhaling something
Abscess .................. Localised accumulation of pus into the lung
and disintegrated tissue Ataxia ...................... Inaccurate movement
Acetabulum ............ Cup-like cavity Atelectasis .............. Lung collapse
Actin ........................ A contractile muscle protein Autoimmune ........... Production of antibodies against
Adaptation .............. Any change in structure or new own tissue response
environment
Bolus ....................... A rounded mass of food
Adduct .................... To move towards the midline of
Bursa ....................... A fibrous sac with synovial
body
membrane, containing synovial
Agglutination ......... Clumping
fluid
Agonist ................... Muscle that bears the major
responsibility for effecting a Calculus .................. Stone
particular movement Callus ....................... 1. Localised thickening of skin
Allontois ................. Embryonic membrane resulting from persisting
Alleles ...................... Gene coding for same trait and friction
found at the same locus on 2. Repair tissue (fibrous or
homologous chromosome bony)
Alveolus ................. Microscopic air sacs Calyx ........................ A cup-like extension
Analgesia ................ Reduced ability to feel pain Canaliculus ............. Extremely small tubular passage
Anastomosis ........... A union Carcinogen .............. Cancer causing agent
Aneurysm ............... Dilatation Carotene .................. Yellow or orange pigment
Angiogram .............. Diagnostic technique involving
Cataract ................... Clouding of eye’s lens
infusion of radiopaque subs-
Cerebral palsy ......... Neuromuscular disablity in
tance into circulation for specific
which the voluntary muscles are
visualisation of blood vessel
poorly controlled or paralysed
Anus ........................ Distal end of GI tract
Chemoreceptor ....... Receptors sensitive to various
Aponeurosis ........... Membranous sheet
chemicals
Arachnoid ............... Web-like
Areola ...................... Circular pigmented area sur- Chemotaxis .............. Movement of a cell, organisms
rounding the nipple toward or away from a chemical
Arrector pili ............. Tiny smooth muscle attached to substance
hair Cirrhosis .................. Chronic disease of liver charac-
Arthritis ................... Inflammation of joint terised by fibrosis
Arteriole .................. A minute artery Cisternae ................. Any cavity serving as reservoir
Cleavage ................. An early embryonic phase Fracture ................... A break in bone

consisting of rapid mitotic cell Fundus .................... Base of an organ
division Gastrulation ............ Developmental process that
Clone ....................... Descendant of a single cell produces three primary germ
Cochlea .................... Snail-shaped chamber layers
Conjunctiva ............ Thin protective mucous mem- Gene ......................... One of the biological units of
brane lining the eyelids and heredity located in chromatin
covering the anterior surface of Genotype ................. One’s genetic make up
eye itself Gestation ................. The period of pregnancy
Contraception ......... Birth control Glomerulus .............. Cluster of capilaries
Contralateral............ Relating to opposite side Glottis ...................... Opening between vocal cords
Corona radiata ........ Crown-like arrangement Gonad ...................... Primary reproductive organ
Cortex ...................... Outer surface layer of an organ Hematoma ............... Mass of clotted blood that forms
Deglutition .............. Swallowing in an injured site
Diaphragm ............... Partition Hemostasis ............. Stoppage of bleeding
Diaphysis ................ Elongated shaft of a long bone Hepatitis .................. Inflammation of liver
Dislocation .............. Displacement from normal Hernia ...................... Abnormal protrusion of an
alignment organ or a body part
Dyskinesis .............. Disorder of muscle tone and Hilus ........................ The indented region of an organ
posture Hirsutism ................. Excessive hair growth
Dysplasia ................ A change in cell size and shape Histology ................ Study of tissues
or arrangement Homeostasis ........... Stable internal environment of
Dyspnea .................. Difficult breathing the body
Edema ...................... Abnormal accumulation of fluid Hyperplasia ............. Accelerated growth
in tissues Hypertrophy ........... Increase in size
Emesis ...................... Vomiting Hypothermia ........... Low body temperature
Encephalopathy ...... Any disease of brain In vitro .................... In a test tube
Epitaxis .................... Bleeding from nose In vivo ...................... In the living body
Extrinsic ................... Of external origin Incontinence ........... Inability to control micturation
Exudate .................... Any fluid that escapes from volantarily
tissue containing pus Infarct ...................... Region of dead tissue resulting
Fascicle ................... Bundles of nerve or muscle fiber from a lack of blood supply
bound together by connective Inflammation ........... A nonspecific defensive res-
tissue ponse of body to tissue injury
Fenestrated ............. Pierced with one or more small Infundibulum .......... A stalk
opening Ischemia .................. Local decrease in blood supply
Fissure ..................... A groove Isometric ................. Contraction in which the muscle
Fixator ...................... Muscle that immobilises one or does not shorten contraction
more bones Karyotype ............... Chromosome character-istics of
Flexion ..................... Bending an individual
Foramen ................... Opening of a bone Keratin ..................... Water-soluble protein found in
Fossa ....................... A depression epidermis, hair and nails
Fovea ....................... A pit Labia ........................ Lips, singual, labium
Glossary 311
Lacrimal ................... Pertaining to tears Nociceptor .............. Mechanism for the perception
Lacteal ..................... Special lymphatic capillaries of and transmission of painful or
the small intestine that takes up injurious stimuli
lipid Nondisjunction ....... Failure of one or more pairs of
Lacunae ................... A small space chromosome to separate at the
Lamella ..................... A layer mitotic stage of karyokinesis
Lesion ...................... Wound Occlusion ................ Closure
Ligament ................. Band of fibrous tissue that Olfaction ................. Smell
connects bone Organelles ............... Small cellular structure (like
Limbic system ......... Functional brain system invol- mitochondria, ribosome, etc.)
ved in emotional response Osteomalacia ........... Soft bone resulting from inade-
Malignant ................ Life threatening quate mineralisation
Mandible ................. Lower jaw bone Osteophyte ............. A bony outgrowth
Mastication ............. Chewing Osteoporosis .......... Gradual atrophy of skeletal
Medial ...................... Toward the midline of the body tissue
Melanin ................... Dark pigment formed by cell Palate ....................... Roof of the mouth
melanocyte Paresthesia .............. An abnormal (burning or
Menarche ................ The first menstrual period tingling) sensation
Menopause ............. Cessation of menstruation Parturation .............. Give birth
Microcephaly .......... Formation of small brain tissue Pectoral ................... Pertaining to chest
Midsagittal plane .... Specific sagittal plane that lies Pedigree .................. Ancestral history (family tree)
exactly in the midline (median) Petechae .................. Minute hemorrhagic spot
plane Phagocytosis .......... Engulfing
Mixed nerve ............ Nerve containing motor and Pathology ................ Study of changes in organs and
sensory neurone tissues by disease
Mucus ..................... A sticky thick fluid Phenotype ............... To display (external feature)
Muscle tone ............ Sustained partial contraction of Phlebitis .................. Inflammation of a vein
a muscle; keeps the muscle Pinocytosis ............. Engulfing of extracellular fluid
healthy and ready to act Polyps ...................... Benign mucosal tumor
Myocardium ............ Muscle coat of heart Presbyopia .............. Loss of near focusing ability
Myometrium ............ Uterine musculature Prime mover ............ Muscle that bears the major
Myopia .................... Short sightedness responsibility for a particular
Nares ....................... Nostrils movement
Necrosis .................. Dead tissue caused by disease Puberty .................... Period of life when reproductive
or injury maturity is achieved
Neonatal period ...... The four-week period imme- Radioactivity ........... The process of spontaneous
diately after birth decay seen in some of the
Neoplasm ................ An abnormal mass of prolife- heavier isotopes
rating cells, commonly known as Ramus ...................... Branch
tumors Referred pain ........... Pain felt at a side other than the
Nerve impulse ......... A self-propagating wave of area of origin
depolarisation Regeneration ........... Replacement
Renal ........................ Pertaining to kidney Synarthrosis ............ Immovable joint

Renin ....................... Substance released by the Synchondrosis ....... A joint in which bones are
kidney articulated by hyaline cartilage
Rennin ..................... Stomach secreted enzyme that Synergist ................. Stabilises joint to prevent
acts on milk protein undesired movement
Rhombencephalon .. Hind brain Systemic .................. Pertaining to whole body
Rugae ...................... Elevation or ridges as in Tendon .................... Cord of dense fibrous tissue
stomach mucosa attaching muscle to bone
Sebaceous gland .... Oil secreted gland Tendonitis ............... Inflammation of tendon sheath,
Serosa ...................... Serous membrane (moist typically caused by overuse
membrane) Thrombus ................ A clot
Sinus ........................ Mucous membrane lined air Tract ........................ A collection of nerve fibers in
filled, cavity the central nervous system
Somatic reflexes ...... Reflexes that activate skeletal Trophic hormone .... A hormone that regulates the
muscles function of another gland
Somite ...................... A mesodermal segment of the Tumor ...................... An abnormal growth of cells that
body of embryo that forms produces a swelling
skeletal muscles, vertebrae and
Uvula ....................... Tissue tag hanging from soft
dermis of skin
palate
Splanchnic .............. The vessel serving the digestive
Varicosities .............. Dilatation and tortousity of
system circulation
veins
Sprain ...................... Ligaments of a joint are
Vas ........................... A duct
stretched or torn
Ventral ...................... Anterior or in front
Stenosis .................. Narrowing
Venule ...................... A small vein
Stimulus .................. An extitant or irritant
Vesicle ...................... A small liquid-filled sac
Stroke ...................... Condition in which brain tissue
Villus ........................ A finger-like projection
is deprived of blood supply
Sudoriferous gland . Sweat producing gland Visceral .................... Partaining to internal organ
Sulcus ...................... A furrow Viscosity ................. Sticky or thick
Surfactant ................ Substance that reduces the Vulva ........................ Female external genitalia
surface tension, thus preventing Xenograft ................ Tissue graft taking from another
the collapse of alveoli after each animal species
expiration Zygote ..................... Fertilised egg
Index
A white matter of cerebral stages 203

hemisphere 192 Erb-Duchenne paralysis 99
Abdominal hernia 89 Branchial (pharyngeal) arches 216 Eyeball 199
Abdominal incisions 158 Bronchogenic carcinoma 157 interior of eye 200
Abdominal viscera 157 muscles and nerves of
Achalasia 109 right eye 202
C
Alimentary system 214 muscles of eye 201
Allantois 209 Caecum 165 ocular muscles 200
Amnion 211 Caput medusae 141 retina 200
Anal canal 166 Cardiac muscle 67 sclera 199
Anatomy Cartilage injuries 65 uveal tract 200
anatomical position 1 Central nervous system 95
anatomical terms 2 Cervical plexus 95, 96 F
description of bones 3 Cervical rib 24
specific body areas 3 Chorea 191 Facial nerve 115
Angina pectoris 123 Chorion 209 Female reproductive system 173
Arches of foot 62 Coccydynia 21 Femoral nerve 103
Arterial aneurysm 124 Conchae 182 Folding of embryo 207
Arteries of stomach Congenital megacolon 109 Folds of peritoneum 159
and spleen 159 Conjoint twins 211 Fracture of leg bones 37
Atherosclerosis 124 Coronary arterial system 123 Frail chest 24
Autonomic nervous system 106, 107 Cramp 71 Frozen shoulder 66
Cranial nerves 110, 111
B G
D
Base of brain 111 Genito urinary system 169
Bell’s palsy 115 Deep fascia 223
Biceps and triceps tendinitis 71 Degenerative disease of joint 66 H
Blasctocyst 209 Development
Body lever system 69 face 215 Heart 119
Body posture 1 heart 212 aorta 124
Brachial plexus 97, 98 human 204 arterial supply superior
important nerves 100 septum 212 extremity 126
lesion of important nerves 99 palate 216 arteries
Brain 186 tongue 217 superior extremity 125
basal ganglia 191 Dialator muscles of lip 90 thorax 127
basal nuclei 190 Dislocation 66 abdomen 128
cerebral peduncle 194 Duodenum 160, 161 inferior extremity 130
corpus callosum 192 Duodenum and pancreas 161 head and neck 132
functional cortical areas 189 artery supply 123
medulla oblongata 195 E great vessels 120
mid brain 194 interior of right atrium 122
spinal cord with meninges 197 Embryo blast derivatives 206 major arteries of systemic
substantia nigra 194 Embryology 203 circulation 124
tegmentum 194 nomenclature 203 pericardium 123
right ventricle 122 sphenoid 41 Large intestine 163

sternocostal surface 122 temporal bone 40 Lesion of the phrenic nerve 97
Heart failure 124 zygomatic bone ribs and Lumbar plexus 102
Hemiballismus 191 sternum 21 Lumbar puncture 198
Hemorrhoids 139 typical and atypical ribs 23 Lung cancer 157
Hirschsprung’s disease 109 sclerous tissue 6 Lungs 153
Histology 272 vertebral column 14
bronchopulmonary segments 156
circumvallate papilla of tongue 274 atypical cervical vertebrae 17
medial surface 154
classification of glands 272 atypical lumbar vertebra 19
different glands 273 atypical thoracic vertebrae 18 left lung 155
differential types of epithelia 273 cervical 16 right lung 154
epithelial tissue 272 lumbar 16 pleura 153
fungiform papilla of tongue 274 other atypical vertebrae 19 Lymph 148
point of identifications under thoracic 16 Lymphadenitis 149
microscopy 275 Hypertension (high blood Lymphangitis 148
gastrointestinal system 275 pressure) 109 Lymphatic system 148
genitor urinary system 281 Hypoglossal nerve 118 regional lymph nodes 149
respiratory system 279 lymph nodes of head and neck
Horner’s syndrome 109 I 149
Human skeleton 5 lymphatic drainage of tongue
applied anatomy of bones 13 Ileum 160, 161
150
bones of inferior extremity 24 Interventricular septum 214
Intraembryonic mesoderm 207 lymphatic drainge of breast
articulated skeleton of foot 34 151
calcaneum 33
inguinal lymph nodes 151
femur 28 J
Lymphoedema 149
hip bone 26
Jejunum 160, 161
iliac crest 25
Joint injuries 65 M
male and female pelvis 27
Joints 48
patella 32 Mackel’s diverticulum 211
classification
pectoral girdle 35 Male generative organ 175
ankle 61
pelvic girdle 35 Male reproductive system 175
craniovertebral 65
talus 33 Misnomer spondylitis 21
elbow 55
tibia and fibula 30 head and neck 64 Movements of shoulder joint 53
bones of superior extremity 8 hip 49, 58 Muscle cells 67
articulated skeleton of hand 12 inferior extremity 58, 60 Muscle connecting 71
clavicle 8 knee 61 scapula to humerus 74
humerus 9, 10 lower limb 50 upper limb to thoracic wall 71
radius and ulna 11 radioulnar 56 upper limb to vertebral column
scapula 9 shoulder joint 53 72, 73
cartilage and bones 6 superior extremity 52 Muscle injury 71
classification of bones 7 upper limb and sternum 50 Muscle of arm 74
cranial bones 37 whole body 49 anterior compartment 83
fontanellae 38 degenerative disease 66 anterior muscle 74
frontal bone 38 deep group 79, 85
hyoid bone 45 deep muscles 77
K
important landmarks in gluteal region 86
cranium 45 Kidney 170 lateral compartment of leg 84
mandible 41, 42 medial compartment of thigh 81
maxilla 43 L muscles of forearm 75
occipital bone 39 muscles of front of thigh 80
parietal bone 38 Large gut 164 muscles of inferior extremity 79
Index 315
muscles of leg 83 Q Spondylolisthesis 21

posterior compartment (back) of Spondylosis 21
leg 85 Quadriceps weakness 71 Sprain 65
posterior compartment of Stomach 159
forearm 77 R Structures around the kidney 169
posterior compartment of thigh 82 Superfacial fascia 223
Radial nerve 101
posterior muscles 75 Supination 56
Radiology 286
Muscle strain 71 Surface anatomy 296
conventional X-ray plates 288
Muscles of abdomen 88 abdomen 301
abdomen 290, 291
Muscles of anterior triangle lines 302
chest 289
of neck 91 planes 301
contrast radiography 290
Muscles of facial expression 90 points 301
elbow joint 288
Muscles of head 89 head and neck 304
head and neck 292, 293
Muscles of mastication 90 lines 305
inferior extremity 293, 294
Muscles of neck 91 points 304
postero-anterior view of wrist
Muscles of posterior triangle inferior extremity 299
joint and hand 289
of neck 91 anterior tibial artery 301
pylogram 291
Myocytes 67 arteria dorsalis pedis 301
superior extremity 288
lines 300
methods of imaging technique
N points 299
angiographies 286
popliteal artery 300
Naming of muscle 69 computerized topography 287
posterior tibial artery 300
Nasal cavity 182 magnetic resonance imaging 287
palpable landmarks 296
Nasal septum 182 ultrasound 286
superior extremity 296
Nervous system 95 radiophoto
brachial artery 298
Notochord 209 conventional 286
opaque 286 lines 297
translucent 286 points 296
O radial artery in the forearm 299
standard position
anteroposterior view 286 radial nerve in the back of the
Oogenesis 209
lateral view 286 arm 299
Optic nerve 110
Osteoarthritis 66 posteroanterior view 286 superficial palmar arch 299
Osteoporosis 13 Rectum and anal canal 165 ulnar artery in forearm 299
Rectus sheath 88 ulnar nerve in forearm 299
Rheumatoid arthritis 66 thorax
P
Rotator cuff 71 lines 303
Paranasal air sinuses 183 points 303
Parkinson disease 191 S visible landmark 296
Parotid gland 184 Sympathetic trunk 108
Per rectal examination 166 Sacral plexus 104
Pericardial effusion 123 Sciatic nerve 105, 106 T
Peripheral arterial pulse 134 Single rib fracture 24
Peritoneal cavity 159 Skeletal muscle 67 Tennis elbow 66
Pharyngeal pouches 217 Skeleton of larynx 181 Testis 176
Placenta 205 Skin 223 Thorax 153
Placental barrier 209 Smooth muscle 67 Thyroid gland 185
Porto-systemic anastomosis Spasm 71 Tibial nerve 105
139, 141 Spermatic cord 176 Tongue (dorsal surface) 177
Positioning 1 Spermatogenesis 207 Trigeminal nerves 113
Prolapsed disk 21 Spinal nerves 95 Tuberculosis 21
Pronation 56 Splanchnic nerve 109 Twining 211
Psoas major 104 Spleen 164 Types of fracture 13
U veins of superior extremity 144 face 66

veins of thorax 137 femoral triangle 242
Ulnar nerve 101 venae cavae 135 front of arm 230
Umbilical cord 210 venous drainage of inferior front of forearm 232
Urinary bladder 171 extremity 143 gluteal region 250
Uterus 174 Viscera of head and neck 176 inguinal canal 260
Voluntary muscle 68
kidney from back 264
V
palm 234
Vagus nerve 117 W poplitearl fossa 252
Valvular disease 123 Waiters tip 99 posterior triangle of face 270
Vaso-occlusive disease 109 Window dissections 223 rectus sheath 262
Veins 135 antero lateral compartment 246 sole 258
cardiac veins 138 axilla 226 superior extremity 225
cranial dural venous sinuses 146 back of arm 238 triangular and quandrangular
portal vein 139 back of forearm 240 space 236
formative tributaries 140 back of thigh 254
tributaries 139 clavi pectoral fascia 224 X
veins of abdomen and pelvis 139 cubital fossa 228
veins of head and neck 145 dorsum of foot 248 XI accessory nerve 118

Anatomy at A Glance

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ANATOMY

JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD

First Edition: 2009

14. Surface Anatomy ......................................................................................................................... 296

Appendix ......................................................................................................................................... 307

Glossary .......................................................................................................................................... 309

Index ............................................................................................................................................... 313

Positioning (Body Posture) (Fig. 1.1)

Anatomical Terms (Figs 1.2A to D)

Fig. 1.3: Terminology used for description of bones

SKELETON (FIG. 2.1)

Fig. 2.1: Adult skeleton (Total bones—206)

SCLEROUS TISSUE (specialized connective tissue). It is of two types—cartilage and bones.

Difference between cartilage and bones

Hyaline cartilage (e.g. articular, costal,

Classification of Bones According 3. Flat bone: It consist of two thin plates of

Fig. 2.3: Classification of bones according to shape

Bones of Superior Extremity

Names Comments Important features Anatomical positions

Fig. 2.5: Scapula

Names Comments Important features Anatomical positions

Humerus Longest and Upper end presents • Place globular head

Names Comments Important features Anatomical positions

Surgical—it is the most constricted portion, in the • Place greater tubercle

Radius Lateral bone of Upper end • Place dorsal tubercle

Names Comments Important features Anatomical positions

Ulna Medial bone of Upper end—hook-like—two processes: • Place more expanded

Classification of Bones in General C. According to Position

Fig. 2.7: Skeleton of hand

Fracture type Description Comments

Fig. 2.8: Types of fracture

Osteoporosis: A diminution of bone mass; particularly in elderly fellow.

Injury of upper limb bone

Bone involved Comments

Forearm fracture These fractures interfere with pronation and supination.

Fig. 2.9: The vertebral column add-its different

Fig. 2.10B: Abnormal vertebral curvatures (comparing with normal)

Regional Characteristics of Cervical, Thoracic

Vertebral forearm Triangular in shape. Circular in shape. Triangular in shape.

Fig. 2.11: Movements of vertebral column

ATYPICAL CERVICAL VERTEBRAE (Fig. 2.12A)

Fig. 2.12A: Atypical cervical vertebrae (Atlas)

Names Comments Important features Anatomical positions

Vertebra (1) Spine—not bifid, long and • Convex superior

ATYPICAL THORACIC VERTEBRAE (Fig. 2.12B)

Fig. 2.12B: 7th cervical (V. prominens)

Names Comments Important features Anatomical positions

Names Comments Important features Anatomical positions

Twelfth (1) Full costal facet in the • Shaft (Inner surface)

Other Atypical Vertebrae

Names Comments Important features Anatomical positions

Fig. 2.12D: Atypical lumbar vertebra

Names Comments Important features Anatomical positions

Applied Anatomy (Vertebrae)

Ribs and Sternum