1 Cerebellum Anatomy.pdf

BASIC CONCEPT, TRICKS AND MAGIC OF ANATOMY What is Anatomy:- cut & observe the Cadaver Different types of layers of body superficially to deep: - Roof :- –– Skin –– Superficial fascia (fat , cutaneous nerves & vessels) –– Deep fascia (includes c...

BASIC CONCEPT, TRICKS AND MAGIC OF ANATOMY What is Anatomy:- cut & observe the Cadaver Different types of layers of body superficially to deep: - Roof :- –– Skin –– Superficial fascia (fat , cutaneous nerves & vessels) –– Deep fascia (includes collagen fibers) Floor :- –– Muscles –– Bone Why Anatomy is important & how to study :- Proper coordination, balance & integration among different subjects = cerebellum Dissection: autopsy /surgery For Proper Coordination Balance & Integration Among Different Subjects Conceptual Brainstorming integration: - 2 Anatomy Transverse dissection diagram :- Revision capsule/PYQs:- Roof is formed by skin, superficial fascia, deep fascia Floor is formed by muscles, bone Contents of any space: - neuromuscular bundle (VAN) Q. Neurovascular bundle is absent in which compartment of leg? [AllMS MAY 18] 1. Anterior 2. Lateral Vein – thin walled & collapsing 3. Superficial posterior Artery – thick walled & recoil 4. Deep posterior Nerve – no lumen, solid cord Q. Neurovascular bundle in abdomen runs in All neurovascular bundle of our body have between? (DEC FMGE 21) sequence as vein-artery-nerve except - 1. Between external & internal oblique –– 1st Intercostal space –– Popliteal fossa 2. Between external oblique & transversus abdominis HILTON’S LAW: - Hilton observed that nerves supplying the MUSCLE also innervate 3. Between internal oblique & transversus the SKIN overlying the muscle and the JOINT abdominis over which that muscle acts. 4. Between transversus abdominis & fascia transversalis FOCUS AREA FOR EXAM: - Femoral triangle & hernia Inguinal canal & hernia Triangle Of neck Cadaveric images Surgery & ENT integration  POSITION, PLANES AND TERMINIOLOGY Anatomical position 1. Supine - lying on back - Cardiothoracic surgeries 2. Prone - lying on abdomen - Spine or back surgeries 3. Lithotomy - patient lying on the back with both feet supported with footrest. Perineum area is exposed. For Obstetric-gynaecological procedures and Genito-Urinary surgeries. 4. Lateral decubitus - lie on one side of the body - Body is erect Best for ear surgeries. Eyes looking forward PLANES Hands on side with palms directed forward 1. Mid-sagittal plane - Plane divides the plane into Legs together with toes in front two equal halves. 2. Sagittal plane - Any plane parallel to mid-sagittal plane. 2 Anatomy 3. Coronal/Frontal Plane - Divides the plane into front & back. 4. Transverse/Horizontal plane - Divides plane into upper and lower parts, parallel to the ground. 5. Oblique plane - Any plane making angle with the ground Superior/Cranial - Near to Head Inferior/Caudal - Near to Foot Anterior/Ventral - Any point in Front of the body. Posterior/Dorsal - Any point in the back of the body. Proximal - Near to trunk. Distal - Away from trunk. TERMINOLOGY Medial - Close to Midline. Lateral - Away from Midline. Focus Areas for Exams:- Direct question may not be asked BUT.. In each subject & questions patient position is described in anatomical position (if not specified). Planes Of the body are very important for radiology especially. Anatomy Terminology is also commonly used in each subject. PYQs:- Frontal plane section is termed as? (DEC FMGE 2021) 1. Sagittal Section 2. Coronal Section 3. Horizontal Section 4. Oblique Section  JOINTS Definition : Junction between 2 bones which makes possible movement. TYPES FIBROUS JOINT CARTILAGINOUS JOINT SYNOVIAL JOINT 1. Fibrous Joint obliquely with each other. E.g. - Tempro-parietal suture. 3. Serrated suture - Articulating surfaces have serrated margins with fibrous tissue in between. E.g. - Interparietal suture 4. Dentate suture - One is fitted into the other with fibrous tissue in between. E.g. - Lambdoid suture. 5. Wedge and Groove/Schindylesis suture. E.g. - Sphenoid bone & Vomer. B. Syndesmosis Not movable 2 bones are connected via Ligaments. Present in skull bones - fibrous tissue in between 2 E.g. - Middle Radio-Ulnar joint, Middle Tibio-fibular bones. Interosseous Membrane, Inferior Tibio-fibular joint. Types of Fibrous joint (Mnemonic - SaSu G) C. Gomphosis Sa - Sutures Joint found in Gums. Su - Syndesmosis G - Gomphosis 2. Cartilaginous joints A. Sutures A. Primary Cartilaginous/Synostosis/Synchondrosis- 1. Plane suture - Articulating surfaces parallel to → Ossified in later stages of life. each other with fibrous tissue in between. E.g. - Growth plate E.g. - Intranasal suture B. Secondary Cartilaginous joint/Symphysis joint - 2. Squamous suture - Articulating surfaces placed Ends of Bone covered with Hyaline Cartilage 2 Anatomy while the in-between space has fibrous So - Superior Tibio-fibular joint connective tissue. Show partial Movements. C.Hinge joint (Mnemonic - IEA) → Only Uniaxial movement possible (due to bony Present in midline of the body (except prominences) Symphysis menti - 10 Cartilaginous) (Mnemonic - SIM/MIS) I - Interphalangeal movement S - Symphysis pubis, Sacro-coccygeal joint E - Elbow joint I - Intervertebral Disc A - Ankle joint M - Manubrio-strenal joint, Xiphi-sternal joint. D. Ellipsoid joint 3. Synovial Joints → Convex-concave surfaces face each other. → Multi-axial with Restricted movements. E - M - W Metacarpo-phalangeal joint Wrist joint Atlanto-occipital joint (Yes movement - Above atlas) E. Saddle joint (Mnemonic - PICS) → Concavo-convex surfaces in each bone. P - Patello-femoral joint (Anatomically) I - Incudomalleolar joint C - Carpo-metacarpal joint (1st joint) S - Sterno-clavicular joint F. Pivot joint → Rotatory movements between bones around an axis. Atlanto-axial joint → between C1 and C2 (No movement - Below atlas) Superior (via annular ligament) and Inferior Radio- A. Ball and socket joint (Mnemonic - SHIP) ulnar joint S - Shoulder joint - most movable joint G. Condylar joint H - Hip joint → Condyles of the 2 bones fit into each other. I - Incudo-stapedial joint Knee - Bicondylar > Condylar joint T - Talo-calcaneo-navicular joint Temporomandibular joint (TMJ) - Bicondylar joint B. Plane synovial joint (Mnemonic PICASo) Cartilaginous Joint → Articulating surfaces are plane and only gliding movement present. P - Patello-femoral joint (Functionally only) I - Intercarpal & Intertarsal joints C - Costovertebral and costotransverse joint A - Acromio-clavicular joint  3 Joints 4 Anatomy Focus Areas for Exams PYQs Identification of joint & its type based on: Q. The type of joint marked in the image below a. Osteology is (NEET PG 2020) A. Syndesmosis b. Radiology B. Synarthrosis Sure shot questions from Joint directly and also related to Orthopaedics. C. Synchondrosis D. Synovial Q. Which type of joints is involved in shown Revision Capsule / PYQs movement in image (June FMGE 2022) Joint permits a person to look to the right A. Pivot joint and left (NEET PG 2019) : …................. B. Saddle joint The joint between the attachment of the C. Ball & socket joint 8th & 9th rib to the 7th rib is (NEET PG D. Hinge joint 2018): ……............ Q. At a marked arrow which type of joint is MiddIe radioulnar joint is (FMGE 2022) shown? (DEC FMGE 2021)................... A. Saddle synovial lnferior tibiofibular joint is (AIMS 2017): B. Secondary................... cartilaginous C. Primary cartilaginous D. Ellipsoid synovial  MUSCLE & MOVEMENT Total 639 muscles in our body ƒƒ Articular processes of vertebrae Muscle is modified cell with contractile protein:- ƒƒ Tarsals actin & myosin (Carpal bones mnemonic :- She Looks Too Pretty Try 2 parts of Muscle:- Belly (soft & contractile) To Catch Her) and Tendon (non contractile) –– Sometime tendon is becoming flat known as aponeurosis Raphe:- it is Inter-digitation of Muscle fibers Movements at a joint:- –– Muscle only help to movement of joints when it’s crossing 2 joints –– If any Muscle crossing joint from front can make forward movement & if crossing from back can perform backwards movement Gliding:- –– Flat surfaces of two bones glide across each other Gliding occurs between ƒƒ Carpals 2 Anatomy –– Popliteus Muscle having action of unlocking( beginning of flexion is known as unlocking) –– Quadriceps femoris known as footballer’s muscle Which responsible for kick action & it’s doing extension of knee (unlocking- popliteal muscle, locking – Quadriceps femoris) –– Inversion Muscle of foot:- tibialis Anterior & Posterior –– Evertor of foot:- Peroneus longus & brevi Angular movement:- movement in which there Basic rules of muscle identification in cadaveric is a change in angle images:- –– Decrease in angle called flexion movement –– Increase in angle called extension movement –– Movements towards midline called adduction –– Movements away from midline called abduction –– Movements as rotating towards midline called internal rotation –– Movement as rotating away from midline called external rotation –– Circumduction is the combination of Movements (ex. During bowling) –– Surfacing the palm upward called supination –– Surfacing the palm downward called pronation (supination & pronation occur between sup. & inf. radio ulnar joint) Foot drop:- due to paralysis of some muscles no upward movement in foot which mainly involves common peroneal muscle  3 Muscle & Movement 1. Parallel muscles:- ƒƒ Bipennate:- 3rd & 4th lumbrical , all dorsal interosseous Strap muscle fiber –– Sternohyoid –– Sternothyroid –– Omohyoid –– Longest muscle of body :- Sertorius a.k.a. honeymoon muscle / tailor’s muscle ƒƒ Multipennate:- middle fiber of deltoid, subscapularis muscle Quadrilateral muscle fiber –– Thyrohyoid –– Rectus abdominis:- have Tendinous intersection ƒƒ Circumpennate Fusiform muscle :- biceps 3. Cruciate:- Which crossing each other, ex:- Sternocleidomastoid, masseter (strongest muscle of body) 2. Oblique muscle :- 4. Twisted / spiral :- pectoralis major –– Pennate (NEET 18) ƒƒ Unipennate :- 1st & 2nd lumbrical , Palmar interosseous 4 Anatomy Focus Areas for Exams: 1. Identification of muscles in cadaveric images 2. Action of muscle 3. Nerve supply of muscle 4. Muscle & nerves related different clinical tests & signs. PYQs: Q. What is the function of the lumbricals at the metacarpophalangeal joint? (NEET PG 2018) A. Flexion B. Extension C. Adduction D. Abduction Q. What is the nerve supply of the first lumbrical? (INI-CET 2022 Pattern) A. Radial nerve B. Median nerve C. Ulnar nerve D. Musculocutaneous nerve Q. Action performed by marked muscle? (June FMGE 2022) A. Abduction of shoulder joint B. Adduction of shoulder joint C. Protraction of scapula D. Retraction of scapula  PECTORAL REGION Bones of pectoral region:- Clavicle is the only bone which pierced by the nerve – Intermediate supraclavicular nerve Clavicle:- It is aka collarbone / beauty bone / key bone Scapula:- Coracoid process fits in infra clavicular groove Clavicle parts:- medial 2/3rd & lateral 1/3rd ( / fossa aka delto- pectoral groove Mc fracture location) < Medial 3/5th & Lateral 2/5th Above the spine of Scapula there is supraspinous Fossa & below infraspinous Fossa. Clavicle is the only bone having 2 ossification center 2 Anatomy Muscles of Pectoral region : Pectoralis major & minor Serratus anterior aka boxer’s muscle because it has punching & pushing ability & it’s supplied by bell’s nerve aka long thoracic nerve, responsible for winging of scapula. Subclavius Pectoralis minimus Rectus sternalis Winging of Scapula:- In this, Medial border of PYQs: Scapula elevated and person is not able to lift Mc congenital absent Muscle is pectoralis weight or do lifting exercises (FMGE 2020), major, this situation is known as Poland serratus anterior muscles responsible for this. syndrome. Forward movement of Scapula known as Climber's Muscle / extensor of shoulder joint protraction of scapula are P. Major & latissimus dorsi Humerus / funny bone:- Key Muscle of the pectoral region is P. Minor Parts:- head, neck, greater & smaller tubercle Boxer's Muscle is supplied by bell's nerve (intertubercular groove between them), Medial Alman's classification: - It tells about & Lateral epicondyle fracture of Clavicle and divide it into 3 parts: - Below lesser tubercle there is Inter tubercular med 1/3rd (5%), lateral 1/3rd middle 1/3rd (80%) sulcus aka bicipital groove (from here, long head of biceps with his synovial sheets & ascending branch of anterior circumflex artery is passing) At the Medial epicondyle, the ulnar nerve is passing.  AXILLA-1 (AXILLARY ARTERY) It is a truncated pyramidal shaped space on the lateral side of the chest wall and medial to the upper end of the humerus. Boundaries: 4. Floor - Skin and fascia 1. Lateral wall - Intertubercular Sulcus, Biceps 5. Apex - directed towards the neck 2. Medial wall - Serratus anterior 6. Posterior wall - Coracobrachialis, Teres major & Scapula 3. Anterior wall - Pectoralis major & Pectoralis minor 2 Anatomy Biceps - Short head is related to N - Axillary Nerve Coracobrachialis muscle. Lymph nodes - Axillary group of lymph nodes Contents of Axilla: Axillary Artery V - Axillary Vein Continuation of Subclavian artery. A - Axillary Artery Mnemonic : “STA, ATA, LTA → ACHA, PCHA, SSA” NOTE: KEY Muscle of Axillary region - Pectoralis Minor Mnemonic for Branches of axillary artery which supply Focus Areas for Exams & PYQs to breast - SALI Axillary artery S - Superior Thoracic Artery (STA) Parts of axillary artery & its branches A - Acromiothoracic Artery (ATA) L - Lateral Thoracic Artery (LTA) Revision Capsule / PYQs I - Internal Mammary Artery (IMA) 1. Branches of axillary artery which supply to breast: 2. Largest branch of axillary artery:  AXILA-2 (BRACHIAL PLEXUS) Brachial Plexus Parts of brachial plexus - (Ramu Tailor Drinks Cold Thickest cord of Brachial Plexus - Posterior cord Beer)/ RTDCB Thickest nerve of Brachial Plexus - Radial nerve Roots - Part of nerve attached to the spinal cord. 5 in About cords - number → C5-C8 and T1. All posterior divisions unite to form → Posterior Cord Trunk - 3 in numbers → Upper, Middle & Lower Trunk. (Radial nerve) Divisions - 1 anterior and 1 posterior from each Trunk. Anterior divisions of Upper and Middle trunks → Cords - 3 in number → Medial, Lateral & Posterior Lateral Cord (Median nerve) Cord (named according to the anatomical relation with Anterior divisions of Lower trunk → Medial Cord axillary artery). (Ulnar nerve) Note - Sometime contribution from other segments also present: (Note - In bracket - Main continuation of respective C4 - Pre-fixed brachial plexus Cords) T2 - Post-fixed brachial plexus 2 Anatomy Branches from Brachial Plexus:- 1. Nerve from roots R - Radial nerve (C5-T1) Dorsal Scapular nerve A - Axillary nerve (C5-C7) Long Thoracic nerve (aka Nerve of Bell - C5-C7 6. Branches from Medial Cord (Mnemonic → to Serratus Anterior) M4U) 2. Nerves arises from upper trunk (only Upper Trunk gives branches) (C5-C6) M - Medial root of Median nerve Nerve to Subclavius muscle M - Medial cutaneous nerve of Arm Suprascapular nerve M - Medial cutaneous nerve of Forearm 3. No Branches from Divisions M - Medial Pectoral nerve U - Ulnar nerve 4. Branches from Lateral Cord (Mnemonic LML) (C5-C6) Clinical Integration - Lateral root of Median nerve A. ERB’s Paralysis Musculocutaneous nerve Lateral Pectoral nerve Injury between Head and shoulder → involve Upper trunk (C5-C6 involve) 5. Branches from Posterior Cord (Mnemonic ULTRA) Causes - U - Upper subscapular nerve (C5-C7) Fall with a stretched arm or on shoulder. L - Lower subscapular nerve (C5-C7) Shoulder dystocia during delivery. T - Thoracodorsal nerve (nerve to Latissimus dorsi) (C6-C8)  3 Axilla-2 Erb’s point - Junction of 6 nerves Defects - Revision Capsule / PYQs Adducted arm - defect in Deltoid Parts of Brachial plexus: Medial Rotation of arm - defect in Trapezius Phrenic nerve root value: minor Thickest nerve of brachial plexus: Pronated hand - defect in Biceps, Brachioradialis and Radial nerve weakness. Thickest cord of brachial plexus: Extended elbow - defect in Coracobrachialis, Nerves with all root values in brachial plexus: Biceps, Brachioradialis. Aka Waiter’s/Porter’s Tip hand OR Policeman’s Tip UPDATES: GRAY’S 42nd UPDATE hand. Q. Root value of Ulnar nerve? B. KLUMPKE’s Paralysis A. C5,6,7 Causes - B. C6,7,8 Overstretching of Arm/Axillary area. Pulling of hand during delivery. C. C7,8 T1 Defects - D. C7,8 Ulnar Claw hand - Ulnar nerve damage Axillary nerve : C5-C6 Horner’s Syndrome - due to T1 damage Musculocutaneous nerve : C5-C7 Pectoralis minor supplied by : Focus Areas for Exams a. Lateral pectoral nerve Brachial Plexus Formation & Branches b. Medial pectoral nerve Brachial Plexus Injury Erb's Palsy Klumpke's Palsy Formation of Radial, Median, Ulnar Nerves  BACK 2. Latissimus Dorsi - by Thoracodorsal nerve 3. Levator scapulae - by Dorsal Scapular nerve 4. Rhomboid Major & Minor - by Dorsal Scapular nerve Triangle of Auscultation - Less muscles - easily get LUNGS sounds Lateral border - medial border of Scapula Medial border - Trapezius Base - Latissimus dorsi Dissection / Surgery : Superficial to deep Skin → Superficial fascia → Deep fascia → Muscles → Bones Muscles:- 1. Trapezius - by XI / Accessory spinal nerve Shrugging of shoulder → Upper fibres Retraction of scapula → Middle fibres Overhead abduction → Lower fibres 2 Anatomy NOTE - Q. What is the shape of Trapezius muscle? Winging of scapula due to paralysis of → Serratus (CONTROVERSIAL QUESTION: AllMS NOV 17) anterior > Trapezius > Rhomboids A. Triangular Focus Areas for Exams B. Quadrangular Cadaveric images C. Strap Clinically integrated questions D. Fusiform Revision Capsule / PYQs Q. Which muscle is known as Climber's muscle? TRAPEZIUS is supplied by: (CONTROVERSIAL QUESTION) Stand at ease muscle is: A. Serratus anterior Dorsal scapular nerve & muscles supplied by it: B. Levator scapulae Winging Of scapula (controversial question): C. Pectoralis major PYQs D. Latissimus dorsi Q. The muscle marked by the arrow in the image below is innervated by the? (NEET PG 2020) A. Dorsal scapular nerve B. Suprascapular nerve C. From the dorsal rami of C1 D. Subscapular nerve  SHOULDER/SCAPULAR REGION Dissection/ Surgery : Deltoid - Give rounded contour to the shoulder Skin → Superficial fascia → Deep fascia → Muscles Rotator Cuff (SITS) - Supraspinatus, Infraspinatus, Teres minor & Subscapularis. Muscles (Mnemonic for muscles in Bicipital Groove - Lady Between the 2 Majors) Subscapularis muscle (Multipennate) - Hybrid muscle → from upper and lower Subscapular nerve. Muscle least damage in Rotator Cuff injury - Subscapularis → hence called as Forgotten muscle of the Rotator Cuff. Nerve supply of deltoid : Axillary nerve Muscle most commonly damaged in Rotator (related to Surgical neck of Humerus) Cuff injury - supraspinatus Teres Minor - supplied by nerve to teres minor (branch of Axillary Nerve → Pseudoganglion present). Teres Major - by Lower Subscapular nerve. 2 Anatomy Bursa of the Body PYQs: Largest Bursa - Iliopsoas Bursa > Subacromial Bursa Q. Action performed by marked? (June FMGE 2022) (Inflammation → Subacromial Bursitis) Uses - Act as Shock absorber. Provide proper joint movement. Clinical - Inflammation is called Bursitis. Subacromial Bursitis → Positive Dawbarn’s Sign (Pain disappear on Abduction of arm) A. Abduction of shoulder joint Regimental Badge Anaesthesia - B. Adduction of shoulder joint Due to injury to Axillary Nerve. C. protraction of scapula (It’s posterior branch is sensory to upper part of D. Retraction of scapula the lateral arm area via cutaneous branch known as Q. A patient who has taken the first COVID vaccine regimental badge) comes for the second dose. An astute nurse noticed that the Shoulder was flabby, fat, and Cause - During Intramuscular injection or injury at was asymmetrical. There was an associated the surgical neck of the humerus. loss of Contour of the Shoulder joint. Injury to which of the structures might have resulted Focus Areas for Exams: and was avoidable? (INICET 2021 Pattern) Cadaveric images A. Rotator cuff Clinically integrated questions Rotator cuff & Injury B. posterior Circumflex artery Shoulder abduction C. Lateral cutaneous nerve of arm D. Deltoid muscle Revision Capsule: Deltoid & Shoulder abduction: Q. 0 to 15 degree of abduction of joint is caused by? (CONTROVERSIAL QUESTION: AIIMS Deltoid is supplied by: NOV 17) Another muscle supplied by axillary nerve: A. Supraspinatus Characteristic Of nerve to Teres minor is: B. Infraspinatus Nerve supply Of Teres major: Rotator / Musculo - tendinous cuff is formed by: C. Deltoid Most Common muscle getting injury in Rotator cuff: D. A & C both Least common muscle getting injury in Rotator cuff: Example of Multipennate muscle fibres:  ARM Nerve Site of injury Muscles Clinical Affected Features Axillary Surgical neck Deltoid - Regimental of Humerus batch Teres minor anaesthesia - 0-90 degree Abduction weakness - Loss of rounded contour of shoulder - medially rotated arm Radial Radial groove Extensors Wrist drop of Upper limb Ulnar Medial Small Ulnar/Partial epicondyle muscles of Claw hand hand Median Supracondylar Flexors of - Median Claw Area Wrist hand - Benediction hand deformity Student’s/Miner’s Elbow - Inflammation of Olecranon Bursa (Olecranon Bursitis) ORTHO-RADIO-ANAT INTEGRATION: Humerus connected to 4 nerves 2 Anatomy Supracondylar humerus Fracture Q. A male presented with symptoms of inability to Radial Artery damage → Volksmann’s Ischaemia → flex the distal interphalangeal joint of the 4th Gun Stock deformity and 5th digits. He was also not able to hold a Focus Areas for Exams: piece of paper between his fingers. What is the Cadaveric images likely site of injury? (INI-CET 2021 Pattern) Fracture Of humerus & nerve injured Radio Ortho & Anatomy Integration Controversial questions Revision Capsule: Cadaveric images Nerve supply of BBC: Clinical integration With Radio & Ortho PYQs Q. A patient visited to trauma & casualty ward with multiple fracture of shaft Of humerus. He was having the difficulty in elbow flexion & supination. He also complained about loss of sensation Over lateral side of forearm. nerve is most probably A. A damaged? (NEET PG 2021) B. B A. Musculocutaneous nerve C. C B. Median nerve C. Ulnar nerve D. D D. Radial nerve  3 ARM Q. A patient Who has taken the first COVID vaccine Comes for the second dose. An astute nurse noticed that the Shoulder Was flabby, flat, and was asymmetrical. There Was an associated loss Of Contour Of the shoulder joint. Injury to which of the structures might have resulted and was avoidable? [INI.CET 2021 Pattern] A. Rotator cuff B. posterior circumflex artery C. Lateral cutaneous nerve of arm D. Deltoid muscle A. Axillary nerve Q. After a road traffic accident, a 35 yr. old male presents in emergency with fracture at B. Radial nerve the arrow marked location. He presents with C. Ulnar nerve inability to extend his wrist. On examination, there is loss of sensation of dorsum of lateral D. Median nerve aspect of hand and fingers. Which nerve will be injured in this case? (FMGE 2020)  FOREARM → give rise to Lumbricals 3. Flexor pollicis longus (FPL) Nerve supply : (All supplied by Anterior Interosseus nerve (Deep branch of Median nerve) except medial ½ of FDP (supplied by ulnar nerve) A. Anterior Compartment About FDP - Hybrid muscle Medial half - Ulnar nerve Lateral half - Anterior Interosseous nerve > Median nerve A.1. Superficial Muscles: B. Posterior Compartment 1. Pronator teres (PT) B.1. Superficial Group 2. Flexor carpi radialis (FCR) 3. Palmaris longus (PL) → used for tendon grafting operation of upper limb. 4. Flexor digitorum superficialis (FDS) 5. Flexor carpi ulnaris(FCU) → Pisiform bone ossify in this muscle. B.2. Deep Group Nerve supply : All are supplied by the Median nerve (Labourer nerve) except Flexor carpi ulnaris. Supplied by Posterior interosseous nerve (PIN) A.2. Deep Muscles: 1. Quadratus pronator (QP) 2. Flexor digitorum profundus (FDP) (Hybrid Muscle) 2 Anatomy Focus Areas for Exams: Cadaveric images Nerve supply of muscles Clinically integrated questions Cubital fossa, boundaries & contents Revision Capsule: Cadaveric images Cubital Fossa: Nerve supply of BBC: Triangular, muscular depression in front of the Clinical integration with Radio & Ortho elbow. Importance of cubital fossa - PYQs: 1. Measurement of Blood Pressure Q. A patient visited to trauma & casualty ward with multiple fracture of shaft of humerus. He was 2. Biceps jerk reflex having the difficulty in elbow flexion & supination. 3. Intravenous injection site He also complained about loss of sensation over lateral side of forearm. Which nerve is most probably damaged? (NEET PG 2021) A. Musculocutaneous nerve B. Median nerve C. ulnar nerve D. Radial nerve Q After a road traffic accident, a 35 yr old male presents in emergency with fracture at the arrow marked location. He presents with inability Boundaries - to extend his wrist. On examination, there is Lateral - medial border of Brachioradialis. loss of sensation of dorsum of lateral aspect of Medial - lateral border of Pronator teres. hand and fingers. Which nerve will be injured in Apex - meeting point of Pronator teres and this case? (FMGE 2020) Brachioradialis. Base - Imaginary line joining Medial and Lateral epicondyle. Roof - Skin, superficial and Deep fascia. Content (medial to lateral → MBBR) - 1. Median nerve 2. Brachial artery 3. Bicipital aponeurosis 4. Radial nerve (Superficial nerve) → emerges between Brachioradialis & Pronator teres. A. Axillary nerve Floor of Cubital Fossa (BSF) B. Radial nerve B - Brachialis C. Ulnar nerve S - Supinator D. Median nerve F - Floor  HAND Short intrinsic muscles of hand → 20 in numbers. Musician nerve - Ulnar nerve Labourer’s nerve - Median nerve Eye of the hand - Median nerve Dupuytren's contracture- Fibrosis of palmar aponeurosis Causes Chronic Alcoholism Connective Tissue Disorder Rheumatoid arthritis 3 Grades are there - 1. Nodule formation 2. Cords like structure ANAT - FMT INTEGRATION: Wrist Cut Injury 3. Flexion contracture of finger(s) Structure cut - all 5 structures above Flexor Most common site - Medial half Retinaculum Most common finger - Ring finger 1. Palmaris longus tendon 2. Ulnar nerve and artery 3. Palmar cutaneous branch of ulnar nerve and flexor retinaculum 2 Anatomy 4. Palmar cutaneous branch of median nerve Dorsal interossei - 5. Palmar aponeurosis Bipennate - 4 in number → by Ulnar nerve In case of suicidal cut injury Hesitation Marks/ Function - Abduction of fingers Tentative Marks. 2 Dorsal interossei in Middle finger Lumbricals: Test - Egawa test Focus Areas for Exams: Cadaveric images with clinical tests & signs Nerve supply of muscles 1st and 2nd Lumbricals - Unipennate → Median Revision Capsule: Nerve. All thenar muscles are supplied by median nerve except: 3rd and 4th Lumbricals - Bipennate → Ulnar nerve. Adductor pollicis is supplied by Function - Flexion at metacarpophalangeal Grave yard of ulnar nerve: Joints extension at Interphalangeal Joints. & 2nd lumbricals are supplied by: Test → Pen holding position (Babaji ka thullu position) 3rd & 4th lumbricals are supplied by: Complete Claw hand → injury of both Ulnar and Clinical integration With Radio & Ortho Median nerve. PYQs: Palmar & Dorsal Interossei:- Q. What is the nerve supply Of the Structure marked in the image? [INI-CET 2022 Pattern) Palmar interossei - Unipennate - 4/3 in number → by Ulnar nerve A. Radial nerve Function - Adduction of fingers B. Median nerve Middle finger has no Palmar interossei Test - Card test C. Ulnar nerve D. Musculocutaneous nerve  ARTERIES & VEINS OF UPPER LIMB Artery of upper limb Brachial Artery branches Branches of arch of Aorta (BSC) 1. Radial artery B - Brachiocephalic artery (Right) → give Right 2. Ulnar artery Subclavian and common carotid artery. 3. Profunda brachii artery S - Subclavian artery (Left) → make Axillary artery 4. Nutrient artery to humerus C - Common carotid artery (Left) Subclavian artery branches : (VITamin CD) It is divided by scalenus anterior muscle into 3 parts: 1st part - Vertebral artery → Lateral Medullary syndrome Internal mammary artery → use for CABG Thyrocervical branch → Suprascapular artery, Inferior thyroid artery & Transverse cervical artery (Mnemonic - SIT). 2nd part - Costocervical trunk (only one branch) 3rd part - Dorsal scapular artery (only one branch) 2 Anatomy Main artery of the thumb - Princeps pollicis artery Main artery of Index fingers - Radialis indicis Allen’s test Make a fist → pallor occur → compress both radial and ulnar artery → open the fist → Release Ulnar artery 1st → Reverse Allen’s test If redness, then ulnar artery patency is present. Instead of Ulnar artery, release Radial artery. (for patency of Superficial arch) (for patency of Deep arch) Veins of Upper limb Important veins of Upper limb: 4. Medial cubital vein (Antecubital vein) → Best vein 1. Dorsal venous arch for Intravenous Infusion (as Fixed and easily seen) 2. Cephalic vein 5. Median vein of forearm 3. Basilic vein  3 Arteries & Veins Of Upper Limb Revision Capsule: PYQs: Branches of Subclavian artery Q. All Of the following are branches of thyro Branches of Thyrocervical trunk cervical trunk except? Branches of Axillary artery A. Suprascapular artery Main artery of thumb B. Transverse cervical artery Main artery of index finger C. Superior thyroid artery D. Inferior thyroid artery  NERVE OF UPPER LIMB -1 Brachial plexus:- MBBR:- Median nerve, Brachial artery, Biceps tendon, Radial artery) Then this nerve passes in between the two head of pronator teres Muscle (pronator teres syndrome - if this nerve compress here) In forearm it is divided into Superficial branch & deep branch (aka anterior interosseous nerve) Deep branch supply all deep flexor Muscle (flexor pollicis longus, pronator quadratus & medial Half of flexor digitorum profundus) At the wrist joint the superficial branch passes through the carpal tunnel below the flexor retinaculum. Here injury to this nerve known as carpal tunnel syndrome (commonly seen with connective tissue disorder as RA, myxoedema and computer worker) Dermatomes of hand:- Sensory branch supplying the Lateral 3 & half of Palmar & dorsal side(known as eye of hand) and nail beds Motor branch supplies 5 muscles of hand :- all 3 thenar muscles except adductor pollicis & 1st & 2nd lumbrical –– Different signs of medial nerve injury:- (CAP-BPT) 1. Median nerve :- C:- Carpal tunnel syndrome Have nerve root of C5 to T1 ( C5, C6, C7 :- A:- Ape thumb deformity Lateral root, C8, T1 :- medial root) P:- Pointing index/ Oschner’s class test This nerve gives no branch in the arm B:- Benediction hand / pope hand deformity It passes Lateral to brachial artery and at P:- Phalen’s sign coracobrachialis, it crossing it & come medially & reach to cubital fossa T:- Tinel sign (Relation of structures at cubital Fossa Medial OK sign:- AIN > median to Lateral 2 Anatomy Treatment of tunnel syndrome:- Sensory branch Supplies medial 1½ of palm & medial 2½ of dorsal hand. Exercise Motor branch supplies all hypothenar muscles Multivitamins & one thenar muscle [adductor pollicis] (aka Painkiller - NSAIDs graveyard of Ulnar nerve), all Palmar & dorsal Steroid interossei. Surgery Ulnar nerve Tests:- (ABCDEFGH) 2. Ulnar nerve - A:- A/Ulnar nerve It is the branch of the medial cord of brachial B:- Book test plexus, nerve root is C7, C8 & T1. C:- Card test (positive in Palmar interossei Runs medially to the axillary artery in the axilla. damage) Passes through medial epicondyle. D:- aDDuctor pollicis test Ulnar nerve getting thickened in leprosy behind E:- Egawa test( positive in dorsal interossei medial epicondyle. damage) The nerve passes through 2 heads of flexor F :- Froment test carpi ulnaris (here compression of nerve known G :- Guyon’s tunnel syndrome as cubital tunnel syndrome) & supplied FCU & H :- Handlebar palsy medial ½ of flexor digitorum profundus. At the wrist, it passes through Guyon’s tunnel:- Compression here known as Guyon canal syndrome.  3 Nerve of Upper Limb -1 Focus Areas for Exams: Q. Identify the nerve involved in test? (NEET PG 2021) Cadaveric images & Nerve supply of muscles Clinical tests I signs integrated with Medicine & Orthopaedics Revision Capsule/PYQs: Which nerve is known as "Labourer’s nerve”: A. Musculocutaneous nerve Which nerve is known as "Musician nerve”: B. Median nerve C. Ulnar nerve Which nerve is known as "Eye of the Hand”: D. Radial nerve Identify the nerve related with tests: Q. A patient was undergoing leprosy treatment. On A. BOOK TEST: a follow up checkup, the patient presented with following presentation. Which nerve is involved B. CARD TEST: here? (Dec FMGE 2021) C. EGAWA TEST: D. FROMENTS SIGN: E. TINEL' SIGN F. POINTING INDEX: G. OK SIGN: A. Ulnar nerve H. BENEDICTION HAND: B. Median nerve C. Radial nerve D. Musculocutaneous nerve  NERVE OF UPPER LIMB -2 3. Radial nerve:- Below radial groove, it gives 4 branches:- (BEBE) It is the thickest nerve of brachial plexus & it –– Brachialis is continuation of thickest cord of B. Plexus. –– External carpi radialis longus Root value:- C5, C6, C7, C8, T1. These all roots make 1 Posterior cord which continue as –– Brachioradialis a radial nerve. –– Elbow joint This nerve passes behind the humerus through radial groove & coming in front at cubital fossa. At forearm radial nerve divides into It will give rise to 3 branches Above radial –– Superficial branch:- runs towards wrist and groove or axilla :- (LMP) makes roof of Anatomical snuff box & gives –– Long head of triceps cutaneous branches to the lateral 2½ dorsum of hand except nail beds. –– Medial head of triceps –– Deep branch/ PIN:- pierces supinator –– posterior cutaneous nerve of arm muscle Gives 5 branches (3 muscular) in radial groove (spiral groove):- (MLA) Clinical :- –– Medial head of triceps Crutch palsy –– Lateral head of triceps –– If fracture at axilla ( loss of extension of –– Anconeus elbow, wrist and fingers) –– if fracture at spiral groove (loss of extension Wrist drop at wrist and fingers ) Finger drop –– if fracture below radial groove (loss of Honeymoon palsy extension of fingers) Saturday night palsy 2 Anatomy Anatomical snuff box:- –– Lateral/anterior border:- abductor pollicis longus & extensor pollicis brevis –– Medial/Posterior border:- extensor pollicis longus –– Roof:- Skin, Superficial fascia (Cephalic vein – site for IV inj., cutaneous branch of radial nerve – cause wrist watch neuropathy), deep fascia. –– Floor:- Styloid process of radius , scaphoid bone (2nd Mc bone getting AVN [Mc is neck of femur, 3rd Mc is talus] → glass holding cast use in scaphoid fracture), trapezium, base of 1st metacarpal bone –– Inflammation to this tendon leads to De Content:- radial artery Quervain’s tenosynovitis:- for diagnosis of this, we can perform a finkelstein test. Boundaries:- Focus Areas for Exams: Revision Capsule: Cadaveric images & Nerve supply of muscles Cadaveric images Clinical tests I signs integrated with Medicine, Clinical integration With Radio & Ortho Orthopaedics & Radiology Branches of radial nerve above the radial ANATOMICAL SNUFF BOX CLINICAL groove: INTEGRATION Branches of radial nerve in the radial groove: Branches Of radial nerve below the radial groove:  3 Nerve of Upper Limb -2 PYQs: Q. Nerve supply of the area marked by arrow in the image is? (NEET PG 2019) Q. Which of the following forms the lateral boundary of the marked space? (NEET PG 2020/ FMGE 2022) A. Radial nerve B. Posterior interosseus nerve C. Median nerve A. Extensor pollicis brevis and abductor pollicis D. Ulnar nerve longus B. Extensor pollicis longus and abductor pollicis brevis C. Extensor pollicis longus and extensor pollicis brevis D. Abductor pollicis longus and abductor pollicis brevis Q. Which Of the following is true regarding De Quervain's tenosynovitis? (NEET PG 2019) A. Fingers are held in mild extension B. It affects APL and EPB C. Most common involvement is index finger D. Treatment is surgery  Anterior Compartment of Thigh Bones of Lower limb 6. Medial malleolus 7. Tibial Tuberosity 8. Shin of tibia Inguinal ligament is attached in between ASIS & Pubic tubercle. THIGH Thigh is Divided into 3 compartment Anterior compartment (Femoral nerve) Medial compartment (Obturator nerve) SURGICAL LANDMARKS : ORTHO Posterior compartment ( Sciatic nerve ) & SURGERY INTEGRATION Most common dislocation of hip joint - Posterior 1. ASIS - Anterior Superior Iliac spine Therefore, Most common nerve affected is the 2. Pubic tubercle Sciatic nerve. 3. Pubic crest 4. Pubic symphysis 5. Lateral Malleolus 2 Anatomy Transverse section of thigh: Roof - Skin, Superficial fascia and Deep fascia. Boundaries - Muscles Floor - Muscles and bone 5 Muscles of anterior compartment of thigh 1. Sartorius - Longest Muscle of body (45 cm) 2. Rectus femoris - Bipennate Quadriceps Femoris → form 3. Vastus Medialis common tendon → Ligamentum Patellae (Patella ossified in it) 4. Vastus Lateralis 5. Vastus Intermedius Aka Tailor’s or Palthi muscle PSM-ANAT-PEDIA INTEGRATION Movements - Flexion at knee and hip + Abduction Vastus Lateralis - site for Intramuscular & lateral rotation of thigh. injection during Vaccination. Also Abduction of hip →opens perineum area Nerve of anterior compartment - Femoral for sexual intercourse → hence, aka Honeymoon nerve muscle. All nerves by Posterior divisions of femoral –– Footballer’s Muscle or Kick muscle or nerve except Locking muscle –– SARTORIUS - Anterior division of femoral –– Extension at knee → Quadriceps Femoris nerve  3 Anterior Compartment of Thigh Femoral Triangle Triangular Muscular depression below inguinal ligament. Floor (Mnemonic - APPI) - Adductor longus, Pectineus, Psoas major tendon & Iliacus. Lateral boundary - Medial border of sartorius Medial boundary - Medial border of Adductor longus Content - (Medial to Lateral → VAN) V - Femoral vein A - Femoral artery N - Femoral nerve Femoral sheath - Deep fascia modification around femoral vessels. Contents : Femoral vein, artery and Lymph Great saphenous vein - Pierces the Cribriform fascia nodes (Not Femoral Nerve). by making an opening called as saphenous opening and Femoral canal → medial most part of Femoral receive 3 tributaries: sheath (contain Deep Inguinal Lymph node- → 1. Superficial external pudendal vein aka Lymph nodes of Rossenmuller and Cloquet). 2. Superficial epigastric vein Femoral Ring → Uppermost part of femoral canal. 3. Superficial circumflex iliac vein Femoral fossa - Depression over Femoral septa Skin over the femoral triangle is supplied by (Fat over the Femoral canal). - Femoral branch of the Genito-femoral nerve. Lateral cutaneous nerve of thigh → Meralgia paresthetica Cause : Compression under Inguinal ligament Injury during injection or trauma. SURGERY-ANAT INTEGRATION A. Femoral Herni 1. Wider pelvis 2. Smaller vessels Femoral hernia reduction - By Cutting of Lacunar ligament. 4 Anatomy PYQs: Q. Identify the type of muscle shown in the image below? (NEET PG / INICET PATTERN) B. Inguinal Hernia → more common in males. External Obliques modifications: (Mnemonic - LIP) 1. Lacunar Ligament 2. Inguinal Ligament A. Cruciate 3. Pectineal Ligament B. Spiral Focus Areas for Exams: C. parallel Cadaveric images D. Unipennate Sartorius (INICET NOV 2022) Q. All are Content Of femoral Sheath except: FEMORAL TRIANGLE & HERNIA A. Femoral artery Revision Capsule: B. Femoral vein Floor Of femoral triangle is formed by: C. Femoral nerve Content of femoral canal: D. Lymph node Longest muscle of body: Vaccination in thigh is done in which muscle: Locking muscle is: Unlocking muscle is:  Medial & Posterior Compartments of Thigh Medial Compartment Gluteal Region Muscles: Muscles - Adductor muscles →Adduction of 1. Gluteus maximus thigh 2. Gluteus minimus All are Supplied by → Obturator Nerve 3. Gluteus minimus 5 muscles : Mnemonic for adductors - LBW/M 4. Piriformis → Key muscle of Gluteal region 1. Adductor longus 5. Obturator internus - related with 2 gamelli 2. Adductor brevis Superior gamelli 3. Adductor magnus → also by Sciatic nerve [Ischial Inferior gemelli Head] (Hybrid muscle). 6. Quadratus femoris 4. Pectineus → also by femoral nerve (Hybrid muscle). 5. Gracilis FMT-ANATOMY INTEGRATION Gracilis → also known as Anti-rape muscle/Custodian of virginity. Smooth and fragile → easily break/tear during opposite forces. Use to assess cases of rape and forced sexual offences. Gluteus Maximus Origin - Posterior gluteal line, Area behind posterior gluteal line, outer lip of the iliac crest & adjacent surface of sacrum/coccyx. Insertion - Into Gluteal tuberosity (¼th) & Ilio-tibial tract (¾th). Movement - Chief extensor of Hip joint → help from sitting to standing position. Nerve - Inferior Gluteal nerve Posterior Compartment 2 Anatomy ANAT-MEDICINE-PAEDIA- ORTHO INTEGRATION Duchenne Muscular Dystrophy: GOVER’S SIGN Defect in Gluteus Muscle (Paralysis) Nerve involve - Inferior Gluteal nerve Gluteus medius and minimus Nerve supply : Superior gluteal nerve Movement - Abduction of the hip joint.  3 Medial & Posterior Compartments of Thigh ANAT-ORTHO INTEGRATION Trendlenberg’s Sign: Normal = During elevation of one limb → Gluteus medius, minimus & Tensor fascia lata of opposite side contract → Pulling/Elevate the opposite side ASIS/Pelvis → Preventing Sagging of Pelvis. Superior Gluteal nerve injury → Sagging of Pelvis occurs i.e. Positive Trendelenburg’s sign. Gait is known as In case of Unilateral palsy - Lurching gait In case of Bilateral palsy - Duck gait or Waddling gait Focus Areas for Exams: PYQs: Q. In Trendelenburggait which muscles are involved? Cadaveric images (INICET NOV 2022) Gluteal region A. Gluteus maximus, Gluteus medius, Gluteus Clinical based questions minimus B. Gluteus medius, Gluteus minimus, Tensor Revision Capsule/PYQs: fascia lata Gluteus maximus is supplied by: C. Gluteus minimus, Tensor fascia lata & Piriformis Gluteus medius is supplied by: Abduction Of hip is done by: D. All are correct 1M injection in gluteal region is given in: Q. Which muscle is attached in this indicated part? [NEET PG PATTERN] Identify the Piriformis & Quadratus femoris (NEETPG 2016) A. Gluteus maximus B. Gluteus medius C. Gluteus minimus D. Tensor fascia lata  BACK OF THIGH & POPLITEAL FOSSA All back of thigh muscles are having same Origin (from ischial tuberosity) Insertion (at bone of leg) Nerve supply (sciatic nerve) Action (runner’s action ) So, they combinedly known as hamstring muscles (includes semitendinosus , semimembranosus, long head of biceps femoris, add magnus) Long head of biceps femoris originates from ischial tuberosity. Lower part of ischial tuberosity divides by longitudinal ridge into inferolateral {gives origin to add Magnus (ischial head)} & intermedial part (known as ischial bursa). Ischial bursitis is known as weaver’s bottom. 2 Anatomy –– Popliteal vein –– Popliteal artery –– Popliteal lymph nodes Focus Areas for Exams: Hamstring muscles Cadaveric images Contents of popliteal fossa Clinical integration Revision Capsule/PYQs: Hamstring muscles are supplied by: Action Of hamstring: Weaver’s bottom is: Boundaries of popliteal fossa: Boundaries of popliteal fossa:- Relation of contents of popliteal fossa from –– Supero-lateral - biceps femoris superficial to deep is: –– Supero-medial - semitendinosus & semi membranes PYQs: –– Infero-lateral - lateral head of gastrocnemius Q. Popliteal artery ends at? –– Infero-medial - medial head of gastrocnemius A. Upper border of popliteus ( ossification of bone here known as Fabella) Content of popliteal fossa (medial to lateral - B. Lower border of popliteus Artery → vein → nerve (AVN) C. Upper border of plantaris –– Tibial nerve D. Lower border of plantaris –– Common peroneal nerve  NERVES OF LOWER LIMB ANATOMY Lumbar plexus Iliohypogastric & ilioinguinal L1: situated at the posterior surface of kidney. Cremaster reflex (Genito femoral nerve L1 L2 is involved) - when we scratch at Inner part of thigh then due to this reflex, testis elevated. Compression of Lateral cutaneous nerve of the thigh causes abnormal sensation characterized by tingling, numbness and burning pain in the outer part of the thigh as known as Meralgia paresthetica. Obturator nerve have root value of L 234 ventral division 2 Anatomy 1. Femoral nerve Longest cutaneous nerve of the body is the 3. Sciatic nerve:- Saphenous nerve. 2. Obturator nerve Superior Gluteal Nerve (SGN L4,L5,S1) supplies to gluteus medius, minimus and  3 Nerves Of Lower Limb Anatomy tensor fascia lata(damage leads to positive Bumper’s fracture:- Trendelenburg sign). Inferior Gluteal Nerve (IGN L5,S1,S2) supplies to gluteus maximus. Tibial nerve root value is L4, L5, S1 S2 S3. Common Peroneal Nerve (CPN) root value is L4-5 and S1-2 and take a round at the neck of fibula. Deep Peroneal Nerve (DPN) supplies the anterior compartment of the leg. Foot drop - Injury of CPN > DPN > SCIATIC NERVE. Superficial peroneal nerve at Lateral compartment of leg. FOOT DROP Revision Capsule/PYQS: Sartorius is supplied by: Referred pain of knee is felt at hip joint due to: Root value of sciatic nerve: Root value of superior gluteal nerve: Root value of inferior gluteal nerve:  LEG COMPARTMENT TRANSVERSE SECTION OF LEG 2 Anatomy Leg have 3 compartments:- Anterior/ Extensor compartment - Deep Peroneal Nerve (DPN) Lateral/ Peroneal compartment - Superficial Peroneal Nerve (SPN) Posterior/ Flexor compartment - have Superficial & deep group :- Tibial Nerve (TN) In lateral compartment of leg :- Peroneus longus & Peroneus brevis both innervated by SPN 1. Anterior compartment of leg:- The - tibialis anterior ANAT- ORTHO INTEGRATION : Hospitals - Hallucis longus Jones Fracture:- Are - artery (Anterior tibial artery ) Never - nerve (Deep peroneal nerve ) Dirty - Digitorum longus Places- Peroneus tertius March Fracture:- 2. Lateral compartment of leg  3 Leg Compartment 3. Posterior compartment:- Superficial group - have gastrocnemius, soleus (helping in cardiac output so it is aka Peripheral heart), plantaris “(GSP)” Plantaris & palmaris longus both use in tendon grafting operations. Focus Areas for Exams: Leg compartments & their contents Inversion & eversion of foot Cadaveric images Ortho-Radio & Anatomy integrated questions Deep structures of this compartment - TibialisRevision Capsule: Posterior, flexor digitorum longus, Posterior Tibial artery, Tibial nerve, flexor hallucis longus. Foot drop is due to paralysis of muscles of: –– mnemonic : Tom Dick And Nervous Harry Invertors of foot: –– Tom - Tibialis posterior Evertors of foot: –– Dick- Digitorum longus Inversion & eversion occurs at which joint: –– And - Artery (Posterior tibial artery) Ankle jerk performed at which tendon: –– Nervous- nerve (Tibial nerve) PYQs: –– Harry - Hallucis longus Q. Neurovascular bundle is absent in which Achilles tendon - The strongest muscle of body compartment of leg? (AIIMS MAY 18) A. Anterior B. Lateral C. Superficial posterior D. Deep posterior Q. Which of the following muscle is not responsible –– Gastrocnemius (lateral & medial head) + for inversion of foot? (AllMS NOV 18) Soleus = Achilles tendon A. Tibialis anterior –– Ankle jerk reflex has root value S1 & S2. B. Tibialis posterior NOTE:- C. Extensor hallucis longus Medial compartment: is absent but at upper part 3 muscles insertion present : D. peroneus longus Contains Sartorius, gracilis, semitendinosus and Tibial collateral ligament  FOOT ANATOMY Arches of Foot Inversion and eversion of foot occurs at the subtalar joint. Upper part of calcaneus which support the talus known as sustentaculum tali. Largest bone of foot - calcaneus Arches of foot - It is due to special arrangements of foot bone due to close interlocking short & small bones. Arches are helpful for running , walking and standing. Deformities of foot: Radiology integration : 2 Anatomy Clubfoot:- aka CTEV Most common congenital abnormality in the world. –– Talipes –– Equino –– Varus ƒƒ Presentation – CAVE:- –– Cavus –– Adductus –– Varus –– Equinus Deltoid ligament’s1upper end is attached to the ƒƒ Calcaneo-navicular ligament is aka spring medial malleolus. ligament. This ligament has Superficial & deep fibers. ƒƒ Talo calcaneo-navicular is ball & socket joint.  3 Foot Anatomy PYQs: Q. Ligaments not attached to talus? A. Talo-navicular ligament B. Spring ligament C. Deltoid ligament D. Cervical ligament A. Talo-navicular ligament? B. Spring ligament The lisfranc ligament connects the medial cuneiform to the base of the 2nd metatarsal. C. Deltoid ligament Lisfranc ligament is a cuneometatarsal D. Cervical ligament interosseous ligament. Q. Ligament supporting head of talus? It’s the strongest among all 3 cuneometatarsal int ligament. A. Talo-navicular ligament Deformity of this ligament can lead to instability B. Spring ligament & Deformity of tarsometatarsal joint. C. Deltoid ligament Focus Areas for Exams: D. Cervical ligament Identification of foot bones: Anat-Radio Integration Q. Which ligament connects medial cuneiform to Arches of foot & foot deformities the base of the 2nd metatarsal? [INI-CET 2022 Pattern] Ligaments of foot A. Chopart B. Spring Revision Capsule/PYQs: C. Lisfranc Ligament below head of talus/ supporting head of talus: D. Deltoid Spring & deltoid ligament supports which arch: Most common congenital deformity of foot: Most important arch of foot is:  ARTERIES AND VEINS OF LOWER LIMB ANATOMY Arteries of lower limb:- Vascular sign of Narath Mid-inguinal point where we feel the femoral At lower border of Popleteus muscles:- artery pulses is known as the Vascular sign of popliteal artery continue into Anterior Tibial narath. Artery (ATA) & Posterior Tibial Artery (PTA). Hiatus Magnus:- where femoral artery converts ATA ends between 2 malleoli & continues as into popliteal artery. Dorsalis Pedis Artery (DPA). PTA is palpable just behind the medial malleolus. 2 Anatomy Clinical:- –– Smoking leads to atherosclerosis, gangrene, thromboangiitis obliterans or buerger’s disease. –– Palpable arteries of LL:- ƒƒ Femoral Artery - at head of femur ƒƒ Popliteal Artery - lower border of Popleteus ƒƒ ATA- between 2 malleoli ƒƒ PTA- behind medial malleolus ƒƒ DPA- palpable against navicular bone –– Venous drainage of lower limb:- Lower limb vein damage can lead to deep venous thrombosis  3 Arteries And Veins Of Lower Limb Anatomy 4 Anatomy CLINICAL : PYQs: Phlebotomy :- cutting the vein Q. A patient Who underwent Varicose veins surgical Hemochromatosis :- excessive iron treatment now presents with loss of sensation in medial leg. Which Of the following is injured in Sural nerve having S1 nerve root this patient? [NEET pattern 2021 & 2022] Medial part of leg and foot have L4 dermatome A. Sural Nerve GSV used for bypass surgery in 40 – 50% MI blockage , now a days we use internal mammary B. Saphenous Nerve artery (radial & ulnar vein also) C. Obturator Nerve D. Plantar Nerve PYQs: Q. Which artery is palpated here? (June FMGE 2022 & Dec FMGE 2021) Revision Capsule: Femoral artery is palpable against: Popliteal artery is palpable against: Dorsalis pedis artery is palpable against: Posterior tibial artery is palpable against: A. post tibial artery Great saphenous vein is related to which nerve: B. Medial plantar artery Short saphenous vein is related to which nerve: C. Anterior tibial artery D. Dorsalis pedis artery  SCALP & FACE Scalp is having magic of 5:- 5 nerves in front of ear 5 layers 5 nerves behind ear 5 arteries & veins 5 applied parts 5 Layers of scalp:- 1. Skin 2. Connective tissue 3. Aponeurosis 4. Loose areolar connective tissue 5. Pericranium Clinical:- Loose areolar connective tissue layer is Dangerous area of scalp Surgical layers of scalp Black eye Cephalhematoma 2 Anatomy Caput succedaneum (Risk factor - vacuum Grief muscle - Depressor labii inferioris delivery) Dimple location:- Modiolus Muscles of facial expressions:- Motor nerve branches of face : VII nerve It gives 5 terminal branches within parotid gland which supplies all facial muscles Temporal, zygomatic, buccal, mandibular, cervical. Muscles derived by 2nd pharyngeal arch and supplied by facial nerve except LPS (Levator Palpebrae Superioris : by 3rd cranial nerve) Dissection of face - 1. Skin 2. Superficial Fascia 3. Deep Fascia -nt but only present in buccopharyngeal fascia & parotido-masseteric fascia (In all other part of face, thorax and abdomen Deep Fascia is absent) 4. Subcutaneous Muscles (in animal it is known as panniculus carnosus) Remnants of this panniculus carnosus are - face muscle, Palmaris Brevis, dartos muscle, cutis ani. Bell’s palsy - Loss of Wrinkling, Wide palpebral fissure, Whistling loss, loss of nasolabial fold and drooling of saliva. Winking muscle of eye - orbicularis oculi Whistle muscle - Buccal Smiling muscle - Zygomatic major Sad muscle - levator anguli superioris Grinning muscle/ winner smile muscle - Risorius Horror muscle -