Anatomy > MD > Upper Limb (To finish)

Write short notes on the cubital fossa - 175

Introduction - Inverted triangular shaped intramuscular fossa - Located anterior to elbow joint, base is superiorly and apex inferiorly Boundaries - Superior (base) - imaginary horizontal line between medial and lateral humeral epicondyles - Medial - lateral border of pronator teres - Lateral - medial border of brachioradialis muscle - Apex - meeting point of brachioradialis and pronator teres muscles - Floor - lower part of brachialis muscle medially, anterior surface of supinator muscle laterally - Roof - consists of skin, superficial fascia (containing basilic vein and medial cutaneous nerve of the forearm medially, cephalic vein and lateral cutaneous nerve of the forearm laterally and median cubital vein inbetween) and deep fascia (reinforced by bicipital aponeurosis) Contents (from medial to lateral) (mnemonic MBBR) - Median nerve - exits the fossa by passing between the heads of pronator teres - Brachial artery - terminates in the fossa by dividing into radial and ulnar arteries at the neck of radius - Biceps tendon - attaches to the posterior part of the radial tuberosity - Radial nerve - courses between brachialis and brachioradialis with the deep branch entering the cubital fossa and piercing supinator muscle

Write short notes on the radius - 275

Introduction - Long bone in the forearm, lateral in anatomical position - Ossification - 1 primary centre in mid shaft shows in week 8 of intrauterine life and 2 secondary centres (upper end shows at age 5 and fuses by age 12, lower end shows up in first year of life and fuses at age 20) Gross anatomy Osteology Proximal End - Head - rounded and has 2 articular facets. Smooth upper surface articulates with capitulum of humerus and medial smooth surface articulates with radial notch of ulna and annular ligament - Neck - constricted part inferior to head - Radial tuberosity - attachment site for biceps brachii Shaft - 3 borders - anterior (continuation of oblique line), posterior and medial - 3 surfaces - anterior, posterior and lateral surfaces Distal end - Anterior surface - smooth - Posterior surface - has dorsal tubercle of Lister - Medial surface - has the ulnar notch of radius for distal radioulnar joint - Lateral surface - projects inferiorly as the styloid process - Inferior surface - has a medial quadrangular shaped facet for lunate and a lateral triangular shaped facet for scaphoid bone Articulations - Radiohumeral joint - between capitulum of humerus and head of radius, part of elbow joint - Proximal and distal radioulnar joints - pivot type synovial joints - Radiocarpal joint - between distal radius and scaphoid and lunate Attachments - Ligaments - annular ligament, radial collateral ligament and radio-carpal ligaments and interosseous membrane - Muscles - pronator teres, biceps brachii, brachioradialis, flexor digitorum superficialis, flexor pollics longus, abductor pollics longus, supinator, extensor pollics brevis and pronator quadratus muscles Blood supply - Nutrient arteries off radial artery Variants - Absent radius - Sesamoid bone over radial tuberosity - Duplicated radius

Write short notes on the scapula - 285

Introduction - Triangular shaped flat bone - On the posterolateral thoracic wall, over ribs 2-7 - Has 2 surfaces, 3 borders, 3 angles and 3 processes - Ossification - 1 primary and 7 secondary centres. Appear in week 8 of intrauterine life, fuse by puberty. All centres completed by age 20 Gross anatomy Osteology Surfaces - Costal surface - has subscapular fossa - Dorsal surface - has supraspinous and infraspinous fossae separated by scapula spine Borders - Superior border - has suprascapular notch 5min - Media border - thin, from superior to inferior angles - Lateral border - thick, from inferior angle to glenoid cavity Angles - Superior angle - at rib 2 - Inferior angle - at rib 7 - Lateral angle - formed by head of scapula and has the glenoid cavity for articulation with head of humerus. Shows supra and infra glenoid tubercles Processes - Spine - large projection on dorsal surface separating supra and infra scapular fossae - Acromion - expanded lateral end of the spine, has medial and lateral borders - Coracoid - forward projecting bone from the head of scapula. Has superior and inferior surface and a tip Articulations - Glenohumeral joint - ball and socket synovial joint between glenoid cavity and head of humerus - Acromioclavicular joint - plane type synovial joint Attachments - Ligaments - acromioclavicular, coracoclavicular, transverse scapular ligament, coracoacromial, Glenohumeral and coracohumeral ligaments - Muscles - supraspinatus, infraspinatus, subscapularis, teres minor and major, rhomboid minor and major, deltoid, trapezius, pectoralis minor, coracobrachialis, long and short heads of biceps, long head of biceps, serratus anterior, latissimus dorsi and levator scapulae Blood supply - Arterial - suprascapular, subscapular and dorsal scapular arteries - Venous - similar named veins Innervation - Suprascapular and dorsal scapular nerves Variants - Os acromiale - Scapular foramen - Coracoclavicular joint

Write short notes on the pectoral muscles - 250

Introduction - 2 main muscles located in the pectoral region on the anterior wall of the thorax Gross anatomy Pectoralis major Origin - Clavicular head - arises from the anterior surface of the medial 2/3 of the clavicle - Sternocostal head - arises from the anterior surface of the medial aspect of the sternum, upper 6 costal cartilages and inferiorly from external oblique aponeurosis Course - Fibres course laterally from their fan shaped origin Insertion - Lateral lip of the bicipital groove of the humerus Function - Clavicular head - flexion of the shoulder joint - Sternocostal head - medial rotation and adduction of shoulder joint Innervation - Medial (C8-T1) and lateral (C5-C7) pectoral nerves from brachial plexus Blood supply - Pectoral branches off Thoracoacromial artery Relations - Anterior - fascia, skin. Breast in females. - Posterior - Costal cartilages 1-6, pectoralis minor and clavipectoral fascia - Cephalic vein lies in the deltopectoral groove - Forms part of the anterior wall of axilla Pectoralis minor Origin - Arises from the anterior surface of ribs 3-5 Course - Fibres pass upwards and laterally Insertion - Superior surface of coracoid process of scapula Function - Protract scapula - Raise rib cage as an accessory muscle of respiration Innervation - Medial and lateral pectoral nerve Blood supply - Same as major Relations - Anterior - clavipectoral fascia (encloses muscle), pectoralis major - Posterior - second part of axillary artery and clavipectoral fascia - Divides axilla lymph nodes into levels - Forms part of anterior wall of axilla Variants - Poland syndrome (congenital absence of pectoral muscles) - Prefixed pectoralis minor - origin from ribs 2-4 - Postfixed pectoralis major - origin from ribs 4-6 - Pectoralis minimus muscle NOTE Pectoral region also includes serratus anterior and subclavius - briefly mention them

Write short notes on the triceps brachii muscle - 285

Introduction - 3 headed Muscle in the posterior compartment of the arm Gross anatomy Origin - Long head - arises from the infraglenoid tubercle on the lateral angle of the scapula - Lateral head - arises from the posterolateral surface of the humerus above the radial groove and lateral part of intramuscular septum - Medial head (deep) - arises from the posterior part of the humerus below the radial groove and intramuscular septum Course - Long head - courses between teres minor and major and laterally to attach onto the upper medial part of the triceps tendon - Lateral head - courses medially to attach onto the upper lateral part of the triceps tendon - Medial head - lies deep and attaches onto the triceps tendon 5 MIN Insertion - Inserts onto the proximal surface of the olecranon process of the ulna and deep fascia of the arm Function - Extension of the forearm at the elbow joint - Accessory extensor of the shoulder joint (long head) Innervation - Long head - branch of radial nerve in the axilla - Lateral and medial heads - branches of radial nerve in the radial groove Blood supply - Muscular branches of the deep brachial artery Relations - Profunda brachii artery and radial nerve course deep to the long and lateral heads and superficial to the medial head - Long head forms the medial boundary of both quadrangular space and triangular interval - Subtendinous bursa - lies between olecranon process and triceps tendon - Intratendinous bursa - lies within the tendon of triceps Variants - Can have two heads - Additional 4th head - Can be supplied by axillary or ulnar nerves - Patella cubiti (sesamoid bone within tendon)

Write short notes on the Glenohumeral joint - 280

Introduction - Ball and socket synovial joint of the upper limb Articular surfaces (lined by hyaline cartilage) - Glenoid cavity - pear shaped shallow fossa on the lateral angle of scapula - Humeral head - anteroinferior portion - Glenoid labrum - fibrocartilaginous disc attaching to margins of glenoid cavity to deepen the socket Fibrous capsule - Attaches to the articular margins and lined internally by synovial membrane - Superiorly extends to cover the supraglenoid tubercle (hence long head of biceps tendon is intracapsular) - Inferiorly attaches to anatomical neck of humerus but does extend to cover a small portion of the surgical neck - Redundant inferomedially to allow abduction - Deficiencies - both anteriorly, for long head of biceps tendon and subscapular bursa 5min Ligaments - Glenohumeral ligaments - superior, middle and inferior. Weak ligaments supporting the capsule anteriorly. Attach from margins of glenoid fossa to humerus - Coracohumeral ligament - attaches from coracoid process to greater tuberosity of humerus - Transverse humeral ligament - attaches between greater and lesser tuberosities over the long head of biceps tendon Bursa - Subacromial, subdeltoid and subscapular Blood supply - Anterior and posterior circumflex humeral arteries (off axillary artery) Innervation - Axillary, musculocutaneous, subscapular and suprascapular nerves Movement - Flexion - pectoralis major, anterior deltoid, biceps and coracobrachialis - Extension - posterior deltoid, latissimus dorsi - Abduction - supraspinatus and deltoid - Adduction - pectoralis major, latissimus dorsi, teres major and minor - Internal rotation - subscapularis, pectoralis major - External rotation - infraspinatus Relations - Anterior - deltoid, subscapularis, subscapular bursa, coracobrachialis and biceps - Posterior - infraspinatus, posterior deltoid and teres minor - Superior - coraco-acromial arch, subacromial bursa, supraspinatus and deltoid - Inferior - circumflex humeral vessels, axillary nerve and long head of triceps Variants - Absent labrum

Write short notes on the wrist joint - 255

Introduction - Biaxial condyloid synovial joint Gross anatomy Articular surfaces (lined by hyaline cartilage) - Inferior surfaces of distal radius for scaphoid and lunate - Inferior surface of the articular disc of distal radioulnar joint - Convex articular surfaces of scaphoid and lunate - Articular surface of triquetrum for articular disc (only in full adduction) 5MIN Fibrous membrane - Attaches to articular margins and lined internally by synovial membrane Ligaments - Radial collateral ligament - attaches from tip of radial styloid process to lateral surfaces of scaphoid and trapezium - Ulnar collateral ligament - attaches from ulnar styloid process to medial surfaces of triquetrum and pisiform - Palmar radiocarpal ligaments - attaches from anterior surface of distal radius to carpal bones. Consist of radioscaphoid, radiolunate, radioscaphiolunate and radioscaphocapitate ligaments - Dorsal radiocarpal ligaments - from posterior surface of distal radius to carpal bones. Consists of radiolunate, radioscaphoid and radiotriquetrial ligaments Note - if only on ligaments, add intrinsic ligaments between carpal bones. Movement - Flexion - flexor carpi radialis, flexor carpi ulnaris - Extension - extensor carpi radialis longus and brevis, extensor carpi ulnaris - Abduction - flexor and extensor carpi radials - Adduction - flexor and extensor carpi ulnaris Blood supply - Carpal branches of radial and ulnar arteries - Anterior interosseous artery Innervation - Articular branches of median, ulnar and radial nerves Relations - Anterior - contents of carpal tunnel (tendons of flexor digitorum longus and profunds, tendon of flexor pollics longus and median nerve), tendon of flexor carpi radialis laterally and ulnar nerve and artery medially - Posterior - extensor tendons, radial artery and superficial radial nerve Variants - Accessory ossicles (os centrale) - Ulnar variance

Write short notes on the lunate bone - 150

Introduction - Bone in the proximal row of carpal bones - Semi-lunar / crescent shaped - Ossification - one primary center and completes by 5 years of age (4 in females) Gross anatomy - Proximal surface - convex, has an articular facet for radius - Distal surface - concave, articular facet for capitate - Medial surface - square shaped articular facet for triquetrum - Lateral surface - semi-lunar shaped articular facet for scaphoid 5MIN Articulations - Radiocarpal joint - synoial joint beteween the lunate and scaphoid and distal radius - Intercarpal joints - medially with triquetrium, laterally with scaphoid and distally with capitate Attachments - Muscular - none - Ligaments - scapholunate, lunotriquetral, radioscaphiolunate, ulnolunate and radiolunotriquetral Blood supply - Dorsal carpal and intercarpal arches Relations - Superior - flexor retinaculum, carpal tunnel and its contents (FDS, FDP, FPS and median nerve) - Medial - triquetrum - Lateral - scaphoid - Distal - capitate - Proximal - distal radius Variants - Coalition with other carpal bones (lunotriquetral) - Os epilunate - Os hypolunatum - Can articulate with hamate

Write short notes on the venous drainage of the upper limb - 350

Introduction - Consists of superficial and deep systems Gross anatomy Superficial veins Dorsal venous arch - On the dorsal aspect of the hand - Receives tributaries draining the digits, dorsal and palmar surfaces of the hand - Drains into cephalic and basilic veins Cephalic vein Origin - Arises as a continuation of the lateral aspect of the dorsal venous arch at the roof of the anatomical snuff box Course - Forearm - passes onto the anterior surface of the forearm to ascend on the lateral aspect - Cubital fossa - within superficial fascia of the roof on the lateral side (related to lateral cutaneous nerve of forearm) - Arm - ascends lateral to the biceps brachii and then through the deltopectoral groove 5MIN Termination - Pierces the clavipectoral fascia and drains into axillary vein Basilic vein Origin - Arises as a continuation of the medial aspect of the dorsal venous arch Course - Forearm - ascends on the posteromedial aspect and becomes on the anterior surface just below the elbow - Cubital fossa - in superficial fascia of the roof on the medial aspect (related to medial cutaneous nerve of forearm) - Arm - ascends medial to biceps to pierce the deep fascia in the middle of arm and ascends medial to brachial artery Termination - Becomes the axillary vein at the lower border of teres major Median vein of the forearm - Originates at the wrist on the anterior surface and ascends in the forearm to the median cubital vein Median cubital vein - From cephalic vein, runs obliquely and upwards across the roof of the cubital fossa and ends in the basilic vein - Deep relations - bicipital aponeurosis and brachial artery Deep veins Axillary vein Origin - Arises as a continuation of the basilic vein at the lower border of teres major after it is joined by venae comitantes of brachial artery Course - Ascends in the axilla medial to axillary artery Termination - Continues as the subclavian vein at the outer border of first rib Tributaries - Anterior and posterior circumflex humeral veins - Subscapular vein - Lateral thoracic vein - Thoracoacromial vein - Cephalic vein

Write short notes on the carpal tunnel - 200

Introduction - Fibro-osseous tunnel located anterior to the carpal bones in the region of the wrist joint Gross anatomy Boundaries - Roof - formed by the flexor retinaculum attaching to the pisiform and hook of hamate medially and scaphoid tubercle and trapezium laterally - Floor - concavity formed by the carpal bones (carpal arch) Contents - 4 tendons of flexor digitorum superficialis (those of digits 3 and 4 lie above those of digits 2 and 5 - 4 tendons of flexor digitorum profunds - Median nerve laterally - Tendon of flexor pollics longus most lateral TIP: ALL LONG FLEXORS OF DIGITS 1-5 5MIN Synovial sheaths - Tendons of flexor digitorum superficialis and profunds are all enclosed in a single synovial sheath - Tendon of flexor pollics longus has its own sheath Relations - Superficial (to flexor retinaculum) - ulnar nerve, ulnar artery, palmar branch of ulnar nerve, palmaris longus tendon and palmar branch of median nerve - Deep - tendons of extensor carpi ulnaris, extensor carpi radialis longus and brevis, extensor digitorum, extensor pollics longus, radial artery, basilic and cephalic veins - Medial (above) - ulnar nerve and artery in Guyon's canal - Lateral (above) - tendon of flexor carpi radialis in synovial sheath located between superficial and deep lamina of the lateral attachment of flexor retinaculum

Write short notes on the rotator cuff muscles - 250

Introduction - Group of 4 muscles playing an important role in the stability of the Glenohumeral (GH) joint Gross anatomy Supraspinatus - Origin - supraspinous fossa of dorsal scapula - Insertion - superior facet on the greater tuberosity of humerus - Innervation - suprascapular nerve - Function - initiates abduction of the GH joint for the first 15 degrees - Blood supply - suprascapular artery (thyrocervical trunk) - Relations - tendon courses deep to acromion process Infraspinatus - Origin - infraspinous fossa of dorsal scapula - Insertion - middle facet on greater tuberosity of humerus - Innervation - suprascapular nerve - Function - external rotation and stabilisation of GH joint - Blood supply - suprascapular artery - Relations - tendon passes posterior to shoulder joint Teres minor - Origin - dorsal surface of lateral border of scapula - Insertion - inferior facet on greater tuberosity of humerus - Innervation - axillary nerve (C5-C6) - Function - external rotation and stabilisation of GH joint - Blood supply - posterior circumflex humeral artery - Relations - passes posterior to shoulder joint. Long head of triceps passes between teres major and minor. Forms the upper boundary of the quadrangular space. Subscapularis - Origin - subscapular fossa of scapula - Insertion - lesser tuberosity of humerus - Innervation - upper and lower subscapular nerves - Function - internal rotation, adduction and stabilisation of GH joint - Blood supply - subscapular artery - Relations - passes anterior to the shoulder joint. Subscapular bursa pierces the fibrous capsule of the joint. Variants - Two bellies for supraspinatus - Infraspinatus fused to teres minor - Absent or doubled bellied teres minor - Subscapularis minor

Write short notes on the elbow joint - 300

Introduction - Hinge type synovial joint - Formed by Radiohumeral and ulnohumeral articulations Gross anatomy Articular surfaces (lined by hyaline cartilage) - Humerus - trochlear medially and capitulum laterally - Radius - superior surface of the head of radius for capitulum - Ulnar - trochlear notch for the trochlear of humerus Fibrous capsule - Attaches to articular margins and lined internally by synovial membrane 5MIN - Thin anteroposteriorly and thickened medially and laterally - Proximally attaches to humerus just below the epicondyles, enclosing the radial, olecranon and coronoid fossae - Distally attaches to the annular ligament of radius and coronoid process of ulna - Also extends to attach to the articular surfaces of the proximal radioulnar joint making it continuous with the elbow joint Ligaments - Medial (ulnar) collateral ligament - triangular shaped with apex superiorly attaching to medial epicondyle and base inferiorly attaching to the medial surface of the olecranon and coronoid process Prevents abduction. - Lateral (radial) collateral ligament - attaches from lateral epicondyle to the lateral surface of annular ligament. Prevents adduction. Bursa and fat pads - Olecranon bursa - between subcutaneous tissue and olecranon - Fat pads - lie between superficial and deep layers of the capsule. Radial fossa and coronoid fossa fat pads anteriorly and olecranon fossa fat pad posteriorly Blood supply - Arterial - Anastomotic network around elbow joint from radial, ulnar and brachial arteries - Venous - basilic and cephalic veins Innervation - Articular branches of musculocutaneous, median, radial and ulnar nerves Movement - Flexion - brachialis, biceps brachii, brachioradialis (in semi-supinated position) and flexor group attaching to medial epicondyle - Extension - triceps, anconeus and extensor group attaching to lateral epicondyle Relations - Anterior - cubital fossa and its contents - brachialis, supinator, median nerve, brachial artery, biceps tendon and radial nerve. - Posterior - triceps, anconeus, olecranon bursa Variants - Synovial folds - Os supratrochlear dorsale (ossicle in olecranon fossa)

Write short notes on the scaphoid bone - 210

Introduction - Largest and most lateral of the proximal row of carpal bones - Boat shaped, directed obliquely - Ossification - one primary centre, begins around 4th year, can complete by 10-12 years of age (earlier in females) Gross anatomy Osteology - Proximal pole - convex, has articular site for distal radius - Waist - narrow constricted part - Distal pole - has the scaphoid tubercle on the lateral aspect of the ventral surface (attaches flexor retinaculum). Also has a medial articular facet for capitate and lateral articular facets for trapezium and trapezoid - Medial surface - concave, articulates with lunate Articulations - Radius proximally - Lunate medially - Trapezium, trapezoid and capitate distally Attachments - Muscle - none - Ligaments - dorsal radiocarpal, radial collateral, scapholunate, scaphocapitate and radioscaphocapitate (and flexor retinaculum) Blood supply - Arterial - Branch of radial artery (enters via distal pole, retrograde supply for rest) - Venous - radial vein Innervation - Median and radial nerves Relations - Distal - capitate, trapezium and trapezoid - Proximal - radius - Superior - flexor retinaculum, fascia and skin - Laterally - radial artery (passes posterior to scaphoid) - Medially - lunate bone and carpal tunnel contents (FDS, FDP, flexor pollics longus and median nerve) Variants - Bipartite / tripartite scaphoid - Scaphoid hypoplasia or agenesis - Coalition with other carpal bones - Accessory ossicles around scaphoid - paranavicular, os radiale externum

Write short notes on the upper limb lymph nodes - 300

Introduction - Lymphatic drainage of the upper limb consists of superficial and deep systems Superficial group Lymphatic vessels - Located within the superficial fascia, more numerous than deep vessels - Lymph from the medial aspect of the hand and limb course along the basilic vein. These end in the lateral humeral axillary group - Lymph from the lateral aspect of the hand and limb course along the cephalic vein and end in infraclavicular nodes Lymph nodes - Supratrochlear - above medial epicondyle along basilic vein. Drain lymph for medial side of hand and forearm - Deltopectoral - in deltopectoral groove along cephalic vein. - Infraclavicular - below the clavicle on clavipectoral fascia along cephalic vein Deep group Lymphatics vessels - Located deep to the deep fascia - Course along radial, ulnar, brachial and axillary vessels - End in the lateral humeral group of axillary nodes 5min Lymph nodes Axillary nodes Anterior pectoral group - Located on inferior border of pectoralis minor near lateral thoracic vessels - Drains skin and muscles of anterolateral abdominal wall above umbilics and breast - Drains into central and apical nodes Posterior subscapular group - Located on inferior border of subscapularis near subscapular vessels - Drains skin and muscles of posterior and inferior body wall - Drains into central and apical nodes Lateral humeral group - Located along the axillary vein - Drains most of the upper limb - Drains into central and apical nodes Central group - Located centrally on the floor of the axilla - Drain anterior, posterior and lateral nodes - Drains into apical nodes Apical group - Located at the apex of the axilla, posterosuperior to pectoralis minor - Drains all above nodes and upper outer breast - Drains into the subclavian trunk (which in turn drains into right lymphatic duct or thoracic duct)

Write short notes on the axillary artery - 280

Introduction - Main artery supplying the upper limb and is located in the axilla Gross anatomy Origin - As a continuation of the subclavian artery at the lower border of the first rib Course - Courses in the axilla from its apex to base, passing posterior to pectoralis minor - First part - proximal to pectoralis minor - Second part - posterior to pectoralis minor - Third part - distal to pectoralis minor 5MIN Termination - Continues as the brachial artery at the lower border of teres major Branches (Screw the lawyer, save a patient) First part - Superior thoracic artery - supplies supper thoracic wall Second part - Thoracoacromial artery - gives pectoral, deltoid, acromial and clavicular branches - Lateral thoracic artery - supplies chest wall and breast Third part - Subscapular artery - largest branch, gives thoracodorsal and circumflex scapular arteries - Anterior and posterior humeral circumflex arteries - pass around humerus and supply shoulder Relations First part (Related to cords) - Anterior - pectoralis major - Posterior - posterior and medial cords of brachial plexus and serratus anterior - Medial - axillary vein - Lateral - lateral cord Second part (Related to cords) - Anterior - pectoralis minor - Posterior - posterior cord and subscapularis - Medial - medial cord and axillary vein - Lateral - lateral cord Third part (related to branches) - Anterior - roots of median nerve - Posterior - radial and axillary nerves and teres major - Medial - ulnar nerve and axillary vein - Lateral - musculocutaneous nerve Variants - Common trunk for lateral thoracic and subscapular arteries - Subscapular artery off second part - Common trunk for subscapular and posterior humeral circumflex - Common trunk for anterior and posterior humeral circumflex - Scapular circumflex and thoracodorsal artery as direct branches - High division into radial and ulnar arteries

Write short notes on the collateral ligaments of the elbow - 160

Introduction - Medial and lateral collateral ligaments which reinforce the fibrous capsule of the elbow joint Gross anatomy Lateral (radial) collateral ligament - Consists of 3 parts - Function is to prevent adduction of the elbow - Radial collateral ligament - from lateral epicondyle to annular ligament - Lateral ulnar collateral ligament - from lateral epicondyle to supinator crest of ulna - Annular ligament - from radial notch to supinator crest of ulna. Swings around the articular groove on the radial head. Medial (ulnar) collateral ligament - Y shaped ligament - Function is to prevent abduction - Anterior band - attaches from medial epicondyle to coronoid process of ulna - Posterior band - attaches from medial epicondyle to olecranon process of ulna - Oblique band (Cooper's ligament) - attaches between the insertions of the anterior and posterior bands (from olecranon process to coronoid process) Variants - Accessory oblique ligament - Absence of one of the components of either ligament - Accessory lateral collateral ligament

Write short notes on the axillary nerve - 170

Introduction - One of the branches of the brachial plexus Gross anatomy Origin - Arises as the smaller of the 2 terminal branches of the posterior cord of the brachial plexus - Receives nerve fibres from ventral rami of C5-C6 Course - Axilla - Courses posterior to the third part of axillary artery and deep to subscapularis to exit the axilla via the quadrangular space (with posterior humeral circumflex artery) and enter the posterior scapular region 5MIN - Arm - Curves laterally and posteriorly around the surgical neck of humerus Termination - Divides into anterior and posterior branches deep to the deltoid - Anterior branch - continues around the surgical neck of the humerus to supply deltoid - Posterior branch - passes backwards to continue as the upper lateral cutaneous nerve of the arm and supply teres minor Branches - Muscular - teres minor and deltoid - Articular - shoulder joint - Cutaneous - upper lateral cutaneous nerve of the arm supplying skin over the lateral aspect of the deltoid Variants - Can supply teres major, subscapularis, long head of triceps or infraspinatus

Write short notes on the median nerve - 310

Introduction - One of the terminal branches of the brachial plexus Gross anatomy Origin - Arises from a medial and lateral root of the medial and lateral cords of the brachial plexus - Receives fibres from C5-T1 ventral rami Course - Axilla - courses laterally to the third part of the axillary artery - Arm - continues to descend lateral to the upper part of the brachial artery. In the middle of the arm, it crosses anterior to the artery to become medial to it - Cubital fossa - lies medial to the brachial artery and biceps tendon - Forearm - enters the forearm between the two heads of pronator teres, separated form the ulnar artery by the ulnar head. Descends a vertical course deep to the flexor digitorum superficialis - Wrist - becomes superficial and appears between tendons of flexor carpi radialis and palmaris longus - Hand - enters via the carpal tunnel deep to flexor retinaculum in a lateral position to the digitorum tendons Termination - Divides into a palmar cutaneous and recurrent motor branches TOFIN Branches Muscular - Median nerve - pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis - Anterior interosseous nerve - given off in the upper forearm and courses on the anterior interosseous membrane. Supplies lateral half of flexor digitorum profunds, flexor pollics longus and pronator quadratus - Recurrent motor nerve- abductor pollics brevis, flexor pollics brevis, opponens pollics Articular - Branches to the elbow, wrist, carpal and interphalangeal joints Cutaneous - Palmar cutaneous branch - given off at the wrist and courses superficial to the flexor retinaculum. common and proper palmer digital nerves- Supplies skin of the palmar aspects of the lateral 3- and one-half digits and the dorsal aspect of the distal phalanges of the same digits. Also supplies motor to the lateral two lumbricals Variants - Bifid median nerve - Can course posterior to the brachial artery - Martin-Gruber anastomosis (between ulnar and median nerves) - Accessory branches

Write short notes on the distal radioulnar joint - 160

Introduction - Pivot type synovial joint Gross anatomy Articular surfaces - Head of ulna - Ulnar notch of distal radius Fibrous capsule - Attaches to articular margins and lined internally by synovial membrane - Sacciform recess - extension of the synovial membrane over the anterior aspect of the lower part of the interosseous membrane Articular disc - Fibrocartilaginous disc which unites the radius and ulnar and separates ulnar from wrist joint - Attaches to ulnar styloid process and the lower border of the ulnar notch of radius - Also known as triangular ligament, part of the triangular fibrocartilage complex 5min Ligaments - Distal radioulnar ligaments - anterior and posterior - Interosseous membrane - attaches from interosseous border of radius to that of ulna Movement - Supination - supinator and biceps brachii - Pronation - pronator teres and pronator quadratus Blood supply - Anterior and posterior interosseous arteries (branches of ulnar artery) Innervation - Articular branches of Anterior interosseous nerve (median nerve) and posterior interosseous nerve (radial nerve)

Write short notes on the flexor retinaculum - 205

Introduction - Rectangular shaped fibrous band formed by thickening of deep fascia - Located anterior to the carpal bones, transforming their concavity into the carpal tunnel with the flexor retinaculum forming its roof - Ulnar aspect forms the floor of Guyon's canal Gross anatomy Attachments - Medial - attaches to the pisiform and hook of hamate - Laterally - divides into a superficial lamina attaching to the scaphoid tubercle on its ventrolateral surface and crest of trapezium. Deep lamina attaches to the medial lip of the groove on the ventral surface of trapezium - Superior - deep fascia of forearm - Inferior - deep fascia of palm of the hand and palmar aponeurosis 5MIN Relations Deep - All contents of the carpal tunnel - 4 tendons of flexor digitorum superficialis - 4 tendons of flexor digitorum profunds - Tendon of flexor pollics longus - Median nerve Superficial (from medial to lateral) - Ulnar nerve (in Guyon's canal) - Ulnar artery (in Guyon's canal) - Palmar branch of ulnar nerve - Palmaris longus tendon - Palmar branch of median nerve Between superficial and deep lamina of lateral end - Tendon of flexor carpi radialis Muscles attached - Medial - hypothenar muscles (origin) - Lateral - thenar muscles (origin) - Superficial surface - palmaris longus (insertion)

Write short notes on the clavicle - 255

Introduction - S shaped concavo-convex long bone - Functions - connects upper limb to axial skeleton and weight transmission - Lacks a medullary cavity - Ossification - via membranous ossification and has 2 primary centres (starts in 5-6 weeks of intrauterine life and completes at 25 years of age) Gross anatomy Osteology Medial end - Quadrilateral in shape - Has a saddle shaped articular facet for clavicular notch of manubrium Shaft - Medial two-thirds convex anteriorly, lateral third convex posteriorly - Superior surface is smooth, features on inferior surface - Costoclavicular ligament - oval impression medially for its attachment - Subclavian groove - for subclavius muscle - Conoid tubercle - laterally, for conoid part of coracoclavicular ligament - Trapezoid line - most lateral, for trapezoid part of coracoclavicular ligament - Also has a nutrient foramen and attachment of clavipectoral fascia 5min Lateral end - Flattened superiorly and inferiorly - Has an oval shaped articular facet for articulation with the medial aspect of the acromion Articulations - Sternoclavicular joint - saddle type synovial joint - Acromioclavicular joint - plane type synovial joint Attachments Ligaments - Sternoclavicular ligaments - anterior and posterior - Costoclavicular ligament - Coracoclavicular ligament - conoid and trapezoid parts - Interclavicular ligament - Acromioclavicular ligament Muscles - Clavicular head of pectoralis major - Clavicular head of sternocleidomastoid - Trapezius - Deltoid - Subclavius - Sternohyoid Blood supply - Nutrient branch - suprascapular artery Relations - Inferior (medial two thirds) - third part of subclavian artery becoming axillary artery and cords of brachial plexus Variants - Forked clavicle - Supraclavicular foramen - Coracoclavicular joint - Hypertrophic conoid tubercles Extra notes - Only long bone which is directed horizontally - Subcutaneous through its extent

Write short notes on the joints of the clavicle - 200

Introduction - Sternoclavicular joint - modified saddle synovial joint - Acromioclavicular joint - modified plane synovial joint Gross anatomy Sternoclavicular joint Articular surfaces - Saddle shaped articular surface of the quadrilateral shaped medial end of clavicle - Clavicular notch of manubrium - First costal cartilage - Lined by fibrocartilage Fibrous capsule - Attaches to articular margins and lined internally by synovial membrane Articular disc - Fibrocartilage disc splitting the joint into two cavities. - Attaches anteroposteriorly to fibrous capsule, clavicle superiorly and costal cartilage inferiorly. 5min Ligaments - Sternoclavicular ligaments - anterior and posterior - Interclavicular ligament - over supra-sternal notch - Costoclavicular ligament - anterior and posterior lamina Function - Allows movements of the pectoral girdle Blood supply - Internal thoracic and suprascapular arteries Innervation - Medial supraclavicular and nerve to subclavius Relations - Anterior - SCM - Posterior - brachiocephalic vessels and left common carotid Acromioclavicular joint Articular surfaces - Flattened lateral end of clavicle - Medial surface of acromion - Lined by fibrocartilage Fibrous capsule - Attaches to articular margins and lined internally by synovial membrane Ligaments - Acromioclavicular ligament - Coracoacromial ligament - Coracoclavicular ligament - conoid and trapezoid parts Function - Minimal movement Blood supply - Thoraco-acromial and suprascapular arteries Innervation - Lateral pectoral and suprascapular nerves Variants - Low lying acromioclavicular joint - Os acromiale

Write short notes on the glenoid labrum and Glenohumeral ligaments - 250

Introduction - Structures of the shoulder joint acting to stabilise it and strength the joint capsule Glenoid labrum Gross anatomy - 4mm thick fibrocartilaginous disc which acts to deepen the articular surface of the glenoid cavity to improve stability of the shoulder joint and prevent dislocation Attachments - Attaches to the articular margin of the glenoid cavity - The fibrous capsule of the shoulder joint attaches to the labrum and to the same articular margins of the glenoid cavity - Superior portion - continuous with long head of biceps tendon 5MIN - Intermediate portion - continuous with middle Glenohumeral joint - Inferior portion - continuous with inferior Glenohumeral joint (anterior band) Blood supply - Outer labrum is vascular - anterior and posterior circumflex humeral arteries - Inner labrum is avascular Variants - Absent labrum - Buford complex (deficient anterosuperior labrum in 1-3 oclock position - congenital) - Sublabral foramen - Sublabral sulcus Glenohumeral ligaments Gross anatomy - 3 ligaments that reinforce the fibrous capsule of the shoulder joint anteriorly Superior Glenohumeral ligament - Attaches from the superior margin of the glenoid cavity to the fovea capitis just superior to the lesser tuberosity of humerus Middle Glenohumeral ligament - Attaches from the superior margin of the glenoid cavity just inferior to the superior ligament. Inserts onto the anterior aspect of anatomical neck of humerus Inferior Glenohumeral ligament - Attaches from the inferior 2/3 of the glenoid labrum to the humerus. - Consists of an anterior band, posterior band and an axillary pouch portion inbetween - Most important of the three ligaments (prevents dislocation in the abducted position)

Write short notes on the ulnar nerve - 320

Introduction - Terminal branch of the brachial plexus supplying motor and sensory innervation to forearm and hand Gross anatomy Origin - Arises as the larger terminal branch of the medial cord of the brachial plexus - Receives fibres from C8-T1 Course Axilla - Courses in the axilla medial to the third part of the axillary artery and lateral to axillary vein Arm 5min - Courses distally medial to the upper part of the brachial artery - Courses posteromedially to pierces the medial intramuscular septum at the middle of the arm and enter the posterior compartment of the arm - Passes posterior to the medial epicondyle in the cubital groove Forearm - Enters the forearm between two heads of flexor carpi ulnaris - Courses distally deep to flexor carpi ulnaris and superficial to flexor digitorum profunds - Becomes superficial in the distal wrist between flexor carpi ulnaris and flexor digitorum superficialis Wrist - Enters the hand via Guyon's canal medial to the ulnar artery and superficial to the flexor retinaculum Termination - Divides into superficial and deep terminal branches within the canal - Superficial branch is short and sensory - Deep branch is motor and arches across the hand deep to the flexor tendons in relation with the deep palmar arch Branches Muscular - Ulnar nerve - flexor carpi ulnaris and medial half of flexor digitorum profunds - Deep terminal branch - supplies flexor digiti minimi, abductor digiti minimi, opponens digiti minim, all interossei, medial 2 lumbricals and adductor pollics Articular - Branches to elbow, wrist, carpal and phalangeal joints Cutaneous - Palmar cutaneous branch - medial surface of the palm - Dorsal cutaneous branch - medial surface of dorsal hand and 1 and half digits - Superficial terminal branch - palmar surface of medial one and half digits Variants - Connection with median or radial nerves - Courses anterior to medial epicondyle - Can supply all thenar muscles - Martin-Gruber anastomosis (median and ulnar nerves)

Write short notes on the deep branch of the ulnar nerve - 150

Introduction - Terminal branch of the ulnar nerve supplying motor innervation to muscles of the hand Gross anatomy Origin - Arises as the ulnar artery terminates by dividing into deep and superficial branches in Guyon's canal superficial to flexor retinaculum, medial to ulnar artery and next to pisiform 5MIN Course - Enters the hand at the hypothenar eminence between flexor and abductor digiti minimi lying superficial to opponens pollics - Pierces the opponens pollics to become deep - Arches laterally across the hand deep to the flexor tendons and superficial to the metacarpals in association with the deep palmar arch Termination - By giving its branches to adductor pollics Branches Muscular - Abductor digiti minimi - Flexor digiti minimi - Opponens digiti minimi - Palmar interossei - Dorsal interossei - Medial 2 lumbricals - Adductor pollics Articular - Branches to wrist joint Cutaneous - None Variants - Connections between median and ulnar nerve

Write short notes on the arterial supply to the hand - 285

Introduction - Arterial supply to the hand is via palmar and dorsal arches from radial and ulnar arteries Gross anatomy Superficial palmar arch Origin - Formed by the ulnar artery and superficial palmar branch of the radial artery Course - Arches across the palm at the level of the distal border of the extend thumb - Lines in a plane superficial to flexor tendons and deep to palmar aponeurosis Branches - Palmar digital artery - supplies medial aspect of little finger - Common palmar digital arteries - 3 arteries that course between fingers and divide into proper palmar digital arteries supplying the medial 3 and one-half fingers Deep palmar arch Origin - Formed by the radial artery and deep palmar branch of the ulnar artery Course - Arches across the palm proximal to the superficial arch at the level of the base of metacarpals - Lies deep to flexor tendons and superficial to metacarpals Branches - Palmar metacarpal branches - 3 arteries supplying the metacarpals and anastomose with common digital arteries of superficial arch and dorsal metacarpal branches of dorsal arch Dorsal carpal arch Origin - Formed by union of dorsal carpal branches of radial and ulnar arteries Course - Arches across the dorsal aspect of the wrist Branches - Dorsal metacarpal branches - course between metacarpals and supply metacarpals and anastomose with deep metacarpal branches of deep arch Other branches Princeps pollics artery - Branch of radial artery supplying first metacarpal and divides into two digital branches Radialis indicis artery - Branch of radial artery supplying lateral side of index finger Variants - Duplicated arch - Incomplete superficial palmar arch Absent anastomosis between superficial and deep arches