Surface anatomy & Nerve injuries of the Limbs
Class:
Year 1
Module:
BMF
Lecturer:
Dr. Vijayalakshmi S B
Department of Anatomy
Office no. 340
Email id: vbhojaraja@rcsi-mub.com
Date:
8th December 2022
1
Learning Outcomes

Review the bones of the upper and lower limbs

Revise the anatomy and function of the major nerves of the upper and lower
limbs;

Give examples of causes of pathological sensory and motor loss to the upper
and lower limbs

Review the myotomes and reflexes of the upper and lower limbs

Revise the vascular system (arterial and venous) within the upper and lower
limbs

Describe the surface anatomy of the peripheral pulses of the limbs and identify
these on examination

Identify some of the more common traumatic injuries to the upper and
lower limbs
Anatomy of Brachial plexus
• Nerves entering the upper limb
• Functions:
 Sensory innervation to the skin &
deep structures such as joints
 Motor innervation to the muscles
• Formed in the posterior triangle of
the neck by the union of the
anterior rami of the 5th, 6th, 7th,
8th cervical and 1st thoracic
spinal nerves
3
Anatomy of Brachial plexus
Course:
 Neck – Begins as roots (5); in
posterior triangle of neck
 Root of neck: Roots unite to form
trunks (3) that lie behind clavicle as
they enter the cervico-axillary canal.
 Cervico-axilla canal: Each trunk
divides into divisions (6);
(anterior and posterior)
 Pectoral region: The divisions
form cords (3) as they enter the
axilla
Roots of the brachial plexus:
 Emerge through respective intervertebral foramina
 Eventually unite to form 3 trunks behind the clavicle.
 Give two terminal branches:
• Dorsal scapular nerve (C5)
• Long thoracic nerve (C5-C7)
Brachial plexus (trunks) – The roots join to form three
trunks at the lower aspect of the neck:
• Upper trunk: from C5 & C6 roots
• Middle trunk: from C7 root alone
• Lower trunk: from C8 & T1 roots
The upper trunk gives two terminal branches:
• Suprascapular nerve (C5 & C6)
• Nerve to subclavius (C5 & C6)
Posterior to the clavicle, each trunk divides into anterior
& posterior divisions.
Brachial plexus (cords) –
• 3 Cords are formed by the joining of posterior divisions or anterior
divisions.
• The cords are named with reference to their location around the
axillary artery (2nd part)
• The three cords are:
 Medial cord: formed by the continuation of the anterior division of
the lower trunk
 Lateral cord: formed by the union of the anterior divisions of the
upper & middle trunks
 Posterior cord: formed by the union of the three posterior
divisions.
Brachial plexus (terminal branches)
 From the posterior cord: ULTRA
• Upper (C5 & 6) & lower (C5 & 6) subscapular nerves
• Thoracodorsal nerve (C6, 7 & 8)
• Axillary nerve (C5 & 6)
• Radial nerve (C5, 6, 7, 8; T1)
 From the lateral cord: LML
• Lateral pectoral (C5, 6, 7)
• Musculocutaneous nerve (C5, 6, 7)
• Lateral root of the Median nerve
 From the medial cord: 4MU
• Medial pectoral nerve (C8 & T1)
• Medial cutaneous nerves of arm (C8, T1)
• Medial cutaneous nerves of forearm (C8, T1)
• Lateral root of the Median nerve
• Ulnar nerve (C8 & T1)
The medial & lateral cords give roots to form the median nerve (C5, 6, 7, 8; T1)
Anatomy of Brachial plexus
Supraclavicular division:
4 Branches arise from the roots and trunks
Nerve
Origin
Structure/Area
innervated
• Rhomboid major & minor
• Levator scapulae
1. Dorsal scapular nerve
Anterior ramus of C5
2. Long thoracic nerve
Anterior ramus of C5, C6 and • Serratus anterior muscle
C7
3. Suprascapular nerve
Superior/Upper trunk;
fibers from C5, C6
• Supraspinatus,
• Infraspinatus
• Glenohumeral joint
4. Subclavian nerve
Superior/Upper trunk;
fibers from C5, C6
• Subclavius
• Sternoclavicular joint
Infraclavicular division:
Branches arising from the lateral cord
Nerve
Origin
Structure/Area
innervated
1. Lateral pectoral nerve
Lateral cord; receives
fibers from C5, C6 C7
• Pectoralis major muscle
2. Musculocutaneous
nerve
Lateral cord; receives
fibers from C5, C6, C7
• Muscles anterior
compartment of arm
(coracobrachialis, biceps
brachii, brachialis)
• Skin, lateral aspect of
forearm (continuing as
lateral cutaneous nerve
of forearm)
Infraclavicular division:
Branches arising from the medial cord
Nerve
1. Medial pectoral nerve
Origin
Medial cord; receives fibers
from C8, T1
Structure/Area
innervated
• Pectoralis major & minor
muscles
2. Medial cutaneous nerve Medial cord; receives fibers
of arm
from C8, T1
•Skin of medial side of the arm
3. Medial cutaneous nerve Medial cord; receives fibers
of forearm
from C8, T1
• Skin of medial side of forearm
up to wrist
4. Ulnar nerve
• Flexor carpi ulnaris (FCU)
• Medial half of FDP in the
forearm
• Most of intrinsic muscles of the
hand
• Skin of medial half of palmar &
dorsal surfaces of hand
• Skin of palmar & dorsal
surfaces of medial 1 & half
fingers
Medial cord; receives fibers
from C8, T1
Infraclavicular division:
Median nerve
Nerve
Median nerve
Origin
Structure/Area
innervated
Lateral cord (lateral root of
nerve); receives fibers from
C5,C6, C7.
Medial cord (medial root of
nerve); receives fibers from
C8, T1
• Muscles of anterior
compartment of forearm
(except FCU and medial
half of FDP)
• 5 intrinsic muscles thenar
half of palm
• lateral half of palm &
digital branches to palmar
surface of lateral 3 & half
fingers
• Elbow, wrist & carpal
joints
Infraclavicular division:
Branches arising from the posterior cord
Nerve
Origin
Structure/Area
innervated
Posterior cord; receives
fibers from C5, C6
• Teres minor muscle
• Deltoid muscle
• Glenohumeral joint
• Skin overlying deltoid
2. Upper subscapular nerve
Posterior cord; receives
fibers from C5, C6
• Superior part of Subscapularis
muscle
3. Thoracodorsal nerve
Posterior cord; receives
fibers from C6, C7, C8
• Latissimus dorsi
4. Lower subscapular nerve
Posterior cord; receives
fibers from C5, C6
• Inferior part of Subscapularis
• Teres major
5. Radial nerve
Posterior cord; receives
fibers from C5, C6, C7, C8, T1
(Note: Largest branch of BP)
• Muscles of the posterior
compartment of arm & forearm
• Skin, posterior & inferio-lateral
aspect of arm; posterior aspect of
forearm
• Skin on lateral side of dorsum of
hand & dorsal surface of lateral 3 &
half fingers
• Elbow, wrist & hand joints
1.
Axillary nerve
Note:
Brachial Plexus supplies all muscles & cutaneous areas of the upper
limb except:
 Trapezius muscle (innervated by the spinal accessory nerve
CN XI), and
 Levator scapulae (innervated by branches of C3, C4 cervical
nerves and dorsal scapular nerve (C5)
 Skin overlying axilla (supplied by lateral branch of 2nd intercostal
nerve)
 Skin overlying dorsal scapula (supplied by cutaneous branches
of dorsal rami)
DERMATOME & MYOTOME
INNERVATION OF
UPPER LIMB
Summary: Upper limb dermatomes
NERVES
AREAS SUPPLIED
C3 & 4
Supplies skin over base of neck extending laterally over
shoulder
C5
Supplies arm laterally
C6
Supplies forearm laterally and the thumb
C7
Supplies forearm and middle fingers + middle of
posterior surface of upper limb
C8
Supplies little finger and medial aspect of hand and
forearm
Supplies middle of forearm to axilla
T1
T2
Supplies a small part of arm and the skin overlying the
axilla
Source: Moore, K.L and A Daley, A.F.: Clinically oriented anatomy. 3 rd edition, 2006. LLW. Page 745.
Segmental innervation of joint
movements of the upper limb
Joints
Movements
Shoulder
Abduction, lateral rotation
Segmental
innervation
C5
Adduction, medial rotation
C6, 7, 8
Flexion
C5, 6
Extension
C7, 8
Supination
C6
Pronation
C7, 8
Wrist
Flexion and Extension
C6, C7
Digits
Flexion and Extension
C7, C8
Elbow
Forearm
Movements and muscles tested to determine
the location of a lesion in the upper limb
Movements & Muscles tested
Nerve roots & nerves innervating
Shoulder abduction (Deltoid)
C5 – Axillary nerve
Elbow flexion (Biceps, Brachioradialis)
C5, 6 – Musculocutaneous nerve
C6 - Radial nerve
Elbow extension (Triceps brachii)
C7– Radial nerve
Wrist flexion (FCR, FCU, palmaris longus)
C7, 8 – Ulnar & Median nerve
Wrist extension (ECRL)
C7 – Radial nerve
Thumb extension (EPL, EPB)
C7– Posterior interosseous nerve
Thumb opposition (Opponens pollicis)
T1 – Median nerve
Finger flexion (FDS, FPL, FDP)
C8 – Median (Anterior interosseous)
& Ulnar nerves
Finger extension (ED)
C7 – Posterior interosseous nerve
Finger abduction (dorsal interosseous,
Abductor pollicis Brevis - APB)
T1 – Ulnar nerve
T1 – Median nerve
Source: Neurology & Neurosurgery Illustrated by K W Lindsay, I Bone, G Fuller; 5th edition, Page 20 & 21
BRACHIAL PLEXUS INJURIES
Common causes of
Brachial plexus injuries
Trauma
 Birth-related
 Motor vehicular-related
 Sports-related
 Fall-related
Non-trauma
Upper lesions of the Brachial plexus
• Commonly results from injuries that increase angle between neck
and shoulder as in fall on the shoulder
• May cause rupture or avulsion of C5,6 roots
• May also occur following obstetrics related injuries (difficult
labor)
• Suprascapular nerve, nerve to subclavius, musculocutaneous &
axillary nerve will be functionless
• Loss of sensation down the lateral side of the arm
• Limb will hang limply by the side, medially rotated, elbow
extended & forearm will be pronated – Water’s tip/Policeman’s
tip position
Illustration showing mechanism of fall (A) and type of birth related injury (C)
causing “Waiter’s tip position” deformity (B)
Source: Moore, K.L and Agur, A.M.R.: Essential Clinical Anatomy. 3rd edition, 2007. LLW. Page 435
Lower lesions of Brachial Plexus
• Less common
• Commonly results from excessive abduction of the arm – as
in breaking a fall or during delivery
• May cause rupture of lower/inferior trunk of plexus – C8, T1
• Typified by “Klumpke paralysis” in affected limb
• Produces “Claw hand” – ulnar nerve is affected & involves
intrinsic muscles and long flexors of the hand
• Hyperextension of metacarpophalangeal joints & flexion of
the interphalangeal joints
• Loss of sensation on medial side of the arm, forearm & hand
Illustration showing mechanism of fall (D) and type of birth related injury (E)
causing Klumpke palsy (or claw hand) (F)
Photo Source: Moore, K.L and Agur, A.M.R.: Essential Clinical Anatomy. 3rd edition, 2007. LLW. Page 435
Brachial Plexus
Mononeuropathies
1. Musculocutaneous nerve – Musculocutaneous
nerve palsy
2. Median nerve - Ape hand and Sign of Benediction
3. Ulnar nerve - Ulnar claw
4. Radial Nerve - Wrist drop
5. Axillary Nerve - Flat shoulder
Musculocutaneous nerve
• Nerve of the anterior compartment of the arm
• Terminal branch of the lateral cord
• Root value – C 5,6
• Enters the arm by piercing the
coracobrachialis muscle
• At the lower end of the arm and
pierces the deep fascia to become
superficial and supplies the
lateral side of the forearm as
“lateral cutaneous nerve of forearm”.
Musculocutaneous nerve palsy - Clinical
Rare
Mechanisms:
 Injury proximal to coracobrachialis - due to fracture of
humerus or systemic causes
 Injury distal to coracobrachialis - usually occurs in
weight-lifting due to arm muscle hypertrophy or entrapment
between the enlarged biceps aponeurosis and brachialis
fascia
Presentation:
• Weakness in elbow flexion and supination of the
forearm (biceps brachii, coracobrachialis, brachialis)
• Cutaneous sensory loss on lateral part of forearm
Median nerve
• Formed by the union of the lateral
root of lateral cord and medial
root of medial cord
• Root value – C5,6,7,8 & T1
• In the cubital fossa: Lies medial
to Brachial artery
• Leaves the fossa between two
heads of Pronator teres
• In the carpal tunnel lies deep to
flexor retinaculum.
• Branches: In the forearm
 Muscular branches
 Anterior interosseous nerve
 Palmar cutaneous branch
(*passes superficial to flexor retinaculum)
In the hand
 Palmar digital branches
 Muscular branches
Median nerve palsy - Clinical
 Travels with brachial artery in the arm, and with
radial artery in proximal forearm
 Does not innervate any muscle in arm.
 Supplies articular branches to elbow joint
 Innervates anterior forearm muscles except
Flexor carpi ulnaris and Flexor digitorum
profundus (medial belly) which are
innervated by Ulnar nerve
 Supplies cutaneous sensation to skin areas
shaded in hand as shown
Presentation:
1. Sign of Benediction/ Median nerve palsy(Lesions at the elbow and forearm areas).
• Forearm is kept in the supine position
• Wrist flexion is weak, wasting of thenar group of
muscles
• No flexion at the PIP & DIP joints of index and middle
fingers (due to paralysis of FDS & FDP). Inability to flex
lateral two MCP joints (Paralysis of lateral 2 lumbricals).
• When the patient tries to make a fist, the index and
middle fingers tend to remain straight
• Flexion of the terminal phalanx of the thumb is lost
• Loss of sensation on the lateral half of the palm &
lateral 3 & half fingers on the palmar aspect, distal part
of the dorsal surfaces of the lateral 3 & half fingers
Presentation:
2. Ape hand / Median nerve palsy(at the wrist) causes paralysis of thenar
muscles with eventual wasting. Opposition
and flexion of the thumb are lost. The
thumb and index finger are arrested in
adduction and hyperextension position
Presentation:
3. Carpal tunnel syndrome- Unknown causes but often
occurs with repetitive stress syndrome that causes
pressure on the median nerve in carpal tunnel. Results
in numbness, tingling, or burning sensations and
eventually weakness and atrophy of thenar muscles
and lateral 3 and ½ fingers
Palmar cutaneous branch intact
Distribution of sensory
loss in Carpal tunnel
syndrome
Most patients with carpal tunnel syndrome
have normal power and may have
symptoms but no signs
Wasting of thenar
muscles
Ulnar Nerve
• Origin: medial cord of
brachial plexus in the axilla
• Root value: C8, T1
• Course & Relations:
In the arm:
 Runs on the medial side of the
brachial artery
 No branches in the arm
 Lodges in a groove on the posterior
surface of the medial epicondyle
In the forearm:
 Enters the forearm between two heads of flexor carpi ulnaris, Runs with
ulnar artery
Reaches the hand via Guyon’s canal to provide motor and sensory
innervation to the digits
Ulnar nerve palsy - Clinical:
Distribution of sensory
loss in ulnar palsy
The ulnar nerve reaches the hand via Guyon’s canal
to provide motor and sensory innervation to the digits.
Guyon’s canal is a unique location where the
ulnar nerve is vulnerable to compressive injury,
although the more common location of the ulnar nerve
injury occurs at the elbow which is known as cubital
tunnel syndrome
Wasting of hypothenar eminence
Ulnar nerve damage will show up as
hyperextension of metacarpophalangeal joint
Presentation
and flexion at the interphalangeal joints of the 4th
and 5th digits (due to paralysis of lumbricals)
The clawing becomes most obvious when the
person is asked to straighten their fingers
Patients exhibiting ulnar claw hand are
frequently unable to abduct or adduct the fingers
against resistance since ulnar nerve also
Partial Claw hand
innervates palmar and dorsal interossei of the
hand
Affected thumb will flex due to loss of
function of adductor pollicis
Test Adductor Pollicis
Ulnar nerve paradox
• Clawing is more pronounced with an ulnar nerve lesion
at the wrist compared to at or above elbow
• Lesion at or above elbow – causes loss of FDP –
therefore loss of flexion of the interphalangeal joints
• Ulnar nerve paradox – lesser, distal lesion causes
greater deformity
Radial Nerve
• Origin: posterior cord of brachial
plexus in the axilla
• Root value: C5, C6, C7, C8, T1
• Course & Relations:
In the arm –
 lies posterior to the brachial
artery
soon enter the lower triangular
space, through which it reaches
the spiral groove along with the
profunda brachii vessels.
In the cubital fossa - forms lateral
most content and terminates into
superficial and deep branches
In the forearm – Deep branch
continues as Posterior
interosseous nerve
Radial nerve palsy - Clinical
Supplies motor fibers to:
 Muscles of posterior compartment of arm and forearm
 Brachioradialis of anterior arm compartment
Supplies following sensory nerves:
 Inferior lateral cutaneous nerve of arm
 Posterior cutaneous nerve of arm & forearm
Radial nerve palsy - Clinical
Mechanisms:
 Damage from spiral fracture at junction of
upper and middle third of humerus (i.e.,
involving spiral groove)
 Prolonged pressure
Presentation:
 Wrist drop: Forearm extensors unable to
extend hand at wrist from a flexed position
 Loss of elbow extension from a flexed position
Sensory loss to the posterior surface of the
lower part of arm, forearm and hand
Axillary Nerve
• Origin: posterior cord of
brachial plexus in the axilla
• Root value: C5, C6
• Course & Relations:
In the axilla –
 passes along with the posterior
circumflex humeral artery through
the quadrangular space
 As the axillary nerve passes through the quadrangular space it gives off
an articular twig to the shoulder joint and then divides into anterior and
posterior branches/divisions.
 The anterior division winds around the surgical neck of the humerus
accompanied by the posterior circumflex humeral artery
 The posterior division continues to the back and ends as the upper
lateral cutaneous nerve of the arm.
Axillary nerve palsy - Clinical:
Mechanisms:
May result from:
 Anterio-inferior and/ or posterio-inferior dislocation
of the shoulder joint
 Compression of the axilla with a crutch
 Fracture of the surgical neck of humerus
Presentation:
 Flat Shoulder deformity: Due to paralysis of deltoid muscle
causing flaccid weakness and loss of rounded nature of the shoulder
 Loss of abduction of arm (15-90 degrees-Deltoid muscle paralysis)
 Minor loss of lateral rotation of shoulder (Teres minor damaged, but
supraspinatus and infraspinatus ok)
 Loss of sensation in the skin over a small part of the lateral upper arm
(over Regimental patch)
Anatomy of Lumbar plexus
• One of the main nervous pathways
supplying the lower limbs
• Formed in the psoas muscle from
the anterior rami of the upper
four lumbar nerves with frequent
contribution from T12 and L5
Anatomy of Lumbar plexus
Branches are:
• Femoral nerve (L2, 3 & 4)
• Obturator nerve (L2, 3 & 4)
• Lumbosacral trunk (L4 & 5)
• Iliohypogastric (L1)
• Ilioinguinal (L1)
• Genitofemoral (L1 & 2)
• Lateral cutaneous nerve of thigh (L2 & 3)
Source:
http://faculty.rcc.edu/ivey/2b/ppt_pdf/Lumbosacral%20Plexus.pdf
Anatomy of Sacral plexus
• Lies on the posterior pelvic wall in front of the piriformis
muscle
• Formed from lumbosacral trunk (L4 & 5) and the
anterior rami of the upper three sacral nerves
• Branches are:
 Sciatic nerve (L4 & 5, S1, 2 & 3) – largest branch of the
plexus
 Superior gluteal nerve
 Inferior gluteal nerve
 Nerve to quadratus femoris muscle
 Nerve to obturator internus muscle
 Posterior cutaneous nerve of the thigh
 Pudendal nerve (S2 & 3)
 Nerve to piriformis muscle
 Pelvic splanchnic nerves
Source: http://faculty.rcc.edu/ivey/2b/ppt_pdf/Lumbosacral%20Plexus.pdf
DERMATOME & MYOTOME
INNERVATION OF
LOWER LIMB
AnteriorMedial
Source: http://www.chiro.org/ChiroZine/FULL/Paresthesias.shtml
Lateral
Right
Lateral
PosteriorMedial
Lateral
Source: http://www.nycspinecare.com/corporate/uploads/lower-dermatomes.jpg
Segmental innervation of joint
movements of the lower limb
Joints
Movements
Hip
Flexion, Adduction,
medial rotation
Extension, Abduction,
lateral rotation
Extension (Knee jerk)
Knee
Ankle
Foot
Segmental
innervation
L2, 3
L4, 5, S1
L3, 4
Flexion
L5, S1
Dorsiflexion
L4, 5
Plantarflexion (Ankle jerk)
S1, 2
Inversion
L4
Eversion
L5, S1
Movements & Muscles tested
Nerve roots & nerves
innervating
Hip flexion (Ilio-psoas)
L1, 2 – Femoral nerve
Hip extension (Gluteus maximus)
L5, S1 - Inferior gluteal nerve
Hip abduction (Gluteus medius, minimus &
tensor fasciae latae)
L4, 5 – Superior gluteal nerve
Hip adduction (Adductors)
L2, 3, 4 – Obturator nerve
Knee flexion (Hamstrings)
L5, S1 – Sciatic nerve
Knee extension (Quadriceps)
L3, 4 – Femoral nerve
Dorsiflexion (Tibialis anterior)
L4 – Deep peroneal nerve
Plantar flexion (Gastrocnemius, Soleus)
S1, 2 – Tibial nerve
Toe extension (EHL, EDL)
L5 – Deep peroneal nerve
Inversion (Tibialis posterior)
L4, 5 – Tibial nerve
Eversion (Peroneus longus & brevis)
L5, S1 – Superficial peroneal nerve
Source: Neurology & Neurosurgery Illustrated by K W Lindsay, I Bone, G Fuller; 5th edition, Page 25 & 26
Lumbar and Sacral Plexus:
Mononeuropathies
1. Femoral nerve – Weakness of hip flexors &
knee extensors
1. Obturator Nerve – Weakness of hip adductors
2. Common peroneal nerve – Foot drop
3. Sciatic nerve – Weakness of hamstrings
4. Tibial nerve – Weakness of plantarflexion &
foot inversion
Femoral nerve palsy - Clinical:
Mechanisms: Damage from:
 Upper femoral fracture
 Congenital dislocation of hip
 Hip surgery
 Neoplastic infiltration
 Psoas abscess & iliopsoas hematoma
 Systemic causes (e.g., diabetes)
Presentation:
 Weakness of hip flexors
 Weakness of knee extensors + wasting of anterior thigh
muscles
 Sensory loss anterior and medial aspect of thigh, medial side
of the lower part of the leg & along the medial border of the foot
 Loss of knee jerk
Obturator nerve palsy - Clinical:
Mechanisms:
Damage from:
 Upper femoral fracture
 Congenital dislocation of hip
 Hip surgery
 Neoplastic infiltration
 Labor complications
 Compression by hernia in obturator canal
Presentation:
 Weakness of hip adductors and external rotators
 Inability to cross affected leg on the other
 Sensory loss – innermost aspect of thigh
Sciatic nerve palsy - Clinical:
Mechanisms:
Damage from:
 Congenital + traumatic hip dislocation
 Penetrating injuries
 Misplaced I.M. injection
 Pyriformis syndrome
 Systemic causes (e.g., diabetes)
Presentation:
 Weakness of hamstring muscles with loss of knee
flexion
 Manifestations of tibial & common peroneal nerve palsy
 Sensory loss – outer aspect of leg
 Loss of ankle reflex
Common peroneal nerve palsy - Clinical:
Mechanisms:
Damage from:
 Fracture neck of the fibula
 Systemic disorders (e.g., diabetes)
Presentation:
 Weakness of dorsiflexors and evertors of foot
 Foot drop - Inability to heel strike
 Sensory loss – anterior & lateral sides of the leg,
dorsum + outer aspect of foot
Tibial nerve palsy - Clinical:
Mechanisms:
Damage from:
 Trauma in the popliteal fossa
 Fracture of the tibia
 Entrapment in tarsal tunnel
 Systemic causes (e.g., diabetes)
Presentation:
 Pain in sole of foot (as part of tarsal tunnel syndrome)
 Weakness of plantar flexors and invertors of the foot
 Atrophy – small muscles of foot
 Inability to stand on toes
 Sensory loss – sole of foot
 Loss of ankle reflex
Surface Anatomy
Upper limb
 Brachial artery
 Radial artery
 Axillary group of lymph nodes
 Cephalic vein
 Basilic vein
 Superficial palmar arch
 Deep palmar arch
 Anatomical snuff box
 Flexor retinaculum
Lower limb
 Femoral canal
 Adductor canal
 Long/Great saphenous vein
 Short/Small saphenous vein
 Femoral artery
 Popliteal artery
 Posterior tibial artery
 Dorsalis pedis artery
 Mid-inguinal point
 Mid point of Inguinal ligament
References