Anatomy Case study 1.Infant was noted to have a good cry but unable to movie it’s right arm (a) Name the condition of patient and define it Ans. Condition of the patient- Erb’s paralysis Site of injury: One region of the upper trunk of the Brachial plexus is called Erb’s point . Six Nerves meet here. Injury to the upper trunk causes Erb’s paralysis. (b) what muscles are primarily responsible for shoulder abduction and give it’s nerve supply Ans. Abduction from 0°-90°: 1. Supraspinatus -Suprascapular nerve (C5, C6) 2. Deltoid - Axillary nerve (C5, C6) Abduction from 90°-180°: 1. Serratus anterior - Nerve to serratus anterior (c5-c7) 2. Upper and lower fibres of trapezius – Spinal part of accessory nerve and branches from C3, C4 C. Explain Brachial plexus with a neat labelled diagram: Ans. Brachial plexus arise from the anterior primary rami of spinal nerves from C5-C8 and T1, with occasional contribution from C4 and T2. The origin of brachial plexus may shift 1 segment upward or downward: Prefixed plexus: The contribution of C4 is large , C5 is present, T1 is small, T2 is absent Postfixed plexus: The contribution of T1 is large, T2 is present, c5 is small, C4 is absent Brachial plexus consists of roots, trunks, divisions, cords, branches. Roots and trunksC5 and C6 join to form the upper trunk. C7 forms the middle trunk. C8 and T1 join to form the lower trunk Divisions of trunksEach trunk divides into ventral and dorsal division Cords: Lateral cord is formed by the Union of ventral division of upper and middle trunks. Medial cord is formed by the ventral division of lower trunk. Posterior cord is formed by the union of dorsal divisions from all 3 trunks Branches of the roots: 1. Nerve to serratus anterior (C5-C7) 2. Nerve to rhomboids(C5) 3. Branches to longus colli and scaleni muscles (C5-C8) Branches of the trunks: Suprascapular nerve (C5 , C6) Nerve to subclavius (C5, C6) Branches of the lateral cord: 1. Lateral pectoral nerve(C5-C7) 2. Musculocutaneous nerve (C5-C7) 3. Lateral root of median nerve (C5-C7) Branches of medial cord: 1. Medial pectoral nerve (C8.T1) 2. Medial cutaneous nerve of arm(C8.T1) 3. Medial Cutaneous nerve of forearm (C8, T1) 4. Ulnar nerve (C7, C8, T1) 5. Medial root of median nerve(C8, T1) Branches of posterior cord: 1. Upper Subscapular (C5, C6) 2. Lower Subscapular (C5, C6) 3. Nerve to Lattissimus dorsi (C6-C8) 4. Axillary nerve (C5, C6) 5. Radial nerve (C5-C8, T1) (d) Give nerve supply of the extensor compartment of forearm. What the condition when this nerve is damaged Ans. The extensor compartment of forearm is supplied by radial nerve. Conditions when this nerve is damaged1. Saturday night Paralysis/crutch Paralysis 2. Wrist drop (e) Mention any 3 muscles of hand which are supplied by median nerve Ans. Abductor pollicis brevis Flexor pollicis brevis Opponens pollicis (2) (b) what is the major blood supply of the organ related to this condition m Ans The bronchial arteries supply nutrition ti the bronchial tree and Pulmonary tissue. On the right side there is one bronchial artery On the left side, there are 2 bronchial arteries (d) Write any 5 difference between left and right organ related to this lung e. Name the lobes and fissures in the organ related to this condition: Ans. Left lung: Left lung consists of 1 fissure and 2 lobes. Oblique fissure divides the left lung into 2 lobes Left lung consists of : (a)Upper lobe (b)Lower lobe Right lung: Right lung Right lung consists of 2 fissures and 3 lobes. Fissures of right lung: (a) Horizontal fissure (b) Oblique fissure Lobes of the right lung: (a) Upper lobe (b) Middle lobe (c) Lower lobe Important questions 1Q. Describe the shoulder joint under following headings: 1. Articular surfaces (2) Ligaments 3. Relations 4. Bursae 5. Movements and muscles associated 6.Applied anatomy Ans. Shoulder joint is a synovial joint of ball and socket variety. 1. Articular surfaces: a. glenoid cavity scapula b. Head of humerus 2.Ligaments : a. Capsular ligaments b. Glenohumeral ligaments (Superior, middle and inferior) c. Coracohumeral ligament d. Transverse humeral ligament 3. Relations: a. Superiorly: Subacromial bursa Supraspinatus Deltoid b. Inferiorly: Triceps long head Axillary nerve Posterior circumflex humeral artery c. Anteriorly: Subscapularis Coracobrachialis Biceps Deltoid d. Posteriorly: Infraspinatus Teres minor Deltoid 4. Bursae: Subacromial bursa, Subscapular bursa and infraspinatus bursa 2q. Describe elbow joint. Ans. Elbow joint is a synovial joint of hinge variety 1. Articular surface: a. Cupitulum and trochlea of humerus b. Olecranon process Of ulna c. Olecranon fossa of humerus d. Upper surface of head of radius e. Trochlear notch 2. Ligaments: a. Capsular ligament b. Ulnar collateral ligament (Triangular shaped) c. Radial collateral ligament (fan shaped) 3. Relations: a. Anteriorly: Brachialis, Median nerve, Brachial artery, Biceps brachii tendon b. Posteriorly: Triceps brachii and anconeus c. Medially: Ulnar nerve, common flexors, flexor carpi ulnaris d. Laterally: supinator, common extensors, extensor carpi radialis brevis 4. Movements : Flexion : caused by Brachialis, Biceps brachii, Brachioradialis muscle Extension: caused by Triceps brachii and anconeus muscle 5. Applied anatomy: a. Pulled elbow (Subluxation) b. Elbow dislocation is common posteriorly and often associated with coronoid process fracture c. Student’s elbow d. Tennis elbow 3q. Describe wrist joint Ans. Wrist joint is a synovial joint of Ellipsoidal variety 1. Articular surface: Inferior surface of lower end of radius Articular disc of Inferior radioulnar joint Scaphoid Lunate Teiquetral bone 2. Ligaments: Articular capsule Palmar radiocarpal ligament Palmarulnocarpal ligament Dorsal radiocarpal ligament Radial collateral ligament Ulnar collateral ligament 3. Relations: Antriorly: long flexor tendons Median nerve Posteriorly: Extensor tendons of wrist and fingers Laterally: Radial artery 4. Movements : Flexion- caused by Flexor carpi radialis Flexor carpi ulnaris Palmaris longus Extension: caused by Extensor carpi radialis longus Extensor carpi radialis brevis Extensor carpi ulanris 5. Clinical anatomy: a. Wrist and IP joints are commonly involved in rheumatoid arthritis b. The back of the wrist is common site for a ganglion c. Wrist joint can aspirated from posterior surface between the tendons of extensor pollicis longis and extensor digitorum. 4q. Mention the muscles of arm and explain any 2 muscles origin and insertion. Ans. The muscles of the arm are: 1. Coracobrachialis 2. Biceps brachii 3. Brachialis 4. Triceps brachii Biceps brachii: origin- Long head arises from Supraglenoid tubercle of scapula Short head arises from coracoid process of scapula Insertion: Both heads insert into the radial Tuberosity of Radius Brachialis: origin- Lower half of front of the Humerus Insertion- Coronoid process of ulna Ulnar tuberosity 5q. Describe cubital fossa boundaries, contents with a diagram Ans. Cubital Fossa is a triangular hollow Situated on the front of the elbow Boundaries: 1. Laterally- Medial border of brachioradialis 2. Medially- Lateral border of pronator teres 3. BASE – represented By an imaginary line joining the front of two epicondyles of the humerus 4. Apex- formed By the area where brachioradialis crosses the pronator teres Contents1. Median nerve 2. Brachial artery (Termination) 3. Biceps brachii tendon 4. Radial nerve 6q. Mention the origin, insertion, nerve supply and action of Deltoid muscle Ans. ORIGIN1. Anterior border of lateral 1/3rd of clavicle 2. Lateral border of acromion process 3. Lower lip of crest of spine of scapula INSERTION1. Deltoid Tuberosity of humerus NERVE SUPPLY- Axillary nerve (C5, C6) ACTION1. Anterior fibres- flexors and medial rotators of arm 2. Posterior fibres-Extensor and lateral rotators of arm 3. Acromial fibres -abductors of arm 7q. Mention the muscles of extensor compartments of forearm and explain origin, insertion, nerve supply and action of any 2 muscles. Ans. Superficial muscles1. Anconeus 2. Brachioradialis 3. Extensor carpi radialis longus 4. Extensor carpi radialis brevis 5. Extensor digitorum 6. Extensor digiti minimi 7. Extensor carpi ulnaris Deep muscles1. Supinator 2. Abductor pollicis longus 3. Extensor pollicis longus 4. Extensor pollicis brevis 5. Extensor indicis BRACHIORADIALISOrigin- Upper 2/3rd of lateral supracondylar ridge of humerus Insertion- Styloid process of radius Nerve supply- Radial nerve Action- Elbow flexion Extensor carpi ulnarisOrigin- Lateral epicondyle of humerus Insertion- base of 5th metacarpal bone Nerve supply – Deep branch of radial nerve Action – Extension and addiction of wrist joint 8q. Mention the muscles of thenar and hypothenar eminence Ans. THENAR EMINENCE1. Abductor pollicis brevis 2. Flexor pollicis brevis 3. Opponens pollicis 4. Adductor pollicis HYPOTHENAR EMINENCE1. Palmaris brevis 2. Abductor digiti minimi 3. Flexor digiti minimi 4. Opponens digiti minimi Flexor pollicis brevisOrigin- flexor retinaculum, crest of trapezium, capitate bones Insertion- Base of proximal phalanx of thumb Nerve supply- Median nerve Action- Flexion of metacarpophalangeal joint of thumb Flexor digiti minimiOrigin- Flexor retinaculum Insertion-Base of proximal phalanx of little finger Nerve supply- Deep branch of ulnar nerve Action- flexes little finger 9q. Name the Broncho pulmonary segments with a labelled diagram Ans. 10q. Mention the origin, insertion, nerve supply and action of external and internal intercostal muscles Ans. Nerve supply-All intercostal muscles are supplied by the intercostal Nerves of the spaces in which they lie. Action - 1. Internal intercostal muscles- Depression of ribs during expiration 2. External intercostal muscles- elevation of ribs during inspiration 11q. Discuss the external features of the heart Ans. • The human heart has four chambers. They are 1. Left atria 2. Right atria 3. Left ventricle 4. R8ght ventricle • The atria lie above and behind the ventricles. • On The surface of the heart, atria are separated from the Ventricles by an atrioventricular groove • Atria are separated from each other by an interatrial groove • Ventricles are separated from each other by an Interventricular groove, which is subdivided into Anterior and posterior parts • Apex directed downwards, forwards and to the left. • Base directed backwards • Surfaces of the heart: 1. Anterior (2) inferior (3) left lateral • Borders of the heart: (1)Upper border (2) Inferior border (3) left border (4) Right border 12q. Draw a labelled diagram of heart Ans. 13Q. Describe the mediastinum under the following headings: Definition, subdivisions and contents Ans. Is the middle space left in the thoracic cavity in between The lungs The Mediastenum is divided into: 1. Superior Mediastenum 2. Inferior Mediastenum Inferior Mediastenum is further divided into: 1. Anterior Mediastenum 2. Middle Mediastenum 3. Posterior Mediastenum Superior Mediastenum contents: 1. Trachea 2. Oesophagus 3. Muscles- Sternohyoid and Sternothyroid 4. Artery- Arch of aorta Brachiocephalic artery Left subclavian artery Left common carotid artery 5. Veins – Right and left brachiocephalic veins Upper half of the superior vena cava Left superior intercostal vein. 6. Nerves – vagus nerve Phrenic nerve Cardiac nerves Left recurrent laryngeal nerve 7. Thymus 8. Thoracic duct Anterior Mediastenum content : 1. Sternopericardial ligaments (Fig. 17.1) 2 Lymph nodes with lymphatics 3 Small mediastinal branches of the internal tthoracic artery 4.The lowest part of the tthymus 5. Areolar tissue Middle Mediastenum contents: 1. Heart 2. Arteries-Ascending aorta Pulmonary trunk 2 pulmonary arteries 3. Veins- Lower half of the superior vena cava, (ii) terminal part of the azygos vein (iii) right And left pulmonary veins 4. Nerves- cardiac plexus Phrenic nerve 5. Lymph nodes Posterior Mediastenum contents: 1. Oesophagus 2. Descending aorta and it’s branches 3. Veins- Azygos vein, (ii) hemiazygos vein, (iii) accessory hemiazygos vein. 4. Nerves- vagi Splanchnic nerves Lymph nodes 14q. Describe the coronary circulation or Arterial supply of heart Ans. The heart is supplied mainly by Right and left coronary artery. Right Coronary artery: • Right coronary artery arises from the anterior aortic sinus of ascending aorta • It passes front and to the right between the root of pulmonary trunk and right Auricle. • It then runs downwards the right anterior coronary sulcus • It winds around the inferior border to reach the diaphragmatic surface • It then runs in the posterior coronary sulcus to reach posterior Interventricular groove. Area of distribution: 1. Right atrium 2. Greater part of right ventricle 3. Smaller part of left ventricle Left coronary artery: • Left coronary artery arises from the posterior aortic sinus of ascending aorta • It passes front and to the left between the root of pulmonary trunk and left Auricle. • It then runs downwards the left anterior coronary sulcus • It winds around the left border of heart and continues in left posterior coronary sulcus. • It anastamoses with left right coronary artery in posterior Interventricular groove. Area of distribution: 1. Left atrium 2. Greater part of left ventricle 3. Small part of right ventricle 15q. Describe the medial surface of right and left lungs Ans. 16q.Mention the differences between right and left lungs. Ans. 17q. Describe the stomach under the following headings: Situation, parts, interior surface, blood supply, nerve supply and clinical anatomy Ans. Stomach is a muscular bag, forming the widest part of the digestive tube. Situation: The stomach lies Obliquelly in upper left part of abdomen. It occupies the Epigastric region, left hypochondriac region and umbilical region. In normal active person it’s somewhat J-shaped. Parts: The stomach is mainly divided into 2 parts: 1. Cardiac part 2. Pyloric part Cardiac part is further divided into- Fundus Body Pyloric part is further divided into- pyloric antrum Pyloric canal Interior of stomach: 1. Mucuosa of an empty stomach consists of folds called as Gastric rugae • The rugae are longitudinal along the lesser curve and irregular elsewhere • The longitudinal rugae along the lesser curvature forms the gastric canal • The gastric canal allows the rapid flow swallowed liquid along lesser curvature directly to lower part before it spreads to other parts of the stomach. 2. Submucosal coat is made up of connective tissues, Arterioles, nerve plexus 3. Serous coats consists of peritoneal covering Blood supply: 1. Lesser curvature supplied by left and right gastric arteries 2. Greater curvature supplied by left and right Gastroepiploic arteries 3. Fundus is supplied by 5-7 short gastric arteries arising from splenic arteries. Nerve supply: 1. T6-T10(sympathetic nerves) 2. Anterior gastric nerve 3. Posterior gastric nerve Clinical anatomy: 1. Gastric pain is usually felt in epigastric region because the stomach is supplied by T6-T9 segments of spinal cords. 2. Peptic ulcer can occur in the lower end of esophagus, stomach, or Duodenum 3. Gastric ulcer can occur along the lesser curvature of the stomach 4. Gastric carcinoma can occur along the greater curvature of the stomach. 18q. Describe duodenum under the following heading Situation, parts, interior surface, blood supply, nerve Supply Ans. Duodenum is the widest, shortest part of large intestine Situation: • It extends from pylorus to dudenojejunal flexure. • It is curved around the head of pancrease in the form of letter C • It lies above the level of umbillicus, opposite to 1st, 2nd and 3rd vertebrae Parts of duodenum: Duodenum is 25Cm long and is mainly divided into 4 parts: 1. Superior part 2. Descending part 3. Horizontal part 4. Ascending part Interior surface: Presence of circular folds of mucous membrane, villi, Microvilli. Blood supply: 1. Superior pancreaticoduodenal artery 2. Inferior pancreaticoduodenal artery Nerve supply: 1. T9-T10 spinal segments (sympathetic nerves) 2. Vagus nerve, through coeliac plexus Clinical anatomy: 1. Duodenal carcinoma 2. 1st part of duodenum is common site of peptic ulcer mostly due to direct exposure to acidic content from stomach 19q. Describe pancrease under the following headings: Ans. Shape: It is J-shaped Situation• The pancrease lies at the level of 1st and 2nd lumbar vertebrae • Head of the pancrease is placed under the concavity of duodenum Parts: 1. Head(placed in c shaped duodenum) 2. Neck ( directed forwards, upwards and left) 3. Body(directed upwards, backwards and left) 4. Tail Ducts1. Main pancreatic duct- begins at the tail, runs towards right through the body, and enters within the head of pancrease. The pancreatic duct and bile duct enter the 2nd part of duodenum and join to form Helatopancreatic ampulla which opens into major duodenal papilla 2. Accessory pancreatic duct -Begins at the lower part of head and opens into minor duodenal papillae. 20q. Describe liver: Shape, situation, surface, relations, ligaments, blood supply, applied aspect Ans. Shape- The liver is wedge shaped. Situation• IT is situated in right upper quadrant of abdominal cavity • It occupies left hychondric region, epigastric region and a part of right hypochondriac region • Most of the liver is covered by ribs and coastal cartilage except in the upper part of epigastrium where it’s covered by anterior abdominal wall. Surfaces1. Superior surface 2. Inferior surface 3. Anterior surface 4. Posterior surface 5. Right lateral surface Ligaments• Falciform ligament • Ligamentum venosum • • • • • Ligamentum teres Superior layer of coronary ligament Inferior layer of coronary ligament Right triangular ligament Left triangular ligament Relations1. Superior surface- Diaphragm 2. Inferior surface • On the inferior surface of the left lobe, there is a large Concave gastric impression • Ligamentum teres • Fossa for gallbladder • The inferior surface of the Right lobe bears the colic impression for hepatic Flexure of colon, renal impression for right Kidney, and duodenal impression for second Part of the duodenum. 3. Anterior surface• Falciform ligament • Diaphragm • Xiphoid process 4. Posterior surface• Bare area is related to diaphragm • Groove for inferior venacava • Right suprarenal gland • Ligamentum venosum 5. Right surface- Diaphragm Blood supply- Liver receives 20% blood from hepatic artery and 80% from portal vein. Clinical anatomy : • Hepatitis- Inflammation of liver • Liver is the common site of metastatic tumours Venous blood from GIT with primary tumor Drains via portal vein into the liver. • Liver resection • Liver transplantation 21q. Describe kidney: shape, situation, covering, parts, relations, blood supply, applied aspect Ans. Shape- The kidneys are bean shaped. Situation• The kidneys occupy hypochondriac, epigastric, lumbar and umbilical regions. • The right kidney is slightly lower than the left kidney due to the presence of liver in the right hypochondrium. • Vertically the kidneys extend from upper border of Twelfth thoracic vertebrae to the middle of the body of 3rd lumbar vertebrae Coverings1. Fibrous capsule 2. Perirenal fat 3. Renal fascia 4. Pararenal fat RelationsCommon relations of both kidneys1. Upper pole of each kidney is related to suprarenal gland. 2. Medial border of each kidney is related to ureter 3. Posterior surface of each kidney is related to – a. Diaphragm b. Medial and lateral arcuate ligaments c. Psoas major D. Quadratus lumborum E. Transversus abdominis F. Subcostal vessels g. Left kidney related to eleventh to twelfth rib and right kidney related to twelfth rib Other anterior relations of left kidney – 1 Left suprarenal gland 2 Spleen 3 Stomach 4 Pancreas 5 Splenic vessels 6 Splenic flexure and descending colon 7 jejunum Other anterior relations of Right kidney1 Right suprarenal gland 2 Liver 3 Second part of duodenum 4 Hepatic flexure of colon 5 Small intestine Blood supply of kidneysRenal artery gives 5 segmental branches. 4 branches from anterior division (apical, upper, middle, lower) 1 branch from posterior division Applied anatomy1. Kidney is likely to have stones As urine gets concentrated here. 2. Kidney stone lies on the body of the vertebrae 3. Common diseases of kidney are nephritis, tuberculosis of kidney, renal Stones and tumours. 4. In cases of chronic renal failure, dialysis needs to Be done. Structure/parts: Cross sectional view of kidney shows: a. Outer cortex b. Inner medulla c. Renal sinus 22q. Describe urinary bladder : Position, parts, ligaments and blood supply Ans. Urinary bladder is a muscular reservoir of urine, Which lies in the anterior part of the pelvic cavity Position- When the bladder is empty, it lies in the pelvis. But when filled, it expands and extends upwards into abdominal cavity reaching upto umbillicus . External featuresAn empty baldder has1. Apex (directed forwards) 2. Base (directed backwards) 3. Neck 4. 3 surfaces( superior,right and left inferolateral, ) 5. 4 borders ( Anterior, posterior, 2 lateral) Filled bladder has1. Apex(directed upwardsl 2. Neck(directed downwards) 3. 2 surfaces ( Anterior and posterior) Ligaments: 1. Lateral true ligament 2. Lateral Puboprostatic ligament 3. Medial Puboprostatic ligament 4. Median umbilical ligament 5. Posterior ligament Blood supply: superior and Inferior vesical arteries 23Q. Describe uterus: Axes, parts, ligaments, blood supply,nerve supply and applied aspects Ans. Uterus is a child bearing organ in females, present between urinary bladder and rectum. Axes: • Normally the long axis of uterus forms an angle of about 90° with the long axis of vagina • The forward tilting of the uterus relative to vagina is known as antiversion • The backward tilting of uterus relative to the vagina is known as retroversion. Parts: The uterus consists of 4 parts: 1. Fundus 2. Body (Anterior and posterior surface) 3. 2 lateral borders 4. Cervix Ligaments1. Anterior ligament 2. Posterior ligaments 3. Right and left broad ligament Fibromuscular ligaments1. Round ligaments of uterus 2. Transverse cervical ligaments 3. Uterosacral Ligaments 24q. Describe testis: Parts, coverings, blood supply, nerve supply Ans. Testis is a male gonad. Structure – • Each testis consists of 200-300 lobules • Each lobule consists of 2-3 seminiferous tubule • The seminiferous tubules join together at the apices of The lobules to form 20 to 30 straight tubules which enter The mediastinum. • Here they anastamose with each other to form Rete testis. • In turn, Rete testis gives rise to 12-30 efferent ductules which emerge near the upper pole of the testis and enter the epididymis. CoveringsTestis is covered by layers of the scrotum. In Addition, it is also covered by three coats. From outside Inwards, these are the tunica vaginalis, Tunica albuginea and tunica vasculosa Blood supply: Testicular artery arising from abdominal aorta at the level of L2 vertebrae. Nerve supply- T10 segments of spinal cord(sympathetic nerves) 25q. Describe superior mesenteric artery Ans. Superior mesenteric artery arises from the front of the abdominal aorta behind the head of pancrease. It supplies all the derivatives if midgut. i.e: 1. Lower part of duodenum below the opening of bile duct 2. Jejunum 3. Ileum 4. Appendix 5. Caecum 6. Ascending colon 7. Right 2/3rd of transverse colon 8. Lower half of head of pancrease 26q. Write any 2 functions of peritoneum Ans. Peritoneum is a large serous membrane lining the abdominal cavity. Functions: 1. Storage of fat 2. Provides passage for nerves, vessels and lymphatics 3. Facilitating movement’s of viscera 4. Protection of viscera 27q. Give the blood supply of ureter Ans. Ureter is supplied by 3 sets of long arteries: 1. Upper part receives branches from the renal artery 2. Middle part receives branches from the aorta 3. Lower part receives branches from the vesical, middle rectal or uterine vessels. 28q. Name any 2 ligament of uterus. Ans. 1. Anterior ligament 2. Posterior ligament 3. Right and left broad ligament 29q. What is Trigone of bladder Ans. Trigone if bladder is a triangular area situated in the lower part of the base of the urinary bladder, where the mucosa is smooth. The internal urethral orifice is located at the apex of this trigone The ureters of both the kidneys open at the Posterolateral angles. 30q. What are the Contents of spermatic cord? Ans. Contents of spermatic cord is/are: a. Ductus deferens b. Testicular artery c. Pampiniform plexus of veins d. Ilioinguinal nerve 31q. Mention the branches of coeliac trunk Ans. 1. Left gastric artery (2) Common hepatic artery (3) splenic artery 32q. Give the blood supply and nerve supply of ovary Ans. Blood supply1. Ovarian artery 2. Uterine artery Nerve supply: 1. Ovarian plexus 33q. Mention the different parts of large intestine Ans. 1. Caecum 2. Appendix 3. Ascending colon 4. Transverse colon 5. Descending colon 6. Sigmoid colon 34q. What is the location and shape of spleen Ans. Spleen is a wedge shaped organ. It occupies hypochondriac region and a part of epigastrium. Radial Nerve PERSENTATION BY: DANIEL (22BPTR101) HABIBA(22BPTR102) KRUTHIK(22BPTR103) THRISHA(22BPTR104) ATHARVA(22BPTR105) KATHAL(22BPTR106) JACKSON(22BPTR107) SURCHANDRA(22BPTR108) NONGPOKNGANBA(22BPTR109) GAGANA(22BPTR110) The Radial nerve is the thickest branch arising from the posterior cord of Brachial plexus . • Root value of the radial nerve is Ventral rami of C5-C8 and T1 segments of the spinal cord. • The nerve Supplies branches to the triceps muscle. • • It also supplies branches to all the twelve muscles of the back of forearm For e.g. Extensor digitorum, extensor carpi ulnaris, Extensor indicis, etc. Axilla: •Radial nerve lies against the muscles forming the posterior wall of axilla, i.e. subscapularis, teres major and latissimus dorsi. • It then lies for a short distance in arm behind brachial artery. Axilla: Then it enters in the lower triangular space between teres major, long head of triceps brachii and shaft of humerus. It gives two muscular and one cutaneous branches in the axilla. Radial Sulcus •Radial nerve enters through the lower triangular space into the radial sulcus, where it lies between the lateral and medial heads of triceps brachii along with profunda brachii vessels. • It leaves the sulcus by piercing the lateral intermuscular septum. Radial sulcus: Long and lateral heads form the roof of the radial sulcus. In the sulcus, it gives three muscular and two cutaneous branches. Front of Arm •The radial nerve descends on the lower and lateral side of front of arm deep in the interval between brachialis on medial side and Brachioradialis with extensor carpi radialis longus on the lateral side to reach capitulum of humerus. Cubital Fossa: •The nerve enters the lateral side of cubital fossa. • There the radial nerve terminates by dividing into superficial and deep branches. •The deep branch supplies extensor carpi radialis brevis and supinator. •Then it courses between two heads of supinator to reach back of forearm. Front of Forearm •The superficial branch leaves the cubital fossa to enter lateral side of front of forearm, accompanied by the radial vessels in its upper twothirds. • At the junction of upper twothirds and lower one-third, the superficial branch turns laterally to reach the posterolateral aspect of forearm. Wrist and Dorsum of Hand •The superficial branch descends till the anatomical snuffbox to reach dorsum of hand, where it supplies skin of lateral half of dorsum of hand and lateral 2½ digits till distal interphalangeal joints. Back of Forearm and Wrist The deep branch of radial nerve enters the back of forearm, where it supplies the muscles present there . Lower down it passes through the 4th compartment under the extensor retinaculum to reach the back of wrist where it ends in a pseudoganglion, branches of which supply the neighbouring joints. Axilla: Muscular branch: 1. Long head of triceps brachii 2. Medial head of triceps brachii Cutaneous branch: Posterior cutaneous nerve of arm Radial sulcus: Muscular branch: 1. Lateral head of triceps brachii 2. Medial head of triceps brachii 3.Anconeus Cutaneous branch: 1. Lower lateral cutaneous nerve of arm 2. Posterior cutaneous nerve of forearm Vascular branch: Branch to profunda brachii artery Lateral side of arm Muscular branch: 1. Brachioradialis, 2.Extensor carpi radialis longus, 3.Lateral part of brachialis (proprioceptive) Terminal : Superficial and deep interosseous branches Cubital fossa Muscular- Extensor carpi radialis brevis and supinator Back of forearm Muscular- Abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor digitorum, extensor indicis, extensor digiti minimi and extensor carpi ulnaris. Wrist: Articular- To inferior radioulnar, wrist and intercarpal joints. Forearm Cutaneous and vascularLateral side of forearm and radial vessels. Anatomical snuffbox and dorsum of hand Cutaneous and vascular- Skin over anatomical snuffbox, lateral half of dorsum of hand and lateral 2½ digits till their distal interphalangeal joints. Articular -To wrist joint, 1st carpometacarpal joint, metacarpophalangeal and interphalangeal joints of the thumb, index and middle fingers. The radial nerve is very commonly damaged in the region of the radial (spiral) groove. Common causes: Sleeping in an armchair with the limb hanging by the side of the chair (Saturday night palsy) or even the pressure of the crutch (crutch paralysis) Fractures of the shaft of the humerus. This results in the weakness and loss of power of extension at the wrist (wrist drop) and sensory loss over a narrow strip on the back of forearm, and on the lateral side of the dorsum of the hand