Discussion Topics Anat

Pectoralis major and structures under cover of it

Pectoralis Major:
Origin: Clavicular head from the medial half of the clavicle, sternocostal head from
the anterior surface of the sternum and superior six costal cartilages.
Insertion: Lateral lip of the bicipital groove of the humerus.
Action: Adduction, flexion, and medial rotation of the humerus.
Structures Undercover:
Pectoralis Minor: Located beneath the pectoralis major, originates from the third
to fifth ribs and inserts into the coracoid process of the scapula.
Axillary Artery and Vein: Running through the axilla, the axillary artery becomes
the brachial artery, and the axillary vein joins the subclavian vein.
Lateral Thoracic Artery: Arises from the axillary artery, supplies the pectoralis
muscles.
Medial Pectoral Nerve: Innervates both pectoralis major and minor muscles.
Thoracodorsal Nerve and Vessels: Supply the latissimus dorsi muscle.

Upper triangular , lower triangular and quadrangular spaces

Upper Triangular Space:
Boundaries: Teres minor, teres major, and long head of the triceps.
Contents: Axillary nerve and posterior circumflex humeral vessels.
Lower Triangular Space:
Boundaries: Teres major, long head of the triceps, and the surgical neck of the
humerus.
Contents: Radial nerve and profunda brachii vessels.
Quadrangular Space:
Boundaries: Teres minor, teres major, long head of the triceps, and the surgical
neck of the humerus.
Contents: Axillary nerve and posterior circumflex humeral vessels.

Deltoid and structures under cover of it

Deltoid:
Origin: Lateral third of the clavicle, acromion, and spine of the scapula.
Insertion: Deltoid tuberosity of the humerus.
Action: Abduction of the arm.
Structures Undercover:
Axillary Nerve: Innervates the deltoid muscle.
Posterior Circumflex Humeral Artery and Vein: Supply the deltoid.
Deep Brachial Artery: Branching from the brachial artery, runs along the radial
nerve.
Flexor compartment of arm
Muscles:
Biceps Brachii: Flexes the elbow and supinates the forearm.
Brachialis: Prime flexor of the elbow.
Coracobrachialis: Assists in flexion and adduction.
Vessels:
 Brachial Artery: Main blood supply to the arm.
Deep Brachial Artery: Branch supplying the posterior compartment.
Nerves:
Musculocutaneous Nerve: Innervates the biceps brachii and brachialis.
Median Nerve: Innervates most flexor muscles in the forearm.
Brachial Plexus in detail
The brachial plexus is a complex network of nerves arising from the anterior rami
of the cervical spinal nerves (C5-T1) and extending into the upper limb. It is
responsible for the innervation of the muscles and skin of the shoulder and upper
extremity. Here is a more detailed description:
Roots (C5-T1):
Originating from the anterior rami of the spinal nerves, these roots give rise to
the brachial plexus.
The roots emerge between the anterior and middle scalene muscles in the neck.
Trunks (Upper, Middle, Lower):
The roots combine to form three trunks, named according to their position in
relation to the scalene muscles.
The upper trunk consists of C5 and C6, the middle trunk consists of C7, and the
lower trunk consists of C8 and T1.
Divisions (Anterior, Posterior):
Each trunk divides into anterior and posterior divisions.
Anterior divisions supply the anterior compartment of the limb, and posterior
divisions supply the posterior compartment.
Cords (Lateral, Medial, Posterior):
The divisions recombine to form three cords based on their relative position to
the axillary artery.
The lateral cord is formed by the anterior divisions of the upper and middle
trunks.
The medial cord is formed by the anterior division of the lower trunk.
The posterior cord is formed by the posterior divisions of all three trunks.
Terminal Branches (Musculocutaneous, Median, Ulnar, Radial, Axillary):
The cords give rise to various terminal branches, each serving specific regions
of the upper limb.
The musculocutaneous nerve arises from the lateral cord and innervates the
muscles in the anterior compartment of the arm.
The median nerve is formed by contributions from the lateral and medial cords,
supplying muscles in the anterior forearm and intrinsic hand muscles (except the
thenar muscles).
The ulnar nerve arises from the medial cord and innervates muscles in the
anterior forearm and intrinsic hand muscles (particularly the hypothenar
muscles).
The radial nerve is primarily derived from the posterior cord and supplies
muscles in the posterior compartment of the arm and forearm.
The axillary nerve, also from the posterior cord, innervates the deltoid and
teres minor muscles.
- Clinical Aspects:
Brachial Plexus Injury: Trauma, such as traction during childbirth or accidents,
can lead to brachial plexus injuries. Conditions like Erb's palsy (C5-C6 injury) or
Klumpke's palsy (C8-T1 injury) result from these injuries, leading to weakness or
paralysis in specific muscle groups.
Thoracic Outlet Syndrome (TOS): Compression of the brachial plexus or
subclavian vessels at the thoracic outlet can cause symptoms like pain,
numbness, and weakness in the upper limb.
Axillary Nerve Injury:Seen in shoulder dislocations or fractures, resulting in
weakness in shoulder abduction.
Extensor compartment of arm
Muscles:
Triceps Brachii: Extends the elbow.
Anconeus: Assists in extending the elbow.
Brachioradialis: Flexor at the elbow, but in the extensor compartment.
Nerves:
Radial Nerve: Innervates the muscles of the extensor compartment.
Vessels:
Deep Brachial Artery: Branching from the brachial artery.

Spiral/Radial groove boundaries and contents in detail

Boundaries:
1. Medial Border: Humeral shaft.
2. Lateral Border: Spiral groove.
3. Contents: Radial Nerve.
Shoulder joint in detail
Articulation: Glenohumeral joint between the head of the humerus and the glenoid
fossa of the scapula.
Ligaments (Glenohumeral, Coracohumeral, Transverse Humeral):
a. Rotator Cuff Muscles: Supraspinatus, Infraspinatus, Teres Minor, Subscapularis.
Bursae (Subacromial, Subcoracoid):
a. Movements: Flexion, Extension, Abduction, Adduction, Medial and Lateral
Rotation.
Cubital fossa boundaries and contents in detail
Boundaries:
Superior: Pronator Teres.
Medial: Brachioradialis
Lateral: Imaginary line between the epicondyles.
Contents:
Brachial Artery: Divides into Radial and Ulnar arteries.
Median Nerve: Runs alongside the brachial artery.
Flexor compartment of forearm: muscles, vessels and nerves in detail
Muscles (Superficial):
Pronator Teres: Pronation of the forearm.
Flexor Carpi Radialis: Flexes and abducts the hand.
Palmaris Longus: Weak wrist flexor.
Vessels:
Ulnar and Radial Arteries: Main blood supply.
Ulnar and Radial Veins: Drain the blood.
Nerves:
Median Nerve: Innervates most muscles in the flexor compartment.
Extensor compartment of forearm
Muscles (Superficial):
Brachioradialis: Flexes the forearm at the elbow.
Extensor Carpi Radialis Longus: Extends and abducts the hand.
Vessels:
Posterior Interosseous Artery: Branch of the common interosseous artery.
Nerves:
Radial Nerve: Innervates most muscles in the extensor compartment.
Superficial palmar arch formation and branches
The superficial palmar arch is a vital vascular structure in the palm of the hand,
formed primarily by the ulnar artery, with a contribution from the superficial
palmar branch of the radial artery.
Formation:
 The ulnar artery, the larger contributor, gives off the superficial palmar branch.
The superficial palmar branch of the radial artery provides a smaller but
significant contribution.
These vessels anastomose, forming the arch within the palm.
Branches:
The arch gives rise to common palmar digital arteries, which further divide into
proper palmar digital arteries.
These arteries supply the fingers, contributing to the rich vascular network
supporting the structures of the palm.
Clinical Aspects:
Variations in the formation of the arch may exist, influencing patterns of
collateral circulation in the hand.
Understanding the anatomy is crucial for surgeons performing procedures in the
palm and managing conditions affecting hand circulation.
Deep palmar arch and deep branch of ulnar nerve
The deep palmar arch is another important vascular structure contributing to the
blood supply of the hand. The deep branch of the ulnar nerve accompanies this
arch.
Formation:
The deep palmar arch is primarily formed by the continuation of the radial artery,
after giving off the superficial palmar branch.
The deep palmar arch is completed by the deep palmar branch of the ulnar artery.
Branches:
The arch provides palmar metacarpal arteries and palmar digital arteries that supply
the deep structures and digits of the hand.
The deep branch of the ulnar nerve courses alongside the deep palmar arch,
providing innervation to intrinsic hand muscles.
Clinical Aspects:
Occlusion or injury to the deep palmar arch can have implications for the blood
supply to the deep structures of the hand.
Damage to the deep branch of the ulnar nerve can result in motor deficits in the
intrinsic hand muscles.
Dorsum of hand in detail
The dorsum (back) of the hand is characterized by specific muscles, tendons, and
vascular structures, each contributing to its function and appearance.
Muscles:
The extensor digitorum, extensor carpi ulnaris, and extensor pollicis longus are
prominent muscles contributing to finger and wrist extension.
These muscles originate from the lateral epicondyle of the humerus and are
innervated by the radial nerve.
Tendons:
The tendons of the extensor muscles form the extensor hood over the
metacarpophalangeal joints, crucial for finger extension and stability.
The extensor indicis and extensor digiti minimi are additional tendons extending to
specific fingers.
Nerves:
The dorsum is primarily innervated by the radial nerve, responsible for sensory and
motor functions.
Cutaneous branches of the radial nerve provide sensory innervation to the dorsum
of the hand.
Clinical Aspects:
Injuries to the extensor tendons or their synovial sheaths can lead to conditions
like mallet finger or boutonniere deformity.
Radial nerve injuries or entrapments can result in weakness or sensory deficits in
the dorsum of the hand.

Distribution of nerves in hand(palm and dorsum)

 The hand exhibits a complex nerve distribution, with different nerves responsible for
innervating specific regions of the palm and dorsum.
Palm:
The median nerve is a primary contributor to the innervation of the palm, supplying
the thenar muscles and lateral two lumbricals.
The ulnar nerve provides motor innervation to the hypothenar muscles and the medial
one and a half lumbricals.
The radial nerve contributes to the innervation of the dorsal thumb and lateral three
and a half fingers.
Dorsum:
The dorsum of the hand is primarily innervated by the radial nerve.
Cutaneous branches of the radial nerve supply sensory innervation to the dorsum,
forming a comprehensive network.
Clinical Aspects:
Understanding the nerve distribution is crucial for diagnosing and managing
conditions such as carpal tunnel syndrome, cubital tunnel syndrome, and nerve
injuries in the hand.
Flexor retinaculum of hand
The flexor retinaculum is a fibrous band located on the palmar surface of the wrist,
forming the roof of the carpal tunnel. It plays a crucial role in maintaining the
structural integrity of the carpal tunnel and protecting the tendons and nerves that
pass through it
Location:
Positioned on the anterior aspect of the wrist.
Extends laterally from the pisiform and hook of hamate to the tubercles of the
scaphoid and trapezium.
Composition:
Consists of tough, fibrous tissue.
Creates a tunnel-like structure that covers and protects the tendons passing
through it.
Function:
Forms the roof of the carpal tunnel, along with the carpal bones on the floor.
Provides a protective sheath for the tendons of the flexor muscles and the
median nerve.
Helps maintain the proper alignment of tendons during wrist movement.
Contents:
Flexor Tendons: The tendons of the muscles in the anterior compartment of the
forearm (e.g., flexor digitorum superficialis, flexor digitorum profundus, flexor
pollicis longus) pass beneath the flexor retinaculum.
Median Nerve: Also passes beneath the flexor retinaculum within the carpal
tunnel.
Clinical Aspects:
Carpal Tunnel Syndrome (CTS):
Compression of the median nerve within the carpal tunnel.
Symptoms include pain, tingling, and numbness in the thumb, index, middle, and
part of the ring finger.
Often associated with conditions causing increased pressure within the carpal
tunnel, such as repetitive hand movements, pregnancy, or inflammatory
conditions.
Extensor retinaculum of hand
The extensor retinaculum is a fibrous band on the dorsal aspect of the wrist,
contributing to the structural integrity of the extensor tendons.
Location:
Situated on the dorsal surface of the wrist, the extensor retinaculum covers the
extensor tendons as they pass from the forearm to the hand.
Purpose:
It holds the extensor tendons in position during wrist and finger movements,
preventing bowstringing.
Divided into six compartments, each housing specific extensor tendons that facilitate
finger and wrist extension.
Clinical Aspects:
Tenosynovitis, inflammation of the tendon sheaths beneath the extensor retinaculum,
can cause pain and swelling.
De Quervain's tenosynovitis is a condition involving inflammation of the tendons
within the first dorsal compartment, often requiring intervention.
Typical intercostal spaces boundaries and contents in detail
Boundaries:
1. Superior: Inferior border of the rib above.
2. Inferior: Superior border of the rib below.
3. Lateral: External and internal intercostal muscles.
4. Medial: The intercostal space itself.
Muscles:
1. External Intercostal Muscles: Assist in inspiration.
2. Internal Intercostal Muscles: Assist in expiration.
3. Innermost Intercostal Muscles: Deepest layer, involved in expiration.
Nerves:
Ventral rami of spinal nerves (T1-T11) supply muscles and skin in the intercostal
spaces.
Arteries and Veins:
Posterior Intercostal: Arise from the thoracic aorta or azygos system.
Anterior Intercostal: Branches of the internal thoracic artery.
Lymphatics:
Drain into parasternal and posterior intercostal lymph nodes.
Pleura:
Parietal pleura lines the inner thoracic wall.
Visceral pleura covers the lungs.
Thoracic Wall Structures:
Costal cartilages connect ribs to the sternum.
Internal thoracic artery and vein run along the posterior surface of costal
cartilages.
Clinical Aspects:
Intercostal Nerve Blocks: Used for pain management, especially in rib fractures or
postoperative pain.
Lungs (right and left) in detail with pleura
Right Lung:
Divided into three lobes: superior, middle, and inferior.
The superior lobe extends from the apex to the horizontal fissure, the middle lobe is
between the horizontal and oblique fissures, and the inferior lobe is below the
oblique fissure.
The right lung accommodates the larger and shorter right primary bronchus.
Left Lung:
Divided into two lobes: superior and inferior.
The left lung is slightly smaller to accommodate the heart and has only an oblique
fissure.
It houses the longer and narrower left primary bronchus.
Pleura:
The pleura is a serous membrane surrounding each lung, consisting of parietal and
visceral layers.
The parietal pleura lines the thoracic cavity, and the visceral pleura adheres to the
lung surface.
The pleural cavity, between the parietal and visceral layers, contains a small amount
of pleural fluid, reducing friction during lung movements.
Clinical Aspects:
Conditions such as pleurisy (inflammation of the pleura) can lead to chest pain
during breathing.
Pneumothorax, the presence of air in the pleural cavity, can result in lung collapse
and respiratory distress.
Root of lungs
The root of the lung is the region where structures enter and leave the lung,
including the bronchi, pulmonary vessels, lymphatics, and nerves.
 Components:
The root of the lung is located at the hilum, the medial depression of each lung.
The main bronchus, pulmonary arteries, pulmonary veins, bronchial vessels,
lymphatics, and nerves comprise the structures within the root.
Clinical Aspects:
Surgical procedures involving the lung often necessitate manipulation and careful
management of structures at the lung's root.
Understanding the anatomy of the root is crucial for thoracic surgeons performing
lung resections.
Pericardium and external features of heart
Pericardium:
Fibrous Pericardium:
Tough outer layer providing protection and anchoring the heart within the
mediastinum.
Serous Pericardium:
Consists of parietal and visceral layers.
Parietal layer lines the fibrous pericardium, while the visceral layer (epicardium)
covers the heart's surface.
External Features of Heart:
Atria (Right and Left):
Upper chambers receiving blood from the body (right atrium) and lungs (left atrium).
Ventricles (Right and Left):
Lower chambers responsible for pumping blood to the lungs (right ventricle) and the
systemic circulation (left ventricle).
Coronary Sulcus:
Groove that separates the atria from the ventricles.
Anterior and Posterior Interventricular Sulci:
Grooves marking the boundaries between the ventricles.
Coronary Arteries:
Right Coronary Artery (RCA):
Supplies the right atrium, right ventricle, and part of the interventricular septum.
Left Coronary Artery (LCA):
Divides into the left anterior descending (LAD) and circumflex arteries.
LAD supplies the anterior interventricular septum and anterior walls of both
ventricles.
Circumflex supplies the left atrium and the lateral and posterior walls of the left
ventricle.
Sinuses of pericardium
The sinuses of the pericardium are potential spaces within the pericardial sac,
allowing for movement during cardiac contractions.
Transverse Sinus:
Located posterior to the ascending aorta and pulmonary trunk.
Forms a passage between the posterior and anterior parts of the pericardial cavity.
Oblique Sinus:
Formed by the reflection of the pericardium over the pulmonary veins.
Lies behind the heart between the left atrium and the esophagus.
Clinical Aspects:
These sinuses are crucial for surgeons during procedures like pericardiocentesis
(fluid drainage) or coronary artery bypass surgeries.
Blood supply of heart
The heart receives its blood supply from the coronary arteries, ensuring oxygen and
nutrients reach the myocardium.
Coronary Arteries:
The right coronary artery (RCA) originates from the right aortic sinus and supplies
the right atrium, right ventricle, and part of the interventricular septum.
The left coronary artery (LCA) divides into the left anterior descending artery (LAD)
and the circumflex artery. The LAD supplies the anterior and septal regions, while the
circumflex artery supplies the left atrium and lateral left ventricle.
Clinical Aspects:
Coronary artery disease can result in conditions such as angina or myocardial
infarction, impacting cardiac function.
Revascularization procedures like coronary artery bypass grafting (CABG) aim to
restore blood flow to the heart muscle.
Interior of right atrium
The right atrium is one of the four chambers of the heart and is responsible for
receiving deoxygenated blood returning from the body. Its interior features several
essential structures:
Tricuspid Valve (Right Atrioventricular Valve):
Positioned between the right atrium and the right ventricle.
Composed of three leaflets or cusps (anterior, posterior, and septal).
Opening of Superior and Inferior Vena Cava:
Blood returning from the systemic circulation enters the right atrium through two
main vessels.
The superior vena cava receives deoxygenated blood from the upper part of the
body, while the inferior vena cava collects blood from the lower part.
Opening of Coronary Sinus:
Located in the atrial septum.
Drains deoxygenated blood from the myocardium back into the right atrium.
Fossa Ovalis:
Remnant of the fetal foramen ovale, a hole in the interatrial septum allowing blood
to bypass the non-functional fetal lungs.
In adults, it closes, forming the fossa ovalis.
Pectinate Muscles:
Internal muscular ridges in the anterior portion of the right atrium.
Give the atrium a textured appearance.
Interior of chambers of heart -Atria and ventricles
The interior of the heart chambers comprises various features essential for the
cardiac function:
Atria:
Smooth Walls:
The atria have relatively smooth walls, allowing for efficient filling of the ventricles.
Auricles:
Ear-like extensions on the anterior surface of each atrium.
Increase atrial volume, facilitating additional blood storage.
Ventricles:
Trabeculae Carneae:
Irregular muscular ridges on the internal surfaces of both ventricles.
Contribute to the pumping efficiency of the ventricles.
Papillary Muscles:
Cone-shaped muscles attached to the cusps of the atrioventricular valves by chordae
tendineae.
Prevent inversion of the valves during ventricular contraction.
Interventricular Septum:
Wall dividing the left and right ventricles.
Contains the bundle of His, conducting the electrical impulses between the atria and
ventricles.
Foramen Ovale (in Fetal Heart):
An opening in the interatrial septum, allowing blood to bypass the non-functional
fetal lungs.
Closes after birth, forming the fossa ovalis.
Superior mediastinum in detail
The superior mediastinum is a region in the thoracic cavity that houses critical
structures and plays a crucial role in the conduction of various systems. Key
components include:
Great Vessels:
Aorta:
Ascends from the left ventricle and gives off branches supplying the upper body.
Brachiocephalic Trunk:
Arises from the aortic arch and divides into the right common carotid and right
subclavian arteries.
Left Common Carotid and Subclavian Arteries:
Arise directly from the aortic arch.
Trachea and Esophagus:
Trachea:
Windpipe carrying air between the larynx and bronchi.
Esophagus:
Muscular tube conveying food from the pharynx to the stomach.
Located posterior to the trachea.
Thymus Gland:
Lymphoid organ crucial for immune system development, prominent in childhood.
Gradually involutes with age.
Superior Vena Cava:
Collects deoxygenated blood from the upper part of the body.
Drains into the right atrium.

Posterior mediastinum in detail

The posterior mediastinum is a region containing structures primarily related to the
descending thoracic aorta and the esophagus. Key components include:
Thoracic Aorta:
Descends through the posterior mediastinum, giving off various branches.
Provides systemic circulation to the thoracic and abdominal regions.
Azygos Vein:
Ascends on the right side of the vertebral column.
Drains venous blood from the posterior thoracic and abdominal walls into the
superior vena cava.
Esophagus:
Passes through the posterior mediastinum, posterior to the trachea.
Functions in the transportation of food from the pharynx to the stomach.
Thoracic Duct:
Main lymphatic duct, responsible for draining lymph from the lower body and the left
upper body into the left subclavian vein.
Sympathetic Chain:
Part of the sympathetic nervous system.
Runs along the vertebral column, playing a role in the fight-or-flight response.