Anatomy Syllabus a Note on Normal Variants

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Anatomy Syllabus A Note on Normal Variants

Categorisation of Required Skills Understanding and recognizing normal variants is a crucial part of being a radiologist, so as to avoid and Knowledge for Anatomical potentially damaging confusion with serious pathology. Structures This is to be distinguished from congenital anomalies, although sometimes the distinction between these Knowledge of pathologically relevant anatomy needs categories is somewhat blurred. In general however, to be learned in the early stages of training to ensure normal variants are not the cause of significant disease trainees have a baseline of knowledge to undertake the but may mimic significant abnormalities such as fractures, Anatomy exam. tumours, dysplasias etc. As a result it is important for trainees to become very familiar with these variants early Application of anatomical knowledge to disease will be in their training, and consequently, these are examined learned throughout all stages of training. formally in the Part 1 examination.

Anatomical tasks of a radiologist that provide the basis Lists of radiologically relevant Normal Variants as they for the categories: pertain to clinical practice and specific body systems are contained in the section on body systems. All Part 1 1. Identification of a structure in projectional modalities examination candidates should specifically refer to this list and in cross sectional modalities. This includes to learn some of the common normal variants, especially identification of the structure’s expected location and those listed in Category 1. relations and size even if not visible. Category 1 • Projectional modalities: radiography, fluoroscopy, angiography (including spin angiography), Critical anatomical structures planar nuclear medicine studies. The multitude of radiography and fluoroscopy specific adaptations Must recognise and interpret, must know and explain. (e.g. OPG, planar arthrography, contrast studies, etc) are all subsumed in this. These structures comprise core basic radiologic anatomy, and a deficiency of anatomical knowledge and skills • Cross sectional modalities: CT, MR, US, SPECT and for these structures will jeopardise a radiology trainee’s PET nuclear medicine studies; includes CT variants ability to perform to a satisfactory level during radiology such as angio-CT. training.

2. Identification of a structure as normal or abnormal. Projectional identification: identifies confidently on all This requires the knowledge of the range of normality and common projectional modalities, also of normal variants, particularly those that simulate recognises normal variants and knows range of normality, disease or are on the borderlands with disease. can identify and point out expected location, shape and size even if not visible, and the adjacent category 1 3. Coherent communication with referrers, colleagues, structures. patients and the entire health care team regarding a particular anatomical structure or structures (normal Cross sectional identification: identifies confidently or abnormal as the case may be) in a language that on all common cross-sectional modalities, in standard is anatomically correct, radiologically relevant, and radiological planes and any dedicated planes (straight meaningful to the intended audience. or curved) commonly used for that structure, recognises normal variants and knows range of normality, can trace This is anatomical competence required at a basic level of structure from plane to plane in an interactive stack; Part 1 exit standard. Knowledge of pathologically relevant can identify and point out expected location, shape anatomy is a competence to be developed during training and size even if not visible, and the adjacent category 1 and to be assessed at the level of Part 2 exam. ANATOMY

© 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 Page 81 structures; can point out this expected location and size in functional anatomy. Knows and can concisely describe a interactive scrolling stack. clinically important anatomical variants, particularly those that endanger the structure or those that simulate Knowledge base: can give a structured coherent verbal disease. account (oral or written) of the anatomical structure in language applicable to radiology reporting and to inter- Category 3 specialty communication; this includes all common and important anatomical characteristics of the structure, for Useful radiologic anatomical structures example course, parts, relations, distribution, etc. Knows and can concisely describe normal anatomical variants, Good to recognise, good to know. particularly those that endanger the structure or other structures, and those that simulate disease. Can draw a Anatomical structures in this category must be known to basic diagram (artistic skills not required) to illustrate key category 2 level for satisfactory sub-specialist radiology morphology, internal composition and external relations performance. A radiology trainee at the end of radiology of the structure in a way applicable to radiology image training would not be expected to know these structures analysis and identification. to category 2 level, but is aware of their existence. A radiology trainee at the beginning of radiology training is Category 2 unlikely to know these structures.

Important anatomical structures Projectional identification: with increasing training and experience able to identify on all common projectional Must recognise, must know. modalities on which it is visible, and distinguish normal structure from abnormality of either this or other Anatomical structures in this category must be known structures. for competent generalist radiologist performance. For radiology trainees at the beginning of radiology training, Cross sectional identification: with increasing training anatomical knowledge of these structures is needed to and experience able to identify on all common cross- permit the acquisition of skills and knowledge of imaging sectional modalities on which it is visible in key working manifestations of disease. standard planes (transverse and coronal), and distinguish normal structure from abnormality of either this or other Projectional identification: identifies confidently on all structures. common projectional modalities, recognises normal variants, can differentiate normal from abnormal Knowledge base: with increasing training and experience appearance, can describe and point out the nearest aware of the structure’s existence, name, and functional category 1 structures to which it relates when not visible. anatomy. SAME AS FOR CATEGORY 1 STRUCTURES.

Cross sectional identification: identifies confidently on all common cross sectional modalities in key working standard planes (transverse and coronal), recognises normal variants, can differentiate normal from abnormal appearance, can describe and point out the nearest category 1 structures to which it relates when not visible.

Knowledge base: can give a concise, coherent verbal account (oral or written) of the anatomical structure in language applicable to radiology reporting and to inter- speciality communication; this includes all the clinically important anatomical characteristics of the structure, for example course, area of supply, location of vulnerability,

1. INTRACRANIAL CAVITY (EXTRA AXIAL)

Anterior Cranial Fossa

• Ethmoid bone • Meningeal coverings • Frontal bone & sinus • Crista galli • Sphenoid: Lesser wing • Olfactory bulb and tract

Middle Cranial Fossa

• Sphenoid body, greater wing • Meningeal coverings & sinus • Temporal bone & apex • Middle meningeal artery

• Foramina of middle cranial fossa • Vidian canal & contents • Foramen spinosum ¡ Optic canal • Foramen lacerum ¡ Superior orbital fissure ¡ Foramen rotundum ¡ Foramen ovale ¡ Carotid canal

Posterior Cranial Fossa

• Temporal bone • Meningeal coverings • Occipital bone

• Foramina of posterior cranial fossa • Ganglia of CN IX & X in jugular & contents foramen ¡ Internal auditory meatus with CN VII & VIII ¡ Jugular foramen & contents ¡ Hypoglossal canal & CN XII ¡ Foramen magnum

2. CRANIAL VAULT

Bones

• Layers of skull • Dural coverings • Bones including prominences, • Arachnoid granulations foramina and key vascular • Sutures markings: ¡ Frontal ¡ Parietal ¡ Sphenoid ¡ Temporal ¡ Occipital ANATOMY

• Galea • Frontalis muscle • Blood supply to scalp • Occipitalis muscle

Nerves

• Meningeal • Skull bones • Scalp

3. THE ORBIT

Bony Orbit

• Boundaries & walls, including • Lacrimal fossa/crest contributions from specific skull • Periorbita bones • Medial & lateral tubercles • Foramina & contents • Orbital septum • Optic canal • Superior orbital fissure • Inferior orbital fissure

Preseptal Structures

• Lacrimal sac & duct • Lids & tarsal plates • Lateral and medial check • Blood supply & venous drainage ligaments of the globe • Levator palpebrae superioris & nerve supply • Conjunctival sac boundaries • Lacrimal canaliculi

Extraocular Muscle Cone

• Intraconal fat • Tendon annulus • Extraocular muscles & their nerve supplies

Extraconal Space

• Lacrimal gland • Nerve & blood supply to the lacrimal gland • Extraconal fat

Globe & Contents

• Cornea & sclera • Canal of Schlemm • Choroid & retina • Macula position • Iris & lens • Short ciliary arteries • Nerve supply ¡ Short and long ciliary nerves • Ciliary ganglion

• Fovea • Optic nerve • Central artery of retina • Central retinal vein • Optic nerve sheath

Arteries

• Ophthalmic artery • Supraorbital • Anterior ciliary • Infraorbital artery • Supratrochlear • Posterior ciliary • Central artery of retina • Lacrimal • Zygomaticotemporal • Dorsal nasal • Zygomaticofacial • Anterior & posterior ethmoidal

Veins

• Superior and inferior ophthalmic • Ophthalmic vein tributaries veins • Facial-cavernous anastomoses

Nerves

• Oculomotor nerve & divisions • Branches of ophthalmic nerve • Ciliary ganglion • Zygomatic branches of maxillary • Ophthalmic nerve nerve • Maxillary nerve • Infraorbital nerve

4. NASAL CAVITY & PARANASAL SINUSES

Bones & Foramina/Canals

• Key bones • Other bones • Mucosa • Ethmoid bone ¡ Premaxilla (incisive bone) • Palatine bone ¡ Pterygoid plates of sphenoid • Maxilla ¡ Nasal bone • Conchae & meati ¡ Lacrimal bone • Ostiomeatal complex & its ¡ Nasal septum & vomer components ¡ Ethmodial cell variants • Sphenoid sinus ¡ Haller cell • Sphenoethmoidal recess ¡ Agger nasii cell • Foramina ¡ Sphenopalatine foramen ¡ Palatine canals ¡ Incisive foramen • Variations of pneumatisation

Blood Supply

• Sphenopalatine artery • Anterior and posterior ethmoidal arteries

• Venous drainage ANATOMY

• Anterior ethmoidal • Nasopalatine • Branches of greater palatine nerve

Lymphatics

• Lymphatic drainage & nodal pathways

5. THE FACIAL BONES

• Bones, processes, articulations, sinuses, foramina/canals & their contents ¡ Sphenoid ¡ Palatine ¡ Ethmoid ¡ Nasal ¡ Vomer ¡ Zygoma ¡ Maxilla ¡ Mandible

6. THE TEMPORAL BONE

External Ear & Petrous Temporal

• External auditory meatus • Auricle & its innervation • Tympanic membrane • Tympanic ring • Mastoid air cells

Middle Ear

• Floor & roof features, windows & • Ossicular chain joints & ligaments foramina • Muscles • Ossicular Chain ¡ Tensor tympani ¡ Malleus ¡ Stapedius ¡ Incus • Jacobson’s nerve ¡ Stapes • Nerves ¡ Facial nerve ¡ Chorda tympani

Inner Ear

• Bony & membranous labyrinth • Dorello’s canal, abducens n. • Facial nerve canal, course & parts • Cochlear aqueduct • Stylomastoid foramen • Vestibular aqueduct

• Condylar fossa & eminence • Joint capsule • Articular disc & components • Normal motional variants • Condyle & articular cartilage • Fully open & closed positional anatomy

8. MANDIBLE

• Condyle, neck, ramus & body • Mental nerve • Muscle attachments • Dental nerves • Inferior alveolar artery & nerve • Nerve to mylohyoid • Canals & foramina • Inferior alveolar vein ¡ Mandibular canal ¡ Lingula ¡ Inferior alveolar foramen ¡ Mental foramen

9. THE TEETH

• Dental terminology ¡ Mesial-distal, buccal-lingual, crown-roots • Parts of tooth ¡ Crown, neck, root, root canal, enamel, dentine, pulp cavity, roots • Numbering and naming (FDI terminology)

10. SUPERFICIAL FACE

• Veins • Veins • Muscles of facial expression ¡ Facial vein ¡ Supratrochlear & supraorbital ¡ Facial venous anastomoses ANATOMY

1. THE BRAIN White Matter

• Corpus callosum • Middle thalamic radiation • Anterior, posterior, habenular • Fornix and forniceal commissure • Spinothalamic tract and spinal commissures • Corticospinal tracts (and lemniscus • Posterior & inferior thalamic corticobulbar tract) • Medial lemniscus system radiations • Optic tract, geniculocalcarine tract • Spinocerebellar tracts • Auditory system and optic radiation • Rubrospinal tract ¡ Lateral lemniscus • Internal capsule & components ¡ Inferior brachium ¡ Auditory radiation • Association tracts (subcortical WM) • Anterior thalamic radiation • Trigeminothalamic tract • Reticular formation • Reticulospinal tracts Grey Matter Nuclei (Non-Cranial Nerve)

• Caudate nucleus • Putamen • Globus pallidus • Amygdala Cerebral Cortex

• Frontal, temporal & occipital poles • Important gyri • Other gyri • Frontal, temporal, parietal, & ¡ Frontal ¡ Pyriform cortex occipital lobes ¡ Orbital ¡ Insular gyri • Key gyri ¡ Superior parietal & paracentral ¡ Precentral lobules ¡ Postcentral ¡ Gyrus rectus ¡ Precuneus ¡ Supramarginal and angular ¡ Calcarine ¡ Cuneus ¡ Cingulate ¡ Lingual ¡ Operculum ¡ Occipitotemporal • Hippocampus & components ¡ Temporal • Parahippocampal gyrus & subiculum Cerebral Sulci

• Interhemispheric fissure • Circular sulcus • Temporooccipital notch • Lateral (Sylvian) fissure • Collateral sulcus • Occipitotemporal • Central (Rolandic) sulcus • Superior & inferior frontal • Fimbriodentate • Callosal sulcus • Superior & inferior temporal • Intraparietal • Cingulate sulcus • Postcentral • Subparietal • Parietooccipital fissure • Calcarine sulcus

• Cortical motor system • Olfactory system • Cortical sensory system • Speech: Broca & Wernicke areas • Auditory system • Visual System 2. THE BRAINSTEM

White Matter

• Cerebral peduncle • Superior cerebellar peduncle • Middle cerebellar peduncle • Inferior cerebellar peduncle • Pyramid and pyramidal decussation Grey Matter Nuclei (Non-Cranial Nerve)

• Thalamus • Subthalamic nucleus • All other thalamic nuclei ¡ Lateral and medial genicular • Thalamic nuclei bodies ¡ Ventral posterior nucleus • Pineal gland • Red nucleus • Posterior pituitary • Pontine nuclei (neurohypophysis) • Olivary nucleus • Substantia nigra • Hypothalamus • Superior and inferior colliculi ¡ Infundibulum ¡ Mammillary body 3. VENTRICULAR SYSTEM

• Lateral ventricles • Septum pellucidum, velum • Third ventricle & boundaries interpositum • Cerebral aqueduct • Choroid fissures of lateral • Fourth ventricle ventricles • Obex, median (Magendie) and • Superior medullary velum lateral (Luschka) foramina • Features of fourth ventricle floor • Choroid plexus 4. BASAL CSF CISTERNS

• Suprasellar cistern • Interpeduncular cistern • Ambient cistern • Quadrigeminal cistern • Prepontine cistern • Cerebellopontine cistern • Premedullary & perimedullary cisterns • Cisterna magna ANATOMY

• Sella turcica • Diaphragma sellae • ICA dural rings • Cavernous sinus, walls and contents • Neurohypophysis & Stalk • Adenohypophysis • Pituitary blood supply & portal system • Planum sphenoidale 6. THE CRANIAL NERVES

Cranial Nerve Systems

• Olfactory bulb & tract • Edinger-Westphal nucleus • Retina, optic nerve & chiasm • Spinal trigeminal tract nucleus • Oculomotor nerve & nucleus, • Superior salivary nucleus, Lacrimal ciliary ganglion nucleus, Facial motor nucleus, • Trochlear nucleus & n. facial sensory components • Trigeminal nuclei, ganglion & • Vestibular nuclei, cochlear nucleus roots • Inferior salivary nucleus • Abducens nucleus & n. • Motor & dorsal nuclei • Facial nucleus & n. • Multi-nerve nuclei • Vestibulocochlear nerve & spiral ¡ Spinal nucleus of trigeminal ganglion nerve • Glossopharyngeal nerve & ganglia ¡ Nucleus of tractus solitarius • Vagus nerve & ganglia ¡ Nucleus ambiguus • Accessory nucleus & n. • Mesencephalic ganglion • Hypoglossal nucleus & n. • Trigeminothalamic tract Organisation of Cranial Nerve Nuclei

• Somatic motor efferent • Brachiomotor efferent ¡ Hypoglossal, abducens, ¡ Nucleus ambiguus trochlear, oculomotor • Somatic sensory • Brachiomotor efferent ¡ Mesencephalic, spinal ¡ Motor nucleus of VII • Visceral sensory ¡ Motor nucleus of V ¡ Nucleus of tractus solitarius • Somatic sensory • Visceral motor efferent ¡ Trigeminal sensory ¡ Dorsal nucleus of vagus, • Vestibular and cochlear nuclei salivary, lacrimal, Edinger Westphal 7. THE MENINGES

• Pia mater (in general) • Meningeal blood supply • Arachnoid mater (in general) • Meningeal innervation • Dura mater (in general) • Falx cerebri • Tentorium cerebelli • Falx cerebelli • Middle meningeal artery • Subarachnoid space (in general) • Subdural space (in general) • Extradural space (in general)

• Neocerebellum • Superior & inferior medullary • Vermis velum • Cerebellar tonsils • Dentate nuclei • Superior, middle and inferior peduncles 9. VASCULAR SUPPLY TO THE BRAIN

Arterial

• Internal carotid arteries, branches • Extradural ICA branches • Anterior choroidal artery & segments ¡ Inferolateral trunk • Anterolateral and anteromedial • Ophthalmic artery and branches ¡ Menigohypophyseal trunk perforating arteries including • Circle of Willis configuration and ¡ Artery of Vidian canal artery of Heubner common variations • Intracranial – extracranial • Middle cerebral artery (MCA), anastomoses segments & branches ¡ Ophthalmic/facial • Anterior cerebral artery (ACA), ¡ Inferolateral & maxillary segments & branches • Posterolateral perforating arteries • Anterior communicating artery • Posteromedial perforating arteries (AComA) • Basilar and vertebral perforators • Posterior cerebral artery (PCA), segments & branches • Vertebral & basilar artery • Anterior & posterior spinal arteries • Posterior communicating artery (PComA) • Cerebellar arteries (SCA, AICA, PICA) • Arterial territories on cross- sectional imaging, variations Venous

• Ophthalmic vein • Venous territories and overlap • Internal cerebral vein • Thalamostriate vein • Basal vein (of Rosenthal) • Septal veins • Great cerebral vein (of Galen) • Anterior cerebral vein • Venous sinuses • Deep middle cerebral vein • Cortical veins • Superior anastomotic vein (of Trolard) • Inferior anastomotic vein (of Labbe) • Superficial middle cerebral vein ANATOMY

Spinal Cord Structure

• Craniocervical junction • Cervical enlargement • Cervical cord • Thoracic cord • Lumbar enlargement • Conus medullaris • Filum terminale • Cauda equina Spinal Grey Matter

• Anterior horn and motor neurons • Lateral horn and autonomic • Laminae of gray matter • Posterior horn and sensory neurons neurons • Dorsal root ganglion • Central canal Spinal White Matter Tracts

• Anterolateral funiculi (columns) • Reticulospinal tract • All other tracts ¡ Corticospinal tract • Ventral white commissure ¡ Medial longitudinal fasciculus ¡ Spinothalamic tract • Lateral funiculi (columns) ¡ Corticospinal tract ¡ Corticorubral tract ¡ Spinocerebellar tracts • Dorsal funiculi (columns) ¡ Fasciculus and nucleus gracilis ¡ Fasciculus and nucleus cuneatus Spinal CSF Spaces & Coverings

• Ventral nerve roots • Dorsal nerve roots • Denticulate ligament • Pia mater • Arachnoid mater • Dura mater • Subarachnoid space • Subdural space • Epidural (extradural) space Functional Anatomical Systems of the Cord

• Lumbar enlargement • Thoracic autonomic outflow • Pain & temperature sensation • Sacral autonomic outflow • Vibration & proprioception sensation

• Anterior spinal artery • Spinal segmental veins • Posterior spinal artery • Spinal segmental reinforcing arteries (esp. Adamkiewicz) • Spinal venous plexus ANATOMY

1. MUSCLES OF THE NECK

• Suprahyoid muscles (digastric, sternohyoid, mylohyoid) • Infrahyoid muscles (sternothyroid, thyrohyoid, sternohyoid, omohyoid)

2. VISCERAL AXIS OF THE NECK

• Hyoid bone and related muscles and ligaments

Larynx

• Laryngeal cartilages • Fibromuscular structures & folds • Saccule • Laryngeal divisions: supraglottic, • Intrinsic muscles glottic and subglottic • Vestibule, ventricle/sinus • Pyriform recess/sinus/fossa

Pharyngeal Muscles

• Circular • Longitudinal ¡ Superior constrictor & ¡ Stylopharyngeus components ¡ Palatopharyngeus ¡ Middle constrictor ¡ Salpingopharyngeus ¡ Inferior constrictor & components

Nasopharynx

• Palatine tonsil, its features and • Boundaries relations • Auditory/Eustachian tube • Rosenmüller fossa

Oropharynx

• Palatine tonsil, its features and • Boundaries relations • Palatine tonsil, blood supply

Laryngopharynx (Hypopharynx)

• Boundaries

Thyroid gland

• Parts • Relations • Arteries and veins

• Location & Relations

3. FASCIAE & SPACES OF THE NECK

Superficial Layer of Deep Cervical Fascia (DCF)

• Spaces & their contents ¡ Masticator space ¡ Parotid space ¡ Submandibular & sublingual spaces ¡ Suprasternal space (of Burns)

Deep layer of DCF

• Perivertebral space • “Danger space” and its significance

Middle layer of DCF

• Buccopharyngeal fascia • Cloison sagittale • Pharyngobasilar fascia

Other spaces:

• Parapharyngeal space • Pre-styloid & retrostyloid • Anterior, posterior cervical, • Retropharyngeal space parapharyngeal spaces suboccipital triangles • Visceral space

4. INFRATEMPORAL & TEMPORAL FOSSAE

Temporal Fossa

• Temporalis muscle • Masseter muscle • Zygomatic arch ANATOMY

• Muscles ¡ Medial pterygoid ¡ Lateral pterygoid ¡ Pterygopalatine fossa ¡ Palatine plates ¡ Contents • Foramen ovale • Nerves ¡ Mandibular n. & branches ¡ Maxillary n. & branches ¡ Pterygopalatine ganglion • Vessels ¡ Maxillary artery & branches ¡ Deep maxillary vein ¡ Pterygoid venous plexus

5. THE TONGUE

• Muscles • Other Muscles ¡ Genioglossus ¡ Geniohyoid ¡ Mylohyoid ¡ Intrinsic muscles ¡ Hyoglossus ¡ Styloglossus • Hyoid bone ¡ Palatoglossus • Mylohyoid sling • Lingual vein • Lingual artery, nerve and chorda tympani • Facial artery & vein • Hypoglossal & glossopharyngeal nerves • Lymphatic drainage

6. BLOOD VESSELS AND NERVES OF THE NECK

• Common carotid artery, course, • Relations of external carotid and relations, vertebral level of Internal carotid arteries in the bifurcation neck • Relations of common carotid artery

• All branches of external carotid • Branches (especially cutaneous artery and their relations branches & phrenic nerve) • Vertebral artery in the neck • Thyrocervical trunk and its branches in the neck

• Internal jugular vein and its relations • Anterior, external jugular veins, their course, origin and termination, relations

Page 96 © 2014 RANZCR. Radiodiagnosis Training Program – Curriculum Version 2.2 • Cervical plexus • Branches (especially cutaneous ¡ Topography,relations with branches & phrenic nerve) scaleni anterior and medius ¡ Relations with sternomastoid

Brachial plexus in the neck

• Topography, relations • Formation, roots and trunks and branches in the neck

7. CAROTID SHEATH

• Internal carotid artery • Jugular tributaries • External carotid artery and its • Carotid sympathetic plexus head branches • Internal-external carotid • Internal jugular vein anastomoses • Carotid body • Nerves ¡ Glossopharyngeal ¡ Vagus ¡ Accessory ¡ Hypoglossal

8. LYMPH NODES

• Traditional divisions ¡ Superficial cervical chain ¡ Spinal accessory chain ¡ Deep cervical chain ¡ Jugulo-digastric and jugulo- omohyoid, Virchow nodes ¡ Retropharyngeal nodes ¡ Transverse cervical chain

• Imaging-based classification ¡ Levels I – VI

9. SECTIONAL ANATOMY

• Cross sections (horizontal sections) of the neck at all vertebral levels • Median section (Mid-sagittal section) of the neck • Cross sections of the larynx and pharynx ANATOMY

Clavicle, Scapula and Humerus

• Bony features • Attachments of muscles • Articular surfaces • Joint capsular attachments • Attachments of ligaments • Epiphyses – (sites, dates of appearance/fusion) Radius and Ulna

• Bony features • Attachments of muscles • Articular surfaces • Joint capsular attachments • Attachments of ligaments • Epiphyses (sites, dates of appearance/fusion) Carpal Bones

• Names of all bones • Articular surfaces • Attachments of muscles • Bony features • Ossification Metacarpals & Phalanges

• Bony features • Sesamoids • Attachments of muscles • Articular surfaces • Joint capsular attachments • Epiphyses (sites, dates of appearance/fusion) 2. JOINT

Joints of the Shoulder Girdle

• Acromioclavicular joint • Sternoclavicular joint

Shoulder Joint

• Articular surfaces • Tendon of long head of biceps • Glenohumeral ligaments • Fibrous capsule & joint cavity • Subacromial bursa • Labrum Elbow Joint

• Articular surfaces • Carrying angle • Olecranon bursa • Fibrous capsule & joint cavity • Pads of fat Radioulnar Joints

• Proximal radioulnar joint • Articular disc • Distal radioulnar joint

• Articular surfaces • Capsule & ligaments Joints of the Hand

• Intercarpal joints • Carpometacarpal joints • 1st carpometacarpal joint • Intermetacarpal joints • Metacarpophalangeal joints • Interphalangeal joints 3. LIGAMENTS

Clavicular

• Coracoclavicular ligament • Costoclavicular ligament • Anterior & posterior sternoclavicular ligaments Acromioclavicular

• Acromioclavicular ligament

Shoulder

• Coracoacromial ligament • Coracohumeral ligament • Glenohumeral ligaments Elbow

• Collateral ligaments

Radioulnar

• Annular ligament

Metacarpophalangeal

• Palmar ligaments (Plates) • Collateral ligaments Interphalangeal

• Collateral ligaments • Palmar ligaments (Plates) 4. MUSCLE/GROUP

Muscles of the Shoulder (Pectoral) Girdle and Upper Arm

• Subscapularis • Pectoralis major • Subclavius • Supraspinatus • Pectoralis minor • Infraspinatus • Serratus anterior • Teres minor • Deltoid • Biceps (brachii) • Teres major • Coracobrachialis • Brachialis • Triceps (brachii) ANATOMY

• Flexor compartment superficial • Flexor compartment very deep layer: layer: ¡ Pronator teres • Pronator quadratus ¡ Flexor carpi radialis ¡ Palmaris longus ¡ Flexor carpi ulnaris • Intermediate layer: ¡ Flexor digitorum superficialis • Deep layer: ¡ Flexor pollicis longus ¡ Flexor digitorum profundus • Extensor compartment superficial layer lateral group: ¡ Brachioradialis ¡ Ext. carpi radialis longus ¡ Ext. carpi radialis brevis • Extensor compartment superficial • Extensor compartment superficial layer posterior group: layer posterior group: ¡ Extensor digitorum ¡ Anconeus ¡ Ext. digiti minimi ¡ Extensor carpi ulnaris • Extensor compartment deep layer: ¡ Abductor pollicis longus ¡ Extensor pollicis brevis ¡ Extensor pollicis longus ¡ Extensor indicis ¡ Supinator Deep Fascia

• Flexor Retinaculum • Interosseus membrane • Extensor retinaculum • Palmar aponeurosis • Fibrous flexor sheaths of digits • Deep transverse metacarpal ligament Long Tendons and Synovial Sheaths

• Flexor tendons • Extensor tendons

• Intrinsic muscles of palm 1st layer: • Intrinsic muscles of palm 4th ¡ Abductor pollicis brevis layer: ¡ Flexor pollicis brevis ¡ 3 Palmar interossei ¡ Flexor digit minimi ¡ Abductor digit minimi • Intrinsic muscles of palm 2nd layer: ¡ 4 lumbricals (from long tendons) • Intrinsic muscles of palm 3rd layer: ¡ Opponens pollicis ¡ Adductor pollicis ¡ Opponens digit minimi • Intrinsic muscles of palm 4th layer 5. ARTERIAL STRUCTURE

Axillary (all Category 1 except as shown)

• Subscapular artery • Circumflex humeral arteries (anterior & posterior) Brachial

• Profunda brachii artery

Radial & Ulnar

• Anterior & posterior interosseous • Superficial palmar arch • Deep palmar arch • Digital arteries 6. VENOUS STRUCTURE

Superficial Veins

• Cephalic • Dorsal venous arch • Basilic • Communications: Medial cubital vein Deep Veins

• Axillary vein • Venae comitantes

7. LYMPHATICS

Axillary Lymph Nodes (all Category 1 except as indicated) • Apical, central, lateral, posterior, • Supratrochlear lymph nodes subscapular groups ANATOMY

Axillary

• All category 1 except upper lateral • Upper lateral cutaneous nerve of cutaneous N. of arm arm Musculocutaneous

• Lateral cutaneous nerve of forearm Median

• Median nerve course, relations • Recurrent (Thenar) branch • Anterior interosseus nerve and innervation • All other median branches except anterior interosseous Ulnar Nerve

• Ulnar nerve course, relations and • Deep (terminal) branch • Dorsal branch innervation • Superficial (terminal) branch Radial Nerve

• Radial nerve course, relations and • Deep Branch (posterior • Superficial (terminal) branch innervation interosseus nerve) Brachial Plexus (Infraclavicular Part) and Branches

Lateral Cord (all Category 2 except as indicated):

• Lateral pectoral nerve

Medial Cord (all Category 2 except as indicated)

• Medial pectoral nerve • Medial cut. nerves of arm & forearm Posterior Cord (all Category 2 except as indicated):

• Upper & lower subscapular • Thoracodorsal nerves Branches from Supraclavicular Part of Brachial Plexus

• Long thoracic nerve • Suprascapular nerve • Nerve to subclavius • Nerve to rhomboids 9. REGIONS ANTERIOR

Pectoral Region

• Breast • Boundaries • Others • Contents

• Boundaries • Contents Anterior Compartment of Arm

• Boundaries • Contents Cubital Fossa

• Boundaries • Contents Anterior Compartment of Forearm

• Boundaries • Contents Carpal Tunnel

• Boundaries • Contents Palm of Hand

• Boundaries • Contents Palmar Aspect of Digits

• Boundaries • Contents 10. REGIONS POSTERIOR

Scapular Region

• Boundaries • Contents Deltoid Region

• Boundaries • Contents Posterior Compartment of Arm

• Boundaries • Contents Posterior Compartment of Forearm

• Boundaries • Contents Anatomical Snuff Box

• Boundaries • Contents ANATOMY

• Boundaries • Contents Dorsal Aspect of Digits

• Boundaries • Contents 11. COMMON VARIANTS (all Category 1 except as indicated) • Bony/ligamentous • Muscular • Vascular • Nervous

Hip Bone, Femur and Patella

• Parts • Attachments of muscles • Bony features • Attachments of ligaments • Articular surfaces • Epiphyses (sites, dates of appearance) Tibia and Fibula

•Parts • Attachments of muscles • Bony features • Articular surfaces • Attachments of ligaments • Epiphyses (sites, dates of appearance) Bones of the Foot

• Tarsal bones • Navicular & cuboid • Cuneiforms • Talus & calcaneus • Metatarsals • Ossification • Accessory bones and sesamoids • Phalanges • Epiphyses 2. JOINTS

Hip Joint

• Articular surfaces • Bursae • Fibrous capsule and retinacular • Pad of fat fibres • Acetabular labrum Knee Joint

• Articular surfaces (patello-femoral • Synovial membrane • Intracapsular tendon of popliteus & femoro-tibial) • Bursae: suprapatellar, prepatellar, • Fibrous capsule & deficiencies semimembranosus • Menisci (medial & lateral) • Infapatellar pad of fat Tibiofibular Joints

• Distal tibiofibular joint • Proximal tibiofibular joint (Syndesmosis) Ankle Joint

• Articular surfaces • Fibrous capsule ANATOMY

• Subtalar & talocalcaneonavicular • Other intertarsal joints (including joints calcaneocuboid) • Tarsometatarsal & intermetatarsal joints • Metatarsophalangeal & interphalangeal joints 3. LIGAMENTS

Hip Bone

• Inguinal ligament

Hip Joint

• Iliofemoral ligament • Transverse acetabular ligament • Pubofemoral ligament • Ligament of head of femur • Ischiofemoral ligament Knee Joint

• Ligamentum patellae • Oblique popliteal • Arcuate popliteal, transverse • Collateral ligaments (medial & • Intermeniscal ligaments • Coronary lateral) • Patellar retinacula • Ligamentum mucosum • Cruciate ligaments (anterior & posterior) Deep Fascia

• Deep transverse metatarsal ligament Ankle Joint

• Collateral ligaments (medial & lateral) Joints of Foot

• Interosseous talocalcaneal • Plantar plates ligament • Spring ligament • Bifurcate ligament • Cervical ligament • Collateral ligaments 4. MUSCLE

Muscles of Hip and Thigh

• From posterior abdominal wall • Psoas major (& minor) • Iliacus

• Piriformis • Gluteus maximus • Tensor fascia lata • Gluteus medius • Superior gemellus • Gluteus minimus • Inferior gemellus • Obturator internus • Quadratus femoris Anterior Compartment of Thigh

• Sartorius • Rectus femoris • Vastus lateralis • Vastus medialis • Vastus intermedius • Pectineus Medial Compartment of Thigh

• Gracilis • Adductor longus • Adductor brevis • Adductor magnus • Obturator externus Posterior Compartment of Thigh

• Semitendinosus • Semimembranosus • Biceps femoris Muscles of Leg

• Anterior compartment ¡ Tibialis anterior ¡ Extensor hallucis ¡ Extensor digitorum ¡ Peroneus tertius • Lateral compartment ¡ Peroneus longus ¡ Peroneus brevis Posterior Compartment of Leg

• Popliteus • Plantaris • Gastrocnemius • Soleus • Flexor digitorum longus • Flexor hallucis longus • Tibialis posterior Deep Fascia

• Flexor Retinaculum • Extensor retinacula • Peroneal retinacula • Plantar aponeurosis • Fibrous flexor sheaths of digits • Synovial sheaths ANATOMY

• Extensor tendons • Peroneal tendons • Flexor tendons Muscles of the Foot

• Intrinsic muscle(s) of dorsum • Intrinsic muscles of sole ¡ Extensor digitorum (& hallucis) ¡ Abductor hallucis brevis ¡ Flexor digitorum brevis • Intrinsic muscles of sole ¡ Abductor digiti minimi ¡ Flexor hallucis brevis ¡ Flexor accessorius ¡ Adductor hallucis ¡ 4 lumbricals ¡ Dorsal interossei ¡ Flexor digiti ¡ Minimi brevis ¡ Plantar interossei Arches of the Foot

• Longitudinal arch • Transverse arch • (Medial & lateral) 5. ARTERIAL STRUCTURES

Femoral

• Profunda femoris artery • Medial & lateral circumflex • Perforating arteries • Dorsalis pedis Femoral arteries • Genicular arteries • Popliteal • Plantar vascular arches • Posterior tibial • Lateral & medial plantar arteries • Anterior tibial • Digital arteries • Peroneal 6. VENOUS STRUCTURES

Superficial

• Great saphenous • Small saphenous

Deep Veins

• Femoral vein • Popliteal vein • Venae comitantes of arteries • Venous plexus (sinuses) in soleus 7. LYMPHATICS

• Superficial inguinal (horizontal & • Popliteal vertical) • Deep inguinal 8. NERVES

Thigh

• Saphenous nerve • Obturator nerve • Sciatic nerve

• Common peroneal nerve • Sural nerve • Superficial peroneal nerve • Medial plantar nerve • Deep peroneal nerve • Lateral plantar nerve • Superficial & deep terminal branches 9. REGIONS ANTERIOR

Femoral Triangle & Subsartorial Canal

• Boundaries & contents

Anterior & Medial Compartments of Thigh

• Boundaries & contents

Anterior & Lateral Compartments of Leg

• Boundaries & contents

Dorsum of Foot & Digits

• Boundaries & contents

10. REGIONS POSTERIOR

Gluteal Region

• Boundaries & contents

Posterior Compartment of Thigh & Popliteal Fossa

• Boundaries • Contents

Posterior Compartment of Leg

• Boundaries & contents

Tarsal Tunnel & Sole of Foot

• Boundaries & contents

Plantar Aspect of Digits

• Boundaries & contents ANATOMY

• Cervical vertebra including atlas and axis • Thoracic vertebrae • Lumbar vertebrae • Sacrum • Coccyx • Features of vertebrae (body, pedicle, facets etc) • Intervertebral foramina 2. Joints

• Atlantoaxial joints • Atlantooccipital joints (median and lateral) • Costovertebral and • Intervertebral discs costotransverse joints • Zygapophyseal (facet) joints • Sacrococcygeal joint • Sacroiliac joints 3. Ligaments

• Ligamentum flavum • Anterior and posterior longitudinal • Interspinous and supraspinous • Transverse ligament of atlas ligaments ligaments • Apical and alar ligaments • Intertransverse ligaments • Cruciform ligament • Ligamentum nuchae (nuchal ligament) • Tectorial membrane • Anterior and posterior atlantooccipital membranes • Anterior and posterior atlantoaxial membranes 4. Muscles

• Extrinsic back muscles • Spinalis • Intrinsic back muscles • Longissimus • Splenius capitis and cervicis • Iliocostalis • Erector spinae group • Semispinalis muscles • Transversospinalis group • Rotatores • Multifidus • Intertransversarii and interspinales • Suboccipital muscles muscles 5. Vertebral canal and contents

• Spinal cord and nerve roots including cauda equina • Dura mater and dural sleeves • Subarachnoid space including lumbar cistern • Epidural space

• Vertebral artery • Spinal arteries • Artery of Adamkiewicz 7. Veins

• Epidural venous plexus • Batson vertebral plexus ANATOMY

• Ribs • Clavicle • Sternum • Costal cartilages • Typical thoracic vertebral bodies • Scapula 2. JOINT

• Sternoclavicular joint • Costochondral joint • Manubriosternal joint • Costocervical joint 3. LIGAMENT

• Arcuate ligament • Central tendon of the diaphragm • Pulmonary ligament • Ligamentum arteriosum • Pericardial ligament 4. MUSCLE

• Diaphragm • Scapular muscles • Serratus muscles, posterior • Intercostal muscles • Paravertebral muscles • Pectoral muscles • Serratus muscle, anterior 5. ARTERIAL STRUCTURE

• Aorta • Thyrocervical trunk • Lateral thoracic artery • Brachiocephalic artery • Costocervical trunk • Dorsal scapular artery • Common carotid arteries • Thyroidea ima artery • Subclavian arteries • Pulmonary arteries • Bronchial arteries • Right and left internal mammary arteries • Coronary arteries • Intercostal arteries, posterior and anterior 6. VENOUS STRUCTURE

• SVC and IVC • Accessory hemiazygous vein • Internal mammary veins • Brachiocephalic veins • Superior and supreme intercostal • Thebesian veins • Subclavian veins veins • Azygous vein • Lateral thoracic vein • Hemiazygous vein • Pulmonary veins • Coronary veins 7. LYMPHATICS

• Thoracic duct • Cisterna chyli • Intrathoracic nodal groups

• Recurrent laryngeal nerve • Intercostal nerves • Cardiac plexus • Phrenic nerve • Vagus nerves • Spinal cord 9. RADIOLOGICAL SPACES

• Pleural spaces • Pericardial spaces 10. HOLLOW VISCUS

• Oesophagus • Trachea • Bronchial tree 11. SOLID VISCUS

• Lung • Heart • Thymus 12. CROSS SECTION

• Level of T5

13. UNCLASSIFIABLE

• Superior thoracic aperture (thoracic inlet) ANATOMY

• Aorta • Inferior phrenic • Median sacral • Parietal branches • Lumbar arteries • Common iliacs • Inferior and superior epigastric arteries 2. Arterial structure: Visceral branches

• Celiac • Adrenals • Duodenal • Common hepatic • Gonadals • Pancreatic • SMA • Splenic • Gastric • IMA • Genital • Gallbladder • Renals 3. Ligament

• Inguinal ligament and associated structures 4. Radiological Spaces

Retroperitoneal

• Renal fasciae and spaces • Anterior pararenal spaces Intraperitoneal Spaces & Cavities • Greater sac • Lesser sac • Right mesenteric space • Left mesenteric space • Supramesocolic • Inframesocolic • Right and left paracolic • Inguinal canal • Scrotal sac 5. Neural tract or nerve

• Lumbar nerves and plexus • Vagus nerves • Greater, lesser, least splanchnics • Thoracoabdominal and subcostal • Autonomic plexuses and ganglia nerves in abdominal wall • Sympathetic trunk and ganglia

• Oesophagus (abdo) • Stomach • Duodenum • Jejunum • Ileum • Caecum • Appendix • Colon • Renal pelves and ureters • Gallbladder • Biliary tree 7. Venous Structures

• Common iliacs • Gonadal veins • IVC and tributaries • Ascending lumbar vein • Portal system • Portosystemic anastomoses 8. Cross Section

• Identifications at any level transverse or coronal 9. Bone

• Ribs

10. Muscle/group

• Rectus abdominis and fascias • Posterior abdominal muscles and • Anterolateral abdominal muscles fasciae and aponeuroses • Psoas 11. Fascias

• Properitoneal and retroperitoneal • Superficial abdominal fascia

12. Lymphatics

• Common iliac nodes • Cisterna chyli • Paraaortic nodes • Preaortic nodes • Portal, portocaval nodes • Peripancreatic nodes • External iliac nodes ANATOMY

• Liver, specifically • Couinaud segments • Venous anatomy • Spleen • Suprarenal glands • Kidneys • Pancreas • Testis (note: ovary is classified in pelvis)

• Ilium • Ischium • Pubis • Sacrum 2. JOINT

• Sacroiliac joints • Pubic symphysis • Lumbosacral joint 3. LIGAMENT

• Sacrotuberous ligament • Sacrospinous ligament • Sacroiliac ligaments 4. MUSCLE

• Levator ani and coccygeus • Piriformis (pelvic floor) • Obturator internus 5. ARTERIAL STRUCTURE

• Internal iliac artery • Superior and inferior gluteal • Umbilical artery • Superior, middle and inferior arteries • Superior and inferior vesical rectal arteries • Obturator artery arteries • Internal pudendal artery • Vaginal artery • Ovarian artery • Uterine artery • Iliolumbar artery and lateral • Median sacral artery sacral arteries 6. VENOUS STRUCTURE

• Internal iliac vein • Pelvic venous plexuses: prostate, • Internal pudendal vein bladder, uterus, vagina 7. LYMPHATICS

• Internal iliac lymph nodes

8. NERVES

• Sacral plexus • Superior & inferior gluteal nerves • Lumbosacral trunk • Hypogastric nerves • Sciatic nerve • Inferior hypogastric plexus • Pudendal nerve • Pelvic splanchnic nerves • Obturator nerve (parasympathetic) • Cauda equina • Sacral splanchnic nerves (sympathetic) ANATOMY

• Greater and lesser sciatic foramen • Superficial and deep perineal • Presacral and rectovesical fascia • Rectouterine & rectovesical pouches pouches • Ischioanal fossae • Mesorectal fascia 10. VISCERA

• Rectum and anal canal • Seminal vesicles and ejaculatory • Bladder and urethra (male and ducts female) • Uterus • Uterine tubes & broad ligament • Ovaries • Vagina • Pelvic ureters • Prostate • Ductus deferens and spermatic cord • External genitalia (male and female) • Testis and epididymis 11. CROSS SECTION

• Midline sagittal hemipelvis

12. UNCLASSIFIABLE

• Pelvic inlet and outlet