Anatomy Upper Limb Bones of upper extremity 1. Largest carpal bone is the Capitate bone. 2. Ossification centre for lunate appears at 4 years. 3. The ossification centre of pisiform bone appears at the age of 12-13 years. 4. Third metacarpal has epiphysis at head. Joints of upper limb 1. The term "Dynamic stabilizer of shoulder joint" is used for Rotator cuff. 2. Subscapular bursa communicates with the shoulder joint. 3. Pectoralis minor has no action at shoulder joint. The main action of the pectoralis minor muscle is to move the scapula or shoulder blade. 4. Metacarpophalangeal joint is a synovial joint of the condylar variety. 5. Upward rotation of the glenoid cavity during overhead abduction of shoulder occurs by Trapezius and Serratus anterior. 6. Rupture of supraspinatus manifests as difficulty in initiation of abduction. 7. Wrist joint is an ellipsoid joint. 8. Wrist joint is formed by articulation of the lower end of radius, articular disc and carpal bones. 9. Adduction of hand at wrist is done by Flexor carpi ulnaris and extensor carpi ulnaris! 10. The weight of the upper limb is transmitted to the axial skeleton by the coracoclavicular ligament. Nerves of Upper Limb 1. Suprascapular nerve is a branch from the upper trunk of the brachial plexus. 2. Root value of thoracodorsal nerve(middle subscapular nerve) is C6,C7,C8. 3. Median nerve carries fibres from all the roots of brachial plexus. 4. Erb's point is at the junction of C5, C6. 5. Klumpke's paralysis involves C8 and Tl. Median Nerve 1. Median nerve is also known as the "laborer's nerve". 2. Median nerve injury at wrist, is commonly tested by the contraction of abductor pollicis brevis. 3. Median nerve injury at the wrist causes loss of opposition of thumb. 4. Compression of a nerve within the carpal tunnel produces inability to oppose the thumb. 5. Pointing index sign is seen in Median nerve palsy. 6. Ape thumb deformity is seen in involvement of the Median nerve. 7. Nerve damaged due to lunate dislocation (in carpal tunnel) is the Median Nerve. 8. Median nerve injury at elbow affects flexion at DIP joints of2nd finger, flexion at PIP joints of 3rd finger and flexion at DIP of 1st fingers. Ulnar Nerve 1. Deep branch of ulnar nerve supplies the Adductor pollicis . 2. Loss of extension of little and ring finger, along with hypothenar atrophy is seen in injury of Ulnar nerve. 3. Froment's sign is characteristically seen in Ulnar nerve injury. 4. Claw hand is caused by lesion of the Ulnar nerve. 5. Low ulnar nerve palsy is characterized by increase in severity of claw hand (Ulnar Paradox). 6. injury to the Ulnar nerve at the wrist causes paralysis of Adduction of the thumb. 7. A cut injury of the ulnar nerve results in the loss of all interossei. 8. Wasting of the intrinsic muscles of the hand can be expected to follow injury of the Ulnar nerve. 9. Adduction of thumb is lost in ulnar nerve injury. 10. The term "Guyon's canal" is in relation to the Ulnar nerve. Radial nerve 1. Damage to the radial nerve in the spiral groove spares Long head of triceps. 2. Injury to radial nerve in lower part of spiral groove leaves extensions at elbow joint intact. 3. ECRL will be paralyzed when radial nerve is injured just below the spiral groove. 4. Wrist drop is due to injury of Radial nerve. 5. The thumb action that is totally affected in radial nerve trauma is extension. 6. Lower lateral cutaneous nerve of arm is a branch of the Radial nerve. Other Nerves 1. Axillary nerve supplies the Deltoid + Teres minor. 2. Carpel tunnel syndrome is due to compression of the Median nerve. 3. The nerve supply of nail bed of index finger is the Median nerve. Muscles of upper limb 1. Perforating branch of internal thoracic artery supplies the Pectoralis Major. 2. Serratus anterior muscle helps in forced inspiration. 3. Winging of scapula is due to paralysis of Serratus anterior. 4. Teres major muscle is supplied by the Lower subscapular nerve. 5. Latissimus dorsi is inserted into the floor of the intertubercular sulcus or bicipital groove of the humerus. 6. Anatomically a muscle of upper limb, but functionally related to the trunk is the Latissimus dorsi. 7. The muscle that crosses both the shoulder and elbow joint is Biceps brachii. 8. Biceps brachii is supplied by Musculocutaneous nerve. 9. Coracobrachialis is pierced by Musculocutaneous Nerve. 10. Lumbricals originate from the tendons of Flexor Digitorum Profundus muscle. Vessels of upper limb 1. Occlusion occurs at the 2nd part of axillary artery, blood flow is maintained by anastomosis between the deep branch of the transverse cervical artery and the subscapular artery. 2. Arteries forming anastomosis around surgical neck of humerus take origin from the 3rd part of axillary artery (ie. Anterior & Posterior Circumflex Humeral Artery) 3. Anastomosis around the shoulder is for connection of the 1st part of subclavian artery with 3rd part of axillary artery. 4. Nerve running along with Profunda brachii artery, in spiral groove is the Radial Nerve. 5. Interosseous membrane of forearm is pierced by the Anterior interosseous artery. 6. Recurrent interosseous artery is a branch of the Posterior Interosseous Artery. Important spaces and structures 1. Lateral border of cubital fossa is formed by Brachioradialis. 2. Abductor pollicis longus and Extensor pollicis brevis form the lateral boundary of the anatomical snuff box. 3. Radial Artery is a content of anatomical snuffbox are. 4. Nerve related to anatomical snuff box is the Superficial branch of radial nerve(Present in roof). 5. Radial bursa is the synovial sheath covering the tendon of FPL. 6. Infection of index finger spread to the thenar space. Breast & Axilla 1. Level 3 axillary lymph nodes is the Apical. 2. Clavipectoral fascia is derived from Costocoracoid membrane. 3. Lymphatic drainage of upper outer quadrant of breast anterior axillary lymph nodes. Lower Limb Bones of Lower Extremity 1. Angle of the neck of femur to shaft is 125°. 2. Linea aspera continues as gluteal tuberosity. 3. Lower end of femur is ossified from 1 ossification center. 4. The nutrient artery to the femur is the Profunda femoris artery. 5. Ligament supporting the talus is the Spring ligament. Vessels of lower limb 1. Femoral artery begins at the mid-inguinal point. 2. Femoral artery lies midway between the ASIS & pubic symphysis. 3. The superficial external pudendal artery is a branch of the Femoral artery. 4. Popliteal artery is difficult to palpate because it is not superficial & does not pass over prominent bony structure. 5. Dorsalis pedis artery is the continuation of the Anterior tibial artery. 6. Line from mid inguinal point to adductor tubercle represent Femoral artery. 7. Main blood supply to the head and neck of femur comes from the Medial circumflex femoral Artery. 8. The blood supply to femoral head is mostly by the Profunda femoris. 9. Peroneal artery is a branch of the Posterior tibial artery. 10. Nutrient artery arises to fibula from the Peroneal artery. Venous Drainage 1. The Great saphenous vein starts as a continuation of medial marginal vein. 2. The Saphenous opening is covered by cribriform fascia. 3. Hunterian perforators are seen in mid-thigh. Muscles of Lower Extremity 1. Gluteus maximus is inserted on Iliotibial Tract. 2. Gluteus medius is supplied by the Superior Gluteal Nerve. 3. Gluteus maximus is supplied by the Inferior gluteal nerve. 4. Gluteus medius muscle is supplied by the Superior gluteal artery. 5. Gluteus Medius is attached to lateral surface of greater trochanter. 6. Gluteus maximus is involved in movements from sitting to standing position. 7. Rectus femoris attaches to capsule of hip joint. 8. Tibialis posterior originates from both tibia and fibula and interosseous membrane. 9. Extensor hallucis longus is supplied by the Deep peroneal nerve. 10. First layer of sole has Abductor hallucis . 11. Popliteus is an intra-articular tendon. 12. Site of injection in gluteus is superolateral. 13. Longest muscle in the body is Sartorius. 14. Plantaris is more likely to rupture during violent dorsiflexion of the foot. 15. The sacrotuberous ligament represents the origin of Long head of biceps femoris. 16. Flexor hallucis longus passes below the sustentaculum Tali. 17. Tibialis Posterior has attachments on sustentaculum Tali. 18. Gastro-soleus is known as 'Triceps surae". Femoral triangle 1. In femoral triangle the most medial structure seen is Lymphatics. 2. Adductor canal lies beneath the Sartorius. 3. Structure passing deep to flexor retinaculum is Post tibial artery. 4. Gluteofemoral bursa is in between gluteus maximus and Vastus lateralis. Joints of the lower extremity 1. Iliofemoral ligament arise from the anterior inferior iliac spine. 2. Iliofemoral ligament prevents hyperextension of hip. 3. Capsule of the hip joint is attached to the intertrochanteric line. 4. Femoral nerve supplies the hip joint. 5. Trendelenburg sign is due to paralysis of the Gluteus medius. 6. Major extensor of the thigh is Gluteus maximus. 7. Strongest flexor of the hip is Iliopsoas muscle. Knee joint 1. Coronary ligament is present between Menisci and tibial condyle 2. Oblique popliteal ligament is pierced by the Middle genicular branch of popliteal artery. 3. Posterior cruciate ligament prevents posterior dislocation of tibia. 4. The blood supply of anterior cruciate ligament (ACL) is primarily derived from Middle genicular artery. 5. Anterior cruciate ligament prevents anterior dislocation of tibia. 6. Synovial membrane of knee joint is invaginated posteriorly by cruciate ligament. 7. Physiological locking is internal rotation of femur over stabilized tibia. 8. Physiological unlocking is caused by Popliteus. 9. Medial rotation of tibia in flexed leg is brought about by Popliteus.