DISSECTION SCHEDULE Session I - Pectoral Region Surface anatomy Self study ØØØ Clavicle and its ends ØØØ Sternal angle, xiphoid process, jugular ••• Location, extent, relations, notch blood supply, lymphatic ØØØ Ribs and cartilages drainage, applied anatomy of breast ØØØ Nipple and areola ØØØ Axilla and axillary folds ••• Axillary lymph nodes Dissection ••• ØØØ Cutaneous nerves & vessels Attachments (proximal & distal), nerve ØØØ Deep fascia, clavipectoral supply and actions of fascia pectoralis major ØØØ Breast (in female body) ØØØ Pectoralis major muscle ••• Clavicle - attachments, movements & special ØØØ Cephalic vein features Session II - Axilla (Vessels) Dissection Self study Muscles ••• Boundaries and contents of axilla ØØØ Pectoralis minor ØØØ Coracobrachialis, short head of biceps ••• Origin, course, termination & branches of Nerves axillary artery ØØØ Lateral and medial pectoral nerves ØØØ Median nerve ••• Attachments, nerve supply & actions of ØØØ ØØ Ulnar nerve pectoralis minor ØØØ Musculocutaneous nerve ØØØ Medial cutaneous nerve of arm and forearm; intercostobrachial nerve Vessels ØØØ Thoracoacromial artery ØØØ Axillary artery and vein Other structures ØØØ Axillary pad of fat ØØØ Axillary lymph nodes Session III - Axilla (Brachial Plexus) Dissection Self study Nerves ••• Formation, parts, distribution of brachial ØØØ Cords of brachial plexus plexus ØØØ Median nerve ØØØ Musculocutaneous nerve ••• ØØØ Ulnar nerve Sternoclavicular joint - Type, description, ØØØ Radial nerve movements ØØØ Axillary nerve ØØØ Upper and lower subscapular nerves ••• Root value of median, ulnar, radial, ØØØ Thoracodorsal nerve musculocutaneous & axillary nerves Vessels ØØØ Subscapular artery ØØØ Circumflex scapular artery Joint ØØØ Sternoclavicular joint ØØØ Costoclavicular ligament Session IV - Scapular Region Surface anatomy Self study ØØØ Spine of scapula, ØØØ Inferior angle of scapula ••• Scapula ØØØ Acromion Attachments, ØØØ Spines of vertebrae C7, T1-T12 Movements of scapula Dissection ••• Shoulder girdle Muscles ØØØ Trapezius ••• Anastomosis around the scapula ØØØ Latissimus dorsi ØØØ Levator scapulae ØØØ Rhomboid minor ØØØ Rhomboid major Nerves ØØØ Spinal accessory nerve ØØØ Dorsal scapular nerve Vessels ØØØ Superficial and deep branches of tranverse cervical artery Session V - Free upper limb & Shoulder Surface anatomy Self study ØØØ Greater tubercle of humerus ØØØ Medial and lateral epicondyles of ••• Cutaneous nerves - dermatomes humerus ••• Bones Veins of upper limb ØØØ Humerus, radius, ulna Superficial Deep Dissection ØØØ Cutaneous nerves ••• Lymph vessels and lymph nodes of upper ØØØ Cutaneous vessels limb ØØØ Veins - cephalic, basilic ••• Deep fascia of upper limb Muscles ØØØ Deltoid ••• ØØØ Supraspinatus Muscles connecting trunk to scapula ØØØ Infraspinatus Attachments, nerve supply, actions ØØØ Teres major ØØØ Teres minor ••• Muscles connecting scapula to humerus ØØØ Long head of triceps brachii Attachments, nerve supply, actions ØØØ Subscapularis ØØØ Long head of biceps brachii ••• Shoulder joint – Type, articulation, ØØØ Quadrangular space ligaments, relations, blood supply, nerve ØØØ Upper and lower triangular spaces of supply, movements and muscles producing arm them Vessels Ø Suprascapular vessels ••• Nerve Ø Suprascapular nerve Differences between Shoulder girdle movements and Ligaments Shoulder joint movements ØØØ Coracoclavicular ligament ØØØ Coracoacromial ligament Joints: ØØØ Interior of shoulder joint ØØØ Glenoid labrum ØØØ Gleno-humeral ligaments ØØØ Acromio-clavicular joint ØØØ Subscapular bursa ØØØ Subacromial bursa Session VI - Arm Dissection Self study Muscles ØØØ Coracobrachialis ••• Attachments, nerve supply and actions of ØØØ Biceps brachii (two heads) biceps brachii, coracobrachialis, brachialis & ØØØ Brachialis triceps ØØØ Triceps brachii (three heads) Nerves ØØØ Median nerve ••• Origin, root value, course and distribution of ØØØ Ulnar nerve musculocutaneous, axillary nerve and ØØØ Radial nerve radial nerve ØØØ Musculocutaneous nerve Vessels ••• Origin, course, termination and branches of ØØØ Brachial artery and branches brachial artery & profunda brachii artery ØØØ Profunda brachii artery and branches ••• Boundaries and contents of cubital fossa Cubital Fossa Session VII - Forearm and Hand (Superficial) Dissection Self study ••• Attachments, nerve supply and actions of ØØØ Superficial muscles of the forearm Pronator teres ØØØ Flexor retinaculum Flexor carpi radialis ØØØ Radial artery Palmaris longus ØØØ Ulnar artery Flexor digitorum superficialis ØØØ Palmar aponeurosis Flexor carpi ulnaris ØØØ Palmaris brevis ØØØ Superficial palmar arch ••• Formation, relations & branches of Superficial ØØØ Branches of median nerve & ulnar palmar arch nerve in the palm ØØØ Flexor tendons, lumbricals ØØØ Fibrous flexor sheath ••• Formation and attachments of Palmar ØØØ Synovial sheath aponeurosis ••• Boundaries & contents of Carpal tunnel ••• Attachments of Flexor retinaculum Session VIII- Forearm (Deep) Dissection Self study ØØØ Deep muscles of forearm ••• Attachments, nerve supply and actions of ØØØ Median nerve Flexor digitorum profundus ØØØ Anterior Interosseus nerve Flexor pollicis longus ØØØ Ulnar nerve Pronator quadratus ØØØ Radial artery ••• Origin, course, relations And branches of ØØØ Ulnar artery Radial artery ØØØ Anterior interosseus artery Ulnar artery ••• Anastomosis around the elbow joint ••• Origin, root value, course and distribution of Median nerve & Ulnar nerve Session IX - Hand (Deep) Dissection Self study ØØØ Muscles of thenar eminence ••• Boundaries and clinical importance of fascial ØØØ Muscles of hypothenar eminence spaces of palm ØØØ Adductor pollicis ••• Attachments, nerve supply and actions of ØØØ Deep palmar arch Abductor pollicis brevis ØØØ Deep branch of ulnar nerve Flexor pollicis brevis ØØØ Palmar interossei Opponens pollicis Abductor digiti minimi Opponens digiti minimi Adductor pollicis ••• Formations, relations and branches of deep palmar arch ••• Movements of thumb Session X - Forearm and Hand (Extensor Aspect) Dissection Self study ØØØ Muscles of extensor compartment ••• Attachments, nerve supply and actions of all ØØØ Extensor retinaculum & its six extensor muscles, palmar and dorsal compartments & contents interossei, lumbricals ØØØ ØØ Extensor expansion ••• Attachments of extensor retinaculum and ØØØ Posterior interosseus nerve & vessels compartments & contents ØØØ Dorsal interossei ••• Extensor expansion - Formation & actions ••• Movements of fingers & thumb ••• Boundaries and contents of anatomical snuff box Session XI - Joints Dissection Self study ØØØ Elbow joint ••• Type, articulation, ligaments, relations, ØØØ Wrist joint nerve supply, movements of ØØØ Radio-ulnar joints Elbow joint Wrist joint Revision and study of bones Radio-ulnar joints Intercarpal, carpometacarpal and intermetacarpal joints Metacarpophalangeal joints Interphalangeal joints DEMONSTRATIONS TOPICS ANNEXED TO SESSION GOALS 1 Clavicle ••• Mammary gland 2 Axilla - boundaries and contents ••• Axillary lymph nodes 3 Brachial plexus ••• 4 Scapula; muscles of the back •• Movements of pectoral girdle 5 Humerus; Shoulder joint; muscles of the ••• Scapular anastomosis shoulder region ••• Dermatomes and myotomes 6 Muscles, vessels & nerves of arm; cubital ••• fossa Elbow anastomosis 7 Radius & ulna ••• Superficial and deep palmar arches 8 Muscles, vessels & nerves of flexor ••• Movements of thumb & Carpal tunnel compartment of forearm ••• Fascial spaces of palm 9 Articulated hand; palmar aponeurosis, ••• nerves of the hand Extensor expansion 10 Muscles, vessels & nerves of back of forearm ••• Radio-ulnar & Metacarpophalangeal joints 11 Elbow, wrist and 1st CMC joints Topics for Clinical Integration (covered in Applied Anatomy lecture) ••• Nerve injuries at different levels of median, radial and ulnar nerves ••• Concept of common fractures and dislocations ••• Surgical approaches Wilhelm Heinrich Erb (1840 –1921) He was a German neurologist. He began his medical career in the fields of toxicology and histology, but later his interest switched to neurology. Erb’s point - an anatomical location 2-3 cm above the clavicle, at the upper trunk of brachial plexus where six nerves meet. Erb’s palsy or Erb-Duchenne palsy - lesion of upper trunk of brachial plexus.