Impulse

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IMPULSE ‘21
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CHAPTERWISE
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PREVIOUS YEARS SOLVED QUESTION PAPERS
ANATOMY PHYSIOLOGY BIOCHEMISTRY
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KUHS SYLLABUS FOLLOWED

REFERENCE
Textbook of Anatomy- Vishram Singh, 3rd edition
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Human Embryology- Inderber Singh, 10th edition
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Textbook of Medical Physiology- GK Pal
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Physicon- Sanoop KS, Mridul GS, Nishanth PS

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Biochemistry- U Satyanarayana
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THANK ALMIGHTY
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ACKNOWLEDGEMENT
ASSOCIATE EDITOR
ATUL VINCENT
AKSHAY KUMAR
BHARATH LAL
CREATIVE DIRECTOR
ANANDHU LAL
SIBIN JOSEPH CYRIAC
SAHIL M S
CONTENT EDITORS
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NOUSHAD PARACKAL ABHIJITH SATHEESAN
UNNIKRISHNAN SHAMUVEL JOE
USAMA AHAMED MANOOP M P
FAWAS YUSEF SAYANTH B KUMAR
SARATH MONI AKHIL H K
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SIVAPRASAD AMITH PADAVIL

RONET PAUL ABHIJITH SHIBU
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MUHAMMED SUHAIL SULFIKER THAJUDEEN

BINIL SHAJAN NIKHIL KUMAR
DEVAKRISHNAN ASIF KALANGADAN
PRINCE FERDINENT MAJIDGAFFAR
SIDHARTH NAIR MUHAMMAD JUNAID
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ALFIN BASIL PAULOSE

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ASHITH SURESH SREEVISHNU

ANAS ABDUL KAREEM MUHAMMAD JAFEER
PRAJITH P ZAJID RAHMAN
MUHAMMED SHIBIL
SPECIAL COURTESY
SREEYESH MANIKANDAN
CHIEF EDITOR
ASIF ABBAS
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PREFACE
First of all, I thank Almighty for his blessings during the completion of this venture.
Without him, nothing was possible.
With great pride we present to you the IMPULSE Series. It’s been a tedious task, but the
satisfaction in having an endeavour is worth remembering.
For all those medicos out there, we are sure that this book will help you in great detail.
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Most of the questions asked in the university exams (KUHS-FIRST MBBS) are
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previously asked.And we believe, studying these questions will guaranty a sure pass in the
university exams.This book contains all the previous year question papers and their solutions in
chapter wise manner. Diagrams and answers were taken from different standard text books in
order to make the solutions simpler and easily understandable.
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I hope that this book will definitely solve the problems of students and relieve them from
pre-examination stress. However the student should be aware that this book is meant only for
revision purpose and not to replace the standard textbooks.
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I am confident this book will serve the purpose for which it meant.
Wishing each student a productive time ahead. All the best!
Asif Abbas
CONTENTS
ANATOMY
Upper Limb ................................................................................ 01
Lower Limb ............................................................................... 36
Thorax ........................................................................................ 65
Abdomen, Pelvis & Perineum .................................................... 96
Head, Neck & Brain .................................................................. 140
General Anatomy ..................................................................... 196
Embryology .............................................................................. 206
PHYSIOLOGY
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Blood ........................................................................................ 237
CVS ........................................................................................... 252
Respiration ............................................................................... 273
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GIT ........................................................................................... 297

Renal System............................................................................ 314
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Endocrinology .......................................................................... 330

CNS .......................................................................................... 352
Muscle Physiology.................................................................... 375
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BIOCHEMISTRY
Carbohydrates Chemistry & Metabolism ................................. 380
Lipid Chemistry & Metabolism ................................................. 398
Protein Chemistry & Metabolism ............................................. 409
Enzymology .............................................................................. 424
Nutrition .................................................................................. 436
Genetics ................................................................................... 449
MISC-I ...................................................................................... 473
MISC-II ..................................................................................... 479
UPPER LIMB IMPULSE ‘21
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UPPER LIMB
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ESSAYS UPPER LIMB IMPULSE ‘21
AUGUST 2012
1. A football player fell heavily and dislocated his right shoulder joint while playing. A collar and
cuff support was given, after reducing the disloation. Subsequently an orthopaedic surgeon
notied that his right shoulder was less prominenty than the left. The player was finding it
difficult to abduct the arm to the horizontal level.
•Based on your anatomical knowledge answer the following questions:
•What anatomical features make the shoulder joint particularly prone to dislocation.
•Briefly describe the most stabilizing structure of the joint and why the head of the humerus is
often displaced downwards.
•In this case, what is the cause of subsequent flattening of the right shoulder and the difficulty
in abducting the arm to a horizontal level.
•Briefly mention the ligaments and the muscles acting at the shoulder joint.
(2+2½+1+4½ = 10)
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Answers:
•What anatomical features make the shoulder joint particularly prone to dislocation.
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Laxity of fibrous capsule
Small and shallow glenoid cavity
Large head of the humerus fitting with relatively shallow glenoid cavity.
•Briefly describe the most stabilizing structure of the joint and why the head of the humerus is
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often displaced downwards.

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Supraspinatous and tension of upper part of capsule and coracohumeral ligament prevents
downward displacement of humerus.
Musculotendinous rotator cuff formed by Supraspinatous, infraspinatous, teres minor,
subsapularis blending with fibrous capsule.
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•In this case, what is the cause of subsequent flattening of the right shoulder and the difficulty
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in abducting the arm to a horizontal level.

Normally the shoulder is rounded due to the shape provided by humerus and deltoid. Shoulder
appears flat if head is not in its place.
Glenohumeral joint contributes to 90-120 degree of abduction.
Here the joint is dislocated, so abduction above horizontal level is not possible.
•Briefly mention the ligaments and the muscles acting at the shoulder joint.
Ligaments
Capsular ligament
Attachments
Medially: To peripheral margin of glenoid cavity outside the glenoid labrum. The supraglenoid
tubercle is intracapsular.
Laterally: To anatomical neck of humerus except onmedial side where it descends about 2-3 cm
on the shaft, up to the surgical neck of humerus.
Muscles strengthening the capsule: In general, the capsule is loose and lax; but its strengthened
bu the rotator cuff formed by following muscles:
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Supraspinatus above, Subscapularis infront

Infraspinatus and Teses minor, behind.
Transverse humeral ligament: This ligament bridges across the bicipital groove.
Glenohumeral ligaments: These are thickenings in the anterior part of the capsule and are seen
when the capsule is exposed from the behind. They are 3 in number and named superior, middle,
and inferior glenohumeral ligaments according to their location.
Coracohumeral ligament: It is a wide, strong fibrous band on the superior surface of the joint,
extending from base of coracoid process to the anterior aspect of greater tubercle of humerus.
Coracoacromial ligament: It extends between lateral side of coracoid process to the medial
border of acromion.
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Muscles
Flexion: Circular head of Pectoralis major, Deltoid(anterior)
Anterior muscles: Coracobrachialis, Short head of biceps brachii.
Extention: Deltoid(post fibres),LatismussDorsi
Accessory muscles: Teres major, long head of triceps brachii, sternocoastal head of pectoralis
major.
Abduction: Supraspinatus(upto15 degree), acromial fibers of deltoid (upto90)
Adduction: Pectoralis Major, Latissmusdorsi
Medial Rotation:Pectoralis Major, Deltoid, Teres Major, LatissmusDorsi
Lateral Rotation: Infraspinatus, Deltoid, Teres minor
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Applied Anatomy
Dislocation of shoulder joint
The shoulder joint is most commonly dislocated joint in the body due to: (i) disproportionate size
of articular surfaces: head of humerus and glenoid cavity of the scapula. The head of humerus is
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larger to fit properly into smaller glenoid cavity (4:1 ratio) and (ii) laxity of joint capsule.
Dislocation most commonly occurs inferiorly because the joint is least supported below
Frozen shoulder (adhesive capsulitis) It is a clinical condition characterized by painful and
uniform restriction of all movements of shoulder joint. It occurs due to shrinkage of joint capsule
leading to adhesion between rotator cuff and head of humerus.
FEBRUARY 2013
2. A 48 year old women came to surgery out-patient department with complaint of a lump in
her right breast. On examination, surgeon found that the lump was hard and painless and in
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upper outer quadrant of right breast. Axillary lymph nodes on theright side were enlarged and
right breast was not mobile. Histopatologial examination revelaed malignancy of right breast.
With your knowledge in anatomy answer the following questions:
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•What is the normal extent of breast both vertically and horizontally.
•Name three muscles related to the base of the breast.
•What could be the reason for loss of mobility of breast in this condition.
•Describe the lymphatic drainage of breast.
•Describe the arterial supply of breast.
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(1+1½+1+3½+3=10)
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Answers:
•What is the normal extent of breast both vertically and horizontally.
Vertically: It extends from 2nd to 6th rib
in midclavicular line.
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Horizontally:It extends from lateral

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border of the sternum to the

midaxillary line.
•Name three muscles related to the

base of the breast.
Pectoralis major, Serratus anterior,
External oblique muscle of abdomen
•What could be the reason for loss of

mobility of breast in this condition.
Cancer cells infiltrate the suspensory
ligaments making the breast fixed.
•Describe the lymphatic drainage of

breast.
Lymphatic Drainage
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2 Sets:
(a) Set draining the nipple, areola, and parenchyma; (b) Set draining overlying skin excluding
nipple and areola.
a)Those draining the parenchyma including areola and nipple form subareolar plexus of
Sappey, which drains as under:
75% into axillary group of lymph nodes chiefly into anterior (or pectoral) group. Some reach
posterior group. Efferents from these pass to central and thence into apical group.
20% drain into parasternal (internal mammary) nodes.
50% drain into posterior intercostal nodes.
b)Those draining the overlying skin excluding
areola and nipple drain into:
Axillary nodes-from outer part
Supraclavicular nodes-from upper part
Parasternal nodes-from inner part
Subdiaphragmatic nodes-from inner part
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•Describe the arterial supply of breast.
Arterial Supply:
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Internal thoracic artery through its 2nd, 3rd, and 4th
perforating branches, which passes through
intercostal spaces.
Lateral thoracic, superior thoracic, and
acromiothoracic branches of the axillary artery.
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Lateral branches of the posterior intercostal

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arteries.
Applied Anatomy
Carcinoma of the breast:
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The cancer cells may infiltrate the suspensory ligaments (Cooper's ligaments) and as a result the
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breast becomes fixed and immobile.

The contraction of the ligaments causes retraction or puckering of the skin.
The infiltration of the lactiferous duct and their consequent fibrosis leads to retraction of the
nipple. . Secondary breast cancer are usually lodged in the liver, ovaries, or the peritoneum
making the prognosis worse.
The cancer cells may migratetranscelomically to ovary producing a secondary tumor called
Krukenberg tumor.
The cancer cells can also spread to the vertebrae and the brain via venous route, through
communication between the veins draining the breast and the vertebral venous plexus.
Peaud'orange: In breast cancer, the skin over the breast presents an orange peel-
appearance.This occurs due to obstruction of cutaneous lymphatics leading to breast edema
and deepening of the mouths of sweat glands and hair follicles.
FEBRUARY, 2016
3. A football player dislocated his right shoulder while playing. The dislocation was reduced
under general anesthesia. He was discharged from the hospital with a collar and cuff support.
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Subsequently, an orthopaedic surgeon noticed that his right shoulder was less prominent than
the left. The player was finding it difficult to abduct the arm to a horizontal level. Based on
your knowledge in anatomy, answer the following questions.
•Mention the anatomical features which render the shoulder joint more prone to dislocation.
•What is the cause of subsequent flattening of the shoulder and difficulty in abducting the arm
to a horizontal level?
•Name the muscles involved in intiating abduction and overhead abduction.
•Briefly mention the movements occurring at the shoulder joint and the muscles producing
these movements.
•State the reasons, why the head of the humerus is often displaced downwards.
(2+1+2+4+1=10)
Answers:
•Mention the anatomical features which render the shoulder joint more prone to dislocation.
Laxity of fibrous capsule
Small and shallow glenoid cavity
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Large head of the humerus fitting with relatively shallow glenoid cavity.
Disproportionate size of glenoid cavity and head of humerus.
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•What is the cause of subsequent flattening of the shoulder and difficulty in abducting the arm
to a horizontal level?
Injury to the axillary nerve caused paralysis of deltoid muscle.
•Name the muscles involved in intiating abduction and overhead abduction.

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Initial 15 degree by supraspinatous.

Upto 90 degree by acromianfibres of deltoid.
90-120 degree by serratus anterior.
120-180 by Serratus anterior and trapezious.
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•Briefly mention the movements occurring at the shoulder joint and the muscles producing
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these movements.
Movements
Flexion- Anterior fibres of deltoid
Clavicularfibres of pectoralis major
Extension- Posterior fibres of deltoid
Lattismusdorsi
Abdution- given above
Adduction- sterna fibres of pectoralis major
Medial rotation- Pectoralis major, Anteriorfibres of deltoid, Lattismusdorsi, Teres major.
Lateral rotation- Posterior fibres of deltoid, infraspinatous, teres minor.
•State the reasons, why the head of the humerus is often displaced downwards.
Head of humerus presses against the lower unsupported part of the capsular ligament  hence
dislocated downwards.
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AUGUST, 2016
4. A 25 year old cricket player sustained injury in his left arm. On x-ray examination, a fracture
of shaft of humerus was observed. Following internal reduction of fracture, he was not able to
extend his left wrist. Based on your knowledge in anatomy answer the following questions:
•Injury to which nerve in the arm can produce inability to extend the wrist and why.
•Briefly describe the origin, ourse, and distribution of the nerve involved.
•Name the other nerves that are closely related to the humerus, giving its appropriate
sitesand effects of injury.
Answer:
•Injury to which nerve in the arm can produce inability to extend the wrist and why.
Radial Nerve, because it supplies the extensor compartment of the forearm as well as triceps of
arm.
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•Briefly describe the origin, course, and distribution of the nerve involved.
The radial nerve is the thickest and largest nerve of the upper limb.
Root Value : Ventral rami of C5, C6, C7 , C8, and T1.
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Origin, Course and Relations:
It arises from the posterior cord of brachial plexus in axilla behind the 3rd part of the axillary
artery.
It is the thickest and largest branch of the brachial plexus.
It courses successively through 3 regions: axilla, radial groove on the back of arm, and front of
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forearm.
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On the front of forearm, it ends by dividing into superficial and deep terminal branches. The
course and relations of radial nerve in 3 regions traversed by it are as follows:
Axilla: In the axilla, the radial nerve lies against the muscles forming the posterior wall of axilla,
i.e. subscapularis, teres major, and latissimusdorsi. Then it passes through the lower triangular
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space
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betweenteres major, long head of triceps brachii, and shaft of humerus. In axilla, it gives two
muscular branches to supply long and medial heads of triceps and one cutaneous branch
(posterior cutaneus nerve of arm).
Radial groove: The radial nerve from axilla, enters into the radial groove through the lower
triangular space where it lies between the long and medial heads of triceps brachii along with
profundabrachii
artery. It leaves the radial groove by piercing the lateral intermuscular septum. In the radial
groove, it gives 3 muscular branches to supply long and medial heads of triceps and anconeus
and 2 cutaneous
branches, viz., lower lateral cutaneous nerve of arm and posterior cutaneous nerve of forearm.
Front of arm: The radial nerve enters the lower anterolateral part of the front of arm and lies
between brachialis on the medial side and brachioradialis and extensor carpi radialislongus on
the lateral side. It supplies all these muscles.
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Forearm: The radial nerve enters the cubital fossa where in front of lateral epicondyle it ends by
dividing into two terminal branches: (a) superficial terminalbranch (superficial radial nerve) and
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(b) deep terminal branch (post. interosseous nerve).

Deep terminal branch (posterior interosseous nerve): It lies in the lateral part of cubital fossa,
where it supplies extensor carpi radialisbrevis and supinator muscles. Then it enters into the
back of forearm by passing through supinator muscle. Here, it supplies abductor pollicislongus,
extensor pollicisbreyis, extensor pollicislongus, extensor digitorum, extensor indicis, extensor
digitiminimi, and extensor carpi ulnaris. At the back of wrist, it ends in a pseudoganglion,
branches of which supply the wrist and distal radioulnar joints.
Superficial branch (superficial radial nerve) it is regarded as the downward continuation of the
trunk of radial nerve. It runs on the lateral side of the front of forearm accompanied by the radial
artery in the upper 2/3rd of forearm with radial artery being on its medial side. About
7 cm above the wrist, it curves posteriorly deep to tendon of brachioradialis to reach the
anatomical snuff box. Here, it divides into 4 or 5 digital branches, which supply the skin of lateral
half of dorsum of hand and lateral 2½ digits till their distal interphalangeal joints.
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Branches
Axilla:
Muscular branches: Long and medial heads of triceps brachii
Cutaneous branches: Posterior cutaneous nerve of arm
Radial groove
Muscular
Lateral head oftricepsbrachii
Medial head of triceps brachii
Anconeus
Cutaneous
Lower lateral cutaneous nerve ofarm
Posterior cutaneous nerve offorearm
Vascular
To profundabrachii artery
ln the arm
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Muscular
Brachioradialis
Extensor carpi radialislongus
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Lateral part ofbrachialis (proprioceptive)
ln the forearm
Superficial terminal branch: Digital branches to supply the skin of lateral half of dorsum and
lateral 3.5 digits up to distal interphalangeal (DIP) joints.
Deep terminal branch (posterior interosseous nerve): Muscular branches to all the muscles of
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back of forearm except anconeus, brachioradialis, and extensor carpi radialislongus.

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•Name the other nerves that are closely related to the humerus, giving its appropriate
sitesand effects of injury.
Axillary nerve around surgical neck.
Radial nerve in radial groove.
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Ulnar nerve behind medial epicondyle.

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AUGUST, 2017
5. Assisted delivery was required during the birth of a baby at term. The maneuver involved an
unusually wide stretching at the neck shoulder angle. The neonate on examination by a
neurologist showed upper brachial plexus injury. Answer the following based on your
knowledge:
•Describe the formation and braches of the brachial plexus. Explain the anatomical basis of
the above lesion.
Answers:
Formation
It is formed by central divisions of C5, C6, C7 , C8, and T1.
Components
Roots, Trunks, Divisions, Cords
Location
Roots and trunks lie in the root of neck
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Division lies behind the clavicle.

Cords lie in the axilla.
Branches:
From roots
Dorsal scapular nerve (C5) for
rhomboids.
Nerve to serratus anterior (C5,
C6, and C7).
From trunk (only upper trunk
gives branches)
Suprascapular nerve (C5 and
C6) for supraspinatus and
infraspinatus muscles.
Nerve to subclavius.
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From Lateral cords
Lateral cord
Lateral pectoral nerve (C5-C7)
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Musculocutaneous nerve (C5-
C7)
Lateral root of median nerve
(C5-C7)
Mnemonic: Laila Loved Majnu
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From Medial cord

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Medial pectoral nerve for pectoralis major and pectoralis minor

Medial cutaneous nerve of arm
Medial cutaneous nerve of forearm
Medial root of median nerve
Ulnar nerve
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From Posterior cord

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Upper subscapular nerve for subscapularis muscle

Lower subscapular nerve for subscapularis and teres major muscles
Nerve to latissimusdorsi (thoracodorsal nerve)
Axillary nerve for deltoid and teres minor muscles
Radial nerve
Mnemonic: ULNAR
Applied Anatomy
Erb's paralysis: It occurs due to injury of the upper trunk of brachial plexus at the Erb's point
Kumpke'sparalysis:It occurs due to injury of the lower trunk of brachial plexus .
Horner's syndrome: It occurs due to involvement of the sympathetic fibres (T1).
Winging of scapula: It occurs due to injury of lhenerye to serratus anterior.
Erb's Paralysis
Site of injury: Erb's point (the region of upper trunk where 6 nerves meet, viz. ventral divisions
of C5 and C6, anterior and posterior divisions of the upper trunk, and suprascapular nerve and
nerve to subclavius) Cause: Too much separation of head from shoulder, e.g., (a) pulling of fetal
head by forceps during delivery (birth injury) and (b) fall on shoulder.
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Clinical features
Arm hangs by the side. It is adducted and medially rotated.
Forearm is extended and pronated.
Klumpke's paralysis
Site of injury: Lower trunk of brachial plexus involving C8 and T1.
Causes: Undue abduction of arm from body, e.8., (a) birth injury (pulling of upper limb during
delivery); (b) Reflex catching something with hand while falling from a height, viz. branch of a
treewhile falling from a tree.
Clinical features: Claw hand
Sensory loss along the medial border of forearm and hand
Horner's syndrome.
FEBRUARY, 2019
6. A 45 years old man was brought to the hospital with a fracture of the shaft of the humerus.
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On examitaion, he had impairment of extension of the wrist. Tere was also loss of cutaneous
sensation on the dorsum of the forearm and lateral aspect of dorsum of hand and lateral digits.
With your knowledge of anatomy, answer the flowing questions:
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•Name the structure involved at the site of fracture.
•Mention its origin, course and distribution.
•Mention its branches at different levels.
•Mentionthe reason for loss of cutaneous sensation in the areas mentioned.
•Name the accompanying blood vessel at the site of fracture.
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Answers:
•Name the structure involved at the site of frature.

Radial nerve
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•Mention its origin, course and distribution.

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Origin, Course and Relations:

It arises from the posterior cord of brachial plexus in axilla behind the 3rd part of the axillary
artery.
It is the thickest and largest branch of the brachial plexus.
It courses successively through 3 regions: axilla, radial groove on the back of arm, and front of
forearm.
On the front of forearm, it ends by dividing into superficial and deep terminal branches. The
course and relations of radial nerve in 3 regions traversed by it are as follows:
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Axilla: In the axilla, the radial nerve lies against the muscles forming the posterior wall of axilla,
i.e. subscapularis, teres major, and latissimusdorsi. Then it passes through the lower triangular
space between teres major, long head of triceps brachii, and shaft of humerus. In axilla, it gives
two muscular branches to supply long and medial heads of triceps and one cutaneous branch
(posterior cutaneus nerve of arm).
Radial groove: The radial nerve from axilla, enters into the radial groove through the lower
triangular space where it lies between the long and medial heads of triceps brachii along with
profundabrachii artery. It leaves the radial groove by piercing the lateral intermuscular septum.
In the radial groove, it gives 3 muscular branches to supply long and medial heads of triceps and
anconeus and 2 cutaneous branches, viz., lower lateral cutaneous nerve of arm and posterior
cutaneous nerve of forearm.
Front of arm: The radial nerve enters the lower anterolateral part of the front of arm and lies
between brachialis on the medial side and brachioradialis and extensor carpi radialislongus on
the lateral side. It supplies all these muscles.
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Forearm: The radial nerve enters the cubital fossa where in front of lateral epicondyle it ends by
dividing into two terminal branches: (a) superficial terminalbranch (superficial radial nerve) and
(b) deep terminal branch (post. interosseous nerve).
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Deep terminal branch (posterior interosseous nerve): It lies in the lateral part of cubital fossa,
where it supplies extensor carpi radialisbrevis and supinator muscles. Then it enters into the
back of forearm by passing through supinator muscle. Here, it supplies abductor pollicislongus,
extensor pollicisbreyis, extensor pollicislongus, extensor digitorum, extensor indicis, extensor
digiti minimi, and extensor carpi ulnaris. At the back of wrist, it ends in a pseudoganglion,
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branches of which supply the wrist and distal radioulnar joints.

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Superficial branch (superficial radial nerve) it is regarded as the downward continuation of the
trunk of radial nerve. It runs on the lateral side of the front of forearm accompanied by the radial
artery in the upper 2/3rd of forearm with radial artery being on its medial side. About
7 cm above the wrist, it curves posteriorly deep to tendon of brachioradialis to reach the
anatomical snuff box. Here, it divides into 4 or 5 digital branches, which supply the skin of lateral
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half of dorsum of hand and lateral 2½ digits till their distal interphalangeal joints.
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•Mention its branches at different levels.

In Axilla:
Muscular branches: Long and medial heads of triceps brachii
Cutaneous branches: Posterior cutaneous nerve of arm
In Radial groove
Muscular
Lateral head oftricepsbrachii
Medial head of triceps brachii
Anconeus
Cutaneous
Lower lateral cutaneous nerve ofarm
Posterior cutaneous nerve offorearm
Vascular
To profundabrachii artery
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ln the arm
Muscular
Brachioradialis
Extensor carpi radialislongus
Lateral part ofbrachialis (proprioceptive)
ln the forearm
Superficial terminal branch: Digital branches to supply the skin of lateral half of dorsum and
lateral 3.5 digits up to distal interphalangeal (DIP) joints.
Deep terminal branch (posterior interosseous nerve): Muscular branches to all the muscles of
back of forearm except anconeus, brachioradialis, and extensor carpi radialislongus.
•Mention the reason for loss of cutaneous sensation in the areas mentioned.
In the Axilla
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Loss of sensations:
Posterior surface of the lower part of arm.
Narrow strip on the back of forearm.
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Lateral part of the dorsum of hand and lateral 3 ½ digits.
In the Radial groove:
Loss of sensations on lateral part of the dorsum of hand and lateral 3 ½ digits.
In the proximal part of forearm
Loss of sensations on the lateral part of dorsum of hand and lateral 3 ½ digits.
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•Name the accompanying blood vessel at the site of fracture.

Profundabrachii artery
MARCH 2021
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7. Describe the Brachial Plexus under the following headings

Formation, Relations, Branches, Applied Anatomy
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Answers:
Formation
Components
Location
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Branches:
From roots
rhomboids
Nerve to serratus anterior
(C5, C6, and C7).
gives branches)
From cords
Lateral cord
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C7)
Lateral root of median nerYe
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(C5-C7)
From Medial cord
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Ulnar nerve
From Posterior cord
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Radial nerve
Mnemonic: ULNAR
Applied Anatomy
Kumpke's paralysis: It occurs due to injury of the lower trunk of brachial plexus .
Erb's Paralysis
Site of injury:Erb's point (the region of upper trunk where 6 nerves meet, viz. ventral divisions of
C5 and C6, anterior and posterior divisions of the upper trunk, and suprascapular nerve and
Clinical features
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Klumpke's paralysis
Horner's syndrome.
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NO
16
SHORT ESSAYS UPPER LIMB IMPULSE ‘21
SEPTEMBER 2011
7.Rotator cuff of shoulder joint.
The four of scapulohumeral muscles, viz.

supraspinatus infraspinatus, teres minor, and
subscapularis (often referred to as SITS muscles)
are called rotator cuff muscles for they form
musculotendinous/ rotator cuff around the
glenohumeral joint.
The rotator cuff is the name given to the tendons
of supraspinatus, infraspinatus, teres minor, and
subscapularis which are fused with the underlying
capsule of the glenohumeral joint. Tendon of
supraspinatus fuse superiorly, tendons of
infraspinatus and teres minor fuse posteriorly, and
LE
that of subscapularis fuse anteriorly. This cuff plays an important role in stabilizing the shoulder
joint.
The primary function of rotator cuff muscles is to grasp the relatively large head of humerus and
SA
hold it against the smaller, shallow glenoid cavity. The musculotendinous cuff is a fibrous sheath
around the shoulder joint.
MARCH 2012
8. Blood supply & Lymphatic drainage of the Breast.
R
Blood Supply
FO
Arterial Supply:
Internal thoracic artery through its 2nd, 3rd, and 4th perforating branches, which passes through
intercostal spaces.
Lateral thoracic, superior thoracic, and acromiothoracic branches of the axillary artery.
Lateral branches of the posterior intercostal arteries.
T
Venous Drainage:
NO
Axillary vein, Internal mammary vein, Intercostal veins

Lymphatic Drainage
2 Sets:
(a) Set draining the nipple, areola, and parenchyma; (b) Set draining overlying skin excluding
nipple and areola.
a)Those draining the parenchyma including areola and nipple form subareolar plexus of Sappey,
which drains as under:
20% draininto parasternal (internal mammary) nodes.
b)Those draining the overlying skin excluding areola and nipple drain into:
Subdiaphragmatic nodes-from inner part
17
AUGUST 2013
9. Inter muscular spaces of scapular region.
Quadrangular Space
Boundaries
Superior:
Subsapularisinfront
Teres minor behind
Capsule of the shoulder joint(in between
subscapularis and teres minor)
Inferior: Teres major
Medial: Long head of triceps brachii
LE
Lateral: Surgical head of humerus
Structures passing through the Space
Axillary nerve
SA
Posterior cirumflex humeral vessels
Applied Anatomy
The fracture of surgical neck ofhumerus may damage the axillary nerve leading to paralysis of
deltoid muscle.
R
Upper Triangular Space

FO
Boundaries
Superomedial: Teres minor
Lateral: Long head of triceps brachii
T
The circumflex scapular artery interrupts the origin of teres minor to reach the infraspinous
NO
fossa.
Applied Anatomy
The circumflex scapular artery anastomoses with the suprascapular and deep branch of the
transverse cervical arteries to form an important arterial anastomosis around scapula.
Lower Triangular Space

Boundaries
Medial: Long head of tripesbrachii
Lateral: Shaft of humerus
Superior :Teres major
Radial nerve
Profundabrahii vessels
Applied Anatomy
The fracture of middle third of humerus may damage radial nerve leading to wrist drop.
18
FEBRUARY 2014
10. Brachial Plexus
Formation
Components
Location
Branches:
From roots
LE
rhomboids
Nerve to serratus anterior
SA
(C5, C6, and C7).
gives branches)
R
FO
From cords
Lateral cord
T
C7)
NO
Lateral root of median nerYe

(C5-C7)
From Medial cord
Ulnar nerve
From Posterior cord
Radial nerve
Mnemonic: ULNAR
19
Applied Anatomy
Kumpke's paralysis: It occurs due to injury of the lower trunk of brachial plexus .
Erb's Paralysis
Site of injury:Erb's point (the region of upper trunk where 6 nerves meet, viz. ventral divisions of
C5 and C6, anterior and posterior divisions of the upper trunk, and suprascapular nerve and
Clinical features
LE
Klumpke's paralysis
SA
R
Horner's syndrome.
FO
AUGUST 2014
11. Deltoid muscle and its deep relations.
The deltoid is a three-in-one muscle. It is a triangular,

T
multipennate, and is present in the shoulder region.

NO
It is responsible for the rounded contour of the

shoulder.
Origin
The muscle arises as under:
Anterior unipennate part: From anterior border and
upper surface of lateral 1/3rd of clavicle.
Intermediate multipennate part: From lateral border
of acromion process of scapula.
Posterior unipennate part: From lower lip of crest of
spine of scapula.
Insertion
In the V-shaped deltoid tuberosity on the lateral
aspect of the shaft of humerus.
20
FEBRUARY 2015
12. Ulnar nerve in Hand.
The ulnar nerve is so named because it

runs along the ulnar side of the upper
limb.
Root Value: Ventral rami of C8 and
T1.It also gets contribution from
ventral ramus of C7.
Course and Relations
It is the continuation of the medial
cord of brachial plexus in the axilla. It
courses successively through 4
regions: axilla, arm, forearm, and
hand, where it terminates by dividing into superficial and deep branches.
LE
Hand: The nerye enters the palm by passing superficial to the flexor retinaculum and medial to
ulnar artery. At the distal border of flexor retinaculum, it ends by dividing into superficial and
deep terminal branches.
SA
Branches and Distribution
ln hand
Superficial terminal branch, which supplies:
Palmaris brevis muscle
Cutaneous innervation to medial 1/3rd of palm and medial 172 fingers, including their nail beds.
R
Deep terminal branch, which supplies:

FO
Medial two lumbricals.

Musles of hypothenar eminence (abductor digitiminimi, flexor digitiminimi, and
opponensdigitiminimi)
All the interossei (3 palmar and 4 dorsal)
Adductor pollicis
T
NO
13. Axillary Artery.
Source & Extent

It’s a continuation of sublavian artery into
axilla.
It extends from the outer border of 1sr rib
to the inferior border of teres major.
Parts
It is divided into 3 parts by pertoralis
minor:
1st part: proximal to the muscle
2nd part: behind the muscle
3rd part: distal to the muscle
Branches
They are 6 in number:
1st part gives 1 branch: superior thoraic artery
21
2nd part gives 2 branhes: (i) thoracoaromial artery, (ii) lateral thoracic artery
3rd part gives 3 branches: (i) subscapular artery, (ii) anterior circumflex umeral artery, and
(iii)posterior cirumflex humeral artery
Relations
LE
SA
R
FO
Applied Anatomy
The axillary artery can be effetively compressed against te upper part of shaft of humerus.
AUGUST 2015
T
14. Superficial palmar arch

NO
The superficial palmar arch is an irnportant

anastomosis between ulnar and radial arteries in the
palm of the hand.
Formation
It is formed by the superficial palmar branch of the
ulnar artery (the main continuation of ulnarartery).
The arch is completed on the lateral side by one of
the following arteries :
Superficial palmar branch of the radial artery.
Princepspollicis artery
Radialis indices artery
Location & Branches
The arch lies superficial to the long flexor tendons
with convexity directed distally.
It lies at the level of distal border of the fully
extended thumb.
22
It gives off 4 palmar digital arteries,which supply medial 3½ digits.

Applied Anatomy
The superficial palmar arch is one of the important anastomotic arterial channels for efficient
blood supply to the hand in case of blockage of the radial or ulnar artery.
FEBRUARY 2016
15. Median Nerve- branches, distribution, in forearm & hand and applied anatomy.
The median nerve is so called because it runs in the

median plane of the forearm.
Root Value: Ventral rami of C5 to C8 and Tl.
The median nerve is formed in the axilla by 2 roots-
lateral root from lateral cord of brachial plexus and
LE
medial root from medial cord of brachial plexus. Then it
courses successively through 4 regions:
axilla, arm, forearm, and palm of the hand. The medial
SA
root crosses the axillary artery to join the lateral root.
Forearm: In the forearm, the median nerve passes
through cubital fossa lying medial to the brachial
artery.It leaves the fossa between the two heads of
pronator teres before crossing superficial to the ulnar
R
artery from medial to lateral side and giving its anterior

FO
interosseousbranchbelow this. Then it passes deep to

fibrous arch of flexor digitorumsuperficialis. Adheres to
deep surface of flexor digitorumsuperficialis, leaves the
muscle, along its lateral border. About 5 cm above the
wrist it
T
lies between the tendons of palmarislongus and flexor

NO
carpi radialis. It enters the palm through carpal tunnel

under the flexor retinaculum, but in front of common
synovial sheath enclosing tendons of
flexordigitorumsuperficialis (FDS) and flexor
digitorumprofundus (FDP).
Palm: In the palm at the distal border of flexor
retinaculum, it ends by dividing into lateral and medial terminal branches. Before dividing into
terminal branches, the median nerve gives off a recurrent muscular branch from its lateral side.
Branches
Forearm:
Anterior interossei nerve: Lateral half of FDP, FPL, PronatorQuadratus.
Palmar cutaneous branch to supply lateral 2/3 of palm.
ln the palm:
Recurrent muscular branch, which supplies muscles of thenar eminence, viz. abductor
pollicisbrevis, flexor pollicisbrevis and opponenspollicis.
23
Lateral terminal branch, which gives off digital nerves to supply both the sides of thumb and
radial side of index finger.
Note: The digital branch to lateral side of index finger also supplies lstlumbrical muscle.
Medial terminal branch, which gives offdigital nerves to supplythe adjacent sides of index and
middlefingers and adjacent sides of index and little fingers.
Applied Anatomy
Carpal Tunnel Syndrome
It occurs due to compression of median nerve in the carpal tunnel. The carpal tunnel is an
osseofibrous
tunnel formed by the anterior concavity of the corpus bridged by the flexor retinaculum. This
tunnel is tightly packed with long flexor tendons of the fi.ngers with their surrounding synovial
sheaths and the median nerve.
Clinical Features
Painful paraesthesia (i.e., burning pain or pins and needles) along the distribution of the median
nerve to the palm and lateral 3 ½ fingers.
LE
Weakness and wasting of thenar muscles. No paraesthesia over the skin of thenar eminence
because this area of skin is supplied by the palmar cutaneous branch of median nerve, which
arises in the forearm proximal to flexor retinaculum.
SA
It is more frequent in women than men.
ULNAR 2016
16. Ulnar nerve- origin, course and distribution in the forearm and hand.
FIG 1.15
R
The ulnar nerve is so named because it runs along the ulnar side of the upper limb.
FO
Root Value: Ventral rami of C8 and T1.It also gets contribution from ventral ramus of C7.
It is the continuation of the medial cord of brachial plexus in the axilla. It courses successively
through
4 regions: axilla, arm, forearm, and hand, where it terminates by dividing into superficial and
T
deep
NO
branches. The course and relations of ulnar nerve in forearm and hand regions are as follows:
Forearm: The ulnar nerve enters the front of forearm by passing between two heads of flexor
carpi ulnaris.Here it lies on medial part of flexor digitorumprofundus. It is accompanied by the
ulnar artery
on its lateral side in the lower 2/3rd of forearm.
Hand: The nerye enters the palm by passing superficial to the flexor retinaculum and medial to
ulnar artery. At the distal border of flexor retinaculum, it ends by dividing into superficial and
deep terminal
branches.
Branches and Distribution
ln forearm
Muscular branches to supply:
Flexor carpi ulnaris
Flexor digitorumprofundus (medial half)
Palmar cutaneous branch: It arises at about midforearm and provides cutaneous innervation to
skin of the hlpothenar eminence.
24
Dorsal cutaneous branch: It arises about 5 cm above the wrist and gives off dorsal digital nerves
to supply sensory innervation to dorsal aspects of the medial ½ digits excluding their distal
phalanges.
ln hand
Superficial terminal branch, which supplies:
Palmaris brevis muscle
Cutaneous innervation to medial 1/3rd of palm and medial ½ fingers, including their nail beds.
Deep terminal branch,which supplies:
Medial two lumbricals.
Muscles of hypothenar eminence (abductor digitiminimi, flexor digitiminimi, and
opponensdigitiminimi)
All the interossei (3 palmar and 4 dorsal)
Adductor pollicis
LE
17. Superficial palmar arch.
Refer Page: 22 SA
FEBRUARY 2017
18. Axillary artery and distribution.
Refer Page: 21
19. Palmar fascial Spaces.

R
Mid-palmar Space
FO
It is a triangular in space
located under the inner half of
the hollow of the palm.
Boundaries
Anterior From superficial to
T
deep, the structures forming

NO
anterior boundary are: palmar

aponeurosis, superficial
palmar arch, ulnar bursa
enclosing flexor tendons of
middle, ring, and little fingers
and 2nd, 3rd, and 4th (medial
three) lumbricals.
Posterior Fascia covering the interosseiofthe 3rd and 4th spaces.
Lateral Oblique intermediate palmar septum extending from palmar aponeurosis to 3rd
metacarpal bone, which separates it from thenar space.
Medial: Medial palmar septum extending from palmar aponeurosis to 5th metacarpal bone,
which separates it from hypothenar muscles.
Proximally: It is continuous with the space of Parona's situated behind the flexor tendons and in
front ofpronatorquadratus.
Distally: It continues as extensions around lumbrical canals to web spaces of medial 3 fingers.
25
Applied Anatomy
This space is primarily infected by puncture wounds. It may be involved secondarily due to
infection spreading from digital synovial sheaths of flexor tendons. From here, the infection may
spread to Parona's space. The pus from midpalmar space can be drained by an incision into 3rd
or 4th web space, depending on where the pus points.
Thenar Space
It is a triangular space located under the outer half of the hollow of palm.
Boundaries
Anterior: Flexor tendons of index finger, lstlumbrical and palmar aponeurosis.
Posterior: Fascia covering transverse head ofadductorpollicis and lst dorsal interosseous muscle
Medial: Oblique intermediate palmar septnm, which separates it from midpalmar space.
Lateral:Lateral palmar septum extending from palmar aponeurosis to 1st metacarpal.
Proximally: It is continuous with Parona's space.
Distally: Extends around the lstlumbrical (1stlumbrical canal) to 1st web space.
LE
Applied Anatomy
Primary infection to thenar space occursthrougihpuncture wounds. Secondary
SA
infectiln may be due to infection spreading from digital synovial sheath of index finger'
This space can be drained by an incision in the 1si web space or where the pus points.
AUGUST 2018
R
20. Flexor retinaculum of upper limb

FO
The flexor retinaculum is a strong fibrous band formed by the thickening of deep fascia in front
of carpal bones (anatomical wrist). It bridges the anterior concavity of corpus and converts it
into an osseofibrous tunnel called carpal tunnel
Attachments: It is rectangular in shape and attached as follows .Medially, to pisiform bone and
hook of Hamate Laterally to tubercle of scaphoid and crest of trapezium.
T
NO
Features
Converts the concavity of corpus into an
osseofibrous tunnel- the carpal tunnel.
Proximally it gives attachment to the tendon
of palmarislongus.
Distally it gives attachment to the apex of
palmar aponeurosis.
Superficial Relations:
Ulnar artery and nerve, Palmar cutaneous
branch of median nerve, Tendon of
palmarislongus, Superficial palmar branch of radial artery.
The structures passing deep to the flexor retinaculum are :
Median nerve, Four tendons of the flexor digitorumsuperficialis
Four tendons of the flexor digitorumprofundus
Tendon of the flexor pollicislongus, Ulnar bursa, Radial bursa
26
SHORT NOTES UPPER LIMB IMPULSE ‘21
SEPTEMBER 2011
22. Lymphatic drainage of breast.
Lymphatic Drainage
2 Sets:
(a) Set draining the nipple, areola, and parenchyma; (b) Set draining overlying skin excluding nipple
and areola.
a)Those draining the parenchyma including areola and nipple form subareolar plexus of Sappey,
which drains as under:
20% drain into parasternal (internal mammary) nodes.
b)Those draining the overlying skin excluding areola and nipple drain into:
LE
Subdiaphragmatic nodes-from inner part SA
23. Posterior interosseous nerve.
It’s the deep terminal branch of radial nerve.
Origin: arises from radial nerve just above cubital fossa in front of lateral epicondyle.
Course: The nerve winds around lateral side of radius and passes through supinator muscle to
appear on back of forarm.
R
Termination: On back of wrist were it ends by a pseudoganglion.

FO
Branches:
In the cubital fossa, it supplies: Extensor Carpi RadialisBrevis, Supinator
In the back of forearm, it supplies; Abductor Pollicislongus, Extensor pollicisbrevis, Extensor
pollicislongus, Extensor digitorum, Extensor indicis, Extensor digitiminimi, Extensor carpi ulnaris.
Applied Anatomy : lesion leads to wrist drop.
T
NO
MARCH 2012
Refer Page: 22
AUGUST 2012
25. Flexor retinaculum of hand: attachments, relations, functions and applied aspects.
Refer Page: 26
AUGUST 2013
26. Axillary lymph nodes
27
27. Interosseous muscles of hand

LE
SA
R
FO
T
NO
Interossei are small muscles present between the metacarpals. They are divided into two group.
palmarinterossei and dorsal interossei; each group consists of 4 muscles.
Origin and Insertion
Muscle ; Origin ; Insertion
Palmar interossei: . Arise from metacarpals 1st from medial side of base of 1st metacarpal . 2nd
from medial side of 2nd metacarpal and index finger, respectively .3rd from lateral side of 4th
metacarpal3rd and 4th on the lateral side of the - 4th from lateral side of 5th
metacarpal.Inserted through dorsal digital expansion.1st and 2nd on the medial side of the bases
of proximal phalanges of thumb and index finger.3rd& 4th on lateral sides of the bases of
phalanges of ring and little finger, respectively.
28
Dorsal interossei: 1st from adjacent sides of 1st and 2nd metacarpals. 2nd from adjacent sides of
2nd and 3rd metacarpals. 3rd from adjacent sides of 3rd and 4th .4th from adjacent sides of 4th
and 5th metacarpals.Via extensor expansion into dorsum of bases of proximal phalanges of 2nd,
3rd, and 4th digits metacarpals metacarpals.
Nerve Supply
Deep branch of Ulnar nerve.
Actions: PAD. DAB
FEBRUARY 2014
28. Carpal tunnel
Anterior concavity of arpus is brided by flexor retinaculum & converts it into a tunnel- carpel
tunnel.
Attachments of flexor retinaculum
Medially – pisiform bone, hook of hamate
LE
Laterally- tubercle of scaphoid, rest of trapezium
Structures passing trough carpel tunnel
Median nerve
SA
4 tendons of flexor digitorumsuperficialis
4 tendons of flexor digitorumprofundus
Tendon of flexor pollicislongus.
R
FEBRUARY 2015
FO
29. Erbs paralysis

Site of injury: Erb's point (the region of upper trunk where 6 nerves meet, viz. ventral divisions
of C5 and C6, anterior and posterior divisions of the upper trunk, and suprascapular nerve and
nerve to subclavius) .
Cause: Too much separation of head from shoulder, e.g., (a) pulling of fetal head by forceps
T
during delivery (birth injury) and (b) fall on shoulder.

NO
Clinical Features
FEBRUARY 2016
30. Supination and pronation of forearm.
Movements
Supination: movement of forearm in which the palm of hand is turned forwards/ upwards.
Radius and Ulna lies parallel to each other.
Muscles: Supinator, Biceps Brachii, Brachioradialis
NS: Post interosseous nerve, Musculocutaneous nerve, Radial nerve.
Pronation: movement of forearm in which the palm of hand is turned backwards/ downwards.
Radius is carried obliquely across the front of ulna.
Pronator teres, Pronator quadratus, Brachioradialis.
NS: Median nerve, Anteriorinterosseous nerve, Radial nerve.
The flexor retinaculum and distally continuous with the synovial sheath of the thumb.
29
31. Palmar space

Refer Page No : 25
AUGUST 2016
32. Brachial artery
Origin: continuation of axillary artery below lower

border of teres major.
Course: it runs downwards to reach cubital fossa
where it terminates at the level of neck of radius by
dividing into radial and ulnar arteries.
Applied Anatomy: BP is recorded by auscultating the
pulsation of brachial artery in cubital fossa. It can be
ruptured in supracondylar fracture of humerus.
LE
JULY 2017
33. Rotator cuff muscles of the shoulder joint
SA
Refer Page 16
FEBRUARY 2019
34. Anterior interosseous nerve
Origins
R
Arises from the median nerve at the radiohumeral

FO
joint line
C5-T1 roots
Medial and lateral cord of brachial plexus
Median nerve
AIN
T
Branch to FDP
NO
Branch to FPL
Branch to pronator quadratus
Course
Arises 5-8 cm distal to lateral epicondyle
Passes between two heads of pronator teres
Runs along the volar surface of the FDP
Courses distally along the interosseous membrane
Terminates in PQ near wrist joint
Motor Innervation
Deep forearm muscles:
Flexor digitorumprofundus
Flexor pollicis longue
Pronator quadrates
Sensory innervations
Sensory fibres to volar wrist joint capsule
No cutaneous innervations
30
Applied Anatomy
AIN compressive neuropathy.
Paediatricsupraondylar fractures.

Refer Page 21
MARCH 2021
Mid-palmar Space
It is a triangular in space
located under the inner half of
the hollow of the palm.
Boundaries
Anterior From superficial to
deep, the structures forming
LE
anterior boundary are: palmar
aponeurosis, superficial
palmar arch, ulnar bursa
SA
enclosing flexor tendons of
middle, ring, and little fingers
and 2nd, 3rd, and 4th (medial
three) lumbricals.
Posterior Fascia covering the interosseiofthe 3rd and 4th spaces.
R
Lateral Oblique intermediate palmar septum extending from palmar aponeurosis to 3rd
FO
metacarpal bone, which separates it from thenar space.

Medial: Medial palmar septum extending from palmar aponeurosis to 5th metacarpal bone,
which separates it from hypothenar muscles.
Proximally: It is continuous with the space of Parona's situated behind the flexor tendons and in
front ofpronatorquadratus.
T
Distally: It continues as extensions around lumbrical canals to web spaces of medial 3 fingers.
NO
Applied Anatomy
This space is primarily infected by puncture wounds. It may be involved secondarily due to
infection spreading from digital synovial sheaths of flexor tendons. From here, the infection may
spread to Parona's space. The pus from midpalmar space can be drained by an incision into 3rd
or 4th web space, depending on where the pus points.
31
SHORT ANSWERS UPPER LIMB IMPULSE ‘21
March 2012
36. Boundaries and contents of quadrangular space of scapular region.
Quadrangular Space
Boundaries
Superior:
Subsapularisinfront
Teres minor behind
Capsule of the shoulder joint(in between subscapularis and teres minor)
Medial: Long head of triceps brachii
Lateral: Surgical head of humerus
Axillary nerve
Posterior cirumflex humeral vessels
LE
Applied Anatomy
The fracture of surgical neck ofhumerus may damage the axillary nerve leading to paralysis of
deltoid muscle.
SA
August 2012
37. Parts and branches of axillary artery
FIG 1.11
R
Source & Extent

FO
It’s a ontinuation of sublavian artery into axilla.

It extends from the outer border of 1sr rib to the inferior border of teres major.
Parts
It is divided into 3 parts by pertoralis minor:
1st part: proximal to the muscle
T
2nd part: behind the muscle

NO
3rd part: distal to the muscle

Branches
1st part gives 1 branch: superior thoraic artery
2nd part gives 2 branhes: (i) thoracoaromial artery, (ii) lateral thoracic artery
3rd part gives 3 branches: (i) subscapular artery, (ii) anterior circumflex umeral artery, and
(iii)posterior cirumflex humeral artery
38. Interossei of Hand

Refer Page 27
FEBRUARY 2013
39. Palmar aponeurosis
The palmar aponeurosis is the thick central part of the deep fascia of the palm. It is triangular in
shape with its apex facing proximally and base facing distally. It overlies the superficial palmar
32
arch, long flexor tendons, terminal part of the median nerve, and superficial branch of the ulnar
nerve.
Attachments
Apex
It is attached to the flexor retinaculum and provides
insertion to the tendon of palmarislongus.
Base
Just proximal to the heads of metacarpals, divides
into 4 longitudinal slips-one for each media four
digits. Each slip has a superficial and a deep set of
fibres. The superficial fibres are attached to the skin
of fingers at their roots. The deep fibres blend with
the fibrous flexor sheaths and are also connected to
deep transverse ligaments of palm.
LE
Relations
Between the slips (in the web spaces of fingers), the
digital nerve and vessels emerge to pass distally.
SA
From the medial and lateral borders of palmar aponeurosis, medial & lateral intermuscular septa
extend inwards and get attached to 5th and 1st metacarpals, respectively. These septa divide the
palm into compartments.
Functions
Protects the underlying tendons, nerves, and vessels Helps to improve the grip of hand by fixing
R
the skin of the palm.

FO
Applied Anatomy
The progressive contraction of medial part of palmar aponeurosis produces a deformity called
Dupuytren's contracture. The little and ring fingers are usually involved. The proximal and middle
phalanges become flexed and cannot be straightened. The distal phalanges, however, remain
unaffected or may become hyperextended.
T
NO
AUGUST 2014
40. Adductor pollicis
Small muscle of hand insertion: Base of proximal phalanx of thumb
Nerve supply: Deep branch of ulnar nerve which ends in it
Action: Adduction of pollicis
41. Coracoid proess of scapula

Directed forwards and slightly laterally.
Arises from upper part of the head (glenoid cavity) of scapula and lies below the clavicle.
Divided into ascending and horizontal parts.
Horizontal part has upper & lower surfaces.
Lower surfaces: (1) Subarachnoid bursa, (2) Subscapularis muscle
Upper Surface: (1)Conoid tubercle
Trapezoid muscle
Attachments: Pectoralismajor (insertion)
Coracobrachialis (origin from the tip of coracoid process)
33
Short head of biceps

Coracoclavicular ligament
Coracoacromial ligament
Coracohumeral ligament
FEBRUARY 2015
42. Coracoid process
Trapezoid muscle
LE
SA
43. Nerve supply of lumbricals

Nerve Supply
R
1st and 2ndlumbricals are supplied by median nerve, whereas 3rd and 4th lumbricals are supplied
FO
deep branch of ulnar nerve.
AUGUST 2015
44. Anatomical snuff box
T
Its an elongated triangular depression seen on the

NO
dorsal aspect of 1st metacarpal when the thumb is

hyperextended.
Boundaries
Medial Tendon of extensor pollicislongus
Lateral
Tendon of abductor pollicislongus
Tendon of extensor pollicisbrevis
Floor Scaphoid, trapezium
Roof Deep fascia stretching between the medial and
lateral boundaries
Contents
Radial artery
Structures crossing the Roof
Cephalic Vein, Terminal branches of superficial radial nerve.
Applied Anatomy
Tenderness in the region of anatomical box indicates fracture of scaphoid.
34
Pulsations of radial artery can be felt at this site.
AUGUST 2016
45. Median cubital vein
The median cubital vein is a communicating venous channel on the front of the elbow joining the
ephalic vein with the basilica vein. It begins from cephalic vein 2.5cm below the bend of elbow
and runs upward and medially to join the basilica vein 2.5cm above the bend of elbow. It shunts
the blood from cephalic vein to the basilica vein. It is the most superficial vein in the body.
JULY 2017
46. Rotator cuff muscles of the shoulder joint
The musculotendinous cuff is a fibrous sheath around the soulder joint. It is formed by the
flattened tendons of 4 muscles, which blend with the capsule of shoulder joint as under:
Supraspinatus, superiorly
Infraspinatus and teres minor, posteriorly
LE
Subscapularis, anteriorly
JANUARY 2018
SA
47. Coracoid process of scapula
R

FO

Trapezoid muscle
T
NO
48. Erbs point

Refer Page : 27

Refer Page 21
AUGUST 2018
50. Median cubital vein
The median cubital vein is a communicating venous channel on the front of the elbow joining the
ephalic vein with the basilica vein. It begins from cephalic vein 2.5cm below the bend of elbow
and runs upward and medially to join the basilica vein 2.5cm above the bend of elbow. It shunts
the blood from cephalic vein to the basilica vein. It is the most superficial vein in the body.
35
LOWER LIMB IMPULSE ‘21
LE
SA
LOWER LIMB
R
FO
T
NO
36
ESSAYS LOWER LIMB IMPULSE ‘21
SEPTEMBER, 2011
1. A 12 year old boy following an inadvertent intramuscular injection in the gluteal region
developed intramuscular injection in the gluteal region developed certain neurological deficit
including difficulty to dorsiflex the foot. With your knowledge of Anatomy answer the
following questions:
•Mention briefly the structures under cover of gluteus maximus.
•Name the structure which is affected in this case. Give its origin, course and distribution in
thigh.
•Give the cutaneous innervations of lower limb below knee.
•Name the muscles responsible for dorsiflexion and eversion of the foot.
(2+4+2+2=10)
Answers:
• Structures Under Cover of Gluteus Maximus
LE
SA
R
FO
T
NO
Muscles: All the muscles of gluteal region except Tensor fascia latae. Reflected head of Rectus
Femoris.Origin of Hamstrings, Insertion of upper fibers of adductor mahnus.
Vessels: Superior & Inf Gluteal Vessels. Internal Pudendal vessels.Trochanteric anastomosis.Cruciate
arterialanstomosis.
Nerves: Superior & Inferior Gluteal nerves. Sciatic nerve.Posterior cutaneous nerve of thigh.Nerve to
quadratusfemoris.Pudendal nerve.Nerve to ObturatorInternus, Perforating cutaneous nerve.
Joints & Ligaments: Hip joint, Sacroiliac joint. Sacrotuberous ligament.Sacrospinous
ligament.Ischiofemoral ligament.
Bursae: Trochanteric bursae. Ischial bursa.Gluteo-femoral bursa.
•Sciatic Nerve
Origin
Tibial component- medial-ventral divisions of L4, L5, S1, S2, S3 anterior primary rami.
Common peroneal part- lateral- dorsal division of L4, L5, S1 and S2 anterior primary rami.
Course
37
Pelvis to gluteal region- through the greater sciatic foramenbelow the piriformis.
Descends to enter posterior compartment of thigh at lower border of gluteus maximus.
Passes through inferomedial quadrant of gluteal region.
Back of thigh
It desends vertically lying between adductor magnus anteriorly and long head of biceps femoris
posteriorly. It is crossed by long head of biceps femoris from medial to lateral side.
Termination
Upper edge of popliteal fossa by dividing into tibial and common peroneal part.
Distribution
Gluteal region- articular branch to hip joint
Thigh- muscular branches from tibial part are:
Long head of biceps femoris, semitendinosus, semimembranosus, ischial part of adductor
magnus.
Muscular branch from common peroneal part is short head of biceps femoris.
LE
•Popliteal fossa
SA
R
FO
T
NO
The cutaneous nerves on the front of the leg and dorsum of the foot are as under:
1. Infrapatellar branch of the saphenous nerve: It pierces the deep fascia on the medial side of
the knee, curves downward and forward to supply the skin over the ligamentum patellae.
2. Saphenous nerve (L3, L4): It pierces the deep fascia on the medial side of the knee between
the sartorius and gracilis and runs downward in front of the great saphenous vein. It supplies the
skin on the medial side of the leg and medial border of the foot up to the ball of the big toe.
3. Lateral cutaneous nerve of calf (L5; S1, S2): It is a branch of the common peroneal nerve. It
pierces the deep fascia over the lateral head of the gastrocnemius and then descends to supply
the skin of the upper two-third of the leg laterally.
4. Superficial peroneal nerve (L4, L5; S1): It arises from the common peroneal nerve on the
lateral side of the neck of the fibula. It pierces the deep fascia at the junction of the upper two-
third and lower one-third of the lateral side of the leg and divides into medial and lateral
branches. The superficial peroneal nerve supplies:
(a) Skin over the lower one-third of the lateral side of the leg.
38
(b) Whole of the skin on the dorsum of the foot except for:
(i) Cleft between the first and second toes which is supplied by the deep peroneal nerve.
(ii) Lateral border of the foot which is supplied by sural nerve.
(iii) Medial border of the foot up to the ball of the big toe which is supplied by the saphenous
nerve.
5.Digital branches of the medial and lateral plantar nerves curve upward and supply the distal
parts of thedorsal aspects of the toes.
• Musles responsible for dorsiflexion:

Tibialis anterior, Extensor Hallucislongus, Extensor digitorumlongus.
Muscles responsible for Eversion:
Peroneus longus, Peroneus brevis
FEBRUARY 2014
2. A 30 year old man was brought to the causality following a road traffic accident. On
LE
examination, his right lower limb was shorted, flexed and internally rotated. X-ray of his right
hip showed posterior displacement of head of femur. Following surgical correction of
dislocation of hip, the patient was not able to dorsiflex his right foot. Based on your
SA
knowledge in anatomy answer the following questions.
• Injury to which nerve in posterior dislocation of hip, can produce inability to dorsiflex the
foot.
• Briefly describe the articular surfaces, capsule and ligaments , blood supply and nerve supply
of hip joint.
R
• Name the muscles acting at hip joint and mention the appropriate movements produced by
FO
them.
• Mention the anatomical features under this joint prone to dislocation.
(1+4½+2½+2=10)
T
Answer
NO
• Sciatic Nerve
• Classification
It is a synovial joint of ball and socket variety. It is formed between rounded head of femur and
cupshaped acetabulum of the hip bone. The acetabulum is deepened at its margins by a
fibrocartilaginous rim - the labrumacetabulare (Fig. 23.1).
• Ligaments
Capsular ligament Above, it is attached to the acetabular margin and transverse acetabular
ligament.
Below, it is attached to the femur on intertrochanteric line anteriorly and on femoral neck about
1 cm above the intertrochanteric crest posteriorly.
The capsular fibers are reflected from their lower attachment upward on the femoral neck to
form retinacula.
39
Iliofemoral ligament (Bigelow's ligament): It is strong inverted'Y'-shaped ligament. The

apex/stem of 'Y' is attached to the anterior inferior iliac spine, while its medial and lateral limbs
are attached to the intertrochanteric line.
Pubofemoral ligament: It is triangular in

shape and attached above to the
iliopubic junction and below to the
anteroinferior part of the capsule,
adjacent to intertrochanteric line.
Ischiofemoral ligaments: It is attached
above to the ischium, and below some
fibersare attached to the base of
greater trochanter, but majority of
LE
fibers spiral and blend with capsule
around femoral neck to form zona
orbicularis.
SA
Ligament of head of femur (round ligament/ligamentumteres):clt is a flat and triangular
ligament withcapex attached to the fovea capitis of femoral head and its base to transverse
acetabular ligament.
R
• Relations
FO
T
NO
40
• Movements
Flexion (110-120 degree) : Psoas major and Iliacus
Extention (15 degree) : Gluteus maximus, Hamstring muscles
Adduction: Adductor Longus, Brevis and Magnus
Abduction: Gluteus medius and minimus
Medial rotation (25): Tensor fasciae latae
Lateral rotation (60) : Short muscles : Piriformis, Obturatointernus,
Obturatorexternus&Quadratusfemoris.
• Applied Anatomy
Dislocation: Acquired dislocation mostly occurs posteriorly and often injures sciatic nerve.
Fracture of neck of femur It commonly occurs between 40 and 60 years of age, especially in
LE
females.
Referred pain:In diseases ofhip, pain is referred to the knee.
SA
• Mention the anatomical features render this joint prone to dislocation.
Hip joint has high degree of stability as well as mobility.
Stability depends upon
Dept of acetabulum & narrowing of its mouth by acetabular labrum.
Tension & strength of ligament.
R
Strength of the surrounding muscles.

FO
Length & obliquity of neck of femur.

Atmospheric pressure.
AUGUST 2014
T
3. While driving a car, a 30 year old man was accidently hit against a tree. He was rushed to the
hospital. His chief complaint was that he could not stand up because of severe pain. Physical
NO
examination revealed, his lower limb was slightly fixed , adducted, medially rotated and
appeared shorter than the other limb. X-rays were taken. Posterior dislocation of the right hip
with fracture of the posterior margin of acetabulum was diagnosed. With your knowledge in
anatomy, answer the following ;
• Mention the type and articular surfaces of hipjoint.
• Describe the ligaments.
• Describe the blood supply of the joint giving its clinical importance.
• Which nerve is prone to get injured in this case . What is its origin and root value.
• Enumerate the movements of the hip joint and the muscles producing them.
(1+3+2+2+2=10)
Answer:
•Classification
41
•Ligaments
Capsular ligament: Above, it is attached

to the acetabular margin and transverse
Below, it is attached to the femur on
intertrochanteric line anteriorly and on
femoral neck about 1 cm above the
intertrochanteric crest posteriorly.
The capsular fibers are reflected from
their lower attachment upward on the
LE
femoral neck to form retinacula.
Iliofemoral ligament (Bigelow's
ligament): It is strong inverted'Y'-
SA
shaped ligament. The apex/stem of 'Y' is
attached to the anterior inferior iliac
spine, while its medial and lateral limbs
are attached to the intertrochanteric
line.
R
Pubofemoral ligament: It is triangular in

FO
shape and attached above to the

Ischiofemoral ligaments: It is attached
T
above to the ischium, and below some

NO
fibersare attached to the base of

greater trochanter, but majority of fibers spiral and blend with capsule around femoral neck to
form zona orbicularis.
•The knee joint is richly supplied by the blood through the arterial anastomosis around the knee,
which is formed by:
(a) five genicular branches of popliteal artery, (b) descending genicular branch of femoral artery,
(c) descending branch of the lateral circumflex femoral artery, (d) two recurrent branches of the
anterior tibial artery, and (e) circumflex fibular branch of the posterior tibial artery.
•Sciatic nerve
Origin and Root Valve
42
It arises from ventral and dorsal divisions of ventral rami of L4, L5, S1, S2, and S3.
Tibial part from ventral divisions of the anterior primary rami of L4, L5, 51, 52, and 53.
Common peroneal part from dorsal divisions of anterior primary rami of L4 and L5 and S1
and S2.
•Movements
Lateral rotation (60) : Short muscles : Piriformis, Obturatointernus,
LE
FEBRUARY 2015
4. A 35 year old lady was admitted to the hospital with pain abdomen and vomiting: on
SA
examination a small lemon sized swelling was noticed on the upper medial aspect of right
thigh ,infero lateral to the pubic tubercle. The patient was told she was having the swelling for
the last four months. With your knowledge in anatomy answer the following question s.
• What is the swelling in front of thigh.
• Why did the patient present with abdominal pain and vomiting.
R
• Describe the boundaries and contents of femoral triangle.

FO
(2+2+6=10)
Answer:
•Femoral hernia
•Abdominal pain and vomiting
T
•Cardiac symptoms of intestinal obstruction

NO
(incarcerated hernia)
•Neck of sac unable to expand
•Abdominal viscus once passed through neck into
the body of sac, it is difficult to push it up and
return to abdominal cavity.
•Strangulation
•Boundaries of femoral triangle

Boundaries:
Lateral: Medial border of sartorius.
Medial: Medial border of adductor longus.
Base: Inguinal ligament.
Apex: Meeting point of the medial borders of
adductor longs and sartorius.
Floor: From medial to lateral; adductor longus, pectineus, psoas major, &iliacus.
Roof: Skin, Superficial fascia, Deep fascia
43
Contents:
Femoral Vein, Artery, and Nerve
Lateral cutaneous nerve of thigh, Deep inguinal lymph nodes, Profundafemoris artery and its
two branches, Genital branch of genitofemoral nerve.
AUGUST 2015
5. A footballer is suffering from sustained injury to his right knee while kicking. His leg got
forcefully abducted in a slightly flexed position.
• Which is the likely meniscus that has injured in this case.
• Why this meniscus is more prone to injury as compare to the other one.
• Enumerate the other intracapsular structures of the knee joint.
• Briefly describe the process of locking and unlocking at knee joint.
(1+2+3+4=10)
LE
Answer:
•Medial meniscus
•Because it is only supported by medial collateral ligament and not supported by any muscle but
SA
lateral menisci is supported by tendon of poppliteus.
•Ligaments
R
Medial(Tibial) Collateral Ligament :

Consists of superficial and deep parts.
FO
Superficial part is attached above to

epicondyle of femur and below to
upper part of medial border of tibia.
Deep part if firmly attached to medial
T
meniscus.
NO
Lateral (Fibular) CollateralLigament :

Its attached above to epicondyle of
femur and below to head of fibula. It
lies away form meniscus.
Cruciate ligament (anterior and posterior): They are intracapsular. The anterior cruciate
ligament extends from anterior part of the intercondylar area of the tibia to the medial side of
lateral femoral condyle. It prevents hyperextension and resists forward movement of tibia on
the femur.
The posterior cruciate ligament extends from posterior part of intercondylar area of tibia to
lateral side of medial femoral condyle. It becomes taut in hyperflexion and resists posterior
displaacemtn of tibia on femur.
d) The full extension of knee is called locking of the knee joint. It occurs due to medial rotation
of femur on fixed tibia or lateral rotation of tibia on fixed femur in terminal phase of extension.
44
The initial flexion of locked knee is called unlocking of the knee joint. It occurs due to lateral
rotation of femur on tibia.
The purpose of locking and unlocking of the knee is to provide stable movements at the knee
joint.
Anatomical basis of locking and unlocking
Articular surfaces of tibia and femur are not proportionate and incongruent.
During the terminal phase of the knee extension, the small articular surface of tibia is used by
the femur. Now to accommodate this unused articular surface of femur on tibia, the femur or
tibia rotates to have a stable movement at knee.
JANUARY 2018
6. A 35 years male patient was brought to casuality with a swollen right knee and a history of a
full during mountain climbing. There was severe pain and restricted mobility at the joint.
Answer the following based on your anatomical knowledge:
•Describe the attachments and relations of the ligaments of this joint.
LE
•What are the movement at this joint and which muscles are involved.
(5*5) SA
Answer:
• Classification
It is a compound synovial joint with following components:
Condylar joint (modified hinge joint), between mediai and lateral condyles of femur and tibia.
Saddle jointbetween femur and patella.
R
FO
• Ligaments
Capsular ligament: It is attached to the margins of articular surfaces except anteriorly
where it is deficient and supplemented by extensor apparatus of the knee joint consisting of
tendon of quadriceps, patella, and ligamentum patellae.
Posterolaterally, it prevents an opening for the passage of the tendon of popliteus.
T
Medial(Tibial) Collateral Ligament : Consists of superficial and deep parts. Superficial part is
NO
attached above to epicondyle of femur and below to upper part of medial border of tibia. Deep
part if firmly attached to medial meniscus.
Lateral (Fibular) Collateral Ligament : Its attached above to epicondyle of femur and below to
head of fibula. It lies away form meniscus.
Cruciate ligament (anterior and posterior): They are intracapsular. The anterior cruciate ligament
extends from anterior part of the intercondylar area of the tibia to the medial
side of lateral femoral condyle. It prevents hyperextension and resists forward movement of
tibia on the femur.
Menisci
Menisci (semilunar cartilages) These are semilunar fibrocartilaginous plates that lie on
the articular surfaces of the superior surface of tibia. The medial meniscus is larger and 'C'-
shaped, while lateral meniscus is relatively smaller and'O'-shaped. They are attached to the
45
tibialintercondylar area by their horns (anterior and posterior) and peripherally by coronary
ligaments.
• Relations
LE
SA
• Movements
Extention: Qudricepsfrmois, Tenor fascia latae
R
Flexion: Popliteus, Biceps femoris, Semitendinosus, Semimembranosus, Sartorius

FO
Medial rotation: Semimembranosus, Sartorius

Lateral rotation: Biceps femoris, Gracilis
AUGUST 2018
T
7. A 50 year old man came to the casuality with complaints of pain in the hipjoint. Answer the
NO
following questions:
•Bones forming the hip joint
•Ligaments
•Movements and muscles causing them.
•Nerve supply
•Blood supply
•Applied aspects
Answer:
• Classification
fibrocartilaginous rim - the labrum acetabulare.
• Ligaments
46
Capsular ligament Above, it is attached to the acetabular margin and transverse acetabular
ligament.
form retinacula.
Iliofemoral ligament (Bigelow's

ligament): It is strong inverted'Y'-
shaped ligament. The apex/stem of 'Y'
is attached to the anterior inferior iliac
spine, while its medial and lateral limbs
are attached to the intertrochanteric
line.
Pubofemoral ligament: It is triangular
LE
in shape and attached above to the
SA
Ischiofemoral ligaments: It is attached above to the ischium, and below some fibers are attached
to the base of greater trochanter, but majority of fibers spiral and blend with capsule around
femoral neck to form zona orbicularis.
Ligament of head of femur (round ligament/ligamentumteres):clt is a flat and triangular ligament
R
withcapex attached to the fovea capitis of femoral head and its base to transverse acetabular
FO
ligament.
Relations
Refer Page 34 for figures
Anterior: Iliopsoas, Psoas bursa, Pectineus, Rectus femoris, Femoral nerve and vessels
T
Posterior: Sciatic nerve, PiriformisObturatorInternus with gamely, Quadratusfemoris, Gluteus

NO
maximus
Superior: Gluteus minimus, Gluteus medius, Rectus femoris
Inferior: Pectineus, Obturatorexternus
Movements
Medialrotation (25): Tensor fasciae latae
Lateralrotation (60) : Short muscles : Piriformis, Obturatointernus,
Applied Anatomy
females.
Referred pain:In diseases ofhip, pain is referred to the knee.
47
MARCH 2021
An 18 year old boy was hit down by car while walking on the road and sustained injury to his right
knee joint. He visited to orthopaedic clinic with complaints of pain, swelling and while walking his
right knee is giving out (instability). On examination, soft tissue swelling and tenderness present
around right knee joint. Lachman test was performed and shows abnormal forward and backward
movement of right tibia. With your anatomical knowledge answer the following questions related to
knee joint.
• Describe the articular surfaces of knee joint.
• Describe the ligaments of knee joint.
• Name the structures that maintain the anteroposterior stability of knee joint.
• What is locking and unlocking of knee joint.
• Nerves that supply knee joint.
Answers:
LE
•Articular Surfaces of Knee Joint
1. Articular surfaces of medial and lateral condyles of the femur.
SA
2. Trochlear surface of the femur.
3. Articular surface of the patella.
4. Articular surfaces of medial and lateral condyles of the tibia.
R
•Ligaments
FO
Medial(Tibial) Collateral Ligament :

Consists of superficial and deep parts.
Superficial part is attached above to
epicondyle of femur and below to
upper part of medial border of tibia.
T
Deep part if firmly attached to medial

NO
meniscus.
Lateral (Fibular) CollateralLigament :
Its attached above to epicondyle of
femur and below to head of fibula. It
lies away form meniscus.
Cruciate ligament (anterior and
posterior): They are intracapsular. The anterior cruciate ligament extends from anterior part of
the intercondylar area of the tibia to the medial side of lateral femoral condyle. It prevents
hyperextension and resists forward movement of tibia on the femur.
d) The full extension of knee is called locking of the knee joint. It occurs due to medial rotation
of femur on fixed tibia or lateral rotation of tibia on fixed femur in terminal phase of extension.
48
The initial flexion of locked knee is called unlocking of the knee joint. It occurs due to lateral
rotation of femur on tibia.
The purpose of locking and unlocking of the knee is to provide stable movements at the knee
joint.
• Factors Maintaining the Stability of the Knee Joint

The stability of the knee joint is maintained by the following factors:
1. Strength and actions of the surrounding muscles and tendons.
2. Medial and lateral collateral ligaments maintain side-toside stability.
3. Cruciate ligaments maintain anteroposterior stability.
4. Iliotibial tract helps in stabilizing a partly flexed knee.
• Anatomical basis of locking and unlocking

Articular surfaces of tibia and femur are not proportionate and incongruent.
During the terminal phase of the knee extension, the small articular surface of tibia is used by
LE
the femur. Now to accommodate this unused articular surface of femur on tibia, the femur or
tibia rotates to have a stable movement at knee.
SA
•Nerves that supply Knee Joint
(a) Femoral nerve through its branches to vasti, especially to vastus medialis.
(b) Tibial and common peroneal nerves through their genicular branches.
(c) Obturator nerve through its posterior division.
R
FO
T
NO
49
SHORT ESSAYS LOWER LIMB IMPULSE ‘21
MARCH 2012
8.External ligaments of Knee joint.
Classification
It is a compound synovial joint with following components:
Condylar joint (modified hinge joint), between medial and lateral condyles of femur and tibia.
Saddle joint between femur and patella.
Ligaments
Capsular ligament: It is attached to the
margins of articular surfaces except
anteriorly
where it is deficient and supplemented
by extensor apparatus of the knee
joint consisting of tendon of
LE
quadriceps, patella, and ligamentum
patellae.
Posterolaterally, it prevents an
opening for the passage of the tendon
SA
of popliteus.
Medial(Tibial) Collateral Ligament: Consists of superficial and deep parts. Superficial part is
R
FO
Cruciate ligament(anterior and posterior): They are intracapsular. The anterior cruciate ligament
T
NO
tibia on the femur.
Menisci
ligaments.
50
AUGUST 2012
9. Sciatic nerve: formation, course and
branches.
It is the thickest nerve of the body and

consists of two components:
Tibial, Common peroneal
Origin and Root Valve
It arises from ventral and dorsal
divisions of ventral rami of L4,L5, S1, S2,
and S3.
Tibial part from ventral divisions of the
anterior primary rami of L4, L5, 51, 52,
and 53.
Common peroneal part from dorsal
LE
divisions of anterior primary rami of L4
and L5 and S1
and S2.
SA
Course
In the pelvis: The sciatic nerve lies in front of the piriformis under the cover of its fascia.
In the gluteal region: The nerve enters the gluteal region through the greater sciatic foramen
below the piriformis. It runs downward with a slight lateral convexity passing between the
ischial tuberosity and greater trochanter.
R
In-the thigh: The nerve emerges from lower border of gluteus maximus to enter the back of the
FO
thigh where it runs vertically downward up to the superior angle of the popliteal fossa where it
terminates by dividing into the tibial and common peroneal nerve.
Relations
ln the gluteal region
Superficial: Gluteus maximus.
T
Deep:
NO
Body of the ischium.

Tendon of the obturatorinternus with the gemelli.
Quadratusfemoris and obturatorexternus.
Ascending branch of the medial circumflex femoral artery.
Capsule of the hip joint.
Upper transyerse fibers of adductor magnus.
ln the thigh
Superficial: Long head of the biceps femoris.
Deep: Adductor magnus. . Medial
Posterior cutaneous nerve ofthe thigh.
Semimembranosus and semitendinosus.
Lateral: Biceps femoris.
Branches
Articular: To hip joint.
Muscular:
Tibial part supplies hamstring muscles,
51
viz.:
Semitendinosus
Semimembranosus
Long head of biceps femoris
Ischial head of adductor magnus
Common peritoneal part supplies short head of biceps femoris.
Applied Anatomy
Sleeping foot: It is the feeling of tingling and numbness in the lower limb. It often occurs due to
compression sciatic nerve against femur for long duration, such as sitting on the bicycle rod.
Sciatica: It is a shooting pain along the cutaneous distribution of the sciatic
nerve usually due to compression and irritation of one or more of its nerve roots. The pain
begins in gluteal region and radiates to back of thigh, lateral side of leg and dorsum of foot.
10. Longitudinal arches of foot.

Definition
LE
The human foot is designed to form
segmented arches not only to support the
body weight but also to propel the body
SA
forward during walking and running. The
arches of foot are distinguished features of
a human.
Classification
When looked from below, the foot appears
R
arched not only longitudinally, but also

FO
transversely. Thus, there are two types of

arches.
Longitudinal Arches
Medial & Lateral
Transverse Arches
T
Anterior & Posterior

NO
Formation of Lateral Longitudinal Arch

It is low with limited mobility. It is built to
transmit weight and thrust to the ground. It
acts as shock absorber. From behind forward, it is formed by: calcaneum, cuboid, and two
lateral metatarsals.
Features of Lateral Longitudinal Arch

Ends
Anterior end: heads of fourth and fifth metatarsals.
Posterior end: lateral tubercle of calcaneus.
Summit :Cuboid
Pillars
Anterior pillar: is formed by cuboid and fourth and fifth metatarsals. It is long and weak.
Posterior pillar: is formed by lateral half of the calcaneum. It is strong and short.
52
Joint: Calcaneocuboid joint.
Factors Responsible for the Maintenance of the arches of Foot

Shapes of the Bones: They are very important for maintaining posterior transverse arch where
many tarsal bones are involved and interlocked.
lntersegmental ties or ligaments: They hold different segments of arches together like spring
ligament for medial longitudinal arch and the long and short plantar ligaments for lateral
longitudinal arch.
Tie beams or bowstrings: They connect the two ends of the arch, which prevent the arches from
flattening. It is done by plantar aponeurosis and muscles of first layer of sole in case of
longitudinal arches and adductor hallucis in case oftransverse arch.
Slings They keep the summit pulled up.
. Medial longitudinal arch,by tendons passing from posterior segment of leg into the sole.
. Lateral longitudinal arch,tendons of peroneus longus and brevis.
. Transverse arches, peroneus longus and tibialis posterior.
LE
Functions of the Arches
Provide rigid support and distribute the body weight to the weight-bearing areas of the sole in
SA
standing position.
Act as a mobile springboard during walking and running.
Act as a shock absorber during jumping.
Protect the nerves and vessels of the sole from rubbing against the ground.
R
Applied Anatomy
FO
Flat foot (pesplanus) It occurs either due to absence or due to collapse of the longitudinal
arches, especially the medial longitudinal arch. Clinically, it presents as:
Clumsy and shuffling gait due to the loss of spring action of foot.
Foot trauma and osteoarthritis due to the loss of shock absorption.
Compression of nerves and vessels of the sole due to the loss of concavity.
T
High-arched foot (pescavus) It occurs when longitudinal arches become unduly elevated due to
NO
shortening of plantar aponeurosis or contracture of intrinsic muscles of the sole.
FEBRUARY 2013
11. Popliteal fossa – boundaries, contents,
applied aspects.
It is a diamond-shaped fossa on the posterior
aspect of the knee.
Boundaries:
Superolaterally: Biceps femoris,
Superomedially: Semimembranosus and
semitendinosus.
Inferolaterally: Lateral head of gastrocnemius
supplemented by the plantaris.
Inferomedially: Medial head of gastrocnemius.
53
Roof: Popliteal fascia.

Floor: From above downward, it is formed by popliteal surface of femur, capsule of the knee joint
oblique popliteal ligament, and fascia covering the popliteus muscle.
Contents
Tibial nerve, Common peroneal nerve, Pop vein, Pop artery, Pop LN, Pop pad of fat.
Applied Anatomy: Popliteal Aneurysm: Popliteal artery common site for this. Bakers cyst:
Swelling in Pop fossa.
12. Ankle joint – types, bones articulating, movements occurring that joint and muscles causing
the movements.
Classification
It is synovial joint of modified hinge variety.
It is formed between lower ends of tibia and fibula, and talus.
Ligaments
LE
Capsular ligament: It encloses
the articular surfaces. It is lax
SA
anteriorly to permit
uninhibited hinged
movements.
Medial collateral (deltoid)
Iigament: It is a strong
R
triangular ligament and

FO
consists of superficial and

deep parts.The deep part is
vertical band extending between medial malleolus and talus. The superficial component is fan-
shaped. It is attached above to medial malleolus and below to (from front to back) tuberosity of
navicular, spring ligament, sustentaculumtali, and posterior tubercle of the talus.
T
Lateral collateral ligament: It consists of 3 bands/components: anterior talofibular, posterior

NO
talofibular, and calcaneofibular ligament. The anterior talofibular ligament is attached to the
neck of talus, posterior talofibular ligament to the lateral tubercle of the talus, and
calcaneofibular ligament to the lateral surface of the calcaneus.
Relations
Anterior: From medial to lateral:
. Tendon of tibialis anterior
. Extensor hallucislongus
. Anterior tibial vessels
. Deep peroneal nerve
. Extensor digitorumlongus
. Peroneus tertius
Posterior (Behind tibial malleolus) From anterior to posterior:
. Tendon of tibialis posterior
. Flexor digitorumlongus
. Posterior tibial artery
54
. Tibial nerve
. Tendon of flexor halluces longus.
Movements & Muscles Producing Them:
Dorsiflexion(10 -2-0 degree) Tibialis anterior, Extensor HallucisLongus, Extensor
DigitorumLongus
Plantar Flexion(20-40degree) Triceps surae, Tibialis posterior , FDL, FHL
Applied Anatomy
Ankle sprains: It occurs due to tear in anterior talofibular (most common) and
calcaneofibularligaments following excessive eversion of plantar flexed foot. Clinically, it
presents as pain, swelling, and loss of movements.
Pott's fracture: It includes avulsion of deltoid ligament (first degree); avulsion of deltoid
ligament and fracture of medial malleolus (second degree); and avulsion of deltoid ligament,
fracture of medial malleolus, and fracture of lateral malleolus (third degree').
LE
AUGUST 2013
13. Hip joint- articular surfaces, capsule and ligaments, muscles involved in appropriate
movements of the joint.
SA
Classification
It is a slmovial joint of ball and socket variety. It is formed between rounded head of femur and
R
Ligaments
FO
Capsular ligamentAbove, it is attached to the acetabular margin and transverse acetabular

ligament.
T
form retinacula.
NO
Iliofemoral ligament (Bigelow's ligament): It is strong inverted'Y'-shaped ligament. The

apex/stem of 'Y' is attached to the anterior inferior iliac spine, while its medial and lateral limbs
are attached to the intertrochanteric line.
Pubofemoral ligament: It is triangular in shape and attached above to the iliopubic junction and
below to the anteroinferior part of the capsule, adjacent to intertrochanteric line.
Ischiofemoral ligaments: It is attached above to the ischium, and below some fibersare attached
to the base of greater trochanter, but majority of fibers spiral and blend with capsule around
femoral neck to form zona orbicularis.
Relations
FIG 1.27
55
Anterior: Iliopsoas, Psoas bursa, Pectineus, Rectus femoris, Femoral nerve and vessels
Posterior: Sciatic nerve, PiriformisObturatorInternus with gamely, Quadratusfemoris, Gluteus
maximus
Superior: Gluteus minimus, Gluteus medius, Rectus femoris
Inferior: Pectineus, Obturatorexternus
Movements
Flexion (110-120 degree): Psoas major and Iliacus
Extention (15 degree): Gluteus maximus, Hamstring muscles
Lateral rotation (60): Short muscles :Piriformis, Obturatointernus,
Applied Anatomy
LE
females.
Referred pain: In diseases ofhip, pain is referred to the knee.
SA
February 2014
14. Venous drainage of lower limb.
Great Saphenous Vein
The great saphenous vein is the longest vein of the body. It drains venous blood from whole of
R
lower extremity, except the medial side of leg. It represents the preaxial vein of the lower limb.
FO
Formation & Course

It is formed on dorsum of the foot, by the union of medial end of dorsal venous arch and medial
marginal vein of the foot. It runs upward in front of medial malleolus and crosses obliqtiely on
medial surface of lower third of tibia. It ascends a little behind the medial border of tibia to reach
knee about one hand's breadth posterior to patella. Then, it runs along the medial side of thigh
T
to drain into the femoral vein after piercing cribriform fascia of saphenous opening.
NO
Peculiaritles: It contain 10 to 15 valves, which prevent backflow of venous blood. One of the
valves is always present at saphenofemoral junction.
Perforating veins: (perforators) connect saphenous vein to deep vein.
Tributaries
Medial marginal vein.
.Anterior leg vein
.Posterior arch vein of calf
.Posteromedial vein of thigh (accessory saphenous vein)
.Anterior lateral vein of thigh
.Superficial epigastric vein
.Superficial circumflex iliac vein
.Superficial external pudendal vein
.Deep external pudendal vein
Communicating vein n to small saphenous vein.
56
Perforators
These are communicating channels that connect the superficial long saphenous vein with the
deep vein. They are provided with the valves that permit the flor,v of blood only from superficial
to deep veins.
Sites of Perforators:Location of the perforators is fairly constant. These are:
Adductor Canal Perforator: in the lower part of adductor canal. Knee Perforator: just below
knee, close to medial border of tibia. Lateral Ankle Perforator: at the junction of middle and
lower 1/3rd of lateral leg. Three Medial Angle Perforator : close to medial border of lower third
of tibia.
Applied Anatomy
Varicose veins: These are dilated tortuous and enlarged veins commonly seen in the lower limb.
They often occur in people who are standing for long time . The valve within
perforators and one at saphenofemoral junction become incompetent. As a result, the flow of
the blood is reversed. The defective veins become'high pressure leaks'. Consequently, the
superficial veins become dilated and tortuous forming varicose veins. The blood is stagnated in
LE
the superficial veins causing gradual degeneration of their valves and subsequent formation of
varicose ulcers. SA
AUGUST 2015
15. Inversion & Eversion
When the foot is of the ground

Inversion is the movement in which medial border of foot is raised so that sole faces medially.
R
Eversion is the movement in which lateral border of foot is raised so that sole faces laterally.
FO
These movements take place at talocalcaneoavicular and midtarsal joints.

These movements takes place around an oblique axis, which passes forward and upwardand
medially from back of calcaneum through sinus tarsi to speromedial aspect of neck of talus.
The inversion is akin to supination and eversion to pronation of forearm.
The range of motion is more in inversion than that in eversion.
T
Inversion is produced by tibialis anterior and tibialis posterior, while eversion is produced by
NO
peroneus longus and peroneus brevis.
FEBRUARY 2016
16. Femoral triangle-boundaries and contents.
Triangular depression on the anteromedial aspect of upper 1/3rd of thigh, with its apex directed
downwards.
FIG 1.28
Boundaries
Lateral: Medial border of sartorius.
Medial: Medial border of adductor longus.
Base: Inguinal ligament.
Apex: Meeting point of the medial borders of adductor longs and sartorius.
Floor: From medial to lateral; adductor longus, pectineus, psoas major, &iliacus.
Roof: Skin, Superficial fascia, Deep fascia
Contents:
Femoral Vein, Artery, and Nerve
57
Lateral cutaneous nerve of thigh, Deep inguinal lymph nodes, Profundafemoris artery and its
two branches, Genital branch of genitofemoral nerve.
Applied Anatomy
Swelling in femoral triangle due to: Enlarged LN, Psoas abcess, Saphenavarix.
February 2017
17. Femoral sheath and applied aspects
Introduction
Funnel shaped fascial sleeve enclosing upper 1 and ½ inch of femoral vessels. Its 4 cm long.
Formation
Formed by downward prolongation of fascial layers of abdominal cavity.
Anterior wall: fascia transversalis.
Posterior wall: by fascia iliaca
Compartments
Lateral compartment: contains femoral artery and femoral branch of genitofemoral nerve.
LE
Intermediate compartment: contains femoral vein.
Medial compartment: it contains lymph node (lymph node of Cloquet)
SA
JULY 2017
18.Boundaries and contents of adductor canal
It’s a musculoaponeurotic tunnel situated on medial side of the middle third of thigh. Provides
passage for femoral vessels.
R
Boundaries:
FO
Anterolateral: Vastusmedialis.
Posterior(floor): Adductor longus above and adductor magnus below.
Roof: Fibrous sheet extending b/w anterolateral and post boundaries and is overlapped by
Sartorius muscles.
Contents:
T
Femoral artery and vein, Saphenous nerve, Nerve to vastusmedialis, Desc. Genicular artery, Ant.
NO
& Post.div. of Obturator nerve.

Applied Anatomy
Femoral artery is ligated in adductor canal in treat of popliteal aneurysm. Tourniquet is applied
on thigh for bleeding.
JANUARY 2019
19. Ligaments of knee joint.
Ligaments
Capsular ligament: It is attached to the margins of articular surfaces except anteriorly
where it is deficient and supplemented by extensor apparatus of the knee joint consisting of
tendon of quadriceps, patella, and ligamentum patellae.
Posterolaterally, it prevents an opening for the passage of the tendon of popliteus.
Medial(Tibial) Collateral Ligament : Consists of superficial and deep parts. Superficial part is
58
tibia on the femur.
Menisci
LE
ligaments.
MACRH 2021
SA
FEMORAL CANAL
It is a short fascial tube (medial compartment of femoral sheath) which diminishes rapidly in width
from above downward and is closed inferiorly by the fusion of its walls.
The upper end of the femoral canal, which opens into the abdominal cavity is called femoral ring. A
fatty areolar tissue called femoral septum normally closes it. Cloquet’s node is a lymph node situated
R
in the femoral canal. The canal provides a dead space for the expansion of femoral vein during
FO
increased venous return.
Boundaries
Anterior: Inguinal ligament
Medial: Sharp edge of the lacunar ligament
T
Posterior: Pecten pubis

Lateral: Femoral vein
NO
Below the inguinal ligament, the canal lies posterior to

the saphenous opening and thin cribriform fascia, and
anterior to the fascia covering the pectineus muscle.
Applied Anatomy
Femoral hernia: The protrusion of abdominal contents
(a loop of intestine) through the femoral canal is called
femoral hernia. The femoral hernia presents as a globular swelling in groin inferolateral to the pubic
tubercle below the inguinal ligament
59
SHORT NOTES LOWER LIMB IMPULSE ‘21
MRCH 2012
20.Femoral Sheath
Introduction
Funnel shaped fascial sleeve enclosing upper 1
and ½ inch of femoral vessels. Its 4 cm long.
Formation
Formed by downward prolongation of fascial
layers of abdominal cavity.
Anterior wall: fascia transversalis. Posterior
wall: fascia iliaca
AUGUST 2012
21. Great Saphenous Vein : formation, course, termination and applied aspect.
LE
Longest vein of the body. It drains venous
blood from whole of lower extremity,
SA
except the medial side of leg.
Formation & Course
It is formed on dorsum of the foot, by the
union of medial end of dorsal venous arch
and medial marginal vein of the foot. It runs
R
upward in front of medial malleolus and

FO
crosses obliqtiely on medial surface of lower

third of tibia. It ascends a little behind the
medial border of tibia to reach knee about
one hand's breadth posterior to patella.
Then, it runs along the medial side of thigh
T
to drain into the femoral vein after piercing

NO
cribriform fascia of saphenous opening.

Peculiaritles: It contain 10 to 15 valves, which
prevent backflow of venous blood. One of
the valves is always present at
saphenofemoral junction.
Perforating veins: (perforators) connect
saphenous vein to deep vein.
Tributaries
. Anterior leg vein
. Posterior arch vein of calf
. Posteromedial vein of thigh (accessory saphenous vein)
. Anterior lateral vein of thigh
. Superficial epigastric vein
. Superficial circumflex iliac vein
. Superficial external pudendal vein
57
. Deep external pudendal vein

Communicating vein to small saphenous vein.
Perforators
These are communicating channels that connect the superficial long saphenous vein with the
deep vein. They are provided with the valves that permit the flor,v of blood only from superficial
to deep veins.
Sites of Perforators: Location of the perforators is fairly constant. These are:
Adductor Canal Perforator: in the lower part of adductor canal. Knee Perforator: just below
knee, close to medial border of tibia. Lateral Ankle Perforator: at the junction of middle and
lower 1/3rd of lateral leg. Three Medial Angle Perforator : close to medial border of lower third
of tibia.
Applied Anatomy
Varicose veins: These are dilated tortuous and enlarged veins commonly seen in the lower limb.
They often occur in people who are standing for long time . The valve within
LE
perforators and one at saphenofemoral junction become incompetent. As a result, the flow of
the blood is reversed. The defective veins become'high pressure leaks'. Consequently, the
superficial veins become dilated and tortuous forming varicose veins. The blood is stagnated in
SA
the superficial veins causing gradual degeneration of their valves and subsequent formation of
varicose ulcers.
Great saphenous vein Graft:The great saphenous vein is commonly used for arterial grafting in
coronary artery bypass surgery. Due to the presence of valves, a segment of vein to be used for
grafting is reversed.
R
FO
AUGUST 2013
22. Hamstring muscles
Semitendinosus
Semimembranosus
T
Long head of biceps femoris

NO
Ischial part of the adductor magnus

Characteristic Features
All arise from ishial tuberosity
All are inserted into one of the two leg bones.
All are supplied by tibial part of the sciatic nerve.
All extend the hip joint and flex the knee joint.
FEBRUARY 2014
23. Cruciate ligaments
tibia on the femur.
displacement of tibia on femur.
58
AUGUST 2014
24. Inversion & eversion of foot
When the foot is of the ground
Inversion is the movement in whichmedial border of foot is raised so that sole faces medially.
Eversion is the movement in which lateral border of foot is raised so that sole faces laterally.
These movements take place at talocalcaneoavicular and midtarsal joints.
These movementstakesplace around an oblique axis, which passes forward and upwardand
medially from back of calcaneum through sinus tarsi to speromedial aspect of neck of talus.
The inversion is akin to supination and eversion to pronation of forearm.
The range of motion is more in inversion than that in eversion.
Inversion is produced by tibialis anterior and tibialis posterior, while eversion is produced by
peroneus longus and peroneus brevis.
25. Extent and branches of femoral artery
LE
It’s a continuation of external iliac artery below the inguinal ligament.
It passes downward and medially, successively in the femoral triangle and adductor anal.
At the adductor hiatus, it continues as popliteal artery.
SA
Branches
Superficial Branches
Superficial external pudendal artery
Superficial epigastric artery
Superficial circumflex iliac artery
R
Deep Branches
FO
Deep external pudendal artery

Profundafemoris artery
Descending genicular artery
Muscular
T
AUGUST 2015
NO
26. Structures under Gluteus maximus.

Muscles: All the muscles of gluteal region except Tensor fascia latae. Reflected head of Rectus
Femoris.Origin of Hamstrings, Insertion of upper fibers of adductor mahnus.
Vessels: Superior & Inf Gluteal Vessels. Internal Pudendal vessels.Trochanteric anastomosis.Cruciate
arterialanstomosis.
Nerves: Superior & Inferior Gluteal nerves. Sciatic nerve.Posterior cutaneous nerve of thigh.Nerve to
quadratusfemoris.Pudendal nerve.Nerve to ObturatorInternus, Perforating cutaneous nerve.
Joints & Ligaments: Hip joint, Sacroiliac joint. Sacrotuberous ligament.Sacrospinous
ligament.Ischiofemoral ligament.
Bursae: Trochanteric bursae. Ischial bursa.Gluteo-femoral bursa.
AUGUST 2016
27. Gluteus maximus
Origin:
• Gluteal surface of the ilium behind posterior gluteal line
• Outer slope of the dorsal segment of ilium.
59
• Dorsal surfaces of the sacrum and ilium.

• Sacrotuberous ligament.
Insertion:
• 3/4th of the muscle into the iliotibial tract
• 1/4th of the muscle into the gluteal tuberosity
Nerve Supply: • Inferior gluteal nerve (L5,S1& S2)
Actions: Chief extensor of the hip joint • Assists in getting up from sitting position
FEBRUARY 2017
28. Medial longitudinal arch
Formation of Medial Longitudinal Arch
It is considerably higher mobile and resilient.
From behind forward, it is formed by:
Calcaneus, Talus, Navicular.
Three cuneiforms, Three medial metatarsals
LE
Features of Medial Longitudinal Arch
Ends
Anterior end: heads of 1st, 2nd and 3rd metatarsals.
SA
Posterior end:medial tubercle of calcaneum.
Summit: superior articular surface ofthe body oftalus.
Pillars
Anterior pillaris long and weak. It is formed by talus, navicular, 3 cuneiforms,
and 1st three metatarsals.
R
Posterior pillar is short and strong. It is formed by medial part of the calcaneum.
FO
JointTalocalcaneonavicular joint.
JULY 2017
29. Tibial collateral ligament
T
Refer knee joint

NO
JANUARY 2018
30.Great saphenous vein
The great saphenous vein is the longest vein of the body. It drains venous blood from whole of
lower extremity, except the medial side of leg. It represents the preaxial vein of the lower limb.
Formation & Course
It is formed on dorsum of the foot, by the union of medial end of dorsal venous arch and medial
marginal vein of the foot. It runs upward in front of medial malleolus and crosses obliqtiely on
medial surface of lower third of tibia. It ascends a little behind the medial border of tibia to reach
knee about one hand's breadth posterior to patella. Then, it runs along the medial side of thigh
to drain into the femoral vein after piercing cribriform fascia of saphenous opening.
Peculiaritles: It contain 10 to 15 valves, which prevent backflow of venous blood. One of the
valves is always present at saphenofemoral junction.
Perforating veins: (perforators) connect saphenous vein to deep vein.
Tributaries
60
Anterior leg vein

Posterior arch vein of calf
Posteromedial vein of thigh (accessory saphenous vein)
Anterior lateral vein of thigh
Superficial epigastric vein
Superficial circumflex iliac vein
Superficial external pudendal vein
Deep external pudendal vein
Communicating vein to small saphenous vein.
Perforators
Adductor Canal Perforator: in the lower part of adductor canal.
Knee Perforator: just below knee, close to medial border of tibia.
Lateral Ankle Perforator: at the junction of middle and lower 1/3rd of lateral leg.
Three Medial Angle Perforator : close to medial border of lower third of tibia.
LE
AUGUST 2018
31. Sciatic nerve
Page No: 51
SA
JANUARY 2019
32. Superficial inguinal lymph nodes
The superficial inguinal lympoh nodes (4-5 in
number) are arranged in the form of a letter ‘T’.
R
Horizontal set lies along the inguinal ligament.

FO
Vertical set lies along the upper part of the great

saphenous vein.
Areas drained
Lower vertical set receives lymph from whole of
llower limb except from lateral side of the back of
T
the leg and lateral side of the heel and foot.

NO
Upper horizontal set:

Lateral group reeives lymph from buttock, flanks and back.
Medial group reeives lymph from anterior abdominal wall, below umbilicus, external genitalia
except glans penis part of anal canal below the pectineal line, vaina below the hymen, penile
part of the male urethra and superolateral angle of the uterus.
Applied Anatomy
The upper medial group is often enlarged if tere is any infection in their drainage area.
61
SHORT ANSWERS LOWER LIMB IMPULSE ‘21
AUGUST 2012
33. LineaAspera
Strutures attached to Linea Aspera

Medial intermuscular septum
Lateral intermuscular septum
Vastumintermedius
Vastuslateralis
Vastusmedialis
Addutormagnus
Adductor brevis
Adductor longus
Short head of biceps femoris
FEBRUARY 2013
LE
34. Greater sciatic foramen
It’s a lare bony notch on the posterior border of ilium, above teischial spine. Its divided into
SA
upper and lower parts by piriformis muscle.
Structures
Structures passing through the greater sciatic notch
Piriformis passes through the middle of notch
Structures passing above piriformis
R
Superior gluteal vessels

FO
Superior gluteal nerve

Structures passing below piriformis
Siatic nerve
Pudendal nerve
Internal pudendal vessels
T
Nerve to obturatorinternus
NO
Inferior gluteal nerve and vessels

Posterior femoral cutaneous nerve
AUGUST 2014
35. Common Peroneal nerve
It’s the smaller terminal branch of the sciatic nerve (root value: L4, L5, S1 & S2).
Origin & Course
It begins at the junction of upper 2/3rd and lower 1/3rd of the back of thigh. It enters the popliteal
fossa through its upper angle and then follows the tendon of biceps tendon to reah the back of
the head of fibula, were it curves forward the lateral side of the neck of fibula and terminates by
dividing into superficial and deep peroneal nerves.
Branches
In popliteal fossa,
Superior and inferior lateral genicular nerves
62
Lateral cutaneous nerve of calf

Communicating branch of the sural nerve
In le below
Recurentgenicular
Deep peroneal nerve
Superficial peroneal nerve
Applied Anatomy
Effects of injury to common peroneal nerve: It’s the most commonly injured peripheral nerve in
the lower limb. It gets injured either due to fracture neck of fibula or due to direct pressure of
tightly applied plaster cast. Clinically, it presents as (due to the involvement of both deep and
superficial peroneal nerves):
Foot drop (foot is inverted and plantar flexed) due to the paralysis of dorsiflexors of ankle and
evertors of the foot. As a result, the patients walk on the toes.
Sensory loss on the dorsum of foot and toes exept medial and lateral margins of the foot and
lateral side of the little toe.
LE
FEBRUARY 2017
36. Saphenous nerve
SA
Saphenous nerve (L3, L4):
Origin
L3, L4
It pierces the deep fascia on the medial side of the knee between the sartorius and gracilis and
runs downward in front of the great saphenous vein. It supplies the skin on the medial side of
R
the leg and medial border of the foot up to the ball of the big toe.
FO
Dorsum of Foot: It supplies medial margins of the dorsum of the foot up to the head of the first
metatarsal.
JULY 2017
37. Head of femur
T
The femoral head's surface is smooth. It is coated with cartilage in the fresh state, except over
NO
an ovoid depression, the fovea capitis, which is situated a little below and behind the center of
the femoral head, and gives attachment to the ligament of head of femur.
The head of the femur, which articulates with the acetabulum of the pelvic bone, comprises two-
thirds of a sphere. The head of the femur is connected to the shaft through the neck or collum.
MARCH 2021
38. Dorsalis pedis artery
It is the chief artery of the dorsum of the foot.
Origin
The dorsalis pedis artery is the direct continuation of the anterior tibial artery in front of the
ankle.
Course
It passes forward along the medial side of the dorsum of the foot to reach the proximal end of
the first intermetatarsal space, where it dips downward between the two heads of the
63
first dorsal interosseous muscle to enter the sole of the foot where it ends by anastomosing
with the lateral plantar artery.
Relations
Superficial: Extensor hallucis brevis
crosses the artery
superficially from the lateral to
medial side.
Deep: Ankle joint and tarsal bones.
Medial: Tendon of the extensor
hallucis longus (EHL).
Lateral: First tendon of the extensor
digitorum longus (EDL).
Branches
LE
1. and 2. Lateral and medial tarsal
arteries: They take part in the formation of lateral and medial malleolar arterial networks.
3. Arcuate artery: It arises near the base of the second metatarsal, and runs laterally with slight
SA
convexity toward the toes, to reach the lateral edge of the foot. It gives three dorsal metatarsal
arteries (second, third, and fourth), each of which divides into two dorsal arteries for the lateral
four toes. The lateral one sends a twig to the lateral side of the little toe.
4. First dorsal metatarsal artery: It arises just before the dorsalis pedis artery dips into the sole of
the foot. It divides into dorsal digital arteries for the adjacent sides of the first
R
and second toes. It also gives a dorsal digital artery to the medial side of the big toe.
FO
T
NO
64
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LE
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KUHS SYLLABUS FOLLOWED

Textbook of Anatomy- Vishram Singh, 3rd edition

Physicon- Sanoop KS, Mridul GS, Nishanth PS

SIVAPRASAD AMITH PADAVIL

MUHAMMED SUHAIL SULFIKER THAJUDEEN

ALFIN BASIL PAULOSE

ASHITH SURESH SREEVISHNU

Wishing each student a productive time ahead. All the best!

GIT ........................................................................................... 297

Endocrinology .......................................................................... 330

often displaced downwards.

in abducting the arm to a horizontal level.

Supraspinatus above, Subscapularis infront

Horizontally:It extends from lateral

border of the sternum to the

•Name three muscles related to the

•What could be the reason for loss of

•Describe the lymphatic drainage of

Lateral branches of the posterior intercostal

breast becomes fixed and immobile.

•Name the muscles involved in intiating abduction and overhead abduction.

Initial 15 degree by supraspinatous.

(b) deep terminal branch (post. interosseous nerve).

back of forearm except anconeus, brachioradialis, and extensor carpi radialislongus.

Ulnar nerve behind medial epicondyle.

Division lies behind the clavicle.

From Medial cord

Medial pectoral nerve for pectoralis major and pectoralis minor

From Posterior cord

Upper subscapular nerve for subscapularis muscle

•Name the structure involved at the site of frature.

•Mention its origin, course and distribution.

Origin, Course and Relations:

branches of which supply the wrist and distal radioulnar joints.

•Mention its branches at different levels.

•Name the accompanying blood vessel at the site of fracture.

7. Describe the Brachial Plexus under the following headings

Medial cutaneous nerve of forearm

Medial root of median nerve

Nerve to latissimusdorsi (thoracodorsal nerve)

Axillary nerve for deltoid and teres minor muscles

Forearm is extended and pronated.

The four of scapulohumeral muscles, viz.

Axillary vein, Internal mammary vein, Intercostal veins

Upper Triangular Space

Lower Triangular Space

Lateral root of median nerYe

The deltoid is a three-in-one muscle. It is a triangular,

multipennate, and is present in the shoulder region.

It is responsible for the rounded contour of the

The ulnar nerve is so named because it

Deep terminal branch, which supplies:

Medial two lumbricals.

13. Axillary Artery.

Source & Extent

14. Superficial palmar arch

The superficial palmar arch is an irnportant

It gives off 4 palmar digital arteries,which supply medial 3½ digits.

The median nerve is so called because it runs in the

artery from medial to lateral side and giving its anterior

interosseousbranchbelow this. Then it passes deep to