General

Anatomy
To the point, according to syllabus,
For the students of MBBS, DPT, Pharm D and Allied Health Sciences

Written by : Dr. Malik Muhammad Awais Hassan Awaan

Composed by : AVI Series 2021
General Anatomy

Written By: Malik Muhammad Awais Hassan Awaan

0315 490 6946

AVI Series 2
 General Anatomy

Part 1.
Anatomy
“ The study of the structure and function of the body called anatomy .”
Clinical anatomy is the study of the macroscopic structure and function of the body as it relates to the
practice of medicine and other health sciences.
Basic anatomy is the study of the minimal amount of anatomy consistent with the understanding of the
overall structure and function of the body.
ANATOMICAL POSITION
The human body is regarded as standing erect, the eyes looking forward to the horizon, arms by sides
and the palms of the hands and toes directed forwards. This position is known as Anatomical position.
The body is derived into halves (right & left) by the median plane or sagittal plane.

TERMS OF RELATIONSHIP
. The following terms are applicable to all regions and all the parts of the body.

Positions Description
1 Anterior In front, near the front surface of the body.
2 Posterior Behind, near or the backside of the body.
3 Superior Above, upper part of the body.
4 Inferior Below, lower part of the body.
5 Medial Mid line, median plane of the body.
6 Lateral Away, away from median plane of the body.
7 Cranial (cranial=brain) near the head / cephalic end.
8 Caudal Near the tail end caudal.
9 Proximal Near the center/trunk for example, the arm is proximal to the forearm.
10 Distal Away from the trunk/center e.g. the hand is distal to the forearm.
11 Pre-Axial The lateral border of upper limb and medial border of the lower limb.
12 Post-Axial The medial part of upper limb and the lateral border of the lower limb.
13 Flexor surface The anterior surface of the upper limb and posterior surface of lower limb.
14 Extensor surface The posterior surface of upper limb and anterior surface of lower limb.
15 Para-median Planes situated to one or the other side of the median plane and parallel to it are
termed as Para-median.
16 Palmar Surfaces are used in place of anterior and in describing the foot.
17 Dorsal Dorsal surfaces are used in place of posterior, and in describing the foot.
18 Ipsilateral The term ipsilateral refers to the same side of the body; for example, the left hand
and the left foot are ipsilateral.
19 Contralateral Contralateral refers to opposite sides of the body; for example, the left biceps
brachii muscle and the right rectus femoris muscles are contralateral.
20 Superficial The terms superficial denote the relative distances of structures to the surface of
the body (near to skin or toward the skin)
21 Deep Deep denote the relative distances of structures from the surface of the body (away
from the skin)
22 Interior Inner part of the hollow organ. Interior

AVI Series 3
 General Anatomy
23 Exterior Outer part of the hollow organ.
24 Supine The supine position of the body is lying on the back. (supination)
24 Prone The prone position is lying face downward. (pronation)
25 Dorsal Toward the back /posterior.
26 Ventral Toward the belly/anterior.
27 Invagination Inward movement(protrusion) of the hollow organ.
28 Evagination Outwardmovement(protrusion) of the hollow oragn.
29 Plantar The inferior surface of the foot.

P lanes of the body

Planes are the lines perpendicular to the axis, there are 3 planes that are described below.

1. Sagittal plane
The lines that are parallel to the median plane is called as sagittal plane and it should be vertical
antero-posterior plane. Median plane could be refer as sagittal plane. Divide the body into two parts
in right and left .
2. Frontal/ Coronal plane
It is right angle/ perpendicular to the sagittal plane and it divide the body into two parts interiorly and
posteriorly.
3. Transverse plane
Any plane right angle /perpendicular to the frontal or sagittal plane called transverse plane. It cut the
body into upper and lower parts.

[ Cross section (C.S) and Transverse section (T.S) is perpendicular to the long axis of any organ or
structure. Oblique plane may be at any angle.]

Organization of the body

Cell is the basic structural and functional unit of the human body (a complex system).
. Similar cells organize to perform specific function called tissues and classified as

➢ Epithelium (Layers that cover the internal and external surface of the body and low intercellular matrix)
➢ Connective tissues (Bones and cartilage, intercellular matrix is in high amount)
➢ Muscles tissues (have elongated cells)
➢ Nervous tissues (CNS and Spinal cord, Axon elongated)
Different tissues arrange to form an organ e.g. stomach, muscles, bones.
Group of organ having related and specific function form a system e.g, ,
Digestive system for digestion.
Skeletal system for shape and support.
Muscular system for movement.
Cardiovascular system for circulation of blood and oxygenation.
Respiratory system for respiration .
Nervous system to control all body functions.
Integumentary system for covering.

AVI Series 4
 General Anatomy
Urogenital system for urine and reproduction.
Organs of special senses e.g. nerve and stimulai.
Lymphatic system for transport fluid ,fats and lymphocytes to bloodstream.
Endocrine system for hormonal activities.

ALL THE ORGAN SYSTEMS ARE CO -ORDINATE TO MAINTAIN THE NORMAL HEALTH OF THE BODY .

Skin 2-3 mm thick

It classified into 3 membranes.
Epithelium membranes
It consists of mainly 2 tissues i.e. the epithelium and connective tissues. It cover the inner cavities of the body
like
Mucous membrane (secrete chemicals),
Pleura(membrane round the lungs),
Serous pericardium (membrane cover the heart that secrete pericardium fluid),
Peritoneum (membrane around the gut),
Ependyma (lining the ventricular system of brain and spinal cord).

Fibrous membrane
It consist of the fibrous cartilage of collagen and elastic fibers e.g.
Fascia (layer) ,
Capsule of the joints (membrane around the joints),
Meninges (membrane of the brain),
Perichondrium (surround the cartilage of developing bone),
Periosteum (around the bone).

Synovial membrane

Present around the synovial joint. This membrane secrete a fluid called synovia and it lubricate the
synovial cavity and articular surface of the joint to prevent the damage. (:. Articular surface = joint )
Two layers Inner layer release synovia
. Outer layer contain elastic and collagen fibers.
BODY form by 6 following contents. Sebaceous glands pour their secretion, the
1. SKIN sebum, onto the shafts of the hairs as they pass up
Names of layers through the necks of the follicles. They are situated on
A) EPIDERMIS the sloping undersurface of the follicles and lie within
The outer most layer of the skin is epidermis, it is avascular the dermis. Sebum is an oily material that helps
keratinized epithelium here damage and replacement preserve the flexibility of the emerging hair. It also oils
processes are going on simultaneously. Damage can be occur in the surface epidermis around the mouth of the follicle.
the superficial cells (dead cells contain keratin) and sub- Sweat glands are long, spiral, tubular glands
divided as distributed over the surface of the body, except on the
{bs-glc} red margins of the lips, the nail beds, and the glans
- Stratum corneum penis and clitoris. These glands extend through the full
- Stratum lucidum thickness of the dermis, and their extremities may lie
in the superficial fascia. The sweat glands are therefore
- Stratum Granulosum the most deeply penetrating structures of all the
- Stratum spinosum epidermal appendages.

AVI Series 5
 General Anatomy
- Stratum basale
B) DERMIS
The second layer of the skin called dermis also refer as “True skin”.
- Papillary layer (nipple like)
- Reticular layer (contain blood vessels, nerves, sweat glands, hair follicles, fats)
Both layers collectively called Cutaneous membrane.
2. SUBCUTANEOUS TISSUE
It is refer as superficial fascia and is included in general covering.
3. DEEP FASCIA
It is a membranous layer and is included in general covering.
4. MUSCLES
The muscles that are attached to the bones.
5. NEUROVASCULAR BUNDLES AND LYMPHATICS
6. BONES
That support the body or maintain its structure.

The superficial fascia, or subcutaneous tissue, is a mixture of loose areolar and

adipose tissue that unites the dermis of the skin to the underlying deep fascia. In the
scalp(top of head), the back of the neck, the palms of the hands, and the soles of the feet,
it contains numerous bundles of collagen fibers that hold the skin firmly to the deeper
structures. In the eyelids, auricle of the ear, penis and scrotum, it is devoid of adipose
tissue.

The deep fascia is a membranous layer of connective tissue that invests the
muscles and other deep structures. In the neck, it forms well-defined layers that may play
an important role in determining the path taken by pathogenic organisms during the
spread of infection. In the thorax and abdomen, it is merely a thin film of areolar tissue
covering the muscles. In the region of joints, the deep fascia may be considerably
thickened to form restraining bands called retinacula.

AVI Series 6
 General Anatomy

Part 2.

A xilla

M “It is a pyramidal space situated between the upper part of arm and chest cavity”.
• It start from the root of neck.
It is a distributing center.
• It have neurovascular bundles.

Parts
It has 6 parts.

1. APEX

Also called cervico-axillary canal.

It has 4 walls Anterior Posterior Medial Lateral
Apex form by

 upper part of scapula,

 1st rib, cervico-axillary canal
 clavical

Boundries of Apex
Anteriorly => posterior (back) surface of clavical.
Posterioly => coracoids process and superior part of scapula.
Medially => outer border of 1st rib.

1. BASE
Covered by superficial fascia (skin) or axillary fascia.
2. ANTERIOR WALL
Contain pect. Major
Pect. Minor
Clavicopectoral fascia
3. POSTERIOR WALL
Consist of subscapularis
Teres major The attachment that moves the
Latissimus dorsi least is referred to as the origin,
4. MEDIAL WALL and the one that moves the most, the
Contain upper 4 ribs insertion.
Upper part of serratus anterior

AVI Series 7
 General Anatomy
5. LATERAL WALL
Contain upper part of the shaft of humerus
Coracobrachialis short head

C ONTENTS

➔ Axillary artery and its branches

➔ Axillary veins and its tributries
➔ Infraclavicular part of brachial plexus
➔ 5 group of lymph node
➔ Long thoracic and intercostobrachial nerve
➔ Axillary fats and areolar tissues.

AXILLARY ARTERY
It is the continuation of subclavian artery
It have 3 parts

1. Proximal and superior

2. Deep

AVI Series 8
 General Anatomy

3. Distal and inferior

Branches
Slap The Lair Save A Patient
Superior thoracic artery } 1st part
Thoracoacromial Artery
Lateral Thoracic Artery 2nd part
Subclavian Artery
Anterior circumflex of humerus Artery 3rd part
Posterior circumflex of humerus Artery

1. Superior thoracic artery

Arises from 1st part
It moves downward , medially between two muscles
Provide blood supply to thoracic wall and muscles
2. Thoracoacromial artery ABCD
Arises from 2 part
nd

It moves to the upper border of pect. Minor

Provide the blood supply to Acromial portion,brest/ pectoralis, Clavicular portion, deltoid muscle.
3. Lateral Thoracic Artery
Arises from 2nd part
Moves to the lower border of pect. Minor
It provide lateral mammary branches

AVI Series 9
General Anatomy
4. Subclavian Artery
Arises from 3rd part
It is the largest branch
Moves to latissimus dorsi, serratus interior
5. Anterior circumflex of humerus Artery
Arises from 3rd part
In front of intertubercle sulcus antamose (network) with posterior circumflex => Humerus ,
shoulder joint
Provide blood to the lower part arm
6. Posterior circumflex of humerus Artery
It form antamose with anterior circumflex.
It supply blood to shoulder joint, and deltoid

AVI Series 10
General Anatomy

LYMPH NODE
There are 5 lymph nodes in axilla
Lateral group => lies along the upper part of humerus , receive lymph from upper limb.
Posterior group => scapular group, lies along the wall of upper half of trunk.
Anterior group => pectoral group, lies at the upper half of anterior wall of trunk & upper half of brest.
Central group => receive lymph from posterior group (that receive lymph from anterior and
. lateralgroup) and move to apical group.
Apical group => receive lymph from central group.

AVI Series 11
General Anatomy

part 3.
Brachial Plexux Really Tired Drink Coffee Now

Root => Trunk => Division => Cords => Nerves

Vasomotor : constrict the arteriolar of the skin

Sudomotor : increase the sweat secretion
Pilomotor : Contract the arrector pilorum muscle to cause erection of the hair

AVI Series 12
 General Anatomy

part 3.
The Skin and Subcutaneous Tissues

The skin is the first layer of the body.

It is the largest organ of the body.
It is composed of two types of the tissues Connective Tissues and Epithelium Tissues
Two layers of the skin 1st.epidermis derived from ectoderm and 2nd dermis is derived from mesoderm.
The SURFACE AERA of skin is 1.5 to 2 m2 . It can be dertermined by Du Bois formula

AVI Series 13
 General Anatomy
A = W × H × 71.84 [ Area = m2 , Weight = kg , H = cm ]

Thickness varies from 0.5 to 3mm and depend upon two factors.
- The horny layer of the epidermis
- The dermis as a whole.

Epidermis Dermis Example

Thick horny layer Thin Palms and soles
Thin Thick Skin of back
Thin Tend to be Thick Extensor surface of the body

Colour of the skin

Color Reason
Yellow ting Due to the presence of carotene.
Reddish hue Due to blood flow through the dermis.
Shades of Brown Due to the presence of melanin pigment. Pigment
elaborating cells are melanocytes and the cells are
scattered basal llayer of epidermis. Some also found in
dermis.
Other characteristic
1. Finger prints
The ridges and grooves on the finger are the finger prints . It present on the finger tips, palms, sole, and toes. These
ridges appear during fetal (developmental) state of 3-4 months.
It is preculiar and after birth enlarge and not change through out the life*. The structure below the dermis maintain
it.
2. Creases
Flexure lines over joint called creases. Here skin is thin and attached to the deep fascia. The skin over joints always
folds in the same place, the SKIN CREASES.
3. Langer lines
The line for surgery that are parallel to the connective tissue ,heal the cut in
less time and with less scar of the tissue.

Appendages of skin
Certain structure originate from the epidermis called the appendages of the skin.
A) Nails
B) Cutaneous Glands
C) Hairs

A)Nails
Nails are modified keratin plates lying on the dorsal surface of the distal(away) phalanges of the
fingers and toes.
PARTS OF NAIL

AVI Series 14
 General Anatomy

Parts Description
Nail plate The part that can be seen.
Nail root The hidden part of the nail.
Nail fold The skin folds boundries on the nail
Nail bed Beneath the nail plate is nail bed ( stratified
squamous epithelium)
Nail matrix Beneath the proximal portion of the nail fold is the
epithelium from which nail grows. Nail growth rate
is 0.5mm/week.
Hyponychium : thick epidermis under the free edges of the nail.
Eponychium : extension of epidermis/proximal portion of the nail fold to the free surface of the nail plate

A) Cutaneous glands
Sebaceous glands pour their secretion, the sebum, onto the shafts of the hairs as they pass up through the necks of
the follicles. They are situated on the sloping undersurface of the follicles and lie within the dermis. Sebum is an oily material that helps
preserve the flexibility of the emerging hair. It also oils the surface epidermis around the mouth of the follicle.

Sweat glands are long, spiral, tubular glands distributed over the surface of the body, except on the red margins of the lips,
the nail beds, and the glans penis and clitoris. These glands extend through the full thickness of the dermis, and their extremities may
lie in the superficial fascia. The sweat glands are therefore the most deeply penetrating structures of all the epidermal appendages.

B). Hairs
Thread like structure originate from epidermis and are elastic keratin called hairs.
Present on all the body except palm, sole, anal and urogenital apertures.
Hair has two parts * the shaft is free portion * root is embedded
Root of the hair is packed in a tubular hair follicle. Lower end is expanded called hair bulb.
The muscle attached to the hair tubules are arrector pilorum cause the formation of goose bumps.
The growth rate is 0.3mm/day
Hair grow in a cycle having phase * Growth * Transitional phase * rest and elimination of old hairs
BLOOD AND NERVE SUPPLY
Arterial Blood (subcutaneous arteries) ===drain to= > subcutaneous veins
In subcutaneous tissues , cutaneous lymphatic plexuses drain to large lymph vessels.
FUNCTION OF SKIN
The functions of skin are as under
 Sensation of the stimulus

AVI Series 15
 General Anatomy
 Protection from foreign invaders
 Temperature regular
 Control of water output (Sweat gland)
 Absorption
 Secretion (oil )
 Excretion (water)
 Synthesis of vitamin D (by sun)
 Storage
 Regulation
 Repair after trauma (mitosis)
 Feeling

Fasciae
The fasciae of the body can be divided into two types- superficial and deep—and lie between the skin
and the underlying muscles and bones.
. The superficial fascia, or subcutaneous tissue, is a mixture of loose areolar and adipose tissue that
unites the dermis of the skin to the underlying deep fascia. In the scalp, the back of the neck, the palms of the
hands, and the soles of the feet, it contains numerous bundles of collagen fibers that hold the skin firmly to the
deeper structures. In the eyelids, auricle of the ear, penis and scrotum, and clitoris, it is devoid of adipose
tissue.Function of the hypodermis is * padding * space filling * storage.
. The deep fascia is a membranous layer of connective tissue that invests the muscles and other deep
structures. In the neck, it forms well-defined layers that may play an important role in determining the path
taken by pathogenic organisms during the spread of infection.
In the thorax and abdomen, it is merely a thin film of areolar tissue covering the muscles and aponeuroses.
In the limbs, it forms a definite sheath around the muscles and other structures, holding them in place.
Fibrous septa extend from the deep surface of the membrane, between the groups of muscles, and in many
places divide the interior of the limbs into compartments .
In the region of joints, the deep fascia may be considerably thickened to form restraining bands called
retinacula.
Their function is to hold underlying tendons in position or to serve as pulleys around which the tendons may
move. IMPORTANCE to find out the fluid like pus cells, blood accumulate and help in extent of resection in the
case of malignance of any organ.

AVI Series 16
 General Anatomy

Part 4.
BONES AND CARTILAGES
The study of the bones and the cartilage is known as osteology.
Bone is a rigid, vascular, dynamic, constantly changing, mineralized connective tissue.
Bone and forming cells are osteocytes and bone maturing cells are aosteoblast.
FUNCTION OF BONES
 Help in providing the shape of the body.
 It give support to the human body(mechanical support)
 It give protection to a certain organ like skull protects brain, thoracic cage protects lungs and heart.
 It is a site for attachment of muscles and tendons /ligaments.
 Help in locomotion.
 They posses the erthropoiesis (blood forming organ).
 Help in transmission of the sound waves ossicles of middle ear (ear drum to internal ear)
 Help in speech hyoid bone, mandible, bones of palate are the examples.
 Help to maintain ion balance/electrolyte balance like Ca++ and P.
 Help in detoxification, e.g. lead, arsenic, fluorine, radium.
 Help to defend the body (site of Reticuloenothelial system)
 Help in respiration e.g. ribs
 Stores Ca++ and P.
 Help in forming skeleton are divided into two parts
• Exoskeleton = that are superficial / related to skin
• Endoskeleton = present deep ,form main skeleton. It is divided into two parts
Visceral Endoskeleton Somatic Endoskeleton
Present in certain organ All the bones of the body.
❖ OS Cordis in the heart of Ox
❖ Bacculum in between the corpora cavernosa of many
carnivores e.g. Dog, Bear, Tiger.
❖ Bones of visceral arches e.g. mandible, hyoid bone, ear
ossicles.
Bone exists in two forms: compact and cancellous.
Compact bone appears as a solid mass;
Spongy/cancellous bone consists of a branching network of trabeculae. The trabeculae are arranged in
such a manner as to resist the stresses and strains to which the bone is exposed.

1.Classification of Bones (on the base of shape & size)

Bones may be classified regionally or according to their general shape. Bones are grouped as follows
based on their general shape: long bones, short bones, flat bones, irregular bones, and sesamoid bones.
Long Bones
Long bones are found in the limbs (e.g., the humerus, femur, metacarpals, metatarsals, and phalanges). Their
length is greater than their breadth. They have a tubular shaft, the diaphysis, and usually an epiphysis at
each end.

Short Bones
Short bones are found in the hand and foot (e.g., carpal; in hand 8 in number, tarsal; in foot 7 in number ).

AVI Series 17
 General Anatomy
They are roughly cuboidal in shape and are composed of cancellous bone surrounded by a thin layer of
compact bone.

Flat Bones
Flat bones are found in the vault of the skull (e.g., the frontal and parietal bones). The scapulae, and sternum,
ribs.

Irregular Bones
Irregular bones include those not assigned to the previous groups e.g., hipbone, sphenoid bone, maxilla bone,
vertebrae.

Sesamoid Bones
sesamoid bone is the patella, which is located in the tendon of the quadriceps femoris. Other examples are
found in the tendons of the flexor pollicis brevis and flexor hallucis brevis. The function of a sesamoid bone is
to reduce friction on the tendon; it can also alter the direction of pull of a tendon.

Long-short Bones
The bone has two ends and a shaft and short in length. e.g. Metacarpal (hand) , phalanges, meta-tarsal
(foot) , phalanges.

2.Classification of Bones (on the base of Development)

Intramembraneous
Here embryonic mesnchyma(immature embryo connective tissue), these bones provide urgent support
and protection e.g.
Bone in the vault of skull
Bone of the face
Clavicle
Subperiosteal bone formation.
Intracartilagenous
Here first cartilagenous model of bone form after that form a bony tissue e.g. all long bone excluding
clavical , short bones, irregular bones.
Membrano-cartilagenous
Only one such example found in the human body that it is present at the junction of vault and base of the skull.
The center of bone formation found in the shaft of the bone is referred to as the diaphysis; the
centers at the ends of the bone, as the epiphyses. The plate of cartilage at each end, lying between the
epiphysis and diaphysis in a growing bone, is called the epiphyseal plate. The metaphysis is the part of the
diaphysis that abuts onto the epiphyseal plate.

Types of epiphysis
pressure epiphysis develop in the vicinity of the site of articulation during the 1st or 2nd year of the development
e.g. head of humerus, condyle (joint) other bones are fermur, tibia, fibula and radius.
Traction epiphysis develop at the site of attachment of the tendon
e.g. tuberrosities of humerus and the trochanters of the femur.

AVI Series 18
 General Anatomy
Atavistic epiphysis independent bones that’s become the part of other bones e.g. coracoids process of scapula
. During the growing phase, the diaphysis is separated from the epiphysis by an epiphyseal
cartilage. The part of the diaphysis that lies adjacent to the epiphyseal cartilage is called the metaphysis.) The
shaft has a central marrow cavity containing bone marrow. The outer part of the shaft is composed of compact
bone that is covered by a connective tissue sheath, the periosteum.
3.Classification of Bones (on the base of structure)
There are 2 types of the structural bones

• Compact bone
• Spongy bone

Compact Bones (haversian bone)

• Well developed haversian lamellae

• Lamellae consist of—collagen fibers, lying in calcified material, adjacent lamellae held together by
interchange fibers

• Bone cells lie scattered

• E.g

• Shafts of long bones

• Outer and inner tables of skull bones

Spongy Bones ( cancellous bones)

• Lamellae are arranged flat

• No typical haversian system

E.g

• Ends of long bones

• Diploe of skull

AVI Series 19
 General Anatomy

4. Classification of Bones (on the base of Regions)

Total 206 bones

1. Axial bones (80)

• Examples

I. Skull (29)

• Cranium n facial bones hyoid bone ear ossicles

II. Vertebrae (26)

• Cervical thoracic lumbar sacral coccygeal

III. Ribs (24)

IV. Sternum (1)

2. Appendicular bones (126)

• Examples

• Upper limb(60)

• Shoulder girdle (4)

• Lower limb(60)

• Hip girdle (2)

6.Classification of Bones (Miscellaneous)

a) Sesamoid bones (seed-like)

• Develop in tendons

• E.g patella (largest, tendon of quadriceps femoris)

• Pisiform(flexor carpi ulnaris)

• Un-named sesmoid bones

In tendons of

• Flexor hallucis brevis

• Adductor pollicis brevis

• Flexor pollicis brevis

AVI Series 20
General Anatomy
• Tibialis posterior

• Peroneus longus

• Gastrocnemius

b) Supernumery bones (extra bones)

• Most commonly in relation with appendicular skeleton

• Due to traction or pressure

• E.g

• Polydactyl (6th finger)

c) Accessory bones

• Usually in relation with axial skeleto

• E.g cervical rib

• Lumbar rib

• Two piece 5th lumbar vertebra

d) Pneumatic bones

• Hollow n filled with air

• E.g

• Ethmoid (air sinuses)

• Maxilla

• Sphenoid (air sinuses)

• Mastoid process

e) Wormian bone

• Rarely found

AVI Series 21
General Anatomy
• Sometimes centre of ossification develops in middle of primitive frontal bone which forms
wormian bone

AVI Series 22
 General Anatomy

Part 5.
Bones of upper limb
The upper limb is characterized by its mobility & ability to grasp , strike and to conduct fine motor skills
(manipulation=move/operate). It consist of shoulder, Arm, Forearm and Hand.

1. Clavical
 The only long bone that lies horizontally.
 It is also called collar bone or beauty bone.
 The clavical transmits the weight of the limb to the sternum.
 The cylindrical part of the bone is called shaft.The shaft is divided into
two parts the lateral (away from medial line) is 1/3 while the medial
is 2/3.
 Medial also called sternal end (triangular) and lateral side also called acromial
end (flat) .
 Arm can swing clearly away from the trunk is just because of the
clavical bone.

Superior Aspect

Sides Upper border Lower border

Lateral end Trapezius muscle (I) Deltoid (O)
Medial end Sternocleidomastoid (O) Pectoralis Major (O)

AVI Series 23
 General Anatomy
Inferior Aspect

Sides Upper border Lower border

Lateral end Deltoid muscle (O) Trapezius (I)
Medial end Pectoralis Major (O) Sternohyoid (O)
 Subclavian muscle insert in the center.
 Trapezoid and conoid parts of coracoclavicular ligament present at the lateral border.
 Costoclavicular ligament present at the medial/sterna end.
 Inferior surface of clavical and upper surface of 1st rib contain subclavian vessels and cords of brachial
plexus that pass toward the Axilla.

2. Scapula
The bone on the posterior-lateral (back-sides) of the rib cage, having two surfaces, three borders, three angles
and three processes.
Two surfaces
1. The costal surface sub scapular fossa is concave.
It moves medially(towards center) and forward.
2. The dorsal surface give attachment to the spine of the scapula.
Due to spine the dorsal surface divides into the supra-spinous fossa and infra-spinous fossa both
connected by spinoglenoid.

Three borders

1. Superior border => thin, shorter. It present the

suprascapular notch near the root of the coracoids
process.
2. Lateral border => thick. Upper end contain infra
glenoid (lower part of glenoid) tubercle
3. Medial border => thin , extends from the superior
angle to the inferior angle.

Three Angle
Angle Muscle
Superior Trapezius
Inferior Latissimus dorsi (moves forward round the chest)
Lateral / Glenoid Contain glenoid cavity(forward laterally & upward)

AVI Series 24
General Anatomy

Three processes
processes Explanation
Spine / spinous process A triangular plate of bone with 3 border and 2 surfaces. Divides the
scapula.posterior border of it called the crest of the spine.
Acromion process Has 2 borders, medial and lateral. Has 2 surfaces, superior and inferior. A Facet
(site) for the clavical
Coracoid process Bent and finger like. It directed forward and laterally. (show atavistic epiphysis)

circumflex scapular artery is present b/w teres major and teres minor muscles

AVI Series 25
 General Anatomy

Part 6.

BACK
Key Points
 Scapula is placed on the postero-lateral (Back and away from mid line) aspect of upper part of the
thorax. It extend from 2nd to the 7th rib, it is covered by muscles but it can be felt. The acromion can be
felt at the top of the shoulder. Spine of the scapule lies from acromion medially and downwards to
the medial border of the scapula. Medial and inferior angle can be felt.

 8th rib is just below the inferior angle of the scapula.

 Iliac crest is the bony ridge below the waist. It have two spine ends. Anterior-Superior spine =>
anterior end of the crest and posterior-Superior spine => felt above buttock /5cm from median plane.

 The scrum lies b/w right and left dimple of the buttock. Three scral spine can be felt in median plane.

 In median plane lies coccyx between two buttocks.

 5cmbelow the external occipital knob/spine 2nd cervical spine can be felt.

Spine of 7th cervical vertebrae felt at the root of the neck.

T3 at the root of the spine of scapula.

L4 at the highest point of iliac crest.

S2 at the posterior superior iliac crest.

 Superior Nuchal line and occipital knob is the junction of the head to the back. Superior Nuchal line is
extend from occipital knob to the mastoid process(projection of temporal bone behind the ear) to the
C7.

Position
➔ The skin can sustain pressure and body weight. The skin of the back is thick and fixed to the
underlying fasciae
Superficial fascia contain fats, is thick and strong, connected to the overlying skin.
Deep fascia is dense.

Cutaneous nerves
➔ Cutaneous nerves of the back are derived form the posterior primary rami of the spinal nerves.
Distribution extends up to posterior axillary lines.

➔ T1-12, L1-L3 and five sacral nerves give cutaneous branches. Other don”t participate.

AVI Series 26
General Anatomy
➔ Posterior primary rami divide into medial and lateral branches. Both supply erector spine muscles,
one of them form the cutaneous nerve.

➔ Upper half of the back of body up to T6 medial branches

Lower half of the back of body below T6 lateral branches
of the posterior primary rami provide the cutaneous branches. Before supply skin each cutaneous
nerve divide into medial (smaaler) and lateral (larger) branch. Posterior primary rami not supply the
limb’s muscles and skin.

➔ Intrinsic Muscles of back and skin cover them supplied by posterior primary rami.
Attachments
Trapezius muscle cover the upper back portion, Latissimus dorsi lower portion of the back. Levator
scapulae and rhomboid muscle also participate.

AVI Series 27
 General Anatomy

Part 7.

Pectoral Region
Key Points
 At the root of the neck the clavicle lies horizontally. It separate the the neck and the chest.
Medially attach with the sternum (sternoclavicular joint masked by sternocleidomastoid muscle)
Laterally attached to the acromion ( acromioclavicular joint)
Both the joints are palable.

 Suprasternal or interclaviacular notch called the JUGULAR NOTCH, lies medial end of the clavical and
superior border of the manubrium sterni (sternum most upper part)

 5cm below the jugular notch is the sterna angle, it

identified the manubriosternal joint. It is the landmark
of the 2nd rib.

 Infrasternal angle is the identification of the epigastric

fossa (pit of the stomach), Identify the 7th rib.

 In the 4th intercostal space /10cm from the midsternal

line lies nipple.

 The midclavicular line passes vertically to the tip of 9th

costal cartilage.

 The junction of the lateral and middle third of the clavicle lies the infraclavicular fossa.
Medially bounded the pect. Major, lateral by anterior fibers of the deltoid superior by clavicle.

 2-3cm below the clavicle lies the tip of the coracoids process, overlapped by anterior fibers of the
deltoid.

 Acromion of the scapula form the top of the shoulder.

Posterior end of its lateral border is called as acromial angle, continuous with the lower lip of the crest
of the spine of scapula. Anterior end of its medial border articulate with the clavicle.

 Deltoid form the rounded countour of the shoulder, extend vertically from acromion to the deltoid
tuberosity of the humerus.

 Axilla a space between the arm and the chest.

Floor of the axilla raise as arm is raised, anterior-posterior folds stand out space become more
prominent
Anterior fold contain lower border of the pect. Major
Posterior fold contain teres major and tendon of the latissimus dorsi.
Medially cover by upper for ribs and serratus anterior.
Lateral wall contain upper part of humerus and short head of the biceps and choracobrachialis.
Mid axillary line is a vertical line drawn in the mid between the anterior and posterior axillary folds.

AVI Series 28
 General Anatomy
Contents
• Cutaneous nerves from cervical plexus

• Cutaneous branches from internal thoracic and posterior intercostals arteries.

• Platysma

• The breast

CUTANEOUS NERVE OF PECTORAL REGION

➔ MEDIAL, LATERAL and INTERMEDIATE supraclavicular nerve are the branches of cervical plexus
C3, C4 , supply the skin over upper half of the deltoid and from clavicle to the 2nd rib.

➔ ANTERIOR and LATERAL cutaneous branches of the 2nd to the 6th intercostals nerves supply skin
below the 2nd rib.

➔ T2 supply the floor of axilla and upper half of the medial side of the arm.

➔ T2 and T3 meets the C3 and C4 not overlap because the intervening nerves C5, C6, C7, C8 and T1
have been pulled away to supply the upper limb.

CUTANEOUS VESSELS

The anterior cutaneous nerves are accompanied by perforating branches of the internal thoracic artery.
2nd, 3rd, and 4th of these branches are supplied to the breast (more in females)
The lateral cutaneous nerves are accompanied by the lateral cutaneous branches of the posterior intercostals
arteries.

PLATYSMA OF PECTORAL REGION

The platysma is a thin, broad sheet of subcutaneous muscles.

It cover the pectoral major run medially and upward, crossing the clavicle and the side of the neck,
inserted into the mandible and into the skin of the face (Posterior nad lower part).
It is supplied by FACIAL NERVE.

BREAST / MAMMARY GLAND

Situation
Breast lies in the superficial fascia of the pectoralis region.
It divided into 4 quadrants

AVI Series 29
 General Anatomy

UL = Upper Lateral LL = Lower Lateral

UM = Upper Medial LM = Lower Medial

Small extension of the upper lateral quadrant called axillary tail of the Spence, passes through an
opening in the deep fascia and lies in the axilla, opening called foramen of Langer.

Extent
• Vertically it extends from the 2nd to the 6th rib.
• Horizontally it extend from lateral border of the sternum to the midaxillary line.

Deep Relations
• Breast lie on the deep fascia and cover the pectoralis major.
• Three parts of muscles are covered by breast name as Pect. Major, serratus anterior
and muscles of abdomen (external oblique).
• Retro-mammary space(loose areolar tissues) separate the breast and the pectoralis fascia.

Structure of the Breast

Breast divided into skin, Parenchyma, Stroma.

Skin
➔ Nipple is the conical projection and present just below the center of the breast and at the level of 4th
intercostals space(10cm from midline).
➔ Nipple contain 15-20 lactiferous ducts (contains circular and longitudinal smooth muscles which stiffen and
flatten the nipple respectively)
➔ It has a few modified sebaceous and sweat glands.
➔ It is rich in nerve supply and has many sensory end organs at the termination of the nerve fibers.
➔ The skin surround the nipple is pigmented and forms a circular area called areola.
➔ Areola is richly supplied by both glands, oily secretion that prevent from cracking during laction.

AVI Series 30
 General Anatomy
➔ Areola become enlarged during pragnancy and lactation, areola also contain hairs.
➔ Below areola lies the lactiferous sinus where stored milk is seen.
Parenchyma
➔ It is a tubulo-alveolar gland which secretes milk.
➔ The gland consists of 15-20 lobes. Each lobe is a cluster of alveoli, and is drained by lactiferous duct. The
lactiferous ducts converge towards the nipple and open on it. At the end is a dilatation called lactiferous sinus.
➔ In resting phase ALVEOLAR EPITHELIUM is cuboidal. And columnar during lactation
➔ The passage of the milk from the alveoli into and along the ducts is facilitated by contraction of
myoepitheliocytes(lie around the alveoli and around the ducts, lying between the epithelium and the
basement membrane).
Stroma
➔ It forms the supporting framework of the gland.
➔ It compose of fibers and fatty acids
Fiberous stroma forms septa called suspensory ligaments of cooper (fixed the skin and the glands to the
pectoralis fasci ).
Fatty stroma forms the main bulk of the gland. Except areola and nipple it distributed all over the breast.

Blood Supply
 Mammary gland is highly vascular. It is supplied by following branches of arteries
1. Internal thoracic artery, a branch of subclavian artery.
2. Lateral thoracic, superior-thoracic and thoraco-acromial branch of axillary artery.
3. Lateral branch of posterior intercostals artery.
 Superficial Veins drain into internal thoracic vein,
into the superficial veins of the lower part of the neck.
Deep veins drain into the axillary and posterior intercostals vein.

Nerve Supply
 The breast is supplied by the anterior and lateral cutaneous branches of the 4th to 6th intercostals
nerves.
 The nerve convey
sensory fibers to skin and autonomic fibers to smooth muscles and to blood vessels.
 The nerve don’t control the secretion of the milk. Secretion is controlled by the hormone prolactin.

AVI Series 31
 General Anatomy
Lymphatic Drainage
The subject can be describe by lymph nodes and lymphatic vessels.

1. LYMPH NODES
1. The axillary lymph node including anterior, posterior, lateral, central and apical groups of nodes also
receive lymph from the breast.
2. Internal mammary nodes lies along the internal thoracic vessels.
3. Some lymph from the breast also reaches the supraclavicular nodes,cephalic node, posterior
interncostal nodes, subdiaphragmatic and subperitoneal lymph plexus.
2. LYMPHATIC VESSELS
1. Superficial lymphatics drain the skin over the breast except for the nipple and areola. The
lymphatics pass radially to the surrounding lymph nodes(upper 3)
2. Deep lymphatics drain the parenchyma of the breast , also drain areola and nipple.

AVI Series 32
 General Anatomy

Part 8.

Diseases
Erb’s Paralysis
Erb’s point is one region of the upper trunk of the brachila plexus. Injury to this point cause Erb’s
paralysis.
Cause by the separation of head from shoulder during birth, anesthesia and fall on shoulder.
Mainly C5 effected and partly C6.
Any one arm may affected and cause forelimb extended and pronated. Muscles of upper limbs effected.

klumpke’s Paralysis
Cause by injury in the lower trunk(T1 and partly C8) of brachial plexus.
Cause Under abduction of the arm, after a fall from height or during birth.
Effect = complete claw hand.
Disabilities including
cutaneous anesthesia and analgesia in a narrow zone along the ulnar border of forearm and hand.
Horner’s syndrome, vasomotor change and trophic changes.

Extract the table of origin, insertion, nerve supply and action’ from Anatomy Book page # 41,42, 62 and 67 in B.D Chaurasia. Thanks

Contact for further notes

0315 490 69 46
AVI Home Lahore @ FaceBook
avihomelahore08@gmail.com

AVI Series 33