Pectoral Girdle & Upper Limb | | | 1 Clavicle @ 0) ©) @) © Type: Modified long bone Characteristic features: + Itis devoid of medullary cavity. + Ossifies mostly from membrane. «First bone to start and last bone to complete ossification in the body. + Though it is a long bone, it is placed horizontally. * Sometimes, itis pierced by intermediate branch of supraclavicular nerve. NOTE: | ‘lavicle i also known as dermal bone as itis pierced by supraclavicular nerve, Presenting parts: sternal end, acromial end and shaft. Anatomical position: «The enlarged sternal end is directed medially, forward and downward. * Thesubclavian groove in the shaft is placed inferiorly. «The convexity of medial 2/3" of shaft should be directed anteriorly. Muscles attached: + Pectoralis major: from medial half of anterior surface of clavicle. + Sternocleidomastoid muscle: from medial 1/3" of superior surface of clavicle, «Deltoid: from anterior border and superior surface of lateral 1/3" of clavicle. + Trapezius: inserted into posterior border and superior surface of lateral 1/3" of clavicle. + Subclavius muscle: in subclavian groove Joints formed by it: + Sterno-clavicular joint: Saddle variety of synovial joint. + Acromio-clavicular joint: Plane variety of synovial joint. Coraco-clavicular ligament + Superior Attachment: to the conoid tubercle and trapezoid ridge present in inferior surface of lateral 1/3" of clavicle. | 188 ratory PreInferior attachment: root and upper surface of coracoid process of scapula, ae i ial skeleton, i ission from upper limb to axi + Importance: helps in weight transmis z ) Comment site of fracture: atthe junction of medial 2/3 and lateral 1/3 of clavicle, 2. Scapula {@) Type: Flat bone ; : . Preseniag Parts: two surfaces- costal and dorsal, three borders- superior, medial 7 lateral, three angles- superior, inferior and lateral, three processes- spine, acromion an coracoid. (©) Anatomical position: / * — Costal surface is directed forward and medially. © Glenoid cavity faces laterally and slightly upwards. * Tip of coracoid process is directed almost straight forward. Vertebral level: @) * _Rootof spine of scapula-3* thoracic spine, inferior angle-7* thoracic spine. (©) Types of Epiphysis: * __Atavistic epiphysis: coracoid process of scapula, (Muscles attached: *_Costal surface: origin of subscapulris muscle, Medial border on costal surface: inserti Dorsal surface: sup; ra-spinous fossa- ori fossa- rigin of supraspinatus muscle, infra-spinous origin of infraspinatus muscle, Lateral border on dorsal Surface: upper 2/3¢4_ origin of teres minor, lower 1/3 ~ origin of teres major. * Medial border on dorsal surface: insertion of levator scapulae, and thomboideus major, Supraglenoid tubercle: Infraglenoid tubercle: Coracoid process: thomboideus minor *oviin of long head of biceps branchii, orsin of long head of triceps brachii, From tip: origin of Soracobrachialis and short head of biceps branchii, Superior surface and antero-medial border: insertion of pectoralis minor. Actomion process: Medial border: i nsertion of trapezius, Lateral border: origin of, deltoid. Spine of scapula: Upper lip of spine °f scapula: insertion of trapezius, Lower lip of spine °F apula: otigin of dette, 184 | Anatomy Practical(@) Suprascapular notch: Converted into foramen by transverse scapular ligament * — Structure passing through it: supra-scapular nerve. * Structures passing above it: supra-scapular vessels, (h) Joints formed by it: Shoulder joint: Ball and socket variety of synovial j int. * — Actomio-clavicular joint: Plane variety of synovial joint. Humerus (2) Type: Typical long bone (b) Presenting parts: Upper end: head, neck, intertubercular sulcus, lesser and greater tubercle. * Shaft Lower end: medial epicondyle, trochlea, capitulum, lateral epicondyle. (from M-L) coronoid, radial and olecranon fossa. © Neck: Anatomical neck: junction of head with rest of upper end. Surgical neck: constriction between upper end and shaft of humerus. Morphological neck: represented by epiphyseal line between upper epiphysis and diaphysis of young humerus. It is about 0.5 cm above the surgical neck. (4) Anatomical position: Head faces medially and slightly upwards and backwards. Olecranon fossa faces posteriorly. (©) Types of Epiphysis present: ‘Traction epiphysis: Lesser and greater tubercle, medial and lateral epicondyle. Pressure epiphysis: head of humerus. (Muscles attached: + Lesser tubercle: insertion of subscapularis muscle. * Greater tubercle: insertion of supraspinatus, infraspinatus and teres minor. NOTE: | Rotator cuff muscles: Subscapuars muscle, Supraspinatus, Infraspinatus and Teres mina (g) Shaft: © Middle of shaft close to medial border: insertion of coracobrachialis, + Anterolateral surface near middle of shaft: insertion of deltoid muscle. + Anterlateral and anteromedial surface in lower half: origin of brachialis, Oblique ridge above spiral groove: origin of lateral head of triceps. Posterior surface below spiral groove: origin of medial head of triceps, Lateral supracondylar riage: origin of brachioradialis and extensor carpi radialis longus. Anatomy Practical | 185© tntertubercutar sulcus, Bieipital yroove: (A lady between two majors) Lateral lip: insertion of pectoralis major = Foor: insertion of latissimus dorsi = Medial lip: insertion of teres major, andl vessels related: + Surgical neck: axillary nerve and posterior circumflex humeral vessels. (by + Spiral groove: radial nerve and profunda brachii vessels. * Posterior to medial epicondyle: ulnar nerve. + Bicipital yroove: ascending branch of anterior circumflex humeral artery. (other ‘encon of long head of bieps brachii) structure relates (h) Joints formed by it + Shoulder/Glenohumeral joint: Ball and socket variety of synovial joint. + Elbow joint: Hinge variety of synovial joint. 4, Radius (a) Type: (b) Presenting parts: ‘Typical long bone * Upper end: head, neck and radial tuberosity. + Shatt * Lower end: anterior, posterior (dorsal tubercle of Lister), lateral (styloid process) medial (ulnar notch) and inferior surface. (©) Anatomical position: * Head is directed upwards. + Dorsal tubercle of Lister facing posteriorly. + Styloid process facing laterally. tached: * Radial tuberosity (posterior part): insertion of biceps branchii. (4) Important muscles + Lateral surface just above styloid process of lower en on ae ‘Anterior part ofraial tuberosity is related with bursa, (@) Joints formed by it: * Elbow joint: Hinge variety of synovial joint. * — Wrist/Radlio-carpal joint: Ellipsoid variety of synovial joint. * Superior radioulnar joint: Pivot variety of synovial joint. * Middle radioulnar joint; Syndesmosis variety of fibrous joint. * Inferior radioulnar joint: Pivot variety of synovial joint. 186 | Anatomy PracticalIntertubercular sulcus/Bicipital groove: (A lady between two majors) Lateral lip: insertion of pectoralis major Floor. insertion of latissimus dorsi = Medial lip: insertion of teres major. {h) Nerves and vessels related: * Surgical neck axillary nerve and posterior circumflex humeral vewels * Spiral groove radial nerve and profunda brachii vessels. * Posterior to medial epicondyle ulnar nerve. + Bicipital groove ascending branch of anterior circumflex humeral a structure related: Tendon of long head of bieps brachii) (h) Joints formed by it * Shoulder/Glenohumeral jount. Ball and socket variety of synovial joint ° Uibow joint Hinge variety of synovial joint. 4. Radius (a) Type: Typical long bone (b) Presenting parts: + Upper end: head, neck and radial tuberosity. . Shatt * — Lower end. anterior, posterior (dorsal tubercle of Lister), lateral (styloid process medial (ulnar notch) and inferior surface (6) Anatomical position: + Head is directed upwards. + Dorsal tubercle of Lister facing posteriorly. + Styloid process facing laterally. (4) Important muscles attached: * Radial tuberosity (posterior part): insertion of biceps branchii * Lateral surface just abovestyloid process of lower end: insertion of branchioradialis ‘NOTE: [Samaaamaraaes —_ (©) Joints formed by it: * Elbow joints Hinge variety of synovial joint, * _ \ris/Radio-carpal joint: Elipsoid variety of synovial joint. * Superior radioulnar joint: Pivot variety of synovial joint. * Middle racioulna: joint: Syndesmosis variety of fibrous joint. * Inferior radioulnar joint: Pivot variety of synovial joint. 186 | Anatomy Practical“aN 5, Ulna -@) Type: Typical long bone, (&) Presenting parts: Upper end: olecranon and coronoid processes, trochlear and radial notch, * Shaft * Lower end: head of ulna and styloid process. (© Anatomical position: Trochlear notch faces anteriorly. Sharp interosseous border faces laterally. Olecarnon process faces superiorly. (@) Important muscles attached: Upper surface of olecranon process: insertion of triceps branchii. Ulnar tuberosity: insertion of brachialis. Supinator crest: origin of supinator muscle. (©) Joints formed by it: Elbow joint: Hinge variety of synovial joint. Superior radioulnar joint: Pivot variety synovial joint. Middle radioulnar joint: Syndesmosis variety of fibrous joint. Inferior radioulnar joint: Pivot variety synovial joint. Anatomy Practica! | 187 |Pelvic Girdle & Lower Limp 1. Hip/ Innominate bone (@) ©) © ‘Type: irregular bone Parts: ium, ischium and pubis Joint formed: + Hip joint: Ball and socket variety of synovial joint + Pubic symphysis: Secondary cartilaginous joint. (between two hip bone) + Socro-iliae joint: Plane variety of synovial joint Structures attached @) ) © (d) ©) @ (hy) @ 0 (k) 188 | Anatomy Practical Anterior superior iliac spine: origin of sartorious, lateral end of inguinal ligament. ‘Anterior inferior iliac spine: straight head of rectus femoris and ilio-femoral ligament Iliac crest: fascia lata, tensor fascia latae, external oblique, internal oblique, transverse abdominis and gluteus maximus. Muscles attached on gluteal surface (anterior to posterior): origin of gluteus minimus gluteus medius and gluteus maximus, Above the acetabulum on dorsal: origin of reflected head of rectus femoris. Structures running on dorsal surface of ischial spine: (lateral to medial) nerve © obturator internus, internal pudendal vessels, pudendal nerve. Ischial tuberosity: + Superior part: origin of semimembranosus, semitendinosus and long biceps. + Inferior part origin of hamstring part of adductor magnus. Pubic tubercle: inguinal ligament, cremaster muscle. Acetabulum: acetabular labrum, transverse acetabular ligament (on the notch) and ligamentum teres femoris/ligament of head of femur. Structure passing through obturator canal: obturator yessels and nerve Anatomical position: dof acetabillat é i i 7 6 Pubic bone lies superiorly with the symphysial surface facing 4°" forwards and medially, + Anterior superior iliac spine and superior surface of pubic symphy' coronal plane. e sis lienAcetabulum is faces downward, forward and laterally. + Ischial spine and superior end of pubic symphysis lie on same horizontal plane. + Ischial tuberosity occupies the lowest point. Femur (@) Type of bone: typical long bone (0) Parts: upper end, shaft and lower end Upper end: head, neck, greater and lesser trochanter, inter-trochanteric line and intertrochanteric crest * Lower end: lateral and medial condyles and epicondyles; and condylar fossa (©) Joints formed: hip joint and knee joint. * Knee joint: modified hinge variety of synovial joint. (@) Types of epiphysis * Pressure epiphysis: head and condyles of femur. Traction epiphysis: greater and lesser trochanter, quadrate tubercle. (©) Structures attached: * Head: ligamentum teres femoris * Greater trochanter: insertion of gluteus minimus, gluteus medius and gluteus maximus. ‘Trochanteric fossa: insertion of obturator externus Lesser trochanter: insertion of psoas major and iliacus Inter-trochanteric line: vastus medialis and lateralis * — Quadrate tubercle: quadratus femoris ® Gluteal tuberosity: 1/4 of insertion of gluteus maximus. * Linea aspera: | Medial lip: medial intermuscular septum and vastus medialis. Intermediate lip: posterior intermuscular septum, adductor brevis, longus and magnus. Lateral lip: lateral intermuscular septum, vastus lateralis and short head of biceps femoris. | + Lateral epicondyle: fibular collateral ligament © Below lateral epicondyle (in the groove): attachment of popliteus muscle ‘Above the lateral epicondyle (in the depression): origin of lateral head of gastrocnemius + Medial epicondyle: tibial collateral ligament + Adductor tubercle: insertion of adductor magnus (hamstring part) * Intercondylar fossa’ ~ Medial wall (at antero-inferior part): posterior cruciate ligament = Lateral wall (postero-superior part): anterior cruciate ligament Anatomy Practica! | 189 \i ition: , ° a ie a is directed upward, medially and slightly forward, + Head of : . ity of shaft faces anteriorly. / a axis of shaft of femur is facing downwards and medially so that the . a femoral condyles lie on the horizontal plane. Clinical importance: : 2 * The secondary enter of ossification for lower end appears just before the birth, The Presence of this center indicates that fetus is mature and viable enough to survive after the borth. This fact is used to determine if new born infant found dead was capable of survible at birth or not. Fracture of neck of femus, Patella (2) Type: sesamoid bone (b) Features of sesamoid bone: * Bones develop in the tendons of the muscle. It ossifies after the birth. Ttis not lined by Periosteum, There is absence of Haversian system, (©) Joint formed: knee joint (4) Side determination: ‘The apex of patella is directed downwards, The articular surface should Large lateral part should be (©) Parts: apex, base, be facing posteriorly, on lateral side. medial and lateral borders and anterior and Posterior surfaces. Tibia @) Type: typical long bone (©) Parts: Upper end, shaft and lower end * Upper end: medial and tat eminence and tibial tuberosi Lower end: medial malleo} (©) Joint formed: knee joint with fe * Tibio-fibular joints: g 'ype of fibrous joint, Ankle joint: modifi eral condyles, interco: ity. lus ndylar area with intercondylat mur and patella, uperior- osis: Plane synovial joint, middle and lower syndesm (d) Structures attached:+ Intercondylar area (from before to backwards): anterior horn of medial meniscus, anterior cruciate ligament, anterior horn of lateral meniscus, posterior horn of Jateral and medial menisci and posterior cruciate ligament. + Tibial tuberosity: ligamentum patellae « Atsoleal line: soleus muscle + Above soleal line: insertion of popliteus * Below the soleal line: flexor digitorum longus and tibialis posterior Anatomical position: + Upper surface of tibial condyles should be facing upwards. * Tibial tuberosity and anterior border of tibia are directed anteriorly. * Tibial malleolus at the lower end is placed medially. Fibula @ ® © (a) Type: long bone Parts: upper end, shaft and lower end + Upper end: consists of oval or circular facet, styloid process * Lower end: lateral malleolus Joint formed: tibio-fibular joint and ankle joint Structures attached: + Styloid process: insertion of biceps femoris, collateral ligament + Neck: related with common peroneal nerve on lateral side. + Lateral malleolus: groove in the posterior surface: lodgement of tendons of peroneus longus and brevis. NOTE: Fibula violates the law of ossification Le. the 2° centr which appears 11s aso fist to fuse wih bone, Lower end which ossfies firot also fuse ist with the shat, wile the upper end which ossifies laterals fuses tater with the shaft1 Sternum ang Sternum (a) Type: Flat bone : (0) Presenting parts: Manubrium, body and xiphoid process. () Vertebral level: (@) © + Manubrium: opposite 3 and 4* thoracic vertebrae. + Body: 5-8 thoracic vertebrae. + Manubrio-sternal joint: lower border of T,. + Xiphi-sternal joint: IVD between T, and T,, Sternal angle/angle of Louis: * Important events occurring at sternal angle: - Bifurcation of trachea occurs (in supine position). - Junction between superior and inferior mediastinum. - Superior venacava pierces fibrous pericardium and arch of azygos vein terminates. - Beginning and ending of arch of aorta. - Deviation of thoracic duct from right to left. Importance: Important landmark in counting of the ribs as it articulates with 2" costal cartilage. Important muscles attached: * Anterior surface of manubrium: origin of sternal head of Sternocleido-mastoid and Pectoralis Major muscle. * Anterior surface of body: origin of Pectoralis Major. * Anterior surface of xiphoid process: insertion of Rectus abdominis. Posterior surface of xiphoid process: sternal origins of diaphragm. Joints formed by it: Manubrio-sternal joint - Type: Secondary cartilaginous joint. It ossifies after 60 years. ¢ — Xiphi-sternal joint: | "ype: Secondary cartilaginous joint. It ossifies after 40 years. | + Sterno-clavicular joint: Type: Saddle variety of synovial joint.* — 1*Chondro-sternal joint: Type: Primary cartilaginous joint. It ossifies after 25 years + 21-7 Chondro- sternal joint: Type: Synovial joint. ® Clinical importance: * — Sternal puncture to aspirate bone marrow. « — Sternotomy Typical ribs (@) Type: Flat bone (b) Presenting parts: two ends and shaft > Sternal end: Vertebral end: head, neck and tubercle. - Shaft: (Anatomical position: Vertebral end is kept posterior and higher than sternal end. The sharp border of the shaft should be kept downwards. The concave curved surface should be kept medially. Characteristic features: The vertebral end consists of head, neck and tubercle (articular and non-articular part). ‘The shaft is thin, flat and curved. It consists of external and internal surfaces, upper and lower borders. The internal surface consists of costal groove along the lower border. Costal groove: * Upper lip: origin of innermost intercostal muscle. Floor: origin of internal intercostal muscle. Lower lip: origin of external intercostal muscle. Structures present in it (above downward): intercostal vein, artery and nerve. (VAN) Ligaments attached to it: ‘Superior costo-transverse ligament: between upper border of neck of rib and transverse process of upper vertebra. Costo-transverse ligament: between neck of rib and transverse process of vertebra. Lateral costo-transverse ligament: between non-articular part of tubercle of rib and tip of transverse process of vertebra, Capsular ligament, Joints formed by Costo-vertebral joint: between head of rib and adjacent vertebral bodies. Costo-transverse joint: between costal facet of transverse process and articular part of tubercle. Costo-chondral joint: between sternal end of ribs and its costal cartilage. Anatomy Practical | 1883. First rib a ae Sternal end, Vertebral end- (head, neck and tubercle), Shaft, 4 Characteristic features: ' + Itis shortest, latest and most curved rib. + Its head has only one articular facet for the body of first thoracic vertebra, * The posterior angle of the first rib coincides with the tubercle. + The shafts flat and presents upper and lower surfaces, outer and inner borders + The upper surface presents the scalene tubercle close to its inner border, ‘The lower surface is smooth and doesn’t present a costal groove. (@) Anatomical position: + The sternal end is placed anterior and lower level than vertebral end, ji, The rough superior surface of shaft (having, grooves) should face superiorly iii, ‘The concave inner border lies medially. ‘The side ofthe fist rib can be should touch the surface, easily determined by placing the bone on a fat surface. Both the sternal and vertebral end (©) Anterior relation of neck of first rib: (from medial to lateral) * Sympathetic trunk, first posterior inter ascending branch of ventral ramus of () Important muscles attached: costal vein, superior intercostal artery and first thoracic nerve. Superior surface near its anterior end: origin of subclavius muscle Scalene tubercle: insertion of scalenus anterior. Outer border behind the groove: origin of serratus anterior, Outer border: origin of. external and internal intercostals muscle. | NoTE: Innermast intercostals muscles absent in rst ib (8) Important vessels related to upper surface: * Anterior groove lodges subclavian vein. Posterior groove lodges subclavian artery, 4. Second rib (a) Type: Flat bone (0) Presenting parts: ternal end, Vertebral end- (head, neck and tubercle), Shaft () Characteristic features: * — Itis thinner and twice the length of first tib. and internal surfaces, 194 | Anatomy Practical‘The external surface presents a prominent tuberosity near the middle of shaft. Ithas a faint, short costal groove in the posterior part of internal surface. The angle of second rib is situated close to the tubercle. (@ Anatomical position: The sternal end is placed anterior and lower level than vertebral end. The convex external surface is facing upward and laterally. (© Important muscles attached: Prominent tuberosity on external surface: origin of serratus anterior. External surface in its posterior part: insertion of scalenus posterior. Upper and lower borders: intercostals muscle. Tenth rib (@) Type: Flat bone (©) Presenting parts: Sternal end, Vertebral end- (head, neck and tubercle), Shaft. (©) Characteristic features: * Itpresents a single articular facet on its head. Eleventh rib (a) Type: Flat bone (b) Characteristic features: + Itpresents a single large facet on its head. ’ It has no neck and tubercle. + Theshaft presents a slight angle and shallow costal groove. Twelfth rib (@) Type: Flat bone (b) Characteristic features: ° It is shorter than eleventh rib. © Itpresents a single facet on its head. + Ithasno neck, no tubercle, no angle and no costal groove. Anatomy Practical | 195Vertebra @) ) © Cervical vertebrae: (Vi) Structure passin (vii) Structure rel MT Cory |. Ts Type: irregular bone Parts: body and neural /vertebral arch @ Body: presents basi-vertebral foramen in Posterior surface (1) Vertebral arch: a pair of pedicles and lamina; and 7 processes superior and inferior articular processes and a sing Joints formed: @ _ Inter-vertebral joint: between the (Paired transverse, gle spinous process) @ Typical: 3* to 6% vertebrae {@) Atypical: 14, 2"! and 7 vertebrae Features of typical cervical vertebra: ® Body: small, transversely oval and surface. Uncal Process forms the s Presence of uncal Process at the sides on upper Gi) Vertebral foramey ‘ynovial unco-vertebral joints, n: large and triangular, (iii) Pedicle: present at the midpoint between the Upper and lower borders of the body. (ii) “Spinous process: short and bifid (iv) Articular proce te articular pillar. Superior articular facet directed upwards © and backwards and inferior articular facet directed downwards and forwards. Y) Transverse process: short and directed later; eeu : i ally, Presence of single transverse anterior and posterior Toots and tubercles and costo-transverse Dar i eleme; rn 7 t eal anterior root, anterior tubercle, Costo-transverse bar and posterio! tubercle. Posterior root Tepresents the : ympathetic 8 through transverse foramen: 2 part of vertebral artery, sym™P2 plexus and vertebral vein, : nding ated (0 upper surface of, “osto-transverse bar: ventral rami of corresp0! nerve, true transverse process, 198 | Anatomy PracticaFirst cervical vertebra/ Atlas: (i) Parts: pair of lateral masses, short anterior and long posterior arches. (i) Anterior arch: presents anterior tubercle and posterior median facet to articulate with . dens of axis. Lateral mass: presents upper and lower articular facets. + Upper facet is kidney shaped, deeply concave and articulates with occipital condyles. © Lower facet is flat and circular and articulates with corresponding facet of axis. Posterior arch: presents a groove for the lodgement of the 3" part of vertebral artery and 1 cervical nerve. Peculiar features: + Ring shaped * Largest cervical vertebra. + Absence of body and spinous process. (vi) Anatomical position: + Concave superior articular process should be placed upwards with the inferior articular process facing downwards. + Anterior tubercle is placed anteriorly. (vii) Joints formed: Atlanto-occipital joint and. atlanto-axial joints. © Atlanto-occipital joint: ellipsoid variety of synovial joints. i + Atlanto-axial joint: consists of a median and 2 lateral joints. i * Median: pivot variety and lateral: plane variety of synovial joint. (b) Second cervical vertebra/ Axis (@) Parts: odontoid process or dens, body and neural arch. (ii) Peculiar features: presence of dens in upper part | + Superior articular process placed lateral tothe dens, The facet is ‘oval and lies partly | on body and partly on pedicle. «Presence of massive bifid spine. (ii) Anatomical position: + Body of the vertebra should be placed anteriorly. + Dens should be facing upwards and bifid spine should be placed posteriorly. (iv) Joints formed: Atlanto-occipital joint, other inter-vertebral joints with 3rd cervical vertebra. (©) Seventh cervical vertebra/ vertebra prominens (i) Peculiar features: spine is unbifid and elongated «Large transverse process is present with small and duplicated or may ‘be absent foramen transversarium. (i) Structure passing from transverse foramen: plexus of vertebral veins Thoracic vertebra (i) Typical: 2" to 8% vertebra (i) Atypical: 1%, 9-12" vertebra ratory Practical | 197(a) @) © (@) Lumbar vertebra bra: . , earl Sel ear two costal demifacets on each side close to its borders, @ ly: heart shap¢ : small and circular. —_ a club shaped with a full oval costal facet on the anterior (iii) ‘ransverse B close to the tips. (iv) a articular ae flat and directed postero-laterally. (v) Inferior articular facet: directed antero-medially. (vi) Spinous process: long and slopes downwards. 7 (vii) Joints formed: costo-vertebral joints and intervertebral joints. * Costo-transverse joint: tubercle of ribs and transverse process of vertebra. + Costo-vertebral joint: between the body of the vertebra and the head of the rib, . NOTE: The spinal nerve related tothe vertebra above passes through superior vertebral notch and the spinal nerve corresponding to the same vertebra passes through inferior vertebral notch, 1* thoracic vertebra: Features: @ Body:small and cervical type; presence of a full costal facet in its upper part and a demi- costal facet in its lower part. @) Prominent superior vertebral notch (C, nerve passes) due to presence of uncal process (ii) Vertebral foramen is large and triangular. (iv) | Spinous process is long and horizontally placed. 9 thoracic vertebra: presence of a single costal demi-facet on the side of body to articulate with head of 9th rib only. 10" thoracic vertebra: a si 11® thoracic vertebra: (@ Asingle circular costal facet on (ii) Transverse process is shor 12* thoracic vertebra: () The full costal facet encroachin, ies . (i) Transverse process 2 'g on the pedicle in the midway of the body. small and lacks | , } accessary and lateral, *® *® Costal facet. It also consists of 3 tubercles; ff or articular facets are convex ingle full costal facet on each side of body close to its upper border. each side of the body below its superior border. ‘tand does not contain the costal facet. mai (ii) The inferi ; and directed forwards and laterally. © Typical: upper 4 lumbar vertebra (i) Atypical: 5" lumbar vertebra, a : (ii) Transverse process: direc TM*BUlat shaped, direct; : part of the root, ed laterally with Accessory tubercles on the postero-inferior (iv) Superior articular facet co * Presents on articular face() (hy @ 0 (k) Sacrum (¥) Inferior articular facet: convex and directed forwards (vi) Lamina: non-overlapping a (vi) Spinous process: quadrangular and horizontally direct 54 Jumbar vertebra: Feed, (Transverse processes encroach on the sides ofthe body, (i) Distance between the superior arti i i i be Superior articular processes is equal with that of inferior articular (ii) Anterior surface of the body is more extensive than the posterior surface Shape: Large and triangular Parts: base, apex and four surfaces: anterior or pelvic, 4 pairs of sacral foramina are present in both anterior Joint formed: sacroiliac joint, lumbo-sacral joint and s @ Sacroiliac joint: plane synovial joint posterior/dorsal and 2 lateral surfaces, and posterior surfaces. acro-coccy geal joint Base: consists of oval body with sacral promontory and lateral mass/ala, sacral canal, thick Pedicle and lamina, superior articular facet. Anterior surface: smooth and concave. () Presence of four transverse lines (i) Presence of 4 pairs of sacral foramina. Dorsal surface: rough and convex. () Presence of 4 pairs of dorsal sacral foramina. (ii) Presence of median sacral crest in the midline, intermediate crest and lateral crest on each side of dorsal sacral foramina. (iii) Sacral hiatus is present in the lower part of the dorsal surface. Structure passing through the sacral canal: sacral and coccygeal nerves, spinal meninges, subdural and subarachnoid spaces and filum terminale. Structure emerging form sacral foramen: (Ventral foramen: ventral rami of upper 4 sacral nerves and lateral sacral arteries. (i) Dorsal foramen: dorsal rami of upper 4 sacral nerves. (ii) Sacral hiatus: 5* sacral nerves, coccygeal nerves and filum terminale. Structure related to sacrum: () Ala: obturator nerve, ilio-lumbar artery, lumbo-sacral and sympathetic trunks. (OILS) (i) Pelvic surface: median sacral vessels, sympathetic trunk, rectum, pelvic mesocolon and lateral sacral artery. Anatomical position: (i) Pelvic surface is directed forwards and downwards (i) Base faces forwards and upwards. Sex differences: (i) Male: itis long and narrower. + Width of the body of the 1* sacrum is greater than the width of ala. + Pelvic surface is uniformly concave and swallower. (ii) Female: it is wider and broad. «Width of the body of 1* sacrum is either equal or less than the width of the ala. + Pelvic surface is more flat in upper part with abrupt concavity in lower part. Anatomy Praca! | 189Pelvis (=) Bones forming it two hip bones and scarum = (0) Division: true/lesser pelvis and greater/ false pelvis. (©) Pelvic inlet of lesser pelvis: (@) Formed on each side by (posterior to anterrior): sacral promontory, anterior margin of ala ofthe sacrum linea terminals arcuate line of ilium, ilio pubic eminence, pectin pubis and pubic crest), upper end of pubic symphysis. Pelvic outlet: (anterior to posterior) Pubic symphysis (lower end), ischio-pubic rami ischial tuberosity, and tip of coccyx. @ sacrotuberous ligaments Difference between male and female pelvis (@) Male pelvis: @ Thick, heavy with prominent muscular impressions, (ii) Sub pubic angle is narrow i.e. 50°-60°, (ii) Acetabulum is large. The tr of the pubis to the anterior margin of acetabulum are almost equal. (i) Ischio-pubic rami are thick and everted, (¥) Ischia spines are inturned, (vi) Obturator formen is large and oval, (©) Female pelvis () Lighter with less (i) Sub pubic angle (ii) Acetabulum is anterior margin Prominent muscular impressions, is wide- 80°-99°, sinall. The distance between the Symphysial surface of the pubis to the / ; of acetabulum is longer than the transverse diameter of acetabulum. (iv) Ischio-pubic Tami are thin and not much everted, () Ischia! spines are outsurned, : (vi) Obturator foramen is s mall and triangular, Anatiomical position » me tenner And the anterior superior iiac spines lie in the coronal plane. © coceyx and the upper marpi : (© Pelvic inlet faces forwards upwards tvs Pubics lie on the same plane. (4) Sacrum is directed downwards x 200 | Anatomy PracticalSJ abt SYoy TA Cranium _ Structures passing through the various foramens @ _(®) Optic canal: optic nerve and ophthalmic artery _ (©) Superior orbital fissure: Cribriform plate: olfactory nerves Lateral part: lacrimal nerve, frontal and trochlear nerves, branches of recurrent meningeal and ophthalmic arteries and superior ophthalmic veins, Intermediate part: oculomotor, nasociliary and abducent nerves. * Medial part: inferior ophthalmic veins. (4) Foramen rotundum: maxillary nerve (¢) Foramen ovale: mandibular nerve, accessary meningeal artery, lesser petrosal nerve and j emissary vein, (MALE) © Foramen spinosum: middle meningeal artery and nervous spinosus. Foramen lacerum: presents the opening of pterygoid canal and carotid canal. + _ Pterygoid canal: pterygoid vessels and nerve Carotid canal: internal carotid artery surrounded by plexus of sympathetic nerves and veins. (h) Inferior orbital fissure: infra orbital vessels and nerve, zygomatic nerve, orbital branch of pterygopalatine ganglion. Internal acoustic meatus: facial and vestibulo-cochlear nerves and labyrinthine artery, @) Jugular foramen: + Anterior part: inferior petrosal sinus * Intermediate part: glossopharyngeal, vagus and accessory nerves, meningeal branch of ascending pharyngeal artery and emissary veins. * Posterior part: internal jugular vein. &) Foramen magnum: divided by alar ligament into anterior and posterior parts. Anterior osseo-ligamentous compartment: apical ligament, tip of dens, upper band of cruciate ligament and membrana tectoria, Anatomy Practical | 201Posterior neuro-vascu artment: lower part of medulla oblongata and mening : lower Bi , i lar comp: thetic plexus of nerves, spinal roots surrounded by sympat i are aes posterior spinal arteries and occasionally tonsil of the of accessory nerve, ® i —— hypoglossal nerve and meningeal branch of ascending pharyngeal artery, !)_ Hypoglossal “ (an) Stylomastoid foramen: facial nerve and stylomastoid artery. Structures related to the various parts ; (a) Sulcus chiasmaticus: optic chiasmaticus lies slightly above. (b) Frontal crest with crista galli: attachment of flax cerebri. (©) Hypophyseal fossa: pituitary gland lodges in it. : (4) Carotid groove: internal carotid artery surrounded by sympathetic plexus of nerves, {e) _ Internal occipital protuberance: related to confluence of the venous sinuses. (Transverse sulcus: lodgement of transverse sinuses (8) Sigmoid sulcus: lodgement of sigmoid sinuses. (fh) Vermian fossa: vermis of cerebellum. (i) Styloid process: * Muscles attached: styloglossus, stylohyoid, stylopharyngeus Ligaments: stylohyoid and stylomandibular ligaments, Mandible (@) Parts: consists of horseshoe shaped body and two rami, * Body consists of ‘upper and lower border, Ramus consists of 4 borders; anterior, > 2surfaces: lateral and medial s (b) Important muscles attached to mandible: * Lateral surface of ramus: j external and internal surface. Posterior, upper and lower borders, ‘urfaces, 2 processes: condylar and coronoid process. Prerygoid fovea (depression eee are 'n front of neck of the mandible): insertion of later | inatot on Neral surface of body of mandible: origin of buccinal® Mylohyoid line: origin of mylohyoig Muscle, 202 | Anatomy Practical© (@) Nerves related to mandible: Lingual nerve on medial side of alveolar border slightly below the third mot Mylohyoid nerve in mylohyoid groove. “ * Inferior alveolar nerve in mandibular foramen, + Auriculo-temporal nerve on medial side of neck of mandible. Masseteric nerve in mandibular notch. Mental nerve emerging from mental foramen. Ligaments attached to mandible: + Spheno-mandibular ligament: at the lingula, Pterygomandibular raphe: behind the third molar tooth. Stylo-mandibular ligament: at the angle of mandible. * Temporo-mandibular ligament: on the lateral and posterior surface of neck. Joint formed by it: + Temporo-mandibular joint: Type: Synovial, Sub-type: Condylar variety. Age related changes occurring in mandible: Mental foramen: At birth: mental foramen lies close to its lower border. © Inadult: mental foramen lies midway between upper and lower border. In old age: mental foramen near to the upper border. Angle of mandible: + Innewbom: angle of mandible is obtuse (140°). + Inadults: angle of mandible is about 110°-115°. + Inold age: angle of mandible is obtuse (140°). Level of the condylar and coronoid process: «* _ Innewborn: coronoid process is above the level of condylar process. « Inadults: condylar process is above the level of coronoid process. + Inold age: coronoid process is slightly above the condylar process. Anatomy Practical | 209