ANATOMY (302)

Contents
Upper Limbs bones of shoulder girdle and arms, Muscles, Axilla, Brachial plexus,
cubital fossa, the forearm, hand bones, muscles, blood supply, nerve supply,
lymphatic.
Lower limbs, the lower limb fascia, bones, muscle, femoral triangle, blood supply,
nerve supply, lymphatic supply.
Head and neck, skull, mandible, cranial nerves, cranial cavity, meninges, brain,
head face, sinuses, neck, orbit
Endocrine system, classification of endocrine glands, pituitary gland
Thyroid glands, renal gland and difference between the cortex and medulla.
Pelvic cavity, ureter, urinary bladder, male genital organs, female genital organs,
muscles of the pelvic region, blood supply, nerve supply
Special senses, eyes, tongue, ear
PRACTICALS
• Anatomy of Upper and lower limbs
• Anatomy of head, neck and throat
• Anatomy of eyes, ear, tongue
• Human models
• Video demonstration
UPPER LIMB
• The upper limb starts from the pectoral girdle to hand.
• The pectoral girdle is made up of the clavicle and scapula.
• Next is the arm, which contains the humerus, the forearm containing
the radius and the ulna
• The wrist made up of the carpals; the hand made up of
the metacarpals; and finally, digits contain phalanges.
Shoulder

• Glenohumeral joint: humerus, scapula, clavicle

• The shoulder is where the upper limb attaches to the trunk. Its most important part
is the glenohumeral joint; formed by the humerus, scapula and clavicle.

• The humerus anatomy is a must-know before any discussion on the glenohumeral

joint, and you can learn everything about it in our learning materials.

• Muscles:
• The shoulder joint is reinforced with two groups of muscles, superficial and
deep. Superficial muscles include the deltoid and the trapezius, whereas
the deep group contains the supraspinatus, infraspinatus, teres minor and
subscapularis (rotator cuff) muscles.
• - Superficial: deltoid, trapezius
- Deep: Supraspinatus, Infraspinatus, Teres minor, Subscapularis
(rotator cuff) muscles
Mnemonic: Rotator cuff SITS on the shoulder

• To easily remember the rotator cuff muscles, use the mnemonic given
below!
• Rotator cuff SITS on the shoulder
• Supraspinatus
• Infraspinatus
• Teres minor
• Subscapularis
• Arm
• The arm is the area between the shoulder and the elbow. Depending on
whether you’re a gym lover or not, it may be more or less important to you.

• But anatomically, all parts of the arm are a must-know. There is only one
bone within the arm, and that is the humerus. It is the pillar on which all the
other soft tissue structures rely.

• Bones: humerus
Nerves: they all originate from the brachial plexus
Arteries: branches of the brachial artery
Muscles:
- Anterior compartment: coracobrachialis, brachialis, biceps brachii muscles
- Posterior compartment: triceps brachii
• The muscles are grouped into anterior and posterior compartments by the
septa that attach to the humerus.

• The anterior compartment contains the coracobrachialis, brachialis and

biceps brachii muscles. While the posterior compartment contains only one
muscle, the triceps brachii.

• Last but not least, is the neurovascular compartment. Every single structure
of the arm is innervated by the brachial plexus, a network of nerves that
originate from the C5-T1 spinal nerves.

• Arterial blood comes from the brachial artery, which arborizes on its way
down the arm giving many branches for the supply of the structures of the
arm.Learn more about the nerves of the upper limb with Kenhub.
• Elbow
• The elbow is another “bridge” within the upper limb that attaches the
arm and the forearm. Three bones participate in the elbow joint: the
humerus, the radius and the ulna. They are shaped and attached in
such a way that allows the unique forearm movement of pronation
and supination. In order to understand these movements, you can
find everything you need to know about elbow anatomy through
these learning materials:
• Bones: humerus, radius, ulna
Movements: flexion, extension, pronation, supination

• The anterior of the elbow is called the cubital fossa, in which, besides
the joint, are found important nerves and vessels intended for the
supply of both the forearm and hand.
• Forearm
• Here comes the part that most students consider the hardest. The twenty muscles,
and two bones (radius and ulna), of the forearm. When in anatomical position
(supination), the radius is found laterally while the ulna is medially in the forearm.

• This is why while studying the forearm anatomy, you'll often encounter with
terms radial, meaning lateral, and ulnar referring to the medial part of the
forearm.

• Bones: radius, ulna

Nerves: radial, ulnar, median nerves
Arteries: branches of the radial and ulnar arteries
Muscles:
- Anterior compartment: superficial, deep layers
- Posterior compartment: superficial, deep layers
• Radius and ulna articulate with each other by proximal and
distal radioulnar joints and also contribute to the elbow and wrist joints
. Thanks to the common sense of the mother nature while designing these
two bones, we can perform movements uniquely seen in the forearm such
as supination and pronation

• The muscles of the forearm are grouped into anterior and posterior
compartments, with the anterior compartment containing mostly flexors,
and the posterior, extensors. Both the anterior and deep compartments
can be further divided into superficial and deep layers.

• Arterial supply of the forearm is through the branches of the radial and
ulnar arteries, whereas innervation comes from the radial, ulnar and
median nerves.
• Hand
• The hand is probably the finest product of human evolution from the aspect of our
body mechanics. The hand anatomy enables us various movements, with the
spectrum ranging from rough movements, such as smashing a mosquito, to the finest
movements like playing the guitar, drawing, or writing calligraphically.
• To understand how this works, let’s start with the basic parts of the hand, which are:
• the wrist (carpus)
• the metacarpus
• the digits

• Bones: scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate,

hamate, metacarpals (5), phalanges (proximal, middle, distal)
Nerves: radial, ulnar, median nerves
Arteries: terminal branches of the radial and ulnar arteries
Muscles: thenar, hypothenar, metacarpal muscle groups
• The bony background of the hand is very interesting. The carpus contains 8
bones, the metacarpus are comprised of 5, and the digits have 14 bones.

• The bones within the carpus are small, irregularly shaped, and have such
curious names that you may like to choose one for your instagram account:
scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate and
hamate bones.

• Metacarpal bones, on the other hand, are easier to remember since they are
named metacarpal I to V, with metacarpal I being the ‘root’ for the thumb and
metacarpal V for the pinky finger.

• Finally the digits are supported with three consecutively attached bones called
the proximal, middle and distal phalanges, all specifically named by adding I-V
at the end.
• When it comes to the muscles, they are called the intrinsic muscles of
the hand. Meaning they both originate and insert within the hand.

• This is in contrast to the ‘extrinsic’ forearm muscles that originate

from the forearm, and insert into the hand.

• The intrinsic muscles of the hand are the: palmaris brevis, interossei (
palmar and dorsal), adductor,pollicis, thenar, hypothenar and
lumbrical muscles.

• As far as the neurovasculature is concerned, both arteries and nerves

are continuations from the neurovascular elements of the forearm
LOWER LIMB
• Fascia is a sheet or band of fibrous tissue lying deep to the skin. It
lines, invests, and separates structures within the body. There are
three main types of fascia:
• Superficial fascia – blends with the reticular layer beneath the
dermis.
• Deep fascia – envelopes muscles, bones, and neurovascular
structures.
• Visceral fascia – provides membranous investments that suspend
organs within their cavities.
• The fascia lata is a deep fascial investment of the musculature of the thigh, and is
analogous to a strong, extensible, and elasticated stocking. It begins proximally
around the iliac crest and inguinal ligament and ends distal to the bony
prominences of the tibia.

• It is continuous with what is renamed the deep fascia of the leg (also known as the
crural fascia).

• The depth of the fascia lata varies considerably across the thigh. It is thickest along
the superolateral aspect of the thigh, where it arises from the fascial
condensations of gluteus maximus and medius.

• It is also thick around the knee where the fascia receives reinforcing fibres from
tendons of the quadriceps muscles. The fascial investment is thinnest where it
covers the adductor muscles of the medial thigh.
• The deepest aspect of the fascia lata gives rise to three intermuscular
septa that attach centrally to the femur. The septa divide the thigh
musculature into three compartments; anterior, medial, and lateral.

• The lateral intermuscular septum is the strongest of the three due to

reinforcement from the iliotibial tract (see later), whereas the other two
septa are proportionately weaker.

• An ovoid hiatus known as the saphenous opening is present in the

fascia lata just inferior to the inguinal ligament.

• The opening serves as an entry point for efferent lymphatic vessels and
the great saphenous vein, draining into superficial inguinal lymph nodes
and the femoral vein respectively.
• Tensor Fascia Lata (TFL)
• The tensor fascia lata is a gluteal muscle that acts as a flexor, abductor, and
internal rotator of the hip. Its name, however, is derived from its additional
role in tensing the fascia lata.

• It is innervated by the superior gluteal nerve, like gluteus medius and

minimus, but is located more anterolaterally than the other gluteal muscles.

• The muscle originates from the iliac crest and descends inferiorly to the
superolateral thigh. At the junction of the middle and upper thirds of the
thigh, it inserts into the anterior aspect of the iliotibial tract.

• When stimulated, the tensor fasciae lata tautens the iliotibial band and
braces the knee, especially when the opposite foot is lifted.
• The property of TFL tightening the fascia lata is analogous to hoisting
an elastic stocking up the thigh. When the fascia lata is pulled taut, it
forces muscles in the anterior and posterior compartments closer to
towards the femur.

• Contraction within each compartment centralises muscle weight and

limits outward expansion, which in turn reduces the overall force
required for movement at the hip joint.

• An additional property of tensing the fascia lata is that it makes

muscle contraction more efficient in compressing deep veins, which
ensures adequate venous return to the heart from the lower limbs.
• Attachments
• Proximal
• The fascia lata arises from multiple superior attachments around the
pelvis and hip region:
• Posterior – sacrum and coccyx.
• Lateral – iliac crest.
• Anterior – inguinal ligament, superior pubic rami.
• Medial – inferior ischiopubic rami, ischial tuberosity, sacrotuberous
ligament.
• The fascia lata is also continuous with other regions of deep and superficial
fascia at its superior aspect.

• The deep iliac fascia descends from the thoracic region at the diaphragm,
covers the entire iliacus and psoas regions, and blends with the fascia lata
superiorly.

• The deep layer of the superficial fascia of the abdominal wall (Scarpa’s fascia)
blends with the fascia lata just below the inguinal ligament.

• Lateral
• The lateral thickening of fascia lata forms the iliotibial tract and receives
tendon insertions superiorly from gluteus maximus and tensor fascia lata. The
widened band of fibres descends the lateral thigh and attaches to the lateral
tibial condyle on the anterolateral (Gerdy) tubercle.
• Inferior
• The fascia lata ends at the knee joint where it then becomes the deep fascia
of the leg (the crural fascia).

• Attachments are made at bony prominences around the knee including the
femoral and tibial condyles, patella, head of fibula and the tibial tuberosity.

• Central
• The deep aspect of fascia lata produces three intermuscular septa which
attach centrally to the femur. The lateral septum joins to the lateral lip of the
linea aspera and the medial and anterior septa attach to the medial lip.

• These attachments then continue along the whole length of the femur to
include the supracondylar lines.
Muscles of the Gluteal Region

• The gluteal region is an anatomical area located posteriorly to the pelvic

girdle, at the proximal end of the femur. The muscles in this region move
the lower limb at the hip joint.
• The muscles of the gluteal region can be broadly divided into two groups:

• Superficial abductors and extenders – group of large muscles that abduct

and extend the femur. Includes the gluteus maximus, gluteus medius,
gluteus minimus and tensor fascia lata.

• Deep lateral rotators – group of smaller muscles that mainly act to

laterally rotate the femur. Includes the quadratus femoris, piriformis,
gemellus superior, gemellus inferior and obturator internus.
• The arterial supply to these muscles is mostly via the superior and inferior
gluteal arteries – branches of the internal iliac artery. Venous drainage follows
the arterial supply.

• We shall examine the two groups of gluteal muscles – their attachments,

innervations and actions.

• We shall also look at the clinical consequence of gluteal muscle disorders

• The Superficial Muscles

• The superficial muscles in the gluteal region consist of the three glutei and the
tensor fascia lata.

• They mainly act to abduct and extend the lower limb at the hip joint.
• Gluteus Maximus
• The gluteus maximus is the largest of the gluteal muscles. It is also the
most superficial, producing the shape of the buttocks.

• Attachments: Originates from the gluteal (posterior) surface of the

ilium, sacrum and coccyx. The fibres slope across the buttock at a 45
degree angle and insert onto the iliotibial tract and gluteal tuberosity
of the femur

• Actions: It is the main extensor of the thigh, and assists with lateral
rotation. However, it is only used when force is required, such as
running or climbing.
• Gluteus Medius
• The gluteus medius muscle is fan-shaped and lies between to the
gluteus maximus and the minimus. It is similar in shape and function to
the gluteus minimus.

• Attachments: Originates from the gluteal surface of the ilium and

inserts into the lateral surface of the greater trochanter.

• Actions: Abduction and medial rotation of the lower limb. It stabilises

the pelvis during locomotion, preventing ‘dropping’ of the pelvis on the
contralateral side.

• Innervation: Superior gluteal nerve.

• Gluteus Minimus

• The gluteus minimus is the deepest and smallest of the superficial gluteal
muscles. It is similar in shape and function to the gluteus medius.

• Attachments: Originates from the ilium and converges to form a tendon,

inserting to the anterior side of the greater trochanter.

• Actions: Abduction and medial rotation of the lower limb. It stabilises the
pelvis during locomotion, preventing ‘dropping’ of the pelvis on the
contralateral side.

• Innervation: Superior gluteal nerve.

• Tensor Fascia Lata
• Tensor fasciae lata is a small superficial muscle which lies towards the
anterior edge of the iliac crest. It functions to tighten the fascia lata,
and so abducts and medially rotates the lower limb.

• Attachments: Originates from the anterior iliac crest, attaching to the

anterior superior iliac spine (ASIS). It inserts into the iliotibial tract,
which itself attaches to the lateral condyle of the tibia.

• Actions: Assists the gluteus medius and minimus in abduction and

medial rotation of the lower limb. It also plays a supportive role in the
gait cycle.
• The Deep Muscles
• The deep gluteal muscles are a set of smaller muscles, located underneath the gluteus
minimus. The general action of these muscles is to laterally rotate the lower limb. They
also stabilise the hip joint by ‘pulling’ the femoral head into the acetabulum of the pelvis.

• Piriformis
• The piriformis muscle is a key landmark in the gluteal region. It is the most superior of
the deep muscles.

• Attachments: Originates from the anterior surface of the sacrum. The fibres travel
inferiorly and laterally through the greater sciatic foramen to insert onto the greater
trochanter of the femur.

• Actions: Lateral rotation and abduction.

• Innervation: Nerve to piriformis.

• Obturator Internus
• The obturator internus forms the lateral walls of the pelvic cavity. In
some texts, the obturator internus and the gemelli muscles are
considered as one muscle – the triceps coxae.

• Attachments: Originates from the pubis and ischium at the obturator

foramen. It travels through the lesser sciatic foramen, and attaches to
the greater trochanter of the femur.

• Actions: Lateral rotation and abduction.

• Innervation: Nerve to obturator internus.

• The Gemelli – Superior and Inferior
• The gemelli are two narrow and triangular muscles. They are separated by
the obturator internus tendon.

• Attachments: The superior gemellus muscle originates from the ischial

spine, the inferior from the ischial tuberosity. They both attach to the
greater trochanter of the femur.

• Actions: Lateral rotation and abduction.

• Innervation: The superior gemellus muscle is innervated by the nerve to

obturator internus, the inferior gemellus is innervated by the nerve to
quadratus femoris.
• Quadratus Femoris
• The quadratus femoris is a flat, square-shaped muscle. It is the most
inferior of the deep gluteal muscles, located below the gemelli and
obturator internus.

• Attachments: Originates from the lateral aspect of the ischial

tuberosity and attaches to the quadrate tuberosity on the
intertrochanteric crest.

• Actions: Lateral rotation.

• Innervation: Nerve to quadratus femoris.

FEMORAL TRAINGLE
• The femoral triangle is a wedge-shaped area formed by a depression between the muscles
of the thigh. It is located on the medial aspect of the proximal thigh.
• It is the region of the passage of the main blood vessels between the pelvis and the lower
limb, as well as a large nerve supplying the thigh.

• Borders (SAIL)
• Lateral border: Sartorius muscle
Medial border: Adductor longus muscle
Base or superior border: Inguinal Ligament

• Contents (NAVEL)
• Femoral Nerve, Femoral Artery, Femoral Vein, Femoral canal (Empty space), Lymphatics

• Clinical importance
• Femoral pulse, vascular access and catheterization, femoral hernias
FEMORAL TRAINGLE
Head and neck, skull, mandible, cranial nerves, cranial cavity,
meninges, brain, head face, sinuses, neck, orbit

HEAD AND NECK

• CRANIAL CAVITY
• The cranial cavity, also known as intracranial space, is the space within
the skull that accommodates the brain.

• The skull minus the mandible is called the cranium.

• The cavity is formed by eight cranial bones known as

the neurocranium that in humans includes the skull cap and forms the
protective case around the brain.
SKULL BONES
 The Skull
• The skull protects
• The brain
• Entrances to respiratory
system
• Entrance to digestive
system
• The skull contains 22
bones
• 8 cranial bones:
• Form the braincase or
cranium
• 14 facial bones:
• Protect and support
entrances to digestive
and respiratory tracts
 The Skull
• Superficial Facial Bones
• Maxillae = maxillary
bones
• Lacrimal
• Nasal
• Zygomatic
• Mandible
• Deep Facial Bones
• Palatine bones
• Inferior nasal conchae
• Vomer
 The Skull
• Sinuses
• Cavities that decrease the
weight of the skull
• Lined with mucous membranes
• Protect the entrances of the
respiratory system

• Sutures
• The immovable joints of the
skull
• The four major sutures
• Lambdoid suture
• Coronal suture
• Sagittal suture
• Squamous suture
 The Cranial Bones of the Skull
• The Occipital Bone
• Functions of the occipital
bone
• Forms the posterior and
inferior surfaces of the
cranium
• Articulations of the occipital
bone
• Parietal bones
• Temporal bones
• Sphenoid
• First cervical vertebra (atlas)
• Marks of the occipital bone
• External occipital
protuberance
• External occipital crest:
• to attach ligaments
The Orbital Complex

Figure: The Orbital Complex.

The Orbital Complex

Figure: The Nasal Complex.

The Orbital Complex

Figure: The Nasal Complex.

Fontanelles
• The Infant Skull
• Grows rapidly

• Is large compared to the body

• Has many ossification centers

• Fusion is not complete at birth

• Two frontal bones

• Four occipital bones

• Several sphenoidal and temporal elements

Fontanelles
• Fontanelles (sometimes spelled fontanels)
• Are areas of fibrous connective tissue (soft spots)
• Cover unfused sutures in the infant skull
• Allow the skull to flex during birth
• Anterior fontanelle:
• frontal, sagittal, and coronal sutures
• Occipital fontanelle:
• lambdoid and sagittal sutures
• Sphenoidal fontanelles:
• squamous and coronal sutures
• Mastoid fontanelles:
• squamous and lambdoid sutures
Fontanelles

Figure: The Skull of an Infant.

 Blood supply of the face
Supraorbital A. Superficial
temporal A.

Supratrochlea
r A.

Buccal A.

Infraorbital A. Facial
MentalA.
A.
 Facial
vein
Masseter

Facial artery
 Lat.nasal a.

Sup.labial A.

Inf.labial A.

Facial A.
 Superficial
temporal A.
Transverse
facial A.

Parotid duct
 Superficial
temporal A.

Pulsation sites
Facial A.
 Transverse facial Vs.

superficial temporal Vs.

Tragus

Lat.Nasal Vs.

Sup.Labial Vs.

Inf.Labial Vs.

Facial A. Masseter
Facial V.
 Auricle

Buccinator
Parotid gland

Masseter
Facial
vessels
CRANIAL NERVE
The cranial nerves are a set of 12 paired nerves that arise directly from the brain.
The first two nerves (olfactory and optic) arise from the cerebrum, whereas the
remaining ten emerge from the brainstem.

The names of the cranial nerves relate to their function and they are numerically
identified in roman numerals (I-XII).

They can arise from a specific part of the brainstem (midbrain, pons or medulla), or from
a junction between two parts:

Midbrain – the trochlear nerve (IV) comes from the posterior side of the midbrain. It has
the longest intracranial length of all the cranial nerves.
Midbrain-pontine junction – oculomotor (III).
Pons – trigeminal (V).
Pontine-medulla junction – abducents, facial, vestibulocochlear (VI-VIII).
Medulla oblongata
Posterior to the olive: glossopharyngeal, vagus, accessory (IX-XI).
Anterior to the olive: hypoglossal (XII).
 CRANIAL NERVE

• Olfactory nerve (CN I)

• Optic nerve (CN II)
• Oculomotor nerve (CN III)
• Trochlear nerve (CN IV)
• Ttrigeminal nerve (CN V)
• Abducens nerve (CN VI)
• Facial nerve (CN VII)
• Vestibulocochlear nerve (CN VIII)
• Glossopharyngeal nerve (CN IX)
• Vagus nerve (CN X)
• Accessory nerve (CN XI)
• Hypoglossal nerve (CN XII).V