ANATOMY SPOTTERS

ACADEMIC CLUB
COLLEGE UNION’ 18
1.Pectoralis Major (Climbing Muscle) nerve(proprioceptive)
-Origin, Insertion, NS and Action -other upper limb muscles with dual
-Congenital absence –Poland Syndrome nerve supply are –supinator, flexor
digitorum profundus, flexor pollicis
brevis

2.Pectoralis Minor
-Attachments, NS Action
-Surgical importance: grouping of axillary
lymph nodes wrt uscle
a)Level 1/lower nodes: below the
muscle(ant, post, lat) 4 Biceps Brachi
b)Level 2/ middle group: behind the - Origin: by two heads
muscle(central, Rotters )(Rotters nodes - -insertion :bicipetal
between pec major and minor muscle) aponeurosis, biceps tendon to
c)Level 3 /upper nodes: Above the radial tuberosity
muscle extending upto lower surface of - -NS: musculocutaneous nerve
clavicle(Apical) - -actions: flexion of elbow,
supination when
flexed,(another muscle with
same action :supinator)

3.Brachialis
-Attachments
-Action: flexion of elbow
-dual nerve supply (musculocutaneous
nerve(motor) and radial
5. Deltoid
-type of muscle : multipinnate
muscle(acromial fibres only) (advantage-
diminishes the range of contraction but
increases the force of pull)
-Attachments : Origin-3 fibres:
-Insertion: Deltoid tuberosity
-Actions
a)acromial fibres :abduction of arm 7.Triceps
from 0-90 -Attachments origin 3 heads
b)anterior fibres :Flexion and medial -NS: Radial nerve
rotation -Action: Extensor of elbow
c)posterior fibres : Extension and
lateral rotation
-NS : axillary nerve
-Applied anatomy : intramuscular
injections and regimental badge palsy

8.Supinator
-origin: Supinator crest of ulna,
annular ligament , radial collateral
ligament , lateral epicondyle
6.Anconeus -Insertion: post , lat and ant surface
-origin: Posterior surface of lateral of radius
epicondyle -Dual NS – Radial nerve and posterior
- Insertion: Olecranon process and interrossious nerve
proximal and posterior and proximal
surface of ulna
-NS nerve to medial head of
triceps(branch of radial nerve)
-Action: weak extensor of elbow
9.Serratus Anterior 11. Pronator Quadratus
-attachments
-NS Long thoracic nerve Flat quadrilateral muscle, which
-Applied anatomy : Winging of scapula extends across the front of the distal
parts of the radius and ulna

10.Supraspinatus
-Bursa related to it : subacromial bursa
-Structure lying above : coracoacromial
arch
-movement affected in inflammation
:Abduction of arm

Nerve supply
By anterior interosseous nerve.
Actions
Pronator quadratus is the chief
pronator of the forearm
12. Cephalic Vein The cephalic vein is not preferred for
cardiac catheterization due to the
Begins as the continuation of lateral end following reasons:
of the dorsal venous arch (a) Its diameter does not increase as
it ascends.
(b) It joins the axillary vein at a right
angle hence it is difficult to
maneuver the catheter around sharp
cephaloaxillary angle.
(c) In deltopectoral groove, it
frequently divides into small
branches. One of these branches
ascends over the clavicle and joins
the external jugular vein.
At elbow, greater amount of blood from The cephalic vein is preferred for
the cephalic vein is shunted into the basilic hemodialysis in the patients with
vein through median cubital vein. chronic renal failure (CRF), to remove
• Cephalic vein is accompanied by the waste
lateral cutaneous nerve of the forearm. products from blood.
• An accessory cephalic vein from back of • The cut-down of cephalic vein in
the forearm (occasional) ends in the the deltopectoral groove is preferred
cephalic vein below the elbow. when the superior vena cava infusion
• Cephalic vein is the preaxial vein of the is necessary
upper limb and corresponds to the great
saphenous vein of the lower limb. 13. Basilic Vein
Begins as the continuation of the
medial end of the dorsal venous arch
of the hand.
The basilic vein is preferred for
cardiac catheterization for the
following reasons:
(a) The diameter of basilic vein
increases as it ascends from cubital
fossa to the axillary vein.
(b) It is in direct line with the axillary
vein. To enter the right atrium the
catheter passes in succession as
follows: Morphologically, palmaris longus is a
Basilic vein → axillary vein → subclavian degenerating muscle with small short
vein →brachiocephalic vein → superior belly and a long tendon. The palmar
vena cava → right atrium of the heart. aponeurosis represents the distal
part of the tendon
• Basilic vein is the postaxial vein of the of palmaris longus. The palmaris
upper limb and corresponds to the short longus corresponds to the plantaris
saphenous vein of the lower limb. muscle on the back of the leg.
• About 2.5 cm above the medial • It is absent on one or both sides
epicondyle of humerus, it is joined by the (usually on the left) in approximately
median cubital vein. 10% of people, but its actions are not
• It is accompanied by the medial missed. Hence, its tendon is often
cutaneous nerve of the forearm. used by the surgeons for tendon
grafting.

15. Interossei

14. Palmaris Longus

Nerve Supply- deep branch of ulnar nerve
17. Adductor Pollicis
PAD DAB
Palmar Interossei Adduction
Dorsal Interossei Abduction

-Nerve supply : Deep branch of the

ulnar nerve (C8, TI).
-Actions : Adduction of the thumb to
provide power to the grip
16. Lumbricals
Clinical testing (Froment’s sign)
Give the patient a thin book and ask
Innervatio
Muscle Origin Insertion
n
Action him to grasp it firmly between the
Flexion
thumbs and index fingers of both
Extensor Median n.
of MP, hands. If the muscle is healthy and
FDP extensio
Lumbrical
tendon
expansion (radial 2)
n of PIP acting normally, the thumbs will be
s s of digits & ulnar n.
s
II-V (ulnar 2)
& DIP of
digits II-
straight. But if the muscle is
V paralyzed and not acting, the thumbs
are flexed at IP joints . This occurs
because when adductors are not
acting, flexor pollicis compensates for it. 19. Cubital fossa
 Boundaries:
Med: Lateral border of pronator
teres
Lat: Medial border of brachioradialis
Apex: imaginary line joining two
epicondyles of humerus
Floor : Supinator below and
Brachialis above
18. Anatomical snuff box Roof: Skin, superficial fascia and
deep fascia
 Contents : MBBS – medial to
lateral
Median nerve, Brachial A, Biceps
tendon,Superficial radial N
 Applied : median cubital vein
for IV &blood samples,
Brachial pulse

 Boundaries:
Anterolaterally: Tendon of APL and EPB
Posteromedially: Tendon of EPB
Floor: Scaphoid and Trapezium
 Contents : Radial Artery
Strscrossung roof: Cephaljc V and Sup.
Radial N
Applied : Radial Pulse
20. Palmar aponeurosis 21. Flexor retinaculum

 Continuation of Palmaris longus

tendon
 Features:
Apex,Base,Medial border, Lateral border
 Functions:
Improve the grip of the hand by fixing skin
Protects underlying structures
 Applied:
Dupuytren's contracture: progressive
fibrosis in the medial part of the palmar  Attachments:
aponeurosis.Ring finger most commonly
affected. Medial : pisiform and hook of
hamate
Lateral : tubercle of scaphoid and
crest of trapezium
 Strs passing superficial : ulnar
N, ulnar A, palmar cutaneous
branch of ulnar N, tendon of
PL, palmar cutaneous branch
of median N, superficial
palmar branch of radial A
 Strs passing deep : tendons of
FDS,FDP,FPL and Median N
FDS & FDP in ulnar bursa and FPL in
radial bursa
Applied: carpal tunnel syndrome
22. Extensor Retinaculum 23. Intermuscular spaces

 Attachments :
Medial: Pisiform and Triquetral
Lateral: Anterior border of lower end of
radial shaft  Quadrangular sp :
 Compartments (6) Boundaries
1. APL APB Contents: Axillary N &Post.
2. ECRL ECRB Circumflex humeral A
3. EPL  Upper triangular sp:
4. ED EI PIN & AIA
Boundaries
5. EDM
Contents : circumflex scapular A.
6. EU
 Lower triangular sp:
Boundaries
Contents : Radial N &profundabrachii
vessels
24. Axillary nerve  Suppies biceps brachii,
coracobrachilalis and brachialis
Continues as Lateral cutaneous nerve
of the forearm.

26. Axillary artery

 Origin : Begins at the outer

border of first rib as
continuation of subclavian
artery
 Termination : By becoming
brachial artery at the lower
border of teres major
 Root value : C5 C6
 Axillary vein is medial to the
 Related to surgical neck of humerus artery
 Supplies Deltoid and Teresminor  The cords of brachial plexus
 Posterior branch continues as Upper are arranged around the
lateral cutaneous nerve of arm second part of axillary artery
 Nerve to teres minor has a (medial cord being medial,
pseudoganglion lateral cord being lateral and
 Applied: posterior cord being behind.)
Divided into 3 parts by pectoralis
Injury – in inferior dislocation of humerus minor
and fractures of surgical neck 1. First part : superior to muscle
Regimental bagde palsy- loss of sensation 2. Second part : posterior to ms.
over the lower half of deltoid – Nerve – 3. Third part : Inferior to muscle
upper lateral cutaneous nerve of arm Branches
 Superior thoracic – 1st part
25. Musculocutaneous Nerve  Thoraco-acromial – 2nd part
 Root value C5 C6 and C7  Lateral thoracic – 2nd part
 It pierces coracobrachialis and seen  Subscapular – 3rd part
beneath biceps brachii.  Anterior circumflex humeral –
3rd part
 Posterior circumflex humeral –
3rd part
27. Brachial artery
Origin : Begins at the lower border of
teres major as a continuation of
axillary artery.
Termination : Terminates in front of
the elbow at the level of neck of
radius by dividing into radial and
ulnar arteries.
Relations
Anteriorly – Upper part - medial
cutaneous nerve of the forearm.
Middle part - crossed by the median
nerve from lateral to medial side.
Lower part, in the cubital fossa, it is
crossed by the bicipital aponeurosis.
Posteriorly : From above
downwards, lies successively on long
head of triceps, medial head of
triceps, coracobrachialis, and
brachialis muscles.
Medially : Ulnar nerve and basilic
vein in the upper part of the arm;
and median nerve in the lower part
of the arm.
Laterally : Median nerve,
coracobrachialis, and biceps in the
upper part of arm and tendon of
biceps in the lower part.
Branches :
1. Muscular branches
2. Profunda brachii artery
3. Nutrient artery
4. Superior ulnar collateral
5. Inferior ulnar collateral
6. Ulnar and radial arteries.
 28. Superficial palmar arch
Appiled aspects :
Brachial pulse
Volkmann’s ischemic contracture
(ischemic compartment syndrome): The
sudden complete occlusion (e.g., due to
tight plaster cast) or laceration (due to
supracondylar fracture of the humerus) of
the brachial artery can cause paralysis of
flexor muscles of the forearm due to
ischemia within a few hours.

 Direct continuation of ulnar

artery
 Formation :
1. Superficial palmar branch of the
radial artery (most
common).
2. Radialis indicis artery.
3. Princeps pollicis artery.
 Branches :
1. Three common palmar digital
arteries
2. One proper digital artery
3. Cutaneous branches to the palm
 Surface marking :
Superficial palmar arch lies across
the centre of the palm
at the level of the distal border of the
fully extended thumb.
30. Deep palmar arch
 Arises in the axilla from the
medial cord of brachial plexus.
 Root value : C8 T1
 Muscle pierced : Flexor carpi
ulnaris
 Distribution in the hand :
The ulnar nerve divides into its
terminal superficial and deep
branches. The superficial
terminal branch supplies palmaris
brevis provides sensory
innervation to the skin on the palmar
surface of medial 1½
 Direct continuation of radial artery
fingers.
 Formation : By radial artery and
The deep branch of ulnar nerve is
completed by deep palmar branch
purely motor and supplies all
of ulnar artery
the intrinsic muscles of the hand
 Branches :
except the muscles of thenar
1. Three palmar metacarpal arteries
eminence and first two lumbricals.
2. Three perforation arteries
 Applied aspects:
3. Recurrent branch
1. Ulnar claw hand
 Represents axis artery of upper
Claw-hand deformity affecting ring
limb, others being Axillary artery,
and
brachial artery and anterior
little fingers. The first phalanges of
interosseous artery.
these fingers are
31. Ulnar nerve(Musician’s nerve)
extended and middle and distal
phalanges are flexed.
2. Ulnar paradox
 In leprosy, ulnar nerve is
thickened and is palpable at
medial epicondyle
32. Median nerve (Labourer’s nerve) eminence is supplied by the
 Arises from brachial plexus in axilla palmar cutaneous branch of the
by two roots: (a) lateral and (b) median nerve, which
medial. passes superficial to flexor
 Root value : C5 C6 C7 C8 and T1 retinaculum.
 Crosses brachial artery from lateral • Weakness of thenar muscles.
to medial side. • ‘Ape-thumb deformity’ may occur,
 Supply in the palm: if left untreated, due to
The five palmar digital nerves supply: paralysis of the thenar muscles.
(a) sensory innervation to the skin of the • Positive Tinel’s sign and Phalen’s
palmar aspect of test
the lateral 3½ digits including nail beds • Reduced conduction velocity in the
and skin on the median nerve (<30
dorsal aspect of distal phalanges, and m/s) is diagnosis.
(b) first and second lumbricals.
 Applied aspects : 33. Radial Nerve
1. Carpel tunnel syndrome
The median nerve is injured in
the carpal tunnel due to its compression
and produces a
clinical condition called carpal tunnel
syndrome.
Conditions causing :
(a) tenosynovitis of flexor tendons
(idiopathic),
(b) myxedema (deficiency of thyroxine),
(c) retention of fluid in pregnancy,
Characteristic clinical features of the
carpal tunnel  continuation of posterior cord
syndrome are as follows: of brachial plexus in the axilla
• Feeling of burning pain or ‘pins and  largest nerve of the brachial
needles’ along the plexus.
sensory distribution of median nerve (i.e.,  Related to lower triangular
lateral 3½ space
digits) especially at night.  Branches given off in the spiral
• There is no sensory loss over the thenar groove : 5 branches
eminence because skin over thenar 1. Lower lateral cutaneous nerve
of the arm,
2. Posterior cutaneous nerve of the  Superior and inferior
forearm, radioulnar joints.
3. Nerve to lateral head of triceps.  Type of joint : Syndesmosis
4. Nerve to medial head of triceps.  Structures piercing : Anterior
5. Nerve to anconeus interosseous vessels.
 Direction of fibres :
 Muscles of extensor compartment Downwards and medially from
of forearm which are supplied radius to ulna.
directly from the radial nerve before  Importance:
its division into superficial and deep Weight transmission
branches. Passage of nerves and vessels
Anconeus Connects radius and ulnar
Brachioradialis
Extensor carpi radialis longus 35. Median cubital vein
 Sensory supply :
sensory innervation to skin over the lateral
part of the dorsum of hand and dorsal
surfaces of lateral 3½ digits proximal to
the nail beds.
 Applied aspects
Wrist drop
Saturday night palsy
34. Interosseous membrane

 Shunts blood from cephalic to

basilica vein
 Runs upwards and medially
 Applied aspects:
Intravenous injection
Cardiac catheterization
Blood transfusion