1.

UPPER LIMB AND THORAX

Contents

Preface to the Eighth Edition vii

Preface to the First Edition (excerpts) viii
Index of Competencies xix

Section 1 UPPER LIMB

1. Introduction 3 Clinical Anatomy 33

Sesamoid Bones 33
Parts of the Upper Limb 3 Mnemonics 33
Evolution of Upper Limbs 4 Facts to Remember 33
Study of Anatomy 5 Clinicoanatomical Problem 33
Frequently Asked Questions 5 Further Reading 34
2. Bones 6 Frequently Asked Questions 34
Multiple Choice Questions 34
Introduction 6 Viva Voce 34, 35
Clavicle 6
Ossification 8 3. Pectoral Region 36
Clinical Anatomy 8
Scapula 8 Introduction 36
Ossification 12 Surface Landmarks 36
Clinical Anatomy 13 Dissection 37
Humerus 13 Superficial Fascia 37
Ossification 16 Breast 38
Clinical Anatomy 17 Lymphatic Drainage 41
Radius 18 Clinical Anatomy 43
Ossification 21 Deep Fascia 45
Clinical Anatomy 21 Muscles of the Pectoral Region 45
Ulna 22 Serratus Anterior 48
Ossification 23 Dissection 49
Clinical Anatomy 23 Mnemonics 49
Ossification of Humerus, Radius and Ulna 24 Facts to Remember 49
Importance of Capsular Attachments and Clinicoanatomical Problem 49
Epiphyseal Lines 24 Further Reading 49
Clinical Anatomy 25 Frequently Asked Questions 50
Carpal Bones 25 Multiple Choice Questions 50
Ossification 27 Viva Voce 50
Clinical Anatomy 27
4. Axilla 51
Metacarpal Bones 27
Ossification 31 Introduction 51
Clinical Anatomy 31 Dissection 51
Phalanges 32 Boundaries 51
Ossification 32 Contents of Axilla 53
xii HUMAN ANATOMY—UPPER LIMB AND THORAX

Clinical Anatomy 54 Further Reading 81

Axillary Artery 54 Frequently Asked Questions 82
Relations of Axillary Artery 54 Multiple Choice Questions 82
Clinical Anatomy 58 Viva Voce 82
Axillary Vein 58
Axillary Lymph Nodes 58 7. Cutaneous Nerves, Superficial Veins and
Clinical Anatomy 59 Lymphatic Drainage 83
Spinal Nerve 59 Introduction 83
Brachial Plexus 59
Cutaneous Nerves 83
Dissection 62
Dissection 85
Clinical Anatomy 62
Dermatomes 86
Mnemonics 63
Clinical Anatomy 87
Facts to Remember 64
Superficial Veins 88
Clinicoanatomical Problem 64
Individual Veins 88
Further Reading 64
Clinical Anatomy 89
Frequently Asked Questions 65
Lymph Nodes and Lymphatic Drainage 90
Multiple Choice Questions 65
Clinical Anatomy 91
Viva Voce 65
Facts to Remember 92
5. Back 66 Clinicoanatomical Problems 92
Further Reading 92
Introduction 66 Frequently Asked Questions 93
Surface Landmarks 66 Multiple Choice Questions 93
Skin and Fasciae of the Back 67 Viva Voce 93
Dissection 67
Muscles Connecting the Upper Limb with the 8. Arm 94
Vertebral Column 68
Introduction 94
Dissection 68
Surface Landmarks 94
Additional Features of Muscles of the Back 70
Compartments of the Arm 95
Trapezius 70
Anterior Compartment 95
Latissimus Dorsi 70
Muscles 95
Dissection 71
Nerves 95
Facts to Remember 71 Musculocutaneous Nerve 95
Clinicoanatomical Problem 71 Median Nerve 99
Further Reading 72 Ulnar Nerve 99
Frequently Asked Questions 72 Radial Nerve 99
Multiple Choice Questions 72 Dissection 99
Viva Voce 72 Clinical Anatomy 99
Brachial Artery 100
6. Scapular Region 73
Dissection 101
Introduction 73 Clinical Anatomy 102
Surface Landmarks 73 Changes at the Level of Insertion of
Muscles of the Scapular Region 73 Coracobrachialis 102
Deltoid 73 Cubital Fossa 103
Dissection 76 Dissection 105
Clinical Anatomy 77 Clinical Anatomy 105
Rotator Cuff 78 Posterior Compartment 105
Intermuscular Spaces 78 Triceps Brachii Muscle 106
Dissection 79 Dissection 107
Axillary or Circumflex Nerve 79 Clinical Anatomy 107
Anastomoses Around Scapula 80 Radial Nerve or Musculospiral Nerve 107
Clinical Anatomy 81 Clinical Anatomy 109
Mnemonics 81 Profunda Brachii Artery 110
Facts to Remember 81 Mnemonics 110
Clinicoanatomical Problem 81 Facts to Remember 110
 CONTENTS xiii

Clinicoanatomical Problem 110 Mnemonics 151

Further Reading 110 Facts to Remember 152
Frequently Asked Questions 111 Clinicoanatomical Problems 152
Multiple Choice Questions 111 Further Reading 153
Viva Voce 111, 112 Frequently Asked Questions 153
Multiple Choice Questions 153
9. Forearm and Hand 113 Viva Voce 154
Introduction 113
Surface Landmarks of Front of Forearm 113 10. Joints of Upper Limb 155
Muscles of Front of Forearm 114 Introduction 155
Superficial Muscles 116 Shoulder Girdle 155
Deep Muscles 116 Sternoclavicular Joint 155
Dissection 119 Dissection 156
Arteries of Front of Forearm 119 Acromioclavicular Joint 156
Radial Artery 119 Movements of Shoulder Girdle 156
Ulnar Artery 120 Dissection 158
Dissection 121 Shoulder Joint 158
Nerves of Front of Forearm 121 Movements of Shoulder Joint 160
Median Nerve 122 Dissection 161
Ulnar Nerve 122 Clinical Anatomy 162
Radial Nerve 123 Elbow Joint 164
Dissection 123 Dancing Shoulder 164
Palmar Aspect of Wrist and Hand 124 Carrying Angle 166
Dissection 124 Dissection 166
Flexor Retinaculum 124
Clinical Anatomy 166
Clinical Anatomy 126
Radioulnar Joints 168
Intrinsic Muscles of the Hand 127
Interosseous Membrane 168
Testing of Some Intrinsic Muscles 127
Middle Radioulnar Joint 169
Dissection 133
Supination and Pronation 169
Arteries of Hand 133
Dissection 170
Ulnar Artery 133
Clinical Anatomy 170
Clinical Anatomy 134
Wrist (Radiocarpal) Joint 170
Radial Artery 134
Dissection 173
Dissection 135
Clinical Anatomy 173
Nerves of Hand 136
Joints of Hand 174
Ulnar Nerve 136
Intercarpal, Carpometacarpal and
Clinical Anatomy 137
Intermetacarpal Joints 174
Median Nerve 138
First Carpometacarpal Joint 174
Clinical Anatomy 138
Dissection 175
Fascial Spaces of Hand 141
Clinical Anatomy 175
Clinical Anatomy 143
Metacarpophalangeal Joint 175
Back of Forearm and Hand 143
Interphalangeal Joints 175
Surface Landmarks 143
Mnemonics 177
Dorsum of Hand 143
Facts to Remember 177
Anatomical Snuffbox 144
Clinicoanatomical Problem 177
Extensor Retinaculum 145
Further Reading 177
Dissection 146
Frequently Asked Questions 178
Muscles of Back of Forearm 146
Multiple Choice Questions 178
Superficial Muscles 146
Viva Voce 179
Deep Muscles 147
Dorsal Digital Expansion/Extensor Expansion 147 11. Surface Marking, Radiological Anatomy
Dissection 149
and Comparison of Upper and Lower
Posterior Interosseous Nerve 149
Dissection 150 Limbs 180
Posterior Interosseous Artery 150 Introduction 180
Arches of Hand 151 Surface Marking 180
xiv HUMAN ANATOMY—UPPER LIMB AND THORAX

Arteries 180 Axillary or Circumflex Nerve 191

Nerves 182 Radial Nerve 192
Joints 184 Median Nerve 194
Retinacula 184 Ulnar Nerve 194
Synovial Sheaths of the Flexor Tendons 185 Clinical Anatomy 196
Radiological Anatomy of Upper Limb 185 Arteries of Upper Limb 198
Comparison of Upper and Lower Limbs 188 Sympathetic Innervation 200
Further Reading 190 Embryology of the Upper Limb 200
Frequently Asked Questions 190 Molecular Regulation of Limb Development 200
Clinical Terms 200
Appendix 1: Nerves, Arteries and Further Reading 202
Clinical Terms 191 Frequently Asked Questions 202
Multiple Choice Questions 202
Introduction 191 Spots on Upper Limb 205
Musculocutaneous Nerve 191 Answers 206

Section 2 THORAX

Joints of Thorax 232

12. Introduction 209
Respiratory Movements 234
Surface Landmarks of Thorax 209 Clinical Anatomy 236
Skeleton of Thorax 210 Mnemonics 237
Formation 210 Facts to Remember 237
Clinical Anatomy 212 Clinicoanatomical Problem 238
Shape 212 Further Reading 238
Clinical Anatomy 212 Frequently Asked Questions 238
Superior Aperture/Inlet of Thorax 213 Multiple Choice Questions 238
Clinical Anatomy 215 Viva Voce 239
Inferior Aperture/Outlet of Thorax 215
14. Walls of Thorax 240
Facts to Remember 217
Clinicoanatomical Problem 217 Introduction 240
Further Reading 217 Thoracic Wall Proper 240
Frequently Asked Questions 217 Intercostal Muscles 240
Multiple Choice Questions 217 Intercostal Nerves 242
Viva Voce 218 Dissection 242
Clinical Anatomy 244
13. Bones and Joints of Thorax 219 Typical Intercostal Spaces 245
Intercostal Arteries 245
Introduction 219 Intercostal Veins 247
Bones of Thorax 219 Lymphatics of an Intercostal Sapce 248
Ribs or Costae 219 Internal Thoracic Artery 248
Ossification of a Typical Rib 221 Azygos Vein 249
Ossification 222 Hemiazygos Vein 250
Ossification 223 Accessory Hemiazygos Vein 250
Costal Cartilages 223 Thoracic Sympathetic Trunk 250
Clinical Anatomy 224 Clinical Anatomy 251
Sternum 224 Facts to Remember 253
Development and Ossification 226 Clinicoanatomical Problem 253
Clinical Anatomy 226 Further Reading 253
Vertebral Column 227 Frequently Asked Questions 253
Ossification 231 Multiple Choice Questions 254
Clinical Anatomy 231 Viva Voce 254
 CONTENTS xv

15. Thoracic Cavity and Pleurae 255 Fibrous Pericardium 284

Serous Pericardium 284
Thoracic Cavity 255 Dissection 285
Dissection 255 Clinical Anatomy 285
Pleura 257 Heart 286
Nerve Supply of the Pleura 260 External Features 286
Clinical Anatomy 261 Clinical Anatomy 286
Mnemonics 262 Right Atrium 288
Facts to Remember 262 Dissection 288
Clinicoanatomical Problem 262 Right Ventricle 290
Further Reading 262 Dissection 292
Frequently Asked Questions 263 Left Atrium 292
Multiple Choice Questions 263 Dissection 293
Viva Voce 263 Left Ventricle 293
Dissection 294
16. Lungs 264 Clinical Anatomy 294
Introduction 264 Structure of Heart 294
Dissection 264 Valves 294
Fissures and Lobes of the Lungs 265 Clinical Anatomy 295
Root of the Lung 267 Fibrous Skeleton 296
Bronchial Tree 269 Musculature of the Heart 296
Dissection 269 Conducting System 297
Development of Respiratory System 272 Clinical Anatomy 298
Molecular Regulation 272 Right Coronary Artery 298
Histology 273 Dissection 299
Clinical Anatomy 274 Left Coronary Artery 299
Mnemonics 275 Dissection 300
Facts to Remember 275 Cardiac Dominance 300
Clinicoanatomical Problems 276 Clinical Anatomy 301
Further Reading 276 Veins of the Heart 301
Frequently Asked Questions 276 Nerve Supply of Heart 302
Multiple Choice Questions 277 Clinical Anatomy 303
Viva Voce 277 Developmental Components 303
Molecular Regulation of Cardiac
17. Mediastinum 278 Development 304
Foetal Circulation 304
Introduction 278
Mnemonics 307
Superior and Inferior Mediastina 278
Facts to Remember 307
Dissection 278
Clinicoanatomical Problems 307
Superior Mediastinum 278 Further Reading 308
Inferior Mediastinum 279 Frequently Asked Questions 308
Anterior Mediastinum 279 Multiple Choice Questions 308
Middle Mediastinum 279 Viva Voce 309
Posterior Mediastinum 280
Clinical Anatomy 280 19. Superior Vena Cava, Aorta and Pulmonary
Mnemomics 281 Trunk 310
Facts to Remember 281
Introduction 310
Clinicoanatomical Problem 281 Dissection 310
Frequently Asked Questions 282 Superior Vena Cava 310
Multiple Choice Questions 282 Clinical Anatomy 311
Viva Voce 282 Aorta 311
Ascending Aorta 312
18. Pericardium and Heart 283
Arch of Aorta 312
Introduction 283 Descending Thoracic Aorta 314
Pericardium 283 Clinical Anatomy 316
xvi HUMAN ANATOMY—UPPER LIMB AND THORAX

Pulmonary Trunk 317 Parietal Pleura 330

Development of Arteries 317 Surface Marking of Lungs 331
Development of Superior Vena Cava 318 Borders of the Heart 332
Mnemonics 318 Arteries 333
Facts to Remember 319 Veins 334
Clinicoanatomical Problem 319 Trachea 335
Frequently Asked Questions 320 Right Bronchus 335
Multiple Choice Questions 320 Left Bronchus 335
Viva Voce 320 Oesophagus 335
Thoracic Duct 335
20. Trachea, Oesophagus and 321
Radiological Anatomy 335
Thoracic Duct
Numericals 337
Introduction 321 Further Reading 337
Trachea 321
Histology of Trachea 322 Appendix 2: Autonomic Nervous System,
Clinical Anatomy 323 Arteries, Nerves and Clinical Terms 338
Oesophagus 323 Introduction 338
Dissection 323 Autonomic Nervous System 338
Histology of Oesophagus 325 Sympathetic Nervous System 338
Clinical Anatomy 326 Thoracic Part of Sympathetic Trunk 339
Thoracic Duct 327 Nerve Supply of Heart 340
Facts to Remember 328
Nerve Supply of Lungs 340
Clinicoanatomical Problem 328
Typical Intercostal Nerve 341
Further Reading 328
Atypical Intercostal Nerves 341
Frequently Asked Questions 329
Arteries of Thorax 341
Multiple Choice Questions 329
Clinical Terms 341
Viva Voce 329
Frequently Asked Questions 344
21. Surface Marking and Radiological Multiple Choice Questions 345
Anatomy of Thorax 330 Spots on Thorax 347
Answers 348
Introduction 330
Surface Marking 330 Index 349