Surgical Anatomy: A Student’s Manual Sibani Mazumdar
Page numbers followed by b refer to box, f refer to figure, and t refer to table.
Abdomen 126, 362
anatomy of 176
radiograph of 364f
surface marking of 177f
Abdominal testis 172
Abdominal wall
anterior 169
lower part of anterior 130
posterior 109
Aberrant epiphysis 7
horseshoe-shaped 153
ischioanal 175
ischiorectal 175
Acetabular labrum 104
Acetabulum 372, 372f
Achalasia 27
Achondroplasia 6
Acne 282
Acquired immune deficiency syndrome 407
Acromioclavicular joint 14, 354f
Acromion 354f
Acromiothoracic arteries, branches of 385f
Addison's disease 277
Adductor muscles, paralysis of 110
Adductor tubercle 123, 124f
Adenine 297
Adrenal medulla 277
Air sinuses 234f
Albinism 294, 303
Alimentary system 328f
development of 328
Allantoenteric diverticulum 307, 307f
Allelic gene 292, 292f, 293
Allograft 297
Alzheimer's disease 409
Amniocentesis 297
Amniogenic cells 312
Amnion 311
Amniotic cavity 311
Anal canal 175, 338
distal part of 136, 137
Anal sphincter 417
Aneurysm, arterial 209
Angina pectoris 208
Angiography 352
Anhidrosis 27
Ankle 376
anteroposterior view of 375
joint space 375f, 376f
perforating vein 100
Antibiotic 409
Aorta 359
coarctation of 196, 204
ends, ascending 86
left dorsal 196
Aortic arch 326f
arteries 326f
derivatives 325
left-fourth 196, 327
Aortic knuckle 327
Aortic sac
left horn of 327
left side of 195
Aphasia 261
Aponeurosis 213
bicipital 66
Apoptosis 389
cause of 389
pathological causes in 389
physiologic causes in 389
Appendicular orifice 416
Appendix 337, 337f
base of 177
microanatomy of 268
Aqueous humor 243
composition 243
formation 243
function 243
situation 243
Arachnoid granulations 244
function 244
Arch of aorta 195, 195f, 207f
begins 86
ends 86
Areolar tissue, loose 214
Argyll Robertson pupil 256, 261
Arterial system 28
Arteriole 28
Arteriosclerosis 247
Artery 28, 32t, 58
anesthetic 252
brachial 66, 90, 89f
development 139
fastroepiploic 151
intercostal 182f
large size 28
left anterior descending 206
perforating 103
Arthroscopy 16
Articular cartilage 4
degeneration of 4
Articulation, types of 258
Astrocytes 24
Atavistic epiphysis 6
Atherosclerosis 209
Atrial septal defect 203, 323, 323f
Atrium, right 187
Auditory meatus, external 253, 369f
Auditory radiation fiber 241
Auriculotemporal syndrome 399
Automatic bladder 405
Autonomic nervous system 24
Avascular necrosis 173
Axial sulcus 236
Axillary artery 58, 59f, 89f
left 89
Axillary nerve 46, 47, 54
anterior division 54
posterior division 54
Axillary vein 73
Axonotmesis 27
Azygos lobe
lower 185
upper 185
Azygos vein 190, 190f
lobe of 185
situation 190
Bacteria 319
Banti's disease 137
enema 364f
meal 365
Barr body 291, 291f
Basal nuclei 241f
Basilic vein 73
Basivertebral foramen 164
Battledore placenta 308
Benedict's syndrome 249
Berry aneurysm 246f
Biceps brachii 20, 73
muscle 40, 41f
tendon of 66
Bicornuate uterus 162, 162f, 317
Bifid tongue 335
Bile duct, common 133, 133f
Bladder 367
distension 405
Blastocyst 304
formation of 304f
Blind spot 258
borne effects 389
brain barrier 238
clots 259
communication of 137f
pressure, high 27
supply 134
transfusion of 80
vessels 31, 271
withdrawal of 80
B-lymphocytes, circulation of 392f
Bone 2, 39
cells 2
clinical anatomy of 8
destroyer 2
forming cells 2
function of 2
greenstick fracture of 16
marrow stem cells 409
tissue 4
Bony callus 8
Bowman's membrane 220, 221
Brachial artery, compression of 76
Brachial plexus 44, 45f, 46, 55t
branches 44
median nerve of 49t
ulnar nerve of 51t
Brachialis 66
Brachii 42
Brachiocephalic veins, lower part of right 187
Brachioradialis 66
Brain 211, 235
circulation of 413
supply of 249
venous drainage of 414
Brainstem reticular
formation 410, 410f
nuclei, primary subdivision of 411f
Branchial arch 332, 333t
derivatives of 332, 332f
Branchial fistula 344
course of 345f
arterial supply of 385
blood supply of 385
cancer 75
carcinoma 76
sources of 385f
Bronchi 250
Bronchopulmonary segments 188, 189f, 189t
Bronchoscopy 190
Bronchus 187
right 203
Brunner's gland 279
Bucket handle tear 13f
Buerger's disease 27, 83
Bulbus cordis 324
Calcaneal spur 376f
Calcaneal tuberosity 377f
Calcaneum 376f
Calcarine sulcus 236
Calices minor 146
Calot's triangle 134
Calyces, minor 366f
Canal boundaries, inguinal 129b
Canal, inguinal 128, 128f, 129, 129f
Cancer breast 75
Cancer stomach 170
Capsular ligament 111
Capsule, internal 241, 241f
catheterization 73
impression 187
myocyte cell 405
orifice 176
Cardioesophageal junction 416
Cardiothoracic surgery 193
Carotid artery, common 262
Carpal tunnel
syndrome 78
transverse section of 71f
Cartilage 2, 2t
cells, mature 383
hypertrophic 14
injuries 13
types of 2, 3f
Cauda equina 236f
Caval system 32
Cecum 172, 337, 337f
artery, origin of 176
sprue 382
trunk 150, 151f
origin of 86
arrangement of 223f
mature 2
Central nervous system 22
Central sulcus 236
Central tendon 205
Cephalhematoma 214
Cephalic vein 66, 93f
Cerebellar peduncle, superior 248f
histology of 281
section of 281f
artery, posterior 256
peduncle 242, 248
anterior 414
classification of 414t
external 414
inferior 414
internal 414
superficial middle 414
superior 414
Cerebrospinal fluid 244
ganglia 24
pleura 183
ribs 393
bilateral 394f
stretching 394f
spine 370, 372
seventh 262
discomfort, complaining of 174
X-ray of 359
Chimera 297
Cholecystectomy drain 166
Chorion 306, 306f
Choroidal vein 414
Chromophil cells 399
Chromosomal morphology 295
Chromosome 284
classification of 285, 286f, 286t
end of 284
parts of 284b, 284f
ring 295, 296f
type of disorder of 293
Ciliary body 238
Circle of Willis 245, 246f, 249, 413, 413f
Circumvallate placenta 308
Clavicle 354
fracture of 81f
Clavipectoral fascia 58, 62, 63, 63f
incision of 64f
Claw hand 77
Cleft palate, types of 331f
Cleidocranial dysostosis 414
Club foot 123
Codominant genes 286
Cohn's syndrome 277
Collateral sulcus 236
Colles fascia 156
Colliculus, superior 395
Columnar epithelial lining 318
Communicating junction 405
Compact bone 357f
Compound epiphysis 80
Compression syndrome, type of 78
Congenital deafness, cause of 403
Conjunctival sac 215
Connective tissue 213
Conoid tubercle 354, 355f
Consanguinity 298
Coracoid process 39, 354f
ligament at 39f
Cornea 220, 220f
surfaces of 221
Corneal epithelium 220
Corona radiata 303
fibers 241
Coronal suture 369f
angiography, indication of 391
arterial system 391f
left 192, 192t, 206, 390
right 192, 192t, 193, 390
bypass 209, 209f
circulation 192, 193f, 390
disease 203
sinus 199, 199f
Coronoid fossae 356f
Corpus callosum 239, 240f
parts of 240f
splenium of 240
Corpus striatum 248
Cortex 355f
Corticonuclear fiber 260
Costal pleura 183
Costodiaphragmatic recess 184, 184f
Cramp 20
Cranial nerves, pairs of 22
Cremasteric reflex 163
Cricoarytenoid muscle, posterior 216
Cricoid cartilage 85
anterior arch of 262
border of 274
larynx 260
Cri-du-chat syndrome 295, 296f
Crohn's disease 381
Cruciate anastomosis 102
Cryosurgery 210
Crypts of Lieberkühn 380
Cubital fossa 65, 245
incision of 66f
right 65f
Cubital tunnel syndrome 78
Cubital vein, median 66, 92f
Cubitus valgus 78
Cuneiform, lateral 377f
Cushing's syndrome 401
Cytokeratins 395
Daughter cell 288
Deep fascia 97f
Deep inguinal lymph nodes 116
Deep middle cerebral vein 414
Deep palmar arch 91f, 382
Deep perineal
pouch 157
spaces 157f
Deep peroneal nerve 108, 108f
course 109
origin 108
Deep-cervical fascia, part of 226
Deltoid ligament 112
nature 112
parts 112
superficial part of 112f
Deltoid muscle 40
Dental caries 260
Denticulate suture 213
Deoxyribonucleic acid 284
Dermatome 281
Dermomyotome 314
Descemet's membrane 221
Desmosomes 404
insipidus 401
mellitus, development of 170
Diaphragm, right dome of 360f
Diaphragmatic pleura 184
Diaphysis, epiphyseal end of 3
Digastric muscle 252
bellies of 252
Digital synovial sheath 405
Dislocation 14
Distal talofibular joint 103
Dizygotic twin 317, 317t
Dorsal digital expansion 58
Dorsal venous
arch 93f
network 100f
Down's syndrome 287, 287f, 293, 296
Duchenne muscular dystrophy 386
Duodenal ulcer 168
Duodenojejunal flexure 178, 363
Duodenum 268f, 336, 363
histology of 267
part of 168
resembles, part of 171
second part of 138, 138f, 139
third parts of 138f
Dupuytren's contracture 77
front of 214
middle 262
ossicles of 402
Ectopia vesicae 343
Ectopic pregnancy 313
Ectopic testis 148, 149f, 166
Ectopic thyroid 256
Elastic cartilage 2
Elbow joint 355, 356f, 357f
anastomosis around 61, 61f
Elephantiasis 36f
Embalming of body, technique of 388f
Embryoblast derivatives 307
Embryology 300
Empyema 210
Endochondral ossification 383, 384f
Endocrine cells 389
Endoderm 308
Endothelium 221
Endothoracic fascia 183
Enteric fever 136
Ependymal cells 24
Epicondyles 356
Epicranial aponeurosis 213
Epigastric vessels, inferior 173
Epilepsy, chronic 240
injury 14
plate, structure of 384f
around knee joint 118
law of union of 4
types of 6, 6f
Epiploic foramen 142
Erb's palsy 47f
Erb's point 47f
stricture 170
varices 137
wall, upper 274f
Esophagus 274, 336
barium swallow X-ray of 361
begins 85
constrictions of 200
histology of 274
lower end of 136, 137
starting of 415
Ethmoid air sinus 233, 369, 383
Euchromatin 298
Exomphalos 317
Extrahepatic biliary apparatus 134, 135f
Extrapyramidal system 248
Extremity, inferior 94, 372
optic disc in 258
stem cells 410
Eyeball 235, 238
Face, development of 329, 330f
artery 252
tortuous 254
canal 253
capsule 398
nerve 252, 254
injury 254
intrapetrous part of 254
palsy 253
supranuclear lesion of 260
Falciform margin, sharp 97
Fallopian tube 153, 154f
histology of 278
False ligaments 163
Fascia of Colles 161
Fascia of Scarpa 156
Fascia, superficial 213
Femoral artery, medial circumflex 103
Femoral cutaneous nerve, lateral 96
Femoral hernia 96, 116, 166, 173
Femoral pulse 83
Femoral triangle 95, 95f
articular ends of 374
head of 372f, 373
lateral condyle of 373f, 374f
lower end of 373f
medial condyle of 373f, 374f
neck of 372f, 373
Fertilized ovum 313f
segmentation of 304f
shape of 17
types of 216
Fibrous pericardium 197
head of 373f, 374f
lower end of 377
Fibular collateral ligament 112
Fifth metatarsal, styloid process of 375f, 377f
Filum terminale 235
ends 87
externum 235
internum 235
parts 235
Fissure 231
Fit 240
Flexor pollicis longus 19
Flexor retinaculum 71
Focal adhesion complexes 404
Foot 376
anteroposterior view of 375
boundaries of 143f
cecum 258
interosseous membrane of 72f
supinators of 41, 42t
exposure of 66
interpeduncular 413f
ischioanal 152, 153f
ischiorectal 152
Fourth lumbar spine, tip of 178
comminuted 8
compound 8
simple 8
stages in union of 10f
types of 8t, 9f
union of 8
Frey syndrome 399
Frontal air sinus 207f, 234, 368f, 370f
Fundic gas shadow 363f
Fusiform muscle 20
Galea aponeurosis 213
Gallbladder 169
fundus of 176
neck of 138
pain 171
Gap junctions 405
Gastric 151
triangle 131
Gastritis 381
Gastrosplenic ligament 160
Gastrulation 307
Gene 298
recessive 298
Genetics, terms in 297
Genicular artery, superior lateral 102
development of 344
external 372f
Genome 298
Genu valgum, bilateral 5f
Genu varum, bilateral 5f
bimanual palpation of 399
intestinal 380
Glans penis 344
Glenoid cavity 354f, 355f
Glenoid fossa concavity of 75
Glenoid labrum 12
Glial cells 24
Glossopharyngeal nerve 218, 254
Gluteus medius 111
Goblet cells 318
Gonads, descent of 347
Great cerebral vein 414
Great saphenous vein 97, 98f
formation 97
Great vessels, transposition of 203
Greater sciatic foramen 114, 114f
Greater splanchnic nerve 26
Greater trochanter 373
Greater tube 355f
Greenstick fracture 8
Growth hormones, produces 400
Gubernaculums 347
Gustatory cells 223
Gustatory sweating 399
Gut, sphincters of 415
Hand, sensory supply of 48f
Haversian system 5
Head 211
and neck 263f, 367
surface anatomy of 262
blood supply of
injuries, type of 257
Heart 208, 208f, 359
anomalies of 323f
apex of 206
artery supply to 192
attack 210
development of 319
failure 209
left border of 208
normal 323f
right border of 206
right and left 319f
subdivisions of 320f
venous drainage of 199
Heel dancing 122
bitemporal 255
contralateral homonymous 256
Hemiazygos vein 191
inferior 191
Hemidesmosomes 404
Hemivertebra 314
Hemorrhoids 167
Hepatic lobule, classical 273
congenital 317
direct 130f
inguinal 173
inguinal 168
Herpes zoster 182
Hesselbach's triangle 130, 130f
Heterochromatin 298
Hilton's law 12
Hip, congenital dislocation of 117
Hip joint 111, 117, 166, 172, 372f
anteroposterior view of 372
dislocation of 118
pathology of 118
space 373
Hirschsprung's disease 27
Horn tear
anterior 13f
posterior 13f
Horner's syndrome 27, 205, 239, 259
Human leukocyte antigen 298
complex 298
Human placenta 348
Humerus 75
anatomical neck of 354
epicondyles of 357f
head of 354f
lesser tubercle of 6
surgical neck of 39
Hyaline cartilage 2, 250, 267
Hyoid bone 85, 260
greater cornu of 262
Hyparterial bronchus 187
Hyperacusis 253, 254
Hyperplasia 168
Hypertension 27
portal 167
Hypogastric nerve, branch of 174
Hypoglossal nerve 224, 224f, 224t
Hypophysis cerebri, subdivisions of 400f
Hysterosalpingogram 367
Ileocecal orifice 87, 159, 159f, 416
Ileum 279, 279t, 336, 364
distal part of 364
Iliac crest 372f
Ilioinguinal nerve 174
Iliotibial tract 101, 101f
attachments 101
Incision 68f
Incus 403
Infection 205
Inferior vena cava 187, 190
Infraorbital foramen 263
Inguinal canal
obliquity of 130
protection of 130
Inguinal lymph node
distribution of 115f
superficial 95, 116
Inguinoscrotal phase 348
Interatrial septum, development of 321, 322f
Intercostal vein, left superior 194
Intercostalis internus muscles 182
Intermuscular septum, anterior 106
Internal thoracic artery, branches of 385f
membrane 103, 104f
nerve, posterior 55, 56f, 76
Interventricular septum 321f, 324
arterial supply of 193f
blood supply of 193
development of 323, 324f
Intestine 365
small 381
Intracapsular fracture 117
Iris 238
muscle of 239
Ischial spine 114
Islet cell stem 410
Isochromosome 295, 296f
Jaundice 171
Jejunum 279, 279t, 336, 364, 381f
Jerky rapid eye movement 294
Joint 13, 16
atlanto-occipital 258
blood supply of 11
clinical anatomy of 13
injuries, common 13
intercarpal 56
physiology of 12
range of 12
replacement 15
stabilizing factor of 12
xiphisternal 206
Junctional complexes 404
Karyotyping chromosome 285, 285f
Kidney 340
coronal section of 146, 147f
horseshoe-shaped 167, 340, 342f, 348
stages of development of 324f
Klinefelter's syndrome 288, 290, 290f, 291, 297
Klumpke's paralysis 47
Knee joint 116, 166, 172, 374f
anteroposterior view of 373
extra-articular ligament of 111
locking of 105
menisci of 12
space 373f
unlocking of 105
Krukenberg's tumor 80
Kupffer cells 271, 273
Lacrimal apparatus 215, 215f
Lacrimal artery 216
Lacrimal canaliculi 216
Lacrimal ducts 215
Lacrimal gland 215, 253
Lacrimal sac 216
Lacunar ligament 166
Lamina propria 381
Large intestine, barium enema of 364
Laryngeal nerve 260
Larynx 228f
ends 85
intrinsic muscles of 216f
watershed line of 252
Lateral thoracic artery, branches of 385f
Leg syndrome, anterior compartment of 121
Lens, suspensory ligament of 238
Lenticulostriate arteries 242
Leprosy 83
Levator ani 158
Lienophrenic ligament 160, 161
Lienorenal ligament 160
Ligamentum arteriosum 327
Ligamentum patellae 118
lower 103, 104f
longer 284
short upper 284
Limiting sulcus 236
Lingual thyroid 255
Little's area of epistaxis 219
Liver 142f, 273f, 338
bare area of 132, 132f
pancreas, stages of development of 339f
Long bone, growing end of 4
Lumbar vertebra, caries spine of 122
Lumber vertebrae 367
Lumbrical canals 74f
Lumbrical muscle 81
Lunate sulcus 236
Lung 188f, 361
azygos lobe of 185
histology of 266
left 186f, 187, 187t, 187t, 189, 189f
lobes of 188t
lower border of both 207f
mediastinal surface of 185, 187t
right 186f, 187, 187t, 189, 189f
root of 187
sectional view of 267f
shadow of 355f, 359
Lymph capillary, formation of 33f
Lymph node 275f
inguinal 115
structure of 275
Lymphadenitis 36
Lymphangitis 36
Lymphatic duct, right 34
Lymphatic system 33
Lymphatic tissue
aggregations of 136
small masses of 34
Lymphedema 36, 36f
Lymphoid tissue 218
Lymphomas 37
Lyon's hypothesis 297
MacKenrodt's ligament 155
Macroglossia 335
Macula adherens 404
Macular sparing 256
Magnetic resonance imaging 352
Malleolus, lateral 375f
Malleus 402
Mammillary nucleus 415
Mandible, ramus of 368f
Maternal blood 310
Maternal hormones 319
Maxillary air sinus 368f, 370f
Maxillary sinus 233
McBurney's point 169, 177
Meckel's diverticulum 312, 313f, 340
Medial cuneiform 376f
Medial cutaneous nerve of
arm 46
forearm 46
Medial longitudinal arch 115, 115f
Medial malleolus, tip of 123
Median nerve
lateral root of 46
medial root of 46
Mediastinal pleura 183, 194
divisions of 194f
superior 194
Medulla 275
Medullary cavity 355f
Meiosis cell division 288
Meiotic division starts 301
Membranous urethra 148
Meniscal tear, types of 13f
Mesenteric artery, origin of superior 176
Mesenteric vessels, superior 144
Mesodermal plate 316f
Metacarpals 359
epiphysis of 81
Metaphysis 3
Microglia 24
Midbrain 247
transverse section of 247f, 248f
Mitosis, repeated 301
Molecular layer, outer 396
Mongolism 287
Monozygotic twin 317, 317t
Morison, hepatorenal pouch of 140, 141f, 166
Morula 304
Mother-to-child transmission 407
Mouse-like appearance tissue 16
Mucosal cilia, loss of 263
Mucous membrane 278
clinical anatomy of 381
of small intestine 379
Müllerian duct 317
fusses 317
nonfusion of 317
Multiaxial shoulder joint 92
Muscle 19, 40, 42, 81, 254
atrophy 20
cardiac 18f
coccygeus 158f
fibers, direction of 21f
injury 20
interosseous 19
intimus 182
parallel 20
strain 20
tissue 16
tone 19
types of 17t
parallel 20, 21f
Muscular layer 279
Muscular surface 229
Muscular system 16
Muscularis externa 268
Muscularis mucosa 268
Musculocutaneous nerve 46, 55, 55t
Mutagenic agents 379
Mutagens 379
Myelin sheath 27
Mylohyoid muscle 397f
Myocardial infarction 210
Myocytes 409
Nasal cavity 231, 370f
parts of 232
Nasal conchae 232
Nasal regurgitation of fluid 259
Nasal septum 263, 368f
blood supply of 220f
major contribution 232
Nasion 262
Nasolacrimal duct 216, 233
Nasopharyngeal tonsil 219
Navicular bone, tubercle of 123
Neck 211, 371f
anatomical 355f
of fibula, fracture of 107, 120
vein, enlargement of 205
Nerve 44, 46, 332
block, intercostal 204
entrapment of upper limb 82
fiber 23
layer 397
in facial canal 253
injury, median 75
interosseous 82
least splanchnic 26
median 47, 48f, 82
palsy, median 49f
supply 17, 40, 41, 58, 105, 184, 214, 221, 227
of joint 12
of urinary bladder 163
to pronator teres 66
to subclavius 46
Nervous system 22
Nervous tissue, histology of 22
Neural crest cells 237
Neural tube, development of 305f
Neuroglia 24
Neuron 409
stem cells 409
structure of 23f
Neuropathy 27
anterior 305f
posterior 305f
Neuropraxia 27
Neurotmesis 27
Ninth costal cartilage, tip of 176
Nondisjunction 288
Non-Hodgkin's lymphomas 37
causes 250
lateral wall of 232f
pricking of 219
Notochord 305
Nuclei, position of 17
Nystagmus 294
Obstruction, intestinal 172
Obturator foramen 372f
Obturator nerve 109, 110, 110f
origin 109
Occipital bone 258
Oculocutaneous albinism 294
Olecranon 357f
fossae 356f
Olfaction, loss of 250
Oligodendrocytes 24
Omentum, lesser 145, 146f
Omphalocele 317
Ondine's disease 412
Oocyte, secondary 301
Oogenesis 301, 303f
Optic disc, papilledema of 259
Optic nerve 250, 258
fibers 258
Orbicularis oculi 260
Orbital cavity 370f
Orbital fissure 230
inferior 230, 231
superior 230
Ossicles, movement of 403
Ossification 7, 7f
Osteoarthritis 4
Osteoblast 2
Osteoclast 2
Osteocyte 2
Otitis media 264
Ovarian diseases, pain in 116, 172
Ovarian fossa 150f
of lateral pelvic wall 149
Oxygen from air 221
Palate, development of 329, 331f
Palatine tonsil 217, 217f
Palatoglossal arch 217
Palatopharyngeal arch 217
Palmar arch, superficial 90, 382
Palmar arterial arch 382
Palmar spaces 70f
Palmaris brevis 58
Palmaris longus 71
Palpebral artery
lateral 216
middle 216
Palpebral part, removal of 253
Pancreas, annular 340
Pancreatic tissue, accessory 340
Papez circuit 415
Papillae 222f
Paracentral lobule 237
Paramedian heart tubes 319
Paranasal air sinuses 232f, 233, 235f, 370f
Parasternal lymph node 80
Parathyroids, superior 258
Paravertebral veins 32
Parietal pleura 182
Parona, space of 69, 69f, 73
Parotid abscess 253
Parotid duct 207f, 227
Parotid gland 226
deep part of 226f
enlargement 257
histology of 270
inflammation of 261
periphery of 226f
Parotidomasseteric fascia 226
Pars distalis 399
Pars tuberalis 400
Patella 374f
outline of 373f
Patent ductus arteriosus 196
Peau d'orange 75
Pectoral nerve, lateral 46
Pectoral region, muscle of 42t
Pectoralis major muscles 42
Pectoralis minor 77
diaphragm 158
parts of 158
kidney 340
mesocolon 143
attachment of 144f
wall, lateral 150f
Pelvis 109
Pennate muscle 19
types of 19f
Percutaneous drainage 409
Pericardial cavity 197, 198f, 320
Pericardial effusion 205
Pericardial sinus, oblique 198, 198f
Perineal body 346
Perineal pouch, superficial 156
Perineal tear 165
Peripheral arterial pulse 30f
Peripheral heart 121
Peripheral nerve 258
Peripheral nervous system 22
Peritoneal cavity 179f
Peritonitis 172, 179f
Peritonsillar abscess 218
Peroneal muscle atrophy 125
Peroneal nerve, superficial 106, 107f
Persistent interventricular foramen 324
Persistent truncus arteriosus 323f
Peyer's patches 136, 279
Phalanges 359
Phalanx 377f
modified 81
Pharyngeal arches 332
Pharyngeal pouches, fate of 335t
Pharynx ends 85
Phenylketonuria 299
Philadelphia chromosome 294, 295, 296f
Phimosis 162
Phrenic nerves 184
Pimples 282
Pineal gland 401, 401f
muscle 114
syndrome 114
fossa 369f
gland 399, 401f
tumor 255, 401
large 308
previa 308, 310, 313f
types of 310
succenturiata rare 308
types of 308, 309f
Placental barrier 310, 310f
Plane suture 213
Plantar calcaneonavicular ligament 113, 121
Pleiotropy 293
Pleura 183f
Pleural reflection 184f
Plexiform layer, outer 396
Plica semilunaris 379
Point mutation 386
Polycystic kidney 340, 342f
Polyuria 401
Popliteal ligament, oblique 112
Popliteus muscle 104, 105f
course 104
origin 104
Porta hepatis 141, 142f
Portosystemic anastomosis 135
Pregnancy group 403
Presbycusis 264
Pressure epiphysis 6
Pretectal nucleus, lesion of 261
Pretracheal fascia 260
Primordial germ cells 301
Profunda femoris
artery 102
branches of 102
vessels 96
Pronator syndrome 78
Pronator teres 66
Proprioceptive senses 221
Protein 303, 394
Proximal bulbar septum 324
Proximal segment of bone, avascular necrosis of 77
Proximal urethra, dilatation of 405
Puberty 282
Pubocervical ligaments 156
Pudendal canal 151, 152f
arch 327
artery 187
pleura 267
trunk, bifurcation of 86
vein 187
Pus, discharge of 251
Pyelogram 365
ascending 365
descending 365, 366f
Pyloric antrum 363f
Pyloric canal 363f
Pyriform fossa 251
Quadratus lumborum 20
Radial artery 59, 60f
in forearm 90
Radial blood vessels 66
Radial nerve 46, 52, 53f, 82
in back of arm 91
in cubital fossa will 79
of brachial plexus 52t
palsy 53f
Radial pulse 83
Radiography, contrast 362
Radioulnar joint 56
superior 70
Radius, styloid process of 358f, 359
Raynaud's disease 27
Rectal fistulae, types of 346f
Rectovesical fistula 345
Rectum 338, 416
abdominis 20
femoris 118
sheath 127
formation of 127f
Red cells 409
Renal fascia 139, 140f
Renal sinus 146
Renshaw cells 388
Respiratory epithelium 266
Respiratory part 266
Reticular formation, function of 411, 412
Reticular system, descending 412
Reticuloendothelial system 271
Retina 239, 251, 396
Retrosternal thyroid 256
Rheumatoid arthritis 15
Rhomboid fossa 244, 244f
Ribs, arching of 204
Rickets in children 5f
Right ventricle, small part of 187
Rods and cones, layer of 396
Roof of middle ear, fracture of 264
Rotator cuff
muscle 42, 43t
of shoulder 44f
Rugae 363f
Rutherford-Morrison, pouch of 408
Ryle's tube 200
Salivary gland 270
parotid 270f
Saphenous opening 96
measurement 96
Scalp 213
bleed, wounds of 257
dangerous layer of 255, 261
injury 256
laceration 257
caracoid process of 6, 39f
lateral border of 354f
Schwann cells 27
junction 238
limbus 221
Sclerotome 314
Scrotum, swelling of 171
Sella turcica 399
Semiflexed hip and knee 124f
Septal veins 414
Septate uterus 317
intermedium 203, 321, 324
primum 203, 321
secundum 203, 321
transversum 316
Serous pericardium 197
Serratus anterior 77
Sertoli cells 301
Sex chromatin 291, 291f
Sex chromosome 291, 292f
Sex difference 173
Shenton's lines 373
dislocation of 14f
girdle, movement of 77
joint 14, 16, 74, 79, 354f, 355, 355f, 356
anteroposterior view of 354
region, right 169
Sibso's fascia 183
Sinus venosus, fusion of 319f
Sinusoids 28, 28t
Skeletal muscle 18f
stem cells 409
Skin 213, 271, 272f
stem cells 410
Skull 369
Small intestine
part of 380f
proximal part of 364
Snuffbox, anatomical 57, 57f
Soft palate
paralysis of 259
role of 406
Somatotrophs, tumor of 401
Spasm 20
Spermatocytosis 301
Spermatogenesis 301, 302f
Spermatozoa, maturation of 303
Sphenoidal air sinus 234, 369f
Sphincter of Oddi 416
Sphincter pupillae 239
Spina bifida 314
occulta 346
Spinal cord 22, 260
commencement of 85
histology of 280, 280f
injuries 409
Spinal nerves 24
Spine 371f
of scapula, root of 85
Splanchnic branches 25f
Splanchnic nerve, lesser 26
Splanchnic nerves 26
Spleen 340
ligaments of 160, 160f
section of 277f
Spot desmosomes 404
Sprain 13
Spring ligament 113, 121
Squamous epithelium, simple 266
Squamous suture 213
Stem cell 409
cardiac 410
Sternal angle 181
Sternum anterior 181f
Stomach 336
barium meal X-ray of 362, 363f
bed 131
carcinoma of 174
fundus of 174, 360f
greater curvature of 363f
lesser curvature of 173, 363f
part of 174
end of 416
orifice of 176
pylorus of 87
X-ray of 365
Stratum basale 272
Stratum corneum 272
Stratum granulosum 272
Stratum lucidum 272
Stratum spinosum 272
Stroma 221
Subclavian steal syndrome 414
Subcutaneous tissue 271
Submandibular duct 398
Submandibular gland, parts of 397f
Submandibular salivary gland 397, 398f
Subphrenic abscess 408
Subphrenic space 407, 408
Subscapular nerve
lower 46
upper 46
Substantia nigra 248
Substantia propria 221
Suckling milk 252
Sudden death, artery of 206
Sulcus 236
lateral 236
types of 236, 236t
Superfemale syndrome 291
Superior thoracic arteries, branches of 385f
Supinator 66
muscle 73, 76
Supracondylar ridge 357f
Suprapatellar bursa 111
Suprarenal gland 29, 169, 276, 276f,
Suprascapular nerve 46
Sutural joint 212
types 212
Sutures, types of 212f
Sympathetic trunk 24
thoracic part of 25f
Symphysis pubis 127, 372f
Synovial fluid 12
Synovial joints 11, 16
T and B lymphocyte
maturation of 391
morphology of 391
Talipes equinovarus 123
Talocalcaneonavicular joint, ligament of 113
Talus 375f
articular surface of 376f
avascular necrosis of 119f
fracture of 119
head of 376f, 377f
neck of 376f
Tapetum 239
Tarsal tunnel syndrome 125
Taste buds 222
Tectum 248
Tegmentum 249
Temporal bone
mandibular fossa of 223
petrous part of 368f, 369f
Temporalis muscle 223, 223t
Temporomandibular joint 14, 225, 225f
movement of 225, 225t
Testis descent 347
Tetanus toxin 388
Tetralogy of Fallot 196, 197f, 323f, 324
defects 196
Thalamostriate vein 414
Thalidomide 319
Third ventricle 242, 242f
Thoracic aorta, descending 86
Thoracic duct 34f, 201, 201f
Thoracic nerve, long 79
Thoracoabdominal diaphragm 205
Thoracodorsal nerve 46
Thorax 180
median section of 194f
surface anatomy of 206
Throat infection 251, 262
Thyroglossal duct 258
cartilage 85, 260
eminence 262
fine-needle aspiration cytology of 230f
gland 228, 228f, 259, 260
isthmus of 262
tissue 255
articular ends of 374
lateral and medial condyles of 373f
lower end of 375f
Tibial collateral ligament 111
Tibial nerve entrapment 125
Tibial tuberosity 374f
Tibialis anterior 19, 122
Tip-toe dancing 122
sensitive 353
shadow, soft 373f
soft 32f, 374f
development of 334, 334f
muscles 254
safety muscles of 250
soft tissue of 368f
tie 335
fossa 259
ring 219f
venous plexus 218
Tonsillectomy, performing 259
Tonsillitis 218, 258
pain 262
Total knee replacement 15f
Trachea 228f, 250
begins 85
bifurcation of 86, 206
Tracheoesophageal fistula 204
Tracheostomy 210
Traction epiphysis 6
Transabdominal phase 347
Transitional epithelium 266
Translocation, example of 293
Transsphenoidal hypophysectomy 263
Transverse colon 338
Transverse pericardial sinus 197, 198f
Trendelenburg test 111
Trendelenburg's sign, positive 119
Truncus arteriosus 195
Tubes, fusion of 319f
Tumor, intracranial 259
Tunica vaginalis 171
Turner's syndrome 288, 289f
Twining 315f
Typhoid 136
Ulna, styloid process of 359
Ulnar artery 66
in forearm 90
Ulnar nerve 46, 50, 50f, 71, 72, 82
hickening of 83
in forearm 91
palsy 50f
Ulnar paradox 72
Ulnar vessels 71
Umbilical cord 311, 311f
Umbilical hernia, physiological 316, 316f
Umbilical opening 312f
Umbilical region 136, 138
Upper limb
interosseous membrane of 72
surface anatomy of 88
Urachal fistula 343
histology of 269
pelvis of 366f, 367
transverse section of 270f
Ureteric colic
pain in 165
upper 165
Urinary and congenital anomalies bladder 343f
Urinary bladder 342, 366f
base of 147, 148f
Urinary incontinence 165
sinus 346
triangle 157f
Uterine tube, section of 278f
Uterosacral ligaments 156
anomalies of 318f
cavity of 153
ligamentous supports of 155f
removal of 166
round ligaments of 155
true ligaments of 155
Uveal tract, part of 238
Valveless veins 165
Valves 99
Valvular disease 209
Varicocele occurs 164
Vascular surface 229
Vaso-occlusive disease 27, 83
Vastus intermedius 118
Vastus lateralis 118
Vastus medialis 118
muscle 102
Vein 32, 32t, 66, 137, 221
cardiac 199, 199f
perforating 100
portal 135, 136f
superficial 66
Velamentous insertions of cords 308
Vena cava, superior 187, 190, 194
drainage 386
system, portal 32
Ventricle 324
Ventricular septal defect 197, 289, 323
Ventricular septum proper 323
Vermiform appendix 269f
blood supply of 161
Vesicourethral canal 343
Villi 379
Vinculae brevia 406
Vinculae longa 406
Viral infection 182
Virchow's lymph gland 174
Virus 319
A 319
D deficiency 5
affects 5
D resistant rickets 299
Voice, hoarseness of 259
Volkmann's ischemic contracture 78
Voluntary muscle, classification of 20, 21f
Waldeyer's ring 218, 219f
Weber syndrome 249
Wedge-and-groove suture 213
Wharton's duct 398
and hand, posteroanterior view of 358f
drop 53f
joint 359
X chromosome inactivation 291, 291f
X syndrome, triple 288
Y chromosome, role of 379
Young bone 8
Young vascular tissue 8
Zona fasciculata 276, 277
Zona glomerulosa 276, 277
Zona pellucida 303, 305
Zona reticularis 276, 277
Zygomatic arch 226, 251
Zygote, gene of 318
Chapter Notes

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General AnatomyCHAPTER 1

Bones and cartilages are specialized connective tissue known as sclerous tissue; bones consist of bone cells (osteoblast—bone forming cells, osteocyte—mature cells, osteoclast—bone destroyer which helps in maintaining the shape of bone) and calcified matrix. As it has rich blood supply, bone can repair much more rapidly than cartilage. Lymphatics are absent in bone marrow.
  • Provides mechanical support
  • Gives attachment to the muscle
  • Constitutes leverage action for augmentation of movement, and
  • Is store house of bone marrow.
In case of adult, the site of bone marrow is withdrawn from the manubrium sterni and iliac crest.
Types of cartilages are shown in Table 1.1 and Figure 1.1.
Table 1.1   Cartilage (three types—depending upon the amount and type of protein fibers present in the matrix) (Short note)
Hyaline cartilage (e.g. articular, costal, respiratory) (Fig. 1.1) P.G.
Elastic cartilage (e.g. epiglottis, pinna) (Fig. 1.1)
Fibrocartilage (intervertebral disc) (Fig. 1.1)
  • Ground glass appearance of matrix
  • More flexible than hyaline cartilage
  • Resist stretch. Most compressible cartilage
  • Collagen fibers present and they are very fine and evenly distributed
  • Presence of abundant elastic fibers in matrix
  • Abundant collagen fibers which are arranged in thick bundles
  • In old age, segmental degeneration of cartilage and partially replace by bone
  • No change in old age
  • In old age, intervertebral disc becomes thin
zoom view
Fig. 1.1: Types of cartilages
The epiphyseal end of diaphysis of growing bone is known as metaphysis. It is the most growing region of the bone.4
  • Its width is greater than any other part of the diaphysis.
  • It is the vascular zone of the growing long bone.
  • Infection of the growing long bone starts from here and gives rise to osteomyelitis. It is due to hairpin-like bend of the arteries (site of bacterial enlodgement).
  • Metaphysis gives attachment to capsules, ligaments and sometimes muscles; so it is always subjected to stress and strain and hence become weak and damaged.
  • Infection of metaphysis is common in children and known as osteomyelitis.
The law states that the ends of long bone where ossification starts first unite last with the diaphysis and vice versa. So where the ossification starts first is the growing end of the long bone. The growing end lies opposite end of nutrient artery. In milking cow position the direction of artery is always downwards.
Osteoarthritis is due to degeneration of articular cartilage. This cartilage lacks regeneration because it is devoid of pericondrium. The degeneration of articular cartilage causes difficulty in walking, if it affects the weight-bearing joint like hip and knee.
  • Effect of exercise and mechanical stress on bone tissue: Within limit bone has an ability to alter its strength in response to changes to mechanical stress. Another effect of stress is increased production of calcitonin-hormone that inhibits bone reabsorption. Removal of mechanical stress results in demineralization of bone. Main mechanical stresses are those that result from pull of skeletal muscle and pull of gravity. Athlete's bone is stronger and thicker than nonathlete.5
  • In whole span of life, male loses 15% of skeletal mass and female loses 30% of skeletal mass.
  • Vitamin D deficiency produces rickets in children. Vitamin D deficiency affects the mineralization of osteoids (Haversian system). There is poor absorption of calcium and in turn poor mineralization. There is bowing of legs and knocking of knees due to less strength of bone in children (Figs 1.2A and B).
  • Osteoporosis: Reduction of quality of bones both due to reduction of bony minerals and protein content (occurs in old age). It is more common in female in menopausal age group.
    zoom view
    Figs 1.2A and B: Rickets in children: (A) Bilateral genu varum; (B) Bilateral genu valgum
  • 6Achondroplasia: It is a congenital anomaly of skeletal system where limb bone is usually shorter but the development of trunk is normal size. This is due to defective endochondral ossification of epiphyseal plate of long bone.
  • Fracture of bone: It may be partial or along the whole thickness.
Types of Epiphysis (Fig. 1.3, Short Note)
  • Pressure epiphysis: It bears weight, e.g. head of femur, humerus.
  • Traction epiphysis: It develops due to muscle pull, e.g. lesser tubercle of humerus is formed by pull of subscapularis.
  • Atavistic epiphysis: Ancient history says it is a separate piece of bone but adheres to the host bone for nutrition, e.g. coracoid process of scapula, posterior tubercle of talus.
    zoom view
    Fig. 1.3: Types of epiphysis
  • 7Aberrant epiphysis: Aberrant means extra. It is an extra epiphysis usually present at the head of first metacarpal. Normal epiphysis is present at the base. So, in spite of one epiphysis there are two.
Ossification (Fig. 1.4, Short Note)
The term ossification means bone formation. The bone formation starts in the embryonic period from a variety of preformed model. The model may be membranous, cartilaginous or membranocartilaginous. When ossification occurs in membranous model it is known as membranous ossification and when it occurs in cartilaginous model it is known as endochondral or cartilaginous ossification. In the developing bone, in the region of shaft, first there is proliferating zone, second zone is the zone of maturation. The third zone is the zone of hypertrophy.
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Fig. 1.4: Ossification
8The hypertrophic cartilage suffers from nutrition and death of cartilage occurs. This produces a gap known as primary areolae. This region is invaded by a blood vessel containing osteoblastic cells and osteoclasts. Thus, bone formation starts and it will gradually strengthen the broken model. The artery that enters into the primary areolae is known as nutrient artery. Osteoblasts deposit bone in a lamellar fashion. Osteoclasts is the bone destroyer, remodeled the shape of the bone.
Clinical Anatomy of Bones (in General)
Union of Fracture
During fracture there is bleeding at fracture site. It is organized as clot. The clot bridges end to end of the site of fracture. Fibroblasts invade the site and there is formation of granulation tissue (young vascular tissue). It will be changed into bony callus (young bone) and union takes place. The most common cause of thickening of bone is callus (Figs 1.6A to D).
Table 1.2   Types of fracture
Fracture type
Bone breaks clearly or leanly but does not penetrate the skin
Sometimes called closed fracture
Broken end of bone protrudes through soft tissue and skin
More serious than simple fracture
Broken bone fragments into many pieces
Common in aged whose bones are more brittle
Bones break incompletely, much like green twigs break
Common in children whose bones are more flexible
Broken bone portions are pressed inward
Typical in skull fracture
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Figs 1.5A to E: Types of fracture
  • Plaster or cast applied to heal fracture should not be removed before 6 weeks.
  • Union of bone is rapid than cartilage. So, bone repair is rapid than cartilage.
  • Greenstick fracture in children is common because of less deposition of inorganic material.
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Figs 1.6A to D: Stages in union of fracture
Joints are defined as junction between two or more bones or bones and cartilage or between two cartilages.
Characteristics Features of Synovial Joints
  • Wide range of movement is there.
  • Bony surface is covered by hyaline cartilage.
  • Presence of fibrous capsule which is lined by synovial membrane.
  • Joint cavity is flushed by synovial fluid which is rich in hyaluronic acid and which nourishes the avascular articular cartilage.
Blood Supply of a Joint
Epiphyseal vessels enter the long bone at near the attachment of capsule and give anterior branch which ramify in plexus over synovial 12membrane. It is seen application of temperature or pressure around a joint, reflexly after the blood flow. Hence, massage is important in case of child as well as in patient with disease.
Nerve Supply of a Joint
Segmental innervation of muscles regulate joint movement. Lasts formulation says four contiguous spinal segment regulate movement of particular joint. Upper two control flexion, adduction, medial rotation. Lower two control extension, abduction, lateral rotation.
Articular nerves contain sensory and autonomic fibers.
  • Hilton's law: The law states that the nerve supply of a joint comes from nerve supply of nearby muscle and that nerve also supplies the skin over the joint. Therefore, in joint diseases irritation of nerve causes reflex spasm of muscles and referred pain to the skin overlying the muscles.
Physiology of Joint Motion
  • Depending on motion by synovial fluid: The synovial fluid movement occurs by the compression of all articular cartilages and capsules.
  • Extensibility: Joint mobility maintains the extensibility of articular tissue. If the joint is immobilized, the ligaments, tendons and cartilage loose its extensibility property and it leads to joint stiffness and hypomobility.
Factors that Limit the Range of Joint Motion
It depends not only on the bony configuration but also on muscle, ligaments and soft tissue envelop. These structures, lead to improper functioning of the joint in disease.
  • Shape of articular surface of opposing bones
  • Strength of capsular and intracapsular ligaments
  • Strength of surrounding muscles of the joint
  • Strength provided by rims of cartilage (glenoid labrum)
  • Presence of fibrocartilaginous disc (menisci of knee joint).13
  • 0 position: This is starting position of a joint. In case of shoulder, joint is arm located by the side of chest wall. Always start examination of joint from 0 position.
  • Joint articular surfaces are avascular and it receives nutrition from synovial fluid.
  • Closed pack position: In this position, the joint surfaces are congruent (fits with each other), the ligaments are tight. In this position, dislocation is rare. But damage of intra-articular structure is more common in closed pack position.
  • Loosed pack position: Any position other than closed pack position is known as loose pack position of joint.
Common Joint Injuries
It is a condition where the ligaments reinforcing a joint are stretched or torn. The lumbar region, the knee and ankle are common sites of sprain. RICE; R—for rest; I—for ice, C—for compression and E—for elevation, are the standard treatment for pulled muscle, stretched tendons or ligaments. Torn ligament do not heal well.
Cartilage Injuries (Figs 1.7A to C)
  • It is common in knee joint, particularly in case of sportsman due to twisting force.
  • The avascular cartilage (medial menisci) is unable to repair itself.
    zoom view
    Figs 1.7A to C: Types of meniscal tear: (A) Bucket handle tear (most common); (B) Posterior horn tear; (c) Anterior horn tear
  • 14The patient is unable to fully extend the knee and there is true locking.
Dislocation (Fig. 1.8)
  • It involves displacement of articular surfaces of bones.
  • It is usually accompanied by sprains, inflammation, and joint immobilization, like fracture, dislocation must be reduced (go back to original position). Shoulder joints, finger joints, thumb, patella and temporomandibular joint are commonly dislocated.
  • Subluxation is the partial dislocation of a joint. Shoulder joint is commonly subluxated due to loose capsule on inferomedial aspect.
  • Temporomandibular joint is also dislocated due to loose capsule; even a large yawning produces dislocation. Anterior dislocation of this joint is common. Acromioclavicular joint is also commonly dislocated.
Epiphyseal Injury
Epiphyseal injury occurs in growing long bone. The injuries occur through the weakest area of epiphysis (i.e. through the zone of hypertrophic cartilage). Epiphyseal injury may often be missed as fracture. To clear the doubt (in children), both sided X-ray must be taken for comparison.
zoom view
Fig. 1.8: Dislocation of shoulder
15Inflammation and degenerative disease of joint includes bursitis, tendinitis and various forms of arthritis.
  • Osteoarthritis:
    • Most common degenerative joint disease accompanied by stiffness, pain and discomfort.
    • Most common in aged (above 40 years) particularly in women. It is due to wear and tear of articular cartilage and bone demineralization.
    • Weight-bearing joints are mostly affected, e.g. knee joint.
  • Rheumatoid arthritis:
    • Occurs in any age group (three times more in female).
    • It is most crippling arthritis (due to autoimmune disease) involving severe inflammation of joints.
    • Small joint like, joint of finger, wrist, ankle and feet are affected in the same time (both sides are involved).
  • Joint replacement: It is a procedure of total or partial replacement of diseased joint by prosthesis (artificial aid). It is most commonly done in knee, hip and shoulder joints. Lifespan of prosthesis is 10–15 years (Fig. 1.9).
    zoom view
    Fig. 1.9: Total knee replacement
  • 16Arthroscopy: It is an imaging technique by which a doctor can examine the internal structure of a joint through a small puncture, without the use of extensive surgery.
Q. Greenstick fracture of bone in children? Explain.
Ans. In children, bone cells and collagen fibers are more and minerals and calcium are less. So, bones in case of children are more elastic and the fracture is not involving the full thickness of bone and is known as greenstick fracture.
Must Know Factor of Joint
  • Joints are of three varietiess: (1) fibrous, (2) cartilaginous, and (3) synovial.
  • All synovial joints possess (1) a cavity enclosed by (2) a fibrous capsule, which is lined inside by (3) synovial membrane.
  • Factors maintaining the stability of the joints are: (1) bony configuration, (2) ligaments, and (3) muscles surrounding the joints (e.g. shoulder joint).
Muscle (mouse-like appearance) tissue has the special property of contractility due to presence of abundant actin and myosin protein filament. Muscle cells are known as myocytes. In men, muscle tissue constitutes 40–50% of body mass. All the muscles of body are developed from mesoderm except muscles of hair follicle (arrector pili), 17muscles of iris which developed from ectoderm. It is important to know that blood flow in skeletal muscle is extremely changeable and varies with muscle activity. Muscles and nerve can tolerate 6 hours of ischemia (lack of blood supply), after that muscle is replaced by connective tissue which reduces the power of muscle. There are three types of muscles (Table 1.3).
Table 1.3   Types of muscles (Short Notes)
Skeletal (Fig. 1.10)
Smooth (Fig. 1.11)
Cardiac (Fig. 1.12)
Shape of fibers
  • The fibers are cylindrical
Fibers are fusiform or spindle-shaped
Fibers are cylindrical and branched (intercalated disc present at the junction)
Position of nuclei
  • Peripherally situated multiple nuclei
Single central nucleus
Single central nucleus
Cross striations
  • Numerous prominent cross striation showing light and dark band
No such features
Cross striation may or may not be present (when present, it is faintly stained)
  • They are usually attached to body skeleton
Muscle of organs like gastrointestinal tract, urinary tract, etc.
Present in heart musculature
  • Voluntary in function
Involuntary in function
Involuntary in function
  • Limited
  • Quick, forceful
Slow, sustained contraction (peristaltic contraction)
Continuous rhythmic contraction
Nerve supply
  • Somatic
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Fig. 1.10: Skeletal muscle
zoom view
Fig. 1.11: Smooth muscle
zoom view
Fig. 1.12: Cardiac muscle
zoom view
Fig. 1.13: Types of pennate muscles
Muscle tissue has got the property of contractility. According to orientation of muscle fibers, there are different varieties of muscles. Pennate muscle is one of them. The orientation of its fibers resemble that of a feather, hence the name. Here the muscle fibers are so arranged that their pull is oblique. They are attached to the sides of a tendon. There are different types of pennate muscles (Fig. 1.13):
  • Unipennate: The muscle fibers are oblique and attached to one side of the tendon, e.g. flexor pollicis longus.
  • Bipennate: The oblique muscle fibers are attached on both sides of the tendon giving a feathery appearance, e.g. interosseous muscle.
  • Multipennate: More than one bipennate muscle fibers lie side by side, e.g. deltoid.
  • Circumpennate: The muscle fibers originate from periphery and converge obliquely on central tendon, e.g. tibialis anterior.
Clinical Anatomy
  • Effect of exercise on muscles:
    • Regular aerobic exercise results in increased efficiency endurance (tolerance), strength, and resistant to fatigue of skeletal muscles.
    • Resistance exercise causes skeletal muscle hypertrophy (increase in size) and gains in skeletal muscle strength.
  • Muscle tone: It is the partial state of contraction of muscle. Muscle tone increases at rest and diminishes during activity. Less muscle 20tone is known as hypotonia. Excessive tone is known as hypertonia (rigidity and spasticity). Both conditions are seen in diseased state.
  • Cramp: Sustained spasm of an entire muscle (lasts for a few seconds to several hours) causing the muscle to become tough and painful; common in calf, thigh and hip muscle.
  • Spasm: A sudden involuntary muscle twitch (range from mere irritation to very painful) due to chemical imbalance; common in eyelid, facial muscle.
  • Muscle strain: Excessive stretching and forcible tearing (due to overuse and abuse)—the injured muscle is painful and inflamed. Quadriceps and hamstring muscle strain are very common in athletes.
  • Muscle injury: Very common; formation of hematoma (blood accumulated swelling) within the muscle, e.g. hamstring, gastrocnemius hematoma.
  • Wasting: Wasting due to disuse and confinement in bed due to peripheral nerve injury.
  • Muscle atrophy: When the motor nerve supply of a muscle is destroyed, the muscle undergoes atrophic and degenerative changes.
Common patterns of muscle fascicle arrangement are strap, quadrilateral, fusiform, triangular, pennate, spiral, etc. Muscles with parallel fibers shorten most. Pennate muscles shorten less.
Classification of voluntary muscle (according to shape and direction of muscle fibers) has been shown in Figure 1.14.
The muscles fibers are parallel to the line of the pull. The fibers are long but their numbers are relatively few.
Parallel muscles are divided into following subtypes (Fig. 1.15):
  • Quadrilateral, e.g. quadratus lumborum
  • Strap muscle, e.g. sartorius
  • Strap with tendinous intersections, e.g. rectus abdominis
  • Fusiform muscle, e.g. biceps brachii.21
zoom view
Fig. 1.14: Classification of voluntary muscle (according to shape and direction of muscle fibers)
zoom view
Fig. 1.15: Types of parallel muscles
  • Range of movement is more due to the mere length of fibers
  • Force of contraction is less due to less number of muscle fibers.
The nervous system is controlling and communicating system of our body. Its main functions are to monitor, integrate, and response to information on the environment.
It is divided into two major parts: (1) central nervous system (CNS) (including brain and spinal cord) and (2) peripheral nervous system (PNS) (12 pairs of cranial nerves, 31 pairs of spinal nerves and their associated ganglia).
Functionally, the nervous system is again divided into somatic nervous system (which controls voluntary function) and autonomic nervous system (ANS) (control involuntary function).
Histology of Nervous Tissue
The structural and functional unit of nervous system is neuron (Fig. 1.16). They have a cell body and cytoplasmic processes called axon and dendrites. All neurons have one axon with few exceptions.23
zoom view
Fig. 1.16: Structure of a neuron
Axon transmits impulse away from nerve cell. The axon hillock is the most excitable part of the axon. The axon ends in enlarged terminals which secretes neurotransmitter. The large axons (nerve fibers) are myelinated. Myelination is done by Schwann cell in PNS and oligodendrocyte in CNS. In some places, the myelin sheath is absent known as nodes of Ranvier. The purpose of myelination is propagation of wave of excitation rapidly and also insulation. Myelinated nerve fibers are seen in muscles where reaction speed is needed; whereas unmyelinated fibers occur in transmission of visceral pain.24
These are the supporting cells of CNS. There are different types of neuroglial cells:
  • Astrocytes: They are concerned with the nutrition of the nervous tissue. They are of two types:
    1. Protoplasmic astrocyte
    2. Fibrous astrocyte.
  • Oligodendrocytes are like Schwann cells. They myelinate the CNS.
  • Microglia: Their action is that of macrophages.
  • Ependymal cells: They are short columnar cells lining the cavities of CNS.
Clinical Anatomy
  • Proliferation of glial cells is called “gliosis”. A CNS lesion is healed by gliosis.
  • Tumor of the glial cells is the most common tumor of CNS.
Spinal Nerves
Spinal nerves are united ventral and dorsal roots, attached in a series, to the side of the spinal cords. They are 31 pairs: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. These emerge through intervertebral foramina. Except T2-T12, all ventral rami join one another forming nerve plexuses. This plexuses occur in the cervical, brachial, lumbar and sacral regions.
It is the part of nervous system that controls automatic activity of our body (i.e. involuntary activity) like heart, smooth muscles and gland. It is divided into two parts—sympathetic and parasympathetic and both parts have afferent and efferent nerve fibers.
Sympathetic Trunk (Fig. 1.17)
They lie on either side of vertebral column; extends from base of the skull to the coccyx. It looks like a knotted thread. There are three cervical ganglia: (1) superior cervical ganglia (largest, formed by the fusion of upper four cervical ganglia), (2) middle cervical ganglia (smallest of the three, formed by the fusion of fifth and sixth cervical ganglia) and (3) inferior cervical ganglia (intermediate in size, formed by the fusion of seventh and eighth cervical ganglia.25
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Fig. 1.17: The thoracic part of the sympathetic trunk and its splanchnic branches (schematic)
This ganglia lies between carotid sheath and prevertebral fascia, eleven thoracic, four lumbar, four sacral ganglia. The sympathetic ganglions are structures where synapse (white rami) between pre- and postganglionic fiber takes place. The right and left trunk coverage medially and form ganglion impar (unpaired) in front of coccyx. Most preganglionic fibers reach the sympathetic trunk; they have three types of termination:
  • They may terminate in the ganglion they have entered. These postganglionic nerve fibers (known as rami), now pass through the thoracic spinal nerve and supply the smooth muscle of blood vessels and sweat glands.26
  • The fibers may ascend high up and terminate in cervical ganglia or lower fiber may descend down in lower lumbar and sacral ganglia.
  • Some of the preganglionic fibers may pass through the ganglia on thoracic part of sympathetic trunk without synapsing. These fibers form three splanchnic nerves.
    • Greater splanchnic nerve: Arise from fifth to ninth thoracic ganglia pierces the diaphragm and synapses (neuroneuronal junction) with celiac plexus.
    • Lesser splanchnic nerve: Arise from tenth and eleventh thoracic ganglia, pierces diaphragm and synapses with lower part of plexus.
  • Least splanchnic nerve: Spinal nerves correspond to the same segment of spinal cord, but the sympathetic pathways do not correspond with the segment of spinal cord.
    • T1 segment—passes up and goes to head region
    • T2 segment—goes to neck
    • T3-T6 segment—into thorax
    • T7-T11 segment—for abdomen
    • T12-L2 segment—for leg
According to some author, the parasympathetic system is represented as D division [i.e. digestion, defecation, diuresis (urination)]. The sympathetic system is represented as E division (i.e. excitement, exercise, embarrassment and emergency). Autonomic function is controlled at different levels: (1) reflexes are controlled at spinal cord and brainstem level, (2) hypothalamus controls the integration with autonomic, somatic and endocrine response, and (3) frontal lobe of cerebral cortex controls ANS at subconscious level via limbic connections. The efficiency of ANS decreases in old age.
Preganglionic fibers are cholinergic in both sympathetic and parasympathetic; postganglionic sympathetic fiber is adrenergic except for sweat gland and arrector pili muscle. Postganglionic neuron of parasympathetic is cholinergic. Parasympathetic is essential for life.
Clinical Anatomy
Autonomic nervous system is involved in every important process that goes in our body. Most autonomic disorders reflect, excess, or 27deficient controls of smooth muscle activity. Unlike CNS, the ANS can be easily and effectively controlled by drugs.
  • Hypertension (high blood pressure): It may result from excessive sympathetic activity. It is known as stress-induced hypertension.
  • Vaso-occlusive disease: They are Raynaud's disease affecting the upper limb, Buerger's disease affecting the lower limb. It is characterized by gradual cyanosis (bluish coloration); pain in the affected region in severe cases gangrene (tissue death) may result. To treat severe cases, sympathectomy (cutting of sympathetic trunk in a particular segment) is done. The involved vessels dilate, re-establishing adequate blood supply to the affected region.
  • Congenital megacolon (Hirschsprung's disease): In this condition, parasympathetic innervation of the distal part of colon fails to develop. As a result, distal colon is immobile and dilated. The condition is corrected surgically.
  • Achalasia (not relaxed): A condition where esophagus is unable to propel food in the lower part due to parasympathetic neuron deficiency. The distal esophagus becomes dilated and vomiting is common.
  • Horner's syndrome: It results from an interruption of the sympathetic nerve supply to head and neck. The affected person exhibits constriction of pupil (myosis), slight drooping of eyelid (ptosis), vasodilatation of skin arterioles (flashing of face) and loss of sweating (anhidrosis). Common sites of lesion are brainstem, cervical part of spinal cord or stellate ganglion.
All animals and human being require a mechanism to distribute oxygen and nutrition throughout the tissues of body and to collect waste product and carbon dioxide from the tissues. So, there is requirement of blood—vascular system. It requires a muscular pump—the heart. Various types of blood vessels like (1) arteries, (2) arterioles (3) capillaries, (4) sinusoids, (5) venules, and (6) veins are present within the body.
  • Arteries: Arteries are of three types:
    1. Elastic or large size arteries: Here tunica media (middle coat) contains more elastic tissue, e.g. aorta, carotid, subclavian, axillary, and common iliac arteries.
    2. Muscular or medium size arteries: Most widely distributed. Tunica media consists of predominantly muscle fiber, e.g. brachial, radial, femoral, gastric, superior mesenteric arteries.
    3. Arteriole: It is the smallest arteries having a diameter of 100 micron. They act as resistant vessel to maintain peripheral blood pressure.
  • Capillaries: Primary exchange vessel. Carry blood from arteriole to venule. Arteriole, capillaries and venules together constitutes microcirculation.
  • Sinusoids: Large lumen and tortuous course. Absent or incomplete basement membrane. Very porous (Table 1.4).
Angiogram: Visualization of arterial tree by radiopaque dye is known as angiogram.
Table 1.4   Differences between sinusoids and capillaries (Fig. 1.18)
  • Wider, irregular spaces
  • Lined by endothelial, reticuloendothelial cells, which may be interrupted, fenestrated
  • Basal lamina is not continuous
  • Narrow regular space
  • Lined by continuous endothelial cells
  • Basal lamina is continuous
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Fig. 1.18: Comparison between capillary and sinusoids (seen within suprarenal gland)
At the upper limb brachial artery (just above the cubital fossa) and radial artery (region where radial pulse is felt) are the common site, common carotid artery in neck (near its bifurcation) and femoral artery in lower limb (just below the inguinal ligament) in the site of choice for angiography (Fig. 1.19 and Table 1.5). Various regions in the body where arterial pulsations can be felt are shown in Figure 1.19.30
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Fig. 1.19: Regions where arterial pulsation is felt (peripheral arterial pulse)
Table 1.5   Body regios where pulsation in felt
Condition required for feeling the pulse
In front of auricle at the root of the zygomatic arch
Easily felt in children and in adult easily accessible site by anesthetist
At the anterior-inferior angle of master
Easily accessible site by anesthetist
Along the anterior border of sternocleidomastoid in neck of the upper border of thyroid cartilage
It is the accessible site during cardiac arrest
Medial to the tendon of biceps brachii in the cubital fossa
This pulse is required to measure the blood pressure
At wrist in front of forearm on radial side
Clinician used to access the rate and character of the pulse
Below the inguinal ligament midway between anterior superior iliac spine and symphysis pubis
Used during cardiac arrest
Dorsalis pedis
Over dorsum of foot between extensor retinaculum of great and other toe
Used to access the circulation of lower limb in case vasoocclusive disease
  • Angina pectoris: Chest pain
  • Artery: Carries more oxygenated blood away from the heart
  • Embolous: Plug
  • Infarction: Virtually blood less area
  • Ischemia: Lacking adequate blood supply
  • Stenosis: Narrowing
  • Vein: Carries poorly oxygenated blood towards the heart
  • End artery: The artery which have no precapillary anastomosis
  • Vasa vasorum: A vessel supplying a vessel is known as vasa vasorum. It is present in tunica adventitia coat of large vessels. E.g. coronary arteries.
Veins are the channels that carry blood toward the heart. Poorly oxygenated blood is carried by all veins in the body except pulmonary veins which carries oxygenated blood. It possess thin muscle wall and numerous than the arteries. Veins are elliptical in collapsed state and circular in filling state. Venous valves are numerous in distal part of lower extremity and the number of valves decreases proximally. There is no valve in superior and inferior vena cava. It is formed from capillary tissue fluid (micromolecular in nature). Blood vessels are arranged in following pattern. Arteries have supply function, capillary (terminal vascular bed) have exchange function and veins have reservoir function. In human body four types of venous system are present: (1) caval system, (2) portal venous system, (3) azygos venous system, and (4) paravertebral veins.
Must know:
Differences between artery and vein have been given in Table 1.6.
Table 1.6   Difference between artery and vein
  • Takes more oxygenated blood away from the heart (except pulmonary artery)
  • Carries deoxygenated blood toward the heart (except pulmonary vein)
  • Valves absent
  • Valves present
  • The wall is thick, muscular and elastic
  • The wall is thin, less muscular and nonelastic
  • The lumen is smaller
  • The lumen is bigger
  • Are not collapsible
  • Are collapsible
  • Contain blood under high pressure
  • Contain blood under low pressure
  • Blood flows fast
  • Blood flows slow
  • Blood flows by jerks caused by beating of heart
  • Blood flows evenly without any jerks
Apart from artery and vein, there exist another channel in our body, i.e. lymphatic system. Lymphatic system is accessory to venous system. It also drains tissue fluid from the tissue spaces like veins, but the difference is that it carries protein and fat macromolecules from tissue spaces. The veins carry micromolecular substance from tissue space (Fig. 1.20). Lymphatic tissue is essential for immunological defense of the body from bacteria and viruses. Lymphatic tissue starts developing in the 5th week of intrauterine life.
Lymph is the name given to the tissue fluid, once it has entered a lymphatic vessel. Composition of lymph varies from one part of body to another. Before lymph is drained into the bloodstream, it passes at least one lymph node (small masses of lymphatic tissue), sometimes several.
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Fig. 1.20: Formation of lymph capillary
34The lymph vessels have numerous valves. The lymph vessels which carry lymph toward the lymph node is known as afferent vessel, and that of which carries lymph away from lymph node is known as efferent vessel. The lymph reaches the bloodstream at the root of the neck by two large lymph vessels called right lymphatic duct and thoracic duct (Fig. 1.21).
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Fig. 1.21: Thoracic duct
35The thoracic duct (45 cm long) begins in the abdomen from a sac; cysterna chyli, and enters the thorax through an opening (aortic opening) of diaphragm. It ascends through thorax, lies in front of 7th thoracic vertebrae. At the level of T4 and T5 it bends toward left, lies between aorta on the left-hand side and azygos vein on the right-hand side in the posterior mediastinum behind the esophagus. It then ascends into neck and drains into the angle, formed by left internal jugular and left subclavian vein. From thoracic duct lymph is pumped into venous system during inspiration. The rate of flow of lymph is indirectly proportional to the depth of inspiration. Most of the lymph flow of the body is due to contraction of skeletal muscle like veins.
The right lymphatic duct drains lymph from the body's right upper quadrant (right side of head and neck, right upper limb and right half of thorax). The thoracic duct drains lymph from remainder of the body (Fig. 1.22).
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Fig. 1.22: Lymphatic drainage of whole body
Lymph formation is directly proportional to arterial flow 36and 40% of lymph is formed within skeletal muscle. In the abdomen and pelvis highest number of lymph node is present.
The central nervous system, the eyeball; the internal ear, the epidermis of skin, cartilage and bone are devoid of lymphatic vessels.
  • Lymphangitis: It is the inflammation of lymph vessel. When lymph vessels are severely inflamed, the vasa vasorum (vessel supplying a vessel) become congested with blood. As a result the pathway of the associated lymphatics becomes visible through skin as red line and painful to touch.
  • Lymphadenitis: It is the inflammation of lymph node. These two phenomena may occur when the lymphatic system is involved in the spread of cancer cell.
  • Lymphedema: The accumulation of lymph in tissue space. It occurs when lymph is not drained from an area of the body (Fig. 1.23). It is seen in coastal region of Odisha.
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    Fig. 1.23: Lymphedema (elephantiasis)
    37There is repeated attack by filarial bacteria. The lower limb is most commonly affected and the condition is known as elephantiasis; edema of upper limb occurs due to removal of axillary lymph node for cancer of breast.
  • Lymphomas: These are the tumor of lymph glands and are classified as Hodgkin's and non-Hodgkin's lymphomas.