The General Study Guide

==MEDICINE==

General Anatomy
Head and Abdomen
Mandibular Angle
Cranial Nerves
Olfactory, optic, oculomotor, trochlear, trigeminal (ophthalmic,
maxillary, mandibular), abducens, facial, vestibulocochlear,
glossopharyngeal, vagus, accessory, hypoglossal.

Posterior Triangle of the Neck

This region is bounded anteriorly by the sternocleidomastoid and

posteriorly by the trapezius. These two muscles originate side by
side from a common origin along the superior nuchal line of the
occipital bone. Inferiorly, its base is defined by the medial third of
the clavicle. The omohyoid muscle crosses under these two muscles
inferioposteriorly, and its lower border separates this into an upper,
occipital triangle and a lower, subclavian triangle. The floor is then
formed, anteriorly to posteriorly, by the anterior scalene, middle
scalene, levator scapulae and finally by the splenius muscle. Finally,
it is covered by the cervical fascia (fascia colli)

Occipital Triangle
Subclavian Triangle
The subclavian artery passes over the sternocleidomastoid and
dives into the subclavian triangle and then runs under the clavicle,
upon which it becomes the axillary artery.
Scalene Muscles
These muscles are divided into the anterior, middle and lateral
scalene muscles. The scalenus anterior lies deep to the
sternocleidomasteus, and it originates from the transverse tubercles
of the
They act to elevate the rib they are attached to and cause ipsilateral
flexion at the neck.
Levator scapulae (elevates and posterior rotation of
scapula)
This muscle originates from the posterior tubercles of the transverse
processes of C1 to C4. It forms a band that inserts into the superior
aspect of the medial border of the scapula (right up until about the
spine of the scapula). As one of the muscles forming the floor of the
posterior triangle of the neck (between the anterior and middle
scalenes and posteriorly by the splenius cervicis), it is covered
superiorly by the sternocleidomastoid and inferiorly by the trapezius
as it wraps around the shoulder. Supplied by the dorsal scapular
nerve and artery as well as the cervical nerve.

Spinous process of C7

This is the most prominent (longest) spinous process in the back,

although in 30 percent of people this may be the C6 or T1 vertebra.

Tendon Reflexes
Brachioradialis (lateral side of wrist) C5-7
Biceps reflex C5-6
Triceps reflex C6-8
Subclavian/Axillary/Brachial Artery
These all refer to the same artery. Originating from the
brachiocephalic trunk of the aorta on the right, and directly from the
aorta on the left, it is renamed the axillary artery as it passes under
the clavicle and subsequently is renamed the brachial artery after it
crosses over the first rib. Branches to give the thyrocervical trunk
Thyrocervical Trunk
This is a short artery arising from the subclavian that soon branches
into the suprascapular artery, transverse cervical artery, inferior
thyroid artery and ascending cervical artery.
Transverse Cervical Artery
This artery runs somewhat parallel to the suprascapular artery in
that it runs laterally across the neck. After passing under the
omohyoid, it branches into an superficial (ascending) branch that
rapidly terminates and a deep (descending) branch which goes deep
to the shoulder to run down the medial/vertebral border of the
scapula to anastomose with the subscapular artery at the inferior
angle. Note that this deep branch is also known as the
dorsal/descending scapular artery and that it more commonly arises
directly from the subclavian. The superficial branch meanwhile
passes by the anterior border of the trapezius and merges with the
superficial branch of the descending branch of the occipital artery.
Brachial Plexus
Originating from the ventral (front/anterior) rami of the nerve roots
of C5-T1, they originate from the neck between the anterior and
middle scalene muscles. They are closely associated with the
subclavian/axillary/brachial artery. Note that the dorsal rami serve
the back and as a result it is possible for shingles to cross over past
the midline.
Branches of The Brachial Plexus
The nerve roots of the two top and two bottom join
This gives the upper, middle and lower trunks
Which are given based on their relation to each other as they pass
on top of each other through the scalene fissure with the subclavian
artery.
Each trunk then bifurcates into an anterior and a posterior division.
After passing under the clavicle
The three posterior divisions merge into the posterior cord.
The top two anterior divisions merge into the lateral cord.
The last anterior division remains as the medial cord.
These cords are named based on their relation to the axillary artery.
The lateral cord and the medial cord merge to give the medial
nerves.

Meanwhile the posterior cord bifurcates to give the axillary

(innervates deltoid and teres minor) and radial nerves.
Important Points
The subclavian and suprascapular nerve is given off at the point
where the anterior rami of C5 and C6 join, also known as Erbs point
as it will produce Erbs palsy if it is torn. It joins with the phrenic
nerve as it winds its way down the outer thoracic wall.
There is a noticeable M-type bifurcation in the brachial plexus. The
central V-section is due to the lateral and medial heads of the
median nerve. This is then bordered by the ulnar nerve medially and
the musculocutaneous laterally.
The bifurcation of the posterior cord and the merging of the three
heads of the posterior cord can occur quite closely to each other (ie
it doesnt really exist)
The medial cord gives rise to the medial brachial and antebrachial
cutaneous nerves (innervates skin of arm and forearm) as well as
the medial pectoral nerve.
The lateral cord then gives off the lateral pectoral nerve.
The posterior cord gives rise to the lower and upper subscapular
nerve (innervates subscapularis and teres major) and thoracodorsal
nerve prior to bifurcating.
Note that these branches largely occur in between the clavicle and
first rib.
The long thoracic nerve is then given off directly from the nerve root
of C5 to C7. T1 also supplies the first intercostal nerve.

Superior border of the scapula

There is a raised beak shaped process at the lateral end known as
the coracoid process and the glenoid fossa is just inferior to it. On
the whole, it is bent anteriorly to give the subscapular fossa.
Superior angle of scapula
The medial end of the scapula, it is not easily seen except in the
very skinny or in those with a winged scapula. Continuous with the
superior and medial border of the scapula. The spine of the scapula
runs posterior to it.
Suprascapular notch
A rather distinct notch in the superior border of the scapula, it is
closed off into a foramen by the superior transverse (scapular)
ligament through which the suprascapular nerve passes through
from the great scapular notch, which is the large notch inferior to
the coracoid and acromion. The suprascapular artery (which
branches off from the subclavian) passes above the ligament.
Suprascapular nerve

A posterior branch of the upper trunk of the brachial plexus, it

passes inferiorly with the belly of the omohyoid muscle, which then
passes deep to the trapezius, passes through the great scapular
notch (the notch in between the glenoid and coracoid) before
running along the superior border of the scapula. It then enters the
supraspinous fossae of the scapular through the suprascapular
notch, passes beneath the supraspinatus while innervating it, then
running along the lateral border of the scapula and enters the
infraspinous fossa where it innervates the infraspinatus. It also will
innervate the acromioclavicular joint and the glenohumeral
(shoulder) joint.

Coracoid Process
Passes laterally to the glenoid fossa anterior to it, it is the extension
of the superior border of the scapula. It is the site of insertion of
three muscles (coracobrachialis, pectoralis minor and short head of
the biceps) and ligaments. The conoid ligament from the conoid
process of the clavicle inserts inferiorly. On the superior surface the
Coracobrachialis (flex and adduct humerus)
The smallest muscle to attach to the coracoid process and the only
to originate from it, it inserts into the medial part of the humeral
shaft about halfway down together with the short head of biceps. It
lies medial to the short head of the biceps. In addition to flexion and
adduction of the humerus, it also restrains the arm in the neutral
position. It is supplied by the musculocutaneous nerve which pierces
it on its way up to the biceps brachii
.

Glenoid fossa
A small fossa on the lateral side of the superior border of the
scapula, bounded anteriorly by the coracoid and posteriosuperiorly
by the acromion. It is encircled by the neck of the scapula. It
articulates directly with the head of the humerus, and the articular
surface is extended by means of the circular glenoid labrum
ligament which encircles the glenoid rim. The short head of the
biceps originates on top at the supraglenoid tubercle while the long
head of the triceps originates at the bottom from the infraglenoid
tubercle.
Biceps brachii (supination of the arm in partial flexion and
flexes the arm in pronation)
The most superficial muscle, it originates from the coracoid process
of the scapula (short head doesnt run all the way up the humerus
but rather curves off anteriorly) and the supraglenoid tubercle (long
head), it inserts into the radial tuberosity and there is also a flat
tendon which inserts into the bicipital aponeurosis which is
continuous with the deep fascia of the forearm. This muscle is
responsible for supinating the forearm in partial flexion. Note that
the brachialis (lies deep to it) is the stronger flexor while supinator
assists with supinating the extended forearm. This is shown from
how it is innervated by the musculocutaneous nerve, which pierces

through the coracobrachialis before running deep to the biceps.

There may be two heads inserting into the coracoid sandwiching the
coracobrachialis in doing so, and in fact the short head is often
merged to the coracobrachialis. The long head is deep to the deltoid
while the short head is deep to the pectoralis major.
Triceps brachii and anconeus(extension and some adduction)
This is the largest extensor of the arm although it is also capable of
adduction. The long head is the most posterior of the three and
originates from the infraglenoid tubercle. The lateral head is lateral
to it and originates in a line superior and lateral to the radial groove
while the medial head lies deep to the two other heads and
originates from the rest of the posterior aspect of the bone that lies
inferior to the radial groove. Thus, the radial nerve and profunda
brachii artery runs between the lateral and medial heads. They then
merge into a single tendon that attaches to the superior facet of the
olecranon of the ulna.
The anconeus may be thought of as a fourth head of the triceps in
that it also inserts to the olecranon but it does so on its lateral facet
(originates from the lateral epicondyle). In addition to assisting with
and stabilising the elbow during extension, it also pulls the joint
capsule out of the way. This is done by means of an extension that
originates from the deep distal side of the medial head of the triceps
and inserts into the posterior capsule of the elbow joint, also known
as the articularis cubiti/subanconeus. It originates from the posterior
surface of the lateral epicondyle of the humerus.
Given that they are in the posterior compartment of the arm, they
are innervated by the median nerve although in some cases the
axillary nerve may innervate the long head.

Spine of scapula
Located on the posterior aspect of the scapula, it is a ridge of bone
that runs perpendicular to the rest of the scapula, and separates the
supra- and infraspinatous fossa (the shallow concavity of the
scapular blade). The lateral end is bent anteriorly to give the
acromion at the apex, which forms the top of the shoulder joint. The
trapezius muscle attaches superiorly and the deltoid muscle
attaches inferiorly.

Acromion
The acromion is a ridge of bone that overhangs the glenohumeral
joint. Articulates directly with the clavicle at the acromioclavicular
joint, which is held together by the superior and inferior
acromioclavicular ligament.
Rotator Cuf
These represent a group of four muscles which serve to stabilise the
glenohumeral joint by holding the head of the humerus against the
glenoid fossa. Three of them attach posteriorly to the scapula and

insert on the greater tubercle and perform adduction and external

rotation while the remaining one attaches anteriorly and inserts to
the lesser tubercle.
Supraspinatus (rotator cuf, adduction)
Originates from the supraspinatous fossa, it passes under the
overhang of the acromion then inserts into the superior facet of the
greater tubercle on the humerus. As such, it may be entrapped if
the clavicle is fractured. Assists the deltoid in initiating abduction of
the arm. Innervated by the suprascapular nerve just after it passes
through the suprascapular notch in the superior border of the
scapula.
Infraspinatus (rotator cuf, external rotation)
Arises from the medial two thirds of the medial border of the
scapula and of the infraspinatous fascia that covers it. Converges
into a tendon that runs over the lateral border of the scapula to
attach to the medial border of the greater tubercle. Lies deep to the
teres major and minor but may be fused to teres minor. Innervated
by the suprascapular nerve after it crosses over through the great
scapular notch after innervating the supraspinatus. Opposes the
upward pull of the deltoid on the humeral head during adduction to
prevent injury of the supraspinatus tendon by compression against
the acromion.
Deltoids (arm abduction)
The deltoids comprise of an anterior portion, which arises from the
lateral third of the anterior border and upper surface of the scapula,
the lateral (middle) portion which arises from the superior and
anteriolateral surface of the acromion and the posterior portion
which arises from the inferior side of the spine of the scapula.
The anterior deltoid abducts the externally rotated arm, the lateral
deltoid abducts the medially rotated arm and the posterior deltoid
abducts the internally rotated arm. When they contract they elevate
the arm and this is opposed by the infraspinatus and subscapularis.
Inserts into the deltoid tuberosity, which is a raised ridge continuous
with the lateral lip of the bicipital/intertrabecular groove. Which
facet it inserts to depends on their origin. Innervated by the axillary
nerve (cf regimental badge region)

Clavicle
Forms the anterior part of the thoracic inlet, together with the
manubrium, the 1st rib and T1. Associated with the thoracic inlet.

Coracoid/Conoid tubercle
Represents the spiky bit near the acromial end of the tubercle. It is
the side of origin of the conoid ligament together with a bit of the
clavical lateral to it, and inserts on the inferior surface of the
coracoid process.

Thoracic inlet
Thoracic outlet syndrome
Occurs when the brachial plexus is compressed.

Medial Border of the Scapula

Teres Major (medial rotation and extension not
hyperextension)
Inferior to teres minor, it is only innervated by the lower subscapular
nerve. It originates from the lower third of the medial border
posteriorly/dorsally and inserts into the medial lip of the bicipital
groove. Remember that it extends slightly further across the scapula
than the teres minor.

Axillary/Lateral Border of The Scapula

The lateral edge of the scapula, the posterior side is the origin of the
teres minor muscle. The subscapularis muscle also originates
slightly medial to it from the subscapular fossa.
Teres Minor (rotator cuf, external rotation)
This muscle originates from the middle third of the lateral border of
the posterior face of the scapula and converges onto a tendon which
then attaches to the lowest facet of the greater tubercle. It is
separated from the muscle above it (subscapularis) and the muscle
below it (teres major) by aponeuroses. It is innervated by the
axillary nerve. May be fused with infraspinatus.
Subscapularis (rotator cuf, internal rotation)
This muscle originates from the subscapular fossa (anterior aspect
of scapula) and insert into the lesser tubercle of the humerus with
minor attachments to the greater tubercle. As it passes the neck of
the scapula (around the glenoid fossa) it passes through a bursa
that is continuous with the joint capsule of the shoulder. It is
innervated by the upper and lower subscapular nerves which
originate from the posterior cord of the brachial plexus. It is shallow
to the serratus anterior which is separated from it by a bursa
(subscapular). Opposes the upward pull of the deltoid on the
humeral head during adduction to prevent injury of the
supraspinatus tendon by compression against the acromion.
Subscapular Artery
Branches from the axillary artery, it follows the lateral border of the
scapula together with the lateral/inferior border of the
subscapularis. It gives off the scapular circumflex artery and
thoracodorsal artery before anastomosing with the dorsal scapular
artery (descending branch of the transverse cervical artery) at the
inferior angle of the scapula.

Suprasternal/Jugular Notch
Represents the small of the neck in between the clavicles.
Corresponds to the level of the top of the aortic arch. Is located
directly in front of the manubrium. This delimits the sternum, which
articulates with the ribs to give the anterior (and lateral) thoracic
wall.

Manubrium

Articulates with the 1st and upper part of the 2nd costal cartilages,
and lies opposite T3 to T4. Remember that the first rib cannot be
palpated as it is behind the clavicle.

Sternum
Articulates directly with the costal cartilages of ribs 2-7. Ribs 8-10
join up with the costal cartilage of rib 7 and ribs 11-12 are free
floating (joined to the abdominal muscles). Is the origin of the
pectoralis major and minor.
Pectoralis Major
Originating from the anterior portion of the sternum, the medial
cartilages (costochondral joints) of the second to the sixth rib and
the medial half of the clavicle , these fibers converge onto a flat
tendon which inserts onto the lateral lip of the bicipital groove.
Innervated by the medial and lateral pectoral nerves which arise
from the medial and lateral cords respectively and adducts the arm.
Will be absent in Poland syndrome.
The pectoralis minor originates from the scapula. There may be a
small cosmetic muscle known as the sternalis shallow to the sternal
insertion of the pectoralis major and parallel to the rectus abdominis
and is innervated by the thoracic and/or intercostal nerves.

Aortic Arch
Arises from the aortic root (which also gives rise to the coronary
arteries, and it is associated with the left posterior and anterior
sinuses of Valsalva space filled by cusps of the closed aortic
valve), then the brachiocephalic artery (branches into the right
subclavian and right common carotid), left common carotid and
finally the left subclavian.

Inferior angle of the scapula

Represents where the sternum joins with the manubrium and the 2nd
costal cartilage. Lies opposite T4 and T5. It is located at the same
level as the aortic root.
This defines the thoracic cage which encloses the mediastinum,
heart, lungs and esophagus.

Ribs
Each rib has a narrow costal groove running along the posterior
inferior region of the rib. It carries the intercostal vein, artery and
nerve (VAN) in that order going downwards. Note that the intercostal
nerve originates from the anterior branch of the corresponding
thoracic spinal nerve root (T1-12) The serratus anterior passes
transversely across the ribcage. In between the ribs, there are the
intercostal muscles and their associated aponeuroses. The only
muscle cover over a large part of the ribcage arises from the
pectoralis major and minor.

Intercostal Muscles
Acts to pull the ribs closer together. Forms an aponeurosis anteriorly.
External intercostal muscles Runs downward and forward from
the lower half of the anterior facet of the rib.

Internal intercostal muscles Runs downward and backward from

the costal groove.
Innermost intercostal muscles Separated into anterior, lateral and
posteriolateral segments. Overlies the visceral and parietal pleurae.
Pectoralis Minor
This muscle originates from the superior surfaces of ribs 3-5 and
inserts into the superiomedial surface of the coracoid process of the
scapula. Innervated by the medial pectoral nerve.
Serratus Anterior
The deepest layer of muscles on the lateral edge of the ribcage.
They are innervated by the long thoracic nerve as it drops straight
down from the upper trunk.
Latissimus Dorsi (abduction, internal rotation and extends
the flexed arm)
This muscle covers nearly the entire back superficially. It originates
from the iliac crests, the T7 to L5 vertebrae and associated fascia
(and the inferior angle of the scapula extent of connection
depends on the individual). It then appears to twist to a vertical
plane before curving around the anterior aspect of the humerus to
insert into the floor of the bicipital groove. It is innervated by the
long thoracodorsal nerve which branches out from the posterior cord
of the brachial plexus.

Pleurae
e

Mediastinum
e

Heart
e

Lungs
e

Esophagus
e

Inferior angle of scapula

e

Axillary Lines
e

Subcostal Angle
e

Xiphisternal Joint

Articulates with the 7th costal cartilage. Lies opposite T9.

Small of the Back

Iliac crest

If a line is drawn between the highest points on both, it would

roughly pass through the disk separating L4 and L5, which is the
best location to perform a lumbar puncture..

Pubic symphysis
e

Intergluteal Cleft
The buttocks.

Upper Limbs
Shoulder

The acromion process (found at the end of the spine of the scapula)
delineates the top of the shoulder. Articulates directly with the clavicle.

Armpit

Refers to the region of space directly under the shoulder joint.

Axillary folds
The axillary folds bound the axillary fossa. Easily palpated. Axillary
pulse and
Anterior axillary fold formed by the lower margin of the
axillary tail of the pectoralis major muscle.
Posterior axillary fold formed by the latissimus dorsi tendon
wrapping around the lower body of the teres major muscle.

(Upper) Arm
Note that the anterior face is called the flexor aspect and vice versa.
The lateral side (with the thumb) is called the radial side. (Cant
remember? Remember that if you bang your elbow you can damage
your ulnar nerve) Note that the radius mainly articulates with the
wrist and hand while the ulna articulates with the elbow/humerus,
thus explaining their relative sizes proximally and distally (imagine
two cones side by side). Be aware that all joints in the forearm are
synovial with the exception of the middle radioulnar
joint/syndesmosis. And uniquely, the joints between the wrist bones
are an example of synovial joints that do not normally move as they
are restricted from doing so by ligaments.
The musculocutaneous nerve supplies all the flexors of the arm
while the median nerve supplies all the flexors of the FOREarm
(anterior compartment) except for the medial FDP and FCU which
are supplied by the ulnar nerve. Note that it does not innervate
anything in the forearm with the exception of the brachial artery
which it follows. This is reversed in the hand, where the medial
nerve supplies the muscles of the thenar eminence and nearby
lumbricals only while the ulnar supplies the rest of the muscles in
the hand. The radial nerve supplies the extensors (posterior
compartment) and the axillary nerve innervates the deltoids and
teres minor. Remember, radial=back, ulnar=medial and
medial=front.

Humerus
Proximal Bone
Capitulum
Articulates with the clavicle and is ringed by the anatomical neck of
the humerus. Not to be confused with the surgical neck, which
roughly lies in a transverse plane.
Anterior and posterior circumflex humeral artery
Both originate from the axillary artery. The posterior circumflex
follows the axillary nerve down through the quadrangular space
while supplying blood to the teres minor and deltoids and shoulder
joint before anastomosing with the anterior circumflex and
subsequently the profunda brachii. Meanwhile, the anterior
circumflex passes horizontally beneath the coracobrachialis and
short head of the biceps prior to the anastomosis.
Greater(lateral) tuberosity/tubercle
Could in fact pass as being continuous with the capitulum if not for
the anatomical neck cutting between the two structures. Merges to
the bone via the lateral lip. The infraspinatus attaches on the medial
side while the supraspinatus attaches superiorly and the teres minor
attaches inferiorly. These represent three of the four muscles of the
rotator cuff, which are responsible for adduction and lateral rotation.
Lateral lip
Pectoralis major attaches here.
Bicipital groove/intertubercular sulcus
Bounded by the tuberosities, it represents where the long head of
the biceps passes through it from its origin in the supraglenoid
tubercle on the scapula, which is the small bump just superior to the
glenoid cavity (more like a facet actually). The latissimus dorsi
inserts at the floor/base of this groove. Not to be confused with the
medial bicipital groove, which is formed between the biceps and
triceps muscle on the medial (ulnar) side of the body.
Lesser(medial) tuberosity/tubercle
The more distinct tuberosity that appears anteriorly. The short head
of the biceps brachii passes together with the tendon of the
coracobrachialis medial to this epicondyle on its way to its origin in
the apex of the coracoid process. Note that the coracobrachialis
helps support the humeral head from slipping inferiorly especially
when the arm is not in flexion or extension. Merges to the bone via
the medial lip.
Medial lip
Teres major inserts here. Borders the axilla laterally.
Radial groove
It spirals around the humerus and carries the profunda brachii artery
(deep artery of the arm) in addition to the radial nerve. Note that it
is not actually a groove/sulcus but rather a flat surface on the bone
beginning about a third of the way down and ending about two
thirds of the way down where it merges into the lateral epicondylar
ridge. Passes over the lateral border of the humerus. The lateral

head of the triceps attaches lateral to it while the medial head

attaches inferior to it.
Profunda brachii artery
Branches from the brachial artery just below teres minor.
Quadrangular space and Triangular Space
Represents gaps in the musculature of the arm delineated laterally
by the humerus (and lateral head of triceps) and medially by the
long head of the triceps. The teres minor forms the superior border
while the teres major separates the triangular space between these
three structures into the upper quadrangular space and a lower
triangular space.
The axillary and the posterior circumflex humeral artery pass
through the quadrangular space while the radial artery and a branch
of the profunda brachii pass under the lower triangular space as
they enter the radial groove.

Distal bone
Brachialis (flexion)
Originates from the anterior part of the distal humerus beginning
just distal to the point of insertion of the deltoids (deltoid tuberosity
on the lateral lip) and ending at around the capitulum fossa of the
humerus. It inserts onto the ulnar tuberosity of the ulna (which is a
small bump inferiomedial to the coronoid process of the ulna). Given
that it attaches to the nonrotatable ulna, it cannot rotate the arm
and so it is solely responsible for flexing the arm, and its action is
not compromised by the supination or pronation of the forearm. It is
innervated by the musculocutaneous nerve and lies deep to the
biceps brachii.

Medial epicondyle
Is continuous to the humerus via the medial epicondylar ridge. The
ulnar nerve runs posteriorly to this epicondyle between the medial
epicondyle and the olecranon process of the ULNA in what is known
as the cubital tunnel (it is covered by the aponeurosis between the
humeral and ulnar heads of the flexor carpi ulnaris). As such, it is
vulnerable to injuries. Note that the humeral head of the flexor carpi
ulnaris arises here. The humeral head of the pronator teres
originates from its superior facet. There is a tendon known as the
common flexor tendon that originates from the medial epicondyle
and gives rise to the superficial flexors of the hand. The ulnar
collateral ligament also arises from this point and fans out onto the
medial side.

Common Flexor Tendon

Originating from the medial epicondyle, it gives rise to the pronator
teres, palmaris longus, flexor carpi ulnaris and radialis as well as the
flexor digitorum superficialis.
Pronator teres (pronation and flexion)
The bulk of the muscle originates superficially from the superior
facet of the medial epicondyle and the common flexor tendon. It

then gains a second head from the coronoid process of the ulna
before inserting into the lateral aspect of the radius slightly distal to
the supinator. Delineates the medial border of the cubital fossa. It is
assisted by the pronator quadratus in pronating the hand.
Palmaris longus (wrist flexion)
Originating from the common flexor tendon and inserts into the
palmar aponeurosis (and occasionally the thumb, pisiform, scaphoid,
little finger or even the FCU) after becoming a tendon and passing
under the retinaculum. In some people, it is completely absent or
present only in the form of a tendon.
Flexor digitorum superficialis
Flexor carpi radialis (flexion and abduction)
Originating from the common flexor tendon, it runs between
pronator teres and palmaris longus. It then passes under the
retinaculum and inserts into the base of the second (and third)
metacarpals as well as the trapezial tuberosity.
Flexor carpi ulnaris (flexion and abduction)
Flexes and adducts the hand. It originates from the medial
epicondyle of the humerus and the medial aspect of the olecranon
and inserts into the pisiform and the pisohamate ligament further
anchors it to the hamate.

Trochlea=saddle
The saddle shaped articular surface on the distal part of the
humerus that is bounded by the medial and lateral epicondyles.
Articulates with the ulna at the trochlear notch.

Capitulum
The knob shaped part of the humerus that is (anterio-)lateral to the
trochlea. Articulates with the radius.

Lateral epicondyle
Is continuous to the humerus via the lateral epicondylar ridge. Not
to be confused with the capitulum, which is the larger bump
immediately lateral to the trochlea. The lateral epicondyle is
posteriolateral to the capitulum.
Lateral epicondylar ridge
Runs above the lateral epicondyle, it gives rise to the extensors and
supinators. Specifically, brachioradialis, supinator and associated
muscles arise from it.
Brachioradialis (formerly known as supinator longus. Does
supination and flexion)
Originates along the lateral supracondylar ridge of the humerus
starting just below the deltoid tuberosity, it inserts into the styloid
process of the distal radius, which is the pointy bit that holds the
wrist in place. Despite being a flexor, it is innervated by the radial
nerve because it is in the posterior compartment. Note that due to
its distal and lateral insertion, it is only effective in producing rapid

movements and is only a strong flexor when the hand is in its

neutral position (partially supinated/pronated)
Supinator
Originating from the lateral epicondylar ridge of the humerus, it
wraps around the radius to insert laterally throughout the proximal
region although there are also contributions to the deep fibers from
the supinator crest (inferior to the radial notch) on the ulna, the
radial collateral ligament and the annular radial ligament. Just
proximal to the origin of the supinator, the radial nerve branches
into a sensory (superficial) and the deep branch. The deep branch
then runs in between the superficial and deep fibers of the supinator
and on exiting it becomes the posterior interosseous nerve as it runs
along the interosseous ligament to innervate the extensors and
abductor pollicis longus.
Extensor digiti minimi
This muscle originates from the lateral epicondyle of the humerus
before inserting into the base of the proximal phalanx of the little
finger at the extensor expansion.

Elbow
Cubital Fossa
Bicipital aponeurosis
The bicipital aponeurosis originates from the point of insertion of the
biceps brachii. The median nerve and brachial artery lie deep to it
while the brachial artery and the median cubital vein lies superficial
to it and so during venipuncture the aponeurosis protects the
underlying structures from damage.
The cephalic vein runs laterally while the basilic vein lies medially.

Forearm
Ulna

This bone is medial to the radius in the anatomical position. Distal

end is SMALLER. Does not rotate.

Olecranon
The upper lip of the hook shaped proximal end of the ulna, and is
bordered by the medial and lateral epicondyles. It is easily palpated
as the bony process at the elbow. Fits just nicely into the olecranon
fossa on the humerus when the arm is extended. The ulnar head of
the flexor carpi ulnaris then arises from its medial aspect and it
continues inferiorly medial to the ulna, the upper third of which is
joined by an aponeurosis. The tendon of the triceps inserts at the
upper end.
Ulnar nerve
This nerve passes between the olecranon of the ulna and the medial
epicondyle and runs underneath the aponeurosis of the flexor carpi
ulnaris and simultaneously innervates it while also innervating the

medial half of the flexor digitorum profundus. Innervates the skin of

the median 1.5 fingers.

Trochlear/Semilunar notch
The curved bit between the olecranon and coronoid process that fits
into the trochlea of the humerus. The ulnar collateral ligament
inserts on its medial border.

Coronoid process
Forms the bottom lip of the C-shaped proximal end of the ulna. Fits
neatly into the coronoid fossa on the humerus when the arm is
flexed completely. Inferiorly, there is an ulnar tuberosity on the side
closest to the radius where the brachialis muscle inserts.
Abductor Pollicis Longus/Extensor Pollicis Brevis (abduction
and extension)
It originates from the posterior surface of the ulna just below that of
the anconeus, from the interosseous membrane, and from the
middle third of the dorsal surface of the body of the radius, with the
EPB originating slightly distal to the APL. Both converge distally into
a tendon which runs down a groove in the radius to insert into the
first metacarpal bone (thumb) radially. May be fused in some
people.
Extensor Pollicis Longus
Arises right next to the APL and EPB but inserts into the distal
phalanx of the thumb medially. After passing through the
retinaculum, it is covered in a synovial sheath.

Ulnar styloid process

Corresponds to the styloid process of the radius in order to create a
U shaped socket to better accommodate the bones of the wrist.

Radius

This bone is lateral to the ulna in the anatomical position. Distal end
is LARGER and accommodates the wrist. Involved in forearm
rotation. The radial collateral ligament joins the head of the radius
to the capitulum of the humerus allowing it to rotate freely while the
radial annular ligament forms a socket to hold it in place.

Head of the Radius

Slightly oval in shape (long axis is directed A-P), it articulates with
the radial notch on the lateral aspect of the coronoid process on the
ulna

Radioulnar Joints
There are three radioulnar joints (proximal, medial and distal). They
represent an example of mobile fibrous joints.

Proximal radioulnar joint

The proximal radioulnar joint sees the ovoid head of the radius
articulate with the radial notch on the coronoid. It is stabilized by
the annular ligament (attaches to the radial notch to form a
complete loop), which behaves like a rubber band preventing the
radius from slipping distally. Additionally, the thin quadrate ligament
joins the inferior part of the radial notch (on the ulna) to the neck of
the radius at their nearest approach.

Nursemaids elbow
Note that if the hand is rapidly pulled distally in the young child, the
head of the radius may be pulled partially through the annular
ligament and become stuck. If that happens, the forearm cannot be
supinated and flexion/extension is limited. This is because the head
of the radius is more conical in young children.

Medial radioulnar joint

More commonly known as the interosseous membrane or radioulnar
syndesmosis, it is the only fibrous joint in the forearm and unlike
other fibrous joints, it is capable of articulation during supination
and pronation of the wrist.

Distal radioulnar joints

Represents where the larger round distal head of the ulna fits into
the ulnar notch on the radius. As the radius moves around the
rounded ulna during pronation, it crosses over the ulna.

Radial tuberosity
Faces anteriorly in the anatomical position, it represents the point of
insertion of the biceps brachii muscle.

Radial styloid process

Corresponds to the styloid process of the ulna in order to create a U
shaped socket to better accommodate the bones of the wrist. The
triangular fibrocartilage from the lateral border of the ulna wraps
around it to provide the radial articulation.

Ulnar notch
It is a small notch in the medial side of the radius (opposite the
styloid process) to accommodate the ulna in the distal radioulnar
joint.
Median nerve
So called because it enters the wrist medially through the carpal
tunnel, it innervates all the flexors of the hand with the exception of
the flexor carpi ulnaris and the medial side of the flexor digitorum
profundus. In the hand it innervates the thenar eminence and the
two lumbricals closes to it. Interestingly, it does not innervate
anything in the upper arm apart from the brachial artery. In the arm,
it originates lateral to the brachial artery before crossing over
anteriorly to the medial side approximately halfway down the arm. It
then passes straight down the midline of the forearm between FDP
and FDS before emerging between FDS and FPL.
Flexor Digitorum Profundus
This is in the deep layer of the anterior compartment of the arm. It
originates from the radioulnar syndesmosis and terminates into
separate tendons about midway down the forearm. These tendons
then attach on the palmar face of the distal phalanx. Note that the
lumbricals then arise from the radial (lateral) edge of each tendon in
the hand with the lateral two also arising from the ulnar (medial)
edge of the tendon lateral to it and are hence bipennate. They then
pass posteriorly to insert into the radial edge of the
metacarpophalangeal joint. Thus they flex the metacarpophalangeal
joints and extend the interphalangeal joints.

Wrist
Note that rotating the extended wrist towards the radial side/thumb
is called radial abduction and so forth.

Hand

Innervated primarily by the ulnar nerve (medial 2.5 fingers) which

also innervates all the intrinsic muscles with the exception of the
muscles of the thenar eminence and the first two lumbricals which
are innervated by the median nerve.
volar = palmar
thumb = 1, little finger = 5
Anatomical snufbox
On the dorsum, the anatomical snuffbox can be seen when the
thumb is hyperextended. Medially (ulnarly?), it is bounded by the
extensor pollicis longus and radially (side closer to the thumb) by
the extensor pollicis brevis. If you palpate the extensor pollicis
longus, you will feel the cutaneous branch of the radial nerve.

Palm
Thenar Eminence
The thenar eminence is the part of the palm that bulges out when
the thumb is adducted/flexed. This, together with the lumbricals of
the first 2 fingers are the only parts of the hand that is innervated
by the median nerve.
In infants and in people with cortical lesions causing frontal release,
stroking this distally triggers the palmomental reflex which causes
the ipsilateral mentalis muscle to twitch (causes pouting of the
ipsilateral side of the lower lip)
Ulnar Claw
If the ulnar nerve is paralysed distally in carpal tunnel syndrome,
the ulnar lumbricals and interossei are paralysed. Since they cause
the flexion of the MCP and extension of the PIP and DIP, the MCP is
hyperextended by the unopposed action of the extensors and the
IPs are then flexed as the FDP is still active. If the lesion is more
proximal, then the FDP is also paralysed and the hand remains in a
more neutral state but is still unable to flex or extend. Remember
that the long extensors have minimal affect on the IPs.
Lower Limbs

Gross Structure
Bone