Upper Extremity Circulation and Nerves

Last printed 12/4/2012 10:24 PM
Upper Extremity
Circulation
The subclavian becomes the axillary once it passes the 1st
rib. From here, the axillary gives off 1: superior thoracic, 2:
thoracoacromial, lateral thoracic, 3: subscapular, ant+post
circumflex humeral. The pectoralis minor muscle overlies
the 2nd division. Once the axillary passes out from under the
teres major, it is called the brachial artery. The major
branch it gives off is the profunda brachii artery which
descends posteriorly in the spiral groove along with the radial
nerve. The brachial artery in the arm runs with the median
and ulnar nn, though the ulnar curves off medially near the
medial epicondyle. The brachial artery goes on to split into
the ulnar and radial arteries in the cubital fossa. The ulnar
and radial arteries come together in the superficial and deep
palmar arches of the hand.
For the veins, its more simple. The cephalic vein runs on the
radial side and curves to the posterior in the forearm. The
basilic vein runs on
the ulnar side and
also curves to the
posterior in the
forearm. Joining
them together in the
cubital fossa is the median cubital. The median
antebrachial vein runs down the middle of the
anterior forearm.
The arteries that participate in the scapular

anastomoses: intercostals, dorsal scapular,
suprascapular, transverse cervical, circumflex
scapular (from subscapular).
The axillary sheath contains the axillary artery

and vein, and cords of the brachial plexus, as it
passes through the axilla.
Brachial Plexus
C5-T1 ~ formed from ventral rami
Lateral Cord Makeup and Distal Branch

Some Men Are Lean and Muscular
Superior Middle Anterior Lateral Musculocutaneous
Musculocutaneous (C5-7)
Medial Cord Makeup and Distal Branch

I AM Urs 3 Exceptions
Inferior Anterior Medial Ulnar Axillary C5-6
Ulnar ~ (C8-T1) U+L Subscapular C5-6
Thoracodorsal C6-8
Posterior Cord Distal Branches
Phaeries Are Real 2 Completes
Posterior Axillary Radial Radial (C5-T1)
Axillary ~ (C5-6) ~ note exception! Median (C5-T1)
Radial ~ (C5-T1)
All 3 trunks contribute posterior divisions to the posterior cord.
Medial Cord Branches (All C8-T1)

Peeing Can Feel Agreeable
(not in order. Switch forearm and arm for correct order)
Medial Pectoral
Medial Cutaneous Nerve of Forearm (antebrachial)
Medial Cutaneous Nerve of Arm (brachial)
Posterior Cord Branches (excluding most distal-branches)

Usually Students Tend to Listen Sharply
(in order from proximal to distal, note root values must be memorized)
Upper Subscapular (C5-6)
Thoracodorsal (C6-8)
Lower Subscapular (C5-6)
Lateral Branches
Dinner is to Supper as Soon is to Late
(in order from ramus to cord, note anterior division of middle trunk is just proximal to
the lateral pectoral contributing to its root value)
Dorsal Scapular (C5) ~ from ramus
Suprascapular (C5-6) ~ from trunk
Nerve to Subclavius (C5-6) ~ from trunk
Lateral Pectoral (C5-7) ~ from cord
Nerves Notes
Axillary supplies only the deltoid and teres minor muscles, and senses the lateral aspect
of the arm.
Musculocutaneous supplies all muscles in anterior compartment (flexor) muscles of the

arm, and then continues as lateral cutaneous nerve of forearm.
Median nerve
supplies (almost) all flexor muscles in the forearm.
Rule of 1 - except for flexor carpi ulnaris and medial half of flexor digitorum
profundus.
Runs in the carpal tunnel, so is the nerve that is compressed.
Ulnar nerve
Supplies most intrinsic muscles of the hand
supplies the flexor carpi ulnaris, ulnar part of the flexor digitorum profundus
Runs in Guyons canal which passes between the pisiform and the hook of the
hamate.
Thoracodorsal nerve supplies latissimus dorsi.

Upper subscapular nerve supplies the superior part of the subscapularis.
Lower subscapular nerve supplies the teres major and the inferior part of the
subscapularis.
Radial nerve supplies all extensor muscles of the posterior compartments of upper limb
and forearm. Also supplies brachioradialis, which is a flexor but it is in posterior
compartment. Compression causes Saturday Night Palsy with inability to extend elbow
and causes flexed wrist.
Identifying Nerves of the Arm

Musculocutaneous in the arm, runs between the
biceps and the brachialis. The radial runs with the
profunda brachii artery and runs between the
brachialis and the triceps. The median and ulnar
nerves travel on either side of the brachial artery.
[show x-section of arm]
Musculature
Landmarks
The quadrangular space, bounded by the long
head of the triceps and the humerus, contains the
axillary nerve and posterior circumflex humeral
artery. The triangular space, bounded by the
long and lateral heads of the triceps, contains the profunda brachii artery and radial nerve.
Abductors of Arm
Supraspinatus initiates 15~ suprascapular n. (C5-6)
Deltoid continues ~ axillary n. (C5-6)
Serratus anterior completes to swing scapula away ~ long thoracic (C5-7)
The deltoid muscle originates from the spine of the scapula, acromion, and part of the
clavicle, so it technically has some extension and flexion of the arm.
Adductors of Arm
Latissimus dorsi ~ thoracodorsal n. (C6-8)
Pectoralis major ~ medial+lateral pectoral nn (C8-T1, C5-7)
Teres major ~ lower subscapular n. (C5-6)
Teres major inserts on the intertubercular groove.
Medial Rotators of the Arm

The subscapularis inserts on the lesser tubercle which is on the anterior of the humerus.
Subscapularis ~ upper and lower subscapular (C5-6)
Pectoralis major ~ medial+lateral pectoral nn (C8-T1, C5-7)
Lateral Rotators of the Arm

These muscles attach to the greater
tubercle which is on the lateral side of the
humerus.
Infraspinatus ~ suprascapular n.
(C5-6)
Teres minor ~ axillary n. (C5-6)
The supraspinatus also attaches on
greater tubercle but doesnt laterally
rotate.
Arm Flexors
Biceps brachii
Coracobrachialis
Arm Extensors
Deltoid (posterior part)
Latissimus dorsi
Anterior Arm (Flexors)

All musculocutaneous (C5-7)
Biceps brachii
o flexes at shoulder mostly, some flexion of forearm.
o Long head is from supraglenoid tubercle (on scapula), short head from
coracoid processs. Attaches to the radius. Action is inhibited by
pronation of forearm, due to distal attachment to radius. Not only that,
your biceps will work against you by being trying to supinate. This is
reason why pull-ups are harder than chin-ups.
o Involved in supination, e.g. driving a screw with right hand
Coracobrachialis
o From coracoid process to medial humerous, so flexes and adducts the arm.
Brachialis
o From humerous to ulna. Purely flexes at elbow.
Posterior Arm (Extensors)
Radial nerve innveration (C5-T1).
Triceps brachii
o Long head from infraglenoid tubercle
(on scapula) between teres minor and
major, otherwise medial and lateral
heads are from humerous.
Attachment to olecranon process of
ulna.
o Medial head is deep to the other
heads.
o Purely extends the forearm.
Rule of Odd Numbers 5-3-7-5

Forearm flexor-pronators (anterior compartment)
Mostly originate from medial epicondyle of
the humerus.
Mostly median nerve innervation
Superficial (5) ~ (from pinky to thumb)
o flexor carpi ulnaris
flexes wrist
ulnar nerve innervation!
o palmaris longus
tenses palm
o flexor carpi radialis
median nerve
innervation. Named
for the radius bone.
o pronator teres
reaches over to attach
to the radius, hence
pronator fxn
o flexor digitorum
superficialis
tendon reaches up to
middle phalanges, and
flexes proximal IP
joint
lies deep to the other superficial muscles

Deep (3)
o flexor digitorum profundus
tendons reach up to distal phalanges and flexes the distal IP joint
lies deep to the flexor digitorum superficialis
half by median and half by ulnar nerve
o flexor pollicis longus
flexes thumb
situated on radial side, deep to brachioradialis.
o pronator quadratus
square patch of muscle, running transversely across distal radial-
ulnar joint.
Forearm extensor-supinators (posterior compartment)
Mostly originate from the lateral epicondyle of the humerus.
All innervated by radial nerve
Superficial (7) ~ (from pinky to thumb)
o Anconeus (L. elbow)
goes from lateral epicondyle to ulna, so is extensor
o Extensor carpi ulnaris
o Extensor digiti minimi
Extra extensor for pinky
o Extensor digitorum
o Extensor carpi radialis brevis
Attaches to middle finger
metacarpal (think of giving
the finger and cutting things
short)
o Extensor carpi radialis longus
Attaches to index finger
metacarpal
o Brachioradialis
Actually flexes, but is still
radial nerve innervation
Attaches from lateral
epicondyle to radius
Deep (5)
o Supinator
Attaches from lateral
epicondyle to radius
o Abductor pollicis longus
Brevis is part of thenar
o Extensor pollicis longus
Extends thumb at IP joint
o Extensor pollicis brevis
Extends thumb at MP joint
o Extensor indicis
Extra extensor for index finger that extends at MP, PIP and DIP
Power grip is done by flexors of the hand and extensors of the wrist. Thats why flexing
wrist out will disrupt grip, as it leaves only 1 muscle to do the work.
The anatomical snuff box consists of (from thumb side to pinky side) the abductor
pollicis longus, extensor pollicis brevis, and extensor pollicis longus. Note how they
peek out from under the superficial muscles. The radial artery lies in the snuff box.
Intrinsic Muscles of the Hand

Palmaris Brevis
Hypothenar Muscles
The pinky is like the thumb in that it has more muscles than other digits. Note
arrangement that mirrors the thumb.
Listed in the dissector as Quinti (L. fifth) rather than Minimi (L. smallest)
Abductor digiti minimi
Flexor digiti minimi
brevis
Opponens digiti minimi
o Immediately deep
to the adbductor d.
m. and flexor d. m.
Note: should not be able to see
opponens pollicis. It should be deep to the
flexor and abductor.
Lumbricals (L. worm)

Also known as the bye-
bye muscles
Flex digits at MP joints
and extend mostly PIP
and some DIP
1-2 on digits 2-3 are
median nerve
3-4 on digits 4-5 are
ulnar nerve
Note that the lumbricals
are only on one side of each finger, not both.
Claw hand/St. Benedicts sign results in damage to innervation here, resulting in
hyperextension of MP joint and flexion of IP joints.
Originate from tendons of the flexor digitorum profundus and insert on the
extensor expansions.
Interossei
Located between metacarpals, originating directly from MCs and insert onto the
extensor expansions.
Dorsal ABduct, Palmar ADduct
There are 4 dorsal and 3 palmars.
o Palmars only for digits 2,4,5. Middle finger uses dorsals exclusively for
both directions. Thumb has own abductor pollicis brevis and longus.
o Dorsals only for digits 2,3,4. Pinky has own abductor digiti minimi.
All ulnar nerve innervation, so fanning in/out fingers is easiest way to test for
ulnar nerve damage
Dorsal Palmar
Movement of the Thumb (L. Pollex)

The thumb is capable of 5 movements, mostly 2 mucles/movement
Only ulnar nerve innervation is the adductor pollicis.
Abduction ~ abductor pollicis longus and abductor pollicis brevis
Adduction ~ adductor pollicis and 1st dorsal interosseus
Extension ~ extensor pollicis longus and extensor pollicis brevis
Flexion ~ flexor pollicis longus and flexor pollicis brevis
Opposition ~ opponens pollicis
o Acts on CM joint
The thenar (G. palm) muscles in the hand itself comprise only of the abductor pollicis
brevis (abduction), flexor pollicis brevis (flexion at MP joint), and opponens pollicis
(opposition at CM joint). The thenar muscles are all innervated by the recurrent branch
of the median nerve.
Carpal Bones
There are 8 carpal bones, organized in 2 rows of
4.
The distal 4 from ulna to radius ~
Hamate, Capitate, Trapezoid, Trapezium
The proximal 4 from ulna to radius ~
Pisiform, Triquetrum, Lunate, Scaphoid.
Pick your favorite one:

Some Lovers Try Positions That They Cannot Handle
So Long To Pinky Here Comes The Thumb
Surly Little Trick[q]sters Pour Hot Coal T[z]o Tea[i]se (you)
Remember that Guyons canal lies under the hook of the hamate, which contains the
ulnar nerve. Therefore the hamate is on the pinky side.
Sensory Fields
Sensory Fields of the Hand
1. Ulnar nerve
2. Median nerve
3. Radial nerve
Sensory Fields of Arm and Forearm

Arm
o Anterior
Lateral ~ lateral brachial cutaneous (from axillary)
Medial ~ medial brachial cutaneous (from medial cord)
Forearm
o Anterior
Lateral ~ lateral antebrachial cutaneous (from musculocutaneous)
Medial ~ medial antebrachial cutaneous (from medial cord)

Posterior side is all Radial nerve
Some Joints and Their Types

Elbow
Humeral-radial ~ gliding
Humeral-ulnar ~ hinge
Wrist (Radio-carpal)
Radial-Scaphoid
Radial-Lunate
Carpal
Ellipsoidal joints, a type of synovial.
Anastomoses Around the Elbow

v Brachaii artery Superior ulnar collateral arteries => Posterior Ulnar Recurrent
Ulnar artery
v Brachaii artery Inferior ulnar collateral arteries => Anterior Ulnar Recurrent
Ulnar artery
v Profundas Brachii Artery Medial Collateral Artery => Common interosseous
arteries Ulnar artery
v Profundas Brachii Artery Radial Collateral Artery => Radial Recurrent Artery
Radial Artery
Carpal Tunnel Contents

Median Nerve, Flexor digitorum superficialis+profundus, flexor pollicis longus, flexor
carpi radialis
Clinical Correlates
Winged Scapula
Damage to long thoracic nerve resulting in weakness of serratus anterior.
Scapula bulges out when pushing against wall. Cannot abduct arm past horizontal
position.
Carpal Tunnel Syndrome
Results from compression of the median nerve, often causing atrophy of thenar
muscles.
Claw Hand
Can be caused by fracture at medial epicondyle since ulnar nerve travels posterior
to it.
4th-5th digits hyperextended at MP joint and flexed at IP joints due to paralysis of
their associated lumbricals.
St. Benedicts Sign
Similar to claw hand but with 2nd and 3rd digits affected. Associated with median
nerve damage.
Saturday Night Palsy
radial nerve damage causes failure of extensors and the over-action of flexors.
Wrist becomes hyperflexed (wrist drop).
Radial nerve could have been compressed by somebody sleeping on it; usually
reversible.
Lower Extremities
Innervations
Inferior gluteal (L5-S2)
Gluteus maximus
Superior gluteal (L4-S1)
Gluteus medius+minimus
TFL
N. to piriformis (S1-2)
Piriformis
N. to obturator internus (L5-S2)
Obturator internus
Superior gemellus (L. twin)
N. to quadratus femoris (L4-S1)
Inferior gemellus
Quadratus femoris
Obturator (L2-4)
Obturator externus
Femoral (L2-4)
Iliopsoas (psoas also has extra input
from L1-4)
Notice alternating pattern from superior-
inferior of L5-S2 and L4-S1.
In general
Thigh
Anterior ~ Femoral n. (L2-4)
Posterior ~ Tibial n. (L4-S3)
Medial ~ Obturator n. (L2-4)
Leg
Anterior ~ Deep peroneal n. (L4-S2)
Lateral ~ Superficial peroneal n. (L4-S2)
Posterior ~ Tibial n. (L4-S3)
Im takin the 43 to Sciatica [in Brooklyn accent]
Blood Supply
The femoral artery splits off into the deep femoral and together they supply the whole of
the thigh. The femoral then continues and is called the popliteal artery after passing
through the adductor hiatus of the adductor magnus. The popliteal further branches into
anterior and posterior tibial arteries supplying the anterior and posterior compartments
of the leg, respectively. The posterior tibial gives off the fibular artery which supplies
the lateral compartment of the leg. Distal to the extensor retinaculum, the anterior tibial
artery continues as the dorsalis pedis, which has a palpable pulse. The great saphenous
vein is a branch of the femoral vein, coming out of the femoral sheath through the fossa
ovalis (saphenous opening) and travels medially to come anterior to the medial
malleolus and into the dorsum of the foot. The saphenous nerve travels with the
femoral nerve in the adductor canal but does not exit through the adductor hiatus. It
travels with the great saphenous vein once its in the leg. The small saphenous vein
comes up from the lateral malleolus, running with the sural n., and drains into the great
saphenous near the popliteal fossa.
[need pictures of leg and thigh x-sections]
Femoral Sheath and Contents

The fascia lata (deep fascia) of the thigh is open at the saphenous opening (fossa ovalis).
This is where the great saphenous (G. obviously visible) vein enters the femoral sheath
and drains into the femoral vein. Only the artery, vein, and lymphatics are within the
sheath. The nerve is NOT within the sheath.
From lateral to medial:

N[AVL]
Piriformis as Landmark
The piriformis passes over the greater sciatic foramen. Above it run the superior gluteal
n. and vessels. Below it, run the inferior gluteal n. and vessels, sciatic n., posterior
cutaneous n. of thigh (S1-3). The pudendal n. and internal pudendal artery also exit
below the piriformis, but immediately re-enter the pelvis via the lesser sciatic foramen.
Musculature
Abductors of Thigh
Both superior gluteal nerve (L4-S1)
1) Gluteus Medius+Minimus
2) Tensor Fascia Latae
Adductors of Thigh
All here are obturator EXCEPT for part of the adductor magnus which is tibial n. and
pectineus which also receives femoral n. All these muscles originate from the pubic rami
to the femur except for the gracilis which inserts on the medial proximal tibia. The
adductor magnus does NOT cross 2 joints, despite its mixed innervation.
1) Adductor Magnus
2) Adductor Longus
3) Adductor Brevis
4) Gracilis
5) Pectineus
Medial Rotators of the Thigh

Superior gluteal nerve (L4-S1)
1) Gluteus Medius+Minimus
Lateral Rotators of the Thigh

Piece Goods Often Go On Quilts
PQGOGO
1) Piriformis
2) Sup. Gemellus
3) Obturator internus
4) Inf. Gemellus
5) Obturator externus
6) Quadratus femoris
And Sartorius!!
Extensors of Thigh
Gluteus Maximus
Extends thigh (from sitting position), therefore old people may have trouble
getting out of chairs without armrests as support.
Inferior gluteal nerve (L5-S2)
Inserts partly on the iliotibial tract and originates from dorsums of sacrum, coccyx,
and sacrotuberous ligament.
Hamstrings
Consists of
o Biceps femoris (except short head)
o Semitendinosus
o Semimebranosus
All tibial nerve (L4-S3)
The hamstrings, except short head of biceps femoris, originate from ischial
tuberosity and terminate on tibia, crossing 2 joints, so they extend the leg and flex
the thigh.
Flexors of Thigh
Note that only the iliopsoas is an exclusive flexor of the thigh. All others have multiple
functions. The iliopsoas is also the only muscles to insert on the lesser trochanter.
1) Iliopsoas
2) Rectus femoris
3) Sartorius
4) TFL
Knee Extension
Quadriceps Femoris
Consists of
o Rectus femoris
o Vastus lateralis
o Vastus intermedius
o Vastus medialis
Together work to extend the leg, especially important during climbing and
running.
Femoral nerve (L2-4) for all muscles

Quadriceps tendon attaches to the patella and in turn the patella attaches to the
patellar ligament to the tibial tuberosity.
Rectus femoris originates from AIIS so it also extends hip.
Knee Flexion
Popliteus is initial unlocker of the knee; its tendon runs on the lateral side.
The short head of biceps is the only muscle directly innervated by common peroneal.
Gastrocnemius is used when feet are planted on the ground. The tendons of the
hamstrings split: biceps go laterally, while semitedinosus and semimembranosus go
medially. However, they do not cover the knee joint on the lateral side.
1) Popliteus
2) Hamstrings
3) Short head of Biceps
4) Sartorius
5) Gastrocnemius (G. belly of the leg the bulging muscle)
6) Plantaris
Some Special Ones

Gracilis
From inferior ramus of ant. pubis to medial proximal tibia.
Obturator nerve (L2-4)
Rectus Femoris
From AIIS to patella then to tibia.
Extends hip AND knee
Femoral nerve (L2-4)
Sartorius
From ASIS to medial superior tibia.
The tailor muscle: flexes, abducts, and laterally rotates
thigh and flexes leg
Femoral nerve (L2-4)
Leg
Anterior compartment ~ Lateral compartment ~ superficial
fibular nerve, ant. tibial artery
Posterior compartment ~ tibial nerve, fibular artery, posterior
tibial vessels
Anterior (from medial to lateral)

dorsiflexion of foot
deep fibular nerve, anterior tibial vessels
Consists of
o Tibilalis anterior
Large muscle that runs directly lateral to
the tibia
o Extensor hallucis longus

Tendon does not cross over like the flexor version, so it is more
medial than the extensor digitorum.
Somewhat deeper than the other two muscles; tendon peeks out
inferiorly.
o Extensor digitorum longus
Goes to phalanges of toes 2-5.
o Peroneus tertius
Proximal portion fused with extensor digitorum longus. Distally,
separate tendon goes to 5th metatarsal.
Posterior ~ mostly plantar flexion of foot
Superficial
o Gastrocnemius
Has two heads, which come together to form the tendo calcaneus
(Achilles tendon).
Crosses 2 joints along with plantaris to flex knee when feet planted.
o Plantaris
Tendon runs on medial border of the tendo calcaneus
Tendon often harvested for reconstructive
surgery
o Soleus
Contributes to the Achilles tendon.
Deep ~ tendons of T,D,H run under the medial malleolus
o Flexor hallucis longus
On the lateral (pinky) side, but tendon
crosses under dick in the foot to the
medial (thumb) side.
o Flexor digitorum longus
On the medial side, with tendons going to
digits 2-5.
Dick over harry
o Tibialis posterior
Lies in the middle, but deep to the other
two muscles.
o Popliteus
Runs from lateral epicondyle to medial
side of tibia, superior to the soleus muscle.
This muscle is fairly deep like the
pronator quadratus.
Pes Anserinus (L. foot of a goose) comes together from the Semitendinosus, Gracilis,
and Sartorius on the medial side of the tibial tuberosity. Incidentally, here all 3
compartments of the thigh meet and it is here that you absolutely do NOT penetrate with
biopsy needle.
Eversion of foot (Lateral compartment)

Peroneus longus+brevis
o The tendons of these two muscles run around the lateral malleolus and use
it as a pulley.
o The longus is larger, superficial, and its muscle mass more superior
Inversion of Foot
Tibialis Ant+Posterior
This motion is harder to lose since these 2 muscles are by 2 separate nerves.
Foot
The only joint connection between the
foot and the leg is the talus (ie talo-crural
joint).
Sustentaculum tali (L. support of the talus)

~ part of the calcaneus! Bulge on medial
side that the flexor hallucis longus uses as
a pulley. The spring (plantar
calcaneonavicular) ligament also goes
from here to the navicular bone. This
ligament is important for maintaining
longitudinal arch.
Plantar aponeurosis, which stretches form

calcaneous to the five digits, and the
plantar ligaments maintain the arches.
Knee Joint
Cross index and middle fingers to
visualize orientation of ACL and PCL.
Lateral meniscus ~ O-shaped
o The popliteus separates the lateral meniscus from the lateral collateral
ligament.
Lateral collateral ligament
Posterior cruciate ligament ~ crosses medial to lateral
o Prevents excessive posterior mobility of tibia in flexed knee.
o Prevents hyperflexion of knee
Unhappy Triad
o Medial meniscus
C shaped, continuous with medial collateral
Think of M&C. Medial&C-Shaped
o Medial collateral ligament
o Anterior cruciate ligament ~ crosses lateral to medial
Prevents excessive anterior mobility of tibia in extended knee
Prevents hyperextension of knee joint.
Bursae
o Suprapatellar
Between quadriceps tendon and femur.
Communicates with knee joint synovial cavity!!!
o Infrapatellar
Between patella and tibia
o Prepatellar
Between skin and patella
Shoulder vs Hip Joint

Generally, the shoulder sacrificed stability for mobility. The femur is planted far deeper
into the acetabulum than the humerus is into the glenoid cavity. Both have a labrum,
which extends the joint a bit: acetabular labrum and glenohumeral labrum. The head of
the femur is attached to the acetabulum through the ligament of the head of the femur
or ligamentum teres, but the humerus doesnt have such equivalent.
Anastomoses Around the Knee

Femoral Popliteal (above the knee) Superior Medial / Lateral Genicular => Inferior
Medial / Lateral Genicular Popliteal (below the knee)
Sensory Fields
Butt+Posterior Thigh ~ posterior cutaneous n. of thigh (S1-3)

Anterior Thigh ~ intermediate femoral cutaneous n. + medial femoral cutaneous n. which
are branches of femoral n. (L2-4)
Medial Thigh ~ genitofemoral (L1-2) for sup. part, obturator n. (L2-4) for inf. part
Lateral Thigh ~ lateral femoral cutaneous n. (L2-3)
Medial Leg + Medial foot + Medial malleolus ~ saphenous n. which is branch of femoral
n. (L2-4). The saphenous n. follows the saphenous vein.
Lateral leg superior part ~ lateral sural cutaneous n. which is branch of common fibular.
Lateral leg inferior part + Lateral malleolus ~ sural n. which is formed by union of
lat+med. sural cutaneous nn. Medial sural cutaneous is branch of tibial n.
To make sense of all this, know that lateral leg is tibial+fibular nn. and medial leg is
saphenous n.
Distal 1/3 anterior leg + Dorsum foot ~ superficial fibular n.

Plantar foot ~ tibial n. splitting into medial and lateral plantar nn.
Skin between 1st toe and 2nd toe ~ deep fibular n.
Clinical Correlates
Trendelenburg Gait (The Penguin Walk)
Abduction needed on contralateral side to sustain balance during swing phase of walk.
Manifests in leaning towards paralyzed contralateral side. Suspect superior gluteal nerve
damage that knocks out all abductors: gluteus medius+minimus and TFL.
Gluteus Maximus Lurch

Loss of inf. gluteal n. causes deficit in extension of thigh. Person lurches back and forth
to swing lower extremity forward(check this)
Laseques sign
Usually caused by lumbar nerve root compression. There is pain along entire course of
sciatic nerve (i.e. sciatica). Manifests in painful extension of leg.
Foot Drop
Dragging of foot while walking; indicative of anterior (possibly and lateral) compartment
weakness, and should suspect the fibular nerve.
Compartment Syndrome
Caused by pressure buildup in a particular compartment, ie bleeding. When pressure
exceeds ~40mmHg, capillaries do not perfuse. To diagnose, remember the 3 Ps: Pain!
Paresthesia! Has Pulse!
Head
Skull Features and Bones
Bones of the Orbit

Superior ~ frontal
Inferior ~ maxilla
Medial ~ lacrimal, ethmoid
Lateral ~ zygomatic
Posterior ~ sphenoid (greater
wing), palatine
Lamina papyracea of the

ethmoid form the medial wall of the orbit. This is very thin and brittle.
Foramen spinosum lies on the sphenoid bone.
Infant Skull
Fontanelles
Frontal fontanelle also known as the bregmatic
fontanelle. The anterior fontanelle is the last to close by
about middle of 2nd year. Some adults may also have a
remnant metopic suture just above the nasion.
Other sutures
The infant skull also has intermaxillary and mandibular sutures.
Teeth
An adult has 2-1-2-3 (2 incisors, 1 canine, 2 pre-molars, 3 molars) on either side, with a
total of 32 teeth in total. The child begins to sprout molars every 6 years until age 18.
For example, a skull with 1 molar and 1 molar peeking out could be said to be ~8 yo.
Dural Folds
Falx cerebri ~ between the 2 hemispheres of the cerebrum, attaches to crista galli.
Falx cerebelli ~ between the 2 hemispheres of the cerebellum
Tentorium cerebelli ~ between the cerebrum and the cerebellum
Veins of Skull
Valves:
External Jugular Vein (at entrance to subclavian v. and 4cm above clavicle)
Internal Jugular Vein (2.5cm above entrance to subclavian)
Vertebral v. (at entrance to subclavian v.)
No Valves:
Anterior Jugular v. (drains into ext. jugular)
[really need more detail here]
Venous Sinuses
All venous sinuses are located within the
dura mater and have no valves. The
superior sagittal sinus drains usually to
one side of the transverse sinus. The
superior sagittal, straight, occipital, and
transverse sinuses meet at the confluence
of sinuses. (whys this a lie again?)
Blood received here eventually drains into
the sigmoid sinuses and into the internal
jugular vein.
Other Veins
Diploic veins ~ run in the calvarium itself.
Know: occipital diploic v connects
transverse sinus and occipital v.
Emissary veins ~ connects venus sinuses to

outside of cranium.
Know: mastoid emissary v connects sigmoid
sinus and posterior auricular v.
Cavernous Sinus
Only the abducent nerve and the internal
carotid with its sympathetic plexus are fully
within the sinus. Other nerves are embedded in
the lateral wall. In any case, all these structures
may be affected in a cavernous sinus infection.
Nerves: III, IV, V1, V2, VI

Artery: Internal Carotid
Note: Lateral wall has nerves in order from top to bottom.
This sinus receives venous blood from:

Facial veins (via supraorbital and sup.+inf. ophthalmic vv.)
Sphenoid and middle cerebral vv.
Superior Petrosal (sigmoid sinus)
Inferior petrosal (Internal Jugular v)
Ventricles
CSF circulates within the ventricles. The CSF is generated at the choroid plexus.
Arachnoid granulations are projections of the subarachnoid space into the superior
sagittal sinus. They provide communication between the venous sinuses and CSF.
Circle of Willis
The vertebral arteries enter the foramen
magnum and merge into the basilar as it
ascends the clivus. The vertebral gives off
the PICA, and the basilar give off the AICA.
The internal carotid enters the cranium
through its canal in the temporal bone(!),
gives off the ophthalmic arteies (not shown),
and then quickly divides into the anterior
cerebral and middle cerebral.
Facial Nerve (VII)

Sensory ganglion, called geniculate
ganglion, located in the petrous part of the
temporal bone.
To Zanzibar By Motor Car Please
Temporal, Zygomatic, Buccal, Mandibular, Cervical, Posterior auricular (this part not
involved in mm of facial expression)
Muscles of Facial Expression (VII)

Ready to memorize? Go! Just kidding.
Occipitofrontalis
Corrugator supercilii
Orbicularis oculi
Procerus
Nasalis
Depressor septi
Orbicularis oris
Levator anguli oris
Levator labii superioris
Levator labii superioris alaeque nasi
Zygomaticus major
Zygomaticus minor
Depressor labii inferioris
Depressor anguli oris
Risorius
Buccinator ~ fibers perpendicular and
deeper to masseter
Mentalis
Auricularis ant.+sup.+post.
[insert picture of muscles of facial expression best use dissector]
Trigeminal (V)
Sensory ganglion, called semilunar ganglion (Gasserian), located in Meckels cave
under dura, lateral to cavernous sinus (according to Netter). All branches of the
trigeminal go through foramina in the sphenoid bone.
1) Ophthalmic
a. Frontal (only up to half of scalp)
i. Supratrochlear
ii. Supraorbital (supraorbital notch)
b. Nasociliary
i. Infratrochlear
ii. Long (sympathetic to tarsus muscles+iris dilators)
iii. Short ciliary nn. (parapsympathetic to sphincter+ciliary muscles)
iv. Etc.
c. Lacrimal (does not make you cry!)
2) Maxillary (sensory of pterygopalatine ganglion)
a. Zygomatic
i. Zygomaticofacial (zygomaticofacial foramen)
ii. Zygomaticotemporal (parasympathetics from pterygopalatine jump
over from here to the lacrimal n.)
iii. Post. Superior alveolar
b. Infraorbital (Infraorbital foramen)
i. Ant. Superior alveolar
ii. Middle alveolar
c. Pharyngeal
d. Nasopalatine (sphenopalatine foramen and incisive canal)
e. Greater Palatine (greater palatine canal and foramen)
f. Lesser Palatine (greater palatine canal and lesser palatine foramen)
Pterygopalatine ganglion distributes via zygomaticotemporal, pharyngeal, nasopalatine,
and greater+lesser palatine. The greater petrosal and presumably via the lesser palatine,
according to Gannon and Laitman, carry SVA to soft palate. I dont know why this isnt
mentioned in Not The Syllabus.
3) Mandibular (sensory of otic ganglion)

a. Auriculotemporal (distribution of otic ganglion to parotid gland)
b. Buccal
c. Lingual (joined by chorda tympani from VII, also sensory of
submandibular ganglion)
d. Inferior alveolar (mandibular foramen, do dental anesthesia here)
i. Mylohyoid n. (along mylohyoid groove)
ii. Mental n. (mental foramen)
iii. Inferior dental n. (to lower teeth and gums)
[insert picture of muscles of mastication best use dissector]

Muscles of Mastication (V3)
Comprises of
1) Temporalis
2) Masseter
3) Pterygoid lateral (only opener of the jaw)
4) Pterygoid medial
Think of J. Lo and Lateral Opens.
Branchiomeric Nerves and Fiber Types

1 V Save Gas SVE GSA
2 VII Save Gas Give Saliva SVE GSA GVE SVA
3 IX Save Gas Give Saliva to Godiva SVE GSA GVE SVA GVA
4 X Save Gas Give Saliva to Godiva SVE GSA GVE SVA GVA
5-6 XI Save Geese SVE GSE
Selected Branchiomeric Muscles

Cricothryoid
v Innervated by the external laryngeal which is branch of superior laryngeal which
is a branch of X. This muscle tenses the vocal cords and raises pitch of the voice.
Stylopharyngeus
v Innervated by IX
Mylohyoid+Anterior Belly of Digastric
v Innervated by mylohyoid n. which is branch of inferior alveolar n. of V3.
Posterior Belly of Digastric+Stylohyoid
v Innervated by VII
Branchiomeric Skeletal Elements

1st Arch Meckels cartilage
Sphenomandibular ligament Upper portion of malleus and incus
Lower portion of malleus and incus
(except footplate)
2nd Arch Styloid process
Lesser Horn+Upper Body of Hyoid
Greater Horn+Lower Body of Hyoid
3rd Arch Stylopharyngeus
4th Arch Thyroid cartilage of larynx
5th Arch Cricoid, arytenoids,
corniculate, cuneiform
cartilages
Head+Neck Autonomics
Just some helpful hints. For everything else, refer to beautiful table in study guide.
Sympathetic Ganglia and Associated Arteries
Superior Cervical Internal Carotid
Middle Cervical External Carotid
Inferior Cervical Vertebral
Cervical Plexus
Cervical Plexus = Ventral rami of C1-4
Motor Branches
Ansa cervicalis (C1-3) ~ nerve root formed
by union of superior root (C1) and inferior
root (C2-3). Supplies most infrahyoid
muscles and can be found just anterior to
the carotid sheath.
Phrenic nerve (C3-5) ~ C-3-4-5 keeps the
diaphragm alive! Descends on the anterior
surface of the anterior scalene muscle.
Cutaneous Branches
Lesser Occipital n. (C2-3) ~ scalp behind
auricle
Great Auricular n. (C2-3) ~ skin behind
auricle and near parotid gland
Transverse Cervical n. (C2-3) ~ anterior
triangle of neck
Supraclavicular n. (C3-4) ~ skin over clavicle and shoulder
Note: the Greater Occipital n. (C2) supplies some posterior neck muscles and skin of the
posterior scalp, but is not part of the cervical plexus. The Greater Occipital is formed
from dorsal rami!
Note2: The angle of the jaw is not innervated by V3! It is Great Auricular!
Middle Meningeal Artery Rupture

This can be caused by fracture to squamous part of the temporal bone as the artery runs
just deep to the inner surface of the bone. The pterion is an important landmark of the
arterys course. Rupture of this artery will cause an epidural hematoma, as it runs on the
outside of the dura.
Orbit & Eye

Oculomotor Nerve (III)
Levator palpebrae superioris
Superior rectus ~ up and in
Medial rectus ~ adduction
Inferior rectus ~ down and in

Inferior oblique ~ up and out
Trochlear Nerve (IV)
Superior oblique ~ down and out
Abducens Nerve (VI)

Lateral rectus ~ abduction
The obliques insert posterior to the

equator (resulting in their paradoxical
action), and the recti insert anterior to
the equator.
[Need picture of eyeball layers]

Eyeball Layers
On the outside, the conjunctiva, a
membrane, covers the sclera (NOT the
cornea).
Outer
Sclera ~ the white
Cornea ~ the clear part
Pigmented
Choroid ~ posterior portion which nourishes the retina
Ciliary body ~ muscles here focus the lens; ciliary processes make aqueous
humor; zonular fibers support the lens.
Iris ~ parasympathetics constrict and sympathetics dilate
Nervous
Retina ~ senses light. Has inner nervous layer and outer pigmented layer. Has a
blind optic disk where the optic n. enters. Fovea centralis has highest
concentration of cones, giving best fine and color vision.
Refractive Media
Cornea
Aqueous humor ~ bathes lens
Lens ~ provides much of the refractive power
Vitreous body ~ holds retina in place
The anterior chamber refers to the space between the cornea and the iris. The posterior
chamber refers to the space between the ciliary body to the iris (containing the lens).
The ciliary ganglion can be found lateral to the optic nerve, posterior to the eyeball
(bulbous oculi).
Clinical Correlates
Glaucoma
Cataract
Retinal detachment
Neck
Suprahyoid Muscles
All branchiomeric except geniohyoid
Digastric
o Anterior belly
innervated by n. to
mylohyoid
o Posterior belly
innervated by VII
o Divides on hyoid bone.
Mylohyoid
o Innervated by n. to
mylohyoid which is
branch of inferior alveolar
n. which is branch of V3.
Stylohyoid
o Innervated by VII
o Pierces the tendon of the
digastric!!!
Geniohyoid
o Innervated by C1 via
hypoglossal n.
o Deep to the mylohyoid
Infrahyoid Muscles all ansa cervicalis
(except thyrohyoid)
Sternohyoid
o Covers both sternothyroid
and thyrohyoid.
Sternothyroid
Thyrohyoid
o Innervated by C1 via
hypoglossal n.
Omohyoid
Carotid Sheath
Contains:
Common carotid (some int. carotid)
Internal jugular
Vagus n.
Nerves and Vessels

The ansa cervicalis, distinctively found as
a loop of nerves, lies superficial to the
carotid sheath.
The phrenic nerve lies on top of the anterior scalene m.
The brachial plexus and subclavian artery runs out of the interscalene triangle between
the scalenus anterior and medius. Any compression here can result in entrapment
neuropathy.
The cutaneous nerves of the cervical plexus can be seen peeking out from under the
sternocleidomastoid.
Pharynx
Generally, any muscle with Tensor in name is V. Any muscle with palati but no tensor is
X. Any muscle with glossus but no tensor or palati is XII.
Pharynx Divisions
Nasopharynx: Nasocavity Soft Palate
Oropharynx: Soft Palate Epiglottis
Laryngopharynx: Epiglottis Cricoid cartilage
Muscles of Pharynx
Circular Muscles
All innervated by pharyngeal plexus IX, X, XI via X
Superior/Middle/Inferior constrictors
Identify Middle by its origin from the hyoid bone.
Longitudinal Muscles
Lifts pharynx, aids in swallowing
All pharyngeal plexus except stylopharyngeus which is only IX.
Stylopharyngeus
Palatopharygeus
Salpingopharyngeus
Looking from posterior side, lateral to medial: posterior belly of digastric, stylohyoid,
stylopharyngeus. Anterior to this group is the styloglossus.
Tongue and Palate

Muscles of the Tongue
All XII except for palatoglossus which is X (via pharyngeal plexus, fibers from XI?).
Styloglossus
Hyoglossus
Genioglossus
Palatoglossus
Muscles of the Palate

All X (via pharyngeal plexus) except for tensor veli palatini which is V3.
Tensor veli palatini
Levator veli palatini
Palatoglossus
Palatopharyngeus
Musculus uvulae
The submandibular ducts open on both sides of the root of the frenulum linguae
(midline fold).
The tensor veli palatini (V3) and levator veli palatini (X) hook around the hamulus of
the medial pterygoid plate and form the palatine aponeurosis on the soft palate. Their
distal attachment is to the cartilage of the auditory tube. Their combined action lifts the
soft palate (preventing food from entering nose) and opens the auditory tube (equalizing
atmo and middle ear pressure). These two muscles (anterior: tensor, posterior: levator)
can be seen attaching near the torus tubarius.
The palatoglossus (X) and the palatopharyngeus (X) form the palatoglossal and
palatopharyngeal arches respectively. The musuclus uvulae (X) hangs off the
palatopharyngeal arch. The palatine tonsils jut out between the arches on each side.
The pharyngeal tonsil is found on posterior wall and roof of the nasopharynx, and when
enlarged is called an adenoid. The tubal tonsil lies near the opening of the auditory tube.
Larynx
Muscles of the Larynx
All muscles innervated by recurrent laryngeal (fibers from XI) except for the cricothyroid
(X). The only abductor of vocal cords is posterior cricoarytenoid. The recurrent
laryngeal supplies sensory innervation up to the vocal cord (glottis). The internal
laryngeal (branch of superior laryngealX) supplies sensory down to the vocal cord.
Cartilages of the Larynx

Unpaired: Epiglottis, Thyroid, Cricoid
Paired: Arytenoid, Corniculate, Cuneiform
The vocal ligaments stretch between the arytenoid and thyroid. They are covered by
the vocal folds forming the true vocal fold. Above it, is the vestibular fold, a fold of
mucosa also known as the false vocal fold. Between the vestibular fold and the vocal
fold lies the ventricle, a space where people collect phlegm to spit out with disgusting
noises. The area below the epiglottis, between the aryepiglottic folds and the vestibular
folds is known as the vestibule. The space between the two vocal folds is called the
rima glottidis. The rima glottidis+vocal folds are together called the glottis.
The vocal folds evolved to

Guard airway
Maintain intrathoracic and intra-abdominal pressure e.g. when lifting weights,
defecation, parturition.
Phonation
Joints
Crico-arytenoid ~ synovial
Crico-thyroid ~ synovial (from TAs)
Nose
Nasal Septum
Formed by:
Ethmoid, Vomer, Palatine, Maxilla, and a cartilaginous part.
Superior and Middle Concha part of

ethmoid bone.
Inferior Concha is its own bone (no
idea what the name of this bone is)
[need CT x-section]
Paranasal Sinuses and Drainage

Maxillary
Ethmoid
Frontal
Sphenoid
Posterior Ethmoid, Sphenoid (via

Sphenoethmoidal recess)
superior meatus
Maxillary (via its ostium), Anterior Ethmoid, Frontalinfundibulumsemilunar
hiatusmiddle meatus (Frontal can be simplified to Frontal via frontonasal
ductmiddle meatus)
Middle ethmoid form the ethmoid bulla, a swelling on superior border of semilunar
hiatus and these cells open directly into the middle meatus (confirmed on Grays and
Moore)
Nasolacrimal ductinferior meatus
Maxillary and Ethmoid sinuses apparent at birth. Maxillary are the very first to
appear, budding off the nasal capsule.
Frontal and Sphenoid sinuses develop after birth.
The maxillary sinus is innervated by the superior alveolar n. (branch of V2).
[anatomy tables claim ant+post sup alveolar, and ant comes off of infraorbital n.
Nevertheless, this doesnt change V2 origin.]
Ear
Divisions
External Ear: Auricle, external ear canal
~~~~ Tympanic Membrane ~~~~
Middle Ear: Malleus, Incus, Stapes

~~~~ Oval Window ~~~~
Inner Ear: Cochlea, Semicircular canals (saccule, utricle)
The path of conduction is:

Tympanic MembraneMalleusIncusStapesOval Window of Cochlea
Spiral ganglion, the DRG of the cochlear part is located in the cochlea.
Vestibular ganglion, the DRG of the vestibular part is located in the internal acoustic
canal (i.e. after entering through the int. acoustic meatus).
Tensor tympani (V3) and stapedius (VII) mm. tense with loud sounds to prevent damage.
The tensor tympani inserts on the handle of the malleus. The stapedius inserts on the
neck of the stapes.
Joints
Incudomalleolar (synovial diarthrosis)
Incudostapedial (synovial enarthrosis)
Path of Infection to Middle Ear
Other Air Sinuses

Mastoid
Called mastoid air cells
Middle ear infection can turn into mastoiditis since mastoid air cellsmastoid
antrumaditusmiddle ear.
Clinical Correlates
Pupillary Reflex
Shining a light into the pupil causes the iris to contract. The afferent arm is optic nerve,
and efferent arm is oculomotor (via parasympathetics).
Corneal Reflex
Bilateral blinking caused by blowing on or touching the cornea (note, not sclera!).
Unilateral blinking would indicate other deficits. This reflex is sensed by the nasociliary
nerve (V1) and the contraction of the orbicularis oculi is caused by the facial nerve.
Horners Syndrome
Injury to cervical sympathetic fibers.
Characterized by
1) Miosis ~ pupil constriction due to unopposed parasympathetics
2) Ptosis ~ drooping of upper eyelid due to paralysis of smooth muscle part of
levator palpebrae superioris (ie superior tarsal muscle)
3) Enophthalmos ~ retraction of eyeball from paralysis of tarsal muscle
4) Anhidrosis ~ absence of sweating
5) Vasodilation ~ increased bloodflow in facial and cervical regions
Compare to damage to facial nerve, which could result in ptosis, but no change to pupils.
Compare to damage to oculmotor, which results in ptosis but mydriasis (dilation), and
also eyes that are down and out due to lateral rectus and superior oblique.
Cricothyrotomy
Puncture into membrane between thyroid and cricoid cartilages bypassing blocked airway.
Quick and dirty yet safe at the same time since back part of cricoid cartilage bulges
upward and prevents puncture into esophagus. Also, there are no muscles or major blood
vessels in the midline. The thyroid gland lies inferior to the cricoid cartilage, so there is
no danger of hitting that either.
Trigeminal Neuralgia (Tic Douloureux)

Really bad pain on the course of a branch of trigeminal. Can be triggered by touch, etc.
Danger Area of Face

Popping zits in areas drained by facial vein (side of nose, upper lip) can get into
ophthalmic vein and into the cavernous sinus. Low chance of actually happening, but
death rate even with modern medicine is high when it does happen.
Bells Palsy
Unilateral paralysis of facial muscles due to damaged facial n. Can also cause other
deficiencies such as in lacrimation, taste in anterior 2/3 of tongue, deviation of jaw, etc.
Freys Syndrome (Gustatory Sweating)

Flushing and sweating instead of salivation in response to taste of food. This results
following injury of auriclotemporal n, which contains parasympathetic to the parotid and
sympathetic to sweat glands. When the nerve is severed, e.g. after parotid surgery, the
fibers regenerate along each others pathways and innervate the wrong glands.
Crocodile Tears Syndrome (Bogorads Syndrome)

Spontaneous lacrimation during eating. This is due to lesion of facial nerve, with
associated facial paralysis, proximal to geniculate ganglion. Regenerating
parasympathetics fibers, which formerly innervated the submandibular and sublingual
glands, mistakenly go to the lacrimal glands.
Odds&Ends
Bone Box
Radius has sweet-tart end.
Ulna has olecranon process, forming wrench-like end.
Femur has large head which is used to insert into the acetabulum.
Branches of the External Carotid

Some Anatomists Like Fucking Others Prefer S & M
Superior Thoracic
Ascending Pharyngeal
Lingual
Facial
Occipital
Superficial Temporal
Maxillary
Some important branches of the Maxillary

Maxillary gives off inferior alveolar (mandibular foramen) and middle meningeal
(foramen spinosum)
Some other notable branches of the maxillary just to be familiar with the names
Deep temporal
Buccal
Infraorbital
Branches of the Thyrocervical Trunk

Inferior Thyroid (anastomoses with superior thyroid from external carotid)
Transverse Cervical (participates in scapular anastomoses)
Suprascapular (participates in scapular anastomoses)
Head&Neck Lymphatics
Chains are paired. Assume unilateral drainage. Therefore, if you have cancer on one
side, only need to resect nodes on that side.
Vertical Chains (runs along internal jugular)

Jugulodigastric and Jugulo-omohyoid
Afferents from Superior Deep Cervical. Efferents to Inferior Deep Cervical and on to the
jugular lymphatic trunk.
R Jugular lymphatic TrunkR lymphatic duct or junction between R subclavian and R

internal jugular
L Jugular Lymphatic TrunkThoracic duct or junction between L subclavian and L

internal jugular
Carotid Body&Sinus
Both innervated by IXs GVA
Carotid Body
lies at bifurcation of the common carotid
senses chemicals in blood, e.g. PO2
Carotid Sinus
senses blood pressure
lies near the body.
Some Trivial Facts

If you have time to kill and you dont want to memorize the pharyngeal pouches yet
If you get stabbed in the posterior triangle of the neck, you are at risk for
pneumothorax because the tip of the lung juts into that space. You are not at risk
for laceration of the thyroid gland.
Old Tests think thatSuperficial palmar arch comes from the ulnar artery, and
the Deep palmar arch comes from the radial artery, which makes no sense.
The optic chiasm lies anterior to the pituitary gland.
The capitulum on the humerus is on its distal end, articulating with the radius.
The arachnoid mater is avascular; the pia carries blood vessels that supply the
brain; the middle meningeal supplies the dura mater
The tegmen tympani, part of the temporal bone, separates the middle ear from
the middle cranial fossa.
The joint between metaphyseal and epiphyseal plates is a synchondrosis
The frontal bone (and basically the superior bones of the skull) doesnt go through
a cartilaginous stage of development.
Atlanto-axial joint is synovial.
The sciatic nerve runs lateral to the post. cutaneous n. of the thigh as it exits the
greater sciatic foramen.
The parotid duct runs over the masseter muscle and then pierces the buccinator.
External jugular vein runs over the sternocleidomastoid, while the internal jugular
runs under it.
The medial sural cutaneous n., unexpectedly, starts much higher, near the
popliteal fossa and runs straight down the posterior leg, superficial to the
gastrocnemius.
The temporomandibular joint is a synovial hinge joint.
Medial cutaneous n. of forearm runs right next to ulnar nerve.
Once past the supinator, the radial nerve gives off the posterior interosseus n.
which innervates much of the extensor group.

Upper Extremity Circulation and Nerves

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Last printed 12/4/2012 10:24 PM

The arteries that participate in the scapular

The axillary sheath contains the axillary artery

Lateral Cord Makeup and Distal Branch

Medial Cord Makeup and Distal Branch

All 3 trunks contribute posterior divisions to the posterior cord.

Medial Cord Branches (All C8-T1)

Posterior Cord Branches (excluding most distal-branches)

Musculocutaneous supplies all muscles in anterior compartment (flexor) muscles of the

Thoracodorsal nerve supplies latissimus dorsi.

Identifying Nerves of the Arm

Medial Rotators of the Arm

Lateral Rotators of the Arm

Anterior Arm (Flexors)

Rule of Odd Numbers 5-3-7-5

lies deep to the other superficial muscles

Intrinsic Muscles of the Hand

Lumbricals (L. worm)

Movement of the Thumb (L. Pollex)

Pick your favorite one:

Sensory Fields of Arm and Forearm

Medial ~ medial antebrachial cutaneous (from medial cord)

Some Joints and Their Types

Anastomoses Around the Elbow

Carpal Tunnel Contents

[need pictures of leg and thigh x-sections]

Femoral Sheath and Contents

From lateral to medial:

Medial Rotators of the Thigh

Lateral Rotators of the Thigh

Femoral nerve (L2-4) for all muscles

Some Special Ones

Anterior (from medial to lateral)

o Extensor hallucis longus

Eversion of foot (Lateral compartment)

Sustentaculum tali (L. support of the talus)

Plantar aponeurosis, which stretches form

Shoulder vs Hip Joint

Anastomoses Around the Knee

Butt+Posterior Thigh ~ posterior cutaneous n. of thigh (S1-3)

Lateral Thigh ~ lateral femoral cutaneous n. (L2-3)

Distal 1/3 anterior leg + Dorsum foot ~ superficial fibular n.

Gluteus Maximus Lurch

Bones of the Orbit

Lamina papyracea of the

Emissary veins ~ connects venus sinuses to

Nerves: III, IV, V1, V2, VI

This sinus receives venous blood from:

Facial Nerve (VII)

Muscles of Facial Expression (VII)

[insert picture of muscles of facial expression best use dissector]

3) Mandibular (sensory of otic ganglion)

iii. Inferior dental n. (to lower teeth and gums)

[insert picture of muscles of mastication best use dissector]

Branchiomeric Nerves and Fiber Types

Selected Branchiomeric Muscles

Branchiomeric Skeletal Elements

Middle Meningeal Artery Rupture

Orbit & Eye

Inferior rectus ~ down and in

Abducens Nerve (VI)

The obliques insert posterior to the

[Need picture of eyeball layers]