Anatomy notes

Right Side Blood Supply

• Source : Aorta
• Branches :
  • Brachiocephalic Truncus
  • Common Carotid Artery
  • Subclavian Artery
  • Vertebral Artery
• Transition :
  • Subclavian Artery → Axillary Artery → Brachial Artery → Radial and Ulnar Arteries → Palmar Arch → Digital Arteries

Left Side Blood Supply

• Source : Aorta
• Direct Branches :
  • Common Carotid Artery
  • Subclavian Artery

Venous System

1. Deep Veins :

   • Palmer Metacarpal
   • Leads to:
     • Deep Palmar Veins
     • Radial and Ulnar Veins
     • Brachial Vein
     • Axillary Vein
     • Subclavian Vein
     • Brachiocephalic Vein

2. Superficial Veins :

   • Basilic Vein
   • Cephalic Vein
   • Drain into:
     • Brachial Vein
     • Subclavian Vein
     • Brachiocephalic Vein
     • Superior Vena Cava

Summary

The blood supply of the upper limb originates from the aorta and its branches, particularly the common carotid artery and subclavian artery .

Venous drainage of the upper limb is managed through both deep and superficial veins, culminating in the superior vena cava for return to the heart. Understanding these vascular systems is crucial for clinical evaluation and surgical interventions related to the upper limb.

Upper Limb Nerve Injuries

1. Wrist Drop :
2. • Associated Nerve: Radial nerve.

3. Claw Hand :

   • Associated Nerve: Ulnar nerve.

4. Paresthesia in the Ring and Little Finger :

   • Associated Nerve: Ulnar nerve.

5. Paresthesia in Middle, Index, and Thumb :

   • Associated Nerve: Median nerve.

6. Humeral Neck Fracture :

   • Associated Nerve: Axillary nerve.

7. Humeral Shaft Fracture :

   • Associated Nerve: Radial nerve.

8. Supracondylar Fracture :

   • Associated Nerve: Median nerve (Anterior interosseous nerve branch).

9. Saturday Night Palsy / Crutch Palsy :

   • Associated Nerve: Radial nerve.

10. Winging of Scapula :

    • Associated Nerve: Long thoracic nerve.

11. Dropped Scapula :

    • Associated Nerve: Accessory nerve.

Upper Limb Common Injuries

1. Biceps Rupture

• Proximal Biceps : Characterized by the "Popeye sign," which occurs due to the retraction of the muscle belly after rupture.
• Distal Biceps : Patients often experience a sharp pain located in the cubital fossa.

2. De Quervain Tenosynovitis

• Description : This condition involves inflammation of the extensor pollicis brevis and abductor pollicis longus muscles.
• Cause : It is typically caused by repetitive strain injury.
• Diagnosis : The Finkelstein test is utilized to diagnose this condition.

3. Tennis Elbow (Lateral Epicondylitis)

• A common overuse injury affecting the lateral elbow, leading to pain and tenderness in the lateral aspect of the elbow.

4. Golfer's Elbow (Medial Epicondylitis)

• This condition mirrors tennis elbow but involves pain on the medial side of the elbow, typically resulting from overuse or repeated stress.

Other Nerve Injuries and Associated Conditions:

1. Femur Neck Fracture (Femur neck #)

   • Affects: Sciatic nerve

2. Neck of Fibula Fracture (Neck of fibula #)

   • Affects: Common peroneal nerve

3. Foot Drop

   • Affects: Sciatic nerve / Common & Deep peroneal nerve

4. Loss of Sensation:

   • Medial Side of Foot: Affects Saphenous nerve
   • Lateral Side of Foot: Affects Sural nerve

5. Glove and Stocking Pattern of Paresthesia

   • Often seen in: Diabetes mellitus

Brachial Plexus and Common Injuries

Gross Motor Function by Nerve Roots

C5, C6

• Functions :
  • Shoulder abduction
  • Elbow flexion

C7

• Functions :
  • Triceps function
  • Wrist extension (which may be affected if C7 is involved)

C8, T1

• Functions :
  • Hand function

Common Brachial Plexus Injuries

Upper Brachial Plexus Injury (C5-C6 roots)

• Deformity :
  • Arm: Abducted and internally rotated
  • Forearm: Extension and supination (+/- wrist in flexion)
• Condition : Waiter’s tip deformity
• Causes :
  • Lateral traction to upper limb
  • Common birth injury with shoulder dystocia
  • Accidental injury to neck (e.g., motorbike accidents)
• Affected Actions :
  • Shoulder abduction
  • Elbow flexion
  • Triceps and wrist extension if C7 is involved

Lower Brachial Plexus Injury (C8-T1 roots)

• Causes :
  • Upward force (pulling) to the upper limb
  • Vaginal birth injury
  • Accidental injury to neck (e.g., motorbike accidents)
• Muscles Affected :
  • Muscles of the hand: Intrinsic, Thenar, Hypothenar
  • Forearm pronators
  • Wrist flexors (may be involved)
• Associated Conditions : May be linked to Horner’s syndrome (meiosis + ptosis)
• Deformity :
  • Claw hand
  • Forearm supinated
  • Wrist extended

Summary of Key Injuries and Deformities

• Winging of Scapula : Caused by injury to the Long thoracic nerve (C5, C6, C7) leading to weakness of serratus anterior muscle.
• Erb’s Palsy : Upper brachial plexus injury characterized by Waiter’s tip deformity.

Major Nerves of the Upper Limb

1. Radial Nerve

   • Innervation : All extensors of the hand, including wrist extension, finger extension, and elbow extension.
   • Consequence of Damage : Radial nerve palsy can lead to wrist drop, which prevents extension of the wrist and fingers.

2. Ulnar Nerve

   • Innervation : All intrinsic hand muscles except the LOAF muscles (Lateral lumbricals, Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis) which are innervated by the median nerve.
   • Consequence of Damage : Ulnar nerve palsy can result in claw hand, which is characterized by the inability to extend the fourth and fifth fingers.

3. Median Nerve

   • Innervation : Innervates the LOAF muscles (Lateral lumbricals, Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis).
   • Consequence of Damage : Damage can lead to difficulties in thumb movement and grip strength.

Clinical Significance

• The damage to these nerves can cause significant functional deficits, affecting daily activities and overall quality of life.
• Understanding the innervation patterns and the consequences of nerve damage is essential for diagnosing and managing upper limb neuropathies.

Summary

The radial, ulnar, and median nerves are crucial for the movement and sensation of the upper limb. Knowledge of their roles and the implications of injuries is vital for healthcare professionals involved in the treatment of neurological and musculoskeletal conditions.

Additional Resources:

For further information, refer to Wikipedia - Major Nerves of the Upper Limb.

Myotomes of the Upper Limb

Summary of Upper Limb Myotomes:

Myotomes refer to the group of muscles innervated by the motor fibers of a specific spinal nerve root. In the upper limb, the myotomes are organized as follows:

1. C5 Myotome:

   • Muscles: Deltoid, biceps brachii
   • Movement: Shoulder abduction, elbow flexion

2. C6 Myotome:

   • Muscles: Biceps brachii, brachioradialis, supinator, wrist extensors
   • Movement: Elbow flexion, wrist extension, forearm supination

3. C7 Myotome:

   • Muscles: Triceps brachii, wrist flexors, finger extensors
   • Movement: Elbow extension, wrist flexion, finger extension

4. C8 Myotome:

   • Muscles: Finger flexors, intrinsic hand muscles (e.g., interossei)
   • Movement: Finger flexion, thumb extension, and opposition

5. T1 Myotome:

   • Muscles: Intrinsic hand muscles (e.g., interossei, lumbricals)
   • Movement: Finger abduction and adduction (fine motor control of the fingers)

Clinical Significance:

Understanding myotomes is essential for diagnosing and managing neurological disorders affecting the upper limbs. By testing specific movements associated with each myotome, clinicians can identify the level of spinal nerve root involvement in cases of nerve compression, injury, or degenerative conditions.

• Radiculopathy: Compression or irritation of a spinal nerve root, often due to a herniated disc, can lead to muscle weakness or paralysis in the corresponding myotome. For example, a C5-C6 disc herniation may affect the C6 myotome, leading to weakness in elbow flexion and wrist extension.

• Motor Neuron Lesions: Lesions affecting the motor neurons, such as in amyotrophic lateral sclerosis (ALS), may present with selective weakness corresponding to certain myotomes.

• Peripheral Nerve Injuries: Although peripheral nerves often involve multiple myotomes, understanding the specific myotome can help in localizing the lesion. For example, damage to the radial nerve (which has fibers from C5-C8) can be assessed by testing movements associated with those myotomes, such as wrist extension (C6-C7) and finger extension (C7).

• Assessment of Neurological Function: During a physical examination, testing myotome-specific movements helps assess the integrity of the spinal cord and nerve roots, which is crucial in trauma cases or in the progression of neurological diseases.

• Rehabilitation and Recovery: In cases of nerve damage or spinal cord injury, targeted rehabilitation can be designed to strengthen or restore function in specific myotomes, aiding in more focused and effective recovery.

Dupuytren’s Contracture

Dupuytren’s contracture is a condition characterized by the thickening and shortening of the palmar fascia, the connective tissue in the palm of the hand. This condition leads to progressive flexion deformities of the fingers, particularly affecting the ring and little fingers, which can result in a claw-like appearance.

Key Points:

• Thickened Palmar Fascia : The palmar fascia becomes thickened, which restricts the movement of the fingers.
• Flexion Deformities : Over time, the affected fingers may become increasingly bent towards the palm.
• Affected Fingers : Typically, the ring and little fingers are most commonly involved, although it can affect other fingers as well.

Dupuytren’s contracture often develops without a clear cause, although it is associated with factors such as genetics, age, and certain health conditions. Treatment options may include surgery in severe cases where finger function is significantly compromised.

Winging of Scapula

Cause :
Winging of scapula can occur due to injury to the Long thoracic nerve, specifically involving the C5, C6, and C7 nerve roots. This injury results in weakness of the serratus anterior muscle.

Additional Information :
Winging of the scapula may also occur due to atrophy of the trapezius muscle, which can happen from an injury to the Spinal accessory nerve.

Common Causes of Winging of Scapula :

• Traumatic Injury
• Repetitive Injury

This condition can affect shoulder function and stability, leading to challenges in raising the arm or performing overhead activities. The accompanying weakness of the serratus anterior muscle is a significant factor contributing to this deformity.

Shoulder Muscles Innervation and Functions

1. Shoulder Abduction:

• Muscle: Deltoid
• Nerve: Axillary Nerve
• Spinal Level: C5

2. Elbow Flexion:

• Muscle: Biceps
• Nerve: Musculocutaneous Nerve
• Spinal Levels: C5, C6

3. Elbow Extension:

• Muscle: Triceps
• Nerve: Radial Nerve
• Spinal Level: C7

4. Finger Extension:

• Muscles: Extensor Digitorum Superficialis & Profundus
• Nerve: Radial Nerve
• Spinal Level: C7

5. Finger Flexion:

• Muscles: Flexor Digitorum Profundus & Superficialis
• Nerves: Median & Ulnar Nerves
• Spinal Level: C8

6. Finger Abduction:

• Muscle: First Dorsal Interosseous
• Nerve: Ulnar Nerve
• Spinal Level: T1

7. Thumb Abduction:

• Muscle: Abductor Pollicis Brevis
• Nerve: Median Nerve
• Spinal Level: T1

8. Finger Adduction:

• Muscle: Second Palmar Interossei
• Nerve: Ulnar Nerve
• Spinal Level: T1

Other Shoulder Muscles and Their Functions

• Rhomboideus Muscle:

  • Function: Pulling the arm backward while the hands are on the waist and moving the elbow backward against resistance.

• Serratus Anterior Muscle:

  • Function: Used when pushing a car.

• Supraspinatus Muscle:

  • Innervation: Suprascapular Nerve
  • Function: Lifts arms sideways between 60 and 120 degrees.

• Infraspinatus Muscle:

  • Function: With a flexed elbow, moves the arm inward.

Long Flexors of Fingers

• Flexor Digitorum Profundus: Flexes the distal interphalangeal joints (DIP).
• Flexor Digitorum Superficialis: Flexes the proximal interphalangeal joints (PIP).
• Flexor Pollicis Longus: Flexes the thumb.

Blood Supply of the Lower Limb

The blood supply to the lower limb is primarily derived from the femoral artery and its major branches, which provide oxygenated blood to various regions. Below is a summary of the key arteries involved in supplying the lower limb:

Major Arteries

• Femoral Artery : The main artery supplying the lower limb, which originates from the external iliac artery and travels down the thigh.
• Popliteal Artery : Continuation of the femoral artery as it passes behind the knee. It bifurcates into:
  • Anterior Tibial Artery : Supplies the anterior compartment of the leg and continues onto the dorsum of the foot.
  • Posterior Tibial Artery : Supplies the posterior compartment of the leg and branches into:
    • Medial Plantar Artery : Supplies the medial aspect of the foot.
    • Lateral Plantar Artery : Supplies the lateral aspect of the foot.
• Fibular (Peroneal) Artery : A branch of the posterior tibial artery that supplies the lateral compartment of the leg.

Blood Supply to Specific Regions

• Thigh : The profunda femoris (deep artery of the thigh) branches off the femoral artery and provides additional supply to the muscles and tissues in the thigh.
• Knee : The genicular branches from the popliteal artery supply the knee joint and surrounding structures.
• Foot : The dorsalis pedis artery, a continuation of the anterior tibial artery, provides blood to the dorsum of the foot. The plantar arteries (medial and lateral) supply blood to the plantar aspect.

Overview

The vascular supply of the lower limb is crucial for maintaining proper function and health of the tissues. Proper blood circulation ensures that muscles receive the necessary oxygen and nutrients, while also assisting in the removal of metabolic waste.

Myotomes of Lower Limb

The myotomes of the lower limb represent the muscle groups that are innervated by specific spinal cord segments originating from the lumbar and sacral plexuses. Understanding these myotomes is essential for assessing motor function and diagnosing neurological conditions. Here’s a detailed summary of the myotomes in the lower limb:

Myotome Breakdown

1. L2 Myotome

   • Muscle Group: Hip flexors
   • Function: Primary muscle affected is the iliopsoas.
   • Movement Aspect: Assists in raising the thigh towards the torso.

2. L3 Myotome

   • Muscle Group: Knee extensors
   • Function: Primarily innervates the quadriceps femoris.
   • Movement Aspect: Responsible for extending the knee joint.

3. L4 Myotome

   • Muscle Group: Ankle dorsiflexors
   • Function: Mainly involves the tibialis anterior.
   • Movement Aspect: Aids in lifting the foot upwards and preventing foot drop.

4. L5 Myotome

   • Muscle Group: Long toe extensors
   • Function: Includes extensor hallucis longus and extensor digitorum longus.
   • Movement Aspect: Facilitates extension of the toes and the great toe.

5. S1 Myotome

   • Muscle Group: Ankle plantar flexors
   • Function: Primarily involves gastrocnemius and soleus.
   • Movement Aspect: Responsible for pointing the toes and giving push-off during walking or running.

6. S2 Myotome

   • Function: It continues to support the posterior leg muscles but is less frequently assessed individually in the lower limb.

Clinical Relevance

Understanding these myotomes is critical in clinical settings for evaluating lower limb function and diagnosing potential nerve root injuries or disease states. Testing the strength of specific muscle groups can indicate the health of the corresponding spinal nerves.

Summary

Together, these myotomes allow for a diverse range of movements vital for mobility, balancing, and gait. Knowledge of myotomes assists health professionals in pinpointing neurologic pathologies based on the muscle weakness or dysfunction exhibited during physical examinations.

Dermatomes for Lower Limb

L1 Dermatome:

• Location: Pocket region.

L2 Dermatome:

• Location: Inner thigh.

L3 Dermatome:

• Location: Knee.

L4 Dermatome:

• Location: Medial malleolus.

L5 Dermatome:

• Location: Lateral dorsum of the foot.

S1 Dermatome:

• Location: Sole of the foot.

S5 Dermatome:

• Location: Saddle region.

Clinical Significance

Understanding dermatomes is crucial when diagnosing and localizing neurological deficits in patients with lower limb injuries or disorders. This knowledge aids healthcare professionals in determining which areas of the nervous system might be affected based on the observed sensory deficits.

Summary

Dermatomes for the lower limb correspond to specific regions of skin innervated by spinal nerves. They are essential tools for assessing sensory function and identifying the localization of pathology within the nervous system.

Cranial Nerves and Their Functions

Here is a consolidated list of the cranial nerves along with their main functions:

1. Olfactory Nerve : Responsible for the sense of smell.
2. Optic Nerve : Involved in the pupillary light reflex.
3. Oculomotor Nerve : Controls eye muscles; associated with LR6 (Lateral Rectus controlled by Abducens), SO4 (Superior Oblique controlled by Trochlear), and other eye movements.
4. Trochlear Nerve : Specifically controls the Superior Oblique muscle (SO4).
5. Trigeminal Nerve : Afferent limb of the corneal reflex; causes jaw deviation towards the same side as the lesion.
6. Abducens Nerve : Controls the Lateral Rectus muscle (LR6).
7. Facial Nerve :
   • LMN (Lower Motor Neuron) lesions cause facial paralysis in both upper and lower halves.
   • UMN (Upper Motor Neuron) lesions result in lower facial paralysis only.
   • Provides taste sensation from the anterior two-thirds of the tongue.
8. Vestibulocochlear Nerve : Responsible for hearing and balance.
9. Glossopharyngeal Nerve : Facilitates taste from the posterior one-third of the tongue and is involved in the gag reflex.
10. Vagus Nerve :
    • Motor innervation to the soft palate, pharynx, and larynx.
    • Sensory information from viscera; a weak cough can lead to uvula deviation towards the opposite side of the lesion.
11. Accessory Nerve : Innervates the trapezius and sternocleidomastoid muscles; can result in a dropped scapula.
12. Hypoglossal Nerve : Controls tongue movement, causing deviation towards the same side of the lesion.

This summary outlines the key functions associated with each cranial nerve.

Facial Nerve

Introduction to Facial Nerve

• Definition: The facial nerve is a cranial nerve responsible for innervating the muscles of facial expression and conveying taste sensation from the anterior two-thirds of the tongue.

Functions and Innervation

• Muscles of Expression: The facial nerve innervates the muscles responsible for facial expression, allowing for a range of movements such as smiling, frowning, and blinking.
• Taste and Oral Cavity: It also provides sensory innervation to the anterior two-thirds of the tongue, contributing to taste sensation in this region.

Branches of the Facial Nerve

1. Greater Petrosal Nerve

   • Description: Innervates the nasal glands, palates, and lacrimal glands.
   • Supplies: Stapedius muscle, chorda tympani (involved in taste sensation for the tongue), submandibular gland, and sublingual gland.

2. Posterior Auricular Nerve

   • Description: Provides innervation to the muscles around the ear.

3. Temporal Branch of Facial Nerve

   • Description: Innervates the muscles of the temporal region of the face.

4. Zygomatic Branch of Facial Nerve

   • Description: Supplies innervation to the muscles around the zygomatic bone and upper cheek.

5. Marginal Branch of Facial Nerve

   • Description: Innervates the muscles of the lower lip and chin.

6. Cervical Branch of Facial Nerve

   • Description: Provides innervation to the muscles of the neck and lower portion of the face.

Clinical Considerations

• Facial Paralysis: Damage to the facial nerve can result in facial paralysis, affecting the ability to control facial muscles and causing drooping of the face on the affected side.
• Bell's Palsy: Bell's palsy is a condition characterized by sudden onset facial paralysis due to inflammation or compression of the facial nerve.

Summary

• The facial nerve plays a crucial role in controlling facial expression and conveying taste sensation from the anterior two-thirds of the tongue.
• Its branches supply various muscles and glands in the face, contributing to facial movements and sensory perception.
• Understanding the anatomy and function of the facial nerve is essential for clinical practice and examination preparation.

Trigeminal Nerve

Introduction to Trigeminal Nerve

• Definition: The trigeminal nerve (CN V) is the fifth cranial nerve responsible for sensory innervation to the face and motor innervation to the muscles of mastication.

A. Ophthalmic Branch

• Route: Emerges through the Superior Orbital Fissure.

Branches of the Ophthalmic Branch

1. Frontal Nerve
   • Innervation: Scalp, forehead, upper eyelid, conjunctiva, cornea.
     • Additional Note: Innervates the nose (including the tip) and frontal sinuses.

B. Maxillary Branch

• Route: Passes through the Foramen Rotundum.

Branches of the Maxillary Branch

1. Infraorbital Nerve
   • Innervation: Cheek, upper lip, upper teeth, gums.
     • Additional Note: Innervates nasal mucosa, palate, roof of the pharynx, maxillary, ethmoid, and sphenoid sinuses.

C. Mandibular Branch

• Route: Passes through the Foramen Ovale.

Function of the Mandibular Branch

• Innervation: Lower lip, lower teeth, gums, chin, jaw (excluding angle of the jaw).

Branches of the Mandibular Branch

i) Lingual Nerve

• Innervation: Anterior 2/3 of the tongue.

ii) Inferior Alveolar Nerve

• Innervation: Lower teeth, gums.

iii) Auriculotemporal Nerve

• Innervation: Vulnerable to injury during tempomandibular surgery, leading to loss of sensation around the auricle and skin surrounding the ear.

iv) Buccal Nerve

• Innervation: Mucous membranes of the buccal cavity.

v) Mental Nerve

• Innervation: Chin, lower lip (mucous membrane); a branch of the inferior alveolar nerve.

Clinical Considerations

• Sensory Loss: Damage to the trigeminal nerve branches can result in sensory loss in the corresponding areas of the face.
• Temporomandibular Surgery: Care must be taken to avoid injury to the auriculotemporal nerve during temporomandibular surgery to prevent sensory deficits around the ear.

Summary

• The trigeminal nerve has three main branches: ophthalmic, maxillary, and mandibular, each with specific sensory innervation to different regions of the face.
• Understanding the anatomy and function of the trigeminal nerve branches is important for diagnosing and managing conditions involving facial sensation and motor function.

Specific Nerve Damage

1. T4: Level of Nipples
2. T10: Umbilicus
3. C4: Over Acromioclavicular Joint
4. Diaphragmatic Nerve (Phrenic Nerve):
   • Often irritated in peritonitis, causing shoulder tip pain.
5. Claw Hand:
   • Sign of Ulnar Nerve Damage.
   • Typically affects the little finger and ring finger.
6. Wrist Drop:
   • Sign of Radial Nerve Damage.
7. Carpal Tunnel Syndrome:
   • Sign of Median Nerve Damage.
   • Compression occurs at the level of the wrist.
   • Diagnosis can be made using Phalen’s Test or Tinel Test.
   • Treatment options include conservative measures or surgical intervention (Incision of the flexor retinaculum).
8. Foot Drop:
   • Can be caused by both Peroneal Nerve and Sciatic Nerve damage.
9. Sciatica:
   • Describes lower back pain radiating down the leg to the knee or below.

These specific nerve damages and associated signs can provide valuable diagnostic clues for clinicians evaluating patients with neurological symptoms.

Key Reflexes and Innervation

1. Supinator Reflex

   • Nerve : Radial Nerve
   • Root Value : C6
   • Function : Assesses the integrity of the radial nerve and spinal cord segments, particularly C6.

2. Triceps Reflex

   • Nerve : Radial Nerve
   • Root Value : C7
   • Function : Tests reactions of the triceps muscle; a normal response involves extension of the forearm.

3. Biceps Reflex

   • Nerve : Musculocutaneous Nerve
   • Root Value : C5
   • Function : Assists in evaluating C5 and the function of the biceps brachii; a normal response causes a contraction of the biceps.

4. Finger Reflex

   • Nerves : Median & Ulnar Nerves
   • Function : Evaluates both sensory and motor function of the hand, particularly finger flexors and extensors.

5. Knee Reflex

   • Nerve : Femoral Nerve
   • Root Values : L3, L4
   • Function : Tests the knee extensor mechanism; a normal response is an extension of the knee upon patellar tapping.

6. Ankle Reflex

   • Nerve : Primarily S1, with contributions from S2
   • Function : Evaluates the plantar flexor muscles of the foot; a normal response results in the foot being pushed downward.

Other Related Information

• Reflex Arch : Each reflex involves an afferent sensory neuron and an efferent motor neuron, creating a pathway for the reflex response to occur without direct involvement of the brain.

• Importance of Reflex Testing : Reflexes are critical in diagnosing neurological conditions. The absence or abnormal responses can indicate nerve damage, spinal cord injury, or other neurological impairments.

• Clinical Relevance :

  • Knee Reflex (Patellar Reflex): Commonly tested in neurological exams.
  • Ankle Reflex (Achilles Reflex): Also often assessed; important for lower limb neurological evaluations.

Anatomical Landmarks

• Transpyloric Plane : This plane is significant in identifying abdominal organs and is typically located at the L1 vertebra level in adults.
• Gallbladder Fundus : The fundus of the gallbladder is situated at the ninth costal cartilage level and lies between the transpyloric plane and the vertebra.
• Coeliac Trunk : This major artery branches from the abdominal aorta and is responsible for the blood supply to the liver, stomach, and spleen.
• Superior Mesenteric Artery : It branches from the aorta at the L1 vertebra level and supplies blood to a large portion of the intestines.
• Termination of Spinal Cord in Adults : The spinal cord typically terminates at the lower border of L1 in adults.
• Hilum of Kidney : This structure is located roughly at the L1-L2 vertebrae level and is the entry point for blood vessels and nerves into the kidney.

Key Associations

• The L1 vertebra is a critical reference point for locating various abdominal structures and the termination of the spinal cord.

These points are essential for understanding the human anatomy concerning the abdominal region and the corresponding neurovascular structures.

Diaphragmatic Openings (VOA)

• V: Inferior Vena Cava - located at T8
• O: Oesophagus - located at T10
• A: Aorta - located at T12 (with the umbilicus corresponding to L3-4)

Scapula Anatomy

• Spine of Scapula: Corresponds to T3
• Inferior Angle of Scapula: Corresponds to T7 Spinous Process

Spinal Cord Extension

• Adults: Extends to the Lower border of L1
• Children: Extends to the Lower/Upper border of L3

Key Anatomical Reference Points

• L1 :
  • Transpyloric Plane
  • Gallbladder Fundus
  • Coeliac Trunk
  • Superior Mesenteric Artery
  • Termination of Spinal Cord in Adults
  • Hilum of Kidney

This collection of landmarks is essential for clinical assessments and understanding the anatomy of the thorax and abdomen, as well as for identifying potential areas affected by injuries or trauma.

Anatomical References

1. Stellate Ganglion : C6-7
2. Heart Position : T5-8
   • Apex of Heart :
     • 5th Intercostal Space (Midclavicular Line)
     • 5th Intercostal Space (Mid Axillary Line) - Drain position for pleural tap
3. Gallbladder Fundus : 9th Costal Cartilage
4. Manubrium : T3-4
5. Xiphoid Process : T10
6. Kidney Position : T12-L3
7. Transpyloric Plane : L1
8. Subcostal Plane : L2
9. Iliac Crest : L4
10. Intertubercular Plane : L5
11. ASIS, PSIS : S2

This table includes important anatomical landmarks corresponding to specific vertebral levels and locations within the human body, useful for medical students and professionals in anatomy and clinical medicine.