Medical knowledge is constantly changing As new information becomes available, changes in treatment, procedures, equipment and the use of drugs become necessary The author and the publisher have, as far as it is possible, taken care to ensure that the information given in this text is accurate and up to date However, readers are strongly advised to confirm that the information, especially with regard to drug usage, complies with the latest legislation and standards of practice - - BDChaurasia's HUMAN ANATOMY Regional and Applied Dissection and Clinical Volume 4/e Copyright © Publishers and Author ISBN : 81-239-1156-4 Fourth Edition: 2004 Reprinted: 2005, 2006 First Edition: 1979 Reprinted: 1980, 1981, 1982, 1983, 1984, 1985, 1986, 1987, 1988 Second Edition: 1989 Reprinted: 1990, 1991, 1992, 1993, 1994 Third Edition: 1995 Reprinted: 1996, 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005 Editor: The fourth edition has been revised by Dr Krishna Garg, Ex-Professor and Head, Department of Anatomy, Lady Hardinge Medical College, New Delhi All rights reserved No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system without permission, in writing, from the author and the publishers Production Director: Vinod K Jain Published by: Satish Kumar Jain for CBS Publishers & Distributors, 4596/1A, 11 Darya Ganj, New Delhi - 110 002 (India) E-mail: cbspubs@vsnl.com Website : www.cbspd.com Branch Office: Seema House, 2975, 17th Cross, K.R Road, Bansankari 2nd Stage, Bangalore - 560070 Fax : 080-26771680 • E-mail : cbsbng@vsnl.net Typeset at: CBS P&D Typesetting Unit Printed at: S.D.R Printers, Delhi -110 094 Preface to the Fourth Edition I n July 1996, I had gone to the office of CBS Publishers and Distributors to hand over the manuscript of the third edition of our Textbook of Histology, when Mr SK Jain, Managing Director of CBS, requested me to shoulder the responsibility of editing the three volumes of their extremely popular book BD Chaurasia's Human Anatomy, the third edition of which was earlier edited by respected Prof Inderbir Singh This was a 'God given gift' which I accepted with great gratitude This had also been the wishful thinking of my son, now a nephrologist in the US The three volumes of the fourth edition of this book are extremely student-friendly All out efforts have been made to bring them closer to their hearts through serious and subtle efforts Various ways were thought of, which I discussed with my colleagues and students, and have been incorporated in these volumes One significant method suggested was to add 'practical skills' so that these volumes encompass theoretical, practical and clinical aspects of various parts of human body in a functional manner The paragraphs describing human dissection, printed with blue background, provide necessary instructions for dissection These entail identifying structures deeper to skin which need to be cut and separated to visualise the anatomic details of various structures Dissection means patiently clearing off the fat and fasciae around nerves, blood vessels, muscles, viscera, etc so that their course, branches and relations are appreciated This provides the photogenic memory for the 'doctor-in-making' First year of MBBS course is the only time in life when one can dissect at ease, although it is too early a period to appreciate its value Good surgeons always refresh their anatomical knowledge before they go to the operation theatre Essential part of the text and some diagrams from the first edition have been incorporated glorifying the real author and artist in BD Chaurasia A number of diagrams on ossification, surface marking, muscle testing, in addition to radiographs, have been added The beauty of most of the four-colour figures lies in easy reproducibility in numerous tests and examinations which the reader can master after a few practice sessions only This makes them user-friendly volumes Figures are appreciated by the underutilised right half of the cerebral cortex, leaving the dominant left half for other jobs in about 98% of right-handed individuals At the beginning of each chapter, a few introductory sentences have been added to highlight the importance of the topic covered A brief account of the related histology and development is put forth so that the given topic is covered in all respects The entire clinical anatomy has been put with the respective topic, highlighting its importance The volumes thus are concise, comprehensive and clinically-oriented Various components of upper and lower limbs have been described in a tabular form to revise and appreciate their "diversity in similarity" At the end of each section, an appendix has been added wherein the segregated course of the nerves has been aggregated, providing an overview of their entire course These appendices also contain some clinicoanatomical problems and multiple choice questions to test the knowledge and skills acquired Prayers, patience and perseverance for almost years have brought out this new edition aimed at providing a holistic view of the amazing structures which constitute the human anatomy There are bound to be some errors in these volumes Suggestions and comments for correction and improvement shall be most welcome: These may please be sent to me through e-mail at cbspubs@de!3 vsnl net, in KRISHNA GARG Excerptsfrom Preface tothe First Edition T he necessity of having a simple, systematized and complete book on anatomy has long been felt The urgency for such a book has become all the more acute due to the shorter time now available for teaching anatomy, and also to the falling standards of English language in the majority of our students in India The national symposium on "Anatomy in Medical Education" held at Delhi in 1978 was a call to change the existing system of teaching the unnecessary minute details to the undergraduate students This attempt has been made with an object to meet the requirements of a common medical student The text has been arranged in small classified parts to make it easier for the students to remember and recall it at will It is adequately illustrated with simple line diagrams which can be reproduced without any difficulty, and which also help in understanding and memorizing the anatomical facts that appear to defy memory of a common student The monotony of describing the individual muscles separately, one after the other, has been minimised by writing them out in tabular form, which makes the subject interesting for a lasting memory The relevant radiological and surface anatomy have been treated in separate chapters A sincere attempt has been made to deal, wherever required, the clinical applications of the subject The entire approach is such as to attract and inspire the students for a deeper dive in the subject of anatomy Gwalior February, 1981 The book has been intentionally split in three parts for convenience of handling This also makes a provision for those who cannot afford to have the whole book at a time it is quite possible that there are errors of omisSion and commission in this mostly single handed attempt I would be grateful to the readers for their suggestions to improve the book from all angles, I am very grateful to my teachers and the authors of numerous publications, whose knowledge has been freely utilised in the preparation of this book I am equally grateful to my professor and colleagues for their encouragement and valuable help My special thanks are due to my students who made me feel their difficulties, which was a great incentive for writing this book I have derived maximum inspiration from Prof Inderbir Singh (Rohtak), and learned the decency of work from Shri SC Gupta (Jiwaji University, Gwalior) i am deeply indebted to Shri KM Singhal (National Book House, Gwalior) and Mr SK Jain (CBS Publishers and Distributors, Delhi), who have taken unusual pains to get the book printed in its present form For giving it the desired get-up, Mr VK Jain and Raj Kamal Electric Press are gratefully acknowledged The cover page was designed by MrVasant Paranjpe, the artist and photographer Qf our college; my sincere thanks are due to him I acknowledge with affection the domestic assistance of Munne Miyan and the untiring company of my Rani, particularly during the odd hours of this work BDCHAURASIA Acknowledgements am grateful to Almighty for giving me the Iforopportunity to edit these three volumes, and further sustaining the interest which many a times did oscillate When I met Mr YN Arjuna, Publishing Director in CBS, in May 2003, light was seen at the end of the tunnel and it was felt that the work on the volumes could begin with definite schedule He took great interest in going through the manuscript, correcting, modifying and improving wherever necessary He inducted me to write an introductory paragraph, brief outlines of embryology and histology to make it a concise and complete textbook Having retired from Lady Hardinge Medical College within a fortnight of getting this assignment and having joined Santosh Medical College, Ghaziabad, my colleagues there really helped me I am obliged to Prof Varsha Katira, Prof.Vishram Singh, Dr Poonam Kharb, Dr Tripta Bhagat (MS Surgery), Dr Nisha Kaul and Ms Jaya They even did dissection with the steps written for the new edition and modified the text wherever necessary From 2000-03, while working at Subharti Medical College, Meerut, the editing of the text continued DrSatyam Khare, Associate Professor, suggested me to write the full course of nerves, ganglia, multiple choice questions, etc with a view to revise the important topics quickly So, appendices have come up at the end of each section I am grateful to Prof AKAsthana, Dr AKGarg and Dr Archana Sharma for helping me when required The good wishes of Prof Mohini Kaul and Prof Indira Bahl who retired from Maulana Azad Medical College; Director-Prof Rewa Choudhry, Prof Smita Kakar, Prof Anita Tuli, Prof Shashi Raheja of Lady Hardinge Medical College; Director-Prof Vijay Kapoor, Director-Prof JM Kaul, Director-Prof Shipra Paul, Prof RK Suri and Prof Neelam Vasudeva of Maulana Azad Medical College; Prof Gayatri Rath of Vardhman Mahavir Medical College; Prof Ram Prakash, Prof Veena Bharihoke, Prof Kamlesh Khatri, Prof Jogesh Khanna, Prof Mahindra Nagar, Prof Santosh Sanghari of University College of Medical Sciences; Prof Kiran Kucheria, Prof Rani Kumar, Prof Shashi Wadhwa, Prof Usha Sabherwal, and Prof Raj Mehra of All India Institute of Medical Sciences and all my colleagues who have helped me sail through the dilemma I am obliged to Prof DR Singh, Ex-Head, Department of Anatomy, KGMC, Lucknow, for his Delhi April 2004 constructive guidance and Dr MS Bhatia, Head, Department of Psychiatry, UCMS, Delhi, who suggested the addition of related histology It is my pleasure to acknowledge Prof Mahdi Hasan, Ex-Prof & Head, Department of Anatomy, and Principal, JN Medical College, Aligarh; Prof Veena Sood and Dr Poonam Singh of DMC, Ludhiana; Prof S Lakshmanan, Rajah Muthiah Medical College, Tamil Nadu; Prof Usha Dhall and Dr Sudha Chhabra, Pt BD Sharma PGIMS, Rohtak; Prof Ashok Sahai, KG Medical College, Lucknow; Prof Balbir Singh, Govt Medical College, Chandigarh; Prof Asha Singh, ExProf & Head, MAMC, New Delhi; Prof Vasundhara Kulshrestha, SN Medical College, Agra; and Dr Brijendra Singh, Head, Department of Anatomy, ITS Centre for Dental Science and Research, Muradnagar, UP, for inspiring me to edit these volumes I am obliged to my mother-in-law and my mother whose blessings have gone a long way in the completion of this arduous task My sincere thanks are due to my husband Dr DP Garg, our children Manoj and Rekha, Meenakshi and Sanjay, Manish and Shilpa, and the grandchildren, who challenged me at times but supported me all the while The cooperation extended by Rekha is much appreciated I am deeply indebted to Mr SK Jain Managing Director of CBS, Mr VK Jain, Production Director, Mr BM Singh and their team for their keen interest and all out efforts in getting the volumes published I am thankful to Mr Ashok Kumar who has skillfully painted black and white volumes into coloured volumes to enhance clarity Ms Deepti Jain, Ms Anupam Jain and MsParul Jain have carried out the corrections very diligently Lastly, the job of pagination came on the shoulders of MrKarzan Lai Prashar who has left no stone unturned in doing his job perfectly Last, but not the least, the spelling mistakes have been corrected by my students, especially Ms Ruchika Girdhar and Ms Hina Garg of 1st year Bachelor of Physiotherapy course at Banarsidas Chandiwala Institute of Physiotherapy, New Delhi, and Mr Ashutosh Gupta of st Year BDS at ITS Centre for Dental Science and Research, Muradnagar May Almighty inspire all those who study these volumes to learn and appreciate CLINICAL ANATOMY and DISSECTION and be happy and successful in their lives KRISHNA GARG _ Contents Preface to the Fourth Edition Preface to the First Edition (excerpts) vii ix Section LOWER LIMB Introduction tO the Lower Limb Attachments and relations Parts of the lower limb Related terms Bones of the Lower Limb The hip bone Side determination Ilium Attachments on ilium Pubis g Attachments and relations 13 Acetabulum 15 Ossification 15 Femur 16 Side determination 16 Anatomical position 16 Attachments on the femur 19 Clinical anatomy 22 Patella 22 Side determination 22 Attachments 23 Clinical anatomy 23 Tibia 23 Side determination 23 Attachments on the tibia 26 Fibula 29 Side determination 30 Attachments and relations 30 Clinical anatomy 33 Bones of the foot 33 Talus 34 Side determination 34 Attachments on the talus 36 Calcaneus 36 Side determination 36 37 Navicular bone 38 Attachments 38 Cuneiform bones 39 Common features 39