Part 2 book “Clinical anatomy - A problem solving approach” has contents: Vertebral column, cranial meninges, middle meningeal artery and pituitary gland, development of central nervous system, white matter of cerebrum, olfactory nerve and pathway, vestibulocochlear nerve,… and other contents.
S E C T I O N VERTEBRAL COLUMN AND SPINAL CORD, CRANIAL CAVITY AND BRAIN 53 DEEP MUSCLES OF BACK Chapter Contents ♦♦ DEEP MUSCLES OR INTRINSIC MUSCLES OF BACK • Nerve Supply • Classification of Postvertebral Muscles • Erector Spinae or Sacrospinalis • Suboccipital Triangle • Vertebral Artery • Vertebral Vein • Subclavian Steal Syndrome • Vertebral Angiography Nerve Supply The splenius consists of splenius capitis and splenius cervicis muscles i The splenius capitis takes origin from the lower half of the ligamentum nuchae and spines of the seventh cervical and upper three to four thoracic vertebrae It is inserted into the mastoid process and the lateral third of superior nuchal line (Note: The splenius capitis appears in the upper part of the floor of the posterior triangle of the neck) ii The splenius cervicis takes origin from the spines of third to sixth thoracic vertebrae and is inserted into the posterior tubercles of the transverse processes of the upper two to three cervical vertebrae All deep muscles of back receive nerve supply from the dorsal rami of the spinal nerves Actions DEEP MUSCLES OR INTRINSIC MUSCLES The deep or intrinsic muscles of the back are a complex group of muscles extending from the sacrum to the skull They are collectively called the postvertebral muscles and are very well developed in human being In upright position the weight falls in front of the vertebral column because the line of gravity passes in front of it Therefore, the postural tone of the postvertebral muscles is responsible for maintaining the normal curvatures of the vertebral column Classification of Postvertebral Muscles From superficial to deeper level the muscles are classified in four groups: Splenius muscle is the one in which the muscle fibers are directed upward and laterally ii Erector spinae group of muscles are those in which the muscle fibers run vertically iii Transversospinalis group is the one in which muscle fibers run upward and medially iv Interspinales and intertransversarii are short segmental and the deepest muscles Splenius Muscles The word splenius means a bandage This muscle wraps round the other deep muscles of the neck like a bandage Acting together the muscles of the two sides draw the head directly backward Acting alone the muscle turns the head laterally (lateral flexion) Erector Spinae or Sacrospinalis This is a very long and complex muscle, composed of as many as nine muscles It extends from the sacrum to the cranium The posterior layer of thoracolumbar fascia covers its thoracolumbar part Origin The origin of erector spinae is U-shaped The lateral limb of the U is attached to the posterior segment of iliac crest and lateral sacral crest Its medial limb is attached to the median crest of sacrum, lumbar and lower thoracic spines and their supraspinous ligaments Section 05 474 Vertebral Column and Spinal Cord, Cranial Cavity and Brain In the lumbar region the muscle expands to form a thick fleshy mass, which can be felt in the living This fleshy mass divides into three columns in the upper lumbar region Each column is composed of three muscles The following columns are arranged from lateral to medial side: i Iliocostocervicalis consists of iliocostalis lumborum, iliocostalis thoracis and iliocostalis cervicis ii Longissimus consists of longissimus thoracis, longissimus cervicis and longissimus capitis iii Spinalis consists of spinalis thoracis, spinalis cervicis and spinalis capitis These various muscles are inserted into the spines and transverse processes of thoracic and cervical vertebrae, lower ribs and in the cranium The longissimus column alone is attached to the skull The longissimus capitis is attached to the mastoid process Semispinalis Capitis Actions Boundaries (Fig 53.1) i When the right and left muscles act together they produce extension of vertebral column from the forward flexed position ii Acting singly the muscles cause lateral flexion of the trunk and rotation to the same side The suboccipital triangle has superomedial, superolateral (lateral) and inferomedial (inferior) boundaries i The superomedial boundary is formed by rectus capitis posterior major and minor muscles ii The superolateral boundary is formed by obliquus capitis superior muscle iii The inferomedial boundary is formed by obliquus capitis inferior muscle iv The roof is formed by semispinalis capitis muscle The greater occipital nerve winds round the obliquus capitis inferior and pierces the muscular roof to enter the posterior quadrant of scalp The occipital artery crosses the roof of the triangle to reach the posterior quadrant of the scalp v The floor is composed of posterior atlanto-occipital membrane and posterior arch of atlas Clinical insight The erector spinae is an important postural muscle If it becomes weak in old age or in persons, who not take adequate exercise, the vertebral column tends to bend forward, which may predispose to disc prolapse Exercise and brisk walking help in maintaining the tone of erector spinae Testing Function of Erector Spinae The power of erector spinae is tested by asking the patient to lift shoulders and head against resistance while lying in prone position Transversospinalis The muscles in this group lie deeper to the erector spinae Their fibers run medially and upward from the transverse processes to the adjacent spinous processes They help in stabilizing the vertebrae during movements This group consists of three subgroups The semispinalis subgroup consists of semispinalis thoracis, semispinalis cervicis and semispinalis capitis Besides this, there are multifidus and rotators They are supplied by dorsal rami of cervical and thoracic spinal nerves Collectively, they are the postural muscles But they are extensors, lateral flexors and rotators of the head and vertebral column The semispinalis capitis is situated in the back of the neck under cover of the splenius capitis It may appear in the floor of the posterior triangle of the neck and it forms the roof of the suboccipital triangle at the back of the neck The muscle takes origin from the tips of transverse processes of the upper six thoracic vertebrae and from the articular processes of the fourth, fifth and sixth cervical vertebrae It travels upwards for insertion into medial part of the area between the superior and inferior nuchal lines on the occipital bone It is supplied by suboccipital nerve Suboccipital Triangle The suboccipital triangle is situated in the back of the neck under cover of semispinalis capitis Contents i Vertebral artery ii Suboccipital plexus of veins iii Dorsal ramus of first cervical nerve (suboccipital nerve) Suboccipital Muscles i The rectus capitis posterior major muscle originates from the spine of axis by a pointed tendon and is inserted into the squamous part of occipital bone below the lateral part of the inferior nuchal line ii The rectus capitis posterior minor muscle originates by a small pointed tendon from the tubercle on the posterior arch of atlas and is inserted into the medial part of squamous part of occipital bone below the inferior nuchal line Deep Muscles of Back 475 Chapter 53 Fig 53.1: Boundaries and contents of right suboccipital triangle [Note that on left side, great auricular and lesser occipital nerves (the cutaneous branches of cervical plexus) and greater occipital and third occipital nerves (the cutaneous branches of dorsal rami of cervical nerves) are shown] iii The obliquus capitis superior muscle takes origin by tendinous fibers from the superior surface of the transverse process of atlas and is inserted into the lateral part of squamous part of occipital bone between the superior and inferior nuchal lines iv The obliquus capitis inferior muscle takes origin from the spine of the axis and is inserted into the posterior aspect of the transverse process of atlas Actions The rectus capitis superior major and minor muscles are the extensors of the head at the atlanto-occipital joints The oblique muscles rotate the head and the atlas on the axis at atlantoaxial joints Clinical insight Cisternal Puncture This is a procedure to approach the cisterna magna in the posterior cranial fossa through suboccipital triangle and the foramen magnum for obtaining a CSF sample Vertebral Artery (Fig 53.2) The vertebral artery is a branch of the first part of the subclavian artery at the root of the neck The vertebral artery has a very long course It is divided into following four parts: Fig 53.2: Origin, course and termination of vertebral artery Section 05 476 Vertebral Column and Spinal Cord, Cranial Cavity and Brain The first part extends from its origin to the foramen transversarium of sixth cervical vertebra The second part is located within the foramina in the transverse processes of upper six cervical vertebrae The third part extends from the foramen transversarium of atlas to the foramen magnum It is located in the suboccipital triangle on the superior surface of the posterior arch of atlas The fourth part is its intracranial part The termination of the vertebral arteries is unique in that the arteries of the two sides unite at the pontomedullary junction to form the basilar artery in the midline unite to form a single basilar artery in the midline at the pontomedullary junction Relations of First Part Intracranial Branches The first part lies in the scalenovertebral triangle (Fig 44.10) i Anteriorly, it is related to the vertebral vein and the inferior thyroid artery It is crossed by the thoracic duct on the left side below the loop of the inferior thyroid artery ii Posteriorly, it is related to the ventral rami of seventh and eighth cervical nerves The stellate ganglion is partly behind the vertebral artery Relations of Second Part i The second part is related posteriorly to cervical ventral rami in the intervals between the transverse processes of the adjoining vertebrae and is surrounded by the vertebral venous plexus and the sympathetic fibers (derived from the stellate ganglion) ii At the foramen transversarium of the axis, the vertebral artery takes a wide curve to turn laterally and upward to reach the foramen transversarium of atlas This wide curve (loop) is necessary so that the artery is not compressed every time the head is laterally flexed and it also helps in reducing the intracranial arterial pressure Extracranial Branches (Fig 53.2) i The spinal branches arise from the second and third parts and enter the intervertebral foramina to take part in the supply the contents of the vertebral canal The radicular branches of the spinal arteries supply the nerve roots (refer to chapter 55) ii The muscular branches supply the deep muscles in the upper part of the neck and form rich anastomoses with adjacent arteries i ii iii iv Posterior spinal Anterior spinal Medullary branches Posterior inferior cerebellar artery (PICA) Vertebral Vein The venous plexus surrounding the vertebral artery in the suboccipital triangle accompanies the second part of the vertebral artery and enters the scalenovertebral triangle to become the vertebral vein, which opens into the brachiocephalic vein of its side Vertebral Angiography (Fig 53.3) It is a radiological procedure to visualize the vertebral artery and its branches Relations of Third Part The third part emerges from the foramen transversarium of atlas and turns medially to enter the suboccipital triangle (Fig 53.1), where it grooves the superior surface of the posterior arch of the atlas and is closely related to the dorsal ramus of the first cervical nerve (suboccipital nerve) A rich venous plexus surrounds the vertebral artery in the suboccipital triangle It leaves the triangle by passing medially through the gap between the lateral margin of posterior atlanto-occipital membrane and the lateral mass of atlas Relations of Fourth Part The fourth part pierces the dura mater and enters the foramen magnum In the posterior cranial fossa the vertebral arteries course upward on the anterior aspect of the medulla oblongata The right and left vertebral arteries Fig 53.3: Digital subtraction angiogram (DSA) of vertebral arteries Deep Muscles of Back 477 Subclavian Steal Syndrome (Fig 53.4) If the subclavian artery is narrowed at its origin (from the arch of aorta or from the brachiocephalic trunk), the arterial supply of upper limb of that side is reduced The narrowed subclavian artery is filled with blood in the most unusual way The blood in the vertebral artery of the normal (opposite) side is shunted (at the point of the union of the two vertebral arteries inside the cranium) into the vertebral artery of the affected side There is reversal of blood flow in the vertebral artery of the affected side so that it is able to fill the subclavian artery beyond the stenosis This is likely to result in shortage of blood to the brainstem especially during times of increased demand of blood in the upper limb (e.g exercise ) of the affected side The syndrome presents as a combination of symptoms and signs due to ischemia of upper limb (pain, tingling, low blood pressure and weaker pulse) of normal side with symptoms of medullary insufficiency such as giddiness and fainting Stenosis of the subclavian artery can be confirmed by subclavian angiography Embryologic insight Fig 53.4: Subclavian steal syndrome As a result of narrowing (stenosis) of right subclavian artery proximal to origin of vertebral artery, the blood is siphoned from left to right vertebral artery across the midline at the site of their union There is reversal of blood flow in right vertebral artery Developmental Sources of Vertebral Artery i The first part of vertebral artery develops from the dorsal branch of the seventh intersegmental artery ii The second part from the postcostal anastomosis iii The third part develops from the spinal branch of the first cervical intersegmental artery iv The fourth part develops from the intracranial prolongation of the preneural anastomosis Chapter Clinical insight 53 54 VERTEBRAL COLUMN Chapter Contents ♦♦ ANATOMY OF VERTEBRAL COLUMN • Length of Vertebral Column • Number of Vertebrae • Parts of Vertebra • Intervertebral Joints • Boundaries of Intervertebral Foramina • Contents of Intervertebral Foramen • Vertebral Canal • Curvatures of Vertebral Column • Ligaments of Vertebral Column • Intervertebral Discs ANATOMY OF VERTEBRAL COLUMN The vertebral column (Fig 54.1) is also described by the terms such as the spine or spinal column or backbone It forms the central axis of the body It consists of a number of vertebrae joined to each other by a series of articulations The vertebral column is a flexible but strong pillar that supports the skull, trunk, and limbs It transmits body • • • • Craniovertebral Joints Lumbosacral Joint Sacrococcygeal Joint Movements of Vertebral Column • Arterial Supply • Venous Drainage weight to the lower extremity through the sacroiliac joints It provides a large site for attachment of the muscles of posture and locomotion The bodies of the vertebrae are active sites of hemopoesis throughout life The vertebral column encloses a canal, in which the spinal meninges, spinal cord and the cauda equina are protected Length of Vertebral Column The average length of the vertebral column in adult male is 70 cm and in adult female is 60 cm The vertebral bodies contribute the four-fifths and the intervertebral discs contribute one-fifth of the total length of the column Number of Vertebrae i ii iii iv Seven cervical Twelve thoracic Five lumbar Sacrum is a single bone composed of five fused sacral vertebrae v Coccyx is a single bone composed of four fused coccygeal vertebrae Parts of Vertebra Fig 54.1: MRI image of the sagittal section of the vertebral column to depict its anatomical components The vertebra consists of the centrum or body anteriorly and the vertebral arch posteriorly These two parts enclose a cavity called vertebral foramen The bodies of adjacent movable vertebrae articulate with each other by intervertebral discs The first cervical vertebra (atlas) has no body hence, there is no disc between the atlas and the second Vertebral Column 479 Chapter cervical (axis) vertebra The vertebral arch consists of two pedicles, two laminae which bear seven processes, namely, two pairs of articular processes (zygapophyses), one pair of transverse processes and a spinous process The pedicles connect the body to the laminae and bear the superior and inferior vertebral notches Embryologic insight Development Sources of Vertebra i The mesenchyme of the bilateral sclerotome (derived from somites) condenses around the notochord (Fig 54.2) ii The centrum of vertebra develops from the fusion of caudal half of cranial sclerotome and the cranial half of the succeeding sclerotome iii The anterior sclerotome forms the centrum whereas the posterior sclerotome forms the vertebral arch Fig 54.2: Developmental sources of vertebra and intervertebral disc Costal Elements The costal element is the anterior part of the vertebral arch of the developing vertebra It may form a rib or it may remain incorporated inside the transverse process of the definitive vertebra The true transverse process is the posterior part of the vertebral arch Cervical Vertebra The costal element forms major part of the transverse process (anterior root, anterior tubercle, costotransverse bar and posterior tubercle) Cervical Rib The costal element of the seventh cervical vertebra enlarges to form a cervical rib, which may be complete or incomplete or merely represented by a fibrous cord (Fig 24.2) Thoracic Vertebra The costal element forms the rib Lumbar Vertebra The costal element becomes the definitive transverse process Sacrum and Coccyx i The costal elements of the upper two to three pieces form the anterior part of the lateral mass of the sacrum ii In the coccygeal vertebrae, the costal elements are absent Congenital Anomalies of Vertebrae i Spina bifida results from the failure of fusion of the right and left centers of ossification of the vertebral arches If it is not associated with spinal cord defects it is called spina bifida occulta Occasionally, the defect in the vertebral arches is so large that the spinal meninges only or spinal meninges with spinal cord may protrude through it This causes a midline swelling in the back (Fig 54.3) If the meninges protrude it is called meningocele If the meninges and spinal cord protrude then it is known as meningomyelocele 54 Fig 54.3: Types of spina bifida defects (A) Spina bifida occulta; (B) Meningocele in which the pia-arachnoid protrude forming a sac filled with CSF; (C) Meningomyelocele in which pia-arachnoid with spinal cord protrude forming a sac; (D) Rachischisis in which neural tissue is exposed through the skin of back ii Hemivertebra is due to defective fusion of anterior sclerotome iii Spondylolisthesis is the anterior displacement of the vertebral column, usually at the lumbosacral articulation The fifth lumbar vertebra is in two pieces due to the defect in its pedicle This defect may result in stretching of S1 nerve roots causing symptoms like backache and root pain iv Sacrococcygeal teratoma (Fig 54.4) is a congenital condition in which the fetus is born with a swelling from the coccygeal vertebrae This tumor is composed of tissues from all the germ layers It originates from caudal end of primitive streak 480 Vertebral Column and Spinal Cord, Cranial Cavity and Brain ii Inferiorly by the superior vertebral notch of the vertebra below iii Anteriorly by the intervertebral disc and adjacent vertebral bodies iv Posteriorly by the capsule of the facet joint Section 05 Contents of Intervertebral Foramen i Spinal nerve and its recurrent meningeal branch ii Spinal branches of regional arteries iii Intervertebral veins In narrowing or stenosis of the foramen, the spinal nerve is compressed or irritated producing shooting pain A few causes of stenosis are disc prolapse, osteoarthritis of facet joints and osteophytes (bony spurs) Vertebral Canal Fig 54.4: Sacrococcygeal teratoma in a new born The body and the vertebral arch together enclose the vertebral foramen In the articulated column, the vertebral foramina of all the vertebrae make up the vertebral canal Extent Know More Variations i The sacralization of the fifth lumbar vertebra is the condition in which the fifth lumbar vertebra fuses with the sacrum reducing the number of movable vertebrae to twenty-three ii The lumbarization of first sacral vertebra is a condition in which the first sacral vertebra separates from the sacrum and assumes the features of the lumbar vertebra In such cases, the number of movable vertebrae is increased to twenty-five iii The occipitalization of atlas is a condition in which atlas is fused with occipital bone Intervertebral Joints i The joints between the bodies of adjacent vertebrae (intervertebral joints) are the secondary cartilaginous joints or symphyses ii The zygapophyseal or facet joints between the articular processes of adjacent vertebrae are synovial joints iii The laminae of adjacent vertebrae are connected by ligamenta flava Hence, the joints between laminae are called vertebral syndesmoses Boundaries of Intervertebral Foramina i Superiorly by the inferior vertebral notch of the vertebra above Superiorly, the cervical vertebral canal is continuous with the posterior cranial fossa through the foramen magnum Inferiorly, the lumbar vertebral canal is continuous with sacral canal The caudal opening of the sacral canal is the sacral hiatus Shape In the cervical and lumbar regions, which exhibit free mobility the vertebral canal is large and triangular In the thoracic region, where the movement is restricted it is small and circular Contents The spinal cord and its three meninges lie in the vertebral canal up to the level of the lower border of L1 vertebra Below this level, the lumbar and sacral vertebral canal contain the cauda equina, arachnoid mater and dura mater The arachnoid mater and the dura mater cover the cauda equina up to the lower border of sacral second vertebra, beyond which the sacral canal contains the filum terminale, fifth sacral and coccygeal nerve roots, which exit via the sacral hiatus Curvatures of Vertebral Column (Fig 54.5) In the intrauterine life, the vertebral column has forward concavity because the fetus lies in the position of universal flexion After birth, the vertebral column shows two types of curvatures i The primary curvature with forward concavity is retained in the thoracic and sacral parts 944 Clinical Anatomy (A Problem Solving Approach) Embryo 45f of brachial artery and elbow anastomosis Embryoblast 39f 127f Embryogenesis 39f of femoral artery 850f Embryological of trachea continuity with larynx 212f basis of aberrant right subclavian artery External 247f acoustic meatus 447 remnants in male 755 appearance of palm 160 remnants inside prostate 763 cardiac massage 194 Embryonic disc 43f carotid artery 377 Endoderm 40, 41f ear 446 Endodermal cloaca 656 ear, middle ear and internal ear 446f Endolymphatic duct and sac 457 features of Enlargements of spinal cord 488 eyelids 334 Entry into thorax 618 right and left lungs 220 Ependymal cells 17 skull 303 Ependymoma 538 spleen and visceral relations 701f Epidermis 31f genitalia in indifferent stage of Epispadias in a boy 791f development 788 Epithalamus 542 iliac artery 717 Epithelial tissue jugular vein 351 Equivalent terms for functional and surgical oblique abdominis 640 hepatic segments 695t opening of fistula 783 Erb’s piles 782 palsy 101, 112 Extra-abdominal parts of reproductive organs in male 759f point 186 Erector spinae or sacrospinalis 473 Extracellular synthesis of collagen 11 Esophageal plexus 285 Extracranial 615 Esophagus 286 course 607, 617, 622 Ethmoidal and distribution of facial nerve 333f bone 313 of facial nerve 332 sinuses 428 of spinal part 620 Eustachian tube 446 Extradural hemorrhage 507 Events in development of heart 238 Extraembryonic mesoderm 41f Examination of Extrahepatic anterior axillary lymph nodes 91 course 708 ovary 766 parts 697 Extra-mastoidal sites of air cells 454 rectum in a patient 748 Examples of Extraocular muscles 401 Extraperitoneal structures in true pelvis 737 commissural fibers 562 Extrinsic muscles 416 long association fibers 562 Eyeball 406 projection fibers 564 Exit of Eyelids 334 pelvis 863 branches of facial nerve from parotid gland F 341f contents from femoral triangle 847 Face 323 neurovascular contents 133 Facial spinal nerves 489 artery 327 structures from gland 340 muscles and expressions 332 Exposure of axilla during mastectomy 92f nerve 605 Expressions produces by different facial paralysis 608 muscles 332f processes 323 Extensor vein 328 carpi radialis brevis 147 vessels to submandibular salivary gland 362f digitorum brevis 912 Factors facilitating venous return 839 digitorum longus 895 Falciform ligament 658 hallucis longus 895 False ligaments 750 retinacula 904 Falx cerebri and tentorium cerebelli 501f retinaculum 158 Fascia tendons on dorsum of hand 160f bulbi (tenon’s capsule) 406 Extent of pelvic diaphragm 739 and parts of axillary artery 103f transversalis 645 Fascial boundaries of urogenital triangle 777 capsule 339, 361, 728 capsule and surfaces of submandibular salivary gland 361f compartments of palm 162 roof 349 Fasciculus proprius 496 Fate of components of cardiac tube and pericardial coelom 238 fetal shunts and umbilical blood vessels 248 mesenteries of midgut and hindgut 656 mesonephric and paramesonephric ducts in female 759f paramesonephric ducts in male 756f müllerian eminence 759 primitive streak 41 right and left venous valves guarding sinuatrial orifice 240f sinus venosus 239, 239f Fatty capsule 727 Faucial tonsil 435 Faulty myelination 17 Features of anterior cranial fossa 309 anterior surface of liver 691f floor of fourth ventricle 538f hand 159 inner surface of mandible 315f laryngopharynx in posterior view 437f medullary part 538 middle cranial fossa 310 norma basalis 307f norma frontalis 304f norma lateralis 305f oral cavity and oropharynx direct inspection 414f pontine part 537 posterior cranial fossa 311 spinal cord in a cross-section 490f supraspinatus 109 typical rib viewed inferior aspect 195f Features on floor of mouth and ventral surface of tongue 415f walls of middle ear 449f Features visible at base of brain 517 Female bony pelvis seen front 634f breast 87 external genitalia 787, 788f reproductive organs 757 Femoral angiogram normal right femoral artery and narrowed 851f artery 850 ligation 848 nerve 715, 849 Index 945 pulse 850 sheath 845 and contents 846f triangle 846 vein 852 Femur 822 Fenestrated capillaries 27 Fertilization 38 Fetal circulation 246, 247f membranes 44 skull 311, 311f Fiber composition 565 Fibrocartilage 19 Fibrous capsule 115, 135, 156, 394, 872, 883, 908 and synovial membrane of hip joint 873f Fibrous flexor sheath 161 layer 408 pericardium 250 skeleton of heart 268 after removal of atria 268f skeleton, conducting tissue and nerve supply of heart 268 Fibula 828 Fibular collateral ligament 885 Fifth lumbar vertebra 631 Figure of 8-bandage to immobilize clavicle 73f First carpometacarpal joint 172 cervical vertebra 318f posterior intercostal artery 196f rib 196 shunt in liver 247 Fissures 220 Flexion and extension 875 Flexor digiti minimi brevis 917 retinaculum 157, 905 Floor 424 of mouth 415 rhomboid fossa 537 Folding of embryonic disc 44 Fontanelles 312 of fetal skull 312f Foot 835, 911 Foramina in hard palate 420 Forced expiration 235 inspiration 235 Forearm 139 Formation of accessory nerve 620 basilic vein 123 bilaminar embryonic disc 40 branches of cervical plexus 381f cephalic vein 122 connections of MLF 529f course and termination of internal cerebral veins 560f ophthalmic veins 406f embryonic mesenteries 655 midgut loop 655 neural tube (neurulation) 43 notochord 42 portal vein and presence of parallel streams of blood in portal vein 708f rectus sheath three levels 643f roof 424 superficial veins from dorsal venous arch 122f termination of external jugular vein 351f tributaries and termination of brachiocephalic veins 277f internal jugular vein 380f Fourth ventricle 536 Fractures of axis 319 bones of foot 832 bones of leg 829 scaphoid 81 bone 81f seventh cervical vertebra 485f shaft of femur 825 Froment’s sign 178 Front of leg 835 Frontal bone 313 nerve 404 sinus 427 Frontonasal process 323 Full-term fetus in immensely enlarged uterus 74f Function of areas of brodmann on medial surface of left cerebral hemisphere 552f superolateral surface of left cerebral hemisphere 552f areas of cerebral cortex 552 classification of cranial nerve nuclei in brainstem 597f neurons in developing brain 514 components and branches of facial nerve 606f correlation to histology 729 fetal kidney 725 importance of hippocampus 573 pleural cavity 218 sensory nuclei 602 JG complex 730 lobes 694 of cerebellum 533 segments of liver on anterior surface 694f Functions of arches 923 basement membrane fontanelles 312 lymphatic tissue 28 nasal cavity 423 peritoneum 658 skin 30 Fundus 40f, 667 Further development of cardiac tube 239 G Galea aponeurotica 320 Gall stones 700 Gallbladder 697 Gametogenesis 36 Ganglion of wrist joint 157 Gangrene of foot and toes to arterial insufficiency 913f Gap junction (nexus) Gastric banding to separate small pouch of stomach for receiving food 672f orifices 667 pathology gastroscope 670f Gastrophrenic ligament 669 Gastroscopic of normal mucosa of stomach 670f Gastrosplenic ligament 669 Gastrulation 42f Gemelli 859 General disposition of viscera 653 embryology and genetics 36 layout of arteries 26 somatic efferent 203 visceral afferent 203 visceral efferent 203 Genetic diseases to gene mutation 48 disorders of collagen synthesis 11 factors and congenital anomalies 47 Genicular anastomosis 880 Geniculate ganglion 607 Geniohyoid muscle 360 Genitofemoral nerve 714 Giemsa 50 Girdle joints 113 Glands of skin 32 Glandular epithelium Glenohumeral ligaments 116 and coracoacromial ligament 116f Globus hystericus 432 Glossopharyngeal nerve 614, 615f Gluteal region 834, 855 posterior compartment of thigh and sciatic nerve 855 Gluteus maximus 856 medius and minimus 857 Gooseflesh 32 Gracilis 867 Gravid uterus 774 Gray matter 490 and fiber tracts in subthalamus 544 and white matter 512 at sensory decussation 521 Great saphenous vein 836 Greater omentum 659, 669 Gridiron muscle splitting incision 648 Gross anatomy of female urethra 788 946 Clinical Anatomy (A Problem Solving Approach) kidneys 726 male urethra 790, 791f ovaries, fallopian tubes and uterus 766 testis, epididymis, vas deferens 759 appearance of dorsum 415 kidney in coronal section 729 placenta 47 features of auricle (pinna) 447 Grossly enlarged lymph nodes in neck cancer cheek 385f Ground substance 10 Growth in diameter of bone 21 Gustatory or taste pathways 419 Gynecomastia 93, 93f H Hallux valgus 924f Hand 159 of benediction 175f Head and neck 301 of femur 872 Heart 251 Height of arches of foot from ground 922f Hemiazygos vein 206, 278 Hepatic artery proper 705 Herniation of nucleus pulposus 482f Herniation of uncus 531 Herniation via foramen magnum 520 Hexagonal hepatic lobule 695f Hiatal or hiatus hernia 234 Highest intercostal vein 196f Hilum of kidney 727 Hip bone or innominate bone 817 joint or coxal joint 872 Hippocampal formation 573 Histogenesis of caudal part of neural tube to develop into spinal cord 513f Histological peculiarity 715 types of cartilage 18 Histology of arteries and veins 26 cerebellar cortex 534 Holandric or y-linked inheritance 48 Holden’s line 844f Horizontal extent 86 section through left eyeball showing three coats of eyeball 408f section to relations of right parotid gland 340f Hormones of suprarenal cortex 723 medulla 723 Horner’s syndrome 383 Humerus 75 Hunter’s canal 849 Hyaline cartilage 18 Hydrocephalus 570, 575 Hyoglossus muscle 359 Hyoid bone 317 Hyperabduction at girdle joints 118 Hypodermis or superficial fascia 33 Hypoglossal nerve 621 Hypospadias in a boy 790f Hypothalamic nuclei 543f Hypothalamus 543 Hypothenar muscles 167 I Ileocolic intussusception in patient 683f Iliacus muscle 713 Iliohypogastric and ilioinguinal nerves 714 Iliotibial tract or band 845 tract syndrome 845 Ilium 817 Illustration of ligaments attached to cervix uteri 772f Implantation 40f of blastocyst 39 Importance of anterior fontanelle 312 carina 212 lingual tonsils 416 Important relations of constrictor muscles 433 Impressions on mediastinal surface of left lung 223 right lung 222 Incisions related to rectus sheath 648 Indirect or oblique inguinal hernia 652 Individual cranial bones 312 Inferior colliculus 612 extensor retinaculum 905 hemiazygos vein 278 horn 569 hypogastric plexus 721 meatus 425 mesenteric arteriography 707 artery 706 or visceral surface 693 radioulnar joint 152 ramus 822 surface of petrous temporal bone 308 vena cava 717 view of bony and soft palate 420f Infrahyoid region 352 Infranuclear lesion of right facial nerve 608f Infraorbital nerve block 326 in patient 327f Infraspinatus 109 Infratemporal fossa 388 and pterygopalatine fossa 388 Infundibulum 509 Inguinal canal 649 hernia 651 ligament 641f Injuries to male urethra 792 Injury at axilla 180 Injury at carpal tunnel 176 elbow 175, 178 mid-forearm 176 wrist 176, 178 Injury in mid-arm 180 palm 178 Injury to superficial peroneal nerve 898 Inlet of right ventricle 256 Insertion of interossei and lumbrical muscles 171f long flexor tendons in ventral aspect 169f pes anserinus muscles on upper medial surface of tibia 827f quadriceps femoris 853f Inspection of dorsum of tongue 419 laryngopharynx 438 nasopharynx 434 oropharynx 435 Insula (island of reil) 550 Interatrial septum 256 sulcus 253 Intercondylar area of tibia 827f Interconnecting fiber tracts 572 Intercostal muscles 202 spaces 201 Interior of bladder 751 cecum opening of vermiform appendix and ileocecal opening 682f cranium 309 skull showing cranial fossae 310f stomach 669 stomach showing location of gastric canal 669f temporomandibular joint parts of articular disc 394f Intermediate group 139 mesoderm 44 Intermuscular spaces 110 Internal acoustic meatus 311 capsule 564 carotid artery 376 carotid pulse 377 derangement of knee joint 889 ear 455 iliac artery 717, 741 vein 742 jugular vein 380 laryngeal nerve 432f oblique muscle 641 piles 781 pudendal artery 797 Index 947 pudendal artery in male and female 797f pudendal vein 797 structure 489 of midbrain 527 of pons 524 thoracic (mammary) artery 206f trigone 751 of urinary bladder 751f Interossei muscles 169 in right hand 169f Interosseous membrane of leg 907 Interpeduncular fossa 517 Interphalangeal joints 172 Intersegmental plane and segmental resection 695 tract 496 Intertarsal joints 920 Interventricular septum 243, 259, 259f sulci 252 Intervertebral discs 482 joints 480 Intestinal angina 706 Intra-abdominal branches of vagus nerves 720 Intra-articular fossae 136 structures 886 of knee joint 886f Intracavernous part 555 Intracellular synthesis of procollagen 11 Intracerebellar nuclei 532 Intracranial course of internal carotid artery 555 mandibular nerve 602 maxillary nerve 602 ophthalmic nerve 602 Intraembryonic mesoderm 44f Intrahepatic part 697 Intramedullary 23f Intramural part of ureter 735 course and point of emergence of oculomotor nerve 597f Intraoperative view of stomach 672f Intraorbital course and branches 598 Intraparotid course 333 Intrapelvic branches of sacral parasympathetic outflow 720 Intrapetrous course and branches of facial nerve 607f Intrapulmonary airways 226 Intrarenal course of segmental arteries 731 Intratympanic muscles 452 Intraventricular hemorrhage 570 Intravesical part of ureter 735 Intrinsic arterial supply of spinal cord 496f blood supply 497 membranes and ligaments of larynx in lateral view 441f muscles 417 of hand 166 larynx 444, 444f Invasive methods 58 Involuntary muscles 401 Ischiococcygeus 739 Ischiorectal fossa 777 Ischium 820 Isochromosome 53 Isotropic 14 J Jackson’s metallic tracheostomy tube upper airway obstruction 215f Jaw deviation to left 398f jerk 604 necrosis after tooth extraction 414 Jefferson’s fracture 318 Jejunum and ileum 677 Joints of foot 920 pelvis 634 sternum 194 Jugular foramen 309 syndrome 309 fossa 309 Junctional point of shaft 71 Juxtaglomerular complex 730 K Kartagener’s syndrome Karyotype 50f Karyotyping 49, 58f using giemsa banding 50 Kidney 724 Killian’s dehiscence 433 Klinefelter’s syndrome 55 Klumpke’s palsy 101f paralysis 101 Knee joint 883 L Lacrimal apparatus 336 nerve 404 Lacuna of howship or resorption bay 20 Laminae of rexed 491 Laparoscopic of reproductive organs in female 757f Laparoscopy 648 Large intestine 680 Laryngeal cartilages 439 muscles 443 Laryngopharynx 437 Laryngoscopic examination 443 view of vocal cord 443f Laryngotracheal tube 210 Larynx 439 Lateral aortic lymph nodes 719 circumflex femoral artery 871 cutaneous nerve of thigh 714 dislocation of patella 826 geniculate body 593 lemniscus 612 medullary or wallenberg syndrome 523 plate mesoderm 44 position 35 pterygoid plate 308 recesses 536 spinothalamic tract origin to termination 493f sulcus or sylvian fissure 548 surface 633 of left pinna 447f tympanic membrane a speculum 450f ventricle 568 view of skull interior of cranial cavity 500f wall 424, 537 Latissimus 107 Layers of anterior abdominal wall 638, 639f epidermis in thick skin 30 pharyngeal wall 430 retina 411 retina and site of emergence of optic nerve 412f scalp 320, 320f scrotal wall 794 skin 30 soft palate 420 Left atrium 257 gastric artery 704 hemiliver 694 internal mammary artery 207 lateral relations 214 main bronchus 225 ventricle 258 by angiography 259f proper 258 Leg 835 Length of ribs 195 vertebral column 478 Lentiform nucleus 571 Lesion of abducent nerve 600 arteria radicularis magna 497 axillary nerve 111 hypoglossal nerve proper 622 lateral geniculate body 595 lower trunk 101 MLF 530 neuronal bodies of limbic system 574 oculomotor nerve 599 optic chiasma 594 nerve 594 radiation 595 tract 595 948 Clinical Anatomy (A Problem Solving Approach) posterior column tracts 493 spinal accessory nerve 620 cord 498, 498f trigeminal ganglion 602 trochlear nerve 600 vagus nerve 618 vertical gaze center 530 vestibular nerve 611 visual pathway 594 Lesser omentum 659, 668 Levator ani 738 Ligaments 114, 151, 156, 394, 750 attached to clavicle 72 attached to mandible 316 connecting axis and occipital bone 483 of hip joint 873f of ovary 767 of uterus 773 of vertebral column 481 Ligamentum patellae 884 Lima graft 207 Limbic lobe 574 system 572 Line of discontinuous dermatomes 84 pleural reflections 217 Lingual tonsils 419 Lissauer’s tract 495 Lithotomy position 35 Little’s area and Kiesselbach’s plexus 426 Liver 691 biopsy 696 Lobes and fissures of lungs viewed anterior aspect 220f of cerebrum 548 Location and appearance of thymus in adolescence 280f constituent fibers of internal capsule 564f parts of parotid gland 338f testis 759 thyroid gland 368f Location of fibers in oculomotor nerve 597 pharyngeal opening 453 surgical incisions on anterior abdominal wall 648f Long nerves of upper limb 174 thoracic nerve 96 Longus capitis 387 colli 387 Loose connective tissue 12 Loss of symmetry of cardinal veins 279 taste sensations 419 Lower end of esophagus 710f esophageal sphincter 288 Male limb 815, 817 and female 724 Lowest eight to ten millimeter 779 bony pelvis from front 633f Ludwig’s angina 360 external genitalia 793 Lumbar fascia 711 reproductive organs 754 and posterior abdominal wall 711 Malignancy of Lumbar breast 90 plexus 713 lung apex 221 puncture 484 Mammogram of normal breast and cancer in patient 485f breast 93f vertebrae 479, 631 Mandible 315 Lumbosacral joint 483 Mandibular Lumbrical fossa 308 canals 163 nerve 388 muscles 168 Marfan’s syndrome 12 Lungs 219 Marginal artery of drummond 707, 707f Lymph drainage 215, 792 Margins of heart 253 Lymph node 28 Massive splenomegaly 703f of abdomen and pelvis 719 Mastectomy 92 of thorax 281 Mastoid Lymph vessels and air cells 454 lymph nodes of upper limb 125f antrum and internal ear 446 venous 640f or tympanic antrum 454 drainage of Mastoiditis 454 anal canal 781f Maxilla 315 breast parenchyma 90f Maxillary lung and trachea 228f artery 392 rectum 748f nerve 390 skin overlying breast 90f processes 323 thyroid gland 372f sinus 428 tongue 419f Mcburney’s point 683 upper limb 124 Measurement of portal pressure 709 uterus, ovary, fallopian tube and cervix Mechanism of 772f descent of gonads 649 various zones of stomach 671f respiration 235 organs 280 Meckel’s and autonomic nerves of thorax 280 diverticulum 657f tissue 27 scan after technetium injection 658f within other organs 28 Medial and lateral rotation 875 circumflex femoral artery 870 M geniculate body 612 longitudinal fasciculus 529 Macewen’s triangle 306 medullary syndrome 523 Macroscopic appearance of dorsum of tongue pectoral nerve 87f 415f relation 734, 827 Magnetic resonance cholangiopancreatography surface of 700f cerebral hemisphere 550 Main tympanic membrane as seen through features of middle meatus 425 middle ear 449f parts of brain 512 Median parts of pancreas 688f nerve 143, 174 supports of medial longitudinal arch 923f in arm 130 Major region of front of neck 352 apertures 232 section of ascending tracts 491 head and neck to subdivisions of blood vessels 271 pharynx 431f of thorax 271 hindbrain to location of fourth deep veins 838 ventricle 536f descending tracts 495 through upper cervical vertebral folds of cranial dura mater 501f column 481f parts of capsule 872 vein of forearm 123 veins of thorax 277 Index 949 Mediastinal syndrome 210 Mediastinum 208 and respiratory organs 201 Medicolegal importance 317 Medulla oblongata 518 Meinere’s disease 457 Meiosis 55f Membranes and ligaments of larynx 441 Membranous labyrinth 458 urethra 789 Meningocele in lumbar region in stillborn infant 513f Menisci or semilunar cartilages 888 Meralgia paresthetica 641 Mermaid 42f Mesenteric cyst 678 Mesentery 659, 677 Metacarpal bones 82 Metacarpophalangeal joints 172 Metacentric chromosome 49 Metanephros or permanent kidney 724 Metaplasia Metatarsal bones 832 Metathalamus 545 Methods of palpation of epitrochlear lymph node 125f palpation of popliteal pulse 880f prenatal diagnosis 57 Microglia 17 Microscopic structure 690, 695 bone 20 multipolar neuron 16 retina 591f seminiferous tubule 761 Midbrain 526 Middle cerebral artery 559 ear or tympanic cavity 448 layer 711 meatus 425 meningeal artery 507 and pituitary gland 500 meningeal vein or sinus 508 radioulnar joint 152 Midline fissure on posterior wall of anal canal 782f sternotomy 194 Midsagittal plane 35 Migrant cells 10 Millard gubler syndrome 526 Minor apertures 232 Mitochondrial inheritance 49 Mitosis 54f Mobility 212 Modes of inheritance of monogenic diseases 48 insertion of flexor digitorum superficialis 141f secretion 89 Modifications of deep fascia 33 Modiolus 331 Monogenic diseases 48 Morphological types of chromosomes 49 attachment 453, 631 Morton’s metatarsalgia 919 guarding 646 Morula 59 in first layer of sole 915f Mosaicism 56f in floor 847f Motor in third layer of sole 916f and sensory muscles involved in distribution of mandibular nerve 389f movement of hip joint 875f nuclei 601 various movements of shoulder joint areas 552 118t effects 111, 175 Muscles fibers 596 of deep perineal pouches in male and homunculus on precentral gyrus and female 784 paracentral lobule 553f of extensor compartment 149f nerve supply 232, 417, 421 of facial expression 329, 330f root 390f of inspiration 235 Movements of of iris 410 abduction of arm at shoulder joint 118f of lateral compartment of leg 897f cervical spine 483 of mastication 396 foot 921 of posterior abdominal wall 712 lumbar spine 484 of pronation 153 pronation and supination 152f of soft palate 420 ribs 195 in coronal section 421f scapula 114 of sole 915 scapula at girdle joints 114f of superficial perineal pouches in male and synovial joints 24 female 783f thoracic spine 483 of supination 154 thumb 172f and pronation 153f thumb and fingers 171 of tongue 416 vertebral column 483 of typical intercostal space on right side 202f wrist joint 156 MRI origin medial border of scapula 108 anterior cruciate ligament in sagittal plane producing dorsiflexion 910 887f producing plantarflexion 910 appearance of sulci and gyri 548f responsible for movements 156, 875 Muscular image showing pericardium 249f knee close relation of popliteal artery to attachments to anterior surfaces of joint 891f radius and ulna 78f of brain showing thalamus 539f floor 349 of head in sagittal section 509f part 320 of sagittal section of vertebral 478f tissue 13 posterior cruciate ligament in sagittal plane Musculocutaneous nerve 129 887f Myelination in CNS and PNS 17 Mylohyoid muscle 359 structures from posterior aspect of knee 889f Myosin 13 Mucosa of Myxomatous connective tissue 13 laryngeal cavity 443 male urethra 792 N Mucosal lining 788 Mucous membrane 430 Names of bronchopulmonary segments Multipennate muscle 15 226t Multiple air-filled areas 234f Nasal Muscles bones 317 acting on thumb 172 cavity 423 and ligaments attached and paranasal air sinuses 423 dorsal surface of scapula 74f proper 423 to inferior aspect of clavicle 72f septum 425, 427 and tendons in second layer of sole 916f vestibule 423 attached to Nasociliary nerve 404 cartilaginous part of auditory tube Nasopharyngeal carcinoma 435 453f Nasopharynx 433 lumbar fascia 712 Neck of bladder 750 superior aspect of clavicle 72f Neocerebellum 533 ventral surface of scapula 74f Nephrogenesis 725 950 Clinical Anatomy (A Problem Solving Approach) Nephrons (secretory part) 724 Nerve supply of anal mucosa 781, 781f dura mater 502 extraocular muscles 402 heart 269 interossei 917 lateral wall and medial wall 426f nasal cavity 426 pleura 218 stomach branches of vagus nerves 671f strap muscles 354f thenar muscles 168 urinary bladder 751f Nerves and arteries of scalp 322f closely related to mandible 316 in gluteal region 860 Nerves of anterior abdominal wall 645 anterior quadrant 321 arches 365 palm 165 posterior quadrant 321 sole 919 Nerves related to humerus 76 maxillary sinus 429 Nervi terminalis 590 Neural and vascular relations of lateral pterygoid muscle 397f control of eye movements in conjugate lateral gaze 530f crest 43 tissue 15 tube 512 defects 43, 516 Neuroglia 17 cells in CNS 17 Neurological effects 523 Neurons in cerebellar cortex 534, 534f Neurotransmitter at parasympathetic synapses 576 sympathetic synapses 576 Neurovascular bundle of neck 376f relation of scapula 75f relations 73 in right popliteal fossa 881f Newborn gastroschisis 658f Nipple and areola 88 No scalpel vasectomy 762 Nodular liver due to cirrhosis a result of consumption of alcohol 696f Non-homologous chromosomes 52f Nondisjunction during gametogenesis 53 gametogenesis producing a gamete 56f Noninvasive methods 57 Norma basalis 306 frontalis 311f, 304 lateralis 305 occipitalis 305 verticalis 304 Normal action of genioglossi in protrusion of tongue 417 anteverted and anteflexed position of uterus 770f position of uterus 770 site of implantation 40 Nourishment Nuclear scan of thyroid gland 372 Nuclei of origin 597f, 605, 616 and functional components of glossopharyngeal nerve 614f origin and functional components of vagus nerve 616f termination 611 thalamus and cortical connections 540f Number of vertebrae 478 Numerical anomalies of chromosomes 53 O Oblique facial cleft 325 popliteal ligament 884 sinus of pericardium 251f Obliteration 45f Obturator artery 870 externus 859, 867 fascia 738 foramen 817 internus 737, 859 nerve 714, 896 and ovarian pathology 768 Occipital bone 313 Occlusion of striate arteries 557 Oculomotor lesion on left side 599f nerve 596 trochlear nerve and abducent nerve 597 Odontoid process of axis 319f OK sign 144f Olfactory 589 cortex 590 nerve and pathway 589 tract 589 Oligodendrocytes 17 Oogenesis 36, 37f in lateral wall of nasal cavity 425f Operations on thyroid gland 373 Operative steps in repair of direct inguinal hernia 652f view of lima to lad graft 266f Ophthalmic artery 405 nerve 404 veins 406 Ophthalmoscopic view of retinal blood vessels in right eye 411f Optic chiasma 592 nerve 592 and pathway 591 and visual pathway 591 radiation 593 tract 593 Oral cavity 414 tongue and palate 414 Oral diaphragm 360 Orbicularis oris 331 Orbit 399 and eyeball 399 Orientation lines 201 of heart in thorax 251 Orifices in interior of cecum 682 Origin and insertion of adductor pollicis muscle 168f extensor digitorum brevis 912f lumbrical muscles 168f intrapetrous course 610, 612 termination 266, 378 of submandibular duct relations 363f Origin of cranial and spinal parts of accessory nerve 620 deltoid muscle 108f left coronary artery 264 medial pterygoid muscle 398f platysma muscle 84f right coronary artery 262 Oropharynx 435 widely opened mouth 435f Ossification 80 centers in newborn 832 centers of tarsal bones 832 of humerus 76 of radius 78 of ulna 80 Osteoarthritis 19 Osteocartilaginous framework of thorax 113f Osteofascial compartments 843 Other small ligaments 116 Otic ganglion 390 Outline of normally positioned heart in relation to sagittal plane 252f Ovarian 37f disorders 768 Ovaries 766 Overaction of antagonistic muscles in Porter’s tip position 101t Overall layout of aorta in mediastinum 274f Overview of autonomic nervous system 576 Index 951 P Painful conditions of anal canal 782 Palatine branch of ascending pharyngeal artery 432f tonsil 29, 435 Paleocerebellum 533 Pallidum 570 Palm 160 Palmar aponeurosis 161 aponeurosis and attachments 161f cutaneous branch of median nerve 157f ulnar nerve 157f spaces 162 Palmaris brevis 161 Palpable parts 73 Palpation of axillary lymph nodes 97 bony landmarks in clinical examination of hip joint 875 brachial artery in cubital fossa 129f cervical lymph nodes 385 dorsalis pedis pulse 912f kidneys 732 popliteal lymph nodes 883 posterior tibial pulse 901f supraclavicular lymph nodes from behind 352f Pancoast syndrome 221 Pancreas 687 liver, extrahepatic biliary apparatus and spleen 687 Pancreatic ducts 690 Papez circuit 573 of limbic system 574f Para-aortic lymph nodes 719 Paracentesis of abdomen 648 Paralysis of buccinator 332 gluteal muscles 858 orbicularis oculi 330 Paranasal air sinuses 427 around nasal cavity 428f Paranephric fat 728 Parasagittal section of axilla 94f Parasympathetic part 720 supply 284, 686 Parathyroid glands 373 Paraumbilical, cystic and prepyloric veins 709 Paravertebral muscles of neck 385 Paraxial mesoderm 44 Parietal bone 312 pleura 216 Parieto-occipital sulcus 549 Parotid abscess 342f duct or Stensen’s duct 340 gland 338 sialography 341 tumor 342f Partition between pericardial and pleural cavities 210 pleural and peritoneal cavities 210 Parts and articulations of right talus 830f attachments of femur in anterior view 822f posterior view 824f attachments of hyoid bone 317f Parts of conducting system of heart 269f axillary artery 102 bony and membranous labyrinth of internal ear 455f brain 512t brainstem and sites of attachments of cranial nerves 518f breast 88 cerebellum 532 chromosome 49 corneal reflex 603f developing long bone 22 disc 482 extensor expansion 170 interventricular septum 259 intervertebral disc 482f midbrain 527 obturator internus and their relations 738 ovary 767 patella 825 primitive gut 655f retina 411 sternum 193 stomach 667f subclavian artery 378 surfaces and borders 338 tongue 415 uterine tube and length 769f vertebra 478 Passavant’s ridge or palatopharyngeal sphincter 432 Patella (knee-cap) 825 Patellar articular surface 883 Patent ductus arteriosus 248, 248f Path of femoral hernia 846f pain from ischemic myocardium to spinal cord 270f pupillary light reflexes 595f Pathway of secretomotor nerve supply of lacrimal gland 336f parotid gland 341f Patient of chronic renal failure 124f with enlarged thyroid gland 372f with hydrocele (right side) 795f Peau d’ orange appearance of skin of breast 91f Pecten 779 Pectinate line of anal canal 710f Pectineus 866 Pectoral girdle 113 and shoulder joint 113 region 83 and breast 83 Pectoralis major 85 minor 85 Pediatric elbow 80 Pelvic cavity 635 diaphragm 738f or pelvic floor 738 inlet 635 lymph nodes 719 mesocolon 659, 744 outlet 635 part of ureter in female 734 male 734 Pelvic venous plexuses 742 Penis 793 turned inwards 791f Per vaginum examination 787 Perforating arteries 871 Pericardial cavity 249 sinuses 250f Pericardiocentesis left costoxiphoid angle 251f Pericardium 249 and heart 249 Perilymph 456 Perinaud’s syndrome 531 Perineal body in female 786 male 785 membrane in female 786 male 785 pouches 777 Perineum 776 in male and female 776 Periorbita 399 Peritoneal and visceral relations of urinary bladder in male 749f folds attached to stomach 668f ligaments 693 recesses 681 around duodenum 677f in relation to duodenum 677 related to cecum 681f relation 683, 767 of urinary bladder in female 750f Peritoneum 657 Peritonsillar space 436 Peroneal compartment 897 retinacula 905 952 Clinical Anatomy (A Problem Solving Approach) Peyer’s patches 679 Pharyngeal aponeurosis 431 arch arteries 244 and fetal circulation 244 arches 365f branchial apparatus 365 branchial arches 365 muscles 431 Pharyngobasilar fascia 431 Pharynx 430 Phenotype 56f of Klinefelter’s syndrome 57f of Turner’s syndrome 57f Pheochromocytoma 723 Philadelphia chromosome 53 Phrenic nerves 235382 Physiological herniation of midgut loop 656 Pia mater 487, 506 Pilosebaceous 31f Pin syndrome 150 Piriform fossa 437 Piriformis 740, 858 syndrome 859 Pituitary gland 508 Placental pathology 47 Plain or visceral muscle 15 Plantar aponeurosis and division into five slips distally 914f arteries and plantar arterial arch 918f interossei muscles 917f Platysma 343 Pleura and pleural cavities 216 Pleural cavity and costodiaphragmatic recesses 216f costomediastinal recess in cross-section 216f Pleurisy 219 Pointing index in injury mid-forearm 176f Poland anomaly 85 Polarity Polygenic diseases 48 Pons 523 Pontine hemorrhage 526 Popeye deformity in rupture of long head of biceps muscle 154f sign and deformity 154 Popliteal artery 879 fossa 835, 878 and knee joint 878 lymph nodes 882 pulse 879 vein 881 Portal vein 707 obstruction 640 Positions of menisci and ligaments 888f ovaries 766 perforating veins 837 thalamus in relation to third ventricle 540f cranial nerves inferior surface of brain 517f dural venous sinuses 502f internal piles proctoscope 782f tip of appendix 683 Positive anterior drawer sign in rupture of anterior cruciate ligament 887f posterior drawer sign in rupture of posterior cruciate ligament 888f Postallantoic hindgut 656 Posterior Anastomosis laterally 134 medially 134 and diaphragmatic surfaces of heart 254f attachments of sternum 194f cerebral artery 559 column tracts 493 column tracts from origin to termination 493f compartment of forearm 147, 149f leg 898 thigh 861 dislocation of elbow joint 137f hip joint 865 horn 569 intercostal veins 278 interosseous artery 150 nerve 150 neuropores 43f part of norma basalis 309 relations of entire rectum whereas 746f medial two-third 72 second, third and fourth parts of duodenum 675f spinal arteries 496 spinocerebellar tract and cuneocerebellar tract 494f surface 254 triangle of neck 98, 348 view of lower pharynx and upper esophagus 373f view of plain radiograph of chest 261f wall of inguinal canal 650f Posteroinferior aspect of ischial tuberosity to depict origin of hamstring muscles 861f view veins of heart 266f Posterolateral disc prolapse in lumbar region 483f Postfixation of brachial plexus 100 Postmastectomy lymphedema of upper limb in a patient 125f Postnatal changes in fetal circulation 248 Pott’s spine 484 Preaortic lymph nodes 719 Prefixation of brachial plexus 100 Prenatal diagnosis of genetic disorders 56 Pressure effects of thyroid swellings 372 epiphysis 22 Prevention of fertilization by contraceptive methods 38 Prevertebral muscles of neck 387 Primary and secondary yolk sac 40 brain vesicles 514 cartilaginous joints 23 lymphoid organs 28 villi 46 Primitive gut 655 node 42f peritoneal cavity 655 streak 42f streak and gastrulation 41 Procedure of caudal analgesia 485f Prochordal plate 41 Profunda brachii artery 131 femoris artery 870 Projection fibers 563 Prolapse of piles 782f Pronator quadratus 153 teres 153 Prone position 35 Prostate 763 Prostatic urethra 764, 789 Protection of inguinal canal 651 Protraction and retraction 115 Proximal or femoral articular surface 883 row 80 tibiofibular joint 907 Pseudounipolar 16f Psoas major 712 Pterygoid plexus-emissary vein route 329f venous plexus 393 Pterygomandibular raphe 432f Pterygopalatine fossa 390 ganglion 391 Ptosis 401 in left eye 599f Pubis 821 Pudendal nerve 795 block 797 Pudendal or Alcock’s canal 778 Pulled elbow 152 hamstrings 863 Pulmonary cushions 242 ligament 224 plexuses 285 stenosis 261 Index 953 trunk 271 and branches 271f veins 272 vessels 271 viewed posterior aspect 273f Pupillary light reflexes 595 Pyloric part 668 Pyramidal tract 566 Q Quadrangular and triangular intermuscular spaces 110f Quadrants of breast and tail of spence 88f tympanic membrane 450 Quadratus femoris 859 lumborum 712 Quadriceps femoris 853 Quiet expiration 235 inspiration 235 R Radial and ulnar bursae 163f artery 143 nerve 131, 179 Radicular arteries 496 Radiocarpal ligaments 156 Radiograph of ankle joint 908f dislocated elbow joint 137f Radiological appearance in carcinoma of esophagus 289f image of lima to lad graft 207f Radiology of biliary apparatus 699 PNS 429 spinal cord 497 suprarenal gland 724 urinary organs 732 Radioulnar joints 151 and wrist joint 151 Radius 77 Rat’s tail appearance of esophagus in achalasia cardia 290f Recesses 546 Reciprocal translocation 52f Recording blood pressure 128 Rectal support 747 Rectosigmoid junction 744 Rectum 745 Rectus capitis anterior 387 capitis lateralis 387 sheath 643 Referred pain in angina pectoris 270 of pelvic surface 632 Refractive media 413 of pituitary 509 Regimental badge anesthesia in injury to of posterior belly 358 axillary nerve 112f of posterior surface 152 Regional variation in internal appearance of of psoas major in abdomen 713 spinal cord 496 of right lateral surface of liver 692f Regions of abdomen 638f of right suprarenal gland 723 Relations apex of femoral triangle 847 of sigmoid colon 744 esophageal aperture in diaphragm 288 of superior surface 360 in anterior mediastinum 281 of superior surface of first rib 196f in axilla 111 of thoracic esophagus 287 in carotid triangle 377 of thoracic part of esophagus 287f in femoral triangle 713, 850 of various parts of axillary artery 103f in jugular foramen 615 of visceral and posterior surfaces of liver in posterior part of digastric triangle 377 692f in quadrangular space 111 of walls of sinus 428 in subsartorial canal 851 to facial artery 316, 362 in superior mediastinum 280 to levator palpebrae superioris 336 of inferior surface of body of gallbladder to ovary 769 698f to popliteal lymph nodes 879 of abdominal aorta 715 to recurrent laryngeal nerves 245 of anterior surface 152 to salivary glands 316 of apex 221 to styloid process 333 of apex of lung on right side 222f to submandibular salivary gland 360 of base 750f to vagus nerves 288 of cavernous sinus 504f Relationship of structures at hilum of right lung of cervical esophagus 287 and left lung 220f of cervical part of thoracic duct 283f Remnants of of cords to axillary artery 100 notochord 43 of deep branch of radial nerve to supinator thyroglossal duct 369 155f Renal of deep part of gland 362 angle 727 of developing tongue and thyroid gland artery angiography 731 369f Repair of direct inguinal hernia 652 of diaphragmatic surface of spleen 702f Reproductive organs in male and female of field of vision to retinal quadrants 592 754 of first part of duodenum 674f Resident cells 10 of gastric surfaces 667 Reticular fibers 12 of head 689 Reticular tissue 12 of head of pancreas 689f Retina 411 of hernia to pubic tubercle 652 Retinacula of hip joint 874f around ankle 904 of hyoglossus muscle 359f at wrist 157 of inferior surface 360 Retrobulbar anesthesia 405 of isthmus 370 Ribs or costae 195 of IVC 718 Right of joint 136, 873 and left hepatic ducts 697 of kidney 728 atrium 255 of knee joint 891 hemiliver 694 of left suprarenal gland 723 lateral relations 214 of lobe of thyroid gland 370f lateral view of opened right atrium 255f of lobes 370 lymphovenous portal 283 of mandibular head to articular tubercle main bronchus 224 396f ventricle 256 of medial surface of left lung 223f Rima glottis 442 of medial surface of right lung 222f Ring occlusion test 652 of medial surface of superficial part of Role of submandibular gland 362f mesencephalic nucleus 604 of neck 689 Y chromosome in sex differentiation 50 of optic chiasma 593 Roof of of palatine tonsil 436f fourth ventricle 537f of pelvic diaphragm 739 infratemporal fossa 308 954 Clinical Anatomy (A Problem Solving Approach) Root of lung 224 neck to scalenovertebral triangle 386f Root stage 98 Rotation in semiflexed knee 892 of kidney 725 of scapula 115 Rotter’s nodes 97 Roux-en-Y gastric bypass procedure 673f Rule of ossification 22 Rupture of anterior cruciate ligament 887 bulbar urethra in male causing accumulation 783 EPL tendon 149 tendocalcaneus resulting in dorsiflexed foot 900f S Sacral hiatus 633 plexus 740 Sacrococcygeal joint 483 teratoma 479 in newborn 480f Sacrum 632 and coccyx 479 Sagittal plane 35 section of abdominal and pelvic cavities in male 660f cranial vault 321f shoulder joint 117f Salient features of fascia lata 844 Saphenous nerve 849 graft 850 opening 844 Sartorius 852 Scalene triangle 200 Scalenus anterior 385 syndrome 386 medius 386 minimus 387 posterior 387 Scalp 320 Scapula 72 Scapular anastomosis 104 on anterior aspect of right scapula 104f Scar of radiocephalic fistula 124f ulnobasilic fistula 124f Schwannoma of eighth cranial nerve 524 Sciatic nerve 863 Scrotum 794 Second cervical vertebra 318f rib 196 shunt in heart 247 Secondary brain vesicles 514 cartilaginous joints 23 lymphoid organs 28 plexuses from celiac plexus 720 inferior hypogastric plexus 721 villi 46 Secretomotor innervation 336, 427 of parotid gland 341 nerve supply 363 supply 364 Segmental innervation of muscles of upper extremity 180 some muscles of lower limb 904 Semicircular canals 456 ducts 457 Semimembranosus 862 Seminal vesicle and ejaculatory duct 766 Semispinalis capitis 474 Semitendinosus 862 Sensory areas 553 fibers 596 ganglia 617 innervation of dorsum of hand 159f loss 111 in lesion of median nerve 176f ulnar nerve 178f nerve supply 232, 417, 422 and blood supply 443 of sole 913f nerves of face 325 scalp and auricle 326f supply of mucosa of nasopharynx 434 Septation of embryonic heart 240 truncus arteriosus,bulbus cordis and common ventricle 242f Septum transversum 44 Serous pericardium 250 Serratus anterior muscle 95 in medial wall 96f Seventh cervical vertebra 318 Sex chromatin 52f chromosomes 50 differences 633 in pelvis 635 Shaft of radius 77 tibia 827 Shenton’s line 823 Shift of apex 253 Short lateral rotators of thigh 858 Shoulder joint 115 Sigmoid colon 744 rectum and urinary bladder 744 Significance of barr bodies 51 Simple epithelium Sinus or ventricle of larynx 442 Sinuses of valsalva 273 Sinusoids 27 Sirenomelia 42f Site of feeling radial pulse 145f lumbar puncture 485f palpation of carotid pulse 356f femoral pulse 850f production 574 exit of vessels femoral triangle 847f portosystemic anastomoses 710f Sixth cervical vertebra 319 Size of oral orifice 325 Skeletal muscle 13 relations of ureter 735 Skeleton of foot 830 hand showing muscular attachments 81f Skin 30, 368 and fasciae covering penis 793 hypodermis and deep fascia 30 Skull 303 Small intestine 672 small bowel 678 saphenous vein 838 Smooth muscle 15 Soft palate 420 Solar plexus 720 Sole of foot 835, 913 Somites 44 Sources of arterial supply of palatine tonsil 436f to spinal cord 496f development of urinary bladder 753f Spaces in relation to prevertebral fascia 345 of infracolic compartment 664 on dorsum 159 Special features of superior sagittal sinus 503 relations of anterior layer 712 Specimen of partial gastrectomy 672f Sperm 38f Spermatic cord 762 Spermatogenesis 37, 37f Spermiogenesis 38 Sphenoethmoidal recess 425 Sphenoid bone 313 Sphenoidal sinus 428 Sphenopalatine ganglion 391 Sphincters of female urethra 789 Spina bifida defects 513 Spinal cord 486 after myelography 498f dura mater 487 gray matter Rexed’s laminae 491f Index 955 meninges 487 and spaces surrounding spinal cord 487f nerves 488 pia mater posterior aspect 488f segments 488 and vertebral levels 489f Spinocerebellar tracts 494 Spinothalamic tracts 492 Spiral or radial groove 130 organ of corti 456 in section cochlear duct 456f Spleen 28, 700 Splenic artery 705 Splenic circulation 702 Splenius muscles 473 Split brain syndrome 563 Splitting of accessory nerve 620 Spread to axillary lymph nodes 90 S-shaped embryonic heart after folding of cardiac tube 239f Stages in development of face 324f development of interatrial septum 240f development of kidney 724 development of pancreas from endoderm of foregut 688f development of permanent kidney 725f formation of brachial plexus 99f movement of abduction 118 rotation of midgut loop 656 Stellate ganglion block 383 Stent in right coronary artery 265, 265f appendicectomy 684f eversion of tunica vaginalis testis 796f low tracheostomy 354 Sternoclavicular and acromioclavicular 113f joint 113 Sternocostal surface 253 of heart 254f Sternomastoid muscle 346 Sternum 193 Stomach 666 duodenum, small intestine and large intestine 666 Stratified epithelium Stratum basale 30 corneum 31 granulosum 31 lucidum 31 spinosum 30 Striatum 570 Structural and functional inter-relationship of hypothalamus 510f anomalies of chromosomes 51 organization of human body specialization for protection specializations for absorptive functions Structure of adenohypophysis 510 breast and muscles related to base of breast 88f compact bone 20 cornea 409 eyelids 334 iris 410 neurohypophysis 511 spongy bone 20 tympanic membrane 449 Structures forming lung roots 224f forming stomach bed 668f in anterior compartment of leg 895f fossa 518 in interpeduncular fossa 518f in median region in anterior part of neck 352f on dorsum 159 passing through diaphragm 231f passing through greater and lesser sciatic foramen 860f thoracic inlet 199f piercing clavipectoral fascia 87 piercing perineal membrane in male and female 785f piercing superior constrictor 432 under cover of gluteus maximus 856f Stylohyoid muscle 358 Sub metacentric chromosome 49 Subarachnoid cisterns 506 hemorrhage 506 space 506 Subclavian artery 378 steal syndrome 477, 477f vein 380 Subclavius 86 Subcortical connections of amygdala 572 gray matter 572 Subcutaneous injections 33 Subdivisions and internal features of anal canal 779f Subdivisions of cardiac tube 238 cranial part of neural tube and derivatives 514f decidua 40 efferent component 576 embryonic cardiac tube 239f intraembryonic mesoderm 43 laryngeal cavity 441 lateral ventricle 569f mediastinum 209f nervous system 15 parietal pleura 216 pelvis 634 peritoneal cavity 658 pituitary 509 pituitary gland 509f postallantoic hindgut 657f Sublingual salivary gland 363 Submandibular gland around posterior margin of mylohyoid muscle 361f or Wharton’s duct 362 region and submandibular gland 357 salivary gland 360 Submucosa 430 Suboccipital muscles 474 triangle 474 Subphrenic abscesses 664 spaces 662, 693 in relation to liver 663f Subsartorial canal 848 plexus of nerves 848 Subscapularis 110 Subtalar and midtarsal joints and sinus tarsi 831f joint 921 Subthalamus 544 Subtypes of cartilaginous joints 23 fibrous joints 23 multicellular exocrine glands Sulci and gyri on inferior 548f surface 551 medial surface 550 superolateral surface 549, 549f Sulcus tubae 308 Summary of dermatomes of upper limb 121t functions of cerebellum 535 sensory distribution 603 Sunken abdomen of a child with CDH 233f Superficial branch of radial nerve 142, 179 cardiac plexus 285 external inguinal ring 650 fascia of palm 161 fascia of thigh 843 lymph nodes 281, 384 of head and neck 384f lymph vessels 124 and superficial inguinal lymph nodes 841f muscles 106, 147 in anterior compartment of forearm 139f of back and scapular region 106 nerves inside posterior triangle 349f palmar arch 164, 164f perineal pouch in female 785 perineal pouch in male 782 perineal pouch in male and female root of penis 783 temporal artery 328 temporal pulse 328 956 Clinical Anatomy (A Problem Solving Approach) to deep 202 veins 122, 836 in cubital fossa 134f Superior and inferior relations of arch of aorta 275f azygos vein 278 constrictor 431 extensor retinaculum 904 hypogastric plexus 721 laryngeal artery 432f meatus 425 mesenteric arteriography 706 mesenteric artery 705 middle and inferior radioulnar joints 151f radioulnar joint 151 ramus 821 vena cava 277 Superolateral surface of left cerebral hemisphere poles 547f Supination and pronation 153 Supinator 154 jerk or reflex 147 Supine position 35 Support by peroneus longus tendon to lateral longitudinal arch 923f Supports of kidney 728 uterus 773 vagina 787 Supraclavicular brachial plexus block in a patient 102f space 344 Supraclinoid part 555 Supracondylar fracture of humerus 76, 77f Suprahyoid region 352 Supranuclear lesion 608 Supraorbital nerve block 326 Suprarenal glands 722 kidneys and ureters 722 Suprascapular nerve 111 Supraspinatus 109 Suprasternal space of burns 344 Surface epidermal ridges 31 features of spinal cord 488 landmarks in pectoral region 83f landmarks on posterior chest wall 201f marking of anterior aspect 691 arch of aorta 274f axillary artery 102f fissures of right lung 220f inguinal canal 649f lung 220 middle meningeal artery 507f parotid duct 341 parotid gland and parotid duct 339f root of mesentery 678f sciatic nerve in gluteal region 864f superficial branch 179 suprameatal triangle 454 marking on anterior surface 734 back of trunk 727 posterior surface 734 cardiac auscultation areas 260 cardiac borders, valves and auscultation areas 260f cardiac valves 260 fissures 220 of left cerebral hemisphere 548f Surfaces of borders and poles 701 foot 911 heart 253 superficial part of gland 361 Surgical approach to hypophysis 428 approaches to prostate 765 dissection of facial nerve in parotid gland 342f exposure of radial nerve 132 importance of transverse sinus 250 incisions on anterior abdominal wall 647 opening in trachea 445f Swellings of bilateral inguinal hernia in a male 651f Sympathetic chains 196f, 206f, 284 in abdomen and pelvis 720 Sympathetic connections of spinal nerves 488 ganglia 382 part 719 Symphyses 23 Synarthroses 23 Synchondroses 23 Syncytiotrophoblast 41f Synovial sheaths around flexor tendons 163f of flexor tendons 904 T T lymphocytes 28 T1 ventral ramus 196f Tail of pancreas 690 Talocalcaneonavicular joint 921 Tarsal bones 830 tunnel syndrome 906 Tectum 530 Teeth or dentition 414 Tegmentum level of inferior colliculi 528 level of superior colliculi 528 of pons 525 Telocentric chromosomes 49 Temporal bone 314 in newborn 315 Temporomandibular joint 393 Tendon grafting 899 Tendon of biceps 134f palmaris longus 157f Tendons on dorsum 911 Tennis leg 899 Tensor fasciae latae 852 Tenth rib 196 Teratogenesis 47 Teratogenic effects on primitive streak 42 Teres major 109 minor 109 Terminal branches of radial nerve 179 Termination of sensory fibers of trigeminal nerve on sensory nuclei 601f olfactory nerves in olfactory bulb 589f Territory of distribution of vagus nerve in neck, thorax and abdomen 617f Tertiary villi 46 Testicular thermoregulation 761 Testing function of abductor digiti minimi 167 adductor pollicis 168 brachioradialis 147 deltoid 109 ECRL and ECRB 147 EPB 149 extensor digitorum 148 extensor digitorum longus 896 facial muscles 332 infraspinatus 109 latissimus dorsi 107 muscles of mastication 398 opponens pollicis 168 pectoralis major 85 pronator teres 153 psoas major 713 supraspinatus 109 trapezius 107 Testing integrity of collateral ligaments 886 mobility of breast on contracted pectoralis major muscle 89f muscle function 96 nerve function 622 sensory areas of trigeminal subdivisions 603 Testis and epididymis on section 760 Tetrahedral shape of urinary bladder,surfaces and angles 749f Thalamic syndrome 542 Thalamus 539 Thenar muscles 167 Thigh 835 Third shunt to bypass lung 247 ventricle 545 Thoracic branches of sympathetic chain 285 cage 193, 193f course of phrenic nerves 236 duct 282 inlet 199 and thoracic wall 199 spinal nerve and functional components 488f Index 957 vertebra 197f, 479 wall 200 in clinical examination 201 Thoracolumbar outflow 576 sympathetic outflow 577f Thorax 191 Three muscles of anterior compartment 127f parts of floor of popliteal fossa 879f lateral ligament of ankle joint 909f Thymus 28, 280 Thyroid arteries and accompanying nerves on left side 371f gland 368 gland and parathyroid glands 368 swellings 372 Tibia shin bone 826 Tibial collateral ligament 884 nerve in popliteal fossa 881 Tibialis anterior 895 Tibiofibular joints 907 and ankle joint 907 Time of anatomical closure 248 appearance of ossification centers 80 Tongue 415 Torticollis 347f Trachea 211 Tracheal patency 212 Tracheo esophageal fistula 211 Tracheostome 445f Tracheostomy 354 Traction epiphysis 22 Transformation of arch arteries 244 Translocation 52 Transverse colon 685 disposition of peritoneum 661 mesocolon 659, 685 section of abdomen level of pylorus 662f section of medulla at level of inferior olive 522f medulla at level of sensory decussation 521f medulla oblongata at level of pyramidal decussation 520f midbrain at inferior colliculus 527f, 529f pons lower level 524f right knee joint 891f spermatic cord 762f superior mediastinum 214t upper part of pons 526f Transversospinalis 474 Transversus abdominis 642 Trapezius 106 Traube’s space 667 Triangle of auscultation 73 Triangles of neck 348 related to latissimus dorsi 107 Triangular portal lobule and diamond-shaped portal acinus of rappaport 695f sign in testing integrity of anterior interosseous nerve 144f Tributaries and termination of long saphenous vein 837f of cavernous sinus 504 of IVC 718 of portal vein 709f Triceps brachii muscle 130 Trigeminal gasserian ganglion 602 nerve 601 and related sensory pathway 601 sensory pathways 604 Trilaminar embryonic disc 44f Triple relation of lingual nerve to submandibular duct 363f Trisomy 54 Trochanteric anastomosis 861 Trochlear nerve 599 Trophoblast 39f, 41f True capsule 727 ligaments 750 pelvis 737 Trunk stage 99 Tumors of neuroglia 17 Tunica vaginalis testis 760 Turner’s syndrome 55 Two neuron spinocerebellar tracts 494f Tympanic ring of fetal skull 313f Type of joint 394 Types of arches 922 atrial septal defect 241f basic tissues bones 21 coarctation of aorta 246f epiphyses 22 female pelvis 636 hydrocephalus 575 inguinal herniae 651 injuries 100 lymphocytes 28 muscle tissue 13 numerical anomalies 53 sulci 551 synarthroses 23 synovial joints 23 tracheoesophageal fistulae 212f Typical intercostal nerve in fourth intercostal space 204f lumbar vertebra 631 rib 195 thoracic vertebra 197 U Ulna 78 Ulnar artery 145, 157f claw hand 178f nerve 142, 157f, 176f in arm 130 Umbilical cord 47 Umbilicus 646 UMN facial palsy on right side 608f vs LMN 497 Unhappy triad of knee joint 889f Unilateral swelling in a female 651f varicose vein in a patient 839f Union of roots 174 Unipennate muscle 15 Unique features of clavicle 71 coronary arteries 262 fetal circulation 247 first metacarpal 82 thymus 281 Upper attachment 136 extremity 69 fifteen millimeter 779 limb 120 Ureteric peristalsis 735 Ureters 733 Urethral sphincters 792 Urinary bladder 748 stress incontinence 789 Urogenital triangle 782 Uterine 39f cavity 45f, 770 tube 40f or fallopian tube 768 Uterus 39f, 770f uterine tube and ovary from posterior aspect 770f Utricle and saccule 457 Uveal tract 407, 409 V Vagina 786 Vaginal fornices 787 Vagotomy 671 Vagus nerve 284, 616 Valves in femoral vein 852 Van lint block in zygomatic branch of facial nerve 334f Variations in cystic artery 699 Varicocele 761 ulcer near medial malleolus 840f Various anatomical terms 34 degrees of prolapse of uterus 775f 958 Clinical Anatomy (A Problem Solving Approach) Vascular relation of third part of duodenum 676f trachea 214f segments 732 tissue 26 and lymphatic tissue 26 Vein puncture of median cubital vein cubital fossa in patient 124f Veins of heart 265 neck 380 pelvis 742 sole 919 thoracic wall 207f upper limb 122 Vena caval obstruction 639 Venous channels draining spinal cord 497f communications 279 drainage of abdominal part of esophagus 288 anal canal 781f cerebrum 560 nasal cavity 426 rectum 747 retina 413 thyroid gland 371f route of cancer cells to spread to vertebral column 92f sinuses related to falx cerebri 501 Ventricles of brain 568f Vermiform appendix 682 Vertebral angiography 476 artery 475 attachments of layers of lumbar fascia 711f canal 480 column 478 and spinal cord, cranial cavity and brain 471 extent 715 surface of left lung 224 right lung 223 vein 476 venous plexus and basivertebral vein 484f Vertebrobasilar arteries 555 Vertical disposition of peritoneum 658 extent 86 of clavipectoral fascia 86f section upper eyelid 335f Vessels of gluteal region 860 Vestibular nerve 610 Vestibulocochlear nerve 610 Vestigial part of hippocampal formation 573 Visceral afferent fibers 284, 285, 578 pleura 216 surface 694f Visual cortex 594 field defects to lesions 594f Visualization of urinary bladder 752 Vitello-intestinal duct 45 Vitreous body 407 Voluntary muscles 401 sphincters of anal canal 779f W Waldeyer’s ring 437 Walls of axilla 94 inguinal canal 650 laryngopharynx 437 middle ear 449 nasopharynx 434 oropharynx 435 Weber’s syndrome 531 White commissure 491 matter 491 lower pons 525 of cerebrum 562 pyramidal decussation 521 Whitlow or felon 164 Winging of scapula 75f, 96, 96f Wrist drop deformity in patient 131f drop to inaction of carpal extensor muscles 180f joint 155 Wryneck 347f X X-linked dominant inheritance 48 recessive inheritance 48 Y Yellow elastic tissue 12 Yolk sac 41f, 45 Z Zonula adherens occludens Zygomatic bone 316 Zygote 39f ... L1 vertebra Below this level, the lumbar and sacral vertebral canal contain the cauda equina, arachnoid mater and dura mater The arachnoid mater and the dura mater cover the cauda equina up to... of head around a transverse axis while the atlantoaxial joints permit rotation of the head around a vertical axis Thus, we say “yes” at the atlanto-occipital joints and “no” at atlantoaxial joints... puncture in a patient Caudal (Sacral) Analgesia (Fig 54. 12) The caudal analgesia or anesthesia is given in obstetric practice for painless labor To carry out the procedure at first the sacral hiatus