top exam Q Flashcards
- Object and tasks of topographical anatomy and operative surgery, connection with by other types of anatomy.
-Topography anatomy : a science that studies and describes the spatial position and relationshios of organs in various areas of the bods as applied to medicine, especially surgery.
-Task : to answer the questions arising in medical specialties connected with
The morphology of the human body
-OPERATIVE SURGERY:the doctrine of technology, methods and rules for performing surgical interventions.
-GENERAL PRINCIPLES OF OPERATIVE SURGERY
- ANATOMICAL AVAILABILITY
“ TECHNICAL POSSIBILITY
• PHYSIOLOGICAL AVAILABILITY
-Task : is to choose the method of surgical intervention , which gives the patient the best operative access with least trumataization of tissue
- Methods of studying of topographical anatomy and operative surgery.
-METHODS OF RESEARCH IN TOPOGRAPHIC ANATOMY
A) On live subjects:
Anthropometry
X-ray diagnostic
Computed tomography (CT)
Angiography
Scintigraphy
Thermography
Magnetic resonance imaging (MRI)
-B) On cadavers:
Dissection
Sawing of frozen corpses
Sculpture
Injection
Corrosion
Histological methods
Electron microscopy
Experimental methods
- History of development of topographical anatomy and operative surgery.
N.I. Pirogov is a founder of topographical anatomy and operative surgery.
- Russian scientists that made a contribution into the development of discipline.
- Topographical anatomy of upper limbs
-Topographical anatomy of upper limbs. TOPOGRAPHY OF THE UPPER EXTREMITY (EXTREMITAS SUPERIOR)
The upper extremity is divided into the following regions:
-Scapular region (regio scapularis)
-Deltoid region (regio delfoidea)
-Infraclavicular region (regio infraclavicularis)
-Axillary region (regio axillaris)
-Anterior and posterior regions of the arm (regio brachi s. humeri anterior et posterior)
-Anterior and posterior elbow regions (regio cubiti anterior et posterior)
-Anterior and posterior regions of the forearm (regio antebrachii anterior et posterior)
-Wrist region (regio carpi)
-Palmar and dorsal regions of the hand (regio palmae et dorsi manus)
- Topographical anatomy of scapular and deltoid regions.
———Scapular region ————-
-TOPOGRAPHY OF THE SCAPULAR REGION (REGIO SCAPULARIS)
A) Landmarks:
-Acromion
-Superior angle of the scapula
-Inferior angle of the scapula
B) Borders:
-Superior: Horizontal line drawn through the acromion (at the level of the 7th ce vertebra)
-Inferior: Horizontal line drawn through the inferior angle of the scapula
-lateral : vertical line drawn through the acromin
-medial : medial margin of the scapula
C) Layers:
Skin:
i. It is thick with limited movement.
i. It is innervated by the superior lateral cutaneous nerve of the arm (lateral supraclavicular nerve, dorsal rami of the upper thoracic nerve).
• Subcutaneous tissue
• superficial fascia :
i. It is dense and consists of many layers.
ii. It contains the fibrous tissues which connect the subcutaneous tissue and are fixed to the skin. That is why the skin has limited movement.
iii. It contains fat and cutaneous nerve.
Deep fascia:
i. It consists of 2 layers:
Superficial layer covers the latissimus dorsi and trapezius muscles.
Deep layer covers the supraspinatus, infraspinatus, teres major and teres minor muscles.
———Deltiod region ———-
A) Landmarks:
—-Anterior and posterior margins of the deltoid muscle
-Clavicle
-Acromioclavicular joint
-Acromion
-Spine of the scapula
B) Borders:
-Superior: Line drawn on the deltoid musele from lateral 1/3 of the clavicle, acromion and lateral 1/3 of the spine of the scapula
-Inferior: Horizontal line drawn on the lower margin of the pectoralis major muscle and latissimus dorsi muscle
-Anterior: Anterior margin of the deltoid muscle
-Posterior: Posterior margin of the deltoid muscle
C) layers
i- thick with limited movement.
ii-. Upper half of the deltoid muscle: Lateral supraclavicular nerve in.
iii-Lower half of the deltoid muscle: Superior lateral brachial cutaneous nerve
•Subeutancous tissue with superficial fascia:
i. It contains moderate amount of fat. ii. It is divided by septa.
•Deep fascia (deltoid fascia):
i-Superficial layer
-It covers the outer surface of the deltoid muscle.
- Itis continuous with the pectoral fascia.
-It divides the deltoid muscle into 3 parts, which are the clavicular, acromial (and spinal (of scapula) parts).
ii. Deep layer
-It invests the deltoid nerve
-:continuous with the fascia covering the triceps brachli muscle.
-It sends numerous septa and fasciculi.
- Topographical anatomy of scapular-deltoid arterial circle.
.
-SCAPULAR ARTERIAL NETWORK
A) Anastomosis around the scapula:
Anastomosis occurs in 3 fossae:
1. Supraspinous fossa
2. Infraspinous fossa
3. Subscapular fossa
It is formed by;
i. Suprascapular artery (branch of the thyrocervical artery of the subclavian artery)
ii. Dorsal scapular artery / deep branch of the transverse cervical artery (branch of the thyrocervical artery of the subclavian artery)
iii. Circumflex scapular artery (branch of the subscapular artery of the axillaryartery)
Importance:
i. To provide collateral circulation when the subclavian artery or axillary artery is blocked / damaged
ii. To help preserve the upper limb during injury
—To the second collateral network - deltoacromial circle - the acromial and deltoid branches of a. thoracoacromialis, both circumflex humeral arteries, and the deltoid branch of deep artery of arm belong. These branches anastomose mainly in the depth of-the deltoid and connect the system of the axillary artery with that of the deep artery of arm (
- Topographical anatomy of subclavian region.
-A) Landmarks:
-Sternum
-Clavicle
-Coracoid process
-3rd rib
-Cephalic vein
-Pectoralis major muscle
-Deltoid muscle
-Border between pectoralis major and deltoid muscles (sulcus deltoideopectoralis)
——
B) Borders:
-Superior: Clavicle
-Inferior: Horizontal line drawn through the 31 rib (in men); upper margin of the mammary gland (in women)
-Medial: Lateral margin of the sternum
-Lateral: Anterior margin of the deltoid muscle
——
1) Layers:
•Skin:
i. It is thin, easily movable.
i. It contains sebaceous glands.
iii. It’is innervated by the supraclavicular nerve (branch of the cervical plexus).
•Subcutaneous tissue:
i. It is well-developed, especially in women.
ii. It contains the cutaneous nerve.
iii. It contains the thoracoacromial and thoracoepigastric veins which form the cephalic and axillary veins.
•Superficial fascia:
i. It is thin and firm.
ii. It is attached to the inferior margin of the clavicle and upper margin of the mammary gland, which forms the Cooper’s suspensory ligaments of the mammary gland (ligamentum suspensorium mammae).
•Deep fascia (pectoral fascia):
i. It covers the pectoralis major muscle.
ii. It divides the pectoralis major muscle into 3 parts:
_ Clavicular
- Sternocostal
- Abdominal
iii. Borders:
- Superior: Clavicle
- Inferior: Fascia of the serratus anterior and rectus abdominis muscles
- Medial: Sternum
- Lateral: Deltoid and axillary fasciae
•Proper fascia (clavipectoral fascia):
i- is attached to the lower margin of the clavicle, coracoid process and I* rib it.
ii- covers the subclavius and pectoralis minor muscles.
iii. Lower part of proper fascia forms the suspensory ligaments of the mammary gland.
——
-Topography of neurovascular fascicle
In the subclavian region, : we study the topography of that part of the axillary fas-cicle, which lies within the limits of the clavipectoral triangle (between the clavicle and the superior border of the pectoralis minor),
In this triangle right under the clavipectoral fascia lies the axillary vein, v. axillaris, coming from under the superior border of the pectoralis minor and going in oblique direction from bottom upwards to the point, located 2.5 cm inwards from the middle of the clavicle. In the area between the first rib and the clavicle, this vein is already called the subclavian. The fascial sheath of this vein closely adjoins the fascia of the subclavian muscle and the periosteum of the first rib. It prevents the walls of the vein from moving closer to each other.
This is why there comes air embolism hazard when the vein is injured. At the same time, a good fixation of the vein allows to puncture it at this place.
The axillary artery. a. axillaris. lics laterally and deeperto the vein. In the clavipec-toral triangle, from the axillary artery branches a. thoracica superior splitting in the first and second intercostal spaces, and a. thoracoacromialis that almost at once splits into three branches: deltoid, pectoral and acromial. All of them perforate the clavipectoral fascia and run to the respective muscles. In the same place, v. cephalica passes through
- Topographical anatomy of axillary region.
TOPOGRAPHY OF THE AXILLARY REGION (REGIO AXILLARIS)
A) Landmarks:
-Outlines of the pectoralis major, latissimus dorsi and coracobrachialis muscles
-Axillary fossa is shown by lifting up the upper extremity.
B) Borders:
-Anterior: Lower margin of the pectoralis major muscle
-Posterior: Lower margin of the latissimus dorsi muscle
-Medial: Line connecting the margin of the pectoralis major and latissimus dorsi muscles along the sagittal section of the lateral surface of the thorax at the level of the 3rd rib -Lateral: Line connecting the margin of the pectoralis major and latissimus dorsi muscles on the medial surface of the arm
—The projection of the axillary neurovascular fascicle (a. et v. axillaris, fascicles of plexus brachialis and nerves, branching off from them) is a line, drawn from a point between the anterior and middle thirds of the lateral limit of the region (the medial surface of the arm) up to the point I cm inwards from the middle of the clavicle
Skin:
i. It is thin and easily movable.
ii. It contains lots of sweat glands, sebaceous glands and hair.
iii. It is innervated by intercostobrachial nerve.
•Subcutaneous tissue:
i. It contains the superficial axillary lymph nodes.
ii. It is innervated by the intercostal nerve of the medial cutaneous nerve of the arm
•Superficial fascia
•Deep fascia (axillary fascia):
i- It contains nerve and vessels.
ii-. It contains the suspensory ligament of the axilla.
iii. It separates and forms the pectoral fascia anteriorly, thoracolumbar fascia posteriorly and brachial fascia laterally.
- Topographical anatomy of vascular-nervous bundle of axillary region.
-Topography of neurovascular structures:
The a. axillaris as a continuation of a. subclavia right below the clavicle is the mai vessel of the upper limb (fig. 2.7).
Its topography is studied usually in triangles formed in relation to the m. pectora lis minor: tr clavipectorale, tr. pectorale, and tr subpectorale (they were mentioned the section about the topography of the subclavian region). In the first of them, fron the axillary artery the a. thoracica superior and a. thoracoacromialis branch off; in the
second one a. thoracica lateralis, and in the third, subpectoral triangle, from a. axil-laris - - a. subscapularis, aa, circum/lexae humeri anterior et posterior branch off.
The topography of elements of the neurovascular fascicle in trigonum clavipecto-rale has been studied in the section about the subclavian region.
In the pectoral triangle, medially (nearer to the surface) from the artery, there is the axillary vein and lymph nodes, going along it. Three fascicles of the brachial plexus the medial, lateral and posterior - lie near to a. axillaris respectively to their names: the medial one - medially from the artery, the lateral - laterally, the posterior - behind the artery. The a. thoracica lateralis runs to the medial wall of the axillary fossa, where branches of the artery run to muscles and to the mammary gland.
In the subpectoral triangle, the topography of vessels and nerves is the most com-plex. Here, fascicles of the brachial plexus break into several large nerves, each of which takes a certain place relative to the axillary artery. It is useful to recall that the medial fascicle of the brachial plexus gives off the medial brachial cutaneous nerve,
n. cutaneus brachii medialis, the medial antebrachial cutaneous nerve, n. cutaneus an-tebrachti medialis, the ulnar nerve, n. ulnaris, and the medial root of the median nerve,
n. medianus. The lateral root of the median nerve and the musculocutaneous nerve,
-n. musculocutaneus [Casserio] branch off from the lateral fascicle, and from the posterior one go the radial nerve. n. radialis, and the axillary nerve, n. axillaris.
-The most superficial structure is axillaris that in relation to the artery and nerves on its whole extent lies anteriorly and medially.
The n. medianus is located to the front from the artery. It is easy to find by the place of junction of its two roots - medial and lateral (an internal landmark), in the form of the letter Y. Between the roots, the trunk of the axillary artery is well seen.
- Topographical anatomy of axillary cavity, its walls and content.
—The walls :
1-the anterior - by the J. clavipectoralis with the pectoralis minor within it;
2- the medial one - by the f. thoracica covering the thoracic wall and the serratus anterior,
3- the lateral - by the . brachil covering the m. coracobrachialis and the short head of the m. biceps brachil up to the place of their attachment to the coracoid process;
4-the posterior - by the f. m. subscapularis and by the broad flat tendon of m. latis-simus dorsi.
—-B) Contents:
-Axillary artery is divided into 3 parts and gives branches according to:
1. Clavipectoral triangle: Thoracoacromial artery, arteria thoracica suprema, lateral and medial pectoral nerves
2-. Pectoral triangle: Lateral thoracic artery and long thoracic nerve.
3-Subpectoral triangle: Subscapular artery, anterior and posterior circumflex humeral arteries
—Axillary lymph nodes (5 groups )
1-. Lateral axillary lymph nodes
2-Central axillary lymph nodes
3-Anterior (pectoral) axillary lymph nodes
4-. Posterior (subscapular) axillary lymph nodes
5-. Apical (infraclavicular) axillary lymph nodes
—NB! Then fatty tissue
- Topographical anatomy of anterior region of the upperarm.
A) Landmarks:
-Deltoid muscle
-Pectoralis major muscle
-Latissimus dorsi muscle
-Biceps brachii muscle
-Triceps brachii muscle
-Medial and lateral epicondyles of the humerus
-Greater tubercle of the humerus
-Suici bicipitales lateralis et medialis
B) Borders:
-Superior: Horizontal line drawn from the pectoralis major and latissimus dorsi muscles
-Inferior: Imaginary line drawn with 2 fingers above the lateral and medial epicondyles of the humerus
-Medial and lateral: Vertical lines drawn on medial and lateral epicondyles of the humerusC) Layers:
•Skin:
i. Lateral is thicker than the medial one. It is slightly movable. it.
ii- innervated by the medial cutaneous nerve of the arm, lateral cutaneous nerve of the arm, superior lateral cutaneous nerve of the arm and inferior lateral cutaneous nerve of the arm.
•Subcutaneous tissue:
i. It contains the cephalic and basilic veins (at the lateral and medial margins of the biceps brachi muscle respectively). in.
ii- contains the cubital lymph nodes.
•Superficial fascia:
i. It forms a covering for the superficial veins and cutaneous nerves.
•Superficial fascia:
i. It forms a covering for the superficial veins and cutaneous nerves.
•Deep fascia (brachial fascia);
1. It forms 2 septa which are connected to the humerus, namely the lateral and medial intermuscular septa.
2. These 2 septa divide the brachial region into anterior (flexor) and posterior (extensor) parts.
in.
3-Transverse septum separates the biceps brachii muscle from the brachialis muscle and encloses the musculocutaneous nerve.
4-. Medial septum is pierced by the ulnar nerve and superior ulnar collateral artery to the posterior surface of the medial epicondyle.
5-. Lateral septum is pierced by the radial nerve and anterior descending branch of profunda brachii artery (arteria collateralis radialis) to the anterior surface of the lateral epicondyle.
6-. Anteroposterior septum separates the brachialis muscle from the muscles aftached to the lateral supracondylar ridge. This septum also encloses the radial nerve and anterior descending branch of the deep artery of arm (arteria profunda brachii).
— Muscles:
i. Corachobrachialis muscle
ii. Biceps brachii musele
iii. Brachialis muscle
—Bone :
1- Humerus
- Topographical anatomy of median nerve.
1-The median nerve is derived from the medial and lateral cords of the brachial plexus. It contains fibres from roots C6-T1 and can contain fibres from C5 in some individuals.
2-After originating from the brachial plexus in the axilla, the median nerve descends down the arm, initially lateral to the brachial artery. Halfway down the arm, the nerve crosses over the brachial artery, and becomes situated medially. The median nerve enters the anterior compartment of the forearm via the cubital fossa.
3-In the forearm, the nerve travels between the flexor digitorum profundus and flexor digitorum superficialis muscles. The median nerve gives off two major branches in the forearm:
3.1 Anterior interosseous nerve – supplies the deep muscles in the anterior forearm.
3.2 Palmar cutaneous nerve – innervates the skin of the lateral palm.
4-After giving off the anterior interosseous and palmar cutaneous branches, the median nerve enters the hand via the carpal tunnel – where it terminates by dividing into two branches:
4.1 Recurrent branch – innervates the thenar muscles.
4.2 Palmar digital branch – innervates the palmar surface and fingertips of the lateral three and half digits. Also innervates the lateral two lumbrical muscles.
- Topographical anatomy of posterior region of the upperarm.
—TOPOGRAPHY OF THE POSTERIOR REGION OF THE ARM (REGIO BRACHI POSTERIOR)
-It is also called as posterior brachial region.
A) Landmarks:
-Deltoid muscle
-Pectoralis major muscle
-Latissimus dorsi muscle
-Biceps brachii muscle
-Triceps brachii muscle
-Medial and lateral epicondyles of the humerus
-Greater tubercle of humerus
-Sulcus deltoideopectoralis
-Sulci bicipitales lateralis et medialis
———
B) Borders:
-Superior: Horizontal line drawn from the pectoralis major and latissimus dorsi muscles
-Inferior: Imaginary line drawn with 2 fingers above the lateral and medial epicondyles of the humerus
-Medial and lateral: Vertical lines drawn on the medial and lateral epicondyles of the humerus respectively
——-
C) Layers:
•Skin:
- It is thick and well connected with the subcutaneous tissue.
•Subcutaneous tissuer
- It contains the superior lateral sutaneous nerve of the the arm. inferior lateral cutaneous nerve of the arm (nervi cutanei brachit lateralis et inferior) and posterior cutaneous nerve of the forearm (nervus cutaneus antebrachil posterior)
•Superficial fascia
•Deep fascia:
- It forms a covering for the triceps brachii muscle and its tendon.
•Muscle:
- Triceps brachii muscle
•Humeromuscular canal (canalis humeromuscularis):
- It is also known as canalis spiralis.
- Radial nerve, deep artery of arm (arteria profunda brachii) and its vein pass through this canal.
•Bone:
- Humerus
- Topographical anatomy of radial nerve.
1-The radial nerve is the largest terminal branch of the brachial plexus. It originates from the posterior cord along with the axillary nerve, carrying fibers from ventral roots of spinal nerves C5-C8 and T1.
2-The radial nerve arises in the axilla, immediately posterior to the axillary artery, between coracobrachialis and teres major muscles. It descends obliquely downwards through the posterior aspect of the arm, between the bellies of medial and lateral head of triceps, through a shallow depression on the posterior surface of the humerus (radial groove).
For the most part of its course in the arm, the nerve is accompanied by the brachial artery.
3-In the distal part of the arm, the radial nerve wraps around the distal humerus and courses anterior to the lateral condyle of humerus, where it penetrates the lateral intermuscular septum. Upon crossing the cubital fossa, the radial nerve terminates by dividing into two terminal branches: superficial (sensory) and deep (motor).
—Branches and innervation :
1-The deep branch, also known as the “motor branch”, provides motor innervation to the posterior compartment of the forearm.
This nerve descends inferiorly through the posterior aspect of the forearm where it penetrates the supinator muscle and emerges as the posterior interosseous nerve. Its main function is to supply the muscles located in the posterior compartment of the forearm (the wrist extensors and the long muscles of the thumb). These muscles include the: extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, extensor digitorum, extensor indicis, extensor digiti minimi, extensor pollicis longus, extensor pollicis brevis and abductor pollicis longus.
2-The superficial branch continues the course of the radial nerve and enters the hand from the radial side. This branch is also known as the “sensory branch” because of its primary role to provide sensation to the thenar eminence and dorsal aspect of the radial 3 and a half digits of the hand.
- Topographical anatomy of bone-fascial compartments of the upperarm region
–he proper fascia, fascia brachii, circumflexes the entire arm. On the borderline of the middle and lower thirds of the arm in the medial sulcus of the arm, there is an opening in the proper fascia, through which v. basilica enters the splitting of the fascia (the canal of Pirogoff), while the n. cutaneus antebrachi medialis leaves it.
From the internal surface of the proper fascia, medially and laterally, the inter-muscular septa (septa intermusculare laterale et mediale) branch off to the humerus, therefore, two fascial compartments are formed on the arm: anterior and posterior.
The walls of the anterior fascial compartment of the arm, compartimentum brachil anterius, are: anteriorly - the proper fascia, posteriorly - the humerus with intermus-cular septa attaching to it
—The superficial fascia is feeble.
The proper fascia covers the triceps brachi. Together with the already mentioned medial and lateral intermuscular septa, the proper fascia forms the posterior fascial compartment of the arm, compartimentum brachii posterior. The contents of the posterior fascial compartment are the triceps brachi and radial nerve with the deep artery of the arm, accompanying it. The n. ulnaris and a. collateralis ulnaris superior pass in the posterior compartment in the lower third of the arm.
- Topographical anatomy of anterior region of elbow.
A) Landmarks:
Olecranon of the ulna
Brachioradialis muscle
Tendon of the biceps brachi muscle
Medial and lateral epicondyles of the humerus
Sulci cubitales posteriores lateralis et medialis
Sulci cubitales anteriores lateralis et medialis
When a tourniquet is applied to the arm, the cephalic, basilic and merfian cubital veins are clearly visible.
B) Borders:
-A horizontal line is drawn 4 cm (or by 2 fingers) from the level which connects the medial and lateral epicondyles of the humerus.
-2 vertical lines are drawn through the medial and lateral epicondyles of the humerus and divide the elbow region into the —anterior (cubital) region and posterior region.
A) Skin:
It is thin, movable and non-pigmented.
b- subcoutenous tissue
c-superfacial fcia
d- deep facia
e- 3 gourp of muscles :
Lateral: Brachioradialis muscle and supinator muscle
Median: Biceps brachii muscle (superficial) and brachialis muscle (deep)
Medial: (I layer) Pronator teres, flexor carpi radialis, palmaris longus and flexor carpi ulnaris muscles
Medial: (2m layer) Flexor digitorum superficialis musele
f- neuourvacsular bundle
- Topographical anatomy of ulnar nerve.
-The ulnar nerve arises from the brachial plexus within the axilla region. It is a continuation of the medial cord and contains fibres from spinal roots C8 and T1. After arising from the brachial plexus, the ulnar nerve descends in a plane between the axillary artery (lateral) and the axillary vein (medial).
- Topographical anatomy of anterior region of forearm.
- Topographical anatomy of posterior region of forearm.
