Clinically Oriented

Anatomy
Clinically Oriented
Anatomy
Other CBS Books in Anatomy
1. BD Chaurasia’s Human Anatomy Vol. 1, Vol. 2, Vol. 3)
2. BD Chaurasia’s Handbook of General Anatomy
3. Textbook of Histology Krishna Garg, Indira Bahl, Mohini Kaul
4. Human Embryology Arushi, Indu Khurana
5. Human Osteology (A Clinical Orientation) Nafis Ahmed Faruqi
6. Human Anatomy (Upper Limb & Thorax) A. Halim
7. Clinical Anatomy RK Zargar, Sushil Kumar
8. Human Embryology Daksha Dixit
9. Manipal Manual of Anatomy Sampath Madhyastha
10. Exam-Oriented Anatomy Shoukat N Kazi
11. Anatomy and Physiology of Eye AK Khurana, Indu Khurana
12. Surface and Radiological Anatomy A. Halim
13. MCQ in Human Anatomy DK Chopade
14. Exam-Oriented Anatomy for Dental Students Shoukat N Kazi
Clinically Oriented
Anatomy
Jnanesh S Rayapati MBBS MD DFM
Associate Professor of Anatomy
MSU-GEF International Medical School
MS Ramaiah, Bangalore campus
Bangalore, Karnataka, India
Formerly
Assistant Professor of Anatomy and Histology
St Matthews University School of Medicine
Grand Cayman, Cayman Islands
British West Indies

CBS Publishers and Distributors Pvt Ltd

New Delhi • Bengaluru • Pune • Kochi • Chennai
Mumbai • Kolkata • Hyderabad • Patna • Manipal
 Disclaimer
Science and technology are constantly changing fields. New
research and experience broaden the scope of information
and knowledge. The author has tried his best in giving
information available to him while preparing the material for
this book. Although, all efforts have been made to ensure
optimum accuracy of the material, yet it is quite possible
some errors might have been left uncorrected. The publisher,
printer and the author will not be held responsible for any
inadvertent errors or inaccuracies.

Clinically Oriented
Anatomy
ISB
ISBNN : 978-81-239-1875-4
Copyright © Author and Publishers

First Edition: 2010

Reprint: 2013

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopying, recording, or any information storage and retrieval system
without permission, in writing, from the author and the publisher.

Published by Satish Kumar Jain for

CBS Publishers & Distributors Pvt Ltd
4819/XI Prahlad Street, 24 Ansari Road, Daryaganj, New Delhi 110 002, India.
Ph: 23289259, 23266861, 23266867 Fax: 011-23243014 Website: www.cbspd.com
e-mail: delhi@cbspd.com; cbspubs@airtelmail.in

Corporate Office: 204 FIE, Industrial Area, Patparganj, Delhi 110 092
Ph: 4934 4934 Fax: 4934 4935 e-mail: publishing@cbspd.com; publicity@cbspd.com

Branches

• Bengaluru: Seema House 2975, 17th Cross, K.R. Road,

Banasankari 2nd Stage, Bengaluru 560 070, Karnataka
Ph: +91-80-26771678/79 Fax : +91-80-26771680 e-mail : bangalore@cbspd.com
• Pune: Bhuruk Prestige, Sr. No. 52/12/2+1+3/2 Narhe, Haveli
(Near Katraj-Dehu Road Bypass), Pune 411 041, Maharashtra
Ph: +91-20-64704058, 64704059, 32342277 Fax : +91-20-24300160 e-mail : pune@cbspd.com

• Kochi: 36/14 Kalluvilakam, Lissie Hospital Road, Kochi 682 018, Kerala
Ph: +91-484-4059061-65 Fax : +91-484-4059065 e-mail: cochin@cbspd.com
• Chennai: 20, West Park Road, Shenoy Nagar, Chennai 600 030, Tamil Nadu
Ph: +91-44-26260666, 26208620 Fax : +91-44-42032115 e-mail: chennai@cbspd.com

Representatives
• Mumbai 0-9833017933 • Kolkata 0-9831437309 • Hyderabad 0-9885175004
• Patna 0-9334159340 • Manipal 0-9742022075

Printed at Magic International Private Limited, Greater Noida, UP

 to

my wife
Lakshmi

my daughter
Sachita

and

my parents
Dr Sreenathan and Rukmini
for their support and love
 Preface

T he main aim of this book is to provide a concise yet sufficient material on clinical anatomy.
It is written in simple language in a point format. Unnecessary details have been omitted.
Facts of clinical importance have been highlighted in distinctive colour.
I hope that this book will be of benefit to undergraduate, postgraduate (graduate) students
preparing for examinations as a rapid review. It will be helpful as a review book for students
preparing for exams like USMLE, PLAB and All India PG Entrance Examinations. The book
focuses on material that is most likely to be tested in these examinations.
The book provides enough information for those wishing to refresh their knowledge of
anatomy. I shall be grateful to the readers for their suggestions to improve the book.

Jnanesh S Rayapati
viii Clinically Oriented Anatomy

Acknowledgements

I am grateful to my father Dr RN Sreenathan, formerly Dean of Students Affairs, Chairman,

Department of Anatomy, St Matthews University School of Medicine, Grand Cayman, for
his help in the production of this book. I wish to acknowledge Dr Sandhya Belwadi, Professor,
Department of Microbiology and Dr YJ Visweswara Reddy, Head, Department of Medicine,
PES Medical College, Kuppam, for their encouragement. I am indebted to Mr SK Jain, Managing
Director, Mr YN Arjuna, Publishing Director, and Mr Deepak Rao of CBS Publishers &
Distributors, for their cooperation. I am grateful to Mr RK Majumdar for his wonderful
illustrations.

Jnanesh S Rayapati
 Contents ix

Contents
Preface vii

1. General Anatomy 1 Lymphatic Drainage of the Upper Limb 63

Joints 64
Subdivisions of Anatomy 1
Anatomical Terminology 1 3. Lower Limb 72
Skin 5
Fascia 6 Hip Bone 74
Bones 6 Femur 76
Ligaments 9 Patella 78
Bursae and Synovial Sheaths 9 Tibia 78
Muscles 9 Fibula 79
Joints 9 Lymphatic Drainage of the Lower Limb 80
Circulatory System 13 Venous Drainage of the Lower Limb 80
Nervous System 15 Front of the Thigh 81
Imaging Techniques 17 Femoral Triangle 82
Femoral Artery 83
2. Upper Limb 18 Femoral Nerve 83
Femoral Canal 85
Clavicle 18 Adductor Canal 85
Scapula 20 Medial Compartment of the Thigh 85
Humerus 23 Gluteal Region 87
Mammary Gland 24 Back of Thigh 90
Deltopectoral Triangle (Groove) 27 Sciatic Nerve 91
Axilla 27 Popliteal Fossa 92
Brachial Plexus 29 Popliteal Artery 93
Deltoid 33 Posterior Compartment of the Leg 95
Axillary Nerve 35 Anterior Compartment of the Leg 97
Anterior Compartment of the Arm 37 Lateral Compartment of the Leg 98
Brachial Artery 38 Dorsum of the Foot 100
Musculocutaneous Nerve 39 Sole of the Foot 101
Cubital Fossa 40 Joints 104
Back of the Arm 40 Arches of Foot 108
Radius 41
Ulna 42 4. Thorax 109
Anterior Compartment of the Forearm 42
Thoracic Vertebrae 110
Palm 45
Ribs 111
Extensor Compartment of the Forearm 50
Sternum 112
Dorsum of the Hand 53
Joints of Thorax 113
Median Nerve 55
Respiratory Movements 115
Ulnar Nerve 57
Intercostal Spaces 117
Radial Nerve 59
Internal Thoracic Artery 120
Radial Artery 61
Azygos System of Veins 121
Ulnar Artery 61
Pleura 122
Veins of the Upper Limb 62
The Lungs 126
x Clinically Oriented Anatomy

Bronchopulmonary Segments 130 Ovary 223

Mediastinum 131 Vagina 223
The Pericardium 134 Female External Genitalia 224
The Heart 136 Internal Iliac Artery 224
Right Atrium 139 The Sacral Plexus 225
Right Ventricle 140
Left Atrium 142 6. Head and Neck 226
Left Ventricle 142 Norma Verticalis 226
Conducting System of the Heart 145 Norma Occipitalis 227
Arterial Supply of the Heart 145 Norma Lateralis 227
Venous Drainage of the Heart 148 Norma Basalis 229
Nerve Supply of the Heart 149 Norma Frontalis 231
Superior Vena Cava 150 Inferior of the Cranium 231
Ascending Aorta 150 Interior of Cranial Vault 233
Arch of Aorta 150 Cervical Vertebrae 234
Descending Thoracic Aorta 152 Mandible 235
Trachea 152 Hyoid Bone 237
Oesophagus 153 Scalp 237
Thoracic Duct 154 Face 241
Thoracic Sympathetic Trunk 155 Lacrimal Apparatus 246
Parotid Gland 247
5. Abdomen 158 Deep Fascia of the Neck 250
Sternocleidomastoid Muscles (SCM) 251
Anterior Wall of the Abdomen 158 Posterior Triangle 252
Rectus Sheath 162 Muscles of the Back 255
Abdominal Herniae 164 Suboccipital Triangle 255
Inguinal Canal 165 Curvatures of the Vertebral Column 257
Testes 167 The Anterior Trinagle 258
Peritoneum 170 The Submandibular Gland 259
Stomach 176 Hyoglossus Muscle 260
Duodenum 179 Cervical Plexus 262
Large Intestine 181 Thyroid Glands 262
Liver 184 Parathyroid Gland 264
Extrahepatic Biliary Apparatus 187 Subclavian Artery 265
Spleen 189 The Vertebral Artery 267
Portal Vein 191 The common Carotid Artery 267
Pancreas 191 Internal Carotid Artery 268
Rectum 192 Temporal Fossa 268
Anal Canal 194 Infratemporal Fossa 269
Kidneys 196 Mandibular Nerve 270
Ureter 199 Maxillary Artery 271
Suprarenal Glands 200 Temporomandibular Joint 272
Abdominal Aorta 201 Muscles of Mastication 273
Inferior Vena Cava 202 Tongue 273
Lumbar Plexus 203 Palate 275
Diaphragm 203 Palatine Tonsil 275
External Iliac Artery 204 Pharynx 276
Posterior Abdominal Wall 204 Nose 277
Perineum 205 Larynx 279
Ischiorectal Fossa 208 Meninges 282
Pudendal Canal 209 Dural Venous Sinuses 288
The Pelvis 211 Cavernous Sinus 289
Pelvic Diaphragm 214 Pituitary Gland 290
Urinary Bladder 215 Ear 291
Orbit 294
Prostate 217
Extraocular Muscles 296
Urethra 218
Cranial Nerves 300
Ductus Deferens 219
Cervical Sympathetic Chain 310
Seminal Vesicle 219
Craniovertebral Joints 311
Uterus 220
Fallopian Tube 222 Index 313
 1 General Anatomy
• Human anatomy deals with the structure of • Percussion.
the body. • Auscultation.
• Anatomy = cutting up (Greek word). It is a • Endoscopy (bronchoscopy, gastroscopy,
wide field of study. etc.).
• Dissection = cut into two (Latin word). It is • Radiography.
a technique. • Electromyography.
• Anatomy is the basic foundation for the
3. Embryology (developmental anatomy): Prenatal
field of medicine.
(before birth) and postnatal (after birth)
• It introduces most of the medical termino- developmental changes in an individual.
logies.
4. Histology (microscopic anatomy): Study of the
structure with the aid of microscope.
SUBDIVISIONS OF ANATOMY
5. Surface anatomy (topographic anatomy): Study
1. Cadaveric anatomy is studied on dead bodies of deeper structures in relation to the skin
usually with naked eye (gross anatomy). surface projection. Important in clinical and
a. Regional anatomy: Body is studied in parts surgical fields.
such as upper limb, lower limb, etc.
6. Radiographic anatomy: Study of deeper
b. Systemic anatomy: Body is studied organs by plain and contrast X-rays.
system-wise such as:
7. Comparative anatomy: Human anatomy
• Skeletal system (osteology).
compared to that of other animals.
• Muscular system (myology).
• Articular system (arthrology). 8. Applied anatomy (clinical anatomy):
Application of the anatomical knowledge
• Vascular system (angiology).
to the medical and surgical field.
• Nervous system (neurology).
• Respiratory, digestive, urogenital and
endocrine system (splanchnology). ANATOMICAL TERMINOLOGY
• Locomotor system includes osteology, Terms of Position
arthrology and myology.
Anatomical Position
2. Living anatomy is studied on living humans: “Anatomical position” represents the basis
• Inspection. from which all directions and directional
• Palpation. concepts will be developed.
1
 1
2 Clinically Oriented Anatomy

Please note that the subject is standing • Prone is lying face down.
erect with his eyes looking forward, arms at • Supine is lying down, face upwards.
his side, the palms of the hands facing • Lateral recumbent is lying on the side. A
forward and feet beside each other (Fig. 1.1). patient found “left lateral recumbent” is
Throughout the course of study, all lying down on the left side.
structures or organs in the body are described • Lithotomy position is lying supine with the
in relation to the anatomical position. It is hips and knees fully flexed and thighs apart.
generally assumed that a student of anatomy
remembers this basic concept each time a Anatomical Planes
structure is encountered in the course of 1. Median (midsagittal plane) vertical plane:
study. Divides the body or an organ into left and
In the dissection hall, the cadaver is kept right halves (Fig. 1.1).
on the table in supine or prone position. 2. Sagittal plane: Plane parallel to the median
However, when description of a structure and plane.
its relation is to be given, it should be
3. Coronal plane: Vertical plane that divides the
explained in terms of its location in the body
body or organ into anterior and posterior
in anatomical position. If we do not realize
parts. It is at right angles to the median
and practise this basic, the subject of anatomy
plane (Fig. 1.1).
becomes a big puzzle.
4. Transverse (horizontal) plane: Divides the
• Erect is standing up.
body or organ into superior (upper) and
• Recumbent is lying down.
inferior (lower) portions (Fig. 1.1).
5. Oblique plane: Any other plane.

Sagittal plane Divides body into left and

right parts.
Median plane Divides body into equal left
and right halves.
Coronal plane Divides body into ante-
rior/posterior.
Transverse plane Divides body into supe-
rior/inferior.

Other Terms Commonly Used

• Anterior—towards front.
• Posterior—towards back.
• Superior—towards head.
• Inferior—towards feet.
• Medial—towards the median plane.
• Lateral—away from the median plane.
• Anterosuperior, anteroinferior, postero-
Fig. 1.1: Use of some anatomical terms and body superior, posteroinferior, anterolateral,
planes anteromedial, etc. are terms used in
 1
General Anatomy 3

Fig. 1.2: Use of various anatomical terms

combination (Fig. 1.2).

Ventral Dorsal
The anterior surface is the front, and the
Proximal Distal
posterior surface is the back.
Medial Lateral
• Interior or inner.
• Exterior or outer. Superficial Deep
• Invagination or inward protrusion. External Internal
• Evagination or outward protrusion.
• Superficial or towards the surface. • There are eight pairs of directional concepts
• Deep or away from the surface and inwards to define. Left and right, always refers to the
(Fig. 1.2). patient’s left or right. To the left or right of
the midline, moving away from it or back
Superior Inferior toward it, is a concept that defines lateral
Cranial/Rostral Caudal or medial.
Anterior Posterior • Lateral being farther from the midline,
medial being closer to the midline
 1
4 Clinically Oriented Anatomy

(Fig. 1.2). wrist, and the elbow is distal to the

• Superior is closer to the head than inferior shoulder.
which is closer to the feet (simply stated • Radial outer border in the upper limb.
higher or lower) (Fig. 1.2). • Ulnar inner border in the upper limb.
• Superficial and deep are “measurements” of • Tibial inner border in the lower limb.
depth from the surface of the skin, and do • Fibular outer border in the lower limb.
not need much explanation (Fig. 1.2). • Flexor surface: Anterior surface in the upper
limb. Posterior surface in the lower limb.
• Bilateral and unilateral are used to describe
structures or occurrences in the body. Eyes, • Extensor surface: Posterior surface in the
for example are bilateral (one on either side upper limb. Anterior surface in the lower
of the midline) whereas some organs are limb.
unilateral (only on one side, e.g. the spleen). • Palmar (volar) referring to the palm of the
A patient might be a bilateral amputee hand.
(having lost both legs) or might be • Plantar towards the sole of the foot.
experiencing unilateral paralysis secondary A patient might have pain that originates
to a stroke. in an area just superior to the left ear, travels
• Ipsilateral of the same side. over the superior aspect of the skull and
• Contralateral of the opposite side. travels down the contralateral aspect of the
• Ipsilateral and contralateral refer to the same upper torso (pain starts just above the left
side or different sides. ear, goes over the top of the head and down
the right side of the body) or a patient may
The following terms are commonly used in have sustained superficial burns to the
embryology, but sometimes in gross anatomy: medial aspect of the right upper extremity,
• Ventral and dorsal refer to the anterior and with superficial and deep burns to lateral
posterior aspects of the torso. These two aspect of the ipsilateral lower extremity
terms are also useful to describe aspects of (superficial burns to the inside of the right
the feet and hands, but more specifically the upper limb and superficial and full thickness
ventral (inferior) aspect of the foot is burns to the outside of the right lower limb).
referred to as plantar and the ventral That is medical terminology, cool, ok?
(anterior) aspect of the hand as palmar.
• Cranial or rostral towards the head. Terms used for describing Movements
• Caudal towards the tail. • Flexion reduces joint angle. Approximation
of flexor surfaces.
• Extension increases joint angle. Approxi-
Terms used for Limbs
mation of extensor surfaces.
• Proximal and distal refer to directions or • Abduction moves away from body midline.
relationships between different structures • Adduction moves closer to body midline.
or aspects of the extremities (upper and • Medial rotation inward rotation toward
lower limbs) (Fig. 1.2). midline on the body.
• Proximal nearer the trunk. • Lateral rotation outward rotation away from
• Distal away from the trunk. midline on the body.
• For example, the elbow is proximal to the • Circumduction combination of the above
movements.