Clinical charts

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Identify the pointed region, mention the various changes that occur
at this region and write the clinical importance

Sternal angle
• Beginning and end of the aortic arch
• Bifurcation of the trachea
• Bifurcation of the pulmonary trunk
• Left recurrent laryngeal loops under arch of aorta
• Ligamentum arteriosum lies at this level
• Azygos vein drains into superior vena cava
• Location of cartilage of second rib
• Thoracic duct empties into left subclavian vein
• Boundary between superior and inferior mediastinum
• Highest point of pericardial sac
• Point where rt and lt pleura meet at midline.
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 Identify the given chart
Write the cause
Write the factors responsible to prevent this condition

FLAT FOOT / PES PANUS

• Collapse of longitudinal arches, especially medial longitudinal arch
• Entire sole of foot comes in contact with ground
• Compression of plantar nerves and vessels - may be asymptomatic or painful
• May be congenital or acquired
• Factors responsible:
hindered bone development
Injury
Advanced age
Being overweight
Conditions like cerebral palsy, spina bifida

A podiatrist or a physiotherapist advice may be helpful with wearing proper devices like
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shoe insoles, stretching exercises etc
 Identify the given chart
Mention the nerve, its origin, root value and muscles involved

ULNAR CLAW / SPINSTER’S CLAW HAND

Ulnar nerve lesion at the wrist

Nerve involved : ULNAR N
Origin : Medial cord of brachial plexus
Root value: C8, T1
Muscles involved: Extensor muscles of hand mainly
the 3rd and 4th lumbricals
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 Identify the given chart, write down the causes and name
the perforators
VARICOSE VEINS
They are the swollen twisted blood vessels, under the skin surface in the lower body - lower
limb
The walls of the vein will be weak, the valves of perforators or of superficial veins at
termination becomes incompetent and the blood accumulates in the veins.
Causes : ageing, pregnant females, heredity, standing or sitting for long time, increasing
weight, deteriorating health conditions, tobacco ect.
Perforators affected : large and small perforators, the small being one below the knee, the
medial and lateral perforators of leg ect. 5
 Identify the pointed bone, write the cause, mention the clinical features
related to the bone
CERVICAL RIB
Its a congenital overdevelopment of transverse process of cervical vertebra ( usually the 7th)
Cause: the mutation in hox genes and growth differentiation factors may mislead the
mesenchymal cells (sclerotome) in forming the normal rib pattern
Clinical features: 0.5-1perc
Unilateral or bilateral
Vary in size, shape and attachment sites
Usually asymptomatic but occasionally neck pain
Conditions associated :
Thoracic outlet syndrome - neurogenic, arterial 6 or venous
 Identify the given chart, mention the test and its
inference
TRENDELENBURG TEST

The Brodie - trendelenburg test is a diagnostic test performed to determine the

site of valvular incompetence in a patient with varicose vein.
The tourniquet is tied above the knee to assess the mid thigh perforators

Its tied below the knee to assess the competence between short saphenous vein
and popliteal vein.the pattern of refilling of blood back due to gravity determines
the site of the incompetent valve
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 Identify the given chart, mention the nerve involved, its origin,
root value and cause of injury
WRIST DROP / KLUMPKE’S PARALYSIS
Its the inability to lift the wrist or perform extension of the digits at MCP joints.
Nerve involved: Radial nerve
Origin : posterior cord of brachial plexus
Root value: C5,C6,C7,C8 & T1
Causes : The radial nerve may be involved/paralysed in axilla, radial sulcus, or its deep branch in
cubital fossa
Stab wounds
Broken humerus
Lead poisoning
Persistent injury
Improper correction of dislocated shoulder
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Neuropathy ex: rh arthritis.
 What is the clinical condition and name the nerve involved ?
Write the cause and after effects of nerve injury

AXILLARY NERVE PALSY

Deltoid muscle is affected

The underlying bones like greater tubercle, acromion process are
visible due to wasting of deltoid
The affected person cannot lift the arm above the shoulder
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 Identify the given chart, how do you elicit the sign, name the
muscles involved

TRENDELENBURG SIGN

The patient is made to walk for a short distanc, and the gait is tested, for the
ab, ductors of hip .
Positive trendelenburg sign reveals, abductor weakness when they lift the
unaffected leg, posture and balance could not be maintained, leading to
instability
The muscles involved are gluteus medius10 and minimus
 Identify and write about the given
clinical condition in detail
MEDIAN NERVE INJURY
When the median nerve is injured above the elbow, like as in supra condylar
fracture.
Vasomotor and trophic changes are seen
The skin on the lateral 3 and 1/2 digit is warm, dry and scaly.
The nails get cracked easily 11
 Identify the given condition and explain the cause.
Write its clinical significance

DUPUYTREN’S CONTRACTURE
It is a fibro muscular disorder, where there is slowly progressive thickening
and shorting of the palmar fascia which eads to debilitating contracures,
particularly the MCP or PIP joints.
It may usually affect the 4th or 5th digit
Due to fibrosis of medial part of palmar aponeurosis
Proximal and middle phalanges are flexed, distal phalanges remain extended
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 Identify the given chart.
Mention the nerves involved, cause of
injury, muscles paralysed and deformity
resulting due to this condition

PORTERS TIP / POLICEMAN’S TIP

ERBS PARALYSIS

Injury at the Erb’s point - upper trunk of brachial plexus

6 nerves meet at this point - may be affected.
Nerve roots mainly C5 and partly C6 involved.
Muscles paralysed : Mainly - biceps brachii, deltoid, brachialis &
brachioradialis
Partly - supraspinatus, infraspinatus & supinator
Deformity: Arm hangs side by side, adducted & medially rotated.
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Forearm extended and pronated
Identify the given chart, mention the nerve involved, its origin, root
value and muscle paralysed

WINGING SCAPULA

Nerve involved: nerve to serratus anterior / long thoracic nerve (bell)

Origin : from root of brachial plexus. C5,C6,C7
Muscle paralysed: serratus anterior

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 Identify the given chart, mention the nerve and muscles
involved in the deformity
CLAW HAND

Partial or complete
Nerve involved: Ulnar N
Muscles paralysed : intrinsic muscles of hand
Ulnar flexors of the wrist & digits

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 Identify the given chart
Draw a neat labelled diagram of the anatomical region concerned.
Why is the condition common in females

FEMORAL HERNIA
Common in females -
Larger pelvis
Smaller blood vessels
Larger femoral canal
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 Identify the given condition and explain the cause
HORNERS SYNDROME
Horner syndrome is a condition that affects the face and eye on one side of the body.
It is caused by the disruption of a nerve pathway from the brain to the head and neck.
Typically, signs and symptoms of Horner syndrome include decreased pupil size, a
drooping eyelid and decreased sweating on the affected side of the face.
Paralysis of the mullers muscle (involuntary part of LPS) supplied by sympathetic
fires from superior cervical ganglion leads to partial PTOSIS

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 Identify the given chart,
Name the nerve involved, its root value and name the three
muscles affected

FOOT DROP
Nerve involved : Common peroneal N
Root value : L4,L5,S1,S2
Muscles involved: Tibialis anterior
Extensor hallucis longus
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Extensor digitorum longus
Identify the pointed region, mention its boundaries,
contents and its importance
ANATOMICAL SNUFF BOX

Supf br of radial nerve

Pulsations of radial artery can be felt

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Identify the type of bone, give three examples of same
type, mention the peculiarities of the type of bone

SESMOID BONES

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 Name various quadrants of the given region
Which quadrant is preferred to give deep intramuscular injection
Mention the after effect of nerve injury if injection is given in wrong quadrant

ANTERO - LATERAL QUADRANT

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4th layer
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Anterior fontanelle
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Black eye
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BLACK EYE:

Subdural hematma
Skull fracture
Dengue fever
Brkn nse
Haemophilia
Head injury
Epidural and subdural hematma
factr I, V, VII & X def
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Maxilla - Pneumatic b0ne
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Facial /bell’s palsy
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Dangerous area 0f face
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Walderyer’s ring
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Little’s area
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Pteri0n
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Thrombus - cavernous sinus
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