4.2Anatomy

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Pagel
Key 1
- Wrist Drop ➔ Radial Nerve .

- Foot Drop ➔ Either Common Peroneal Nerve or Sciatic Nerve .
- Claw Hand ➔ Ulnar Nerve .
- Paraesthesia of thumb, index, MIDDLE finger ➔ Median Neve .
- Paraesthesia of little finger+ ring finger ➔ Ulnar nerve
- Paraesthesia of the dorsal aspect of the THUMB+/- a small area
over the ((dorsal)) area between 1st (Thumb) and 2nd (Index)
fingers ➔ Radial Nerve .
- Numbness on Superior aspect of upper arm just below shoulder
joint ➔ Axillary Nerve .
- Fibular Neck Fracture ➔ Common Peroneal Nerve .
- Femur Neck Fracture ➔ Sciatic Nerve .
- Acetabular Fracture ➔ Sciatic Nerve .
- Humeral Shaft Fracture ➔ Radial Nerve .
- Humeral Neck Fracture ➔ Axillary Nerve .
- Monteggia Fracture ➔ Radial Nerve .
- Paraesthesia and impaired sensation in both hands (Glove
distribution) ➔ Peripheral Neuropathy .
- Monteggia Fracture ➔ (Radial Nerve ): Anterior Dislocation of the
head of radius+ Fracture of the proximal 1/3 of the Ulna.
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The Monteggia fracture is a fracture of the proximal third of the ulna with dislocation of the
proxima l head of the radius.
- Unable to flex the 11 Proximal'' interphalangeal joints AND

Metacarpophalangeal (MCP)joint ➔
Flexor Digitorum Superfjcialis.
- Unable to flex the ''Distal'' interphalangeal joints ➔

Flexor Digitorum ro undu .
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Key 2 - Affected !Accessorynerve (e.g. during a surgery of the POSTERIOR

Triangle of Neck) ➔ Dropped Scapula= Unable to move the
shoulder.
- The accessory nerve is the CN XI (the 11th Cranial Nerve) ➔ supplies
trapezius muscle and sternocleidomastoid.
Kev 3 - rProximal Bic~D§ T~ndon Runtur~ !: MLJSCIP hLJnchPs LJO in thP

I ,- - ---------- - --- ,-- - -------- ----,- ---- -,- --- - - - - - - -- - --- - -- -- --,- --- - -- -
distal arm, Popeye appearance.
- Distal BicepsTendon Rupture: Single traumatic event (e.g.

flexion against resistance), sudden sharp tearing sensation,
painful swollen elbow, weakness of flexion and supination.
''Thepatient feels that something in the cubital fossa has ruptured~
- Notes:
- De Quervain's disease (=washerwoman 1
: = mammy thumb): Pain
under root of thumb (tenosynovitis ).
- jTennis elbow= lateral epicondylitis ➔ affected wrist extension.
Mainly due to overuse e.g. in tennis players.
1
- Golfer's Elbow= [Medial epicondylitis all flexors to fingers and 1
:
pronator are affected. Seen in baseball players, construction injury,

plumber injury.
Key 4 - Fracture of the neck of the Fibula leads to an injury of ➔

Common peroneal nerve\ ➔ Foot drop (inability to evert and
dorsiflex the foot)
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Common fibular
(peroneal) N.
Superficia
fibular N.
Deep fibular N.
• Fibular Nerve supplies biceps femoris (which flexes the Knee).

• It, also, gives TWO MOTORbranches:
Superficial Fibular (Which innervates the Lateral compartment of

1ne 1eg, ana 11sa11ec11on causes 1nao11rcy10 ever11ne 1001,.
!Deep fibular nerv~ {Wh ich innervates the Anterior compartment of
the leg and also extends the digits, and its affection causes inability
to dorsiflex the foot).
The injury of Common peronea l Nerve leads to FOOT DROP (No

dorsiflex ion, No eversion of foot).
• The Common peroneal nerve gives also Four SENSORYbranches:
Sural communicating ➔ (lower postero latera l leg).
Lateral Sural Cutaneous ➔ (Upper Lateral Leg)
Superficial Fibular (peroneal) ➔ (Skin of Anterolateral leg except
the skin between first and second toes)
Deep Fibular (peroneal) ➔ (Skin between the first and second toes)
Key 5 - Loss of sensat ion in MEDIAL Foot ➔ Saphenous Nerve.

- Loss of Sensation in LATERALFoot ➔) ura!: Nerve.
- Foot Drop ➔ Common Peroneal Nerve.
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• Saphenous Nerve is the Largest Cutaneous branch of the Femoral

Nerve. It is purely Sensory. It supplies the Medial Foot. It can be
injured during Varicose vein surgery, vein harvest for bypass surgery,
or Knee arthroscopy.
/~ -- lnfrapate llar branch of

saphenous nerve
- ---- atera l cutaneous

nerve of calf
,- -- Saphenousn Ne
______,_,_________
_ Su p e rfi c ia I
peroneal nerve
Key 6 - The order of the lntercostal Vessels (VAN ), Vein, then ~rtery, then
Nerve.
- Anv of these vessels± intercostal musclescould be pierced
during chest drain insertion.
They locate at the inferior border of a rib. Therefore, the insertion
of the chest-drain "intercostal tube'' should be at the superior
border of a rib.
- The site of Chest Drain ➔
(5 th lntercostal space, slightly anterior to the mid-axillary line).
- The boundaries of the safe triangle (The site f insertion of
intercostal tube- Chest Drain) are:
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Anterior ly: Pectoralis Major . Posteriorly: Latissimus Darsi.

Superiorly: Base of Axi la. Inferiorly: 5th intercostal space.
of cto irSm · r
Key 7 On Lymphatic Drainage
• Gonads (Ovary , Testis ) ➔ Para-aortic LNs.

-------
• Skin (Perineum , Scrotum , Vulva ) ➔ Superficialinguinal LNs.
Tongue:
• Tip of tongue: ubmental LNs.
------
• Anterior 2/3 of tongue: ubmandibular LNs.
-------
• Posterior 1/3 of tongue: Uugulo-Omohyoid (Deep Cervical LNs).
E.g. A woman with ovarian cancer, the likely LNs to be involved ➔

Para-aortic LNs.
Key 8 • Peroneal Strike: a blow just below knee ➔ Temporary loss of motor
and sensory function (from 30 seconds to 5 minutes) ➔ foot drop ➔
the affected nerve is: The ommon Peroneal Nerv
Remember that, the two motor branches of the common peroneal

nerve:
• Superficial peroneal nerve ➔ Supplies the lateral Compartment of
leg ➔ evert the foot.
• Deep peroneal nerve ➔ Supplies the Anterior Compartment of the

leg ➔ dorsiflex the foot.
Key 9 • Extensor Digitorum ➔ (Extends the middle three fingers: index,

middle and ring).
• Extensor Digitorum ➔ (Extends all fingers at MCP and IP joints).
• Extensor digiti minimi ➔ (Extends the little finger).
• Extensor indices ➔ (Extends the index finger).
• Extensor Pollicis➔ (Thumb)
• Extensor PollicisLongus➔ (Extends the Thumb at the

interphalangeal joints "IP").
N.B. Full extension of a thumb is achieved by extensor pollicis

LONGUS.
N.B. Long=IP
• Extensor PollicisBrevis ➔ (Extends Thumb at Metacarpophalangeal

MCP joints)
Q) A patient with an injury on his hand cannot extend the

distal phalanx of his ring finger. What is the affected muscle?
The ring finger has no specific muscle like in the thumb (pollicis) for
instance; therefore, pick the bulk one (Extensor Digitorum) which
extends index, midd le and ring fingers.
!
Don't get confusedwith FLEXORS
- Unable to flex the ''Proximal'' interpha langeal IP joints AND

Metacarpophalangeal (MCP)joint ➔ Flexor Digitorum Super{icialis.
- Unable to flex ''Distal'' interphalangeal joints ➔ Flexor Digitorum
profundus.
Other Clinchers for Anatomy:
• Ulnar Nerve (CS-Tl) injury:

- Claw hand ➔ (no abduction or adduction of 4 th and 5th fingers:
Iitt Ie a n d r ing) .
- Also, lossof sensation over the 5th finger (the little finger) + a
variable area of the 4th (ring) finger both dorsal and palmar
aspects.
• Radial Nerve (CS-Tl):

- Motor supply to the Extensors of the (thumb, fingers, wrist and
forearm).
If damaged ➔ Wrist Drop
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- Radial nerve can be compressed against the operating table

(medial aspect of the arm) during an operation ➔
{Saturday Night Palsy).
- Also, Crutch palsy (a compression against the spiral groove on

the medial aspect of humerus).
- Injury to the Radial nerve can also lead to sensory lossof the
dorsal aspect of the THUMB± a small area over the dorsal aspect
between 1st and 2nd fingers.
Key 10 Short saphenousVein: The only vein that runs on the LATERAL
aspect of the leg.
In contrast, the long (great) SaphenousVein runs on the MEDIAL

aspect of the angle.
Do not get confused with NERVES, Saphenous nerve runs

medially , Sura[ nerve runs laterally .
501 on the medial aspect of a leg ➔ Long Saphenous Vein +

Saphenous Nerve .
Q) Varicose veins on the lateral aspect of the leg. The affected

vein is ➔ Short Saphenous Vein.
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Pagel
Key 11 points on the E~e Nerves~
LR6(S04) 03
• Lateral Rectus muscle ➔ supplied by Abducens Nerve (6 th CN).

• Superior Oblique muscle ➔ supplied by Trochlear Nerve (4th CN)
• Oculomotor Nerve {3rd CN)
O:T:A
(3rd 1 4th ,6th )
Same, Opposite, Same side
• Oculomotor (3 rd) :
Controls most of the eye muscles, Constricts the pupils, innervates
the Levator palpebrae superioris.
I
Its injury ➔ Dilated pupil, Ptosis (On the Same side), Others:
outward gaze, diplopia
• Trochlear (4th ):
Diplopia on Downward' gaze ((:Oppositej side)) e.g. while climbing
the stairs.
If looks left and sees double ➔ then the lesion is on the right.
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• Abducens (6th ):
Diplopia on Lateral' gaze ((,Same:side).
If looks left and sees double ➔ then the lesion is on the left {(Same
Side)).
Remember O:T:AI
0 (Oculomotor) 3 rd CN T (Trochlear) 4 th CN A (Abducens) 6th CN
Same side Opposite side
--- Same side --- -
-
Dilated pupil, ptOs
--~--
is Diplopia on Downgaze Diplop·a on
-
Lateral gaze
-
OTA
Oculomotor {3 rd ), Trochlear (4th ), A bducens (6t h )
Same, Opposite, Same
Ptosis, Downward gaze, Lateral Gaze
Example:
After getting a hit on his face, a boy sees double when climbing the
stairs. He also sees double when looking to the right side.
The affected nerve is ➔ Left Trochlear nerve
Climbing the stairs= "downward gaze" ➔ Trochlear ➔ opposite

side ➔ diplopia when looking to the Right ➔ the Left trochlear
nerve is affected.
Key 12 C8 radiculopathy:
1
Affects thumb abduction and extension, ulnar dev iation of the wrist,
and causes paraesthesia of a thin area on the forearm which runs
down to include the little finger.
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iTl Radiculopathy:
Affects Finger Abduction and Adduct ion, Pain and Paraesthesia along
the affected nerve.
To Summarise:
- Fingers' Abduction and Adduction weakness ➔ rr1nerve root
• •
1nJury.
- Thumb movement weakness, Wrist Ulnar deviation, Little finger
Paraesthesia ➔ CSnerve roo1 injury.
- Loss of Thumb Sensation, Loss of elbow flexion ➔ (CS,6) erb's
pals~
The motor function of the nerve roots of an upper limb (Reading)

CS,C6,C7,C8
Flex, extend, extend, flex
Wrist, elbow, wrist, fingers
cs C6 C7 CB
Flex Extend Extend Flex
Wrist Elbow Wrist Fingers
Adduct and Abduct Fingers ➔ Tl
N.B. There is nothing called (CSVertebral injury), but there is (CS

Nerve root lesion) which is manifested by impaired thumb movement
+ Wrist ulnar deviation+ Little finger paraesthesia.
C6: Thumb/ C7: Middle three fingers/ C8: little (Pinky) finger.
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Example Scenario:
A patient presents with pins and needles sensation of the skin over the
lateral posterior of the distal forearm including the little finger,
weakness of thumb extension, wrist ulnar deviation and slight loss of
the muscle of the affected hand.
The likely affected structure ➔ CSRoo1.
Key 13 - The Important iTranspyloricPlane= The level of Ll = The level of the

:9th Rib, "its anterior end" = The level of the pylor"usof the stomach=
Fundusof the Gall Bladder.
- So, the TIP of the 9th costal cartilage correlates the Fundusof GB.
The level of 9th CC ➔ Many structures
But the (Tip) of 9 th CC ➔ (Fund us) of GB
Key 14 • Perforation of a Posterior (Gastric) Ulcer (Fund us or Body of

Stomach) ➔ accumulation of pus in the LesserSac (behind the
1
stomach) ➔ Abscess formation that passes to the peritonea l cavity

through the Foramen of Winslow ➔ Generalized Peritonitis.
• Perforation of Posterior (Pyloric) Or (Duodenal) Ulcer ➔

Retroperitoneal Abscess.
Key 15 • CVE (Stroke) of the Temporal lobe ➔ (Memory Impairment,

Superior homonymous quadrantinopias).
-
PiTs,: Parietal lobe affected ➔ i nferior homonymous quadrantinopias
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Temporal ➔ superior homonymous quadrant inopias
- Temporal lobe lesion: long term memory loss, changes of sexual

behaviour, (Visual defect) ➔ superior homonymous
quadrantinopias
- Frontal lobe lesion: changes of personality and SOCIAL behaviour,

no visual field defect.
Example Scenario:
An elderly with a Hx of Stroke present w ith impaired long-term

memory, altered sexual behaviour and visual defect. What is this visual
defect?
His Affected lobe is ➔ the Temporal lobe.

-----------------
PiTs ➔ Temporal lobe ➔ Superior HomonymousQuadrantinopias.
ye
Vi al el
Lesia L.e
0
2
() 1e ora l (h ero
Ina ia 1
u
3
0 f)
4
f) e h OLIS ia
5 e m or antan
6 Le s er ior dra tanop 3
8 ia
ac lar
yrus.
a
Key 16 Rule of 17 for the deviated tongue
: Deviation to the if!!IH!l!j

-- side of the lesion
12 + : Deviation to the am ide of the lesion
10 vague, 7 facial, 12 hypoglossal, 5 trigeminal
e.g. If tongue is deviated towards the right and there is an injury on the
right side of the neck (the same side) ➔ hypoglossal(12th).
10th (vagus): Uvular deviation

7th /f".'.lri".'.ll\• C".'.lri".'.llrlt:n,i".'.ltinn
I I \IU\,,,,IUI/• I U\,,,,IUI ""41'-VIU'-1'-'11
12th (hypoglossal): Tongue deviation

5th (trigeminal): Jaw deviation
Key 17 The Lymphatic drainage of the Testis ➔ Para-aortic LNs.

The Lymphatic drainage of the Scrotum ➔ Superficial inguinal LNs.
Remember:
• Gonads (Ovary, Testis) ➔ Para-aortic LNs. ______ ___ ,..___
• Skin (Perineum, Scrotum, Vulva) ➔ Superficial inguinal LNs.
Key 18 The Common bile duct {CBD) connects with the Pancreatic duct to
form ➔ the Ampul/a of Voter (hepatopancreatic ampu/la ) at the
middle of the second part of duodenum .
So, Ampulla of Vater = Hepatopancreatic ampulla .
Sites vilh hig, concentra

tions
of stemce niches
Right H patic Duct

Left Hepatic Duct
Hilum
Common Hepatic Duct
Common Duct
Common Hepatopancreatic Duct '1-----...J

Ampulla ofVater
Example:
ERCPwas done and found a calculus in the 2 nd part of duodenum.
What is the structure that contains this calculus?
➔ Hepatopancreatic Ampulla (Or) The Ampulla of Vater
Key 19 Rememberthat,
Common peroneal nerve gives superficial peroneal (which runs

laterally and evert the foot), and Deep peronea (which runs
anteriorly and dorsiflex the foot and give sensation to the area
between 1st and 2 nd toes ).
Example:
A man sat cross-legged for 40 minutes. He found himself unable to
dorsif lex his left foot and there is loss of sensation over the area
between the big toe and the second to. What is the affected nerve?
➔ Deep Peroneal (Deep Fibular) nerve which is a branch of the

common peroneal nerve.
- PED Peroneal nerve: Eversion, Dorsiflexion of the foot.

1
:
- jTIP Tibial nerve: Inversion, Planter flexion of the foot.

1
:
Key 20 The Common Bile duct (CBD) lies in a close proximity to the head of
pancreas. Therefore, the initial presentation in 70% of head of
pancreas cancer patients present with Jaundicedue to the obstruction
of CBD by the tumour.
Key 21 Saturday Night Palsy ➔ Wrist drop ➔ ((Radial Nerve)):
Radial Nerve lnj ury in

Axi lla:
Radial erve Palsy
Mechanism:
1. Crutches pressing in
axilla
2. Saturday night palsy!
Radial nerve can be compressed against the operating table
(medial aspect of the arm) during an operation. This is called
Saturday Night Palsy.
Key 22 LNs of Posterior Oropharynx ➔ Deep Cervical LNs or(= Uugular LNs)
Key 23 Scenario:
A man complains of pain on the media side of his right forearm.
There is weakness of finger abduction and adduction as wel l as
thumb adduction. No abnormality with finger flexion. The right-
hand muscles are slightly atrophied. What is the likely affected
structure?
➔ 1 Nerve Root lnju
• Fingers' Abduct ion and Adduction weakness ➔ 11 nerve roo injury.

• Thumb movement weakness, Wrist Ulnar deviation, Little f inger
Paraesthesia ➔ 8 nerve roo injury.
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• Loss of Thumb Sensation, Loss of elbow flexion ➔ (CS,6) erb's pals~

~
Key 24 rTrigeminal Nerve branches!: Ophthalmic, Maxillary, Mandibular .
Maxillary Nerve:
The 2 nd branch of the trigeminal nerve, it supplies a number of structures:
• Sinuses:ethmoid, maxillary, sphenoid,
• Mucosa: Palate, roof of pharynx, nasal mucosa,
• Others: lower eyelid, upper lip, upper teeth and gum, Nares, Parts of
the meninges.
N.B. The palate:is a mucous membrane'.
Example:
Herpes Zoster Virus along the dermatome of the maxillary nerve. What is
the MUCOSAthat would be affected?
➔ rrhePalate.
Key 25 The Deep Inguinal Rin is located about 1 inch (2.5 cm) ABOVEthe
midpoint of the inguinal ligament.
Deep inguinal ring

0
i point of
ingu ·nal ligamen
al lig m
Inguinal ca al Sp ic
Superfic·a1inguinal ring co
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Key 26 LA (Left Anterior DescendingArtery) is a continuation of the Left

Coronary Artery, and it descends into the ~nterior lnterventricular
groove).
Left puln'llnar _ arte ry
Rid1t atrium --.
Rigl1t coronar , - .
artery
Poste rior
desc~nding arter_1 ,_,,......
__ ___ anterior de:scen:h
interventr icular ,
Right onal bran: h
margireJ arter:it ---
---.,___Left v entricle
Right v errtricle_ ,
Key 27 • The skin at the Medial Ma leolus drains into the inguinal LNs.
• The skin over the Lateral Malleolus ➔ popliteal LNs ➔ inguinal LNs.
Remember that: During a surgery of the melanoma of the feet, the

inguinal LNsare dissected. So, medial malleolus skin is drained to the
inguinal LNs.
Example:
A patient with a non-healing ulcer over the medial malleolus. What
are the draining lymph nodes?
➔ Inguinal LNs.
Key 28 - Glioma is a tumour arising from the glial cells in the brain or spinal
cord, so, the cturamatte is to be opened during the surgery.
Skin
Arachnoid
mate r
DAP (from outside inwards): Dura ➔ Arachnoid ➔ Pia
Key 29 • Extensor Digitorum ➔ Extend all fingers at MCP and IP joints.
• Extensor Digitorum Communis ➔ extends the phalanges first, then

the wrist, them finally the elbow. It also tends to separates the
fingers while extending them.
Example:
An elderly woman with Rheumatoid Arthritis has fallen down the stairs
and she is now unable to extend her right-hand fingers at the
metacarpophalangeal joints and the interphalangeal joints. What is
the like ly affected tendon?
➔ ExtensorDigitoruml.
Key 30 A man presents complaining of diplopia while climbing down the

stairs. What is the likely affected nerve?
Climbing the stairs= Downward gaze.

I - -I
Diplopia on Downward gaze ➔ jTrochlearNeNel (41:nCN). Opposite.
Remember:o:T:A
0 (Oculomotor) 3 rd CN T (Trochlear) 4th CN A (Abducens) 6th CN
------
Same side
-----------t---
Opposite side Same side
Di lated pupil , ptosis Diplopia on Downgaze Diplopia on Lateral gaze
Key 31 • Ataxic Hemiparesis (same side)+ Dysarthria ➔ Lacunar infarct

([Internal Capsule).Internal capsule is a part of lacunas.
• "Contra lateral" hemiplegia or Sensory Loss+ Dysphasia +

Homonymous Hemianopia ➔ Cerebral infarct.
• Quadriplegia, Vertigo, Diplopia, Locked-in syndrome ➔ Brainstem

infarct.
Scenario:
An elderly woman had a stroke and developed paralysis of left upper
and left lower limbs (Hemiparesis) and difficulty in speaking.
The likely affected anatomical site ➔ Internal Capsule(Lacunas)
For those who do not know where is the internal capsule:

--- ..r- --- ·-
For your own knowledge

Locked-in Syndrome or Pseudocoma
• The patient is aware but cannot move or communicate verbally due to
complete paralysis of nearly all voluntary muscles in the body except
for vertical eye movements and blinking.
• Cognitive function is usually unaffected.
• Communication is possible through eye movements or Blinking.
• Locked-in syndrome 1scaused by a damage to the pons, which 1sa
part of the brainstem that contains nerve fibres that relay information
to other areas of the brain.
Key 32
• Central retinal artery is a branch of Ophthalmic artery which is a
branch of Internal carotid artery .
• maurosisFuga : Painless, Temporary and Recurrent loss of vision

that lasts from a few seconds to a few minutes due to embolism
(transient occlusion) of the Central retinal arter .
• Usually resolves within 24 hours.
• RiskFactors:Atherosclerosis I
Hypertension.
• A patient may describe it as" A black Curtin ComingDown"
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• The em bolus in Amaurosis Fugax comes from atherosclerotic

Internal carotid artery while in Transient lschemic Attack (TIA), the
emboli of the cerebral hemispheres come from the heart .
Scenario:
An elderly man presents with 4-hour sudden painless loss of vision
on the right eye. He has Hx of recurrent and transient episodes
sudden loss of vision in the same eye. The patient is a heavy
smoker and has hypertension.
• The likely affected artery ➔ ~entral Retinal Arte~ .
Key 33 A white lesion on the middle third of the tongue drains to which
LNs?
~ Submandibular LNs
1
• Tip of tongue: ~ubmental LNs -----•
• Anterior 2/3 of tongue: 5ubmandibular LNs.

• Posterior 1/3 of tongue: ~ ugulo-Omohyoid _(_D_ee
_p_ Ce
_r_v-ic-al_L_N_sl).
Key 34 • Trigeminal nerve (5th CN) ➔ gives the Mandibular nerve (the third
~=-.:,_:
~._..
\
UIVl:>IUI IJ.
• ➔ The mandibular nerve gives the Inferior alveolar nerve (which

innervates the lower teeth)
• ➔ the inferior alveolar nerve gives the Mental nerve that supplies
Chin, Lower lip (Skin and Mucosa).
Trigeminal ➔ Mandibular ➔ Inferior Alveolar ➔ Mental
• Inferior Alveolar Nerve is often injured during dental procedures and

mandibular trauma.
Therefore, a lossof sensation of the lower lip and chin after a

mand·bu ar trauma/fracture ➔ Inferior Alveolar nerve.
Key 35 • Unilateral Injury to the Recurre t laryngeal nerve ➔ Hoarsenessof

•
voice
• Bilateral Injury to the Recurrent laryngeal nerve ➔ Aphonia.
• Injury to the External (superior) laryngeal nerve ➔ changes of the

voice Pitch (Decreased pitch).
N.B. About 18% of Lungcancer patients experience hoarsenessof voice

due to compression of the tumour on the recurrent laryngeal nerve.
Recurrent laryngeal nerve is a branch of Vagus nerve (10th CN)
I rt tP. t Superior
Thyroid Al1ery
and Vein
• Superior thyroid artery is
closely related to external
External Branch
laryngeal nerve at its origin Superior Laryngeal
• Nerve moves away from the Nerve
artery as artery approaches the
upper pole of the g and.
• In order to avoid injury of
external laryngeal nerve the
superior thyroid artery need to
be ligated during surgery just
near the superior po e of
thyroid gland
• A superior laryngeal nerve
injury will lead to changes in
the pitch of the voice and
causes an inability to make
explosive sounds due to Thyroid gland
paralysis of the cricothyroid
muscle.
•
. ..
A bilateral 1nJurypresents as a
X - Do not ligate here
tiring and hoarse voice , - Do igate here
- - 1- I . .U ' . - - '- . . - ' '- - .. - I - . - - ...
A patient with lung cancer on chemotherapy presents with

hoarseness ➔ ecurrent La n eal Nerve Palsy.
Others:
- Hypoglossal Nerve (12 th ) ➔ Tongue muscles
- Phrenic nerve ➔ Diaphragm
Key 36 Important Anatomical Levels
• The level of iliac crest ➔ L4
We know that the umbilicus level is between L3 and L4. Therefore, the
iliac crest (below the umbilicus level) would be L4.
N.B. L4/5 where the lumbar puncture can be performed in adults

(Doubtfu l !)
• Umbilicus level ➔ L3/ 4
• Umbilical Dermatome: TlO
• Iliac crest ➔ L4
• Ll ➔ Transpyloric plane ➔ 9th Costal Cartilage, GB fundus,

Stomach pylorus, Kidney hilum, SMA (Superior mesenteric artery),
Celiac trunk. All these structures are at the Ll level.
N.B. iTranspyloricplane (or Addison's plane) is a transverse line

located midway between e1inaln ch and ~~~!!!!!!!!!!!!!!!~!!!!!!!!!!!!!!!
·
DuOOl:IIU
fl -,---
- Endof n 00!:tll
Supenormes 1 ric ery-- -
• TS: IVC {Inferior Vena Cava)
• Tl0 : Oesophegus(0 ➔ O I Oesophagus ~ T10 )

• T12 : Aorta
Mnemonic:
{IOA) ➔ I Opened A door ➔ IVC, Oesophagus, A orta (TS, 10, 12)
Key 37 When inserting a chest drain in the 5th ICS anterior to mid-axillary
line, not only the vessels ( a )
intercostal Vein, Artery and Nerve
can be pierced, but also intercostal MUSCLE is liable to be pierced.
Key 38 • Extensor Pollicis Longus➔ (Extends the Thumb at the

interphalangeal joints "IP").
• Extensor Pollicis Brevis ➔ (Extends Thumb at Metacarpopha langeal
MCP joints)
Example:
A man with a Hx of fractured radius presents with inability to
extend his thumb at the interphalangeal joint.
The likely Affected structure ➔ ExtensorPollicisLongus.
Key 39 Example:
A man with a Hx of Rheumatoid arthritis hits the door by his hand
and presents with inability to extend his thumb at the
metacarpophalangeal joint. However, he is able to extend his
thumb at the interphalangeal joint.
The likely Affected structure ➔ ExtensorPollicisBrevis.
Key 40 An important landmark above the 5th intercostaf space and just
---
nv,+or,inr, +n +ho mirl_nvillnr,,, liv,o ~ +t,,o ~i+D nf ~ a.-~+ " .. ,,i.-.T.-.~.-
..+ift.J
""'I I I '-" I I V I I V I I I '-" I I I I '-" ""'', I I I ""'I , t I I I'-" ' I r I '-" w I I '-" V I rir • ..... ~ • 111111.r
I .... I 9 ~- -~ .... I I I~- ~•
Key 41 A patient with right eye ptosis, outward gaze and diplopia.
The affected structure ➔ RightOculomotor nerve (3rd CN)
Remember: PtOsis ➔ Oculomotor. (Same Side)
0:T:A
1
- -
0 (Oculomotor) 3 rd CN T (Trochlear) 4 th CN A (Abducens) 6th CN
-
Same side -~-----------r--
Opposite side Same side
Di lated pupil , ptosis Diplopia on Downgaze Diplopia on Lateral gaze
I I I
Key 42 Structures at the level of ~1 ➔ jrrans~lloric ~lane

• 9th Costal Cartilage,
• GB fundus,
• Stomach pylorus,
• Kidney hilum,
• SMA (Superior mesenteric artery),
• Celiac trunk.
Key 43 Paraesthesia {Loss of sensation) of the little finger+ ring finger ➔

Ulnar nerve
Remember that:
• Paraesthesia of The middle three fingers (thumb, index, MIDDLE)

fingers ➔ Median Neve .
• Paraesthesia of little finger+ ring finger (both dorsal and palmar) ➔
Ulnar nerve
• Paraesthesia of the dorsal aspect of the THUMB± a small area over
the ({dorsal)) area between 1st (Thumb) and 2nd {Index) fingers ➔
Radial Nerve .
uln r
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Page4
Key 44 A blow or a trauma to the lateral aspect of the area below the knee
This called ➔ Peroneal Strike
The resulted lesion ➔ Foot drop (inability to evert or dorsiflex foot)
The affected nerve ➔ Common peroneal nerve.
Key 45 If the hit was above the knee and the resulted abnormality was
foot drop, the affected nerve is also ➔ Common peroneal nerve.
Key 46 There is no CSvertebra, it is just a nerve root that emerges below C7.
Also:
Median nerve: CS-Tl

Ulnar nerve: C8-Tl
These are roots, not vertebrae.
Both Median and Ulnar nerves are responsible for the weakness of the
hands
Important: On a lateral neck X-ray, the lowest level needed to be

seen after a neck injury is ➔ [7-TlJ
Copyr ights @ Piabl Keys.com
In a suspected Cervical fracture, we need to get X-ray of all cervical
vertebrae from Cl to C7
Sometimes, [C7-Tl junction] does not appear on AP, Lateral, Open-

moth odontoid (the peg view) X-rays. Hence, ordering what is called
(Swimmer Lateral view ) is required.
Again, if this does not show C7-Tl ➔ order CT Scan.
Key 47 A sudden fall on a knee ➔ pain and swelling below the knee cap ➔ The
affected structure is either infrapatellar or prepatellar bursa.
Prepatellar bursitisis the most common type among the knee bursae.
The prepatellar bursa is a thin bursa in front of the knee (between the
knee and the patella). It is commonly seen in people who kneel a lot
such as housemaids and plumbers.
Features: redness, pain, swelling, inability to flex knee ➔ Rest usually

relieves the symptoms.
Prepatellar Bursitis
Remember that:
- Housemaid Knee: Prepatellar bursitis.
- Clergyman or jumper's Knee: lnfrapatellar bursitis.
Key 48 Again:
Scrotum drains into ➔ Inguinal LNs. (particularly: Superficial
inguinal LNs)
Key 49 A man complains of double vision when looking to the right. The
likely affected nerve is ➔ RightAbducens
Diplopia on lateral gaze ➔ Abducens nerve (Same Side)
- - - -
O (Oculomotor) 3rd CN T (Trochlear) 4th CN A (Abducens) 6th CN
--- - --
Same side _
Opposite side
_,,__
Same side
Dilated pupil, ptOsis Diplopia on Downgaze Diplopia on Lateral gaze
Key 50 Nerve roots of the important deep tendon ref Iexes
So:
Biceps C5 and C6 I Brachioradialis C6 and C7
C7 and CBI Triceps
Ankle S1 and S2 1 Anal (contraction of external sphincter) S2 - S4
llnee L3 and L4
Key 51 The land mark that is midway between symphysis pubis and
suprasternal notch ➔ iTranspyloric
plane (Ll Level)
Notes:
• Suprasternal notch = jugular notch = fossa jugularis sternal is.
• Facial Nerve crh)

Lesion ~ facial weakness + Loss of taste of the
Anterior 2/3 of tongue.
• Vogus Nerve (10 th ) lesion ~ Weak cough, Vocal Cord Paralysis

with Dysphonia.
Also, parasympathetic loss of Respiratory, GIT, CVS.
• Trigeminal Nerve (5 th ) lesion:

- Weakness of the muscles of Mastication.
- Deviation of tongue towards the same side of the weak pterygoid
muscle
- Loss of facial sensation
• GlossopharyngealNerve (9 th ) lesion:
- Loss of gag ref lex
- Loss of taste from the Posterior 1/3 of the tongue
- Loss of general sensation from posterior pharynx, tonsils, and soft
palate.
So, Loss of Taste Sensation: Ant. 2/3: Facial Nerve (7 th )

Post. 1/3: Glossopharyngeal (9 th )
• HypoglossalNerve (12 th ): innervates the muscles of the tongue.

An injury to it would deviate the tongue to the same side as the
injury side.
Also remember:
10 + 7: Tongue Deviation to the D1pposite side of the lesion
1
.12 + 5: Tongue Deviation to the Same side of the lesion

e.g. If tongue is deviated towards the right and there is an injury on the
right side of the neck (the same side) ➔ hypoglossal(12 th ).
10th (vagus) ➔ Uvular deviation

7th (facial) ➔ Facial deviation
Key 52 Du u ren I s contracture

• a condition in which there is fixed forward curvature (fixed
flex ion) of one or more fingers, caused by the development
of a fibrous connection between the finger tendons and the
skin of the palm.
• Dupuytren's contracture has a prevalence of about 5%.
• It is more common in older male patients.
• 60-70% have a positive family history.
• Specificcausesinclude ➔ Manual labour I
phenytoin treatment
I
alcoholic liver disease trauma to the hand I
DM Smoking I
• Mechanism ➔ Formation of thickened fibrous tissue within the
palmar fascia.
• Rx ➔ Fasciotomy
Scenario:
A 38-year old man is unable to extend and straighten his 4 th and 5 th
fingers (ring and little fingers). A firm nodule was found on the
distal palmar crease in the same line with the ring finger. His father
has a Hx of a similar condition.
The likely diagnosis ➔ Dupuytren'scontracture.
The likely mechanism ➔ Formation of thickened fibrous tissue

within the palmar fascia.
Key 53 Sensory Loss Responsible Nerve Roots:
• Anterior thigh ➔ L2
• Inner thigh and distal anterior thigh ➔ L3
• Inner shin ➔ L4
• Outer shin and Dorsum of the foot ➔ LS
• Lateral Foot ➔ S1
Scenario:
A man develops severe low back pain shooting down his right leg
after lifting heavy objects. His Ankle and Knee reflexes are intact.
He has reduced sensory stimulus over the dorsum of the right foot.
-
The likely nerve root affected ➔ LS
Knee reflex is intact ➔ (Not L3 or L4)

Ankle Reflex is intact ➔ (Not S1 or S2)
Reduce sensation over the foot dorsum ➔ LS
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Key Sensory Loss Responsible Nerve Roots in LL:

53
e in. the thi9 R I l.2.in. the shinj 11.1.in. the Foo~
• Groin and pelvic Girdle ➔ ~

• Anterior thigh ➔ ~
• Inner {Medial) thigh and distal anterior thigh ➔ ~
• Inner (medial) shin ➔ ~
• Outer (Lateral) shin and Dorsum of the foot ➔ ~
• Lateral Foot ➔~
Scenario:
A man develops severe low back pain shooting down his right leg after lifting
heavy objects. His Ankle and Knee reflexes are intact. He has reduced sensory
stimulus over the dorsum of the right foot .
The likely nerve root affected ➔ ~
Knee reflex is intact ➔ (Not L3 or L4)
Ankle Reflex is intact ➔ (Not S1 or S2)
Reduced sensation over the foot dorsum (lateral shin) ➔ LS
Scenario 2:
A patient with OM present for routine check-up. His reflexe s and motor
function s are normal . However, th ere is a deficit in fine touch sensation on
the medial aspect of his low er right leg.
The likely dermatome to be affected ➔ ~
(inner shin= Medial side of a leg= L4)
Key A 40 YO man had a left elbow injury. Following that, he developed a loss of
54 sensation over the ulnar side of his left hand. His hand looks "Claw".
Which movement against resistanc e would help confirm an injury to the

affected nerve?
♦ The inj ured nerve is ➔ Ulnar nerve (Claw hand + Paraesthesia of little finger
+ ring finger "ulnar border" ).
♦ As the ulnar nerve supplies dorsal and palmar interossei that are involved in
fingers adduction and abduction , the answer would be:
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Alllal llne Axial line
Ooraal lnieroaael (1-4) Palma, lntero11el (1-3)

PIlmIr views
Key The level of iliac Crest ➔ L4

55
Key 1111 Paraesthesia (Loss of sensation) of the little finger+ ring finger
56
➔ !ulnar nervel
Remember that :
a Paraesthesia of the middle three fingers (thumb, index, MIDDLE) fingers
- !Median Nevel.
a Paraesthesia of little finger + ring finger (both dorsal and palmar)
- !Ulnar nerv~.
a Paraesthesia of the dorsal aspect of the THUMB ± a small dorsal area
between 1st (Thumb) and 2nd (Index) fingers
- !Radial Nervel.
During a laparoscopiccholecystectomy, the mid line structure that is pierced

Key 1111
57 is ➔ !Linea Albal.
While
1111 performing laparoscopy, the anatomical structure(s) to be pierced
while inserting a port at the midway point between umbilicus and anterior
superior iliac spine is
➔ !internal oblique muscle and external oblique aponeurosi 4
When
1111 inserting a chest drain in the 5th ICSanterior to mid-axillary line, not
only the vessels ( -_--~) intercostal Vein, Artery and Nerve can be pierced, but
also ~ntercostal MUSCL~ is liable to be pierced.
Key After a right wrist injury, a man lost sensation over the palmar side of the
58 index, thumb, middle fingers and half the ring finger. There is also atrophy of
the thenar eminence. He cannot touch his right little finger with his right
thumb .
The likely injured nerve is ➔ !Median nerve!.
Key A man sustained a trauma below the knee and presented with loss of foot
59 dorsiflexion . The affected nerve is:
➔ ~ ommon peroneal nerve!.
Key During chest drain Insertion, th e structure that might be damaged

60
➔ llntercoastal Arter ~
Also, intercostal VAN (Vein, Artery, Nerve) and intercostal muscles.
Key The level of iliac Crest ➔ L4

61
Key 1111A swelling behind the knee (in the popliteal fossa), usually asymptomatic,
62 round, smooth, non-tender ➔ !Baker cyst (popliteal cyst)I
Key Numbn
1111 ess and Tingling of the thumb , index and middl e fingers
63
➔ Think of ~ arpal Tunnel Syndrome (Median Nerve) I
v IPregnanc~ is an important risk factor for Carpal Tunnel Syndrome {due to

fluid retention).
v Tinel Test is not always positive in Carpal Tunnel Syndrome "very low
sensitivity".
The
1111 Transverse Carpal Ligament compresses the MEDIAN nerve
Thus, the treatment would be ➔ lcut the Transverse Carpal Ligament!

1111
to release the pressure on the median nerve.
~ Note : Transverse Carpal Ligament is also called= Flexor Retinaculum =

Anterior Annular Ligament .
Key A man is unabl e to abduct and adduct his finger s, X-ray neck showed cervical
64 vert ebrae showing degenerativ e changes. The likely nerve root of brachia!
plexus affected?
a.CS
b.C6
c. C7
d.C8
e. I!!]
~8 radiculopath~
Affects thumb abduction and extension , ulnar deviation of the wrist , and
causes paraesthesia of a thin area on the forearm which runs down to include
the little finger.
[1 Radiculopath~
Affects Fingers Abduction and Adduction , Pain and Paraesthesia along the
affected nerve.
Key Patient with cut to the wrist and inability to flex the distal phalanx of little
65 finger. Which structure is damaged?
A) ~lexor digitorum profundusl

B) flexor digitorum superficialis
C) ulnar nerve
- Unable to flex the "Proximal" interphalangeal joints AND

Metacarpophalangeal (MCP) joint ➔
IFlexor Digitorum Superficiali~.
- Unable to flex the " Distal" interphalangeal joints ➔
IFlexor Digitorum profundu~.
Key A man who works as a builder was working with a screwdriver and felt that
66 something gives way in his upper arm. There is a bulging present in the upper
part of his arm.
tf
A. endon rupture!
8. Muscle haematoma
- [ProximalBicepsTendonRupture: Muscle bunches up in the distal arm,

Popeye appearance.
- bistal BicepsTendonRupture1: Single traumatic event (e.g. flexion against

resistance), sudden sharp tearing sensation, painful swollen elbow,
weakness of flexion and supination.
IThe
patient feels that something in the cubitalfossa has rupture~
Key A man with crutches having w eakne ss on the left arm on dorsiflexion of
67 wri st, and wri st drop, structur e affected?
a.CS
b.C6
C. !Radialnervel
D. lnterosseous nerve
E. Median nerve
~adial Nerve (CS-Tlj
- Motor supply to the Extensors of the (thumb, fingers, wrist and forearm).
If damaged ➔ Wrist Drop
- Radial nerve can be compressed against the operating table (medial aspect
of the arm) during an operation ➔
(Saturday Night Palsy).
- Also, Crutch palsy (a compression against the spiral groove on the medial
aspect of humerus).
- Injury to the Radial nerve can also lead to sensory loss of the dorsal aspect
of the THUMB ± a small area over the dorsal aspect between l51 and 2 nd
finger s.
Key A young man presents with sudden pain in the chest while lifting weights . He
68 is unable to lift the arm above the head. He also has difficulty in abducting his
left arm beyond 90. When the arm is stretched out against resistance, the
scapula is noticed to be prominent. Injury to which of the following nerves is
affected?
A. Dorsal scapula nerve
B. !Longthoracic nervel
C. Posterior interosseus nerve
D. Axillary nerve
E. Thoracodorsal nerve
~ong thoracic nerve! (CS-C7)

Serratus anterior
!Longthoracic nervel (CS-C7) Serratus Often during sport e.g. following a

anterior blow to the ribs. Also, possible
complication of mastectomy
Damage results in a lwinged scapula!
Key !Femoral Nerve lnjuryj:

69
e.g. a stab injury to the inguinal area.
v Weakness on hip flexion .

v Weakness on knee extension.
v Loss of sensation, Paraesthesia over the medial side of the thigh.
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Femoral nerve
(L2, L3, L4)
\.--- macus
~ Femoral _ _ _
♦,.. nerve
~ Quadriceps
Key ower limb anatom

70
Nerve Motor Sensory Typical mechanism of injury &

note s
Femoral Knee Anterior and Hip and pelvic fractures

nerve extension, medial aspect of Stab/gunshot wounds
thigh flexion the thigh and
lower leg
Obturator Thigh Middle part of Anterior hip dislocation

nerve adduction Medial thigh
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Lateral None Lateral and Compression of the nerve near

cutaneous posterior the ASIS➔ meralgia
nerve of surfaces of the paraesthetica, a condition
the thigh thigh characterised by pain, tingling and
numbness in the distribution of
the lateral cutaneous nerve
Tibial Foot Sole of foot Not commonly injured as deep

nerve plantarflexion and well protected.
and inversion Popliteal lacerations, posterior
knee dislocation
Common Foot Dorsum of the Injury often occurs at the neck of

peroneal dorsiflexion foot and the the fibula
nerve and eversion lower lateral Tightly applied lower limb plaster
Extensor part of the leg cast
hallucis longus
Injury causes foot drop
Superior Hip abduction None Misplaced intramuscular injection

gluteal Hip surgery
nerve Pelvic fracture
Innervates gluteas minimis , medius , piriformis Posterior hip dislocation
Injury results in a positive

Trendelenburg sign

Inferior Hip extension None Generally injured in association

gluteal and lateral with the sciatic nerve
nerve rotation
Injury results in difficulty rising
Innervates gluteas maximus
from seated position. Can't jump,
can't climb stairs
Key A young man presents with sudden pain in the chest while lifting weights . He
68 is unable to lift the arm above the head. He also has difficulty in abducting his
left arm beyond 90 . When the arm is stretched out against resistance, the
scapula is noticed to be prominent. Injury to which of the following nerves is
affected?
A. Dorsal scapula nerve
B. !Longthoracic nervel
C. Posterior interosseus nerve
D. Axillary nerve
E. Thoracodorsal nerve
~ong thoracic nervel (CS-C7)

Serratus anterior

!Longthoracic nervel (CS-C7) Serratus Often during sport e.g. following a

anterior blow to the ribs. Also, possible
complication of mastectomy
Damage results in a lwinged scapula!
Key A 21 YO male presents complaining of inability to grip objects with his right
71 hand. He has noticed this issue since he had trauma to his hand while playing
rugby a few days ago . On examination, the patient cannot flex the distal
phalanx of his right ring finger. What is the most likely affected structure?
➔ IFlexor digitorum profundus l.
Notes on Fingers Flexors
- Unable to flex the "Proximal" interphalangeal joints± Metacarpophalangeal

(MCP) joint ➔
IFlexor Digitorum Super(iciali!
- Unable to flex the "Distal" interphalangeal joints ➔
IFlexor Digitorum profundu!
Key A 55 YO man presents complaining of a neck pain, left arm discomfort and
72 left-hand weakness. On examination, he has weakness in abducting and
adducting the fingers of his left hand. MRI reveals a left-sided disc herniation
in one area of spinal cord. What is the likely affected nerve root?
Remember:
FBradiculopath~
Affects thumb abduction and extension , ulnar deviation of the wrist , and
causes paraesthesia of a thin area on the forearm which runs down to include
the little finger.

tr1 Radiculopath~
Affects Fingers Abduction and Adduction , Pain and Paraesthesia along the
affected nerve.
Also Remember:
The motor function of the nerve roots of an upper limb
CS,C6,C7,C8
Flex, extend, extend, flex
elbow, wrist, elbow, fingers
cs C6 C7 C8
Flex Extend Extend Flex
elbow wrist elbow Fingers
Adduct and Abduct Fingers ➔ Tl
Key The arterial supply of the Lower Limbs:

73

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) ~ Commoniliac artery
/ ~ External iliac artery
/ . ommon Femoral artery
I nt erno 111tac .___
artery
Profunda femoris
artery
Groin cr ease
Superficial femoral
arter y
Popliteal artery
Tibio-peroneol
tru nk
Anterior t ibial
Peroneolartery___, r , artery
Posterior tibial
artery
External iliac - Femoral - Popliteal - Anterior tibial - Dorsalis pedis
(The obstructed artery is a lways one leve l prox ima l "above" the
affected musc le group).
Or, one leve l above the artery that cannot be fe lt.
Example 1:
An elderly with Hx of smoking and uncontrolled DM presents with
pain on calf muscles after walking. He has to rest for a while to be
able to continue walking. Popliteal artery and dorsalis pedis cannot
be felt.
• The likely occ luded artery is - W

emoropopliteal arter ~.
Example 2:
A patient whose femoral and popliteal pulses are not felt.
• The likely occ luded artery - !External iliac arteryl.
Claudication pain in Peripheral Arterial Disease
The level of ischemia
♦ ~ orto -iliac artery occlusion!:

Pain in buttocks, thighs± Erectile Dysfunction {Leriche Syndrome).

♦ lcommon iliac artery occlusionl:

➔ pain extends to just above inguinal ligament.
♦ !Femoral artery occlusionl:
➔ pain in leg (below inguinal ligament). Femoral pulse is felt but the pulses
below it are not felt.
•IFemoro-politeal l
➔ Pain is below knee.
Key III Pregnancy can predispose to Guyon 's canal syndrome

74
(IUlnan nerve compression at wrist
- numbness over little finger + half the ring finger).
111Pregnancy can predispose to Carpal tunnel syndrome

(IMedian l nerve compression
- numbness over thumb , index and middle fingers).
Key A young man fell down on his right shoulder and arm and presents
75 with the following:
Weakness of right shoulder abduction and external rotation.

Numbness over the lateral side of the right arm.
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Numbness over the lateral side of the right forearm.
What is the likely affected structure?
Answer :
➔ !upp er brachia I plexus= superior trunk of the brachiaI plexus.I
v Weakness of right shoulder abduction and external rotation = axillary nerve=

CS, C6.
v Numbness of lateral arm= axillary nerve= CS, C6.

v Numbness of lateral forearm= musculocutaneou s nerve= CS, C6, C7
Upper brachia! plexus = CS, C6, C7
Lower brachia! plexus = C8, Tl
Key A young man fell on outstretched arm and was treated surgically. 6
76 months later, he presents with the following:
v Decreased sensation of little finger and medial half if the ring finger.
v Wasting of the interosseous muscles.
v Inability to cross the two fingers (little+ ring) or abduct his little finger.
What is the likely affected structure?
Answer :
➔ !Lower brachia I plexus= Inferior trunk of the brachia I plexus.I

Another correct answer ➔ !ulnar nervel.
v All given 3 features indicate damage to Ulnar nerve.

v Ulnar nerve= C8, Tl
v C8 and Tl= inferior (lower) trunk of brachia! plexus.
Upper brachia! plexus = CS, C6, C7
Lower brachia! plexus = C8, Tl
Remember:
[!) Ulnar nerve injury (CS, Tl) :
♦ Claw hand + Paraesthesia of little finger+ ring finger "ulnar border" .
♦ The ulnar nerve supplies dorsal and pal mar interossei that are involved in
fingers adduction and abduction ➔ interosseous muscles wasting, no
abduction/ adduction of fingers.

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- Wrist Drop ➔ Radial Nerve .

- Unable to flex the 11 Proximal'' interphalangeal joints AND

- Unable to flex the ''Distal'' interphalangeal joints ➔

Key 2 - Affected !Accessorynerve (e.g. during a surgery of the POSTERIOR

Kev 3 - rProximal Bic~D§ T~ndon Runtur~ !: MLJSCIP hLJnchPs LJO in thP

distal arm, Popeye appearance.

- Distal BicepsTendon Rupture: Single traumatic event (e.g.

pronator are affected. Seen in baseball players, construction injury,

Key 4 - Fracture of the neck of the Fibula leads to an injury of ➔

• Fibular Nerve supplies biceps femoris (which flexes the Knee).

Superficial Fibular (Which innervates the Lateral compartment of

The injury of Common peronea l Nerve leads to FOOT DROP (No

Key 5 - Loss of sensat ion in MEDIAL Foot ➔ Saphenous Nerve.

• Saphenous Nerve is the Largest Cutaneous branch of the Femoral

/~ -- lnfrapate llar branch of

- ---- atera l cutaneous

Anterior ly: Pectoralis Major . Posteriorly: Latissimus Darsi.

Key 7 On Lymphatic Drainage

• Gonads (Ovary , Testis ) ➔ Para-aortic LNs.

E.g. A woman with ovarian cancer, the likely LNs to be involved ➔

Remember that, the two motor branches of the common peroneal

• Deep peroneal nerve ➔ Supplies the Anterior Compartment of the

Key 9 • Extensor Digitorum ➔ (Extends the middle three fingers: index,

• Extensor Digitorum ➔ (Extends all fingers at MCP and IP joints).

• Extensor digiti minimi ➔ (Extends the little finger).

• Extensor indices ➔ (Extends the index finger).

• Extensor Pollicis➔ (Thumb)

• Extensor PollicisLongus➔ (Extends the Thumb at the

N.B. Full extension of a thumb is achieved by extensor pollicis

• Extensor PollicisBrevis ➔ (Extends Thumb at Metacarpophalangeal

Q) A patient with an injury on his hand cannot extend the

- Unable to flex the ''Proximal'' interpha langeal IP joints AND

Other Clinchers for Anatomy:

• Ulnar Nerve (CS-Tl) injury:

• Radial Nerve (CS-Tl):

- Radial nerve can be compressed against the operating table

- Also, Crutch palsy (a compression against the spiral groove on

In contrast, the long (great) SaphenousVein runs on the MEDIAL

Do not get confused with NERVES, Saphenous nerve runs

501 on the medial aspect of a leg ➔ Long Saphenous Vein +

Q) Varicose veins on the lateral aspect of the leg. The affected

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Key 11 points on the E~e Nerves~

• Lateral Rectus muscle ➔ supplied by Abducens Nerve (6 th CN).

Same, Opposite, Same side

The affected nerve is ➔ Left Trochlear nerve

Climbing the stairs= "downward gaze" ➔ Trochlear ➔ opposite

The motor function of the nerve roots of an upper limb (Reading)

Adduct and Abduct Fingers ➔ Tl

N.B. There is nothing called (CSVertebral injury), but there is (CS

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The likely affected structure ➔ CSRoo1.

Key 13 - The Important iTranspyloricPlane= The level of Ll = The level of the

Key 14 • Perforation of a Posterior (Gastric) Ulcer (Fund us or Body of

stomach) ➔ Abscess formation that passes to the peritonea l cavity

• Perforation of Posterior (Pyloric) Or (Duodenal) Ulcer ➔

Key 15 • CVE (Stroke) of the Temporal lobe ➔ (Memory Impairment,

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Temporal ➔ superior homonymous quadrant inopias