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There are several sites on the web where books by Singh can be downloaded for free. Here's one: Anatomy Vishram Singh. Online search for PDF Books. - Free download as PDF File .pdf), Text File .txt) or read online for free. Anatomy Vol-I Vishram Singh - Ebook download as PDF File .pdf), Text File .txt) or read book online. Anatomy for Medical.

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Anatomy Books PDF download. Here is the list of VISHRAM SINGH. Vishram Singh In this section you can download the 1st proff books PDF 1) Anatomy. publisher's note In the months from September to the beginning of December , reportedly Helen scribed the section. Clinical pharmacology is the science of drug use in humans. Clinicians of all specialties pre A Textbook o Anatomy & Physiology. Pages··

The digits nearest to the preaxial border are thumb and big toe in the upper and lower limbs. The upper epiphysis fuses at the age of 12 years. The superficial lymphatics of the breast of one side communicate with those of the opposite side. Goldy Bhatnagar Project Coordinator. First coracoid centre represents precoracoid element and second coracoid subcoracoid centre represents coracoid proper of reptilian girdle. They articulate with each other at the acromioclavicular joint and form the shoulder girdle.

The disabling effects of an injury to the upper limb. The human hand with its digits can perform complex skilled movements under the control of the brain. Forelimbs Hindlimbs A Upper limb forelimb 1.

It is freely movable. The power and hook grips are primitive in nature. All the terrestrial vertebrates possess four limbs—a pair of forelimbs and a pair of hindlimbs.

In quadrupeds such as dogs and buffaloes. In human beings. As a result. Hence man is considered as the master mechanic of the animal world. Appearance of joints permitting rotatory movements of the forearm. Suitable changes for free mobility of the fingers and hand. The bone of the arm is humerus. The shoulder girdle articulates with the rest of the skeleton of the body only at the small sternoclavicular joint. It is not weight bearing and is. The carpal bones articulate a with each other at intercarpal joints.

They articulate with each other at the acromioclavicular joint and form the shoulder girdle. Forearm or antebrachium.

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The hand or manus consists of the following parts: The bones of the shoulder region are the clavicle collar bone and the scapula shoulder blade. The wrist consists of eight carpal bones arranged in two rows. Only one small joint sternoclavicular joint connects the skeleton of upper limb to the rest of the skeleton of the body.

These bones articulate with humerus at the elbow joint and with each other forming radio-ulnar joints. The arm is the part of the upper limb between the shoulder and elbow or cubitus.

The shoulder region includes: Upper Limb and Thorax that of hand is far more than the extent of an injury. The pectoral girdle is composed of two bones — scapula and clavicle. The primary function of the pectoral girdle is to provide attachment to numerous muscles.

Arm or brachium. The pectoral girdle is not a complete girdle because it is attached to the axial skeleton only anteriorly.

The upper limbs are connected to the trunk by a pectoral girdle. The scapula is connected to the clavicle by the acromioclavicular joint. The forearm is the part of the upper limb between the elbow and the wrist. The bones of the forearm are radius and ulna. Note that pelvic girdle is a complete girdle. The limb girdle is defined as the bones which connect the limbs to the axial skeleton.

Each has dorsal and ventral surfaces. A short account of the development of the limbs further makes it easier to understand the differences between the upper and lower limbs Fig. First they are simple flipper-like appendages so that the upper and lower limbs are similar in their appearance. The development of upper and lower limbs begins in the 4th week of intrauterine life IUL. The proximal part is called limb girdle and attaches the limb to the trunk.

The preaxial border faces towards the head. The digits are five and numbered 1 to 5 from lateral to medial side.

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The phalanges form metacarpophalangeal joints with metacarpals and interphalangeal joints with one another. The homologous parts of the upper and lower limbs are enumerated in Table 1. For example. A pair of small elevations appears on the ventrolateral aspect of the embryo called limb buds. The subdivisions. The posterior pair of lower limb buds appears 3 or 4 days later at the level of lumbar and upper sacral segments. The first digit is called thumb and remaining four digits are fingers.

Each digit is supported by three short long bones—the phalanges except thumb. The distal part is free and consists of proximal. The functional value of thumb is immense. Each limb is made up of two portions: They articulate a proximally with distal row of carpal bones forming carpometacarpal joints.

Later in Table 1. Thus during an early stage of development all the four limbs appear as paired limb buds. The anterior pair of the upper limb buds appears opposite the lower cervical segments. Introduction to the Upper Limb Table 1.

The digits nearest to the preaxial border are thumb and big toe in the upper and lower limbs. Table 1. The clavicle is attached to the scapula by a strong coracoclavicular ligament strongest ligament in the upper limb.

The limbs then rotate. The differences between the upper and lower limbs are listed in Table 1. The two bones of girdle are joined together by even smaller joint.. The five main branches of brachial plexus are axillary.

Scapula Axial skeleton 5. The axillary nerve supplies the deltoid and teres minor muscles. The deltoid muscle covers the shoulder like a hood and is commonly used for intramuscular injections. The muscles of anterior compartment are mainly flexors and those of posterior compartment extensors.

The lines of force transmission in the upper limb are shown in Flowchart 1. Introduction to the Upper Limb Coracoclavicular ligament Clavicle Sternoclavicular joint Forces of the upper limb are transmitted to the axial skeleton by clavicle through costoclavicular ligament and sternoclavicular joint.

The muscles of anterior and posterior compartments mainly act synergistically to carry out specific functions. The muscles of hand are responsible for its various skilled movements such as grasping.

The arm and forearm are invested in the deep fascia like a sleeve and are divided into anterior and posterior compartments by intermuscular septa. The radial and ulnar arteries supply the lateral and medial parts of the forearm. All the intrinsic muscles of the hand are supplied by the ulnar nerve except muscles of thenar eminence and first two lumbricals. At the lower border of the teres major muscle its name is changed to brachial artery.

In the hand. The axillary is the continuation of subclavian artery. The brachial artery supplies the anterior and posterior compartments of the arm. The brachial artery continues down the arm and just distal to the elbow joint. The radial nerve supplies the muscles of the posterior extensor compartments of the arm and forearm.

Upper Limb and Thorax Axillary nerve Musculocutaneous nerve Radial nerve Radial nerve Median nerve Ulnar nerve Ulnar nerve Deep branch of radial nerve posterior interosseous nerve Deep branch of radial nerve posterior interosseous nerve Superficial branch of radial nerve superficial radial nerve A B Fig.

The subclavian vein continues towards the root of the neck where it joins the internal jugular vein to form the brachiocephalic vein. The superficial veins of the upper limb originate from the dorsal venous arch of the hand. Anterior to the elbow. The deep lymph vessels follow the deep arteries viz.

The medial end of the dorsal venous arch forms the basilic vein. The two brachiocephalic veins right and left join each other to form superior vena cava. The lateral end of the dorsal venous arch forms the cephalic vein. The superficial lymph vessels follow the superficial veins. The three major nerves of the upper limb e. The scaphoid is the most commonly fractured bone of the hand. The arterial pulse is most commonly felt on the lateral side of the front of distal forearm of recording pulse rate.

The upper limb is therefore light built. The arterial pulsation is most commonly felt and auscultated on the medial side of the front of elbow for recording of blood pressure. The common dislocations in the upper limb are dislocations of shoulder joint most commonly dislocated joint in the body. The compression of median nerve at wrist is most common peripheral neuropathy in the body. The common fractures in the upper limb are fracture of clavicle most commonly fractured bone in the body.

The mechanism of grasping is provided by hand with the four fingers flexing against the opposable thumb. The common nerve injuries in the upper limb are injuries of brachial plexus.

The human upper limb is meant for prehension.

The ulnar nerve can be easily palpated behind the medial epicondyle of the humerus. Bones of the pectoral Clavicle. Each upper limb contains 32 bones Fig. This allows free swing of the upper limb for various prehensile acts such as holding. The study of bones also helps to understand the position of various articulations. It acts as a strut for holding the upper limb far from the trunk so that it can move freely.

It is the only bony attachment between the trunk and upper limb.

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Phalanges 14 Fig. It articulates medially with the sternum and 1st rib cartilage and laterally with the acromion process of the scapula. Carpal bones. The students must read the features and attachments of the bones before undertaking the study of the upper limb. It is subcutaneous and hence it can be palpated through its entire extent. CHAPTER 2 Bones of the Upper Limb The study of bones of the upper limb is important to understand the general topography of the upper limb and the attachment of various muscles and ligaments.

It is located horizontally on the anterior aspect of the body at the junction of root of the neck and trunk.

Radius and ulna. It provides an area for the attachment of muscles. The medial sternal end is enlarged and quadrilateral. The peculiar features of the clavicle are as follows: It articulates with the clavicular notch of the manubrium sterni.

It is the only long bone which ossifies in membrane except for its medial end cf. The lateral end provides attachment to fibrous capsule of acromioclavicular joint.

It is the only long bone which ossifies by two primary centers. Acromial end Ant. The lateral acromial end is flattened above downwards and articulates with medial margin of the acromion process.

It provides attachment to a fibrous capsule b articular disc. A Trapezoid ridge Shaft Post. It is the only long bone which lies horizontally. Rough impression for costoclavicular ligament It is subcutaneous throughout its extent.

It transmits forces from the upper limb to the axial skeleton sternum. It may be pierced through and through by cutaneous nerve intermediate supraclavicular nerve. The convexity of its medial two-third and concavity of its lateral one-third face forwards with longitudinal groove in the middle third of shaft facing inferiorly.

It has no medullary cavity. It is the first bone to start ossifying between the fifth and sixth week of intrauterine life and last bone to complete its ossification at 25 years. Conoid tubercle Acromial end Sternal end Med.

Bones of the Upper Limb 2. An oval facet on this end articulates with the facet on the medial margin of the acromion to form acromioclavicular joint. B Subclavian groove groove for subclavius muscle Fig. The inferior surface of the shaft possesses a small longitudinal groove in its middle third.

Sternal end Med. Its medial two-third is round and convex forwards. Ends 1. Subclavius Trapezoid part B Capsule of sternoclavicular joint Conoid part Costoclavicular ligament Articular facet for manubrium Coracoclavicular ligament Fig.

Third part of subclavian artery. Trunks of brachial plexus. It has two surfaces. A small tubercle called deltoid tubercle may be present on this border.

Posterior surface: It is concave backwards and gives origin to sternohyoid muscle near its medial end. The muscles and ligaments attached to the clavicle are given in Table 2. Table 2. Inferior surface: It presents the following features: Costoclavicular ligament is attached to an oval impression at its medial end. Anterior surface: It is convex forwards and gives origin to clavicular head of pectoralis major.

Superior surface: The clavicular head of sternocleidomastoid muscle originates from medial half of this surface. The trapezoid ridge extends forwards and laterally from conoid tubercle.

Subclavius muscle is inserted into the subclavian groove on this surface. The conoid tubercle is located on the inferior surface near the posterior border at the junction of the lateral one-fourth and medial three-fourth of the clavicle.

Posterior border: It is convex backwards and provides insertion to the trapezius muscle. Medial Two-third It is cylindrical in shape and presents four surfaces: Shaft The shaft of the clavicle is divided into two parts: The medial two-third of shaft is convex forward and lateral one-third is concave forward..

Trapezius Ant. Surfaces Superior surface: It is subcutaneous between the attachments of deltoid and trapezius. The lateral part of this surface forms the anterior boundary of cervico-axillary canal and is related to the following structures: Borders Anterior border: It is concave forwards and gives origin to deltoid muscle.

Lateral One-third It is flattened from above downwards. Nutrient foramen of clavicle is located on the lateral end of the subclavian groove. It presents a conoid tubercle and trapezoid ridge. Clavipectoral fascia is attached to the margins of subclavian groove. The radiological appearance of this epiphysis in females confirms their bone age for legal consent to marriage.

Whole of it ossifies in the membrane except its medial end which ossifies in the cartilage. Bones of the Upper Limb Table 2. Acromial end Secondary centre at the acromial end occasional Sternal end Two primary centres Fig.

Page A B Clinical correlation Congenital anomalies: It is a clinical condition in which medial and lateral parts of clavicle remain separate due to nonunion of two primary centers of ossification. Secondary centre at the sternal end The site of appearance.

It ossifies by four ossification centres — two primary centres for shaft and two secondary centres. The fracture at the junction of lateral onethird and medial two-third occurs because: Muscle spasm Teres major and Pectoralis major Fig. Growing end of clavicle: The sternal end of clavicle is its growing end. It commonly fractures at the junction of its lateral one-third and medial two-third due to blows to the shoulder or indirect forces.

The medial fragment is slightly elevated by the sternocleidomastoid muscle. It is a clinical condition characterized by partial or complete absence of clavicle associated with defective ossification of the skull bones. The clavicle begins to ossify before any other bone in the body. In addition. The clavicle is the most commonly fractured bone in the body. It is the last of all the epiphyses in the body to fuse with the shaft. All rights reserved.

Copyright Elsevier Clinical and Surgical Anatomy. When fracture occurs. The dorsal surface presents a shelf-like projection on its upper part called spinous process. The suprascapular notch is converted into suprascapular foramen by superior transverse suprascapular ligament. Spinous process. Borders Superior border 1.

The supraspinatus muscle arises from medial two-third of supraspinous fossa. Two surfaces: Coracoid process. These are as follows: Some authorities divide scapula into three parts. Three borders: It arises from the upper border of the head and bends sharply to project superoanteriorly. The serratus anterior muscle is inserted on this surface along the medial border and inferior angle.

Dorsal surface 1. The spinoglenoid notch lies between lateral border of the spinous process and the dorsal surface of the neck of scapula. The acromion process projects forwards almost at right angle from the lateral end of the spine. The superior border is the shortest border and extends between superior and lateral angles. The spinous process is a shelf-like bony projection on the dorsal aspect of the body. The glenoid cavity faces laterally. The upper.

The lateral angle is truncated to form an articular surface—the glenoid cavity. The teres minor muscle arises from the upper two-third of the dorsal surface of lateral border. Acromion process. The teres major muscle arises from the lower one-third of the dorsal surface of lateral border and inferior angle of scapula.

The spinous process divides the dorsal surface into supraspinous and infraspinous fossae. It is concave and directed medially and forwards. It presents three longitudinal ridges. The latissimus dorsi muscle also arises from dorsal surface of the inferior angle by a small slip. The dorsal surface is convex and presents a shelf-like projection called spinous process. The lateral angle is thickened and called head of the scapula.

The coracoid process is directed forwards. Body The body is triangular. The suprascapular notch is present on this border near the root of coracoid process. Processes There are three processes.

Three angles: This origin is interrupted by the circumflex scapular artery. The shelf-like spinous process is directed posteriorly. The infraspinatus muscle arises from medial two-third of infraspinous fossa.

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Through this notch supraspinous fossa communicates with the infraspinous fossa and suprascapular nerve and vessels pass from supraspinous fossa to the infraspinous fossa.

Coracoacromial ligament Short head of biceps brachii and coracobrachialis. Suprascapular ligament Deltoid Superior angle Glenoid cavity lateral angle. A, costal surface; B, dorsal surface. The suprascapular artery passes above the ligament and suprascapular nerve passes below the ligament, through suprascapular foramen. Air force flies above the Navy, i. The inferior belly of omohyoid arises from the superior border near the suprascapular notch. Lateral border 1.

The lateral border is the thickest border and extends from inferior angle to the glenoid cavity. The infraglenoid tubercle is present at its upper end, just below the glenoid cavity. The long head of triceps muscle arises from the infraglenoid tubercle.

Lateral border of scapula is thick because it acts as fulcrum during rotation of the scapula. Medial border vertebral border 1. It extends from superior angle to the inferior angle. It is thin and angled at the root of spine of scapula. The serratus anterior muscle is inserted on the costal surface of the medial border and the inferior angle.

The levator scapulae muscle is inserted on the dorsal aspect of the medial border from superior angle to the root of spine. The rhomboideus minor muscle is inserted on the dorsal aspect of the medial border opposite the root of spine. The rhomboideus major muscle is inserted on the dorsal aspect of the medial border from the root of spine to the inferior angle.

Angles Inferior angle: It lies over the 7th rib or the 7th intercostal space. Superior angle: It is at the junction of superior and medial borders, and lies over the 2nd rib. Lateral angle head of scapula 1. It is truncated and bears a pear-shaped articular cavity called the glenoid cavity, which articulates with the head of humerus to form glenohumeral shoulder joint.

A fibrocartilaginous rim, the glenoid labrum is attached to the margins of glenoid cavity to deepen its concavity. The capsule of shoulder joint is attached to the margins of glenoid cavity, proximal to the attachment of glenoid labrum. The long head of biceps brachii arises from supraglenoid tubercle. This origin is intracapsular. Processes Spinous process spine of scapula 1.

It is a triangular shelf-like bony projection, attached to the dorsal surface of scapula at the junction of its upper one-third and lower two-third. It divides the dorsal surface of scapula into two parts— upper supraspinous fossa and lower infraspinous fossa. The spine has two surfaces— a superior and b inferior, and three borders— a anterior, b posterior, and c lateral. Surfaces a The superior surface of spine forms the lower boundary of supraspinous fossa and gives origin to supraspinatus.

Borders a The anterior border of spine is attached to the dorsal surface of scapula. Trapezius is inserted to the upper lip of crest of spine, while posterior fibres of deltoid take origin from its lower lip.

Acromion process acromion 1. It projects forwards almost at right angle from the lateral end of spine and overhangs the glenoid cavity. Its superior surface is subcutaneous. It has a tip, two borders medial and lateral , and two surfaces superior and inferior. The medial and lateral borders of acromion continue with the upper and lower lips of the crest of the spine of scapula, respectively. Its superior surface is rough and subcutaneous.

Its inferior surface is smooth and related to subacromial bursa. The medial border of acromion provides insertion to the trapezius muscle. Near the tip, medial border presents a circular facet, which articulates with the lateral end of clavicle to form the acromioclavicular joint.

The lateral border of acromion gives origin to intermediate fibres of the deltoid muscle. The coracoacromial ligament is attached to the tip of acromion.

The acromial angle is at the junction of lateral border of acromion and lateral border of the crest of the spine of scapula. Coracoid process 1. It arises from the upper part of the head of scapula and bent sharply so as to project forwards and slightly laterally. The coracoid process provides attachment to three muscles—short head of biceps brachii, coracobrachialis, and pectoralis minor, and three ligaments— coracoacromial, coracoclavicular, and coracohumeral.

The short head of biceps brachii and coracobrachialis arise from its tip by a common tendon. The pectoralis minor muscle is inserted on the medial border of the upper surface. The coracoacromial ligament is attached to its lateral border. The conoid part of the coracoclavicular ligament rhomboid ligament is attached to its knuckle. The trapezoid part of the coracoclavicular ligament rhomboid ligament is attached to a ridge on its superior aspect between the pectoralis minor muscle and coracoacromial ligament.

The coracohumeral ligament is attached to its root adjacent to the glenoid cavity. The cartilaginous scapula is ossified by eight centres—one primary and seven secondary. The primary centre appears in the body. The secondary centres appear as follows: Two centres appear in the coracoid process. Two centres appear in the acromion process. One centre appears each in the a medial border, b inferior angle, and c in the lower part of the rim of glenoid cavity.

The primary centre in the body and first secondary centre in the coracoid process appears in eighth week of intrauterine life IUL and first year of postnatal life, respectively and they fuse at the age of 15 years. All other secondary centres appear at about puberty and fuse by 20th year. First coracoid centre represents precoracoid element and second coracoid subcoracoid centre represents coracoid proper of reptilian girdle. The scapula develops in the neck region during intrauterine life and then migrates downwards to its adult position i.

In this condition the scapula is hypoplastic and situated in the neck region. It may be connected to the cervical part of vertebral column by a fibrous, cartilaginous, or bony bar called omovertebral body.

An attempt to bring down scapula by a surgical procedure may cause injury to the brachial plexus. It is the longest and strongest bone of the upper limb. Upper End The upper end presents the following five features: Greater tubercle.

Lesser tubercle. Intertubercular sulcus. The head is smooth and rounded, and forms less than half of a sphere. It is directed medially backwards and upwards.

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It articulates with the glenoid cavity of scapula to form the glenohumeral shoulder joint. Lower End The lower end presents the following seven features: Capitulum, a lateral rounded convex projection. Trochlea, a medial pulley-shaped structure. Radial fossa, a small fossa above the capitulum. Coronoid fossa, a small fossa above the trochlea. Medial epicondyle, a prominent projection on the medial side. Lateral epicondyle, a prominent projection on the lateral side but less than the medial epicondyle.

Olecranon fossa, a large, deep hollow on the posterior aspect above the trochlea. Shaft The shaft is a long part of bone extending between its upper and lower ends. It is cylindrical in the upper half and flattened anteroposteriorly in the lower half.

Coronoid fossa Lateral supracondylar ridge Medial supracondylar ridge Radial fossa Lateral epicondyle. The rounded head at the upper end faces medially, backwards and upwards. The lesser tubercle, greater tubercle, and vertical groove intertubercular groove at the upper end faces anteriorly.

It is smooth, rounded and forms one-third of a sphere. It is covered by an articular hyaline cartilage, which is thicker in the center and thinner at the periphery. Anatomical neck 1. It is constriction at the margins of the rounded head.

It provides attachment to the capsular ligament of the shoulder joint, except—superiorly where the capsule is deficient, for the passage of tendon of long head of biceps brachii, medially the capsule extends down from the anatomical neck to the shaft for about 1—2 cm. It is related to axillary nerve and posterior and anterior circumflex humeral vessels.

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It is the most important feature of the proximal end of the humerus because it is weaker than the more proximal regions of the bone, hence it is one of sites where the.

A, anterior aspect; B, posterior aspect. Morphological neck 1. It is the junction between diaphysis and epiphysis. It is represented by an epiphyseal line in the adult bone.

It is a true junction of head with the shaft. Greater tubercle 1. It is the most lateral part of the proximal end of humerus.

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Its posterosuperior aspect bears three flattened facet-like impressions: SIT, supraspinatus, infraspinatus, teres minor. Lesser tubercle 1. It is small elevation on the front of upper end of humerus, just above the surgical neck. It provides attachment to subscapularis muscle.

It is a vertical groove between lesser and greater tubercles. It contains a long head of biceps, enclosed in the synovial sheath and b ascending branch of anterior circumflex humeral artery. Three muscles are attached in the region of this groove: Lady between 2 Majors.

Shaft The upper part of the shaft is cylindrical and its lower part is triangular in cross section. It has three borders and three surfaces. It starts from the lateral lip of the intertubercular sulcus, and extends down to the anterior margin of the deltoid tuberosity and become smooth and rounded in the lower half, where it ends in the radial fossa.

Medial border 1. It extends from the medial lip of the intertubercular sulcus down to the medial epicondyle. Its lower part is sharp and called medial supracondylar ridge. This ridge provides attachment to medial intermuscular septum. A rough strip on the middle of this border provides insertion to the coracobrachialis muscle. A narrow area above the medial epicondyle provides origin to the humeral head of the pronator teres.

Its upper part is indistinct while its lower part is prominent where it forms the lateral supracondylar ridge. Above the lateral supracondylar ridge, it is illdefined but traceable to the posterior part of the greater tubercle. About its middle, this border is crossed by the radial groove from behind.

The lower part of this border, lateral supracondylar ridge, provides attachment to the lateral intermuscular septum. Surfaces Anterolateral surface 1.

It lies between the anterior and lateral borders. A little above the middle, this surface presents a characteristic V-shaped tuberosity—the deltoid tuberosity which provides insertion to the deltoid muscle. Anteromedial surface 1. It lies between the anterior and medial borders. The upper part of this surface forms the floor of the intertubercular sulcus.

About its middle and close to the medial border it presents a nutrient foramen directed downwards. Posterior surface 1. It lies between the medial and lateral borders. In the upper one-third of this surface, there is an oblique ridge directed downwards and laterally.

This ridge provides origin to the lateral head of the triceps brachii. The entire posterior surface below the spiral groove provides origin to the medial head of the triceps brachii. Lower End 1. It is flattened from before backwards and expanded from side to side. The capitulum rounded convex projection laterally articulates with the head of radius.

The trochlea pulley-shaped projection medially articulates with the trochlear notch of ulna. The ulnar nerve is related to the posterior surface of the medial epicondyle. The anterior surface of the medial epicondyle provides an area for common flexor origin of the superficial flexors of the forearm. The anterolateral part of lateral epicondyle provides an area for common extensor origin. The posterior surface of lateral epicondyle gives origin to anconeus muscle. Upper End Head 1. It is shaped like a disc and in living it is covered with an articular hyaline cartilage.

Three secondary centres for upper end. The narrow disc-shaped end head is directed upwards. The radial tuberosity is just below the medial part of the neck. Neck 1. Clinical correlation The separate centre for medial epicondyle and its late union with the shaft may be mistaken for the fracture of medial epicondyle of humerus.

One primary centre for shaft. The convexity of shaft faces laterally. The neck is constricted part below the head.

The lateral surface projects distally as the styloid process. Shaft The long shaft extends between the upper and lower ends and presents a lateral convexity. Upper End The upper end presents head. It articulates superiorly with capitulum to form humero-radial articulation. It widens rapidly towards the distal end and is concave anteriorly in its distal part.

Its sharpest interosseous border is located on the medial side. Four secondary centres for lower end. The head is disc shaped and articulates above with the capitulum of humerus. The sharpest border interosseous border of the shaft is kept medially. The quadrate ligament is attached to the medial side of the neck.

Lower End The lower end is the widest part and presents five surfaces. It is the constricted part just below the head and is embraced by the lower part of annular ligament. The circumference of head is smooth and articulates medially with the radial notch of ulna. The upper part of this border is called anterior oblique line and lower part forms the sharp lateral border of the anterior surface.

Borders Anterior border 1. Radial tuberosity 1. It starts below the anterolateral part of radial tuberosity and runs downwards and laterally to the styloid process. Shaft The shaft has three borders and three surfaces.

Biceps tendon is inserted to its rough. A small synovial bursa covers its smooth anterior part and separates it from the biceps tendon. Posterior border Medial interosseous border 1. It is well-defined only in its middle third of the shaft. It is the sharpest border. Above it runs upwards and medially to the radial tuberosity and form the posterior oblique line. Its anterior oblique line gives origin to radial head of flexor digitorum superficialis FDS.

It also presents grooves for other extensor tendons. The posterior surface presents the dorsal tubercle of Lister lateral to the groove for the tendon of extensor pollicis longus. The radius is most commonly fractured bone in people over 50 years of age. Clinical correlation Fracture of radius: The radius is a weight-bearing bone of the forearm.

Nutrient foramen is present a little above the middle of this surface in its upper part. It extends above up to radial tuberosity and below its lower part forms the posterior margin of the small triangular area on the medial side of the lower end of the bone.

Extensor pollicis brevis EPB arises from lower part of this surface. The anterior surface presents a thick ridge. Lateral surface: The lateral surface projects downward as the styloid process and is related to tendons of adductor pollicis longus and extensor pollicis brevis. One primary centre appears in the mid-shaft during 8th week of 1UL. Nutrient artery for radius is a branch from anterior interosseous artery. Medial surface: The medial surface presents the ulnar notch for articulation with the head of ulna.

Flexor pollicis longus originates from its upper two-fourth. Supinator is inserted on the widened upper one-third of this surface. The brachioradialis is inserted to the base of styloid process and radial collateral ligament of wrist joint is attached to the tip of styloid process. It lies between anterior and posterior borders. Through the groove medial to groove for extensor pollicis longus passes tendons of extensor digitorum and extensor indicis. Interosseous membrane is attached to its lower threefourth.

Copyright Articular disc of inferior radio-ulnar joint is attached to the lower margin of ulnar notch. It lies between the interosseous and posterior borders. The inferior distal surface presents a lateral triangular area for articulation with the scaphoid and a medial quadrangular area for articulation with the lateral part of the lunate. The nutrient canal is directed upwards.

Upper Limb and Thorax 2. It is concave and lies between anterior and interosseous borders. It is often fractured as a result of a fall on outstretched hand. Pronator teres is inserted on the rough area in the most convex middle part of this surface. Lateral surface 1. Abductor pollicis longus APL arises from the middle one-third of this surface. Lower End The lower end is the widest part of the bone and has five surfaces.

Surfaces Anterior surface 1. Pronator quadratus is inserted on its lower one-fourth. Posterior surface a It forms a subcutaneous triangular area. The lateral border interosseous border is sharp crest-like. The lower epiphysis fuses at the age of 20th year. It has four surfaces: Its thickness diminishes progressively from above downwards throughout its length. Upper surface a Its rough posterior two-third provides insertion to the triceps brachii.

It is smooth and forms the lower part of trochlear notch. It is triangular in shape. Shaft The long shaft extends between the upper and lower ends. It has the following five surfaces: The sharp crest-like interosseous border of shaft is directed laterally.

Upper End The upper end is expanded and hook-like with concavity of hook facing forwards. Two secondary centres. Clinical correlation Madelung deformity: It is a congenital anomaly of radius which presents the following clinical features: ULNA The ulna is the medial bone of forearm and is homologous to the lateral bone of leg—the fibula.

Processes Olecranon process: It projects upwards from the upper end and bends forward at its summit like a beak. Its upper part provides attachments to three structures: The ulna looks like a pipe wrench with olecranon process resembling the upper jaw.

Coronoid process: It is bracket-like projection from the front of the upper end of the ulna below the olecranon process. The medial margin provides attachment to the following structures from proximal to distal: The upper epiphysis fuses at the age of 12 years. The concavity of upper end trochlear notch lies between large olecranon process above and the small coronoid process below.

Lower End The lower end is slightly expanded and has a head and styloid process. The broad hook-like end is directed upwards. It is smooth and forms upper part of the trochlear notch. The styloid process is posteromedial to the head. The concavity of the hook-like upper end and the coronoid process are facing forwards. The upper part of this surface possesses a radial notch for articulation with the head of the radius.

Area above the oblique line receives insertion of anconeus muscle. Notches articular surfaces Trochlear notch 1. Area below the oblique line is divided into larger medial and smaller lateral parts by a faint vertical line. It is ill-defined below. It projects downwards from the posteromedial aspect of the head of ulna. Medial surface 1.

Anterior border 1. It has a non-articular strip at the junction of its olecranon and coronoid parts. The lateral part provides attachment to three muscles form proximal to distal as follows: Borders Lateral interosseous border 1.

It is C-shaped semilunar and articulates with the trochlea of humerus. Meninges and cerebrospinal fluid Meninges Cerebrospinal Fluid Chapter No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher.

As new information becomes available, changes in treatment, procedures, equipment and the use of drugs become necessary. The authors, editors, contributors and the publishers have, as far as it is possible, taken care to ensure that the information given in this text is accurate and up-to-date.

Gate No. Sales and Publishing Office: Head, Medical Education: Jalees Farhan Managing Editor: Binny Mathur Copy Editor: Goldy Bhatnagar Manager — Publishing Operations: Sunil Kumar Manager — Production: Printed and bound at Ajanta Offset, New Delhi.

Dedication Dedicated to My Parents Preface to the second edition It is with great pleasure that I express my gratitude to all the students and teachers of the Indian subcontinent who have whole heartedly appreciated and recommended this book. It is because of their support that this book was reprinted more than 10 times since its first publication in