Human Anatomy Vol 1

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the root, which supplies intrinsic muscles of hand.
The injury is called 'Klumpke's paralysis'. The
metacarpophalangeal joints are extended while both
the interphalangeal joints of all fingers are actually
flexed (see Fig.9.49).
Breast: The breast is a frequent site of carcinoma
(cancer). Several anatomical facts are of importance
in diagnosis and treatment of this condition.
Abscesses may also form in the breast and may
require drainage. The following facts are worthy of
note.
Incisions into the breast are usua\ made radially
to avoid cutting the lactiJerous ducts (see Fig.3.9).
Cancer cells may infiltrate the suspensory
ligaments. The breast then becomes fixed. Con-
traction of the ligaments can cause retraction or
puckering (folding) of the skin.
Infiltration of lactiferous ducts and their
consequent fibrosis can cause retraction of the skin
(see Fig.3.14).
Obstruction of superficial lymph vessels by cancer
cells may produce oedema of the skin giving rise to
an appearance like that of the skin of an orange
(peau d'orange appearance) (see Fig. 3.15).
Because of bilateral communications of the
lymphatics of the breast across the midline, cancer
may spread from one breast to the other (see
Fi9.3.16).
Because of communications of the lymph vessels
with those in the abdomen, cancer of the breast may
spread to the liver. Cancer cells may'drop'into the
pelvis especially ovary (Krukenberg's tumour)
producing secondaries there (see Fi9.3.15).
Apart from the lymphatics, cancer may spread
through the veins. In this connection, it is important

to know that the veins draining the breast
communicate with the vertebral venous plexus of
veins. Through these communications cancer can
spread to the vertebrae and to the brain (seeFig.3.17).
Blood pressure: The blood pressure is universally
recorded by auscultating the brachial artery on the
anteromedial aspect of the elbow joint (see Fig. 8.11).
lnttaoenols injection: The median cubital vein is
the vein of choice for intravenous injections, for
withdrawing blood from donors, and for cardiac
catheterisation, because it is fixed by the perforator
and does not slip away during piercing (seeFig.7.B).
Intr amuscul ar ini ection: Intramuscular injections
are often given into the deltoid. They shouldbe given
in the middle of the muscle to avoid injury to the
axillary nerve (see Fig. 6.9).
Radial pulse: The radial artery is used for feeling
the (arterial) pulse at the wrist. The pulsation can be
felt well in this situation because of the presence of
the flat radius behind the artery (see Fig. 9.10).
Ligaments of Cooper Fibrous strands extending
between skin overlying the breast to the underlying
pectoral muscles. These support the gland.
Montgomery's glands: Glands beneath the areola
of mammary gland.
Subareolar plexus of Sappey: Lymphatic plexus
beneath the areola of the breast.
Lister's tubercle: Dorsal tubercle on lower end of
posterior surface of radius. This acts as a pulley for
the tendon of extensor pollicis longus.
de Queroain's disease is a thickening of sheath
around tendons of abductor pollicis longus and
extensor pollicis brevis giving rise to pain on lateral
side of wrist.

APPENDIX 1

b. Subscapularis ii. Lateral rotation
c. Latissimus dorsi iii. Abduction
d. Teres minor iv. Extension
Muscles and their nerve supply:
a. Deltoid i. Ulnar
b. Supinator ii. Median
c. 1st lumbrical iii. Axillary
d. Adductor pollicis iv. Radial
Sensory innervation of skin:
a. Palmar surface of ring
and little fingers
b. Palmar surface of
thumb and index finger

A.


L.

MUTTIPLE CHOICE QUESTIONS

Motch lhe following on the Ieft side with their
oppropriole onswers on the right side:
The nerve injury and the clinical signs:
a. Radial nerve i. Partial claw hand 4.

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b. Median nerve ii. Wrist drop
c. Long thoracic nerve iii. Ape thumb
d. Ulnar nerve iv. Winging of scapula
Tendon reflexes and segmental innervation:
a. Triceps i. C5, C6, C7 5.
b. Biceps brachii ii. C5, C6
c. Brachioradialis iii. C6, C7,C8
Muscles and the movements at shoulder joints:
a. Deltoid i. Medial rotation

i. c3, c4

ii. c8
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