hello guys so how are you doing all fine thank you safely i'm fine hi suraj gopiraj hi hello mad booster marva hi birappa hello hello hello everyone harsha vardan hi harsha vardan aditya batil hello ashwin number hi Ramesh Uddin, hi, I'm fine. Mohamed Arif, I'm fine, thank you so much. Prateek Raut, hi Prateek. Right, so let us wait a minute so that students could join and then we shall start this, okay?
Vikas Kumar Chowdhury, hi Vikas. Sai Vinila, good evening. Hello everyone, I'm fine. Medbooster, thank you so much.
Fatima Jebin, I'm fine. I'm fine, Fatima. I'm fine, Karthik. Thank you so much.
Abdullah from Bangladesh. Thank you. Rameezuddin. Thank you so much. Right, guys.
So all of you are from which university, guys? I hope you're from ISM. And which year are you? Hi, I'm Gendra Kumar.
Hello. Good evening, Adil. okay which which year are you guys now i hope you are third year right most of you are yeah most of you are first year most of you are second and third year as well right yeah fine so guys whether it is a first year student or whether it is a third year student whether it is a first year or third year student so today i'll be teaching you anatomy guys okay and the second important thing is that listen carefully i don't know what the university or the what the faculty has taught you so far right so i even don't know how much you have learned from the faculty whatever it is if you look here everyone yeah whatever it is whatever anatomy i'm teaching you today guys so that will be helpful for your entire life till you finish all your exams now i can guarantee you that after uh after the lessons which i'll be teaching you all the topics which i'll be teaching you you you go and solve all the question banks right either it might be dams or marrow or pre-plan or whatever it is you solve all of them and all the questions will be covered okay so in that way i have prepared the material for you and as i can say that this will be the final go of anatomy you need not to study anything more or anything less other than this okay so i'll be teaching you anatomy after that next day immediately i'll be sending this pdf on to the telegram group So we will also post the telegram group down. So some of you who haven't joined, you can join there and my notes will be there over there.
Okay. So are you all ready guys? Are you all ready?
Shall we start? Yeah. Yes. Yes.
You can even write your doubts. I will, I'll answer all your doubts guys. Don't worry about that.
But one thing I want from your side is that. till the end of the session this session will be for one one and a half hour okay till the end of the session i want you to focus And whatever I am writing down, whatever I am writing down, I want you to write it down on your paper. Take a pen and paper and jot down all the points, whatever I am writing. Because all the points, I will be covering all the topics. I will be covering all the topics and I will be covering all those questions which were previously asked in your exams.
Your FMG exams or the NEET exams. Yes, it is harsh over them. It is relevant.
Yes, this is relevant. yeah cricket cricket video i'll i'll i'll look at your doubt okay i'll look at you so let's get started so first topic in your anatomy we'll start from the upper limb okay so i want all of you yes this lecture will also be available pratiksha i want all of you to pay full attention here so the first topic which we shall be starting on is your clavicle okay now all of you know all of you know few important points about your clavicle so what are those important points The first important point is that clavicle is a S-shaped bone, all of you know. And second important point, which was previously asked in your exam, that clavicle is the only bone which lies horizontally in your body, right?
So clavicle is the only bone which lies horizontally. And next important thing is that, as all of you can see, you can palpate the clavicle, right? From one end to the other end, you can palpate the clavicle very easily. It means it is just beneath your skin. So that is the reason why we also tell that clavicle is subcutaneous throughout.
Clavicle is subcutaneous throughout. And third important point about clavicle which was asked in the exams is that this is the first bone in your body to ossify. Which is the first bone in your body to ossify? The first bone in your body to ossify is your clavicle. So this is the first bone to ossify.
The first bone to ossify. Now, this was a question that is asked guys previously. What they have asked is that, okay, you told me that this is the first bone to ossify. Can you tell me in which week this bone will be ossified?
This bone will be ossified during 5th and 6th week of intrauterine life. This is very, very, very important. All of you have to remember it. Okay. Right.
Next important. Next important thing you have to know here is that within the clavicle, we have got two important points. As you can see, this bone is your clavicle.
Okay. Now, in this clavicle, this part is called as the lateral end. This is called as the medial end. Okay. This is the lateral end and this is the medial end.
Now, exactly the junction between the lateral end and medial end, this is the place where most commonly the fractures of clavicle happen. Right. So, all of you know this thing.
What is the most common? bone which is fractured in your body guys this was an mcq what is the most common fractured bone in the body yes the most commonly fractured bone in the body is your clavicle can anyone tell can anyone tell what is the site of the clavicular fracture anyone yes from your comments i want to look that what is the site of clavicular fracture Very good. Very good.
All of you. Vikendra, Adil, Kiran Singadi. Very good.
Akbar, Ashraf, no. Yes, most of you, most of you are commenting it as medial two third and lateral one third. Actually, guys, I know you have read it previously somewhere, but that was right till then. But right now, there is a new update. Okay.
And this update will be asked in your exams. Keep this thing in your mind. Now, there is a new update. It is not medial two-third or lateral one-third.
Now, the new update is that it is medial three-fifth and lateral two-fifth. So, the clavicular fracture, the very good, very good, all clips, very good. Clavicular fracture site is, it is the junction between, it is the junction between medial three-fifth And lateral two-fifths.
So, this is the updated one. This is the updated one. Very, very important.
Whatever updates are there, I will be telling you everything guys up to date. And these things can definitely come in your exam. Okay.
So, all of you are clear so far. Next important and last MCQ which was asked from the clavicle is that, if you open up the clavicle, inside that there is no medullary cavity. Okay. Clavicle is the bone which has got no medullary cavity.
which has got no medullary cavity, which has got no medullary cavity, right? Now, next important thing is that just one point you remember guys, if someone asks you how many ossification centers does clavicle have? Now, what do I mean by ossification centers?
Ossification centers is the ossification centers in the sense, this is the point from where the bone development starts, okay? So, let us say there are two centers, primary center and secondary center. So, these are the centers from where? The bone growth starts, the entire bone forms. You know bones, how they are formed guys?
Yes, because of osteocytes. So all the osteocytes, they gather together, they gather together and finally they form your entire clavicle. Okay.
So we have got two ossification centers guys. One in the center, one in the center of the clavicle, another in the periphery of the clavicle. Okay. Whatever ossification center is located in the center, that is called as primary ossification center. And on the either sides, you have got secondary ossification.
centers. So, two ossification centers primary and secondary. Clear everyone? So, these are the questions which were asked previously.
It is the only bone that lies horizontally. First question, the first bone to ossify in your body, right? Most common fractured bone in the most common fractured bone in the body is clavicle.
Everyone know it. So, they do not ask you. But what they are going to ask you is that clavicular fracture site. Again, I am telling you guys my gut feeling is this that these questions might be repeated in the up.
upcoming exam so when you come when you finish up your all medical studies and come back so you might get this question okay and it has got no medullary care so these are the questions that are framed from clavicle so far okay and this is all you need to know regarding the clavicle now next important thing is that this is the clavicle clavicle is attached to your sternum all of you know so the joint where the clavicle and sternum are attached this joint is called as sternoclavicular joint. What is this joint? This joint is called as sternoclavicular joint.
And next, clavicle is also attached on the other side to the acromion process. So, can I call it as acromioclavicular joint? See, exactly here. This is called as acromioclavicular joint.
I hope all of you are writing down the notes. Don't worry. Tomorrow in the morning itself, I'll be sending you. the pdf as well right so this is acromioclavicular joint so what is the question that can be asked from here why is it so important why is it so important is the sense previously they asked a question previously they have asked a question that what type of joint is sternoclavicular joint and what type of joint is acromioclavicular joint sternoclavicular joint is a saddle joint i hope all of you if you are first year students from your plus 1 plus 2, from your intermediates, you have learned a lot about this joint.
But anyways, I will take a detailed lecture on joints later on. But for now, just remember that sternoclavicular joint is a saddle joint. Acromioclavicular joint is a plain synovial joint, plain synovial joint, plain synovial joint. Clear so far, right? And next important thing, what is the next important thing is that now when you finish your MBBS and when you come back to India you are not gonna write FMG what you will write is next exam definitely it will be next and next is completely clinical oriented okay it is completely clinical oriented they won't ask you what is the most common fractured bone in the body these things are they're not gonna ask you they'll ask you completely clinical things about your clavicle okay or any other thing in the anatomy now what clinical point I can frame from During development in some children what might happen is that the clavicles might be completely absent or they might be half developed.
They might be half developed or completely absent. So these are called as hypoplastic clavicles. Hypoplasia means underdeveloped clavicles.
These are called hypoplastic clavicles. As you can see in this sketch. both the clavicles are absent.
So, when both the clavicles are absent, both the shoulders can touch each other. Here, now this problem you call it as cledocranial dysostosis. This condition you call it as very, very, very important. This condition called as cledocranial dysostosis.
This is called cledocranial dysostosis and this is a genetic condition. Guys, till here, all of you have understood or not? Yeah?
Have you understood till here? Very good, Dharmavir Prasad. Excellent. Very good. Have you understood, guys?
Migendra, all clips, Thinide, Arshad, Adil, Pratikshah, all of you have understood, right? Safwan Karthik, you understood? Yes.
Fine. Now. This is all you need to know regarding the clavicles few important points and we are done with the clavicle Okay.
Now let us enter into your scapula. Okay now all of you know all of you know that this Part of the bone is your scapula right now, whatever you are seeing here. This is the dorsal side This is the ventral side of the scapula.
Okay now on this scapula you can see this spine This is called a spine of the scapula. What is this? This is called as fine of your scapula.
And what is this one? This is called as acromion process of scapula. Okay. This is called as your acromion process of scapula. Now, when I turn the scapula here, this part which you can see, this is called as a coracoid process of scapula.
Okay. This is called as your coracoid process of scapula. And finally, this is called as your glenoid cavity.
What is your glenoid cavity? This is the place where your humerus bone will articulate. Okay. Now...
what are the things we have just discussed guys we have discussed that this is called as coracoid process of scapula we have discussed this as acromion process of scapula and this one as your glenoid cavity this is your glenoid cavity clear this is all you need to remember nothing more than this and if i turn the scapula on to the back like this right so this would be yours spine of the scapula. This is all you need to remember. But one MCQ that has been asked from this osteology of scapula is that this scapula has got this angle you can see this is called superior angle. This is called as a medial border.
Superior angle, medial border and this is called inferior angle and this is called as a lateral border. Clear? Superior angle, inferior angle, medial border. lateral border now what is the question that has been asked they simply asked what is the thickest border of scapula you see guys this is the medial border and look at the lateral border here which is thick medial border or lateral border obviously lateral border is thick right so this was the question that was asked that this is your medial border this is your medial border and this is your lateral border So, the question they have asked is that lateral border is called as the thickest border of the scapula, thickest border of the scapula.
This was a very, very, very important question they have asked. Can anyone tell scapula ranges from which vertebral level to which vertebral level guys? Scapula ranges from scapula ranges. this session is also important for Jan FMG as well.
Okay. But I'm discussing it a little bit in detail because, uh, uh, UG students are also there. The graduate students are also here.
Okay. Very good. Ravi Chauhan. Ravi Chauhan. Very good.
The scapula is located all the way, all the way from T2, right? Sorry. It is all the way located from the second posterior rib.
till the seventh posterior second till seventh posterior rib. So, is this difficult to remember guys? Is this difficult to remember?
And it is the thickest border obviously, right? Now, next important thing, next important thing is that one very important thing all of you know, look here, this is your clavicle. All of you put your finger inside your clavicle. Now, raise your hand like this, raise your hand like this.
always all of you what you do is that you just palpate beneath your clavicle when you palpate beneath your clavicle you can feel a bone over there isn't it so this was a question asked what is the bone which you can palpate in the infraclavicular fossa below the clavicle so in the infraclavicular fossa the bone which i can palpate is anyone anyone any answer be fast Yes, very, very easy, guys. Very, very easy. Very good.
Raffaenil, raffile, raffile. Very good, raffile. In the infraclavicular fossa, in the infraclavicular fossa, very good, you can palpate, you can palpate the coracoid process, coracoid process, coracoid process, okay.
So, this was the question about the coracoid process, clear. And they also asked, coracoid process is an example of what type of epiphysis? You know, you have got traction epiphysis, you have got atavistic epiphysis. and all of that. So, coracoid process is an example for, yes, coracoid process is an example for atavistic.
Akbar Ashraf, very good, very good Akbar. It is responsible for atavistic epiphysis. So, this is very, very, very important which you have to know, okay. Now forget about whatever I have taught you. Look here.
Now concentrate on me. Look here guys. Very important thing. Usually during 9th to 12th week of development, during 9th to 12th week of development, what happens is that basically this scapula, this scapula is not in the shoulder region.
This scapula is in your cervical region. From the cervical region, from the neck on the back, from the cervical region, the scapula will descend down onto the right onto the left. This happens during 9 to 12 week of gestation. But sometimes what will happen is that there is a syndrome called as Kippelfield syndrome. I will tell you later on.
There is a syndrome called Kippelfield syndrome. Now in this Kippelfield syndrome, what will happen is that patient will have problem with the cervical region. So when a patient will have problem with the cervical region, the scapula don't descend down.
The scapula, one scapula will remain in the cervical region only, but another scapula will descend down. Okay. So all of you understood?
One scapula will remain in the cervical region only, but other will descend down. Now that problem, that problem here, you call it as congenitally high scapula because scapula is on the top. Right. You can see this.
One scapula is on the top. One scapula is in the normal position. And this condition is always associated with a syndrome called.
kippel field syndrome and this deformity where one scapula is above one scapula is below this is called a sprengell deformity this is called sprengell deformity guys i'm not teaching you i'm not teaching you usmle i'm not teaching you high standard exams guys this is this is what they're gonna ask you in your upcoming next exam i'm telling you right so you're gonna see questions on this definitely everything has to be clinical very good adil it is springle deformity very good priyanka yes sure will complete it so springle deformity is all the time associated with which syndrome kippelfield syndrome okay from today onwards if you see a patient of congenitally high scapula this is a springle field deformity okay i can also call it as i can also call it as congenital high scapula congenital high scapula so this is all this is all they're going to ask you regarding the scapula guys okay so let us move on to the next bone that is your humerus now all of you understood regarding clavicle and scapula before i move on to the next one now you have to be fast here yes be fast come on All of you have understood or not? Very good. So, let us start now.
Let us start continuing now. Right. Now, regarding the humerus, this is your humerus bone. Okay.
Now, in this humerus, you have got few parts. You can see this part. This is called head of the humerus. You have been studying from your first year anatomy.
You know it. This is called head. okay and this is called as neck from where i am holding this is called as the neck of the humerus okay now this is called as a shaft this is called as a shaft and this is the lower part of the humerus fine now this is called as the head of the humerus this is called as the head of the humerus now within this humerus we have got two important things what are those two important things this is called as greater tuberosity this is called as lesser tuberosity One is called as greater tuberosity, another one is called as lesser tuberosity. Now all of you have might have heard that there will be two necks within your humerus.
One is called as surgical neck. Another one is called as anatomical neck. You know it, right?
Now, where is this anatomical neck? Look here very carefully. You see this one, this neck here is called as your anatomical neck.
This is called as your anatomical neck. Then where is surgical neck? Surgical neck is this one. This is called as your surgical neck. Sir, why is it so important?
Because so far, whenever they have asked question on upper limb, in any exam you take, any exam you take, whenever they have asked a question on upper limb, definitely there will be one question from humerus. Now, what is that question? We shall be discussing.
Okay. What are the questions that can be asked from the humerus? I'll be teaching you.
Right. All of you look here now. So, surgical neck, anatomical neck, you are done.
Now, another important thing is that between the greater tuberosity and lesser tuberosity, can you see a gap over there? Yeah. So, between this greater and lesser tuberosity, I can see a small gap over here, right? I can see a small gap over here. Now, this gap is called as inter tubercular groove, okay?
So, this gap over here, this gap, I can call it as inter tubercular sulcus or I can also call it as bicipital groove I can also call it as bicipital groove clear now next very good adhyaja very good very good very good you have already answered this very good now that is what I am going to tell you okay so now all of you look here guys this is your humerus right Now, within this humerus, I told you that this is your greater tubercle. This is your lesser tubercle. Pay attention now. Greater and lesser tubercle.
Now, here I will draw a line like this. I will draw another line like this. Okay.
Now, this line is called as lateral lip. Lateral lip of bicipital groove. And this line is called as the medial lip of bicipital groove. One is called as a lateral lip. Another one is called as a medial lip.
Now, when I am putting my hand like this. The center one is called as a bicipital groove here and this is called as a lateral lip. This is called as a middle lip. Why are you so stressing on this? The reason is that there are three muscles that are attached at this position.
What are those three muscles that are attached at this position? To remember those three muscles, you have to remember a nimone, a lady between two majors. A lady between two majors. Who is a lady here? Lady is nothing but Lattissimus dorsi.
Okay. What does lady stand for? Lady stands for Lattissimus dorsi. Lattissimus dorsi.
Okay. What are the two majors in my body? In the upper arm, what are the two major muscles guys? Can anyone tell?
Very good. Adil, teres major, pectoralis major. These are the two.
I will teach you the muscles separately guys. Okay. Don't worry about that.
As I am teaching you humerus, I am teaching you here. Teres major, pectoralis major. So two majors are, two majors are, one is teres major, another one is pectoralis major. So these are the three muscles that are attached at this region. Now, all of you have to remember one last mnemonic that is MET.
MET stands for MET. What does it also stand for? M E stands for medial lip. What does M E stands for?
Medial lip. Okay. And what does T stand for? Teres major. So can I tell, can I tell that teres major is attached to lateral lip?
Okay. Teres major is attached to lateral lip. Next pectoralis major, obviously it will be attached to medial lip.
And in the center, I mean the bicipital sulcus or bicipital groove. In the bicipital groove, what is the muscle that is attached? Latissimus dorsi. If you remember this box, if you remember this box, forget all my explanation. If you remember just this box, your MCQs will be covered.
Remember that if you remember just this box, all, most of your MCQs will be covered. Okay. So, this is the first MCQ that they can ask you. regarding the humorous second important thing second important thing yes that's what i've written okay i've written it opposite right i'm sorry thank you for correcting me Terese is medial lip, right?
Medial lip. Very good. Thank you so much, Harshavardhan.
This is lateral lip. Clear? Right. Now, look here, guys.
All of you look here. Right. Which is your surgical neck?
This is your surgical neck. Sometimes, guys, whenever you fall on an outstretched hand, right? So, for example, for example, forever believer, I repeat, see here, nothing is there to repeat here. In the humerus region, we have got two lips. One is called lateral lip, medial lip.
In the center, we have got bicipital groove. Lateral lip, the muzzle attached is pectoralis major. Medial lip, the muzzle attached is teres major.
And in the center, it is bicipital groove. Clear? Now, regarding the humerus, sometimes what will happen is that if this is my humerus bone, okay this is my humerus bone now when i'm falling on my outstretched hand what will happen is that then the surgical neck of the humerus will be fractured so when the surgical neck of the humerus will be fractured this is a really dangerous problem why because surrounding this surgical neck there are two important things there are two important things surrounding this surgical neck what are those two important things look here there is a nerve like this there is a nerve what is that nerve axillary nerve, axillary nerve.
Not only that, there is an artery that is passing from the front. There is an artery that is passing from the back. So, what is an artery that is passing from the front? It is called as anterior circumflex.
Very good, very good, very good. Humeral artery which is from the back is posterior circumflex humeral artery. So, these three things will be damaged these three things will be damaged kunsh prajapati very good these three things will be damaged guys but how will they ask you in the exam they will they ask you that patient had fracture of surgical neck then what all structures will be damaged those questions were asked previously previously one year two years back but now in the next exam what they'll ask you is they will give you this x-ray They will give you directly this x-ray and ask you what nerve is injured, what vessels are injured.
So looking at this x-ray, what you can say that this is a clear cut x-ray of fracture of the surgical neck of the humerus. So axillary nerve will be injured, anterior circumflex humeral artery, posterior circumflex humeral artery also will be injured. Clear everyone?
Yeah? Very good. Look here now. Look here, all of you. Right.
Now, let us let us write down all the nerve injuries in a single point, a single slide. Right. So I will tell you what are the questions.
That will be asked what is important in the humerus bone. Okay. Now, all of you know the first important thing that there is a nerve that is passing. What is that?
Axillary nerve. And this neck here is called as surgical neck. Surgical neck.
Surgical neck is having what? It is having axillary nerve. It is having axillary nerve. It is having anterior and posterior circumflex vessels. Circumflex humeral vessels.
These two things will be, these two things will be affected. Second important point, all of you look here now, all of you look here, concentrate here. This is called as a shaft, okay? This is called as the shaft of the humerus. Next important thing, down if you see, this is called as medial epicondyle, this is called as lateral epicondyle.
Can you see medial epicondyle is more prominent and it is more protruding, right? So, if I am falling on my outstretched hand. then medial epicondyle will be more injured in comparison with the lateral epicondyle.
Next, above these epicondyles, above medial and lateral epicondyles, whatever space you can see, this is called a supracondyle because it is above the condyles. So, supracondyle are region. So, I told you to remember three things. One is this is the shaft, medial epicondyle, lateral epicondyle, supracondyle are region.
So, remember these three things. Now, look here. On to the shaft. backside onto the shaft, posteriorly onto the shaft, you have got a small groove that is called as the radial groove. through this radial groove a nerve passes down all the way like this okay and this nerve you call it as a radial nerve radial nerve okay radial nerve and where does it pass radial groove radial groove third important thing third important thing so let us say this is the lateral epicondyle this is the medial epicondyle lateral and medial epicondyle now there is a nerve That comes all the way down.
It passes behind the medial epicondyle like this. It is passing how? It is coming all the way down and it is passing behind the medial epicondyle. And that nerve you call it as?
Very good guys. Very good. Very good. Alnar nerve.
Where it is passing behind the medial epicondyle. Epicondyle. Very good Kiran.
Aiman Kazi. Perfect Aiman. Ravi Chauhan. Perfect. Very good.
Next important thing is that there is also a nerve, there is also a nerve that passes from the supracondylar region down like this, in this way, okay? So, there is a nerve that passes all the way down like this. This is called as median nerve.
What is this nerve? This nerve is called as median nerve, okay? Which region is this median nerve passing?
In the supracondylar region. supra condylar region. Okay. So what are the clinical points which you can tell?
First question they can ask you is how these nerves are passing from which area this nerve is passing. I told you second question they can ask you is, for example, if patient is having fracture of the shaft, if there is a fracture of the shaft, they will ask you which nerve is injured, which nerve is injured. If there is a fracture of the shaft, Yes.
In case of mid shaft, very good. Very good, Adil. Very good. In case of mid shaft fracture of humerus, mid shaft fracture of humerus, which nerve will be injured? Radial nerve.
Very easy. Look at this diagram and you can answer it. Next, they will also ask you, there is a fracture of medial epicondyle.
Patient add fracture of medial epicondyle. Then which nerve will be injured? obviously, ulnar nerve, medial epicondyle fracture will cause ulnar nerve injury. Next important thing is that they will also ask you, patient had fracture exactly here in the supracondylar region.
Then which nerve will be injured again? Median nerve. Clear all of you guys. All of you clear.
Very good guys. All of you have understood whatever I told you guys. Now, I will go into the clinical part. Now, before that, all of you have understood whatever I told you.
Just taking a confirmation. Right. The first year students, my main focus is on first and third year students. Are you understanding?
Because this is the perfect time for you to learn the basics. Okay. Are you understanding all of you, the first year students? Only first year and third year students comment down.
Are you understanding? Yeah, fine. Now, guys, look here. Yes, Kunj Prajapati.
Muzzles also I will be teaching you. Don't worry about that. I will also teach you muzzles.
Look here, very important thing. Previously, when I was working in a hospital, I got a case. Now what is that case is that by the time I went the patient was completely he was completely having a slap there. Okay. But what happened to the patient is that he was riding a bike and unfortunately he fell down like this.
Right. He had a fall on outstretched hand. This is called push injury. Fall on outstretched hand. So he fell like this.
When he fell like this there is a supracondylar fracture. Okay. Now that patient was in the hospital. I was not there in the hospital but the ward boy was there in the hospital.
Now what the ward boy did is that he has seen many cases of this supracondylar fracture. So what he has done? He has taken the patient's hand into position and finally he had completely wrapped that slab. He has wrapped it so tightly.
He wrapped that slab so tightly. The POP so tightly. What has happened because of that is that I know that in the supracondylar region, Along with the median nerve, brachial artery is also passing. What is this artery?
Brachial artery. But the what boy don't know that there is brachial artery and median nerve. So what has happened is that when he completely tied and compressed it, the artery got compressed, the nerve got compressed. So when the artery and nerve got compressed, the forearm will not be supplied by blood. When the forearm is not receiving blood, all the muscles here will undergo necrosis.
They will die because of lack of blood and oxygen. The muscles will die. This complication.
This complication, you call it as, this complication, you call it as workman's contracture. Workman's contracture. Why workman's contracture has happened?
It is because, it is because of obstruction of brachial artery. Obstruction of brachial artery. Because of obstruction, what has happened?
Your forearm muscles. have undergone ischemia. All of you, the first year students, ischemia means whenever the blood is not supplied to a specific organ or a specific tissue, that will die because of lack of oxygen.
That is called as ischemia. Okay. Right.
So, this is called as woke man's contracture. I'll show you the picture down. Look here. This is the woke man's contracture. All the muscles, all the muscles have been necrotized and the hand has taken this shape over here.
Okay. This is called as Vokman's contraction. All of you clear?
Right. Next important thing is that, next important thing is that, this is the first important thing. Second important thing is that, the ward boy doesn't know that because of tying that slab so hardly, what will happen is that, the calcium starts depositing because calcium has nowhere to go. So, calcium starts depositing within the muscle.
Calcium deposition in the muscle is... called myositis ossificans myositis ossificans muscle having calcium can you see this picture over here can you see this white color uh cotton cotton like thing here this is nothing but calcium deposition and this condition is called as myositis ossificans myositis ossificans this is the second complication If I ask you, if I ask you what are the two important, thank you Bendik. If I ask you what are the two important complications of supracondylar fracture, you will answer me. One is Walkman's contracture. Second one is myositis oscilla.
Clear all of you? Vishwa understood. Yes. Kunj Prajapati amputate karna padega.
We have to amputate it. Right. Now let us take, let us take a small, you know. Let us take a small quiz for all of you guys. I will not answer.
You have to answer me. Now tell me what nerve will be injured. Nerve injury. What nerve will be injured here?
Now you gonna tell me. All of you have to answer now. All of you who are watching my lecture have to answer.
Right? What nerve will be injured here? In this fracture? Very good.
Mohamad. Very good. Akanksha. Excellent.
Aiman. Perfect. Veerappa.
Kiran. Savinila. forever forever believer abhay perfect perfect guys and and all of you might have known that this fracture is called as what is this fracture mid shaft fracture of the humerus mid shaft fracture of the humerus where your radial nerve will be damaged clear ravi chauhan not green stick fracture green stick fracture is seen in children okay it is not this fracture there is simply there will be bending of the bone okay muskan very good muskan kapoor now again next question question number two what is this type of fracture and what kind of nerve injury will you see here come on very good nitya excellent nitya akanksha ayman very good very good dr bendict obviously praveena excellent excellent guys All of you, I'm really happy.
You can see a fracture over here. This is called as medial epicondylar fracture. And your ulnar nerve will be damaged. Ulnar nerve will be damaged.
Right. Okay. Next important thing. So, let us move on to the next important thing. That is your radius as well as ulnar.
So, wherever your thumb is there, that is your radius bone. Wherever your little finger is there, that is your ulnar bone. Okay? So, this is your radius bone. This is your ulnar bone.
Clear? Now, in radius and ulnar, what questions they can ask? They will definitely ask you fractures in radius and ulnar. No matter what, definitely they will ask you fractures, guys.
Trust me. They will definitely ask you fractures. Okay?
What fractures they are going to ask you? Point number one. Look here. I am just drawing this radius bone.
Yeah, Birappa, you are right. Lateral bone is radius. Medial bone is Alnar bone. So, this radius bone, I am drawing it right now. This is the radius bone.
What is this bone? This is your radius bone. I will draw, let us say, I will draw four of them.
This is one radius and This is another radius and this is a third radius. So, how many radius I have drawn? 1, 2, 3, 4. Now, important thing.
Sir, we are first year students. Should we learn about what are the joints that are located here on the surface of the bone? What is this?
What is this tuberosity? What is that? You can learn that. When I will be teaching you osteology completely, that will be enough. But the reality is that once when you complete your MBBS and come there, no one is going to ask you any question about osteology.
All the thing they are going to ask you is completely integrated material. So, but as for the basics, you have to learn it. So, these are the four radius bones.
All these are radius bones. Let us say in one patient, the fracture happened like this. Look here. Let us say one patient, what happened is that? There is a fracture here.
You see, there is a fracture like this. There is another fracture like this. Okay.
Now, what has happened here? This fracture fragment has turned above. This fracture fragment has displaced upward like this.
Has displaced upward like this. Now, another patient came into my clinic. Now, this patient is also having a fracture. but look here how is this fracture this fracture is like this the distal end turned completely downward like this one in one fracture the distal end turned above distal end in the sense for first-year students I am telling this is the distal end the distal end turned above in another fracture the distal end turned below okay now the fracture where the distal end deviated upward that is called as that is called as Collie's fracture. Now, this fracture is called as Smith fracture.
This is called as Smith fracture. So, if someone asks you, without drawing, can you tell me orally what is Collie's fracture? Simple thing is that the radial head displaced upwards is called as Collie's fracture.
Next, the radial head displaced downwards is called as Smith fracture. Sir, how do I remember? How do you remember is that whenever you think of cost, what is cost?
Cost is always too high. It is costly. Costly in the sense it is too high. Prices are up. So, collies is always up.
Opposite to that, small. Small in the sense chota, niche, right? Down.
Smith is S for small, S for down. Clear? Collies and Smith fracture. Next important fracture. Next important fracture is that, look here all of you.
This part, this part of the radius bone, this part of the radius bone, this is fractured and it is deviated up. Next important fracture is that this part of the radius bone is fractured and it is deviating down. Now, what is that part of the radius bone, guys? Look here. This is your radius all over there.
And this is your ulna. This is your radius. This is your ulna. Now, what is this part? this is called as styloid process of radius, styloid process of radius.
In the same way, what is this called as? This is called as styloid process of ulna. So, what has happened in 3 and 4 is that the styloid process of radius has deviated upwards, the styloid process of radius deviated downwards, okay.
Now, what is 3 and 4? 3 and 4 fractures are called as Barton fracture, Barton fracture. This is also Barton fracture. Then what is the difference? One is called as dorsal Barton fracture because it went upward, dorsally upward.
Another one is called as ventral Barton fracture, which went downward. Clear so far? These are the questions which they will ask you.
Okay. One additional point. Remember here, additional point.
What you need to remember is that all of you know that you have got eight carpal bones. Let us say one, two, three, four. 5, 6, 7, 8. Okay.
Now, you also know, but between the radius and the carpal bones, you have got a joint. This joint is called as radiocarpal joint. Between the radius and the carpal bones.
So, what I am trying to tell you is that in Barton's fracture, not only the radial styloid process, but also radiocarpal joint is also displaced or dislocated. Clear all of you? Yeah.
So this is called as radial evolution fracture with radiocarpal displacement. Even this radiocarpal joint is also, I mean, what I am trying to tell you is that, see, even this part over here also is displaced like this. It is going upward like this.
Clear? All of you clear? First years, are you clear? Yeah.
All the first year students, are you clear? All of you clear, right? Okay. Now, let us look on to the next important thing. Let us look on to the next important thing.
What is the next important thing? Simple way to remember, whatever is going up is called extension fracture. Whatever is going down is called flexion fracture.
Okay. Now you tell me, collies, collies fracture is an extension or flexion fracture. It is going up, right? So this is an extension type of fracture, extension type of injury.
Smith is going down. So, it is called as flexion type of injury. Flexion type of injury. Again, dorsal barton. Barton is going up.
This is called as extension type of injury. And ventral barton is going down. Again, this is called as flexion type of injury.
Clear everyone? Right. Ijaz Khan, I will tell you about myself later on. But we have short time now. So, we shall completely concentrate here.
Okay? Right. Look here, guys.
Look here. Now you will tell me, you will tell me, I told you radial head is going upward and downward. Now you tell me which fracture is this, which the patient's hand is like this.
The radius head, is it upward or downward? Very good. Very good.
Very good. Very good. You're really pro guys. Very good.
Excellent. Excellent. You see.
radial head is upward. Look in the next picture. Look in the next picture. The radial head is downward. Radial head is downward.
So this is called a Smith fracture. This is called as Collies fracture. Collies fracture.
Very good. Very good. Very good.
Okay. In Collies fracture. Okay.
In Collies fracture, when you look at the patient's hand, as the radial head is bumping up, This is the radial head which is coming up. So this looks like a dinner fork deformity. All of you know dinner fork, right? So this is called as dinner fork deformity. So from today onwards, whenever someone tells you what is dinner fork deformity, then keep thing in mind that it is a police fracture.
If someone tells you garden spade deformity, Such type of deformity is called as garden spade. I did not put a picture. All of you type in the Google and see what is garden spade.
Garden spade deformity is your Smith deformity. Dinner fork is collies. Dinner fork is collies. You eat with the dinner fork. With the collie, you wash out the plates.
Dinner fork is collies. Smith garden. Keep that thing in mind.
Right. Next important thing. Next important thing is that, say this condition.
This condition happens basically around 4 to 10 years of age. This condition mainly happens in around 4 to 10 years of age. Okay. And this is a condition where this radius bone, whatever is there, there is complete bend of the radius bone, complete bending of the radius bone. Or in medical terms, you do not call it as bending.
You call it as bowing. Right. I am stressing this for all my first year students.
It is called bowing. Okay. This is called anterior bowing of radius.
Anterior bowing of radius. And this type of deformity, you call it as made lung deformity. Made lung deformity. Right? So, this is very important.
Sir, we have never studied this in anatomy. These things will definitely be in your anatomy. This is the thing that they don't teach you in anatomy because these things will be covered in your orthopedics also.
It will be even covered in your different different subjects also. Okay. But when you come to those subjects, now you are in first third year.
When you come to those subjects, you will understand the importance of this. Okay. I am clubbing out all of them together so that none of the MCQ should miss.
Clear. So this completely. This completely completes the discussion of the made length deform.
Okay. One last, one last important question I want to discuss about radius and ulna before we move on to the muscles. Okay.
One last important thing is that all of you look here. All of you pay attention. Pay attention here. This is your radius.
This is your ulna. Right. I will draw four lines.
I will draw four lines here. What is the first line is that I am drawing a line here. I am drawing another line here.
Next, I am drawing a line here. I am drawing another line over here. Okay. Now, what are these two lines? Look here.
The first line, the first line, this is your Alna bone. The upper end of Alna, upper third of Alna. Can I call it as upper third of Alna? Right. So, upper third of Alna shaft.
if it undergoes fracture, if it undergoes fracture, okay, along with that, along with that, there is also radio Alnar joint dislocation between the radius and Alnar, the joint, whatever you have, that is called radio Alnar joint. So, look, look at this point over here, this is called radio Alnar joint. So, along with that, if there is radio Alnar dislocation, dislocation. Now what kind of fracture do you call it as?
Look at the fracture there. Upper third of the shaft of ulna along with radial ulnar dislocation. The joint between radius and ulnas has been dislocated like this. Okay.
So easy way to remember. All of you remember? Easy way to remember is that where is this fracture located? Upper part.
Up. In the up what do you have? You have moon.
You have moon on the up. right in the sky so this is called as montagia fracture montagia fracture it is actually single o but i am writing it as two o's so so that you have to remember it exactly opposite of montagia fracture will be another fracture why are you calling it as opposite because look here upper opposite of upper is lower lower third next here alna Opposite of ulna will be what? Radius.
Radius shaft. Next, radial ulnar joint dislocation. Kaha kar radial ulnar joint dislocation? Superior radial ulnar joint dislocation. So, opposite of superior will be inferior.
So, inferior radial ulnar joint dislocation. Inferior radial ulnar joint dislocation. Now, this fracture whatever is there, it is downward towards the ground.
So you call it as Gailesi fracture. Gailesi fracture. G stands for ground.
Ground. Down. Clear everyone? All of you just look at these two fractures for a minute. Look at these two fractures.
What is Montague and what is Gailesi? Clear all of you? All of you are clear guys?
Guys, are you all understanding? So far we have discussed 11 pages. have you all understood all these things yeah look here now all of you understood guys come on come on comment down because only then i can go forward you have a doubt then i'll explain it immediately that's why let's not waste the time The first years, right? Who are commending here are the first to third years only, right? Right.
Look here now. Now it is a test for you. Which kind of fracture is this?
Which kind of fracture is this? Come on. Come on, come on, come on. You have to answer it, guys. Don't be late here.
Which kind of fracture is this? No, no, no, no. Aiman, look at this. Kushal Reddy, look at it carefully, Kushal.
Very good, all of you. Ravi Chauhan. Come on, Ravi. It is not Montegia.
See, the radial head is displaced upwards. We called it as Collies. We called it as Collies, right?
Right. Now. Now, all of you look here, all of you look, let us decode this x-ray. What is this x-ray here?
Look here. This is your radius bone and this is your ulnar bone. So now look here, where is the fracture?
The fracture is exactly here in the upper third of the shaft of, okay. Along with that, patient also had dislocation between radio ulnar joint. You can see the dislocation. I cannot see it so clearly, but anyways, think there is a dislocation.
Very good. You have already commented. Very, very good. This is Montague fracture.
Now look here. Where is radius? Where is ulna?
This is radius. This is ulna. Previously fracture of ulna. Now fracture of radius. That too where?
Where? Lower part. There is a fracture in the lower part.
And look here. The joint has been disrupted here. Can you see it very clearly? The joint has been gone. Right?
So this fracture is called as guy lazy fracture. Very, very easy guys. Don't, you need not to, you know, use all your brain and look at this. If you look at this x-rays, let us say 2 x-rays, 3, maximum 10 x-rays if you look, then you will never forget in your life. Okay.
Just look at, look at that x-rays. Look at different types of x-rays. You will understand it. And the website which you use for x-rays is Radiopedia. Okay.
Right. Next important thing is that all of you concentrate here. Now, what is this bone guys?
This is called as your humerus, right? And this is called as a medial epicondyle. This is called as a lateral epicondyle.
And this is called as your radius. This is called as your ulna bone. Okay.
Radius as well as ulna bone. Clear. Now, why I am trying to tell you is that this is the radius bone, right?
In this radius bone, there is a ligament like this. There is a ligament that is attached all the way like this. Okay.
With the help of this ligament, it is attaching to your ulna. Action. So, look here now. There is a ligament like this.
there is a ligament in this way okay now what is the name of this ligament is that this ligament you call it as annular ligament you call it as annular ligament now why this annular ligament is important why is it important because see guys the the small kids right when you go to your office when you and your wife goes to the office leaving the small kid near a maid okay so or a babysitter So for sometimes if the babysitter wants to lift the baby up, so he'll withhold the hand, right? She will hold the hand like this and completely lift the baby up. So suddenly when you hold the hand and lift the baby up like this, like this completely, what will happen is that this annular ligament will be displaced.
Displacement, you call it as subluxation, okay? For all the first years, I'm telling you displacement means subluxation. So the annular ligament will be displaced. This condition where the annular ligament will be displaced, right?
Annular ligament will be displaced. or dislocated or subluxation subluxation this condition you call it as nursemaid elbow nursemaid elbow nursemaid elbow i'll teach you the entire anatomy guys don't worry what i want all of you to do is that just write down learn whatever i'm teaching that's it that is the only from my side i am asking you okay nurse made elbow okay so this is all the discussion regarding your radius and ulna police fracture smith fracture barton fracture up and down bontegia fracture gailesi fracture nurse made elbow questions will not be asked other than this if you want you can solve the q banks and you can know it okay let us enter on to the next topic that is your carpal bones right you So let us name these bones. This is Radius.
This is Alna. Okay. Now what are the carpal bones which you know guys? Tell me.
Yeah. What I know is that she likes to play. She likes to play.
Try to catch her. So this is what I learned during my med school days. She likes to play try to catch her or she looks too petty try to catch her, right? Whatever it might be, whatever it might be.
S stands for scaphoid. S stands for scaphoid. L stands for lunate. Why you call it as lunate?
Because it is a moon shaped bone. Sir, will they ask you this question in the exam? No, they won't ask you. Don't worry.
T stands for, what does T stands for? Trichotrum. And P stands for pissy form bone.
It is what? It is a sesimoid bone, okay? Spiceiform bone. Spiceiform bone means seed-like bone. T stands for trapezium.
And T stands for trapezoid. T stands for capitate. Capitate.
Every question I will be discussing here, don't worry. H stands for hamid, okay? So, how many carpal bones do we have?
We have got in total 8 carpal bones. Just below the carpal bones, what are these bones here? These are called as metacarpals. How many do we have? We have got 1, 2, 3, 4, 5. 5 metacarpals we have got.
Okay. Metacarpals we have got 5. And what are these bones here? Phalanges or digits. Right. Phalanges or digits.
How many are there? 14 are there. Okay. 14 bones we have. We have got 14 bones.
So. what is the arrangement here she likes to play try to catch her clear all of you right so after learning this what are the questions that will be asked okay after learning this what questions can be asked from this now tell me the first question guys what is the most common fractured bone in your body i mean sorry what is the most common fractured carpal bone these are the questions which are asked Very, very, very important questions. Bruce Wayne, Bruce Wayne, perfect Bruce, perfect. Most common fractured carpal bone is your scaphoid bone, scaphoid bone, okay, scaphoid bone.
You know guys, one very important thing, let us say this is a bone, okay, let us say this is some carpal bone, okay, this is clavicle, I know it is clavicle, but Just think that this is a carpal bone. This small part is a carpal bone. Now there is an artery that is supplying to this carpal bone. Artery that is supplying to this carpal bone.
Now if I block that artery, will it supply to this carpal bone? No. If it will not supply to this carpal bone, the carpal bone will suffer from a condition called as avascular necrosis. So out of all of your carpal bones, which is the carpal bone that suffers from avascular necrosis? Yes.
That is your scaphoid. Scaphoid undergoes avascular necrosis. Avascular necrosis.
I can tell you guys, I can put a 100 star rating for this question. Because, because I think around 10 times they have asked this question. 10 times, literally. 10 times they have asked this question.
Scaphoid is the bone which undergoes avascular necrosis. Most common dislocated carpal bone is this. located.
L stands for lunate. Okay, next largest carpal bone is capitate, which is the largest thing, largest and most important thing in your body or head, right? So capitate, capitate, what is the first carpal bone to ossify?
That is also capitate. Capitate is the first carpal bone to ossify. But if I ask what is the first bone to ossify in your body, your answer will be what is the first bone to ossify in your body?
Adil. Adil answered first. Very good Adil.
Safwan. Praveena. Perfect. The first bone to ossify in your body is? Yeah.
You know it? Clavicle. Here the first bone is capillary.
Shortest metacarpal. The first metacarpal is the shortest metacarpal. Obviously guys. Look this is short. These are all long here.
Right? This is short. Shortest metacarpal.
Now. All of you look here. All of you look.
So look here. There are two fractures. There are only two fractures here.
What are those two fractures? First finger. Opposite of first finger will be fifth finger.
Obviously opposite of first finger will be fifth finger. Right? Next.
Opposite of lower will be upper. Isn't it? Opposite of lower will be upper. Opposite of upper will be lower. First finger opposite is fifth finger.
Fifth finger opposite is first finger. Keep this thing in mind. That is enough. Look at the x-ray here. This is your first finger.
This is your first finger. The first finger, lower part of the first finger or I can also call it as the base. The base of the first finger, right?
The base of the first finger or simply I can call it as Base of first metacarpal. The base of first metacarpal is fracture. Opposite of first finger will be fifth finger.
So this is fifth finger. Opposite of lower will be. Opposite of lower will be upper. So the upper part. This fracture is called as.
What is this fracture? Boxer's fracture. Boxer's fracture.
And what is this fracture called as? What is not visible? What is visible now?
Right. So, this is called as Bennett fracture. Bennett fracture.
Okay. Bennett fracture. Simple way. Whenever you do boxing, right?
So, when you do boxing, this is the finger. The little finger will be more injured guys. Okay.
The little finger will be more injured. That is why it is called Boxer's fracture. And another one is called as Bennett's fracture. Okay. Clear all of you.
Now, let us enter into the muscles. Let us enter into the muscles. Now, all of you, whoever is sleeping, I want you to wake up.
Right. Whoever is active, I want you to be hyperactive. What are the muscles we have?
Chown Murphy, thank you so much. Thank you. Now, Nidhi, Bennett and Boxer are different. Bennett means base of the first metacarpal, whereas Boxer is the fifth metacarpal neck region. The neck of the fifth metacarpal is Boxer.
Coming to muscles, look here. What can you see on my shoulder? Now, this region is called as my pectoral region.
All of you know this is called my pectoral region. Next important thing. This is called as the scapular region because I have scapula there.
So this is called scapular region. This is called as the arm. This is called as the forearm.
This is called as the hand. Okay. So what all muscles I have got?
I have got muscles in the pectoral region. Yes. Stuffy.
Black fur makes stuffy. Yes, this is all enough. Stuffy.
Abdomen will also start. Don't worry. Abdomen will also start.
I will even continue the classes which I have left there. Right. Pectoral region.
Next, we have got muscles of back. Right. Peekche bhi muscles raega. Right.
Whatever are attached to the hand. Next, scapula me muscles. Aur arm ke andar. forearm ke andar and hand ke andar right these are the muscles now we shall target today on the pectoral region muscles so muscles of the pectoral region muscles of the pectoral region when i discuss muscles of the pectoral region i want you to remember two one mnemonic okay what is that one mnemonic 2p 2s just 2p 2s so ppss what is ppss P stands for pectoralis major.
As I say, because we are discussing about pectoral region. Another one is pectoralis minor. Okay. Pectoralis minor. Next, S stands for subclavius.
All the first year students, don't worry. I will teach you. Next one is serratus anterior.
Serratus anterior. right. Now, one very important thing, make a clarity in your mind. For the first third year students, guys, you have to know origins and insertions, okay, because as an MBBS student, you have to know the origins and insertions.
But the reality what I am telling you is that in your next exam, no one is going to ask you the origins and insertions, okay. No one will ask you origins and insertions. Mostly, they will ask you the action of the muscles. That's it. And what will happen if this muscle undergoes palsy?
If there is paralysis of this muscle or the nerve supplying it, innervating it. Okay. Other than that, you need not to worry about origins and insertions. But as an MBBS student, you have to learn about origins and insertions.
Clear all of you? So, we have got four muscles, pectoralis major minor, subclavius, serratus anterior. Now, look here. This muscle, whatever you can see, this muscle, whatever you can see, this is called a pectoralis major. Look at this.
This is the clavicle. Okay. This is your sternum. This is your sternum like this.
Okay. Now, this is your muzzle. This entire thing is your muzzle.
Let me use another color. See, this entire thing is your muzzle like this. Okay. This entire thing is your muzzle, your chest muzzle, main chest muzzle.
Okay. So, this is called as your pectoralis major. your pectoralis major. Clear all of you. This is called as your pectoralis major.
Now, where is pectoralis major attached? In the starting when I was discussing humerus, I told you where was pectoralis major attached. Now, you will tell me where is pectoralis major attached. Everyone, before I make, I will make a picture over here.
Before that, you just have to answer it, okay, very fast. Be first. Very good. Pectoralis major is attached to the lateral lip.
Okay. It is attached to the lateral lip. Now look here.
For the first year students, first year students look here. Origin of this pectoralis major is from the clavicle. All of you pay attention.
It is from the clavicle. It is also originating from the sternum. It is also originating from the sternum like this.
Okay. And all the way this muscle will attach to your lateral lip. So, this lip here is called as your lateral. And this muscle is called as your pectoralis major muscle. I will remove the pectoralis major.
Inside I will find pectoralis minor muscle. Okay. So, pectoralis major and minor are done. What is subclavius?
Look here. Sub in the sense below. Clavius in the sense clavicle.
Just beneath your clavicle, you have got a muscle that is called subclavius. Okay. That is called subclavius. Right.
Next important thing, serratus anterior. What is serratus anterior? If you look here on the side, right, you will have these muscles.
These are called serratus anterior. Look here. All of you can see these muscles over here, right?
Can all of you see these muscles? These are called as serratus. anterior muscles, serratus anterior muscles.
Okay. Very good. Dr. Bentech is telling that it is called as boxer muscle. Why? Because whenever you are doing boxing like this, right, this is the muscle that is mostly used, right?
I'm doing boxing in this way. So when I'm doing like this, this is the muscle that is mostly used. That is why you call it a serratus anterior. Or you can also call it as boxer's muscle. Boxer's.
Muscle, very, very important, very, very, very important, okay, very, very, very important, right, next important thing, next important thing is that this muscle over here is called as pectoralis minor muscle, okay, why it is called, why pectoralis minor is called as key muscle of axilla, you know, there is a saying called pectoralis muscle is called as key muscle of axilla. or key muscle of the pectoral region or key muscle, key muscle of the pectoral region. Instead of axilla, let us write it as key muscle of pectoral region. Yes, can anyone answer me why pectoralis minor is called as key muscle of pectoral region?
Anyone? Very good, Jilan. Jilan, perfect. Right?
Look here now. Not breast surgery, Bruce. Look here.
Let us say, let us say this is pectoralis. This is pectoralis minor. Okay? This is pectoralis minor. Now, there is an artery that is passing like this.
Okay? This artery name is called as axillary artery. I will teach you later on what is axillary artery, how it is coming and all for all the first year students.
I am telling you, but this artery is called axillary artery. Now, this muscle, the pectoralis minor muscle, pectoralis minor muscle divides this axillary artery into three parts. Above the pectoralis minor, this is called as the first part. Behind the pectoralis minor, this is called as the second part.
After pectoralis minor, this is called as the third part. Now, because of this, artery is getting divided into three parts. That is the reason why pectoralis minor is called as The key muscle of your upper limb, I mean your pectoral region. Keep that thing in mind.
Okay. Next important thing. If someone asks you, what is the action of pectoralis major?
Pectoralis major origin insertion I have told you. Now, what is the action? You know, pectoralis major is a very famous muscle.
Very, very, very famous muscle. Why it is famous muscle? Because it performs flexion of arm.
It performs flexion. It. performs medial rotation, medial rotation, it also performs adduction, adduction, right? So, F, A, M. So, it performs flexion, medial rotation and adduction of arm, right?
It performs flexion, medial rotation means this is medial rotation, this is lateral rotation and adduction in the sense sticking my hand to the body. Bringing my hand to the body is called as adduction. This is called as abduction.
Clear? All of you clear? Right. One very important thing.
All of you know, one very important thing is that, sir, from pectoral region, pectoral region, I don't want to learn everything. Just tell me what the questions are so far asked. And what the questions will be asked in the future also. In the future, they are going to ask you regarding the pectoral region. Question number one, why it is called chemozylophagzilla.
Question number two, what are the actions of pectoralis major. Question number three is that, which nerve is supplying your serratus anterior. The nerve that innervates serratus anterior is your long thoracic nerve.
Long thoracic nerve. All of you have heard of brachial plexus, right? Now you tell me guys, brachial plexus is all the way from C5 till T1, isn't it?
C5 till T1. So long thoracic nerve also originates from C5, C6 and C7. It originates from C5, C6 and C7. So this was a question that was asked.
Second question that was asked is that this nerve is also called as nerve of bell. Someone already started answering. Nerve of bell.
okay third important question that was asked was this nerve supplies which muscle it supplies your serratus anterior muscle your boxer's muscle fourth question that was asked was what happens if this nerve is injured for example i'm boxing someone hit my ribs from the lateral side like this what will happen this nerve passes like this superficially so someone hit here the nerve will be damaged when the nerve will be damaged your serratus anterior won't work you When your serratus anterior is paralyzed that will result in winging of scapula so this scapula which you can see here is called as winging of scapula very very very very important question winging of scapula this is called as winging of scapula right so you know even examiners know that whenever I tell winging of scapula, then students will definitely answer it as long thoracic nerve, boxer's muzzle, serratus anterior and all these things. So, what examiners have started to put in the question paper, you know, they have asked this question recently. Which muzzle is responsible or which nerve is responsible for partial winging of scapula? This is complete winging of scapula. Now, I am discussing about partial winging of scapula.
Partial winging of scapula. Partial winging of scapula is done by a nerve that is called a spinal accessory nerve. Spinal accessory nerve. You know spinal accessory nerve supplies to your trapezius muscle.
Trapezius muscle all of you know where is your trapezius muscle. See this is how your trapezius muscle is located guys. Like this.
This is your trapezius muscle. okay so partial winging of scapula is because of the paralysis of the trapezius muscle why because the spinal accessory nerve has been damaged this is also very very very important okay next important thing is that guys whenever i'm doing in this way whenever i'm boxing like this whenever i'm boxing look at the scapula how is the scapula moving tell me whenever i'm boxing the scapula is moving forward like this isn't it see whenever i'm boxing the scapula is moving forward this is called protraction of scapula what is this protraction of scapula so if i ask you a question who is a powerful protractor serratus anterior is a powerful protractor this is also a question serratus anterior is a powerful protractor you powerful protractor of scapula is your serratus anterior is your serratus anterior here all of you screen right guys can you look at the screen here no you cannot look at the screen no just give me a second cannot look at the screen Alright guys, so there is some technical issue. We will get back to that.
By the way guys, are you all understanding? Right? Are you all understanding without any doubt here?
I know it might be little bit difficult for you. For the MBBS student, the first year and the third year. Because all the things I am putting at one place and telling you.
But this is how you basically learn and this is how the coaching is also the case. But OK, you just have to cope up with that. I'm trying to teach you as easy as possible. So I want you to pay full attention over here.
OK, if you have any doubts, then ask me. I'm always free to answer. Right. So let us discuss about the nerve supply.
OK, we have discussed pectoralis major. We have discussed pectoralis minor. We have discussed sub. clavius we have discussed serratus anterior now all of you know all of you know alphabets you know abcde you also know l-o-m-n-o-p right l-m-n-o-p-q-r-s-t right so write it as l-m-n-o-p-q and so on l stands for you L stands for lateral and medial. What is this muscle?
Pectoralis muscle. So the nerve also will be pectoral nerve. Next, M stands for medial.
What is this muscle? Pectoralis muscle. Again the nerve will be pectoral nerve. Next, what is N stands for?
Nerve to, nerve to which muscle? What is this muscle? Subcrevius. Nerve to subcrevius. subclavius muscle, nerve to subclavius muscle.
And serratus anterior, need not to tell because all of you know serratus anterior is long thoracic nerve, long thoracic nerve, okay, long thoracic nerve. So, these are the routine questions which have been asked from years guys. But in the clinical exam, what they will ask you is that there is one problem with the patient.
What is the problem is that? I have two pectoral muscles. Pectoral is major muscles. Even you have two pectoral muscles.
But in some patients, only one side of the pectoral muscles will be there. Other side, the pectoral muscle will be absent. This is called hypoplasia of pectoral muscle. Completely no developed pectoral muscle.
Pectoral muscle is not at all developed. Look at this patient. One side, this is a male patient, not a female.
This is pectoral region. But look at the pectoral region on the other side, right? Pectoral region on the other side.
So, here the patient is not having any pectoralis muscles, right? So, this syndrome you call it as Poland syndrome, Poland syndrome, right? In Poland syndrome, one side unilaterally patient will have chest wall hypoplasia, chest wall hypoplasia.
So, in the exam if they ask you, okay, then which muscle? Mainly pectoral. pectoralis major muscle, mainly pectoralis major muscle. All of you clear?
Clear, right? Now, look here. Let us discuss another important part here, another important thing in the pectoral region.
And I am telling you, whatever topic I am teaching you right now, which I will be teaching you right now, that is called clavipectoral fascia. This topic guys, if they ask you from your upper limb, if they ask you three or four questions, out of that one question will be from clavipectoral. Keep this thing in mind. I have been seeing papers from years and definitely one question will be from clavipectoral fascia.
So, I will be teaching you in detail everything. Clavipectoral fascia. Simple thing.
Don't worry about this. clavipectoral between clavicle and pectoralis muscle the fascia whatever is there that is called clavipectoral fascia okay look here what is this bone here clavicle what is this bone clavicle so let me draw the clavicle i will show you a real picture also this is clavicle okay beneath the clavicle just beneath the clavicle what is the muscle i have attached to the clavicle i told you remember what is that subclavius muscle isn't it So beneath this, all of you don't write guys, put your pens aside. This is called a subclavius muscle.
Just beneath subclavius muscle. In front of the clavicle, this is my clavicle. In front of it, this muscle whatever I have, this is called pectoralis major muscle. In front of that, the muscle whatever I have, this is called as pectoralis major muscle.
This muscle is pectoralis major muscle. Okay. All of you know muscle is always and always covered by fissure.
right. So, even on the pectoralis muscle also, I have got a fascia, right. Now, what is this fascia? Obviously, pectoral fascia, pectoral fascia. And what is this muscle?
Pectoralis, major muscle. And what is this bone? Clavicle, okay. And what is this muscle below the clavicle?
Subclavius, subclavius, clear. Now, I told you in the starting that when I remove pectoralis major, inside I will find what? Pectoralis minor.
So this is pectoralis major. I am removing it. Then inside, I will find a chota muscle, small muscle, minor, pectoralis minor.
So this muscle is pectoralis minor. What is clavipectoral fascia? Clavipectoral fascia means between the clavicle, between the pectoralis minor, whatever fascia you can see here, this is called clavipectoral. This is called as clavipectoral fascia, clavipectoral fascia. Understood?
Clear? Easy? Yeah? Everyone easy? Right?
But what they will ask you in the exam is that what are the structures that are piercing this clavipectoral fascia they'll ask you all the first year students i want to ask you are is this easy guys clavipectoral fascia was it easy for you nagastri very good safwan kathik very good ayman very good dr bandit obviously right what are the structures that are piercing this clavipectoral fascia look at the picture below look at this picture below The same picture I have put it here, right? So, this one is called as clavipectoral fascia, EPM. The same picture is on the other side also. Look here. What are the structures that are piercing this clavipectoral fascia?
What are the structures? Look here. The first structure is, this is A.
This is the first structure. And look here. Let me draw it little bit dark, this is clavipectoral fascia. You see, this is clavipectoral fascia.
Second structure, I am writing it as B. Third structure as C. Fourth structure as D.
Okay. What is this ABCD? What is this ABCD? A stands for an artery called as thoracoacromian artery. This is piercing the clavicle fascia.
Second, B stands for, what is this vein here? Blue color one, cephalic vein, cephalic vein. C stands for a nerve, golden color nerve. What is that nerve here?
Lateral pectoral nerve. Because I told you that pectoralis major is supplied by medial and lateral pectoral nerve, right? So this is the lateral pectoral nerve. And D stands for the snake-like thing that is called as your lymphatics. Lymphatics.
So if someone asks you, what are the structures piercing? structures piercing clavipectoral fascia structures piercing clavipectoral fascia so these are the structures guys very very important very very important if you really understood this whatever i've taught you now then definitely one question is in your mark i mean one one mark one mark is in your pocket okay one mark is in your pocket for sure is everyone clear guys everyone We are about to end. Is everyone clear? Right?
Very good. Let us enter into the topic, the most important topic, guys. I don't know if you have understood the previous topics or not also, but...
you have to try to understand this topic because this topic will come in your physiology it will come in your anatomy it will come in your surgery also okay and hundred and ten percent i'm telling you if you understood this topic then from surgery definitely they will ask you one question from this topic what is the topic is breast okay mammary gland mammary gland okay you Definitely one question from surgery, one question from anatomy will be asked every year from your mammary gland. Because all of you know, if there are any senior students here, even you might also know this, right? That definitely there will be a question from the mammary gland.
And mammary gland is very, very, very difficult to understand. Jilan, yes, Pewdie Orange, I will be teaching you all of that. So what is mammary gland? Mammary gland is a modified. sweat gland right modified sweat gland of epocrine activity you know epocrine glands merocrine glands epocrine glands will open uh will will have a opening on the top right so what is that opening on the top that is a nipple right from there the milk comes from modified sweats Where does sweat come from?
No, it is not sweat. Sweat gland in the sense sweat doesn't come out of that. Okay, whatever is secretions. So these are all the secretions either it might be a milk or sweat or whatever it is.
These are just the secretions. So look here the first important thing. The first important question they will ask you is mammary gland is ranging from which rib to which rib. Mammary gland ranges all the way.
This is called as a second rib till the sixth rib. Clavicle scapula there. Guys scapula please remind yourself scapula ranges from.
which posterior rib to which posterior rib very good ravi chauhan ravi chauhan very good from second to seventh here second to sixth okay q because the back of the mammary gland is exactly the same so it will be around that fine so next important thing first question is it ranges all the way from the second rib till the sixth rib you till the sixth day. Next important thing is that if I divide the breast into four quadrants, if I am dividing the breast into four quadrants, so what will happen? See, these two quadrants, these two quadrants, these are called as medial quadrants and these two quadrants are called as lateral quadrants.
In the lateral quadrants also, I have got one on the top, one on the down, below. So, this top one which I am coloring it right now, look here, this top one is called as superior and lateral quadrant, superior lateral quadrant because it is superior and lateral, superior lateral quadrant, ok? Why are you telling this?
Why am I telling you this is that superior lateral quadrant has got a small tail, isn't it? It has got a small tail. This tail is called as ag... auxiliary tail of spins, auxiliary tail of spins. It has got a tail called as auxiliary tail of spins.
Okay. Clear? Second important thing. I will tell you one more thing about the foramen also.
Just give me a second. Second important thing is that why are you discussing about this auxiliary tail of spin? Because this is the region where highest risk of breast cancers appear.
High risk of breast cancers, where do you see? In the four quadrants. I see in the upper and the outer quadrant or the superior lateral quadrant or the quadrant where the axillary tail of sphynx is present. This region has got the highest risk of breast tumors.
Highest risk of breast tumors. Highest risk of breast tumors. Clear?
This is a very very very important. Second important question they'll ask you is that, okay, you are telling it is a breast, right? Now, what are the muscles that are attached to the breast?
I mean, they're not attached actually. What are the muscles are in relation with the breast? Means, below the breast, on the side of the breast and above the breast, what kind of muscles are there? Look here, above the breast here, you can see this muscle like this, right? Can you see this muscle?
You know what is this muzzle? All of you know it? Very good. Very good Aiman Kazi.
This is pectoralis major. The first muzzle is pectoralis major. Very good. Second muzzle. I told you that here muzzles will be there and that is useful for boxing.
Boxer muzzles isn't it? See this. Here are muzzles.
These muzzles are called as boxer muzzle. Boxer Aiman. Boxer. That is serratus. anterior and finally down in the abdomen region also you have got muscles that are going out like this right so look here these are the muscles these are the muscles so these muscles are called as external oblique muscles third important thing is external oblique muscles so three muscles pectoralis major serratus anterior external oblique these three are in relation with the breast are in relation with the breast?
Very, very, very, very important question. Very, very important question, guys. Okay?
Guys, regarding the breast, is everything going fine? Right? Do not worry.
I am not taking this session lengthy. Okay? We shall cover the topics in the remaining sessions as well.
Okay? Do not worry. This will not be your last session.
We will continue it if there is anything left over. So, second question is also done. What is the first question?
First question is Axillary tail of Spence. Or kaha se kaha tak? Second se, sixth tak? Tige? Third question.
Third question is that, simple question. Where is breast? Now don't answer me, breast is located in females.
No. Breast is located in the superficial fascia. I will tell you what is that. Breast is located in the superficial fascia. Superficial fascia.
Concentrate on this picture very carefully. Very clear. This is called as clavicle.
You know it. Below the clavicle is called as subclavius muscle. I told you in front of that. What is this muscle guys?
This muscle is your pectoralis major muscle. We discussed this already in front of pectoralis major. Can you see a green color line like this? This green color line is called as pectoral fascia.
pectoral fascia all of you know that right remember one thing pectoral fascia is also called as deep fascia pectoral fascia is also called as deep fascia pectoral fascia is called deep fascia means when i tell deep fascia there should also be superficial fascia then where is superficial fascia you cannot see superficial fascia because superficial fascia is having breast. Where is breast located? Breast is located in the superficial fascia. Okay. Breast is located in the superficial fascia.
That is the reason why you cannot locate the superficial fascia. So from today onwards, where is breast located? Superficial. Okay. Or one more thing.
Behind the breast, can you look at this yellow color thing, yellow color space behind the breast? Can I call it as retro mammary space? Retro means back, right? Retro means back. So can I call it as retro mammary space?
Very good. Dr. Lipun is telling that retro mammary space is having fat. You are right.
Retro mammary space is having fat. Okay. So this is the retro mammary space.
clear right next important question actually it is having loose areolar connective tissue okay it is having a loose areolar connective okay keep this thing in mind you want to remember it remember it or else leave it okay sir All the way lies from second rib till the sixth rib. Okay. Then they also started asking a question. Sir, where does nipple lie? This is the nipple.
Right. Where does the nipple lie? You tell me.
Where will the nipple lie? Nipple lies in the fourth intercostal space. Where does the nipple lie? It lies in the fourth intercostal space.
Clear. Nipple lies in your fourth intercostal space. Very good.
Very good. It lies in the fourth intercostal. Right.
Next important thing. The surrounding region of the nipple is a little bit hyperpigmented. All of you know.
Right. All of you know. Means you might have seen.
So that hyperpigmented region is called as areola. Okay. The hyperpigmented region surrounding the nipple is called areola.
Right. So this is the nipple. This is the. nipple over here surrounding the nipple jo bhi a hyperpigmented area hai isko bolte areola why are you telling this why am i telling this is that areola ke andar within this areola there are some glands called as sebaceous glands sebaceous glands tike toh what will happen is that during pregnancy right or after pregnancy during lactation when the mother starts to you know feed the baby with the milk that time what will happen is that these sebaceous glands they will start to enlarge see here sebaceous glands have been enlarged or not the sebaceous glands have been enlarged now these enlarged sebaceous glands are called as tubercles tubercles of montgomery these are called as tubercles of montgomery these are called Tubercles of Montgomery And remember one thing, nipple and areola don't have hair and fat. So nipple and areola are devoid of hair and fat.
Hair and fat don't happen on nipple and areola. Clear all of you? All of you clear?
Come on. Adhya? Ayman Qazi, all of you are clear. Bruce Wayne, you are right. Right.
Last important thing, last important thing is that, sir, what are these tubes under the breast? What are these tubes? These are not tubes. What are these are?
These are called as lobes. You know, in 2017, I think, 2017 or 2018, I don't remember, in FMG, 2017 or 18 FMG, maybe in the December or June attempt, I think, they asked that how many lobes are present in a breast? How many are there? There are around 15 to 20 lobes. Okay, there are around 15 to 20 lobes.
If you look carefully, all of you look here, lobe, this is a lobe. This is a lobe. Lobe is opening into a cavity like this and from there a small duct comes. Isn't it? Look at the picture.
This is called as lobe. How much will it be? 15 to 20. After that what is this? This is called as lactiferous sinus.
What is this? This is called as lactiferous sinus. Okay. Lactiferous sinus. And what is this part?
This is called as lactiferous duct. Lactiferous duct. So, how many lobes we have? 15 to 20. Jitane lobes se utane ducts rahenge.
Hegi nahi. So, 15 to 20 lobes are there. So, obviously, 15 to 20 ducts also will be there.
This is the simple deadliest equation which they have asked in 2017, guys. And you know, most of the people whom I know, they kept it as wrong. They have completely left this question. They kept it. They kept it completely wrong.
Dr. Bendict is telling that these lobes are absent in man. That is why no lobar carcinomas. Yes.
There will also be cancer that will be developed from these lobes, guys. Okay. So, these lobes, wherever they are present, there will be cancer. In the females, they have.
So, they will have lobar carcinomas. In men, they don't have. So, lobar carcinomas are not present in men.
Right. The last important thing, the last important thing is the blood supply guys. Okay. Before I discuss blood supply, I can discuss it directly.
I can discuss it directly, but I want all the first year students to understand it. So I'm going with a little bit basic. Okay.
All of you look first year students. Now, this is your heart. Okay. Now coming out of your heart from your left ventricle, you have got a branch like this.
What is this called as? This is called as your aorta. All of you know this is called as your aorta, right?
On one side, on one side, the aorta opens into a trunk. This is called as brachiocephalic trunk, okay? Brachiocephalic trunk divides into two branches. One branch goes on to the right side like this. One branch goes on to the top.
The branch which is going on to the right side, this is called as subclavian artery, right subclavian artery, clear? Right subclavian artery. Now, From the subclavian artery, subclavian artery continues down as another artery called as axillary artery, axillary artery, okay?
Next, axillary artery continues down as brachial artery, axillary artery continues down as brachial artery, okay? Brachial artery divides into two branches, brachial artery divides into two branches. So, axillary artery is coming, brachial artery is coming, it is dividing into two branches.
One is called as radial artery, one is called as ulnar artery, okay? One is called as radial artery, another one is called as ulnar artery. Now, my main discussion will be between subclavian as well as the axillary artery.
Clear, all of you? The first years, are you clear? Very good.
first years in the sense 30 years also i'm asking for all of you right look at the Question here now, look at the thing here. Let us say this is your clavicle like this. This is your clavicle. Now, what is this artery? This is called subclavian artery.
I told you subclavian artery will continue as axillary artery. So, this is your axillary artery which is entering into your arm. Axillary artery will continue further as brachial artery. Okay.
So, this is your subclavian artery. This is your axillary artery. Now, look very carefully.
Subclavian artery will give a branch, subclavian artery will give a branch which will enter inside my thoracic cavity. So, I call it as internal thoracic artery. Okay. It will enter inside my thoracic cavity like this.
Okay. So, branch number one, branch number one is called as internal thoracic artery or you can also call it as internal mammary artery because it is supplying to your mammary gland. mammary artery mammary gland here second axillary artery branches one branch one branch supplies from the top from the top so superior it enters into the thoracic region thoracic artery okay this is called two what is that superior thoracic artery next there is a branch that supplies like this laterally I mean, it comes like this laterally, it supplies laterally.
So, lateral thoracic artery. Let us write it as 4, okay? 4. What is this 4? Lateral thoracic artery.
Next, another one supplies exactly in the center like this. Now, this is called as acromiotoracic artery. Third one. Artery number 3 is called acromiotoracic artery. Acromiotoracic artery.
okay acromiothoracic artery and there are last branches guys what are these branches are look here there are some perforating branches like this small branches which are perforating like this now these branches are called as posterior intercostal artery these are the perforating branches called as posterior intercostal artery so these are the things which supply to your this these are the things which supply to your breast okay. Jilan is telling you can remember by a mnemonic called as SLAP okay SLAP S stands for superior thoracic L stands for lateral thoracic A stands for acromiothoracic P stands for posterior intercostal and also remember write it as ISLAP okay obviously you will only slap right so ISLAP I in the sense internal thoracic or internal mammary artery so these are the branches of the These are the branches which are supplying to your breast. And one very important thing you need to know is that this internal thoracic artery is on the right side, right? So, the left internal thoracic artery is mainly used for CABG, coronary artery bypass grafting.
Okay. For the first year students, you might not know what is coronary artery bypass grafting, but if you know it, it's well and good. And anyways, I'll be teaching you later on in the session.
Okay. So, this is, these notes I'll be posting you tomorrow and regarding the lymphatics the venous drainage and the muscles of the upper limb the forearm the hand okay the arterial supply everything we shall be discussing in the further sessions guys but as far as this session is concerned i want all of you uh to answer yes tomorrow morning definitely in the telegram group the notes will be posted but i just want you i want to know whether you have understood whatever i have taught today guys my main focus is on first and third year students so guys have you all understood whatever i've taught you today is there any difficulty right so should i teach you in this way and continue the classes further or no i want your feedback so that i can progress further right i want all of you to answer guys whatever it might yeah you're understanding all of you adil yes right all of you all of you are understanding right no doubt i'm really tense that because these materials whatever are there we teach Thank you so much. Thank you so much forever. Thank you. So guys, yes, yes, Shantanu Ghosh, yes, the entire first year anatomy will be covered.
So for meantime, we shall be continuing the classes offline. I mean, online like this. But later on, we shall be having classes offline, right? So if there is a chance that I would come there and teach you in your university online there in front of you.
offline fine so these are those classes before that but i shall be teaching all these again when i come over there so i hope you understood all of these things guys so tomorrow we shall continue the remaining part tomorrow we shall be mainly focusing tomorrow we shall be mainly focusing on the upper limb okay the upper limb and all the the muscles the arterial supply and we shall also discuss some very important things like cubital fossa carpal tunnel syndrome spaces of hands Very nice topics we have guys. Okay. So tomorrow morning I'll be posting this or, or let us do like this, that after completing tomorrow's session also together, I'll club it and post it as upper limb. Okay.
So that would be fine. So thank you so much guys. Thank you so much for your patience.
All of you. Goodbye and good night.