MRCS Anatomy

Limbs And Spine

Lumbar
large kidney-shaped body
small vertebral canal
massive transverse and spinous processes (not sloping)
large pedicles
Synovial joints
intervertebral discs: secondary cartilaginous joints
periphery: tough fibrous tissue - annulus fibrosis
centre: gelatinous matrix called the nucleus pulposus
Disc herniation
Normally affects roots
L4/L5 and L5/S1
Nucleus pulposus: collagenous fibres (type II collagen) in a
mucoprotein gel containing polysaccharide
cervical vertebrae
large, triangular vertebral foramen
small transverse processes containing a foramen
small and wide body
short and bifid (C3C5) spinous process
Uncus
uncovertebral joints with successive vertebrae
allow rotational movements
anterior and posterior tubercles- attachments to scalenus anterior,
scalenus medius and scalenus posterior
Ligaments
anterior and posterior longitudinal
supraspinous and interspinous
intertransverse ligaments
cervical rib - supernumerary rib that arises from the anterior
tubercle C7
impingement of nearby anatomical structures
reduced blood flow in the subclavian vessels
stretching of the lower brachial plexus nerve roots
o T1 root impingement can: weakness of the small
muscles of the hand
thoracic vertebrae
heart-shaped body
small and circular vertebral foramen

MRCS Anatomy

long transverse processes that angle posteriorly

facets on the sides of the body for articulation with the ribs
long spinous processes - angle inferiorly

Lumbar puncture:
- line between iliac crests (supracristal plane)
- Intersect vertebral column at L4
- Pass needle between L4/5
layers
skin
subcutaneous fat
deep fascia
supraspinous ligament
interspinous ligament
ligamentum flavum
dura mater
arachnoid mater
Sympathetic chain
cell bodies of sympathetic nerve cells lie within lateral horn of
grey matter of spinal cord from T1 to L2
Preganglionic fibres from cell bodies anterior roots of the
spinal cord anterior rami of spinal nerves of T1 to L2
fibres white rami communicantes sympathetic chainsynapse with postganglionic fibres
o synapses occur at the level of the nerve root, or
preganglionic fibres may ascend or descend a level
o Some fibres pass through the sympathetic chain without
synapsing splanchnic nerves
postganglionic fibres anterior rami via grey rami
communicantes for distribution to the target organs
sympathetic chain receives white rami communicantes from
the T1 to L2 levels only
3 cervical ganglia: superior, middle and inferior
o inferior cervical ganglion is fused with T1 ganglion =
larger stellate ganglion- lies just above the neck of the
first rib.
Raise arm
forward flexion: contraction of anterior fibres of deltoid
abduction, supraspinatus initiates movement, subsequently
taken over by deltoid
Beyond 90 abduction, humerus is rotated laterally by
subscapularis, teres major and infraspinatus.
rotation of scapula to elevate glenoid: trapezius and serratus
anterior

MRCS Anatomy

Painful arc
disorders of the rotator cuff muscle tendons, most commonly
supraspinatus
Inflammation of tendon and overlying subacromial bursa
(degeneration or trauma): painful abduction of the arm
between 60 and 120
posterior cord - posterior border of axilla, deltoid and posterior
muscles of the arm/ forearm.
upper subscapular nerve subscapularis
thoracodorsal nerve latissimus dorsi
lower subscapular nerve subscapularis and teres major
axillary nerve deltoid, teres minor
radial nerve triceps, all the extensor muscles of the
forearm. Head And Neck
Thorax And Abdomen
Neuroscience