Deep Cervical Fascia

We all have been so far believing that Investing layer (the most superficial layer of Deep Cervical fascia) encloses Trapezius posteriorly , then become a single layer in the ROOF of POSTERIOR TRIANGLE and then encloses Sternocleidomastoid, again become single layer and attached in the midline to mandible, hyoid bone and down to manubrium of sternum.

 Ming Zhang, University of Otago conducted a sectional anatomic investigation with the use of E12 sheet plastination in six human adult cadavers in 2002.

The finding was amazing!!!

Investing layer was absent between sternocleidomastoid and trapezius muscles. The intervening space was fully occupied by fatty tissue that was indistinguishable from the subcutaneous tissue.
The investing layer of the deep cervical fascia is incomplete so that the carotid sheath is directly exposed to the subcutaneous tissue via a gap between the sternocleidomastoid and trapezius muscle. 

Gray's Anatomy states that the portion of the investing layer lying between the sternocleidomastoid and trapezius is made up of the areolar connective tissue rather than the dense connective tissue

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What is Perineum?

Watch the video-Reconstruction of Male Perineum ...interesting

•Narrow region, Diamond-shaped

Between Mons Pubis/scrotum Anteriorly, between Medial Surface of thigh laterally and between Gluteal folds/Natal Cleft Posteriorly

•Boundaries

Bounded by bones forming pelvic outlet

Separated from pelvic cavity Fascia covering inferior surface of pelvic diaphragm and Pelvic Diaphragm (LEVATOR ANI)

Bones: Anterior: PUBIC SYMPHYSIS, Lateral: Ischial Tuberosities

Anterolateral: Ischio-pubic Rami, Posterolateral: Sacrotuberous ligament

Posterior: Sacrum, Coccyx

Superficial Structures of Perineum (Structures of Superficial Perineal Pouch, Lying beneath the Deep Fascia, which is called Colles' Fascia in this region)

•Inferior to PERINEAL MEMBRANE & Superior to PERINEAL Fascia (COLLES’ Fascia)

•Bounded laterally by Ischio-pubic ramus:

•Superficial Perineal Pouch (open & Continuous with scrotum, penis & ant abd.wall)

•Contents

Male: Bulb of penis, part of body penis                                                                                                ----Bulbospongiosus,  --Ischiocavernosus muscles

--Superficial Transversus perineal muscles

--Proximal part of spongy urethra

--Perineal branches of internal pudendal vessels and pudendal nerve

Female: Clitoris,                                                                                                                              --Ischiocavernosus Muscle, 

--Bulb of vestibule & surrounding Bulbospongiosus muscle (lying beneath labia majora);              --Greater Vestibular glands, ---Superficial Transverse Perineal muscles

-Perineal branches of internal pudendal vessels and pudendal nerve

My Research Artcles

(2013) Effect of intra-cisternal application of kainic acid on the spinal cord and locomotor activity in rats

(2012) Evaluation of the neurotoxic effects of ethanol on the cerebellar and cortical neurospheres isolated from E14 mouse embryo

(2012) A comparison of neurotoxicity in cerebellum produced by dermal application of chlorpyrifos in young and adult mice

(2011) The effect of consequent exposure of stress and dermal application of low doses of chlorpyrifos on the expression of glial fibrillary acidic protein in the hippocampus of adult mice

(2011) Neuroprotective effect of bioflavonoid quercetin in 6-hydroxydopamine-induced oxidative stress biomarkers in the rat striatum

(2010) Evaluation of difference in the neurotoxicity produced by dermal application of chlorpyrifos on the neonatal and adult mice

(2009) Effect of concurrent application of heat, swim stress and repeated dermal application of chlorpyrifos on the hippocampal neurons in mice.

(2008) Effect of chronic ethanol exposure on the count of cerebellar Purkinje cells and motor coordination in adult mice

(2008) EVALUATION OF NEUROTOXICITY OF REPEATED DERMAL APPLICATION OF CHLORPYRIFOS ON HIPPOCAMPUS OF ADULT MICE

Let us see HOW MICTURITION OCCURS

MICTURITION REFLEX

When the urine collects in urinary bladder (about 150 ml), afferent parasympathetic nerves carry sensation from the stretch receptors in Internal Trigone to Sacral Spinal cord [ S2, S3, S4, lateral horn called SACRAL MICTURITION CENTRE]
Then the the efferent motor parasympathetic nerves (from Sacral Micturition Centre) stimulate detrusor smooth muscles of bladder wall generating the urge for micturition.
If you are not willing or not in a proper place the HIGHER CENTRES in the BRAIN (Paracentral Lobule in cerebral cortex, CORTICAL MICTURITION CENTRE) can suppress SACRAL MICTURITION CENTRE and thereby suppress contraction of detrusor muscles.
During filling of bladder at initial stage the sympathetic nerves make the INTERNAL URINARY SPHINCTER (smooth muscles) (at bladder neck, junction of prostatic urethra and lower end of bladder) contracted which helps filling. Once micturition reflex sets in, the internal sphincter is relaxed and urine enters prostatic (in female urethra) urethra.
But EXTERNAL SPHINCTER (Skeletal muscles) remains closed by SOMATIC SPINAL NERVES called PUDENDAL NERVE (coming from Anterior Horn cells of S2, S3, S4). This nerve is under the influence of higher centre (particularly PONTINE MICTURITION CENTRE). When you are comfortable to void urine, the pudendal nerve under the guidance of higher centre, relaxes EXTERNAL SPHINCTER, thus we can void urine.Please see the video:

Cranial Nerve lesion

What will be the physical sign in THIRD NERVE Palsy?
Can you describe the physical sign observed in the picture?
Which side IIIrd cranial nerve lesion is evidenced here?

Fracture Classification Outline of management

Dear All
Please Click FRACTURE
You can read Merck manual on classification of fracture, important fractures and outline of management of fractures

Enjoy reading

Knee Joint

Hi
You should know every anatomy of this joint, WHY?
Largest joint in the body, most extensively used & most 'ABUSED'
Hinge joints move in only one plane-flexion/extension, but the knee is modified hinge as during beginning of flexion--there is lateral rotation of femur & at the end of extension--medial rotation of femur. Hence rotation in mild degree is accompanied both in flexion & extension
Enjoy this video--showing a simple anatomy of knee joint

Structures in Anterior Abdominal Wall

Hi! Attached is a picture of 'Superficial dissection' of Anterior Abdominal Wall from Netter's Atlas

Please try to identify the structures labelled, there are some questions also. Please feel free to answer even if it is presumed to be wrong for 'feedback' from me.

i. The structure labelled 'o' is quite important. Is there any implication if during surgery incision is made through it?

ii. The structures 'P' & 'Q' both are layers of same layer out of the 8 layers of 'Anterior Abdominal Wall '. What are the layers P & Q , is there any clinical significance to these 2 layers?

iii. There is an opening seen as 'R'. What is this opening? which muscular aponeurosis is dragged to produce this opeing in early part of our life. what is the structure which drags this aponeurosis ?

iv. 'S' denotes some structure which gives strength to 'R' opening. What is 'S'

v. 'V' is very important rope like thing, on which integrity of all the strutures around are dependent. what is it?

vi. What is the layer of fascia seen lying over spermatic cord as 'X'? is it the only layer of fascia over the cord, what are the others and how they are derived during early years of life?

vii. List the different types of structures formed by 'M'.

Best of luck in answering this question using your 'GI' knowledge.

Arm & Cubital Fossa

Hi!

Identify the structures in this picture. Then

a) Which muscles and skin area is supplied by B

b) What is the peculiar thing about tendon D?

c) What is the muscle supplied by E before it enters forearm?

d) what will happen to F in fracture involving medial epicondyle? what is the functional loss?

e) In supracondylar fracture of elbow, what is the after effect due to affection of G?

f) By dint of attachment to ulna by H, this muscle can cause a movement- what is the movement?

Cheers

Nilesh

Elbow joint

Hi you are using your elbow joint so frequently, is it not? Eating your food, while showering or even combing your hair or shaking hands with your friends.


Click ELBOW to have some fun


Can you comment on the type of joint produced in between RADIUS & HUMERUS?
or
type joint produced by ULNA & HUMERUS?

Which part of Radius join with which part of Humerus?

Which part of Ulna join with which part of Humerus?

Joints

Hi Can you comment on the types of the joints found in between two vertebrae?

You can think of joint between articular processess

You can think of intervertebral disc in between two bodies

You should choose out of the following types--Fibrous/Cartilaginous/Synovial--Under Cartilaginoous: Primary & Secondary, Under Synovial: Plane, Ball& Socket, Condylar, Ellipsoid,Pivot etc.

Interesting structures in thorax, neck, posterior mediastinum

Hi! 1. Identify the big vein R, which important vein drains blood from the thyroid into it and may be injured in 'Low Tracheostomy'?

2. Identify the nerve P, What happens when it is compressed by a metastatic lymph node or a tumour in mediastinum, How is it different from its right counterpart?

3. V is a part of aorta just distal to origin of left subclavian artery, Which congenital anomaly is common in the V-part of aorta?

4. Identify S, which parts of the body is drained by it?

5. Identify the nerve T, which important organ does it supply, what is the most important symptom in case of irritation of this nerve?

Can you tell about U-the muscle in front of which T-the nerve lies?, which important rib it is attached to? What two important vessels of the thorax it does separate on that rib?

6. Identify the vein Q, where does it drain and at what level (thoracic)?

Identify the structures in section of brain

Hi! Please try to identify the structures in the horizontal section of brain image from Netter's atlas
a) which of these structures is supplied by posterior cerebral artery?
b) which of these structures when affected in epilepsy, produce loss of recent memory?
c) Which of these structures make you turn your head while you see that 'beautiful' passing by at the corridor?
d) which of these structures when degenerated, may make you dance crazily?

Identify the nerves

Hi! try to identify the three nerves shown in this image from Netter's atlas.
Which one of these nerves will be damaged in 'Inferior Dislocation of Shoulder' or 'Surgical Neck Fracture of Humerus'?