Accessory obturator artery is a branch

of inferior epigastric artery, which itself

is given by external iliac artery.

Lacunar ligament is medial boundary of

femoral ring and accessory obturator
artery may lie on that in some
percentage of population.
In reduction of femoral hernia, we must
be careful of accessory obturator artery,
while we cut lacunar ligament to
enlarge the femoral ring to reduce the
hernia.

Inguinal hernia (direct or indirect) lies

supero-medial to pubic tubercle, and
enters the scrotum. Whereas, femoral
hernia lies infero lateral to pubic
tubercle and enters the thigh region.
Femoral vein lies lateral to femoral
ring. (JIPMER2016).
In femoral hernia, the intestine may
enter the femoral ring, and the femoral
canal to reach thigh region, and lie
inferolateral to pubic tubercle.
The most medial content of femoral
triangle is the inguinal lymphatics. The
arrangement of structures ( medial to
lateral) are: Inguinal lymphatics -
Femoral vein, femoral artery, femoral
nerve.
Femoral nerve lies outside the femoral
sheath.
Inferior epigastric artery enters the
rectus sheath, and is a landmark to
differentiate between direct and indirect
inguinal hernia.
Limbus fossa ovalis is present in the
septum secundum and at its floor is
seen the septum primum.

Fusion between septum primum and

septum secundum takes place at about
3 months after birth.

The vas deferens is usually derived

from the superior vesical artery, and
occasionally from the inferior vesical
artery, both branches of the internal
iliac artery.
Note: It may also arise from middle
rectal artery.
Ligamenta denticulatum is made up of
piamater. It lies on each side between
the dorsal and ventral nerve roots,
forming narrow ribbon-like transparent
bands.
The lateral margin of each ligamentum
denticulatum sends
21 teeth-like projections, which pass
through subarachnoid space and
arachnoid mater to gain attachment on
the inner surface of the dural tube
between the points of emergence of
two adjacent spinal nerves.
Note: Ligamentum denticulatum
attaches to duramater.
Ligamenta denticulatum helps to
anchor the spinal cord in the middle of
the subarachnoid space.
The first tooth of ligamentum
denticulatum is at the level of the
foramen magnum, while the last tooth
lies between T12 and L1 spinal nerves

Each ovary lies in the ovarian fossa (of

Waldeyer) on the lateral pelvic wall
below the pelvic brim.
The ovarian fossa is a slight peritoneal
depression bounded
Posteriorly by the ureter and internal
iliac vessels (and origin of uterine
artery). retroperitoneal structures
Anteriorly by the external iliac vessels.
Inferiorly by the uterine tubes (in the
free margin of broad ligament).
The obturator nerve and vessels cross
the floor of the fossa.

Capitate bone articulates with Second

metacarpal Lunate Trapezoid Scaphoid

Pisiform (a sesamoid bone) ossifies at

9-12 years of age.

Optic vesicle derived from an

evagination developing on either side
of the forebrain ( neuroectoderm) of
the early embryo, from which the
percipient parts of the eye are formed.

Rotator cuff (formed by SITS muscles)

stablizes it postero-superiorly, but
weak antero-inferiorly - Shoulder
dislocations are more commonly
antero - inferior. ( Subscapularis is the
forgotten muscle in rotator cuff).

Bicipital Groove Contents:

Tendon of long head of biceps brachii
enclosed in the synovial sheath
Ascending branch of anterior
circumflex humeral artery

Pectoralis Major on the lateral lip of

the groove.
Teres Major on the medial lip of the
groove.
Latissimus dorsi in the floor of the
groove.
Levator ani muscle is subdivided into
named portions according to their
attachments and the pelvic viscera to
which they are related (
pubococcygeus, iliococcygeus
and puborectalis).

Ischiococcygeus muscle is a component

of pelvic diaphragm, but is not included
under levator ani muscle.

Hiltons law: The nerve supplying a

joint also supplies the muscles that
move the joint and the skin covering
the insertion of such muscles.
Sites of sesamoid bones:
In the knee - the patella (within the
quadriceps tendon)
In the hand - two sesamoid bones in
the distal portions of the first
metacarpal bone (within the tendons
of adductor pollicis and
flexor pollicis brevis).
In the wrist - The pisiform of the wrist
is a sesamoid bone (within the tendon
of flexor carpi ulnaris), develops at age
912.
In the foot - two sesamoid bones in
the distal portions of the first
metatarsal bone (within the tendons of
flexor hallucis brevis.
In the ear - the lenticular process of
incus is a sesamoid bone and therefore
is considered the fourth ossicle of
middle ear.

Traction epiphyses are extra capsular

Pressure epiphyses are intra capsular

Deltoid tuberosity is not an epiphysis

(it is present on the shaft/diaphysis)

Epiphysis on the head of first

metacarpal is an example of aberrant
epiphysis.!

Elastic cartilage is present at E3 -

External ear/Eustachian
tube/Epiglottis. It is also seen at the
tip of the arytenoid, corniculate &
cuneiform cartilages (Larynx).

Ventricles of brain are lined by

ependyma (ciliated columnar
epithelium)

Otic placode is a thickening on

ectoderm which appears at day 20
25, and develops into components
of ear.
Trophoblast differentiates into cyto
and syncytiotrophoblast at post
fertilization day 6-8.