Applied and clinical anatomy

Upper limb

When you think of the arm, some major structures may come to mind like the brachial plexus and the shoulder joint. We know for a fact that the brachial plexus supplies the entire upper limb, and that the shoulder joint enables us with a wide range of movement.

But what happens when they are injured, and how does this type of injury even occur? Here we present to you a brachial plexus injury which resulted from an attempted suicide by hanging, and a shoulder dislocation following an epileptic seizure. After reviewing them, among many other things, you will also learn why brachial plexus is a common obstetrical injury, and the mechanisms of shoulder injury by solidifying its anatomy.

But, does every acute disability of the arm have to be related to either a brachial plexus or shoulder joint injury? Not quite. Even the pectoralis minor muscle can compress the neurovascular bundle of the upper limb and cause severe dysfunction of the arm. Or an elbow joint injury can compress the brachial artery and alter the function of the upper extremity.

After reviewing the case of pectoralis major syndrome and brachial artery injury, you will understand why venous drainage of the upper limb is susceptible to compression and what is meant by compartment syndrome.

Now, you may not be a fan of the elbow joint, but you’ll be surprised how its lesions may alter the patient's quality of life, whether they resulted from a neglected fracture of the radius and ulna that didn’t heal properly, or from a hit in the elbow that dislocated the ulnar nerve. Take a look at these cases of Volkmann’s ischemic contracture and ulnar nerve subluxation and see for yourself why your knowledge about the elbow and arm anatomy is precious for your future plans to help others.

When we move distally on the upper limb, we eventually reach the hand. The hand is one of the most useful products of evolution, enabling us even the finest movements and processes such as drawing and writing. But what happens when something alters the functions of the hand? To be able to diagnose the disease that led to hand dysfunction, we must know its anatomy, from bones to muscles and neurovasculature. To see why it is so important, check out these cases of Dupuytren's contracture and Raynaud’s syndrome. And even the best clinicians can make a mistake, so we’ll also present to you a case of glomus tumor of the hand that was misdiagnosed as carpal tunnel syndrome.

Head and neck

When we say head and neck, we bet you think “cranial nerves”. Exactly! The most challenging part of head and neck anatomy are the cranial nerves. Some of them, such as facial nerve (CN VII), have a very broad field of innervation. Others innervate just a few structures, like the optic (CN II) and oculomotor nerve (CN III), but are essential for normal life, such as accommodation of the eye. 

To understand the importance and functions of these three cranial nerves we present to you interesting clinical cases, such as malignancy along the facial nerve, optic nerve vascular compression, oculomotor nerve palsy which you will be able to describe the course and anatomical relations, their functions, and possible ways of injuring them.

Besides the cranial nerves, in head and neck anatomy there are other structures, with quite complicated anatomy that are important for many clinical entities. Such structures are the nasal cavity or the pharynx. Understanding nasal cavity anatomy will help you understand all the effects of tumorous masses that clog it, and what happens when swallowing is altered in the nasopharynx. Check out these two interesting clinical cases about Schwannoma of the nasal cavity and pharyngeal diverticula.

Since we’ve reached the neck, let’s mention briefly its lymphatic drainage. Lymphatic system is not a very popular topic, but with the following case you will see an interesting clinical example of why the anatomy of the lymphatic system is important in a clinical setting. Did you know that swollen lymphatics of the neck can cause Horner’s syndrome? You can assume that it has something to do with the location of the lymphatics. To see exactly how and why, check out our case of Horner’s syndrome.

But before we wrap up this neck section, we thought about that you might be interested in pediatrics. If you are, you probably already know that kids like to swallow literally everything, including the button batteries! To learn why it is so dangerous, spice up your anatomy knowledge about larynx with the clinical aspects of it that we have presented you in this case.

Thorax

Thorax has many of our vital organs packed inside it. First, let’s look at the heart. We certainly feel safe knowing that is protected by the pericardium and the rib cage. But what if some force is so strong that it penetrates both the chest wall and the pericardium? We got an unbelievable clinical case after which you’ll know everything about the pericardial effusion and penetrating injuries of the thorax. 

Also, we just can’t proceed further without a look at coronary arteries. They are indeed, mostly damaged by atherosclerosis, but what if you’re born with an abnormality of coronaries? Take a look at the long ectopic coronary artery syndrome case and see the anatomical bases of angina pectoris and heart dominance. In addition, we covered you here with cadaver images of heart and thorax as they bring high yield questions in anatomy exams.

Let’s stick for a bit on the thoracic blood vessels. The largest and most significant is certainly the aorta, so it’s logical to think that any abnormalities of the aorta can be instantly fatal. But let’s not forget the pulmonary circulation, too. Without it, our tissues would starve without oxygen in no time.

To learn everything about the aneurysm of aorta, pneumothorax, pulmonary embolism and surgical procedures that are life-saving in those patients, dive into these clinical cases we have prepared for you.

Now, we did mention briefly the chest wall. Can you think of any way of disturbing it besides mechanical trauma? If you thought about cancer, you’re right. Mostly, cancers of chest wall associated structures affect the breast. It is important to catch it as soon as possible, when there are many treatment options. Besides breast, tumors may arise in some unexpected places, such as ribs. Then you start your race with time to remove it before it spreads to the lungs.

Check out these two clinical cases after which you will learn what is invasive ductal breast cancer, and surgical and anatomical considerations related to it. Additionally, we present to you a case of a giant first rib tumor, and how tumors within the lungs eventually lead to death.

In the end, let’s not forget the lungs. Lungs may be affected by an entire spectrum of diseases, ranging from inflammations to the tumors. This pulls a wide range of therapeutic options. But what do you think can happen to the lungs, when the only option is to surgically remove the part of the lung? Certainly tumors.

After removing a part of a lung, a patient will develop a postpneumonectomy syndrome. To revise the lung anatomy from a clinical aspect and learn the anatomical basis of the postpneumonectomy syndrome, check out these two very interesting clinical cases.

Abdomen

The anterior abdominal wall is highly distensible and is involved in various functions ranging from support of movements of the abdominal viscera to protection of the abdominal cavity. In addition, anterior abdominal fasciae in men extend all the way to the scrotum, transmitting the testicular vessels.

But what happens when the anterior abdominal wall gets seriously inflamed, or when abdominal viscera prolapses through the inguinal canal into the scrotum? To understand these life-threatening conditions and to know how to act on them, we have a case of necrotizing fasciitis and another one of an inguinal hernia prepared for you. They will help you to reinforce your knowledge about the anatomy of the anterior abdominal wall and the inguinal canal from a clinical aspect, and make the surgical consideration and recovery from necrotizing fasciitis and inguinal hernia a piece of cake for you. 

Human intestines are almost 8 meters (25 feet) long. The anatomy of the small intestine differs significantly from the large intestine and each of these parts of the GI tract has the specific anatomical organization.  

To revise the anatomy of duodenum and cecum from a clinical aspect, and to learn how pathologies within these two differently manifest in a patient, take a look at these two interesting clinical cases about duodenal duplication and subhepatic caecum we have prepared for you. 

Another important structure of the abdominal cavity is the kidney. The kidneys are bilateral organs placed retroperitoneally in the upper left and right abdominal quadrants and are part of the urinary system. The main function of the kidney is to eliminate excess bodily fluid, salts and byproducts of metabolism. A common congenital malformation of the kidneys is the so-called horseshoe kidney. Read our case report of a horseshoe kidney and learn the anatomy of the kidneys in a clinical context. 

The next case describes a case of a bowel obstruction which developed as a complication of a previous episode of pancreatitis. In this case you will learn the relationship between gallstone disease (cholelithiasis) and pancreatitis as well as several interesting facts on intestinal anatomy and physiology. 

Our last two cases for the abdominal organs deal with a large branch of the abdominal aorta and an urachal cyst. Starting from the abdominal aorta, you just can’t tell which artery is more important than the other. Thus, we’ll take a look at the one whose rupture may be life-threatening – the splenic artery. What is especially unfortunate is that the splenic artery rupture often occurs during pregnancy. To recall the anatomy of the splenic artery and then to understand clinical considerations related to its rupture, check out our clinical case.

After that, we’ll guide you through something more exotic: a urachal cyst. You may think that who knows when I would see that, but trust us, it is so easy to misdiagnose the urachal cysts as an acute appendicitis. If you do so even once in your career, then you’ll open your patient’s abdomen at the wrong place.

Pelvis

Pelvis – that’s where we all come from. Female pelvis anatomy is frequently tested on anatomy exams, because if you choose that at some point engage with gynecology, you must have a solid anatomy background. 

Here we help you consolidate your knowledge about the ovaries and vagina anatomy by reviewing the clinical cases of ovarian torsion and Müllerian cyst. After reviewing them, besides reinforcing your anatomy knowledge, you’ll learn what are the cystocele, rectocele, enterocele and spinal anesthesia. In addition, you’ll find out what is Caesarian section and the difference between the testicular and ovarian torsion.

Let’s now take a look at the venous and lymphatic drainage of the pelvis. The main pelvic vein is the iliac vein. Knowing its relations will help you consider what are the possible structures that may compress it. When it’s about lymphatics, they may signalize that something really bad, such as a tumor, is developing within the patient’s pelvis.

To breathe in the spirit of the clinic into your anatomy knowledge about venous and lymphatic drainage of the pelvis, check out the case of iliac vein compression syndrome and Sister Mary Joseph nodule that we have prepared for you. Besides that, you’ll learn everything about the embryological remnants that possibly provide a mechanism whereby metastases could spread from the ovaries or abdominal viscera to the umbilicus and what is meant by the caput medusae sign.

Before wrapping up the clinical revision of the pelvis, we’d like to mention that some conditions related to female genitalia, unfortunately, are not just accidentally acquired, but may be a result of abuse. This clinical case of female genital mutilation is something that will definitely shake your bones, but also will provide you with the knowledge how to treat and manage the recovery of young girls that have gone through that. 

Spine

You may be wondering why you had to learn so much about the vertebral column anatomy. Well, as it is the main protector of the spinal cord, any case of the vertebral column damage could lead to serious injuries of the spinal cord. It’s like a two bladed sword.

In most cases, back pain is related to some form of vertebral column distortion. These two interesting articles will lead you through the cases of degenerative sacrolisthesis and radiculopathy, after which you’ll learn what is a lumbar puncture, radicular pain, spondylolisthesis and muscle strength scale. Of course, we’ll lead you through all these terms from anatomical and surgical aspects, and you’ll be proud when you realize that your knowledge is what connects those two.