AIIMS

A proctodeum is the back ectodermal part of an alimentary canal. It is created during embryogenesis by a folding of
the outer body wall. It will form the lower part of the anal canal, below the pectinate line, which will be lined by
stratified squamous non-keratinized (zona hemorrhagica) and stratified squamous keratinized (zona cutanea)
epithelium. The junction between them is Hilton's white line (This line represents the transition point from
non-keratinized stratified squamous epithelium of the anal canal to keratinized stratified squamous
epithelium of the anus & perianal skin-Below it, lymphatic drainage is to the superficial inguinal nodes)

The anal canal just above the pectinate line for about 1-2 cm is called the anal pecten or transitional zone. Above this
transitional zone, the anal canal is lined with columnar epithelium (which is insensitive to cutting). Anal columns (of
Morgagni) are 6-10 longitudinal (vertical) mucosal folds in the upper part of the anal canal.
At the bottom of these columns are anal sinuses or crypts, into which open the anal glands and anal papillae. Infection
of the anal glands is likely the initial event in causation of perianal abscess and fistula-in-ano. Three of these columns
(left lateral, right posterior, and right anterior, at 3-, 7-, and 11-oclock positions in supine position) are
prominent; they are called anal cushions and contain branches and tributaries of superior rectal (hemorrhoidal) artery
and vein. When prominent, veins in these cushions form the internal hemorrhoids.
The anal canal above the pectinate line is supplied by the terminal branches of the superior rectal (hemorrhoidal)
artery, which is the terminal branch of the inferior mesenteric artery. The middle rectal artery (a branch of the internal
iliac artery) and the inferior rectal artery (a branch of the internal pudendal artery) supply the lower anal canal.

Carpal tunnel syndrome (CTS) CTS is characterised by tingling, numbness, or pain in the distribution of the median
nerve (the thumb, index, and middle fingers, and medial half the ring finger on the palmar aspect) that is often worse
at night and causes wakening.
Cubital Tunnel Syndrome is a condition that involves pressure or stretching of the ulnar nerve (also known as the
funny bone nerve), which can cause numbness or tingling in the ring and small fingers, pain in the forearm, and/or
weakness in the hand.
This syndrome is much less common than Carpal Tunnel Syndrome (CTS), but may be present along with CTS. The
ulnar nerve supplies sensation to the little finger and half of the ring finger, and if these fingers are involved in any
symptoms of numbness, compression of the ulnar nerve in Guyon's canal may be present.
Tarsal tunnel syndrome (TTS), also known as posterior tibial neuralgia, is a compression neuropathy and painful foot
condition in which the tibial nerve is compressed as it travels through the tarsal tunnel. This tunnel is found along the
inner leg behind the medial malleolus (bump on the inside of the ankle).
Anterior interosseous syndrome or Kiloh-Nevin syndrome I is a medical condition in which damage to the anterior
interosseous nerve (AIN), a motor branch of the median nerve, causes pain in the forearm and a characteristic
weakness of the pincer movement of the thumb and index finger.

LIGAMENT OF STRUTHERS may compress MEDIAN NERVE

ARCADE OF STRUTHERS: involves ULNAR NERVE compression