The Importance of External Anatomy

In the study of human anatomy, it is easy to become so preoccupied with internal structure that we forget the importance of what we can see and feel externally. Yet external anatomy and appearance are major concerns in giving a physical examination and in many aspects of patient care. A knowledge of the body's surface landmarks is essential to one's competence in physical therapy, cardiopul-monary resuscitation, surgery, making X rays and electrocardiograms, giving injections, drawing blood, listening to heart and respiratory sounds, measuring the pulse and blood pressure, and finding pressure points to stop arterial bleeding, among other procedures. A misguided attempt to perform some of these procedures while disregarding or misunderstanding external anatomy can be very harmful and even fatal to a patient.

Having just studied skeletal and muscular anatomy in the preceding chapters, this is an opportune time for you to study the body surface. Much of what we see there reflects the underlying structure of the superficial bones and muscles. A broad photographic overview of surface anatomy is given in atlas A (see fig. A.5). In the following pages, we examine the body literally from head (fig. B.1) to toe (fig. B.14), studying its regions in more detail. To make the most profitable use of this atlas, refer to the skeletal and muscular anatomy in chapters 8 to 10. Relate drawings of the clavicles in chapter 8 to the photograph in figure B.1, for example. Study the shape of the scapula in chapter 8 and see how much of it you can trace on the photographs in figure B.3. See if you can relate the tendons visible on the hand (fig. B.8) to the muscles of the forearm illustrated in chapter 10, and the external markings of the pelvis (fig. B.4) to bone structure in chapter 8.

For learning surface anatomy, there is a resource available to you that is far more valuable than any laboratory model or textbook illustration—your own body. For the best understanding of human structure, compare the art and photographs in this book with your body or with structures visible on a study partner. In addition to bones and muscles, you can palpate a number of superficial arteries, veins, tendons, ligaments, and cartilages, among other structures. By palpating regions such as the shoulder, elbow, or ankle, you can develop a mental image of the subsurface structures better than you can obtain by looking at two-dimensional textbook images. And the more you can study with other people, the more you will appreciate the variations in human structure and be able to apply your knowledge to your future patients or clients, who will not look quite like any textbook diagram or photograph you have ever seen. Through comparisons of art, photography, and the living body, you will get a much deeper understanding of the body than if you were to study this atlas in isolation from the earlier chapters.

At the end of this atlas, you can test your knowledge of externally visible muscle anatomy. The two photographs in figure B.15 have 30 numbered muscles and a list of 26 names, some of which are shown more than once in the photographs and some of which are not shown at all. Identify the muscles to your best ability without looking back at the previous illustrations, and then check your answers in appendix B at the back of the book.

Saladin: Anatomy & I Atlas B Surface Anatomy I Text I © The McGraw-Hill

Physiology: The Unity of Companies, 2003 Form and Function, Third Edition

Atlas B Surface Anatomy 393

Greater Supraclavicular Fossa

Superciliary ridge

Superior palpebral sulcus

Inferior palpebral sulcus

Auricle (pinna) of ear Philtrum Labia (lips) Trapezius muscle

Supraclavicular fossa

Supraclavicular fossa

Anatomy Sulcus Mentolabial
Frons (forehead) Root of nose Bridge of nose Lateral commissure

Medial commissure Dorsum nasi Apex of nose Ala nasi

Mentolabial sulcus

Mentum (chin)

Sternoclavicular joints

Clavicle

Suprasternal notch Sternum

Figure B.1 The Head and Neck. (a) Anatomical regions of the head, lateral aspect. (b) Features of the facial region and upper thorax.

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394 Part Two Support and Movement

Supraciavicuiar fossa

Ciavicie

Deltoid -

Pectoralis major Nipple

Rectus ■ abdominis

Tendinous insertion of rectus abdominis

Anterior superior spine of ilium

Iliac crest

Inguinai iigament (a)

Supraciavicuiar fossa

Ciavicie

Iliac Furrow

Body

Xiphoid process

Sternocleidomastoid Thyroid cartilage Trapezius Suprasternal notch Acromion

Manubrium

Sternum

Body

Xiphoid process

Serratus anterior

Linea semiiunaris Linea aiba

Umbiiicus

Externai abdominai obiique

Supraciavicuiar fossa

Ciavicie

Acromion Deitoid m.

Breast: Axiiiary taii Nippie Areoia

Costai margin

Linea semiiunaris

Externai abdominai obiique m.

Costai margin

Linea semiiunaris

Externai abdominai obiique m.

Suprasternal Notch Diagram

Linea alba

Rectus abdominis m.

Umbilicus

Anterior superior spine of ilium

Trapezius m. Sternum:

- Suprasternal notch

- Manubrium

- Angle

- Body (gladiolus)

- Xiphoid process

Linea alba

Rectus abdominis m.

Umbilicus

Anterior superior spine of ilium

Figure B.2 The Thorax and Abdomen, Ventral Aspect. (a) Male; (b) female. All of the features labeled are common to both sexes, though some are labeled only on the photograph that shows them best.

Saladin: Anatomy & Physiology: The Unity of Form and Function, Third Edition

Atlas B Surface Anatomy 395

Flexor carpi ulnaris Brachioradialis

Biceps brachii Triceps brachii Deltoid Anterior part Middle part Posterior part Teres major

Infraspinatus

Medial border of scapula

Trapezius Vertebral furrow Erector spinae Latissimus dorsi

Iliac crest (a)

Infraspinatus Trapezius —

Olecranon

Iliac crest

Gluteus medius Gluteus maximus

Hamstring muscles

Iliac crest (a)

Infraspinatus Trapezius —

Olecranon

Iliac crest

Gluteus medius Gluteus maximus

Hamstring muscles

Sacral Dimple Adult

Erector spinae

Sacrum

Coccyx Natal cleft

Gluteal fold

Erector spinae

Sacrum

Coccyx Natal cleft

Greater trochanter of femur

Gluteal fold

Figure B.3 The Back and Gluteal Region. (a) Male; (b) female. All of the features labeled are common to both sexes, though some are labeled only on the photograph that shows them best.

Saladin: Anatomy & I Atlas B Surface Anatomy I Text I © The McGraw-Hill

Physiology: The Unity of Companies, 2003 Form and Function, Third Edition

396 Part Two Support and Movement

Dimple Surface Anatomy

Figure B.4 The Pelvic Region. (a) The anterior superior spines of the ilium are marked by anterolateral protuberances (arrows). (b) The posterior superior spines are marked in some people by dimples in the sacral region (arrows).

Saladin: Anatomy & Physiology: The Unity of Form and Function, Third Edition

Atlas B Surface Anatomy 397

Surface Anatomy Axilla

Olecranon

Biceps brachii Triceps brachii

Anterior axillary fold (pectoralis major)

Deltoid

Axilla (armpit)

Posterior axillary fold (latissimus dorsi) Pectoralis major

Latissimus dorsi

Serratus anterior

Thenar Atrophy Dimpling

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398 Part Two Support and Movement

What Anterolateral Movement Limb

Figure B.6 The Upper Limb, Lateral Aspect.

Upper Extremity Vein DiagramAnatomi Antebrachium

Figure B.7 The Antebrachium (forearm). (a) Ventral aspect; (b) dorsal aspect.

Saladin: Anatomy & Physiology: The Unity of Form and Function, Third Edition

Pollex (thumb) Flexion creases

Interphalangeal joints

Thenar Fold

Palmaris longus tendon Flexor carpi radialis tendon

Flexion creases Thenar eminence

Hypothenar eminence

Pollex (thumb) Flexion creases

Metacarpophalangeal joint

Interphalangeal joints

Styloid process of radius Styloid process of ulna

Extensor pollicis brevis tendon Anatomical snuffbox Extensor pollicis longus tendon Extensor digiti minimi tendon Extensor digitorum tendons

Adductor pollicis

Figure B.S The Wrist and Hand. (a) Ventral aspect; (b) dorsal aspect.

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400 Part Two Support and Movement

Laterai

Mediai

Laterai Tensor fasciae iatae

Rectus femoris-

Graciiis

Vastus iateraiis -Vastus mediaiis

Quadriceps femoris tendon liiotibiai band —

Pateiia

Pateiiar iigament Tibiai tuberosity

Mediai

Vastus iateraiis -Vastus mediaiis

Pateiia

Pateiiar iigament Tibiai tuberosity

Vastus Lateralis Injection Infants

Mediai

Popliteal Fossa

Popliteal fossa

Vastus iateraiis

Biceps femoris (iong head) Semitendinosus

Semimembranosus Graciiis

Popliteal fossa

Figure B.9 The Thigh and Knee. (a) Ventral aspect; (b) dorsal aspect.

Saladin: Anatomy & Physiology: The Unity of Form and Function, Third Edition

Atlas B Surface Anatomy 401

Fibularis Longus

Lateral head of gastrocnemius Soleus

Fibularis longus Tibialis anterior

Fibularis longus and fibularis brevis tendons

Calcaneal tendon Lateral malleolus Calcaneus

Vastus lateralis Biceps femoris Iliotibial band

Lateral epicondyle of femur

Head of fibula Patellar ligament

Lateral head of gastrocnemius Soleus

Fibularis longus Tibialis anterior

Fibularis longus and fibularis brevis tendons

Calcaneal tendon Lateral malleolus Calcaneus

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402 Part Two Support and Movement

Palpating The Anterior Tibial Artery

Saladin: Anatomy & Physiology: The Unity of Form and Function, Third Edition

Atlas B Surface Anatomy 403

Surface Marking The Body

Saladin: Anatomy & I Atlas B Surface Anatomy I Text I © The McGraw-Hill

Physiology: The Unity of Companies, 2003 Form and Function, Third Edition

404 Part Two Support and Movement l a

Palpating Pedal ArteryMetatarsal Head Anatomy

Saladin: Anatomy & Physiology: The Unity of Form and Function, Third Edition

Palpate Tibialis Anterior

Soleus Tibia

Tibialis anterior

Medial malleolus

Lateral malleolus

■ Site for palpating dorsal pedal artery

■ Extensor hallucis longus tendon

■ Extensor digitorum longus tendons

Head of metatarsal I

Soleus Tibia

Tibialis anterior

Medial malleolus

Lateral malleolus

■ Site for palpating dorsal pedal artery

■ Extensor hallucis longus tendon

■ Extensor digitorum longus tendons

Head of metatarsal I

Hallux (great toe)

Head of metatarsal I Transverse arch

Head of metatarsal V -

Abductor digiti minimi -Abductor hallucis-

Medial longitudinal arch Lateral longitudinal arch

Lateral malleolus

Calcaneus (b)

Head of metatarsal V -

Abductor digiti minimi -Abductor hallucis-

Medial longitudinal arch Lateral longitudinal arch

Abductor Digiti Minimi

Figure B.14 The Right Foot. (a) Dorsal aspect, (fa) plantar aspect.

Saladin: Anatomy & I Atlas B Surface Anatomy I Text I © The McGraw-Hill

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406 Part Two Support and Movement l a

Labeled Muscles

Figure B.15 Muscle Test. To test your knowledge of muscle anatomy, match the 30 labeled muscles on these photographs to the alphabetical list of muscles below. Answer as many as possible without referring to the previous illustrations. Some of these names will be used more than once, since the same muscle may be shown from different perspectives, and some of these names will not be used at all. The answers are in appendix B.

a.

biceps brachii

J.

infraspinatus

s.

sternocleidomastoid

b.

brachioradialis

k.

latissimus dorsi

t.

subscapularis

c.

deltoid

l.

pectineus

u.

teres major

d.

erector spinae

m.

pectoralis major

v.

tibialis anterior

e.

external abdominal oblique

n.

rectus abdominis

w.

transversus abdominis

f.

flexor carpi ulnaris

o.

rectus femoris

x.

trapezius

g.

gastrocnemius

P.

serratus anterior

y.

triceps brachii

h.

gracilis

q.

soleus

z.

vastus lateralis

i.

hamstrings

r.

splenius capitis

Saladin: Anatomy & I 11. Muscular Tissue I Text

Physiology: The Unity of Form and Function, Third

Saladin: Anatomy & I 11. Muscular Tissue I Text

Physiology: The Unity of Form and Function, Third

Neuromuscular Junction Sem

CHAPTER

Neuromuscular junctions (SEM)

CHAPTER OUTLINE

Rectus Femuris Diagram
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Responses

  • AAMOS
    What is the antebrachium?
    6 years ago
  • jan
    Where is the xiphoid process?
    6 years ago
  • mimosa
    What is the importance of external anatomy?
    6 years ago
  • romola
    How to palpate the anterior inferior iliac spine?
    6 years ago
  • liisi
    What is sacral dimple?
    3 years ago

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