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Surface Anatomy BODY ORIENTATION OUTLINE 13.1 A Regional Approach to Surface Anatomy 398 13.2 Head Region 398 13.2a Cranium 399 13 13.2b Face 399 13.3 Neck Region 399 13.4 Trunk Region 401 13.4a Thorax 401 Surface 13.4b Abdominopelvic Region 403 13.4c Back 404 13.5 Shoulder and Upper Limb Region 405 13.5a Shoulder 405 Anatomy 13.5b Axilla 405 13.5c Arm 405 13.5d Forearm 406 13.5e Hand 406 13.6 Lower Limb Region 408 13.6a Gluteal Region 408 13.6b Thigh 408 13.6c Leg 409 13.6d Foot 411 MODULE 1: BODY ORIENTATION mck78097_ch13_397-414.indd 397 2/14/11 3:28 PM 398 Chapter Thirteen Surface Anatomy magine this scenario: An unconscious patient has been brought Health-care professionals rely on four techniques when I to the emergency room. Although the patient cannot tell the ER examining surface anatomy. Using visual inspection, they directly physician what is wrong or “where it hurts,” the doctor can assess observe the structure and markings of surface features. Through some of the injuries by observing surface anatomy, including: palpation (pal-pā sh ́ ŭ n) (feeling with firm pressure or perceiving by the sense of touch), they precisely locate and identify anatomic ■ Locating pulse points to determine the patient’s heart rate and features under the skin. Using percussion (per-kush ̆ ́ŭn), they tap pulse strength firmly on specific body sites to detect resonating vibrations. And ■ Palpating the bones under the skin to determine if a via auscultation (aws-ku ̆l-tā sh ́ un), ̆ they listen to sounds emitted fracture has occurred from organs. ■ Passively moving the limbs to observe potential damage to In our discussion of surface anatomy in this chapter, the muscles and tendons illustrations include some structures that we have discussed previ- ■ Examining skeletal and muscular landmarks to discover ously and other features yet to be discussed. We strongly suggest whether joints are dislocated that you return to this chapter often as you explore and examine Examination of surface anatomy must often substitute for other body systems in subsequent chapters. In addition, before you interviewing the patient, and when the health-care professional is a begin, refer back to chapter 1 and review the discussion of body keen observer, it may be very accurate in assessing illness or injury. region names and abdominopelvic regions and quadrants. 13.1 A Regional Approach Study Tip! to Surface Anatomy When preparing for an anatomy exam, your best study aid is your Learning Objectives: own body. Palpating surface anatomy features on yourself will help 1. Explain the importance of surface anatomy in learning you recall these features on an exam and, more importantly, give you about internal structures. a richer understanding of human anatomy. 2. Discuss how surface anatomy studies help us diagnose and treat disease. Surface anatomy is a branch of gross anatomy that exam- ines shapes and markings on the surface of the body as they 13.2 Head Region relate to deeper structures. An understanding of surface anatomy Learning Objective: is essential for locating and identifying anatomic structures prior 1. Identify the surface features of the cranial and facial regions. to studying internal gross anatomy. Health-care personnel use surface anatomy to help diagnose medical conditions and to treat The head is the most complex and highly integrated region patients, as when taking a pulse, inserting a needle or tube, or of the body because it houses the brain, which communicates performing physical therapy. You have already begun your study with and controls all of the body systems. The head is structur- of surface anatomy; each time we have asked you to palpate a ally and developmentally divided into the cranium and the face. part of your body and feel for a structure, you have examined Figure 13.1 shows the regions and many of the surface anatomy your own surface anatomy. structures of the head and neck. Frontal region Superciliary arch Frontal (with eyebrow) Cranial Temporal Bridge of Superior palpebra Occipital nose Auricular Auricle Dorsum nasi Orbital External acoustic meatus Apex of nose Zygomatic arch Ala nasi Nasal Nostril Buccal region Lips (labia) Facial Oral Inferior palpebra Mental region Buccal Philtrum Thyroid Mental cartilage Neck (cervical) Sternoclavicular joint of larynx Thyroid cartilage Nuchal of larynx Clavicle (posterior neck) Suprasternal notch (a) Lateral view (b) Anterior view Figure 13.1 Head and Neck. The major regions of the head and neck are shown in ( a) lateral view, while specific features are shown in (b) anterior view. mck78097_ch13_397-414.indd 398 2/14/11 3:28 PM Chapter Thirteen Surface Anatomy 399 13.2a Cranium The cranium (also called the cranial region or braincase) is cov- CLINICAL VIEW ered by the scalp, which is composed of skin and subcutaneous tissue. The cranium can be subdivided into three regions, each Lip Color as a Diagnostic Tool having prominent surface anatomy features. Lip color is the collective result of a combination of pigments The frontal region of the cranium is the forehead. that contribute to a person’s skin color, most notably melanin, Covering this region is the frontal belly of the occipitofronta- hemoglobin, and carotene. lis muscle. The frontal region terminates at the superciliary arches. You can feel these bony elevations immediately inferior The pigment melanin has two subtypes: Eumelanin is black, and to your eyebrows. pheomelanin is typically slightly yellow in low concentrations but Laterally, the scalp covers the sides of the skull in each tem- slightly reddish in high concentrations. The ratio of these types poral region and terminates just superior to the ear. The tempora- of melanin determines the skin and lip color. Hemoglobin, an lis muscle is attached at the temporal region, and is easily palpable oxygen-binding protein in red blood cells, contributes a red or pink when the jaw is repeatedly clenched. Running over the temporalis hue. Carotene, a yellow-orange pigment found in carrots, sweet muscle is the superficial temporal artery. You can feel the pulse potatoes, and squash, contributes those hues to the skin and lips. of this artery just posterior to the orbits and anterior to the auricle Variations in lip color result from the combinations and amounts of of your ear. these pigments. However, lip color is also affected by our environ- The posterior part of the cranium is the occipital (ok-sip ́i-tăl) ment and state of health. For example, cold weather causes our lips region. In the center of that region is the external occipital protu- to appear “blue” because blood (and its reddish-colored hemoglobin) berance, a rounded or pointed projection (see f i g u re s 7.5, 7.8). I n is being shunted away from the superficial lips and toward deeper chapter 7, you learned that males tend to have a more prominent, body structures in order to conserve heat. Low body temperature pointed external occipital protuberance than females. Palpate your for other reasons, as well as several health conditions, also cause own external occipital protuberance. Is it small and rounded, or “blue lips.” For instance, a patient who has anemia, pneumonia, somewhat larger and pointed? emphysema, or certain disorders of the cardiovascular system could WHAT DO YOU THINK? exhibit blueness or discoloration of the lips. ●1 Can you name some other facial muscles not already mentioned in this chapter that can be palpated easily under the skin? when the mouth is open. Look in the mirror and observe the verti- 13.2b Face cal depression between your nose and upper lip; this is called the The face is divided into five regions: auricular, orbital, nasal, oral, philtrum (fil tr ́ ŭm; philtron = a love charm). and mental. The buccal (bŭk al) ́ region refers to the cheek. Within this = The auricular (aw-rik ́ū -lăr; auris ear) region is composed region is the buccinator muscle. Palpate the superolateral region of of the visible surface structures of the ear as well as the ear’s your cheek and locate your zygomatic bone and the zygomatic arch. internal organs, which function in hearing and maintaining equi- Finally, continuing in the inferior direction, look in the mir- librium. The auricle (aw ri-kl), ́ or pinna, is the fleshy part of the ror and observe the mental region, which contains the mentum, or external ear. Within the auricle is a tubular opening called the chin. Usually, the mentum tends to be pointed and almost triangular external acoustic meatus. The mastoid process is posterior and in females, while males tend to have a “squared-off” mentum. inferior to the auricle. Palpate your mastoid process; it should feel like a bony bump immediately posteroinferior to the ear. WHATW DID YOU LEARN? The orbital (or ocular) region includes the eyes and associated structures. Most orbital region surface features pro- ●1 Identify at least two surface features of the orbital region that protect the eye. tect the eye. Eyebrows protect against sunlight and potential mechanical damage to the eyes; eyelids (palpebrae; pal p ́ ē -brē ) ●2 Identify the narrow, bony, superior part of the nasal region close reflexively to protect against objects moving near the eye; between the eyes. and eyelashes prevent airborne particles from contacting the eyeball. The superior palpebral fissure, or upper eyelid crease, is palpated easily on most individuals, although Asians do not 13.3 Neck Region have a superior palpebral fissure. Learning Objectives: The nasal region contains the nose. The firm, narrow part of 1. Outline the palpable structures in the regions of the neck. the nose that projects anteriorly between the eyes is the bridge; it is 2.
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