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Home , Cubital fossa, Femoral triangle, Hypochondrium, Popliteal fossa, Transpyloric plane, Umbilical region

The A to Z of Surface Anatomy Table of contents Introduction 1 Acknowledgement 1 Dedication 1 How to use this Book 2 Table of Contents 3 Abbreviations 7 Common Terms used in Surface Anatomy 9 Anatomical Planes and Relations 18 Movements – general copyrightUpper limb & shoulder 20 Head, Neck & Back 22 Lower limb and Hip 24 Foot and Hand 25 Hand Grips 26 Dr Measurements 28 Proportions and forms of human measurement 30 Human face proportions 32 Human body proportions 34 Vitruvian Man 36 (Symbol of proportionality & derivative of measurements) IndexA of Surface Anatomy Abdomen see also Aorta, Trunk dermatomes 38 bones + muscles 40 alimentary - GIT 42 non-alimentary Neill- / liver / pancreas / spleen 44 regions 46 scars - from incisions 48 Adam’s apple = Thyroid cartilage see Thyroid Adrenals see Back, Trunk Anatomical snuff box see Thumb Ankle see also Foot 50 Anus see Perineum Aorta 52 Appendix see Abdomen GIT Arm see also Axilla, Forearm, Shoulder 54 Axilla see also Breast bones , muscles boundaries 56 lymph nodes 58

© A. L. Neill 3 The A to Z of Surface Anatomy Back lower 60 upper see Chest Belly see Abdomen Belly button see Abdomen Bladder see Kidneys, Pelvis, Uterus Breast see also Axilla arterial 62 lymphatic & venous 63 Buttock see Gluteum Caecum see Abdomen GIT Carpal tunnelcopyright see Hand Chest Wall see also Abdomen, Lungs great vessels 64 heart 65 heart valves sounds 66 incision or marks = scars 67 Drlungs & pleura 68 Cubital Fossa 72 Diaphragm + assoc structures see also Oesophagus 74 Duodenum see Abdomen GIT Kidneys Ear 76 Elbow see arm, cubital fossa, forearm Eye A 78 Face arteries 82 bones see also TMJ 88 Facial N 90 muscles Neill 92 veins 94 Femoral triangle contents & borders 96 muscles & bones 98 Finger see Hand Flexor Retinaculum see Hand Foot dorsum bones 100 tendons 102 sole fascia / muscle layers 104 bones / dermatomes 109 Forearm bones 112 muscles 114

4 © A. L. Neill The A to Z of Surface Anatomy Gall Bladder see Abdomen GIT, Diaphragm Genitalia – female 120 male see Penis Testis Gluteum / Gluteal region bones 122 muscles / Sciatic N 124 Hand see also grips bones 126 dorsum extensors 128 palm copyrightfeatures 130 flexors 132 flexor retinaculum 134 thenar/ hypothenar eminences 136 Head see Face, Neck, Temporomandibular joint Heart see also Chest, Oesophagus 138 DrHip see also Gluteum 140 Hyoid see Neck, Thyroid Inguinal nodes superficial 142 Kidneys see also Back 144 Knee see also lower leg, popliteal fossa, Thigh 146 Large Intestine see Abdomen GIT 148 Leg / ALower leg muscles and bones 150 Liver see Abdomen non-GIT, Diaphragm Lungs see also Abdomen, Chest 156 Lymph nodes see Axilla,Neill Breast, Inguinal, Mouth, Neck Mouth salivary glands 158 tonsil & uvula 160 Nail 162 Neck BVs & access points 164 LNs and veins 166 submandibular regions 168 triangles 170 Nipples see Breast Nose 174 Oesophagus 184 Ovaries see Pelvis, Uterus Pancreas see Abdomen non-GIT, Kidneys Pelvis see Genitalia, Perineum, Uterus also specific organs listed

© A. L. Neill 5 The A to Z of Surface Anatomy Penis 186 Perineum see also Genitalia 188 Phrenic N see Oesophagus Pleura see Chest, Lungs Popliteal fossa 192 Rectum see Abdomen GIT, Pelvis, Perineum, Sigmoid colon Salivary Glands see Head, Mouth, Neck Sciatic N see also Gluteum 194 Scrotum see Femoral Triangle, Penis, Testis Shoulder bones copyright 196 BVs & Ns 198 muscles 200 Sigmoid Colon see Abdomen GIT, Large Intestine Sinuses 206 Small Intestine see Abdomen GIT DrSpleen see also Abdomen, Back, Diaphragm 208 Stomach see also Abdomen 210 Teeth see Face, Mouth, TMJ A to Z of the Head & Neck for complete map Temporomandibular Joint 214 Testis/Testes see also Femoral Triangle, Penis, Scrotum Perineum 216 Thigh see alsoA Femoral Triangle, Hip & Knee 218 muscle Throat see Mouth Thumb 220 Thymus see also OesophagusNeill 222 Thyroid see also Neck 222 Tongue see also Mouth 224 Tonsil see Mouth, Tongue Trachea see also Neck 228 Trunk see Abdomen, Back Umbilicus see Abdomen Ureter see Kidneys Uterus see also Pelvis 230 Uvula see Mouth, Tongue Vagina see Pelvis, Perineum Vagus N see Oesophagus Womb see uterus Wrist see also Hand & grips 232

6 © A. L. Neill The A to Z of Surface Anatomy Abbreviations A = atrium, (pl atria) / actions CVA = cerebrovascular accident / movements of a joint = stroke a = artery defn = definition abdo = abdomen / abdominal diff. = difference(s) ACF = anterior cranial fossa dist. = distal adj. = adjective DM = dura mater AIIS = anterior inferior iliac spine DVT = deep vein thrombosis aka = also known as EAM = external auditory meatus alt. = alternative e.g. = example AM = arachnoid mater EC = extracellular (outside the cell) ANScopyright = autonomic nervous system ECG = electrocardiogram ant = anterior ED = extensor digitorum art. = artery ER = Extensor Retinaculum AS = Alternative Spelling, generally FDP = Flexor digitorum porofundus referring to the diff. b/n British FDS = Flexor digitorum superficialis & American spelling FPB = Flexor pollicus brevis DrASIS = anterior superior iliac spine FPL = Flexor pollicus longus assoc.= associated with FR = Flexor Retinaculum AV = atrioventricular Gk. = Greek B = blood H = hormone(s) BBB = blood brain barrier H = hypochondrium bc = because HB = heart beat BF A= blood flow HF = heart failure BM = basement membrane HR = heart rate b/n = between HS = heart sounds BP = brachial plexus IC = intercostal bpm = beats per minute IC = intercarpal br = branch (of a vessel)Neill ICS = intercostal space BS = blood supply / blood stream IP = interphalangeal BV = blood vessel(s) Ix = investigation cap. = capillary IVC = inferior vena cava c.f. = compared to jt(s) = joints = articulations C = carpal L = left C = cervical L = lumbar CC = costal border LA = Left Atrium CC = costal cartilage lat. = lateral CH = cerebral hemispheres LH = left hypochondrium cm = cell membrane LL = lower limb CNS = central nervous system LIF = left iliac fossa collat. = collateral lig = ligament CP = cervical plexus Lt. = Latin Cr = cranial m = muscle CSF = Cerebrospinal fluid MC = metacarpal CT = connective tissue MCF = middle cranial fossa

MCL = mid clavicular line SVC = superior vena cava MCP = metacarpophalangeal SyNS = sympathetic nervous system med. = medial T = thoracic MI = myocardial infarction TMJ = temporomandibular joint MIP = midinguinal point UL = upper limb, arm MT = metatarsal V = vertebra N = nerve V = ventricle NAD = normal (size, shape) VC = vertebral column NAD = no abnormality detected WM = white matter NR = nerve root w/n = within NS = nervouscopyright system/nerve supply w/o = without NT = nervous tissue wrt = with respect to nv = neurovascular bundle & = and P = pressure ∩ = intersection with PAD = peripheral artery disease PaNS = parasympathetic nervous Dr system Ph = phalanges PIIS = posterior inferior iliac spine pl. = plural PM = pia mater PN = peripheral nerve post. = posteriorA proc. = process prox. = proximal PS = pubic symphysis PSIS = posterior superior iliac spine R = right Neill RA = right atrium RH = right hypochondrium RIF = Right Iliac Fossa S = sacral S1 = first heart sound S2 = second heart sound SA = sinoatrial SCM = sternocleidomastoid muscle sing. = singular SC = spinal cord SN = spinal nerve SP = spinal process SR = sarcoplasmic reticulum subcut. = subcutaneous supf = superficial

8 © A. L. Neill The A to Z of Surface Anatomy A Abdominal Wall GIT projection Anterior view of the abdomen showing the GIT projected. 1 Xiphisternum 2 oesophagus - enters the abdomen at T10, L of the midline 3 spleen 4 funduscopyright of the stomach – stomach fills the epigastric region, varies in size partially covered by the ribcage 5 costochondral border 6 pyloris antrum [ to pyloric sphincter Dr7 duodenum - first part - begins R of midline below transpyloric plane near hepatic flexure of LI 8 descending duodenum - second part 9 horizontal duodenum - third part 10 duodenojejenalA flexure - midline T12 subcostal plane 11 terminal ileum - in RIF 12 appendix - 2/3 of line from ASIS to umbilicus 13 caecum - RIF closelyNeill assoc with appendix 14 ascending colon - retroperitoneal structure 15 transverse colon - attached to mesentery 16 splenic flexure 17 descending colon - retroperitoneal structure 18 sigmoid colon - attached to mesentery 19 iliac tubercle 20 ASIS

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© A. L. Neill 43 The A to Z of Surface Anatomy A Abdominal Wall non Alimentary structures projection Anterior view of the abdomen showing the liver, pancreas & spleen. 1 liver - fills the RH across to the epigastrium & above the CC to 4th ICS 2 gall bladder - MCL ∩ with the CC 3 spleencopyright - post wall ribs 9-11 4 pancreas - body - stomach fills the epigastric region, varies in size partially covered by the ribcage 5 pancreas - tail - lodges in the hilum of the spleen Dr6 pancreas - head - lodges in the “C” of the duodenum 7 duodenum - 8 aortic bifurcation - ant. at the umbilicus - post. L4 9 IVC - midline to the R of the aorta - L5 10 external iliac artery - superior to inguinal lig at the AMIP 11 femoral artery - inf to the inguinal lig 12 inguinal ligament 13 ASIS Neill 14 iliac tubercle

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© A. L. Neill 45 The A to Z of Surface Anatomy A Abdominal Wall Regions Anterior view of the abdomen showing regions. There are several ways to describe the regions of the Abdomen. This commonly used schema divides the abdomen into 9 regions, based upon anatomical landmarks - numbered Regions are coloured areas labelled with letters 1 Xiphisternumcopyright 2 midclavicular line (MCL) - vertical line ½ way along the Clavicle 3 transpyloric plane - midway b/n Xiphisternum and umbilicus = L1 passes through pyloric sphincter Dr and 1st part of the duodenum 4 subcostal plane - passes through L3 5 transtubercular plane - passes through L5 6 Inguinal ligament 7 midinguinal point (MIP) - intersection b/n MCL andA inguinal lig 8 anterior superior iliac spine = ASIS 9 iliac tubercle 10 7th rib - b= bone c = cartilage 11 MCL 9th rib Neill ∩ 12 CC - lower border of the ribs from the Xiphisternum around 13 umbilicus - varies with age & weight approx. T10 dermatome E = epigastrium - area b/n 3 & 12 H = hypochondrium - area b/n MCL 3 & 4 L = left & R = right I = iliac region - area b/n MCL & 6 L= left & R = right L = lumbar region - area b/n MCL & 4 & 5 L = left & R = right P = pelvic area AKA suprapubic region - area below 5 above 6 U = umbilical region - area b/n MCLs 4 & 5 46 © A. L. Neill The A to Z of Surface Anatomy

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© A. L. Neill 51 The A to Z of Surface Anatomy A Aorta – Abdominal Anterior view of the abdomen with projections of Aorta & Vena cavae. 1 aortic arch 2 descending / thoracic aorta - gives off the intercostal arteries 3 site of aorta leaving the thorax and forming the coeliac trunk – T12 beginningcopyright of the abdominal aorta 4 renal arteries L = left , R = right (slightly lower) I transpyloric plane – midway b/n Xiphisternum and umbilicus = L1/2 Dr5 superior mesenteric artery 6 gonadal L = left , R = right (slightly lower) II subcostal plane - passes through L3 7 inferiorA mesenteric artery III intercristal plane = L4 site of the aortic bifurcation &... 8 formation of the Iliac arteries IV transtubercular plane/intertubercularNeill plane = L5 b/n AIIS site of formation of the... 9 9e = external iliac artery 9i = internal iliac

10 length of the abdominal aorta approx 10cm 11 11i = inferior vena cava 11s = superior vena cava 12 RA = right atrial wall

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© A. L. Neill 53 The A to Z of Surface Anatomy A Arm Muscles Anterior view abducted medially rotated flexed 1 FDS 2 Brachioradialiscopyright 3 Biceps 3L Biceps long head 3S Biceps short head + Coracobrachialis Dr4 Triceps 4L Triceps long head 4m triceps medial head 5 Brachialis 6 DeltoidA 7 Latissumus dorsi Neill

54 © A. L. Neill The A to Z of Surface Anatomy Cubital Fossa Bones, Muscles and Vessels C Anterior views - deep to superficial Clinically important area for accessing venous and arterial blood, testing reflexes and muscle strength in the upper limb - defn - the area b/n the Biceps & its aponeurosis & the muscles of the common flexor origin & Brachioradialis (anterior fossa of the ant of the elbow) 1 Humeruscopyright – anterior surface 2 epicondyles of Humerus l = lateral m = medial 3 Capitulum 4 head of Radius Dr5 bicipital tuberosity 6 coronoid process (of Ulna) 7 trochlea 8 interosseus membrane

9 BicepsA a = aponeurosis 10 Brachioradialis 11 Flexor digitorumNeill superficialis 12 common flexor origin 13 Pronator Teres 14 Brachialis

15 cephalic vein 16 median cubital vein 17 basilic vein 18 brachial artery 19 ulnar artery 20 radial artery

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© A. L. Neill 73 The A to Z of Surface Anatomy Diaphragm + Gallbladder + Liver + Spleen Anterior view Expiration - Inspiration. Diaphragm = a musculotendinous dome, dividing the thorax & D abdomen, centrally flattened the L(4th ICS T10-11) > R (6th rib T12) – both in the MCL (through the nipple). Up to 1 rib higher in the supine position and in the broad-chested. G Resting respiration - ± 1cm – but may vary up to 10cm. Attachedcopyright - ant. – to the Xiphisternum, costal margin lat. - ribs 6-12 post. L1-3 contraction - flattens the dome shape – pulls the IVC open Dr abdominal P L ↑ core strength ↑lowers & moves the Liver to the L lowers & flattens the Spleen to the R Both the Live r& Spleen are intimately related to the Diaphragm and the IVCA and move as described. 1 Liver L = left R = right p = ptosed (ie lowered in inspiration) Liver edge palpableNeill just below the CC on inspiration - 2 Gallbladder (9th CC) – divides the liver into the R & L functional ½ S 3 Spleen spans ribs 6-9 NAD – but in certain disease states partic parasitic infections - (malaria) may fill down to the LIF p = ptosed (ie lowered in inspiration) 4 Diaphragm e =expiration position i = inspiration position n = neutral position

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© A. L. Neill 75 The A to Z of Surface Anatomy Ear External view of the ear and its components. 1 triangular fossa 2 helix E 3 antihelix 4 tragus 5 EAM = external auditory meatus 6 antitraguscopyright 7 lobe 8 scapha Dr9 concha A Neill

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© A. L. Neill 103 The A to Z of Surface Anatomy Foot – sole Fascia First layer of muscles Inferior view 1 superficial transverse metatarsal lig. 2 digital bands – longitudinal extensions of 4 ... F 3 transverse bands of 4 4 centralcopyright aponeurosis Dr 1 A 2 Neill3

104 © A. L. Neill The A to Z of Surface Anatomy The foot has 4 muscle layers overlaid with a strong protective fascia. the central aponeurosis (4) is similar to the palmar aponeurosis with extensions (2) to accommodate the extended MTs. A bridging fortified transverse ligament (1) joints all the heads of the MTs to reflect the weight bearing function of the foot 5 abductor digiti minimi 6 flexor digitorum brevis 7copyright abductor hallicus Dr A Neill

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© A. L. Neill 105 The A to Z of Surface Anatomy Foot – sole 2nd & 3rd muscle layers Inferior view 1 Flexor Hallicus Longus – tendon 2 lumbrical muscles F 3 posterior tibial artery and N L = lateral br mcopyright = medial br 4 Flexor Digitorum Longus – tendons Dr5 Quadratus Plantae A 1 Neill 2 3m

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106 © A. L. Neill The A to Z of Surface Anatomy Face – Arteries - major Lateral There are extensive anastomising b/n all the arteries in the face for more detail see the A to Z of the Head and Neck. 1 Facial artery 2 mental br + submental brs F 3 inferior labial br 4 superiorcopyright labial br 5 internal nasal br 6 external nasal br 7 angular br /infraorbital artery Dr8 Supratrochlear artery 9 Supraorbital artery (may feel pulse 1 in = 2.5 cm from midline) 10 Superficial temporal artery (may feel pulse) 11 parietal br 12 frontalA br 13 transverse facial br 14 infraorbital br 15 External carotidNeill artery 16 posterior auricular br 17 deep transverse facial / maxillary 18 occipital

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© A. L. Neill 85 The A to Z of Surface Anatomy Face – Arteries - major brs of the Common Carotid artery Lateral 1 Common carotid 2 External carotid F 3 Internal caotid 4 Superior thyroid 5 Lingualcopyright 6 Facial 7 Maxillary 8 Superfical temporal Dr9 Posterior auricular 10 Occipital A Neill

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© A. L. Neill 125 The A to Z of Surface Anatomy Hand – Bones Dorsal surface 1 Ph = Phalanges d = distal, m = middle, p = proximal 2 MC 3 Radius s = styloid process, t = dorsal tubercle 4 Ulna s = styloid process 5 Trapeziumcopyright H 6 Trapezoid

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8h 2 8 11 7 6 5r 13 5 10 9t 4s 9 3s 34 © A. L. Neill 127 The A to Z of Surface Anatomy Hand – Dorsum Extensor tendons & synovial sheaths The hand is highly mobile, hence it must have strong mobile tendinous attachments. To improve mobility these expand to individual synovial sheaths commencing from the base of the fingers. 1 Abductor pollicus longus 2 Extensor pollicus brevis 3 Extensor carpi radialis longus 4 Extensorcopyright carpi radialis brevis H 5 Extensor pollicus longus 6 Extensor indicis Dr7 Extensor digitorum (communicans) 8 Extensor digit minimi 9 Extensor carpi ulnaris – in supination / shown more laterally as in pronation 10 Extensor retinaculum 11 sharedA synovial bursa of extensors Neill

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© A. L. Neill 145 The A to Z of Surface Anatomy Knee – Flexed Lateral Medial The knee is the most unstable joint in the body. It relies extensively on its ligaments and muscles for structural integrity as the bony surfaces are not compatible and provide little or no support. 1 Rectus femoris t = tendon 2 Vastuscopyright lateralis 2L / V medialis 2m 3 Biceps femoris t = tendon (note bipennate muscle) 4 Iliotibial tract 5 Patella DrK 6 femoral condyle L = lateral m = medial 7 lateral collateral lig 8 meniscus l = lateral, m = medial 9 common tendon insertion = the patella tendon (bursaA behind) 10 tibial condyle l = lateral, m = medial 11 common perineal N 12 head of Fibula Neill 13 Semimembranous 14 Sartorius 15 Gracilis 16 Semitendinous

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1t 6m 16 5 15 14 10m © A. L. Neill 13 8m 9 147 The A to Z of Surface Anatomy Large Intestine Anterior Surface projection of the LI showing mesenteries and position in Abdomen. 1 ileum 2 caecum 1-2 ilieocaecal junction 3 ascending colon = Right sided colon 4 hepaticcopyright flexure 5 Transverse colon (= Horizontal colon) & mesentery 6 splenic flexure 7 descending colon = Left sided colon Dr8 Sigmoid colon & mesentery L IS - Interspinous plane MCL - midclavicular line TP - transpyloricA plane Neill