Surface Anatomy of the Thorax

AAAA01 21/5/05 10:34 AM Page 1 Anatomy at a Glance OMAR FAIZ BSc (Hons), FRCS (Eng) Specialist Registrar in General Surgery DAVID MOFFAT VRD, MD, FRCS Emeritus Professor of Anatomy University of Cardiff Blackwell Science AAAA01 21/5/05 10:34 AM Page 2 © 2002 by Blackwell Science Ltd a Blackwell Publishing company Editorial Offices: Osney Mead, Oxford OX2 0EL, UK Tel: +44 (0)1865 206206 Blackwell Science, Inc., 350 Main Street, Malden, MA 02148-5018, USA Tel: +1 781 388 8250 Blackwell Science Asia Pty, 54 University Street, Carlton, Victoria 3053, Australia Tel: +61 (0)3 9347 0300 Blackwell Wissenschafts Verlag, Kurfürstendamm 57, 10707 Berlin, Germany Tel: +49 (0)30 32 79 060 The right of the Authors to be identified as the Authors of this Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. First published 2002 by Blackwell Science Ltd Reprinted 2002 Library of Congress Cataloging-in-Publication Data Faiz, Omar. Anatomy at a glance / Omar Faiz, David Moffat p. cm. Includes index. ISBN 0-632-05934-6 (pbk.) 1. Human anatomy—Outlines, syllabi, etc. I. Moffat, David, MD. II. Title. [DNLM: 1: Anatomy. QS 4 F175a 2002] QM31 .F33 2002 611—dc21 2001052646 ISBN 0-632-05934-6 A Catalogue record for this title is available from the British Library. Set in 9/11A pt Times by Graphicraft Limited, Hong Kong Printed and bound in Italy by G. Canale & C. SpA, Turin For further information on Blackwell Science, visit our website: www.blackwell-science.com AAAA01 21/5/05 10:34 AM Page 3 Contents Preface, 5 39 The hand, 88 40 Surface anatomy of the upper limb, 90 The thorax 1 The thoracic wall I, 6 The lower limb 2 The thoracic wall II, 8 41 The osteology of the lower limb, 92 3 The mediastinum Iathe contents of the 42 The arteries of the lower limb, 94 mediastinum, 10 43 The veins and lymphatics of the lower limb, 96 4 The mediastinum IIathe vessels of the thorax, 12 44 The nerves of the lower limb I, 98 5 The pleura and airways, 14 45 The nerves of the lower limb II, 100 6 The lungs, 16 46 The hip joint and gluteal region, 102 7 The heart I, 18 47 The thigh, 106 8 The heart II, 22 48 The knee joint and popliteal fossa, 109 9 The nerves of the thorax, 24 49 The leg, 112 10 Surface anatomy of the thorax, 26 50 The ankle and foot I, 114 51 The ankle and foot II, 116 The abdomen and pelvis 52 Surface anatomy of the lower limb, 118 11 The abdominal wall, 28 12 The arteries of the abdomen, 31 The autonomic nervous system 13 The veins and lymphatics of the abdomen, 34 53 The autonomic nervous system, 120 14 The peritoneum, 36 15 The upper gastrointestinal tract I, 38 The head and neck 16 The upper gastrointestinal tract II, 40 54 The skull I, 122 17 The lower gastrointestinal tract, 42 55 The skull II, 124 18 The liver, gall-bladder and biliary tree, 44 56 Spinal nerves and cranial nerves I–IV, 126 19 The pancreas and spleen, 46 57 The trigeminal nerve (V), 128 20 The posterior abdominal wall, 48 58 Cranial nerves VI–XII, 130 21 The nerves of the abdomen, 50 59 The arteries I, 132 22 Surface anatomy of the abdomen, 52 60 The arteries II and the veins, 134 23 The pelvis Iathe bony and ligamentous pelvis, 54 61 Anterior and posterior triangles, 136 24 The pelvis IIathe contents of the pelvis, 56 62 The pharynx and larynx, 138 25 The perineum, 58 63 The root of the neck, 140 26 The pelvic viscera, 60 64 The oesophagus and trachea and the thyroid gland, 142 65 The upper part of the neck and the submandibular The upper limb region, 144 27 The osteology of the upper limb, 62 66 The mouth, palate and nose, 146 28 Arteries of the upper limb, 66 67 The face and scalp, 148 29 The venous and lymphatic drainage of the upper limb and the 68 The cranial cavity, 152 breast, 68 69 The orbit and eyeball, 154 30 Nerves of the upper limb I, 70 70 The ear, and lymphatics and surface anatomy of the head and 31 Nerves of the upper limb II, 72 neck, 156 32 The pectoral and scapular regions, 74 33 The axilla, 76 The spine and spinal cord 34 The shoulder (gleno-humeral) joint, 78 71 The spine, 158 35 The arm, 80 72 The spinal cord, 160 36 The elbow joint and cubital fossa, 82 37 The forearm, 84 Muscle index, 162 38 The carpal tunnel and joints of the wrist and hand, 86 Index, 168 Contents 3 AAAA01 21/5/05 10:34 AM Page 4 AAAA01 21/5/05 10:34 AM Page 5 Preface The study of anatomy has changed enormously in the last few decades. The anatomical drawings are the work of Jane Fallows, with help No longer do medical students have to spend long hours in the dissect- from Roger Hulley, who has transformed our rough sketches into the ing room searching fruitlessly for the otic ganglion or tracing the small finished pages of illustrations that form such an important part of the arteries that form the anastomosis round the elbow joint. They now book and we should like to thank her for her patience and skill in carry- need to know only the basic essentials of anatomy with particular ing out this onerous task. Some of the drawings have been borrowed or emphasis on their clinical relevance and this is a change that is long adapted from Professor Harold Ellis’s superb book Clinical Anatomy overdue. However, students still have examinations to pass and in this (9th edn) and we are most grateful to him for his permission to do this. book the authors, a surgeon and an anatomist, have tried to provide a We should also like to thank Dr Mike Benjamin of Cardiff University means of rapid revision without any frills. To this end, the book follows for the surface anatomy photographs. Finally, it is a pleasure to thank the standard format of the at a Glance series and is arranged in short, all the staff at Blackwell Science who have had a hand in the prepara- easily digested chapters, written largely in note form, with the appro- tion of this book, particularly Fiona Goodgame and Jonathan Rowley. priate illustrations on the facing page. Where necessary, clinical appli- cations are included in italics and there are a number of clinical Omar Faiz illustrations. We thus hope that this book will be helpful in revising and David Moffat consolidating the knowledge that has been gained from the dissecting room and from more detailed and explanatory textbooks. Preface 5 AAAC01 21/5/05 10:38 AM Page 6 1 The thoracic wall I Thoracic outlet (inlet) First rib Clavicle Suprasternal notch Manubrium 5 Third rib 1 2 Body of sternum Intercostal 4 space Xiphisternum Scalenus anterior Brachial Cervical Costal cartilage plexus rib Costal margin 3 Subclavian 1 Costochondral joint Floating ribs artery 2 Sternocostal joint Fig.1.3 3 Interchondral joint Bilateral cervical ribs. 4 Xiphisternal joint 5 Manubriosternal joint On the right side the brachial plexus (angle of Louis) is shown arching over the rib and stretching its lowest trunk Fig.1.1 The thoracic cage. The outlet (inlet) of the thorax is outlined Transverse process with facet for rib tubercle Demifacet for head of rib Head Neck Costovertebral T5 joint T6 Facet for Tubercle vertebral body Costotransverse joint Sternocostal joint Shaft 6th Angle rib Costochondral Subcostal groove joint Fig.1.2 Fig.1.4 A typical rib Joints of the thoracic cage 6 Thorax AAAC01 21/5/05 10:38 AM Page 7 The thoracic cage • The 2nd rib is less curved and longer than the 1strib. The thoracic cage is formed by the sternum and costal cartilages in • The 10th rib has only one articular facet on the head. front, the vertebral column behind and the ribs and intercostal spaces • The 11th and 12th ribs are short and do not articulate anteriorly. laterally. They articulate posteriorly with the vertebrae by way of a single facet It is separated from the abdominal cavity by the diaphragm and com- on the head. They are devoid of both a tubercle and a subcostal groove. municates superiorly with the root of the neck through the thoracic inlet (Fig. 1.1). The sternum (Fig. 1.1) The sternum comprises a manubrium, body and xiphoid process. The ribs (Fig. 1.1) • The manubrium has facets for articulation with the clavicles, 1st • Of the 12 pairs of ribs the first seven articulate with the vertebrae pos- costal cartilage and upper part of the 2nd costal cartilage. It articulates teriorly and with the sternum anteriorly by way of the costal cartilages inferiorly with the body of the sternum at the manubriosternal joint. (true ribs). • The body is composed of four parts or sternebrae which fuse between • The cartilages of the 8th, 9th and 10th ribs articulate with the carti- 15 and 25 years of age. It has facets for articulation with the lower part lages of the ribs above ( false ribs).

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