Surface Anatomy Text © the Mcgraw−Hill Physiology: the Unity of Companies, 2003 Form and Function, Third Edition ATLAS B

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Saladin: Anatomy & Atlas B Surface Anatomy Text © The McGraw−Hill Physiology: The Unity of Companies, 2003 Form and Function, Third Edition ATLAS B

The Importance of External Anatomy 392

Head and Neck (fig. B.1) 393

Trunk 394 • Thorax and Abdomen (fig. B.2) 394 • Back and Gluteal Region (fig. B.3) 395 • Pelvic Region (fig. B.4) 396 • Axillary Region (fig. B.5) 397

Upper Limb 398 • Lateral Aspect (fig. B.6) 398 • Antebrachium (forearm) (fig. B.7) 398 • Wrist and Hand (fig. B.8) 399

Lower Limb 400 • Thigh and Knee (fig. B.9) 400 • Leg (figs. B.10–B.12) 401 • Foot (figs. B.13–14) 404

Muscle Test (fig. B.15) 406 Saladin: Anatomy & Atlas B Surface Anatomy Text © The McGraw−Hill Physiology: The Unity of Companies, 2003 Form and Function, Third Edition

392 Part Two Support and Movement

visible on the hand (fig. B.8) to the muscles of the forearm The Importance of External illustrated in chapter 10, and the external markings of the pelvis (fig. B.4) to bone structure in chapter 8. Anatomy For learning surface anatomy, there is a resource In the study of human anatomy, it is easy to become so pre- available to you that is far more valuable than any labo- occupied with internal structure that we forget the impor- ratory model or textbook illustration—your own body. tance of what we can see and feel externally. Yet external For the best understanding of human structure, compare anatomy and appearance are major concerns in giving a the art and photographs in this book with your body or physical examination and in many aspects of patient care. with structures visible on a study partner. In addition to A knowledge of the body’s surface landmarks is essential bones and muscles, you can palpate a number of superfi- to one’s competence in physical therapy, cardiopul- cial arteries, veins, tendons, ligaments, and cartilages, monary resuscitation, surgery, making X rays and electro- among other structures. By palpating regions such as the cardiograms, giving injections, drawing blood, listening to shoulder, elbow, or ankle, you can develop a mental heart and respiratory sounds, measuring the pulse and image of the subsurface structures better than you can blood pressure, and finding pressure points to stop arterial obtain by looking at two-dimensional textbook images. bleeding, among other procedures. A misguided attempt And the more you can study with other people, the more to perform some of these procedures while disregarding or you will appreciate the variations in human structure misunderstanding external anatomy can be very harmful and be able to apply your knowledge to your future and even fatal to a patient. patients or clients, who will not look quite like any text- Having just studied skeletal and muscular anatomy book diagram or photograph you have ever seen. Through comparisons of art, photography, and the living Atlas B in the preceding chapters, this is an opportune time for you to study the body surface. Much of what we see there body, you will get a much deeper understanding of the reflects the underlying structure of the superficial bones body than if you were to study this atlas in isolation from and muscles. A broad photographic overview of surface the earlier chapters. anatomy is given in atlas A (see fig. A.5). In the following At the end of this atlas, you can test your knowledge pages, we examine the body literally from head (fig. B.1) of externally visible muscle anatomy. The two photo- to toe (fig. B.14), studying its regions in more detail. To graphs in figure B.15 have 30 numbered muscles and a list make the most profitable use of this atlas, refer to the of 26 names, some of which are shown more than once in skeletal and muscular anatomy in chapters 8 to 10. Relate the photographs and some of which are not shown at all. drawings of the clavicles in chapter 8 to the photograph in Identify the muscles to your best ability without looking figure B.1, for example. Study the shape of the scapula in back at the previous illustrations, and then check your chapter 8 and see how much of it you can trace on the pho- answers in appendix B at the back of the book. tographs in figure B.3. See if you can relate the tendons Saladin: Anatomy & Atlas B Surface Anatomy Text © The McGraw−Hill Physiology: The Unity of Companies, 2003 Form and Function, Third Edition

Atlas B Surface Anatomy 393

Occipital Frontal

Orbital Temporal Nasal

Auricular Oral

Buccal (cheek) Mental Nuchal (posterior cervical) Cervical Atlas B

(a)

Frons (forehead) Root of nose Bridge of nose Superciliary Lateral commissure ridge Superior palpebral sulcus Medial commissure Inferior palpebral Dorsum nasi sulcus Apex of nose Auricle (pinna) Ala nasi of ear Mentolabial sulcus Philtrum Labia (lips) Mentum (chin) Trapezius muscle Sternoclavicular joints

Supraclavicular Clavicle fossa Suprasternal notch Sternum

(b)

Figure B.1 The Head and Neck. (a) Anatomical regions of the head, lateral aspect. (b) Features of the facial region and upper thorax. Saladin: Anatomy & Atlas B Surface Anatomy Text © The McGraw−Hill Physiology: The Unity of Companies, 2003 Form and Function, Third Edition

394 Part Two Support and Movement

Supraclavicular Sternocleidomastoid fossa Thyroid cartilage Clavicle Trapezius Suprasternal notch Deltoid Acromion

Manubrium Pectoralis major Body Sternum Nipple Xiphoid process

Rectus abdominis Serratus anterior

Tendinous Linea semilunaris insertion of Linea alba rectus abdominis Umbilicus

Atlas B Anterior superior spine of ilium External abdominal oblique Iliac crest

Inguinal ligament

(a)

Supraclavicular Trapezius m. fossa Sternum: Clavicle Suprasternal notch Acromion Deltoid m. Manubrium Angle Breast: Body (gladiolus) Axillary tail Xiphoid process Nipple

Areola Corpus (body)

Linea alba

Rectus Costal margin abdominis m. Umbilicus Linea semilunaris

External abdominal oblique m. Anterior superior spine of ilium

(b)

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 & Atlas B Surface Anatomy Text © The McGraw−Hill Physiology: The Unity of Companies, 2003 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 Atlas B

Iliac crest (a)

Acromion

Medial border Infraspinatus of scapula Trapezius

Inferior angle of scapula Latissimus Olecranon dorsi Erector spinae

Iliac crest Sacrum Gluteus medius Coccyx Gluteus maximus Natal cleft

Greater trochanter of femur Gluteal fold Hamstring muscles

(b)

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 & Atlas B Surface Anatomy Text © The McGraw−Hill Physiology: The Unity of Companies, 2003 Form and Function, Third Edition

396 Part Two Support and Movement

Atlas B (a)

(b)

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 & Atlas B Surface Anatomy Text © The McGraw−Hill Physiology: The Unity of Companies, 2003 Form and Function, Third Edition

Atlas B Surface Anatomy 397

Olecranon

Biceps brachii

Triceps brachii

Anterior axillary fold (pectoralis major)

Deltoid Atlas B

Axilla (armpit)

Posterior axillary fold (latissimus dorsi)

Pectoralis major

Latissimus dorsi

Serratus anterior

Rectus abdominis

External abdominal oblique

Figure B.5 The Axillary Region. Saladin: Anatomy & Atlas B Surface Anatomy Text © The McGraw−Hill Physiology: The Unity of Companies, 2003 Form and Function, Third Edition

398 Part Two Support and Movement

Trapezius

Acromion

Interphalangeal Deltoid joints Pectoralis major

Metacarpophalangeal Biceps brachii joints Triceps brachii Styloid process Long head of ulna Lateral head Brachioradialis Extensor carpi Extensor digitorum radialis longus Lateral epicondyle of humerus Olecranon

Figure B.6 The Upper Limb, Lateral Aspect. Atlas B

Biceps brachii Triceps brachii Cubital fossa Medial epicondyle of humerus Cephalic vein Olecranon Median cubital vein Head of radius Brachioradialis Brachioradialis Flexor carpi radialis Palmaris longus Flexor carpi ulnaris Flexor carpi ulnaris Extensor carpi ulnaris

Extensor digitorum

Styloid process of Styloid process of radius ulna Hypothenar eminence Thenar eminence Flexion creases Tendons of extensor digitorum Palmar surface of hand

Pollex (thumb) Dorsum of hand

Volar surface of fingers Flexion lines

(a) (b)

Figure B.7 The Antebrachium (forearm). (a) Ventral aspect; (b) dorsal aspect. Saladin: Anatomy & Atlas B Surface Anatomy Text © The McGraw−Hill Physiology: The Unity of Companies, 2003 Form and Function, Third Edition

Palmaris longus tendon Flexor carpi radialis tendon

Flexion creases

Thenar eminence

Hypothenar eminence

Pollex (thumb) Flexion creases I

Metacarpophalangeal joint

Interphalangeal joints

V Atlas B II IV III (a) ()

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

(b)

Figure B.8 The Wrist and Hand. (a) Ventral aspect; (b) dorsal aspect.

399 Saladin: Anatomy & Atlas B Surface Anatomy Text © The McGraw−Hill Physiology: The Unity of Companies, 2003 Form and Function, Third Edition

400 Part Two Support and Movement

Lateral Medial

Vastus lateralis Tensor fasciae latae

Biceps femoris (long head) Rectus femoris Semitendinosus

Semimembranosus

Gracilis Gracilis Atlas B

Vastus lateralis

Vastus medialis

Quadriceps femoris tendon Popliteal fossa Iliotibial band

Patella

Patellar ligament

Tibial tuberosity

(a) (b)

Figure B.9 The Thigh and Knee. (a) Ventral aspect; (b) dorsal aspect. Saladin: Anatomy & Atlas B Surface Anatomy Text © The McGraw−Hill Physiology: The Unity of Companies, 2003 Form and Function, Third Edition

Atlas B Surface Anatomy 401

Vastus lateralis

Biceps femoris

Iliotibial band

Lateral epicondyle of femur

Head of fibula

Patellar ligament

Lateral head of gastrocnemius

Soleus Atlas B

Fibularis longus

Tibialis anterior

Fibularis longus and fibularis brevis tendons

Calcaneal tendon

Lateral malleolus

Calcaneus

Figure B.10 The Leg and Foot, Lateral Aspect. Saladin: Anatomy & Atlas B Surface Anatomy Text © The McGraw−Hill Physiology: The Unity of Companies, 2003 Form and Function, Third Edition

402 Part Two Support and Movement

Semimembranosus

Semimembranosus tendon

Patella

Medial epicondyle of femur Semitendinosus tendon Medial condyle of tibia

Medial head of gastrocnemius

Tibia Atlas B

Soleus

Medial malleolus

Extensor hallucis longus tendon

Medial longitudinal arch

Head of metatarsal I

Abductor hallucis

Figure B.11 The Leg and Foot, Medial Aspect. Saladin: Anatomy & Atlas B Surface Anatomy Text © The McGraw−Hill Physiology: The Unity of Companies, 2003 Form and Function, Third Edition

Atlas B Surface Anatomy 403

Medial Lateral

Hamstring muscles

Biceps femoris tendon

Semitendinosus tendon

Popliteal fossa Atlas B

Gastrocnemius Medial head

Lateral head

Soleus

Fibularis longus

Tibialis anterior

Calcaneal tendon

Lateral malleolus

Extensor digitorum brevis

Calcaneus

Figure B.12 The Leg and Foot, Dorsal Aspect. Saladin: Anatomy & Atlas B Surface Anatomy Text © The McGraw−Hill Physiology: The Unity of Companies, 2003 Form and Function, Third Edition

404 Part Two Support and Movement

Calcaneal tendon

Lateral malleolus

Extensor digitorum brevis

Lateral longitudinal arch Atlas B

Extensor digitorum longus tendons (a)

Medial malleolus

Calcaneal tendon

Medial longitudinal arch

Calcaneus

Head of metatarsal I

(b)

Figure B.13 The Foot. (a) Lateral aspect; (b) medial aspect. Saladin: Anatomy & Atlas B Surface Anatomy Text © The McGraw−Hill Physiology: The Unity of Companies, 2003 Form and Function, Third Edition

Soleus

Tibia

Tibialis anterior

Medial malleolus

Lateral malleolus

Site for palpating dorsal pedal artery

Extensor hallucis longus tendon

Extensor digitorum longus tendons

Digits (I–V) Head of metatarsal I Atlas B

II Hallux (great toe) III V IV III II I I IV Hallux (great toe)

V Head of metatarsal I (a) Transverse arch

Head of metatarsal V

Abductor digiti minimi

Abductor hallucis

Medial longitudinal arch

Lateral longitudinal arch

Lateral malleolus

Calcaneus

(b)

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

405 Saladin: Anatomy & Atlas B Surface Anatomy Text © The McGraw−Hill Physiology: The Unity of Companies, 2003 Form and Function, Third Edition

406 Part Two Support and Movement

1 8 9 17 2 23 10 18 24 19 25 3 11 20 4 12 26 13 27

21 14 22

Atlas B 5 6 28 7

29 15 30 16

(a) (b)

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