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

Atlas B Surface Anatomy Text © The McGraw−Hill Companies, 2003

A T L A S BSurface Anatomy

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



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The Importance of ExternalAnatomyIn the study of human anatomy, it is easy to become so pre-occupied with internal structure that we forget the impor-tance of what we can see and feel externally. Yet externalanatomy and appearance are major concerns in giving aphysical examination and in many aspects of patient care.A knowledge of the body’s surface landmarks is essentialto one’s competence in physical therapy, cardiopul-monary resuscitation, surgery, making X rays and electro-cardiograms, giving injections, drawing blood, listening toheart and respiratory sounds, measuring the pulse andblood pressure, and finding pressure points to stop arterialbleeding, among other procedures. A misguided attemptto perform some of these procedures while disregarding ormisunderstanding external anatomy can be very harmfuland even fatal to a patient.

Having just studied skeletal and muscular anatomyin the preceding chapters, this is an opportune time foryou to study the body surface. Much of what we see therereflects the underlying structure of the superficial bonesand muscles. A broad photographic overview of surfaceanatomy is given in atlas A (see fig. A.5). In the followingpages, we examine the body literally from head (fig. B.1)to toe (fig. B.14), studying its regions in more detail. Tomake the most profitable use of this atlas, refer to theskeletal and muscular anatomy in chapters 8 to 10. Relatedrawings of the clavicles in chapter 8 to the photograph infigure B.1, for example. Study the shape of the scapula inchapter 8 and see how much of it you can trace on the pho-tographs in figure B.3. See if you can relate the tendons

visible on the hand (fig. B.8) to the muscles of the forearmillustrated in chapter 10, and the external markings of thepelvis (fig. B.4) to bone structure in chapter 8.

For learning surface anatomy, there is a resourceavailable to you that is far more valuable than any labo-ratory model or textbook illustration—your own body.For the best understanding of human structure, comparethe art and photographs in this book with your body orwith structures visible on a study partner. In addition tobones and muscles, you can palpate a number of superfi-cial arteries, veins, tendons, ligaments, and cartilages,among other structures. By palpating regions such as theshoulder, elbow, or ankle, you can develop a mentalimage of the subsurface structures better than you canobtain by looking at two-dimensional textbook images.And the more you can study with other people, the moreyou will appreciate the variations in human structureand be able to apply your knowledge to your futurepatients or clients, who will not look quite like any text-book diagram or photograph you have ever seen.Through comparisons of art, photography, and the livingbody, you will get a much deeper understanding of thebody than if you were to study this atlas in isolation fromthe earlier chapters.

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

392 Part Two Support and Movement



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Atlas B Surface Anatomy 393

(b)

SuperciliaryridgeSuperior palpebralsulcus

Inferior palpebralsulcusAuricle (pinna)of earPhiltrum

Labia (lips)

Trapezius muscle

Supraclavicularfossa

Frons (forehead)

Root of nose

Bridge of nose

Lateral commissure

Medial commissure

Dorsum nasiApex of noseAla nasi

Mentolabial sulcus

Mentum (chin)

Sternoclavicularjoints

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.

Frontal

Orbital

Nasal

Oral

Mental

Cervical

Occipital

Temporal

Auricular

Buccal (cheek)

Nuchal (posterior cervical)

(a)



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(b)


Clavicle

Deltoid m.

Rectusabdominis m.

Anterior superiorspine of ilium

Trapezius m.

Suprasternal notchAcromion

Manubrium

Angle

Body (gladiolus)

Xiphoid process

Linea alba

Linea semilunaris

Costal margin

Corpus (body)

Areola

Nipple

Axillary tail

Breast:

Umbilicus

Sternum:

External abdominaloblique m.

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


Clavicle

Deltoid

Pectoralis major

Nipple

Rectusabdominis

Tendinousinsertion ofrectus abdominis

Anterior superiorspine of ilium

Iliac crest

Inguinal ligament

(a)

Sternocleidomastoid

Thyroid cartilage

Trapezius

Suprasternal notch

Acromion

Manubrium

Body

Xiphoidprocess

Serratus anterior

Linea alba

Linea semilunaris

Umbilicus

Sternum

External abdominaloblique



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Infraspinatus

Trapezius

Iliac crest

Gluteus medius

Gluteus maximus

Hamstring muscles

Acromion

Medial borderof scapula

Inferior angleof scapula

Latissimusdorsi

Erector spinae

Sacrum

CoccyxNatal cleft

Greatertrochanterof femur

Gluteal fold

Olecranon

(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 labeledonly on the photograph that shows them best.

Flexor carpi ulnaris

Brachioradialis

Biceps brachiiTriceps brachiiDeltoid

Anterior partMiddle part

Posterior part

Teres major

Infraspinatus

Medial borderof scapula

Trapezius

Vertebral furrow

Erector spinae

Latissimus dorsi

Iliac crest

(a)



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

(a)

(b)



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Olecranon

Biceps brachii

Triceps brachii

Anterior axillary fold (pectoralis major)

Deltoid

Axilla (armpit)

Posterior axillary fold (latissimus dorsi)

Pectoralis major

Latissimus dorsi

Serratus anterior

Rectus abdominis

External abdominal oblique

Figure B.5 The Axillary Region.



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Interphalangealjoints

Metacarpophalangealjoints

Styloid processof ulna

Extensor digitorum

Trapezius

Acromion

Deltoid

Pectoralis major

Biceps brachii

Triceps brachiiLong headLateral head

BrachioradialisExtensor carpiradialis longus

Lateral epicondyleof humerusOlecranon

Figure B.6 The Upper Limb, Lateral Aspect.

(b)

Triceps brachii

Olecranon

Head of radius

Brachioradialis

Flexor carpi ulnaris

Extensor carpi ulnaris

Extensor digitorum

Tendons of extensor digitorum

Dorsum of hand

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

Cubital fossa

Cephalic vein

Median cubital vein

Brachioradialis

Styloid process of radius

Thenar eminence

Palmar surface of hand

Pollex (thumb)

Flexion lines

(a)

Biceps brachiiMedial epicondyleof humerus

Flexor carpi radialisPalmaris longusFlexor carpi ulnaris

Styloid process ofulna

Hypothenar eminence

Flexion creases

Volar surface of fingers



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399

(b)

Styloid process of radius

Styloid process of ulna

Extensor pollicis brevis tendonAnatomical snuffboxExtensor pollicis longus tendon

Extensor digiti minimi tendonExtensor digitorum tendons

Adductor pollicis

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

Hypothenar eminence

Thenar eminence

Pollex (thumb)

Palmaris longus tendon

Flexion creases

Flexion creases

Flexor carpi radialis tendon

Interphalangealjoints

Metacarpophalangealjoint

( )

I

II

IIIIV

V

(a)



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Lateral Medial

Tensor fasciae latae

Rectus femoris

Gracilis

Vastus lateralis

Vastus medialis

Quadricepsfemoris tendon

Iliotibial band

Patella

Patellar ligament

Tibial tuberosity

(a)

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

(b)

Lateral Medial

Vastus lateralis

Biceps femoris (long head)Semitendinosus

Semimembranosus

Gracilis

Popliteal fossa



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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 fibularisbrevis tendons

Calcaneal tendon

Lateral malleolus

Calcaneus

Figure B.10 The Leg and Foot, Lateral Aspect.



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Semimembranosus

Semimembranosus tendon

Patella

Medial epicondyle of femur

Semitendinosus tendon

Medial condyle of tibia

Medial head of gastrocnemius

Tibia

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.



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Medial Lateral

Hamstring muscles

Semitendinosus tendon

Biceps femoris tendon

Popliteal fossa

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.



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Calcaneal tendon

Lateral malleolus

Extensor digitorum brevis

Lateral longitudinal arch

Extensor digitorum longustendons

(a)

Calcaneal tendon

Medial malleolus

(b)


Calcaneus


Figure B.13 The Foot. (a) Lateral aspect; (b) medial aspect.



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Tibia

Soleus

Tibialis anterior

Medial malleolus


Hallux (great toe)

(a)

Lateral malleolus

Site for palpating dorsal pedal artery

Extensor digitorum longus tendons

Extensor hallucis longus tendon

IIIIIIIVV

(b)

Lateral longitudinal arch

Lateral malleolus

Transverse arch

Digits (I–V)


Calcaneus


Head of metatarsal V

Abductor digiti minimi

Abductor hallucis

Hallux (great toe)I

II

III

IV

V

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

405



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89

10

11

12

13

14

1516

5

3

2

1

4

6

7

(a)

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

(b)

27

26

25

24

28

29

30

2317

18

19

20

21

22

a. biceps brachii

b. brachioradialis

c. deltoid

d. erector spinae

e. external abdominal oblique

f. flexor carpi ulnaris

g. gastrocnemius

h. gracilis

i. hamstrings

j. infraspinatus

k. latissimus dorsi

l. pectineus

m. pectoralis major

n. rectus abdominis

o. rectus femoris

p. serratus anterior

q. soleus

r. splenius capitis

s. sternocleidomastoid

t. subscapularis

u. teres major

v. tibialis anterior

w. transversus abdominis

x. trapezius

y. triceps brachii

z. vastus lateralis

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