Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about Palpation of arterial pulses Skeleton, muscles, and blood vessels Sounds of the heart and lungs Where to give injections

The Head Cranium – selected structures felt through the skin Superciliary arches External occipital protuberance Mastoid process Temporalis muscle – at temple region Frontalis muscle Feel wrinkling of the forehead when eyebrows are raised

Surface Anatomy of Lateral Aspect of the Head Figure 11.26

The Head Face – selected structures felt through the skin Lacrimal fossa Root and bridge of the nose Auricle of the ear Zygomatic arch Masseter muscle Mandible Temporomandibular joint

The Neck Skeletal landmarks Spinous processes of cervical vertebrae C7 is particularly prominent (vertebra prominens) Hyoid bone – in the anterior, superior neck Laryngeal prominence – the “Adam’s Apple” Cricoid cartilage – inferior to the laryngeal prominence Jugular notch – depression in the superior part of the sternum

The Neck Figure 11.27

Muscles of the Neck Sternocleidomastoid – most prominent neck muscle Sternal head Clavicular head Deep to the sternocleidomastoid Common carotid artery Internal jugular vein Trapezius – posterior aspect of the neck

Triangles of the Neck The sternocleidomastoid muscles divide the neck Anterior triangle Posterior triangle Figure 11.28a

Triangles of the Neck Figure 11.28b

The Trunk The trunk consists of the Thorax Abdomen Pelvis and perineum

The Thorax Sternum – portions felt through the skin Manubrium, xiphoid process, and sternal angle Midaxillary line – line from the center of the axilla onto the lateral thoracic wall Midclavicular line – vertical line from midpoint of the clavicle to the groin

Muscles of the Thorax Pectoralis major Serratus anterior

The Anterior Thorax and Abdomen Figure 11.29

The Abdomen Structures felt through the skin Iliac crest Anterior superior iliac spine Inguinal ligament Runs medially from anterior superior iliac spine to the pubic tubercle Pubic crest

Inguinal Hernia Figure 11.30

Muscles and other Abdominal Surface Features Linea alba The “white line” extending from xiphoid process to the pubic symphysis Rectus abdominis Linea semilunaris – lateral margin of rectus abdominis

The Pelvis and Perineum Four bony structures define the perineum Pubic symphysis Two ischial tuberosities Coccyx

The Back Posterior median furrow – vertical groove along the midline Spinous processes of vertebrae Spine of the scapula Medial end is opposite T3 Medial border of the scapula

The Back Inferior angle of the scapula Iliac crests Supracristal line – intersects L4 Sacrum – superior to cleft in the buttocks Coccyx – posterior to the anus

Surface Anatomy of the Back Figure 11.31a

Muscles of the Back Trapezius Latissimus dorsi Erector spinae

Surface Anatomy of the Back Figure 11.31b

Upper Limb and Shoulder The Axilla Base of the axilla – where armpit hair grows Deep to the axilla – axillary lymph nodes and blood vessels Anterior axillary fold – pectoralis major Posterior axillary fold –latissimus dorsi and teres major

Shoulder and Arm Figure 11.32a, b

The Shoulder Acromion – lateral end of the spine of the scapula Acromioclavicular joint Deltoid muscle Covers the greater tubercle of the humerus Figure 11.33

The Arm The region between the shoulder and elbow Humerus Palpated through skin along its entire length Biceps brachii Medial bicipital groove The medial boundary of the biceps brachii Triceps brachii

The Arm Figure 11.34

The Elbow Lateral and medial epicondyles of the humerus Ulnar nerve – “funny bone” runs across medial epicondyle Olecranon process of the ulna Cubital fossa – (antecubital fossa) Forms anterior surface of forearm

The Anterior Surface of the Forearm and Fist Figure 11.35a

Forearm Bones Radius – partly covered in muscle Ulna – palpate entire length Styloid process and head – distal end Radius – partly covered in muscle Head of the radius – proximal end Styloid process – distal end

Muscles of the Forearm Flexor muscles – anterior forearm Flexor carpi radialis Palmaris longus This muscle is absent in about 30% of people Extensor muscles – posterior forearm

Other Structures of the Forearm Anatomical snuff box bordered by Extensor pollicis brevis Extensor pollicis longus

The Hand Dorsum of hand Palmar surface Dorsal venous network Tendons of extensor digitorum Palmar surface Thenar eminence (not labeled on figure 11.35b) Hypothenar eminence (see figure 11.17a–c ) Pisiform bone

The Dorsum of the Hand Figure 11.36

Gluteal Region Iliac crests Posterior superior iliac spine Sacroiliac joint Prominences of the buttocks “Cheeks” of the buttocks Formed from subcutaneous fat and the gluteal muscles

The Gluteal Region Figure 11.37

Lower Limb and Gluteal Region Natal cleft (gluteal cleft) Vertical midline groove between “cheeks” Gluteal fold Horizontal fold below each “cheek” Ischial tuberosities Greater trochanter of the femur Located at the lateral hip

Lower Limb and Gluteal Region Figure 11.38a

Thigh Medial and lateral condyles of the femur Patella Three groups of muscles Quadriceps femoris – anterior thigh Vastus lateralis – injection site Adductors – medial thigh Hamstrings – posterior thigh

Thigh Figure 11.38b

The Thigh The Femoral Triangle Popliteal fossa Superior border – inguinal ligament Inferior borders Sartorius Adductor longus Popliteal fossa Diamond-shaped hollow on posterior knee Defined by borders of “hamstring” tendons and gastrocnemius

Leg and Foot Palpate patella to find the patellar ligament Structures of the proximal leg Tibial tuberosity Lateral and medial condyles of the tibia Head of the fibula Structures of the distal leg Medial malleolus Lateral malleolus

Leg and Foot Figure 11.40a, c

Muscle Groups of the Leg Posterior calf muscles Gastrocnemius and soleus Calcaneal tendon – inferior end of the soleus and gastrocnemius Anterior compartment muscles Tibialis anterior Extensor digitorum Fibularis

Muscle Groups of the Leg Figure 11.41

Foot Tendons on the dorsal surface of the foot Extensor digitorum longus tendon Extensor hallucis longus

Foot Figure 11.40d