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Chapter 13

Lecture Outline
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Chapter 13 Outline

A Regional Approach to Surface Anatomy


Head Region
Neck Region
Trunk Region
Shoulder and Upper Appendage Region
Lower Appendage Region

A Regional Approach
to Surface Anatomy
Surface anatomy is a branch of gross
anatomy that examines shapes and markings
on the surface of the body as they relate to
deeper structures
Four techniques are used:
1. Visual inspection
2. Palpation
3. Percussion
4. Auscultation

Head Region
Most complex area of the body
Structurally divided into two regions:
1. Cranium
2. Face

Surface Anatomy
Distinguish between the cubital fossa (Figure
13.8) and the popliteal fossa (Figure 13.10).
Cubital fossa: think venipuncture!

Surface Anatomy
The Adams Apple is the __________.

Head and Neck

Figure 13.1

Cranium
The cranium is divided into three regions:
1. Frontal: The forehead
2. Temporal: Lateral skull just superior to the
ear
3. Occipital: Posterior part of the skull

Face
The face is divided into six regions:
1.
2.
3.
4.
5.

Auricular
Orbital
Nasal
Oral
Mental

Face
The auricular region is composed of the
visible structures of the ear and the ears
internal structures, including:
1. Auricle: Fleshy part of the external ear
2. External acoustic meatus: Opening within
the auricle
3. Mastoid process: Posterior and inferior to
the auricle

Face
The orbital region includes the eyeballs
and associated structures:
1. Eyebrows: Protect against sunlight and
mechanical damage
2. Eyelids: Protect against objects moving
close to the eye
3. Superior palpebral fissure

Superior Palpebra Fissure

Face
The nasal region contains the nose and
other structures:
1.
2.
3.
4.

Bridge: Formed by the two nasal bones


Dorsum nasi: Fleshy part of the nose
Apex: Tip of the nose
Nostrils (external nares): Paired openings
into the nose
5. Ala nasi: Flared posterolateral margin of
each nostril

Face
The oral region is inferior to the nasal region; it
includes the following:
1. Lips (labia): Fleshy upper and lower lips
2. Oral cavity: Mouth when opened
3. Philtrum: Midline vertical depression between
nose and upper lip
What is the evolutionary significance of the

philtrum?
4. Buccal region: Cheek

Face
The buccal region refers to the cheek
Within this region is the buccinator muscle
This region ends superolaterally as the
zygomatic bone and the zygomatic arch

Face
The mental region refers to the chin
The chin is referred to as the mentum

Neck Region

The neck (cervical region) connects the


head to the trunk
Contains the spinal cord, nerves,
trachea, esophagus, major blood
vessels, many muscles, the larynx, and
major glands
Can be divided into three regions:
1. Anterior
2. Posterior
3. Lateral

Neck Region
The anterior region contains several
palpable landmarks:
1. Larynx (voice box): Found in the middle
of the neck
2. Thyroid cartilage: Contains the laryngeal
prominence, commonly referred to as the
Adams apple
3. Trachea
4. Suprasternal notch: On the superior
border of the manubrium of the sternum

Neck Region
The posterior region houses the spinal cord
and cervical vertebrae, and contains the
following features:
1. Vertebra prominens (C7) spinous process
2. Ligamentum nuchae: A thick ligament that
extends from C7 to the nuchal lines of the skull

Neck Region
In the lateral portion of the neck, the
sternocleidomastoid delineates two
clinically important triangles:
1. Anterior triangle
2. Posterior triangle

Neck Region
The anterior triangle lies anterior to the
sternocleidomastoid muscle and inferior to
the mandible
Subdivided into four smaller triangles:
1. Submental triangle
2. Submandibular triangle
3. Carotid triangle
4. Muscular triangle

Neck Region
The submental triangle is the most
superior of all anterior triangles
It is posterolateral to the chin and
bounded by the anterior belly of the
digastric muscle
It contains some cervical lymph nodes,
which may enlarge and become tender
when you have an infection

Neck Region
The submandibular triangle is inferior to
the mandible and posterolateral to the
submental triangle
It is bounded by the mandible and the
bellies of the digastric muscle
It contains the submandibular gland,
which is a bulge inferior to the mandible

Neck Region
The carotid triangle is bounded by the
sternocleidomastoid, omohyoid, and
posterior digastric muscles
Within this triangle one can feel the strong
pulsation of the common carotid artery

Neck Region
The muscular triangle is the most inferior
of the four anterior triangles
It is bounded by the sternocleidomastoid
muscle and superior belly of the omohyoid
and midline of the neck
It contains the lateral edges of the larynx
and thyroid gland

Neck Region
The posterior triangle is located in the
lateral region of the neck, posterior to the
sternocleidomastoid muscle, superior to
the clavicle, and anterior to the trapezius
It is divided into two smaller triangles:
1. Occipital triangle
2. Supraclavicular triangle

Neck Region
The occipital triangle is bounded by the
omohyoid, trapezius, and sternocleidomastoid muscles
It contains the following structures:
1. External jugular vein
2. Accessory nerve
3. Brachial plexus
4. Lymph nodes

Neck Region
The supraclavicular triangle is bounded
by the clavicle, omohyoid, and
sternocleidomastoid muscles
It contains portions of the subclavian
artery and subclavian vein as well as
some lymph nodes

Anterior and Posterior Triangles


of the Neck

Figure 13.2

Trunk Region
The trunk is partitioned into three areas:
1. Thorax
2. Abdominopelvic region
3. Dorsal surface

Thorax
Superior portion of the trunk contains the following
structures:
1. Clavicles
2. Suprasternal notch
3. Costal margins
4. Infrasternal angle
5. Sternum

With manubrium, body, and xiphoid process

6. Sternal angle
7. Breast

With nipple and areola

Anterior Trunk Region

Figure 13.3a

Anterior Trunk Region

Figure 13.3

Abdominopelvic Region
Portion of the trunk that lies inferior to the thorax or rib
cage, containing the following features:
1. Umbilicus
2. Linea alba
3. Pubic bones
4. Rectus abdominis
With tendinous intersections

5. Anterior superior iliac spine


6. Inguinal ligament
7. Pubic tubercle
8. Superficial inguinal ring
9. Inguinal canal

Dorsal Region
This region contains the following structures:
1. Lateral and medial borders of the scapula
2. Spine of the scapula
3. Triangle of auscultation as defined by three
muscles:
Rhomboid major
Trapezius
Latissimus dorsi

4. Iliac crests

Posterior Trunk Region

Figure 13.4a

Posterior Trunk Region

Figure 13.4b

Shoulder and Upper Limb Region

Clinically important because of frequent trauma


to these body regions
Vessels of the upper limb are often used as
pressure sites and as sites for drawing blood,
providing nutrients and fluids, and administering
medicine
The regions are divided into these areas:
1.
2.
3.
4.
5.

Shoulder
Axilla
Arm
Forearm
Hand

Shoulder
Consists of the scapula, clavicle, and
proximal part of the humerus
Important landmarks:
1. Clavicle
2. Acromion of the scapula
3. Deltoid muscle, which is a frequent site of
intramuscular injections

Axilla
Commonly called the armpit
Clinically important because it contains
many nerves and blood vessels that go to
and from the upper limb
Contains axillary lymph nodes that drain
the mammary glands and the upper limb

Axilla
The anterior axillary fold is formed by
the pectoralis major
The posterior axillary fold is formed by
the latissimus dorsi and the teres major
muscles
The axillary artery can be palpated in the
region

Axilla and Trunk

Figure 13.5

Arm
The cephalic vein is visible in muscular
individuals
It ends in the clavipectoral triangle, which is a
region bordered by the deltoid and pectoralis major
muscles and the clavicle

The basilic vein is evident along the medial side


of the arm
The brachial artery becomes subcutaneous
along the medial side of the arm and is clinically
important in the measurement of blood pressure

Arm
The biceps brachii becomes prominent
when the elbow is flexed
The cubital fossa is a depression on the
anterior elbow region
The median cubital vein resides in the
cubital fossa and is a source for
venipuncture
The triceps brachii forms the bulk of the
posterior brachium

Arm

Three bony prominences are present at the


distal end of the brachium:

1.
2.
3.

Lateral epicondyle of the humerus


Olecranon of the ulna
Medial epicondyle of the humerus

The ulnar nerve traverses posterior and


inferior to the medial epicondyle.

When we hit our funny bone, we are actually


compressing the ulnar nerve against the medial
epicondyle

Arm

Figure 13.6

Upper Limb

Figure 13.7

Forearm
The proximal portion of the forearm, the
antebrachium, is fleshy and contains the
muscle bellies that control hand and wrist
movements
The styloid process of the radius is easily
palpable as a lateral bump along the wrist
The head and styloid process of the ulna
form the medial prominence of the wrist

Forearm
The pulse of the radial artery can be
found between the tendons of the flexor
carpi radialis and the brachioradialis
The medial bump at the base of the hand
is the pisiform bone

Forearm and Hand

Figure 13.8

Hand
The hand has the following characteristics:
1.
2.
3.
4.
5.

Metacarpophalangeal (MP) joints


Proximal interphalangeal (PIP) joints
Distal interphalangeal (DIP) joints
Thenar eminence: At the base of the thumb
Hypothenar eminence: At the base of the
little finger

Wrist and Hand

Figure 13.9

Lower Limb Region


Many of the surface features of the lower
limb are important with respect to
locomotion
Divisions include:
1. Gluteal region
2. Thigh
3. Leg
4. Foot

Gluteal Region
Note the location of the sciatic nerve and
the proper placement of a gluteal
intramuscular injection in order to avoid
damage to the nerve

Gluteal Intramuscular Injection

Thigh
The femoral triangle is clinically important
because it contains the femoral artery, vein, and
nerve, and can be used as a pressure point for
controlling lower limb hemorrhage
It is bounded:
Superiorly by the inguinal ligament
Laterally by the sartorius muscle
Medially by the adductor longus muscle

Thigh
At the distal part of the anterior thigh,
three of the four quadriceps femoris
muscles can be palpated
The lateral and medial condyles of both
the femur and tibia can be palpated at
each knee

Thigh
On the posterior thigh, the distal tendinous
attachments of the hamstrings can be
palpated when the knee is flexed
These tendons help to form the superior
borders of the popliteal fossa, which is
the depression of the posterior knee

Thigh and Knee

Figure 13.10

Leg
The tibial tuberosity can be palpated on
the anterior surface just inferior to the
knee joint
The sharp anterior surface (shin) runs
almost the entire length of the tibia
At the distal end of the leg are the medial
malleolus and the lateral malleolus

Leg
The calcaneal tendon can be palpated on
the posteroinferior leg
The pulse of the posterior tibial artery
can be felt posteroinferior to the medial
malleolus of the tibia

Leg
The head of the fibula can be palpated at
the superior part of the lateral leg
The small saphenous vein is seen along
the lateral malleolus (look distally)
The great saphenous vein is seen
subcutaneously on the medial side of the
leg

Leg

Figure 13.11a

Leg

Figure 13.11b,c

Foot
On the dorsum of the foot one can palpate
the tendons for the extensor digitorum
longus
The foot has both a lateral and medial
longitudinal arch
Phalanges, metatarsalphalangeal
joints, PIP and DIP joints, and toenails
are easily observable

Ankle and Foot

Figure 13.12