surface anatomy 2013 final version

8/22/2019 Surface Anatomy 2013 Final Version

http://slidepdf.com/reader/full/surface-anatomy-2013-final-version 1/136

QuickTime™ and a decompressor

are needed to s ee this picture.



Surface Anatomy

QuickTime™ an d a

decompressor are needed to see this picture.



SURFACE ANATOMYprovides knowledge of what lies under the skin

and what structures are perceptible to touch

in the living body.

requires a thorough understanding of the

anatomy of the structures beneath the surface



the aim of this method is to visualize structuresthat give contour to the surface

SURFACE ANATOMY



SURFACE ANATOMY

physical examination is the clinical application ofsurface anatomy

INSPECTION

PALPATION

PERCUSSION

AUSCULTATION



QuickTime™ and a

decompressor are needed to s ee this picture.

SURFACE ANATOMY OF THE HEAD AND FACE



Surface Anatomy of the Head and Face

Neurocranial Portion PARIETAL

OCCIPITAL

TEMPORAL

MASTOIDAURICULAR

FRONTAL




FRONTAL REGION

region of the head

corresponding to the

outlines of the frontalbone




PARIETAL REGION

surface region of the head

corresponding to the

outlines of the parietalbone



TEMPORAL REGION


includes the lateral area

of the scalp and deeper

soft tissues overlying thetemporal fossa




TEMPORAL REGION

bounded by: temporal lines,

frontal and zygomatic bones,

zygomatic arch, infratemporalcrest




TEMPOROMANDIBULAR JOINT

modified hinge type of

synovial joint

allow the ff. movements:

close mouth

open mouth

protrude chinretrude chin

grinding and chewing



AURICULAR REGION


includes the ear which

consists of the external,

middle and internal parts



MASTOID REGIONconical prominence

projecting from the

undersurface of the

mastoid portion ofthe temporal bone

behind the external

acoustic meatus

lateral to the styloid

process

larger in the male


http://en.wikipedia.org/wiki/Mastoid_portion_of_the_temporal_bone


http://en.wikipedia.org/wiki/External_acoustic_meatus


http://en.wikipedia.org/wiki/Styloid_process_%28temporal%29











OCCIPITAL REGION

includes the external

occipital protuberance

Note: protuberance means

a bulge beyond the adjacent

surface

posterior aspect of the

cranium




Viscerocranial Portion

ORBITAL

PAROTID

ORAL

MENTAL

BUCCAL

ZYGOMATIC

INFRAORBITAL

NASAL




ORBITAL REGION

area of the face overlying

the orbit and eyeball

ORBIT EYEBALL

ORBITAL

REGION




ORBITAL REGIONEYEBROW

SUPRAORBITAL

MARGIN



GLABELLA


ORBITAL REGION




ORBITAL REGION

EYELIDmovable fold that covers

the eyeball

protects the eyeball from

injury and excessive light




EPICANTHAL FOLDORBITAL REGION

fold of skin that covers the

medial angle of the eye

note: canthi means angle

MEDIAL CANTHI

LATERAL CANTHI




SUPRAPALPEBRAL

SULCI

INFRAPALPEBRAL

SULCI

ORBITAL REGION

depressions superior and inferior to the eyelids

Note: sulcus means a shallow depression




INFRAORBITAL REGION

located below the orbit and lateral to the nose on

each side




ZYGOMATIC

BONE

ZYGOMATIC REGION

includes the zygomatic

bone

form the prominences

of the cheek

lie on the inferolateralsides of the orbits and

rests on the maxillae




PAROTID REGION

includes the parotid gland

and duct, the masseter

muscle

located at the posterolateral

part of the facial region

bounded by: zygomatic arch,

external ear, mandible and

masseter

PAROTIDGLAND

MASSETERMUSCLE




NASAL REGION

NASAL

REGION

includes the external nose

and nasal cavity




ROOT OF NOSE

OR BRIDGE

DORSUM OF

NOSE

APEX

NARES

ALA

NASAL REGION




ORAL REGION

ORAL

REGION

includes the oral cavity,

teeth, gingivae, tongue,

palate and palatinetonsils




LABIALCOMMISURE

MENTOLABIAL

SULCUS

PHILTRUM

TUBERCLE OF

UPPER LIP

LOWER LIP

VERMILLION

BORDER

NASOLABIAL

SULCUS

ORAL

FISSURE

ORAL REGION




BUCCAL REGION (CHEEKS)

CHEEK

bounded by: oral and mental

regions, zygomatic region,

parotid region and mandibleprincipal muscle include the

buccinators

BUCCINATOR




MENTAL REGION

region of the chin

includes the mental protuberance



QuickTime™ and a


Surface Anatomy of the Neck




HYOID BONE

THYROID

CARTILAGE

CRICOID

CARTILAGE

THYROID

GLAND

LARYNGEAL

PROMINENCE

SUPRACLAVICULAR

FOSSA




HYOID BONE

U Shaped

lies in the anterior part of

the neck




LARYNGEAL PROMINENCE

produced by the meeting

of the laminae of the

thyroid cartilage in the

anterior midline

palpable and visible




CRICOTHYROID LIGAMENT

inferior to the laryngeal

prominence

site for needle coniotomy

or cricothyrotomy




CRICOID CARTILAGE

can be felt inferior to the

laryngeal prominence




THYROID GLAND

apex of each lobe is at the

middle of the lamina of the

thyroid cartilage

Isthmus lies inferior to thecricoid cartilage




THYROID GLAND

can be palpated anteriorly or posteriorly



The neck is divided into 5 regions:

a. Sternocleidomastoid Region

b. Anterior Cervical Region

c. Lateral Cervical Region

d. Posterior Cervical Regione. Suboccipital Region




1. Sternocleidomastoid Region

-the key landmark is the

Sternocleidomastoid muscle

-contents:Sternocleidomastoid muscle

Superior part of the external jugular

vein

Greater auricular nerve

Transverse cervical nerve


Sternocleidomastoid Region




Sternocleidomastoid Region

Sternocleidomastoid Muscle



2. Anterior Cervical Region or Anterior Triangle of Neck

-bounded by: Median line of the neck

Anterior border of Sternocleidomastoid m.

Inferior border of Mandible-divided into 4 smaller Triangles:

a. Submental Triangle

b. Submandibular Trianglec. Carotid Triangle

d. Muscular Triangle





Anterior Cervical Region or Anterior Triangle of Neck



A. Submental Triangle

-bounded by:

Rt. and Lt. anterior bellies of

Digastric muscle

Body of Hyoid bone

Mandibular Symphysis

-contents:

Submental lymph nodes

Small veins forming the ant.

Jugular vein


Submental Triangle



Submental Triangle

Submental Lymph Nodes



B. Submandibular Triangle

-bounded by:

Inferior border of the Mandible

Anterior and posterior bellies of

the Digastric muscle

-contents:

Submandibular gland

Submandibular lymph node

Hypoglossal and mylohyoid

nerve

Parts of the facial artery and

vein


Submandibular

Triangle




Submandibular Triangle

Submandibular Gland

Submandibular Lymph

Nodes



C. Carotid Triangle

-bounded by:

Superior belly of the Omohyoid m.

Posterior belly of the Digastric m.

Anterior border of the SCM

-contents:

Common carotid artery

External carotid artery

Internal jugular vein

Thyroid gld., larynx, pharynx


CarotidTriangle




Carotid Triangle

Common Carotid Artery



D. Muscular Triangle

-bounded by:

Superior belly of the Omohyoid m.

Anterior border of the SCM

Median plane of the neck

-contents:

Sternothyroid m.

Sternohyoid m.

Thyroid and Parathyroid Glands


Muscular

Triangle



Muscular Triangle


Sternohyoid Muscle Sternothyroid Muscle



3.Lateral Cervical Region or Posterior Triangle of theNeck

-bounded by: Posterior border of the SCM

Anterior border of the Trapezius

Middle third of the Clavicle

-divided into 2 Triangles:

a. Occipital Triangle

b. Omoclavicular Triangle





Lateral Cervical Region or Posterior Triangle of the neck



a. Occipital Triangle

-bounded by:

Posterior border of the SCM

Anterior border of the Trapezius

Inferior belly of the Omohyoid

-contents:

Part of the external jugular vein

Spinal accessory nerve

Trunks of the brachial plexus

Cervical lymph nodes


OccipitalTriangle




Occipital Triangle

Trunks of Brachial Plexus

Spinal Accessory NerveCervical Lymph Nodes



b. Omoclavicular Triangle

-also known as Supraclavicular or

Subclavian Triangle

-bounded by:

Posterior border of the SCM

Inferior belly of Omohyoid m.

Clavicle

-contents:

3rd part of the Subclavian artery

Suprascapular artery

Supraclavicular lymph nodes


Omoclavicular

Triangle




Omoclavicular Triangle

Subclavian Artery

Suprascapular Artery

Supraclavicular Lymph Nodes



4. Posterior Cervical Region-This region is posterior to

the anterior borders of the

Trapezius muscle.

-The Trapezius definesthis region

Surface Anatomy of the NeckPosterior

CervicalRegion

Trapezius




5. Suboccipital Region

-Triangular area inferior to the

occipital region of the head

-bounded by:

Rectus capitis posterior major

Superior Oblique of head

Inferior Oblique of head

-contents:

Vertebral artery

Suboccipital nerve



Surface Anatomy of the Thorax




Breastmost prominent surface

feature of the anterior

thoracic wall

overlies the pectoralis

major and serratus

anterior muscles

nipple lies in the 4th ICS

in men and young

nulliparous women




attaches to the clavicle and

sternum and superior 6 costal

cartilages

the lower border of the

pectoralis major muscle

forms the anterior axillary fold

Pectoralis Major Muscle




attaches to the lateral parts

of the 1st to 8th ribs

helps elevate the ribs to

expand the thoracic cavity

when inspiration is deep

and forceful

Serratus Anterior Muscle




Clavicle

collar bones

palpable bony ridges at

the junction of the thoraxand neck

demarcate the zones of

lymphatic drainage




Sternum

lies in the anterior

median line

palpable throughout

its length




Suprasternal or Jugular Notchlarge, visible dip where the

clavicles join the sternum

palpable between themedial ends of the clavicle

http://en.wikipedia.org/wiki/Clavicles

http://en.wikipedia.org/wiki/Sternum


http://en.wikipedia.org/wiki/Clavicles




Suprasternal or Jugular Notch

lies opposite the inferior

border of the body of T2




Suprasternal or Jugular Notch




Manubrium

approximately 4 cm. long




Manubrium

lies at the level of the

bodies of T3 and T4




Manubrium

Left side

anterior to Arch of Aorta

Right side

overlies the merging

Brachiocephalic veins

that form the SuperiorVena Cava



angle made between themanubrium and the bodyof sternum

also known as theManubriosternal Joint

or the Angle of Louis


Sternal Angle

http://en.wikipedia.org/wiki/Manubrium



http://en.wikipedia.org/wiki/Manubrium




Sternal Angle

palpable and visible inyoung people

marks the level of the 2ndpair of costal cartilages

.

http://en.wikipedia.org/wiki/Costal_cartilage

http://en.wikipedia.org/wiki/Costal_cartilage




Sternal Angle

marks approximately thebeginning and end of theaortic arch and bifurcation of

the trachea into left and rightmain bronchi

lies at the level of T4-T5 IV disc



approximately 10 cm. long

Intermammary cleft overlies it


Body of the Sternum



Surface Anatomy of the ThoraxBody of the Sternum

lies anterior to the right

border of the heart

lies anterior to T5-T9

vertebrae



Surface Anatomy of the ThoraxXiphoid Process

lies in the epigastric

fossa

Xiphoid Process



Surface Anatomy of the ThoraxXiphisternal Joint

palpable ridge at the

level of the inferior

border of T9 vertebra




Manubrium

Body of Sternum

Xiphoid Process

Intermammary Cleft

Subcostal Angle



medial margin formed by

the costal cartilages of

the seventh rib to the

tenth rib

extend inferolaterally from

the xiphisternal joint

form the sides of theinfrasternal angle


Costal Margin

http://en.wikipedia.org/wiki/Tenth_rib

http://en.wikipedia.org/wiki/Tenth_rib



located at the inferior end

of the sternum

formed by the convergingcostal margins

used in cardiopulmonary

resuscitation


Infrasternal or subcostal Angle



provide a basis for

locating/describing the

position of structures or

sites of trauma

1st rib is not palpable,count starts with the

2nd rib


Ribs and Intercostal Spaces




Ribs and Intercostal Spaces

to identify a particular rib,

always identify the 2nd

costal cartilage then countthe cartilages and ribs

downward

useful during auscultation of

heart sounds




Visible Landmarks




Site of Apex Beat of the Heart

Palpable Landmarks



MIDSTERNAL

LINE

lies in the medianplane over the

sternum


Lines of Orientation



MIDCLAVICULA

RLINE

runs verticallydownward from the

midpoint of theclavicle





ANTERIOR

AXILLARY LINE

runs vertically alongthe anterior axillary

fold






MID-AXILLARY

LINEfrom the apex of

axillary fossa,parallel to the AAL

LINES OF ORIENTATION



POSTERIOR

AXILLARY LINE

runs along the posterioraxillary fold, parallel to

the AAL

Surface Anatomy of the ThoraxLINES OF ORIENTATION



Surface Anatomy of the ThoraxLINES OF ORIENTATION




Borders of the Heart




Superior

Border

Right

Border

InferiorBorder

Left

Border

Borders of the Heart




THE FOUR BORDERS AND APEXSuperior Border is formed by the Roots of the Great Vessels

Right Border is formed by the Right Atrium

Left Border is formed by the Left Ventricle

Inferior Border is formed by the Right Ventricle and Apical part of the

Left Ventricle

Apex formed by the Left Ventricle, corresponds to the apex beat at the

5th left ICS



Apex beat [Point of maximum impulse] =

4th or 5th ICS, Left MCL, 6-10 cm from AML


Apex Beat of the Heart

S f f



Tricuspid valve-lies

behind the right half of

the sternum, opposite

the 4th ICS;

Best heard: over the

right half of the lowerend of the body of the

sternum.


The Heart Sounds

S f A f h Th




Mitral Valve- behind the

left half of the sternum,

opposite the 4th costalcartilage

Best heard: Apex Beat.

THE HEART SOUNDS



Pulmonary Valve- lies

behind the medial end

of the 3rd left costalcartilage


medial end of the 2nd

left ICS.


THE HEART SOUNDS




Aortic Valve- lies

behind the left half

of the sternum,

opposite the 3rd ICS


medial end of the

2nd right ICS

THE HEART SOUNDS




THE HEART SOUNDS




The Lungs



QuickTime™ and a


Surface Anatomy of the Abdomen




UMBILICUS

LINEA

SEMILUNARIS

RECTUS

ABDOMINIS

TENDINOUS INTERSECTIONS

OF THE RECTUS ABDOMINIS

EPIGASTRIC

FOSSA

EXTERNAL

OBLIQUE

MUSCLE

LINEA ALBA

INGUINAL

LIGAMENT




ILIAC

CREST

ANTERIOR SUPERIOR

ILIAC SPINE




-LIVER: RIGHT LOBE

-GALLBLADDER

-STOMACH: PYLORUS

-DUODENUM: PARTS 1-3-PANCREAS: HEAD

-RIGHT SUPRARENAL GLAND

-RIGHT KIDNEY

-RIGHT COLIC FLEXURE

-ASCENDING COLON: SUPERIOR

PART

-TRANSVERSE COLON: RIGHT

HALF

RIGHT UPPER QUADRANT



-LIVER: LEFT LOBE

-SPLEEN

-STOMACH

-JEJUNUM, PROXIMAL ILEUM-PANCREAS: BODY AND TAIL

-LEFT KIDNEY

-LEFT SUPRARENAL GLAND

-LEFT COLIC FLEXURE

-TRANSVERSE COLON: LEFT HALF-DESCENDING COLON: SUPERIOR

PART

LEFT UPPER QUADRANT





-CECUM

-VERMIFORM APPENDIX

-MOST OF ILEUM

-ASCENDING COLON: INF. PART

-RIGHT OVARY-RIGHT UTERINE TUBE

-RIGHT URETER: ABDOMINAL

PART

-RIGHT SPERMATIC CORD:

ABDOMINAL PARTUTERUS (IF ENLARGED)

URINARY BLADDER ( IF VERY FULL)

RIGHT LOWER QUADRANT




-SIGMOID COLON

-DESCENDING COLON:INF. PART

-LEFT OVARY

-LEFT UTERINE TUBE

-LEFT URETER: ABDOMINALPART

UTERUS (IF ENLARGED)

URINARY BLADDER (IF VERY FULL)

LEFT LOWER QUADRANT

S f A t f th Abd



QuickTime™ and a


Surface Anatomy of the Back





S f A t f th B k




Vertebral Column

S f A t f th B k



C1 has no spinous process

C2 spinous process is the first

bony point that can be felt

Spinous processes of C3-C5

may be felt in the nuchal

groove but not easily palpable

Spinous process of C6 is easilyfelt


Cervical Vertebrae

S f A t f th B k



Cervical Vertebrae

seventh cervical

vertebra

most distinctivecharacteristic

existence of a long

and prominent spinous

process

palpable from the skin

surface


S f A t f th B k

http://en.wikipedia.org/wiki/Cervical_vertebra






C7 Spinous process is

usually evident

superficially and when

standing erect this is the

only spinous process

visible thus it is called

vertebra prominens.


Vertebraprominens

Cervical Vertebrae

S f A t f th B k




Thoracic Vertebrae

spinous process of T1

may be more prominent

the short 12th rib can be

used to confirm the

identity of T12 spinous

process




when the trunk is

flexed it is easily seen

and palpated

the L2 spinous process

provides an estimate

on the position of the

inferior end of thespinal cord


Spinous

Process

of Lumbar

Vertebrae

Lumbar Vertebrae





horizontal line

joining the high

points of the iliac

crests passes thruthe L4 spinous

process and L4-L5

intervertebral discs

(useful for lumbar

puncture).

Horizontal line joining thehigh points of the iliac

crests

(SUPRACRISTAL PLANE)

Lumbar Vertebrae





Lumbar Vertebrae





Dimples

(Posterior Superior Iliac

Spine)

skin dimples are formed

by the attachment of

skin and fascia to the

posterior superior iliac

spines.

S2 spinous process lies

at the middle of these

dimples.

indicates the inferior

extent of the subarachnoid

space

Sacrum





SACRAL

TRIANGLE

formed by the lines

joining the two posterior

superior iliac spines and

the superior part of theintergluteal cleft

the sacral triangle

outlines the sacrum

common area of pain

from low back sprains

Sacrum





Sacrum





Coccyx

can be palpated in the

intergluteal cleft

examined with a gloved

finger in the anal canal



References:

1. Clinically Oriented Anatomy

by Keith Moore

2. Clinical Anatomy

by Richard Snell

3. The Wonderful World

Wide Web

by Dr. Google



5x8 Index Card

Picture

Name

Cel no.

Pre med course

Pre med school

Transfer student/ Med school

back



back• Lecture grades

• Module Score

1

2 3

4

Lab gradesModule Score

1

2 3

4

surface anatomy 2013 final version

Documents