Contents

D The body Component parts

Bones 56
56

Muscles 57
What is anatomy? 2 Vertebra l ca nal 59
How can gross anatomy be studied? 2 Spinal nerves 60
Important anatomical terms 2 Relationship to other regions 61
Head 6 1
Imaging 5
Thorax, abdomen, and pelvis 62
Diagnostic imaging techniques 5
Limbs 62
Nuclear medicine imaging 8
Key features 62

I mage interpretation 10 Long vertebra l col u m n and short spinal cord 62

I ntervertebral foramina and spinal nerves 63
Plain radiography 10
I n nervation of the back 63
Computed tomography 10
Magnetic resonance imaging 11 Regional anatomy 64
Nuclear medicine imaging 11 Skeletal framework 64
Vertebrae 64
Safety in imaging 11 I ntervertebral fora min a 72
Posterior spaces between vertebral a rches 73
Body systems 12
Joints 77
Skeletal system 12
Joints between vertebrae in the back 77
Carti lage 1 2
Ligaments 80
Bone 1 3
Joints 1 8 Anterior and posterior longitudinal ligaments 80
Ligamenta tlava 80
Skin and fascias 24
Supraspinous liga ment and liga mentum nuchae 81
Skin 24
I nterspinous liga ments 82
Fascia 24
Back musculature 84
Muscular system 25
Su perficial g ro u p of back m u scles 84
Cardiovascular system 27
I ntermediate g ro u p of back muscles 90
Lymphatic system 29 Deep g ro u p of back muscles 92
Lym phatic vessels 29 Su boccipita l muscles 97
Lymph nodes 30 Spinal cord 99
Lym phatic tru n ks and d u cts 30 Vascu latu re 1 00
Nervous system 31 Meninges 1 03
Central nervous system 3 1 Arrangement of structu res in the vertebra l
Fu nctional su bdivisions of the CNS 32 c a n a l 1 04
Somatic part o f the nervous system 33 Spinal nerves 1 06
Visceral part of the nervous system 38
Other systems 48
Surface anatomy 111
Back surface anatomy 111
Clinical case SO Absence of lateral curvatures 111
Primary and secondary curvatures in the sagittal

IJ Back
plane 112
Useful non vertebral skeletal landmarks 112
How to identify specific vertebral spinous
Conceptual overview 53 processes 114
General description 53
Visualizing the inferior ends of the spinal cord and
Functions 54 subarachnoid space 115
Su pport 54
Identifying major muscles 116
Movement 54
Protection of the nervous system 55 Clinica l cases 118
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IJ Thorax How to count ribs 231

Surface anatomy of the breast in women 232
Visualizing structures at the TIVN vertebral
Conceptual overview 123
level 232
General description 123
Visualizing structures in the superior
Functions 124
mediastinum 234
Breathing 1 24
Visualizing the margins of the heart 235
Protection of vita l organs 1 24
Cond uit 1 24 Where to listen for heart sounds 236

Component parts 124 Visualizing the pleural cavities and lungs, pleural
Thoracic wa l l 1 24 recesses, and lung lobes and fissures 236
Superior thoracic aperture 1 26 Where to listen for lung sounds 238
I nferior thoracic aperture 1 26
Diaphragm 1 27 Clinical cases 241
Mediasti n u m 1 28
Pleural cavities 1 28
Relationship to other regions 130 IJ Abdomen
Neck 1 30
U pper l i m b 1 30 Conceptual overview 255
Abdomen 1 30 General description 255
Breast 1 3 1 Functions 256
Key features 132 Houses and protects major viscera 256
Vertebra l level TIVN 1 32 Breath ing 258
Venous shu nts from left to right 1 32 Changes in intraa bdominal pressure 258
Seg menta l neu rovascular supply of thoracic Component parts 259
wa l l 1 34 Wa l l 259
Sym pathetic system 1 36 Abdominal cavity 260
Flexible wa l l and i nferior thoracic aperture 1 36 I nferior thoracic aperture 262
I n nervation of the diaphra g m 1 38 Diaphragm 262
Regional anatomy 139 Pelvic i n let 263
Relationship to other regions 263
Pectoral region 139
Breast 1 39 Thorax 263
Muscles of the pectora l reg ion 1 42 Pelvis 263
Lower l i m b 264
Thoracic wall 143
Key features 265
Skeleta l fra mework 1 43
I ntercosta l spaces 1 50 Arrangement of abdom inal viscera in the adult 265
Skin and muscles of the a nterior and latera l
Diaphragm 161
abdom inal wa l l and thoracic i ntercosta l
Arteria l su pply 1 62
nerves 268
Venous d rainage 1 62
The g roin is a weak a rea in the a nterior abdominal
I n nervation 1 62
wa l l 269
Movements of the thoracic wall and diaphragm
Vertebra l level Ll 271
during breathing 162
The gastroi ntestinal system and its derivatives a re
Pleural cavities 162 su ppl ied by th ree major a rteries 271
Pleura 1 63 Venous shu nts from left to right 273
Lungs 1 67 All venous d rainage from the gastroi ntestinal system
Mediastinum 180 passes throug h the liver 274
Middle mediasti n u m 1 80 Abdominal viscera a re supplied by a large
Superior mediasti n u m 2 1 0 prevertebra l plexus 276
Posterior mediasti n u m 222
Anterior mediasti n u m 230 Regional anatomy 277
Surface topography 277
Surface anatomy 231 Fou r-q uadra nt pattern 277
Thorax surface anatomy 231 Nine-reg ion pattern 278
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Abdominal wall 280 Component parts 426

Su perficial fascia 280 Pelvic inlet 426
Anterolatera l muscles 282 Pelvic wa l l s 426
Extra peritoneal fascia 288 Pelvic outlet 428
Peritoneum 288 Pelvic floor 429
I n nervation 289 Pelvic cavity 429
Arterial supply and venous d rainage 291 Perineum 430
Lym phatic d rainage 292 Relationship to other regions 432
Groin 292 Abdomen 432
I n g u i n a l canal 294 Lower l i m b 433
I n g u i n a l hernias 299 Key features 434
Abdominal viscera 303 The pelvic cavity projects posteriorly 434
Peritoneum 303 I m porta nt structu res cross the u reters in the pelvic
Peritoneal cavity 304 cavity 435
Organs 3 1 0 The prostate i n men and the uterus in women a re
Arterial supply 343 a nterior to the rectum 436
Venous drainage 354 The peri neum is innervated by sacral spinal cord
Lymphatics 358 seg ments 436
I n nervation 358 Nerves a re related to bone 437
Posterior abdominal region 366 Parasympathetic innervation from spinal cord levels
Posterior abdominal wa l l 367 52 to 54 controls erection 438
Viscera 373 Muscles and fascia of the pelvic floor and perineum
Vasculature 387 i ntersect at the peri neal body 439
Lym phatic system 392 The course of the u rethra is d ifferent in men and
Nervous system in the posterior abdominal women 440
reg ion 394
Regional anatomy 441
Sym pathetic tru n ks and splanchnic nerves 394
Pelvis 441
Surface anatomy 402 Bones 44 1
Abdomen surface anatomy 402 Joints 446
Defining the surface projection of the abdomen 402
Orientation 448
Differences between men and women 448
How to find the superficial inguinal ring 403
True pelvis 449
How to determine lumbar vertebra/ levels 404
Viscera 460
Visualizing structures at the Ll vertebral /eve/ 405 Fascia 48 1
Visualizing the position of major blood vessels 406 Peritoneum 481
Using abdominal quadrants to locate major Nerves 486
viscera 407 Blood vessels 495
Defining surface regions to which pain from the gut is
Lymphatics 5 0 1
referred 408 Perineum 502

Where to find the kidneys 409

Borders and ceilin g 502
Ischia-anal fossae and their a nterior recesses 504
Where to find the spleen 409
Anal triangle 504
Clinical cases 410 U rogen ita l tria ngle 506
Somatic nerves 5 1 3

IJ Pelvis and perineum

Viscera l nerves 5 1 5
Blood vessels 5 1 6
Veins 5 1 6
Conceptual overview 423 Lymphatics 5 1 9

General description 423 Surface anatomy 520

Functions 423 Surface anatomy of the pelvis and perineum 520
Conta i n and su pport bladder, rectum, anal canal, and Orientation of the pelvis and perineum in the
reprod uctive tracts 423 anatomical position 520
Anchors the roots of the external genita lia 425
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How to define the margins of the perineum 520 Nerves 603

Identification of structures in the anal triangle 522 Knee joint 606
Tibiofi b u l a r joint 6 1 6
Identification of structures in the urogenital triangle
of women 523
Popl itea l fossa 6 1 6
Leg 618
Identification of structures in the urogenital triangle
Bones 6 1 8
of men 524
Joi nts 620
Clinical cases 527 Posterior compartment of leg 621
Lateral compartment of leg 628
Anterior compartment of leg 630
Foot 633

rl Lower limb
Bones 634
Joi nts 638
Ta rsal tunnel, reti nacula, and arrangement of major
Conceptual overview 535 structu res at the a n kle 646
General introduction 535 Arches of the foot 648
Pla nta r a poneurosis 649
Function 537
Fi brous sheaths of toes 649
Su pport the body weight 537
Extensor hoods 650
Locomotion 537
I ntrinsic muscles 650
Component parts 539
Arteries 657
Bones and joi nts 539
Vei ns 659
Muscles S43
Nerves 659
Relationship to other regions 545
Abdomen 545 Surface anatomy 663
Pelvis 545 Lower limb surface anatomy 663
Perineum 545 A voiding the sciatic nerve 663
Key points 545 Finding the femoral artery in the femoral
I n nervation is by l u m ba r and sacra l spinal triangle 664
nerves 545
Identifying structures around the knee 664
Nerves related to bone 550
Visualizing the contents of the popliteal fossa 666
Su perficial vei ns 550
Finding the tarsal tunnel-the gateway to the
Regional anatomy 551 foot 667
Bony pelvis 5 5 1 Identifying tendons around the ankle and in the
Proxi mal fem u r 554 foot 668
Hip joint 558
Finding the dorsalis pedis artery 669
Gateways to the lower limb 562
Approximating the position of the plantar arterial
Nerves 563
arch 669
Arteries 566
Vei ns 568 Major superficial veins 670

Lymphatics 570 Pulse points 671

Deep fascia and the saphenous opening 571
Femora l triangle 572
Clinical cases 672
Gluteal region 574
Muscles 574

II
Nerves 579
Arteries 582
Veins 583
Lymphatics 583 Conceptual overview 685
Thigh 583 General description 685
Bones 584 Functions 686
Muscles 589 Positioning the hand 686
Arteries 600 The hand as a mechanical tool 689
Vei ns 603 The hand as a sensory tool 689
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Component parts 690 Carpa l tunnel and structures at the wrist 798
Bones and joi nts 690 Pa l m a r a poneurosis 800
Muscles 692 Pa l m a ris brevis 800
Relationship to other regions 693 Anatomical sn uffbox 800
Neck 693 Fibrous digital sheaths 801
Back and thoracic wa l l 694 Extensor hoods 802
Key points 695
Muscles 804
I n nervation by cervical and upper thoracic Arteries and vei ns 8 1 0
nerves 695 Nerves 8 1 4
Nerves related to bone 699 Surface anatomy 819
Su perficial vei ns 700
Upper limb surface anatomy 819
Orientation of the t hum b 701
Bony landmarks and muscles of the posterior
Regional anatomy 702 scapular region 819
Shoulder 702 Visualizing the axilla and locating contents and
Bones 702 related structures 820
Joints 705 Locating the brachial artery in the arm 821
Muscles 7 1 3 The triceps brachii tendon and position of the radial
Posterior scapular region 776 nerve 822
Muscles 7 1 7 Cubital fossa (an terior view) 822
Gateways to the posterior sca pular reg ion 71 7
Identifying tendons and locating major vessels and
Nerves 7 1 9
nerves in the distal forearm 824
Arteries and vei ns 7 1 9
Normal appearance of the hand 825
Axilla 721
Position of the flexor retinaculum and the recurrent
Axi l l a ry inlet 723
branch of the median nerve 826
Anterior wa l l 723
Medial wa l l 726 Motor function of the median and ulnar nerves in the
Latera l wa l l 727 hand 826
Posterior wa l l 728 Visualizing the positions of the superficial and deep
Gateways i n the posterior wa l l 730 palmar arches 827
Floor 73 1 Pulse points 827
Contents of the axi l l a 73 1
Arm 750
Clinical cases 829
Bones 75 1
Muscles 754
Arteries and veins 756
Nerves 760
Elbow joint 764 B Head and neck
Cubital fossa 768
Forearm 717
Conceptual overview 837
Bones 773 General description 837

Joints 774 Head 837

Neck 839
Anterior compartment of the forearm 776
Muscles 776 Functions 841

Arteries and vei ns 782 Protection 841

Nerves 784 Contains u pper parts of respi ratory and digestive
tracts 841
Posterior compartment of the forearm 785
Com m u n ication 841
Muscles 785
Positioning the head 841
Arteries and vei ns 791
Connects the u pper and lower respi ratory and
Nerves 792
digestive tracts 841
Hand 792
Component parts 842
Bones 793
Sku l l 842
Joints 795
Cervical vertebrae 844
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Hyoid bone 845 Vessels 91 6

Soft palate 846 Scalp 922
Muscles 846 Layers 922
Relationship to other regions 847 Innervation 924
Thorax 847 Vessels 925
U p per l i m bs 847 Lymphatic d rainage 926
Key features 848 Orbit 927
Vertebra l levels C I I I/IV and CVNI 848 Bony orbit 927
Ai rway in the neck 849 Eyelids 928
Cranial nerves 850 Lacri m a l apparatus 932
Cervical nerves 85 1 Sensory i n nervation 933
Fu nctional separation of the digestive and respi ratory Fissures and fora mina 934
passages 85 1 Fascia l specia l izations 935
Triang les of the neck 854 Muscles 936
Regional anatomy 855 Vessels 941
Skull 855
I n nervation 942
Anterior view 855 Eyeba l l 947
Latera l view 857 Ear 953
Posterior view 859 External ear 954
Su perior view 860 Middle ear 958
I nferior view 860 I nternal ear 965
Cranial cavity 864 Temporal and infratemporal fossae 972
Roof 864 Bony fra mework 973
Floor 865 Tem poromandibular joi nts 975
Meninges 873
Masseter muscle 977
Cra n i a l d u ra mater 873 Tem pora l fossa 978
Arachnoid mater 876 Infratem poral fossa 981
Pia mater 877 Pterygopalatine fossa 992
Arrangement of meninges and spaces 877 Skeleta l fra mework 993
Brain and its blood supply 879
Gateways 994
Bra i n 879 Contents 994
Blood su pply 879 Neck 1000
Venous d rainage 886 Fascia 1 000
Cranial nerves 894
Superficial venous d rainage 1 003
Olfactory nerve [I] 896 Anterior tria ngle of the neck 1 006
Optic nerve [II] 896 Posterior tria ngle of the neck 1 023
Ocu lomotor nerve [ I l l] 897 Root of the neck 1 030
Troch lear nerve [IV] 897 Pharynx 1040
Trigeminal nerve M 898 Skeleta l fra mework 1 04 1
Ophthalmic nerve [V,] 898 Pharyngeal wa l l 1 042
Maxi l l a ry nerve [V2] 898 Fascia 1 045
Mandibular nerve [V3] 898 Gaps in the pharyngea l wa l l and structu res passing
Abducent nerve [VI] 898 through them 1 046
Facial nerve [VI I] 898 Nasopharynx 1 046
Vesti bu lococh lear nerve [VI I I] 899 Oropharynx 1 048
G l ossopharyngea l nerve [IX] 899 La ryngopharynx 1 048
Vagus nerve [X] 900 Tonsils 1 048
Accessory nerve [XI] 900 Vessels 1 049
Hypog lossal nerve [XI I] 900 Nerves 1 05 1
Face 904 Larynx 1052
Muscles 904 La ryngeal cartilages 1 053
Pa rotid gland 9 1 1 Extrinsic liga ments 1 056
I n nervation 9 1 4 I ntrinsic liga ments 1 05 7
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La ryngeal joi nts 1 058 Roof-palate 1 1 OS

Cavity of the larynx 1 059 Ora l fissure and l i ps 1 1 1 3
I ntrinsic m u scles 1 06 1 Oropharyngea l isthmus 1 1 1 4
Fu nction o f t h e l a rynx 1 064 Teeth and ging ivae 1 1 1 4
Vessels 1 066
Nerves 1 068 Surface anatomy 1120
Head and neck surface anatomy 1120
Nasal cavities 1069
Lateral wa l l 1 070 Anatomical position of the head and major
Reg ions 1 07 1 landmarks 1120
I n nervation a n d blood sup ply 1 072 Visualizing structures at the C/11/C/V and CVI vertebral
Skeleta l fra mework 1 072 levels 1121
External nose 1 074 How to outline the an terior and posterior triangles of
Paranasal sin uses 1 074 the neck 1122
Wa l l s, floor, and roof 1 076 How to locate the cricothyroid ligament 1123
Nares 1 080
How to find the thyroid gland 1124
Choanae 1 08 1
Estimating the position of the middle meningeal
Gateways 1 082
artery 1124
Vessels 1 082
I n nervation 1 085 Major features of the face 1125

Oral cavity 1087 The eye and lacrimal apparatus 1126

M u ltiple nerves innervate the oral cavity 1 088 External ear 1127
Skeleta l fra mework 1 088 Pulse points 1128
Wa lls: the cheeks 1 09 1
Floor 1 092 Clinica l cases 1129
Tongue 1 095
Sal ivary g l a nds 1 1 02

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