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Surface Anatomy

SURFACE ANATOMY
provides 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

SURFACE ANATOMY
the aim of this method is to visualize structures that give contour to the surface

SURFACE ANATOMY
physical examination is the clinical application of surface anatomy
PALPATION

INSPECTION AUSCULTATION

PERCUSSION

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SURFACE ANATOMY OF THE HEAD AND FACE

Surface Anatomy of the Head and Face Neurocranial Portion

FRONTAL

PARIETAL

OCCIPITAL

TEMPORAL

AURICULAR

MASTOID

Surface Anatomy of the Head and Face FRONTAL REGION

region of the head corresponding to the outlines of the frontal bone

Surface Anatomy of the Head and Face PARIETAL REGION

surface region of the head corresponding to the outlines of the parietal bone

Surface Anatomy of the Head and Face TEMPORAL REGION

includes the lateral area of the scalp and deeper soft tissues overlying the temporal fossa

Surface Anatomy of the Head and Face TEMPORAL REGION

bounded by: temporal lines, frontal and zygomatic bones, zygomatic arch, infratemporal crest

Surface Anatomy of the Head and Face TEMPOROMANDIBULAR JOINT modified hinge type of synovial joint

allow the ff. movements: close mouth open mouth protrude chin retrude chin grinding and chewing

Surface Anatomy of the Head and Face AURICULAR REGION includes the ear which consists of the external, middle and internal parts

Surface Anatomy of the Head and Face MASTOID REGION

conical prominence projecting from the undersurface of the mastoid portion of the temporal bone
behind the external acoustic meatus lateral to the styloid process larger in the male

Surface Anatomy of the Head and Face OCCIPITAL REGION posterior aspect of the cranium

includes the external occipital protuberance

Note: protuberance means a bulge beyond the adjacent surface

Surface Anatomy of the Head and Face Viscerocranial Portion

INFRAORBITAL ORBITAL

ZYGOMATIC

NASAL
PAROTID

BUCCAL ORAL MENTAL

Surface Anatomy of the Head and Face ORBITAL REGION

area of the face overlying the orbit and eyeball

ORBIT EYEBALL

ORBITAL REGION

Surface Anatomy of the Head and Face ORBITAL REGION

EYEBROW SUPRAORBITAL MARGIN

Surface Anatomy of the Head and Face ORBITAL REGION

GLABELLA

Surface Anatomy of the Head and Face ORBITAL REGION movable fold that covers the eyeball
EYELID

protects the eyeball from injury and excessive light

Surface Anatomy of the Head and Face ORBITAL REGION fold of skin that covers the medial angle of the eye note: canthi means angle

EPICANTHAL FOLD

MEDIAL CANTHI
LATERAL CANTHI

Surface Anatomy of the Head and Face ORBITAL REGION

SUPRAPALPEBRAL SULCI INFRAPALPEBRAL SULCI

depressions superior and inferior to the eyelids

Note: sulcus means a shallow depression

Surface Anatomy of the Head and Face INFRAORBITAL REGION located below the orbit and lateral to the nose on each side

Surface Anatomy of the Head and Face ZYGOMATIC REGION includes the zygomatic bone

form the prominences of the cheek

lie on the inferolateral sides of the orbits and rests on the maxillae
ZYGOMATIC BONE

Surface Anatomy of the Head and Face PAROTID REGION PAROTID

GLAND

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

MASSETER MUSCLE

Surface Anatomy of the Head and Face NASAL REGION includes the external nose and nasal cavity
NASAL REGION

Surface Anatomy of the Head and Face NASAL REGION

ROOT OF NOSE OR BRIDGE DORSUM OF NOSE

ALA

APEX NARES

Surface Anatomy of the Head and Face ORAL REGION includes the oral cavity, teeth, gingivae, tongue, palate and palatine tonsils
ORAL REGION

Surface Anatomy of the Head and Face ORAL REGION

NASOLABIAL SULCUS

ORAL FISSURE
PHILTRUM

LABIAL COMMISURE MENTOLABIAL SULCUS

TUBERCLE OF UPPER LIP

LOWER LIP VERMILLION BORDER

Surface Anatomy of the Head and Face BUCCAL REGION (CHEEKS)

bounded by: oral and mental regions, zygomatic region, parotid region and mandible principal muscle include the buccinators

BUCCINATOR

CHEEK

Surface Anatomy of the Head and Face MENTAL REGION

region of the chin includes the mental protuberance

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Surface Anatomy of the Neck

Surface Anatomy of the Neck

LARYNGEAL PROMINENCE

HYOID BONE THYROID CARTILAGE CRICOID CARTILAGE

SUPRACLAVICULAR FOSSA

THYROID GLAND

Surface Anatomy of the Neck HYOID BONE

U Shaped lies in the anterior part of the neck

Surface Anatomy of the Neck LARYNGEAL PROMINENCE

produced by the meeting of the laminae of the thyroid cartilage in the anterior midline palpable and visible

Surface Anatomy of the Neck CRICOTHYROID LIGAMENT

inferior to the laryngeal prominence site for needle coniotomy or cricothyrotomy

Surface Anatomy of the Neck CRICOID CARTILAGE

can be felt inferior to the laryngeal prominence

Surface Anatomy of the Neck THYROID GLAND

apex of each lobe is at the middle of the lamina of the thyroid cartilage Isthmus lies inferior to the cricoid cartilage

Surface Anatomy of the Neck THYROID GLAND

can be palpated anteriorly or posteriorly

Surface Anatomy of the Neck

The neck is divided into 5 regions:

a. Sternocleidomastoid Region
b. Anterior Cervical Region c. Lateral Cervical Region d. Posterior Cervical Region e. Suboccipital Region

Surface Anatomy of the Neck

1. Sternocleidomastoid Region
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

Surface Anatomy of the Neck

Sternocleidomastoid Region

Sternocleidomastoid Muscle

Surface Anatomy of the Neck

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 Triangle c. Carotid Triangle d. Muscular Triangle

Surface Anatomy of the Neck

Anterior Cervical Region or Anterior Triangle of Neck

Surface Anatomy of the 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

Surface Anatomy of the Neck

B. Submandibular Triangle -bounded by: Inferior border of the Mandible Anterior and posterior bellies of the Digastric muscle -contents: Submandibular Triangle

Submandibular gland
Submandibular lymph node Hypoglossal and mylohyoid nerve Parts of the facial artery and vein

Surface Anatomy of the Neck

Submandibular Triangle

Submandibular Gland

Submandibular Lymph Nodes

Surface Anatomy of the Neck

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 Carotid Triangle

Surface Anatomy of the Neck

Carotid Triangle

Common Carotid Artery

Surface Anatomy of the Neck

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

Surface Anatomy of the Neck

Muscular Triangle

Sternohyoid Muscle

Sternothyroid Muscle

Surface Anatomy of the Neck

3.Lateral Cervical Region or Posterior Triangle of the Neck -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

Surface Anatomy of the Neck

Lateral Cervical Region or Posterior Triangle of the neck

Surface Anatomy of the Neck

a. Occipital Triangle
-bounded by: Posterior border of the SCM Occipital Triangle

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

Surface Anatomy of the Neck

Occipital Triangle

Trunks of Brachial Plexus Cervical Lymph Nodes Spinal Accessory Nerve

Surface Anatomy of the Neck

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

Surface Anatomy of the Neck

Omoclavicular Triangle

Suprascapular Artery

Supraclavicular Lymph Nodes

Subclavian Artery

Surface Anatomy of the Neck

4. Posterior Cervical Region -This region is posterior to the anterior borders of the Trapezius muscle. -The Trapezius defines this region
Posterior Cervical Region

Trapezius

Surface Anatomy of the Neck

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

Surface Anatomy of the Thorax Breast most 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

Surface Anatomy of the Thorax Pectoralis Major Muscle

attaches to the clavicle and sternum and superior 6 costal cartilages the lower border of the pectoralis major muscle forms the anterior axillary fold

Surface Anatomy of the Thorax Serratus Anterior 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

Surface Anatomy of the Thorax

Surface Anatomy of the Thorax

Surface Anatomy of the Thorax Clavicle collar bones palpable bony ridges at the junction of the thorax and neck demarcate the zones of lymphatic drainage

Surface Anatomy of the Thorax Sternum lies in the anterior median line

palpable throughout its length

Surface Anatomy of the Thorax Suprasternal or Jugular Notch

large, visible dip where the clavicles join the sternum

palpable between the medial ends of the clavicle

Surface Anatomy of the Thorax Suprasternal or Jugular Notch

lies opposite the inferior border of the body of T2

Surface Anatomy of the Thorax Suprasternal or Jugular Notch

Surface Anatomy of the Thorax Manubrium approximately 4 cm. long

Surface Anatomy of the Thorax Manubrium

lies at the level of the bodies of T3 and T4

Surface Anatomy of the Thorax Manubrium

Left side anterior to Arch of Aorta Right side overlies the merging Brachiocephalic veins that form the Superior Vena Cava

Surface Anatomy of the Thorax Sternal Angle

angle made between the manubrium and the body of sternum

also known as the Manubriosternal Joint or the Angle of Louis

Surface Anatomy of the Thorax Sternal Angle palpable and visible in young people

marks the level of the 2nd pair of costal cartilages

.

Surface Anatomy of the Thorax Sternal Angle

marks approximately the beginning and end of the aortic arch and bifurcation the trachea into left and right main bronchi
lies at the level of T4-T5 IV disc

of

Surface Anatomy of the Thorax Body of the Sternum approximately 10 cm. long Intermammary cleft overlies it

Surface Anatomy of the Thorax Body of the Sternum lies anterior to the right border of the heart lies anterior to T5-T9 vertebrae

Surface Anatomy of the Thorax Xiphoid Process

lies in the epigastric fossa

Xiphoid Process

Surface Anatomy of the Thorax Xiphisternal Joint

palpable ridge at the level of the inferior border of T9 vertebra

Surface Anatomy of the Thorax

Intermammary Cleft Body of Sternum

Manubrium

Xiphoid Process

Subcostal Angle

Surface Anatomy of the Thorax Costal Margin 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 the infrasternal angle

Surface Anatomy of the Thorax Infrasternal or subcostal Angle located at the inferior end of the sternum formed by the converging costal margins

used in cardiopulmonary resuscitation

Surface Anatomy of the Thorax Ribs and Intercostal Spaces 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

Surface Anatomy of the Thorax Ribs and Intercostal Spaces to identify a particular rib, always identify the 2nd costal cartilage then count the cartilages and ribs downward useful during auscultation of heart sounds

Surface Anatomy of the Thorax Visible Landmarks

Surface Anatomy of the Thorax Palpable Landmarks

Site of Apex Beat of the Heart

Surface Anatomy of the Thorax

Lines of Orientation

MIDSTERNAL LINE
lies in the median plane over the sternum

Surface Anatomy of the Thorax

Lines of Orientation

MIDCLAVICULA RLINE
runs vertically downward from the midpoint of the clavicle

Surface Anatomy of the Thorax Lines of Orientation

ANTERIOR AXILLARY LINE

runs vertically along the anterior axillary fold

Surface Anatomy of the Thorax LINES OF ORIENTATION

MID-AXILLARY LINE
from the apex of axillary fossa, parallel to the AAL

Surface Anatomy of the Thorax

LINES OF ORIENTATION

POSTERIOR AXILLARY LINE

runs along the posterior axillary fold, parallel to the AAL

Surface Anatomy of the Thorax

LINES OF ORIENTATION

Surface Anatomy of the Thorax

Surface Anatomy of the Thorax Borders of the Heart

Surface Anatomy of the Thorax Borders of the Heart

Superior Border Right Border Left Border

Inferior Border

Surface Anatomy of the Thorax

THE FOUR BORDERS AND APEX
Superior 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

Surface Anatomy of the Thorax Apex Beat of the Heart

Apex beat [Point of maximum impulse] =

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

Surface Anatomy of the Thorax The Heart Sounds

Tricuspid valve-lies behind the right half of the sternum, opposite the 4th ICS; Best heard: over the right half of the lower end of the body of the sternum.

Surface Anatomy of the Thorax

THE HEART SOUNDS

Mitral Valve- behind the left half of the sternum, opposite the 4th costal cartilage Best heard: Apex Beat.

Surface Anatomy of the Thorax

THE HEART SOUNDS

Pulmonary Valve- lies behind the medial end of the 3rd left costal cartilage Best heard: over the medial end of the 2nd left ICS.

Surface Anatomy of the Thorax

THE HEART SOUNDS

Aortic Valve- lies behind the left half of the sternum, opposite the 3rd ICS
Best heard: over the medial end of the 2nd right ICS

Surface Anatomy of the Thorax

THE HEART SOUNDS

Surface Anatomy of the Thorax The Lungs

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Surface Anatomy of the Abdomen

Surface Anatomy of the Abdomen

TENDINOUS INTERSECTIONS OF THE RECTUS ABDOMINIS EPIGASTRIC FOSSA

LINEA SEMILUNARIS
EXTERNAL OBLIQUE MUSCLE INGUINAL LIGAMENT

LINEA ALBA RECTUS ABDOMINIS

UMBILICUS

Surface Anatomy of the Abdomen

ANTERIOR SUPERIOR ILIAC SPINE
ILIAC CREST

Surface Anatomy of the Abdomen

Surface Anatomy of the Abdomen

Surface Anatomy of the Abdomen

RIGHT UPPER QUADRANT
-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

Surface Anatomy of the Abdomen

LEFT 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

Surface Anatomy of the Abdomen

RIGHT LOWER QUADRANT

-CECUM -VERMIFORM APPENDIX -MOST OF ILEUM -ASCENDING COLON: INF. PART -RIGHT OVARY -RIGHT UTERINE TUBE -RIGHT URETER: ABDOMINAL PART -RIGHT SPERMATIC CORD: ABDOMINAL PART UTERUS (IF ENLARGED) URINARY BLADDER ( IF VERY FULL)

Surface Anatomy of the Abdomen

LEFT LOWER QUADRANT
-SIGMOID COLON

-DESCENDING COLON:INF. PART -LEFT OVARY -LEFT UTERINE TUBE -LEFT URETER: ABDOMINAL PART UTERUS (IF ENLARGED) URINARY BLADDER (IF VERY FULL)

Surface Anatomy of the Abdomen

Surface Anatomy of the Abdomen

Surface Anatomy of the Abdomen

Surface Anatomy of the Abdomen

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Surface Anatomy of the Back

Surface Anatomy of the Back

Surface Anatomy of the Back

Surface Anatomy of the Back Vertebral Column

Surface Anatomy of the Back Cervical Vertebrae

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 easily felt

Surface Anatomy of the Back Cervical Vertebrae seventh cervical vertebra most distinctive characteristic

existence of a long and prominent spinous process

palpable from the skin surface

Surface Anatomy of the Back Cervical Vertebrae

C7 Spinous process is usually evident superficially and when standing erect this is the only spinous process visible thus it is called vertebra prominens.

Vertebra prominens

Surface Anatomy of the Back 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

Surface Anatomy of the Back Lumbar Vertebrae 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 the spinal cord
Spinous Process of Lumbar Vertebrae

Surface Anatomy of the Back Lumbar Vertebrae

horizontal line joining the high points of the iliac crests passes thru the L4 spinous process and L4-L5 intervertebral discs (useful for lumbar puncture).

Horizontal line joining the high points of the iliac crests (SUPRACRISTAL PLANE)

Surface Anatomy of the Back Lumbar Vertebrae

Surface Anatomy of the Back Sacrum

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
Dimples (Posterior Superior Iliac Spine)

Surface Anatomy of the Back Sacrum

formed by the lines joining the two posterior superior iliac spines and the superior part of the intergluteal cleft the sacral triangle outlines the sacrum common area of pain from low back sprains

SACRAL TRIANGLE

Surface Anatomy of the Back Sacrum

Surface Anatomy of the Back 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

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Lecture grades

Module
1 2 3 4

Score

Lab grades Module Score 1 2 3 4