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1 The body What is anatomy? 4 How can gross anatomy be studied? 4 Important anatomical terms 4 Imaging 7 Diagnostic imaging techniques 7 Nuclear medicine imaging 10 Image interpretation 11 Plain radiography 12 Computed tomography 12 Magnetic resonance imaging 13 Nuclear medicine imaging 13 Safety in imaging 13 Body systems 14 Skeletal system 14 Cartilage 14 Bone 15 Joints 20 Skin and fascias 26 Skin 26 Fascia 26 Muscular system 27 Cardiovascular system 29 Lymphatic system 31 Lymphatic vessels 31 Lymph nodes 32 Lymphatic trunks and ducts 32 Nervous system 34 Central nervous system 34 Functional subdivisions of the CNS 34 Somatic part of the nervous system 35 Visceral part of the nervous system 41 Other systems 52 Clinical cases 53 2 Back Conceptual overview 56 General description 56 Functions 57 Support 57 Movement 57 Protection of the nervous system 58 Component parts 58 Bones 58 Muscles 60 Vertebral canal 62 Spinal nerves 63 Relationship to other regions 64 Head 64 Thorax, abdomen, and pelvis 65 Limbs 65 Key features 65 Long vertebral column and short spinal cord 65 Intervertebral foramina and spinal nerves 66 Innervation of the back 66 Regional anatomy 67 Skeletal framework 67 Vertebrae 67 Intervertebral foramina 75 Posterior spaces between vertebral arches 75 Joints 79 Joints between vertebrae in the back 79 Ligaments 82 Anterior and posterior longitudinal ligaments 82 Ligamenta flava 82 Supraspinous ligament and ligamentum nuchae 83 Interspinous ligaments 84 Back musculature 86 Superficial group of back muscles 86 Intermediate group of back muscles 92 Deep group of back muscles 93 Suboccipital muscles 99 Spinal cord 101 Vasculature 102 Meninges 104 Arrangement of structures in the vertebral canal 106 Spinal nerves 107 Surface anatomy 112 Back surface anatomy 112 Absence of lateral curvatures 112 Primary and secondary curvatures in the sagittal plane 112 Useful nonvertebral skeletal landmarks 112 How to identify specific vertebral spinous processes 114 Visualizing the inferior ends of the spinal cord and subarachnoid space 115 Identifying major muscles 116 Clinical cases 118 3 Thorax Conceptual overview 124 General description 124 Functions 125 Breathing 125 Protection of vital organs 125 Conduit 125 Component parts 125 Thoracic wall 125 Superior thoracic aperture 126 Inferior thoracic aperture 126 Diaphragm 127 Mediastinum 128 Pleural cavities 128 Relationship to other regions 129 Neck 129 Upper limb 130 Abdomen 130 Breast 130 Key features 130 Vertebral level TIV/V 130 Venous shunts from left to right 132 Segmental neurovascular supply of thoracic wall 132 Sympathetic system 134 Flexible wall and inferior thoracic aperture 134 Innervation of the diaphragm 134 Regional anatomy 137 Pectoral region 137 Breast 137 Muscles of the pectoral region 139 Thoracic wall 141 Skeletal framework 141 Intercostal spaces 147 Diaphragm 156 Venous drainage 158 Innervation 158 Movements of the thoracic wall and diaphragm during breathing 158 Pleural cavities 159 Pleura 159 Lungs 163 Mediastinum 176 Middle mediastinum 177 Superior mediastinum 204 Posterior mediastinum 215 Anterior mediastinum 223 Surface anatomy 224 Thorax surface anatomy 224 How to count ribs 224 Surface anatomy of the breast in women 225 Visualizing structures at the TIV/V vertebral level 226 Visualizing structures in the superior mediastinum 227 Visualizing the margins of the heart 227 Where to listen for heart sounds 228 Visualizing the pleural cavities and lungs, pleural recesses, and lung lobes and fissures 228 Where to listen for lung sounds 229 Clinical cases 233 44 Abdomen Conceptual overview 246 General description 246 Functions 247 Houses and protects major viscera 247 Breathing 249 Changes in intra-abdominal pressure 249 Component parts 250 Wall 250 Abdominal cavity 251 Inferior thoracic aperture 253 Diaphragm 253 Pelvic inlet 254 Relationship to other regions 254 Thorax 254 Pelvis 254 Lower limb 255 Key features 256 Arrangement of abdominal viscera in the adult 256 Skin and muscles of the anterior and lateral abdominal wall and thoracic intercostal nerves 259 The groin is a weak area in the anterior abdominal wall 260 Verterbral Level L1 262 The gastrointestinal system and its derivatives are supplied by three major arteries 262 Venous shunts from left to right 264 All venous drainage from the gastrointestinal system passes through the liver 265 Abdominal viscera are supplied by a large prevertebral plexus 266 Regional anatomy 268 Surface topography 268 Four-quadrant pattern 268 Nine-region pattern 269 Abdominal wall 270 Superficial fascia 270 Anterolateral muscles 272 Extraperitoneal fascia 278 Peritoneum 279 Innervation 279 Arterial supply and venous drainage 280 Lymphatic drainage 282 Groin 282 Inguinal canal 284 Inguinal hernias 288 Abdominal viscera 292 Peritoneum 292 Peritoneal cavity 293 Organs 297 Arterial supply 327 Venous drainage 337 Lymphatics 341 Innervation 341 Posterior abdominal region 348 Posterior abdominal wall 349 Viscera 355 Vasculature 366 Lymphatic system 372 Nervous system in the posterior abdominal region 374 Sympathetic trunks and splanchnic nerves 374 Surface anatomy 382 Abdomen surface anatomy 382 Defining the surface projection of the abdomen 383 How to find the superficial inguinal ring 384 How to determine lumbar vertebral levels 385 Visualizing structures at the L1 vertebral level 386 Visualizing the position of major blood vessels 387 Using abdominal quadrants to locate major viscera 388 Defining surface regions to which pain from the gut is referred 389 Where to find the kidneys 390 Where to find the spleen 390 Clinical cases 391 5 Pelvis and perineum Conceptual overview 406 General description 406 Functions 406 Contain and support bladder, rectum, anal canal, and reproductive tracts 406 Anchors the roots of the external genitalia 408 Component parts 408 Pelvic inlet 408 Pelvic walls 409 Pelvic outlet 409 Pelvic floor 411 Pelvic cavity 411 Perineum 412 Relationship to other regions 414 Abdomen 414 Lower limb 414 Key features 415 The pelvic cavity projects posteriorly 415 Important structures cross the ureters in the pelvic cavity 415 The prostate is anterior to rectum 417 The perineum is innervated by sacral spinal cord segments 417 Nerves are related to bone 418 Parasympathetic innervation from spinal cord levels S2 to S4 controls erection 418 Muscles and fascia of the pelvic floor and perineum intersect at the perineal body 419 Gender determines the course of the urethra 419 Regional anatomy 421 Pelvis 421 Bones 421 Joints 426 Orientation 428 Gender differences 428 True pelvis 429 Vicera 438 Fascia 458 Peritoneum 460 Nerves 462 Blood vessels 471 Lymphatics 477 Perineum 478 Borders and ceiling 478 Ischio-anal fossae and their anterior recesses 480 Anal triangle 480 Urogenital triangle 483 Somatic nerves 490 Visceral nerves 492 Blood vessels 492 Veins 494 Lymphatics 496 Surface anatomy 497 Surface anatomy of the pelvis and perineum 497 Orientation of the pelvis and perineum in the anatomical position 497 How to define the margins of the perineum 497 Identification of structures in the anal triangle 499 Identification of structures in the urogenital triangle of women 500 Identification of structures in the urogenital triangle of men 501 Clinical cases 504 6 Lower limb Conceptual overview 512 General introduction 512 Function 513 Support the body weight 513 Locomotion 515 Component parts 517 Bones and joints 517 Muscles 518 Relationship to other regions 520 Abdomen 520 Pelvis 521 Perineum 521 Key points 521 Innervation is by lumbar and sacral spinal nerves 521 Nerves related to bone 525 Superficial veins 525 Regional anatomy 526 Bony pelvis 526 Proximal femur 529 Hip joint 532 Gateways to the lower limb 535 Nerves 537 Arteries 540 Veins 542 Lymphatics 542 Deep fascia and the saphenous opening 544 Femoral triangle 545 Gluteal region 547 Muscles 548 Nerves 551 Arteries 554 Veins 554 Lymphatics 554 Thigh 555 Bones 555 Muscles 561 Arteries 569 Veins 573 Nerves 573 Knee joint 575 Tibiofibular joint 584 Popliteal fossa 584 Leg 585 Bones 586 Joints 588 Posterior compartment of leg 588 Lateral compartment of leg 595 Anterior compartment of leg 596 Foot 600 Bones 600 Joints 605 Tarsal tunnel, retinacula, and arrangement of major structures at the ankle 612 Arches of the foot 614 Plantar aponeurosis 615 Fibrous sheaths of toes 615 Extensor hoods 616 Intrinsic muscles 616 Arteries 622 Veins 624 Nerves 624 Surface anatomy 628 Lower limb surface anatomy 628 Avoiding the sciatic nerve 628 Finding the femoral artery in the femoral triangle 630 Identifying structures around the knee 630 Visualizing the contents of the popliteal fossa 632 Finding the tarsal tunnel-the gateway to the foot 633 Identifying tendons around the ankle and in the foot 634 Finding the dorsalis pedis artery 635 Approximating the position of the plantar arterial arch 635 Major superficial veins 636 Pulse points 637 Clinical cases 638 77 Upper limb Conceptual overview 650 General description 650 Functions 651 Positioning the hand 651 The hand as a mechanical tool 651 The hand as a sensory tool 654 Component parts 654 Bones and joints 654 Muscles 655 Relationship to other regions 657 Neck 657 Back and thoracic wall 658 Key points 659 Innervation by cervical and upper thoracic nerves 659 Nerves related to bone 663 Superficial veins 663 Orientation of the thumb 664 Regional anatomy 665 Shoulder 665 Bones 665 Joints 668 Muscles 675 Posterior scapular region 678 Muscles 678 Gateways to the posterior scapular region 680 Nerves 682 Arteries and veins 682 Axilla 684 Axillary inlet 685 Anterior wall 686 Medial wall 688 Lateral wall 690 Posterior wall 691 Gateways in the posterior wall 692 Floor 693 Contents of the axilla 693 Arm 710 Bones 712 Muscles 715 Arteries and veins 717 Nerves 720 Elbow joint 724 Cubital fossa 729 Forearm 731 Bones 732 Joints 734 Anterior compartment of the forearm 736 Muscles 736 Arteries and veins 742 Nerves 743 Posterior compartment of the forearm 745 Muscles 745 Arteries and veins 750 Nerves 751 Hand 751 Bones 752 Joints 754 Carpal tunnel and structures at the wrist 756 Palmar aponeurosis 758 Palmaris brevis 759 Anatomical snuffbox 759 Fibrous digital sheaths 759 Extensor hoods 760 Muscles 762 Arteries and veins 767 Nerves 770 Surface anatomy 775 Upper limb surface anatomy 775 Bony landmarks and muscles of the posterior scapular region 775 Visualizing the axilla and locating contents and related structures 777 Locating the brachial artery in the arm 779 The triceps brachii tendon and position of the radial nerve 779 Cubital fossa (anterior view) 779 Identifying tendons and locating major vessels and nerves in the distal forearm 781 Normal appearance of the hand 782 Position of the flexor retinaculum and the recurrent branch of the median nerve 783 Motor function of the median and ulnar nerves in the hand 783 Visualizing the positions of the superficial and deep palmar arches 784 Pulse points 784 Clinical cases 786 8 Head and neck Conceptual overview 796 General description 796 Head 796 Neck 798 Functions 799 Protection 799 Contains upper parts of respiratory and digestive tracts 799 Communication 800 Positioning the head 800 Connects the upper and lower respiratory and digestive tracts 800 Component parts 800 Skull 800 Cervical vertebrae 802 Hyoid bone 803 Soft palate 804 Muscles 804 Relationship to other regions 805 Thorax 805 Upper limbs 805 Key features 806 Vertebral levels CIII/IV and CV/VI 806 Airway in the neck 806 Cranial nerves 807 Cervical nerves 808 Functional separation of the digestive and respiratory passages 808 Triangles of the neck 811 Regional anatomy 812 Skull 812 Anterior view 812 Lateral view 814 Posterior view 816 Superior view 818 Inferior view 819 Cranial cavity 822 Roof 822 Floor 823 Meninges 830 Cranial dura mater 830 Arachnoid mater 833 Pia mater 833 Arrangement of meninges and spaces 834 Brain and its blood supply 835 Brain 835 Blood supply 837 Venous drainage 842 Cranial nerves 848 Olfactory nerve [I] 849 Optic nerve [II] 850 Oculomotor nerve [III] 850 Trochlear nerve [IV] 850 Trigeminal nerve [V] 851 Ophthalmic nerve [V1] 852 Maxillary nerve [V2] 852 Mandibular nerve [V3] 852 Abducent nerve [VI] 852 Facial nerve [VII] 852 Vestibulocochlear nerve [VIII] 853 Glossopharyngeal nerve [IX] 853 Vagus nerve [X] 853 Accessory nerve [XI] 854 Hypoglossal nerve [XII] 854 Face 856 Muscles 857 Parotid gland 863 Innervation 865 Vessels 869 Scalp 873 Layers 873 Innervation 874 Vessels 876 Lymphatic drainage 877 Orbit 878 Bony orbit 878 Eyelids 879 Lacrimal apparatus 882 Sensory innervation 882 Fissures and foramina 885 Fascial specializations 886 Muscles 887 Vessels 892 Innervation 893 Eyeball 898 Ear 902 External ear 903 Middle ear 906 Internal ear 913 Temporal and infratemporal fossae 920 Bony framework 920 Temporomandibular joints 922 Masseter muscle 925 Temporal fossa 926 Infratemporal fossa 929 Pterygopalatine fossa 940 Skeletal framework 940 Gateways 941 Contents 942 Neck 947 Fascia 948 Superficial venous drainage 950 Anterior triangle of the neck 954 Posterior triangle of the neck 968 Root of the neck 976 Pharynx 985 Skeletal framework 986 Pharyngeal wall 987 Fascia 990 Gaps in the pharyngeal wall and structures passing through them 990 Nasopharynx 991 Oropharynx 993 Laryngopharynx 993 Tonsils 993 Vessels 994 Nerves 996 Larynx 997 Laryngeal cartilages 998 Extrinsic ligaments 1000 Intrinsic ligaments 1001 Laryngeal joints 1002 Cavity of the larynx 1003 Intrinsic muscles 1005 Function of the larynx 1008 Vessels 1010 Nerves 1012 Nasal cavities 1013 Lateral wall 1014 Regions 1015 Innervation and blood supply 1016 Skeletal framework 1016 External nose 1018 Paranasal sinuses 1018 Walls, floor, and roof 1020 Nares 1024 Choanae 1024 Gateways 1024 Vessels 1026 Innervation 1028 Oral cavity 1030 Multiple nerves innervate the oral cavity 1031 Skeletal framework 1031 Walls: the cheeks 1034 Floor 1035 Tongue 1037 Salivary glands 1044 Roof-palate 1047 Oral fissure and lips 1055 Oropharyngeal isthmus 1055 Teeth and gingivae 1056 Surface anatomy 1061 Head and neck surface anatomy 1061 Anatomical position of the head and major landmarks 1062 Visualizing structures at the CIII/CIV and CVI vertebral levels 1063 How to outline the anterior and posterior triangles of the neck 1063 How to locate the cricothyroid ligament 1064 How to find the thyroid gland 1065 Estimating the position of the middle meningeal artery 1066 Major features of the face 1067 The eye and lacrimal apparatus 1068 External ear 1069 Pulse points 1070 Clinical cases 1071