Anatomy at a Glance

177 Pages·2001·6.23 MB·English

by  Omar Faiz

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Anatomy at a Glance
OMAR FAIZ
BSc (Hons), FRCS(Eng)
Specialist Registrar in General Surgery
DAVID MOFFAT
VRD, MD, FRCS
Emeritus Professor of Anatomy
University of Cardiff
Blackwell
Science
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First published 2002 by Blackwell Science Ltd
Reprinted 2002
Library of Congress Cataloging-in-Publication Data
Faiz, Omar.
Anatomy at a glance / Omar Faiz, David Moffat
p. cm.
Includes index.
ISBN 0-632-05934-6 (pbk.)
1. Human anatomy—Outlines, syllabi, etc. I. Moffat, David, MD. II. Title.
[DNLM: 1: Anatomy. QS 4 F175a 2002]
QM31 .F33 2002
611—dc21 2001052646
ISBN 0-632-05934-6
A Catalogue record for this title is available from the British Library.
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Contents
Preface, 5 39 The hand, 88
40 Surface anatomy of the upper limb, 90
The thorax
1 The thoracic wall I, 6 The lower limb
2 The thoracic wall II, 8 41 The osteology of the lower limb, 92
3 The mediastinum Iathe contents of the 42 The arteries of the lower limb, 94
mediastinum, 10 43 The veins and lymphatics of the lower limb, 96
4 The mediastinum IIathe vessels of the thorax, 12 44 The nerves of the lower limb I, 98
5 The pleura and airways, 14 45 The nerves of the lower limb II, 100
6 The lungs, 16 46 The hip joint and gluteal region, 102
7 The heart I, 18 47 The thigh, 106
8 The heart II, 22 48 The knee joint and popliteal fossa, 109
9 The nerves of the thorax, 24 49 The leg, 112
10 Surface anatomy of the thorax, 26 50 The ankle and foot I, 114
51 The ankle and foot II, 116
The abdomen and pelvis 52 Surface anatomy of the lower limb, 118
11 The abdominal wall, 28
12 The arteries of the abdomen, 31 The autonomic nervous system
13 The veins and lymphatics of the abdomen, 34 53 The autonomic nervous system, 120
14 The peritoneum, 36
15 The upper gastrointestinal tract I, 38 The head and neck
16 The upper gastrointestinal tract II, 40 54 The skull I, 122
17 The lower gastrointestinal tract, 42 55 The skull II, 124
18 The liver, gall-bladder and biliary tree, 44 56 Spinal nerves and cranial nerves I–IV, 126
19 The pancreas and spleen, 46 57 The trigeminal nerve (V), 128
20 The posterior abdominal wall, 48 58 Cranial nerves VI–XII, 130
21 The nerves of the abdomen, 50 59 The arteries I, 132
22 Surface anatomy of the abdomen, 52 60 The arteries II and the veins, 134
23 The pelvis Iathe bony and ligamentous pelvis, 54 61 Anterior and posterior triangles, 136
24 The pelvis IIathe contents of the pelvis, 56 62 The pharynx and larynx, 138
25 The perineum, 58 63 The root of the neck, 140
26 The pelvic viscera, 60 64 The oesophagus and trachea and the thyroid gland, 142
65 The upper part of the neck and the submandibular
The upper limb region, 144
27 The osteology of the upper limb, 62 66 The mouth, palate and nose, 146
28 Arteries of the upper limb, 66 67 The face and scalp, 148
29 The venous and lymphatic drainage of the upper limb and the 68 The cranial cavity, 152
breast, 68 69 The orbit and eyeball, 154
30 Nerves of the upper limb I, 70 70 The ear, and lymphatics and surface anatomy of the head and
31 Nerves of the upper limb II, 72 neck, 156
32 The pectoral and scapular regions, 74
33 The axilla, 76 The spine and spinal cord
34 The shoulder (gleno-humeral) joint, 78 71 The spine, 158
35 The arm, 80 72 The spinal cord, 160
36 The elbow joint and cubital fossa, 82
37 The forearm, 84 Muscle index, 162
38 The carpal tunnel and joints of the wrist and hand, 86 Index, 168
Contents 3
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Preface
The study of anatomy has changed enormously in the last few decades. The anatomical drawings are the work of Jane Fallows, with help
No longer do medical students have to spend long hours in the dissect- from Roger Hulley, who has transformed our rough sketches into the
ing room searching fruitlessly for the otic ganglion or tracing the small finished pages of illustrations that form such an important part of the
arteries that form the anastomosis round the elbow joint. They now book and we should like to thank her for her patience and skill in carry-
need to know only the basic essentials of anatomy with particular ing out this onerous task. Some of the drawings have been borrowed or
emphasis on their clinical relevance and this is a change that is long adapted from Professor Harold Ellis’s superb book Clinical Anatomy
overdue. However, students still have examinations to pass and in this (9th edn) and we are most grateful to him for his permission to do this.
book the authors, a surgeon and an anatomist, have tried to provide a We should also like to thank Dr Mike Benjamin of Cardiff University
means of rapid revision without any frills. To this end, the book follows for the surface anatomy photographs. Finally, it is a pleasure to thank
the standard format of the at a Glanceseries and is arranged in short, all the staff at Blackwell Science who have had a hand in the prepara-
easily digested chapters, written largely in note form, with the appro- tion of this book, particularly Fiona Goodgame and Jonathan Rowley.
priate illustrations on the facing page. Where necessary, clinical appli-
cations are included in italics and there are a number of clinical Omar Faiz
illustrations. We thus hope that this book will be helpful in revising and David Moffat
consolidating the knowledge that has been gained from the dissecting
room and from more detailed and explanatory textbooks.
Preface 5
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1 The thoracic wall I
Thoracic outlet (inlet)
First rib
Clavicle
Suprasternal notch
Manubrium
5 Third rib
2
1
Body of sternum
Intercostal
space
4
Scalenus
Xiphisternum
anterior
Cervical
Brachial
Costal cartilage rib
plexus
Costal margin
3
Subclavian
1 Costochondral joint Floating ribs artery
2 Sternocostal joint
Fig.1.3
3 Interchondral joint
Bilateral cervical ribs.
4 Xiphisternal joint
On the right side the brachial plexus
5 Manubriosternal joint
is shown arching over the rib and
(angle of Louis)
stretching its lowest trunk
Fig.1.1
The thoracic cage. The outlet (inlet)
of the thorax is outlined
Transverse process with
facet for rib tubercle
Demifacet for head of rib
Head
Neck Costovertebral T5
joint
T6
Facet for Tubercle
Costotransverse
vertebral body
joint
Sternocostal
joint
6th
Shaft
Angle
rib
Costochondral
Subcostal groove joint
Fig.1.2 Fig.1.4
A typical rib Joints of the thoracic cage
6 Thorax
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The thoracic cage • The2nd rib is less curved and longer than the 1strib.
The thoracic cage is formed by the sternum and costal cartilages in • The10thribhas only one articular facet on the head.
front, the vertebral column behind and the ribs and intercostal spaces • The 11th and 12th ribs are short and do not articulate anteriorly.
laterally. They articulate posteriorly with the vertebrae by way of a single facet
It is separated from the abdominal cavity by the diaphragm and com- on the head. They are devoid of both a tubercle and a subcostal groove.
municates superiorly with the root of the neck through the thoracic
inlet(Fig. 1.1). The sternum(Fig. 1.1)
The sternum comprises a manubrium, body and xiphoid process.
The ribs (Fig. 1.1) • The manubrium has facets for articulation with the clavicles, 1st
• Of the 12 pairs of ribs the first seven articulate with the vertebrae pos- costal cartilage and upper part of the 2nd costal cartilage. It articulates
teriorly and with the sternum anteriorly by way of the costal cartilages inferiorly with the body of the sternum at the manubriosternal joint.
(true ribs). • The body is composed of four parts or sternebraewhich fuse between
• The cartilages of the 8th, 9th and 10th ribs articulate with the carti- 15 and 25 years of age. It has facets for articulation with the lower part
lages of the ribs above (false ribs). of the 2nd and the 3rd to 7th costal cartilages.
• The 11th and 12th ribs are termed ‘floating’ because they do not articu- • The xiphoidarticulates above with the body at the xiphisternal joint.
late anteriorly (false ribs). The xiphoid usually remains cartilaginous well into adult life.
Typical ribs (3rd–9th) Costal cartilages
These comprise the following features (Fig. 1.2): These are bars of hyaline cartilage which connect the upper seven ribs
• A headwhich bears two demifacets for articulation with the bodies directly to the sternum and the 8th, 9th and 10th ribs to the cartilage
of: the numerically corresponding vertebra, and the vertebra above immediately above.
(Fig. 1.4).
• A tubercle which comprises a rough non-articulating lateral facet as Joints of the thoracic cage (Figs 1.1 and 1.4)
well as a smooth medial facet. The latter articulates with the transverse • Themanubriosternal jointis a symphysis. It usually ossifies after the
process of the corresponding vertebra (Fig. 1.4). age of 30.
• A subcostal groove: the hollow on the inferior inner aspect of the • The xiphisternal jointis also a symphysis.
shaft which accommodates the intercostal neurovascular structures. • The1st sternocostal joint is a primary cartilaginous joint. The rest
(2nd to 7th) are synovial joints. All have a single synovial joint except
Atypical ribs (1st, 2nd, 10th, 11th, 12th) for the 2nd which is double.
• The1st rib (see Fig. 63.2) is short, flat and sharply curved. The head • Thecostochondral joints(between ribs and costal cartilages) are prim-
bears a single facet for articulation. A prominent tubercle (scalene ary cartilaginous joints.
tubercle)on the inner border of the upper surface represents the inser- • Theinterchondral joints(between the costal cartilages of the 8th, 9th
tion site for scalenus anterior. The subclavian vein passes over the 1st and 10th ribs) are synovial joints.
rib anterior to this tubercle whereas the subclavian artery and lowest • Thecostovertebral joints comprise two synovial joints formed by the
trunk of the brachial plexus pass posteriorly. articulations of the demifacets on the head of each rib with the bodies of
A cervical rib is a rare ‘extra’ rib which articulates with C7 poster- its corresponding vertebra together with that of the vertebra above. The
iorly and the 1st rib anteriorly. A neurological deficit as well as vascu- 1st and 10th–12th ribs have a single synovial joint with their corres-
lar insufficiency arise as a result of pressure from the rib on the lowest ponding vertebral bodies.
trunk of the brachial plexus (T1) and subclavian artery, respectively • Thecostotransverse jointsare synovial joints formed by the articula-
(Fig. 1.3). tions between the facets on the rib tubercle and the transverse process
of its corresponding vertebra.
The thoracic wall I 7
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2 The thoracic wall II
Vein
Artery Intercostal
Nerve
External
Internal Intercostal muscles
Innermost
Posterior ramus Posterior
intercostal
artery
Fig.2.1
Spinal
Intercostal
An intercostal space Collateral branch branch
nerve
(to muscles)
Aorta
Pleural and
lateral
peritoneal Lateral branch
sensory
branches
Internal
Cutaneous thoracic artery
branches
Fig.2.2 anterior Anterior
The vessels and nerves intercostal
of an intercostal space artery
Xiphisternum
Costal margin
Vertebral
levels
Central tendon
T8
Inferior vena cava
T10 Oesophagus
Aorta
T12 Lateral arcuate ligament
Medial arcuate ligament
Right crus
Psoas major
Quadratus lumborum
Fig.2.3
The diaphragm Third lumbar vertebra
8 Thorax
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The intercostal space (Fig. 2.1) • A collateral branch which supplies the muscles of the intercostal
Typically, each space contains three muscles comparable to those of space (also supplied by the main intercostal nerve).
the abdominal wall. These include the: • Sensory branches from the pleura (upper nerves) and peritoneum
• External intercostal:this muscle fills the intercostal space from the (lower nerves).
vertebra posteriorly to the costochondral junction anteriorly where it Exceptions include:
becomes the thin anterior intercostal membrane. The fibres run down- • The 1st intercostal nerve is joined to the brachial plexus and has no
wards and forwards from rib above to rib below. anterior cutaneous branch.
• Internal intercostal:this muscle fills the intercostal space from the • The 2nd intercostal nerve is joined to the medial cutaneous nerve of
sternum anteriorly to the angles of the ribs posteriorly where it becomes the arm by the intercostobrachial nerve branch. The 2nd intercostal
the posterior intercostal membrane which reaches as far back as the nerve consequently supplies the skin of the armpit and medial side of
vertebral bodies. The fibres run downwards and backwards. the arm.
• Innermostintercostals:this group comprises the subcostalmuscles
posteriorly, the intercostales intimilaterally and the transversus thor- The diaphragm (Fig. 2.3)
acisanteriorly. The fibres of these muscles span more than one inter- The diaphragm separates the thoracic and abdominal cavities. It is com-
costal space. posed of a peripheral muscular portion which inserts into a central
The neurovascular space is the plane in which the neurovascular aponeurosisathe central tendon.
bundle (intercostal vein, artery and nerve) courses. It lies between the The muscular part has three component origins:
internal intercostal and innermost intercostal muscle layers. • A vertebral part: this comprises the cruraand arcuate ligaments.
The intercostal structures course under cover of the subcostal The right crus arises from the front of the L1–3 vertebral bodies and
groove. Pleural aspiration should be performed close to the upper bor- intervening discs. Some fibres from the right crus pass around the lower
der of a rib to minimize the risk of injury. oesophagus.
The left crus originates from L1 and L2 only.
Vascular supply and venous drainage of the chest wall The medial arcuate ligament is made up of thickened fascia which
The intercostal spaces receive their arterial supply from the anterior overlies psoas major and is attached medially to the body of L1 and lat-
and posterior intercostal arteries. erally to the transverse process of L1. The lateral arcuate ligament is
• The anterior intercostal arteriesare branches of the internal thoracic made up of fascia which overlies quadratus lumborum from the trans-
artery and its terminal branch the musculophrenic artery. The lowest verse process of L1 medially to the 12th rib laterally.
two spaces have no anterior intercostal supply (Fig. 2.2). The median arcuate ligament is a fibrous arch which connects left
• The first 2–3 posterior intercostal arteries arise from the superior and right crura.
intercostal branch of the costocervical trunk, a branch of the 2nd part of • A costal part: attached to the inner aspects of the lower six ribs.
the subclavian artery (see Fig. 60.1). The lower nine posterior inter- • A sternal part: consists of two small slips arising from the deep sur-
costal arteries are branches of the thoracic aorta. The posterior inter- face of the xiphoid process.
costal arteries are much longer than the anterior intercostal arteries
(Fig. 2.2). Openings in the diaphragm
The anterior intercostal veins drain anteriorly into the internal thor- Structures traverse the diaphragm at different levels to pass from
acic and musculophrenic veins. The posterior intercostal veins drain thoracic to abdominal cavities and vice versa. These levels are as
into the azygos and hemiazygos systems (see Fig. 4.2). follows:
• T8, theopening for the inferior vena cava: transmits the inferior vena
Lymphatic drainage of the chest wall cava and right phrenic nerve.
Lymph drainage from the: • T10, theoesophageal opening: transmits the oesophagus, vagi and
• Anterior chest wall:is to the anterior axillary nodes. branches of the left gastric artery and vein.
• Posterior chest wall:is to the posterior axillary nodes. • T12, theaortic opening: transmits the aorta, thoracic duct and azygos
• Anterior intercostal spaces:is to the internal thoracic nodes. vein.
• Posterior intercostal spaces:is to the para-aortic nodes. The left phrenic nerve passes into the diaphragm as a solitary
structure.
Nerve supply of the chest wall (Fig. 2.2)
The intercostal nerves are the anterior primary rami of the thoracic seg- Nerve supply of the diaphragm
mental nerves. Only the upper six intercostal nerves run in their inter- • Motor supply:the entire motor supply arises from the phrenic nerves
costal spaces, the remainder gaining access to the anterior abdominal (C3,4,5). Diaphragmatic contraction is the mainstay of inspiration.
wall. • Sensory supply: the periphery of the diaphragm receives sensory
Branches of the intercostal nerves include: fibres from the lower intercostal nerves. The sensory supply from the
• Cutaneous anterior and lateral branches. central part is carried by the phrenic nerves.
The thoracic wall II 9