Clinical Anatomy for Medical Students

916 Pages·2000·65.347 MB·English

by  MD Snell, Richard S.

Clinical Anatomy
FOR Medical Students

Clinical Anatomy
FOR Medical Students
SIXTH EDITION
Richard S. Snell, MD, PhD
Emeritus Professor of Anatomy
George Washington University
School of Medicine and Health Sciences
Washington, DC
Lippincott Williams & Wilkins
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Copyright © 2000 Lippincott Williams & Wilkins
Previous editions copyright © 1973, 1981, 1986 by Little, Brown and Company (Inc); 1992, 1995 copyright © by Richard S. Snell, MD, PhD
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tained herein. This publication contains information relating to general principles of medical care which should not be construed as spe¬
cific instructions for individual patients. Manufacturers’ product information and package inserts should be reviewed for current informa¬
tion, including contraindications, dosages, and precautions.
Arabic edition: World Health Organization, Egypt, 1990
Greek edition: Medical Books, Costas Litsas, 1986
Indonesian edition: EGG Medical Pub, 1989
Italian edition: USES Edizioni Scientifiche Firenze, 1984
Japanese edition: Medical Sciences International Ltd, 1992
Portugese edition: Medsi Editora Medica e Cientifica Ltda, 1984
Spanish edition: Nueva Editorial Interamericana SA de CV, 1984
Turkish edition: Klinikleri, 1993
Printed in the United States of America
Library of Congress Cataloging-in-Publication Data
Snell, Richard S.
Clinical anatomy for medical students / Richard S. Snell—6th ed.
p.; cm.
Includes index.
ISBN 0-7817-1574-1
1. Human anatomy. 1. Title.
[DNLM: I. Anatomy. QS 4 S671c 2000]
QM23.2 .S55 2000
611—dc21
99-053905
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Again I say to the Medical Students:
“The first day that you look at or place your hand on a patient, you require a basic
knowledge of anatomy to interpret your observations. It is in the Anatomy Department that
you learn the basic medical vocabulary that you will carry with you throughout your profes¬
sional career and that will enable you to converse with your colleagues. Anatomy can be a
boring subject; clinical anatomy is fascinating. ”
“In an era of unprecedented technological advances and automation, remember that
your patient is a human being like yourself and should always receive the personal atten¬
tion, respect, and care that you would wish to receive in similar circumstances. Your knowl¬
edge of their anatomy may save their life. ”
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s we enter the second millennium, faculty 6. The clinical problems section at the end of each chapter
and students should pause and seriously has been reconstructed so that the problem solving can
consider the type of factual information be answered in a manner similar to that found in the
that is necessary for the successful diagnosis and treat¬ National Boards, with multiple-choice features.
ment of patients. During the last 2 decades alone there
Each chapter of Clinical Anatomy for Medical Students is
has been an explosion in technological advances in all
constructed in a similar manner. This will give students
the medical disciplines. The detailed anatomic knowl¬
ready access to material and will facilitate moving from one
edge once taught to generations of physicians is no
part of the book to another. Each chapter is divided into the
longer desirable or necessary. However, future physi¬
following categories.
cians (you) should be able to recall the basic anatomic
information necessary to examine patients successfully 1. Clinical Example: A short case report that dramatizes the
and to interpret the findings of modern technological
relevance of anatomy in medicine introduces each chap¬
procedures.
ter.
Although this sixth edition continues with the successful
2. Chapter Outline: A list of selected headings with page
and popular format of providing students with the core
numbers is provided so that immediate access is possi¬
knowledge of anatomy to carry out clinical practice, great
ble. This information is supplied in addition to the de¬
efforts have been made to weed out unnecessary material
tailed index at the end of the book.
and generally streamline the text. The following changes
3. Chapter Objectives: This section focuses the student on
have been introduced:
the material that is most important to learn and under¬
stand in each chapter. It emphasizes the basic structures
1. Tables have been used wherever possible to reduce the
in the area being studied so that once mastered, the stu¬
size of the text. This includes reference tables at the end
of the text that give important dimensions and capacities dent will be able to easily build up his or her knowledge
of various anatomic structures. base. This section also points out structures on which ex¬
2. More emphasis is given to pediatric anatomy, and em- aminers have repeatedly asked questions on national ex¬
bryologic explanations to some important congenital de¬ aminations.
fects have been added. 4. Basic Anatomy: This section provides basic information
3. The anatomy of common medical procedures section on gross anatomic structures that are of clinical impor¬
has been expanded and includes sections on complica¬ tance. Numerous examples of normal radiographs, CT
tions caused by an ignorance of normal anatomy. scans, MRIs, and sonograms are also provided. Labeled
4. The advent of a more violent society has necessitated photographs of cross-sectional anatomy of the head,
that greater attention be paid to areas commonly trau¬ neck, and trunk are included to stimulate students to
matized by gunshot and knife wounds and automobile think in terms of three-dimensional anatomy, which is so
accidents. important in the interpretation of CT scans, MRIs, and
5. The more extensive use of computed tomographic (CT) sonograms.
scans, magnetic resonance images (MRIs), sonograms, 5. Surface Anatomy: This section provides surface land¬
and echocardiograms has resulted in the need for in¬ marks of important anatomic structures, many of which
creased knowledge of cross-sectional anatomy so that are located some distance beneath the skin. This section
the findings can be interpreted. is important because most practicing physicians seldom
VII
Viii PREFACE
explore tissues to any depth beneath the skin. Photo¬ 1 am greatly indebted to many faculty members of the
graphs of living subjects have been used extensively. Department of Radiology at the George Washington
6. Clinical Notes: This section provides the practical appli¬ University School of Medicine and Health Sciences for the
cation of anatomic facts that are essential in clinical prac¬ loan of radiographs, CT scans, and MRls that have been re¬
tice. It emphasizes the structures that the physi¬ produced in different sections of this book. 1 am also grate¬
cian will encounter when making a diagnosis and treat¬ ful to Dr. Carol Lee, Dr. Gordon Sze, and Dr. Robert Smith of
ing a patient. It also provides the anatomic knowledge the Department of Radiology at Yale University Medical
necessary to understand many procedures and tech¬ Center for supplying examples of mammograms, CT scans
niques and notes the anatomic "pitfalls" commonly en¬ of the vertebral column, and MRls of the limbs. My special
countered. thanks are due to Dr. Michael Remetz of the Department of
7. Clinical Problem Solving: Examples of clinical cases are Cardiology at Yale for providing examples of coronary arte¬
given at the end of each chapter. Each is followed riograms.
As in the past, 1 wish to express my sincere thanks to Terry
by multiple-choice questions. Answers to the problems
Dolan, Virginia Childs, and Myra Feldman for the earlier
are given at the end of the chapter.
preparation of the artwork and to Ira Alan Grunther, AMI, for
8. National Board Type Questions: Examples of National
the very fine new art in this edition.
Board Type Questions are found at the end of each chap¬
To the librarians of the George Washington University
ter. Solutions to the problems are provided at the end
School of Medicine and Health Sciences, thanks are due for
of the chapter.
the continued help in procuring much needed reference
To assist in the quick understanding of anatomic facts, material.
the book is heavily illustrated, and most figures have been Finally, 1 wish to express my deep gratitude to the staff
kept simple; color has been used extensively. Illustrations of Lippincott Williams & Wilkins for their enthusiasm and
summarizing the nerve and blood supply of regions have support throughout the preparation of this book.
been retained, as have overviews of the distribution of cra¬
nial nerves. R.S.S.