Human Anatomy. A clinically-orienated approach

233 Pages·2007·87.482 MB·English

by  Sam Jacob

Commissioning Editor: Timothy Horne
Development Editor: Hannah Kenner
Project Manager: Nancy Arnott
Design Direction: Erik Bigland
Illustration Manager: Bruce Hogarth
Human Anatomy
A Clinically-Orientated Approach
AN ILLUSTRATED COLOUR TEXT
S. Jacob
MBBS MS (Anatomy)
Senior Lecturer
University of Sheffield;
Member of the Court of Examiners
Royal College of Surgeons of England, London;
Visiting Professor St George’s University
Grenada, West Indies
Dissections by
David J. Hinchliffe
Photography by
Mick A. Turton
Illustrated by
Amanda Williams
EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO 2007
iv
The right of Sam Jacob to be identified as author of this work has been
asserted by him in accordance with the Copyright, Designs and Patents
Act 1988
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This book was originally published as Atlas of Human Anatomy
ISBN 0-443-05364-2 in 2002
This edition 2007
ISBN-13: 978-0-443-10373-5
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Note
Neither the Publisher nor the Author assume any responsibility for
any loss or injury and/or damage to persons or property arising out
of or related to any use of the material contained in this book. It is
the responsibility of the treating practitioner, relying on independent
expertise and knowledge of the patient, to determine the best
treatment and method of application for the patient.
The Publisher
Printed in China
v
Preface
Human gross anatomy is one of the starts with a relevant account of surface A forerunner of this book was
most important subjects in the study of anatomy and osteology. published as Atlas of Human Anatomy in
Medicine and Allied Health Sciences. In planning this book I took into 2002 by Churchill Livingstone. It was
Dissection of the cadavers is the best account the time constraint affecting received well by students world over and
means of studying gross anatomy. most modern Anatomy courses as well had translations into Portuguese,
However, this is often difficult because of as the wide variety of teaching Spanish, Greek and Chinese, besides the
limitations of facilities, the short time methodology used. It is hoped that the original English edition.
available in the curriculum and the book will act as a useful companion for I would like to express my gratitude to
growing scarcity of cadavers for those who learn anatomy by dissection many co-workers and friends who gave
dissection. By using a combination of or by using prosections and plastinated me invaluable help and encouragement
fully labelled photographs of dissections, specimens. towards the production of this book. I
radiological anatomy, and drawings The level of details contained in the am greatly indebted to David Hinchliffe
along with a comprehensive descriptive book is more than adequate for most for producing the excellent dissections
text this book aims to provide the undergraduate medical and dental and to Mick Turton for his exceptional
student with a real understanding of the courses. This illustrated text may also be expertise in photography. This work
anatomy of the human body. This useful for students of Biological, would not have been possible without
illustrated colour text of human Biomedical and Allied Health Sciences their dedicated efforts and unswerving
anatomy contains illustrations of surface where human anatomy is part of the enthusiasm. Jill Revill, Caroline
anatomy, osteology, dissections, curriculum. Surgeons in training can use Couldwell, Andy Fitzgerald and Malcolm
radiological, CT and MRI images and this for a rapid review of anatomy while Hinchliffe also deserve credit for
line artwork. There are nearly 480 preparing for postgraduate facilitating this work. Professor Rachel
illustrations. The background text, examinations. Koshi and the late Dr Thomas Koshi
concise but comprehensive, describes Anatomy is a descriptive subject. In (Christian Medical College, Vellore)
the most important features of each area the past a medical student was expected provided many of the radiographs. The
with special emphasis on clinical to master all the detailed accounts of the MRI and CT scans were obtained from
relevance and application. Features of subject. I do appreciate the fact that there Dr Matthew Bull, Consultant, Northern
anatomy that are of clinical importance are medical curricula which still demand General Hospital, Sheffield. Dr Sujatha
are indicated with an ✪ icon in the text. a lot of factual details which can be quite Varkey, Consultant Radiologist,
Clinical anatomy is further emphasised daunting to a student who is doing the Rotherham District General Hospital
by clinical boxes relevant to each area of subject for the first time. Having been in provided the mammogram and the renal
description. Each clinical box illustrates the front line of medical undergraduate ultrasound scan. I am grateful to them all.
the value of anatomy in medical practice. and postgraduate teaching for nearly 40 Finally my sincere thanks to Hannah
The book has about 85 such clinical years I have a good idea as to what is Kenner, Nancy Arnott and the Elsevier
boxes. humanly possible during the time production team for the expertise and
Organised on a regional basis this available and what is essential for the care with which they made possible the
human anatomy book contains practice of medicine. Students can no preparation of this book, and to Timothy
illustrations and description of the upper longer afford to master the voluminous Horne of Elsevier for entrusting me with
limb, thorax, abdomen and pelvis, details in traditional textbooks, nor this project.
vertebral column and spinal cord, lower should they try to learn anything other
limb and head and neck. Each chapter than what is essential for clinical practice. Sheffield 2007 S. Jacob
1
Chapter 1
What is anatomy?
Anatomy is the study of the structure of the body. The word and allied health sciences there is none more directly related
anatomy is derived from the Greek word anat’ome which to their professional practice than gross anatomy and its
means to cut up. The Latin equivalent of this is dissecare application.
from which the word dissection is derived. Of all the basic The arrangement of structures in the body is very
science courses offered to students of medicine, dentistry complex. The first task in the study of anatomy is the
Trachea
Thoracic cavity
Lung
Heart
Diaphragm Abdominal
cavity
Liver
Spleen
Stomach
Pancreas
Transverse colon
Small intestine
Ascending colon Descending colon
Appendix
Pelvic cavity
Fig. 1.1 The internal organs within the various cavities of the body – anterior view.
2 HUMAN ANATOMY
Brain in cranial cavity 1
4
3
Spinal cord in vertebral canal
5
6
Thoracic cavity
7
6
Diaphragm
2
5
Abdominal cavity
1. Superior/cranial
2. Inferior/caudal
8 3. Anterior
4. Posterior
5. Medial
6. Lateral
7. Proximal
Pelvic cavity 8. Distal
Fig. 1.3 Commonly used positional and directional terms when the body is
in standard anatomical position.
internal organs are located within the various cavities of the
body. The cranial cavity contains the brain and the vertebral
canal in the vertebral column contains the spinal cord. The
Fig. 1.2 Internal organs within the various cavities of the body – lateral
right and left lungs and the heart are in the thoracic cavity.
view.
Each lung is surrounded by the pleural cavity and the heart
by the pericardial cavity. The thoracic cavity is separated
from the abdominal cavity by the dome-shaped diaphragm,
visualisation of the different structures, appreciating which is a sheet of muscle. The abdominal cavity is further
especially the way they are packaged in the body and their divided into the abdominal cavity proper, which contains
relationship to one another. Study of dissection illustrations the liver, stomach, small intestine, parts of the large
along with that of diagnostic images such as plain intestine, pancreas, spleen and kidneys, and the pelvic cavity,
radiographs, angiograms, CT and MRI scans play a major which has the sigmoid colon, rectum, urinary bladder and
role in achieving this goal. Surface anatomy is the art of parts of the reproductive system.
projecting on to the surface the underlying structures. Many Anatomy has a highly specialised vocabulary, most of
definitive elements of the living body can be easily identified them derived from Greek or Latin. It is the language of
on the surface. Ignorance of this part of anatomy will be a medicine. Communications between health professionals
serious handicap during the physical examination of a can be severely hampered without the accurate use of
patient. anatomical nomenclature.
The main divisions of the body are the head, neck, thorax, The anatomical position, about which the anatomical
abdomen and the upper and lower limbs (Figs 1.1, 1.2). The relations of structures are described, is that in which the
What is anatomy 3
person stands erect, arms by the sides, palms of the hands
facing forwards (Fig. 1.3). Structures in front are termed
anterior and those behind, posterior. Structures above are
superior and those below, inferior. Structures nearer the
midline of the body are medial and those away from the
Frontal (coronal) midline, lateral. Structures nearer to the surface are
superficial and those further from the surface are deep. In
the limbs, the term proximal is used to describe structures
nearer to the trunk and distal for those away from the
Sagittal
trunk. A sagittal plane passes vertically anteroposteriorly
through the body and the coronal plane is at right angles
to the sagittal plane. A plane that passes at right angles to
both the coronal and sagittal plane dividing the body
into cross sections is the transverse or horizontal plane
(Fig. 1.4).
Movement in the coronal plane away from the
Transverse
midsagittal plane is called abduction, return towards the
midsagittal plane is adduction. Bending of any part in the
sagittal plane is fl exion and straightening is extension.
Rotation occurs around a vertical axis. It may be medial
rotation, towards the midline, or lateral, away from it.
Fig. 1.4 Body planes.
5
Chapter 2
Upper Limb
The wrist containing the carpal bones connects the
Introduction 5
forearm and hand. The skeleton of the hand is formed by
Surface anatomy and bones of the shoulder and pectoral
the five metacarpal bones and that of the fingers by the
regions 5
phalanges. The anterior aspect of the hand is the palm of the
The skeleton viewed from the back 7
Surface anatomy of the back 8 hand. The hand can act as a tactile organ as the skin of the
Superfi cial muscles of the back 8 palm has a rich sensory innervation. The hand is for
Structures deep to the trapezius 9 grasping objects. In the precision grip, as in holding a pen,
Bones of the shoulder girdle 9 the thumb is in the opposed position where the pulp of the
Joints of the shoulder girdle 11
thumb faces the pulp of the index finger. The thumb is of
Movements of the pectoral girdle (scapula and clavicle) 12
great functional value in all grips, especially in the precision
The shoulder joint 12
grip. In a power grip, as in holding a hammer, the wrist is
Axilla 16
Anterior aspect of the arm 21 kept extended and the powerful long fl exors of the digits
Posterior compartment of the arm 23 contract to make the fingers fl ex to hold the handle (Fig. 2.3).
Anatomy of the forearm 24 The thumb reinforces the grip. All grips and manipulations
Muscles of the front of the forearm 28 rely on normal mobility of all the fingers. A single immobile
Arteries and nerves of the forearm 31
finger can make the whole hand clumsy.
Palm of the hand 32
Back of the forearm and hand 39
The joints of the forearm and hand 42
The radioulnar joints: pronation and supination 45 Surface anatomy and bones of the shoulder
The wrist joint 47 and pectoral regions
The clavicle, which is subcutaneous, is palpable throughout
and its movements during the movements of the upper limb
Introduction can be felt by holding it between finger and thumb. The
jugular notch (suprasternal notch) is felt between the
The human upper limb, which is primarily used for prominent medial ends of the clavicles. The clavicular and
grasping and manipulating objects, consists of the following sternal heads of the sternocleidomastoid muscle are visible
five regions (Fig. 2.1): (Fig. 2.4). The pulsation of the subclavian artery is felt on
deep palpation against the first rib in the supraclavicular
■ shoulder
region just lateral to the clavicular head of the muscle. More
■ axilla
posteriorly in the root of the neck the upper lateral border
■ arm
of the trapezius is visible. The muscle can be felt contracting
■ forearm
by elevating the shoulder against resistance. The pectoralis
■ hand.
major muscle, as it bridges across the chest wall and arm,
The shoulder has a wide range of mobility by virtue of forms the anterior wall of the axilla. Its lower border is the
the movements of the humerus, the clavicle and the anterior axillary fold. The muscle can be felt contracting
scapula. The axilla or the armpit is the space between the when the abducted arm is adducted against resistance. The
chest wall and the upper part of the arm and contains the clavicular and the sternocostal heads of the muscle may be
principal nerves and vessels. The bone of the arm, the visible in a muscular person. Below and lateral to the
region between the shoulder and the elbow, is the pectoralis major the digitations of the serratus anterior may
humerus (Fig. 2.2). In the arm the muscles are arranged in be seen (Fig. 2.4).
two compartments, fl exors anteriorly and extensors The acromion of the scapula (Fig. 2.5) forms the highest
posteriorly. A similar arrangement is seen in the forearm bony point of the shoulder region. This point is used to
as well. The forearm is the region between the elbow and measure the length of the upper limb. The coracoid process
the wrist. The radius and the ulna of the forearm articulate of the scapula is felt on deep palpation below the clavicle at
with the humerus at the elbow joint and with each other at its junction between the lateral third and the medial two-
the superior and inferior radioulnar joints. Pronation and thirds. The muscle covering the whole of the shoulder
supination to rotate the forearm and hand for grasping region and giving it its rounded contour is the deltoid. The
and manipulating objects occur at the radioulnar joints; cephalic vein, a superficial vein of the upper limb, lies
fl exion and extension of the forearm take place at the subcutaneously in the deltopectoral triangle, which is the
elbow joint. gap between the deltoid and the pectoralis major.
6 HUMAN ANATOMY
Flexed fingers
Shoulder
Thumb
Arm
Elbow
Extended wrist
Forearm
Bulge produced by the
Wrist contraction of flexor
digitorum superficialis
Palm of the hand
Fig. 2.3 Power grip.
Fig. 2.1 Regions of the upper limb.
Pectoralis major
This large muscle connects the upper part of the chest wall
to the upper extremity (Fig. 2.6).
Origin Medial third of the clavicle (clavicular head) and
the sternum and costal cartilages (sternocostal head).
Clavicle
Insertion Lateral lip of the bicipital groove on the shaft of
the humerus.
Scapula
Nerve supply Lateral and medial pectoral nerves.
Action The sternocostal fibres adduct and medially rotate
the humerus at the shoulder joint. The clavicular fibres fl ex
Humerus
the humerus. If the upper limb is abducted and fixed the
muscle can move the ribs and act as an accessory muscle of
respiration.
Test ✪ For clavicular head – abduct the arm to 90° and ask
the patient to push the arm forward (fl ex) against resistance.
For sternocostal head – abduct the arm to 60° and adduct
it against resistance. The contracting heads can be seen
and felt.
Radius Pectoralis minor
This lies deep to the pectoralis major (Fig. 2.7).
Origin Third to fifth (often second to fourth) ribs.
Ulna
Insertion The coracoid process of the scapula.
Nerve supply Medial pectoral nerve.
Action Draws the scapula (hence the arm) forwards –
protraction of shoulder. It can also depress the shoulder.
Carpal bones
Serratus anterior
Metacarpal bones
Origin By a series of digitations from the upper eight ribs.
Insertion The costal surface of the scapula along its medial
Phalanges border. The muscle forming the medial wall of the axilla lies
between the scapula and the chest wall before reaching its
insertion.
Fig. 2.2 Bones of the upper limb. Nerve supply Long thoracic nerve from the roots of the
brachial plexus (Clinical box 2.1; see Fig. 2.36).
Action Protraction (forward movement) of the scapula as
in pushing, punching and fencing.
Upper Limb 7
Acromion Suprasternal (jugular) notch Sternal head of sternocleidomastoid
Trapezius
Clavicular head of
Deltopectoral triangle sternocleidomastoid
Clavicle
Deltoid
Pectoralis major
Latissimus dorsi
Serratus anterior
Fig. 2.4 Surface anatomy of the shoulder and pectoral region.
Coracoid process Sternoclavicular joint Clavicle
Acromioclavicular joint
Acromion
Bicipital groove Manubrium of sternum
Scapula
Body of sternum
Xiphoid process
of sternum
Costal cartilages
Fig. 2.5 Bones of the pectoral and shoulder regions.
Deltoid
Clinical box 2.1
Winging of the scapula
Clavicular head of The long thoracic nerve supplying the serratus anterior
pectoralis major
lies on the surface of the muscle on the medial wall of
the axilla and is vulnerable in surgical procedures such
Sternocostal head as ‘axillary clearance’ of lymph nodes for the treatment
of pectoralis major
of carcinoma of the breast (p. 228). Nerve damage
causes ‘winging’ of the scapula where its medial border
is seen more raised and prominent.
Serratus The skeleton viewed from the back
anterior
Figure 2.8 illustrates the skeleton as viewed from the back.
The most prominent point in the midline on the occipital
Fig. 2.6 Pectoralis major, deltoid and serratus anterior. bone is the external occipital protuberance from which the