Surface Anatomy

Principles of Clinical Medicine Brion Benninger MD MS

Surface Anatomy • It is important to obtain the ability to appreciate the neurovascular bundle and viscera within the architectural layers that consist of bone and soft tissue • Being able to visualize or appreciate problematic structures or regions and manipulate these areas for examination, diagnosis or treatment.

Surface Anatomy Objectives • Understand clinically important landmarks of the • • • • • •

Head and neck Upper Limb Thorax Back Abdomen Lower limb

Surface Anatomy Landmarks • Head • • • •

Ear Tragus Corner of mouth Mandible

• Neck • • •

C3 C4 C6

Surface Anatomy Nose • Septum • Double Pack • Intubation

Surface Anatomy

Surface Anatomy Larynx • Viewing Vocal cords • True cords - white • False cords - pink • Asymmetrical • • •

Intubation Surgery Recurrent laryngeal n.

Surface Anatomy Mouth • Uvula • Palatoglossal arch • Tonsil • Palatopharyngeal arch • Buccal fold • Retromolar fossa • Vestibule • Dens level

Ear • Helix/pinna-pull • Tragus • Haematomas • Tragus to corner of mouth • Parotid duct - 2nd molar • Zygomatic arch • Superficial temporal art. • Facial nerve

Surface Anatomy • Nerves • • • •

Vagus nerve Facial nerve Great Auricular n. Lesser occiptal n.

• • • •

Modiolus Levators Depressors Landmark

• • • •

Pulses Sup. Temp. Facial Labial

Surface Anatomy Neck landmarks • C3 - hyoid • C4 - thyroid cart. • CC Pulse / Carotid body • Laryngeal prom. • Cricothyroid mem. • C6 - cricoid cart. • Nodes • Mental • Submandibular

Surface Anatomy Neck landmarks • Triangles • Post. - Ext. Jugular • Supraclavicular • Subclavian vein • Lower trunk BP • CVP • Lymph node GI Resp. Ca • SCM - 2 distal heads •• Internal Internal Jugular Jugular

• Sternal notch • 1st rib

Surface Anatomy Upper Limb • Clavical • Medial 1/3 - Gr vessels • Mid 1/3 - pleura • Subclavian vein

• Lateral 1/3 - AC joint • Ant. / Lat. injections

• Corocoid • Benninger’s Sign

• Acromion

Sub acromial bursa

supraspinatus

infraspinatus

subscapularis

Biceps tendon

Surface Anatomy • Medial epicondyle • Flexor origin • Ulna nerve - posterior

• Lateral epicondyle • •

Extensor origin Radial nerve - anterior

• Radial head

Lateral epicondylitis

Medial epicondylitis

Carpal Tunnel

Abd pol longus / Ext pol brevis

Surface Anatomy • Thorax • Sternal Angle - T4 • • • •

Asc. And desc. Aorta Trachea bifracation Axygos vein enters SVC 2nd rib meets sternum (counting landmark)

• The substernum • right ventricle • left ventricle

• Xiphisternum to axilla - pericardial tap

• Vertical planes x 2 1. midline 2.midclavicular - *midclav - midinguinal crosses 9th CC and runs with semilunaris Horizontal Planes x 2 * Hands breadth xiphi 1.Transpyloric L1 9th CC, GB, Pylorus, hila of kidney, SMA, term of SC, pancreas, portal vein 2. Transtubercular plane joining tubercles of iliac crest Indicates com. Iliac veins

Surface Anatomy Lower Limb • Pulses • • •

Femoral - beneath inguinal ligament Popliteal - deep to vein X3 at the ankle • • •

Anterior tibial - ant. Ankle joint DP - between 1st and 2nd toe Posterior tibial - medial malleolus

Adductor longus

Trochanteric bursa

hamstrings

Peroneal tendons

Lateral ankle complex

Deltoid lig (med ankle complex)

Thank you • Enjoy your break and happy holidays !!!!