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Surface Anatomy Palpation – feeling internal structures through the skin • “Living anatomy” – provides information about – Palpation of arterial pulses – Skeleton, muscles, and blood vessels – Sounds of the heart and lungs – Where to give injections
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Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Dec 16, 2015

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Hillary Skinner
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Page 1: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Surface Anatomy

• Palpation – feeling internal structures through the skin

• “Living anatomy” – provides information about– Palpation of arterial pulses– Skeleton, muscles, and blood vessels– Sounds of the heart and lungs– Where to give injections

Page 2: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Head

• Cranium – selected structures felt through the skin– Superciliary arches – External occipital protuberance – Mastoid process – Temporalis muscle – at temple region– Frontalis muscle

• Feel wrinkling of the forehead when eyebrows are raised

Page 3: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Surface Anatomy of Lateral Aspect of the Head

Figure 11.26

Page 4: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Head

• Face – selected structures felt through the skin– Lacrimal fossa – Root and bridge of the nose– Auricle of the ear– Zygomatic arch– Masseter muscle– Mandible – Temporomandibular joint

Page 5: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Neck

• Skeletal landmarks– Spinous processes of cervical vertebrae

• C7 is particularly prominent (vertebra prominens)

– Hyoid bone – in the anterior, superior neck– Laryngeal prominence – the “Adam’s Apple”– Cricoid cartilage – inferior to the laryngeal

prominence– Jugular notch – depression in the superior

part of the sternum

Page 6: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Neck

Figure 11.27

Page 7: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Muscles of the Neck

• Sternocleidomastoid – most prominent neck muscle– Sternal head– Clavicular head

• Deep to the sternocleidomastoid – Common carotid artery – Internal jugular vein

• Trapezius – posterior aspect of the neck

Page 8: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Triangles of the Neck

• The sternocleidomastoid muscles divide the neck– Anterior triangle– Posterior triangle

Figure 11.28a

Page 9: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Triangles of the Neck

Figure 11.28b

Page 10: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Trunk

• The trunk consists of the – Thorax– Abdomen– Pelvis and perineum

Page 11: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Thorax

• Sternum – portions felt through the skin– Manubrium, xiphoid process, and sternal

angle

• Midaxillary line – line from the center of the axilla onto the lateral thoracic wall

• Midclavicular line – vertical line from midpoint of the clavicle to the groin

Page 12: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Muscles of the Thorax

• Pectoralis major

• Serratus anterior

Page 13: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Anterior Thorax and Abdomen

Figure 11.29

Page 14: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Abdomen

• Structures felt through the skin– Iliac crest– Anterior superior iliac spine– Inguinal ligament

• Runs medially from anterior superior iliac spine to the pubic tubercle

– Pubic crest

Page 15: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Inguinal Hernia

Figure 11.30

Page 16: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Muscles and other Abdominal Surface Features

• Linea alba– The “white line” extending from xiphoid

process to the pubic symphysis

• Rectus abdominis– Linea semilunaris – lateral margin of rectus

abdominis

Page 17: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Pelvis and Perineum

• Four bony structures define the perineum – Pubic symphysis– Two ischial tuberosities– Coccyx

Page 18: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Back

• Posterior median furrow – vertical groove along the midline

• Spinous processes of vertebrae

• Spine of the scapula– Medial end is opposite T3

• Medial border of the scapula

Page 19: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Back

• Inferior angle of the scapula

• Iliac crests– Supracristal line – intersects L4

• Sacrum – superior to cleft in the buttocks

• Coccyx – posterior to the anus

Page 20: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Surface Anatomy of the Back

Figure 11.31a

Page 21: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Muscles of the Back

• Trapezius

• Latissimus dorsi

• Erector spinae

Page 22: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Surface Anatomy of the Back

Figure 11.31b

Page 23: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Upper Limb and Shoulder

• The Axilla– Base of the axilla – where armpit hair grows– Deep to the axilla – axillary lymph nodes and

blood vessels– Anterior axillary fold – pectoralis major– Posterior axillary fold –latissimus dorsi and

teres major

Page 24: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Shoulder and Arm

Figure 11.32a, b

Page 25: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Figure 11.33

The Shoulder

• Acromion – lateral end of the spine of the scapula

• Acromioclavicular joint

• Deltoid muscle– Covers the greater

tubercle of the humerus

Page 26: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Arm

• The region between the shoulder and elbow

• Humerus– Palpated through skin along its entire length

• Biceps brachii

• Medial bicipital groove– The medial boundary of the biceps brachii

• Triceps brachii

Page 27: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Arm

Figure 11.34

Page 28: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Elbow

• Lateral and medial epicondyles of the humerus – Ulnar nerve – “funny bone” runs across

medial epicondyle

• Olecranon process of the ulna

• Cubital fossa – (antecubital fossa)– Forms anterior surface of forearm

Page 29: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Anterior Surface of the Forearm and Fist

Figure 11.35a

Page 30: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Forearm

• Bones– Ulna – palpate entire length

• Styloid process and head – distal end

• Radius – partly covered in muscle– Head of the radius – proximal end– Styloid process – distal end

Page 31: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Muscles of the Forearm

• Flexor muscles – anterior forearm– Flexor carpi radialis– Palmaris longus

• This muscle is absent in about 30% of people

• Extensor muscles – posterior forearm

Page 32: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Other Structures of the Forearm

• Anatomical snuff box bordered by– Extensor pollicis brevis– Extensor pollicis longus

Page 33: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Hand

• Dorsum of hand– Dorsal venous network– Tendons of extensor digitorum

• Palmar surface– Thenar eminence (not labeled on figure

11.35b)– Hypothenar eminence (see figure 11.17a–c )– Pisiform bone

Page 34: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Dorsum of the Hand

Figure 11.36

Page 35: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Gluteal Region

• Iliac crests

• Posterior superior iliac spine

• Sacroiliac joint

• Prominences of the buttocks– “Cheeks” of the buttocks– Formed from subcutaneous fat and the gluteal

muscles

Page 36: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Gluteal Region

Figure 11.37

Page 37: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Lower Limb and Gluteal Region

• Natal cleft (gluteal cleft) – Vertical midline groove between “cheeks”

• Gluteal fold– Horizontal fold below each “cheek”

• Ischial tuberosities

• Greater trochanter of the femur– Located at the lateral hip

Page 38: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Lower Limb and Gluteal Region

Figure 11.38a

Page 39: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Thigh

• Medial and lateral condyles of the femur

• Patella

• Three groups of muscles– Quadriceps femoris – anterior thigh

• Vastus lateralis – injection site

– Adductors – medial thigh– Hamstrings – posterior thigh

Page 40: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Thigh

Figure 11.38b

Page 41: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

The Thigh

• The Femoral Triangle – Superior border – inguinal ligament– Inferior borders

• Sartorius• Adductor longus

• Popliteal fossa– Diamond-shaped hollow on posterior knee

• Defined by borders of “hamstring” tendons and gastrocnemius

Page 42: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Leg and Foot

• Palpate patella to find the patellar ligament

• Structures of the proximal leg– Tibial tuberosity – Lateral and medial condyles of the tibia– Head of the fibula

• Structures of the distal leg– Medial malleolus– Lateral malleolus

Page 43: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Leg and Foot

Figure 11.40a, c

Page 44: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Muscle Groups of the Leg

• Posterior calf muscles– Gastrocnemius and soleus

• Calcaneal tendon – inferior end of the soleus and gastrocnemius

• Anterior compartment muscles– Tibialis anterior– Extensor digitorum– Fibularis

Page 45: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Muscle Groups of the Leg

Figure 11.41

Page 46: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Foot

• Tendons on the dorsal surface of the foot– Extensor digitorum longus tendon– Extensor hallucis longus

Page 47: Surface Anatomy Palpation – feeling internal structures through the skin “Living anatomy” – provides information about –Palpation of arterial pulses –Skeleton,

Foot

Figure 11.40d