During extension the upper border of the olecranon is slightly above the level of the medial epicondyle and nearer to this than to the lateral; when the forearm is fully flexed the olecranon and the epicondyles form the angles of an equilateral triangle.
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On the back of the olecranon is a smooth triangular subcutaneous surface, and running down the back of the forearm from the apex of this triangle the prominent dorsal border of the ulna can be felt in its whole length: it has a sinuous outline, and is situated in the middle of the back of the limb above; but below, where it is rounded off, it can be traced to the small subcutaneous surface of the styloid process on the medial side of the wrist.
The styloid process forms a prominent tubercle continuous above with the dorsal border and ending below in a blunt apex at the level of the wrist-joint; it is most evident when the hand is in a position midway between supination and pronation. When the forearm is pronated another prominence, the head of the ulna, appears behind and above the styloid process.
Below the lateral epicondyle of the humerus a portion of the head of the radius is palpable; its position is indicated on the surface by a little dimple, which is best seen when the arm is extended. If the finger be placed in this dimple and the semiflexed forearm be alternately pronated and supinated the head of the radius will be felt distinctly, rotating in the radial notch.
The upper half of the body of the bone is obscured by muscles; the lower half, though not subcutaneous, can be readily examined, and if traced downward is found to end in a lozenge-shaped convex surface on the lateral side of the base of the styloid process; this is the only subcutaneous part of the bone, and from its lower end the apex of the styloid process bends medialward toward the wrist. About the middle of the dorsal surface of the lower end of the radius is the dorsal radial tubercle, best perceived when the wrist is slightly flexed; it forms the lateral boundary of the oblique groove for the tendon of Extensor pollicis longus.
On the front of the wrist are two subcutaneous eminences, one, on the radial side, the larger and flatter, produced by the tuberosity of the navicular and the ridge on the greater multangular; the other, on the ulnar side, by the pisiform. The tuberosity of the navicular is distal and medial to the styloid process of the radius, and is most clearly visible when the wrist-joint is extended; the ridge on the greater multangular is about 1 cm.
The pisiform is about 1 cm. The rest of the volar surface of the bony carpus is covered by tendons and the transverse carpal ligament, and is entirely concealed, with the exception of the hamulus of the hamate bone, which, however, is difficult to define.
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On the dorsal surface of the carpus only the triangular bone can be clearly made out. Distal to the carpus the dorsal surfaces of the metacarpal bones, covered by the Extensor tendons, except the fifth, are visible only in very thin hands; the dorsal surface of the fifth is, however, subcutaneous throughout almost its whole length. Slightly lateral to the middle line of the hand is a prominence, frequently well-marked, but occasionally indistinct, formed by the styloid process of the third metacarpal bone; it is situated about 4 cm.
The heads of the metacarpal bones can be plainly seen and felt, rounded in contour and standing out in bold relief under the skin when the fist is clenched; the head of the third is the most prominent. In the palm of the hand the metacarpal bones are covered by muscles, tendons, and aponeuroses, so that only their heads can be distinguished.
The base of the metacarpal bone of the thumb, however, is prominent dorsally, distal to the styloid process of the radius; the body of the bone is easily palpable, ending at the head in a flattened prominence, in front of which are the sesamoid bones. The enlarged ends of the phalanges can be easily felt.
When the digits are bent the proximal phalanges form prominences, which in the joints between the first and second phalanges are slightly hollow, but flattened and square-shaped in those between the second and third. If this muscle be relaxed a depression between the end of the clavicle and the sternum can be felt, defining the exact position of the joint.
The position of the acromioclavicular joint can generally be ascertained by determining the slightly enlarged acromial end of the clavicle which projects above the level of the acromion; sometimes this enlargement is so considerable as to form a rounded eminence.
The shoulder-joint is deeply seated and cannot be palpated. If the forearm be slightly flexed a curved crease or fold with its convexity downward is seen in front of the elbow, extending from one epicondyle to the other; the elbow-joint is slightly distal to the center of the fold. The position of the radiohumeral joint can be ascertained by feeling for a slight groove or depression between the head of the radius and the capitulum of the humerus, at the back of the elbow-joint. The position of the proximal radioulnar joint is marked on the surface at the back of the elbow by the dimple which indicates the position of the head of the radius.
The site of the distal radioulnar joint can be defined by feeling for the slight groove at the back of the wrist between the prominent head of the ulna and the lower end of the radius, when the forearm is in a state of almost complete pronation.
Of the three transverse skin furrows on the front of the wrist, the middle corresponds fairly accurately with the wrist-joint, while the most distal indicates the position of the midcarpal articulation. The metacarpophalangeal and interphalangeal joints are readily available for surface examination; the former are situated just distal to the prominences of the knuckles, the latter are sufficiently indicated by the furrows on the volar, and the wrinkles on the dorsal surfaces. Muscles Figs. The inferior border of the muscle forms an undulating ridge passing downward and medialward from the root of the spine of the scapula to the spinous process of the twelfth thoracic vertebra.
The lateral border of the Latissimus dorsi Fig.
Lower Limb Anatomy, Palpation and Surface Markings free pdf
The Pectoralis major Fig. Its sternal origin presents a border which bounds, and determines the width of the sternal furrow. The upper margin is generally well-marked medially and forms the medial boundary of a triangular depression, the infraclavicular fossa, which separates the Pectoralis major from the Deltoideus; it gradually becomes less marked as it approaches the tendon of insertion and is closely blended with the Deltoideus. The lower border of Pectoralis major forms the rounded anterior axillary fold.
Occasionally a gap is visible between the clavicular and sternal parts of the muscle. When the arm is raised the lowest slip of origin of Pectoralis minor produces a fulness just below the anterior axillary fold and serves to break the sharp outline of the lower border of Pectoralis major. The origin of the Serratus anterior Figs. When the arm is abducted the lower five or six serrations form a zigzag line with a general convexity forward; when the arm is by the side the highest visible serration is that attached to the fifth rib.
The Deltoideus with the prominence of the upper end of the humerus produces the rounded contour of the shoulder; it is rounded and fuller in front than behind, where it presents a somewhat flattened form. Above, its anterior border presents a slightly curved eminence which forms the lateral boundary of the infraclavicular fossa; below, it is closely united with the Pectoralis major.
Its posterior border is thin, flattened, and scarcely marked above, but is thicker and more prominent below. The insertion of Deltoideus is marked by a depression on the lateral side of the middle of the arm.
See enlarged image. Of the scapular muscles the only one which influences surface form is the Teres major; it assists the Latissimus dorsi in forming the thick, rounded, posterior axillary fold. When the arm is raised the Coracobrachialis reveals itself as a narrow elevation emerging from under cover of the anterior axillary fold and running medial to the body of the humerus. On the front and medial aspects of the arm is the prominence of the Biceps brachii, bounded on either side by an intermuscular depression. It determines the contour of the front of the arm and extends from the anterior axillary fold to the bend of the elbow; its upper tendons are concealed by the Pectoralis major and Deltoideus, and its lower tendon sinks into the anticubital fossa.
When the muscle is fully contracted it presents a globular form, and the lacertus fibrosus attached to its tendon of insertion becomes prominent as a sharp ridge running downward and medialward. On either side of the Biceps brachii at the lower part of the arm the Brachialis is discernible.
Laterally it forms a narrow eminence extending some distance up the arm; medially it exhibits only a little fulness above the elbow. On the back of the arm the long head of the Triceps brachii may be seen as a longitudinal eminence, emerging from under cover of Deltoideus and gradually passing into the flattened plane of the tendon of the muscle at the lower part of the back of the arm. When the muscle is in action the medial and lateral heads become prominent.
On the front of the elbow are two muscular elevations, one on either side, separate above but converging below so as to form the medial and lateral boundaries of the anticubital fossa.
The medial elevation consists of the Pronator teres and the Flexors, and forms a fusiform mass, pointed above at the medial epicondyle and gradually tapering off below. The Pronator teres is the most lateral of the group, while the Flexor carpi radialis, lying to its medial side, is the most prominent and may be traced downward to its tendon, which is situated nearer to the radial than to the ulnar border of the front of the wrist and medial to the radial artery. The Palmaris longus presents no surface marking above, but below, its tendon stands out when the muscle is in action as a sharp, tense cord in front of the middle of the wrist.
The Flexor digitorum sublimis does not directly influence surface form; the position of its four tendons on the front of the lower part of the forearm is indicated by an elongated depression between the tendons of Palmaris longus and Flexor carpi ulnaris. The Flexor carpi ulnaris determines the contour of the medial border of the forearm, and is separated from the Extensor group of muscles by the ulnar furrow produced by the subcutaneous dorsal border of the ulna; its tendon is evident along the ulnar border of the lower part of the forearm, and is most marked when the hand is flexed and adducted.
The elevation forming the lateral side of the anticubital fossa consists of the Brachioradialis, the Extensors and the Supinator; it occupies the lateral and a considerable part of the dorsal surface of the forearm in the region of the elbow, and forms a fusiform mass which is altogether on a higher level than that produced by the medial elevation. Its apex is between the Triceps brachii and Brachialis some distance above the elbow-joint; it acquires its greatest breadth opposite the lateral epicondyle, and below this shades off into a flattened surface.
About the middle of the forearm it divides into two diverging longitudinal eminences. The lateral eminence consists of the Brachioradialis and the Extensores carpi radiales longus and brevis, and descends from the lateral supracondylar ridge in the direction of the styloid process of the radius. Contains clinical advice and information on sports injuries and accessory movements. Details anatomy at every layer with high-quality photographs showing the surface anatomy and detailed drawings depicting corresponding structures below the surface.
High-quality, full-color illustrations make content more easily understandable by clearly illustrating the topic. Review questions and illustrations at the end of each chapter provide users with an opportunity to assess their knowledge and easily study. Chapter 3 The lower limb. Chapter 4 The head and neck. Chapter 5 The thorax.
Chapter 6 The abdomen. Chapter 7 Conclusion.
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