SURFACE ANATOMY PART 2

Aldwin A Yaneza, MD,FPCS

 Chapter 3
SURFACE ANATOMY OF
THE THORAX
SURFACE ANATOMY OF THE THORAX
CLAVICLE
• collar bones

• palpable bony ridges at the

junction of the thorax and neck
SURFACE ANATOMY OF THE THORAX
CLAVICLE
•demarcates the superior division
between zones of lymphatic
drainage
• above clavicle lymph flows to the
inferior jugular lymph nodes
• below the clavicle parietal lymph
flows to the axillary lymph nodes
SURFACE ANATOMY OF THE THORAX
STERNUM
•breast bone

•located at the anterior median line

SURFACE ANATOMY OF THE THORAX
STERNUM
•Parts:
A. Jugular Notch
• also known as suprasternal
notch
• large, visible dip where the
clavicles join the sternum
• palpable between the medial
ends of the clavicle
SURFACE ANATOMY OF THE THORAX
STERNUM
•Parts:
B. Manubrium
• approx. 4 cm. long
• lies at the level of T3 and T4
• anterior to the arch of the
aorta on the left side
• overlies the merging
brachiocephalic veins that
forms the SVC
SURFACE ANATOMY OF THE THORAX
STERNUM
•Parts:
C. Sternal Angle
• also known as the Angle of
Louis or Manubriosternal Joint
• angle made between the
manubrium and the body
of sternum
• marks the level of the 2nd pair
of costal cartilages
SURFACE ANATOMY OF THE THORAX
STERNUM
•Parts:
C. Sternal Angle
• marks approximately the
beginning and end of the
aortic arch and bifurcation
of the trachea into left and
right main bronchi
SURFACE ANATOMY OF THE THORAX
STERNUM
•Parts:
D. Body of the Sternum
• approximately 10 cm. long

• intermammary cleft overlies it

SURFACE ANATOMY OF THE THORAX
STERNUM
•Parts:
D. Body of the Sternum
• lies anterior to the right border
of the heart

• lies anterior to T5-T9 vertebrae

SURFACE ANATOMY OF THE THORAX
STERNUM
•Parts:
E. Xiphisternal Joint
• palpable ridge at the level of
the inferior border of T9
vertebra
SURFACE ANATOMY OF THE THORAX
STERNUM
•Parts:
F. Xiphoid Process
• lies in the epigastric fossa
SURFACE ANATOMY OF THE THORAX
COSTAL MARGIN
•medial margin formed by the costal
cartilages of the seventh rib to the
tenth rib
•extend inferolaterally from the
xiphisternal joint
•form the sides of the infrasternal
angle
SURFACE ANATOMY OF THE THORAX
INFRASTERNAL ANGLE
•located at the inferior end of
the sternum

•formed by the converging

costal margins

•landmark for CPR

SURFACE ANATOMY OF THE THORAX
RIBS AND INTERCOSTAL SPACES
•provide a basis for locating/describing
the position of structures or sites of
trauma or pathology

•1st rib is not palpable

•rib counting in PE starts with the

2nd rib
SURFACE ANATOMY OF THE THORAX
BREAST
•overlies the pectoralis major and
serratus anterior muscles

•nipple lies in the 4th ICS in men

and young nulliparous women
SURFACE ANATOMY OF THE THORAX
SURFACE ANATOMY OF THE THORAX
LINES OF ORIENTATION
1. Anterior Median Line (Midsternal
Line)
• intersection of the median plane
with the anterior thoracic wall

2. Midclavicular Line
• passes through the midpoint of
the clavicle, parallel to the AML
SURFACE ANATOMY OF THE THORAX
LINES OF ORIENTATION
3. Anterior Axillary Line
• runs vertically along the anterior
axillary fold (formed by the
inferolateral border of the
pectoralis major muscle)
SURFACE ANATOMY OF THE THORAX
LINES OF ORIENTATION
4. Midaxillary Line
• runs from the apex of the axillary
fossa; parallel to the anterior
axillary line

5. Posterior Axillary Line

• runs vertically along the posterior
axillary fold (formed by latissimus
dorsi m. and teres major m.;
parallel to the AAL)
SURFACE ANATOMY OF THE THORAX
LINES OF ORIENTATION
6. Posterior Median Line
• vertical line along the tips of the
spinous processes of the vertebrae

7. Scapular Lines
• parallel to the posterior median line
and intersect the inferior angles of
the scapula
SURFACE ANATOMY OF THE THORAX
HEART BORDERS
1. Superior Border
• inferior border of 2nd left costal
cartilage to the superior border
of the 3rd right costal cartilage

2. Right Border
• from 3rd right costal cartilage to
6th right costal cartilage
SURFACE ANATOMY OF THE THORAX
HEART BORDERS
3. Inferior Border
• inferior end of the right border to
the left 5th ICS close to the left
MCL

4. Left Border
• left ends of the lines representing
the superior and inferior borders
SURFACE ANATOMY OF THE THORAX
HEART BORDERS
1. Superior Border is formed by the
roots of the great vessels
2. Right Border is formed by the
right atrium
3. Left Border is formed by the left
ventricle
4. Inferior Border is formed by the
right ventricle and apical part of
the left ventricle
SURFACE ANATOMY OF THE THORAX
HEART SOUNDS
1. Tricuspid Valve
• lies behind the right half
of the sternum, opposite
the 4th ICS

• best heard: over the

right half of the lower
end of the body of the
sternum.
SURFACE ANATOMY OF THE THORAX
HEART SOUNDS
2. Pulmonary Valve
• lies behind the medial
end of the 3rd left costal
cartilage

• best heard: over the

medial end of the 2nd
left ICS
SURFACE ANATOMY OF THE THORAX
HEART SOUNDS
3. Mitral Valve
• behind the left half of
the sternum, opposite
the 4th costal cartilage

• best heard at the area of

the apex beat.
SURFACE ANATOMY OF THE THORAX
APEX BEAT
• impulse that results from the apex
of the heart being forced against
the anterior thoracic wall when the
left ventricle contracts

• 4th or 5th ICS, 6-10 cm from AML

SURFACE ANATOMY OF THE THORAX
HEART SOUNDS
4. Aortic Valve
• lies behind the left half
of the sternum, opposite
the 3rd ICS

• best heard over the

medial end of the 2nd
right ICS
HEART SOUNDS
HEART VALVES LOCATION BEST HEARD
TRICUSPID (R) 4TH ICS (R) LOWER
VALVE END OF BODY
OF STERNUM

PULMONARY (L) 3RD CC (L) 2ND ICS

VALVE

MITRAL VALVE (L) 4TH CC APEX BEAT

AORTIC VALVE (L) 3RD ICS (R) 2ND ICS

SURFACE ANATOMY OF THE THORAX
LUNGS AND PLEURA
CLINICAL CORRELATION
THORACENTESIS
• insert a hypodermic needle
through an ICS into pleural
cavity

• obtain sample of fluid

or remove blood or pus

• needle is inserted at the 9th

ICS MAL
 Chapter 4
SURFACE ANATOMY OF
THE ABDOMEN
SURFACE ANATOMY OF THE ABDOMEN
EPIGASTRIC FOSSA
•pit of the stomach

•slight depression in the epigastric

region, just inferior to the xiphoid

•noticeable when a person is in the

supine position

•pyrosis or heartburn is felt at this site

SURFACE ANATOMY OF THE ABDOMEN
EPIGASTRIC FOSSA
• Used as a guide in cardiopulmonary
resuscitation to position the hand on
the inferior part of the sternum
SURFACE ANATOMY OF THE ABDOMEN
RECTUS ABDOMINIS MUSCLE
• can be palpated and observed when
a supine person is asked to raise
their head and shoulders against
resistance
SURFACE ANATOMY OF THE ABDOMEN
TENDINOUS INTERSECTIONS OF
THE RECTUS ABDOMINIS MUSCLE
• skin grooves also overlie the
tendinous intersections of the
rectus abdominis

• clearly visible in persons with

well-developed rectus muscles
SURFACE ANATOMY OF THE ABDOMEN
LINEA ALBA
• raphe approx. 1 cm wide between
the two parts of the rectus abdominis
superior to the umbilicus

• visible in lean individuals because of

the skin groove superficial to it

• it is not indicated by a groove inferior

to the umbilicus
SURFACE ANATOMY OF THE ABDOMEN
CLINICAL CORRELATION
• some pregnant women, especially
those with dark hair and a dark
complexion, have a heavily
pigmented line, the linea nigra, in
the midline skin external to the linea
alba

• after pregnancy, the color of this

line fades
SURFACE ANATOMY OF THE ABDOMEN

SEMILUNAR LINES
• curved, linear impressions in the skin
that extend from the inferior costal
margin near the 9th costal cartilages
to the pubic tubercles

• 5–8 cm from the midline

• parallel with the lateral edges of the

rectus sheath
SURFACE ANATOMY OF THE ABDOMEN
UMBILICUS
•puckered indentation of skin in the
center of the anterior abdominal wall

•lies at the level of the IV disc between

the L3 and L4 vertebrae

•reference point for the transumbilical

plane
SURFACE ANATOMY OF THE ABDOMEN
INGUINAL GROOVE
• skin crease that is parallel and
inferior to the inguinal ligament

•marks the division between the

anterolateral abdominal wall and
the thigh

• landmark for the inguinal ligament

SURFACE ANATOMY OF THE ABDOMEN
INGUINAL GROOVE
• the inguinal groove is readily
visualized by having the person
drop one leg to the floor while
lying supine on an examining table
SURFACE ANATOMY OF THE ABDOMEN
PUBIC CREST
• upper margins of the pubic bones

PUBIC SYMPHYSIS
• cartilaginous joint that unite the
pubic bone

ILIAC CREST
• extends posteriorly from the ASIS
SURFACE ANATOMY OF THE ABDOMEN

Median Plane
SURFACE ANATOMY OF THE ABDOMEN
MIDCLAVICULAR
PLANE

SUBCOSTAL PLANE

TRANSTUBERCULAR
PLANE
SURFACE ANATOMY OF THE ABDOMEN
Nine Regions of the Abdominal Cavity
Some clinicians use the following planes:
1. Transpyloric Plane
• midway between the superior borders
of the manubrium of the sternum and
the pubic symphysis (typically the L1
vertebral level)

2. Interspinous Plane
• passes through the easily palpated
ASIS on each side
Nine Regions of the Abdominal Cavity
 Chapter 5
SURFACE ANATOMY OF
THE BACK
SURFACE ANATOMY OF THE BACK
POSTERIOR MEDIAN FURROW
• overlies the tips of the spinous
processes of the vertebrae

• continuous superiorly with the nuchal

groove in the neck and is deepest in
the lower thoracic and upper lumbar
regions

• ends in the triangular area covering

the sacrum
SURFACE ANATOMY OF THE BACK
• C1 has noVERTEBRA
CERVICAL spinous process
• C2 spinous process is the
first bony point that can be
felt
• spinous processes of C3-C5
may be felt in the nuchal
groove but not easily
palpable
• spinous process of C6 is
easily felt
SURFACE ANATOMY OF THE BACK

7TH CERVICAL VERTEBRA

• long and prominent spinous process

• palpable from the skin surface

• C7 spinous process is usually evident

superficially and when standing erect
this is the only spinous process visible
thus it is called vertebra prominens
SURFACE ANATOMY OF THE BACK
LUMBAR VERTEBRA
• when the trunk is flexed it is
easily seen and palpated

• the L2 spinous process provides

an estimate on the position of
the inferior end of the spinal
cord
SURFACE ANATOMY OF THE BACK
LUMBAR VERTEBRA
• horizontal line joining the high
points of the iliac crests
(Supracristal Plane)
CLINICAL CORRELATION
• Supracristal plane passes thru the
L4 spinous process and L4-L5
intervertebral discs

• useful for lumbar puncture

SURFACE ANATOMY OF THE BACK
SACRUM
• skin dimples are formed by the
attachment of skin and fascia to
the posterior superior iliac spines

• S2 spinous process lies at the

middle of these dimples and
indicates the inferior extent of the
subarachnoid space
SURFACE ANATOMY OF THE BACK
SACRUM
• sacral triangle is formed by the
lines joining the two posterior
superior iliac spines and the
superior part of the intergluteal
cleft

• outlines the sacrum

• common area of pain from low

back sprains
SURFACE ANATOMY OF THE BACK
COCCYX
• can be palpated in the
intergluteal cleft

• examined with a glove

finger in the anal canal
SUMMARY
REFERENCE