INTRODUCTION TO SURFACE ANATOMY OF UPPER & LOWER LIMBS Prof. Saeed Makarem & Dr. Zeenat ZaidiBy the end of the lecture, students should be able to: . Palpate and feel the bony prominences in the upper and the lower limbs. Palpate and feel the different muscles and muscular groups and tendons. Perform some movements to see the action of individual muscle or muscular groups in the upper and lower limbs. Feel the pulsations of most of the arteries of the upper F-Vale Moy (-ym tt oS Locate the site of most of the superficial veins in the upper and lower limbsWhat is Surface Anatomy? A branch of gross anatomy that examines shapes and markings on the surface of the body as they relate to deeper structures. It is essential in locating and identifying anatomic structures prior to studying internal gross anatomy. It helps to locate & identify the affected organ/structure/region in disease process.The clavicle is subcutaneous and can be palpated throughout its length. Its projects little above the manubrium. Between the sternal ends of the 2 clavicle Sa) (suprasternal notch). The acror end of the clavicle can be palpated medial to the lateral border of the particularly when the eet ea is alternately raised and depressed. The large vessels and nerves to the upper limb pass posterior to the convexity of the clavicle. ser tubercle+ The coracoid process of scapula can be felt deeply below the lateral one third of the clavicle in the lg + The clavipectoral (deltopectoral) triangle is the slightly depressed area just inferior to the lateral third of clavicle. It is bounded by: superiorly, laterally, and Tem LelaThe lateral and posterior borders of iam (econ oman c=lt to form the Inferior to the bec OF scapular A a ~ Root J acromion, the forms the rounded contour of the shoulder.Biome icc lle meld humerus can be felt when the arm is by the side on deep palpation through the deltoid muscle, inferior to the acromion. In this position, the greater tubercle is the most lateral bony point of the shoulder. Bie arm ema W a ol) felt in different areas through the muscles surrounding it. The medial and lateral epicondyles of the humerus are palpated on the medial and lateral aspects of the elbow region.ati forms a rounded subcutaneous prominence that can be easily seen and palpated on the medial side of the (ele gt-lE- elem Ra The pointed subcutaneous may be felt slightly distal to the ulnar head when the hand is supinated. tn and lie subcutaneously and can be palpated easily. Ss i, the tip of the olecranon process, the medial and the lateral epicondyles lie in a straight line. When the , the olecranon forms the apex of an equilateral triangle, of which the epicondyles form the angles at its base. Fractures of any of these structures will disturbs this arrangement.a Bal) can be palpated and felt to rotate in the depression on the posterolateral aspect of the extended elbow, just distal to the lateral epicondyle of Laman ctO UL Le Telia Ula] and pronation. + The can be palpated on the lateral side of the wrist in the anatomical snuff box; it is approximately 1 cm distal to that of the ulna.aie although they overlapped by the long extensor tendons of the fingers, they can be palpated on the dorsum of the hand. ai form the knuckles. Notice that the 34 metacarpal head is the most prominent. The dorsal aspects of the can be palpated CIN The knuckles of the fingers are formed by the the proximal and middleAxillary Folds * The anterior axillary fold is formed by the lower margin of the pectoralis major muscle and can be palpated between the finger and thumb. This can be made to stand out by asking the patient to press his or her hand against the ipsilateral hip. * The posterior axillary fold is formed by the tendon of latissimus dorsi as it passes around the lower border of the teres major muscle. It can be easily palpated between the finger and thumb.Axilla + The axilla should be examined with the forearm supported and the pectoral muscles relaxed. With the arm by the side, the inferior part of the head of the humerus can be easily palpated through the floor of the Ele + The pulsations of the axillary artery can be felt high up in the axilla, and around the artery can be palpated the cords of the brachial plexus. * The mecial wall of the ax la is formed by the upper ribs covered by the serratus anterior muscle, the serrations of which can be seen and felt in a muscular subject. The lateral wall is formed by the coracobrachialis and biceps brachii muscles and the bicipital groove of the humerus.A Blam lolol Rome Le ok VR 1 10)(-) when the arm is abducted against resistance.The distal attachment of the deltoid can be palpated on the lateral surface of the humerus. Biceps brachii & Triceps brachii form bulge on the anterior and posterior surfaces of the arm respectively. The bulges are separated by aaa) ascends superiorly in the lateral groove and the ascends in the medial groove. The biceps tendon can be palpated in the cubital fossa, immediately lateral to the midline. The triceps tendon can be palpated where it is attached to the olecranon process.Sia Bal) (era ol) felt pulsating deep to the medial border of the biceps. + For compression of the artery in the upper half of the arm it is pushed laterally against the humerus. In the lower half it is pushed posteriorly. Sa am) macs) beneath the bicipital aponeurosis, and, at a level just below the head of the radius, it divides into theIn the cubital fossa, ; and are clearly visible. The median cubital vein connects the cephalic to the basilic vein and crosses over the bicipital aponeurosis. It is the vein of choice for IV line The mass of the long flexors of the forearm forms the medial border of the fossa (mainly pronator teres). The lateral group of the forearm extensors, the long extensors of the wrist and brachioradialis lie between the fossa and the lateral epicondyle.of superficial veins can be seen on the dorsum of the hand. The network drains upward into the (laterally) and a (medially). + The tendons of and (er Tal felt as they pass distally to the bases of the fingers.The Radial artery can be drawn by a line Co a(ciale ire taTc) midpoint of the cubital fossa to the base of the styloid process of radius. The pulsations of the radial artery can easily be felt anterior to the distal third of the radius. Here it lies just beneath the skin and fascia lateral to the tendon of flexor carpi radialis muscleer , eee eet ere a the wrist joint whichis | +» The snuff box is bounded Preece MCR Mea Cne nen see atria a Abductor pollicis longus and J Extensor pollicis brevis } Cae] by extensor = pollicis longus + In the proximal part of the anatomical TT ia lem Ul is palpable. * The is also palpable in the distal part of floor of the anatomical snuff box.mae c-CelUaC) pulsation can be felt against the floor of the Saleligcleye More superficially, the anatomical snuff box is crossed by aioe: TI The radial nerve. Anatomical snuff box: radial artery and nerve, and cephalicis located in the central part of the palm and lies on a line drawn across the palm at the level of the proximal border of the fully extended thumb.+ The inguinal ligament Cato m ellie) * The pulsations of the femoral artery can be felt at the midinguinal point . + The femoral vein lies on the medial side of the artery, while the nerve lies lateral to the artery.Femoral arteryThe iliac crest is subcutaneous and can be palpated throughout its length, from the anterior superior iliac spine to posterior superior iliac Solin of the femur is also subcutaneous and can be palpated on the lateral 87 aspect of the hip joint Gees hip joint: Pe behind and distal to the interior superior iia anterior superior iliac spine.KNEE REGION Sod pore Peau Ey + In front of the knee joint the patella and the ligamentum patellae can be easily palpated. « The ligamentum patellae can be traced downward to its attachment to the tuberosity of the tibia. + The condyles of the femur and tibia can be recognized on the sides of the knee and the joint line can be identified Letra UCL* On the medial aspect of the knee Joint try to palpate: . Medial femoral condyle . Medial tibial condyle . Sartorius. . Gracilis . Semitendinosus. On the lateral aspect of the knee Joint try to palpate: Lateral femoral condyle EV Or IR el Reese ic La(-r-le Kolm MiLeU-\ Neck of the fibula Tendon of biceps femori i a ajal tuberosity The anterior border of the tibia. The medial tibial condyle a Ma Mile ee ROM UR elLct The medial malleolus The lateral malleolus uTem ie an) ty of the 5" metata tubercle of navicular. at he+ On the back of the knee and leg try to palpate: 1. The boundaries of the popliteal fossa. rae at em lel stl] mo lm Tc) popliteal artery.+ On the lateral aspect of the leg try to palpate: 1. The tendons of peroneus longus and brevis. 2. The Achilles tendon Pee emt) malleolus.On the Medial aspect of the ankle try to palpate: 1. ee ca ed VITolEe Mure lte) 0S The tendons of tibialis posterior The tendon of flexor digitorum longus. The posterior tibial artery ated aa) Flexor hellucis longus Flexor retinaculum The calcaneus.