Contents
Preface / vii
Acknowledgments / xi
List of Clinical Blue Boxes / xix
Figure Credits / xxv
Introduction to Clinically Oriented
Anatomy/ 1
APPROACHES TO STUDYING ANATOMY / 2
Regional Anatomy / 2
Systemic Anatomy / 3
Clinical Anatomy / 4
ANATOMICOMEDICAL TERMINOLOGY / 4
Anatomical Position / 5
Anatomical Planes / 5
Terms of Relationship and Comparison / 6
Terms of Laterality / 7
Terms of Movement / 7
ANATOMICAL VARIATIONS / 12
INTEGUMENTARY SYSTEM / 12
FASCIAS, FASCIAL COMPARTMENTS, BURSAE,
AND POTENTIAL SPACES / 16
SKELETAL SYSTEM / 19
Cartilage and Bones / 19
Bone Markings and Formations / 20
Joints / 25
MUSCLE TISSUE AND MUSCULAR SYSTEM / 29
Types of Muscle (Muscle Tissue) / 29
Skeletal muscles / 29
Cardiac Striated Muscle / 36
Smooth Muscle / 36
CARDIOVASCULAR SYSTEM / 37
Vascular Circuits / 37
Blood Vessels / 37
LYMPHOID SYSTEM / 43
NERVOUS SYSTEM / 46
Central Nervous System / 47
Peripheral Nervous System / 47
Somatic Nervous System / 57
Autonomic Nervous System (ANS) / 57
MEDICAL IMAGING TECHNIQUES / 66
Conventional Radiography / 66
Computed Tomography / 67
Ultrasonography / 67
Magnetic Resonance Imaging / 68
Nuclear Medicine Imaging / 70
1 Thorax / 71
OVERVIEW OF THORAX / 72
THORACIC WALL / 72
Skeleton of Thoracic Wall / 74
Thoracic Apertures / 78
Joints of Thoracic Wall / 79
Movements of Thoracic Wall / 81
Muscles of Thoracic Wall / 86
Fascia of Thoracic Wall / 91
Nerves of Thoracic Wall / 91
Vasculature of Thoracic Wall / 93
Breasts / 98
Surface Anatomy of Thoracic Wall / 99
VISCERA OF THORACIC CAVITY / 106
Pleurae, Lungs, and Tracheobronchial Tree / 108
Overview of Mediastinum / 128
Pericardium / 128
Heart / 135
Superior Mediastinum and Great Vessels / 160
Posterior Mediastinum / 166
Anterior Mediastinum / 171
Surface Anatomy of Heart and Mediastinal Viscera / 171
Auscultatory Areas / 173
2 Abdomen / 181
OVERVIEW: WALLS, CAVITIES, REGIONS,
AND PLANES / 183
ANTEROLATERAL ABDOMINAL WALL / 184
Fascia of the Anterolateral Abdominal Wall / 186
Muscles of Anterolateral Abdominal Wall / 187
Neurovasculature of Anterolateral Abdominal Wall / 193
Internal Surface of Anterolateral Abdominal Wall / 201
Inguinal Region / 202
Spermatic Cord, Scrotum, and Testes / 206
Surface Anatomy of Anterolateral
Abdominal Wall / 210
PERITONEUM AND PERITONEAL CAVITY / 217
Embryology of Peritoneal Cavity / 218
Peritoneal Formations / 219
Subdivisions of Peritoneal Cavity / 221
ABDOMINAL VISCERA / 226
Overview of Abdominal Viscera and Digestive Tract / 226
Esophagus / 229
Stomach / 23
xvi Contents
Structure and Function of Vertebrae / 440
Regional Characteristics of Vertebrae / 443
Ossification of Vertebrae / 453
Variations in Vertebrae / 455
VERTEBRAL COLUMN / 464
Joints of Vertebral Column / 464
Movements of Vertebral Column / 470
Curvatures of Vertebral Column / 470
Vasculature of Vertebral Column / 472
Nerves of Vertebral Column / 473
MUSCLES OF BACK / 482
Extrinsic Back Muscles / 482
Intrinsic Back Muscles / 482
Surface Anatomy of Back Muscles / 492
Suboccipital and Deep Neck Muscles / 492
CONTENTS OF VERTEBRAL CANAL / 496
Spinal Cord / 496
Spinal Nerves and Nerve Roots / 496
Spinal Meninges and Cerebrospinal Fluid (CSF) / 498
Vasculature of Spinal Cord and Spinal Nerve Roots / 501
5 Lower Limb / 508
OVERVIEW OF LOWER LIMB / 510
DEVELOPMENT OF LOWER LIMB / 510
BONES OF LOWER LIMB / 512
Arrangement of Lower Limb Bones / 512
Hip Bone / 514
Femur / 516
Tibia and Fibula / 520
Bones of Foot / 522
Surface Anatomy of Bones of Foot / 524
FASCIA, VEINS, LYMPHATICS, EFFERENT VESSELS,
AND CUTANEOUS NERVES OF LOWER LIMB / 532
Subcutaneous Tissue and Fascia / 532
Venous Drainage of Lower Limb / 532
Lymphatic Drainage of Lower Limb / 535
Cutaneous Innervation of Lower Limb / 536
Motor Innervation of Lower Limb / 538
POSTURE AND GAIT / 542
Standing at Ease / 542
Walking: The Gait Cycle / 542
ANTERIOR AND MEDIAL REGIONS OF THIGH / 545
Organization of Proximal Lower Limb / 532
Anterior Thigh Muscles / 545
Medial Thigh Muscles / 548
Neurovascular Structures and Relationships in
Anteromedial Thigh / 551
Surface Anatomy of Anterior and Medial Regions of
Thigh / 557
GLUTEAL AND POSTERIOR THIGH REGIONS / 562
Gluteal Region: Buttocks and Hip Region / 562
Muscles of Gluteal Region / 563
Small Intestine / 239
Large Intestine / 246
Spleen / 263
Pancreas / 265
Liver / 268
Biliary Ducts and Gallbladder / 277
Kidneys, Ureters, and Suprarenal Glands / 290
Summary of Innervation of Abdominal Viscera / 301
DIAPHRAGM / 306
Vessels and Nerves of Diaphragm / 307
Diaphragmatic Apertures / 308
Actions of Diaphragm / 309
POSTERIOR ABDOMINAL WALL / 309
Fascia of Posterior Abdominal Wall / 310
Muscles of Posterior Abdominal Wall / 311
Nerves of Posterior Abdominal Wall / 312
Vessels of Posterior Abdominal Wall / 313
SECTIONAL MEDICAL IMAGING OF ABDOMEN / 321
3 Pelvis and Perineum / 326
INTRODUCTION TO PELVIS AND PERINEUM / 327
PELVIC GIRDLE / 327
Bones and Features of Pelvic Girdle / 328
Orientation of Pelvic Girdle / 330
Joints and Ligaments of Pelvic Girdle / 330
PELVIC CAVITY / 338
Walls and Floor of Pelvic Cavity / 338
Peritoneum and Peritoneal Cavity of Pelvis / 343
Pelvic Fascia / 345
NEUROVASCULAR STRUCTURES OF PELVIS / 349
Pelvic Arteries / 350
Pelvic Veins / 355
Lymph Nodes of Pelvis / 356
Pelvic Nerves / 357
PELVIC VISCERA / 362
Urinary Organs / 362
Rectum / 368
Male Internal Genital Organs / 376
Female Internal Genital Organs / 382
Lymphatic Drainage of Pelvic Viscera / 400
PERINEUM / 402
Fasciae and Pouches of Urogenital Triangle
Features of Anal Triangle / 410
Male Urogenital Triangle / 418
Female Urogenital Triangle / 428
SECTIONAL IMAGING OF PELVIS AND PERINEUM / 434
Magnetic Resonance Imaging / 434
4 Back / 439
OVERVIEW OF BACK AND VERTEBRAL COLUMN
VERTEBRAE / 44
ARM / 731
Muscles of Arm / 731
Brachial Artery / 736
Veins of Arm / 737
Nerves of Arm / 737
Cubital Fossa / 739
Surface Anatomy of Arm and Cubital Fossa / 739
FOREARM / 744
Compartments of Forearm / 744
Muscles of Forearm / 746
Arteries of Forearm / 757
Veins of Forearm / 760
Nerves of Forearm / 761
Surface Anatomy of Forearm / 764
HAND / 771
Fascia and Compartments of Palm / 771
Muscles of Hand / 773
Long Flexor Tendons and Tendon Sheaths
in Hand / 779
Arteries of Hand / 779
Veins of Hand / 782
Nerves of Hand / 782
Surface Anatomy of Hand / 786
JOINTS OF UPPER LIMB / 793
Sternoclavicular Joint / 794
Acromioclavicular Joint / 796
Glenohumeral Joint / 796
Elbow Joint / 800
Proximal Radio-Ulnar Joint / 804
Distal Radio-Ulnar Joint / 806
Wrist Joint / 809
Intercarpal Joints / 809
Carpometacarpal and Intermetacarpal Joints / 811
Metacarpophalangeal and Interphalangeal Joints / 812
7 Head / 820
OVERVIEW OF HEAD / 822
CRANIUM / 822
Facial Aspect of Cranium / 822
Lateral Aspect of Cranium / 827
Occipital Aspect of Cranium / 828
Superior Aspect of Cranium / 829
External Surface of Cranial Base / 829
Internal Surface of Cranial Base / 830
Walls of Cranial Cavity / 835
Regions of Head / 836
FACE AND SCALP / 842
Face / 842
Scalp / 843
Muscles of Face and Scalp / 844
Nerves of Face and Scalp / 849
Superficial Vasculature of Face and Scalp / 855
Posterior Thigh Region / 569
Neurovascular Structures of Gluteal and
Posterior Thigh Regions / 572
Surface Anatomy of Gluteal
and Posterior Thigh Regions / 578
POPLITEAL FOSSA AND LEG / 584
Popliteal Region / 584
Anterior Compartment of Leg / 587
Lateral Compartment of Leg / 595
Posterior Compartment of Leg / 596
Surface Anatomy of Leg / 603
FOOT / 609
Skin and Fascia of Foot / 610
Muscles of Foot / 610
Neurovascular Structures and Relationships in Foot / 614
Surface Anatomy of Ankle and Foot Regions / 622
JOINTS OF LOWER LIMB / 626
Hip Joint / 626
Knee Joint / 634
Tibiofibular Joints / 645
Ankle Joint / 647
Foot Joints / 650
Surface Anatomy of Joints of Knee, Ankle, and Foot / 656
6 Upper Limb / 670
OVERVIEW OF UPPER LIMB / 672
COMPARISON OF UPPER AND LOWER LIMBS / 673
BONES OF UPPER LIMB / 673
Clavicle / 673
Scapula / 675
Humerus / 676
Bones of Forearm / 677
Bones of Hand / 679
Surface Anatomy of Upper Limb Bones / 680
FASCIA, EFFERENT VESSELS, CUTANEOUS INNERVATION,
AND MYOTOMES OF UPPER LIMB / 688
Fascia of Upper Limb / 688
Lymphatic Drainage of Upper Limb / 691
Cutaneous Innervation of Upper Limb / 693
Motor Innervation (Myotomes) of Upper Limb / 693
PECTORAL AND SCAPULAR REGIONS / 697
Anterior Axio-appendicular Muscles / 697
Posterior Axio-appendicular
and Scapulohumeral Muscles / 700
Scapulohumeral (Intrinsic Shoulder) Muscles / 704
Surface Anatomy of Pectoral, Scapular, and Deltoid
Regions / 707
AXILLA / 713
Axillary Artery / 715
Axillary Vein / 718
Axillary Lymph Nodes / 719
Brachial Plexus / 721
Contents xvi
xviii Contents
Platysma / 985
Deep Cervical Fascia / 987
SUPERFICIAL STRUCTURES OF NECK: CERVICAL
REGIONS / 989
Sternocleidomastoid Region / 989
Posterior Cervical Region / 992
Lateral Cervical Region / 992
Anterior Cervical Region / 999
Surface Anatomy of Cervical Regions and Triangles of
Neck / 1005
DEEP STRUCTURES OF NECK / 1012
Prevertebral Muscles / 1012
Root of Neck / 1012
VISCERA OF NECK / 1018
Endocrine Layer of Cervical Viscera / 1018
Respiratory Layer of Cervical Viscera / 1021
Alimentary Layer of Cervical Viscera / 1032
Surface Anatomy of Endocrine and Respiratory Layers
of Cervical Viscera / 1039
LYMPHATICS OF NECK / 1051
9 Summary of Cranial
Nerves / 1053
OVERVIEW / 1054
OLFACTORY NERVE (CN I) / 1054
OPTIC NERVE (CN II) / 1061
OCULOMOTOR NERVE (CN III) / 1062
TROCHLEAR NERVE (CN IV) / 1064
TRIGEMINAL NERVE (CN V) / 1065
Ophthalmic Nerve (CN V1) / 1065
Maxillary Nerve (CN V2) / 1065
Mandibular Nerve (CN V3) / 1065
ABDUCENT NERVE (CN VI) / 1068
FACIAL NERVE (CN VII) / 1068
Somatic (Branchial) Motor / 1068
Visceral (Parasympathetic) Motor / 1068
Somatic (General) Sensory / 1068
Special Sensory (Taste) / 1068
VESTIBULOCOCHLEAR NERVE (CN VIII) / 1071
GLOSSOPHARYNGEAL NERVE (CN IX) / 1072
Somatic (Branchial) Motor / 1072
Visceral (Parasympathetic) Motor / 1072
Somatic (General) Sensory / 1072
Special Sensory (Taste) / 1072
VAGUS NERVE (CN X) / 1073
SPINAL ACCESSORY NERVE (CN XI) / 1075
HYPOGLOSSAL NERVE (CN XII) / 1075
Appendix A: References and Suggested Readings / 1083
Index / 1087
Surface Anatomy of Face / 859
CRANIAL MENINGES / 865
Dura Mater / 865
Arachnoid Mater and Pia Mater / 872
Meningeal Spaces / 872
BRAIN / 878
Parts of Brain / 878
Ventricular System of Brain / 878
Arterial Blood Supply to Brain / 882
Venous Drainage of Brain / 883
EYE, ORBIT, ORBITAL REGION, AND EYEBALL / 889
Orbits / 889
Eyelids and Lacrimal Apparatus / 891
Eyeball / 893
Extra-ocular Muscles of Orbit / 898
Nerves of Orbit / 903
Vasculature of Orbit / 905
Surface Anatomy of Eye and Lacrimal Apparatus / 907
PAROTID AND TEMPORAL REGIONS,
INFRATEMPORAL FOSSA, AND
TEMPOROMANDIBULAR JOINT / 914
Parotid Region / 914
Temporal Region / 916
Infratemporal Fossa / 916
ORAL REGION / 928
Oral Cavity / 928
Lips, Cheeks, and Gingivae / 928
Teeth / 930
Palate / 934
Tongue / 938
Salivary Glands / 943
PTERYGOPALATINE FOSSA / 951
Pterygopalatine Part of Maxillary Artery / 951
Maxillary Nerve / 951
NOSE / 955
External Nose / 955
Nasal Cavities / 956
Vasculature and Innervation of Nose / 959
Paranasal Sinuses / 960
EAR / 966
External Ear / 966
Middle Ear / 967
Internal Ear / 973
8 Neck / 981
OVERVIEW / 982
BONES OF NECK / 982
Cervical Vertebrae / 982
Hyoid Bone / 984
FASCIA OF NECK / 985
Cervical Subcutaneous Tissue an

• The lymphatic system is a network of lymphatic vessels
that withdraws excess tissue fl uid (lymph) from the body’s
interstitial (intercellular) fl uid compartment, fi lters it
through lymph nodes, and returns it to the bloodstream.
• The alimentary or digestive system (gastroenterology)
consists of the digestive tract from the mouth to the anus,
with all its associated organs and glands that function in
ingestion, mastication (chewing), deglutition (swallowing),
digestion, and absorption of food and the elimination
of the solid waste (feces) remaining after the nutrients
have been absorbed.
• The respiratory system (pulmonology) consists of the air
passages and lungs that supply oxygen to the blood for cellular
respiration and eliminate carbon dioxide from it. The
diaphragm and larynx control the fl ow of air through the
system, which may also produce tone in the larynx that is
further modifi ed by the tongue, teeth, and lips into speech.
• The urinary system (urology) consists of the kidneys,
ureters, urinary bladder, and urethra, which fi lter blood
and subsequently produce, transport, store, and intermittently
excrete urine (liquid waste).
• The genital (reproductive) system (gynecology for
females; andrology for males) consists of the gonads (ovaries
and testes) that produce oocytes (eggs) and sperms,
the ducts that transport them, and the genitalia that
enable their union. After conception, the female reproductive
tract nourishes and delivers the fetus.
• The endocrine system (endocrinology) consists of
specialized structures that secrete hormones, including
discrete ductless endocrine glands (such as the thyroid
gland), isolated and clustered cells of the gut and blood
vessel walls, and specialized nerve endings. Hormones
are organic molecules that are carried by the circulatory
system to distant effector cells in all parts of the body.
The infl uence of the endocrine system is thus as broadly
distributed as that of the nervous system. Hormones infl uence
metabolism and other processes, such as the menstrual
cycle, pregnancy, and parturition (childbirth).