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Clinical Anatomy
Applied anatomy for students and junior doctors
Harold Ellis
ELEVENTH EDITION
Clinical Anatomy
ECAPR 7/18/06 6:33 PM Page i
To my wife and late parents
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Clinical Anatomy
A revision and applied anatomy
for clinical students
HAROLD◊ ELLIS
CBE, MA, DM, MCh, FRCS, FRCP, FRCOG, FACS (Hon)
Clinical Anatomist, Guy’s, King’s and
St Thomas’ School of Biomedical Sciences;
Emeritus Professor of Surgery, Charing Cross
and Westminster Medical School, London;
Formerly Examiner in Anatomy, Primary FRCS (Eng)
ELEVENTH EDITION
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© 2006 Harold Ellis
Published by Blackwell Publishing Ltd
Blackwell Publishing, Inc., 350 Main Street, Malden, Massachusetts 02148-5020, USA
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK
Blackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053,
Australia
The right of the Author to be identified as the Author of this Work has been asserted
in accordance with the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system, or transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, except as permitted by the UK
Copyright, Designs and Patents Act 1988, without the prior permission of the
publisher.
First published 1960 Seventh edition 1983
Second edition 1962 Revised reprint 1986
Reprinted 1963 Eighth edition 1992
Third edition 1966 Ninth edition 1992
Fourth edition 1969 Reprinted 2000
Fifth edition 1971 Tenth edition 2002
Sixth edition 1977 Reprinted 2003, 2004
Reprinted 1978, 1980 Greek edition 1969
Eleventh edition 2006
1 2006
Library of Congress Cataloging-in-Publication Data
Data available
ISBN-13: 978-1-4051-3804-8
ISBN-10: 1-4051-3804-1
A catalogue record for this title is available from the British Library
Set in 9/12 Palatino by SNP Best-set Typesetter Ltd., Hong Kong
Printed and bound in India by Replika Press Pvt Ltd
Commissioning Editor: Martin Sugden
Editorial Assistant: Ellie Bonnett
Development Editor: Mirjana Misina
Production Controller: Kate Charman
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sustainable forestry policy, and which has been manufactured from pulp processed
using acid-free and elementary chlorine-free practices. Furthermore, the publisher
ensures that the text paper and cover board used have met acceptable
environmental accreditation standards.
Blackwell Publishing makes no representation, express or implied, that the drug
dosages in this book are correct. Readers must therefore always check that any
product mentioned in this publication is used in accordance with the prescribing
information prepared by the manufacturers. The author and the publishers do not
accept responsibility or legal liability for any errors in the text or for the misuse or
misapplication of material in this book.
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Contents
Preface, xiii
Acknowledgements, xiv
Part 1:◊The Thorax
Surface anatomy and surface markings, 3
◊◊Surface markings of the more important thoracic contents, 3
The thoracic cage, 7
◊◊The thoracic vertebrae, 7
◊◊The ribs, 7
◊◊The costal cartilages, 10
◊◊The sternum, 11
◊◊The intercostal spaces, 11
◊◊The diaphragm, 14
◊◊The pleurae, 18
The lower respiratory tract, 19
◊◊The trachea, 19
◊◊The bronchi, 23
◊◊The lungs, 23
The mediastinum, 28
◊◊The pericardium, 28
◊◊The heart, 29
◊◊The superior mediastinum, 42
◊◊The oesophagus, 42
◊◊The thoracic duct, 45
◊◊The thoracic sympathetic trunk, 47
On the examination of a chest radiograph, 49
◊◊Radiographic appearance of the heart, 50
Part 2:◊The Abdomen and Pelvis
Surface anatomy and surface markings, 55
◊◊Vertebral levels, 55
◊◊Surface markings, 55
The fasciae and muscles of the abdominal wall, 58
◊◊Fasciae of the abdominal wall, 58
◊◊The muscles of the anterior abdominal wall, 58
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◊◊The anatomy of abdominal incisions, 61
◊◊The inguinal canal, 63
Peritoneal cavity, 65
◊◊Intraperitoneal fossae, 68
◊◊The subphrenic spaces, 69
The gastrointestinal tract, 70
◊◊The stomach, 70
◊◊The duodenum, 75
◊◊Small intestine, 77
◊◊Large intestine, 78
◊◊The appendix, 79
◊◊The rectum, 81
◊◊Arterial supply of the intestine, 86
◊◊The portal system of veins, 87
◊◊Lymph drainage of the intestine, 88
◊◊The structure of the alimentary canal, 88
◊◊The development of the intestine and its congenital abnormalities, 90
The gastrointestinal adnexae: liver, gall-bladder and its
ducts, pancreas and spleen, 93
◊◊The liver, 93
◊◊The biliary system, 98
◊◊The gall-bladder, 99
◊◊The pancreas, 101
◊◊The spleen, 104
The urinary tract, 105
◊◊The kidneys, 105
◊◊The ureter, 109
◊◊The embryology and congenital abnormalities of the kidney and
ureter, 110
◊◊The bladder, 112
◊◊The urethra, 115
The male genital organs, 116
◊◊The prostate, 116
◊◊The scrotum, 119
◊◊Testis and epididymis, 119
◊◊Vas deferens (ductus deferens), 123
◊◊The seminal vesicles, 124
The bony and ligamentous pelvis, 124
◊◊The os innominatum, 124
◊◊The sacrum, 125
◊◊The coccyx, 126
◊◊The functions of the pelvis, 126
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◊◊Joints and ligamentous connections of the pelvis, 127
◊◊Differences between the male and female pelvis, 128
◊◊Obstetrical pelvic measurements, 128
◊◊Variations of the pelvic shape, 130
The muscles of the pelvic floor and perineum, 132
◊◊The anterior (urogenital) perineum, 133
◊◊The posterior (anal) perineum, 134
The female genital organs, 136
◊◊The vulva, 136
◊◊The vagina, 137
◊◊The uterus, 139
◊◊The Fallopian tubes, 144
◊◊The ovary, 145
◊◊The endopelvic fascia and the pelvic ligaments, 146
◊◊Vaginal examination, 147
◊◊Embryology of the Fallopian tubes, uterus and vagina, 148
The posterior abdominal wall, 149
◊◊The suprarenal glands, 151
◊◊Abdominal aorta, 151
◊◊Inferior vena cava, 153
◊◊Lumbar sympathetic chain, 153
Part 3:◊The Upper Limb
The female breast, 159
◊◊Structure, 159
◊◊Blood supply, 159
◊◊Lymphatic drainage, 159
◊◊Development, 161
Surface anatomy and surface markings of the
upper limb, 162
◊◊Bones and joints, 163
◊◊Muscles and tendons, 164
◊◊Vessels, 166
◊◊Nerves, 167
The bones and joints of the upper limb, 168
◊◊The scapula, 168
◊◊The clavicle, 168
◊◊The humerus, 169
◊◊The radius and ulna, 171
◊◊The bones of the hand, 174
◊◊The shoulder, 176
◊◊The elbow joints, 180
Contents vii
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◊◊The wrist joint, 183
◊◊The joints of the hand, 184
The arteries of the upper limb, 186
◊◊The axillary artery, 186
◊◊The brachial artery, 187
◊◊The radial artery, 187
◊◊The ulnar artery, 188
The brachial plexus, 189
◊◊The segmental cutaneous supply of the upper limb, 191
The course and distribution of the principal nerves of the
upper limb, 191
◊◊The axillary nerve, 191
◊◊The radial nerve, 192
◊◊Branches, 194
◊◊The musculocutaneous nerve, 194
◊◊The ulnar nerve, 194
◊◊The median nerve, 195
The anatomy of upper limb deformities, 197
The spaces of the hand, 200
◊◊The superficial pulp space of the fingers, 200
◊◊The ulnar and radial bursae and the synovial tendon sheaths of the
fingers, 201
Part 4:◊The Lower Limb
The anatomy and surface markings of the lower limb, 207
◊◊Bones and joints, 207
◊◊Bursae of the lower limb, 207
◊◊Mensuration in the lower limb, 208
◊◊Muscles and tendons, 211
◊◊Vessels, 211
◊◊Nerves, 214
The bones and joints of the lower limb, 216
◊◊The os innominatum, 216
◊◊The femur, 216
◊◊The patella, 220
◊◊The tibia, 223
◊◊The fibula, 224
◊◊A note on growing ends and nutrient foramina in the long bones, 225
◊◊The bones of the foot, 225
◊◊The hip, 226
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Contents ix
◊◊The knee joint, 229
◊◊The tibiofibular joints, 233
◊◊The ankle, 233
◊◊The joints of the foot, 234
◊◊The arches of the foot, 235
◊◊The anatomy of walking, 237
Three important zones of the lower limb
—
the femoral
triangle, adductor canal and popliteal fossa, 237
◊◊The femoral triangle, 237
◊◊The fascia lata, 238
◊◊The femoral sheath and femoral canal, 238
◊◊Femoral hernia, 239
◊◊The lymph nodes of the groin and the lymphatic drainage of the lower
limb, 241
◊◊The adductor canal (of Hunter) or subsartorial canal, 242
◊◊The popliteal fossa, 242
The arteries of the lower limb, 244
◊◊Femoral artery, 244
◊◊Popliteal artery, 246
◊◊Posterior tibial artery, 246
◊◊Anterior tibial artery, 246
The veins of the lower limb, 247
◊◊Clinical features, 249
The course and distribution of the principal nerves of the
lower limb, 249
◊◊The lumbar plexus, 250
◊◊The sacral plexus, 251
◊◊The sciatic nerve, 253
◊◊The tibial nerve, 255
◊◊The common peroneal (fibular) nerve, 255
◊◊Segmental cutaneous supply of the lower limb, 256
Part 5:◊The Head and Neck
The surface anatomy of the neck, 261
◊◊The fascial compartments of the neck, 262
The thyroid gland, 264
◊◊The parathyroid glands, 267
The palate, 270
◊◊The development of the face, lips and palate with special reference to
their congenital deformities, 270
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[...]... final examinations and into their postgraduate years; it is designed for the clinical student Anatomy is a vast subject and, therefore, in order to achieve this goal, I have deliberately carried out a rigorous selection of material so as to cover only those of its thousands of facts which I consider form the necessary anatomical scaffolding for the clinician Wherever possible practical applications are... six intercostal spaces; those of the 2nd–4th spaces are large in the female and supply the breast The intercostal nerves are the anterior primary rami of the thoracic nerves, each of which gives off a collateral muscular branch and lateral and anterior cutaneous branches for the innervation of the thoracic and abdominal walls (Fig 9) Clinical features 1◊◊Local irritation of the intercostal nerves by... ciliated columnar epithelium with many goblet cells Clinical features Radiology Since it contains air, the trachea is more radio-translucent than the neighbouring structures and is seen in posteroanterior and lateral radiographs as a dark area passing downwards, backwards and slightly to the right In the elderly, calcification of the tracheal rings may be a source of radiological confusion Displacement... lumbar vertebrae and intervertebral discs; the left crus is only attached to the first two vertebrae The arcuate ligaments are a series of fibrous arches, the medial being a thickening of the fascia covering psoas major and the lateral of fascia overlying quadratus lumborum The fibrous medial borders of the two crura form a median arcuate ligament over the front of the aorta 2◊ A costal part is attached to... abdominal musculature which, acting through the contained viscera, forces the diaphragm upwards In deep and in forced inspiration additional muscles attached to the chest wall are called into play (e.g scalenus anterior, sternocleidomastoid, serratus anterior and pectoralis major) to increase further the capacity of the thorax Similarly, in deep expiration, forced contraction of the abdominal muscles aids... artery and vein and the two vagi; 3◊◊the opening for the inferior vena cava (T8) which is placed in the central tendon and also transmits the right phrenic nerve In addition to these structures, the greater and lesser splanchnic nerves (see page 49) pierce the crura and the sympathetic chain passes behind the diaphragm deep to the medial arcuate ligament The development of the diaphragm and the anatomy. .. aids the normal expulsive factors described above The pleurae The two pleural cavities are totally separate from each other (Fig 2) Each pleura consists of two layers: a visceral layer intimately related to the surface of the lung, and a parietal layer lining the inner aspect of the chest wall, the upper surface of the diaphragm and the sides of the pericardium and mediastinum The two layers are continuous... cervical vertebra) C6 Pre-vertebral fascia Carotid sheath (containing common carotid artery, internal jugular vein, and vagus nerve) with sympathetic chain behind and left carotid artery, both arising from the arch of the aorta, the left brachiocephalic (innominate) vein, and the thymus; •◊◊posteriorly—oesophagus and left recurrent laryngeal nerve; •◊◊to the left — arch of the aorta, left common carotid... rib has only one articular facet on the head The 11th and 12th ribs are short, have no tubercles and only a single facet on the head The 11th rib has a slight angle and a shallow subcostal groove; the 12th has neither of these features Clinical features Rib fractures The chest wall of the child is highly elastic and therefore fractures of the rib in children are rare In adults, the ribs may be fractured... carotid and left subclavian arteries, left recurrent laryngeal nerve and pleura; •◊◊to the right—vagus, azygos vein and pleura (Fig 17) Structure The patency of the trachea is maintained by a series of 15–20 U-shaped cartilages Posteriorly, where the cartilage is deficient, the trachea is flattened and its wall completed by fibrous tissue and a sheet of smooth muscle (the trachealis) Within, it is lined by a . my wife and late parents
ECAPR 7/18/06 6:33 PM Page ii
Clinical Anatomy
A revision and applied anatomy
for clinical students
HAROLD◊ ELLIS
CBE, MA, DM,. Clinical Anatomy
Applied anatomy for students and junior doctors
Harold Ellis
ELEVENTH EDITION
Clinical Anatomy
ECAPR 7/18/06 6:33 PM Page i
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