Surface

Anatomy
DAVID EBENEZER
DEPARTMENT OF ANATOMY
VELAMMAL MEDICAL
COLLEGE
Upper
Limb
 Axillary Artery
• Abduct the arm to
right angles with palm
facing upward
X
• Artery is marked by a
straight line joining X
1. Midpoint of clavicle
2. Junction of anterior
1/3 & posterior 2/3 of
lateral wall of axilla at
its lower limit
 Brachial Artery
1. Junction of anterior
1/3 & posterior 2/3 of
lateral wall of axilla
at its lower limit X
X 1
2. Level of neck of 2
radius, medial to the
tendon of biceps
brachii
Join the above points
 Radial Artery (in forearm)
1. Level of neck of
radius, medial to the X
tendon of biceps
brachii
2. At the wrist between
anterior border of
radius & tendon of
Anterior border
flexor carpi radialis Of radius FCR
Its course is curved with X
a gentle convexity
laterally
 Radial Artery (in hand)
1. At the wrist between
anterior border of Styloid process
of radius
radius & tendon of
flexor carpi radialis XAPL &
2. Below tip of styloid X EPB
process of radius
3. Proximal end of 1st
intermetatarsal
space
 Ulnar Artery
1. Level of neck of
radius, medial to the X
tendon of biceps
brachii X
2. Junction of upper 1/3
& lower 2/3 of medial
border of forearm
3. Lateral to pisiform
X Pisiform
The course is oblique in
the upper part & vertical
in the lower part
 Superficial Palmar Arch
1. A point lateral &
distal to pisiform
2. On the hook of
hamate
3. On the palm at the
level of distal border X3
of the extended
thumb in line with
cleft between index
and middle finger
1
2
 Deep Palmar Arch
• It is marked by a
horizontal line 4 cm
long just distal to the
hook of hamate
• The deep palmar arch
lies 1.2 cm proximal
to superficial palmar
arch
 1
Palpation of Arterial Pulse
1. Brachial pulse-
brachial artery lies
medial to biceps 2
tendon
2. Ulnar pulse- ulnar
artery lies lateral to
flexor carpi ulnaris
3. Radial pulse- radial 3
artery lies lateral to
flexor carpi radialis
 Median Nerve (in the arm)
• Mark the brachial
artery
• The nerve is lateral to
the artery in the upper
half
• The nerve is medial to
the artery in the lower
half
 Median Nerve (in the forearm)
• A point medial to the
brachial artery at the
level of neck of radius X
• In front of the wrist
1cm medial to tendon
of flexor carpi radialis
FCR
X
 Cephalic Vein
3
1. In the anatomical
snuff box Biceps
2. In front of the Cepalic v
elbow in the
groove between 1 BrRad
brachioradialis 2
and biceps
3. In the
deltopectoral
groove below
coracoid process
 Median Cubital Vein
1. A point 2.5 cm below
the lateral side of the
elbow
2. A point 2.5 cm above
the medial Median
Cubital v
epicondyle
X
Medial
epicondyle
X
 Axillary Nerve
1. Tip of acromion
Acromion
process
2. Insertion of deltoid Axillary
nerve
Draw horizontal line 2 cm
Deltoid
above the midpoint of the insertion
above points
 Ulnar Nerve (in the arm)
1. A point on the lateral
wall of axilla at its
lower limit
2. Middle of the medial
border of the arm
3. Behind the base of
medial epicondyle of
humerus Medial epicondyle
 Ulnar Nerve (in the forearm)
1. Behind the base of
medial epicondyle of Medial
humerus X epicondyle

2. Lateral to the
pisiform

X Pisiform
 Radial Nerve
• Lateral wall of axilla at its 1

lower limit Radial nerve

• Junction of upper 1/3 & 2
lower 2/3 of a line joining
3
lateral epicondyle & Lateral
epicondyle
insertion of deltoid
• On the front of the elbow
just below the lateral
epicondyle 1cm lateral to
tendon of biceps brachii
 Flexor Retinaculum
1. Pisiform
2. Tubercle of scaphoid
3. Hook of hamate
4. Crest of trapezium

• Proximal border- join

1 & 2 concave 3
4
downward 1
2
• Distal border- join 3 &
4 concave upward
 Extensor Retinaculum
1. Lateral- lower part of
anterior border or
radius
2. Medial- pisiform,
triquetral and styloid
process of ulna
Extensor retinaculum is
2 cm broad band
directed downward and 2
medially
1
Anatomical Snuff Box

EPL APL & EPB

Site for styloid

Process of radius
Trapezium
Scaphoid
Lower
Limb
 Femoral Artery
1. Midinguinal point- A ASIS
point midway between 1
anterior superior iliac
Pubic
spine (ASIS) & pubic symphysis
symphysis
Femoral
2. Adductor tubercle artery

Join the above, the upper 2

2/3 of the line represents Adductor
femoral artery tubercle
Popliteal Artery
1. At the junction of
middle & lower thirds of
thigh, 2.5cm medial to
the midline on the back
of thigh
2. On the midline of the
back of the knee X 1

3. On midline of back of
leg at the level of tibial X 2
tuberosity
X 3
Posterior Tibial Artery
1. On midline of back
of leg at the level of
tibial tuberosity
2. Midway between X
medial malleolus
and
tendocalcanueus

Medial
malleolus
X
Tendocalcaneus
Anterior Tibial Artery
Head of
1. 2.5cm below the fibula
X
medial side of head
of the fibula
2. Midway between the
two malleoli
X
 Dorsalis Pedis Artery
1. Midway between the
two malleoli
2. Proximal end of first
intermetatarsal
Lateral X Medial
space
malleolus malleolus

X
1st intermeta-
Tarsal space
 Palpation of Arterial Pulse
1. Femoral pulse-
inferior to the X
inguinal ligament at
the midinguinal point
2. Popliteal pulse-
deep in the popliteal
fossa medial to the
midline
Continued…
3. Posterior tibial pulse-
posteroinferior to the
medial malleolus
4. Dorsalis pedis pulse-
over tarsal bones
between tendons of
extensor hallucis EHL
Dorsalis pedis
longus and extensor artery
digitorum longus to
the second toe. EDL
Great Saphenous Vein 5 X
1. On the dorsum of foot at
medial end of dorsal
venous arch
2. Anterior surface of medial
malleolus X4
3. On medial border of tibia
at junction of upper 2/3 &
lower 1/3 of leg
4. At the adductor tubercle
5. Saphenous opening- 4cm
X 3
below & 4cm lateral to
pubic tubercle
X 2
X
1
 Femoral Vein
ASIS
Same as femoral artery
except-
1. 1cm medial to X
Pubic
midinguinal point symphysis

2. 1cm lateral to Femoral

adductor tubercle artery

Join the above, the

upper 2/3 of the line
represents femoral vein
X Adductor
tubercle
 Saphenous Opening
Pubic tubercle
• Its center lies 4cm
below and 4cm lateral
to the pubic tubercle
• It is about 2.5cm long
and 2cm broad with
its long axis directed
downward and
laterally

Saphenous opening
 Femoral Nerve
Femoral nerve
1. 1.2cm lateral to
midinguinal point
2. 2.5cm vertically
below the first point
X

X
 Sciatic Nerve
1. 2.5cm lateral to
midpoint between
posterior superior iliac
spine (PSIS) & ischial
tuberosity PSIS

2. Just medial to midpoint

between ischial X Greater
tuberosity & greater X trochanter
trochanter Ischial
3. In midline of back of tuberosity
thigh at junction of Sciatic nerve
upper 2/3 & lower 1/3
i.e superior angle of
popliteal fossa X
 Common Peroneal Nerve
1. Superior angle of X
popliteal fossa
2. On the back of neck
of fibula
X
 Bryant’s Triangle
Drawn with patient supine
to detect disturbance in
femoral head & neck
anatomy
1. Draw line from ASIS
(A) to greater
trochanter (C)
2. Draw a horizontal line
from ASIS
3. Draw vertical line from
greater trochanter
Thorax
 Right Brachiocephalic Vein
1. Medial end of
right clavicle X
2. Lower border of X
right 1st costal
cartilage close to
sternum
Join these by two
parallel lines 1.5cm
apart
 Left Brachiocephalic Vein
1. Medial end of left
clavicle
2. Lower border of X
right 1st costal X
cartilage close to
sternum
Join these by two
parallel lines 1.5cm
apart going behind the
upper half of the
manubrium
 Superior Vena Cava
1. Lower border of right
1st costal cartilage
close to sternum
X
2. Sternal end of upper
border of right 3rd SVC X
costal cartilage
Draw a line 2cm wide
joining these partly
under cover of right
margin of sternum
 Arch of Aorta
1. Right end of sternal
angle
X
2. Center of X X
manubrium
3. Sternal end of left
2nd costal cartilage
Draw a line through
these to represent the
outer convexity
 Trachea
X
1. A point immediately
below the arch of
cricoid cartilage
2. A point 1cm lateral to X
center of sternal
angle
Draw two parallel lines
2cm apart joining these
points
 Sternal Angle
• Marks position of
manubriosternal joint Sternal
• Posteriorly passes angle
through intervertebral
disc between T4 & T5
• Costal cartilage of 2nd
rib articulates with
sternum
• Superior mediastinum
is separated from the
inferior mediastinum
 Sternal Angle
• Ascending aorta ends & arch of aorta begins
• Arch of aorta ends & thoracic aorta begins
• Pulmonary trunk divides into left & right
pulmonary arteries
• Thoracic duct crosses from right to left
• Trachea bifurcates
• Azygous vein arches over right lung to open
into superior vena cava
 Heart Borders (continueus)
1. At lower border of 2nd left
costal cartilage 1.3cm from
sternal margin
2. At upper border of 3rd right
costal cartilage 0.8cm from X
X
sternal margin
3. Lower border of 6th right
costal cartilage 2cm from X X
sternal margin
4. At the apex of the heart at
left 5th intercostal space
9cm from midsternal line
 Heart Borders (continuation)
1. Upper border- join 1 &
2
2. Lower border- join 3 &
4 X
X
3. Right border- convex
line joining 2 & 3 with a X
convexity at 3.8cm from X X
median plane in 4th
intercostal space
4. Left border- convex line
joining 1 & 4
 Heart Valves
• Pulmonary valve- a
horizontal line 2.5cm
long, behind upper
border of 3rd left costal
cartilage & adjoining
part of sternum
• Aortic valve- a slightly
oblique line 2.5cm long,
behind left half of
sternum at the level of
lower border of left 3rd
costal cartilage
 Heart Valves
• Mitral valve- an
oblique line, 3cm long;
behind left half of
sternum opposite the
left 4th costal cartilage
• Tricuspid valve- most
oblique, being nearly
vertical, 4cm long;
behind right half of
sternum opposite 4th &
5th intercostal spaces
 Heart Valve Auscultatory Area
• Pulmonary valve- 2nd left
intercostal space near
the sternum
• Aotic valve- 2nd right
costal cartilage near the
sternum
• Mitral valve- left 5th
intercostal space 9cm
from midsternal
• Tricuspid valve- left of
the lower part of the
sternum near the 5th
intercostal space
 Cardiac Apex
• Left 5th intercostal
space 9cm from the
midsternal line
or
• Left 5th intercostal 5th IC space
space at the
midclavicular line Midclav-
icular line
 Cervical Pleura/ Apex of Lung
1. Mark the
sternoclavicular joint X
X X
2. Mark the junction of
medial and middle-
third of clavicle
3. Put a point 2.5cm
above the medial
third of clavicle
Join by a curved line
 Right Pleura-Anterior Margin
Also called right costo-
medeiastinal reflection
X
1. Right
sternoclavicular joint X

2. Midpoint of sternal
angle X
3. Xiphisternal joint
 Left Pleura-Anterior Margin
Also called left costo-
medeiastinal reflection
X
1 & 2 same as right side
X
3. Midline of sternum at
level of 4th costal X
cartilage X
4. Sternal margin at
level of 6th costal
cartilage
 Pleura- Inferior Margin
Also called costo-
diaphragmatic reflection
1. 8th rib at midclavicular
line
2. 10th rib at midaxillary
line
3. 12th rib at lateral
border of sacrospinalis X
4. 2cm lateral to 12th X
thoracic spine
 Pleura- Posterior Margin
• 2cm lateral to 12th C7
thoracic spine X
• 2cm lateral to 7th
cervical spine

X
 Right Lung-Anterior Border
1. Right
sternoclavicular joint
X
2. Midpoint of sternal
angle X

3. 6th right
costochondral X
junction
 Left Lung-Anterior Border
1 & 2 same as right side
3. 3.5cm from sternal X
margin at level of 4th
costal cartilage X

4. 6th costal cartilage X

4cm from the midline
X
 Lung- Inferior Border
1. 6th rib at
midclavicular line
2. 8th rib at midaxillary
line
3. 10th rib at lateral
border of
sacrospinalis X
X
4. 2cm lateral to 10th
thoracic spine
 Lung- Posterior Border
• 2cm lateral to 10th C7
thoracic spine X
• 2cm lateral to 7th
cervical spine

X
 Fissures of Lung
Oblique fissure
1. Spine of T4
2. 5th intercostal space at
midclavicular line
3. 6th costal cartilage T4 X
7.5cm from midline X X
Horizontal fissure 6th rib
X
1. 5th intercostal space
at midclavicular line
2. Anterior border of right Midaxillary
lung at 4th costal line
cartilage
Abdomen
 Abdominal Planes
• Transpyloric plane- crosses tips of 9th
costal cartilage & lower border of body of
L1 vertebra
• Transtubercular plane- passes through
tubercles of iliac crest & upper border of
body of L5 vertebra
• Right & left midclavicular planes pass
through midinguinal point & crosses tip of
9th costal cartilage
 Abdominal Planes & Regions

Midclavicular
line Transpyloric
plane

Transtubercular
plane
 Location of Abdominal Organs

Spleen

Aorta
& IVC

Rt kidney
Lt kidney

Ceacum

Urinary bladder
Enlarged uterus
Transpyloric Plane Jugular notch

It is indicated by:
• A line midway between
jugular notch & pubic
symphysis (or)
• A line midway between
umbilicus & xiphisternal
joint (or)
• It crosses tips of 9th
costalcartilage &
lowerborder of L1
Pubic
symphysis
Transpyloric Plane Jugular notch

Passes through-
1. Pylorus of stomach
2. Beginning of duodenum
3. Fundus of gall bladder
4. Hilum of kidneys
5. Neck of pancreas
6. Anterior end of spleen
7. Termination of spinal cord
8. Beginning of thoracic
duct
9. Origin of superior
mesenteric artery
Pubic
10. Origin of portal vein symphysis
 Stomach- Orifices
• Cardiac orifice- 2.5cm to
the left of median plane on
the 7th costal cartilage. 4
Draw two parallel lines 2cm 5

apart directed downward & 6

to the left 7

• Pyloric orifice- on the 8

transpyloric plane, 1.2cm 9

lateral to the median plane. 10

Draw two parallel lines
directed upward & to the
right
 Stomach- Curvatures & Fundus
• Lesser curvature- join right
margin of pyloric orifice with
upper margin of pyloric orifice
4
by a J-shaped curve. The
lowest point reaching 5
transpyloric plane X 6
• Fundus- left 5th intercostal 7
space just below nipple 8
• Greater curvature- fundus to 9
lower margin of pyloric orifice. 10
It cuts left costal margin
between 9th & 10th costal
cartilage & extends down to
subcostal plane
 Liver- Inferior Border
1. Left 5th intercostal space
below & medial to left
4 4
nipple
5
2. Tip of 8th costal cartilage 5
X
on the costal margin 6
6
7
3. On the transpyloric plane 7
in the midline X 8
8
4. Tip of 9th costal cartilage X 9
9 X 10
on the right costal margin 10
5. 1cm below right costal X
margin at tip of 10th costal
cartilage
 Liver- Superior & Right Border
Superior border
1. Left 5th intercostal
4
space below & medial 4

to left nipple 5
X
5
X X 6
2. Xiphisternal joint 6
7
3. Below the right nipple 7
8
Right border 8 9
9
1. Same as 3 10
10

2. 1cm below right costal X

margin at tip of 10th
costal cartilage
 Gall Bladder- Fundus
1. Small convex area at
the tip of right 9th costal
4 4
cartilage
5 5
OR 6
6
2. Angle between right 7
7
8
costal margin and linea 8 9
semilunaris 9 X
10
10

Also called as Murphy’s

Point
 Base of Appendix
1. Mark the intersection
of right lateral line
and transtubercular
plane
2. Base of the
appendix is situated
2cm below this
intersection
X
 Mc Burney’s Point
1. Draw a line from
right ASIS to
umbilicus
2. Mark the junction of
outer and middle
third of this line
This is the site of
maximum tenderness in
case of appendicitis X
 Root of Mesentery
1. 1cm below
transpyloric plane &
3cm lateral to the left
of median plane
2. Intersection of right
lateral line and X
transtubercular
plane X
Join the above
 Spleen
• Medial end- 4cm
lateral to T10 spine
on left side
9
• Lateral end- left 10 T10
th Spleen
midaxillary line at 10 11

rib
• Upper border- upper
border of 9th rib
• Lower border- lower
border of 11th rib
 Kidney- on the Back
Map Morrison's
parallelogram by:
1. Draw two horizontal lines
at T11 & L3 spines
2. Draw two vertical lines
T11
2.5cm & 9.5cm apart
from medial plane L1
3. Mark hilum at level of
lower border of L1 L3

Upper poles are nearer &

lower poles are farther from
the median plane
 Abdominal Aorta
1. 2.5cm above
transpyloric plane in
the median plane X
2. 1.2cm below and to
the left of umbilicus
(level of L4) X
Join these by two
parallel lines 2cm apart
 Inferior Vena Cava
1. Mark a point just X
below
transtubercular
plane and 2.5cm
from the median
plane
Trans-
2. Sternal end of right tubercular X
6th costal cartilage plane
Draw two vertical lines
2.5cm joining the above
 Inguinal Canal
1. Deep inguinal
ring(DIR)- 1cm above
midinguinal point
(midway between ASIS
& pubic symphysis) ASIS DIR
2. Superficial ingiunal ring SIR
(SIR)- above & lateral
Pubic
to pubic tubercle symphysis
Join the above by two
parallel lines 1cm apart
and 3.7cm long
Head
&
Neck
 C4 Vertebral Level
• Upper margin of
thyroid cartilage
• Bifurcation of
common carotid
artery

C4
 C6 Vertebral Level
• Arch of cricoid
cartilage
• Transition from
pharynx to esophagus
• Transition larynx to
trachea

C6
 Common Carotid Artery
1. Sternoclavicular joint
2. Anterior border of
sternocleidomastoid
at the level of upper
border of thyroid
cartilage X

X
 External Carotid Artery
1. Anterior border of
sternocleidomastoid
at the level of upper
border of thyroid
cartilage
X
2. Posterior border of
neck of mandible
X
 Internal Carotid Artery
1. Anterior border of
sternocleidomastoid
at the level of upper
border of thyroid
cartilage X
2. Posterior border of
condyle of mandible
X
 Facial Artery
1. At anterior-inferior
angle masseter
2. 1.2cm lateral to the
angle of mandible
3. Medial angle of eye X
The artery is tortuous in
its course X
X
 Internal Jugular Vein
1. Medial to lobule of
ear
2. Medial end of
clavicle
X
The lower bulb of the
vein lies between the
sternal & clavicular
head of
sternocleidomastoid X
 External Jugular Vein
1. Below the angle of
mandible X Angle of
2. On the clavicle just mandible

lateral to posterior
border of
sternocleidomastoid
X SCM
 Subclavian Artery
1. Sternoclavicular joint
2. Middle of lower
border of clavicle
3. 2cm above clavicle
midway between 1 &
2

X
X X
 Subclavian Vein
1. Medial to midpoint of
clavicle
2. Medial end of
clavicle

Join these by short line

convex upwards

X X
 Palpation of Arterial Pulse
1. Superficial temporal-
anterior to the ear &
posterosuperior to
position of TMJ
1
2. Carotid-
posterolateral to the
larynx
3. Subclavian-posterior
to junction of medial 2
& middle thirds of 3
the clavicle
 Parotid gland
1. Upper border of
head of mandible
2. Just above the
center of masseter
3. 2cm posteroinferior
to angle of mandible X
X
4. Upper part of X
anterior border of X
mastoid process
 Parotid Duct
1. Lower border of
tragus
2. A point midway
between ala of nose
and red margin of
upper lip
X
The middle- third of this X
line represents parotid
duct
 Submandibular Gland
1. Angle of mandible
2. Lower border of
mandible midway
between angle & the
symphysis
3. 1.5cm midway
between the above
4. Greater cornu of XX
hyoid X X
Join these with oval line
 Thyroid Gland- Isthmus
1. Upper border- A line
1.5cm long across
the trachea, 1cm
below the arch of
cricoid cartilage
2. Lower border- A line
1.5cm long across Arch of
the trachea, 2.5cm cricoid
below the arch of
cricoid cartilage
 Thyroid Gland- Lateral Lobe
1. 1cm below lateral end
of lower border of
isthmus
2. 2.5cm below & lateral
end of lower border of
isthmus
3. A little in front of Laryngeal
anterior border of prominence
X
sternocleidomastoid at
the level of laryngeal
prominence XX
 Spinal Accessory Nerve
1. Anteroinferior to tragus
X
2. Tip of transverse process
of atlas (midway b/w X
angle of mandible &
mastoid process)
X
3. Middle of posterior border
of sternocleidomastoid
4. Anterior border of X
trapezius 6cm above
clavicle
 Vagus Nerve
1. Anteroinferior to
X
tragus
2. Medial end of
clavicle

X
 Pterion
3.5cm behind & 1.5cm
above fronto-zygomatic
suture Pterion
Fronto
zygomatic
suture

Middle
meningeal
artery
 Mastoid Antrum
The lateral wall of
the mastoid antrum
corresponds to the
suprameatal triangle Cymba
concha
which is represented
on the surface by
cymba concha
 Palpation of Air Sinuses
1. Frontal air sinus- by
pressing upwards
just below the
eyebrow
2. Maxillary air sinus-
by pressing below
the eyes