CLINICAL ANATOMY

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Clinical Anatomy
Arevision 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

© 2006 Harold Ellis
Published by Blackwell Publishing Ltd
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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
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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
◊◊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
◊◊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
◊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
◊◊Anote on growing ends and nutrient foramina in the long bones, 225
◊◊The bones of the foot, 225
◊◊The hip, 226
◊◊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
The tongue and floor of the mouth, 272
◊◊The tongue, 272
◊◊The floor of the mouth, 276
The pharynx, 277
◊◊The nasopharynx, 277
◊◊The oropharynx, 278
◊◊The palatine tonsils, 279
◊◊The laryngopharynx, 280
◊◊The mechanism of deglutition, 282
The larynx, 284
◊◊Blood supply, 287
◊◊Lymph drainage, 287
◊◊Nerve supply, 288
The salivary glands, 289
◊◊The parotid gland, 289
◊◊The submandibular gland, 292
◊◊The sublingual gland, 293
The major arteries of the head and neck, 294
◊◊The common carotid arteries, 294
◊◊The external carotid artery, 294
◊◊The internal carotid artery, 296
◊◊The subclavian arteries, 298
The veins of the head and neck, 301
◊◊The cerebral venous system, 301
◊◊The venous sinuses of the dura, 301
◊◊The internal jugular vein, 303
◊◊The subclavian vein, 305
The lymph nodes of the neck, 306
The cervical sympathetic trunk, 308
The branchial system and its derivatives, 310
◊◊Branchial cyst and fistula, 310
The surface anatomy and surface markings of the head, 31
The scalp, 312
The skull, 314
◊◊Development, 316
The accessory nasal sinuses, 318
◊◊The frontal sinuses, 318
◊◊The maxillary sinus (antrum of Highmore), 319
◊◊The ethmoid sinuses, 320
◊◊The sphenoid sinuses, 321
The mandible, 321
◊◊The temporomandibular joint, 322
◊◊The teeth, 323
The vertebral column, 324
◊◊The cervical vertebrae, 325
◊◊The thoracic vertebrae, 327
◊◊The lumbar vertebrae, 327
◊◊The sacrum, 327
◊◊The coccyx, 327
◊◊The intervertebral joints, 328
Part 6:◊The Central Nervous System
The spinal cord, 333
◊◊Age differences, 333
◊◊Structure, 333
◊◊Descending tracts, 334
◊◊Ascending tracts, 336
◊◊The membranes of the cord (the meninges), 337
The brain, 339
◊◊The medulla, 339
◊◊The pons, 342
◊◊The cerebellum, 342
◊◊The midbrain, 344
◊◊The diencephalon, 346
◊◊The hypothalamus, 346
◊◊The pituitary gland (hypophysis cerebri), 347
◊◊The thalamus, 349
◊◊The cerebral hemispheres, 349
◊◊The cerebral cortex, 349
◊◊The insula, 352
◊◊The connections of the cerebral cortex, 352
◊◊The basal ganglia, 353
◊◊The long ascending and descending pathways, 354
◊◊The membranes of the brain (the meninges), 360
◊◊The ventricular system and the cerebrospinal fluid circulation, 361
The cranial nerves, 364
◊◊The olfactory nerve (I), 364
◊◊The optic nerve (II) and the visual pathway, 365
◊◊The oculomotor nerve (III), 366
◊◊The trochlear nerve (IV), 368
◊◊The trigeminal nerves (V), 369
◊◊The abducent nerve (VI), 374
◊◊The facial nerve (VII), 375
◊◊The auditory (vestibulocochlear) nerve (VIII), 377
◊◊The glossopharyngeal nerve (IX), 379
◊◊The vagus nerve (X), 379
◊◊The accessory nerve (XI), 381
◊◊The hypoglossal nerve (XII), 381
The special senses, 383
◊◊The nose, 383
◊◊The ear, 384
◊◊The eye and associated structures, 388
The autonomic nervous system, 393
◊◊Visceral afferents, 396
◊◊The sympathetic system, 396
◊◊The sympathetic trunk, 396
◊◊The parasympathetic system, 399
Glossary of eponyms, 403
Index, 409