Clinical Surface Anatomy, ed 2.

Clinical Surface Anatomy, ed 2 Backhouse KM, Hutchings RT. St. Louis, MO 63146-3318, Mosby-Wolfe Inc, 1998, paperback, 138 pp, illus, $26.

As the title implies, this is a text that concentrates on identifying anatomical structures that underlie the skin. However, it identifies and discusses not only the locations of anatomical structures, but also their functions and when possible, their nerve supply. It also identities, whenever necessary, the points of superficial entry for the application of anesthesia. As one can surmise, this text relies heavily on photographs, and it sometimes incorporates superimposed illustrations of the underlying anatomical structures. Interestingly, however, the second edition has fewer photographs than its predecessor, and it has been completely rewritten. Furthermore, the authors purposefully photographed models who did not have highly developed muscles; instead they photographed models who would represent typical patients who clinicians are likely to see in everyday practice.

This text contains 10 chapters. It begins with an interesting introductory chapter that covers such topics as skin, surface contours, bone and muscle, and body proportions. The discussion on skin was especially interesting from an anatomical and biomechanical perspective.

Chapters 2 through 10 begin at the head and proceed to the lower extremity. Chapter 2 is the least relevant chapter for physical therapists because it covers structures such as the nose, external ear, salivary glands, and the eye. This chapter, however, does include useful information on the location and assessment of such structures as the muscles of facial expression, extraocular eye muscles, cranial nerves, and blood supply to the face and head. The authors make good use of illustrations that are superimposed over photographs, especially those dealing with the location and course of cranial nerves VII, X, and XI, and the blood supply to the face.

Chapter 3 covers the anatomical structures of the neck. There is an excellent demonstration of posterior cervical triangle structures and a discussion of cervical and brachial plexus nerve blocks. The authors again make good use of superimposed illustrations in their description of the great blood vessels and lymphatic system of the neck. This chapter concludes with a demonstration of submandibular structures, including the larynx, the hyoid bone, and the thyroid gland.

The next chapter discusses the shoulder girdle and arm. It begins with superior and anterior views of musculoskeletal structures about the acromioclavicular joint. It then discusses and identifies, in order, (1) shoulder girdle movements, (2) the superficial back anti anterior chest muscles that control scapular movement, (3) the scapular muscles that move the arm, (4) the structures that form the borders of the axilla and its contents, (5) the bony landmarks of the elbow and forearm, (6) the anatomical structures of the arm and forearm, and finally (7) forearm movements. Photographs of different movements at the wrist follow and include radiographs identifying carpal bones. This chapter concludes with photographs of the wrist, which emphasize tendons of muscles that either attach at, or cross, the wrist. This last discussion makes a nice transition to chapter 5--"The Hand."

Chapter 5 contains a comprehensive review of the surface anatomy and movements of the hand, subjects that are especially appropriate for hand rehabilitation therapists. It contains photographs and discussions of: (1) skin, including nails and the different palmar creases; (2) bony landmarks at the wrist and hand produced by carpal bones; and (3) hand functions, with an emphasis on grips (eg, power grip, lateral pinch grip). The remainder of the chapter concerns the assessment of extrinsic and intrinsic hand muscle function.

The authors dedicate chapter 6 to vessels and nerves of the upper extremity. Much of the chapter covers, in appropriate detail, the location of these anatomical structures and describes where and how to palpate certain vessels and nerves (eg, radial artery, ulnar nerve). Like the other chapters, it makes excellent use of superimposed illustrations of the course of different vessels and nerves in the upper extremity.

Chapter 7 is a short chapter covering the back. It reviews curves and movements of the spine, illustrates how to palpate spinous processes, and discusses and illustrates the procedures involved in a lumbar puncture.

The next chapter; dedicated to the thorax and thoracic wall, is an excellent chapter for cardiopulmonary therapists. It begins with a discussion and accompanying photographs of how and where to palpate different parts of the sternum and its articulations with the ribs and the clavicle bones. Ten photographs further emphasize the chapter's discussion of the surface anatomy, approximate location, blood supply, and lymphatic drainage of the breast. The remainder of the chapter combines photographs of the anterior chest wall with superimposed illustrations of the location and extent of the pleura, the heart and its valves, bronchopulmonary segments, and major blood vessels. It also briefly discusses how to perform a clinical assessment of the heart.

The ninth chapter discusses the surface anatomy of the abdomen at length. It begins with a discussion and photographs of the anterior abdominal wall that demonstrate the location of various borders and muscles associated with this region. The short discussion of the inguinal region contains an excellent photograph with a superimposed drawing of the contents of the femoral triangle and the location of the inguinal ligament in the male subject. The anatomical features of male and female external genitalia are then discussed. Next, the authors provide photographs showing the anterior body wall, accompanied by superimposed illustrations of cutaneous nerves and blood vessels. There is also a nice discussion of referred pain with an accompanying photograph that demonstrates different locations in which pain may be manifested. This chapter concludes with various photographs demonstrating the different locations of various abdominal and pelvic viscera along with the great blood vessels of the abdomen and pelvis.

The last chapter covers the lower extremities. Its discussion of where and how to palpate bony features around the hip provides a smooth transition from the previous chapter. There is a thorough discussion of the ranges of motion available at the hip with accompanying photographs demonstrating such movements. The authors then use the same format for their discussion of the knee tie, bony features followed by available ranges of motion). Next, the authors discuss the muscles around the hip and knee and use photographs that identify the location of these muscles. The bony features, available ranges of motion, and muscles of the ankle and foot are then discussed and demonstrated using photographs. Using photographs and superimposed illustrations of the lower limbs, the authors identify the location and course of blood vessels and various nerves and their dermatomes. There are also photographs that demonstrate how to assess various lower-extremity pulses. The chapter concludes with a demonstration of the lower-limb lymphatic system, emphasizing inguinal lymph nodes.

Overall, this is a fine text. It is very informative and easy to read, and the photographs are excellent. The use of superimposed illustrations over the photographs is extremely helpful in understanding the location and course of certain anatomical structures (eg, nerves, blood and lymph vessels). The introduction to points of application of anesthesia is interesting. The only possible shortcoming is the absence of captions for some of the figures.

The authors intended this text for medical and allied health professionals, dance instructors, and artists. I highly recommend its use in physical therapist and physical therapist assistant class-work and for clinicians who want to review surface anatomy.

Dr. Karnes is Associate Professor in the physical therapy program, where he teaches courses in gross human anatomy and clinical neuroscience. His research interests include the influence of physical agents on soft tissue injury and repair.