Anatomy and Human Movement CommissioningEditor:RitaDemetriou-Swanwick DevelopmentEditor:SallyDavies ProjectManager:ElouiseBall Designer/DesignDirection:CharlesGray IllustrationManager:GillianRichards OriginalIllustration:Keyword NewandUpdatedArtwork:Cactus,JenniferRose IllustrationColouring:Cactus Anatomy and Human Movement Structure and Function SIXTH EDITION Nigel Palastanga MA BAFCSP DMSDipTP Pro-Vice-Chancellor, Universityof Wales; formerlyDirectorof Physiotherapy Education, CardiffUniversity, Cardiff, UK Roger Soames BSc PhD Centre forAnatomy and Human Identification, Collegeof LifeSciences, Universityof Dundee,Dundee, UK Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2012 #2012ElsevierLtd.Allrightsreserved. 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Firstedition1989 Firstpublishedasapaperbackedition1990 Secondedition1994 Thirdedition1998 Fourthedition2002 Fifthedition2006 Sixthedition2012 ISBN9780702035531 InternationalISBN9780702040535 BritishLibraryCataloguinginPublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary LibraryofCongressCataloginginPublicationData AcatalogrecordforthisbookisavailablefromtheLibraryofCongress Notices Knowledgeandbestpracticeinthisfieldareconstantlychanging.Asnewresearchandexperience broadenourunderstanding,changesinresearchmethods,professionalpractices,ormedicaltreatment maybecomenecessary. Practitionersandresearchersmustalwaysrelyontheirownexperienceandknowledgein evaluatingandusinganyinformation,methods,compounds,orexperimentsdescribedherein. Inusingsuchinformationormethodstheyshouldbemindfuloftheirownsafetyandthesafetyof others,includingpartiesforwhomtheyhaveaprofessionalresponsibility. 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PrintedinChina Contents Prefaceto the first edition....................................vii Bones.................................................................205 Prefaceto the sixth edition....................................ix Muscles.............................................................223 Acknowledgements..................................................xi Joints.................................................................275 Aboutthe authors..................................................xiii Nerve supply....................................................384 The sacral plexus.............................................395 1. Introduction...................................................1 Blood supply...................................................396 Lymphatics.......................................................402 Terminology.........................................................1 Termsusedin describingmovement...............2 4. The trunk and neck..................................405 Nervous system....................................................3 Componentsofthemusculoskeletalsystem...8 Introduction....................................................406 Skinand its appendages..................................22 Bones.................................................................412 Earlyembryology..............................................29 Muscles.............................................................423 Joints.................................................................445 2. The upper limb............................................35 Nerve supply....................................................486 Introduction......................................................36 The cardiovascular system............................507 Development ofthe musculoskeletal The respiratory system...................................514 system.................................................................36 The digestivesystem.......................................521 Bones...................................................................40 The urogenitalsystem....................................530 Muscles...............................................................52 The endocrine system....................................540 Joints.................................................................101 Nerve supply....................................................183 5. Head and brain.........................................543 Blood supply...................................................195 Bones.................................................................543 Lymphatics.......................................................198 Muscles.............................................................550 Joints.................................................................559 3. The lower limb..........................................201 The ear, eyeand brain...................................565 Introduction....................................................202 Development ofthe musculoskeletal Index......................................................................593 system...............................................................203 v This page intentionally left blank Preface to the first edition Wehavedesignedandwrittenthisbookforthestudentofanatomywhoisconcernedwiththestudy ofthelivingbodyandwhowishestousethisknowledgefunctionallyforagreaterunderstandingof themechanismswhichallowmovementtotakeplace.Traditionalanatomytextsarewrittenasan adjuncttothestudyofthehumanbodyinthedissectingroom,butonlythesurgeonhastheadvan- tageofdirectlyviewinglivingmusculoskeletalstructures.Thevastmajorityofstudentsinterestedin musculoskeletalanatomyaswellasthoseinvolvedwithhumanmovementanditsdisordersarecon- frontedbyanintactskinandthereforemustvisualizethestructuresinvolvedbypalpationandanal- ysisofmovement.AnatomyandHumanMovementpresentsthemusculoskeletalstructuresasaliving dynamicsystem–anapproachlackinginmanyexistingtextbooks.Theappliedanatomyofthemus- culoskeletalsystemoccupiesthegreaterpartofthebookandisbuiltupfromastudyofthebonesand muscles(whicharegroupedaccordingtotheirmajorfunctions,ratherthanasseeninthedissecting room)toaconsiderationofjointsandtheirbiomechanics.Anatomicaldescriptionsofeachjointare givenwithadetailedexplanationofhowitfunctions,theforcesgeneratedacrossitandhowitmight fail.Wehaveplacedgreatemphasisonthejoints,astheseareofmajorconcerntothoseinterestedin activemovementandpassivemanipulation,andwegiveexamplesofcommontraumaticorpatho- logicalproblemsaffectingthestructuresdescribed.Wherepossible,wedescribepalpationandana- lysemovementwithrespecttothejointsandmusclesinvolved,aswellasanyaccessorymovements. Thecourseanddistributionofthemajorperipheralnervesandbloodvessels,togetherwiththelym- phaticdrainageoftheregion,aregivenattheendofeachrelevantsection.Thereareseparatechapters onembryologyandtheskinanditsappendages,andwehaveincluded,intheintroduction,asection ontheterminologyusedinthebook.Thereisalsoanaccountofthestructureandfunctionofthe nervoussystemwrittenbyNikolaiBogdukwhosecontributionhasbeenextremelyvaluable. Theformatofthebookmatchesapageoftexttoapageofillustrations,wheneverpossible,andwe hopethatthiswillallowthereadertoconfirmhisorherunderstandingofthetextwiththevisual informationprovided.Thebookisextensivelyillustratedwithlarge,clear,fullylabelleddiagrams, all of which have been specially prepared. In the sections covering the joints and biomechanics, theillustrationshavebeendrawnbyRogerSoames,andtheseareparticularlydetailedastheypull togethertheanatomyfromthepreviouspartsofthatchapter. Wehopethatthisnewapproachtotheteachingofanatomywillservetofillthegapwhichhas alwaysexistedforthosewhohavetolearntheiranatomyonalivingsubjectandeventuallyhave todeterminetheirdiagnosesandapplytheirtreatmentsthroughanintactskin. NigelPalastanga DerekField RogerSoames 1989 vii This page intentionally left blank Preface to the sixth edition InthissixtheditionofAnatomyandHumanMovement,wehavemadeanumberofsmallbutsignif- icantchanges,mainlytothetext,whicharedesignedtofurtherimprovetheusefulnessofthisalready successful book. In this edition, there have been further improvements to the illustrations and wehaveaddedsomenewillustrations.Wherepossible,structuressuchasligamentsorcartilagehave been coloured the same throughout the book, in an attempt to further enhance the clarity of illustrations.Thebookhasprogressedalongwaysincethefirsteditionin1989whenonlyblack andwhitewasusedthroughoutthetext. Asregardsthecontent,wehavecontinuedtoengagewiththecommunityofusersofthebook, namely,students,teachers,practitioners,andhaverespondedtoyetmoresuggestions.Asaresult ofthisverypositivefeedback,therehasbeensomeminorreorderingwithinthetextandexpansion ofsomesections,namelythoseonjointreplacement. TheuseofSummaryBoxesattheendofvarioussectionshasbeenretained:theyareintendedtobe usedasaquickaidtorevisionwhenthemajorityofthesubjectareahasbeenlearned,butfeedback suggeststhatsomewillusethemtogetageneraloverviewbeforestartingtotacklethedetailedtext. Helpingindividualstounderstand,rememberandapplyanatomyhasalwaysbeentheprimepurpose ofthisbook. Inresponsetotheadvancesintherangeofelectronicaidstolearning,thesixtheditionalsogives automaticaccess(unlockedbytheuniquePINfoundontheinsidefrontcover)tothee-bookvia Pageburst,allowinguserstoquicklysearchtheentirebook,makenotes,addhighlightsandstudy more efficiently. Inaddition tothis, the authors have helped create aseparate five-hour modular e-learningcourseinfunctionalhumananatomy.Atpresent,thisisonlyavailableforpurchaseby universitiesandotherinstitutions.Thisispresentedinshortlessonchunksfollowingthebody’sre- gionalstructure–idealforthestudenttostudyattheirownpaceandtimeandthelecturertoassign accordingly.Learningisdeliveredviaoutcomemeasures,animation,video,quizzes,activityanalyses andexams. Whetherthebookisbeingusedbyundergraduates,postgraduates,lecturersorpractitioners,the changesandadditionsmadetothiseditionaredesignedtomakeitevenmoreusefultoyourlearning, teachingorpractice.Changestothewayeducationismanagedanddeliveredrequirestudentsand educators to be flexible in their learning. It is recognized that most learning takes place outside theclassroom,andthisrequirestheprovisionofhigh-qualitymaterial,bothelectronicandhardcopy, tosupportlearningwhereveritistakingplace.ThiseditionofAnatomyandHumanMovementandits accompanyingelectronicresourcesaredesignedtofacilitatestudyinthisnewenvironmentofvaried ix