LLWWBBKK442299__FFMM__ppii--xxiivv..iinndddd iiii 1111//1111//0099 55::0055::4400 PPMM CLEMENTE | ANATOMY CHAPTER 1: Pectoral Region, Axilla, Shoulder, and Upper Limb Plates 1–138 CHAPTER 2: The Thorax Plates 139–218 CHAPTER 3: The Abdomen Plates 219–322 CHAPTER 4: The Pelvis and Perineum Plates 323–370 CHAPTER 5: The Back, Vertebral Column, and Spinal Cord Plates 371–408 CHAPTER 6: The Lower Limb Plates 409–516 CHAPTER 7: The Neck and Head Plates 517–668 CHAPTER 8: Cranial Nerves Plates 669–694 Index I-1–I-24 LLWWBBKK442299__FFMM__ppii--xxiivv..iinndddd ii 1111//1166//0099 33::4466::4499 PPMM LLWWBBKK442299__FFMM__ppii--xxiivv..iinndddd iiii 1111//1111//0099 55::0055::4400 PPMM LLWWBBKK442299__FFMM__ppii--xxiivv..iinndddd iiiiii 1111//1111//0099 55::0055::4400 PPMM Acquisitions Editor: Crystal Taylor Marketing Manager: Brian Moody Product Manager: Julie Montalbano Designer: Terry Mallon Compositor: Aptara, Inc. 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To request permission, please contact Lippincott Williams & Wilkins at 530 Walnut Street, Philadelphia, PA 19106, via email at [email protected], or via Web site at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Th is 6th edition of Anatomy: A Regional Atlas of the Human Body is published by arrangement with Elsevier Germany GmbH, publisher and copyright holder of Sobotta Atlas der Anatomie des Menschen, 22. Aufl age, Band 1, Band 2; München: Elsevier/ Urban & Fischer ©2006. Th e English translation was undertaken by Lippincott Williams & Wilkins. Most of the illustrations in this atlas have been previously published in the following: Clemente, Carmine D. Anatomy: A Regional Atlas of the Human Body, 4th Edition. Baltimore: Williams & Wilkins, 1997. Sobotta, J. Atlas of Human Anatomy, 21st German Edition/13th English Edition, Volumes 1 and 2. Edited by R. Putz and R. Pabst. Munich: Urban & Fischer, 2000; Baltimore: Lippincott Williams & Wilkins, 2001. Sobotta, J. Atlas of Human Anatomy, 11th English Edition, Volume 1. Edited by J. Staubesand. Baltimore, Munich: Urban & Schwarzenberg, 1990. Sobotta, J. Atlas der Anatomie des Menschen, 18. Aufl age, Band 2. Edited by H. Ferner. Munich: Urban & Schwarzenberg, 1982. Wicke, L. Atlas of Radiologic Anatomy, 6th English Edition. Edited and translated by A.N. Taylor. Baltimore: Williams & Wilkins, 1998. Library of Congress Cataloging-in-Publication Data Clemente, Carmine D. Anatomy : a regional atlas of the human body / Carmine D. Clemente. – 6th ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-58255-889-9 (alk. paper) 1. Anatomy, Surgical and topographical–Atlases. I. Title. [DNLM: 1. Anatomy, Regional–Atlases. QS 17 C626a 2011] QM531.C57 2011 611–dc22 2009037389 DISCLAIMER Care has been taken to confi rm the accuracy of the information present and to describe generally accepted practices. 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Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. LLWWBBKK442299__FFMM__ppii--xxiivv..iinndddd iivv 1111//1111//0099 55::0055::4466 PPMM Preface to the Sixth Edition It is always reinforcing and rewarding for an author when the from Madrid, Spain, on the progressive unfolding of cardiac publisher of a book requests another edition. I have now had muscle as shown in Plate 186. Th ese studies have given insight- this pleasure fi ve times aft er the fi rst edition of this atlas was ful information on the manner by which the heart muscle devel- published 34 years ago in 1975. Previous editions, as well as this ops and matures. edition, have benefi ted greatly by the many suggestions from Most of the fi gures in this atlas come from the Sobotta colleagues and especially students. Students oft en approach this atlases, recent editions of which have been published by Pro- in a thoughtful subtle manner. First, the student may say how fessor R. Putz in Munich, Germany, and Professor R. Pabst in much he or she has learned from the book and give praise to the Hanover, Germany. My deepest appreciation to these two bril- nature and color of the fi gures and then point out a mistaken liant anatomists knows no bounds. Th eir German editions of label in one of the fi gures that may not have caught my eye. Of Sobotta have been recently reproduced as the 14th English Edi- course, I am always grateful for these suggestions. tion in 2006. A number of drawings, some of which were also In this edition, I have added many new fi gures—for exam- used in the 5th edition, were made by a former resident artist ple, 14 new fi gures on 5 plates dealing with the brachial plexus. here at UCLA, Ms. Jill Penkhus. I am most grateful for her artis- At the same time, a few fi gures that did not prove to be excellent tic creativity. teaching items have been removed. Perhaps the most important I am most indebted to the editors at Lippincott Williams & change in the book is the addition of a signifi cant number of Wilkins in Baltimore, and especially to Ms. Crystal Taylor, with X-rays, CT scans, and ultrasound scans. I am most grateful to whom I have interacted for more than 20 years on several ear- Edward J. H. Nathanial, M.D., Ph.D., Emeritus Professor at the lier editions of this atlas, and Ms. Julie Montalbano, the Prod- University of Winnipeg School of Medicine in Canada, for pro- uct Manager of this edition. Here at UCLA, I am privileged to viding at least 15 fi gures of clinical signifi cance. Several fi gures have worked with outstanding associates who form the gross also were contributed by Dr. G.L. Colborn, Emeritus Professor anatomy faculty for both the medical and dental school at this from the Medical College of Georgia in Augusta, Georgia. I have university. Th ese include Dr. Shelley Metten, the Chairperson also had the pleasure of discussions with Dr. James D. Collins, of the Anatomy Division, and Drs. Robert Trelease, Richard Professor of Radiologic Sciences here at UCLA. I thank Dr. Braun, Joseph Miller, Elena Stark, Yau Shi Lin, Jonathan Constantine Karakousis, Professor of Surgery and Chief of Sur- Wisco, Quynh Pham, Guido Zampighi, David Hovda, Anna gical Oncology at the University of Buff alo in Buff alo, New York, Taylor, Robin Fisher, Charles Olmstead, Francesco Chiap- for the use of several of his fi gures and for comments on the clin- pelli, and Jayc Sedlmayr. Dr. Sedlmayr is now on the faculty ical importance of several plates. Certain X-rays from Dr. Lothar of the Louisiana State University School of Medicine in New Wicke’s 6th English edition of Atlas of Radiologic Anatomy, edited Orleans. In my 57 years of active teaching here at UCLA, col- by Dr. Anna Taylor here at UCLA, were also used. lectively, these anatomists are the fi nest anatomy colleagues I Th ere are more than 200 plates of clinical importance in have ever worked with. this atlas, and I have benefi ted greatly from my discussions and Finally, but by no means least, I must say that my wife, Julie, collaboration with Professor Gerald Buckberg, M.D., Professor has been a steadfast inspiration to me and my academic life, and of Cardiac Surgery here at UCLA, and the late Dr. F. Torrent Guasp I am eternally grateful to her. Carmine D. Clemente Los Angeles, California—October 2009 LLWWBBKK442299__FFMM__ppii--xxiivv..iinndddd vv 1111//1111//0099 55::0055::4466 PPMM From the Preface to the Fifth Edition I continue to observe the use of this atlas in the anatomy class- of no one else. I would be most grateful to any student or pro- room and laboratory here at the UCLA Center for the Health fessor who may have suggestions or who may identify errors, if Sciences, and many suggestions I have received over the past these were transmitted to me here in Los Angeles. six years from students and from friends around the world Many new clinically related plates have been added to those have been incorporated in this edition. Further, students have in the 4th edition. Th is atlas now contains more than 150 plates convinced me that a special section on the cranial nerves that are of direct clinical importance. Th ese are listed in the front would be helpful to them. Th is has now been included and a pages of the book and they include surface anatomy, radiographs series of diagrammatic drawings (patterned aft er Grant and (many of which come from the outstanding collection of Profes- other authors) along with a number of fi gures relevant to the sor L. Wicke of Vienna), MRIs, CT scans, arteriograms, lymp- cranial nerves have been collected in a group of 29 plates at hangiograms, bronchograms, and even a series of arthroscopic the end of the Neck and Head section. Most of the new cranial images of the knee joint. Th ese have been added because of the nerve drawings were done by Ms. Jill Penkhus several years ago increased emphasis on the clinical relevance to the teaching of when she was the resident artist in the Department of Anatomy Anatomy that has become common in medical schools, not only here. In addition to these, several new pieces of art have been in the United States but in many other countries as well. One included in this atlas. plate (#146) is based on the work of Drs. R. Torrent-Guasp of Among the new illustrations in this edition are modifi ed Madrid and Gerald Buckberg of UCLA here in Los Angeles. replacements of the nine remaining illustrations in the 4th edi- Th ere are many who have helped to make this atlas tion that originated from the controversial atlas Topographical possible. Among them are Ms. Betty Sun, Ms. Crystal Taylor, Human Anatomy by Pernkopf. Th ese new color illustrations Ms. Kathleen Scogna, and Ms. Cheryl Stringfellow at Lippincott were expertly rendered by the medical illustrators at Anatomi- Williams & Wilkins in Baltimore and, of course, many at the cal Chart Company (ACC) and David Rini. By far, however, Elsevier Corporation, the publishers that acquired the Sobotta my deepest appreciation is extended to Professors R. Putz in collection from Urban & Fischer. I am especially grateful to Munich and R. Pabst in Hanover, Germany, for their exceed- Dr. Constantine Karakousis, Professor of Surgery and Chief of ingly creative contributions for the 21st German and 13th Surgical Oncology at the University of Buff alo in Buff alo, New English editions of the Sobotta Atlas of Human Anatomy. More York, for his recommendations and comments on the clinical than 325 fi gures in their most recent two-volume set are the importance of several of the plates. Perhaps most of all, my con- principal new drawings on which this edition is based. Th e tinuing gratitude goes to Julie, my wife, who has helped me both other fi gures are ones that were used in my 4th edition. I am at the computer and in being considerate for all the time it has responsible for all the notes that accompany all of the fi gures, taken me to do this manuscript, time that could have been given and any mistakes that may be found in these are mine and those to some of her interests. Carmine D. Clemente Los Angeles, California—February 2006 LLWWBBKK442299__FFMM__ppii--xxiivv..iinndddd vvii 1111//1111//0099 55::0055::4499 PPMM From the Preface to the First Edition Twenty-fi ve years ago, while a student at the University of Penn- the Sobotta plates in a regional sequence—the pectoral region sylvania, I marvelled at the clarity, completeness, and boldness and upper extremity, the thorax, the abdomen, the pelvis and of the anatomical illustrations of the original German editions perineum, the lower extremity, the back, vertebral column and of Professor Johannes Sobotta’s atlas and their excellent three- spinal cord, and fi nally, the neck and head. Th is sequence is volume English counterparts, the recent editions of which were consistent with that followed in many courses presented in the authored by the late Professor Frank H. J. Figge. It is a matter United States and Canada and one which should be useful to of record that before World War II these atlases were the most students in other countries. popular ones consulted by American medical students. In the Many have contributed to bringing this Atlas to fruition. I United States, with the advent of other anatomical atlases, the thank Dr. David S. Maxwell, Professor and Vice Chairman for shortening of courses of anatomy in the medical schools, and Gross Anatomy and my colleague at UCLA, for his encourage- the increase in publishing cost, the excellent but larger editions ment and suggestions. I also wish to express my appreciation of the Sobotta atlases have become virtually unknown to a full to Caroline Belz and Louise Campbell, who spent many hours generation of students. During the past 20 years of teaching proofreading and typing the original text. I especially wish to Gross Anatomy at the University of California at Los Angeles, I thank Mary Mansor for constructing the index—a most labo- have found only a handful of students who are familiar with the rious task. I am grateful to Barbara Robins for her assistance beautiful and still unexcelled Sobotta illustration. in typing some of the early parts of the manuscript, and above Th is volume introduces several departures from the for- all, to her sister Julie, who is my wife and who makes all of my mer Sobotta atlases. It is the fi rst English edition that represents eff orts worthwhile through her encouragement and devotion. Carmine D. Clemente Los Angeles, California—January 1975 Chapter 5 The Back, Vertebral Column, and Spinal Cord LLWWBBKK442299__FFMM__ppii--xxiivv..iinndddd vviiii 1111//1111//0099 55::0055::5500 PPMM Contents CHAPTER 1: Pectoral Region, Axilla, Shoulder, and Upper Limb Plates Body Regions 1 Anterior Th orax, Superfi cial Pectoral Region Including Female Breast 2–18 Axilla, Deep Pectoral Region 19–27 Arteries and Superfi cial Veins of Upper Limb 29–29 Anterior and Posterior Shoulder: Muscles; Neurovascular Structures; Abduction 30–33 Upper Limb: Surface Anatomy and Dermatoses 34–35 Upper Limb: General; Muscles, Vessels and Nerves 36–45 Brachial Plexus 46–53 Shoulder, Anterior and Posterior Arm (Brachium): Muscles, Vessels and Nerves (Detailed) 54–67 Forearm: General (Superfi cial) 68–69 Forearm: Anterior Aspect, Muscles, Vessels and Nerves 70–79 Forearm: Posterior Aspect, Muscles, Vessels and Nerves 80–89 Hand: Dorsal Aspect 90–93 Hand: Palmar Aspect 94–111 Bones and Joints of the Upper Limb 112–131 Cross Sections of the Upper Limb 132–137 Anatomy of Fingers 90–93; 95–98; 100–105; 107–110; 130 CHAPTER 2: The Thorax Plates Surface Anatomy: Th oracic and Abdominal Wall 139 Anterior Th oracic Wall 140–149 Th ymus, Pleura, Lungs, Trachea, and Bronchi 150–165 Pericardium and Heart 166–187 Conduction System of the Heart; Heart Valves 188–191 Circulation of Blood 192–195 Posterior and Superior Mediastina 196–205 Sympathetic Trunks and Vagus Nerves 206–209 Th oracic Duct and Lymphatic System 210–211 Frontal Sections and MRIs and Cross Sections of the Chest 212–218 CHAPTER 3: The Abdomen Plates Regions of the Body, Diagram of the GI System 219 Anterior Abdominal Wall 220–231 LLWWBBKK442299__FFMM__ppii--xxiivv..iinndddd vviiiiii 1111//1111//0099 55::0055::5522 PPMM