HUMAN ANATOMY J.A. Gosling Contributors to previous editions MD, MB ChB, FRCS, FAS Photography by: Professor of Anatomy Stanford University A.L. Bentley ABIPP, AIMBI, MBKS USA Formerly Medical Photographer Faculty of Life Sciences P.F. Harris MD, MB ChB, MSc, FAS University of Manchester Emeritus Professor of Anatomy UK University of Manchester UK J.L. Hargreaves BA(hons) Formerly Medical Photographer J.R. Humpherson MB ChB Faculty of Life Sciences Formerly Senior Lecturer in Anatomy University of Manchester Faculty of Life Sciences UK University of Manchester UK Embalming and section cutting by: I. Whitmore MD, MB BS, LRCP MRCS, FAS J.T. Davies LIAS Professor of Anatomy Formerly Senior Anatomical Technician Stanford University Faculty of Life Sciences USA University of Manchester UK P.L.T. Willan MB ChB, FRCS Formerly Professor of Anatomy University of UAE Al-Ain United Arab Emirates HUMAN SIXTH EDITION ANATOMY Color Atlas and Textbook Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2017 First edition 1985 Second edition 1990 Third edition 1996 Fourth edition 2002 Fifth edition 2008 Sixth edition 2017 © 2017 Elsevier Ltd. All rights reserved. The right of J.A. Gosling, P.F. Harris, J.R. Humpherson, I. Whitmore and P.L.T. Willan to be identified as author/s of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act 1988. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). ISBN 978-0-7234-3827-4 eISBN 978-0-7234-3828-1 Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. The publisher’s policy is to use paper manufactured from sustainable forests Printed in China For Elsevier: Senior Content Strategist: Jeremy Bowes Content Development Specialist: Nani Clansey Project Manager: Andrew Riley Designer/Design Direction: Miles Hitchen Illustration Manager: Amy Faith Naylor Preface to the Sixth Edition The prime purpose of the first edition of Human Anatomy was to In this edition we have continued to improve the text and the present topographical anatomy as it is seen in the dissecting room. diagrams by remedying omissions and removing errors and The unique combination of photographs with accompanying ambiguities. In addition, we have added new radiographs and labelled diagrams and concise text is preserved in this edition. scans. The numerous examples of clinical and applied anatomy However, the book has evolved to accommodate modern trends in each chapter are now clearly identified. After discussions in the teaching of anatomy to emphasise clinical applications and with the publisher, we elected to indicate clinical comments by problem solving. highlighting in blue and to employ enclosing arrows in some electronic media. Changes have included the addition of introductory sections for each chapter to provide an overview of each region; the incorpora- Whilst the book was initially written for medical and dental stu- tion of selected radiographs and CT scans and MR images; and dents, the content will now also be useful to candidates preparing the use of cross sections of all regions of the body to provide a for higher qualifications in surgical specialties and radiology. It basis for interpreting body scans. will also be relevant to students in other professions where anatomy is a significant component of the course. Self-assessment exercises have included clinical case histories and multiple choice questions, as well as radiographs and scans, It is with sadness that we report the death of John Davies whose together with anatomical sections. skills as an embalmer enabled the authors to prepare the many dissections presented in this atlas. In previous editions the terminology was updated to conform to Terminologia Anatomica and a list of alternative terms is included. J.A.G., P.F.H., J.R.H., I.W., P.L.T.W. On occasions fonts have changed to improve readability. 2016 Preface to the First Edition Despite the many anatomical atlases and textbooks currently subsequent chapters describe anatomy primarily through dissec- available, there appeared to be a need for a book which combined tion, a regional approach has been employed. Features of bones the advantages of each of these forms of presentation. This book are described only when considering their related structures, was conceived with the intention of filling that need. With a especially muscles and joints; osteology is not considered in its unique combination of photographs of dissections, accompanying own right. The internal structure of the ear and eye are beyond diagrams and concise text, this volume aims to provide the student the scope of this book since the study of these topics requires with a better understanding of human anatomy. microscopy; the anatomy of the brain and spinal cord are also excluded as they are usually taught in special courses. The basis of this work is the cadaver as seen in the dissecting room; therefore, reference to surface and radiological anatomy is The level of detail contained in this book is appropriate for current minimal. Likewise, comments on the clinical and functional sig- courses in topographical anatomy for medical and dental under- nificance of selected anatomical structures are brief. However, graduates. In addition, it will be of value to postgraduates and to comparison is made where appropriate between the anatomy of students entering those professions allied to medicine in which the living and that of the cadaver. anatomy is part of the curriculum. Each dissection was specially prepared and photographed to The terminology employed is that which is most frequently display only a few important features. However, since photo- used in clinical practice. Where appropriate, alternatives (such graphs of dissections are inherently difficult to interpret, each is as those recommended in Nomina Anatomica) are appended in accompanied by a guide in the form of a drawing. Each drawing brackets. is coloured and labelled to highlight the salient features of the dissection and is accompanied by axes to indicate the orientation Preparation of the dissections and the text has occupied the of the specimen. Adjacent photographs often depict different authors for nearly five years. Our objective was to create a high stages of the same dissection to help the student construct a three quality and visually attractive anatomical work and we hope that dimensional image. the time and effort spent in its preparation is reflected in the fin- ished product. The first chapter introduces anatomical terminology, provides general information about the basic tissues of the body, and J.A.G., P.F.H., J.R.H., I.W., P.L.T.W. includes overall views of selected systems. Because the six Manchester, 1985 Acknowledgements for All Editions The authors are indebted to Drs Victoria Clague, Gulraiz Ahmad Our families deserve special mention, as without their untiring and Peter Mullaney, Professors Waqar Bhatti, R.S. Harris and support and patience these editions would certainly not have A.R. Moody, and to the Departments of Radiology at Kaiser come to publication. Permanente, San Rafael CA and Manchester University for the We thank them all. provision of radiographs, CT scans and MR images. J.A.G., P.F.H., J.R.H., I.W., P.L.T.W. Human Anatomy User Guide Organization In diagrams showing muscle attachments on bone, the areas are shown using the muscle colour enclosed by different coloured This book begins with a chapter on basic anatomical concepts. lines. In other diagrams colour indicates the extent of a compart- This is following seven chapters, each with its own introduction, ment or space. on the different regions of the body. Information is usually pre- sented in dissection order, progressing from the surface to deeper structures. The limbs are described from proximal to distal with the joints considered last. Text and Photographs Where possible the text and photographs are arranged on self-contained two-page spreads, so that the reader can locate relevant illustrations without turning a page. Clinical content is highlighted in blue in the print edition or indicated by enclosing Coracobrachialis arrows in eBook versions ( ). Brachialis Accompanying Diagrams Pectoralis major Adjacent to each photograph is a line diagram in which colour is Deltoid used to focus attention on particular structures in the dissection. The colours usually conform to the following code: Artery Ligament/Tendon Labels and Leader Lines The structures of particular interest in each diagram are labelled. Bone Mesentery/Peritoneum A single structure is named in a label either with a single leader line or by a leader line which branches to show different parts of the same structure. However, if two or more structures are named, Capsule/Fascia Muscle the first has the main leader line terminating on it while the sub- sequent structures are indicated by side branches given off at progressively shorter distances from the label. A leader line Duct Nerve ending in an arrow indicates a space or cavity. Fat Organ Lumen of vein Vein, Fibrocartilage Space artery and nerve Vein Gland Vein Hyaline cartilage Mucous membrane xii Human anatomy user Guide Orientation Guides Terminology Self-assessment Next to the diagrams are orientation guides The book conforms to Terminologia Ana- The photographs in the main body of each in which the following abbreviations tomica, using the English terms. The list of chapter are unfettered by labels, leader are used: alternative terms relates older non-official lines or other superimposed markings; L left P posterior pr proximal terms to their modern equivalent. thus, readers can readily test their knowl- R right A anterior d distal edge by either masking the whole of S superior la lateral the accompanying diagram and studying I inferior m medial the photograph alone, or covering only the labels. Orientation guides in oblique views Exams Skills, Clinical Case Skills & employ large and small arrow heads and Observations Skills are provided after each long and short arrow shafts. Here are four chapter to allow readers to further self-test. examples: Answers to Exam Skills and Clinical Case Skills are at the end of the book; those for Observation Skills are at the bottom of the from in front; same page as the picture. S R L I from behind; d m la pr from the left side and slightly in front; S A P I from the left side, slightly above and in front. S A P I 1 Chapter BASIC ANATOMICAL CONCEPTS Terms of Position and Movement 2 Bone 10 Basic Tissues and Structures 5 Skeleton 11 Skin 5 Joints 12 Subcutaneous tissue (superficial fascia) 5 Serous membranes and cavities 15 Deep fascia 5 Blood vessels 16 Muscle 7 Lymphatic vessels and nodes 19 Cartilage 9 Nervous tissue 20