COVER FRONTMATTER PREFACE ABOUT THE AUTHOR INTRODUCTION CHAPTER 1 - SPINE CHAPTER 2 - SHOULDER CHAPTER 3 - ARM CHAPTER 4 - FOREARM CHAPTER 5 - HAND CHAPTER 6 - PELVIS CHAPTER 7 - THIGH/HIP CHAPTER 8 - LEG/KNEE CHAPTER 9 - FOOT/ANKLE CHAPTER 10 - BASIC SCIENCE ABBREVIATIONS USED IN THIS BOOK Thompson: Netter's Concise Atlas of Orthopaedic Anatomy, 1st ed. Copyright © 2001 Saunders, An Imprint of Elsevier Netter's Concise Atlas of Orthopaedic Anatomy Jon C. Thompson, M.D. Dedication To my parents, for their unwavering faith in me. To my in-laws, for their continual support. To my daughters, who make it meaningful and fun. Especially to my wife Tiffany, who inspires me in every aspect of my life. SAUNDERS ELSEVIER Elsevier Inc. 1600 John F. Kennedy Boulevard Suite 1800 Philadelphia, PA 19103-2899 Netter's Concise Atlas of Orthopaedic Anatomy ISBN-13: 978-0-914168-94-2 ISBN-10: 0-914168-94-0 Published by Icon Learning Systems LLC, a subsidiary of Elsevier, Inc. Copyright © 2002 Elsevier Inc. All rights reserved. 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. Permissions may be sought directly from Elsevier's Health Sciences Rights Department in Philadelphia, PA,USA: phone: (+1) 215 239 3804, fax: (+1) 215 239 3805, e-mail: [email protected] . You may also complete your request on-line via the Elsevier homepage (http://www.elsevier.com ), by selecting ‘Customer Support’ and then ‘Obtaining Permissions’. NOTICE Medicine is an ever-changing field. Standard safety precautions must be followed, but as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the licensed health care provider, relying on experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Neither the publisher nor the editor assumes any liability for any injury and/or damage to persons or property arising from this publication. The Publisher Library of Congress Catalog No: 00-130477 Printed in U.S.A. Last digit is the print number: 9 8 7 6 5 4 Copyright © 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com Thompson: Netter's Concise Atlas of Orthopaedic Anatomy, 1st ed. Copyright © 2001 Saunders, An Imprint of Elsevier PREFACE While working on the Orthopedic Service as a medical student I found myself in need of a quick, but comprehensive reference to help me get through my busy clinics and morning rounds. Having had success with pocket references, I searched the bookstores for something similar for orthopedics. Several were available, but none of them had the quick and easy-to-read format I wanted. As a result, I made pocket-sized note cards for my own use. These cards started with basic anatomy such as diagrams of the Brachial plexus or fascial compartments of the leg. I then added cards for various conditions including notes on pertinent History and Physical Exam findings and treatment options. Many years later, when the growing stack of note cards was too big, unwieldy and tattered to use any longer, I converted the information into a more usable book format. That original hand-assembled book is the foundation of the atlas you are now holding. One well-drawn anatomic picture often explains far more than several pages of detailed text. This concise, quick-reference atlas covers the spine and extremities as well as diagnosis and treatment of orthopedic conditions with primary emphasis on illustrations that educate, oftentimes without the need for explanatory text. Text, when necessary, is presented in tabular form to allow for fast review of essential information. The first nine chapters are divided anatomically. Because I believe quite strongly that the treatment of orthopedic problems is based in anatomy, I have incorporated an extensive review of the anatomy of both the spine and extremities. There are also subsections within each chapter to help in the clinical diagnosis and treatment of the orthopedic patient. For example, the History table offers help in developing a differential diagnosis while the Trauma and Disorder tables assist in the work-up and treatment options of many orthopedic conditions. Chapter Ten is a brief introduction to orthopedic-related basic science. From the first time I opened Frank Netter's Atlas of Human Anatomy, I was impressed, and even inspired, by the clarity and the incredible amount of information contained within each of his illustrations. I consider his work incomparable. As the basis for this text is also deeply rooted in its extensive use of illustrations, you can imagine how pleased I was when Icon Learning Systems asked me to combine our efforts to create this new publication. I thank them for their diligence, expertise,and patience with this project. I would also like to thank Dr. Jim Heckman for lending his wisdom and years of publishing experience to this effort. This book is the result of several years of accumulating and condensing Orthopedic-related data. Indeed, as it stands now, this is truly the reference I had searched for as a medical student, but was never able to find. The information inside these covers served to help me synthesize and retain a large body of information when I was a student and young physician. I trust its readers will be as equally well served. Jon C. Thompson, MD Copyright © 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com Thompson: Netter's Concise Atlas of Orthopaedic Anatomy, 1st ed. Copyright © 2001 Saunders, An Imprint of Elsevier ABOUT THE AUTHOR Jon Thompson, MD, received his medical degree from the Uniformed Services University of the Health Sciences in Bethesda, Maryland. He received his undergraduate degree from Dartmouth College. Dr. Thompson has worked as both an emergency room physician and a research assistant in the Extremity Trauma Branch of the Institute of Surgical Research. Currently, he is a resident in orthopedic surgery in the San Antonio Uniformed Services Health Education Consortium at Brooke Army Medical Center and is a corresponding member of the Department of Surgery at the Uniformed Services University of the Health Sciences. Copyright © 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com Thompson: Netter's Concise Atlas of Orthopaedic Anatomy, 1st ed. Copyright © 2001 Saunders, An Imprint of Elsevier INTRODUCTION Netter's Concise Atlas of Orthopedic Anatomy is an easy-to-use reference and compact atlas of orthopedic anatomy for students and clinicians. Using images from both the Atlas of Human Anatomy and the 13-Volume Netter Collection of Medical Illustrations, this book brings together over 450 Netter images together for the first time in one book. Tables are used to highlight the Netter images and offer key information on bones, joints, muscles and nerves, and surgical approaches. Clinical material is presented in a clear and straightforward manner with emphasis on trauma, minor procedures, history and physical exam, and disorders. Users will appreciate the unique color-coding system that makes information look-up even easier. Key material is highlighted in black, red, and green to provide quick access to clinically relevant information. BLACK for standard text RED highlights key information that if missed could result in morbidity or mortality GREEN highlights “must know” clinical information. Copyright © 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com CHAPTER 1 - SPINE TOPOGRAPHIC ANATOMY OSTEOLOGY TRAUMA SPINAL CORD TRAUMA JOINTS LIGAMENTS HISTORY PHYSICAL EXAM MUSCLES: ANTERIOR NECK MUSCLES: POSTERIOR NECK SUPERFICIAL MUSCLES: POSTERIOR NECK AND BACK DEEP MUSCLES: POSTERIOR NECK AND BACK NERVES OF THE UPPER EXTREMITY: CERVICAL PLEXUS NERVES: BRACHIAL PLEXUS NERVES: LUMBAR PLEXUS NERVES: SACRAL PLEXUS ARTERIES DISORDERS PEDIATRIC DISORDERS SURGICAL APPROACHES Thompson: Netter's Concise Atlas of Orthopaedic Anatomy, 1st ed. Copyright © 2001 Saunders, An Imprint of Elsevier CHAPTER 1 – SPINE TOPOGRAPHIC ANATOMY Copyright © 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com Thompson: Netter's Concise Atlas of Orthopaedic Anatomy, 1st ed. Copyright © 2001 Saunders, An Imprint of Elsevier OSTEOLOGY CHARACTERISTICS OSSIFY FUSE COMMENT C1 ATLAS • Ring shaped Superior facet articulates with • Twwitoh flaatceertasl omna tshseems Aarncthe r(i1o)r • owcitchi pduetn, santerior arch articulates Posterior 6 yrs • No body, no spinous arch (2) Birth • Fractures: most have 2 sites process (1 for each Vertebral artery runs in groove on • Post. Arch has a half) • posterior arch sulcus/groove C2 AXIS Odontoid has precarious vascular Daretincsu/loadteosn wto/iadtlas at Lboowdye r(2) Body 6Byirrtsh • sinucprpelays weadt einrcsihdeedn caere oaf) :nonunion • median atlantoaxial Dens (2) Tip with fractures 12yrs joint Arch (2) Birth • Rotation in neck mostly occurs between C1 and C2 CERVICAL (C3-7) • Ftraonrasmveinrsae i nprocess • Vtraenrtsevberrasl ea rfoterraym ruinnas through Facets: “semi- 7- • Nerve roots at risk of • cfleoxro/enxatel” nasllioown, no PArricmhary 8(fwetkal) 17--21 0yr cNoom foprraemssinioan in transverse rotation Body yr • process of C7 18- • Nfoararrmowin aintervertebral Secondary 1114- yr 25 yr • Cno7n ibsi fvide rstepbinroaul sp rpormocineessns, • Bpriofidce sspsienosus • Kfulsipiopne lo-Ff ceeil rsvyicnadlr voemrtee:b croanegenital THORACIC Facets: form semi- • circle: allow rotation T1 spinous process is as Costal facets (for 7- 1-2 yr • Costal facets (for 7- 1-2 yr • prominent as that of C7 ribs) Primary 8wk 7-10 Arch (fetal) Rotation of spine occurs within T1-9: on the yr • Body the thoracic region • transverse Secondary 11- 18- process 14 yr 25 yr • Spinous processes overlap the next lower vertebrae T10-12: on the pedicle