Surface anatomy:

Surface anatomy, as the named indicates, is anatomy of the surface of

human body structures. It is also known as topographic anatomy. Surface
anatomy establishes a relation between the internal structures of human
body with its surface. It enables a medical professional to locate the
position of internal organs from surface of the body and therefore it is very
important for surgical operations. Sometimes surface anatomy is described
as a sub-branch of gross anatomy but it is better to write it separately to
highlight its importance.

Human anatomy uses its own collection of terms. Many of these are taken
from Latin and Greek languages and each has a very specific meaning. It is
really important to understand the basic terms, which would be used again
and again throughout the course of learning anatomy. Therefor, it is highly
recommended that you try to learn the following terms.
Anatomical terms for describing positions:
Anatomical position: In this position the body is straight in standing
position with eyes also looking straight. The palms are hanging by the sides
close to the body and are facing forwards. The feet also point forwards and
the legs are fully extended. Anatomical position is very important because
the relations of all structures are described as presumed to be in
anatomical position.

Anatomical Position
Supine position: In this position the body is lying down with face pointing
upwards. All the remaining positions are similar to anatomical position with
the only difference of being in a horizontal plane rather than a vertical
plane.

Person Lying in Supine Position (Source: Apers0n/Wikipedia)

Prone position: This is the position in which the back of the body is
directed upwards. The body lies in a horizontal plane with face directed
downwards.

Prone Position
Lithotomy position: In this position the body is lying in a supine with hips
and knees fully extended. The feet are strapped in position to support the
flexed knees and hips.

Lithotomy Position
Anatomical terms for describing planes:

Planes
Median or Mid-Sagittal plane: This is the plane which divides the body
into equal right and left halves.
Sagittal plane: It is any plane parallel to the median plane. This plane
divides the body into unequal right and left halves.
Frontal plane: It is a vertical plane at right angle to median plane. If you
draw a line from one ear to another from above the head and then divide

the whole body along this line, the plane formed will be frontal plane. It is
also known as coronal plane.
Transverse plane: It is the horizontal plane of the body. It is perpendicular
to both frontal and median plane.
Oblique plane: Any plane other than the above described planes will be
oblique plane.
Anatomical terms for describing relations:

Terms of Relation
Anterior means towards the front.
Posterior means towards the back.

Superior means towards the head.

Inferior means towards the feet.
Medial means towards the median plane (near the middle of the body).
Lateral means away from the median plane (away from the middle of the
body).
Anatomical terms for limbs:
Proximal means near the trunk
Distal means away from the trunk
Preaxial border means the outer border in the upper limb and inner border
in the lower limb.
Postaxial border means outer border in upper limb and inner border in
lower limb
Flexor surface means anterior surface of the upper limb and posterior
surface of the lower limb
Extensor surface means the posterior surface of upper limb and anterior
surface of the lower limb.
Anatomical terms for describing muscles:
Origin: The relatively fixed end of muscle during natural movements of the
muscle
Insertion: The relatively mobile end of the muscle during natural
movements of the muscle
Belly: The fat fleshy part of the muscle which is contractile in function
Tendon: The fibrous and non-contractile part of the muscle which attaches
muscle to the bone.
Aponeurosis: It is a flattened tendon arising from the connective tissues
around the muscle.

Anatomical terms for describing movements:

Movements of limbs

Flexion: A movement by which the angle of a joint is decreased

Extension: A movement by which the angle of a joint is increased
Adduction: Movement toward the central axis
Abduction: Movement away from the central axis
Medial rotation: Rotation toward the medial side of the body
Lateral rotation: Rotation towards the lateral side of the body
Pronation: This movement occurs in the forearm whereby the palm is
turned backwards
Supination: This movement also occurs in the forearm whereby the palm
is turned forwards

General aspects

Most clinicians view internal anatomy with the aid of radiographic images
and procedures. Proper interpretation of these images presupposes a
detailed knowledge of anatomy. Radiography has proved particularly
valuable in the detection of the early stages of deep-seated disease, when
the possibility of cure is greatest. During these early stages there is little
departure from the normal, hence knowledge of the earliest detectable
variations, that is, of "the borderlands of the normal and early
pathological..." (Kohler), is of great medical importance. Radiographic
diagnosis is the most important method of non-destructive testing of the
living body.
There are a wide array of procedures that fall under the perview of
radiology. The earliest of these utilized the interaction of ionizing radiation
with the body in order to create an image. Plain radiographs involve
generating x-rays that are directed at the part of the body that is to be
examined. The recognition that these rays can be harmful has resulted in
procedures that restrict the area that is exposed (columation) and also that
shield sensitive areas against the rays. Various methods of detection of xrays have been developed. The earliest of these relied on the direct
interaction between photographic film and the x-rays. Subsequently, there
was development of methods for enhancement of images (using
radiosensitive amplifying screens adjacent to x-ray film). Additionally, the
interaction between x-rays and fluorescent screen permitted the viewing of
moving images (fluoroscopy). More recently, methods for electronic
detection and storage of information have afforded improved safety as well
as the ability to store, manipulate and transmit information generated by
these tests.
Radio-opacity
The fundamental principle of all radiographic tests that employ x-rays is
that different body tissues have a different capacity to block or absorb xrays. The following tissue densities produce the usual radiographic image,
and they are arranged in order of increasing radio-opacity (i.e., whiteness
on conventional radiographic film or computerized tomograms, blackness
on fluoroscopic screens):
1. Air, as found, for example, in the trachea and lungs, the stomach and
intestine, and the paranasal sinuses.

2. Fat.
3. Soft tissues, e.g., heart, kidney, muscles (these are all approximately the
density of water).
4. Calcific (due to the presence of calcium and phosphorus), for example,
in the skeleton.
5. Enamel of the teeth.
6. Dense foreign bodies, for example, metallic fillings in the teeth. Also
radio-opaque contrast media, such as a barium meal in the stomach or
intravascular contrast.
When the density of a structure is too similar to that of adjacent structures,
it is possible to use contrast media to enhance or outline its contours.
Contrast media are classified as radiolucent (e.g., air) and radio-opaque
(e.g., barium or iodinated contrast media).
Plain film radiographs (often, but inappropriately called x-rays) display the
shadow of the body part on the film. The farther the body part is from the
film, the more magnified it will appear, but also its borders will be less
distinct (fig. 5-1). Additionally, since the image is a 2-dimentional
representation of a 3-dimentional object, the antero-posterior location of
structures must be inferred. Images taken from a two perspectives may
permit the skilled radiologist to interpret the antero-posterior location of
objects by their displacement relative to one another in images taken from
orthogonal (right angles) directions (fig. 5-2). Plane film radiographs are still
the most common method of viewing osseous structures or the chest.
Positioning
The views used in plain radiographic images are named for the part of the
body that is nearest the film, for example, anterior, right lateral, left anterior
oblique. Alternatively, the terms anteroposterior and postero-anterior are
used when the x-rays have passed through the object from front to back
(tube in front of object, film behind) or from back to front (tube behind
object, film in front), respectively. Radiographic postioning is highly

standardized in order to facilitate interpretation. Views are selected to

highlight the particular areas or structures being examined.
Skeletal radiology
The skeleton, owing to its high radio-opacity, is generally the most striking
feature of a radiogram. It is important to appreciate, however, that many of
the organs and soft tissues of the body can be investigated
radiographically.
General features of a long bone
Radiographically, the compact substance of the bone is seen peripherally
as a homogeneous band of calcific density. A nutrient canal may be visible
as a radiolucent line traversing the compacta obliquely. In some areas the
compacta is thinned to form a cortex. The cancellous, or spongy, substance
is seen particularly toward the ends of the shaft as a network of lime
density presenting interstices of soft-tissue density. Islands of compacta are
visible occasionally in the spongiosa. The bone marrow and the periosteum
present a soft-tissue densityand are not distinguishable as such.
In many young bones the uncalcified portion of an epiphysial disc or plate
can be seen radiographically as an irregular, radiolucent band termed an
epiphysial line. When an epiphysial line is no longer seen, it is said to be
closed, and the epiphysis and diaphysis are said to be united or fused. The
radiographic appearance of fusion, however, precedes the disappearance
of the visible epiphysial disc as seen on the dried bone.
The term metaphysis is used radiologically for the calcified cartilage of an
epiphysial disc and the newly formed bone beneath it.
General features of a joint
The articular cartilage presents a soft-tissue density and is not
distinguishable as such. The so-called radiological joint space, that is, the
interval between the radio-opaque epiphysial regions of two bones, is
occupied almost entirely by the two layers of articular cartilage, one on
each of the adjacent ends of the two bones. On a radiogram the" space" is
usually 2 to 5 mm in width in the adult. The joint cavity is rarely visible. The
"radiological joint line," that is, the junction between the radio-opaque end

of a bone and the radiolucent articular cartilage, is actually the junction

between a zone of calcified cartilage over the end of the bone and the
uncalcified articular cartilage.