作者：罗军,(美)刘浩
出版社：江西科学技术出版社
格式: AZW3, DOCX, EPUB, MOBI, PDF, TXT
中英文对照骨科康复解剖学学习指导试读：
前言
人体解剖学对临床医师而言，尤其是外科或康复医学科医务人员，是最重要的基础学科。但是，在解剖学的内涵和教学方法上，国内与国外（如美国）仍存在一定的差异。随着国内外医学交流日益增多，在学术会议、实验室交流、科室讲座、论文书写等方面，许多目前正在或者曾经在国外学习的解剖学工作者或者临床医务人员都存在一定程度的英文解剖学术语使用困难。因此，本系列丛书以中英文对照的形式出版，目的在于为国内运动解剖的双语教学提供借鉴，同时也为医务工作者对解剖学知识的掌握和临床应用提供参考。
肌肉骨骼解剖学是人体解剖学的重要组成，也是运动医学、骨科学、康复医学、手法治疗学的基础。本书着眼于肌肉骨骼解剖学，其内容涵盖骨、关节、肌肉系统以及它们在上肢、下肢、躯干的功能。本书还提供了多项选择习题供读者学习并检查对知识的掌握程度。这些习题与美国康复专业的学生所使用的解剖试题非常类似。
本书作者刘浩教授是在美国从事解剖教学和临床康复二十余年的学者，罗军主任医师是国内享有盛誉的骨科康复专家，邱启祥教授是在运动解剖学专业方面具有丰富经验的专家。编者2015年3月
Preamble
Human Anatomy is the most fundamental course for clinicians like surgical and rehabilitation professionals． However, what to teach and how to teach this course might be different in China compared with in other countries like in US．Nowadays, with increasing interactions of medical professionals between China and US, many Chinese anatomists and medical doctors who are studying or have studied abroad found out that it is really challenging for them to communicate with their fellow colleagues with anatomical jargons in English in lab, seminars, and conferences, and even in writing a scientific paper．Therefore, the purpose of this series of anatomy books, which are printed in both English and Chinese for the same contents, is to provide an opportunity for Chinese anatomists see what anatomy contents were taught and how the contents were delivered and examined for students in rehabilitation; and also is to provide a bilingual study guide for Chinese medical doctors to grasp more fundamental knowledge of human structure and relevant functions.
Musculoskeletal anatomy is one of the most important portions of human anatomy that is related to sports medicine, orthopedic surgery, rehabilitation, and manipulation medicine．In this book focusing on musculoskeletal anatomy, its contents cover skeleton, joints, muscles, and their functions in upper extremity, lower extremity, trunk and back．Following the contents, there are multiple-choice questions for readers to evaluate how much they have learned and grasped．These questions are very similar to those questions used by students in rehab sciences in US to examine their anatomical knowledge.
Among authors, Dr．Howe Liu is an anatomist and also a rehab clinician who have taught and practiced in US for more than 20 years． Dr．Jun Luo is a very experienced clinical expert with specialty in orthopaedic rehabilitation．Dr．Qixiang Qiu is an anatomist with considerable knowledge in musculoskeletal anatomy.
人体重要体表标志
脊柱标志
●C2 棘突：头前屈时，两乳突之间的假想连线之下一个手指的距离。
●C3棘突：在舌骨平面。
●C4棘突：甲状软骨上端水平即喉结处。
●颈动脉分叉处：C3和C4之间，在下颌角水平。
●C5 棘突：甲状软骨板下端水平。
●C6 棘突：在环状软骨下缘水平。为气管与喉交界处、咽与食管交界处以及椎动脉进入横突孔水平。
●C7 棘突：颈部向后最突出最明显的骨性结构，头部前屈更容易触摸到。
●胸骨上切迹：在T2和T3椎骨水平之间。
●胸骨柄（中点）：T3和T4椎骨水平之间。
●T3 棘突：在两臂上举起时肩胛冈底部水平。
●胸骨角
○在第二肋软骨（第二胸肋关节）。
○在T4和T5椎体交界水平之间。
○在纵隔之上和之下交界水平。
○在主动脉弓起始和终止水平。
○在奇静脉进入上腔静脉的水平。
○仰卧时的气管分叉水平。
●T7 棘突：平肩胛骨下角水平。
●T8 棘突：平对胸骨和剑突连接处。
●T9 棘突：位于剑突末端水平。
●L3 棘突：在左右肋弓下缘最低点连线水平。
●髂骨嵴：平对L4。
●髂前上棘：沿髂嵴向前，达到最前端时所触摸到的骨性突起。
●髂后上棘：沿髂嵴向后，所触摸到的骨性隆起，在髂后上嵴内侧的皮肤中通常有两个凹陷（骶酒窝），是S2、骶髂关节以及硬脊膜下端水平的标志。
●骶骨沟：为髂后上嵴内侧的压痕，在骶骨棘外侧。
●胸锁乳突肌：由乳突向前下方达胸骨（内侧头）和锁骨（外侧头）。当被测者把头从检查侧转向对侧，尤其是在转头过程中对其施加一点阻力时易触摸该肌肉。颈内静脉位于肌肉两头之间。
●斜角肌：锁骨之上方的三块深层肌肉，位于胸锁乳突肌后面，上斜方肌前方。
心肺系统的解剖标志（胸腔）
●胸膜顶：锁骨内侧1/3上方2.5～3.0厘米处。
●心包区：位于左侧第5、第6肋和第5肋间隙后面未被胸膜覆盖的一小块区域。
●右第二肋间隙：为主动脉听诊区。
●左第二肋间隙：为肺动脉瓣听诊区。
●左第四肋间隙：为三尖瓣听诊区。
●心尖：在第5肋间隙前正中线左侧7～9厘米，左锁骨中线内侧1～2厘米，为二尖瓣或第三心音的听诊区。
●肺下界：锁骨中线平第6肋骨水平，腋中线平第8肋水平，脊柱旁线平第10肋水平。
●右肺斜裂：沿第五肋骨后方到第6肋骨前方水平。
●左肺斜裂：从第3到第5肋水平。或要求被测者将手臂置于头上，肩胛骨内侧缘与斜裂一致。
●横裂线：在第四肋骨水平。
●（右）头臂动脉和颈总动脉的起点：在胸骨角水平。
●右胸锁关节处：左头臂静脉、右头臂静脉汇入上腔静脉处。
●上腔静脉进入右心房：沿胸骨右缘第三肋软骨处。
●胸廓内动静脉：距胸骨外侧缘一横指处走行。
●肋脊角：竖脊肌和12肋骨交角处。肾脏疾病的扣诊点。在下背痛的特异性诊断中常用。
●剑突平面：在T9椎体水平经过剑突。它是肝脏上缘和膈肌中央部的标志。
●幽门平面：颈静脉切迹和耻骨联合连线中点处，实际上位于剑突下一手掌距离处。标志着第一腰椎平面、第9肋软骨肋弓缘和肠系膜上动脉在主动脉的起点水平。
●肋下平面：穿过第十肋软骨，在L3的水平，也就是肠系膜下动脉在主动脉的起点水平。
●嵴上平面：经过髂嵴最高点。平对L4水平，降主动脉（或卧位时脐下方2厘米处）分叉处。
上肢的标志
●锁骨：天然标志。
●胸锁关节：颈静脉切迹和胸骨柄之间的交界处。
●肩锁关节：锁骨外侧端与肩胛骨肩峰之间。
●肩峰：肩锁关节外侧骨性突起。
●肩胛冈：肩胛骨背面由肩峰稍向内下方斜行的骨性突起。
●肩胛骨内侧缘（脊椎缘）：肩胛冈最内侧的部分向上下垂直延伸的部分。
●肩胛下角：肩胛骨内侧缘最低的部分，在第7颈椎棘突水平或第7肋间水平。
●锁骨下窝（或三角胸肌三角）：锁骨外侧下方的小窝（在前突的内侧头与后突的外侧部交界处，此处亦为胸大肌和三角肌的一个起点）。头静脉经此注入锁骨下静脉
●肩胛骨喙突：锁骨下窝外侧，距离锁骨下一个手指的三角肌纤维深面。不随肱骨内旋或外旋而移动。
●肱骨小结节：肩胛喙突外侧，随肱骨内、外旋转而移动。相对来说，小结节在肩胛骨喙突稍前外侧。
●肱骨大结节：肩部最外侧的突起，肩峰外下方，随肩关节运动一起移动。
●结节间沟：肱骨大、小结节之间的凹槽。
●肱骨头：让受试者举起手臂旋转，深压并触触摸腋窝顶部，可以感受到肱骨头的运动。
●冈上肌：肩关节外展时可触摸到其恰位于肩冈上方。
●冈下肌：肩关节外旋时可触摸其恰位于肩冈下方。
●肩胛提肌：在对抗阻力提肩时，可在离肩胛冈上方的肩胛骨内侧缘半指长的范围内摸及。
●大菱形肌：肩胛骨回缩时，可在离肩胛冈下方的离肩胛骨内侧缘半个手指范围内摸及。
●大圆肌：肩关节对抗阻力内收时，可在离沿肩胛骨下角和外侧缘（向上外）半个手指的范围内摸及。
●小圆肌：恰位于大圆肌之上，可在肩关节外旋时触摸。
●肱二头肌长头肌腱：位于肱骨结节间沟内，可在臂外旋状态下做收展运动时触摸。
●前三角肌：锁骨外侧1/3与三角肌粗隆之间，可在对抗阻力肩关节屈曲时触摸。
●中三角肌：位于肩峰和三角肌粗隆之间，可在肩对抗阻力外展时触及。
●后三角肌：肩胛冈外侧1/3和三角肌粗隆之间，可在肩关节对抗阻力后伸时触及。
●上斜方肌：可在耸肩时，于肩峰和枕外隆突中间进行触摸。
●中斜方肌：肩胛骨上回旋时，可在离肩胛冈水平的肩胛骨内侧缘一个手指的范围内摸及。
●下斜方肌：在肩胛对抗阻力上回旋时,肩胛下角内侧或周围可触及。
●背阔肌：肩对抗阻力内收时，可在肩胛下角下方约半个手指范围内触及。
●前锯肌：可当肩对抗阻力屈曲时在胸壁外侧进行触摸。
●胸大肌：胸骨端: 胸骨上1/3外侧，可在肩水平屈时触摸。
●锁骨端：锁骨内侧1/3下方, 可在肩关节屈曲时触摸。
●胸小肌：可当肩对抗阻力内收时在喙突处触摸。
●内侧和外侧髁：肱骨远端肘关节周围最明显骨性突起，屈肘时更为明显。
●内、外上髁：内侧和外侧髁上可触及的向上的突起。
●鹰嘴：在肘尖部，肘屈时更明显。
●肘管：位于内上髁后面的凹槽 (内上髁和鹰嘴之间，内有尺神经穿行)。
●桡骨头：在肘关节伸直时，在外侧髁远端后外侧有一个凹陷，在其底部的骨性结构便是，可在前臂旋前和旋后时触摸。
●肱桡肌：起于肱骨外上髁。当对抗阻力屈肘时，可在近端触摸该肌肉。
●肱二头肌止点腱：肘关节对抗阻力屈曲和旋后时，在肘窝（肘关节窝）能摸到的最明显的肌腱，肌腱内侧有肱动脉经过。正中神经则位于肱动脉内侧。
●肱肌和肌腱：可在肱二头肌深面可触摸到，屈肘和前臂旋前更能明显触摸到肱肌。肌腱可在肘窝肱二头肌肌腱内侧深部触及。
●肱三头肌外侧头：肘关节伸直时手指放在肱骨体上1/3以上，向后外侧，可触感肌肉。
●肱三头肌长头：用手指在肱骨体上1/3后方（外侧头内侧），受试者肩关节处于对抗阻力后伸状态（肘关节伸更好）。
●肘部桡神经：在内侧的肱二头肌肌腱和外侧的肱桡肌之间的深面。
●桡骨茎突:桡骨远端外侧最明显的突起，靠近解剖鼻烟窝。
●尺骨茎突：尺骨远端内侧最明显的突起。相对桡骨茎突更靠近近侧。
●近侧列腕骨位置：在腕关节屈曲时，腕关节掌侧可见有两个折痕，更远端的折痕刚好位于近端腕骨浅面。
●舟骨结节：在大鱼际隆起的底部，常见为一个小隆起; 舟骨也可在解剖学鼻烟壶底部触及。
●月骨：在腕关节屈曲和外展时，在腕背面手舟骨内侧可触及。
●三角骨：手向桡侧偏，在月骨内侧可触及。
●豌豆骨：在小鱼际隆起的近侧。尺侧腕屈肌止于此处。
●钩骨钩：距豌豆骨远侧一个手指的距离,深压可触及，因为尺神浅支正好经过豌豆骨和钩骨之间（盖恩管或尺侧管）所会感觉不舒服。
●头状骨：第3掌骨底部近侧，腕屈曲时背侧可触及该骨性突起。
●小多角骨：第二掌骨底近侧可触及。
●大多角骨嵴：舟骨结节远侧，深压可触及。
●桡侧腕屈肌腱：对抗阻力屈腕及桡侧偏转，外侧最明显可见并能触及的肌腱即是（在掌面止于第二和第三掌骨底）。
●掌长肌腱：拇指尖与其他指尖相接触（对掌运动），在腕管区域最明显可见的肌腱即是，恰位于桡侧腕屈肌内侧。
●指浅屈肌腱：握紧拳头后，在腕管位置掌长肌腱内侧和外侧可触摸到该肌的肌腱，掌长肌腱内侧的肌腱相对更容易触摸。
●指深屈肌腱：在远侧指间关节对抗阻力屈曲时在第2到5指远侧指间关节附近掌侧可触及。
●拇长屈肌腱：拇指指间关节抗阻力屈曲时，拇指掌侧可触及。
●尺侧腕屈肌腱：在手腕抵抗阻力时尺偏并轻微屈曲时，在手腕横纹掌侧水平可触及的最内侧的肌腱。
●指伸肌腱：在手腕抵抗阻力伸每个指尖时，一根根暴露出来的四个伸指肌腱。
●桡侧腕长伸肌腱：伸腕时，在第二掌骨基底部表面最外侧的指伸肌腱外侧可触及。
●桡侧腕短伸肌腱：在对抗阻力伸手腕时，第三掌骨底最内侧，第三掌骨伸肌腱（指伸肌腱的一部分）的内侧。
●尺侧腕伸肌腱：在手腕伸及尺侧偏斜时，在第五掌骨背面近侧腕关节附近可触及。
●拇长伸肌腱：位于鼻烟窝的尺侧边界。
●拇长展肌腱和拇短伸肌腱：位于鼻烟壶的桡侧界。拇短伸肌腱更靠近背侧。
●示指伸肌腱：达第二掌骨的伸指肌腱内侧。
●小指伸肌腱：达第五掌骨的伸肌腱内侧。
●锁骨下动脉：于锁骨中点后向下按至第一肋骨同时头向同侧屈以松弛颈部肌肉。臂丛神经干亦从这里经过。
●中央腱（带）：近节指骨背侧的肌腱。
●外侧带：位于中节指骨的两侧。
●矢状带：食指MP关节内外侧的肌腱。
●末端伸肌腱：手背远节指骨底上面的肌腱。
●腋动脉：可于肱骨体上部腋后襞前方触及。因为正中神经于附近穿行，可能会导致有些麻木和/或刺痛。
●桡动脉：位于桡侧腕屈肌腱和桡骨茎突之间。解剖学鼻烟窝处也可触及。
下肢标志
●髂骨、ASIS、PSIS，上面已经描述。
●坐骨结节：在臀部下部可触及；站立时，它是由臀大肌覆盖；坐时，它是被脂肪和滑液囊所覆盖。
●股骨大转子：髂嵴中点下方约一手距离，髋关节旋转时易触及。
●臀中肌：髂嵴和股骨大转子之间，髋关节外展和外旋时易触及。
●阔筋膜张肌（IT韧带）：髋关节屈曲并外展时，在髂前下棘外侧一个手指距离处可触及。
●股骨内外侧髁：股骨远端两侧的骨性突起。
●胫骨内外侧髁：在膝关节屈曲时，髌韧带两侧有两个凹陷，此处可触及胫骨内侧和外侧髁的前缘。
●Gerdy结节：在胫骨粗隆和腓骨小头中间的骨性隆起。胫骨外侧的结节，是髂胫束的止点。
●鹅足: 胫骨粗隆远侧面供股薄肌、缝匠肌、半腱肌附着之处。
●外侧副韧带LCL：沿外侧膝关节线（股骨外侧髁、腓骨头之间），在膝关节屈曲90度和髋关节外展及外旋状态时易触及。
●内侧副韧带MCL：沿的内侧膝关节线向后外方可触及。
●髌上囊：位于膝关节线上一掌的距离，当膝关节有明显渗出而积液时可能出现一定程度的肿大。
●腓骨头：小腿上端后外侧面的骨性突起。
●腓骨颈：腓骨头正下方，有腓总神经通过。
●内踝：天然标志，有大隐静脉、隐神经在前方通过。
●跟腱：天然标志，位于腿后下部。
●跟骨外侧结节：外踝尖下方一手指距离其正下方是腓骨长肌经过的沟槽。
●跟骨载距突：距离内踝下方一个手指距离处，其正下方的沟槽有踇长屈肌经距骨内外侧结节之间后经过。
●距骨头：足内翻时的胫骨远端前方约两个手指处可触及。
●舟骨粗隆：跟骨载距突前大里约两个手指处。
●内侧楔骨：舟骨粗隆前方，在足内翻和背屈时沿胫前肌腱可触及。
●第五跖骨底茎突：腓骨短肌止点处。
●坐骨神经：起始点: 髂后上棘 (压痕处即是) 和坐骨结节之间的中点。
●途经点：股骨大转子和坐骨结节之间中点
●下行途径：沿大腿后正中线垂直下行至腘窝上角。
●股动脉：位于腰大肌前方，在髂前上棘和耻骨联合之间的中点处可触及。
●股神经：股动脉外侧一个手指距离处。
●股静脉和大隐静脉：恰位于股动脉内侧。
●腘动脉触诊点：俯卧时检查侧膝关节屈曲，按压腘窝的中点，可触其搏动。
●足背动脉触诊点：触摸踇长伸肌腱，然后恰好于肌腱的外侧可触及该动脉（内外踝之间假想线前方约一个手指距离）。
●胫后动脉：内踝后面踇长屈肌腱和趾长屈肌腱之间可触及。
●胫骨粗隆：位于腘动脉分为胫前、后动脉的分叉处水平。
●收肌结节：用手沿大腿内侧向下触摸，直到在股骨内侧上方触及的第一个骨性突起。
●胫骨前肌腱：在足背，当足对抗阻力背屈时可触及的位于最内侧的肌腱。
●踇长伸肌腱：在足背，当足对抗阻力背屈时，恰于胫前肌腱的外侧可触及。
●第三腓骨肌腱：足外翻和背屈时足背最外侧的肌腱，第五跖骨体旁更明显。
●距腓前韧带：外踝前缘前面。
●跟腓韧带：从腓骨远端向后、下连至跟骨。
●三角韧带：该韧带从内踝向后、下连至跟骨，向前、下连于距骨和舟骨，足外翻时易触及。
●长收肌：前屈，外展和外旋大腿时可触及。
LANDMARKS OF SURFACE ANATOMY
Landmark of spine
●C2 spinous process: Flex your head and one finger below the level of the imaginary line between two mastoid processes.
●C3 spinous process: At the level of the hyoid bone.
●C4 spinous processes: At the upper level of thyroid cartilage (laryngeal prominence, Adam’s apple, is given landmark).
●Carotid bifurcation: Between C3 and C4, at mandibular angle level.
●C5 spinous processes: At the lower level of thyroid cartilage.
●C6 spinous process: At the lower level of cricoid cartilage．At this level, it demarcates the junction of larynx with trachea, the junction of the pharynx with esophagus, and the level of vertebral artery entering the transverse foramen.
●C7 spinous process: Most prominent posteriorly projected bony structure, easier to palpate with head flexion.
●Suprasternal notch: A given landmark, at the level between T2 and T3 vertebrae.
●Manubrium: Between the level of T3 and T4 vertebrae.
●T3 spinous process: At the level of base of scapular spine when both shoulder are hanging at side.
●Sternal angle
○At the 2nd costal cartilage.
○At the level of the junction between T4 and T5 vertebrae.
○At the junction of the between superior and inferior mediastina.
○At the level of the origin and termination of the aortic arch.
○At the level of azygos vein entering the superior vena cava.
○Trachea bifurcation at supine.
●T7 spinous process: At the level of inferior scapular angle.
●T8 spinous process: At the level of junction between xyphoid process and sternum.
●T9 spinous process: At the level of the tip of xyphoid process.
●L3 spinous process: At the level of imaginary line of the lowest costal margin.
●Iliac crest: The given landmark, at L4 level.
●ASIS: Travel forward along the iliac crest until you reach the most anterior bony projection.
●PSIS: Travel posteriorly along the iliac crest until you reach a bony bump, usually two indentation (sacral dimple) in the skin medial to PSIS, marking the level of S2, marking the level of the SI joint, and also marking the level of termination of the dural sac.
●Sacral sulcus: An indentation medial to PSIS, lateral to sacral spinal process.
●Sternocleidomastoid (SCM) muscle: Run anteriorly and inferiorly from mastoid process to the sternum (medial head) and clavicle (lateral head)．Felt the muscle if you ask your subject to turn his head away from the examined side, especially if resistance is applied to the turning．Internal jugular vein locates between the two heads.
●Scalenes: Three deep muscles superior to the clavicle, posterior to the SCM muscle, and anterior to the upper trapezius muscle.
Landmarks for cardiopulmonary system (chest)
●Pleural apex: 2.5～3.0 cm above the medial 1/3 of the clavicle.
●Pericardial region: A small area without pleural coverage on the left side over the 5th, 6th, and the 5th intercostal space.
●2nd right intercostal space: Aortic auscultation.
●2nd left intercostal space: Pulmonic auscultation.
●4th left intercostal space: Tricuspid auscultation.
●Cardiac apex: At the 5th intercostal space about 7～9 cm from the midline, or 1～2 cm from the left mid-clavicular line; area for Mitral valve, S3 auscultation.
●Lower border of lungs: At the 6th rib level of mid-clavicular line, at the 8th ribs level of mid-axillary line, at the 10th rib adjacent to the vertebral column.
●Right oblique fissure of lung: Along the 5th rib posteriorly to the 6th rib level anteriorly.
●Left oblique fissure of lung: From the 3rd to 5th rib level．Or ask subject to hold arms over head, the medial border of scapula is corresponding to the oblique fissure.
●Transverse fissure line: At the level of the 4th rib level.
●Origin of Brachiocephalic artery (right) and common carotid artery: At the level of sternal angle.
●Right manubriocostal junction: Left brachiocephalic vein join the right brachiocephalic vein to from the superior vena cava.
●Entry of superior vena cava to the right atrium: At the 3rd right costal cartilage level along the right sternal margin.
●Internal thoracic A．& V.: Run just a finger away from the lateral edge of the sternum.
●Costovertebral angle: Between the erector spinae muscles and the 12th ribs．Percussion spot for kidney problem．Useful in LBP differential diagnosis.
●Xiphisternal plane: Pass through the xiphoid at the level of the T9 vertebra．It marks the upper border of liver, the central part of diaphragm.
●Transpyloric plane: Midway between suprasternal (jugular) notch and the upper border of the symphysis pubis, practically a hand’s breath below the xiphoid．It marks the level of L1, costal margin of at the 9th costal cartilage, the level of superior mesenteric a．from aorta.
●Subcostal plane: Through the 10th costal cartilage, at the level of L3, the level of inferior mesenteric a from aorta.
●Supracristal plane: Through the highest points of iliac crests．It marks the level of L4, the level of bifurcation of the descending abdominal aorta (or 2 cm below the umbilicus in recumbent position).
Landmarks of upper extremities
●Clavicle: A given landmark.
●Sternoclavicular joint: The junction between the jugular notch and the manubrium.
●Acromioclavicular joint: Notch between the lateral end of clavicle and the acromial process of scapula.
●Acromial process: The bony prominence lateral to the acromioclavicular joint.
●Scapular spine: The bony projection on the back of scapula from the acromial process toward medially and slight inferiorly.
●Medial (vertebral) border of scapula: The most medial part of the scapular spine, then up and down vertically.
●Inferior angle of scapula: The lowest part of the medial border of the scapula, at the level of the 7th cervical Spinous process or the 7th intercostal space.
●Infraclavicular fossa (or Deltopectoral triangle): A small depression inferior to the lateral clavicle, at the junction of its medial convex and lateral concave portions (this junction is also one of the origins of pectoralis major and deltoid muscles)．Cephalic vein lies (passes) here to drain into subclavian vein.
●Coracoid process of scapula: Lateral to the infraclavicular fossa, about one finger below the clavicle under cover of deltoid fibers．Not movable with the humeral medial or lateral rotation.
●Lesser tubercle of humerus: Lateral to the coracoid process of scapula, movable with the humeral medial or lateral rotation．Comparatively, the lesser tubercle locates more slightly lateral and anterior to the coracoid process of scapula.
●Greater tubercle of humerus: The most lateral bony projection of the shoulder, lateral and inferior to the acromion, movable with the shoulder movement.
●Intertubercle groove: The depression between the greater and lesser tubercle of humerus.
●Humeral head:Ask the subject to raise his arm and rotate it, palpate with deep pressure to the axillary apex to feel the movement of the humeral head.
●Supraspinatus muscle: Immediately above the scapular spine and palpable with shoulder abduction.
●Infraspinatus muscle: Immediately below the scapular spine and palpable with the shoulder external rotation.
●Levator scapulae muscle: During the scapular elevation against resistance, palpable half finger away from the medial border of scapula above the scapular spine.
●Rhomboid major muscle: During the scapular retraction, palpable half finger away from the medial border of scapula below the scapular spine.
●Teres major muscle: Half finger away from the inferior angle of the scapula along the lateral border of scapula (superiorly and laterally), palpable with shoulder adduction against resistance.
●Teres minor muscle: Immediately above the teres major, palpable with the shoulder external rotation.
●Long head of biceps brachii tendon: Locates in the intertubercle groove of humerus, palpable with arm at externally rotated position to perform adduction/abduction.
●Anterior deltoid muscle: Between the lateral 1/3 of clavicle and the deltoid tuberosity, palpable with the shoulder flexion against resistance.
●Middle deltoid muscle: Between the acromion and the deltoid tuberosity, palpable with the shoulder abduction against resistance.
●Posterior deltoid muscle: Between the lateral 1/3 of the scapular spine and the deltoid tuberosity, palpable with the shoulder extension against resistance.
●Upper trapezius muscle: During shoulder shrugging, palpable at the midway between the acromion process and the occipital protuberance.
●Middle trapezius muscle: Palpable during retraction at the area one finger away from the medial border of the scapula at the level of scapular spine.
●Lower trapezius muscle: During the scapular upward rotation against resistance, palpable around or medial to the inferior angle of scapula.
●Latismus dorsi muscle: Palpable with shoulder adduction against resistance at the area about half finger below the inferior angle of scapula.
●Serratus anterior muscle: Palpable at the lateral side of thoracic wall during the shoulder flexion against resistance.
●Pectoralis major muscle: Sternal part: lateral to the upper 1/3 of sternum, palpable with shoulder horizontal adduction.
●Clavicular part: Inferior to the medial 1/3 of clavicle, palpable with shoulder flexion.
●Pectoralis minor muscle: Palpable on the coracoid process with shoulder adduction against resistance.
●Medial and lateral epicondyle: The most prominent bony projection at the distal end of humerus around the elbow joint, more obvious at elbow flexion.
●Medial and lateral supracondylar ridge: The bony projection felt upward along the medial and lateral epicondyles.
●Olecranon process: At the tip of the elbow, more obvious at elbow flexion.
●Cubital tunnel: The groove immediately behind the medial epicondyle (between the medial epicondyle and olecranon process．Ulnar nerve passing through there.
●Radial head: At elbow extension, distal to the lateral epicondyle, there is depression posteriorly and laterally, the bony structure at the bottom of the depression, felt with forearm pronation and supination.
●Brachioradialis muscle: Origin at the lateral supracondylar ridge．Proximal part of the muscle is felt when the elbow flexes against resistance.
●Biceps brachii muscle insertion tendon: At elbow flexion and supination against resistance, the most obvious palpable tendon at the antecubital fossa (Cubital fossa)．Medial to the tendon, brachial artery lies (passes)．Median nerve is medial to the brachial artery here．Pneumonic: TAN from lateral to medial.
●Brachialis muscle and tendon: Muscle can felt deep to the biceps and better felt with elbow flexion and pronation．Tendon can be palpated at the spot medial and deep to the biceps tendon at the antecubital fossa.
●Lateral head of triceps: Place the fingers over the upper 1/3 of humeral shaft posteriorly and laterally to feel the muscle at elbow extension.
●Long head of triceps: Place the fingers over the upper 1/3 of humeral shaft posteriorly (more medial to the lateral head) with subject’s shoulder extended against resistance (better with elbow extension as well).
●Radial nerve at elbow: Deep in the space between the biceps tendon medially and the radiobrachialis laterally.
●Styloid process of radius: Most lateral prominent projection of the distal radius, it is proximal to the anatomical snuff box.
●Styloid process of ulna: Most medial prominent projection of the distal ulna．It is relatively more proximal than the radial styloid process.
●Proximal carpal bone location: At wrist flexion, two creases visible at the volar side of the wrist joint, the more distal one lies just superficial to the proximal carpal bones.
●Tubercle of the scaphoid: At the base of thenar eminence, often visible as small elevation; Scaphoid also palpable at the base of snuff box.
●Lunate: During wrist flexion and extension, palpable on the dorsal side, medial to the scaphoid.
●Triquetrium: With hand radial deviation, palpable medial to the lunate on the dorsal side.
●Pisiform: At the proximal extremity of the hypothenar eminence．Flexor carpi ulnaris inserts here.
●Hook of the hamate: About one finger distal to the pisiform, palpable with deep pressure．This is uncomfortable because the superficial branch of the ulnar nerve lies over the bone right here between pisiform and hamate (Guyon’s canal, or ulnar canal).
●Capitate: Proximal to the base of the 3rd metacarpal, the palpable bony prominence dorsally at wrist flexion.
●Trapezoid: Palpable proximal to the base of the 2nd metacarpal.
●Trapizum crest: Distal to the scaphoid tubercle, palpable with deep pressure.
●Flexor carpi radialis tendon: At wrist flexion and radial deviation against resistance, the most lateral visible and palpable tendon (insert at the volar surface of the 2nd and 3rd metacarpal bone base.
●Palmaris longus tendon: Tip of thumb to touch other ring finger tip (opposition), you will see the most obvious tendon at the carpal tunnel area, it is medial to the flexor carpi radialis tendon.
●Flexor digitorium superficialis: After making a fist, those tendons medially and laterally to the palmaris longus tendons at the level of the carpal tunnel, the tendons medial to the palmaris longus tendon are relatively more palpable.
●Tendon of the flexor digitorium profundus: Palpable on the volar side of hand just proximal to the DIP joint of the 2nd to 5th fingers with DIP flexion against resistance.
●Tendon of flexor pollicis longus: Palpable on the volar side of thumb with thumb’s IP joint flexed against resistance.
●Flexor carpi ulnaris tendon: At wrist ulnar deviation and slight flexion against resistance, you can palpate the most medial and volar tendon at the wrist line level.
●Extensor digitorium tendon: At wrist extension with resistance against each finger extension over each of the finger tips, the four superficial tendons of the extensor digitorium muscle exposed, respectively.
●Extensor carpi radialis longus tendon: At wrist extension, lateral to the most lateral tendon of the extensor digitorium over the base of the 2nd metacarpal bone.
●Extensor carpi radialis brevis tendon: At wrist extension against resistance, most medial to the base of the 3rd metacarpal bone, medial to the tendon (of extensor digitorium) to the 3rd metacarpal bone.
●Extensor carpi ulnaris tendon: At wrist extension and ulnar deviation, palpable at the area proximal to the dorsal surface of the 5th metacarpal bone near the wrist joint line.
●Tendon of extensor pollicis longus: The ulnar border of the snuff box.
●Tendons of abductor pollicis longus and extensor pollicis brevis (EPB): The radial border of the snuff box．EPB will be more dorsal.
●Tendon of extensor indicis: Medial to the tendon of extensor digitorium to the 2nd metacarpal.
●Tendon of extensor digiti minimi: Medial to the tendon of extensor digitorium to the 5th metacarpal.
●Subclavian artery: Pressing downward onto the 1st rib behind the midpoint of the clavicle with the head tilting to the same side to relax the neck muscle．Trunk of brachial plexus passes here as well.
试读结束[说明：试读内容隐藏了图片]