Basic Sciences:

Applied Anatomy
Authors*
M. Lagopoulos, S.M. Standring,
M.D. Humzah, L. Haine,
M. Larvin, D.C. Howlett

* The authors of this unit are listed in order of number of topics written, from most to fewest.

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Applied Anatomy
Introduction

Introduction
Before general anaesthesia, surgeons only dealt with limbs and external body parts,
whilst physicians held sway over the internal organs: hence the term 'internal medicine'.
In 1870 the Medical Act combined initial medical and surgical training, and the study of
anatomy became mandatory.
Clinicians require anatomical knowledge for accurate diagnosis and treatment, and when
performing practical procedures. In 1993 the GMC report 'Tomorrow's Doctors'
encouraged a reduction in basic science teaching to accommodate newer knowledge,
and there has also been a steady reduction in cadaveric donation. Dissection of every
region has been replaced by prepared prosections, models and electronic materials. The
standard now required is that of a generalist. However surgeons, in common with
anaesthetists, radiologists and pathologists, require more detailed anatomical
knowledge. It is therefore vital that you avail yourself of every opportunity for
postgraduate anatomical learning. The College is currently piloting a regional Anatomy
Teaching scheme.
The STEP Core Applied Anatomy module is intended to complement rather than
replace other anatomy learning resources. It is based on the ISCP Core syllabus and
common MRCS questions. Each topic includes a brief summary followed by one or more
learning exercises. Although Clinical Cases are used widely in STEP Core, they are less
appropriate here, and instead a clinical context is usually provided. Images are used to
illustrate the topic or support the learning exercises. eSTEP Core contains further selfassessment exercises and additional learning resources.
The ISCP curriculum for ST Levels 1 and 2 states that your require anatomical knowledge
on the development, organs and structures, surface and imaging anatomy of thorax,
abdomen, pelvis, perineum, limbs and neck, as appropriate for surgical operations (to
Knowledge Level 4: "knows specifically and broadly"). This represents a basic
introduction to major regions of the body and will be useful whatever sub-specialty you
pursue. Diseases can affect more than one organ system, and you will need to work with
other sub-specialties in the trauma team or during cancer multidisciplinary team
meetings. The list has been sub-divided into topic areas suggested by the MRCS
syllabus current at the time of publication; any future changes will be notified on eSTEP
Core.
Many of the images in this unit are reproduced from three major anatomy texts, which
we have no hesitation in recommending as excellent resources for surgical trainees, both
in training and for ongoing reference:

Clinically Oriented Anatomy, Keith L. Moore & Arthur F. Dalley, 5th ed. 2006,
Lippincott Williams & Wilkins.

Grays Atlas of Anatomy, Richard L. Drake et al., 1st ed. 2008, Churchill
Livingstone.

Lasts Anatomy, Chummy S. Sinnatamby, 11th ed. 2006, Churchill Livingstone.

Other recommended reading and useful weblinks for this unit are listed on the eSTEP
Core website. Likewise, check the website regularly for additional STEP Ahead material
relating to this unit.

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Applied Anatomy
Introduction

ISCP Core Objectives

The ISCP Core Objective for this unit is simply:

Knowledge of anatomy appropriate for surgery.

Bear in mind that this Objective is correct at the time of going to press, but may change
in the future: any such changes will be reported on the eSTEP Core website.

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Applied Anatomy
Introduction

Contents
TOPIC

PAGE

1) Thorax: Development: Heart and great vessels .......................................... 25

2) Thorax: Development: Fetal circulation ........................................................ 26
3) Thorax: Development: Oesophagus ............................................................ 27
4) Thorax: Development: Diaphragm ................................................................ 27
5) Thorax: Thoracic wall .................................................................................. 28
6) Thorax: Mechanics of breathing .................................................................. 29
7a) Thorax: Thoracic cavity and viscera: Superior mediastinum ...................... 30
7b) Thorax: Thoracic cavity and viscera: Inferior mediastinum......................... 31
7c) Thorax: Thoracic cavity and viscera: Heart and pericardium ..................... 32
7d) Thorax: Thoracic cavity and viscera: Lungs and pleurae............................ 33
8) Thorax: Surface/imaging anatomy: Heart and heart valves ......................... 34
9) Thorax: Surface/imaging anatomy: Auscultation sites.................................. 34
10) Thorax: Surface/imaging anatomy: Lungs and pleurae ............................. 35
11) Thorax: Surface/imaging anatomy: Plane of sternal angle ......................... 36
12) Thorax: Surface/imaging anatomy: Dermatomes........................................ 36
13a) Thorax: Surface/imaging anatomy: Chest drainage ................................ 37
13b) Thorax: Surface/imaging anatomy: Thoracic incisions ........................... 38
14) Thorax: Surface/imaging anatomy: Chest x-ray ......................................... 39
15) Thorax: Surface/imaging anatomy: CT/MRI ............................................... 40
16) Abdomen, pelvis, perineum: Development: Foregut, midgut, hindgut ...... 41
17) Abdomen, pelvis, perineum: Development: Gut rotation ............................ 41
18) Abdomen, pelvis, perineum: Development: Anal canal............................... 41
19) Abdomen, pelvis and perineum: Development: Kidney and ureters .......... 42
20) Abdomen, pelvis and perineum: Development: Bladder and urethra ......... 42
21) Abdomen, pelvis and perineum: Development: Testis................................ 42
22) Abdomen, pelvis, perineum: Anterior abdominal wall: Inguinal canal
and spermatic cord ................................................................................... 43
23) Abdomen, pelvis, perineum: Anterior abdominal wall: Inguinal hernia ...... 44
24) Abdomen, pelvis, perineum: Posterior abdominal wall .............................. 44
25) Abdomen, pelvis, perineum: Pelvic floor and wall ..................................... 45
26a) Abdomen, pelvis, perineum: Lumbar plexus ............................................ 46
26b) Abdomen, pelvis, perineum: Sacral plexus .............................................. 47
27) Abdomen, pelvis, perineum: Peritoneal cavity ........................................... 48
28) Abdomen, pelvis, perineum: Intra-abdominal spaces ................................ 49
29) Abdomen, pelvis, perineum: Abdominal viscera: Oesophagus, stomach... 50

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Applied Anatomy
Introduction
30a) Abdomen, pelvis, perineum: Abdominal viscera: Duodenum .................. 51
30b) Abdomen, pelvis, perineum: Abdominal viscera: Jejunum & ileum ......... 52
30c) Abdomen, pelvis, perineum: Abdominal viscera: Large intestine ............ 53
31) Abdomen, pelvis, perineum: Abdominal viscera: Appendix ....................... 53
32a) Abdomen, pelvis, perineum: Abdominal viscera: Liver ............................ 54
32b) Abdomen, pelvis, perineum: Abdominal viscera: Gall bladder and bile
ducts ......................................................................................................... 55
33) Abdomen, pelvis, perineum: Abdominal viscera: Pancreas ....................... 56
34) Abdomen, pelvis, perineum: Abdominal viscera: Spleen ........................... 57
35) Abdomen, pelvis, perineum: Abdominal viscera: Kidney and ureter ......... 58
36) Abdomen, pelvis, perineum: Abdominal viscera: Adrenal gland ................ 58
37) Abdomen, pelvis, perineum: Pelvic viscera: Rectum ................................. 59
38) Abdomen, pelvis, perineum: Pelvic viscera: Bladder ................................. 60
39) Abdomen, pelvis, perineum: Pelvic viscera: Prostate................................. 60
40) Abdomen, pelvis, perineum: Pelvic viscera: Seminal vesicles.................... 60
41) Abdomen, pelvis, perineum: Pelvic viscera: Uterus, uterine tubes, ovaries 61
42) Abdomen, pelvis, perineum: Pelvic viscera: Vagina .................................. 62
43) Abdomen, pelvis, perineum: Perineum: Anal triangle: Anal canal and
ischiorectal fossa ...................................................................................... 63
44) Abdomen, pelvis, perineum: Perineum: Male urogenital triangle: Scrotum 64
45) Abdomen, pelvis, perineum: Perineum: Male urogenital triangle
Testis and epididymis ............................................................................... 64
46) Abdomen, pelvis, perineum: Perineum: Male urogenital triangle:
Penis and urethra ..................................................................................... 65
48) Abdomen, pelvis and perineum: Surface/imaging: Quadrants/nine
regions ...................................................................................................... 66
49) Abdomen, pelvis and perineum: Surface/imaging: Planes subcostal, transpyloric, transtubercular .................................................... 66
50) Abdomen, pelvis and perineum: Surface/imaging: Dermatomes .............. 67
51) Abdomen, pelvis and perineum: Surface/imaging: Abdominal incisions .... 67
52) Abdomen, pelvis and perineum: Surface/imaging: Rectal and vaginal
examinations ............................................................................................ 68
53) Abdomen, pelvis and perineum: Surface/imaging: Imaging
appearances of abdomen, GI, biliary and urinary tracts .......................... 69
54) Abdomen, pelvis and perineum: Surface/imaging: Arteriography ............. 70
55) Abdomen, pelvis and perineum: Surface/imaging: CT/MRI/Ultrasound ...... 71
56) Upper limb and breast: Pectoral girdle ...................................................... 72
57) Upper limb and breast: Breast ................................................................... 73
58) Upper limb and breast: Axilla ..................................................................... 74
59) Upper limb and breast: Brachial plexus ..................................................... 75
60) Upper limb and breast: Scapular region .................................................... 76
61) Upper limb and breast: Arm ....................................................................... 77

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Applied Anatomy
Introduction
62) Upper limb and breast: Cubital fossa ......................................................... 78
63) Upper limb and breast: Forearm ................................................................ 79
64) Upper limb and breast: Hand including carpal tunnel ................................ 80
65) Upper limb and breast: Shoulder joint ....................................................... 81
66) Upper limb and breast: Elbow joint ............................................................ 82
67) Upper limb and breast: Radio-ulnar joints ................................................. 83
68) Upper limb and breast: Wrist joint .............................................................. 84
69) Upper limb and breast: Hand joints ........................................................... 85
70) Upper limb and breast: Surface/imaging: Cubital fossa ............................ 86
71) Upper limb and breast: Surface/imaging: Wrist structures ......................... 86
72) Upper limb and breast: Surface/imaging: Thumb movements .................. 87
73) Upper limb and breast: Surface/imaging: Arteries & pulses ...................... 88
74) Upper limb & breast: Surface/imaging: Superficial veins & lymphatics ...... 88
75) Upper limb and breast: Surface/imaging: Nerves - axillary, radial,
musculocutaneous, ulnar and median ...................................................... 89
76) Upper limb and breast: Surface/imaging: Dermatomes and tendon
reflexes .................................................................................................... 90
77) Upper limb and breast: Surface/imaging: Arteriography/venography ....... 91
78) Lower limb: Gluteal region ......................................................................... 92
79) Lower limb: Thigh, front, medial side, back: Femoral triangle ................... 93
80) Lower limb: Thigh, front, medial side, back: Femoral sheath and canal..... 93
81) Lower limb: Thigh, front, medial side, back: Femoral hernia ..................... 94
82) Lower limb: Thigh, front, medial side, back: Adductor canal ..................... 95
83) Lower limb: Thigh, front, medial side, back: Popliteal fossa ...................... 96
84) Lower limb: Thigh, front, medial side, back: Leg, compartments .............. 97
85) Lower limb: Thigh, front, medial side, back: Foot, arches ......................... 98
86) Lower limb: Thigh, front, medial side, back: Hip joint ................................ 99
87) Lower limb: Thigh, front, medial side, back: Knee joint ........................... 100
88) Lower limb: Thigh, front, medial side, back: Ankle joint ........................... 101
89) Lower limb: Thigh, front, medial side, back: Foot joints .......................... 102
90) Lower limb: Surface/imaging: Femoral triangle ........................................ 103
91) Lower limb: Surface/imaging: Popliteal fossa ........................................... 103
92) Lower limb: Surface/imaging: Arteries & pulses ....................................... 103
93) Lower limb: Surface/imaging: Superficial veins & lymphatics................... 103
94) Lower limb: Surface/imaging: Nerves - femoral, sciatic, tibial,
common peroneal.................................................................................... 103
95) Lower limb: Surface/imaging: Dermatomes and tendon reflexes ............. 103
96) Lower limb: Surface/imaging: Arteriography/venography......................... 103
97) Head, neck & spine: Development: Branchial arches .............................. 104
97) Head, neck & spine: Development: Branchial arches (cont.) ................... 105

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Applied Anatomy
Introduction
98) Head, neck & spine: Development: Face, palate ..................................... 106
99) Head, neck & spine: Development: Thyroid and parathyroid glands........ 107
100) Head, neck & spine: Development: Spine .............................................. 107
101a) Head, neck & spine: Head: Face .......................................................... 108
101b) Head, neck & spine: Head: Scalp ........................................................ 109
102) Head, neck & spine: Head: Cranial cavity, dural venous sinuses,
pituitary gland ......................................................................................... 110
103) Head, neck & spine: Head: Orbit, eyeball .............................................. 111
104) Head, neck & spine: Head: Ear .............................................................. 112
105) Head, neck & spine: Head: Parotid glands ............................................ 113
106) Head, neck & spine: Head: Temporomandibular joint ........................... 114
107) Head, neck & spine: Head: Nose and paranasal air sinuses ................. 115
108) Head, neck & spine: Head: Mouth, tongue ............................................ 116
109) Head, neck & spine: Head: Submandibular and sublingual glands ....... 117
110) Head, neck & spine: Neck: Anterior triangle: Thyroid and parathyroid
glands ..................................................................................................... 118
111) Head, neck & spine: Neck: Anterior triangle: Larynx and trachea ......... 119
112) Head, neck & spine: Neck: Anterior triangle: Pharynx and oesophagus 120
113) Head, neck & spine: Neck: Anterior triangle: Carotid sheath ................. 121
114) Head, neck & spine: Neck: Posterior triangle: Spinal accessory nerve .. 122
115) Head, neck & spine: Neck: Posterior triangle: Cervical plexus............... 122
116) Head, neck & spine: Neck: Root of neck: Thoracic duct ........................ 122
117) Head, neck & spine: Spine: Vertebral column ........................................ 123
118) Head, neck & spine: Spine: Vertebral canal ........................................... 124
119) Head, neck & spine: Surface/imaging: Middle meningeal artery ............ 124
120) Head, neck & spine: Surface/imaging: Neck blood vessels ................... 124
121) Head, neck & spine: Surface/imaging: Central venous
catheterization ........................................................................................ 125
122) Head, neck & spine: Surface/imaging: Larynx and trachea ................... 126
123) Head, neck & spine: Surface/imaging: Airway access............................ 126
124) Head, neck & spine: Surface/imaging: Skull and cervical spine ............ 127
125) Head, neck & spine: Surface/imaging: Arteriography ............................ 128
126) Head, neck & spine: Surface/imaging: CT/MRI ..................................... 129
127) Nervous system: Central nervous system: Cerebral hemispheres ........ 130
128) Nervous system: Central nervous system: Ventricles ............................ 131
129) Nervous system: Central nervous system: Cerebellum, brain stem ...... 132
130) Nervous system: Central nervous system: Spinal cord ......................... 133
131) Nervous system: Central nervous system: Meninges ............................ 134
132) Nervous system: Peripheral nervous system: Cranial nerves ................ 135
133) Nervous system: Peripheral nervous system: Spinal nerves ................. 136

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Applied Anatomy
Introduction
134) Nervous system: Peripheral nervous system: Peripheral nerves ........... 137
135) Nervous system: Autonomic nervous system: general organization ..... 138
136) Nervous system: Surface/imaging: Arteriography .................................. 139
137) Nervous system: Surface/imaging: CT/MRI ........................................... 140