Its walls are rigid and it has valves so the blood does not flow down via gravity. The aortic bifurcation is the point at which the abdominal aorta bifurcates (forks) into the left and right common iliac arteries. It is shallow in the lower cervical region and deepest in the lumbar region. The spinous process of T1 is usually the third prominent bony structure in the midline below the EOP; the spinous processes of C2 and C7 are the first and second, respectively (Fig. It reaches supracristal plane in the sixth month and the level of the xiphisternal joint in the eighth month. Several muscles are commonly visible in the back region. In the midline below the spinous process of the axis, the second prominent palpable structure is usually the spinous process of C7 or the vertebra prominens. Care must be taken when palpating this structure because of the relatively fragile styloid process of the temporal bone that lies a few millimeters anterior to the C1 transverse process and the great auricular nerve that ascends in the fascia superficial to the C1 transverse process. A thorough knowledge of surface anatomy is necessary for the proper performance of a physical examination. This is usually at the level of the L4 vertebrae. These curves are covered in more detail in Chapter 2. The locations of structures in reference to the surface of the body are always approximations, although it has been shown that reliability of locating spinal structures by palpation can be enhanced by training and experience (Byfield et al., 1992; Seven processes arise from the posterior portion of the typical vertebra. The crest of the ilium is the superior border of the wing of ilium and the superiolateral margin of the greater pelvis. The transverse processes are a pair of lateral projections. The supracristal plane (through the highest points of the iliac crests), which is typically at the L4 vertebral level, is used as a landmark for lumbar puncture, and the aorta divides at this level. The aortic bifurcation is usually seen at the level of L4, just above the junction of the left and right common iliac veins. The latissimus dorsi, extending from the region of the iliac crest to the posterior border of the axilla, forms the lateral border of the lower thoracic portion of the back. They drain blood from the pelvis and lower limbs. In the remainder of the healthy population, this plane is fairly evenly found at either L2-3 or L4-5 ( Pysyk et al., 2010 ). Information gathered by the eyes (inspection) and fingers (palpation) is often critical in the assessment of a patient. Anatomical terminology is a form of scientific terminology used by anatomists, zoologists, and health professionals such as doctors. The 24 movable vertebrae consist of, from superior to inferior, 7 cervical (C), 12 thoracic (or dorsal) (T), and 5 lumbar (L). A needle is inserted above or below this spine, which is palpable (lumbar puncture). This fold marks the lower extent of the buttocks. fundus rises above the level of the pubic symphysis in the third month. The tips of the transverse processes of T5-9 are located two spinous interspaces superior to the tips of their respective spinous processes because these spinous processes project inferiorly to a greater degree. Knowledge of the normal relationships between the viscera and the spine is becoming increasingly important in clinical practice, since clinicians are asked with greater frequency to interpret or review studies employing these advanced imaging procedures. The zygapophysial joints between the articular processes of the cervical vertebrae (collectively known as the left and right articular pillars) can be found 1.5 cm lateral of the midline in the posterior neck. Determining the position of the contents of the abdomen can be particularly challenging, and the precise location of abdominal viscera can be established only by verification with appropriate diagnostic imaging procedures. This fold marks the lower extent of the buttocks. A mark, strip, or streak. The abdomen is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. An understanding of the topography of the human body also allows the health care provider to locate the position of deep structures that may need further evaluation. 1-3 A, Palpable landmarks of the back from a posterior view. They exit the pelvic girdle posterior and inferior to the inguinal ligament about one third laterally from the insertion point of the inguinal ligament on the pubic tubercle at which point they are referred to as the femoral arteries. The division into four quadrants allows the localisation of pain and tenderness, scars, lumps, and other items of interest, narrowing in on which organs and tissues may be involved. Transpyloric plane (of Addison) L1 level; Liver: Superior boundary - nipple; Inferior boundary - Right 10th rib Right border - RIGHT anterior axillary line; Left border - LEFT Mid clavicular line, 5th intercostal space; Gallbladder: RIGHT mid clavicular line; RIGHT 9th ribs; Spleen: LEFT 9 - 11th ribs; T9 - L1; Abdominal aorta. supracristal line. [1] It passes through the umbilical region and the left and right lumbar regions. The trapezius is a large, flat, triangular muscle that originates in the midline from the EOP to the spinous process of T12 and inserts laterally onto the spine of the scapula. L4 – the supracristal plane (supracristal line) at the level of the summits of the iliac crests. Respiratory movements also can have marked effects on the locations of structures, especially those of the thorax. Sometimes. In the past the L4 spinous process was considered to be in a horizontal plane with the superior margin of the iliac crests (the supracristal plane), although in approximately 20% of the population the tops of the iliac crests were thought to be aligned with the spinous process of L5 (Oliver & Middleditch, 1991). Note that in about 10% of the population, the C6 spinous process is also very prominent. Anteriorly, the superior border of the thyroid cartilage, forming the laryngeal prominence (Adam’s apple) in the midline, may be used to find the horizontal plane of the C4 disc. The Back The human abdomen is divided into quadrants and regions by anatomists and physicians for the purposes of study, diagnosis, and treatment. Fachwörterbuch Medizin Englisch-Deutsch. The anterior aspects of the transverse processes of the cervical vertebrae may be found in the groove between the larynx and sternocleidomastoid muscle (SCM). Transpyloric plane is the plane that goes across pylorus, mid point between jugular notch and pubic symphysis, across umbilicus, level of LV4, which also turns out to be level of highest part of iliac crests. The erector spinae muscles form two large longitudinal masses in the lumbar region that extend approximately a hand breadth (10 cm) laterally from the midline. The quadrants are referred to as the left lower quadrant, left upper quadrant, right upper quadrant and right lower quadrant. In about 75% of the population the vertebra prominens is the most prominent spinous process, whereas the spinous process of C6 or T1 is more evident in the other 10% and 15% of the population, respectively (Stonelake, Burwell, & Webb, 1988). 1-2). [2] When patients are standing or sitting with their upper extremities resting along the sides of their trunk, the inferior scapular angle usually is at the horizontal level of the spinous process of T8 (Cooperstein & Haneline, 2007; Haneline et al., 2008). 1-2), although according to Oliver and Middleditch (1991) the posterior tubercle of C1 may be palpable in some people between the EOP and the spinous process of C2. The back, or dorsum, is the posterior part of the trunk and includes skin, muscles, the vertebral column, spinal cord, and various nerves and blood vessels (Gardner, Gray, & O’Rahilly, 1975). This muscle is especially noticeable when the upper extremity is adducted against resistance. The spinous process of the axis is the first readily palpable bony structure in the posterior midline below the EOP (see Fig. In this position the scapulae are rotated so that the T9 spinous process is more commonly found at the level of the inferior scapular angle (Cooperstein et al., 2009). Besides these muscles, several bony landmarks usually are visible in the region of the back. supracristal When patients are standing or sitting with their upper extremities resting along the sides of their trunk, the inferior scapular angle usually is at the horizontal level of the spinous process of T8 (Cooperstein & Haneline, 2007; Haneline et al., 2008). Lumbosacral Region B, Anatomic relationships from a lateral view. The anterior and posterior superior iliac spines (the latter being frequently marked by a dimple) are at the level of the second sacral segment. FIG. Interpretation Translation  supracristal line الخط فوق عرفي الحرقفتين. The 24 movable vertebrae consist of, from superior to inferior, 7 cervical (C), 12 thoracic (or dorsal) (T), and 5 lumbar (L). Normally there is no lateral deviation of the spinal column, but such curvature is known as scoliosis when present. It is also a useful landmark in performing a lumbar puncture, since it is well below the level of the termination of the spinal cord, which is approximately at L1 (see page 381 and Fig. Superiorly it begins at the external occipital protuberance (EOP) (see the following discussion) and continues inferiorly as the gluteal (anal, natal, or cluneal) cleft (or crena ani) to the level of the S3 spinous tubercle, the remnants of the spinous process of S3. Supracristal plane (Planum supracristale) (or supracrestal plane) is an anatomical transverse plane lying at the upper most part of the pelvis, the iliac crest. 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