Inconsistencies in surface anatomy: The need for an evidence‐based reappraisal

Abstract

Accurate surface anatomy is a key component of safe clinical practice. But how consistent are modern clinical and surface anatomy texts in their reporting of common surface anatomy landmarks? Thirteen popular texts in common use were analyzed in detail: one clinical and anatomical reference text; seven clinical anatomy texts; two surface anatomy texts; and three clinical examination texts. Content relating to surface anatomy was reviewed, summarized, and assessed for consistency. Four main findings emerged: (i) there are numerous inconsistencies in clinically important surface markings (e.g., the femoral artery in the groin, superficial and deep inguinal rings, and accessory nerve in the posterior triangle), including inconsistencies within some texts; (ii) there is a consensus on many surface markings, e.g., the spleen and termination of the spinal cord; (iii) few texts address variation in surface anatomy related to age, sex, body mass, posture, respiration, and ethnicity; and (iv) the three standard clinical examination texts included in this review contain comparatively little surface anatomy. Seven surface anatomy landmarks were redefined within an evidence-based framework: termination of the spinal cord, supracristal plane, base of the appendix, renal length, the deep inguinal ring, the femoral artery in the groin, and the accessory nerve in the posterior triangle of the neck. An evidence-based framework is essential if surface anatomy is to be accurate and clinically relevant.

Revisiting thoracic surface anatomy in an adult population: A computed tomography evaluation of vertebral level

“…An appreciation of surface anatomy is essential for promoting safe clinical practice, so it must be accurate, clinically relevant and defined within an evidence-based framework (Hale et al, 2010).…”

“…Although the surface anatomy of the thorax is often a neglected aspect of traditional topographic anatomical teaching, a proper understanding of the relationship between superficial and deep structures is important for the clinical assessment of patients and for interpreting clinical images (Sayeed and Darling, 2007). Clearly, surface anatomy needs to be accurate to ensure safe clinical patient assessment (Hale et al, 2010). Modern imaging techniques provide an opportunity to determine the accuracy of surface anatomy in living individuals (Mirjalili et al, 2012a).…”

Diagnóstico de masa inguinal, más allá de la hernia inguinal

“…En pacientes obesos puede ser imposible definir la localización del quiste a nivel del anillo inguinal por pérdida de las referencias anatómicas. Se acepta que el anillo inguinal interno se localiza aproximadamente en la zona media entre la espina ilíaca anterosuperior y la sínfisis púbica 8 . El diagnóstico también puede ser difícil en aquellos casos en los que coexista una hernia inguinal (30-40%) 3,5 .…”

Evidence‐based surface anatomy

“…Using measurements from modern cross-sectional images obtained from healthy living subjects they have examined conventional surface landmarks and compared their results with those published in a number of current anatomical texts. Taken together with their earlier papers on inconsistencies in surface anatomy landmarks in current textbooks (Hale et al, 2010) and the surface anatomy of the major planes of the trunk (Mirjalili et al, 2012), they present a detailed, systematic analysis of the surface anatomy of the head, neck, and trunk. The same experimental design is used throughout the series, rendering the complete study more powerful than the sum of its parts.…”