MANUAL 



OF 



SURGICAL ANATOMY. 



THE SUPERIOR EXTREMITY. 



THE SHOULDER REGION. 



Surface Landmarks. The Clavicle is the most important 

 surgical landmark in this region. Its axis is directed downwards,, 

 forwards., and medially in well - developed subjects, but in 

 poorly - developed individuals the bone assumes a horizontal 

 position. The skin, superficial fascia, and platysma are all 

 freely movable over its subcutaneous surface, and therefore 

 compound fracture is a rare injury. 



The large sternal end of the clavicle forms a rounded 

 prominence immediately to the lateral side of the jugular 

 (supra-sternal) notch and the sternal head of the sterno-mastoid. 

 In its medial two-thirds the shaft is convex forwards and 

 laterally, and this convexity is often greatly exaggerated in 

 children with rickets. The lateral third is concave forwards, 

 and on its anterior border there is a tubercle, of varying size, 

 which is produced by the deltoid. The middle third forms 

 the upper boundary of the superficial infra-clavicular triangle, 

 which is not always a well-marked depression. Its distinctness 

 depends on the proximity and development of the other borders, 

 namely, the anterior margin of the deltoid and the upper margin 

 of the clavicular head of the pectoralis major. On deep pressure 

 in this triangle just below the clavicle, the pulsations of the 

 first part of the axillary artery may be felt, and the vessel can 



1 



