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Preface

This text provides an illustrated guide to clinical examination. It includes the relevant anatomy to understand these techniques and to undertake routine practical procedures, together with an introduction to basic pathology and its associated radiology. Traditional teaching of 363 anatomy is in excess of the current requirements of most clinical practitioners; even surgeons tend to limit their activities to specific regions of the body. Nevertheless, every clinician examining a patient requires anatomical knowledge, to understand the limits and range of 393 normality, before they can diagnose and manage abnormal states. Thus training in practical anatomy remains essential and relevant.

Most clinicians undertake venepuncture and an increasing number are involved in vascular access; this requires unique knowledge in the choice of vessel and potential complications. Many clinicians have to inject local anaesthetic and undertake procedures, such as lumbar puncture, pleural and peritoneal drainage, and organ biopsy, requiring associated anatomical knowledge. Injuries can involve any part of the body, and require knowledge of the structures that may be damaged and need treatment. Some disciplines, including sports medicine, physical medicine and physiotherapy, require knowledge of functional anatomy, with an emphasis on palpable anatomy and movement.

The recent remarkable developments in radiological imaging have increased the need for a comprehensive knowledge of anatomy for their interpretation. This is particularly so for the deeper structures that were only previously accessible to the surgeon and pathologist, e.g. within the head, chest and abdomen. Multi-media diagnosis requires the use of appropriate techniques for specific areas, and whole body imaging requires knowledge of “joined-up” anatomy and the ability to follow structures across adjacent regions.

Surgeons require more anatomy of their specialist area than is included in this text, but they also should be skilled clinicians and diagnosticians, and require enough general anatomy to bring this about. All clinicians should know the operation that has probably been undertaken through an observed scar.

An extensive number of clinicians from multiple disciplines treat disease and dysfunction, each discipline requiring its own body of knowledge and expertise. The anatomical requirements of these groups vary, but may be very specialised, as with acupuncture and chiropody.

This atlas addresses many of the needs of all specialties, but the main audience is the general medical practitioner and those practising all aspects of physical medicine. This is particularly at the start of clinical studies, but the student continually needs to perfect clinical skills and to demonstrate competence in their final examination. In the latter, students can expect to be observed examining patients and this tests the security of the clinical examination to its fullest extent.

Postgraduate students also need careful reappraisal of their techniques of clinical examination before presenting themselves for work-based appraisal and to higher examining authorities. The aim of this Atlas is to provide a reliable yet flexible method of clinical assessment, appropriate to life-long professional application.