Surface Landmarks of the Limbs

UL: Shoulder & Arm - Peak Performance Points

• Acromion: Palpable tip of the shoulder; highest bony point.
• Clavicle: S-shaped; fractures common at junction of middle and outer thirds.
• Coracoid Process: Palpated in deltopectoral groove, inferior to lateral clavicle.
• Greater Tubercle of Humerus: Most lateral bony point of shoulder; rotator cuff insertion.
• Deltoid Muscle: Forms rounded contour; common site for intramuscular injections.
• Surgical Neck of Humerus: Common fracture site; risk to axillary nerve & posterior circumflex humeral artery.
• Spiral Groove: Obliquely crosses posterior humerus; lodges radial nerve & profunda brachii artery.
• Brachial Artery: Medial to biceps brachii; palpated for brachial pulse, used for BP.

⭐ Axillary nerve injury (surgical neck of humerus fracture / anterior shoulder dislocation) causes deltoid paralysis & regimental badge area anesthesia (skin over deltoid).

UL: Forearm & Hand - Handy Landmarks

• Elbow/Proximal Forearm:
  • Olecranon (ulna): Point of elbow.
  • Radial head: Below lat. epicondyle; rotates (pronation/supination).
• Wrist (Distal Forearm):
  • Styloid processes: Radial (lat., extends more distally), Ulnar (med.).
  • Lister's tubercle: Dorsal radius; pulley for Ext. Pollicis Longus.
• Hand:
  • Anatomical Snuffbox:
    • Borders: Abductor pollicis longus & Extensor pollicis brevis (lat.), Extensor pollicis longus (med.).
    • Floor: Scaphoid, trapezium. Contains radial artery.
  • Pisiform: Anteromedial wrist; base of hypothenar.
  • Hook of Hamate: Deep, distal/radial to pisiform.
  • Metacarpal heads: Knuckles.
  • Palmar creases.

⭐ Tenderness in the anatomical snuffbox (floor: scaphoid, lunate) strongly suggests scaphoid fracture, a common wrist injury.

LL: Hip & Thigh - Foundation Formations

• Anterior Superior Iliac Spine (ASIS): Key bony landmark; attachment for inguinal ligament & sartorius.
• Iliac Crest: Palpable superior border of ilium; highest point is supracristal plane (L4 vertebra).
• Pubic Tubercle: Medial attachment of inguinal ligament.
• Greater Trochanter: Prominent bony projection on lateral proximal femur; palpate with hip rotation.
• Ischial Tuberosity: Bears weight when sitting; hamstring attachment.
• Femoral Triangle: Boundaries: inguinal ligament (superior), sartorius (lateral), adductor longus (medial).
  • Contents (Lateral to Medial): Femoral Nerve, Artery, Vein, Lymphatics (📌 NAVEL).

⭐ The femoral artery is palpated at the midinguinal point (midway between ASIS & pubic symphysis) for pulse & vascular access.

• Adductor Tubercle: Medial aspect of distal femur; insertion of adductor magnus.
• Patella: Sesamoid bone within quadriceps tendon; apex points inferiorly.

LL: Leg & Foot - Ground Control Points

• Leg Key Points:
  • Tibial tuberosity: Insertion of patellar ligament.
  • Anterior border of tibia (shin): Subcutaneous, palpable.
  • Medial malleolus: Distal tibia, medial ankle prominence.
  • Lateral malleolus: Distal fibula, lateral ankle prominence.
  • Head of fibula: Posterolateral to lateral tibial condyle.
• Foot Key Points:
  • Base of 5th metatarsal: Prominent, for peroneus brevis.
  • Sustentaculum tali: Medial calcaneal shelf, supports talus.
  • Foot Arches: Medial & lateral longitudinal, transverse.
  • 📌 Tarsal Bones: Tiny Cats Nip My Inner Leg Carefully (Talus, Calcaneus, Navicular, Medial, Intermediate, Lateral cuneiforms, Cuboid).

⭐ Dorsalis pedis pulse, crucial for assessing peripheral circulation, is found lateral to the extensor hallucis longus tendon on the foot dorsum.

High‑Yield Points - ⚡ Biggest Takeaways

• Axillary artery: Palpable in lateral axillary wall, inferior to deltopectoral groove.
• Brachial artery: Medial to biceps tendon in cubital fossa.
• Radial artery: Lateral to FCR tendon at wrist; common pulse site.
• Femoral artery: Located at mid-inguinal point; key for access.
• Popliteal artery: Deep in popliteal fossa; palpate with knee flexed.
• Dorsalis pedis artery: Lateral to EHL tendon on foot dorsum.
• Great saphenous vein: Anterior to medial malleolus; for IV access/cutdown.