The Anatomist - Bill Hayes [40]
With my shirt off, I have assumed what is called the anatomical position: standing upright with feet together, hands at the side, palms forward, with eyes directed toward the horizon, or, in this case, toward the Golden Gate Bridge, visible due north out the lab windows. The anatomical position, used in all medical disciplines, is the standard body position for referring to the location of any structure. In this pose, the subject becomes an object.
Following Dr. Topp’s directive, the eight PT students grouped around me have to find the “bony landmarks” of the surface anatomy of the upper body, all fifty of them. Some are clearly visible, such as the shaft of the clavicle or the spine of the scapula (the collarbone and the sharp edge of the shoulder blade, respectively), but most need to be palpated. The gloves come off, the better to feel what is just under my skin. An easy one to find right away, on me as well as on most people, is the C7 spinous process. Translation: the bump at the seventh cervical vertebra. To most of us, this is the knobbiest knob you feel when massaging the back of the neck. To a physical therapist, it is the starting point for locating any of a patient’s thirty-two other vertebrae. Counting upward, there’s C6 to C1, while downward from C7, the remainder are grouped by region, with twelve thoracic, five lumbar, five sacral, and, finally, at the tailbone, the three to four coccygeal vertebrae.
Just as landmarks are handy when one is driving—Take the second right after the movie theater, for instance, or, If you pass Millie’s Diner, you’ve gone too far—the landscape of the human body is more readily navigable for its markers. One of the most clinically important is the sternal angle, a slight ridge of bone near the top center of the sternum, or breastbone. If you’ve ever pointed at yourself while asking someone, “Are you talking to me?” you have probably pointed right at it. Its exact spot is most easily found by first slipping your finger into the groove at the very bottom of the throat, which is the very top of the sternum. This is the jugular notch, and the tip of the finger seems to fit perfectly in it. Now slide your finger down the sternum about 1½ to 2 inches (4 to 5 centimeters) to the first tiny bump or ridge. You have found the sternal angle. Just behind it, along the same horizontal plane, the arch of the aorta begins its arching, the trachea splits into the bronchi, and, deeper still, the thoracic vertebrae 4 and 5 are situated.
A landmark to other clinical landmarks, the sternal angle is indispensable for correctly identifying the ribs, which are counted top down, with twelve on each side. The first rib, embedded under the clavicle, cannot be palpated. The second, however, lies to the right and left of the sternal angle, though the bump can be subtle. From here, moving downward and sideways, you can count ribs 3 through 10, all of which connect to the sternum via a small portion of cartilage. The last two ribs on each side are unique in that they end roughly halfway around the torso. These are the “floating ribs,” and their tips can be felt just above the waistline.
Now, repeat eight times, without squirming, and you’ll have an idea of what my morning has been like. As it turns out, my rib cage is good for counting because I don’t have a lot of body fat. My arteries are easy to palpate, veins easy to see. The students tell me I have a very well defined bicipital groove and impressive biceps, too. But compliments gradually give way to a sharper truth: my body serves as a primer on being middle-aged.
Both my scapulas wing a bit too prominently, a possible sign of weakening serratus anterior muscles. My collarbones are uneven, probably from shouldering my gym bag on my left side for the past twenty-odd years. And my right shoulder joint makes a clicking sound as it rotates, apparently an early sign of arthritis. Once this is discovered, the entire class descends and I become the morning’s star attraction: Come, see the man who clicks!