How to Read the Body

Part 1 · General anatomy

Anatomical terminology, position, planes and axes, kinematic conventions, and the vocabulary of bone surfaces

Why this chapter exists

Anatomy is the only subject in your course that every other subject quotes. Kinesiology quotes it, electrotherapy quotes it when it tells you where a motor point lies, orthopaedics quotes it in every operative note, neurology quotes it in every localisation, and your own clinical reasoning quotes it every time you decide that a patient’s lateral elbow pain is tendinous rather than radicular.

But before any of that, anatomy has to be written down and spoken. A structure that cannot be described unambiguously cannot be handed from one clinician to another. The whole of this chapter is therefore about one problem and its solution:

The problem. The human body moves. Any description that depends on how the body happens to be arranged at the moment of writing becomes false the moment the body moves.

The solution. Agree on a fixed reference posture, a fixed set of reference planes and axes, and a fixed vocabulary — and describe everything from those, regardless of what the patient is actually doing.

Everything in this chapter follows from that single move. Master it and you will never again write a sentence in a clinical record that a colleague can misread.

Learning outcomes

By the end of this chapter you should be able to:

• Define anatomy and distinguish its branches, and state which are load-bearing for physiotherapy practice.
• Explain what Terminologia Anatomica is, why it replaced eponymous terminology, and where eponyms nonetheless survive.
• Describe the anatomical position exactly, including the position of the forearms, and justify each element of it.
• Explain the embryological limb rotation that makes upper- and lower-limb terminology mirror-images of each other.
• Define the cardinal planes and their paired axes, and predict the movement that occurs in each plane–axis pair at any joint.
• Distinguish osteokinematics from arthrokinematics, and degrees of freedom from planes of motion.
• Explain the instantaneous axis of rotation, the helical axis, Euler/Cardan angle sequences and Codman’s paradox at a level sufficient to read a biomechanics paper.
• Use directional, movement and regional terminology correctly in written clinical documentation.
• Record range of motion using the neutral-zero (AAOS) method and SFTR notation, and classify end-feel.
• Read the surface features of a dried bone and infer the soft-tissue events that produced them.

What anatomy is, and how it is divided

Anatomy (Greek ana-, up; tome, cutting) is the science of the structure of the body and of the spatial relationships between its parts. Physiology is the science of its function. The two are inseparable in practice — structure constrains function and function remodels structure — and the hybrid discipline you actually practise is best called functional anatomy or kinesiology.

1.2.1 The branches

1.2.2 Regional versus systemic organisation

Both schemes are legitimate and you need both.

• Systemic organisation groups by tissue and function: skeletal, articular, muscular, nervous, cardiovascular, lymphatic, respiratory, digestive, urinary, reproductive, endocrine, integumentary. It is the better scheme for understanding a disease (rheumatoid arthritis attacks synovium wherever synovium exists).
• Regional organisation groups by territory: shoulder, arm, forearm, hand. It is the better scheme for understanding a patient (a patient does not present with “the muscular system”; they present with a painful shoulder).

This subject uses the standard compromise: general anatomy systemically first (bone, cartilage, joint, muscle, connective tissue, skin), then the regions.

1.2.3 Terminologia Anatomica, and the problem with eponyms

Until the late nineteenth century, anatomical naming was chaotic: a single structure might carry a dozen names in different European schools. Successive international committees produced standardised lists — Basle Nomina Anatomica (BNA, 1895), Nomina Anatomica (NA, from 1955), and since 1998 Terminologia Anatomica (TA), produced by the Federative International Programme for Anatomical Terminology (FIPAT) under the International Federation of Associations of Anatomists. A second edition (TA2) was released in 2019, alongside companion terminologies for histology (Terminologia Histologica) and embryology (Terminologia Embryologica).

TA has two working rules that are worth internalising:

• Each structure has one Latin term, with an official English equivalent. The Latin is the anchor; translations hang off it.
• Descriptive terms are preferred to eponyms. Uterine tube rather than Fallopian tube; intestinal glands rather than crypts of Lieberkühn; ampulla of the uterine tube rather than a surname.

The reason is not pedantry. A descriptive term teaches you something (the flexor digitorum profundus is the deep flexor of the fingers — you have learnt its compartment, its action and its depth from the name alone). An eponym teaches you nothing except a piece of nineteenth-century European history, and often the wrong history: many eponymous structures were described earlier by someone else, and a proportion of eponyms honour individuals whose conduct the profession would not now wish to commemorate.

But eponyms survive, and you must know them, because clinical practice is not governed by TA. You will meet, and must be fluent in, terms such as the circle of Willis, the ligament of Treitz, the canal of Guyon, the space of Poirier, Gerdy’s tubercle, Lister’s tubercle, the arcade of Frohse, and the anatomical snuffbox. The rule for your own writing: use the TA term, and give the eponym once in parentheses if the eponym is what the referring surgeon will use.

1.2.4 Reading terms rather than memorising them

Anatomical vocabulary is a compositional system built from a few hundred Latin and Greek elements. Learning the elements converts thousands of terms from memorisation into reading.

A muscle name in the standard form encodes up to five facts: shape (deltoid, trapezius, rhomboid), size (maximus, minimus), fibre direction (rectus, obliquus, transversus), location (brachii, femoris, abdominis), attachments (sternocleidomastoid, coracobrachialis), number of heads (biceps, triceps, quadriceps) and action (flexor, extensor, supinator, levator). Flexor pollicis longus is therefore not a name to memorise but a sentence to read: the long flexor of the thumb.

Clinical note — why terminology is a patient-safety issue

Wrong-site surgery remains a “never event” in most health systems, and ambiguous anatomical documentation is one of its recurrent contributors. Laterality (left / right), level (L4–L5 versus L5–S1) and digit naming (the thumb, index, middle, ring and little finger — never “the first finger”, which is ambiguous) must be written in unambiguous form every time. In the foot, the digits are conventionally numbered one to five from the great toe (hallux) laterally; the fifth is the little toe.

The anatomical position

1.3.1 The definition, in full

The anatomical position is the agreed reference posture from which every positional and movement term is defined:

• The body stands erect.
• The head faces directly forward, with the eyes on the horizon. (In craniometric work this is formalised as the Frankfort horizontal plane — a plane through the inferior orbital margins and the superior margins of the external acoustic meatus.)
• The feet are together, flat on the ground, toes directed forward.
• The upper limbs hang by the sides, adducted at the shoulders and extended at the elbows.
• The forearms are fully supinated, so the palms face anteriorly and the thumbs point laterally, away from the body.
• The fingers are extended, and the mouth is closed with the facial expression neutral.

1.3.2 The supination clause, and why it is not trivial

At rest, standing normally, your forearms sit in mid-pronation: the palms face the thighs and the radius crosses obliquely over the ulna. In the anatomical position the forearm is supinated, so radius and ulna lie parallel and uncrossed, with the radius lateral and the ulna medial.

Every downstream statement about the forearm depends on this. The radius is the lateral bone and the ulna is the medial bone — in the anatomical position. Radial deviation of the wrist is abduction — in the anatomical position. The lateral cutaneous nerve of the forearm supplies the lateral forearm — in the anatomical position. Describe from the patient’s incidental posture instead and every one of these becomes wrong.

1.3.3 The fundamental position

Some kinesiology texts also define the fundamental position: identical to the anatomical position except that the forearms are in mid-pronation with the palms facing the body. It is the more natural standing posture and is occasionally used as the starting position for describing forearm rotation itself (where “zero” is mid-position, not full supination). Where a text uses it, it will say so; unless told otherwise, assume the anatomical position.

Deep dive — limb rotation in the embryo, and why the upper and lower limbs are mirror-images

This is the single piece of embryology that explains the most gross anatomy, and it is worth learning now rather than in the development chapter.

The limb buds appear in the fifth week as outgrowths of lateral plate mesoderm covered by ectoderm, with the upper bud a little ahead of the lower. Initially both buds project laterally with a preaxial (cranial) border — the future thumb / great toe side — and a postaxial (caudal) border. The palms and soles both face medially, and the future elbows and knees both point laterally.

During the seventh to eighth weeks the limbs rotate at their roots, and they rotate in opposite directions:

• The upper limb rotates laterally through approximately 90°. The extensor compartment comes to lie posteriorly, the elbow points posteriorly, and the preaxial (thumb) border ends up lateral.
• The lower limb rotates medially through approximately 90°. The extensor compartment comes to lie anteriorly, the knee points anteriorly, and the preaxial (great toe) border ends up medial.

What this explains, immediately:

• Why the elbow flexes anteriorly and the knee flexes posteriorly, despite being homologous joints.
• Why the thumb is lateral but the great toe is medial.
• Why the extensors of the upper limb are posterior but the extensors of the lower limb are anterior — and therefore why the radial nerve (an extensor nerve) runs posteriorly in the arm while the femoral nerve (an extensor nerve) runs anteriorly in the thigh.
• Why dermatomes spiral down the limbs rather than running in neat transverse bands: the segmental innervation was laid down before rotation and was carried around with the tissue.
• Why the great saphenous vein — a preaxial structure — runs on the medial side of the lower limb, while the cephalic vein, its upper-limb equivalent, runs laterally.

Learn this once and a large amount of otherwise arbitrary anatomy becomes derivable.

The cardinal planes

Figure 1 · The three planes of the body

A plane is a two-dimensional surface passing through the body. Three mutually perpendicular cardinal planes are defined, each passing through the body’s centre of mass in the anatomical position.

Three points that separate a competent answer from a superficial one:

• Cardinal planes versus anatomical planes. Strictly, the cardinal planes are the three that pass through the centre of mass. Any parallel plane (a sagittal plane through the shoulder, a coronal plane through the mastoid processes) is an anatomical plane of the same family. Examination answers should use the family name.
• Most functional movement is oblique. Reaching for a seatbelt, rising from a chair, or throwing are all triplanar. The cardinal planes are an analytical simplification, useful because a triplanar movement can be resolved into components in the three planes. When you assess “shoulder abduction in the coronal plane” you are deliberately isolating one component of a movement that never occurs in isolation in life.
• The clinically important intermediate plane has a name. The scapular plane (scaption) lies approximately 30–45° anterior to the coronal plane, matching the resting orientation of the scapula on the thoracic wall. Elevation in this plane places the glenohumeral capsule under least twist, aligns the deltoid with the supraspinatus line of pull, and is the plane in which glenohumeral elevation is both greatest and least likely to impinge. It is the plane used for the “empty/full can” tests and for most early post-operative shoulder rehabilitation.

Radiological convention

A conventional anteroposterior (AP) radiograph or an axial CT/MR slice is displayed as though you are standing at the patient’s feet, looking towards the head. Consequently the patient’s left appears on the right of the image. Getting this wrong is a classic and dangerous error. Coronal images are viewed from the front (again, patient’s left on the viewer’s right); sagittal images are conventionally viewed from the patient’s left side.

Axes, and the plane–axis pairing

Figure 2 · Planes, axes and the movements that pair with them

A plane tells you the surface along which a movement travels. An axis is the line about which the segment rotates — the pin of the hinge. The axis is always perpendicular to the plane of movement.

Learn the three pairings as sentences, not as a table:

• Flexion and extension occur in the sagittal plane, about a frontal axis.
• Abduction and adduction occur in the coronal plane, about a sagittal axis.
• Rotation occurs in the transverse plane, about a vertical axis.

Said this way, you can derive any movement name from first principles instead of recalling a list — which is what an examiner is actually testing when they ask about a movement you have not been taught.

1.5.1 Degrees of freedom

Degrees of freedom (DoF) is the number of independent axes about which a joint can rotate (and, in full rigid-body mechanics, the number of independent translations it permits). It is a property of the joint, not of the plane.

Rigorously, every synovial joint also permits small translations (accessory glides), so a “three degrees of freedom” joint has six in full mechanical description: three rotations and three translations. Manual therapy is largely the exploitation of those translational degrees of freedom, which the patient cannot perform voluntarily.

1.5.2 Osteokinematics and arthrokinematics

This distinction — developed for clinical use in the Nordic manual-therapy tradition (Kaltenborn, Mennell, Maitland) — is fundamental and is examined constantly.

• Osteokinematics describes the motion of bones through space: the large, visible, voluntary, angular movements you measure with a goniometer. Flexion, abduction, rotation. Also called physiological or cardinal movement.
• Arthrokinematics describes the motion of joint surfaces on each other: the small accessory movements of roll, glide (slide) and spin that occur within the joint and cannot be performed in isolation by voluntary effort.

In a healthy joint, roll and glide are combined. Pure rolling would drive the moving surface off the edge of the stationary one; the accompanying glide keeps the surfaces centred. Loss of the glide component — the usual consequence of capsular fibrosis — produces the characteristic clinical picture of restricted, painfully compressed end-range movement despite intact muscle power.

The convex–concave rule (Kaltenborn) predicts the direction of glide, and therefore the direction in which a mobilisation should be applied:

• When a convex surface moves on a fixed concave surface, the glide occurs opposite to the direction of bone (osteokinematic) movement. Example: glenohumeral abduction — the convex humeral head glides inferiorly while the shaft moves superiorly.
• When a concave surface moves on a fixed convex surface, the glide occurs in the same direction as the bone movement. Example: knee extension in open chain — the concave tibial plateau glides anteriorly as the tibia extends anteriorly.

(The rule is a clinically useful approximation rather than an exact law; in vivo imaging shows more complex translation at several joints, notably the shoulder. Treat it as a first hypothesis to be tested against the patient’s response, not as an inviolable principle. This is discussed further in Chapter 4, Joints.)

Deep dive — instantaneous axis of rotation, and the helical axis

Textbook axes are drawn as fixed pins. Real joints have no such thing.

The instantaneous axis of rotation (IAR) is the axis about which a segment is rotating at one instant of a movement. Because articular surfaces are non-congruent and ligaments tighten progressively, the IAR migrates through the range. At the knee, the flexion–extension axis traces a J-shaped path (the classic evolute), moving posteriorly with flexion — which is why a single-axis knee brace hinge can never track the knee exactly, and why the moment arms of the quadriceps and hamstrings change through the range.

The IAR is the two-dimensional simplification. In three dimensions the equivalent is the helical (screw) axis: any displacement of a rigid body from one position to another can be described as a rotation about, plus a translation along, a single unique axis. Three-dimensional joint kinematics research reports finite helical axes for exactly this reason.

Euler and Cardan angles. To describe a 3D joint orientation with three familiar clinical angles, the rotation is decomposed into three sequential rotations about defined axes. The result is sequence-dependent:

• flexion-then-abduction-then-rotation does not give the same numbers as abduction-then-flexion-then-rotation. This is why the International Society of Biomechanics (ISB) publishes standardised joint coordinate systems and rotation sequences (Grood and Suntay’s knee system, 1983
• the ISB recommendations of Wu and colleagues for the ankle, hip, spine, shoulder, elbow, wrist and hand, 2002 and 2005). If you ever compare ROM values between two published studies, check they used the same sequence — otherwise you are comparing different quantities. Near the limits of a sequence, two axes can align and one degree of freedom is lost in the mathematics
• this is gimbal lock, and it is why glenohumeral rotation values become unstable near full elevation

Codman’s paradox. Start with the arm at the side, palm facing medially. Flex the shoulder to 90°, then abduct horizontally through 90° to the coronal plane, then adduct back down to the side. The arm has returned to the start position, but the palm now faces laterally: the humerus has been rotated approximately 180° about its long axis without any rotation ever being performed. This is not a trick — it is a demonstration that finite rotations in three dimensions are non-commutative, and it is the clearest reason why clinical shoulder rotation values must be defined with respect to a stated sequence and starting position.

Terms of position and direction

Figure 3 · Terms of position and direction

These terms come in opposing pairs and describe location, not movement.

The two relative pairs

Proximal/distal and superficial/deep are relational only: nothing is “distal” in itself, only distal to something. “Pain in the distal thigh” is loose writing; “pain in the anteromedial thigh, 5 cm proximal to the superior pole of the patella” can be reproduced by another clinician a month later. The same applies to superficial and deep — always name both terms of the comparison.

The trunk exception

Proximal and distal belong to the limbs. On the trunk, head and neck, use superior/inferior. “Distal cervical spine” is not standard usage; “lower cervical spine” or “C6–C7” is.

Terms of movement

Figure 4 · The shape of the basic joint movements

1.7.1 The general movements

Note the axial-line convention. In the hand, abduction and adduction of the fingers are defined relative to the axis of the middle finger, not the midline of the body — so both index and ring finger move away from the middle finger in abduction. In the foot, the reference axis is the second toe.

1.7.2 Region-specific movements

The thumb, explained rather than memorised

The first metacarpal is rotated approximately 90° about its long axis relative to the other four during development. Because thumb movements are named with reference to the palm rather than the body, the plane–axis pairings invert: thumb flexion and extension occur in the coronal plane of the body, and thumb abduction and adduction in the sagittal plane. Opposition is a composite of abduction, flexion and medial rotation at the saddle-shaped first carpometacarpal joint that brings the thumb pulp to meet the pulp of another digit. It is the movement that defines the human hand, and its loss (median nerve injury) costs approximately 40–50% of hand function in most impairment schedules.

1.7.3 Physiological versus accessory movement

• Physiological (active) movements are those a patient can perform voluntarily: the osteokinematic movements above.
• Accessory (joint play) movements are the glides, rolls, spins, distractions and compressions that occur within the joint and can only be produced passively by an examiner. They cannot be performed on request.

A joint may have full accessory movement with restricted physiological movement (a muscular or neurological problem) or restricted accessory movement with restricted physiological movement (an articular problem). Distinguishing the two is the core purpose of a manual joint examination.

1.7.4 Muscle contraction terminology

Movement terminology is incomplete without the terms for how muscle produces it. These are treated fully in Chapter 6, but note the vocabulary now:

Measuring and recording movement

Terminology becomes clinically usable only when attached to numbers.

1.8.1 The neutral-zero method

The standard convention (AAOS; also the basis of the SFTR system) sets the anatomical position as 0° for every joint. Movement is recorded as degrees away from zero. A knee that lacks 10° of full extension and flexes to 120° is recorded as 10–120°, not as “−10 to 120”. A joint moving from zero is recorded as 0–120°. This removes the ambiguity of negative numbers, which different services interpret differently.

1.8.2 SFTR notation

SFTR records movement plane by plane, with three numbers per plane in a fixed order: movement away from the body / starting position / movement towards the body.

• S = Sagittal (extension / 0 / flexion)
• F = Frontal (abduction / 0 / adduction)
• T = Transverse (horizontal abduction / 0 / horizontal adduction)
• R = Rotation (lateral / 0 / medial)

A shoulder recorded as S: 50–0–170, F: 180–0–40, R (F90): 90–0–70 is fully described in one line, and unambiguously.

1.8.3 Goniometry in brief

Every goniometric measurement requires four things to be stated: the patient’s position, the axis (fulcrum), the stationary arm alignment, and the moving arm alignment. Universal goniometry has good intra-rater reliability at most peripheral joints (ICC typically >0.90 at the knee and elbow) and lower inter-rater reliability, particularly at the shoulder, hip rotation and the subtalar joint. In practice this means: the same clinician should re-measure where possible, and a change should exceed the minimal detectable change (commonly quoted as roughly 5–10° at peripheral joints) before it is called real improvement.

1.8.4 End-feel

The quality of resistance at the end of passive range (Cyriax) is diagnostic information the number alone does not carry.

Abnormal end-feels

Suggests

Empty

Pain stops the movement before tissue resistance is reached — consider acute inflammation, fracture, neoplasm; a red-flag finding

Springy block

An intra-articular displaced fragment — classically a bucket-handle meniscal tear

Muscle spasm

Sudden, guarded arrest — acute injury or instability

Boggy

Joint effusion

Capsular

Fibrosis; correlates with the joint’s characteristic capsular pattern of proportional restriction

The vocabulary of bone surfaces

Figure 5 · The surface features of a long bone

A dried bone is a record of the forces that acted on it. Every named feature is evidence of a soft-tissue event: something pulled there, something slid across, something passed through, or something articulated with it. Learn the features as clues, and the names come free.

1.9.1 Elevations — where something pulls

1.9.2 Articular features — where joints form

1.9.3 Depressions and openings — where something passes or sits

1.9.4 Reading a bone: the inferential rules

• Rough and raised means tensile load. A tuberosity marks an enthesis — a tendon or ligament attachment. Entheses come in two histological types: fibrous (attaching to periosteum or directly to bone, e.g. deltoid tuberosity) and fibrocartilaginous (with a transitional zone of uncalcified then calcified fibrocartilage separated by the tidemark, e.g. Achilles insertion, supraspinatus footprint). The fibrocartilaginous type dissipates stress concentration at the interface and is the site of the enthesopathies.
• Smooth and grooved means something slides. A groove implies a tendon, vessel or nerve crossing under tension; a smooth flat facet implies articulation. Where a tendon changes direction over bone, expect a sesamoid or a fibrocartilaginous pulley (the patella; the peroneal groove of the cuboid).
• A hole means something passes — and can be compressed. Every foramen, canal and fibro-osseous tunnel is a potential entrapment site: the carpal tunnel (median nerve), the cubital tunnel (ulnar), the fibular neck (common fibular nerve), the tarsal tunnel (tibial), the greater sciatic foramen. Reading a bone this way generates the differential diagnosis before you have seen the patient.
• Prominence means palpability, and palpability means vulnerability. Subcutaneous bony points — the olecranon, the greater trochanter, the malleoli, the sacrum, the ischial tuberosity, the calcaneal tuberosity — are both your landmarks and your pressure-sore sites.
• A nutrient foramen has a direction. The oblique nutrient canal of a long bone runs away from the growing end: “to the elbow I go, from the knee I flee” (the humeral canal directs distally-ish toward the elbow region while the femoral, tibial and fibular canals direct proximally away from the knee). This reflects differential epiphyseal growth rates and is a standard viva question.
• Not all bumps are the same age. An epiphysis contributes to length; an apophysis (traction epiphysis) is a growth centre existing solely for a tendon pull — the tibial tuberosity, the calcaneal apophysis, the ischial tuberosity, the greater trochanter. Because the apophysis is a cartilaginous weak link, the adolescent athlete sustains an apophysitis (Osgood–Schlatter, Sever) or an avulsion where an adult would sustain a tendinopathy or a tear.
• Bone form is not fixed. Trabecular architecture aligns with principal stress trajectories (the medial and lateral trabecular systems of the proximal femur, and Ward’s triangle between them), and cortical thickness follows habitual load — the structural expression of Wolff’s law, treated fully in Chapter 2. A dried bone is therefore a fossil record of that individual’s mechanical life: the hypertrophied humerus of a throwing athlete, the porotic femoral neck of a sedentary post-menopausal patient.

Regions, cavities and surface planes

1.10.1 Regional terminology

“Arm” and “leg” mean less than patients think

In precise usage the arm is shoulder to elbow only, the forearm elbow to wrist, the thigh hip to knee, and the leg knee to ankle only. A patient reporting “leg pain” may mean anywhere from buttock to toes. Your record must name the region you examined, not repeat the patient’s word.

1.10.2 Abdominal regions

Two schemes coexist; know both.

• Four quadrants (by the median and transumbilical planes): right upper, left upper, right lower, left lower. The scheme used in emergency documentation.
• Nine regions (by two vertical mid-clavicular planes and two horizontal planes — subcostal and transtubercular, or transpyloric and intertubercular): right hypochondrium, epigastrium, left hypochondrium; right lumbar (flank), umbilical, left lumbar; right iliac (inguinal), hypogastrium (suprapubic), left iliac.

Key surface planes worth knowing now: the transpyloric plane (L1, midway between jugular notch and pubic symphysis — crossing the pylorus, pancreatic neck, hila of the kidneys, origin of the superior mesenteric artery and the ninth costal cartilages), the subcostal plane (L3), the transtubercular plane (L5), and the supracristal plane (the highest points of the iliac crests, at L4 — the landmark for lumbar puncture).

1.10.3 Body cavities and serous membranes

The universal serous pattern: a parietal layer lining the wall, a visceral layer covering the organ, continuous with each other and enclosing a potential space containing a thin film of lubricating fluid. Pathology in every one of these cavities is a variation on the same theme — fluid (effusion, haemothorax, ascites), air (pneumothorax), or fibrous adhesion of the two layers. For physiotherapy the pleural version is the operational one: pleural pain, restricted chest expansion and reduced diaphragmatic excursion.

Putting it to work: documentation

Terminology is not decoration. Its purpose is that a description you write today can be reconstructed exactly by a clinician who was not present, months later, possibly in a medico-legal context.

Vague: > “Pain in the outer part of the arm near the top. Worse lifting the arm out to the side. Tender on pressing.”

Precise: > “Pain over the lateral aspect of the proximal right arm, referred distally to the deltoid insertion, non-dermatomal. Reproduced on active abduction in the coronal plane between 60° and 120°, with a painful arc; passive abduction full and less painful. Tender on palpation over the greater tubercle of the humerus at the supraspinatus footprint, with the arm in extension and internal rotation. Resisted abduction in the scapular plane at 30° reproduces pain without weakness. Cervical spine screening: full painless range, negative Spurling.”

The second entry names side, region, plane, arc, landmark, test position and the structures excluded. Another clinician can repeat that examination and compare findings. That is the entire purpose of the vocabulary — not to sound authoritative, but to be reproducible.

Where the record feeds a rehabilitation plan, this precision also maps directly onto the ICF framework: the anatomical finding is a body structure impairment, the restricted abduction a body function impairment, the inability to reach an overhead shelf an activity limitation, and the inability to return to painting work a participation restriction. Anatomy sits at the base of that chain; it does not replace the rest of it.

Where students consistently go wrong

• Describing from the patient’s actual posture. If the patient is prone, “above the scapula” is meaningless to the next reader. Describe from the anatomical position always.
• Forgetting the palms face forward. This one detail is the reason the ulna is the medial bone, and it is asked every year.
• Using proximal/distal on the trunk. They belong to limbs.
• Confusing coronal and sagittal. Anchor them: a crown sits in the coronal plane; an arrow (sagitta) travels in the sagittal plane.
• Treating circumduction as a movement. It is four movements in sequence. If asked which muscles produce it, the answer is all the flexors, abductors, extensors and adductors of that joint, acting in turn.
• Confusing plane with degree of freedom. A joint has degrees of freedom; a movement occurs in a plane. The elbow has one DoF but its movement occurs in the sagittal plane — those are different statements.
• Confusing foot inversion/eversion with supination/pronation. Inversion and eversion are the frontal-plane components; supination and pronation are the triplanar composites. Examiners test the distinction.
• Learning bone features as vocabulary. A tuberosity is not a lump with a name; it is evidence of a strong pull. Learn the mechanical reason and the name is free.
• Assuming a fixed joint axis. The axis migrates through range. This is why the moment arm — and therefore the strength curve — changes with joint angle.
• Reporting ROM without stating the method. A number without a stated patient position, axis and convention is not reproducible data.

Check yourself

15 questions on this chapter. Tap one to see the answer and the reasoning.

Quick review

Further reading

Chapter 1 of 24 · Human Anatomy · Physiotherapist India Next: Chapter 2 — Bone: living tissue that rebuilds along the lines of force.

Reviewed by the Physiotherapist India Team. · Human Anatomy contents