Category: Fun Facts

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Fun Fact: External Jugular Vein

Anatomy def: The paired external jugular veins are superficial vessels draining blood from the exterior cranium (Anatomy Lesson #60 Let’s Mull the Skull!) and deep facial structures toward the heart.  

Outlander def: Large neck veins often increasing in diameter as blood pressure rises – think of  a hotly contested stramash, such as “I will marry him” vs. “no, ye will not!!!” The neck veins tend to stand out. <G>

Learn about the external jugular vein (EJV) in Anatomy Lesson #12, Claire’s Neck or The Ivory Tower.

Each EJV descends through the neck from the angle of mandible (lower jaw) to middle of the clavicle (collar bone), collecting blood from the outer skull and deep face.

Try this: Turn your neck to one side and look in a mirror.  Can you see a blue line stretching from the angle of your jaw to your clavicle? This is the EJV. If you have no luck, try looking at a friend or family member. These veins are not always visible so don’t despair if you canna located them. 

BTW, although veins appear blue or green under the skin, they are neither color. Various factors including light absorption, light scattering and reflection, less oxygen in venous blood and veins being closer to the surface all help account for this odd color change, an phenom known as the Tyndall effect.

Read about the EJV in Drums of Autumn book.  Here the character’s name is not disclosed as the TV show has yet to catch up with the book (hurry, S4!). But, book readers will ken who Claire is doctoring. The pulsing vein Diana describes, is, indeed, the EJV! 

I didn’t need to check his heart; his head was turned, and I could see the huge vein that ran down the side of his neck, throbbing with a pulse slow and heavy as a hammer blow. I touched him, feeling his skin cool and damp. No fever, no signs of shock. The whole of his enormous person radiated peace and well-being.

Now, wait a sec!!! Arteries pulse, but do veins pulse like arteries? Generally speaking, not that we can see.  However, the right EJV may show a pulse because it lies very close to the right atrium of the heart. Put simply, as the right atrium contracts, blood pressure in the EJV may be seen as a pulse. Hence, Diana’s description is accurate. Score!

See Marsali’s external jugular vein in Starz ep 309, The Doldrums. Pugnacious lass that she is, she casts her stepdad a defiant look.  She will have Fergus no matter what da says!

The deeply grateful,

Outlander Anatomist

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Photo Credit: Sony/Starz

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Fun Fact: Latissimus Dorsi Redux

Anatomy def: A pair of broad, fan-shaped back muscles; each wraps around the ipsilateral (same side) of chest and inserts into the upper humerus (arm bone). 

Outlander def: Whew! An amazing muscle mass of Jamie’s left armpit (red arrow). For sure, his right armpit has its own latissimus, but Claire is in the way!  <G>

Latissimi dorsi (pl.) form the rear boundary of each armpit (pec major forms each front boundary). Claire appears to be gazing at his left latissimus – and, who isn’t???

Learn about latissimus dorsi in Anatomy Lesson #19, To Arms, Too Arms, Two Arms! 

Today’s FF is the second covering this muscle. The first Latissimus dorsi posted December 2016, used a side view of latissimus dorsi as it angles from lower thoracic and lumbar spine towards the armpit (Outlander ep 106, The Garrison Commander). This broad muscle mass passes diagonally across the side of chest. So, now we view this important muscle from two vantage points.

Each latissimus dorsi is a powerful mover of its humerus:

  • abducts (draws humerus toward the thorax)
  • extends  (draws humerus backwards)
  • internally rotates  (rolls humerus inwards, towards chest) 

Read about Jamie’s armpit ablutions aboard the Artemus in Voyager book.  This lovely passage is from Jamie’s promises to Claire, once he gets her on land, <G>:

“Well, ye might moan a bit, if ye like, to encourage me, but otherwise, ye just lie still.” 

He didn’t sound as though he needed any encouragement whatever. One of his hands was resting on my thigh as he used the other to swab his chest with the damp towel. As he finished, the hand slid behind me, and squeezed. 

“My beloved’s arm is under me,” I quoted. “And his hand behind my head. Comfort me with apples, and stay me with flagons, For I am sick of love.” 

There was a flash of white teeth in his beard. 

“More like grapefruit,” he said, one hand cupping my behind. “Or possibly gourds. Grapefruit are too small.” 

“Gourds?” I said indignantly. 

“Well, wild gourds get that big sometimes,” he said. “But aye, that’s next.” He squeezed once more, then removed the hand in order to wash the armpit on that side. “I lie upon my back and have ye stretched at length upon me, so that I can get hold of your buttocks and fondle them properly.” He stopped washing to give me a quick example of what he thought proper, and I let out an involuntary gasp.

See Jamie’s left latissimus dorsi resting in his armpit in Starz ep 306, A. Malcolm.

The deeply grateful,

Outlander Anatomist

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Photo Credit: Sony/Starz

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Fun Fact: Manubriosternal Junction

Anatomy def: Manubriosternal junction is a prominent joint between manubrium and body of the sternum (breastbone). 

Outlander def: Wee Mary MacNab’s chest mound, sweetly straining toward the Dunbonnet. Surrender, Jamie! She kens they both need “this.” 😉

Learn about the manubriosternal junction in Anatomy Lesson #15, Crouching Grants –  Hidden Dagger. 

An adult sternum has three parts:

  • manubrium (top)
  • body (middle; a.k.a. gladiolus)
  • xyphoid process (tip)

These parts are typically fused into a single, elongated bony structure in adults.  Notably, the juncture between manubrium and body forms an elevated bump, the manubriosternal junction.

As this word is a real mouthful, many anatomists and clinicians use the term sternal angle, angle of Louis, or sternal angle of Louis, to supplant manubriosternal junction. (Why use one name when three will do?) <G> And, some anatomists push the envelop further, preferring the term, sternomanubrial joint. So many terms, so little time. Gah!

Taking an easier route, the sternal angle of Louis is a splendid topographical feature because it is easily palpated!  It is the site where costal cartilages of the second ribs attach to the sternum. The T4 – T5 intervertebral disc also lies at this level. And, that is not all. This angle is used to locate or define some 15 (!!!) clinically significant structures and/or compartments of the chest. A useful example: starting at the second ribs, a practitioner can count intercostal (between ribs) spaces to locate organs and evaluate normal anatomy. Lots of splendid stuff going on here!

Try this: Place your fingers at the top of your chest in the small bony divot (suprasternal notch); this marks the top of the manubrium. Run fingers downward about 2” or 5 cm and feel the raised knob of bone? This is your sternal angle of Louis. Run fingers to each side – these are your second ribs and their costal cartilages. Feel them? Yay!  

Here’s a useful hint: If you avoid heavy necklaces because they give you neck pain, choose one that sits above the sternal angle. This way, manubrium and clavicles help support the weight of the piece, easing pull on the neck.

Read about the sternum in Voyager book. Herself conjured this scene between Dr. Claire Randall and a dying Scottish patient (not filmed in S3): 

“I have been thinking,” Graham announced. The sound of his voice echoed tinnily through the earpieces of my stethoscope. “Have you?” I said. “Well, don’t do it out loud ’til I’ve finished here, that’s a good lad.” 

He gave a brief snort of laughter, but lay quietly as I auscultated his chest, moving the disc of the stethoscope swiftly from ribs to sternum. “All right,” I said at last, slipping the tubes out of my ears and letting them fall over my shoulders. “What have you been thinking about?” 

“Killing myself.”

Whoa! Best read the book to find out what happens to Graham (and Claire)!

See Mary’s sternal angle (red arrow) in Starz episode 302, Surrender.  Sweet, sweet Mary is so very slender, her sternal angle of Louis with its curved 2nd ribs and costal cartilages are plain as cave light. Way to rock it, Mary! Ye are a bonny lass!

The deeply grateful,

Outlander Anatomist

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Photo credit: Starz episode 302, Surrender