Background: Surface anatomy provides clinicians with essential skills to identify internal structures based on external landmarks. In the neck and shoulder region, precise palpation is crucial for distinguishing muscles, bones, and nerves, thereby directly supporting safe and effective clinical procedures. Methods: This lecture integrates traditional surface anatomy with real-time ultrasound scanning to demonstrate the precise localization of cervical and shoulder muscles. Palpation techniques are systematically explained based on anatomical orientation, muscle fiber direction, and palpatory resistance, followed by ultrasound imaging to validate the findings. Results: Key anatomical structures—including the scalene muscles, splenius capitis, levator scapulae, and teres minor—are demonstrated with step-by-step palpation techniques accompanied by corresponding ultrasound images. An ultrasound-guided pharmacopuncture protocol is presented, detailing preparation, scanning, needle insertion, and post-procedure care to ensure safe application in clinical practice. Conclusion: Anatomy-based ultrasound-guided pharmacopuncture improves the accuracy and safety of Korean medicine interventions for musculoskeletal disorders of the neck and shoulder. This integrative approach provides clinicians with a reproducible framework for precise needling and effective patient care.