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17 Cards in this Set
- Front
- Back
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Describe the location of the axillaand what constitutes its medial, lateral, anterior, and posterior boundaries (walls), and its apex.
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Area of transition between neck and arm. Irregularly shaped pyramid shaped
Medial - Serratus Anterior Lateral - Intertubecular sulcus Anterior - Pectoralis major, minor, and clavipectoral fascia Posterior - Subscapularis, teres major, latissimus dorsi Apex - clavicle, coracoid, 1st rib |
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Describe the apex of axilla and the cervicoaxillary sheath and explain how the contents of the axilla are continuous with structures found in the neck and in upper limb.
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Its the passageway between the neck and the arms. Axillary vessels and the brachial plexus pass through here.
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List the general attachments, innervations, and actions of the muscles that contribute to the walls of the axilla.
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Pectoralis major
------------------------ Attachments - anterior surfaces of clavicle and sternum; inserts into proximal end of humerus Innervations - medial and lateral pectoral nerves Actions - abducts, flexes, and medially rotates the arms Subclavius ---------------- Attachments - from 1st rib to inferior surface of the middle 3rd of the clavicle Innervations - nerve to subclavius Actions - depress shoulder; stabilize SC joint Pectoralis minor ------------------------ Attachments - anterior surface of ribs 3, 4, and 5 to coracoid process of scapula Innervations - medial pectoral nerve Actions - depress tip of shoulder, protract scapula Serratus Anterior -------------------------- Attachments - later surface of ribs 8 and 9 to medial border of scapula Innervations - long thoracic nerve Actions - protract and rotate scapula Subscapularis ---------------------- Attachments - subscapular fossa to lesser tubercle of humerus Innervations - upper and lower subscapular nerves Actions - rotator cuff muscle; medial rotation of arm at GH joint Teres Major ----------------- Attachments - posterior surface of inferior angle of scapula to medial surface on anterior lip of humerus Innervations - upper and lower subscapular nerves Actions - medial rotation and extension at GH joint Latissimus Dorsi ------------------------ Attachments - spinous process of T6-12 to floor of intertubercular sulcus Innervations - thoracodorsal nerve Actions - adduction, medial rotation, and extend arm at GH joint |
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Describe the functional loss of the muscles of axillary walls resulting from lesions to nerves innervating these muscles.
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Anterior wall
------------------- Pec major - flexion, adduction, and medial rotation of the GH joint Pec minor - pulls tip of shoulder down and protracts scapula Subclavius - pulls shoulder down, pulls clavicle medially Medial Wall ------------------ Serratus Anterior - protraciton and rotation of ; dysfunction of nerve causes winged scapula Posterior Wall --------------------- Subscapularis - medial rotation of arm at GH joint Teres major - medial rotation and extension of arm at GH joint Latissimus dorsi - adduction, medial rotation, extension of arm at GH joint Triceps, long head - extensor of forearm at elbow joint Brachii muscle - flexor of arm at elbow joint; supinator of forearm |
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Defient he extent of the axillary artery and the axillary vein.
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Axillary artery - subclavian becomes axillary at 1st rib; axillary becomes brachial artery at teres major musce
Axillary vein - Basilic vein becomes axillary vein at teres major muscle; axillary becomes subclavian vein at rib 1 |
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Describe the three parts of the axillary artery, their branches, and distribution.
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1st part - 1 branch
- superior thoracic artery - supplies upper region of medial and anterior axillary walls 2nd part - 2 branches - Thoraco-acromial artery - divides to pectoral, deltoid, clavicular, and acromial branches; supply anterior axillary wall - pectoral branch also supplies breast - Lateral thoracic artery - supplies medial and anterior walls of axilla and supplies breast 3rd part - 3 branches - subscapular artery - circumflex scapular artery - anastomoses with suprascapular artery to provide network around scapula - thoracodorsal artery - supplies posterior and medial walls of axilla and lat dorsi - anterior circumflex humeral artery - anastomoses with posterior circumflex humeral artery - supplies surrounding tissues, GH joint, and head of humerus - Posterior circumflex humeral artery - anastomoses with anterior circumflex humeral artery - supplies surrounding muscles and GH joint |
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List the arteries involved in anastomosis around the scapula, and describe the importance of anastomosis for collateral circulation.
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Circumflex scapular, suprascapular, and subscapular arteries.
Anastomosis allows for blood to flow regardless of position of arm. If on of the arteries is blocked, flow can occur through other arteries |
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Describe how blood may reach the upper limb if the 2nd part of the axillary artery is ligated.
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Blood can reach upper limb by collateral circulation through the branch of the 1st part of axillary artery (superior thoracic acrtery). If blockage in 3rd part or axillary, then problem (no branches).
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What is the clinical significance of the axillary sheath in local anaesthesia?
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The axillary sheath can be used for anesthetic block of the brachial plexus without repeated injections.
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What are the anatomical relationships that are important for successful insertion of a catheter for central venous access (infraclavicular subclavian venipuncture)?
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The infraclavicular approach can include any insertion into any of the three veins: cephalic, axillary, or subclavian veins. For central venous access, axillary is most probably used.
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What is the difference of prefixed and post-fixed brachial plexus?
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Pre-fixed is when C4 contributes to the brachial plexus (usually C4-C8)
Post-fixed is when T2 contributes to the brachial plexus (usually C6-T2) |
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Describe the signs and symptoms of an upper brachial plexus nerve lesion.
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Occurs from excessive lateral neck flexion away from the shoulder. Leads to Erb's Palsy and the "waiter's tip" deformity.
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Describe the signs and symptoms of upper brachial plexus lesions when the C7 ventral ramus is iinvolved.
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A trauma with downwards reaction usually involved the upper brachial plexus. Trauma in abduction first involves the lower plexus while a force acting on an anterior to posterior direction involves firstly and predominantly the C7 spinal nerve. Avulsion from the cord or rupture is possible. Rarely seen in brachial plexus lesions.
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Describe the signs and symptoms of a lower brachial plexus nerve lesion.
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Occurs from hyperabduction of the arm leading to "claw hand" deformity and Klumpe's palsy.
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How could a cervical rib contribute to the development of a lower brachial plexus lesion?
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Cervical rib is an extra rib arising from C7. It can cause narrowing of supracostoclavicular space and render adjacent nerves more susceptible to external trauma or extra compression may lead to brachial plexus lesions.
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Signs and symptoms of lesions of the medial, lateral, and posterior cords of the brachial plexus.
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Lesion of the medial cord: affects the medial pectoral nerve, medial ante-brachial cutaneous nerve, medial cutaneous nerve, medial root of median nerve, and the ulnar nerve.
Lesion of the lateral cord: affects the lateral pectoral nerve, musculocutaneous nerve, and lateral root of median nerve Lesions of posterior cord: superior subscapular nerve, thoracodorsal nerve, inferior subscapular nerve, axillary nerve, radial nerve |
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Why may lymphedema result from breast cancer surgery?
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Lymphedema is a condition of localized fluid retention where pitting edema can result in the upper limbs. Excessive removal and inflammation of the lymph nodes can trigger lymphedema after mastectomies or surgical axillary nodal clearances.
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