Ga - Axilla

Front 1

anterior axillary fold and what muscle forms most of its mass

Back 1

-When the arm is partially abducted, it becomes evident that the axilla has muscle-bearing folds of tissue extending between the upper chest wall and upper arm.
-The anterior fold is called the anterior axillary fold, and pectoralis major forms most of its mass.

Front 2

the posterior axillary fold and what 2 muscles forms most of its mass

Back 2

The posterior fold is called the posterior axillary fold, and latissimus dorsi and teres major comprise most of its mass.

Front 3

where does the axillary artery begin and end?

Back 3

• The axillary artery begins at the lateral border of the 1st rib as a continuation of the subclavian artery and ends at the lower border of the insertion of teres major onto the humerus. At its end, the axillary artery is continuous with the brachial artery.

Front 4

The 6 branches of the axillary artert

Back 4

1) superior thoracic artery
2) thoracoacromial arterie
3) lateral thoracic artery
4) subscapular artery
5) anterior circumflex humeral arteries
6) posterior circumflex humeral arteries

Front 5

The superior thoracic and thoracoacromial arteries - what do they supply to

Back 5

The superior thoracic and thoracoacromial arteries are the first two branches of the axillary artery; they supply shoulder muscles.

Front 6

The lateral thoracic artery - what does it supply to (2)

Back 6

The lateral thoracic artery provides the main blood supply to the mammary glandular tissue in the lateral half of the breast; it also supplies shoulder muscles.

Front 7

subscapular artery - what does it do

Back 7

The subscapular artery is generally the largest branch of the axillary artery. Branches of the subscapular artery form an extensive anastomotic network around the scapula with branches of the subclavian artery. This anastomotic network around the scapula is important because it provides for collateral circulation across the shoulder joint whenever an arm movement restricts blood flow through the axillary artery.

Front 8

and posterior circumflex humeral arteries

Back 8

The anterior and posterior circumflex humeral arteries are the last two branches of the axillary artery.

Front 9

Axillary Vein - where does it begin and end, its largest tributary

Back 9

• The axillary vein begins at the lower border of the insertion of teres major onto the humerus as the continuation of the basilic vein and ends at the lateral border of the 1st rib. At its end, the axillary vein is continuous with the subclavian vein. Near its end, the axillary vein receives its largest tributary, the cephalic vein.

Front 10

The basilic vein

Back 10

The basilic vein is the major superficial vein on the medial side of the arm.

Front 11

The cephalic vein

Back 11

The cephalic vein is the largest superficial vein on the lateral side of the arm.

Front 12

There are four major parts to the brachial plexus and where they are located in the body.

Back 12

Read That Damn Cadaver Book:
roots, trunks, divisions, and cords. The roots are located in the neck, the trunks extend from the neck into the axilla by passing over the 1st rib, and the divisions and cords are located in the axilla.

Front 13

Which rami form the roots of the brachial plexus and what are the 2 nerves that arise from these roots and which roots do they arise from

Back 13

-The anterior rami of C5, C6, C7, C8, and T1 form the roots of the brachial plexus. Only two nerves arise from the roots.
-The dorsal scapular nerve arises from the C5 root.
-The long thoracic nerve arises from the C5, C6, and C7 roots.

Front 14

o The unions and extensions of the roots form the three trunks of the brachial plexus. What are they and what roots are they formed from?

Back 14

The upper trunk is formed from the union of the C5 and C6 roots.
The middle trunk is an extension of the C7 root.
The lower trunk is formed from the union of the C8 and T1 roots.

Front 15

What two nerves are the only ones to arise from the trunks

Back 15

The nerve to subclavius and the suprascapular nerve are the only nerves that arise from the trunks; both arise from the upper trunk. The suprascapular nerve transmits C5 and C6 fibers.

Front 16

The divisions of the trunks form the six divisions of the brachial plexus. Each trunk divides to form what two divisions

Back 16

Each trunk divides to from an anterior and a posterior division. The divisions do not give rise to any nerves.

Front 17

The unions and extensions of the divisions form what 3 cords of the brachial plexus and how are they named?

Back 17

1) Posterior Cord
2) Lateral Cord
3) Medial Cord
Each cord is named for its relationship relative to the segment of the axillary artery that lies behind pectoralis minor.

Front 18

The posterior cord - how is it formed and what 5 nerves does it give rise to?

Back 18

-The posterior cord is formed from the union of all three posterior divisions, and it gives rise to the upper, middle, and lower subscapular nerves; the axillary nerve, and the radial nerve.
The middle subscapular nerve is commonly called the thoracodorsal nerve. The axillary nerve transmits only C5 and C6 fibers.

Front 19

The lateral cord - how is it formed and what 3 nerves does it give rise to?

Back 19

The lateral cord is formed from the union of the anterior divisions of the upper and middle trunks, and it gives rise to the lateral pectoral nerve, the musculocutaneous nerve, and the lateral root of the median nerve.

Front 20

The medial cord - how is it formed and what 5 nerves does it give rise to?

Back 20

 The medial cord is a continuation of the anterior division of the lower trunk, and it gives rise to the medial pectoral nerve, the medial cutaneous nerve of the arm, the medial cutaneous nerve of the forearm, the ulnar nerve, and the medial root of the median nerve.

Front 21

thoracic outlet syndromes

Back 21

(Upper limb pain) can be caused by a number of conditions that intermittently compress the brachial plexus, subclavian artery or vein, or axillary artery or vein in the neck and axillary regions between the thoracic outlet and the insertion of pectoralis minor.

Front 22

Common Symptoms when either veins or arteries are compressed

Back 22

-Although symptoms in most cases are neurologic only, they may also be vascular or both vascular and neurologic.
-Pain and paresthesia (abnormal sensation) are common neurologic symptoms, and may occur in various regions of the upper limb.
-Common symptoms produced by compression of the subclavian or axillary artery include decrease in skin temperature, easy fatigability, and Raynaud’s phenomenon in the upper limb.
-Common symptoms produced by compression of the axillary or subclavian vein are edema of the hand, distended superficial veins, or cyanosis.

Front 23

Raynaud’s disease

Back 23

Raynaud’s disease is an idiopathic vascular disorder in which exposure to cold or experience of stress induces spasmodic constriction of the digital arteries of the limbs (the arteries of the thumb and fingers of the hand and the arteries of the toes of the foot are called digital arteries).

Front 24

Raynaud’s phenomenon

Back 24

If the symptoms characteristic of Raynaud’s disease are produced by an identifiable disorder or condition, such as one of the thoracic outlet syndromes, then the term Raynaud’s phenomenon is used to refer to the sequence of vascular changes in the digits

Front 25

Description of Raynaud's disease's attacks

Back 25

Attacks of Raynaud’s disease characteristically occur bilaterally and may involve both the upper and lower limbs. The attacks generally produce, in sequence, pallor (paleness), cyanosis (bluish tint), and finally rubor (inflammation) of the affected digits.
The intensity of the digital pain associated with the attacks is variable.

Front 26

costoclavicular syndrome - what is it, how is it caused, symptoms

Back 26

-The costoclavicular syndrome is one of the thoracic outlet syndromes. This syndrome is the condition in which the subclavian artery, subclavian vein, and/or the divisions of the brachial plexus become compressed between the clavicle above and the 1st rib below.
-The compression may occur as a consequence of prolonged retraction and lowering of the pectoral girdle (such as may occur during the wearing of a heavy coat or backpack or as a result of postural changes associated with advancing age).
-Common neurological and vascular symptoms are as described above for thoracic outlet syndromes in general.

Front 27

hyperabduction syndrome - what is it, how is it caused, symptoms

Back 27

-The hyperabduction syndrome is another thoracic outlet syndrome. This syndrome is the condition in which the axillary artery, axillary vein, and/or cords of the brachial plexus become impinged or compressed beneath the coracoid process of the scapula by prolonged hyperabduction of the arm.
-The compression may occur as a consequence of prolonged hyperabduction during sleep or during the performance of a manual task (such as painting a ceiling).
-Common neurological and vascular symptoms are as described above for thoracic outlet syndromes in general.

Front 28

Except for a few lymph nodes located above the elbow, all the lymph nodes of the upper limb are clustered in the axilla. What are the six distinct groups of axillary lymph nodes?

Back 28

1) anterior (pectoral) group
2) posterior (subscapular) group
3) lateral group
4) central group
5) deltopectoral (infraclavicular) group
6) apical group

Front 29

The anterior (pectoral) group of axillary nodes - where are they palpated against and what tissues do they drain (2)

Back 29

-The anterior (pectoral) group of axillary nodes can be palpated against the posterior aspect of the anterior axillary fold.
-These nodes drain the superficial tissues of the anterolateral region of the trunk, down to the level of the umbilicus; these nodes also drain the mammary glandular tissue in the lateral half of the breast.

Front 30

The posterior (subscapular) group of axillary nodes - where are they palpated against and what tissues do they drain (1)

Back 30

-The posterior (subscapular) group of axillary nodes can be palpated against the anterior aspect of the posterior axillary fold.
-These nodes drain the superficial tissues of the posterior region of the trunk, down to the level of the iliac crest.

Front 31

The lateral group of axillary nodes - where are they palpated against and what tissues do they drain (4)

Back 31

-The lateral group of axillary nodes can be palpated against the head of the humerus and uppermost part of the shaft of the humerus.
-These nodes drain the deep tissues of the hand, forearm, and arm and the superficial tissues on the medial side of the upper limb.

Front 32

The central group of axillary nodes - where are they palpated against and what tissues do they drain (3)

Back 32

-The central group of axillary nodes can be palpated against the chest wall in the center of the axilla.
-These nodes drain the efferent lymphatics from the anterior, posterior, and lateral groups.

Front 33

The deltopectoral (infraclavicular) group of axillary nodes - where are they palpated against and what tissues do they drain (3)

Back 33

-The deltopectoral (infraclavicular) group of axillary nodes can be palpated in the deltopectoral triangle (the deltopectoral triangle is the triangular-shaped area in the anterior shoulder region bordered laterally by deltoid, medially by pectoralis major, and superiorly by the clavicle).
-These nodes drain the superficial tissues of the lateral side of the hand, forearm, and arm.

Front 34

The apical group of axillary nodes - where are they palpated against and what tissues do they drain (1)

Back 34

-The apical group of axillary nodes lies along the axillary vein immediately lateral to the lateral border of the 1st rib.
-These nodes drain efferent lymphatics from the other five groups of axillary nodes.

Front 35

What is the mammary glands' arterial supply provided by and venous lymphatic drainage directed towards?

Back 35

The mammary gland is discussed in association with the axilla because most of its arterial supply is provided by the lateral thoracic artery and most of its venous and lymphatic drainage is directed toward the axilla.

Front 36

axillary tail

Back 36

A prolongation of each mammary gland called the axillary tail extends superolaterally along the lower border of pectoralis major into the axilla.

Front 37

What are lobes of glandular tissue and lactiferous ducts,

Back 37

o In the adult female, each gland consists of 15 to 20 well-developed, radially aligned lobes of glandular tissue. Each lobe is drained by a lactiferous duct.
The lactiferous ducts converge upon the areola and open onto the nipple (the areola is the pigmented, annular area surrounding the nipple).

Front 38

suspensory ligaments of the breast

Back 38

Strands of connective tissue in the interlobar spaces extend from the deep fascia of the thoracic wall to the dermis of the skin. These strands of connective tissue are called the suspensory ligaments of the breast because they help support the mass of the mammary gland.

Front 39

sentinel lymphadenectomy

Back 39

o If mammography and biopsy reveal a breast mass to be a malignant breast tumor, the nuclear medicine procedure called sentinel lymphadenectomy may be used to assess whether tumor cells have spread via lymphatic vessels to axillary lymph nodes. This nuclear medicine procedure is based upon the presumption that the lymph drained from every microscopic region within the breast is first filtered almost exclusively by just one lymph node. This lymph node thus serves as the first guard, or sentinel, against the lymphogenous spread of a breast tumor from the microscopic region in which the tumor initially arises. In sentinel lymphadenectomy, radiolabelled colloids are injected into the tumor site to identify the first lymph node that accumulates the radiolabelled colloids. This node is surgically removed and microscopically examined for metastatic involvement (that is, for the presence of malignant cells).

Front 40

The absence of metastatic involvement of the sentinel node means...

Back 40

The absence of metastatic involvement of the sentinel node has been found to correctly predict that there is no axillary node involvement in over 90% of cases. In other words, if there is no metastatic involvement of the sentinel node, then it is very likely that the lymph nodes which filter lymph drained from the sentinel node are also free of malignant cells.

Front 41

If there is evidence of metastatic involvement of the sentinel node,

Back 41

, however, there is evidence of metastatic involvement of the sentinel node, surgical dissection and removal of axillary nodes is indicated

Front 42

Malignant breast tumors have poorly delineated borders because...

Back 42

-Malignant breast tumors have poorly delineated borders because of their irregular infiltration of the connective tissue framework of the breast. The fixation of the malignant tumor to the surrounding connective tissue framework progressively diminishes the mobility of the tumor within the breast.
-Extensions of the tumor can become attached to and exert traction upon the suspensory ligaments of the breast; such retraction is the anatomical basis for the skin or nipple retraction seen in cases of advanced carcinoma.

Front 43

The lateral thoracic artery provides the blood supply to the...

Back 43

The lateral thoracic artery provides the blood supply to the mammary glandular tissue in the lateral half of the breast.

Front 44

Branches of the internal thoracic artery provide the blood supply to the...

Back 44

Branches of the internal thoracic artery provide the blood supply to the glandular tissue in the medial half of the breast. The internal thoracic artery, which is a branch of the subclavian artery, extends inferiorly alongside the deep surface of the chest wall (just lateral to the sternum).

Front 45

The veins that drain mammary glandular tissue in the lateral half of the breast are tributaries of the...

Back 45

The veins that drain mammary glandular tissue in the lateral half of the breast are tributaries of the axillary vein.

Front 46

The veins that drain glandular tissue in the medial half of the breast are tributaries of the...

Back 46

The veins that drain glandular tissue in the medial half of the breast are tributaries of the internal thoracic veins; the internal thoracic veins are a pair of veins that lie alongside the internal thoracic artery.

Front 47

The lymphatic vessels which drain the mammary glandular tissue in the lateral half of the breast lead primarily to the...
And what is significant about this particular drainage?

Back 47

The lymphatic vessels which drain the mammary glandular tissue in the lateral half of the breast lead primarily to the anterior group of axillary nodes.
-This drainage accounts for approximately 75% of the lymph drained from the mammary gland, as about the same percentage of the glandular tissue lies in the lateral half of the breast.

Front 48

The lymphatics that drain the glandular tissue in the medial half of the breast lead primarily into the...

Back 48

The lymphatics that drain the glandular tissue in the medial half of the breast lead primarily into the internal thoracic nodes that lie beside the internal thoracic veins.

Front 49

Physicians call the internal thoracic nodes the...

Back 49

Physicians call the internal thoracic nodes the internal mammary or, parasternal, nodes.

Front 50

The supraclavicular nodes - what are they and tell me about their lymphatics

Back 50

The supraclavicular nodes (which are the lowest members of the deep cervical nodes in the neck) also receive some of the lymph drained from the breast.