Ga060808

Front 1

Axilla:
1. Definition
2. Shape
3. Origin of structures emenating from axilla

Back 1

1. Crossroads between areas from neck, structures leaving & entering thoracic cavity & arm.
2. Pyramidally shaped
3. Structures stem from neck & thorax (As come & go, come superior to 1st rib and inferior to clavicle-hence potential to compress those vessels through this region.

Front 2

Breast:
1. Definition
2. Components

Back 2

1. Modified Sweat Gland
2. Cooper's Ligaments
-Nipple
-Areola
-Lactiferous Ducts
-Mammary Lactating Glands (15-20)
-Lactiferous Sinuses (where drain into nipple)

Front 3

Cooper's Ligaments

T4 Landmark

Back 3

-Dense, connective tissue strands

-The nipple is roughly at 4th intercostal space also T4 dermatome.

Front 4

Tail of spence

Back 4

Extension travelling towards axilla from breast
-Palpate tail of spence at axilla during breast exam, since masses/pathologies can go unobserved here

Front 5

Position of breast

Back 5

-lies primarily over pectoralis major, lying over pectoral fascia (should be mobile against this fascia or might be pathologic if not mobile)

Front 6

What two skin areas have fibers that directly connect to the hypothalmus?

Back 6

1. Nipple
2. Perineum

Front 7

Name the Vessels that supply breast.

Back 7

1. Branches of Internal thoracic artery (branch of subclavian)
2. Lateral thoracic artery (branch of axillary artery)-supplies lateral margin of breast
3. Intercostal arteries
4. Thoracoacromial artery through its pectoral branch

Front 8

Axilla
1. Boundaries

Back 8

1. Apex: 1st rib, clavicle, superior angle of scapula
2. Medial: Serratus Anterior & Intercostal muscle
3. Anterior: Pec. Major, Pec minor & claviopectoral fascia
4. Inferior (base): Skin of axilla & fascia of the region
5. Lateral border: Intertubercular groove
6. Posterior: subscapularis, latissimus dorsi, teres major

Front 9

Cervicoaxillary Canal Boundaries

Back 9

Btwn 1st rib, clavicle, superior angle

Front 10

What 3 structures pierce the clavipectoral fascia? (Just medial to pectoralis minor)

Back 10

1. Cephalic Vein
2. Thoracoacromial Artery
3. Lateral Pectoral nerve

Front 11

Subscapularis
1. Location
2. Action

Back 11

1. Posterior border of axilla
2. Inserts into lesser tubercle of humerus
3. Primary internal rotator & one of rotator cuff muscles

Front 12

Serratus Anterior
1. Location
2. Action
3. Innervation

Back 12

1. Huge muscle covering 1st 8 ribs
2. Laterally runs out of vertebral border of scapula (Boxer's muscle); primary protractor; if damaged - winged scapula
3. Long thoracic nerve which is anterior to muscle (easily damaged in mastectomy).

Front 13

Advantage to per-vertebral fascia

Back 13

1. extends down to axilla as axillary sheath, wrapping around the vessels & nerves
2. Clinically useful b/c you can anesthetize a brachial plexus w/o having to hit individual nerves (just bathe proximal brachial plexus)

Front 14

Where does the superior thoracic artery innervate?

Back 14

First two intercostals (muscles between ribs)

Front 15

Name three veins without 'comparable' names.

Back 15

1. Cephalic Vein
2. Basilic Vein
3. Median Cubital Vein (connects basilic & cephalic)

Front 16

Path of Basilic vein.

Back 16

Basilic vein (as trace cephalad) fuses w/ 2 venae comitantes of brachial artery??? to become axillary vein

Front 17

Where is location of greatest number of lymphnodes?

Back 17

Axillary lymph nodes.
-palpate for infections from other infections

Front 18

Where do breast lymph nodes drain?

Back 18

-75% of brest lymph drains into lymph drainage system
- Some mammary lymph nodes drain into parasternal nodes
-Rare drainage to other breast

Front 19

Name 6 different types of lymphnodes of axilla.

Back 19

1. Anterior/Pectoral (posterior to pectoralis major 3-5 & associated with Lateral thoracic vessels)
2. Central: central portion of axillary vein (3-4)
3. Lateral: Lateral side of central nodes (4-6)
4. Apical: medial side of central nodes (3-4)
5. Posterior (subscapular): 6-7 run with subscapular vessels
6. Parasternal: few nodes

Front 20

Describe three regions of breast/lymphnodes.

Back 20

1. Level 1 (lateral to pectoralis minor): nodes not usually involved in cancer
2. Level 2 (posterior to pectroralis minor): can be involved in cancer
3. Level 3 (medial to pectoralis minor): can be involved in cancer

Front 21

Prefixed vs postfixed plexus

Back 21

1. Prefixed = Lot of C4 contribution and little T1 contribution
2. Postfixed = Lot of T2 contribution and Little C5 contribution

Front 22

Supraclavicular vs infraclavicular relating to brachial plexus.

Back 22

Supraclavicular: Rami & trunks
Infraclavicular: Divsions and all distal to divisions (branches,etc.)

Front 23

Ansa pectoralis:
Define & Locate

Back 23

connects medial & lacteral pectoral nerves (hugs lateral edge of thoracoacromial artery

Front 24

What supplies medial skin of forearm & arm?

Back 24

Medial brachial & antebrachial cutaneous nerves. (primarily T1)

Front 25

What if a lesion of C5 & C6 occurs?

Back 25

1. Suprascapular nerve would not work well & would limit first 15 degrees of abduction & would knockout external rotation

Front 26

Explain Crutch Palsy

Back 26

lesion involving posterior cord (radial nerve) Example: over using crutch and compressing radial nerve--> results in poor function of triceps and wrist extensors

Front 27

Intercostal Brachial nerve

Back 27

lateral part of lateral cutaneous branch of T2 (called brachial since runs over laterally w/ medial brachial cutaneous

Front 28

Cardiac Ischemia
why feel pain down left arm?

Back 28

Dermotome of medial arm shows that the dermatome is actually T2 not T1 b/c intercostals brachial nerve is bring T2 fibers into medial arm. On left side, Hert shares a general area of spinal cord with T2, so it can convey its painto a somatic structure like the medial arm.

Front 29

Ulnar nerve/ lower trunk palsy

Back 29

-When inferior trunk of brachial plexus is deviated (strained) due to additional rib
-Remove rib to release tension on nerves

Front 30

Erb Duchene palsy
1. Define
2. Presentation

Back 30

1. Excess separation btwn neck & shoulder which is proximal brachial plexus injury
2. Arm medially rotated b/c internal rotators are pulling unopposed = "waiter's tip"

Front 31

Klumpke Palsy
1. Define
2. Presentation

Back 31

1. Lower Brachial plexus injury (some C7, but definitely C8, T1)
2. Armpit (from overstretching arm hanging from tree limb)