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32 Cards in this Set
- Front
- Back
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Axilla
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Axilla-Pyramidal space inferior to neck thru which neurovascular structures pass from the neck into the upper limb
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Anterior axillary fold –
Posterior axillary fold – Axillary fossa |
Anterior axillary fold – sternocostal portion of pectoralis major
Posterior axillary fold – teres major and latissimus dorsi Axillary fossa (armpit) |
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Axilla-
Apex: Base: |
Apex: points into neck between clavicle and 1st rib
Base: skin of axillary fossa |
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Axilla-
Anterior wall: Medial wall: Posterior wall: Lateral wall: |
Axilla-
Anterior wall: pectoralis muscles Medial wall: serratus anterior, ribs 1-4 Posterior wall: scapula, subscapularis, teres major, latissimus dorsi Lateral wall: humerus (intertubercular groove) |
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Axilla- Components
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Contents:
Axillary artery Axillary vein Infraclavicular portion of brachial plexus Cords and branches Axillary lymph nodes Much axillary fat |
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Axillary Artery
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Axillary Artery
Superior thoracic Thoracoacromial Lateral thoracic Subscapular Circumflex scapular Thoracodorsal Anterior circumflex humeral Posterior circumflex humeral See image in notes |
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Brachial Plexus
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By definition, a plexus is a network of interwoven nerves
Brachial plexus comprised of ventral rami C5-T1 spinal nerves see/draw image-Axillary artery runs through the brachial plexus, know where it is |
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brachial plexus-componets
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Components
Roots (anterior rami) Trunks Divisions Cords Terminal branches |
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Brachial Plexus
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Brachial Plexus
Supraclavicular portion Roots Trunks Divisions Infraclavicular portion Cords Peripheral nerves or terminal branches |
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Bracial Plexus-Roots
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Roots
Anterior rami of C5-T1 Emerge between anterior and middle scalene muscles in neck |
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Brachial Plexus- Trunks
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Trunks
Superior (upper) trunk - C5-6 Middle trunk - C7 Inferior (lower) trunk - C8-T1 Each trunk divides into anterior and posterior divisions |
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Brachial Plexus- Divisions
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Divisions
Anterior division sends nerve fibers to anterior (flexor) compartment of limb Posterior division sends nerve fibers to posterior (extensor) compartment |
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Brachial Plexus-Cords
Cords Lateral cord formed by ____ Medial cord formed by ____ Posterior cord formed by ____ Cords named according to ____ |
Cords
Lateral cord formed by anterior divisions of superior and middle trunks Medial cord formed by anterior division of inferior trunk Posterior cord formed by all 3 posterior divisions Cords named according to relationship with axillary artery |
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Brachial Plexus
Terminal branches of cords Lateral cord () Medial cord () Posterior cord (C) |
Terminal branches of cords
Lateral cord (C5-7) Musculocutaneous nerve Lateral root of median nerve Medial cord (C8-T1) Ulnar nerve Medial root median nerve Posterior cord (C5-T1) Axillary nerve Radial nerve *Median nerve terminal branch from lateral and medial cords |
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Brachial Plexus-
Innervation of terminal branches (big picture) Lateral and medial cords Posterior cords **nerves in each section and innervations |
Innervation of terminal branches (big picture)
Lateral and medial cords Musculocutaneous, ulnar and median nerves Innervate muscles of anterior compartment of arm, forearm, hand Posterior cords Axillary and radial nerves Axillary innervates deltoid, teres minor Radial innervates muscles of posterior compartment of arm and forearm |
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Brachial Plexus-
Branches |
Branches
Supraclavicular Off roots Dorsal scapular Long thoracic Off superior trunk Nerve to subclavius Suprascapular |
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Brachial plexus- branches
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Infraclavicular Branches
Lateral cord Lateral pectoral Medial cord Medial pectoral Medial cutaneous of arm Medial cutaneous of forearm Posterior cord Upper subscapular Lower subscapular Thoracodorsal |
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Brachial Plexus- The "M"
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The “M”
Good reference point for identifying parts of brachial plexus within axilla “M” formed by terminal branches of lateral and medial cords Musculocutaneous Lateral root of median Medial root of median Ulnar |
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Cutaneous Innervation
Segmental innervation or dermatome Peripheral nerve innervation or peripheral field Important in ______ |
Segmental innervation or dermatome
Area of the skin innervated by a specific spinal nerve Important for determining spinal nerve level injuries Peripheral nerve innervation or peripheral field Area of the skin innervated by a peripheral cutaneous nerve 2 or more spinal nerves contribute Important in assessing peripheral nerve damage **know dermatomal innervation-draw it! know cutaneous innervation Know dermatomal innervation!- injury at level of spinal nerve Cutaneous diagram-often indicates injury in peripheral nerves |
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Brachium (arm)- compartments
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Anterior and posterior compartments separated by lateral and medial intermuscular septae
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Anterior compartment of arm
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Anterior compartment – coracobrachialis, biceps brachii, brachialis muscles
Muscles that flex glenohumeral and elbow joint and supinate radioulnar joint Musculocutaneous nerve Brachial artery Exceptions Coracobrachialis Arm adductor Brachialis Also, radial nerve |
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Posterior component of brachium
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Posterior compartment – triceps brachii and anconeous
Muscles that extend glenohumeral and elbow joints Radial nerve Profunda brachii artery Exceptions Long head triceps Extends arm |
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Muscle innervation for anterior compartment of arm
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3 muscles innervated by musculocutaneous nerve and supplied by muscular branches of brachial artery
Coracobrachialis Biceps brachii Brachialis |
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Corachobrachialis- origin, insertion, etc
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Coracobrachilis=
Origin: Coracoid process Insertion: Medial border, mid-shaft of humerus Adduction and flexion at glenohumeral joint Prevents downward displacement of shoulder joint Musculocutaneous nerve runs right through the coracobrachialis |
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Biceps Brachii- origin, insertion, etc
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Biceps Brachii
Origin: Short head - coracoid process Long head - supraglenoid tubercle Insertion: Biceps tendon attaches to radial tuberosity Bicipital aponeurosis attaches to deep fascia of forearm which covers wrist flexors) Crosses 3 joints: glenohumeral, elbow, radioulnar Flexion glenohumeral joint Powerful flexor when forearm supinated; powerful supinator when forearm flexed Passes through 3 joints- |
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Brachialis- origin insertion etc
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Brachialis-Origin:
Anterior surface of distal half of humerus Insertion: Coronoid process of ulna and ulnar tuberosity Workhorse of elbow flexion Musculocutaneous nerve and radial nerve (same spinal cord levels) |
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Brachium- posterior component
muscles, innervations, blood supply |
2 muscles:
Triceps brachii Anconeus Innervated by radial nerve Blood supply via profunda brachii (deep brachial) artery |
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Triceps brachii- origin, insertion, etc.
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Origin:
Medial head Shaft of humerus below radial groove True counterpart to brachialis Lateral head Humerus above radial groove Long head Lies medially; from infraglenoid tubercle outside shoulder joint Insertion: All 3 attach to upper surface of olecranon action:3 heads participate in elbow extension differently: Medial head is always active Long head is quiet during active extension Lateral head shows minimal activity To overcome resistance lateral and long heads recruited Long head crosses GH joint; assist adduction and extension of arm |
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Anconeus-
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Anconeus-
Origin: Lateral epicondyle humerus Insertion: Lateral olecranon; superioposterior ulna Assist triceps extending forearm |
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Brachial artery
origin and path |
brachial artery-
Begins inferior border teres major Profunda brachii (deep brachial) Muscular branches to extensor compartment Middle collateral Radial collateral Muscular branches to flexor compartment Humeral nutrient artery Superior ulnar collateral artery Inferior ulnar collateral artery Ulnar artery Radial artery |
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venous drainage of arm
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venous drainage of arm
Superficial Cephalic vein Empties into axillary vein Basilic vein Empties into brachial veins to form axillary vein Median cubital vein Perforating veins Connect to deep veins Deep Similarly named veins to brachial artery |
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aponeurosis
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typically a flat tendon
-example: oblique muscles |
