The Axilla_Mod 2 Lec 3

Front 1

Desccribe the BORDERS of the axilla

Back 1

* Superior Wall (apex)

* Inferior Wall (base)

* Medial Wall

* Lateral Wall

* Anterior Wall

* Posterior Wall

Front 2

Superior Wall (apex) consists of?

Back 2

- Clavicle

- Scapula

- 1st rib

Front 3

Inferior Wall (base) consists of?

Back 3

axillary skin

and

fascia at the lower borders of the pectoralis major and the teres major/ latissimus dorsi (LPT)

Front 4

Anterior Wall consists of?

Back 4

Pectoralis major & minor muscles

Front 5

Posterior Wall consists of?

Back 5

- Subscapularis muscle

- Teres major

- Latissimus dorsi

Front 6

Medial Wall consists of?

Back 6

Serratus anterior

Front 7

Lateral Wall consists of?

Back 7

Humerus (intertubercular groove)

Front 8

Contents of the axilla

Back 8

- Axillary Artery

- Axillary Vein

- Brachial Plexus (terminal branches)

- Axillary Lymph Nodes

- Tendons of the biceps brachii

- Coracobrachialis muscles

Front 9

What are the main branches from the subclavian artery?

Back 9

Branches of subclavian a. include: (mneumonic – VIT C & D) !

* Vertebral A. !

* Internal Thoracic (mammary) A. !

* Thyrocervical Trunk:

• Suprascapular a., ascending cervical a., inferior thyroid a.,transverse cervical a. !

* Costocervical Trunk !

* Dorsal Scapular A. (often a branch of subclavian a. however it some cases it may arise from the transverse cervical a.)

Front 10

What structures do the subclavian artery supply?

Back 10

Provides blood supply to the neck and thoracic wall

Front 11

Locations of 3 segments of the axillary artery

Back 11

Axillary artery = Continuation of the SUBCLAVIAN A.

Divided into thirds - Use pectoralis minor muscle as landmark

o Proximal 1/3: Above superior border of pectoralis minor !

o Middle 1/3: lies posterior or deep to pectoralis minor!

o Distal 1/3: Lies below inferior border of pectoralis minor !

Front 12

What are the branches of FIRST PART of the axillary artery? Describe their course in the axilla

Back 12

Superior thoracic artery

Course: supplies the first and second posterior intercostalspace

Front 13

What are the branches of SECOND PART of the axillary artery? Describe their course in the axilla

Back 13

Thoracoacromial trunk: acromial, deltoid and pectoral branches!

Lateral thoracic a. (supplies lateral thoracic wall including Serratus anterior-which is on the medial wall of the axilla)

Front 14

What are the branches of THIRD PART of the axillary artery? Describe their course in the axilla

Back 14

* Subscapular A.

a. Thoracodorsal a.

b. Circumflex scapular

* Anterior circumflex humeral a. (A. Cx)

* Posterior circumflex humeral a.(P. Cx)

Front 15

Axillary artery - describe its beginning to its termination

Back 15

Front 16

Describe the deep drainage of the upper limb

Back 16

o AXILLARY V. drains the shoulder, arm, forearm and hand

o SUBCLAVIAN V. – the continuation of the axillary v. also receives drainage of the scapular region.

Front 17

Characteristics of VENOUS DRAINAGE OF THE SHOULDER - AXILLARY VEIN

Back 17

-Veins of the limbs often form anastomoses that surround the artery(s) they accompany.

-Unidirectional valves prevent pooling of blood in extremities

- Superficial veins: Basilic v., Cephalic v. and Median Cubital v.

- Deep veins: accompany major arteries

Front 18

How is the pooling of venous blood in the limbs prevented?

Back 18

-Unidirectional valves prevent pooling of blood in extremities

Front 19

VENOUS DRAINAGE OF THE SHOULDER - AXILLARY VEIN - Name the superficial veins

Back 19

Superficial veins:

* Basilic v.

* Cephalic v.

* Median Cubital v.

Front 20

LYMPHATIC DRAINAGE - these vessels often accompany which veins of the shoulder?

Back 20

The superficial system

=> Lymphatic vessels of the upper limb often accompany veins of the superficial system

Front 21

Which lymph nodes are responsible for lymphatic drainage of the upper limb?

Back 21

Axillary lymph nodes

Front 22

LYMPHATIC DRAINAGE of the upper limbs - identify and localize nodes of the Axillary lymph nodes

Back 22

There are some 15 to 20 nodes usually arranged into to five groups. The groups consist of:

- A pectoral (anterior)

- L lateral

- P posterior

- C central

- Ap apical

-----------------------------------

Lower Axillary Nodes: lateral and deep to pectoralis minor

- Pectoral Nodes (P)

- Subscapular Nodes (S)

- Humeral Nodes (H)

- Central Nodes (C)

----------------------------------------------------------------------

o Upper Axillary Nodes

- Apical Nodes (A)

Front 23

What are subclavian lymph trunks?

Back 23

Apical Node (of the upper axillary nodes)

↓ unite to form

Subclavian lymph trunks

↓ drain into

Right and left venous angles (right lymphatic trunk and thoracic duct)

Front 24

Tell the way of the lymphatic drainage of the upper limb

Back 24

- Pectoral Nodes (P)

- Subscapular Nodes (S)

- Humeral Nodes (H)

- Central Nodes (C)

- Apical Nodes (A)

Front 25

Describe the divisions of the brachial plexus

Back 25

* Roots (5)

* Trunks (3)

* Divisions (6)

* Cords (3)

* Terminal Branches (5)

Front 26

What are the roots (5) of the brachial plexus?

Back 26

Anterior rami of C5-T1

Front 27

Where are the Dorsal scapular nerve & Long thoracic nerve?

Back 27

They're from the ROOTS of the brachial plexus

*Dorsal scapular nerve: C5

*Long thoracic nerve: C5-7

Front 28

What are the trunks (3) of the brachial plexus? To which roots they're connected?

Back 28

1. Superior (C5-6)

2. Middle (C7)

3. Inferior (C8-T1)

Front 29

Where are the Suprascapular nerve (C5-6) & Nerve to subclavius (C5-6)?

Back 29

They're from TRUNKS of the brachial plexus

o Suprascapular n. (C5-6)

o Nerve to subclavius (C5-6)

Front 30

What are the divisions (6) of the brachial plexus? To which roots+ trunks they're connected?

Back 30

Front 31

What are the cords (3) of the brachial plexus? To which roots+ trunks they're connected?

Back 31

1. lateral cord (C5-7)

2. medial cord (C8-T1)

3. posterior cord (C5-T1)

Front 32

Where are the:

1. lateral pectoral n.

2. upper and lower subscapular n., thoracodorsal n

3. medial pectoral n., medial cutaneous to the arm and forearm (brachial and antebrachial) ns.

?

Back 32

They're all from the CORDS of the Brachial Plexus

1. lateral pectoral n => FROM LATERAL CORD.

2. upper and lower subscapular n., thoracodorsal n => FROM POSTERIOR CORD

3. medial pectoral n., medial cutaneous to the arm and forearm (brachial and antebrachial) ns.=> FROM MEDIAL CORD

NB: they're NOT terminal branches of the Brachial Plexus

(see cmap for details)

Front 33

What are the terminal branches (5) of the brachial plexus? To which roots+ trunks they're connected?

Back 33

o Musculocutaneous N. (C5-7): from lateral cord

o Ulnar N. (C8-T1): from medial cord

o Median N. (C5-T1): from lateral and medial cords

o Axillary N. (C5-C6): from posterior cord

o Radial N. (C5-T1): from posterior cord

Front 34

Mneumonic for break-down of brachial plexus

Back 34

"Real Thirsty? Drink Cold Beer"

---

Roots

Trunks

Divisions

Cords

Terminal Branches

Front 35

MEDIAL CORD vs MEDIAL NERVE - Difference between those 2

Back 35

see cmap "Brachial plexus"

Front 36

How to draw Brachial plexus

(important!)

Back 36

See pdf "How to draw Brachial plexus"

Front 37

Roots, trunks and divisions - where are they located?

Back 37

Above the clavicle in the neck (supraclavicular)

Front 38

Cords - where are they located?

Back 38

AT the level of the clavicle

Front 39

Terminal branches - where are they located?

Back 39

Inferior to the clavicle (infraclavicular)