Arm & Cubital Fossa

Question 1

define the borders of the axillary space

Answer 1

Apex –
anterior-clavicle
posterior- scapula
medial-1st rib

Base – skin/fascia of armpit

Ant wall– pect mj/pect mn and subclavius

Post wall– teres major
latissimis dorsi &
subscapularis (note that they all do adduction of scapula)

Med wall– serratus anterior

Latwall– intertubercular groove of humerus and long head of biceps

Question 2

what is the first part of the axillary artery

2nd part

3rd part

Answer 2

after 1st rib and before pectoralis minor (this is subclavian artery)

2nd: deep to pectoralis minor and proximal/above pectoralis major

3rd part: lateral to pectoralis minor and inferior border of teres major (this is brachial artery)

Question 3

what branches off the 3 parts of the axillary artery? and what do they innervate

Answer 3

1st branch: Superior thoracic

2nd branch: -Thoracoarcomial trunk (abcd- acromion, pectralis major and minor, clavicle, and deltoid)
and
-lateral thoracic a (serratus anterior)

3rd branch:
-subscapular a (subscapularis)
which turns into the circumflex scapular a (innervates teres minor and teres major) and then the thoracodorsal a (lattisums dorsi)

• anterior humeral circumflex
• posterior humeral circumflex

remember: screw the lawyer, save a a patient

Question 4

run to drink cold beer. how many of each?

what neves come off the brachial plexus?

Answer 4

roots
trunks
divisions
cords
branches

5 roots: C5,6,7,8,T1
3 trunks: superior, inferior, middle
6 divisions: anterior/posterior off each trunk
3 cords: posterior, lateral, medial 
5 terminal branches

My Aunts Really my Uncle

musculocutaneous
axillary
radial
median
ulnar

Question 5

what nerves come off the cords in the brachial plexus

Answer 5

3 off medial and posterior cord

lateral cord:

• lateral pectoral n (pec major)
• lateral part of median n

medial cord: all medially named

1. ulnar nerve
2. medial part of median n

a) medial pectoral n (pec major and minor)
b) medial cutaneous of forearm (aka anti brachial cutaneous)
c) medial cutaneous of arm (brachial cutaneous)

posterior cord:

1. axillary n
2. radial n

a) subscapular upper
b) sub scapular middle (aka thoracodorsal n) (latissimus dorsi)
c) subscapular lower n (teres major)

Question 6

what nerves come off the roots

Answer 6

dorsal scapular

long thoracic

Question 7

what nerves come off the trunks

Answer 7

suprascapular

nerve to subclavian

Question 8

Describe the lymphatic drainage of the breast

Answer 8

Lymph passes from the nipple, areola, and lobules to the subareolar lymphatic plexus.

From there:
MOST (75%) of the lymph goes to the axillary lymph nodes, via the pectoral lymph nodes. (It is extremely important to consider the axillary nodes when performing a breast exam on a patient.)
Most of the rest goes to the parasternal lymph nodes.
A small amount of lymph goes to the opposite breast.
A small amount of lymph goes to the abdominal wall and downward.
Lymphatic vessels in the skin of the breast drain into the axillary, inferior deep cervical, infraclavicular, and parasternal lymph nodes.

Lymph from the axillary lymph nodes subsequently drains into the subclavian lymph trunk. Lymph from parasternal nodes enters the bronchomediastinal trunk.

Question 9

Why are lateral pectoral and medial pectoral nerves reversed (with respect to their names and relative locations) from what you would expect?

Answer 9

Both of these nerves supply the pectoralis major. The “medial” and “lateral” designations of these two nerves refers to the cords of the brachial plexus from which they are derived. (Do not worry about this now, but it will haunt you later!) They are not topographic designations. (To remember which is which, think about the Medial pectoral nerve being a Major nerve which supplies both the pectoralis Major and the pectoralis Minor. The Lateral nerve is a Little nerve, and only innervates pectoralis major.) (N 430, TG 2-12B, 2-13)

Question 10

Where does the cephalic vein terminate?

Answer 10

The cephalic vein passes between the deltoid and pectoralis major muscles and empties into the termination of the axillary vein.

Question 11

Consider blood supply, and nerve supply drainage of the breasts.

Answer 11

Blood: A breast’s arterial supply is derived from branches of the internal thoracic artery (including anterior intercostals), the lateral thoracic artery, the thoracoacromial artery, and posterior intercostal arteries.
Venous drainage follows arterial supply, primarily draining into the axillary vein, but also draining some blood into the internal thoracic vein.

Nerves: The skin of the breast is innervated by anterior and lateral cutaneous branches of the 2nd through 6th intercostal nerves. For example, the area around the nipple and areola is innervated via the T4 spinal nerve.

Question 12

lymphatic drainage of breasts

Answer 12

a

Question 13

where does breast cancer usually form?

Answer 13

Usually

Question 14

categories of cancer

Question 15

what percent of cancer is breast?

Answer 15

5.22%

Question 16

cancer prevalence?

Answer 16

After

Question 17

lateral quadrants drain to __ and medial quadrants drain to–

Answer 17

lateral- pectoral nodes

medial- parasternal / internal thoracic nodes

Question 18

where are the apical nodes. what is the importance

Answer 18

they parallel the axillary v and lie at the apex of axilla. receive lymph from all other axillary nodes and drain into the subcalvian trunks

Question 19

75% of lymph drains where? what bout the rest

Answer 19

75% drains to the pectoral nodes include the nipple. 20% drains to parasternal nodes and some to contraleateral parasternal nodes

Question 20

describe the location of the lymph and where they receive lymph from

posterior
anterior
central
apical
lateral

Answer 20

posterior aka humeral receives lymph from the posterior thoracic wall and posterior shoulder
it follows the sub scapular artery and vein

anterior aka pectoral is located at the inferior border of pectoralis minor and receives lymph from the anterior and lateral thoracic walls including the breast

central receives lymph from the all the others
and is located at the base of the axilla

apical is located at the apex of the axilla (clavicle, pec minor) and receives lymph from all the others.

lateral aka humeral is located at the lateral border and receives lymph from the upper limb

Question 21

sternoclavicular joint

Answer 21

medial end of clavicle articulates with manubrium of sternum to form synovial saddle joint. meniscus divides joint cavity

Question 22

acromioclavicular jt

Answer 22

plane joint. lateral end of clavicle articulates with acromion of scapula to form a synovial joint

Question 23

upward and downward rotation of scapula refers to

Answer 23

movement of glenoid