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Axilla Flashcards

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1
Q

Axilla

A

. Pyramidal space inferior to glenohumoral joint and sup. To axillary fascia at junction of arm and thorax
. Base, 4 walls, and apex boundaries
. Contents: brachial plexus, axillary blood vessels, lymph vessels, and axillary lymph nodes

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2
Q

Function of axilla

A

. Passageway for vessels and nerves to reach upperlimb

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3
Q

Axilla base boundary

A

. Formed by skin, subQ, and axillary deep fascia of concave armpit

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4
Q

Axillary fascia

A

. Continuous w/ pectoral fascia covering pec major m.

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5
Q

Ant. Wall boundary in axilla

A

. Formed by pec major and minor mm and pec and clavipectoral fascia assoc. w/ them

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6
Q

Pectoral fascia

A

Invests pec major and is continuous inf. W/ fascia of ant. Abdominal wall

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7
Q

Clavipectoral fascia

A

. Fascial layer extends from axillary fascia
. Encloses pec major and subclavius m. Then attaches to clavicle
. Lat. border of pec major form ant. Axillary fold

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8
Q

Medial wall border of axilla

A

. Thoracic wall (1st-4th ribs and intercostal muscles) and overlying serratus ant. M.

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9
Q

Axilla posterior wall boundary

A

. Subscapularis m. Superiorly and teres major and latissimus dorsi inf.
. Post. Axillary fold formed by lat. borders of teres major and latissimus dorsi

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10
Q

Axilla lateral wall boundary

A

Narrow only wall formed by intertubercular sulcus (groove) of humerus

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11
Q

Axilla apex boundary

A

. Entrance from neck to axilla
. Between 1st rib medially, clavicle ant., sup. Border fo scapula post.
. Nerve and vessels of upper limb pass through
. Axillary sheath forms neuromuscular bundle

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12
Q

Axillary sheath is extension of ____

A

Cervical fascia

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13
Q

Contents of axilla

A

. Infraclavicular part of brachial plexus and its branches
. Axillary vessels and branches
. Axillary lymph nodes
. Muscles: Tendon of long head of biceps, Short head of biceps, Coracobrachialis
. Fat and loose areolar tissue

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14
Q

Axillary artery pathway

A

. Direct continuation of subclavian
a.
. Begins at the lat. border of 1st rib
. Ends at inf. border of teres major

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15
Q

WHen does axillary a. Become brachial a.

A

When it passes distal to

the inferior border of teres major

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16
Q

What separates axillary a. Into parts and where does it separate them?

A

. Pec minor
. Part one: prox. To muscle
. Part 2: post. To muscle.
. Part 3: distal to muscle

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17
Q

Part 1 of axilla artery

A

. 1 branch
. Btw lat. border of 1st riba nd med. border pec minor
. Enclosed in axilla sheath
. Sup. Thoracic a

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18
Q

Sup. Thoracic artery supplies __

A

. Sup. Part of thoracic wall including pecs

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19
Q

Second part axilla artery

A

. 2 branches
. Thoracoacromial a.
. Lat. thoracic artery

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20
Q

Thoracoacromial a.

A

. Passes med. to pec minor
. Divides into 4 branches
. Supply pecs and ant. Part fo deltoid

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21
Q

Lat. thoracic artery

A

. Passes lat. to pec minor
. Supplies pecs, serratus anterior
. Gives off lat. mammary arteries of breast in females

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22
Q

Third part fo axilla artery

A

. 3 branches
. Subscapular a.
. Ant. Circumflex humeral a.
. Post. Circumflex humeral a.

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23
Q

Subscapular a.

A

. Largest branch
. Gives off circumflex scapular a.
. Becomes thoracodorsal a. Past branching point of circumflex scapular a.

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24
Q

Circumflex scapular a.

A

. Curves around lat. border fo scapula and anastomoses w/ arteries in dorsal scapular region

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25
Ant. Circumflex humeral a.
. Small branch | . Runs ant. Around surgical neck of humerus and anastomoses w/ post. Humeral circumflex a.
26
Post. Circumflex humeral a.
. Runs post. Around humerus and supplies shoulder joint and adjacent muscles
27
What to do if profuse bleeding of upper limb occurs?
. Compress 3rd branch of axilla artery to stop bleeding
28
Axillary vein
. Med. to axillary a. . Union of brachial veins and basilic vein at inf. Border of teres major . Cephalic vein enters close to transition of subclavian v. . Ends at lat. border 1st rib where it becomes subclavian
29
Exceptions of axillary vein following axillary artery branches
. Veins corresponding to thoracoacromial a. Don’t merge to common tributary, some enter independently and others enter into cephalic vein . Axillary vein receives thoracoepigastric vein
30
Where does cephalic v. Course into?
Deltopectoral triangle
31
Thoracoepigastric v.
. Formed by anastomoses of superficial veins from inguinal region w/ lat. thoracic v. (Axillary tributary) . Gives collateral route for venous return in presence of obstruction of inf. Vena cava
32
Principal groups of axillary lymph nodes
``` . Apical . Pectoral . Subscapular . Humeral . Central ```
33
Apical auxiliary lymph nodes
. At apex of axilla . Receives lymph from all other axillary lymph nodes and cephalic vein lymph . Efferent vessels from group unite to form subclavian lymphatic trunk
34
What trunks forms right lymphatic duct?
. Subclavian lymphatic trunk join jugular and bronchomediastinal trunks on right side
35
Pectoral group of axillary lymph nodes
. Anterior . 3-5 nodes along med. wall of axilla . Receives lymph from ant. Thoracic wall including breast . Efferent lymph vessels pass to central and apical groups of nodes
36
Subscapular group of axillary lymph nodes
. 6-7 lymph nodes . Lie along post. Axillary fold and subscapular blood vessels . Receives lymph from post. Aspect thoracic wall and scapular region . Efferent lymph vessels pass to central and apical node groups
37
Humeral axillary lymph group
. 4-6 nodes on lat. wall of axilla, med. and post. To axillary vein . Receives nearly all lymph from upper limb except that carried by lymph accompanying cephalic vein
38
Central axillary lymph node group
.3-4 nodes deep to pec minor near base of axilla . Associates w/ second part fo axilla a. . Receives lymph from pectoral, subscapular, and humeral groups . Efferent vessels pass to apical group of nodes . Lymph vessels accompanying cephalic v. Drain here
39
. Lymphangitis
. Warm, red streaks in skin | . Lymph nodes enlarge and become tender
40
The brachial plexus is the union of ____
. Union of ventral rami of C5-8 and greater part of ventral ramus of T1 . Small contributions from C4 and T2 spinal nerves
41
Rami/roots of brachial plexus
. 5 segmental ventral rami (C5-T1)
42
Trunks of brachial plexus
. 5 roots form 3 trunks . Sup. (Upper) trunk: formed by uniting C5-C6 ventral rami . Middle trunk: formed by C7 ventral rami . Inf (lower) trunk: C8 and T1 ventral rami
43
Anterior and posterior divisions of brachial plexus
. Each trunk splits into anterior and posterior divisions forming 3 ant. And post. Divisions
44
Cords of brachial plexus
. 6 ant. And post. Divisions unite to form 3 cords . Lateral cord: ant. Divisions of upper and middle trunks unite (C5-7) . Med. cord: ant. Division of lower trunk continues alone as medial cord (T8, T1) . Post. Cord: post. Division of all 3 trunks unite to form post. Cord (C5-T1)
45
Branches of brachial plexus
. 3 cords form 5 terminal branches . Lat. cord splits into musculocutaneous nerve and lat. root of median nerve and ulnar nerve . Post. Cord divides into small axillary nerve and axial nerve
46
Location of roots and trunks of brachial plexus
. Sup. To clavicle in post. Triangle of neck | . Roots emerge between scalenus anterior and scalenus medius mm.
47
Location of divisions in brachial plexus
. Post. To clavicle in apex of axilla
48
Location of cords in brachial plexus
. Inf. To clavicle in axilla where they’re found post. To pec minor . Surround second part of axillary artery on 3 sides
49
Terminal branches location of brachial plexus
. Inf. Part of axilla is when cords split into these
50
Groups of branches of brachial plexus
. Supraclavicular and infraclavicular
51
How are supraclavicular branches grouped?
. Those arising from roots of brachial plexus and those arising from upper trunk of brachial plexus
52
Suprascapular branches arising from roots of brachial plexus
. Muscular branches . Branch that joins phrenic nerve . Dorsal scapular nerve . Long scapular nerve
53
Muscular branches from brachial plexus spinal cord levels and distribution
. C5-8 | . Scaleni and longus colli muscles
54
Branch from brachial plexus that joins phrenic nerve spinal cord level and distribution
. C5 | . Thoracoabdominal diaphragm
55
Dorsal scapular nerve spinal cord level and distribution
. C4-5 . Rhomboideus major and minor . Levator scapulae
56
Long thoracic nerve spinal cord level and distribution
. C5-7 | . Serratus anterior
57
Suprascapular Branches from brachial plexus upper trunk
. Nerve to subclavius | . Suprascapular nerve
58
Nerve to subclavius from brachial plexus spinal cord level and distribution
. C4-6 | . Subclavius and sternoclavicular joint
59
Suprascapular nerve spinal cord level and distribution
. C4-6 | . Supraspinatus, infraspinatus, and glenohumoral joint
60
Infraclavicular branches and how they are traced
. Derived from 3 cords of plexus | . Fibers traced through plexus to spinal cord nerve they originated form
61
Lateral cord infrascapular branches
. Lat pectoral n. . Musculocutaneous n. . Lat. root of median n.
62
Lateral pectoral nerve spinal cord level and distribution
. C5-7 | . Pec major
63
Musculocutaneous n. Spinal cord level and distribution
. C5-7 . Coracobrachialis, biceps brachii, brachialis . Continues as lat. antebracxhial cutaneous nerve
64
Lateral and medial roots of median nerve spinal cord level and distribution
. lat: C5-7 . Med: C8-T1 . Flexor muscles in forearm (except flexor carpi ulnaris, ulnar half of flexor digitorum profundus) and 5 hand muscles
65
Medial cord infrascaplar branches from brachial plexus
``` . Med. root of median nerve . Med. brachial cutaneous n. . Med. antebrachial cutaneous n. . Ulnar n. . Med. pectoral n. ```
66
Medial brachial cutaneous nerve spinal cord level and distribution
C8, T1 | . Skin of med. side of arm
67
Medial antebrachial cutaneous n. Spinal cord level and distribution
. C8, T1 | . Skin over med. side of forearm
68
Ulnar nerve spinal cord level and distribution
. C7-8, T1 | . 1.5 flexor muscles in forearm, most small muscles in hand and skin of hand med. to line bisecting 4th digit
69
Medial pectoral nerve spinal cord level and distribution
. C8, T1 | . Pec major and minor
70
Posterior cord infrascapular branches from brachial plexus
``` . Upper subscapular n. . Thoracodorsal n. . Lower subscapular n. . Axillary n. . Radial n. ```
71
Upper subscapular nerve spinal cord level and distribution
. C5-6 | . Sup. Portion of subscapularis
72
. Thoracodorsal n. Spinal level and distribution
. C6-8 | . Latissimus dorsi
73
Lower subscapular nerve spinal cord level and distribution
. C5-6 | . Inf. Portion of subscapularis and teres major
74
Axillary nerve spinal cord level and distribution
. C5-6 | . Teres minor and deltoid, shoulder joint, and skin over inf. Part of deltoid
75
Radial nerve spinal cord level and distribution
. C5-8, T1 . Triceps brachii, anconeus, brachioradialis, and extensor muscles of forearm . Skin on post. Aspect of arm and forearm via post. Cutaneous nerves of arm and forearm
76
Upper plexus injuries (Erb’s palsy or Erb-DUchenne palsy)
. C5-6 rami or sup. Trunk torn/severed . Paralysis of proximal limbs (C5-6 myotomes) and loss of sensation in C5-6 dermatomes . Examples: thrown from horse, stretching infant neck during delivery
77
What nerve branches are affected by paper plexus injuries?
. Axillary (C5,6), musculotaneous (C5-7), and suprascapular nerves
78
Signs and symptoms of upper plexus injuries and what muscles correspond
. Loss of flexion and weakness of supination (biceps, brachialis, and brachioradialis) . Loss of flexion, adduction, and loss of lat. rotation of shoulder joint/arm (biceps, deltoid, supraspinatus, infraspinatus, teresminor) . Contracture deformities . Adducted upper limb, medially rotated arm, extended and prostrated forearm (waiter’s tip position) . Loss sensation on lat. side of upper limb
79
Lower plexus injuries (Klumpke’s palsey)
. C8, T1 ventral rami or inf. Trunk are torn/severed . Less common . Causes: grasping something to break fall, rotate shoulder during birth
80
Nerve branches affected in lower plexus injuries
. Skin/ muscle or arm and forearm from medial cutaneous arm and forearm, ulnar nerve, part of median nerve (C8-T1)
81
Signs and symptoms of lower plexus injuries and muscles associated
. Loss of movement in intrinsic hand (palm hollowed ou) . All digits (esp 9 and 10) extended at metacarpophalangeal joints by unopposed extensors . Flexed at inter phalange always joint by long digital flexors . Clawing contracture from loss of medial 2 lumbricals and all interossei m. . Weakness of grip of digits 9-10 from FDP and hypothenar m. . Loess of sensation in C8,T1 dermatomes
82
Posterior cord injury
. Affects radial nerve . Most frequently encountered . Causes: incorrect use of crutches .
83
Movements affected by posterior cord injury
. Loss of extension of elbows and triceps reflex causing elbow flexion . Loss of wrist extension and weakness of ulnar/radial deviation causing wrist flexion . Loss fo extension of MCP joints causing MCP flexion . Loss of extension and abduction of thumb causing flexion and adduction
84
Position of limb in radial nerve injury
. Hand is flexed at wrist, lies flaccid (wrist drop) . Forearm pronated . Thumb adducted, flexed, and opposed . Fingers flexed

Anatomy (49 decks)

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