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Axilla Flashcards

1
Q

Shape of axilla

A

Irregularly shaped pyramidal space with
four sides
an inlet
a floor (base)

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2
Q

Inlet of axilla

A

Lateral margin of rib I
Clavicle (anteriorly)
Superior margin of scapula to coracoid process (posteriorly)

Subclavian artery becomes axillary artery as it passes over lateral margin of rib I.
Axillary vein anterior to axillary artery, which is anterior to brachial plexus.

Inferior trunk of brachial plexus lies directly on rib I, as does subclavian artery and vein. Subclavian artery and vein separated by anterior scalene muscle as they pass over rib I.

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3
Q

Anterior wall of axilla

A

Pectoralis major and minor
Subclavius muscle
Clavipectoral fascia

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4
Q

Lateral wall

A

Intertubercular sulcus

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5
Q

Posterior wall

A

Subscapularis
teres major
latissimus dorsi
long head of triceps brachii

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6
Q

Floor of axilla

A

Skin of armpit

Opens laterally into arm

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7
Q

Medial wall of axilla

A

Upper thoracic wall

Serratus anterior muscle

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8
Q

Pectoralis major

A

Two heads - clavicular head (from medial half of clavicle) and sternocostal head.
Insertion: lateral lip of intertubercular sulcus of humerus
Medial and lateral pectoral nerves

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9
Q

Subclavius

A

Origin: first rib at junction between rib and costal cartilage
Insertion: groove on interior surface of middle 1/3 clavicle
Nerve to subclavius

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10
Q

Pectoralis minor

A

origin: Ribs III to V
insertion: coracoid process of scapula
medial pectoral nerve

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11
Q

Clavipectoral fascia

A

Thick sheet of tissue that connects clavicle to floor of axilla. Encloses subclavius and pectoralis minor and spans the gap between them

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12
Q

Structure passing between subclavius and pec minor through clavipectoral fascia

A

Cephalic vein
Thoraco-acromial artery
Lateral pectoral nerve

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13
Q

Structures passing beneath pec minor through clavipectoral fascia

A

Medial pectoral nerve

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14
Q

Lateral thoracic artery

A

leaves axilla by passing through fascia inferior to pec minor muscle

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15
Q

Subscapularis

A

Insertion: lesser tubercle of humerus
Innervation: upper and lower subscapular nerves
Medial rotation of arm

Forms the largest component of posterior wall of axilla
Tendon crosses anteriorly to joint capsule of glenohumeral joint

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16
Q

Teres major

A

Origin: posterior surface of inferior angle of scapula
Insertion: medial lip of intertubercular sulcus
Innervation: lower subscapular nerve
Medial rotation and extension of arm

Defines inferior limit of axilla laterally

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17
Q

Long heads of triceps brachii

A

Origin: infraglenoid tubercle of scapula
Insertion: olecranon process of ulna
Radial nerve
Extension of forearm

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18
Q

Contents of axilla

A

Major vessels
Nerves and lymphatics of upper limb
Proximal parts of coracobrachialis and biceps brachii
Axillary process of breast

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19
Q

Biceps brachii

A

Origin: long head (supraglenoid tubercle), short head (apex of coracoid process)
Insertion: Radial tuberosity
Innervation: musculocutaneous (C5-6)
Flexor of forearm and supinator

Tendon of long head passes over head of humerus deep to joint capsule of glenohumeral joint and enters intertubercular sulcus where it is held in position by transverse humeral ligament

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20
Q

Coracobrachialis

A

Origin: apex of coracoid process
Insertion: Linear roughening on midshaft of humerus on medial side
Innervation: musculocutaneous C5-6
Flexor of arm

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21
Q

Axillary artery nomenclature

A

Subclavian becomes axillary lateral margin of rib I

Axillary becomes brachial beneath teres major

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22
Q

Axillary parts

A

3 different pars separated by pectoralis minor which crosses anteriorly to axillary artery

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23
Q

Axillary branches

A 
1st part - superior thoracic
2nd part (2) - thoraco-acromial artery, lateral thoracic
3rd part (3) - subscapular, anterior circumflex, posterior circumflex
24
Q

Branches of thoraco-acromial

A

Deltoid - passes into clavipectoral triangle
Pectoral - supplies breast
Clavicular
Acromial

25
LAteral thoracic artery
Contribute to vascular supply of breast
26
Subscapular artery
Largest branch of axillary artery | Divides into circumflex scapular artery and thoracodorsal artery
27
Axillary vein
Begins at inferior margin of teres major and is a continuation of basilic vein Goes through axilla medial and anterior to axillary artery, becomes subclavian vein after lateral border of rib I
28
Tributaries of axillary vein
Follows axillary artery Brachial vein Cephalic vein
29
Cephalic vein
Superficial vein on lateral and posterior part of arm At shoulder, passes into clavipectoral triangle between deltoid, pectoralis major and clavicle. Pierces clavipectoral fascia to join axillary vein
30
Brachial plexus
``` Anterior rami of C5-C8 and most of anterior ramus of T1 Roots Trunks Divisions Cord Branches ``` Passes posterior to subclavian atery in the neck, whilst more distal regions surround axillary artery
31
Roots of brachial plexus
Enter posterior triangle of neck by passing between anterior scalene and middle scalene Lies posterior and superior to subclavian artery C5-T1
32
Trunks
passes laterally over rib I and enter axilla Superior trunk - C5-6 Middle - C7 Inferior - C8-T1 Inferior trunk posterior to subclavian artery Superior and middle more superior in position
33
Divisions
Each trunk split into anterior and posterior division 3 anterior divisions - anterior compartment of arm and forearm 3 posterior divisions - posterior compartments
34
Cords
related to 2nd part of axillary artery Lateral cord - C5-C7 Medial - C8-T1 Posterior - C5-T1 Anterior compartment - medial and lateral Posterior compartment - posterior
35
Branches of roots
Dorsal scapular nerve C5 - rhomboid major and minor Contribution to phrenic nerve C5 Long thoracic nerve C5-7
36
Branches of trunk
Only upper trunk has branches Suprascapular nerve C5-6 nerve to subclavius muscle C5-6 (passes anteroinferiorly to subclavian vein)
37
Suprascapular nerve
Infraspinatus and supraspinatus Passes laterally through posterior triangle of neck and through suprascapular foramen Accompanied in lateral parts of neck and posterior scapular region y suprascapular artery
38
Branches of lateral cord
Lateral pectoral nerve Musculocutaenous nerve Lateral root of median nerve
39
Lateral pectoral nerve
Most proximal branch from lateral cord Passes anteriorly together with thoraco-acromial artery to penetrate clavipectoral fascia between subclavius and pectoralis minor Innervates pec major
40
Musculocutaneous nerve
large terminal branch of lateral cord Pass between biceps brachii and brachialis in the arm Innervates all 3 flexor in anterior compartment of arm, terminating as lateral cutaneous nerve of the forearm
41
Lateral root of median nerve
Largest terminal branch of lateral cord and passes medially to join a similar branch from medial cord to form median nerve
42
Branches of medial cord
``` 5 medial pectoral nerve medial cutaneous nerve of arm medial cutaneous nerve of forearm medial root of median nerve ulnar nerve ```
43
Medial pectoral nerve
Most proximal branch of medial cord | passes anteriorly between axillary artery and vein
44
Ulnar nerve
Large terminal branch of medial cord
45
Median nerve
Formed anterior to third part of axillary artery by union of lateral and medial roots (from lateral and medial cord) Enters arm anterior to brachial artery
46
Branches of posterior cord
5 Superior subscapular nerve - subscapularis Thoraco-dorsal nerve - latissimus dorsi Inferior subscapular nerve - subscapularis and teres major Axillary nerve Radial nerve
47
Axillary nerve
Innervates deltoid and teres minor Superior lateral cutaneous nerve of arm originates from axillary nerve after passing through quadrangular space and loops around posterior margin of deltoid muscle
48
Radial nerve
largest terminal branch of posterior cord. | Posterior cutaneous nerve of arm originates from radial nerve in axilla and innervates skin on posterior surface of arm
49
Injuries to brachial plexus
Spinal cord injuries in cervical region - roots of brachial plexus Severe trauma to first rib - trunks Division and cords - dislocation of glenohumeral joint
50
Lymphatics in upper limb
All lymphatics in upper limb drain into lymph nodes in axilla.
51
Axillary nodes drainage
Extensive area from adjacent trunk, including regions of upper back and shoulder, lower neck, chest and upper anterolateral abdominal wall 75% of mammary gland
52
Groups of axillary nodes
``` Lateral (humeral) nodes Anterior (pectoral) nodes Subscapular (posterior) nodes Central nodes Apical nodes ```
53
Lateral (humeral) nodes
receives most from the upper limb
54
Anterior (pectoral) nodes
located around inferior margin of pectoralis minor, receive from mammary gland
55
Central nodes
Receive from humeral, subscapular and pectoral nodes
56
Apical nodes
Most superior group of nodes in axilla and drain all other groups. Receives lymphatic vessels accompanying cephalic vein + vessels draining superior region of mammary gland Converge to form subclavian trunk and joins venous system at the junction between right subclavian vein and right internal jugular vein. On the left thoracic duct.

MRCS (28 decks)

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