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ANAT 314 > Lecture 19: axilla and brachial plexus > Flashcards

Lecture 19: axilla and brachial plexus Flashcards

1
Q

What is axilla

A

First and largest of 3 n/v funnels in upper limb
Transmits vessels and nerves between thorax/neck and upper limb

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2
Q

Describe shape axilla

A

Pyramidal shape

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3
Q

Describe borders axilla

A

Apex at clavicle, scapula and rib1
Base formed by armpit skin
Ant/posterior and medial/lateral walls formed mainly by muscles of back, shoulder and chest (also shaft humerus)

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4
Q

Name the 4 things in axilla - contents of axilla

A

Axillary fasciae sheath with axillary artery, vein and brachial plexus
Axillary lymph nodes - major collection point lymphatic system
Tendons of coracobrachialis and biceps brachii (2x)
Adipose tissue

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5
Q

Describe vasculature of axilla and upper limbs - gen

A

One major artery -early branch aortic arch, changes name as moves
= subclavian —> Axillary—> brachial artery

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6
Q

Describe vasculature of axilla and upper limbs - subclavian artery

A

Under clavicle
Major early branch of aorta —> becomes Axillary artery

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7
Q

Describe vasculature of axilla and upper limbs - axilary artery

A

After passing under clavicle, inferior border clavicle - sits in armpit —> becomes brachial artery

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8
Q

Describe vasculature of axilla and upper limbs - brachial artery

A

After inferior border teres major
Travels and branches further into upper limb

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9
Q

Describe how axillary artery is divided

A

3 parts by pectoralis minor = medial, under (deep to) and lateral to the muscle
Each part has specific regions that its branches supply

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10
Q

What does first part of axillary artery supply

A

Pectoral muscles - minor and major, subclavius and serratus anterior (upper portions)
One branch

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11
Q

What does second part of axillary artery supply

A

Supplies clavicle, acromion, deltoids, pectoral muscles and serratus anterior
One major trunk

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12
Q

What does third part of axillary artery supply

A

Between pectoralis minor and inferior border teres major
Supplies scapula, (branch to) lats and proximal humerus (anterior and posterior circumflex numeral arteries- forms anastomosis around surgical neck of humerus, *recall, fractures)

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13
Q

Describe superficial veins = gen

A

Highly variable - with numerous tributaries to 2 main veins =
Cephalic (towards head in relation to embryonic limb) and
Basilic (basal - towards tail)
Has general patterns

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14
Q

Describe cephalic vein

A

Starts at dorsal Venous arch
Hand to shoulders/pectoral region
Dives deeper - at deltopectoral groove, drains deep into Axillary vein
(Equiv to greater saphenous)

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15
Q

Describe basilic vein

A

Starts at dorsal Venous arch
Points down - on pinky side
Dives into arm and travels with deeper brains then becomes Axillary vein
(Equiv to lesser saph)

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16
Q

Describe median cubital vein

A

Connection between cephalic and basilic veins

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17
Q

Describe median cubital vein - clinical correlate

A

Site of venipuncture - blood draws

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18
Q

Name all deep veins of axilla

A

Subclavian
Axillary
Cephalic
Basilic
Paired brachial veins (deep veins of upper limb)

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19
Q

Describe deep veins - gen

A

Anatomical variation but common = basilic vein (superficial) joining paired brachial veins (run deep with brachial artery) to form Axillary vein

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20
Q

What does cephalic vein drain into

A

Into axillary vein directly through clavipectoral fascia

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21
Q

Describe venae comitantes

A

Matching veins to arteries often paired in smaller, more distal vessels of the limbs
1 artery: 2 veins

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22
Q

Brachial plexus - describe word

A

Braid
Network of spinal nerves

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23
Q

Brachial plexus Derived from

A

Spinal nerves c5-t1

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24
Q

Brachial plexus Describe emergence

A

From neck between ant and mid scalenes
Passes deep to clavicle
Funnels through Axilla closely associated with Axillary artery (uses Axillary artery as scaffold)

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25
Brachial plexus Provides what
Motor and sensory innervation to upper limb From shoulder to fingertips
26
Describe basic organization
As spinal nerves emerge = combine and divide in various ways - bradining To eventually form 4 terminal branches into distal upper limb
27
Describe basic organization - fromproximal to distal
Plexus organized into sections that reflect this braiding pattern
28
Describe basic organization - peripheral nerves
Branch off along sections
29
Describe basic organization - way to remember sections
Roots 5 —> trunks 3 —> divisions 6 —> cords 3 —> branches 5 = Read The Darn Cadaver Book or Really Thirsty? Drink Cold Beer
30
How can peripheral nerves be divided
Into those that emerge above and below clavicle = Supraclavicular nerves from roots and trunks Infraclavicular nerves from cords and branches
31
What section of basic organization has no peripheral nerves (branches)
Divisions - sits righ under clavicle
32
Name supraclavicular branches
Dorsal scapular nerve Nerve to subclavius Long thoracic nerve Suprascapualr nerve
33
Describe supraclavicular branches
4 branches = from roots (c5-c7) and superior trunk Deep to clavicle and neck structures
34
Dorsal scapular nerve
Root c5 To rhomboids and levator scapulae
35
Nerve to subclavius
Superior trunk - c5/c6 To subclavius
36
Suprascapular nerve
Superior trunk c5/c6 To supraspinatus and infraspinatus
37
Long thoracic nerve
Roots c5,6,7 To serratus anterior
38
Describe infraclavicular branches - from medial and lateral cord
Come from not overlapping roots Lateral and medial cords on opposite sides Axillary = medial and lateral pectoral nerves
39
Describe medial pectoral nerve
C8-t1 From medial cord To pectoralis minor and pectoralis major (sternocostal part)
40
Describe lateral pectoral nerve
C5-c7 From lateral cord To pectoralis major (clavicular part)
41
Describe infraclavicular branches - from posterior cord
Lies posterior to Axillary artery Thoracodorsal nerve Superior subscapualr nerve Inferior subscapular nerve Posterior cord = c5-t1
42
Describe thoracodorsal nerve
C6-c8 To latissimus Dorsi
43
Describe superior subscapular nerve
C5-c6 To subscapularis
44
Describe inferior sub scapular nerve
C5-c6 To subscapularis And teres major
45
Describe infraclavicular branches - terminal branches - Gen
In Axilla - near shoulder joint = the 3 cords split/joint once more to form 5 terminal branches Wrapped around Axillary artery
46
Name the 5 terminal branches
Axillary Musculocutaneous Radial Median Ulnar
47
Describe shape of 3 terminal branches - arise from medial and lateral cords
= musculocuteanous, median, ulnar = form M on anterior aspect of Axillary artery = landmark to help orient
48
Name terminal branches from medial and lateral cords
Musculocutaneous Median Ulnar
49
Musculocutaneous nerve levels
C5-c7 All lateral cord
50
Musculocutaneous nerve Pathway
Pierces coracobrachialis muscle Travels between biceps brachii and brachialis succulents Emerges arterial to biceps - above elbow = AS lateral cutaneous antebrachial nerve (ends cutaneously)
51
Musculocutaneous nerve Motor
To anterior compartment of arm (musculo)
52
Musculocutaneous nerve Sensory
To lateral anterior forearm (cutaneous)
53
median nerve levels
C6-t1 Mixed lateral and medial cords
54
median nerve Pathway
Travels down midline of arm Next to brachial artery Through cubital fossa —> into forearm In centre of anterior forearm Into hand through carpal tunnel towards palm and digits
55
median nerve Motor and sensory
To lateral aspects of anterior compartments of forearm and hand (lateral palm area)
56
ulnar nerve levels
C8-t1 (somtimes c7) All medial cord
57
ulnar nerve pathway
Travels down medial arm Posterior to medial epicondyle of humerus Into medial forearm Into medial hand through ulnar tunnel
58
ulnar nerve motor and sensory
To medial aspects of anterior compartments of forearm and hand (medial palm area) Outside carpal tunnel, sensory to 2 digits (also this is the funny bone effect one)
59
Name terminal branches from posterior cord
Axillary Radial
60
Axillary nerve level
C5-c6 Posterior cord
61
Axillary nerve Pathway
Travels inferior to lateral scapular Borer Through quadrangular space with posterior circumflex numeral artery Onto posterior aspect Wraps around laterally —> surgical neck of humerus
62
Axillary nerve Motor
Deltoid Teres minor
63
Axillary nerve Sensory
Inferior Deltoid region and shoulder joint (Upper arm to lower shoulder region)
64
radial nerve levels
C5-t1 Posterior cord Largest branch
65
radial nerve Pathway
Posterior to humerus in radial groove Visible in triangular interval - with deep brachial artery (between 2 heads of triceps) Then in posterior compartment of arm Anterior to lateral elbow In posterior compartment forearm - and into dorsal of hand
66
radial nerve Motor
Posterior compartments of arm and forearm
67
radial nerve Sensory
Posterior of arms and dorsum of hand - huge job
68
Quadrangular space borders
Teres minor Teres major Long and lateral heads of triceps
69
Qudrangular space Contents
Axillary artery and posterior humeral circumflex artery pass through
70
Triangular interval borders
Teres major Long and lateral heads triceps
71
Triangular interval Contents
Radial nerve Deep brachial artery BOTH = VISIBLE IN INTERVAL BUT DO NOT PASS THROUGH IT
72
Describe cutaneous innervation from brachial plexus = gen
5 TERMInal branches provide most of limbs cutaneous innervtaion But 2 additional sensory only nerves emerge from medial cord
73
Describe cutaneous innervation from brachial plexus = name areas
Axillary - c5,6 =shoulder ish Radial nerve c5-t1 = lateral side, all the way down posterior lay Musculocutaneous c5-c7 AS LATREAL ANTEBRACHIAL CUTANEOUS NERVE = mots of forearm anterior + new branches
74
Describe cutaneous innervation from brachial plexus = 2 new nerves from medial cord
Medial brachial cutaneous nerve - from medial cord c8-t1 Medial antebrachial cutaneous nerve - from medial cord c8-t1 = do medial sides ant and posterior
75
Brachial plexus injuries and cutaneous outcomes - set up
Spinal nerves from c5-t1 = contribute to all peripheral nerves of upper limb Each spinal nerve = innervates specific region of skin =dermatome, does not align with cutaneous - sensory areas of individual peripheral nerves
76
Brachial plexus injuries and cutaneous outcomes - ex
median nerve (C6-T1) injury will lead to loss of sensation in palm of hand and lateral digit tips, while injury to C6 root has more widespread loss of sensation overlapping musculocutaneous n. (C5-C6- C7), median n. (C6-T1 – esp. thumb area), axillary n. (C5-C6), and radial n. (C5-T1)
77
Brachial plexus injuries and motor outcomes - set up
Each spinal levele contributes to innervation of a specific group of muscles = myotome Brachial plexus injuries will have diff outcomes if Inury in peripheral or spinal nerve root
78
Brachial plexus injuries and motor outcomes - ex
injury to musculocutaneous n. (C5-C7) impairs elbow flexion (biceps brachii, brachialis) and to lesser extent, shoulder flexion (biceps brachii, coracobrachialis), while injury to C5 root impairs not only these motions (because C5 contributes to musculocutaneous n.), but also shoulder abduction and lateral rotation (suprascapular n. (C5-C6) to supraspinatus, axillary n. (C5-C6) to lateral deltoid)
79
Describe how medial and lateral pectoral nerves look
Get their names from their cords Not relative anatomical positions on pectoral muscles = Medial pectoral nerv looks more lateral than lateral pectoral nerve (on pectoralis minor)
80
Ulnar nerve sensory hand innervation
Posteromedial hand C8-t1 Medial wrist, medial 1.5 digits anteriorly
81
median nerve sensory hand innervation
C6-t1 Lateral wrist, lateral 3.5 digits and tips digits 2-4

ANAT 314 (27 decks)

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