Shoulder Breast Pec

Question 1

Where is the clavicopectoral fascia?

Answer 1

Deep to pec major (encloses subclavius m. and pectoralis minor m.

Question 2

What dermatome covers the level of the clavicles?

Answer 2

C5

Question 3

What dermatome covers the level of the nipples?

Answer 3

T4

Question 4

What dermatome covers the level of the umbilicus?

Answer 4

T10

Question 5

What are the mm. of the rotator cuff? What does it do?

Answer 5

SITS: Supraspinatus; Intraspinatus; Teres minor; Subscapularis
-Fixes humeral head in glenoid cavity during arm flexion and abduction

Question 6

Pectoralis major: innervation and actions?

Answer 6

• medial and lateral pectoral nerves

- flexes arm, adducts arm, rotates arm medially

Question 7

Pectoralis minor: innervation and actions?

Answer 7

• medial pectoral nerve

- lowers lateral angle of scapula, protracts scapula. elevates ribs if scapula fixed.

Question 8

Serratus anterior: innervation and actions?

Answer 8

• long thoracic nerve
• protracts and rotates scapula, holds it against T-wall (stabilization)
• Boxer’s muscle
• Supplied by lateral thoracic artery

Question 9

Deltoid: innervation and actions?

Answer 9

• axillary nerve
• clavicular part: flexes and medially rotates arm
• acromial part: abducts arm beyond initial 10-15 degrees up to 100 degrees (supraspinatus before, trapezius after)
• spinal part: extends and laterally rotates arm

Question 10

Supraspinatus: innervation and actions?

Answer 10

• suprascapular nerve

- initiates arm abduction (up to 10-15 degrees), acts w/rotator cuff mm. (doesn’t rotate the humerus)

Question 11

Infraspinatus: innervation and actions?

Answer 11

• suprascapular nerve

- lateral arm rotation (w/teres minor)

Question 12

Teres minor: innervation and actions?

Answer 12

• axillary nerve

- laterally rotates arm

Question 13

Subscapularis: innervation and actions?

Answer 13

• upper and lower subscapular nerves

- medially rotates arm, adducts arm, holds humeral head in glenoid cavity

Question 14

Which m. is most commonly torn in rotator cuff injuries?

Answer 14

Supraspinatus m.

Question 15

Teres major: innervation and actions?

Answer 15

• lower subscapular nerve

- adducts arm, medially rotates arm

Question 16

Latissimus dorsi: innervation and actions?

Answer 16

• thoracodorsal nerve
• extends, adducts, and medially rotates humerus at shoulder
• supplied by thoracodorsal artery

Question 17

Levator scapulae: innervation and actions?

Answer 17

• ventral rami of C3-C4, dorsal scapular nerve

- elevates scapula medially, inferiorly rotates glenoid cavity

Question 18

Rhomboid major: innervation and actions?

Answer 18

• dorsal scapular nerve

- fixes scapula to T-wall, retract and rotate scapula to depress glenoid cavity (drops shoulder)

Question 19

Rhomboid minor: innervation and actions?

Answer 19

• dorsal scapular nerve

- fixes scapula to T-wall, retracts and rotates scapula to depress glenoid cavity (drops shoulder)

Question 20

Arteriole anastomoses about the shoulder: subclavian –> axillary route

Answer 20

Subclavian a. –> suprascapular a. –> circumflex scapular a. –> subscapular a. –> axillary a.

• (suprascapular a. is in thyrocervical trunk of subclavian branch)
• (circumflex scapular a. is branch of subscapular a. from axillary branch)

Question 21

What is important about the suprascapular notch?

Answer 21

Suprascapular artery and nerve: army over, navy under (the ligament)

Question 22

Quadrandular space: what makes up its borders? What lies w/in it?

Answer 22

• teres minor, teres major, long head of triceps, humerus

- axillary n. + posterior humeral circumflex a.

Question 23

Triangular space: what makes up its borders? What lies w/in it?

Answer 23

• teres minor, teres major, long head of triceps

- circumflex scapular a.

Question 24

Triangular interval: what makes up its borders? What lies w/in it?

Answer 24

• teres major, long head of triceps, humerus

- deep (profunda) brachial a. and radial n.

Question 25

What nerve innervates all extensor mm. in the arm?

Answer 25

Radial nerve

Question 26

What defines the apex of the axilla?

Answer 26

1st rib, clavicle, superior edge of the scapular

Question 27

What defines the base of the axilla?

Answer 27

Concave skin, sub-Q tissue, axillary fascia (armpit)

Question 28

What defines the anterior wall of the axilla?

Answer 28

Pec major and minor mm., pectoral and clavipectoral fascia

Question 29

What defines the posterior wall of the axilla?

Answer 29

Scapula and subscapularis m.

Question 30

What defines the medial wall of the axilla?

Answer 30

T-wall, 1st-4th ribs (serratus anterior m. covers the ribs)

Question 31

What defines the lateral wall of the axilla?

Answer 31

Intertubercular groove of the humerus (plus coricobrachialis m.)

Question 32

Branches of the axillary artery:

Answer 32

Screw The Lawyer, Save A Patient 1. Superior thoracic a. 2. Thoracoacromial trunk 2. Lateral thoracic arteries 3. Subscapular a. 3. Anterior circumflex humeral a. 3. Posterior circumflex humeral a.

Question 33

What are the suspensory ligaments (of Cooper)?

Answer 33

Breast: attach lobes to skin & divide glandular tissue into lobes

Question 34

How many glands form a breast lobe? How many lactiferous ducts and sinuses are per gland? 80% of tumors originate where?

Answer 34

- 15-20 - 1 - Ducts

Question 35

What 3 arteries supply the breast?

Answer 35

Lateral thoracic a., thoracoacromial (pectoral) a., internal thoracic a.

Question 36

What are the 5 major lymph nodes of the breast?

Answer 36

CLASP | -central, lateral, apical, subscapular, and pectoral nodes

Question 37

What breast quadrant has by far the highest rate of cancer?

Answer 37

Superior lateral quadrant

Question 38

What does the pectoral fascia cover?

Answer 38

Covers pectoralis major

Question 39

What does axillary fascia cover?

Answer 39

It's a continuation of pectoral fascia laterally into the axilla

Question 40

What are the branches of the thoracoacromial trunk ("The" lawyer of the axillary a. branch)

Answer 40

ACDP | Acromial, Clavicular, Deltoid, Pectoral

Question 41

What are the branches of the subscapular artery ("Save" a patient of the axillary a. branch)

Answer 41

Circumflex scapular a. and thoracodorsal a.

Question 42

In the arteriole supply to the shoulder, what's a pathway where blood can bypass the axillary a.?

Answer 42

Subclavian a. --> suprascapular a. --> circumflex scapular a. --> subscapular a. --> axillary a. - (suprascapular a. is in thyrocervical trunk of subclavian branch) - (circumflex scapular a. is branch of subscapular a. from axillary branch)