The axilla and pectoral region Flashcards by Whitney Jennings

Osteology of the Pectoral Region

Clavicles
Sternum
Ribs
Scapula

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Parts of the sternum

Manubrium, body, and xiphoid

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“Atypical” ribs

1, 2, 11, and 12

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“True” ribs (vertebrocostal)

Ribs 1-7

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“False” ribs (vertebrochondral)

Ribs 8-10

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“Floating” ribs

Ribs 11 and 12

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Breasts

Bilateral glandular structures found in both males and females.

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What are mammary glands?

Modified sweat glands

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Where do breast rest?

Rest on pectoral fascia (above pectoralis major)

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Retromammary space

Potential space between breast and pectoral fascia

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Innervation of the Breast

Innervated by intercostal nerves (4th-6th)?

May also receive some innervation from supraclavicular nerve branches of other intercostal nerves

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How does the breast attach to the dermis of the overlying skin?

Suspensory ligaments (Cooper’s ligaments)

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Arterial Supply of the Breast

Mammary branches from anterior intercostal, lateral thoracic, and internal thoracic arteries.
Axillary and subclavian

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Venous Drainage of the Breast

Mainly to axillary vein via lateral thoracic veins and medial mammary veins
Some drainage to internal thoracic vein via anterior intercostal veins

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Why is lymphatic drainage of breast tissue important?

Due to its role in metastasis of cancer cells

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Lymphatic drainage of nipple, areola, lactiferous lobules

Subareolar lymph nodes

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What lymph nodes are responsible for more than 75% of lymph from breast?

Axillary lymph nodes (pectoral, central, apical)

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Fascia of the pectoral region

Clavipectoral fascia (Pectoralis minor)
Axillary fascia 
Pectoral fascia (Pectoralis major)

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Superficial fascia

Platysma
Supraclavicular nerves
Anterior and lateral branches of intercostal nerves

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Components of the Deltopectoral (clavipectoral) triangle

Deltoid, pectoralis major, middle 1/3 of clavicle (Make up borders)
Cephalic vein
Deltopectoral lymph nodes
Deltoid branch of thoracoacromial a. (from axillary a.)

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Clavipectoral fascia invests..

Subclavius and pectoralis minor

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Clavipectoral Fascia attaches to

the clavicle and anterior thoracic wall

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What pierce the clavipectoral fascia?

Cephalic vein, thoracoacrimial artery, and lateral pectoral nerves

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What does the clavipectoral fascia become?

Becomes suspensory ligament of axilla

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Innervation of the muscles of the pectoral region

Innervated by the ventral rami of spinal nerves via branches of the brachial plexus

Proximal attachment of pectoralis major

Claviclular and sternocostal attachments Ant. surface of medial 1/2 of clavicle Ant. surface of sternum and superior 6 costal cartilages

Distal attachment of pectorallis major

Lateral lip of intertubercular sulcus (bicipital groove)

Actions of pectoralis major

Adducts and medial rotates humerus Draws scapula anteriorly and inferiorly (via clavicle) Clavicular portion flexes humerus Sternal portion can extend humerus while it is in this flexed position

Innervation of pectoralis major

Lateral and medial pectoral nerves (C5, C6 clavicular portion; C7, C8, T1 sternocostal portion)

Proximal attachment of pectoralis minor

3rd - 5th ribs, near costal cartilage

Distal attachment of pectoralis minor

Coracoid process of scapula

Actions of pectoralis minor

Stabilizes scapula by pulling it anteriorly & inferiorly against posterior thoracic wall

Blood supply of pectoralis minor

Pectoral branch(es) of thoracoacromial arterial trunk

Innervation of pectoralis minor

Medial pectoral nerve (C8, T1)

Proximal attachment of subclavius

Junction of 1st rib and its costal cartilage

Distal attachment of subclavius

Inferior surface of middle 1/3 of clavicle

Actions of subclavius

Anchors and depresses clavicle

Blood supply of subclavius

Clavicular branch(es) of thoracoacromial arterial trunk

Innervation of subclavius

"Nerve to subclavius" (C5, C6)

Proximal attachment of Serratus Anterior

External surfaces of later parts of ribs 1-9

Distal attachment of Serratus Anterior

Anterior surface of medial border of scapula

Actions of Serratus Anterior

Protracts scapula, rotates scapula, holds scapula against thorax

Blood supply of Serratus Anterior

Lateral thoracic artery

Innervation of Serratus Anterior

Long thoracic nerve (C5, C6, C7)

The 2 large named arteries that have tributaries that provide blood to the pectoral, shoulder, and axillary regions

Subclavian artery and Axillary artery

Origin of subclavian artery

Right: brachiocephalic trunk Left: aortic arch

Where does the subclavian artery arise?

Posterior to sternoclavicular joint

Where is Part 1 of the subclavian artery in relation to anterior scalene muscle?

Medial to the anterior scalene muscle

Where is Part 2 of the subclavian artery in relation to anterior scalene muscle?

Posterior to the anterior scalene muscle

Where is Part 3 of the subclavian artery in relation to anterior scalene muscle?

Lateral to the anterior scalene muscle

Commonly found branches of the medial part (1) of the subclavian artery:

1. Internal thoracic (mammary) a. 2. Vertebral a. 3. Thyrocervical arterial trunk

Thyrocervical Arterial Trunk

1. Transverse Cervical Artery (See slide 36) 2. Inferior Thyroid Artery 3. Ascending Cervical Artery 4. Suprascapular Artery

Commonly found branches of the posterior part (2) of the subclavian artery:

Costocervical arterial trunk: supreme intercostal artery and deep cervical artery

What may arise from the lateral part (3) of the subclavian artery?

Dorsal scapular artery

Where does the subclavian artery become the axillary artery?

Lateral border of first rib

Name the two places that the dorsal scapular artery can arise from

Subclavian artery (usually the 3rd) or from the transverse cervical artery (about 30% of the time and called "deep branch the transverse cervical artery"

What supplies the pectoral region and axilla?

The axillary artery and its branches

Part 1 of the Axillary Artery

Superior Thoracic Artery

Part 2 of the Axillary Artery

Thoracoacromial trunk

Branches of the thoracoacromial trunk

Pectoral branch Deltoid branch Acromial branch Clavicular branch

Part 3 of the Axillary Artery

Subscapular artery (circumflex scapular and thoracodorsal) Anterior circumflex humeral Posterior circumflex humeral

Scapular Anastomoses Components:

``` Suprascapular artery Dorsal scapular artery Posterior intercostal arteries Circumflex scapular artery Thoracodorsal artery ```

The pectoral and axillary regions are drained by the:

Axillary vein

The axillary vein receives blood from the:

Superficial and deep veins of the arm and forearm

Superficial veins of arm and forearm:

``` Basilic veins (continues as the axillary vein) Cephalic vein (drains into axillary before it becomes subclavian vein) ```

Boundaries of the Axilla

``` Apex Base (A and P axillary folds) Anterior wall Posterior wall Medial wall Lateral wall ```

Apex of the Axilla:

Clavicle Scapula 1st Rib

Base of Axilla:

Skin and superficial fascia Anterior axillary fold: pectoralis major Posterior axillary fold: latissimus dorsi and teres major Chest wall: Serratus anterior

Anterior wall of Axilla:

Clavicle Subclavius Pectoralis major Pectoralis minor

Posterior wall of Axilla:

Scapula Subscapularis Latissimus dorsi Teres major

Lateral structures of Axilla:

``` Intertubercular sulcus (bicipital groove) Tendon of long head of biceps Coracobrachialis tendon ```

Axillary Sheath:

1. Axillary vein 2. Axillary artery 3. Brachial plexus

The axilla and pectoral region Flashcards

(72 cards)