upper limb Flashcards
Explain the Subclavian region, DF, landmarks , limits ,Projection, layers , Neuromuscular fascia , Communications , Access
—DF: its belongs to both Thorax and upper limb , since it has layers of subclavian region take a part of forming Axillary fossa / neurovascular fascial in upper arm
—landmarks :
1-clavicle
2-Sternum
3-Pectorals Mj m.
4-Ant. border of Deltoid m.
NB! between the clavicular portion of pectorals mj m. and Ant. border of deltoid pectorlis interclavecular fossa is located ,> and distally Deltopectoral sulcus is located about 1.5-2 cm deeply beneeth the clavicle and its passable to palpate to corcoid process of scapula
—Limits :
1- Superiorly : calvical
2-inf: horizontal line corresponding to 3rd intercostal space
3-latrally: ant,border of deltoid
4- medially : lateral border of sternum
—Projection : from Ant.Ends of 3-5 ribs up to coracoid process and pectorals minor
1-claviupectorl triangle
2-pectoral triangle ( nerovascular fiscial)
3-sub-pectoral triangle ( axillary fossa )
—layers :
1-skin : thin and moderately movable
2-subcoutenous adipose tissue : has no special varieties , from cervical plexus > supra clavicular nerve pass though it
3-superficial fascia :
3-1 upper 3rd forms capsule for platysma (subcoutenous muscles of the neck) which origin from pectoral facia
3-2 in the level of 2nd -3rd ribs its thickening and form sesponsry liquid for mammary glands
4-proper facia : its surrounding the pectoral mj m. from front and back and between superficial and deep lamina divided fibers of the muscles pectorals mj m. into numerous fascial bridles > clavicular,sternocostal , abdominal
5-sub-pectoral cellular space : its between pectorals mj and minor
5.1 superiorly : space enclosed at clavicle where is both fascia unite sup and inf
5.2 Anteriorly : deep fascia of pectorals mj
5.3 Post : calviupectoralis fascia which is covering pectorals mj
5.4 latrally inf : enclosed space by the union of the fascia of pectorals mj and calvipectoralis fascia along the lateral border of pectorlis mj
6- Calvipectoralis fascia :
6.1- sup : begins from clavicle and carcoid process
6.2-medially : begins from pectorals minor at level of 3-5th ribs
6.3- infalaterally: Attached to deep lamina of fascia of pectorals mj m. >NB! thickness of this fascia form a ligament attach to axillary fascia
7-cellular layer of upper part of axillary fossa : in which passes the main NVF>axillary vessels, Brachial Plexus,br of deep subpectoral space
8-thoracic proper fascia: which covers serratus Ant and intercostal spaces
NB! pectoral and calvipectoral fascia fixed in infsurface of clavicle
—NVF:
1-Subclavian Fascicles : axillary vein goes upwards and passes under the superior border of pectorals minor and goes obliquely till point located 2,5cm inward from middle if clavicle so its called subclavian vein
2-Axillary artery : located laterally and deeper of the vein , then branches splitting through claviopectoral fascia >
2.1 Thoracic acromal : supply deltoid , pectoral , Acromial
2.2 Thoracic sup : goes to 1 and 2nd rib and there intercostal space
3-Cephalic v : passes through Fascia from Deltopectoral sulcus into axillary fossa , and runs into axillary vein
4-Brachial plexus fasicles : located more laterally and deeper to artery together with axillary Ar and V
5-group of lymphnodes : located at medial border of axillary v
NB! all these limit by Calvipectoral triangle which located between calvical and Sup border of pectoral minor
-Communication:
1-ThoracicAcromial to Axillary fossa
2-neurovascular bundle to lateral triangle of neck
-Access :
1-Brachial plexus: incision in sup post margin of Sternoclodimastoid M. downward obliquely to mid point of clavical and contenud along the Ant surface of clavicle laterally until reaches Deltopectoral sulcus
explain the axillary region and axillary fossa , land marks , limits, projection , layers ,axillary fossa, boundaries of trilateral and quodraltral , NVF
—land marks :
1-latsmuss doris
2-Coraco brochialis
3-pectoral Mj m.
—limits:
1-Ant: lower border of pectorlis Mj
2-post: lower border of latsmus doris
3-medial: line joins both of borders along the 3rd rib on thoracic wall
4-lateral : line join the borders of same muscles but on meddel surface of the arm
—projection :
1-Nerouvascular bundle: contains Axillary A.V. and brachial plexus and some branches of them > located in line drawn from medial surface of the arm between Ant. and middle third of lateral limit of the region up to 1 cm inward from middle clavicle
—layers :
1-skin : thin and covered by hair , contain large numbers of sweat gland , which may result of inflammation
2-subcotenous : its poor and located between the layers of superficial and lamina contain > coutenous branches of nerves of the arms and superfasical lymph-nodes
3-superfascial : is feeble
4-proper fascia : its thin in the center of the region , narrow intersinc can be seen in it , through which circulatory , lymphatic vessels and nerves br ,
-At the borders : skin is more thick and goes with >
4-1 anteriorly with pectoralis fossa
4-2 posterioy in thoracolumber fascia
4-3 laterally in branches fascia
4-4 medially in proper thoracic fascia
all these borders forming
5- cellular space : its located under axillary fascia here lies adipos tissue with considerable amount of nuero vascular bundle and some group of lymphnodes
—Axillary fossa :
1-base : located in the axillary fasica
2-apex : between meddle of clavical and 1st rib
3-Ant : claviupectoral fasica
4-Post : subscapular fascia
5-medial : thoracic fascia
6-lateral : brachial fascia
—Bounderis of Trilateral and quodralateral :
-Trilateral :
1-sup: inf border of subscapularia
2-inf: tares mj and sup border of latsimus drosi
3-lateral : tendon of long head of triceps
-quadralteral :
1-sup: inf border of supscapularis
2-inf: sup border of latsimus dorsi
3-lateral: surgical neck of humerus
4-medial: tendon of long head of triceps
—Neorivascular bundle :
1-axillary Ar: its continuation of subclavian Ar right below the clavicle and its the main Ar of the upper limb , it give 3 main branches in triangle
1-pectoral triangle : medially , there is axillary V. and lympnodes and bundle of medial lateral post cord of brachial plexus , while lateral thoracic Ar. goes to the medial wall of Axillary fossa
2- Sub-pectoral triangle : here the bundle of brachial plexus divided into several large nerves
explain the Scapular region , land marks , limits , projection , layers , communations
—land marks :
1-medial angle :1 rib
2-Superior border : 2 rib
3- spine : 3rd rib
4-inf angle : 8th rib
—limits :
1- sup : line drawn from Acromoclavicular joint perpendicular to 1st Cervical vertebrae
2-inf : horizontal line goes through the inf angle
3-medial : along the medial border up and down to cross of sup. and inf limit
4-lateral : from the end of Acromin down vertically to inf limit
—projection :
1-supra-scapular Ar,N : projected in line goes from middle of the calvical to the point crossponidng to base of acromion
2- Profundus Ar and transvers cervical Ar: projected lime goes along the medial of scapula about 1cn inward between middle and lateral thirds of spine
3-Cicomflix Scapula Ar: whens enters infa spinous compartment projected line upon middle of projection line of lateral border of scapula
—layers :
1-skin : thick and slightly movable
2-subcotenous : has no layer , only dens and cellular bcs connective tissue septa , which goes from skin to proper fasica
3-superfasical : consist of several lamina with diffraction densty hardly presentand contain branches of axillary n and suprcalvicul
4-properfasica : capsule of muscles trapzus , deltoid , latsmus dorsi
5-supra spinata and infra spinata fascia : proper fascia of deep muscles they origin from post surface of scapula , and as result they form supra and infra spinatous compartment
6-subscapular space : formed in Ant. side of scapula in osteo fascial borders it goes as right tendon to sub deltoid
—Communication :
1-Supra scapular fascia to lateral triangle of neck
2-Circumflex scapular Ar.V to axillary fossa through trilateral foramen
3-tendons to sub deltoid space
explain the Deltoid , Df, landmarks , limits , projection,layers , NVB , communications
—DF: the region is located outward from scapular one and corresponding to deltoid muscle that covers the shoulder joint and upper third of humerus
—landmarks:
1-clavicle
2-spina of scapula
3-deltopectoral sulcus
4-Acromion
5-Deltoid eminince with Ant and Post border
—limits :
1-superior: lateral 3rd of clavicle and spine and acromion
2-inferior: line in external surface of arm connect inf border of pectorals mj m.
3-Ant and post : Corrsponding to borders of deltoid M.
— Projection:
1-Cephalic V. : goes along the deltopectoral sulcus
2-Circumflix humerus Ant.Post/ axillary nerve: projected in neurovascular fasicles of the region , located downward in vertical line from postExterior angle of acromion up to cross with Post border of deltoid m.
3-Recesses Axillary : identified by a point located on same vertical line but 4 cm under post angle of acromion and 2cm above projaction of axillary nerve
—layer :
1-Skin: thick and slightly movable
2-Subcoutnous : solid, especially near the post,sup border of the region
3-superfascial : its feeble
4-properfascia : its tightly limited superiorly with calvical acromion and spine in Ant and inf goes to pectoral and brachia fascia , it has superfasica and deep lamina
5-sub deltoid cellular space : its located between deep lamina and properfascia and proximal end of humerus with the shoulder joint and its capsule
—NVB:
1-Axillary main element: its innervate the deltoid and fasicle sheeth of it and its connected with deep lamina of proper fascia , Coming from axillary fossa through the qudralateral Forman and adjoin the axillary recess of capsule if shoulder joint and then circumflex then to surgical neck of humerus from post to front and lies proximal to post circumflex
—Communications :
1-Subdeltoid space to axillary fossa through qudralteral formen
2-Along the side of tendon to supraspinal and subspinal space
3-under the acromion to sub trapezoid space
explain the Ant arm region , Landmarks,limits,projections,layers,
communications ,
—landmarks :
1-deltoid
2-bicepis brochi
3-triceps brochai
4-pectoralis major
5-latsimus dorsi
6-medial and lateral epicondyle of heumerus
7-greater tubercle of humerus
8-dletopectoralis sulcus
9-inter tubrecal or biseptal groove medial and lateral
—limits:
1-sup : horezintal line between point of attachment of pectoralis mj and latsmus dorsi
2-inf : imaginary line drown with 2 fingers above later and medial epicondyl of heumerus
3-medial and lateral : vertical line drown on medial and lateral epicondyle
—projections :
1-Brachial A. And median N. : they pass from the border line of sup.limits in Ant and middle 3rd if line up to the middle of elbow region exactly 1 cm medially from tendon of biceps in biceptal sulucs
2-ulnar N. : in upper 3rd of arm , behind the neorovascular fascle by 1 cn medially at the base of medial epicondyle
3-Radial N. : projected upon the skin in post of the arm along side of the lateral sulcus
—layers :
1-skin : lateral side its thicker then medial side , slightly movable
2-subcoutenous : its feeble and contain cephalic and bisalic Veins at lateral and median margins of biceps brochai
3-superfasical : it form a sheeth for superfacial veins and nerves € cephalic,basilic , Antlateral coutenous Br
4-properfascia : its covers the Enter arm
4.1 its forms 2 septa which connected to humerus , normally lateral and medial intermasuclar septa
4.2 they divided the brachial region into Ant>flexor , Post>Estenosor part
4.3 medial septa is precede by ulnar N and sup ulnar cellular Ar
4,4 lateral septum is preced bu radial N and Ant descending Br of deep bronchial Ar
—Communication :
1-NVB to axillary fossa and Ant region of elbow
2-radial N to post arm
3-Pregioff canal to adipos tissue
explain the Post Region of the Arm , landmarks , limits , projection , layers , NVB , humomascular canal , communactions
—land marks and limits the same of Ant region of Arm
—projections :
1-radial N: redial N corresponds to the spiral line drown from lower border of the latsmus dorsi up to the point located in the infralateral limit of this region
—layers :
1-skin : thick abs will connected with subcouteouns tissue and slightly movable
2-subcoutnoues : passes through it supralateral brochial coutenous > axillary N , infra lateral brochial coutenous N , post brochial coutenous > radial N
3-superfacial : feeble
4-properfasica : its covers the triceps and its tendon , long head can be identified from medial side
—NVB
1- brochial A : passes from axillary fossa to mid point between medial epicondyle and tendon of biceps brachio m.
2-Ulnar N: in the 3rd of Arm
3-radial N: mid 3rd of the arm
4-median N : sup and middile and inf 3rd of the arm incsion of 8-10 cm along the median line of arm
— humomascular canal; boundaries :
- bounded by tricpes brochai and humerus and contain : radial. and deep bronchial A. and V.
—Communication:
1- radial to Ant compartment ( proximally above the fossa axillreis and distally under the cubital fossa )
