Axilla.txt

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emm64
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104638
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Axilla.txt
Updated:
2011-09-27 12:35:38
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axilla
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axilla posterior triangle
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  1. Brachial Plexus
    • 1. 5 roots
    • a. (C5-T1 ventral rami)
    • 2. 3 trunks
    • a. upper (superior)
    • b. middle
    • c. lower (inferior)
    • 3. 6 divisions
    • a. 3 anterior (to flexors)
    • b. 3 posterior (to extensors)
    • 4. 3 cords
    • a. lateral
    • b. posterior
    • c. medial
    • 5. 5 terminal brs
    • a. axillary n. (post. cord; C5-C6)
    • b. radial n. (post. cord; C5-T1)
    • c. musculocutaneous n. (lat. cord; C5-C7)
    • d. ulnar n. (med. cord; C8-T1)
    • e. median n. (med. & lat. cord; C5-T1)
  2. Non-Terminal Branches
    • 1. roots
    • a. long thoracic n. (serratus anterior)
    • b. dorsal scapular n. (lev. scapulae, rhomboids)
    • 2. upper trunk
    • a. suprascapular n. (supraspinatus, infraspinatus)
    • b. n. to subclavius (subclavius)
    • 3. medial cord
    • a. med. pectoral n. (pec. minor, pec. major)
    • b. med. brachial cutaneous n. (sensory to medial side of arm)
    • c. med. antebrachial cutaneous n. (sensory to medial side of forearm)
    • 4. lateral cord
    • a. lat. pectoral n. (pec. major)
    • 5. posterior cord
    • a. upper subscapular n. (subscapularis)
    • b. thoracodorsal n. (lat. dorsi)
    • c. lower subscapular n. (subscapularis, teres major)
  3. axillary nerve
    • innervates the deltoid & teres minor.
    • Deltoid-flexion, abduction, extension, medial & lateral rotation of humerus at the shoulder joint.
    • Teres Minor-lateral rotation of humerus at the shoulder joint.
  4. long thoracic nerve
    innervates the serratus anterior protraction & stabilization of scapula
  5. dorsal scapular nerve
    innervates the rhomboids(retract & inferiorly rotate scapula) & levator scapulae (elevates scapula).
  6. nerve to subclavius
    innervates the subclavius depresses & stabilizes clavicle
  7. suprascapular nerve
    innervates the supraspinatus initiates abduction of humerus at shoulder joint; also some lateral rotation & infraspinatus lateral rotation of humerus at shoulder joint
  8. medial pectoral nerve
    • pectoralis major adducts & medially rotates arm; also some flexion at shoulder joint
    • pec. minor. protracts & stabilizes scapula; can also elevate ribs 3-5
    • pierces belly of pec. minor
  9. lateral pectoral nerve
    • pectoralis major adducts & medially rotates arm at shoulder joint; also does some flexion at shoulder joint
    • goes around medial border of pec. minor
  10. thoracodorsal nerve
    latissimus dorsi extends, adducts, & medially rotates arm at shoulder joint
  11. lower subscapular nerve
    • innervates
    • subscapularis-medially rotates & adducts arm at shoulder joint
    • teres major-medially rotates & adducts arm at shoulder joint
  12. upper subscapular nerve
    innervates the subscapularis medially rotates & adducts arm at shoulder joint
  13. musculocutaneous nerve
    • innervates the muscles of the anterior compartment of the arm. These are the biceps, brachialis, and coracobrachialis (BBC) which are flexors of the arm at the shoulder (biceps and coracobrachialis) and elbow (biceps and brachialis).
  14. median nerve
    • will supply most of the muscles in the flexor compartment of the forearm (except 1 1/2 muscles) and muscles in 1 1/2 compartments of the hand. In general, these muscles will pronate the forearm, flex the wrist and fingers, and move the thumb (abduction, flexion, opposition).
  15. ulnar nerve
    • will supply 1 1/2 muscles in the flexor compartment of the forearm and most of the muscles in the hand (except for 1 1/2 compartments). In general, these muscles will flex the wrist and move the fingers (abduction, adduction of medial 4 fingers; flexion, abduction, opposition of 5th finger).
  16. radial nerve
    • will supply the posterior (extensor) compartment muscles of the arm and forearm. It is thus responsible for extension at the shoulder, elbow, and wrist
  17. Wrist Drop (�Saturday Night Palsy�)
    results from loss of the radial nerve. The radial nerve is known as the �great extensor nerve.� It innervates the posterior compartments of the arm and forearm which contain extensor muscles. The symptoms resulting from the loss of this nerve depends on how high the lesion is. If the injury occurs in the axilla, then the triceps will be affected and extension at the elbow will be lost in addition to extension at the wrist and fingers (at MP joints). If the injury is lower (in the arm), the wrist drop and loss of finger extension (at MP joints) will result.
  18. Winged Scapula
    will result from a lesion of the long thoracic nerve (arising from C5-C7 roots) which innervates the serratus anterior. The serratus anterior protracts and stabilizes the scapula (by holding it against the thoracic wall). Loss of the long thoracic nerve and serratus anterior will cause the scapula to �wing� when a patient presses his/her arms against a wall.
  19. Axillary Nerve Lesion
    will result in the paralysis of the deltoid and teres minor muscles.
  20. The Axilla Boundaries
    • 1. apex
    • 2. medial wall � lateral bony thorax & serratus anterior
    • 3. anterior wall � pec. major & minor, subclavius, and clavicle
    • 4. lateral wall � bicipital (intertubercular) groove of humerus
    • 5. posterior wall � scapula, subscapularis, teres major, latissimus dorsi
    • 6. base � skin & superficial fascia
  21. Axilla Contents
    • 1. biceps long head tendon
    • 2. biceps short head tendon
    • 3. coracobrachialis m.
    • 4. brachial plexus (infraclavicular)
    • 5. axillary a.
    • 6. axillary v.
    • 7. axillary lymph nodes (5 groups)
    • Note: The axillary artery and brachial plexus are contained within a fascial sheath called the �axillary sheath� (not depicted). This sheath must be removed to visualize these structures
  22. Axillary lymph nodes
    Clinical Note: 75% of the lymph drainage of the breast is received by the axillary lymph nodes. This is important to understand in cases of breast cancer metastasis.
  23. The Axillary A., Parts & Branches �
    • The axillary artery originates from the subclavian artery at the 1st rib and ends at the inferior border of teres major to become the brachial artery. It is divided into 3 parts by the pec. minor.
    • 1. (medial to pec. min.)
    • a. supreme thoracic a.
    • 2. (deep to pec. min.)
    • a. thoracoacromial tr.
    • b. lateral thoracic a.
    • 3. (lat. to pec. min.)
    • a. ant. circumflex humeral a.
    • b. post. circumflex humeral a.
    • c. subscapular a.
    • the lateral thoracic artery & thoracoacromial artery (pectoral branch) form part of the blood supply to the breast (along with the internal thoracic artery and
  24. BP divivisions
    • 1. anterior divisions of the brachial plexus form the musculocutaneous, median, and ulnar ns which innervate the flexor muscles of the arm and forearm
    • 2. posterior divisions of the brachial plexus form the radial n which innervates the extensor muscles of the arm and forearm and the axillary n. which innervates some of the shoulder muscles (deltoid and teres minor)
  25. I. Posterior Triangle of Neck boundaries are
    SCM, trapezius, clavicle
  26. Posterior Triangle roof and floor
    • investing fascia (of the cervical fascia)
    • 1. cutaneous brs. of the cervical plexus
    • a. transverse cervical n. (C2, C3)
    • b. great auricular n. (C2, C3)
    • c. lesser occipital n. (C2)
    • d. supraclavicular ns. (C3, C4)
    • muscular floor
    • 1. splenius capitis
    • 2. levator scapulae
    • 3. posterior scalene
    • 4. middle scalene
    • 5. anterior scalene
  27. supraclavicular brachial plexus (roots and trunks)
    • between the anterior & middle scalene muscles
    • superior to subclavian artery
    • courses over 1st rib
  28. subclavian artery
    • between the anterior & middle scalene muscles
    • inferior to brachial plexus (supraclavicular part)
    • courses over 1st rib
    • ends at inferior margin of 1st rib to become axillary artery
  29. phrenic nerve
    • is a component of the cervical plexus (C1-C4 ventral rami somatic plexus)
    • innervates the diaphragm (major muscle of respiration)
    • courses inferiorly on anterior surface of anterior scalene
  30. suprascapular artery
    • originates from thyrocervical trunk of subclavian artery (1st part)
    • courses posteriorly across floor of posterior triangle, deep to clavicle, to shoulder region to supply supraspinatus & infraspinatus
  31. transverse cervical artery
    • originates from thyrocervical trunk of subclavian artery (1st part)
    • courses posteriorly across floor of posterior triangle, superior to suprascapular artery to deep surface of trapezius (to supply it).
  32. accessory nerve (spinal part)
    • innervates the sternocleidomastoid (SCM) and trapezius
    • travels posteroinferiorly across the levator scapulae, then deep to trapezius to innervate it.
  33. scalene muscles
    • there are 3 scalene muscles (anterior, middle, and posterior)
    • the anterior & middle scalene attach from transverse processes of cervical
    • vertebrae to the 1st rib.
    • they laterally flex the neck and act as accessory muscles of respiration
  34. Post Triangle Borders (img)
  35. Post Triangle Detail (img)
  36. thoracoacromial artery
    • goes around medial border of pec. minor
    • is related to the superior margin of pec. minor. It has pectoral, deltoid, acromial, and clavicular branches
  37. lateral thoracic a.
    runs along the lateral border of pec. minor. It supplies the breast.
  38. 3rd Part of Axillary A
    • Lateral to the pec. minor and has 3 branches.
    • 1. anterior circumflex humeral artery goes lateral and anterior to the neck of the humerus.
    • 2. posterior circumflex humeral artery goes lateral and posterior to the humerus. These two will anastomose.
    • 3. subscapular artery goes medial and quickly divides into the circumflex scapular and thoracodorsal arteries.
  39. 1st Part of Axillary A
    • Medial to the pec. minor.
    • It has 1 branch called the supreme thoracic artery which supplies the 1st intercostal space.
  40. 2nd part of the axillary artery
    • DEEP to pec. minor and has 2 branches
    • thoraco-acromial artery is related to the superior margin of pec. minor. It has pectoral, deltoid, acromial, and clavicular branches.
    • lateral thoracic a. runs along the lateral border of pec. minor. It supplies the breast.
  41. sternocleido-mastoid
    • Attachments: medial portion of theclavicle,mastoid process of the temporal bone
    • Innervation: accessory nerves
    • Actions : Acting alone, tilts head to its own side and rotates it so the face is turned towards the opposite side.
    • Acting together, flexes the neck, raises the sternum and assists in forced inspiration.

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