Axillary Region/Brachial Plexus/Shoulder Joints

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Omidancer1
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144075
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Axillary Region/Brachial Plexus/Shoulder Joints
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2012-04-04 20:40:56
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Axillary Region Brachial Plexus Shoulder Joints
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Axillary Region/Brachial Plexus/Shoulder Joints
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  1. Borders of Axilla
    • Inferior: skin and fat
    • Superior: space between 1st rib and clavicle
    • Anterior: pectoralis major and minor
    • Posterior: subscapularis, teres major, latissimus dorsi
    • Medial: serratus anterior
    • Lateral: humerus
  2. Contents of Axilla
    • Axillary artery and vein
    • Cords of brachial plexus surround artery
    • Axillary sheath (axillary artery, vein, and brachial plexus cords)
    • Lymph nodes
  3. Brachial Plexus
    • Rules of 5:
    • -5 spinal roots:
    • -trunks emerge between anterior and middle scalenes
    • -C5 is highest
    • -5 segments: Roots, Trunks, Divisions, Cords, Branches
    • -5 terminal branches: Musculocutaneous, Axillary, Radial, Median, Ulnar

    • Roots and trunks are supraclavicular
    • Divisions are retroclavicular
    • Cords and terminal branches are infraclavicular
  4. Terminal branch supply (general)
    • Musculocutaneous (C5–C7): anterior arm (in general) – pierces coracobrachialis m.
    • Axillary (C5–C6): Deltoids, teres minor
    • Median (C5-T1): Majority of anterior forearm and thenar eminence (bulge below thumb)
    • Ulnar (C7-T1): a couple of muscles in medial forearm; medial muscles of hand
    • Radial (C5-T1): posterior brachium and posterio forearm muscles
  5. Dorsal Scapular n.
    • C4–C5
    • Comes off roots of brachial plexus
    • Innervates: rhomboids, levator scapulae
  6. Long Thoracic n.
    • C5–C7
    • comes off roots
    • Innervates: serratus anterior
  7. Suprascapular n.
    • C5–C6
    • Comes off superior trunk
    • Innervates: supraspinatus, infraspinatus
  8. Lateral Pectoral n.
    • C5–C7
    • Comes off lateral cord
    • Innervates: pectoralis major - clavicular head
  9. Medial Pectoral n.
    • C8–T1
    • Comes off medial cord
    • Innervates: pectoralis minor, pectoralis major - sternoclavicular head
  10. Medial Antebrachial cutaneous
    • C8–T1
    • Comes off medial cord
    • Innervates: skin of medial forearm
  11. Medial Brachial Cutaneous
    • C8–T1
    • Comes off medial cors
    • Innervates: skin of medial arm
  12. Thoracodorsal n.
    • C6–C8
    • Comes off posterior cord
    • Innervates: Latissimus dorsi
  13. Upper subscapular n.
    • C5–C7
    • Comes off posterior cord
    • Innervates: subscapularis
  14. Lower subscapular n.
    • C5–C6
    • Comes off posterior cord
    • Innervates: subscapularis, teres major
  15. Dermatomes
    • C2: back of head
    • C3: upper neck
    • C4: lower neck and shoulders
    • C5: over deltoid region
    • C6: thumb
    • C7: middle finger
    • C8: pinky finger
    • T1: medial antebrachium
    • T2: upper medial brachium
    • T4: nipple line
    • T10: umbilical
  16. Peripheral Innervation
    • Axillary: Deltoid region (lower)
    • Medial Brachial Cutaneous: Upper medial brachium
    • Medial Antebrachial Cutaneous: Medial antebrachium
    • Ulnar: lateral hand and 1.5 digits
    • Supraclavicular: top of shoulder
    • Radial: Posterior brachium, posterior lateral 2/3 of hand but not finger tips
    • Median: palmar lateral 2/3 of hand
    • Musculocutaneous: lateral antebrachium
  17. Clavicular orientation
    lateral end 20 degrees posterior and 15 degrees superior to medial end
  18. Scapular Plane
    35 degrees anterior off frontal plane
  19. Sternoclavicular Joint
    • Only bone-to-bone connection of UE to axillary skeleton
    • Saddle Joint
    • Convex superior to inferior
    • Concave anterior to posterior
    • Articular disk – allows clavicle to spin
    • Ligaments: anterior and posterior sternoclavicular; interclavicular; costoclavicular
    • Movements: elevation; depression; forward and backward for protraction and retraction; posterior rotation/spin of 30 degrees
  20. Acromioclavicular Joint
    • Plane joint
    • Usually, line of joint is posteromedial about 30 degrees
    • Ligaments: coracoacromial; coracoclavicular – conoid; trapezoid
    • Movements: internal (scapular protraction) and external (scapular retraction) rotation; upward and downward rotation; tilting forward and backward
  21. Scapulothoracic Joint
    • Not a true joint - plane
    • several bursas lie between scapula and thorax
    • Motions: protraction, retraction, anterior and posterior tilting, upward and downward rotation
  22. Glenohumeral Joint
    • Ball and Socket
    • Motions: sliding, gliding, rolling
    • Rotator cuff interval: space between subscapularis and supraspinatus
    • Ligaments: Superior (prevents: ADDuctions, inferior translation, posterior translation), middle (ER at 45 degrees, ABduction, anterior translation) inferior (ER – anterior band – and IR – posterior band) above 45 degrees, ABduction, )
    • GH ligs;
  23. Scapulohumeral Rhythm
    For every 3 degrees of humeral elevation, there is 1 degree of scapular motion (scapulothoracic joint) and 2 degrees of humerus on the scapula (GH joint)
  24. Suprascapular Artery
    • Comes off thyrocervical trunk off subclavian artery
    • Goes under clavicle, above scapula, and through suprascapular notch (below superior transverse scapular ligament)
    • Supplies: supraspinatus, infraspinatus
  25. Superior Thoracic a.
    • Branch off of 1st part of axillary artery
    • Supplies: intercostals; superior part of serratus anterior; overlying pectoral muscles
  26. Thoracoacromial a.
    • Divides into 4 major arteries: acromial, clavicular, pectoral, deltoid
    • 1st branch off 2nd part of axillary a.
  27. Lateral Thoracic a.
    • 2nd branch off 2nd part of axillary a.
    • Supplies: pectoral, serratus anterior, and intercostal muscles
  28. Subscapular a.
    • Largest branch off the 3rd part of the axillary artery
    • Divides into circumflex scapular artery; thoracodorsal artery
    • Circumflex scapular: anastomoses with spurascapular to supply scapula area
    • Thoracodorsal: supplies latissimus dorsi
  29. Anterior and Posterior Humeral Circumflex aa.
    • Branch(es) off 3rd part of axillary artery opposite subscapular a.
    • Sometime have common turnk
    • Posterior passes through quadrangular space

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