Pectoral Breast, Scapular Regions, Brachial Plexus

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Pectoral Breast, Scapular Regions, Brachial Plexus
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2015-11-26 08:09:32
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Pectoral Breast, Scapular Regions, Brachial Plexus
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  1. Acromioclavicular Joint articulates
    Between the acromial facet of clavicle & the acromion process of scapula
  2. The Integrity of the Acromioclavicular joint is primarily maintained by
    Extrinsic ligaments
  3. How many ligaments make up the Coracoclavicular lig
    Two
  4. An Acromioclavicular Joint Dislocation has what clinical implications
    • • Joint may dislocate with or without coracoclavicular lig. rupture
    • • If ligament ruptures:
    • - Shoulder falls inferiorly (from weight of upper limb)
    • - May tear fibrous layer of joint capsule
    • - Acromion becomes more prominent (projecting) Lateral clavicle may displace superiorly
  5. Johnny has a direct blow to shoulder causing a "shouler seperation" what has he seperated
    The Acromioclavicular Joint Dislocation (Shoulder Separation)
  6. Pectoralis minor m. is covered by
    Clavipectoral fascia
  7. Pectoralis Major m. has what action, and is innervated by what nerve
    • Action
    • Clavicular head ONLY: flex humerus

    Sternocostal head ONLY: extend humerus from flexed position

    2 heads TOGETHER: adduction & medial rotation of arm

    • Innervation
    • Lateral + Medial Pectoral nn.
  8. Pectoralis Major m. inserts where
    Lateral lip of intertubercular sulcus
  9. Fracture of the Clavicle has what clinical implications
    • •Most commonly fractured bone
    • •~80% of fractures occur in middle one-third of shaft
    • •Possible deformity due to displacement and overriding of fragments
  10. Pectoralis Minor m. action and inn.
    • Action
    • Stabilize scapula
    • (draws it inferiorly & anteriorly)

    • Innervation
    • Medial Pectoral n.
  11. Serratus Anterior m. action and inn. and test
    • Action
    • Protract scapula
    • Rotate scapula superiorly

    • Innervation
    • Long thoracic n. (C5, C6, C7)

    • To Test
    • Press hand of outstretched limb against a wall
  12. What is a "winged" scapula caused by
    It is caused by damage to the serratus anterior. It can affect a person’s ability to lift, pull, and push weighty objects. In some serious cases, the ability to perform activities of daily living such as changing one’s clothes and washing one’s hair may be hindered
  13. What nerve travels in an inferior direction on the anterior side of the Serratus anterior
    Long thoracic n.
  14. The Brachial a. has its superior end where
    On the inferior border of the teres major where it turns into the axillary a.
  15. What are the superior and inferior boarders of the Axillary a.
    The inferior is the teres major muscle, the superior boarder is the Lateral border of the 1st rib
  16. The Subclavian a. begins where
    At the Lateral border, 1st rib
  17. The Subclavian a. has what branches
    Suprascapular a.

    Cervicodorsal trunk

    Thyrocervical trunk

    Transverse cervical a. (deep & superficial brs)
  18. Where does the Subscapular branch from
    Axillary a.
  19. What does teh
    • Circumflex scapular a. branch from
    • Axillary a. preceeds Subscapular a. then the circumflex scapular proceeds from there
  20. The Arterial Anastomoses Around Scapula are
    • Circumflex scapular a.
    • Suprascapular a.
    • Subscapular a.
    • Intercostal a.
  21. What arteries branch from the Axillary artery: 1st part
    Superior Thoracic a.
  22. What arteries branch from the Axillary artery: 2nd part
    • Thoraco-acromial a.
    • - Clavicular br.
    • - Acromial br.
    • - Pectoral br.
    • - Deltoid br.
    • Lateral thoracic a
  23. What arteries branch from the Axillary artery: 3rd part
    • 1. Subscapular a.
    • - Circumflex scapular a.
    • - Thoracodorsal a.
    • 2. Anterior circumflex humeral a.
    • 3. Posterior circumflex humeral a.
  24. What is the Course of the Cephalic Vein
    • Axillary v.
    • Subclavian v.
  25. The pectoralis minor muscle plays an important role in stabilizing the scapula. The somatic motor innervation for this muscle is most commonly provided by which nerve(s)?
    Medial pectoral
  26. Polymastia is defined as
    More then the average pair of breasts, found in the anterior side of the trunk
  27. Polythelia
    More then two nipples
  28. Amastia
    = absence of breast(s)
  29. Gynecomastia
    = abnormally large breasts in males
  30. What gives the breasts lift
    Suspensory ligament (of Cooper)
  31. Behind the breast is a space called
    Retromammary Space
  32. Anterior cutaneous n. feeds to what, and is a branch of which nerve
    • Innervation of the Breast, Intercostal n.
    • (T4-T6), coming from the ventral ramus
  33. Blood Supply of the Breast is
    • Internal Thoracic a.
    • -Which branch to the Medial mammary brs

    • Lateral Thoracic a.
    • -Which branch into the Lateral mammary brs

    • Posterior intercostal a.
    • - Which branch into the Lateral mammary brs
    • (from lateral cutaneous brs)
  34. Breast cancer frequently spreads by
    lymphogenic metastasis via the Axillary lymph nodes (can metastasize in lungs, pleura, liver, bones, brain)
  35. Cancer cells that invade glandular tissue appear as
    • - Shortened suspensory ligs
    • - Large skin dimpling
  36. Cancer cells invade lactiferous ducts appear
    • - Shortened ducts
    • - Retracted, deviated nipple
  37. Cancer cells interfere with lymph drainage
    • - Lymphedema (excess fluid, swelling)
    • - ‘Peau d’orange’ Sign:Thickened, puffy skin between small, dimpled pores
  38. Cancer cells invade retromammary space, pectoral fascia, or interpectoral lymph nodes
    • - Breast elevates when pec major contracts
    • - To Test: Hands on hips, press while pulling elbows forward
  39. During a follow-up exam after a modified radical mastectomy of the right breast, you notice that the patient is unable to full abduct her ipsilateral arm. Which nerve is likely to have been injured during this patient’s surgery?
    Thoracodorsal
  40. How can the spine of the scapula be used as a landmark
    It marks (in most individuals) the site of T3 vertebrae
  41. How can the spinous process tip be used as a landmark
    It is the on the same plane as T7
  42. Which provides more stability, cartilaginous or fibrous joints
    Fibrous
  43. What is a highly mobile but relatively unstable joint that is frequently injured (>45% of dislocations)
    Glenohumeral Joint
  44. The Intrinsic ligaments of the glenoid humoral joint are
    • - Coracohumeral ligament
    • - Glenohumeral ligaments (superior, middle, inferior)
  45. The Coracoacromial Arch includes
    - Coracoid + acromion + coracoacromial lig.

    - Osseoligamentous structure (prevents superior dislocation)

    - Very strong (forceful superior thrust will fracture humeral shaft or clavicle first)
  46. Movement of the Pectoral Girdle includes what joints
    • •Sternoclavicular (SC) Joint
    • • Acromioclavicular (AC) Joint
    • • Glenohumeral Joint
    • • “Scapulothoracic” Physiological Joint
  47. Deltoid m. action and inn. and test
    • Action
    • Abduct arm (after initial 15 degrees)


    • Innervation*
    • Axillary n. (C5, C6)


    • To Test
    • Abduct arm against resistance
    • (start with arm at approx. 15degrees)
  48. Teres major m. action and inn.
    • Action
    • Adduct arm
    • Medially rotate arm

    • Innervation
    • Lower subscapular n. (C5, C6)

    • To Test
    • The abducted arm is adducted against resistance
  49. Teres major m. insertion and origin
    Inferior angle of the scapula, and medial lip of the intertubercular sulcus of the humerous
  50. Rotator Cuff Muscles are
  51. Supraspinatus m. action and inn
    Action Abduct arm (initial 15 degrees)

    Holds humeral head in glenoid fossa

    Innervation Suprascapular n. (C4, C5, C6) To Test Abduct arm from 0 degrees (resting position)
  52. Infraspinatus m. action inn. and test
    Action Laterally rotate arm

    Holds humeral head in glenoid fossa

    Innervation Suprascapular n. (C5, C6)

    To Test Flex elbow with arm adducted, ask patient to rotate laterally against resistance
  53. Teres minor m.
    Action Laterally rotate arm

    Innervation Axillary n. (C5, C6)

    Holds humeral head in glenoid fossa
  54. Subscapularis m. action and inn.
    Action Medially rotates arm

    Holds humeral head in glenoid fossa

    Innervation Upper & Lower subscapular nn. (C5, C6, C7)
  55. Avulsion Fracture of Greater Tubercle symptoms
    •Arm is medially rotated

    - Intact subscapularis m. pulls arm into medial rotation

    - Lack of opposition from lateral rotators of arm
  56. Glenohumeral Joint Dislocation (Shoulder Dislocation) clinical implications
    • • Risk of tear to fibrous joint capsule, glenoid labrum, rotator cuff tendons
    • • Anterior dislocation most common (>90%):
    • - Humeral head moves inferior to glenoid cavity, anterior to infraglenoid tubercle
    • - Intact flexor + adductor mm. pull head into subcoracoid position
    • • Patient is unable to use arm, supports it with other hand, arm rotates medially
    • • Risk of injury to axillary n. Prone to joint instability & recurrent dislocations
  57. Quadrangular Space boarders and contents
    Contents: axillary n. + posterior circumflex humeral a.

    • Teres minor (suprerior)
    • Teres major (inferior)
    • Long head of tricept (medial)
    • Lateral head (Lateral)
  58. Triangular Space contents and boarders
    • Circumflex scapular a.
    • Teres major (inferior)
    • Teres minor (superior)
    • Long head (lateral)
  59. Triangular Interval contents and boarders
    Radial n. + deep artery of arm

    • Teres major (superior)
    • Long head of tri (medial)
    • Lateral head of tri (lateral)
  60. “Army goes over, Navy goes under” refers to
    The Suprascapular a. & n. in respect to the Superior transverse scapular ligament
  61. Subscapularis is the only muscle that
    Is on the anterior side of the scapula and the only one that attaches to the lesser tubericle
  62. What is the job of the subacromial bursa
    To protect the supraspinatus tendon
  63. Injury to the supraspinatus is very common and will cause
    Innability to initiate arm abduction, patient will often swing their body to get the arm above 15 degrees where the delt will take over
  64. The supraclavicular node is great for checking the status of the nodes because
    It is near the surface and next to the clavicle making it an optimal node for palpitations to identify swollen lymph
  65. Lymph from the right upper limbs are dumped into
    The right venous angle (jugular vein) via the right lymphatic duct
  66. Lymph from the upper left limbs are dumped
    Into the left venous angle (jugular vein) via the thoracic duct
  67. During a physical exam, you palpate an enlarged mass in the axillary region. Based on its location, you suspect that this mass is an enlarged central lymph node. Lymph from which other node does not typically pass through the central node?
    Apical
  68. The only muscle that the dorsal nerve innervate are
    Deep intrinsic back muscles
  69. All of the divisions of the brachial plexus only come from the
    Ventral Rami
  70. Following a traumatic injury to the axillary region, a patient is unable to extend his arm, elbow, wrist and fingers. What component of the brachial plexus has most likely suffered damage in this patient?
    Posterior cord

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