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Axilla+Brac.Plexus
Anatomy of the Axilla and the Brachial Plexus
Question | Answer |
---|---|
* Name the basic divisons of the arteries of the arm | subclavian artery->axillary artery->brachial artery->radial and ulnar arteries |
* Pectoralis Major: nerve, action | medial and lateral pectoral nerve; flexes, adducts, and medially rotates the humerus |
* Pectoralis Minor: nerve, action | medial and lateral pectoral nerves; draws the SCAPULa downward and forward; stabilizes it |
What two structures does the clavipectoral fascia enclose? | The subclavius and the pectoralis minor muscle |
What is the costocoracoid membrane? What three structues pierce it? | The tough mebrane between the subclavius and the pectoralis minor; cephalic vein, lateral pectoral nerve, and the thoracocromial artery |
What are the boundaries of the deltopectoral triangle? | clavicle, deltoid muscle, and the pectoralis major muscle |
Subclavius: nerve, action | nerve to the subclavius, depresses the lateral end of the clavicle, pulls shoulder anteriorly, stabilizes the clavicle |
What are the boundaries of the axilla: Apex | Apex: clavicle anterior, scapula posterior, first rib is medial |
What are the boundaries of the axilla: Base | Base: fascia of the skin of the armpit |
What are the boundaries of the axilla: Anterior wall | pec minor and pec major; lateral border of the pec major forms the anterior axillary fold |
What are the boundaries of the axilla: posterior wall | subscapularis, teres major, the latissimus dorsi muscles; the teres major and the latissimus dorsi muscles form the posterior axillary fold |
What are the boundaries of the axilla: Medial wall | Ribs 1-5; intercostal muscles, serratus anterior |
What are the boundaries of the axilla: Lateral wall | intertubercular (bicipital) groove of the humerus |
What vessels and nerves pass through the axila? What encloses them? | The axillary artery and vein, the brachial plexus (they are enclosed by the axillary sheath) |
Where does the brachial plexus get its nerves from? | Formed by ventral rami of C5-T1, with contributions from T2 and C4 |
What are the trunks of the brachial plexus? What nerves make up each? | Superior: C5 and C6; middle: C7; Inferior: C8, T1 |
* * What are the divisions of the brachial plexus? | anterior division (FLEXOR PART) and the posterior division (EXTENSOR PART) |
* * What are the cords of the brachial plexus? | Posterior: all three posterior divisions of the three trunks; Lateral: anterior divisions of the superior and middle trunks; medial: anterior division of the inferior trunk |
* * What are the terminal branches for the lateral, medial, and posterior cords of the brachial plexus? | Lateral: musculocutaneous nerve and lateral root of the median nerve; Medial: ulnar nerve and medial root of the median nerve; Posterior: radial and axillary nerves |
* * What are the supraclavicular branches of the brachial plexus that come off at the root? | Dorsal scapular nerve (C5)--rhomboids and the levator scapulae muscle; long thoracic nerve (C5, C6, C7): serratus anterior muscle |
* * What does the dorsal scapular nerve innervate? Where does this nerve come from? | Rhomboids and levator scapulae muscle; comes from C5, branching off from one of the roots of the brachial plexus |
* * What does the long thoracic nerve innervate? Where does this nerve come from? | From C5, C6, C7; |
* * Where does the nerve to the subclavius come from? What does it supply? | Supplies subclavius muscle; comes from upper trunk at the root level (from C5 and C6) |
* * Where does the suprascapular nerve come from? What does it supply? | Supplies the supraspinatous and infraspinatous; comes from C5 and C6 from upper trunk |
What branches are given off by the lateral cord? | The lateral pectoral nerve, the musculocutaenous, and the lateral root of the median nerve |
What does the lateral pectoral nerve innervate? | The pectoralis major and minor muscles |
What does the musculocutaenous nerve supply? | Muscles of the anterior arm compartment; ends as the lateral antebrachial cutaneous nerve |
What are the branches of the medial cord? | Medial pectoral nerve, medal branchial cutaneous nerve, medial antebrachial cutaneous nerve, ulnar nerve, and medial root of the median nerve |
What are the branches of the posterior cord? | Upper subscapular nerve, thoracodorsal nerve, lower subscapular nerve, axillary nerve, axillary nerve, radial nerve |
What does the upper subscapular nerve supply? | The subscapular muscle |
What does the thoracodorsal nerve supply? | The latissimus dorsi muscle |
What does the lower subscapular nerve supply? | The subscapularis muscle and the teres major muscle |
What does the axillary nerve supply? | teres minor and deltoid muscles (ends as the upper lateral brachial cutaneous nerve) |
What does the radial nerve supply? | It is the great extensor nerve of the upper limb |
What causes Erb-Duchene palsy? | excessive increase in angle between neck and shoulder-->tearing of the nerve roots C5 and C6 |
What are the symptoms of Erb-Duchene palsy? | upper limb hangs limply, medially rotated by the unapposed action of the pectoralis major muscle; forearm is pronated due to loss of action of the biceps (supination of forearm); loss of sensation along lateral side of the limb; "waiter's tip position" |
What nerves are affected in an Erb Duchene palsy? | Suprascapular (to supraspinatus and infraspinatus nerves); nerve to the subclavius (to subclavius); musculocutaneous nerve (biceps brachii, brachialis, coracobrachialis); axillary (deltoid, teres minor) |
What do you get with a lesion of the lower brachial plexus? How could you injure yourself this way? | Klumpe's palsy; excessive abduction of arm (lifting up arm forcibly) |
What parts of the brachial plexus are injured in Klumpe's palsy? | Tearing of C8 and T1 roots; results in damage to the ulnar nerve, which supplies small muscles of the hand |
What are the symptoms of a Klumpe's palsy? | Hand has clawed appearance (pinky and ring finger flex, all knuckles extend back); loss of sensation along medial side of arm of the upper limb |
What spinal nerves supply the long thoracic nerve? | C5, C6, C7 |
How can you injure the long thoracic nerve? | May be injured by blows or pressure on the posterior triangle of the neck, stab wounds, during mastectomy surgical procedures, or athletic injuries |
* What muscle does the long thoracic nerve supply? | The serratus anterior muscle |
What happens when the serratus anterior muscle is paralyzed? | Medial border of the scapula protrudes-->winging of the scapula; also, since the scapula can no longer be fixed to the posterior chest wall, triceps brachii is seriusly weakened; abduction of the arm is impaired (weak up motion of scapula) |
What causes thoracic outlet syndrome? | Condition involving compression of the brachial plexus nerves, subclavian vessels, or both because of inadequate passageway just above first rib and behind the clavicle |
What are the symptoms of thoracic outlet syndrome? | Neck, shoulder, and arm pain, numbness or impaired circulation to the extremeties |
What are the three passageways where the brachial plexus trunks and subclavian vessels are subject to compression or irritation? | * * Interscalene triangle; costoclavicular triangle; subcoracoid space |
What are the borders of the interscalene triangle? | Anterior scalene, middle scalene, and medial border of the first rib |
What are the borders of the costoclavicular triangle? | Middle third of clavicle; first rib; upper border of the scapula |
What are the borders of the subcoracoid space? | Beneath the coracoid process just deep to the pectorialis muscle |
Where does the axillary artery run through? | Direct continuation of the subclavian artery; extends from the lateral border of the first rib to the inferior border of the teres major muscle |
How is the axillary artery divided? What are the parts? | divided into three parts by the pectoralis MINOR muscle; first part: above muscles, second: behind, third: below |
By convention, medial, lateral, and posterior cords of the brachial plexus are named according to their relationship to the middle segment of the ____. | Axillary artery |
What are the branches of the axillary artery (first part) | superior thoracic artery (for the first two intercostal spaces and the serratus anterior muscle) |
What are the branches of the axillary artery (second part) | Thoracoacromial trunk: arises beneath the pectoralis minor muscle and passes above the upper border of the pectoralis minor and pierces the clavipectoral fascia-->acromial, deltoid, pectoral, and clavicular branches |
What are the branches of the third part of the axillary artery? | The subscapular artery, which passes down and back to give off the circumflex scapular artery and the thoracodorsal artery |
Describe the path of the circumflex scapular artery | passes around the lateral border of the scapula between the scapula and the teres major muscle in the triangular space |
Describe the path of the thoracodorsal artery | passes down along axilla and is joined by the thoracodorsal nerve; both supply latissimus dorsi muscle |
Describe the path of the anterior and posterior circumflex humeral artery | Posterior circumflex is larger; pass around surgical neck of the humerus and anastomose with each other; posterior circumflex runs in the quadrangular space with the axillary nerve |
Describe the path of the axillary vein | direct continuation of the basilic vein as it crosses the lower border of the teres major |
What are the tributaries to the axillary vein | Venae comitantes of the brachial artery, cephalic vein, and tributaries corresponding to the branches of the axillary artery |
* * Nerve and action of the trapezius | N: spinal root of the accessory nerve; A: upper fibers elevate the scapula, middle fibers retract the scapula, lower fibers depress the scapula, superior + inferior upwardly rotate the scapula (for abduction) |
* * Nerve and action of the latissimus dorsi | thoracodorsal nerve; extends adducts and medially rotates the humerus |
* * Nerve and action of the levator scapulae | N: dorsal scapular nerve and ventral rami of C3, C4; elevates the scapula, tilt the glenoid cavity downward, helps retract the scapula |
* * Nerve and action of the rhomboid muscles | N: Dorsal scapular artery; A: retract the scapula, rotate the scapula inferiorly |
* * Nerve and action of the serratus anterior | long thoracic nerve; protracts the scapula, fixes the scapula, rotates the glenoid cavity upward |
* * Nerve and action of the deltoid muscle | Axillary nerve; anterior fibers: flex and medially rotate the humerus, middle fibers: abduct the humerus; posterior fibers: external and laterally rotate the humerus |
* * Nerve and action of the supraspinatus | suprascapular nerve; abducts the humerus |
* * Nerve and action of the infraspinatous | suprascapular nerve; laterally rotates the humerus |
* * Nerve and action of the teres minor | axillary nerve; laterally rotates the humerus |
* * Nerve and action of the teres major | Lower scapular nerve; extends, adducts, and medially rotates the humerus |
* * Nerve and action of the subscapularis | N: upper and lower subscapular nerves; medially rotates the humerus |
What are the borders of the quadrangular space? | Superior: teres minor; inferior: teres major; medial: long head of the triceps brachii; lateral surgical neck of the humerus |
What are the contents of the quadrangular space? | Axillary nerve, posterior circumflex humeral artery |
What are the borders + contents of the triangular space? | Teres minor, teres major, long head of triceps bracchi; circumflex scapular vessels (or their branches) |
What are the borders of the triangular interval? | Teres major, long head of the triceps brachii, and shaft of the humerus |
What are the contents of the triangular interval? | Radial nerve, profundal brachii artery |