007 anatomy of the axilla and brachial plexus Flashcards
what is the axilla?
area of transition between the neck and the shoulder where nerve and vessels can pass through
describe the structure/shape of the axilla
- 4 walls
- a floor
- 1 inlet a the top
- bit like a pyramind
describe the structure and function of the axillary inlet/apex
- triangle opening at the top of the axilla
- sits between the lateral border of rib 1, the superior border of the scapula, and posterior border of the clavicle
- nerves and muscles go over rib 1 and through the axillary inlet to get to the shoulder/arm
what is the anterior boundary of the axilla?
- pectoralis major and minor
- subclavius muscle
- clavipectoral fascia (from clavicle to floor of axilla)
- lower margin of pectoralis major = anterior axillary fold
what is the medial boundary of the axilla?
- thoracic wall ( ribs, intercostal muscles)
- serratus anterior muscles
- long thoracic nerve and intercostobrachial nerve (lateral branch of the 2nd intercostal nerve and innervates skin on upper, medial side of arm)
what is the floor/base of the axilla?
- the skin of the armpit = where you palpate for swollen lymph nodes
what is the lateral wall of the axilla?
- intertubercular sulcus/bicipital groove of humerus
what is the posterior wall of the axilla?
- subscapularis muscle
- teres major msucle
- latissimus dorsi muscle
- long head of triceps
- latissimus dorsi and teres major = posterior axillary fold
what/ where is the posterior axillary fold?
- latissimus dorsi and teres major
what/where is the anterior axillary fold?
- lower margin of pectoralis major
what are the 4 gateways in the posterior wall?
- suprascapular foramen
- quadrangular space
- triangular space
- triangular interval
what is the suprascapular foramen and what are its boundaries?
- a pathway for suprascapular nerve = (through) and artery (above)
- bounded by the suprascapular notch and superior transverse scapula ligament
what is the quadrangular space and what are its boundaries?
- a pathway for the axillary nerve and posterior humeral circumflex artery
- bounded by the surgical neck of the humerus, inferior margin of teres minor, superior margin of teres major and lateral margin of long head of tricep
what is the triangular space and what are its boundaries?
- a pathway for the circumflex scapular margin
- bounded by the medial margin of long head of tricep, superior margin of teres major and inferior margin of teres minor
what is the triangular interval and what are its boundaries?
- a pathway for the radial nerve and profunda brachii artery
- bounded by the lateral margin of triceps, the shaft of the humerus and inferior margin of teres major
what are the 2 muscles in the axillary?
- coracobrachialis
- biceps brachii
what is the origin of biceps brachii?
- 2 heads
- long head = supraglenoid tubercle of scapula
- short head = coracoid process
what is the insertion of the biceps brachii?
- radial tuberosity of forearm and fascia of forearm via bicipital aponeurosis
what is the innervation of the biceps brachii?
musculocutaneous nerve (C5,6)
what is the action of biceps brachii?
- flexion of shoulder and elbow
- supination of forearm ( strongest supinator)
what is the origin of coracobrachialis?
- coracoid process
what is the insertion of coracobrachialis?
- medial side of humeral shaft (at level of deltoid tuberosity)
what is the innervation of coracobrachialis?
- musculocutaneous nerve (C5,6)
what is the action of coracobrachialis?
flexion of arm at shoulder and weak adduction
what is the main artery in the axilla?
axillary artery
how does the axillary artery change names in different areas of the body?
- clavicle = subclavian artery
- once crossed rib 1 = axillary artery
- halfway down humerus, at inferior margin of teres major = brachial artery
what are the 3 parts of the axillary artery and how many branches do they have?
1st part = just past 1st rib until pectoralis minor, 1 branch
2nd part = deep to pectoralis minor muscle, 2 branches
3rd part = past pectoralis minor muscle, until teres major inferior margin, 3 branches
what is the branch of the 1st part of the axillary artery and what does it supply?
- superior thoracic artery
- upper medial and anterior axillary walls
what are the 2 branches of the 2nd part of the axillary artery?
- thoracoacromial artery/trunk
- lateral thoracic artery
what does the thoracoacromial artery/trunk supply?
- clavicular, acromial, deltoid and pectoral branches (Cadavers Are Dead People)
what does the lateral thoracic artery supply?
- pectoralis minor
- serratus anterior
- lateral thoracic wall
what are the 3 branches of the 3rd part of the axillary?
- subscapular artery
- anterior humeral circumflex artery
- posterior humeral circumflex artery
what does the subscapular artery supply?
branches into circumflex scapular artery and thoracodorsal artery which supplies posterior and medial axilla walls
what does the anterior and posterior humeral circumflex artery supply?
glenohumeral joint, teres major and minor, deltoid muscle
- they anastomose together around the humerus
what is the trunk called arising from the right subclavian artery?
thryocervical trunk
what 2 arteries does the thyrocervical trunk (from the right subclavian artery) give rise to?
- transverse cervical artery
- suprascapular artery
describe the anastomoses arising from the suprascapular artery
suprascapular artery –> circumflex scapular artery –> subscapular artery –> axillary artery –> posterior circumflex humeral artery –> axillary artery
describe the anastomoses arising from the transverse cervical artery
transverse cervical artery –> dorsal scapular artery –> circumflex scapular artery –> subscapular artery –> axillary artery
what is the main vein in the axilla?
axillary vein
what does the axillary vein change its name to at different regions, and what is the main branch off the axillary vein?
- subclavian vein = until 1st rib
- axillary vein = below 1st rib (anterior to axillary artery)
- basilic vein = begins at lower margin of teres major muscle
main branch = cephalin vein off axillary vein superior to pectoralis minor and lies in the deltopectoral groove
what are the 5 groups of nodes in the axilla?
- lateral (humeral)
- pectoral
- subscapular
- central
- apical
20-30 in total
what areas drain into the axillary lymph nodes?
- entire upper limb, top areas of back, chest and lower neck
why is the breast relevant to the axilla?
- the mammary gland of the axilla sometimes wraps underneath the armpit, entering the axilla
- therefore if a patient has breast cancer, it may be found in the axilla/armpit
what is a plexus?
- it connects more than one spine root to a single peripheral nerve
where does the brachial plexus originate from?
- ventral rami of C5-T1