9-25 Shoulder/Pectoral/Breast Flashcards
Name and Describe the 3 DEEP Fascia
- Pectoral=Covers Pec Major [3]
ºsuperiorly attaches to clavicle/sternum
ºinferiously continuous w/antrior abd wall fascia - Axillary = lateral continuation of Pectoral Fasica ^^…and forms axilla floor
- Clavipectoral Fascia= [4]
ºDEEP to pec major
ºdescends from clavicle and encloses subclavius & pec minor.
ºInferior to pec minor & becomes suspensory ligament of axilla.
ºPUlls axilla skin superiorly w/shoulder abduction
Name the 2 Shoulder Cutaneous Nerves and Describe them
- Supraclavicular nerve (C3-C4)=passes clavicle anteriorly and is just deep to platysma. Innervates skin over clavicle and superolateral Pec.major
- SUP Lateral Brachial Cutaneous Nerve (C5-C6)= axillary cutaneous branch tht innervates deltoid skin
Shoulder Bones (AKA \_\_\_\_ \_\_\_\_\_) has a Clavicle, SUP surface and iNF surface. *Describe the Clavicle [4]
Shoulder Bones(PECTORAL GIRDLE) has 3 componenets
*Clavicle 1 out of 3=
º sits at top of thoracic cage w/ a lateral concave region
ºMedial anterior conVEX region
ºTransmits weight from UE to axial skeleton and keeps UE clear of the thorax as a “swing arm”
ºEXTREMELY superficial and easily palpable or broken
Shoulder Bones (AKA \_\_\_\_ \_\_\_\_\_) has a Clavicle, SUP surface and iNF surface. *Describe the Superior Surface [3]
º attachment surface for sternocleidomastoid, traps, Pec.major & deltoid
º[Sternal prxmal ] end is enlarged & triangle shaped vs.
[acromial distal ]end is broad & flat
Shoulder Bone Area(PECTORAL GURDLE)
Shoulder Bones (AKA \_\_\_\_ \_\_\_\_\_) has a Clavicle, SUP surface and iNF surface. *Describe the Inferior Surface [4]
Shoulder Bone Area(PECTORAL GURDLE)
- “rough” features due to muscular and ligamentous attachments
- attaches trapezoid portion of the coracoclavicular ligament via acromial trapezoid line
- contains subclavian groove for subclavian muscles on the medial 1/3 end of the shaft
- Contains [conoid tubercle] just medial to trapezoid line
Scapula is a ___shaped bone that is __ and found on the _____. The anterior surface is ____(thorax is ___) and scapula posterior surface is _______. Which ribs does the Scapula cover?
Scapula is a TRIANGLE shaped bone that’s FLAT and found on POSTERIOR surface of the thorax. Scapula anterior surface is CONCAVE (thorax is convex) and Scapula posterior surface is CONVEX.
Scapula covers ribs 2-7 posteriorly
Scapular Spine [2]
ºRuns from upper 1/3 medial border to flattened acromion process laterally & then articulates clavicle = AC joint
ºDivides POSTerior scapula into supraspinous fossa and infraspinous fossa
The scapula has __ angles. What’s so special about the “Lateral” angle? [2]
Scapula 3 angles=inf/ SUP/ Lateral
1: is the Thickest part of scapula and connects neck to glenoid cavity
2:
Lat angle deviating down—–>Scapula downward rotation
Lat angle deviating UPWARD–>Scapula UPWARD rotation
1) Where is the suprascapular notch located?
2) What is its function?
1) on superior border —>lateral side –>1/3 down ..on the scapula
2) transmits suprascapular nerve with the superior transverse scapular ligament
A: HOw is the coracoid process (AKA ___ __) pointed and how many muscles attach to this?
B: The Scapula Glenoid Cavity articulates the ____ and forms _____
C: What muscles are attached to supraglenoid turbercles?
D: What muscles attach to the infraglenoid turbercles?
A: Coracoid process(CROWS BEAK) is pointing anteriorly and on lateral end of the scapula. Is located superiorly to lateral border
B: Scapula Glenoid Cavity articulates the Head of Humerus = forms Glenohumeral joint
C: supraglenoid turbercle=biceps brachii long head
D: infraglenoid tubercle = triceps brachii long head
The Humerus is the ____ bone in the UE!
2) Where does it articulate? [2]
3) Describe the 2 Large tubercles on the Humerus bone
Humerus is the LARGEST bone in the UE!
2) Ariculates Proximally the Scapula @ [glenohumeral joint] AND articulates distally the radius and ulna
3) anterior lesser tubercle is attachment site for subscapularis muscle.
vs.
LATERAL GREATR TURBERCLE is attachment site for [supraspinatus, infraspinatus and teres minor=rotator cuff muscles]
intertubercular groove (AKA___)
2) What separates the head from the tubercles on the humerus?
found >inbetween< the LATERAL GREATR and anterior lesser humerus Tubercles = houses tendon that connects bone w/ [biceps brachia long head]
2) the anatomical neck separates tubercles and is line of attachment for glenohumeral joint capsule
1) What are the 2 prominent features on the Humerus shaft?
2) Describe them
1- Deltoid Tuberosity = on humerus lateral surface 1/2 down shaft and is distal attachment for deltoid muscle
A: Radial Groove = begins POSTerioly 1/2 down shaft and spirals laterally, anteriorly and inferiorly allowing
[radial nerve] and [deep brachial artery] to travel in tht groove
Pectoralis Major [4]
1) Strong adductor and medial rotator of humerus
2) Each head (clavicle vs. sternocosta) is independent and clavicular head alone can help flex humerus
3) sternocosta head alone helps extend an already flexed humerus
4) Can check each head individually since
Clavicular = abduct arm 90º and Sternocosta head abduct arm to 60º BOTH horizontally adduct against resistance
Pectoralis minor [2]
1) Triangle-shaped muscle that forms a tunnel for UE nerves and vessels with coracoid process
2) Almost entirely covered by Pec.major
Subclavius Muscle
1) Pulls clavicle downward & stabilizes it during UE movements
The coracobrachialis (which is 1 of the 3 muscles attached to the ___ ____ ____) sits ____[superficial/deep] to the Biceps brachii short head
Coracobrachialis (1 of 3 attached to scapula Coracoid Process) sits DEEP to the Biceps brachii short head!
What are the 6 muscles which originate from the scapula
ºDeltoid
ºSubScapularis
ºSupra- and infraspinatus
ºTeres minor and Major
Deltoid Muscle [3]
1: CAN’T INITIATE HUMERUS ABDUCTION!–> 1st 15-20º of abduction handled first by supraspinatus muscle smh
- ->then deltoid takes over
2: Has 3 parts (Anterior unipennate, Middle Multipennate and Posterior unipennate)
3: Thick and coarsely textured
pennate = feather
Teres Major Muscle
MEDIAL HUMERAL ROTATION as well as weakens adduction & extension of already flexed humerus
A: Name the 4 Rotator Cuff Muscles
B: What are their functions [3]
A: SItS! «
- SubScapularis
- infraspinatus
- terres minor
- Supraspinatus
B: 1.holds humerus head inside shallow glenoid cavity
- Strengthens the joint and allows a lot of motion
- strengthens and blends w/glenohumeral capsule
Supraspinatus muscle [4]
- 1 of the 4 Rotator cuff muscles
- Prevents humerus downward motion under loads
- Passes under the coracoacromial arch
- INITIATES first 15-20º humerus abduction to help the Deltoid out lol
A: What action does the [infraspinatus muscle] do?
B: Action for [ teres.Minor? ]
A: lateral humeral rotation
B: lateral humeral rotation/weakens adduction & extension
SubScapularis Muscle
Thick triangle shaped muscle tht medially rotates humerus along with Teres.major
Describe the Quadrangular Space [2]
1) Bound by Teres.minor superiorly, Teres.MAJor inferiorly, Humerus laterally and Tricep brachii long head medially
2) allows [C5-C6 Axillary nerve and POSt circumflex humeral artery to exit]
Describe the Triangular Space
1) box sides are: Teres minor superiorly, Teres.MAJor inferiorly and Tricep brachii long head laterally
2) Circumflex Scapular Artery runs WITH (not thru or pierces) Triangular Space
Describe Triangular Interval
1) Bound by Teres.MAJor superiorly, Tricep brachii lateral head laterally and Tricep brachii LOng head medially
2) Radial nerve & deep brachial artery extends across interval floor
Impingement Syndrome
2) Tx? [3]
Balls of shoulders rubs against Acromium ledge—>Rubbing and clicking of shoulder on overhead motion with tendinitis & rotator cuff problems
2) Tx=Anti-inflammatory med/Cortisone/Shave Acromium down
Dislocation
2) Tx? [3]
1) Ball of shoulder pops out of socket
2)
ºTx: Reduction (w/Anesthesia usually)
ºSling for 3-4 weeks
ºSurgery after 2nd or 3rd recurrence(higher in people over 30)
Shoulder Separation
2) Tx? [3]
1) Injury to A-C joint due to collarbone displaced from top of shoulder
2) Tx: Surgery/Rest and sling / Xray
Rotator Cuff Tear
2) Sx? [2]
3) Tx? [3]
Injury to 1 of the muscle/tendons that covers & raises shoulder.
2) Sx= shoulder pain and inability to raise shoulder
3) Tx= MRI if not better / rest / Surgery to repair LARGE tear
What are the 3 MAIN general characteristics of the [Axilla]
- Pyramid-shapped passageway inferior to glenohumeral joint but superior to axillary fascia
- Protective tunnel for neck and UE neurovascular structures
- Has apex, base, and four walls(3 tht are muscle)
1) Which part of the Axilla is the cervicoaxillary canal?
2) Were is the Axillary fossa (_____)
3) What part of the Axilla region can be grabbed with fingers?
4) Where is the Axilla Medial Wall?
5) What forms the Lateral Wall?
1) APEX -bounded by 1st rib, clavicle and scapular superior border
2) Axillary fossa (ARMPIT) is the BASE of the axilla
3) inferior part of both the Axilla ANTERIOR WALL’S FOLD and the POSTERIOR WALL’s FOLD
4) Medial= thoracic wall, ribs #1-4, covered by Serratus anterior
5) Lateral wall formed by humeral intertubercular groove
How is the Axilla Posterior Wall different than Axilla Anterior Wall?
Posterior extends more inferiorly than Anterior Axillary fold
What is the “extent” of the Axillary Artery (daughter of the _____ artery) [4]
Axillary Artery (daughter of SUBCLAVIAN artery) …
ºfirst begins at lateral border of 1st rib
º continues as brachial artery distal to teres.MAJor
º Extends to inferior border of teres.MAJor
º goes deep to the pectoralis minor
Describe the 1st part of the Axillary Artery [2]
º has 1 branch Superior thoracic Artery that…
- supplies subclavius, serratus anterior and some pectoralis
- runs inferiorly and medially
Describe the 2nd part of the Axillary Artery
ºhas 2 branches= Thoracoacromial trunk and Lateral Thoracic Artery
Thoracoacromial trunk/artery
Trunk that stems from the 2nd segment of Axillary Artery. It branches into 4 branches (pec, clavicle, acromial, deltoid)
Lateral Thoracic artery [4]
º travels laterally with border of pec minor and descends
ºhas TONS OF VARIATION from person-person
ºSupplies serratus anterior, intercostal muscles, lateral breast
º Stems from 2nd segment of Axillary Artery
1) What are the 3 branches of the Axillary Artery 3rd segment? [Describe each of those]
1) Subscapular Artery [Divides into Circumflex scapular artery & Thoracodorsal artery ]
2) Anterior circumflex humeral Artery: smaller of the 2 circumflex…runs laterally & deep to bicep muscles but still anterior compared to its brother
3) POSTerior circumflex humera Arteryl : pierces quadrangular space to perfuse deltoid, BOTH Teres &
[tricep brachii long head]
These arteries encircle the humerus’ surgical neck oppositely and anastomose with each other afterward…..
ANT and POST CIRCUMFLEX HUMERAL ARTERIES (derived from 3rd segment of Axillary artery)
Describe the Retromammary space
Loose connective tissue plane that sits between breast and deep pectoral fascia
1) Breast Mammary glands are a ___ and highly ____ type of ___ gland
2) What is the location of Breast Mammary glands? [3]
Breast Mammary glands are a MODIFIED and highly SPECIALIZED type of SWEAT gland
2) º extends transversely from lateral border of sternum to midaxillary line
º extends vertically from 2nd –>6th rib
º2/3 rest on deep pectoral fascia and 1/3 rest on serratus anterior fascia
A: Areolae
B: Nipple (____ ___)
C: What are Lobules, how are they drained /and how are they separated from other Lobules?
D: How many lobules are in each breast?
A: (AKA glands of Montgomery) = houses numerous sebaceous/areolar glands
B: Nipple (papilla mamma)=Circularly arranged smooth muscle fibers that house Lactiferous ducts –> open into the tips
C: FUNCTIONAL UNIT OF THE BREAST drained by single lactiferous duct & separated from other lobules by suspensory ligaments of cooper
D: 15-20 lobules in each breast
- Lactiferous Sinus
* *Suspensory ligaments of Cooper
*Enlargement sinus space of the lactiferous duct proximal to its exit onto the papilla mammae
**SLC: fibrous bands connecting breast skin with the underlying superficial fascia, thus separating glandular tissue into 15-20 lobes in each breast
What is the arterial supply for breast? [4]
1) Medial mammary branches & ANT intercostal arteries<—-Internal Thoracic artery
2) Lateral Thoracic
3) thoracoacromial artery/trunk
4) Posterior intercostal arteries
Internal Thoracic Artery
Subclavian’s 4th daughter! –> stems from Subclavian artery inferior region and perfuses Anterior intercostal arteries and medial mammary branches
A: Describe VENOUS DRAINAGE for Breast
B: Describe Nerve Innervation for Breast
C: Which REGION of the Breast Drains the MOST lymphatic fluids? least?
A: mainly drains to Axillary veins but sometimes internal thoracic vein (Reverse of arterial supply)
B: Innervated by 4th to 6th intercostal nerves (lateral & ANT cutaneous branches)
C: SUPERIOLATERAL DRAINS MOST
–inferiormedial drains least
1) What Lymph Node does MOST breast lymph drain?
2) Where does remaining lymph go?
3) Describe the lymph pathway for lower breast quadrants
4) What is CLASP
1) MOST breast lymph drains to axillary ANT pectoral lymph nodes
2) remaining (specifically from medial quadrants) drains to parasternal nodes or opposite breast
3) lower quad=lymph passes deeply to the inferior phrenic abdominal nodes
4) CLASP=Central, Lateral, Apical, Subscapular, Pectoral Nodes
A: What are common signs of possible Breast Carcinoma? [2]
B: What are the statistics for women who have
Invasive Ductal vs. Invasive Lobular?
A: 1-painless palpable mass (can be very small)
2- skin dimpling or nipple retraction
3-Lump in underarm or near/on breast persisting thru menses
4-blood/clear nipple discharge
5-Skin Redness of breast/nipple
6-marble-like hardening under the skin
B: Invasive Ductal(80%) and Invasive Lobular(10-15%)
1) Which breast area is the MOST frequent area for breast CA?
2) least frequent area associated with Breast CA?
*1) MOST FREQ. = Superior-lateral region (50%)
2) least freq. = inferior-medial (6%)
A: What muscle groups does the Posterior Circumflex Humeral artery perfuse? [2]
B: Where does this artery stem from?
C: Describe its passage [4]
A: DELTOID & teres.minor
B:Stems from 3rd segment of the Axillary Artery(which it itself stems from Subclavian Artery)
C: Passes medial to humerus–>Pierces subscapularis and teres.MAJor–>transmits thru Quadrangular space
—>Perfuses 4 muscles
A: What muscles does this [suprascapular nerve] innervate?
B: Describe the passage of this nerve [4]
C: What happens when the suprascapular nerve is severed?
- Supraspinatous
- infraspinatous
B: Arises from superior trunk of brachial plexus–>passes thru suprascapular notch but underneath [superior transverse scapular ligament] –>both spinatous muscles
C: loss of lateral rotation AND inability to initiate ABduction
The teres.MAJor is innervated by the _____ while the teres.minor is innervated by the _______
2) What are the blood arteries for these muscles?
teres. MAJor = Subscapular Nerve / Scapular Circumflex of Subscapular artery
teres. minor= Axillary nerve–>(along with Deltoid) / Scapular Circumflex of subscapular artery AND POST humeral artery
Cephalic Vein
Suuuuuper Long Vein starting from radial hand–>anterior elbow—->lateral arm—>and then emptying into Axillary Vein
Superior Transverse scapular ligament
small ligament bridging together the suprascapular notch space—>ligament overheads the [suprascapular nerve] and… [suprascapular artery] passes over the ligament
Army/Artery Above, navy/nerve below
What nerve innervates BOTH Rhomboid muscles?
2) What artery perfuses BOTH Rhomboid muscles?
N: Dorsal Scapular Nerve
a: Transverse cervical artery (like the traps)
The Radial Nerve is housed within the ____ _____ and innervates what? [2]
Radial Nerve is housed in TRIANGULAR INTERVAL and innervates POST-arm & forearm muscles and skin
A: What two Nerves travel INSIDE the suboccipital triangle?
B: What’s the Nerve that travels AROUND the Suboccipital Triangle?
A: SUBOCCIPITAL NERVE C1/Motor –>all triangle and rectus minor
and
B: Greater Occipital Nerve C2/Sensor travels AROUND the triangle
Scapular Anastomoses
3 Arteries that anastomose within scapular region
- Dorsal Scapular Artery
- circumflex scapular artery<–Subscapular Artery
- SUPrascpular Artery from above
