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FM1010 > A: Axilla, Brachial plexus, posterior triangle > Flashcards

A: Axilla, Brachial plexus, posterior triangle Flashcards

1
Q

What is the base of axilla made of?

A

Skin going from arm to chest wall

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2
Q

What is apex of axilla made of?

A

1st rib, clavicle in front + superior edge of subscapularis behind

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3
Q

What is anterior wall of axilla made of?

A

Pectoralis minor + pectoralis major

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4
Q

What is posterior wall of axilla made of?

A

Subscapularis, latissimus dorsi + teres major

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5
Q

What are the gateways through posterior wall?

A

Quadrangular space, triangular interval, triangular space

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6
Q

Medial wall of axilla made of?

A

Serratus anterior + intercostal space

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7
Q

Lateral wall of axilla made of?

A

Upper end of humerus, biceps brachii, coracobrachialis.

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8
Q

Axillary sheath contains:

A

axillary artery, axillary vein and cords of brachial plexus.

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9
Q

Brachial plexus is made of:

A

Anterior rami of C5-T1

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10
Q

Components of brachial plexus:

A

Roots, trunks, divisions, cords, branches.

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11
Q

What spinal nerve is responsible for abduction?

A

C5

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12
Q

What spinal nerve is responsible for flexion of digits?

A

C8

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13
Q

What spinal nerve is responsible for adduction and abduction of digits?

A

T1

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14
Q

What spinal nerve is responsible for flexion of elbow

A

C6,C7

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15
Q

What spinal nerve is responsible for extension of elbow

A

C6,7,8

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16
Q

Anterior boundary for posterior triangle of neck

A

Posterior of sternocleidomastoid

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17
Q

Posterior boundary for posterior triangle of neck

A

Anterior of trapezius

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18
Q

Inferior boundary for posterior triangle of neck

A

Middle 1/3 of clavicle

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19
Q

Apex of posterior triangle of neck

A

Where trapezius and SCM meet on occipital bone

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20
Q

Roof of posterior triangle of neck

A

Cervical fascia

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21
Q

Floor of posterior triangle of neck

A

Splenius capitis, levator sculpae, posterior scalene, middle scalene, anterior scalene.

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22
Q

How is the posterior triangle divided?

A

By omohyoid muscle

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23
Q

What cord forms musculocutaneous nerve?

A

lateral

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24
Q

What cord forms median nerve

A

lateral + medial

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25
Q

What cord forms radial nerve?

A

posterior

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26
Q

What cord forms ulnar nerve?

A

medial

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27
Q

What structures mark the beginning and the end of the axillary artery

A

begins = lateral border of 1st rib
ends = inferior border of teres major.

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28
Q

Pectoral lymph node

A

Receives lymph from anterior thoracic wall + breast

29
Q

Subscapular lymph node

A

Receives lymph from upper quadrant of back

30
Q

Infraclavicular lymph node

A

Receives lymph from lymphatics accompanying cephalic vein

31
Q

Central lymph node

A

Receives lymph from anterior, posterior + lateral groups

32
Q

Apical lymph node

A

Receives lymph from all other groups of axillary LN + lymphatics accompanying cephalic vein

33
Q

Humeral lymph node

A

Receives all lymph from upper limb.

34
Q

Sternocleidomastoid

A
  • Sternal head: manubrium of sternum. Clavicular head: medial 1/3 of clavicle
  • Mastoid process of skull
  • Rotate neck to face superiorly to opposite side, tilt neck laterally, flex neck
  • Accessory nerve
35
Q

Posterior scalene

A
  • Cervical vertebrae
  • 2nd rib
  • Raises 2nd rib
  • Cervical nerves
36
Q

Middle scalene

A
  • Cervical vertebrae
  • 1st rib
  • Raises 1st rib
  • Cervical nerves
37
Q

Anterior scalene

A
  • Cervical vertebrae
  • 1st rib
  • Raises 1st rib
  • Cervical nerves
38
Q

Omohyoid

A
  • superior border of scapula near suprascapular notch
  • Hyoid bone
  • Depresses + steadies hyoid bone
  • Cervical nerves
39
Q

Axillary sheath

A

Encloses axillary artery, vein + brachial plexus

40
Q

External jugular vein

A

Drains scalp + face.
Starts at angle of mandible and crosses superficial SCM.
Descends to inferior of posterior triangle and terminates in subclavian vein

41
Q

Subclavian vein

A

Drains upper limb
Passes through inferior part of posterior triangle
Lies anterior to anterior scalene muscle.
Joins internal jugular vein to form brachiocephalic vein.

42
Q

Subclavian artery

A

Passes through inferior part of posterior triangle
Lies posterior to anterior scalene
Passes over 1st rib, so if there is a haemorrhage from UL, you can press on first rib to block artery and control bleeding.

43
Q

Accessory nerve

A

Passes deep (supplies) SCM, crosses posterior triangle + supplies trapezius muscle.
Enters posterior triangle along posterior border of SCM, passes postero-inferiorly through posterior triangle within roof.
Leaves deep to anterior border of trapezius.

44
Q

How to test function of accessory nerve?

A

Ask patient to shrug shoulder while pushing their shoulder down with your hand. Test for weakness of SCM + trapezius.

45
Q

Injury to upper lesion of brachial plexus

A

C5+C6
UL hangs limply
UL medially rotated at shoulder due to unopposed action of pectoralis major
Elbow extended + forearm pronated due to loss of action of biceps + brachialis
Loss of sensation to lateral side of arm

46
Q

Injury to lower lesion of brachial plexus

A

C8, T1
All small muscles of hand affected
Loss of sensation along medial side of arm

47
Q

Injury to accessory nerve

A

Drooping of shoulder + inability to lift arm above shoulder
SCM and trapezius lost nerve supply.

48
Q

Name the nerve(s) and vessel(s) which lie anterior and posterior to anterior scalene muscle

A

Anterior: Subclavian vein, phrenic nerve (lies immediately posterior to the vein)
Posterior: Roots of brachial plexus, subclavian artery

49
Q

Erb-Duchenne palsy

A

Waiters tip position
Injury to C5-6
UL hangs limply
UL medially rotated at shoulder due to unopposed action of pectoralis major
Elbow extended + forearm pronated due to loss of action of biceps + brachialis
Loss of sensation to lateral side of arm

50
Q

Klumpke palsy

A

Injured C8-T1
Small muscles of hand affected (claw hand deformity)
Loss of sensation across medial side of arm

51
Q

Where is the accessory nerve vulnerable to injury?

A

As it crosses posterior triangle - within roof (i.e. investing layer of deep cervical fascia) - susceptible to injury due to its superficial location

52
Q

You can see the sternocleidomastoid muscle contracting on your patient while he is resting in bed. Why is this significant?

A

Physical sign of respiratory distress - used for deep inspiration.

53
Q

What is the location of the subclavian artery and vein relative to the anterior scalene muscle?

A

Subclavian artery: posterior to anterior scalene muscle
Subclavian vein: anterior to anterior scalene muscle

54
Q

What forms the inferior boundary of the posterior triangle

A

Middle third of clavicle, between attachments of trapezius and sternocleidomastoid

55
Q

Profunda brachii artery + where can it be injured

A

Branch of brachial artery that accompanies radial nerve in spiral groove. Can be injured from fracture of midshaft of humerus.

56
Q

Where does the cephalic vein terminate

A

Drains into axillary vein in deltopectoral groove

57
Q

Brachial artery division

A

Divides at apex of cubital fossa into ulnar + radial artery.

58
Q

Which roots supply bicepts tendon reflex?

A

c6

59
Q

Which roots supply triceps tendon reflex

A

C7

60
Q

Where can the pulse of brachial artery be found?

A
  • Mid arm - against medial side of humerus
  • Cubital fossa: medial to biceps tendon
61
Q

Which nerve is closely related to basilic vein

A

Medial cutaneous nerve of forearm

62
Q

Course of basilic vein

A

It drains medial aspect of dorsal venous arch.
It ascends the medial side of forearm and arm.
In mid-arm region, it pierces deep fascia of the arm and joins with veins accompanying the brachial artery to form axillary vein

63
Q

Course of cephalic vein

A

Drains lateral aspect of dorsal venous arch.
Ascends anterolateral border of forearm and arm, enters delto-pectoral groove and pierces clavi-pectoral fascia and empties into axillary vein.

64
Q

When can long thoracic nerve be damaged

A

mastectomy
Damage to thoracic wall when UL is abducted.

65
Q

Fracture of midshaft of humerus can damage profunda brachii artery - why?

A

Lies in spiral groove close to bone

66
Q

Where can brachial artery pulse be palpated?

A

Mid arm - against medial side of humerus
Cubital fossa: medial to biceps tendon

67
Q

Which artery is most likely injured in supracondylar fracture of the humerus? What is the consequence for the patient?

A

Brachial artery
Ischaemia (lack of blood supply) of forearm muscles →
ischaemic contracture (uncontrolled flexion of hand)

68
Q

In which direction is dislocation most likely to occur in axilla?

A

Inferior direction dislocation most common.
Coracoacromial arch & rotator cuff support joint superiorly, anteriorly & posteriorly. Inferiorly, it is not supported.

69
Q

Where is the axillary nerve liable to injury?

A

Dislocation (inferior) of shoulder joint
Fracture of surgical neck of humerus
Quadrangular space syndrome

FM1010 (50 decks)

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