Anatomy of the Upper Limb and Breast Flashcards
Parts of the pectoral girdle
Where they join
The clavicle and the scapula
Sternoclavicular joint and the acromioclavicular joint
Scapula
Location
Most palpable areas
What is required for full abduciton of the arm?
2nd to 7th rib posteriorly
Spine, acromion, coracoid process
Rotation of the scapula required to abduct the arm
Clavicle: difference between the medial 2/3 and lateral 1/3
Medial 2/3: convex anteriorly, cicular
Lateral 1/3: convex posteriorly, flat
Articulations of the clavicle
Sternum (sternoclavicular joint): articular disc in joint
Acromion (acromiclavicular joint): incomplete articular disc in joint
Coracoid process; held by strong coracoclavicular ligament
Interesting facts about the clavicle
development (x2)
what can pierce it
purpose (x2)
related to ortho?
first bone to ossify, only long bone to develop in membrane
supraclavicular nerves
acts as a strut to hold the arm out, transmits forces from the upper limb to the axial skeleton
most commonly fractured site in the body
Humerus anatomy
Head
Shaft
Posterior
Lower end
Head: 1/3 sphere, connects tohe shaft via the anatomical neck, below it are the greater and lesser tubercles between which the bicipital groove where the tendon of the long head of the biceps lies
Upper end and shaft (circular and more flat distally) meet at surgical neck = axillary nerve + circumflex humeral vessels lie
Posterior = radial nerve lies in the spiral groove, between the medial and lateral triceps heads
Lower end has rounded capitulum for articulation with radial head, and trochlear for articulation with trochlear notch of the ulna
Medial and lateral epicondyles are extracapsular: ulnar nerve lies in a groove on the posterior aspect of the medial epicondyle
Scapula anatomy
Anteriorly
Posteriorly
Posterior: superior angle, scapular notch, supraspinous foss, spine, infraspinous fossa, lateral border
Anterior: acromion, coracoid process
Radius - parts
Ulna - parts
Radius: radial head, radial tuberosity, styloid process, expanded end, dorsal tubercle (posterior)
Ulnar: olecranon, trochlear notch, coronoid proces (with its radial notch), head, styloid process
Carpal bones
Proximal row (L to M): scaphoid, lunate, triquetrum (+ pisiform)
Distal row (M to L): hamate, cunate, trapezoid, trapezium
Arched transversly - with the palmar aspect being concave - maintained by the posterior aspect of bone being larger than anterior aspect (except lunate)
AND
flexor retinaculum from scaphoid and trapezium laterally to pisiform and hook of hamate medially
Metacarpals - important articulations
First metacarpal mobility is important for opposition of the thumb
Second metacarpal = articulates with trapezium, trapezoid, capitate
Capitate = articulates with 2nd, 3rd, 4th metacarpal
Joints of the upper limb
Articulations
Where the capsule surrounds
Ball and socket
Articulations: glenoid fosssa (deepened by labrum glenoidale - cartilaginous ring) with head of humerus
Capsule - lax, around the epihyseal line around glenoid and humeral head, extends down to diaphysis at the medial aspect of humerus
Biecps tendon passes through it - capsule lined by synovial membrane here - synovium communicated with the subcapsular bursa, lying beneath tendon of subscapularis
Muscles that provide stability to the shoulder
Rotator cuff
Long head of biceps
Pectoralis major, latissimus dorsi, teres major
Muscles acting on the shoulder joint
Abduction
Adduction
Flexors
Extensors
Medial rotators
Lateral rotators
Abduction: deltoid, supraspinatus
Adduction: pectoralis major, latissimus dorsi
Flexors: anterior deltoid, coracobrachialis, pectoralis major
Extensors: posterior deltoid, latissimus dorsi, teres major
Medial rotators: pectoralis major, latissimus dorsi, teres major, anterior deltoid, subscapulairs
Lateral rotators: infraspinatus, teres minor, posterior deltoid
Ligaments of the clavicle attaching to the coracoid process
Conoid ligament (front)
Trapezoid ligament (behind)
Joints of the shoulder girdle
Sternoclavicular joint: sternum and medial end of clavicle; the costoclavicular ligament attaches to the first costal cartilage: acting as a fulcrum when the shoulders are shrugged to depress the medial end
Acromioclavicular ligament: acormion to lateral boder of clavicle, there are two coracoclavicular ligaments: conoid (in front) and trapezoid (behind) - allows easy reduction of outer end of clavicle, but inclination of surfaces means that this can be hard to stay reduced
Rotator cuff: muscles whose tendons have a sheath surrounding most of the joint (apart from the inferior aspect)
Supraspinatous, infraspinatous, teres minor - inserts into the greater tuberosity; subscapularis inserts into the lesser tuberosity
Supraspinatous - beneath the acromion and coracoacromial ligament - separated from these by the subacromial bursa
Abduction of the shoulder
Supraspinatous - 15 degrees
Deltoid - 90 degrees
Rotation of scapula by trapezius and serratus anterior - 180 degrees
Any movement of the shoulder causes reciprocal movement at the sternoclavicular joint
Muscles to protract and retract the scapula
Protract: pectoralis minor, serratus anterior
Retract: rhomboids, middle fibres of trapezius
Location of the bones after clavicle fracture
Lateral end of clavicle - depressed and moved medial - due to shoulder adductors
Modial end of clavicle - raised due to sternocleidomastoid
Serratus anterior supply
Long throacic nerve of bell; C5,6,7
Damage causes winging of the scapula
Joints at the elbow
Humeroulnar joint - trachlea of humerus with the trochlea notch of ulna (hinge joint)
Humeroradial joint: capitulum and radial head (ball and socket joint)
Proximal radioulanr joint: head of radius and radial notch of ulna (pivot joint)
Capsule of the elbow joint
Lax and thin anterior and posteriorly
Laterallly: thickened to form the lateral and medial collateral ligaments
Lateral ligament is atttached to the annular ligament which holds the head of the radius in place; forms the start of the supinator muscle
Movement of the elbow joint
Flexion / extension
pronation and supination at the proximal radioulnar joint
Muscles around the elbow joint
Flexors: biceps, brachialis, brachioradialis, forearm flexors
Extensors: triceps, ancones
Pronation: pronator teres, pronator quadratus
Supination: supinator, biceps
Articular surfaces of the wrist
Distal radus, and head of the ulnar (which has an articular disc - triangular fibrocartilage)
Proximal articulations with the scaphoid, lunate, triquetrum
Wrist type of joint
Condyloid joint: can flex, extend, adduct, abduct and circumduct
Movements of the wrist
D
Flexion: all anterior muscles of the aforwarm - at both midcarpal and radiocarpal joint
Extension:all posterior compartment mescles
Adduction: flexor and extensor carpi ulnaris, - mainly at the mid carpal joint
Abduction: flexor carpi radialis, extensor carpi radialis longus, adductor policis longus, extensor policis longus
Joints of the hand
Carpo-metacarpal joints - all except thumb have limited gliding movement
thumb is a saddle joint: has flexion/extension (plane of palm), adduction/abduction (right angle of palm), opposition of little finger
Metacarpo-phalangeal joints
Thumb - flexes to 60 degrees, fingers - 90 degrees
Abduction, adduction and circumduction in fingers only, not possible when fully flexed
Deep transverse ligaments stop fingers from spreading out during firm grip
Interphalangeal joints
Hing only- flexion, extension,
collateral ligaments lax in extension, taut in flexion
Muscles controlling the hand
Long flexors - FDP; FDS
Long extensors - EDL + EDI / EDM
Extensor expansion - covers proximal phalanx, base of middle phalanx, and two lateral slips into distal phalanx - consists of EDL, interossei, lumbricals
Small muscles of hand - interossei, lumbricals
Muscles of the thumb - FPL, EPL, EPB, APL
Muscles of little finger - ADM, FDM, ODM
Long flexors of the hand
Flexor digitorum superficialis - attaches to sides of middle phalanx; flexes middle phalanx
Flexor digitorum profundus - gives off lumbricals; attaches to base of distal phalanx; pierces FDS under the proximal phalanx; flexes distal phalamx
Long extensors of the hand
Extensor digitorum longus - inserts into the extensor expansion - on the dorsum of the phlanaxes
Extensor indicis - medial side of EDL to the index finger (extensor expansion) - originates from the posterior surface of ulna and interosseus membrane
Extensor digiti minimi - medial side of EDL to the little finger - originates from lateral epicondyle
Where does the extensor expansion for the fingers sit?
Covers the proximal phalanx
Inserts into the base of the middle phalanx
Provides two slips to insert into the base of the distal phalanx
Receives insertion of the interossei and lumbricals
Interossei
Where they arise?
Insert?
Innervation?
Action?
From the sides and front of the metacarpals
Into the extensor expansion
Deep branch of the ulnar nerve
Abduct / adduct the fingers + flex the MCP, extend the IPJ
Lumbricals
Originate
Insert
Innervation
Action
Arise from FDP tendons
Insert into the extensor expansion
Lateral two - median nerve, medial two- ulnar nerve
Flex the MCP, extend the IPJ
Muscles of the thumb
Long muscles
Thenar muscles
Hypothenar muscles
Long muscles
Flexor pollicis longus - into distal phalanx
Extensor pollicis longus - into distal phalanx
Extensor pollicis brevis - into proximal phalanx
Abductor pollicis longus - into the first metacarpal
Thenar muscles
Adductor pollicis - base of proximal phalanx
Flexor pollicis brevis - base of proximal phalanx
Abductor pollicis brevis - base of proximal phalanx
Opponens policis - along the first metacarpal
Hypothenar muscles
Abductor digiti minimi
Flexor digiti minimi
Opponens digiti minimi
Abduction and adduction of the fingers - muscles in addition to the intrinsic hand muscles
Entensor digitorum longus - weak abduction
Long flexors (FDP, FDS) - weak adduction
Can be eliminated by placing the hand flat on the table
Collateral ligaments of the wrist
Radial collateral ligament: radial styloid to scaphoid, trapezium
U;nar collateral ligament: ulnar styloid to triquetral, pisiform
AP ligaments in wrist
Strong, part of the capsule - Radiocarpal ligaments - dorsal / palmar
Muscles of elbow flexors and extensors
Brachialis - anterior surface of humerus to ulnar tuberosity
Biceps brachii - in front of brachilais - two heads - long attaches to supraglenoid tubercle, short head to the coracoid process (merges with the coracobrachialis tendon), inseerts on the radial tuberosity with another branch fanning out to form the bicipital aponeurosis - whicg merges with the deep fascia of the forearm
Brachoradialis - from just below the deltoid tuberosity on the humerus, to the distal radius
Extensor - only triceps - long head (arising from the infraglenoid tubercle); lateral head from the lateral side of posterior humerus; medial from the medial side and more of the posterior humerus; three heads converge to form a tendon attaching to the olecranon
Anconeus - smaller - running from lateral epicondyle to the lateral aspect of proximal ulna
Radial nerve runs inbetween the medial and lateral humerus
Rotation of the forearm
Pronation
Supination
Pronator teres- originates from medial epicondyle (smaller head from proximal ulna) - inserts into the lateral aspect of radius, about halfway down - median nerve travels in between the two heads
Pronator quadratus- on the distal forearm - originates on the anteromedial aspect of ulna - attaches to anterior aspect of radius
Supinator- arises from lateral epicondyle, annular ligament, supinator crest and inserts into ulnar - just above the insertion of pronator teres
Biceps- onto radial tuberosity
Muscles of the wirst - flexion
Flexors
Common flexor tendon - gives of flexor carpi ulnaris + flexor carpi radialis from the medial epicondule - together they flex - individually one side deviation
FCU - has another head arising from the ulna - between which the ulnar nerve travels - they form a tendon which inserts into the pisiform - this is transmitted onto the base of the 5th metacarpal through the piso-hamate and piso-metacarpal ligaments.
FCR - inserts into the base of the 2nd metacarpal - passing through a deep ligamentous tunnel near the carpal bones
Palmaris longus - from medial epicondyle - through the carpal tunnel inserts into the deep palmar fascia fanning out; it is frequent absent
Muscles of the wrist - extension
extensor carpi radialis longus and brevis - originates from the common extensor tendon; longus - lateral epicondylar ridge; brevis - lateral epicondyle; insert into the 2nd and 3rd metacarpal base
extensor carpi ulnaris - from the medial surface of ulna; insert into the 5th metacarpal base
Pass under the extensor retinaculum
Superficial veins of the upper limbs
Starts on the dorsal venous network of the hand - then drains into the lateral cephalic and dorsal basilic
Cephalic vein on the anterolateral aspect of the arm - stays superficial; runs in the groove along the lateral border of biceps - near the top its between the deltoid and pectoralis major (deltopectoral triangle); pierces the clavipectoral fascia to then enter the axillary vein
Median cubital vein - joins cephalic to basilic
Basilic vein runs along the posterior aspect - then becomes anteiror at the elbow - runs in the medial groove of the biceps. Brachial vein joins basilic vein (the venae comitantes of the brachial artery)and eventually forms the axillary vein - above it are the median nerve and axillary artery - disappears behind pec minor
Deep veins of the upper limb
Also known as venae comitantes, they follow the arteries
Ulnar and radial veins - drain to form the brachial vein at the elbow
Brachial joins with the basilic vein = forms the axillary vein - at the inferior border of teres major
Axillary vein terminal part is joined by the cephalic vein = subclavian vein when it crosses the first rib lateral border
At the elbow what separates the veins from the arteries?
The bicipital aponeurosis
Why is cephalic vein good for diaplysis?
Fairly constant location and in close proximity to the radial artery for a radiocephalic fistula
Axillary artery
Start to finish
Branches and parts
Relations
Subclavian into axillary – at the lateral border of first rib
Axillary into brachial at the inferior border of teres major
Branches made by pec major
1st part - 1 branch
Superior thoracic artery
2nd part - 2 branches
acromiothoracic artery
lateral thoracic artery
3rd part - 3 branches
subscapular artery
anterior circumflex humeral artery
posterior circumflex humeral artery
Relations: cords of brachial plexus - lateral, posterior, medial surround it
Brachial artery
Start to finish
Where does it lie and what crosses it?
Lower border of teres major until the neck of the radius
Lies below the deep fascia (easily accessible) and crossed by median nerve from lateral to medial at the level of mid humerus
Gives off a profunda brachii branch immediately below the border of teres major - travelling to the posterior aspect of the humerus in between the long and lateral heads of the triceps
Radial artery
Superficial - starts at the level of the radial neck
Overlapped by brachioradialis in its upper half
Can be palpated in between braachioradialis and flexor carpi radialis
Travels deep to APL and EPB to enter the anatomical snuff box
Distal to the wrist - gives branches for superficial palmar arch
Pierces through first dorsal interosseus and adductor policis = deep palmar arch
Ulnar artery
Travels deeper than radial
lies on FDP - overlapped by FCU
Crossed supreficially by median nerve with pronator teres (deep head) in between
Can be palpated when superficial between FDP and FCU in the distal forearm
Crosses in front of the flexor retinaculum to become the superficial palmar arch (with the radial artery)
Accompanied by the ulnar nerve in the distal two thirds of the forearm and across the flexor retinaculum
Brachial Plexus
Roman Togas Dont Cover Balls
Roots: C5, C6, C7, C8, T1
Trunks: Superior (C5 + C6), Middle (C7), Inferior (C8 + T1)
Divisions: each trunk divides into anterior and posterior
Cords: Posterior (from all the posterior divisions); lateral (anterior division of superior and middle trunks); medial (anterior division of lower trunk)
Branches: Lateral cord - musculocutaneous; posterior cord - radial and axillary (only C5,6); medial cord - ulnar; lateral + medial cord - median
Additional nerves:
Medial cord - 3M’s = medial antebrachial cutaneous, medial brachial cutaeous, medial pectoral
Posterior cord - LMU - lower middle upper subscapular nerve (middle also known as thoracodorsal nerve)
Lateral cord = lateral pectoral
Superior trunk = 3S’s = suprascapular (supplies supraspinatus/infraspinatus), subclavius, dorsal scapular (from C5 only - supplies rhomboids)
C5,6,7 = long throacic nerve of Bell
Key facts about axillary nerve
C5,C6
Motor - deltoid, teres minor (cant abduct if damaged)
Sensory - skin over deltoid
Wound around the surgical neck of the humerus
Key facts about radial nerve
Arises behind axillary artery, then acoompanies profuda brachii to the posterior compartment - lies in the spiral groove - between the long and medial head of the triceps
Enters anterior compartment by piercing the intermuscular septum
At lateral epicondyle gives off posterior interosseos branch - this supplies supinator, adductor pollicis longus and all extensor muscles except ECR-L
Continues superficially under brachioradialis, emerges posteriorly and provides sensation to radial 3,5 digits posteriorly
Motor innervation of triceps, anconeus, brachioradialis, ECR-L
Key facts about musculocutaneous nerve
Arises from C5,6,7
Pierces coracobrachialis - runs between biceps and brachialis
Motor innervation - biceps, brachialis, coracobrachialis
Sensory innervation - lateral aspect of forearm
Key facts about the median nerve
From C6,7,8,T1
Anterior to the axillary artery, crosses brachial artery to become medial at the midhumerus
Enters forearm between the heads of pronator teres - gives off anterior interosseous branch here
Lies on the deep aspect of FDS
gives off palmar cutaneous branch - supplies palmar skin over thenar eminence - does not travel in the carpal tunnel
Median nerve supplies muscles of the forearm, lateral FDP, lateral lumbricals, OAF of thenar eminence
Sensory to lateral 3.5 on the palmar surface
Key facts about the ulnar nerve
Formed from C7,8,T1
Medial to axillary and brachial artery until midhumerus
then pierces the intermuscular septum to lie on the anterior surface of the triceps
Passess behind the medial epicondyle
Descends between FCU and FDP - lying to the radial side of the tendon of FCU superficially
Gives of dorsal cutaneous branch - sensation for the dorsal aspect of ulnar 1.5 fingers
Motor to the interosseous muscles, medial lumbricals, FCU, FDP medially, adductor policis, hypothenar muscles
Erb’s palsy
Upper roots damaged - C5,C6
Nerves to deltoid, supraspinatus, infraspinatus (abduction)
Nerves to biceps, brachialis (supination)
Can be from forced downward traction during birth, falling on side of head and shoulder - pushing the two apart
Leaves arm adducted, pronated and palm facing backwards
Klumpke’s paralysis
Lower nerve roots damaged
Forced upward traction during breech delivery / fall and holding onto something
Intrinsic hand muscle paralysed - claw hand to due to unopposed long flexors and extensors (long flexors flex the IP joints, long extensors extend the MCP - intrinsic muscles entend the IP)
Loss of sensation on the inner and upper arm and forearm
Wasting of small muscles - channels form; horner’s syndome can occur due to proximity to sympathetic chain
Can also occur in pancoast tumour / cervical rib
Axillary nerve
Damaged during fracture of surgical neck of the humerus / anterior dislocation of the shoulder joint
Cannot abduct and sensory deficit over the regimental area
Radial nerve damage
Fracture of the shaft of the humerus
or Saturday night palsy - lying arm over a chair and compression of the nerve between the chair and the humerus
Causes wrist drop if main radial nerve is damaged
If only posterior interossesous nerve is damaged then no wristdrop as EPL supplied by main radial nerve
Sensory loss in the first web space of the dorsum of the hand
Median nerve damage
Usually at the wrist or a supracondular fracture
At the elbow:
- loss of pronation
- weakness of flexion with ulnar deviation (as now depends of FCU and medial FDP only)
- loss of sensation of radial 3.5 digits
At the wrist
- paralysis of thenar muscles - except adductor policis
- paralysis of lumbricals - lateral two
- loss of sensastion of radial 3.5 digits
Damage at both placesL
- loss of accurate opposition
- loss of tactile response / cutaneous sensation = risk of serios injury
Ulnar nerve damage
Fracture at the medial epicondyle / dislocation of the elbow
Laceration at the wrist
At the wrist:
- clawing of the hand - less clawing in 2 and 3 due to supply from median nerve
- sensory loss over medial 1.5 fingers
At the elbow
- clawing of the hand - less clawing than the wrist at 4 and 5 due to damage to medial FDP
To diagnose - test sensation in medial 1.5 digits + loss of abduction and adduction in digits with hand flat on table
Difference between claw hand and hand of benediction
Pulp space of fingers
What is it?
Result?
Fat packed between fibrous septa around the distal phalanx between the skin and the periosteum
The digital artery has branches that go through the pulp space (except for the branch that goes to the base of the distal phalanx)
Important because pulp space infection = increased pressure = arterial thrombosis and necrosis of the distal phalanx but sparing of the base
Bursa and sheaths of the hand
Flexor tendons travel in fibro-osseous tunnels - flexor sheaths surrounded by synovial membrane (synovial sheaths)
For 2,3,4 fingers - stops at the base of the metacarpal
For little finger - continues onto the the palmar surface forming a sheath that encloses all flexor tendons (except the thumb) - forming the ulnar bursa
The thumb sheath (for FPL) - extends donwards through the flexor retinaculum to 2.5cm below - forming the radial bursa
Ulnar and radial bursa may communicate
Important as infection within 2,3,4 sheaths is confined, whilst elsewhere can spread through the bursa and between each other
What is the mid palmar space?
Behind the sheath, bursa and flexor tendons, in fornt of 3,4,5 metacarpals
Does not extend to 1,2 metacarpal as the adductor policis tendon arises from the shaft of the 3rd metacarpal
What is the thenar space?
Space in front of the the 2nd and 3rd metacarpals and adductor policis, away from the mid palmar space by a fibrous partition
Infection in this space - either from direct penetrating injury / neglected tendon sheath infection
Palmar infections = marked dorsal oedema - cant accumulate in palmar aspect as thick skin joined heavily by palmar aponeurosis - on the dorsum skin is loose and fluid can collected easily deep to it
Palmar aponeurosis
Part of the deep fascia of the hand - blends with the fibrous sheath of the fingers
attached to the sides of the proximal and middle phalanges
Dupuytrens contractures - thickening and contraction of the palmar fascia causing flexion of PIP and MCP
Carpal tunnel bones
Flexor retinaculum - other compartments
Extensor retinaculum attachments
Hook of the hamate + pisiform
Crest of the trapezium and scaphoid tubercle
Radial side - encompasses FCR
Ulnar side - ulnar artery and nerve
From the ridge on the radius to the ulnar styloid, triquetral, hamate
MCP joint - capsule
Capsule surrounds the MCP
Lax on the dorsum - to allow flexion
Thickend palmar ligament at the front - moves with flexion
Also attached are the collatera ligaments - run obliquely from the back of the proximal phalanx to the the head of the distal MC - taut when flexed, lax when extended = allow side to side movement when extended but not flexed
Deep transverse metacarpal ligament attached to the top - joining all for MCPs
IP Joints - collateral ligaments
Equally taut in flexion and extension - so prevent side to side movement
Borders and contents of the axilla
Base: skin and fascia of the armpit
Medial: rib cage covered by serratus anterior
Lateral: bicipital groove of the humerus
Anterior: pec major and minor
Posterior: latissimus dorsi, teres major, subscapularis
Apex bounded anteriorly by clavicle, first rib medially, acromion and superior border of scapula posteriorly
Contents of the axilla
Brachial plexus
Axillary artery
Axillary vein
lymph nodes
fat
Antecubital fossa relations and contents
Medially - pronator teres
Laterally - brachioradialis
Inferiorly - brachialis + supinator
Superiorly - skin + superficial fascia + deep fascia of bicipital aponeurosis
Contents: brachial artery and median nerve (medially)
Carpal tunnel relations and contents
Scaphoid tubercle + crest of the trapezium
Hook of the hamate and pisiform
FDS + FDP + FPL + median nerve
+ FCR (runs in its own osseo-fascial compartment)
Superficial palmar branch of median nerve - innervates the palmar aspect of thenar eminence - not affected in carpal tunnel syndrome
Anatomical snuffbox contents and relations
Medial border - extensor pollicis longus
Lateral border - extensor pollicis brevis + abductor pollicis longus
Contents - base of thumb metacarpal, trapezium, scaphoid, radial styloid, dorsal branch of the radial artery (close proximity to cephalic vein = good for fistula)
Structures around the wrist
See image
Axillary lymph nodes
5 groups
Apical (all drain into here) - immediately behind clavicle at the apex of axilla above pec minor, along axillary vein
“Medial” - deep to pec major along border of pec minor
Lateral - along axillary vein
Central - in the axillary fat
Posterior - along subscapular vessels
From these the subclavian lymph trunk forms
Leves of axillary lymph nodes
Level 1 - below and lateral to the inferolateral border of pec minor
Level 2 - behind pec minor
Level 3 - above the upper border of pec minor
Dermatomes in the arm
C5 lateral
C6 index
C7 middle
C8 medial
T1 upper inner aspect of arm
Cutaneuous nerve suply of the hand
Anterior:
Medial 3.5 fingers
Ulnar 1.5 fingers
Posterior
Radial 1.5 fingers
Ulnar 2.5 fingers
Fingertips of 2.5 fingers + thumb = median
Cutaenous nerve of the arm
Anterior
Supraclavicular
Upper and lower lateral nerve of the arm
Intercostobrachial nerve
Medial and lateral cutaneous nerve of the forearm
Posterior
Supraclavicular
Posterior cutaenous nerve of the arm
Medial cutaneous nerve of the arm
Posterior cutaneous nerve of the forearm
Medial and lateral cutaneous nerve of the forearm
Composition of the female breast
Glands in the areola
Fat, fibrous tissue, glandular tissue
15-20 lobules of glandular tissue - separated by fibrous septa (goes from subcutaneous tissue to the fascia of the chest wall - known as ligaments of Astley Cooper)
Each drains into a lactiferous duct - converges at the nipple - lactiferous sinus
Areola - lubricated by glands of montgomery - large modified sebaceous glands
Blood supply of the breast
Axillary artery via lateral thoracic and acromiothoracic branches
Internal mammary (thoracic) artery via its perforating arteries
Intercostal arteries - via lateral perforators
Venous system corresponds to the arteries
Lymphatic drainage of the breast
Laterally via the axillary vessels to the axillary lymph nodes
Medially via the internal mammary vessels to the internal mammary chain
Male breast
Rudimentary
Small primitive ducts may be present, supported by fat and fibrous tissue
At risk of carcinoma
Where can breast malignanyc spread via lymphatics?
Lymphatic of the contralateral breast
Contralateral axillary lymph nodes
Cervical nodes
Inguinal nodes
What is a glactocoele?
Blocked lactiferous duct during lactation
Montogomery’s tubercles?
Dilatation of montogomery’s glands during pregnancy
Dimpling of the skin over a breast: cause and pathophysiology
Due to contraction of ligaments of Astley-Cooper - due to malignant infiltration by carcinoma
Can also cause nipple inversion
