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Anatomy > Axilla > Flashcards

Axilla Flashcards

1
Q

Axilla

A

. Pyramidal space inferior to glenohumoral joint and sup. To axillary fascia at junction of arm and thorax
. Base, 4 walls, and apex boundaries
. Contents: brachial plexus, axillary blood vessels, lymph vessels, and axillary lymph nodes

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2
Q

Function of axilla

A

. Passageway for vessels and nerves to reach upperlimb

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3
Q

Axilla base boundary

A

. Formed by skin, subQ, and axillary deep fascia of concave armpit

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4
Q

Axillary fascia

A

. Continuous w/ pectoral fascia covering pec major m.

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5
Q

Ant. Wall boundary in axilla

A

. Formed by pec major and minor mm and pec and clavipectoral fascia assoc. w/ them

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6
Q

Pectoral fascia

A

Invests pec major and is continuous inf. W/ fascia of ant. Abdominal wall

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7
Q

Clavipectoral fascia

A

. Fascial layer extends from axillary fascia
. Encloses pec major and subclavius m. Then attaches to clavicle
. Lat. border of pec major form ant. Axillary fold

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8
Q

Medial wall border of axilla

A

. Thoracic wall (1st-4th ribs and intercostal muscles) and overlying serratus ant. M.

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9
Q

Axilla posterior wall boundary

A

. Subscapularis m. Superiorly and teres major and latissimus dorsi inf.
. Post. Axillary fold formed by lat. borders of teres major and latissimus dorsi

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10
Q

Axilla lateral wall boundary

A

Narrow only wall formed by intertubercular sulcus (groove) of humerus

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11
Q

Axilla apex boundary

A

. Entrance from neck to axilla
. Between 1st rib medially, clavicle ant., sup. Border fo scapula post.
. Nerve and vessels of upper limb pass through
. Axillary sheath forms neuromuscular bundle

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12
Q

Axillary sheath is extension of ____

A

Cervical fascia

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13
Q

Contents of axilla

A

. Infraclavicular part of brachial plexus and its branches
. Axillary vessels and branches
. Axillary lymph nodes
. Muscles: Tendon of long head of biceps, Short head of biceps, Coracobrachialis
. Fat and loose areolar tissue

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14
Q

Axillary artery pathway

A

. Direct continuation of subclavian
a.
. Begins at the lat. border of 1st rib
. Ends at inf. border of teres major

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15
Q

WHen does axillary a. Become brachial a.

A

When it passes distal to

the inferior border of teres major

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16
Q

What separates axillary a. Into parts and where does it separate them?

A

. Pec minor
. Part one: prox. To muscle
. Part 2: post. To muscle.
. Part 3: distal to muscle

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17
Q

Part 1 of axilla artery

A

. 1 branch
. Btw lat. border of 1st riba nd med. border pec minor
. Enclosed in axilla sheath
. Sup. Thoracic a

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18
Q

Sup. Thoracic artery supplies __

A

. Sup. Part of thoracic wall including pecs

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19
Q

Second part axilla artery

A

. 2 branches
. Thoracoacromial a.
. Lat. thoracic artery

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20
Q

Thoracoacromial a.

A

. Passes med. to pec minor
. Divides into 4 branches
. Supply pecs and ant. Part fo deltoid

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21
Q

Lat. thoracic artery

A

. Passes lat. to pec minor
. Supplies pecs, serratus anterior
. Gives off lat. mammary arteries of breast in females

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22
Q

Third part fo axilla artery

A

. 3 branches
. Subscapular a.
. Ant. Circumflex humeral a.
. Post. Circumflex humeral a.

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23
Q

Subscapular a.

A

. Largest branch
. Gives off circumflex scapular a.
. Becomes thoracodorsal a. Past branching point of circumflex scapular a.

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24
Q

Circumflex scapular a.

A

. Curves around lat. border fo scapula and anastomoses w/ arteries in dorsal scapular region

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25
Q

Ant. Circumflex humeral a.

A

. Small branch

. Runs ant. Around surgical neck of humerus and anastomoses w/ post. Humeral circumflex a.

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26
Q

Post. Circumflex humeral a.

A

. Runs post. Around humerus and supplies shoulder joint and adjacent muscles

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27
Q

What to do if profuse bleeding of upper limb occurs?

A

. Compress 3rd branch of axilla artery to stop bleeding

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28
Q

Axillary vein

A

. Med. to axillary a.
. Union of brachial veins and basilic vein at inf. Border of teres major
. Cephalic vein enters close to transition of subclavian v.
. Ends at lat. border 1st rib where it becomes subclavian

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29
Q

Exceptions of axillary vein following axillary artery branches

A

. Veins corresponding to thoracoacromial a. Don’t merge to common tributary, some enter independently and others enter into cephalic vein
. Axillary vein receives thoracoepigastric vein

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30
Q

Where does cephalic v. Course into?

A

Deltopectoral triangle

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31
Q

Thoracoepigastric v.

A

. Formed by anastomoses of superficial veins from inguinal region w/ lat. thoracic v. (Axillary tributary)
. Gives collateral route for venous return in presence of obstruction of inf. Vena cava

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32
Q

Principal groups of axillary lymph nodes

A 
. Apical 
. Pectoral
. Subscapular
. Humeral
. Central
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33
Q

Apical auxiliary lymph nodes

A

. At apex of axilla
. Receives lymph from all other axillary lymph nodes and cephalic vein lymph
. Efferent vessels from group unite to form subclavian lymphatic trunk

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34
Q

What trunks forms right lymphatic duct?

A

. Subclavian lymphatic trunk join jugular and bronchomediastinal trunks on right side

35
Q

Pectoral group of axillary lymph nodes

A

. Anterior
. 3-5 nodes along med. wall of axilla
. Receives lymph from ant. Thoracic wall including breast
. Efferent lymph vessels pass to central and apical groups of nodes

36
Q

Subscapular group of axillary lymph nodes

A

. 6-7 lymph nodes
. Lie along post. Axillary fold and subscapular blood vessels
. Receives lymph from post. Aspect thoracic wall and scapular region
. Efferent lymph vessels pass to central and apical node groups

37
Q

Humeral axillary lymph group

A

. 4-6 nodes on lat. wall of axilla, med. and post. To axillary vein
. Receives nearly all lymph from upper limb except that carried by lymph accompanying cephalic vein

38
Q

Central axillary lymph node group

A

.3-4 nodes deep to pec minor near base of axilla
. Associates w/ second part fo axilla a.
. Receives lymph from pectoral, subscapular, and humeral groups
. Efferent vessels pass to apical group of nodes
. Lymph vessels accompanying cephalic v. Drain here

39
Q

. Lymphangitis

A

. Warm, red streaks in skin

. Lymph nodes enlarge and become tender

40
Q

The brachial plexus is the union of ____

A

. Union of ventral rami of C5-8 and greater part of ventral ramus of T1
. Small contributions from C4 and T2 spinal nerves

41
Q

Rami/roots of brachial plexus

A

. 5 segmental ventral rami (C5-T1)

42
Q

Trunks of brachial plexus

A

. 5 roots form 3 trunks
. Sup. (Upper) trunk: formed by uniting C5-C6 ventral rami
. Middle trunk: formed by C7 ventral rami
. Inf (lower) trunk: C8 and T1 ventral rami

43
Q

Anterior and posterior divisions of brachial plexus

A

. Each trunk splits into anterior and posterior divisions forming 3 ant. And post. Divisions

44
Q

Cords of brachial plexus

A

. 6 ant. And post. Divisions unite to form 3 cords
. Lateral cord: ant. Divisions of upper and middle trunks unite (C5-7)
. Med. cord: ant. Division of lower trunk continues alone as medial cord (T8, T1)
. Post. Cord: post. Division of all 3 trunks unite to form post. Cord (C5-T1)

45
Q

Branches of brachial plexus

A

. 3 cords form 5 terminal branches
. Lat. cord splits into musculocutaneous nerve and lat. root of median nerve and ulnar nerve
. Post. Cord divides into small axillary nerve and axial nerve

46
Q

Location of roots and trunks of brachial plexus

A

. Sup. To clavicle in post. Triangle of neck

. Roots emerge between scalenus anterior and scalenus medius mm.

47
Q

Location of divisions in brachial plexus

A

. Post. To clavicle in apex of axilla

48
Q

Location of cords in brachial plexus

A

. Inf. To clavicle in axilla where they’re found post. To pec minor
. Surround second part of axillary artery on 3 sides

49
Q

Terminal branches location of brachial plexus

A

. Inf. Part of axilla is when cords split into these

50
Q

Groups of branches of brachial plexus

A

. Supraclavicular and infraclavicular

51
Q

How are supraclavicular branches grouped?

A

. Those arising from roots of brachial plexus and those arising from upper trunk of brachial plexus

52
Q

Suprascapular branches arising from roots of brachial plexus

A

. Muscular branches
. Branch that joins phrenic nerve
. Dorsal scapular nerve
. Long scapular nerve

53
Q

Muscular branches from brachial plexus spinal cord levels and distribution

A

. C5-8

. Scaleni and longus colli muscles

54
Q

Branch from brachial plexus that joins phrenic nerve spinal cord level and distribution

A

. C5

. Thoracoabdominal diaphragm

55
Q

Dorsal scapular nerve spinal cord level and distribution

A

. C4-5
. Rhomboideus major and minor
. Levator scapulae

56
Q

Long thoracic nerve spinal cord level and distribution

A

. C5-7

. Serratus anterior

57
Q

Suprascapular Branches from brachial plexus upper trunk

A

. Nerve to subclavius

. Suprascapular nerve

58
Q

Nerve to subclavius from brachial plexus spinal cord level and distribution

A

. C4-6

. Subclavius and sternoclavicular joint

59
Q

Suprascapular nerve spinal cord level and distribution

A

. C4-6

. Supraspinatus, infraspinatus, and glenohumoral joint

60
Q

Infraclavicular branches and how they are traced

A

. Derived from 3 cords of plexus

. Fibers traced through plexus to spinal cord nerve they originated form

61
Q

Lateral cord infrascapular branches

A

. Lat pectoral n.
. Musculocutaneous n.
. Lat. root of median n.

62
Q

Lateral pectoral nerve spinal cord level and distribution

A

. C5-7

. Pec major

63
Q

Musculocutaneous n. Spinal cord level and distribution

A

. C5-7
. Coracobrachialis, biceps brachii, brachialis
. Continues as lat. antebracxhial cutaneous nerve

64
Q

Lateral and medial roots of median nerve spinal cord level and distribution

A

. lat: C5-7
. Med: C8-T1
. Flexor muscles in forearm (except flexor carpi ulnaris, ulnar half of flexor digitorum profundus) and 5 hand muscles

65
Q

Medial cord infrascaplar branches from brachial plexus

A 
. Med. root of median nerve
. Med. brachial cutaneous n. 
. Med. antebrachial cutaneous n. 
. Ulnar n. 
. Med. pectoral n.
66
Q

Medial brachial cutaneous nerve spinal cord level and distribution

A

C8, T1

. Skin of med. side of arm

67
Q

Medial antebrachial cutaneous n. Spinal cord level and distribution

A

. C8, T1

. Skin over med. side of forearm

68
Q

Ulnar nerve spinal cord level and distribution

A

. C7-8, T1

. 1.5 flexor muscles in forearm, most small muscles in hand and skin of hand med. to line bisecting 4th digit

69
Q

Medial pectoral nerve spinal cord level and distribution

A

. C8, T1

. Pec major and minor

70
Q

Posterior cord infrascapular branches from brachial plexus

A 
. Upper subscapular n.
. Thoracodorsal n.
. Lower subscapular n. 
. Axillary n. 
. Radial n.
71
Q

Upper subscapular nerve spinal cord level and distribution

A

. C5-6

. Sup. Portion of subscapularis

72
Q

. Thoracodorsal n. Spinal level and distribution

A

. C6-8

. Latissimus dorsi

73
Q

Lower subscapular nerve spinal cord level and distribution

A

. C5-6

. Inf. Portion of subscapularis and teres major

74
Q

Axillary nerve spinal cord level and distribution

A

. C5-6

. Teres minor and deltoid, shoulder joint, and skin over inf. Part of deltoid

75
Q

Radial nerve spinal cord level and distribution

A

. C5-8, T1
. Triceps brachii, anconeus, brachioradialis, and extensor muscles of forearm
. Skin on post. Aspect of arm and forearm via post. Cutaneous nerves of arm and forearm

76
Q

Upper plexus injuries (Erb’s palsy or Erb-DUchenne palsy)

A

. C5-6 rami or sup. Trunk torn/severed
. Paralysis of proximal limbs (C5-6 myotomes) and loss of sensation in C5-6 dermatomes
. Examples: thrown from horse, stretching infant neck during delivery

77
Q

What nerve branches are affected by paper plexus injuries?

A

. Axillary (C5,6), musculotaneous (C5-7), and suprascapular nerves

78
Q

Signs and symptoms of upper plexus injuries and what muscles correspond

A

. Loss of flexion and weakness of supination (biceps, brachialis, and brachioradialis)
. Loss of flexion, adduction, and loss of lat. rotation of shoulder joint/arm (biceps, deltoid, supraspinatus, infraspinatus, teresminor)
. Contracture deformities
. Adducted upper limb, medially rotated arm, extended and prostrated forearm (waiter’s tip position)
. Loss sensation on lat. side of upper limb

79
Q

Lower plexus injuries (Klumpke’s palsey)

A

. C8, T1 ventral rami or inf. Trunk are torn/severed
. Less common
. Causes: grasping something to break fall, rotate shoulder during birth

80
Q

Nerve branches affected in lower plexus injuries

A

. Skin/ muscle or arm and forearm from medial cutaneous arm and forearm, ulnar nerve, part of median nerve (C8-T1)

81
Q

Signs and symptoms of lower plexus injuries and muscles associated

A

. Loss of movement in intrinsic hand (palm hollowed ou)
. All digits (esp 9 and 10) extended at metacarpophalangeal joints by unopposed extensors
. Flexed at inter phalange always joint by long digital flexors
. Clawing contracture from loss of medial 2 lumbricals and all interossei m.
. Weakness of grip of digits 9-10 from FDP and hypothenar m.
. Loess of sensation in C8,T1 dermatomes

82
Q

Posterior cord injury

A

. Affects radial nerve
. Most frequently encountered
. Causes: incorrect use of crutches
.

83
Q

Movements affected by posterior cord injury

A

. Loss of extension of elbows and triceps reflex causing elbow flexion
. Loss of wrist extension and weakness of ulnar/radial deviation causing wrist flexion
. Loss fo extension of MCP joints causing MCP flexion
. Loss of extension and abduction of thumb causing flexion and adduction

84
Q

Position of limb in radial nerve injury

A

. Hand is flexed at wrist, lies flaccid (wrist drop)
. Forearm pronated
. Thumb adducted, flexed, and opposed
. Fingers flexed

Anatomy (49 decks)

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