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MRCS > Axilla > Flashcards

Axilla Flashcards

1
Q

Shape of axilla

A

Irregularly shaped pyramidal space with
four sides
an inlet
a floor (base)

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2
Q

Inlet of axilla

A

Lateral margin of rib I
Clavicle (anteriorly)
Superior margin of scapula to coracoid process (posteriorly)

Subclavian artery becomes axillary artery as it passes over lateral margin of rib I.
Axillary vein anterior to axillary artery, which is anterior to brachial plexus.

Inferior trunk of brachial plexus lies directly on rib I, as does subclavian artery and vein. Subclavian artery and vein separated by anterior scalene muscle as they pass over rib I.

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3
Q

Anterior wall of axilla

A

Pectoralis major and minor
Subclavius muscle
Clavipectoral fascia

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4
Q

Lateral wall

A

Intertubercular sulcus

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5
Q

Posterior wall

A

Subscapularis
teres major
latissimus dorsi
long head of triceps brachii

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6
Q

Floor of axilla

A

Skin of armpit

Opens laterally into arm

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7
Q

Medial wall of axilla

A

Upper thoracic wall

Serratus anterior muscle

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8
Q

Pectoralis major

A

Two heads - clavicular head (from medial half of clavicle) and sternocostal head.
Insertion: lateral lip of intertubercular sulcus of humerus
Medial and lateral pectoral nerves

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9
Q

Subclavius

A

Origin: first rib at junction between rib and costal cartilage
Insertion: groove on interior surface of middle 1/3 clavicle
Nerve to subclavius

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10
Q

Pectoralis minor

A

origin: Ribs III to V
insertion: coracoid process of scapula
medial pectoral nerve

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11
Q

Clavipectoral fascia

A

Thick sheet of tissue that connects clavicle to floor of axilla. Encloses subclavius and pectoralis minor and spans the gap between them

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12
Q

Structure passing between subclavius and pec minor through clavipectoral fascia

A

Cephalic vein
Thoraco-acromial artery
Lateral pectoral nerve

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13
Q

Structures passing beneath pec minor through clavipectoral fascia

A

Medial pectoral nerve

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14
Q

Lateral thoracic artery

A

leaves axilla by passing through fascia inferior to pec minor muscle

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15
Q

Subscapularis

A

Insertion: lesser tubercle of humerus
Innervation: upper and lower subscapular nerves
Medial rotation of arm

Forms the largest component of posterior wall of axilla
Tendon crosses anteriorly to joint capsule of glenohumeral joint

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16
Q

Teres major

A

Origin: posterior surface of inferior angle of scapula
Insertion: medial lip of intertubercular sulcus
Innervation: lower subscapular nerve
Medial rotation and extension of arm

Defines inferior limit of axilla laterally

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17
Q

Long heads of triceps brachii

A

Origin: infraglenoid tubercle of scapula
Insertion: olecranon process of ulna
Radial nerve
Extension of forearm

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18
Q

Contents of axilla

A

Major vessels
Nerves and lymphatics of upper limb
Proximal parts of coracobrachialis and biceps brachii
Axillary process of breast

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19
Q

Biceps brachii

A

Origin: long head (supraglenoid tubercle), short head (apex of coracoid process)
Insertion: Radial tuberosity
Innervation: musculocutaneous (C5-6)
Flexor of forearm and supinator

Tendon of long head passes over head of humerus deep to joint capsule of glenohumeral joint and enters intertubercular sulcus where it is held in position by transverse humeral ligament

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20
Q

Coracobrachialis

A

Origin: apex of coracoid process
Insertion: Linear roughening on midshaft of humerus on medial side
Innervation: musculocutaneous C5-6
Flexor of arm

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21
Q

Axillary artery nomenclature

A

Subclavian becomes axillary lateral margin of rib I

Axillary becomes brachial beneath teres major

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22
Q

Axillary parts

A

3 different pars separated by pectoralis minor which crosses anteriorly to axillary artery

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23
Q

Axillary branches

A 
1st part - superior thoracic
2nd part (2) - thoraco-acromial artery, lateral thoracic
3rd part (3) - subscapular, anterior circumflex, posterior circumflex
24
Q

Branches of thoraco-acromial

A

Deltoid - passes into clavipectoral triangle
Pectoral - supplies breast
Clavicular
Acromial

25
Q

LAteral thoracic artery

A

Contribute to vascular supply of breast

26
Q

Subscapular artery

A

Largest branch of axillary artery

Divides into circumflex scapular artery and thoracodorsal artery

27
Q

Axillary vein

A

Begins at inferior margin of teres major and is a continuation of basilic vein
Goes through axilla medial and anterior to axillary artery, becomes subclavian vein after lateral border of rib I

28
Q

Tributaries of axillary vein

A

Follows axillary artery
Brachial vein
Cephalic vein

29
Q

Cephalic vein

A

Superficial vein on lateral and posterior part of arm
At shoulder, passes into clavipectoral triangle between deltoid, pectoralis major and clavicle. Pierces clavipectoral fascia to join axillary vein

30
Q

Brachial plexus

A 
Anterior rami of C5-C8 and most of anterior ramus of T1
Roots
Trunks
Divisions
Cord
Branches

Passes posterior to subclavian atery in the neck, whilst more distal regions surround axillary artery

31
Q

Roots of brachial plexus

A

Enter posterior triangle of neck by passing between anterior scalene and middle scalene
Lies posterior and superior to subclavian artery
C5-T1

32
Q

Trunks

A

passes laterally over rib I and enter axilla
Superior trunk - C5-6
Middle - C7
Inferior - C8-T1

Inferior trunk posterior to subclavian artery
Superior and middle more superior in position

33
Q

Divisions

A

Each trunk split into anterior and posterior division
3 anterior divisions - anterior compartment of arm and forearm
3 posterior divisions - posterior compartments

34
Q

Cords

A

related to 2nd part of axillary artery
Lateral cord - C5-C7
Medial - C8-T1
Posterior - C5-T1

Anterior compartment - medial and lateral
Posterior compartment - posterior

35
Q

Branches of roots

A

Dorsal scapular nerve C5 - rhomboid major and minor
Contribution to phrenic nerve C5
Long thoracic nerve C5-7

36
Q

Branches of trunk

A

Only upper trunk has branches
Suprascapular nerve C5-6
nerve to subclavius muscle C5-6 (passes anteroinferiorly to subclavian vein)

37
Q

Suprascapular nerve

A

Infraspinatus and supraspinatus
Passes laterally through posterior triangle of neck and through suprascapular foramen
Accompanied in lateral parts of neck and posterior scapular region y suprascapular artery

38
Q

Branches of lateral cord

A

Lateral pectoral nerve
Musculocutaenous nerve
Lateral root of median nerve

39
Q

Lateral pectoral nerve

A

Most proximal branch from lateral cord
Passes anteriorly together with thoraco-acromial artery to penetrate clavipectoral fascia between subclavius and pectoralis minor
Innervates pec major

40
Q

Musculocutaneous nerve

A

large terminal branch of lateral cord
Pass between biceps brachii and brachialis in the arm
Innervates all 3 flexor in anterior compartment of arm, terminating as lateral cutaneous nerve of the forearm

41
Q

Lateral root of median nerve

A

Largest terminal branch of lateral cord and passes medially to join a similar branch from medial cord to form median nerve

42
Q

Branches of medial cord

A 
5
medial pectoral nerve
medial cutaneous nerve of arm
medial cutaneous nerve of forearm
medial root of median nerve
ulnar nerve
43
Q

Medial pectoral nerve

A

Most proximal branch of medial cord

passes anteriorly between axillary artery and vein

44
Q

Ulnar nerve

A

Large terminal branch of medial cord

45
Q

Median nerve

A

Formed anterior to third part of axillary artery by union of lateral and medial roots (from lateral and medial cord)
Enters arm anterior to brachial artery

46
Q

Branches of posterior cord

A

5
Superior subscapular nerve - subscapularis
Thoraco-dorsal nerve - latissimus dorsi
Inferior subscapular nerve - subscapularis and teres major
Axillary nerve
Radial nerve

47
Q

Axillary nerve

A

Innervates deltoid and teres minor
Superior lateral cutaneous nerve of arm originates from axillary nerve after passing through quadrangular space and loops around posterior margin of deltoid muscle

48
Q

Radial nerve

A

largest terminal branch of posterior cord.

Posterior cutaneous nerve of arm originates from radial nerve in axilla and innervates skin on posterior surface of arm

49
Q

Injuries to brachial plexus

A

Spinal cord injuries in cervical region - roots of brachial plexus
Severe trauma to first rib - trunks
Division and cords - dislocation of glenohumeral joint

50
Q

Lymphatics in upper limb

A

All lymphatics in upper limb drain into lymph nodes in axilla.

51
Q

Axillary nodes drainage

A

Extensive area from adjacent trunk, including regions of upper back and shoulder, lower neck, chest and upper anterolateral abdominal wall
75% of mammary gland

52
Q

Groups of axillary nodes

A 
Lateral (humeral) nodes 
Anterior (pectoral) nodes
Subscapular (posterior) nodes
Central nodes
Apical nodes
53
Q

Lateral (humeral) nodes

A

receives most from the upper limb

54
Q

Anterior (pectoral) nodes

A

located around inferior margin of pectoralis minor, receive from mammary gland

55
Q

Central nodes

A

Receive from humeral, subscapular and pectoral nodes

56
Q

Apical nodes

A

Most superior group of nodes in axilla and drain all other groups. Receives lymphatic vessels accompanying cephalic vein + vessels draining superior region of mammary gland

Converge to form subclavian trunk and joins venous system at the junction between right subclavian vein and right internal jugular vein. On the left thoracic duct.

MRCS (28 decks)

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