Axilla and Pectoral Region Flashcards
1
Q
Osteology of the Pectoral Region
A
- Clavicles
- Sternum
- Ribs
- Scapula
2
Q
What are the atypical ribs
A
Ribs 1,2,11, and 12
3
Q
What are the true ribs
A
1-7
4
Q
What makes ribs 1-7 true ribs
A
They are vertebrocostal and have their own costal cartilage attachement
5
Q
What ribs are vertebrocostal
A
Ribs 1-7
6
Q
What are the false ribs (vertebrochondral)
A
Ribs 8-10
7
Q
What are the floating ribs
A
Ribs 11 and 12
8
Q
Why are ribs 1 and 2 atypical
A
They are small
9
Q
why are ribs 11 and 12 atypical
A
they are floating
10
Q
What are general features of typical ribs at the vertebral end
A
- head
- neck
- tubercle
- Angle
11
Q
What is the general feature (s) of the middle part of a typical rib
A
Body (shaft)
12
Q
What are the general features (s) to the sternal end of a typical rib
A
Articulates directly with sternum, costal cartilage, or sits in fascia
13
Q
The mammary glands are modified
A
Sweat glands
14
Q
The breast is a _______ structure
A
Cutaneous
15
Q
The breast rests on the _______ and above ______
A
rests on pectoral fascia above pectoral major
16
Q
what is the potential space between breast and pectoral fascia
A
Retromammary space
17
Q
The breast is innervated by
A
intercostal nerves (4-6th)
18
Q
what is the space where the breast and the pectoral fascia are not adhered to one another
A
Retromammary space
19
Q
The breast attaches to _____ of overlying skin via
A
Dermis, via suspensory ligaments (Cooper’s Ligaments)
20
Q
Mammary gland lobules converge on the
A
nipple
21
Q
how many lactiferous ducts open at nipple, which is surrounded by pigmented areola
A
15-20
22
Q
The nipple is surrounded by
A
pigmented areola
23
Q
Arterial supply to breast tissue
A
mammary branches from anterior intercostal, lateral thoracic, and internal thoracic arteries
24
Q
What is the venous drainage for breast tissue
A
- Mainly axillary vein via lateral thoracic veins and medial mammary veins
- some drainage to internal thoracic vein via anterior intercostal veins
25
Lymphatic drainage of breast tissue
- Subareolar lymph nodes
- axillary lymph nodes (pectoral,central, apical)
- Parasternal and abdominal lymph nodes
26
The nipple, areolar, and lactiferous lobules lymph drainage
subareolar lymph nodes
27
greater an ____ % of lymph drainage from breast goes to axillary lymph nodes (pectoral, central, apical)
75%
28
More than 75% of lymph from breast goes to
axillary lymph nodes (pectoral, central, apical)
29
Remaining lymph of the breast that is not drained into subareolar lymph nodes and axillary lymph nodes drains into
parasternal and abdominal lymph nodes
30
Innervation of the breast tissue
- mainly from the anterior and lateral branches of the 4th-6th intercostal nerves
- May also receive some innervation from supraclavicular nerve branches as well as branches of other intercostal nerves
31
Polymastia and polythelia
Supernumary breasts or nipples
-this growth normally follows the mammary ridge
32
Fascia of the pectoral region consists of
superficial and deep layers that define borders, invest muscles, and create potential spaces
33
Components of superficial fascia of the pectoral region
- Platysma
- Supraclavicular nerves
- Anterior and lateral branches of intercostal nerves
34
Components of the deltopectoral (clavipectoral) Triangle
- Deltoid, pectoralis major, middle 1/3 of clavicle make up borders
- Cephalic vein
- Deltopectoral lymph nodes
- Deltoid branch of thoracoacromial artery (from axillary artery)
35
What make up the borders of the deltopectoral (clavipectoral) Triangle
-Deltoid, pectoralis major, middle 1/3 of clavicle make up borders
36
What are the three components of the sternum from most superior to most inferior
Manubrium
Body
Xiphoid
37
What rib attaches at the sternal angle (manubriosternal joint)
Rib 2
38
The 1st rib attaches to the manubrium by what type of joint
synchondrosis
39
What rib attaches at the Xiphisternal joint
The 7th rib
40
The 2nd-7th ribs are attached by what type of joint
synovial joints with fibrocartilaginous articular surfaces on both the chondral and sternal aspects, allowing for respiration
41
What is the name of the ligaments that lay over the cost0-sternal joints
Radiate sternocostal ligaments
42
Where is the infrasternal angle (subcostal angle)
at the xiphisternal joint
43
The clavipectoral fascia is deep to the
pectoral fascia and pectoralis major
44
The clavipecotral fascia attaches to the ______ and ___-
clavicle and anterior thoracic wall
45
What vein(s), artery (s), and nerve(s) pierce the clavipectoral fascia
cephalic vein
Thoracoacromial artery
lateral pectoral nerves
46
Part of the clavipectoral fascia inferior to the pectoralis minor becomes suspensory ligament of
Axilla
47
Deep to the pectoral fascia and pectorals major, another fascial layer, the _______, descends from the clavicle, enclosing the subclavius and then pectorals minor, becoming continuous inferiorly with the axillary fascia
clavipectoral fascia
48
Clavipectoral fascia invests (list most superior to most inferior)
subclavius and pectoralis minor
49
The costocoracoid membrane is between
subclavius and pectoralis minor
50
the costocoracoid membrane is pierced by the
lateral pectoral nerve
51
Muscles of the pectoral region are innervated by
ventral rami of spinal nerves via branches of the brachial plexus
52
Proximal attachment of pectoralis major
- Clavicular and sternocostal attachments
- anterior surface of medial 1/2 of clavicle
- anterior surface of sternum and superior 6 costal cartilages
53
Distal attachment of pectorals major
Lateral lip of intertubercular sulcus (bicipital groove)
54
Actions of pectoralis major
- adducts and medially rotates humerus
- draws scapula anteriorly and inferiorly (via clavicle)
- Clavicular portion flexes humerus
- Sternal portion can extend humerus while it is in this flexed position
55
What supplies blood to the pectoralis major
pectoral branch (es) of thoracoacromial arterial trunk
56
What supplies innervation of pectoralis major
lateral and medial pectoral nerves (C5, C6 clavicular portion, C7, C8, T1 sternocostal portion)
57
The medial and lateral pectoral nerves are named for
the part of the brachial plexus that they come from
58
The medial pectoral nerve arises form the
medial cord of the brachial plexus
59
The lateral pectoral nerve arises from
the lateral cord of the brachial plexus
60
Are the medial and lateral pectoral nerves named for their position on the anterior thorax
No!!! they are named for the part of the brachial plexus that they come from
61
Proximal attachment of pectoralis minor
-3rd-5th ribs, near costal cartilage
62
Distal attachment of pectoralis minor
Coracoid process of scapula
63
What are the actions of the pectoralis minor
Stabilizes scapula by pulling it anteriorly and inferiorly against posterior thoracic wall
64
What is the blood supply to the pectoralis minor
pectoral branch(es) of thoracoacromial arterial trunk
65
Innervation of pectoralis minor
medial pectoral nerve (C8,T1)
| Note that the pectoralis minor is usually pierced by this nerve
66
proximal attachment of subclavius muscle
junction of 1st rib and its costal cartilage
67
Distal attachment of subclavius muscle
Inferior surface of middle 1/3 of clavicle
68
Actions of subclavius muscle
anchors and depresses clavicle
69
Blood supply to the subclavius
clavicular branch (es) of thoracoacromial arterial trunk
70
Innervation of subclavius
"nerve to subclavius" (C5,C6)
71
Proximal attachment of serrates anterior
external surfaces of lateral parts of ribs 1-9
72
Distal attachment of serrates anterior
anterior surface of medial border of scapula
73
Actions of serrates anterior
protracts scapula, rotates scapula, holds scapula against thorax
74
blood supply of serrates anterior
lateral thoracic artery
75
Innervation of serrates anterior
Long thoracic nerve (C5,C6,C7)
76
if the long thoracic nerve is not functioning you will get a _____ scapula
winged (because it will not be held against the thorax)
77
The two large arteries that have tributaries that provide blood to the pectoral shoulder and axillary region are
subclavian artery
| axillary artery
78
The origin of the right subclavian artery
brachiocephalic trunk
79
The origin of the left subclavian artery
aortic arch
80
The subclavian arises posterior to
sternoclavicular joint
81
The subclavian has how many divisions in relation to the anterior scalene muscle? and what are they?
3
Part 1- is medial to the anterior scalene muscle
Part 2- is posterior to the anterior scalene muscle
Part 3- Is lateral to the anterior scalene muscle
82
The subclavian has 3 divisions in relation to the
anterior scalene muscle
83
What are the commonly found branches at the medial part (part 1) of the subclavian
- Internal thoracic (mammary) artery
- Vertebral artery
- Thyrocervical arterial trunk
84
List the branches of the thyrocervical arterial trunk
- Suprascapular artery
- Transverse cervical artery
- Ascending cervical artery
- Inferior thyroid artery
85
What are the branches off the cervicodorsal trunk
```
deep branch (dorsal scapular artery)
Superficial branch (superficial cervical artery)
```
86
structure where the transverse cervical artery branches into deep branch and superficial branch
Cervicodorsal trunk
87
Commonly found branches of posterior part (part 2) of subclavian artery
Costocervical arterial trunk
| - which gives rise to supreme intercostal artery and deep cervical artery
88
The costocervical arterial trunk gives rise to
supreme intercostal artery
| deep cervical artery
89
The lateral part (part 3) of subclavian typically may have no branches, however, the _________ may arise independently form this part of the subclavian artery
Dorsal scapular artery
90
The lateral border of the first rib is the point at which the subclavian artery
becomes the axillary artery
91
What marks the point at which the subclavian artery becomes the axillary artery
The lateral border of the first rib
92
The artery that runs along the vertebral border of the scapula is always referred to as the
dorsal scapular artery
93
The dorsal scapular artery can arise form either some part of the subclavian artery (usually the ____) or from the _________ (about 30% of the time)
3rd part (lateral part), or form the transverse cervical artery (not that when it arises from transverse cervical artery it is called the "deep branch of the transverse cervical artery")
94
The pectoral region of the axilla is supplied blood by the
axillary artery
95
What artery (ies) are in part 1 of the axillary artery
Superior thoracic artery
96
What artery (ies) are in part 2 of the axillary artery
- Thoracoacromial trunk
- Which is composed of
- pectoral branch
- Deltoid branch
- Acromial branch
- Clavicular branch
97
What artery (ies) make up part 3 of the axillary branch
- Subscapular artery
- Circumflex scapular
- Thoracodorsal
- Anterior circumflex humeral
- posterior circumflex humeral
98
Parts of the scapular anastomoses
- Suprascapular artery (from the subclavian artery)
- Dorsal Scapular artery (from subclavian or deep branch of transverse cervical artery)
- Posterior Intercostal arteries (from thoracic aorta)
- Circumflex Scapular artery (division of sub scapular artery form axillary artery)
- Thoracodorsal artery (division of sub scapular artery form axillary artery)
99
Pectoral and axillary regions are drained by the
axillary vein
100
The axillary vein receives blood from
superficial and deep veins of the arm and forearm
101
The cephalic vein drains into the axillary before it becomes the
subclavian
102
The basilica veins continue as the
axillary vein
103
What are the superficial veins of the arm and forearm
basilic veins and Cephalic vein
104
Boundaries of axilla
```
a pyramid shaped space
apex
base (A and P axillary folds)
anterior wall (A)
Posterior wall (P)
Medial Wall
Lateral wall
```
105
The apex of the axilla is composed of
clavicle
scapula
1st rib
106
The base of the axilla is composed of
-skin and superficial fascia
-anterior axillary fold (pectoralis major)
-posterior axillary fold (Latissimus dorsi and teres major)
Chest wall (serrates anterior)
107
The anterior wall of the axilla is composed of
- clavicle
- subclavius
- pectoralis major
- pectoralis minor
108
The posterior wall of the axilla is composed of
- Scapula
- Subscapularis
- Latissimus dorsi
- Teres major
109
The lateral wall of the axilla is composed of
- intertubercular sulcus (bicipital groove)
- tendon of long head of biceps
- coracobrachialis tendon
