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ANATOMY: upper limb > Axilla, brachial plexus and breast > Flashcards

Axilla, brachial plexus and breast Flashcards

1
Q

What forms the floor of the axilla?

A

Deep fascia, subcutaneous tissue and skin

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2
Q

What forms the anterior wall of the axilla?

A

Pectoralis major and minor

Subclavius

Clavipectoral fascia

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3
Q

What forms the posterior wall of the axilla?

A

Subscapularis

Teres major

The tendon of latissimus dorsi winding around teres major

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4
Q

Which extends lower, the anterior or posterior border of the axilla?

A

Posterior

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5
Q

What forms the medial wall of the axilla?

A

Serratus anterior

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6
Q

What forms the lateral wall of the axilla?

A

Intertubercular or bicipital groove of the humerus

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7
Q

The axillary artery is a continuation of which other vessel?

A

Subclavian artery

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8
Q

Where does the axillary artery begin?

A

The outer border of the first rib

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9
Q

What are the branches of the axillary artery?

A

Subscapular

Anterior and posterior circumflex humeral arteries

Branches to the pectoral muscles, breast and chest wall

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10
Q

What does the subscapular artery become?

A

Passes backwards to from part of the scapular anastomosis

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11
Q

Where do the circumflex humeral arteries anastomose?

What do they supply?

A

Around the surgical neck of the humerus

Glenohumeral joint and the deltoid

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12
Q

Which vessels form the axillary vein?

A

Venae comitantaes and basilic vein. It receives the cephalic vein which pierces the clavipectoral fascia

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13
Q

Where do axillary lymph nodes receive lymph from?

A

Upper limb, breast and the abdominal wall above the umbilicus

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14
Q

What are the domains of the brachial plexus?

A

Roots

Trunks

Divisions

Cords

Branches

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15
Q

Where do the trunks of the brachial plexus arise?

A

Posterior triangle of the neck

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16
Q

When do trunks of the brachial plexus split into anterior and posterior divisions?

A

Apex of the axilla

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17
Q

What are the cords of the brachial plexus named according to?

A

Their relationship to the second part of he axillary artery deep to pectoralis minor

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18
Q

Which part of the axillary artery are the branches of the brachial plexus related to?

A

The third, most distal part

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19
Q

What is he path of the ulnar nerve?

A

Arises from the medial cord of the brachial plexus

Runs along medial aspect of the arm close to coracobrachialis

Pierces intermuscular septum to lie posteriorly in the groove between the olecranon and the medial epicondyle

Passes between 2 heads of FCU

Forms palmar and dorsal cutaneous branches

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20
Q

Where does the palmar cutaneous branch of the ulnar nerve arise?

A

Mid forearm

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21
Q

What does the palmar cutaneous branch of the ulnar nerve supply?

A

Medial side of the palm

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22
Q

Where is the dorsal cutaneous branch of the ulnar nerve located?

What does it supply?

A

Winds around the ulna, deep to FCU

Ulnar one and a half fingers on their dorsal aspects

23
Q

What does the ulnar nerve divide into?

Where does this division occur?

A

Superficial and deep motor branch

The wrist

24
Q

What vessel does the ulnar nerve run alongside?

A

Ulnar artery

25
Q

What does the superficial branch of the ulnar nerve supply?

A

Palmaris brevis and the skin of the ulnar one and a half fingers via 2 digital branches

26
Q

What does the deep terminal branch of the ulnar nerve supply?

A

Muscles of the hypothenar eminence (flexor digiti minimi, abductor digiti minimi and opponens digiti minimi) , all the palmar and dorsal interossei, the ulnar 2 lumbricals and adductor pollicis

27
Q

What is the path taken by the median nerve from the brachial plexus to the cubital fossa?

A

Arises from medial and lateral cords of the brachial plexus

Runs down anteromedial aspect of the arm with the brachial artery

Crosses anterior to artery midway down arm to lie medially before reaching the cubital fossa

28
Q

What is the path taken by the median nerve after it reaches the cubital fossa?

A

Passes between heads of pronator teres

Passes between FDS and FDP

Emerges lateral to FDS to become superficial proximal to the wrist

29
Q

Which muscles in the forearm does the ulnar nerve give branches to?

A

Palmaris longus and flexor carpi radialis

30
Q

What branches are given off by the ulnar nerve?

Proximal to distal

A

Anterior interosseous branch

Palmar cutaneous branch

Recurrent muscular branch

Digital branches

31
Q

Where does the palmar cutaneous branch of the median nerve arise?

What does it supply?

How does it enter the hand?

A

Proximal to the carpal tunnel

Skin over the thenar eminence

passes deep to the flexor retinaculum

32
Q

What does the recurrent muscular branch of the median nerve supply?

A

Thenar muscles

flexor pollicis brevis, abductor pollicis brevis and opponens pollicis

33
Q

What do the digital branches of the median nerve supply?

A

Thumb, index, middle and radial half of the ring fingers

34
Q

Where does the anterior interosseous branch of the median nerve arise?

What does it supply?

A

After the median nerve has pierced pronator teres. Passes distally on the interosseous membrane .

Supplies flexor pollicis longus, radial half of FDP and ends at pronator teres

35
Q

What does the radial nerve divide into?

A

Superficial and deep (posterior interosseous) branch

36
Q

Describe the path of the superficial branch of the radial nerve

A

Lies deep to brachioradialis and lateral to radial artery

Distally, it passes deep to the brachioradialis tendon, curves round the lateral side of the radius and pierces the deep fascia

37
Q

What does the superficial branch of the radial nerve give rise to?

A

Terminal digital branches

38
Q

What do the terminal digital branches of the radial nerve supply?

A

Skin on the radial half of the dorsum of the hand, dorsal aspects of the thumb, index, middle and radial half of the ring fingers, but not beyond the distal interphalangeal joints

39
Q

Where does the deep branch of the radial nerve go?

A

Passes between the heads of the supinator to emerge as the posterior interosseous branch

40
Q

What does the posterior interosseous branch of the radial nerve supply?

A

Extensors of the wrist and fingers and the supinator

41
Q

What is the breast composed of?

A

Fat, connective tissue and glandular elements

42
Q

How are glandular elements arranged in the breast?

A

15-20 lobules, each opening independently onto the surface of the nipple

43
Q

Why is interlobular connective tissue lax in the breast?

A

To allow for expansion of the glandular elements during pregnancy

44
Q

Where is the breast located?

A

Attached from the second to sixth ribs, extending laterally from the lateral sternal edge to the mid axillary line

45
Q

What is the level of the nipple in young people?

A

4th intercostal space

46
Q

What is the axillary tail?

A

Extension of the breast tissue into the axilla

47
Q

How is the breast innervated?

A

4th - 6th intercostal nerves

48
Q

How is the nipple innervated?

Why is sensory stimulation particularly important here?

A

4th intercostal nerve

Part of suckling reflex (however secretory control is principally hormonal)

49
Q

What is the blood supply to the breast?

A

Axillary, intercostal and internal thoracic arteries

Venous drainage via corresponding veins

50
Q

What percentage of lymphatic drainage from the breast is via axillary nodes?

A

75%

51
Q

How many axillary nodes are there? How are they organised?

A

20-30 divided into groups according to location

52
Q

Which groups drain into central axillary nodes?

Where are these nodes?

A

Anterior/pectoral, posterior/subscapular and lateral

within axillary fat

53
Q

Where does lymph drain after passing through central nodes in the axilla?

A

Apical nodes within apex of axilla at the lateral border of the first rib

These drain into the subclavian lymph trunk which drains into thoracic duct on the left and the right lymphatic duct on the right

ANATOMY: upper limb (7 decks)

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