Breast, Axilla, Brachial Plexus 8.22

Question 1

_ ducts in breast

Answer 1

Approximately 15‐25 ducts converge on the nipple/areolar complex

Question 2

Retromammary space

Answer 2

Between the breast and the pectoral fascia is a loose connective tissue plane or potential space— the retromammary space. The retromammary space allows some movement of the breast on the thoracic wall

Question 3

N188

Answer 3

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Question 4

N190

Answer 4

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Question 5

Breast Quadrants

Answer 5

• Quadrants used to describe location of pathology in the breast • Any finding (palpable lump, scar, skin discoloration, etc.) is noted on schematic

Question 6

Lymphatic Drainage in breast

Answer 6

1. Initially most lymph drains to subareolar lymphatic plexus 2. Most lymph then drains to pectoral (anterior) nodes of axillary group then central, apical and clavicular nodes, then to main lymphatic trunk to venous system 3. Remaining to parasternal lymph nodes 4. In some cases lymph may drain deeply to abdominal lymph nodes or to the opposite breast

Question 7

Cooper’s Ligaments

Answer 7

Network of fibrous connective tissue tethers superficial and deep fascial layers and provides support for lobules

Question 8

Peau d’orange

Answer 8

• Peau d’orange = orange‐colored appearance of breast in inflammatory breast cancer • Due to infiltration of tumor into dermal lymphatics and skin

Question 9

Common Form of Breast Cancer

Answer 9

Carcinomas of the breast are usually adenocarcinomas arising from epithelial cells of the lactiferous ducts of the mammary gland • Typically spreads by means of lymphatic vessels (may also spread via venous system) • Because most of lymphatic drainage of the breast is to the axillary lymph nodes, they are the most common site of metastasis from a breast cancer • Abundant communications among lymphatic pathways and among axillary, cervical, and parasternal nodes may also cause metastases from the breast to develop in the supraclavicular lymph nodes, the opposite breast, or the abdomen

Question 10

Parts and Divisions of Axillary Artery

Answer 10

Question 11

N418

Answer 11

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Question 12

Veins of Axilla

Answer 12

Question 13

N416

Answer 13

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Question 14

Anterior Arm Compartment

Answer 14

Anterior compartment:

Coracobrachialis, Biceps brachii & Brachialis muscles

Question 15

Posterior Arm Compartment

Answer 15

Posterior compartment:
Triceps brachii & Anconeus mm.

Question 16

N421

Answer 16

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Question 17

N422

Answer 17

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Question 18

N419

Answer 18

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Question 19

Upper trunk brachial plexus damage

Answer 19

• Upper trunk brachial plexus damage (Erb’s Paralysis, Waiter’s Tip Position). Injuries most commonly result from injuries involving C5 & C6 nerves.

Question 20

Lower Trunk Brachial Plexus

Answer 20

Lower trunk brachial plexus damage (Klumpke’s Paralysis). The symptoms are due to injuries involving C8 & T1 nerves.

Question 21

Damage to Long Thoracic Nerve

Answer 21

Lower trunk brachial plexus damage (Klumpke’s Paralysis). The symptoms are due to injuries involving C8 & T1 nerves.

Question 22

Crutch Palsy

Answer 22

• Crutch palsy. Due to excessive and prolonged pressure on the radial nerve. Symptoms may include loss of extension at elbow and/ or wrist (wrist drop).