Chapter 5: Axilla Flashcards

1
Q

Site of Axilla

A

Pyramidal region, situated between the upper side of the chest wall and the upper part of the medial side of the arm.

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2
Q

Axilla boundries

A

Four sided pyramid having an apex, a base or floor, and four walls (anterior, posterior, lateral, and medial).

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3
Q

Apex (cervico-Axillary canal)

A

Triangular interval directed upwards and medially towards the root of the neck communicating it with the Axilla and through it the Axillary vessels and nerves enter from the neck.

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4
Q

The apex is bounded by?

A
  1. Outer border of the first rib.
  2. Superior border of the scapula posteriorly.
  3. Posterior surface of the clavicle.
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5
Q

Anterior pectoral wall

A
  1. Superficial layer.
  2. Deep layer.
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6
Q

Anterior pectoral wall superficial layer

A

Formed of Pectoralis major muscle.

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7
Q

Anterior pectoral wall deep layer

A

The Axillary septum formed above downwards by:
1. Subclavius muscle
2. Clavipectoral fascia
3. Pectoralis minor muscle
4. Syspensory ligament of the Axilla, attached below the Axillary fascia (deep fascia in the base of the Axilla).

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8
Q

Anterior wall of Axilla

A

Lower border of the anterior wall and is formed by the twisted lower border of Pectoralis major.

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9
Q

Posterior ( subscapular) wall

A

Formed from above downwards by:
1. Subscapularis (lateral part).
2. Teres major.
3. Lattismus dorsi muscle.

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10
Q

Posterior fold of Axilla

A

Lower border of the posterior wall and is formed by teres major and Lattismus dorsi muscles.
Lies at a lower level than the anterior fold as the anterior wall os longer than the posterior wall.

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11
Q

Lateral (humeral) wall: narrowest wall

A

Formed by:
1. Bicipital groove of humerus.
2. Short head of biceps.
3. Coracobrachialis muscles.

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12
Q

Medial (costal) wall

A
  1. Upper four ribs and their corresponding inter coastal muscles.
  2. Upper part of Serratus anterior.
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13
Q

Base (floor) looks downward

A

Formed by:
1. Skin (rich in hairs, sweat, and sebaceous glands).
2. Superficial fascia.
3. Deep (Axillary) fascia: receives the attachment of suspensory ligament of the Axilla.

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14
Q

Contents of the Axilla

A
  1. Vessels.
  2. Nerves.
  3. Lymph nodes.
  4. Special contents.
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15
Q

Axilla Vessels

A
  1. Axillary artery and it’s branches.
  2. Axillary vein and it’s tributaries.
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16
Q

Axilla Nerves

A
  1. Cords of brachial plexus and their branches.
  2. Long thoracic nerve.
  3. Intercostobrachial nerve (lateral cutaneous branch of the 2nd thoracic nerve).
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17
Q

Axilla lymph nodes

A

Five groups of lymph nodes:
1. Anterior
2. Posterior
3. Lateral
4. Central
5. Apical

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18
Q

Axilla special contents

A
  1. Tail of mammary gland.
  2. Axillary fat and loose areolar tissue.
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19
Q

Where does the Axillary artery begin?

A

At the outer border of the first rib as continuation of the subclavian artery.

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20
Q

Where does the Axillary artery end?

A

At the lower border of the teres major muscle (lower limit of the Axilla), where it becomes the brachial artery.

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21
Q

Axillary vessels and brachial plexus course

A

The Axillary vessels and brachial plexus run from the apex to the base along the lateral wall of axilla nearer to the anterior than the posterior wall.

22
Q

Brachial plexus formation

A

A collection of nerves which lie partially in the neck and partly in the Axilla.
It consists of:
1. Roots.
2. Trunks.
3. Divisions.
4. Cords.

23
Q

Roots

A

Formed of the ventral (anterior) primary rami of the 5, 6, 7, and 8 cervical and the 1st thoracic nerves.

24
Q

Trunks

A

The three trunks lie above the clavicle, in the neck.
1. Upper trunk: union of 5th and 6th cervical roots.
2. Middle trunk: 7th cervical root only.
3. Lower trunk: union of 8th cervical and 1st thoracic roots.

25
Q

Divisions

A

Each trunk divides, behind the clavicle, into anterior (ventral) and posterior (dorsal) divisions.

26
Q

Cords

A

The plexus consists of three cords that lie in the Axilla:
1. Medial cord: anterior division of the lower trunk.
2. Lateral cord: fusion of the anterior divisions of the upper and middle trunks.
3. Posterior cord: fusion of the posterior divisions of the three trunks.

27
Q

What do the branches of the cords supply?

A
  1. All branches of both lateral and medial cords supply the flexor side.
  2. All branches of the posterior cord supply the extensor side of the upper limb.
28
Q

Site of brachial plexus

A
  1. Roots and trunks: lie in the neck.
  2. Divisions: lie in the apex of Axilla behind the clavicle.
  3. Cords and it’s branches. Lie in the Axilla.
29
Q

Branches of the brachial plexus

A

Arise from the roots , the upper trunk and three cords.

30
Q

Branches of the roots

A
  1. Nerve to Rhomboids (dorsal scapular nerve).
  2. Nerve to Serratus anterior.
31
Q

Nerve to Rhomboids (dorsal scapular nerve)

A
  1. Arises from C5.
  2. Descends along the medial border of the scapula deep to Levator scapulae and rhomboid muscles and supplies them.
32
Q

Nerve to Serratus anterior (long thoracic nerve)

A
  1. Arises from the roots of C5, 6, and 7.
  2. Descends vertically in the midxillary line on the outer surface of Serratus anterior and supplying it.
33
Q

Branches of the trunks (only upper trunk)

A
  1. Nerve to subclavius (C5 and C6).
  2. Subscapular nerve (C5 and C6).
34
Q

Nerve to subclavius

A

Arises from the upper trunk and descends in front of the brachial plexus to reach the subclavius muscle.

35
Q

Subscapular nerve

A
  1. Arises from the upper trunk and runs downwards and laterally in the neck to reach the Suprascapular notch.
  2. Passes through the Suprascapular foramen ( below the Suprascapular ligament) to reach the supraspinous fossa where it runs deep to Supraspinatus muscle and supplies it.
  3. Then it descends through the spino-glenoid notch to reach infraspinatus muscle.
  4. It also gives articular branches to supply the acromioclavicular and shoulder joints.
36
Q

Branches of the lateral cord

A
  1. Musculocutaneous nerve: C5,6,7.
  2. Lateral root of median nerve: C5,6,7.
  3. Lateral pectoral nerve: C5,6,7.
37
Q

Musculocutaneous nerve

A

C5,6,7
Largest branch.

38
Q

Lateral pectoral nerve

A
  1. Larger than medial pectoral nerve.
  2. Pierces clavi-pectoral fascia and ends by supplying the pectoralis major muscle.
39
Q

Branches of medial cord

A
  1. Ulnar nerve.
  2. Medial root of median nerve.
  3. Medial pectoral nerve.
  4. Medial cutaneous nerve of the arm.
  5. Medial cutaneous nerve of the forearm.
40
Q

Ulnar nerve

A

C8 and T1.
1. Largest branch.

41
Q

Medial pectoral nerve

A

C8 and T1.
Pierces and supplies the pectoralis minor and ends by supplying Pectoralis major.

42
Q

Medial cutaneous nerve of the arm

A

C8 and T1.
1. Supplies the skin on the medial side of the lower half of the arm.

43
Q

Medial cutaneous nerve of the forearm

A

C8 and T1.
1. Descends medial to the third of the Axillary artery and upper half of brachial artery.
2. Supplies the skin of the medial side of the forearm to the wrist.

44
Q

Branches of posterior cord

A
  1. Radial nerve.
  2. Axillary (circumflex) nerve.
    - Anterior branch.
    - Posterior branch.
  3. Upper subscapular nerve.
  4. Lower subscapular.
  5. Nerve to Lattismus dorsi (thoraco-dorsal nerve).
45
Q

Radial nerve

A

C5,6,7,8 T1.
1. Largest of the two terminal branches of the posterior cord.

46
Q

Axillary (circumflex) nerve origin

A

C5,6.
Smaller of the two terminal branches of the posterior cord.

47
Q

Axillar (circumflex) nerve course

A
  1. Passes downwards and laterally on the Subscapularis muscle behind the third part of the Axillary artery.
  2. Reaching the lower border of the Subscapularis, it passes backwards through the Quadrangular space (accompanied by circumflex humeral artery) where they lie below the capsule of the shoulder joint.
  3. Turns around the back of the surgical neck of the humerus where it gives an articular branch to the shoulder joint.
48
Q

Axillary branch

A

Continuous it’s course round the surgical neck to end near the anterior border of deltoid muscle and supplies it.

49
Q

Posterior branch

A

A branch to teres minor and then curves around the posterior border of deltoid to become the upper lateral cutaneous nerve of the arm which supplies the skim over the lower half of deltoid.

50
Q

Upper subscapular nerve

A

C5,C6.
Supplies the upper part of the Subscapularis muscle.

51
Q

Lower subscapular nerve

A

C5,C6.
Supplies the lower part of the Subscapularis muscle and teres major muscle.

52
Q

Nerve to Lattismus dorsi (thoraco dorsal nerve)

A

C6,C7,C8.
1. Supplies the Lattismus dorsi muscle.