Did You Know Interval 7 Flashcards
How do you examine axillary lymph nodes? What muscle is in this area?
Best done with patient sitting upright & then examiner supports patient’s arm so it hangs down in a relaxed way. Then palpate for nodes with other hand running fingers along chest way. Be aware that the bundles of the serratus anterior muscle on lateral chest wall are not lymph nodes.
What is the clinical usefulness of the axillary sheath?
Since it encases the neuro-vascular bundle, local anesthetics can be injected into the sheath using sterile technique. The anesthetic solution diffuses throughout the sheath, anesthetized all 5 major branches of the brachial plexus enabling upper extremity surgery.
What a standard axillary dissection for breast cancer ( and occasionally melanoma ) entails from an anatomic perspective? What nerves are at risk and lesions to them will cause what clinical signs?
There are 3 levels of axillary nodes: Level 1= nodes lateral to pectoralis minor, Level 2= nodes beneath pectoralis minor, Level 3= nodes medial to pectoralis minor.
Usually Level 1&2 are removed en bloc as a part of a modified radical mastectomy or in conjunction with breast preserving surgery.
Level 3 occasionally removed if nodes are palpably suspicious.
The long thoracic, thoracodorsal & intercostobrachial nerves are at risk in axillary dissection. Can get axillary numbness or winged scapula.
What is the difference between a shoulder dislocation and separation?
In dislocation, humerus separates from scapula at glenohumeral joint; over 95% are anterior and inferior; glenohumeral ligament is torn. Usually treated with closed reduction; surgery for chronically recurrent cases.
Shoulder separation is a tear of the coracoclavicular and/or the acromioclavicular ligaments; not a true shoulder “joint” injury. Basically treated with a sling.
What are the cause, signs, and symptoms of biceps rupture?
Long head of biceps tendon, which travels through the shoulder joint to its proximal attachment on the supraglenoid tubercle, can rupture due to tendonitis, shoulder impingement or rotator cuff injuries. Patient notices a bulge in upper anterior arm ( “Popeye muscle” ) above elbow after sudden sharp pain in upper arm sometimes with an audible pop or snap. The short head is still intact so many patients have little functional problems.
What is the relevant anatomy of a femoral hernia? How can it be repaired? What must one worry about during repair?
From lateral to medial the anatomy is: Femoral nerve, artery, vein, empty space, lacunar ligament (“NAVEL”). The femoral canal is the “empty space” ( actually contains a few lymph nodes ) & is the site of femoral hernia occurrence.
Can repair by suturing pectineus fascia to inguinal ligament. If need to incise lacunar ligament to reduce hernia, must be aware of an aberrant obturator artery in 40% from inferior epigastric or external iliac or aberrant large vein; called the “corona mortis” (circle of death) since they can cause significant occult bleeding.
What is the clinical usefulness of the great saphenous vein?
Often removed (“stripped”) to treat varicosities; also commonly used as a conduit in coronary or peripheral vascular bypass operations.
At ankle, it is a good site for an urgent venous cutdown for IV fluids since it is always 1 cm anterior & 1 cm superior to the easily palpable medial malleolus; take care not to injure adjacent saphenous nerve.
What is the clinical importance of the profunda femoral artery?
It is the key to viability of the lower extremity. The leg can remain perfused even if SFA is occluded via collaterals. It is a common site of lodging of a femoral artery embolus at the bifurcation of the CFA into the SFA and profunda femoral.
Its importance is further evidenced by the fact that an aorto-femoral Dacron bypass graft can relieve most of the patient’s symptoms of the profunda is patent and the SFA is totally occluded.
