Pectoral And Shoulder Regions Flashcards
Arm
Part between shoulder and elbow containing the humerus and muscles in the region
Forearm
Between elbow and wrist containing ulna, radius, and muscle in region
Humerus
. Head . Anatomical & surgical necks . Greater and lesser tubercles . Intertubercular (bicipital) groove or sulcus—with lateral and medial lips . Shaft . Deltoid tuberosity
Brachial plexus
. Nerve network formed by ventral rami do spinal nerves C5-8 and T1
. Runs through axilla and will not be exposed by dissection a the time
Teres major m. OIA
O: post. side of the scapula
near inf. angle
I: med. lip of
intertubercular groove, near the insertion
of latissimus dorsi (anterior, superior part
of the humeral shaft)
A: extension, adduction, and med. rotation of humerus (same as lat)
Teres major m. N and B
N: lower subscapular n.
B: subscapular artery
Deltoid m. OIA
O: lateral 1/3 of clavicle, acromion, and spine of scapula; the same as the insertion of trapezius
I: deltoid tuberosity of humerus
A: ant. Part flexes and medially rotates, Lat. (acromial) part abducts, post. Part (scapular spine) extends and lat. rotates
Deltoid N and B
N: axillary nerve
B: post. Circumflex humeral artery
Axillary nerve
Also supplies the skin over the deltoid m.
. Courses w/ post. circumflex humeral artery around post. side of surgical neck of humerus deep to deltoid.
Quadrangular space
. Bordered by teres minor m., teres major m., long head of triceps brachii m., and surgical neck of humerus
. Axillary nerve and post. Circumflex humeral artery located here
. Vulnerable w/ humerus dislocation
Synovial bursa
.btw greater tubercle of humerus and deltoid and acromion
. Flat sac of synovial membrane enclosing synovial fluid
. Helps lubricate motion
. Can have 2 separate bursar or 1 large bursa
Rotator cuff muscles
. “Cuff” glenohumoral joint adhering to fibrous capsule helping to stabilize it
. Subscapularis m., supraspinatus m., infraspinatus m., teres minor m.
Subscapularis m. OIA
O: subscapular fossa
I: lesser tubercle of the humerus
A: med. rotates humerus
Subscapularis m. N and B
N: upper and lower subscapular nn.
B: subscapular a.
Supraspinatus OIA
O: supraspinous fossa
I: sup. part of the greater tubercle of the humerus
A. Abducts humerus
Supraspinatus m. N and B
N: suprascapular n., which courses through the suprascapular notch and under the transverse scapular ligament
B: suprascapular a., which usually courses over the transverse scapular
ligament (not through the suprascapular notch)
Infraspinatus m. OIA
O: infraspinous fossa
I: posterior side of the greater tubercle of the humerus
A: lat. rotates humerus
Infraspinatus N and B
N: suprascapular n., which reaches this muscle by passing between the acromion and neck of the scapula
B: circumflex scapular a.
Teres minor OIA
O: posterior side of the scapula, near its lateral border,
lateral to the origin of teres major
I: Posterior side of the greater tubercle of the humerus,
A: lat. rotates humerus
Teres minor N and B
N: axillary n.
B: circumflex scapular a.
Pectoralis major OIA
O: Clavicular head (med. 1/3 clavicle), Sternocostal head (sternum and costal cartilages)
I: Lateral lip of the intertubercular groove (ant, sup. part of humeral shaft)
A: both heads adduction and med. rotates humerus, Clavicular head flexes humerus, sternocostal head flexes an extended humerus, but extends flexed humerus, depresses and protracts shoulder girdle by pulling on humerus
Pectoralis major Na nd B
N: lat. and med. pectoral nn.
B: branches of internal thoracic, lat. thoracic, and thoraco-acromial arteries
Pectoralis minor OIA
O: ribs 3, 4, 5 near the costochondral junctions
I: coracoid process of the scapula
A: depresses and protracts should girdles, helps w/ inf. Rotation of scapula
Pectoralis minor N and B
N: medial pectoral n. (penetrates pectoralis minor m., and then enters the pectoralis major m.)
B: lateral thoracic and thoracoacromial aa. (both are branches of the axillary a.)
Subclavius m. OIA
O: first costal cartilage
I: inferior side of the clavicle
A: depresses clavicle and resists lat. dislocation of clavicle
Subclavius m. N
N: nerve to subclavius (small branch brachial plexus
Clavipectoral fascia
. Subclavius and pectoralis minor embedded in this sheet
. In coronal plane
Subclavius clavicle injury function
splint a fractured clavicle,
facilitating healing; also protects vessels and nerves in the axilla against injury from the sharp ends of broken bones.
Serratus anterior m. OIA
O: First 8-9 ribs, laterally
I: Anterior (deep) side of scapula along its entire medial border (insert near angle for max leverage in rotating scapula sup.)
A: protracts shoulder girdle by pulling scapula ant., holds scapula to ribcage, rotates scapular sup. During abduction by pulling inf. Angle ant.
Winging of scapula from denervation of serratus ant.
. inf. angle of scapula protrudes post. because the scapula is not fixed by the serratus anterior m.
. severe weakness of abduction and flexion of the arm because the scapula isn’t supported by the serratus anterior m.
Omohyoid m. O.
Originates on sup. Border of scapula
Coracobrachialis m. OIAN
O: coracoid process
I: ant. Surface of humerus mid shaft
A: flexes ad abducts arm
N: musculocutaneous n.
Biceps brachii shape, OIAN
2 heads
O: long head supraglenoid tubercle (sup. To glenoid fossa), short head coracoid process
I: radial tuberosity and antebrachial fascia via bicipital aponeurosis
A: flexes and supinates forearm, long head weakly flexes arm, short head weakly adducts the abducted arm
N: musculocutaneous n.
Triceps brachii m. Shape, OIAN
Shape: 3 heads
. O: long head infraglenoid tubercle of scapula, lat. head: post surface of humerus sup. To spiral groove, med. head: post. Surface of humerus inf. To spiral groove
I: olecranon process of ulna
A: extends forearm; long head weakly extends and adducts arm
N: radial n.
Arteries anastomosing on dorsal of scapula
. Suprascapular a. . Dorsal scapular a. . Subscapular a. . Circumflex scapular a. . Post. Circumflex humeral a.
Suprascapular artery branch of ___
. Branch of thyrocervical trunk from subclavian a.
Dorsal scapular artery branch of ___
. Transverse cervical a. Or directly from subclavian a.
Subscapular a. Branch of ___
Axillary a.
Circumflex scapular a. Branch of ___
Subscapular a.
Post. Circumflex humeral a. Branch of ___
Axillary a.
Subclavian a. Branches off of ___
. Right subclavian off of brachiocephalic trunk, left subclavian off aortic arch
Axillary a. Begins at _____
Lat. border of 1st rib
Brachial a. Begins at ___
. Inf. Border of teres major
Mammary gland location
. Extends transversely from lat. border of sternum to midaxillary line
. Extends vert. From 2-6 ribs
. Small part extends towards axilla (axillary tail of Spence)
. 2/3 on deep pectoral fascia, 1/3 covering serratus ant.
Retromammary space
Between breast and deep pectoral fascia is loose CT plane
Areolae
. Contains numerous sebaceous glands (areolar glands/glands of Montgomery)
Nipple
. Called papilla mammae
. Lactiferour ducts open into it
. Composed of circularly arranged smooth muscle fibers
Lobule
. Functional unit of breast tissue drained by single lactiferous duct
. Separated from other loboules via suspensions ligaments
. 15-20 lobules
Lactiferous ducts
. Each lobule sends duct to nipple
Lactiferous sinus
. Enlargement of lactiferous duct prox. To its opening into nipple
Suspensions ligaments of Cooper
. Fibrous bands of CT that connect skin overlying breast w/ superficial fascia separating glandular tissue into lobules
Breast arterial supply
. Medial: perforating (ant. Cutaneous) branches of internal thoracic a. (ALSO CALLED MED. MAMMARY BRANCHES)
. Lat: thoracromial a. And lat. Mammary branches of lat. thoracic a. And of lat. cutaneous branches of post. Intercostal a.
Breast venous drainage
. Drains to axillary vein
. Some drainage to internal thoracic v.
. Reverse route arterial supply
Lymphatic drainage of breast
. Divided into 4 quadrants (sup. Lat, sup. Med., inf. Lat, inf. Med)
. Lateral quadrants and some medial (75% all tissue) drains to axillary lymph nodes then to central and apical lymph nodes
. Rest of tissue in med. quadrants drains to parasternal lymph nodes or opposite breast
Why is lymph drainage important?
Plays role in metastasis of cancer
Breast N.
4-6 intercostal nerves (lat. and ant. Cutaneous branches of these nerves)
How does carcinoma of breast arise usually?
From epithelial cells of lactiferous ducts
Signs of carcinoma in breast
. Skin dimpling, abnormal contours, edema of skin (Peau d’orange sign), and nipple retraction