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MSK > Pectoral Region, Axilla > Flashcards

Pectoral Region, Axilla Flashcards

1
Q

What is the Pectoral Region and how many muscles does it contain?

Name them

A

A region on the anterior chest wall

Pectoralis Major (Most superficial)
Pectoralis Minor
Serratus Anterior
Subclavius

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2
Q

Describe the Origins and Insertion of Pectoralis Major

A

Clavicular Head: Anterior surface of Medial clavicle

Sternacostal head: Anterior surface of sternum, Upper 6 costal cartilages, Aponeurosis of externa oblique muscle

Insertion: Intertubucular sulcus (Clavicular head inserts inferior)

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3
Q

What are the Actions and Innervations of Pectoralis Major

A

Actions;

  • Medial rotation (Both heads)
  • Adduction (Sternocostal head)
  • Flexion (Clavicular head)

Interactions;

  • Medial Pectoral Nerve
  • Lateral Pectoral Nerve
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4
Q

Describe the Origin, Insertion, Action and Innervation of Pectoralis Minor

A

Origin: Ribs 3-5
Inserts: Coracoid process of scapula

Action: Stabilises scapula (draws it anterioinferiorly)
Innervation: Medial Pectoral Nerve

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5
Q

Describe the Origin, Insertion, Action and Innervation of Serratus Anterior

A

Origin: Lateral aspects of ribs 1-8/9
Insertion: Costal surface of medial border of scapula

Action: Rotates scapula so that arm can be raised over 90 degrees

Innervation: Long thoracic nerve

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6
Q

Describe the Origin, Insertion, Action and Innervation of Coracobrachialis

A

(Deep to Biceps Brachii)

Origin: Coracoid process of scapula
Insertion: Medial side of numeral shaft

Action: Shoulder Flexion, Arm Adduction
Innervation: Musculocutaenous nerve

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7
Q

Describe the Origin, Insertion, Action and Innervation of Subclavius

A

(Directly underneath clavicle)

Origin: Junction of 1st rib and its costal cartilage
Insertion: Inferior surface of middle third of clavicle

Action: Anchors and depresses the clavicle
Innervation: Nerve to subclavius

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8
Q

Describe the Origins and Insertion of Deltoid (3 parts)

A

Anterior fibres: Lateral third of anterior of clavicle
Middle fibres: Acromion of scapula
Posterior fibres: Spine of scapula

Insertion: Deltoid tuberosity on lateral surface of humerus

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9
Q

Describe the Actions and Innervation of Deltoid (3 parts)

A

Innervation: Axillary nerve

Actions;

Anterior fibres- Flexion, Medial rotation of arm
Middle fibres- Abduction of arm (From 15 to 90 degrees)
Posterior fibres- Extension, Lateral rotation of arm

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10
Q

What is the Axilla?

What does it act as?

A

A pyramidal space that lies underneath the shoulder joint, at the junction of the upper arm and thorax.

It acts as a passageway for neurovascular and muscular structures

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11
Q

What are the 6 borders of the Axilla

A

Apex
Base

Lateral Wall
Medial Wall

Anterior Wall
Posterior Wall

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12
Q

What structures form the Apex and Base of the Axilla

A

Apex: Lateral border of 1st rib, Superior border of scapula, Posterior border of clavicle

Base: Axillary fascia and skin

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13
Q

What structures form the Lateral and Medial walls of the Axilla

A

Lateral Wall: Intertubcular groove of humerus

Medial Wall: Serratus Anterior, Ribs, Intercostal Muscles

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14
Q

What structures form the Anterior and Posterior walls of the Axilla

A

Anterior Wall: Pectoralis Major, Minor and Subclavius

Posterior Wall: Teres major, Latissimus Dorsi, Subscapularis

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15
Q

How is Axilla affected when arm is fully abducted

A

Axillary fascia (Base) becomes taught and axillary contents are compressed against proximal humerus

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16
Q

Name 6 important contents of the Axilla

A
  • Axillary arteries (and branches)
  • Axillary vein
  • Brachial plexus (Cords and branches)
  • Axillary lymph nodes
  • Biceps brachial and Coracobrachialis
  • Intercostobrachial nerve
17
Q

What are the 3 main routes through which structures can leave the Axilal

A
  • Inferolaterally into upper limb
  • Via the Quadrangular space
  • Via the Clavipectoral/ Deltopctoral triangle
18
Q

Name 2 structures that pass through Quadrangular Space

A

Axillary nerve

Posterior Circumflex Artery

19
Q

What is the Deltopectoral/ Clavipectoral triangle

Name 3 structures that pass through

A

Opening in anterior wall of Axilla, bound by Pectoralis Major, Deltoid and Clavicle

  • Cephalic vein (Enters)
  • Medial Pectoral Nerve (Leaves)
  • Lateral Pectoral Nerve (Leaves)
20
Q

What is the Axillary Artery?

What is the Axillary Vein?

A

Artery- Main artery supplying the upper limb

Vein- Main vein draining the upper limb (Contributions from Cephalic and Basilic veins)

21
Q

What do the Axillary Lymph Nodes do?

What is their clinical significance?

A

Filter lymph that has been drained from the upper arm and pectoral region

ALN enlargement is a non-specific indicator of breast cancer (75% of lymph from breasts is filtered by ALNs)

22
Q

What are the 6 groups of lymph nodes in the Axilla

A

APICAL

  • Anterior/ Pectoral (Behind Pec Major, Lower border of Pec Minor)
  • Posterior (Anterior to Subscapularis)
  • Infraclavicular (In groove between Deltoid and Pec Major)
  • Central (Centre of axilla within axillary fat)
  • Apical (Apex of axilla)
  • Lateral (Medial side of axillary vein)
23
Q

The Central and Apical groups of Axillary Lymph Nodes receive lymph from where?

A

Central: From Lateral, Posterior, Anterior lymph nodes

Apical: From all other axillary nodes

24
Q

Outline the lymph pathway after it reaches the Apical group of Axillary Lymph Nodes

A
  • Efferent vessels from Apical Nodes converge-> Subclavian Lymphatic Trunk
  • Right subclavian trunk continues-> Right lymphatic duct-> Right Venous Angle (Junction of Subclavian and Internal Jugular Veins)
  • Left subclavian trunk drains into Thoracic Duct-> Left Venous Angle
25
Q

What are 2 possible negative outcomes of Axillary Lymph Node Dissection

A
  1. Interrupted drainage-> Lymphoedema

2. Damage to Long Thoracic Nerve (Supplies Serratus Anterior, so-> Winged Scapula deformity)

26
Q

Outline the Pathway of the 5 main arteries supplying the upper limb

(Go Proximal-> Distal)

A
  • Subclavian Artery enters axilla at Lateral Border of Rib 1-> Axillary Artery
  • Axillary becomes Brachial Artery at inferior border of Teres Major
  • Brachial becomes Radial and Ulnar Arteries at neck of radius

(Radial> Ulnar artery)

27
Q

Relate the 3 parts of the Axillary artery to Pectoralis Minor

A

First part- Proximal to Pec Minor

Second part- Posterior to Pec Minor

Third part- Distal to Pec Minor

28
Q

What are the main branches of the Axillary Artery?

A 
1st part (Proximal to Pec Minor);
- Superior Thoracic Artery

2nd part (Posterior to Pec Minor);

  • Thoracoacromial artery
  • Lateral Thoracic artery

3rd part (Distal to Pec Minor);

  • Subscapular artery
  • Anterior Circumflex Humeral Artery
  • Posterior Circumflex Humeral Artery
29
Q

How are the Anterior and Posterior Circumflex Humeral Arteries related to each other?

A

Form an Anastomosis around the Surgical Neck of the Humerus

30
Q

The head of which bone is the 2nd most common site for Avascular Necrosis after the femur?

Why?

A

Head of humerus

Anastomosis between Anterior and Posterior Circumflex Humeral Arteries can be damaged during fracture

31
Q

Outline the pathway of the following Veins in Upper limb

  • Radial
  • Ulnar
  • Paired Brachial
  • Basilic
  • Cephalic
  • Axillary
  • Subclavian

(Go distal to proximal)

A
  • Radial + Ulnar veins unite -> Paired Brachial veins (at level of distal arm)
  • Brachial + Basilic veins unite-> Axillary vein, at Inferior Border of Teres Major
  • Cephalic Vein drains into (1st part of) Axillary Vein (Proximal to Pec Minor)
  • Axillary vein becomes the Subclavian Vein, at Lateral Border of Rib 1
32
Q

What are the major superficial veins of the upper limb? Which axial borders do they run across?

A

Cephalic: Pre-axial border
Basilic: Post-axial border

33
Q

Compare the Basilic and Cephalic Vein in terms of Origin and how they run up the upper limb to join the Axillary Vein

A

Both originate from Dorsal Venous Network of hand

Cephalic- Runs anterolaterally up the upper limb, between Deltoid and Pec Major, and enters axilla through Deltopectoral Triangle-> Drains into 1st part of Axillary Vein

Basilic- Runs medially up the upper limb, combines with Brachial Veins-> Axillary Vein

MSK (21 decks)

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