Shoulder, Breast, and Pectoral Region

Question 1

What are the 4 unique spaces in the posterior shoulder?

Answer 1

1. Suprascapular notch
2. Quadrangular space
3. Triangular space
4. Triangular interval

Question 2

Suprascapular notch (Superior transverse scapular ligament)

Answer 2

Contains the superior transverse scapular ligament.

The suprascapular artery goes over and the suprascapular nerve goes under it.

Question 3

Quadrangular space

Answer 3

Bordered by the teres minor, teres major, and the long head of the triceps.
The posterior humural circumflex artery and the axillary nerve are present within this space

Question 4

Triangular space

Answer 4

Borderd by teres minor, teres major, and the long head of the triceps.
The cirumflex scapular artery is present within this space.

Question 5

Triangular Interval

Answer 5

Bordered by teres major, long head of the triceps, and lateral head of the triceps.
Within the space is the Radial nerve and the Profunda brachii. artery.

Question 6

Anastomoses around the shoulder is the product of which artery branches?

Answer 6

Subclavian branches: The transeverse cervical and suprascapular arteris from Thyrocervical trunk. Sometimes the Dorsal scapular

Axillary branches: The thoroacromial artery from the thoracoacromial trunk. The circumflex scapular artery from the subscapular artery. Both anterior and posterior circumflex humeral arteries. (Basically all of section 3 of the axillary artery plus one branch from the thoracoacromial trunk)

Question 7

VITamin C & D

Answer 7

Braches of the subclavian artery

V = vertebral
I = internal thoracic (mammary) artery
T = thyrocervical trunk
inferior thyroid artery, 
suprascapular artery, 
transverse cervical artery

C = costocervical trunk
supreme intercostal artery, deep cervical artery

D = dorsal scapular artery

Question 8

Screw The Lawyer Save A Patient

Answer 8

Branches of the Axillary artery

S - Superior Thoracic Artery
T - Thyroacromial trunk (deltoid branch, pectoralis branch, clavical branch, acromian branch)
L - Lateral Thoracic Artery
S - Subscapular Artery (subscapular circumflex)
A - Anterior Circumflex humeral artery
P - Posterior Circumflex humeral artery

Question 9

What are the Fascial Compartments

Answer 9

Pectoral Fascia- Covers pectoralis major muscle
Axillary Fascia- continiation of pectoral fascia laterally
Clavipectoral Fascia- deep to pectoralis major; encloses subclavius muscle and pectoralis minor

Question 10

There is only one Thoracic nerve associated with the upper extremities. Which one is it?

Answer 10

T1

Question 11

What are the rotator cuff muscles?

Answer 11

SitS
Supraspinatus
Infrapsinatus
Teres minor
Subscapularis

The first three insert into the greater tubercle of the humerus. The subscapularis inserts into the lesser tubercle.

Question 12

Which muscle is most frequently torn in the rotator cuff injuries?

Answer 12

Supraspinatus

Question 13

Which muscles are responsible for abduction of the arm?

Answer 13

Supraspinatus - 15 degrees
Deltoid - 15-90 degrees
Trapezius -180 degrees

Question 14

What are the borders that serve as a protected passageway for the neurovascular structures (Axillary artery and vein and the Brachial plexus.

Answer 14

Apex: rib#1, clavicle, and superior edge of the scapula
Base: Axillary fascia( just your armpit really no base)
Anterior Wall(in front of it): Pect. min and maj.
Posterior Wall: Subscapularis and scapula
Medial Wall: Serratus Anterior over first 5 ribs
Laterall Wall: Humerus and coracoid process

Question 15

Where do 80% of tumors in the breast originate?

Answer 15

The lactiferous ducts

Question 16

Tail of Spene

Answer 16

An extension of the tissue of the breast that extends into the axilla.

Question 17

What are the dimensions of the breast?

Answer 17

2/3 rest on the deep pectoral fascia
1/3 rest on the fascia covering the sarratus anterior
Extends vertically from the 2nd rib - 6th rib

Question 18

Tubuloalveolar glands

Answer 18

15-20 glands form a LOBE termed the tubuloalveolar gland. These lead into a lactiferous duct.
1 LOBE per 1 Lactiferous duct.

Question 19

Suspensory Ligament (of Cooper)

Answer 19

Connective tissue in the breast that helps maintain structural integrity by dividing glandular tissues into lobes and by attaching the lobes to the skin

Question 20

What arteries supply the breast?

Answer 20

From MOST important to least important:

Lateral Thoracic Artery ( a branch of the 2nd portion of the axillary artery.

Internal Thoracic Artery aka internal mammary artery ( the I in VITamin, a branch of the subclavian artery)

Pectoral Branch ( a branch of the 2nd portion [thoracoacromial trunk] of the axillary artery

Question 21

In what quadrant does the highest frequency of breast cancer occur? Lowest

Answer 21

The superior-lateral quadrant of the breast.

The Inferior-medial quadrant of the breast

Question 22

Lymphatics of the breast? Remember CLASP

Answer 22

C- Central Nodes
L- Lateral Nodes (Humeral Nodes)
A- Apical Nodes
S- Subscapular Nodes ( Posterior Nodes)
P-Pectoral Nodes (Anterior Nodes)

Question 23

Where do the majority of nodes from the breast drain?

Answer 23

Axilla