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ACE Unit 1 > TBL 5 - Pectoral Muscles, Breasts, Axilla, and Anterior Arm > Flashcards

TBL 5 - Pectoral Muscles, Breasts, Axilla, and Anterior Arm Flashcards

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1
Q

Pectoralis major

A

sternocostal and clavicular heads to the sternum, superior six costal cartilages and clavicle to the anteromedial aspect of the proximal humerus

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2
Q

What do the lateral and medial pectoral nerves innervate and where does the lateral pectoral nerve come from?

A

Clavicular head of major and pectoralis minor and sternocostal head. The lateral pectoral nerve is from the lateral cord

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3
Q

Pectoralis Minor

A

3rd and 5th ribs to the coracoid process of scapula

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4
Q

What muscle stabilizes the scapula against the posterior thoracic wall when stretching to reach something

A

Pectoralis minor

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5
Q

What muscle adducts the upper limb and medially rotates the arm

A

pectoralis major

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6
Q

Serratus Anterior

A

lateral portions of the first 8 ribs to the medial border of the scapula

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7
Q

what muscle protracts the scapula when reaching

A

the serratus anterior

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8
Q

How do the pectoralis minor, serrates anterior, and trapezius all act on the scapula

A

serratus anterior protracts, pec minor stabilizes it here and trapezius retracts

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9
Q

How is serratus anterior involved in abduct with the trapezius

A

Synergistically helps rotate the scapula upward

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10
Q

What does the long thoracic nerve innervate and why is the long thoracic nerve vulnerable to injury and how are abduction and rotation at the glenohumeral joint hindered after its injury?

A

Serratus anterior. the nerve is vulnerable tot injury because it is superficial to the muscle and therefore exposed when the arms are raised. The glenoid cavity cannot be rotated up so the arm cannot be abducted past 90 degrees.

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11
Q

What is the winged scapula deformation

A

When the serratus anterior is paralyzed by long thoracic nerve injury, the medial border of the scapula moves laterally and posteriorly away from the posterior thoracic wall creating the winged scapula

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12
Q

What is the precursor to the pec muscles and what is the poland sequence

A

Parietal layer of lateral plate mesoderm. The poland sequence is where the pec minor and some of the pec major is missing as are the nipple and areola. the digits are fused and shortened

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13
Q

Describe the formation of the mammary glands in embryo

A

Anterior ridge-like epidermal thickenings (primitive nipples) are in the embryo and one pair in the pec region invaginate the dermis. These are modified sweat glands

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14
Q

Describe mammary glands in childhood

A

15-25 rudimentary lactiferous ducts that open onto the surface of the nipple

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15
Q

Mammary glands during puberty

A

Ovarian estrogen and progesterone cause budding of small terminal ducts from distal end of each lactiferous duct. White fat accumulates around each terminal duct

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16
Q

Mammary glands after breast feeding and later after menopause

A

Return to resting state. After menopause, the acini and terminal ducts regress and the lactiferous ducts become fluid-filled cysts

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17
Q

Mammary glands during pregnancy

A

Ovarian hormones and prolactin (pituitary gland hormone) stimulate secretory acini formation at the distal ends of the terminal ducts. Milk secretion is induced by the hormones into the lumens of the acini during lactation

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18
Q

What attaches the breasts to the overlying dermis of skin

A

Suspensory ligaments

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19
Q

Trace the lymph from the lateral quadrates of the breasts

A

Pectoral lymph node (a constituent of axillary nodes) which drain into the supraclavicular lymph nodes

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20
Q

Trace the lymph from the medial quadrants of the breasts

A

Parasternal lymph nodes into the supraclavicular lymph nodes

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21
Q

Where do breast carcinomas typically arise and what is the most common site for metastasis?

A

Usually adenocarcinomas from the epithelial cells of the lactiferous ducts. Axillary lymph nodes are the main sites of metastasis as most lymph is drained through here

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22
Q

The axillary artery is continuous with the

A

subclavian artery at the lateral border of the 1st rib

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23
Q

Where does the axillary artery end and what does it become

A

Ends at the inferior border of the trees major where it becomes the brachial artery

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24
Q

What branch of the axillary artery has the shortest length and the longest diameter

A

Subscapular

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25
Q

What are the two terminal branches of the subscapular artery and which one anastomoses with the suprascapular artery?

A

Circumflex scapular artery, which anastomoses with the supra scapular artery, and the thoracodoral artery

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26
Q

What muscle does the thoracodorsal artery supply

A

Latissimus dorsi

27
Q

What artery supplies the deltoid and describe where it comes from

A

The posterior circumflex artery, a branch of the axillary artery, supplies the deltoid, encircles the humerus, and anastomoses with the anterior circumflex artery

28
Q

Where can the axillary artery be ligated without stopping blood flow into the upper limb?

A

It can be ligated between the 1st rib and subscapular artery. In this case, the direction of blood flow in the subscapular artery is reversed to supply the third part of the axillary artery.

29
Q

Where do the axillary lymph nodes drain?

A

The supraclavicular lymph nodes

30
Q

What nodes receive lymph from the anterior thoracic wall and breasts

A

Pectoral lymph nodes

31
Q

What nodes receive lymph from posterior thoracic wall and scapular region

A

Subscapular lymph nodes

32
Q

What nodes receive lymph from entire upper limb except vessels with cephalic vein

A

Humeral lymph nodes

33
Q

Where do the pectoral, sub scapular, and humeral lymph nodes drain?

A

The apical node which drains into the supraclavicular node

34
Q

Which two nerves are at risk during surgical removal of pathologic axillary nodes? Why can removal result in lymphedema?

A

The long thoracic and thoracodorsal nerves are at risk as they are near the axillary lymph nodes. This affects the serratus anterior and latissimus dorsi.
Lymphedema can occur if lymphatic drainage is impeded after removal of the nodes

35
Q

What roots generate the dorsal scapular nerve and what muscle does it innervate

A

C5 - rhomboids

36
Q

What roots generate the long thoracic nerve and what muscle does it innervate

A

C5, C6, C7 - serratus anterior

37
Q

What generates the supra scapular nerve and what muscle does it innervate

A

The superior trunk and it innervates the supraspinous and infraspinous

38
Q

How does avulsion of brachial plexus roots C5 and C6 typically occur in adults and newborns?

A

If the head and shoulder separate at an awkward angle. Can happen during birth or from a hard fall where shoulder hits something and stops moving and head continues to move forward

39
Q

What strengthens the joint capsule at the articulation of the radius, ulna, and humerus

A

Lateral side - radial collateral ligament

Medial side - ulnar collateral ligament

40
Q

What does the anular ligament do?

A

Encircles the head of the radius and holds it in the radial notch of the ulna. Forms a radio-ulnar joint for pronto and supination of the forearm

41
Q

How does posterior dislocation of the elbow joint typically occur and why is the distal humerus driven anteriorly? Which nerve may be damaged?

A

Fall on hands while elbow is flexed. The ulna is driven posteriorly causing the humerus to go anteriorly. The ulnar nerve is at risk here.

42
Q

What is the most common cause of subluxation of the radial head in preschool children? Which ligament is commonly damaged and how is the injury treated?

A

Occurs when child is lifted suddenly via upper limb and forearm is pronated. Tears the anular ligament off the radius and is treated with a sling for 2 weeks

43
Q

What forms from the torn blood vessels after a fracture

A

Hematoma (clot) form the coagulation of the blood

44
Q

Describe the acute inflammatory response

A

Macrophages are recruited adjacent to the fracture, osteoprogenitors proliferate in the periosteum and endosteum is activated

45
Q

Describe the osteoprogenitor cell differentiation that occurs during fracture repair

A

The periosteal capillaries induce differentiation. Cells close to capillaries become osteoblasts and those farther away become chondroblasts

46
Q

Describe the resolution of the hyaline cartilage external callus that forms on the ends of the bony fragments

A

Osteoclasts degrade the cartilage and osteoblasts reconstruct it with trabecular bone. The bone forms an internal callus that restores the marrow cavity and the external callus is transformed into compact bone

47
Q

How might mesenchymal stem cell technology be beneficial for the reconstruction of fractured bones?

A

The stem cells could differentiate into osteoblasts ex vivo and begin formation of the bone and be inserted into the person

48
Q

Biceps brachii

A

Long head - guided through the inter tubercular sulcus to the supraglenoid tubercle
Short head - coracoid process
Distal - radial tuberosity

49
Q

Where is the tendon of the long head of the biceps commonly ruptured and what deformity results?

A

Ruptured at the supraglenoid tubercle after moving back and forth over the inter tubercular sulcus of the humerus. Forms the popeye deformity where the muscle belly forms a ball in the center of the distal part of the anterior arm

50
Q

Coracobrachialis

A

Coracoid process to the middle third of the humerus

51
Q

Brachialis

A

Inferior half of humerus to the coronoid process and tuberosity of the ulna

52
Q

What muscle flexes the forearm when it is pronated or supinated

A

Brachialis

53
Q

What does the musculocutaneous nerve innervate and where does it come from

A

coracobrachialis, biceps brachii, and brachialis, and skin of the lateral aspect of the forearm. It is a branch of the lateral cord

54
Q

Which spinal cord segments are tested by the biceps tendon reflex?

A

C5 and C6. Musculocutaneous nerve

55
Q

What arises from the posterior cord before it bifurcates into the radial and axillary nerve

A

Thoracodorsal and subscapular nerve

56
Q

What is the spinal segmental origin of the axillary nerve and where does it go?

A

C5 and C6. It is a terminal branch of the posterior cord. Innervates the teres minor and deltoid and skin over the inferior part of the deltoid

57
Q

Would flexion and supination of the forearm be lost after injury to the musculocutaneous nerve? Where would sensation be lost?

A

No but severely weakened. The supinator and brachioradilis can cause some supination and flexion. Sensation would be lost on the lateral side of the forearm

58
Q

What does the radial nerve innervate

A

Supinator and brachioradialis

59
Q

How is an affected upper limb positioned after the onset of Erb-Duchenne palsy?

A

Superior portions of the brachial plexus are hurt. Adducted shoulder, medially rotated arm, and extended elbow

60
Q

What is the first and largest branch of the brachial artery and where does it course

A

profunda brachii (deep artery of the arm) courses with the radial nerve along the radial groove

61
Q

What does the brachial artery branch into

A

The ulnar and radial arteries

62
Q

What is the role of the anastomoses of the brachial, profound brachia arteries with branches of the radial and ulnar arteries

A

Collateral circulation that allows blood to reach forearm when forearm is flexed

63
Q

Why is laceration or occlusion of the brachial artery proximal to the profunda brachii artery a surgical emergency?

A

Paralysis of the muscle happens with a few hours of ischemia of the elbow and forearm

64
Q

Why can the brachial artery be blocked at any level distal to the deep artery of the arm without stopping blood flow to the forearm and hand?

A

The arterial anastomoses around the elbow ensure enough blood reaches the ulnar and radial arteries

ACE Unit 1 (8 decks)

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