The axilla and pectoral region Flashcards

1
Q

Osteology of the Pectoral Region

A

Clavicles
Sternum
Ribs
Scapula

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2
Q

Parts of the sternum

A

Manubrium, body, and xiphoid

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3
Q

“Atypical” ribs

A

1, 2, 11, and 12

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4
Q

“True” ribs (vertebrocostal)

A

Ribs 1-7

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5
Q

“False” ribs (vertebrochondral)

A

Ribs 8-10

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6
Q

“Floating” ribs

A

Ribs 11 and 12

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7
Q

Breasts

A

Bilateral glandular structures found in both males and females.

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8
Q

What are mammary glands?

A

Modified sweat glands

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9
Q

Where do breast rest?

A

Rest on pectoral fascia (above pectoralis major)

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10
Q

Retromammary space

A

Potential space between breast and pectoral fascia

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11
Q

Innervation of the Breast

A

Innervated by intercostal nerves (4th-6th)?

May also receive some innervation from supraclavicular nerve branches of other intercostal nerves

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12
Q

How does the breast attach to the dermis of the overlying skin?

A

Suspensory ligaments (Cooper’s ligaments)

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13
Q

Arterial Supply of the Breast

A

Mammary branches from anterior intercostal, lateral thoracic, and internal thoracic arteries.
Axillary and subclavian

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14
Q

Venous Drainage of the Breast

A

Mainly to axillary vein via lateral thoracic veins and medial mammary veins
Some drainage to internal thoracic vein via anterior intercostal veins

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15
Q

Why is lymphatic drainage of breast tissue important?

A

Due to its role in metastasis of cancer cells

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16
Q

Lymphatic drainage of nipple, areola, lactiferous lobules

A

Subareolar lymph nodes

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17
Q

What lymph nodes are responsible for more than 75% of lymph from breast?

A

Axillary lymph nodes (pectoral, central, apical)

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18
Q

Fascia of the pectoral region

A
Clavipectoral fascia (Pectoralis minor)
Axillary fascia 
Pectoral fascia (Pectoralis major)
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19
Q

Superficial fascia

A

Platysma
Supraclavicular nerves
Anterior and lateral branches of intercostal nerves

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20
Q

Components of the Deltopectoral (clavipectoral) triangle

A

Deltoid, pectoralis major, middle 1/3 of clavicle (Make up borders)
Cephalic vein
Deltopectoral lymph nodes
Deltoid branch of thoracoacromial a. (from axillary a.)

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21
Q

Clavipectoral fascia invests..

A

Subclavius and pectoralis minor

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22
Q

Clavipectoral Fascia attaches to

A

the clavicle and anterior thoracic wall

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23
Q

What pierce the clavipectoral fascia?

A

Cephalic vein, thoracoacrimial artery, and lateral pectoral nerves

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24
Q

What does the clavipectoral fascia become?

A

Becomes suspensory ligament of axilla

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25
Q

Innervation of the muscles of the pectoral region

A

Innervated by the ventral rami of spinal nerves via branches of the brachial plexus

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26
Q

Proximal attachment of pectoralis major

A

Claviclular and sternocostal attachments
Ant. surface of medial 1/2 of clavicle
Ant. surface of sternum and superior 6 costal cartilages

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27
Q

Distal attachment of pectorallis major

A

Lateral lip of intertubercular sulcus (bicipital groove)

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28
Q

Actions of pectoralis major

A

Adducts and medial rotates humerus
Draws scapula anteriorly and inferiorly (via clavicle)
Clavicular portion flexes humerus
Sternal portion can extend humerus while it is in this flexed position

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29
Q

Innervation of pectoralis major

A

Lateral and medial pectoral nerves (C5, C6 clavicular portion; C7, C8, T1 sternocostal portion)

30
Q

Proximal attachment of pectoralis minor

A

3rd - 5th ribs, near costal cartilage

31
Q

Distal attachment of pectoralis minor

A

Coracoid process of scapula

32
Q

Actions of pectoralis minor

A

Stabilizes scapula by pulling it anteriorly & inferiorly against posterior thoracic wall

33
Q

Blood supply of pectoralis minor

A

Pectoral branch(es) of thoracoacromial arterial trunk

34
Q

Innervation of pectoralis minor

A

Medial pectoral nerve (C8, T1)

35
Q

Proximal attachment of subclavius

A

Junction of 1st rib and its costal cartilage

36
Q

Distal attachment of subclavius

A

Inferior surface of middle 1/3 of clavicle

37
Q

Actions of subclavius

A

Anchors and depresses clavicle

38
Q

Blood supply of subclavius

A

Clavicular branch(es) of thoracoacromial arterial trunk

39
Q

Innervation of subclavius

A

“Nerve to subclavius” (C5, C6)

40
Q

Proximal attachment of Serratus Anterior

A

External surfaces of later parts of ribs 1-9

41
Q

Distal attachment of Serratus Anterior

A

Anterior surface of medial border of scapula

42
Q

Actions of Serratus Anterior

A

Protracts scapula, rotates scapula, holds scapula against thorax

43
Q

Blood supply of Serratus Anterior

A

Lateral thoracic artery

44
Q

Innervation of Serratus Anterior

A

Long thoracic nerve (C5, C6, C7)

45
Q

The 2 large named arteries that have tributaries that provide blood to the pectoral, shoulder, and axillary regions

A

Subclavian artery and Axillary artery

46
Q

Origin of subclavian artery

A

Right: brachiocephalic trunk
Left: aortic arch

47
Q

Where does the subclavian artery arise?

A

Posterior to sternoclavicular joint

48
Q

Where is Part 1 of the subclavian artery in relation to anterior scalene muscle?

A

Medial to the anterior scalene muscle

49
Q

Where is Part 2 of the subclavian artery in relation to anterior scalene muscle?

A

Posterior to the anterior scalene muscle

50
Q

Where is Part 3 of the subclavian artery in relation to anterior scalene muscle?

A

Lateral to the anterior scalene muscle

51
Q

Commonly found branches of the medial part (1) of the subclavian artery:

A
  1. Internal thoracic (mammary) a.
  2. Vertebral a.
  3. Thyrocervical arterial trunk
52
Q

Thyrocervical Arterial Trunk

A
  1. Transverse Cervical Artery (See slide 36)
  2. Inferior Thyroid Artery
  3. Ascending Cervical Artery
  4. Suprascapular Artery
53
Q

Commonly found branches of the posterior part (2) of the subclavian artery:

A

Costocervical arterial trunk: supreme intercostal artery and deep cervical artery

54
Q

What may arise from the lateral part (3) of the subclavian artery?

A

Dorsal scapular artery

55
Q

Where does the subclavian artery become the axillary artery?

A

Lateral border of first rib

56
Q

Name the two places that the dorsal scapular artery can arise from

A

Subclavian artery (usually the 3rd) or from the transverse cervical artery (about 30% of the time and called “deep branch the transverse cervical artery”

57
Q

What supplies the pectoral region and axilla?

A

The axillary artery and its branches

58
Q

Part 1 of the Axillary Artery

A

Superior Thoracic Artery

59
Q

Part 2 of the Axillary Artery

A

Thoracoacromial trunk

60
Q

Branches of the thoracoacromial trunk

A

Pectoral branch
Deltoid branch
Acromial branch
Clavicular branch

61
Q

Part 3 of the Axillary Artery

A

Subscapular artery (circumflex scapular and thoracodorsal)
Anterior circumflex humeral
Posterior circumflex humeral

62
Q

Scapular Anastomoses Components:

A
Suprascapular artery
Dorsal scapular artery
Posterior intercostal arteries
Circumflex scapular artery
Thoracodorsal artery
63
Q

The pectoral and axillary regions are drained by the:

A

Axillary vein

64
Q

The axillary vein receives blood from the:

A

Superficial and deep veins of the arm and forearm

65
Q

Superficial veins of arm and forearm:

A
Basilic veins (continues as the axillary vein)
Cephalic vein (drains into axillary before it becomes subclavian vein)
66
Q

Boundaries of the Axilla

A
Apex
Base (A and P axillary folds)
Anterior wall
Posterior wall
Medial wall
Lateral wall
67
Q

Apex of the Axilla:

A

Clavicle
Scapula
1st Rib

68
Q

Base of Axilla:

A

Skin and superficial fascia
Anterior axillary fold: pectoralis major
Posterior axillary fold: latissimus dorsi and teres major
Chest wall: Serratus anterior

69
Q

Anterior wall of Axilla:

A

Clavicle
Subclavius
Pectoralis major
Pectoralis minor

70
Q

Posterior wall of Axilla:

A

Scapula
Subscapularis
Latissimus dorsi
Teres major

71
Q

Lateral structures of Axilla:

A
Intertubercular sulcus (bicipital groove)
Tendon of long head of biceps
Coracobrachialis tendon
72
Q

Axillary Sheath:

A
  1. Axillary vein
  2. Axillary artery
  3. Brachial plexus