The axillary area

Question 1

Contents of the axilla

Answer 1

AXillary vein and artery
Infraclavicular portion of the brachial plexus
Long thoracic nerve
Lymph nodes (Subscapular Central Humeral Apical Posterior)
Axillary fat tissue

Question 2

Outline the borders of the axilla

Answer 2

Apex: First rib, clavicle
Anterior: Pectoral major
Lateral: Long thoracic border, latissimus dorsi
Posterior: Subscapularis
Base: Skin of the axilla

Question 3

Name the vessels that form the scapular anastomoses.

Answer 3

Suprascapular artery - branch of the subclavian
Circumflex scapular artery - From the axillary
Posterior intercostal artery
**Supply from various vessels ensures that blood supply will be maintained in the event of an occlusion

Question 4

Nerves branching from the roots of the brachial plexus

Answer 4

Long thoracic nerve (serratus anterior)
Dorsal scapular (Rhomboids, levator scapulae)

Question 5

Nerves branching from the trunks of the brachial plexus

Answer 5

Suprascapular nerve (Supra and infra spinatus)

Question 6

Nerves branching from the chords of the brachial plexus

Answer 6

Lateral, Posterior and Medial Chords
Lateral: Lateral pectoral nerve (Pectoralis major)
Posterior: Upper subscapular nerve (subscapularis), thoracodorsal (latissimus dorsi), lower supscapular nerve (subscapularis and teres major)
Medial: Medial pectoral (pectoralis major and minor), medial cutaneous nerves of the arm and forearm

Question 7

Damage to the radial nerve results in…

Answer 7

Wrist drop

Question 8

Damage to the ulnar nerve results in…

Answer 8

Claw hand/Ulnar claw

Question 9

Damage to the median nerve results in…

Answer 9

Hand of benediction (unable to form a fist, 2nd and 3rd digit cannot flex)

Question 10

Describe and explain the mechanism of Erb-Duchenne’s Palsy

Answer 10

Resultant of a legion within the superior brachial plexus. Can be caused during birth if excessive stretching of the neck occurs.
Characterised by paralysis of muscles supplied by C5 and C6, the deltoids, biceps and brachialis.
Upper limb is adducted with the arm rotated medially and the elbow extended.

Question 11

Damage to the superior trunk of the brachial plexus…

Answer 11

Results in the waiter’s tip deformity.

Erb’s Palsy

Question 12

Damage to the inferior parts of the brachial plexus…NAME?

Answer 12

Klumpke’s paralysis.
Less common. May occur when the limb is pulled suddenly superiorly, such as during birth
Inferior trunk, C8-T1 are injured. Spinal roots may be avulsed from the spinal cord.
Short muscles of the hand are affected, leading to claw hand.

Question 13

Damage to the cords of the brachial plexus..

Answer 13

May be caused by pro-longed hyperabduction of the arm during performance of overhead tasks.
Symptoms: Pain radiating down the am, numbness, paraesthesia, erythema and weakness of the hands

Question 14

Define the brachial plexus

Answer 14

A plexus of nerves which supplies all of the muscles of the upper arm. Formed from the anterior rami of spinal nerves, C5-C8 and T1

Question 15

Location of the brachial plexus

Answer 15

The spinal roots emerge from the vertebral foramen near the posterior triangle of the neck, between the anterior and medial scalene muscles.
The trunks then pass the base of the posterior triangle.
They pass behind the subclavian artery and over the first rib and the apex of the lung.
Behind the middle third of the clavicle the trunks split into divisions.