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Gross Anatomy > Upper Extremity: Axilla and Brachial Plexus > Flashcards

Upper Extremity: Axilla and Brachial Plexus Flashcards

1
Q

Axilla

A
  • Passageway from neck to upper limb

- Begins at cervico-axillary canal (clavicle, 1st rib, superior scapula)

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2
Q

Boundaries of axilla

A
  • Apex (superior): cervico-axillary canal
  • Base (inferior,floor): axillary fascia
  • Anterior: pectoralis major and minor
  • Posterior: latissimus dorsi, teres major, subscapularis
  • Medial: thoracic wall (ribs 1-5, intercostal muscles, serratus anterior)
  • Lateral: intertubercular sulcus of the humerus
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3
Q

Content of axilla

A
  • Axillary artery/vein
  • Cords and branches of the brachial plexus
  • Lymphatics and axillary lymph nodes
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4
Q

Axillary sheath surrounds

A
  • Axillary vessels

- Brachial plexus cords

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5
Q

Subclavian branches that contribute to the scapular region

A
  • Dorsal scapular
  • Branch from either transverse cervical or subclavian directly
  • Suprascapular
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6
Q

3 parts of the axillary artery

A
  • Part 1: outer border of rib 1 up to pectoralis minor
  • Part 2: posterior to pectoralis minor
  • Part 3: outer edge of pectoralis minor to inferior edge of teres major
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7
Q

Branches of axillary artery 1st part

A
  • Superior thoracic artery (Highest or supreme thoracic artery)
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8
Q

Branches of axillary artery 2nd part

A
  • Thoracoacromial artery
  • Acromial branch
  • Clavicular branch
  • Pectoral branch
  • Deltoid branch (accompanies cephalic vein)
  • Lateral thoracic artery
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9
Q

Branches of axillary artery 3rd part

A
  • Subscapular artery
  • Anterior circumflex humeral artery
  • Posterior circumflex humeral artery
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10
Q

Subscapular artery branches

A
  • Circumflex scapular artery

- Thoracodorsal artery

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11
Q

Anterior circumflex humeral artery

A
  • Supplies surgical neck/humeral head/GH joint
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12
Q

Posterior circumflex humeral artery

A
  • Supplies surgical neck/humeral head/GH joint

- Can anastomosis with profunda brachii artery

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13
Q

Arterial anastosomes around the scapula

A
  • Provide alternate means of blood supply

- Occlusion/ligation of subclavian or axillary arteries

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14
Q

Arteries involved with collateral circulation around scapula

A
  • Transverse cervical
  • Descending scapular (dorsal scapular)
  • Suprascapular
  • Subscapular and circumflex scapular
  • Branches from posterior intercostals (2-7)
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15
Q

Axillary lymph nodes

A
  • Anterior (pectoral)
  • Posterior (subscapular)
  • Lateral (humeral)
  • Central
  • Apical
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16
Q

Anterior (pectoral) axillary lymph nodes

A
  • Located around the lateral thoracic vessels/pec minor
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17
Q

Posterior (subscapular) axillary lymph nodes

A
  • Located along posterior axillary fold and subscapular vessels
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18
Q

Lateral (humeral) axillary lymph nodes

A
  • Located along lateral wall of axilla, medial and posterior to axillary vein
  • Receive most lymph from upper extremity except that which parallels the cephalic vein
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19
Q

Central axillary lymph nodes

A
  • Located deep to pec minor

- Receives lymph from anterior, posterior, and lateral axillary nodes

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20
Q

Apical axillary lymph nodes

A
  • Located at the apex of axilla

- Lymph directly from pectoral region and lateral upper extremity

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21
Q

Apical node pathway

A

Apical nodes –> subclavian lymphatic trunk –> right lymphatic duct (right) and thoracic duct (left)

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22
Q

Brachial plexus

A
  • Origin of the nerves of the upper limb
  • Most branches arise in the axilla (not all)
  • Formed by anterior rami of C5 – T1 (sometimes C4 and T2 may contribute)
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23
Q

Brachial trunks (superior, middle, and inferior trunks)

A
  • Each divides into an anterior and posterior division at the cervico-axillary canal
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24
Q

Superior trunk of brachial plexus

A
  • Union of C5,6 roots (anterior rami)
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25
Middle trunk of brachial plexus
- C7 root
26
Inferior trunk of brachial plexus
- Union of C8,T1
27
Anterior divisions from superior and middle trunk
- Unite to form the lateral cord
28
Anterior division from the inferior trunk
- Forms the medial cord
29
Posterior divisions from all 3 trunks
- Unite to form the posterior cord
30
Roots (ventral rami)
- Pass between anterior and middle scalene muscles | - Receive sympathetic fibers from middle and inferior cervical (stellate) ganglia
31
Supraclavicular/infraclavicular branches
- Some branches arise from the roots and upper trunk - No branches from the divisions - Most branches arise from the cords
32
Branches from roots (ventral rami)
- Dorsal scapular (C5, sometimes C4) | - Long thoracic (C5-7)
33
Branches from trunks
- Nerve to subclavius (C5,6) | - Suprascapular (C5,6)
34
Lateral branches from cords
- Lateral pectoral (C5-7) | - Musculocutaneous (C5-7)
35
Medial branches from cords
- Medial pectoral (C8,T1) - Medial cutaneous nerve of arm (C8,T1) - Medial cutaneous nerve of forearm (C8,T1) - Ulnar nerve (C8,T1; often C7)
36
Lateral and medial branches from cords
- Median nerve (C5-T1)
37
Posterior branches from cords
- Upper and lower subscapular (C5,6) - Thoracodorsal (C6-8) - Axillary (C5,6) - Radial (C5-T1)
38
Dorsal scapular nerve (C5, sometimes C4 contributes)
- Branches off ventral rami of C5 posteriorly, pierces middle scalene - Descends along medial scapular border along with dorsal scapular artery - Supplies levator scapulae and rhomboids (deep to these muscles)
39
Long thoracic nerve
- Branches off C5-7 ventral rami - Passes through cervico-axillary canal - Descends along serratus anterior around the mid-axillary line - Supplies serratus anterior - Injury can cause winging of the scapula
40
Suprascapular nerve
- Derived from upper trunk (C5,6) - Traverses posterior triangle of the neck - Passes through suprascapular foramen, below transverse scapular ligament - Suprascapular vessels pass above ligament - Innervates supraspinatus, infraspinatus, and shoulder joint
41
Lateral pectoral nerve (C5-7)
- Originates from the lateral cord - Pierces through clavipectoral fascia - Innervates pectoralis major primarily - Innervates shoulder joint
42
Medial pectoral nerve (C8,T1)
- Originates from medial cord pierces pectoralis minor, enters deep surface of pectoralis major - Innervates pectoralis minor and major (sternocostal part)
43
Musculocutaneous nerve (C5-7)
- Terminal branch of lateral cord - Pierces coracobrachialis - Descends into the arm between biceps brachii and brachialis - Becomes lateral cutaneous nerve of the forearm
44
Musculocutaneous nerve (C5-7) motor innervation
- Arm anterior compartment - Coracobrachialis - Biceps brachii - Brachialis
45
Musculocutaneous nerve (C5-7) sensory innervation
- Lateral forearm
46
Medial cutaneous nerve of arm
- Originates from medial cord (C8,T1) - Very small - Supplies skin on medial side arm
47
Medial cutaneous nerve of forearm
- Originates from medial cord (C8,T1) - Pierces deep fascia and becomes superficial with basilic vein - Supplies skin over biceps, anterior and medial forearm
48
Ulnar nerve
- Terminal branch of medial cord (C8,T1; often C7) - Descend into the arm on the medial side - Posterior to medial epicondyle - Travels along medial forearm into the hand
49
Ulnar nerve motor innervation
- 1 ½ anterior forearm compartment muscles | - Every hand muscle not innervated by median
50
Ulnar nerve sensory innervation
- Hand medial to midline of 4th digit
51
Median nerve
- Derived from the lateral and medial cord - Descends into arm next to the brachial artery - Passes through cubital fossa to enter the forearm
52
Median nerve lateral root
- (C5-7): terminal branch of lateral cord
53
Median nerve medial root
- (C8,T1): terminal branch of medial cord
54
Median nerve motor innervation
- Anterior forearm compartment (except 1 ½ muscles) | - 5 intrinsic hand muscles
55
Median nerve sensory innervation
- Lateral hand, lateral to midline of 4th digit
56
Superior (upper) and Inferior (lower) Subscapular Nerves
- Originate from the posterior cord (mostly C5,6) - Both supply subscapularis - Lower subscapular nerve also supplies teres major
57
Thoracodorsal nerve
- Originates from the posterior cord (C6-8) - Arises between the subscapular nerves - Travels along axillary wall - Innervates latissimus dorsi
58
Axillary nerve
- Terminal branch of posterior cord (C5,6) - Exits axilla through quadrangular space along with - Posterior humeral circumflex artery
59
Axillary nerve motor innervation
- Deltoid muscle | - Teres minor muscle
60
Axillary nerve sensory innervation
- Superior/lateral arm (superior lateral cutaneous nerve of arm) - Shoulder joint
61
Injuries to axillary nerve
- Surgical neck fracture | - Inferior shoulder dislocation
62
Radial nerve
- Terminal branch of posterior cord (C5-T1) - Passes through triangular interval - Travels with deep artery of the arm - Radial groove (between med and lat heads of triceps) - Enters anterior elbow region and branches (cover later)
63
Radial nerve motor innervation
- Posterior compartment muscles of arm and forearm
64
Radial nerve sensory innervation
- Inferolateral arm - Posterior arm and forearm - Dorsum of hand, lateral to midline of 4th digit
65
Brachial plexus injuries
- Stretching, compression that affects the integrity of the brachial plexus - Thoracic outlet syndrome - Trauma
66
Common trauma injuries to brachial plexus
- Pentrating trauma in the posterior triangle of the neck or axilla
67
Sensory symptoms of brachial plexus injury
- Anesthesia | - Paresthesia
68
Motor symptoms of brachial plexus injury
- Paralysis | - Incomplete paralysis (paresis or weakness)
69
Upper plexus injury causes
- Shoulder depression and lateral flexion head toward opposite side
70
Lower plexus injury causes
- Arm abduction and distraction away from the body
71
Erb-Duchenne’s Palsy (Upper plexus injuries) causes
- Caused by an injury that draws the head away from the shoulder (birth trauma, sports, etc)
72
Nerves damaged in Erb-Duchenne’s Palsy (Upper plexus injuries)
- C5,6 ventral rami are damaged (or upper trunk) | - C5,6 contributes to suprascapular nerve, axillary nerve, musculocutaneous nerve
73
Effects of Erb-Duchenne’s Palsy (Upper plexus injuries)
- Results in medial rotation of the upper limb (Waiter’s tip deformity)
74
Waiter's tip deformity
- Arm/forearm hangs down by the side in a position of extension, pronation, and internal rotation - Wrist is flexed
75
Motor functions lost in Waiter's tip deformity from Erb-Duchenne’s Palsy (Upper plexus injuries)
- Arm lateral rotation - Shoulder abduction and flexion - Elbow flexion - Supination
76
Sensory functions lost in Waiter's tip deformity from Erb-Duchenne’s Palsy (Upper plexus injuries)
- Lateral shoulder, arm, forearm, thumb
77
Dejerine-Klumpke palsy (Lower type plexus injuries)
- C8,T1 ventral rami are effected | - Injury most commonly occurs when the arm is pulled upwards
78
Dejerine-Klumpke palsy (Lower type plexus injuries) innervation issues
- Loss of innervation to intrinsic hand muscle | - Causes claw hand deformity
79
Claw hand deformity
- Hyperextension of metacarpophalangeal joint | - Flexion of interphalangeal joints
80
Sensory functions lost in Dejerine-Klumpke palsy (Lower type plexus injuries)
- Medial side of forearm, hand and 5th digit

Gross Anatomy (50 decks)

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