Clinical Anatomy of the Axilla & Brachial Plexus Flashcards


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1

Serratus Anterior

-Long thoracic nerve

-Rotates scapula upward to allow lifting arm above 90 degrees

-Protracts the scapula to keep the medial border against the thoracic wall

2

Pectoralis Major

-Medial and lateral pectoral nerves

-Flexion, adduction, and medial rotation of the arm

-Anterior wall

3

Pectoralis Minor

-Medial pectoral nerve

-Pulls tip of the shoulder down

-Anterior wall

4

Subscapularis

-Posterior wall

-Upper and lower subscapular nerves

-Medial rotation of the arm

5

Teres Major

-Posterior wall

-Lower subscapular nerve

-Medial rotation, adduction, extension of the arm

6

Latissimus dorsi

-Posterior wall

-Thoracodorsal nerve

-Medial rotation, adduction, extension of the arm

7

Triangular space

Circumflex artery

8

Quadrangular space

-Axillary nerve

-Posterior humeral circumflex artery

9

Triangular interval

-Radial nerve

-Deep brachial artery

10

Axillary artery

-Continuation of subclavian artery

-Begins at lateral border 1st rib

-Ends at inferior margin of teres major

-Divided into 3 parts by pectoralis minor (proximal, posterior, distal)

11

Proximal axillary artery

Superior thoracic

12

Posterior axillary artery

-Thoraco-acromial- acromial, pectoral, clavicular, deltoid

-Lateral thoracic

13

Distal axillary artery

-Subscapular- thoracodorsal, circumflex scapular

-Posterior circumflex humeral

-Anterior circumflex humeral

14

Axillary vein

-Formed by basilic vein and paired brachial veins

-Begins at inferior margin of teres major

-Ends at lateral border 1st rib

-Receives the cephalic

15

Axillary sheath

-Surrounds arteries, viens, nerves and lymphatics

-Can be used for brachial plexus blocks

16

Apical nodes

-Most superior nodes

-Receive lymph from all other axillary nodes and superficial lymphatics from lateral upper limb accompanying cephalic vein

17

Central Nodes

Receive lymph from anterior, lateral, and posterior groups

18

Lateral Nodes (humeral)

Receive lymph from the medial aspect of the upper limb accompanying the basilic vein

19

Posterior Nodes (scapular)

Receive lymph from posterior thoracic wall, back and posterior shoulder

20

Anterior Nodes (pectoral)

Receive lymph from anterior and lateral thoracic wall and breast

21

Pattern of lymphatic drainage

Lateral, anterior, and poster nodes all drain into the central node, which drains into the apical node, which drains in supraclavicular nodes, to subclavian lymphatic trunks

22

Subacromial space

common site of impingement

23

Sternoclavicular joint

-Only articulation of upper limb to axial skeleton

-Stable joint

24

Acromioclavicular ligament

-Strengthens AC capsule superiorly

25

Coracoclavicular ligament

-Anchors the clavicle to the coracoid process

26

Associated intrathoracic injuries of a fractured clavicle

-Pneumothorax

-Damage to subclavian vein and artery

27

Glenohumeral capsule

-Attaches to the anatomical neck of humerus and neck of scapular

-Reinforced by glenohumeral ligaments and tendons of SITS muscles

28

Wide range of motion of glenohumeral joint

-Inverse relationship between range of motion and stability

29

Subdeltoid (subacromial) bursa

allows for easy movement of the supraspinatus tendon under the acromial arch and of the deltoid over the greater tubercle

30

Deltoid

-Abducts arm 15-90

-Innervated by axillary nerve

31

Pectoralis Major

-Flexion, adduction and medial rotation of the arm

-Innervated by medial and lateral pectoral nerves

32

Serratus anterior

-Rotates scapula upward for abduction of arm above 90 degrees

-Protracts the scapula

-Innervated by long thoracic nerve (C5, C6, C7)

33

Trapezius

-Assists in rotating the scapula upwards during abduction of arm 90 degrees

-Elevation of the scapula

-Innervated by spinal accessory nerve

34

Latissimus dorsi

-Extends, adducts, and medially rotates the arm

-Innervated by the thoracodorsal nerve

35

Teres major

-Extension, adduction, medial rotation of the arm

-Lower subscapular nerve

36

Supraspinatus

-Abduction of arm to 15

-Suprascapular nerve

37

Infraspinatus

-Lateral rotation of arm

-Suprascapular nerve

38

Teres minor

-Lateral rotator of arm

-Axillary nerve

39

Subscapularis

-Medial rotation of arm

-Upper and lower subscapular nerves

40

Rotator cuff injuries

-Most commonly involves supraspinatus

-Susceptible to impingement and degenerative changes due to repetitive trauma

•Can be impinged by calcified coracoacromial ligament, swelling of the supraspinatus muscle or bony subacromial spurs

•Produces severe pain on abduction

•Leads to partial or full thickness tears

•Can result in the overlying subacromial bursa becoming inflamed

41

In shoulder dislocation, what sensory and motor deficits may be present in this patient?

•Decreased ability to laterally rotate the arm

•Loss of abduction from 15 to 90 degrees

•Sensory loss:

-Upper lateral part of arm (regimental patch)

42

In shoulder dislocation, what neurovascular structures can be damaged in this patient?

Axillary nerve and posterior humeral circumflex artery

43

Innervation: Hilton's Law

-Any nerve that provides motor innervation to the muscles acting on the joint will carry sensation from the joint

-Branches from the posterior cord of the brachial plexus, terminal branches of the brachial plexus and from the suprascapular, axillary, and lateral pectoral nerves.

44

Blood supply of the shoulder joint

-Branches of the anterior and posterior circumflex humeral and suprascapular arteries.

-Paired veins of the same name, accompany the arteries that supply the shoulder joint.

45

What happens if a muscle crosses a joint?

It will act on it.

46

What happens if a muscles crosses anterior to a joint?

It will flex it.

47

What happens if a muscle crosses posterior to a joint?

It will extend it.

48

Anterior/ flexor compartment is innervated by the

Muscolocutaneous nerve

49

Posterior/extensor compartment is innervated by the

Radial nerve

50

Coracobrachialis

-Flexion of the arm

-Musculocutaneous nerve

51

Brachialis

-Flexion of the forearm flexor

-Musculocutaneous nerve

52

Biceps brachii

-Flexion of the forearm, supination of forearm

-Accessory flexor of the arm

-Musculocutaneous nerve

53

Triceps brachii

-Extension of the forearm

-Long head- assist in extension and adduction of the arm

-Radial nerve

54

Axillary artery becomes the brachial artery at the

Inferior border of the teres major

55

Deep brachial runs posterior to humerus in

Radial groove

56

Brachial bifurcates into ulnar and radial at/distal to the

Elbow

57

Basilic vein

Medial, eventually goes from superficial to deep

58

Cephalic vein

Lateral, empties into axillary vein

59

Median cubital vein

Interconnects basilic and cephalic veins

60

Basilic vein becomes deep and is joined by

Paired brachial veins, becomes axillary vein at the lower margin of teres major.

61

Proximal median nerve

Immediately lateral to the brachial artery

62

Distal median nerve

Crosses to medial side of brachial artery and lies anterior to the supracondylar ridge of humerus

63

Ulnar nerve

crosses elbow joint posterior to the medial epicondyle

64

Radial nerve

Runs with the deep brachial artery in the radial groove

65

Axillary nerve

Runs with posterior humeral circumflex artery in quadrangular pace

66

Supraclavicular nerves

C3 and C4 from cervical plexus

67

Superior lateral brachial cutaneous nerve

Axillary nerve

68

Inferior lateral brachial cutaneous nerve

Posterior brachial cutaneous

Radial nerve