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WEEK 22:
Anatomy of axilla, shoulder, mammary gland and lymphatics:
| Question | Answer |
|---|---|
| humerus parts | |
| clavicle parts | |
| scapula parts | |
| articulation and movement | |
| coracoid process | |
| deltopectoral groove | |
| surface anatomy that can be palpated (4) | acromioclavicular joint, tip of scapula, spine of scapula and clavicle |
| clinical relevance of shoulder | common to give shoulder injections so need to know anatomical landmarks so we can inject safely into the capsule of the shoulder joint |
| anterior approach of a shoulder injection | needle placed just medial to head of humerus and 1cm lateral to coracoid process where the needle is directed posteriorly and slightly superiorly and laterally- if it hits bone it should be pulled back and redirected at different angle |
| posterior approach of a shoulder injection | needle inserted 2-3cm inferior to posterolateral corner of acromion and directed anteriorly in direction of coracoid process- aspiration should be done to ensure needle has not gone into blood vessel |
| breast location | on anterior thoracic wall extending horizontally from lateral border of sternum to mid-axillary line and vertically spans between 2nd-6th costal cartilages, lying superficially to pectoralis major and serratus anterior |
| breast internal structure | modified sweat glands with ducts + secretory lobules where each lobule have alveoli drained by a single lactiferous duct. Ducts converge at nipple + fibrous stroma condenses to form suspensory ligaments (of Cooper) anchoring tissue to thoracic wall |
| lymphatic drainage of breast | lymph fluid originates in breast lobules and drains into subareolar plexus (Sappeys plexus) then into the lymph nodes (axillary nodes which drain more than 75% of lymph from out quadrants, and parasternal nodes which drains 25% from inner quadrants) |
| clinical importance of breast lymphatic drainage | frequency of breast cancer travelling and metastasising via lymphatics in breast tissue means it has to be regularly drained |
| how to palpate pectoralis major and latissimus dorsi muscle of the axilla | put right hand on hip and push palpate muscles that form anterior (pm) and posterior (ld) wall of the axilla |
| lymphatic drainage route | |
| lymph nodes in breast cancer | lymph node positive means at least one axillary lymph node contains cancer and lymph node negative means none of the axillary lymph nodes contain cancer |
| lymph node status highly related to | prognosis (chance of survival) |
| axilla boundaries (6) | apex, lateral, medial, anterior, posterior, and base |
| axilla boundaries- apex | truncated shape found between posterior border of clavicle, superior border of scapula, and external border of first rib |
| axilla boundaries- lateral | humerus, coracobrachialis, biceps brachii |
| axilla boundaries- medial | first four ribs with muscles and part of serratus anterior |
| axilla boundaries- anterior wall | pectoralis major and minor |
| axilla boundaries- posterior wall | subscapularis above teres major and latissimus dorsi below |
| axilla boundaries- base | axillary fascia |
| contents of axilla (7) | axillary artery, axillary vein, brachial plexus, clavipectoral fascia, proximal part of biceps brachii and coracobrachialis, axillary sheath, and collections of lymph nodes |
| clavipectoral fascia | layer of fascia between clavicle and axillary fascia which encloses subclavius and pectoralis minor muscle and is pierced by cephalic vein, lateral pectoral nerve, thoraco-acromial artery, and lymph nodes |
| cervicoaxillary canal ('apex of axilla') | passageway between neck and upper limbs which transmits brachial plexus, axillary artery and vein, and subclavian vein |
| what is the clavipectoral fascia contain/ pierced by (4) | cephalic vein, lateral pectoral nerve, thoraco-acromial artery, and lymph nodes |
| axillary artery location | continuation of subclavian artery at outer border of first rib |
| axillary artery parts | divided into 3 parts based on its position relative to pectoralis minor including first part (proximal to pectoralis major), second part (posterior to pectoralis minor), and third part (distal to pectoralis minor) |
| first part of axillary artery | 1 branch (superior thoracic artery) which is proximal to pectoralis minor |
| second part of axillary artery | 2 branches (thoracoacromial artery and lateral thoracic artery) which is posterior to pectoralis minor |
| third part of axillary artery | 3 branches (subscapular artery and anterior and posterior circumflex arteries) distal to pectoralis minor |
| when does the subclavian artery become the axillary artery | when crosses outer border of 1st rib (between 1st rib-teres major) |
| when does the axillary artery become the brachial artery | when crosses teres major |
| when does the subclavian artery end | at 1st rib |
| axillary vein | large vein that carries blood from upper limb and armpit to the heart, located on each side of the body and begins at the confluence of the brachial and basilic veins and then ends (gets different name) at outer border of first rib |
| deltopectoral triangle/ groove | opening in anterior wall of axilla bounded by pectoralis major, deltoid and clavicle. Cephalic vein enters the axilla via this triangle while medial and lateral pectoral nerves leave |
| brachial plexus | network of nerve fibres supplying skin, masculature of upper limb and begins in root of neck passing through axilla and runs through entire upper extremity |
| brachial plexus is formed by what | |
| roots of brachial plexus | refer to anterior rami of spinal nerves (anterior rami of spinal nerves C5,6,7,8 and T1) |
| divisions and cords of brachial plexus | |
| branches of brachial plexus | |
| anastomosis around scapula | |
| scapular anastomosis system | |
| scapular anastomosis system^^- what aastha said | allows for blood to circulate in shoulder even if subclavian/axilla artery stops working |
| shoulder joint | |
| movements of shoulder joint | |
| flexion at an angle and extension is at angle | |
| rotation needs elbow bent^^ | |
| abduction (upper limb away from midline in coronal plane) ^^ | first 0.15 degrees of abduction is produced by supraspinatus, middle fibres of deltoid are responsible for next 15-90 degrees and past 90 degrees the scapula needs to be rotated carried out by the trapezius and serratus anterior |
| spinal root values for movement | |
| XRAY OF SHOUDL;WEIFHRKJVD |
Created by:
kablooey
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