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WEEK 22:
Anatomy of axilla, shoulder, mammary gland and lymphatics:
| Question | Answer |
|---|---|
| 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 |
| lymph node positive means | at least axillary lymph node contains cancer |
| 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 |
| prognosis of breast cancer is better when | when it has not spread to lymph nodes (lymph node negative) |
| axilla boundaries (6) | apex, lateral, medial, anterior, posterior, and base |
| axilla boundaries- apex | 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 (8) | 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 allowing the cephalic vein enters the axilla and medial and lateral pectoral nerves leave. It is bounded by pectoralis major, deltoid and clavicle |
| 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 |
| spinal roots of the superior trunk | combination of C5 and C6 |
| roots of brachial plexus | refer to anterior rami of spinal nerves (anterior rami of spinal nerves C5,6,7,8 and T1) |
| spinal roots of the middle trunk | continuation of C7 |
| spinal roots of the inferior trunk | continuation of C8 and T1 roots |
| anastomosis around scapula function | provides alternative route for blood to reach shoulder and scapular muscles if the primary arteries are compromised. This is crucial for maintaining blood flow to shoulder and scapular muscles needed for upper limb function |
| scapular anastomosis system | system connecting each subclavian artery and corresponding axillary artery forming an anastomosis around scapula allowing blood to flow past joint regardless of arm |
| what arteries are included in the scapular anastomosis system | transverse cervical artery (subclavian artery), transverse scapular artery (subclavian artery), and subscapular artery (branches of thoracic aorta |
| shoulder joint type joint | ball and socket type synovial joint between head of humerus and glenoid cavity (fossa) of scapula |
| movements of shoulder joint | extension, flexion, abduction, internal rotation, external rotation, and circumduction |
| C5 | innervates muscles involved in shoulder abduction (deltoid middle fibres), flexion (anterior deltoid), and external rotation (infraspinatus and teres minor) |
| C6 | innervates muscles involved in shoulder abduction (deltoid middle fibres), flexion (anterior deltoid), adduction (latissimus dorsi and teres major), and medial rotation (subscapularis, pectoralis major, latissimus dorsi, teres major and anterior deltoid) |
| C7 | contributes to adduction and elbow extension |
| C8 | contributes to adduction and elbow extension |
| what muscle makes up the anterior wall of the axilla | pectoralis major |
| what muscle makes up the posterior wall of the axilla | latissimus dorsi |
| where is the breast located on the thoracic wall | on the anterior thoracic wall |
| breast extends horizontally from where to where | extends horizontally from lateral border of sternum to midaxillary line |
| breast extends vertically from where to where | between 2nd and 6th costal cartilages |
| breast lies superficially to what muscle | pectoralis major and serratus anterior |
| each lobule containing alveoli are drained by | a SINGLE lactiferous duct |
| lactiferous ducts converge where | at nipple |
| fibrous stroma condenses to form what | suspensory ligaments (of cooper) |
| llymph fluid originates where | in breast lobules |
| lymph fluids from breast lobules drain where | into subareolar plexus (Sappeys plexus) |
| lymph fluid from subareolar plexus (Sappey's plexus) drains through which lymph nodes (2) | axillary nodes and parasternal nodes |
| axillary nodes | draining more than 75% of lymph from outer quadrants of breast |
| parasternal nodes | drains 25% from inner quadrants of the breast |
| which quadrant do parasternal nodes drain | inner |
| which quadrant do axillary nodes drain | outer |
| lymph node negative means | none of the axillary lymph nodes contain cancer |
| clavipectoral fascia encloses what | subclavius and pectoralis minor muscle |
| clavipectoral fascia is pierced by (4) | cephalic vein, lateral pectoral nerve, thoraco-acromial artery, and lymph nodes |
| axillary vein carries blood from where | upper limb and armpit to the heart |
| axillary vein begins where | at confluence of brachial and basilic veins |
| axillary vein ends where | at outer border of first rib |
| deltopectoral triangle is bounded by which muscles (3) | pectoralis major, deltoid, and clavicle |
| which structures enter and leave the axilla via the deltopectoral triangle/ groove | cephalic vein enters and medial and lateral pectoral nerves leave |
| extension in shoulder joint | upper limb backwards in sagittal plane using posterior deltoid, latissimus dorsi, and teres major |
| flexion in shoulder joint | upper limb forwards in sagittal plane using pectoralis major, anterior deltoid, coracobrachialis and weakly assisted by biceps brachii |
| abduction in shoulder joint | upper limb away from midline in coronal plane |
| muscles used in the first 0-15 degrees of abduction | supraspinatus |
| muscles used in the next 15-90 degrees of abduction | deltoid (middle fibres) |
| muscle used in abduction past 90 degrees | trapezius and serratus anterior |
| adduction in shoulder joint | upper limb towards midline in coronal plane using pectoralis major, latissimus dorsi, and teres major |
| internal rotation in shoulder joint | rotation towards midline so that thumb is pointing medially using subscapularis, pectoralis major, latissimus dorsi, teres major, and anterior deltoid |
| 3external rotation in shoulder joint | rotation away from midline so that thumb is pointing laterally using the infraspinatus and teres major |
| circumduction in shoulder joint | moving upper limb in a circle produced by a combination of movements |
Created by:
kablooey
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