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GAR AL01

AL01 - Anatomy of the anterior chest wall & breast

QuestionAnswer
Jugular notch Notch located on the superior surface of the manubrium; easy to palpate
Manubrium "handle"; located above sternum body
Sternal angle between manubrium and body; important landmark, easy to palpate
Angle of Louis sternal angle
2nd rib attachment site sternal angle/angle of Louis
Is the sternum flat? No. The body of the sternum is in a different plane than the maubrium
Xiphoid process Most inferior part of the sternum
When does the xiphoid process ossify? Ages 20-40
Sternum contains the articulating surface for Ribs 1-7 and the clavicle
Costal margin Upside down V from ribs 7-10
Ribs attach to the sternum via cartilage at the costochondral joint
How many ribs 12
Intercostal space space between ribs
Rib 12 intercostal space doesn't exist; called the subcostal space
Mid-sternal line line that goes from the jugular notch down the sternum (black)
Mid-clavicular lines lines that go from middle of clavicle down through nipple
Subcostal line runs along border of costal margin
Anterior axillary line line down from lateral border of pectoralis major
Mid-axillary line line down from apex of axilla (most commonly referenced)
Posterior axillary line line down from scapula or latissmus dorsi muscle
Vertebra - how many? 7 Cervical, 12 Thoracic, 5 lumbar, 5 sacral, and 4 coccyx: 33 total
Vertebral body Large round anterior-most portion
Pedicle between transverse process and vertebral body
Lamina flat areas the form the posterior wall of the vertebral foramen
Transverse process projections on either side of vertebra where the lamina and pedicle meet, between the superior and inferior articular processes
Spinous process spiny process that sticks out posteriorly at the junction of the lamina (easy to palpate)
Vertebral foramen space formed by lamina and pedicle, the spinal cord runs through
Articulating process two each (superior and inferior), where laminae and pedicles meet
Articulating facet area where rib attaches
Intervertebral notch above and below pedicles (in articulated vertebrae, notches form foramen that the spinal nerves pass through)
Intervertebral disc between adjacent vertebrae in the spine, a cartilaginous joint that allows movement and holds the vertebrae together
True ribs 1-7; attach via costal cartilage directly to the sternum
False ribs 8-10; attach to the costal cartilage of rib 7
Floating ribs 11-12, do not attach anteriorly
Posteriorly a rib is attached a few intercostal spaces _____ the anterior attachment above
Anteriorly a rib is attached a few intercostal spaces _____ the posterior attachment below
Head attaches to vertebra: wide section containing 2 articulating facets
Neck thinner area between head and tubercle
Tubercle bump that includes an articulating facet which connects with transverse process of vertebra
Angle where rib bends anteriorly and inferiorly (curves down about 2 intercostal spaces from back to front)
Costal groove depression on bottom inside of rib where intercostal neurovascular bundle is located
Coastal demifacets Superior and inferior notches on the lateral posterior surface of the vertebral body where the head of the rib articulates
Describe attachment of typical ribs to vertebrae Rib 5 articulates to T5 on T5's superior demifacet and T4's inferior demifacet. The tubercle articulates with the transverse process of T5
Langer lines the natural orientation of collagen fibers in the dermis and epidermis
Clinical application of Langer Lines surgeons may choose to cut parallel to Langer lines for better healing and less scarring
Lateral cutaneous nerves lateral branches of intercostal nerves which travel to skin surface and help to form dermatomes
Pectoralis major attaches to clavicle, sternum, ribs and humerus
Cephalic vein located between what two muscles? deltoid and pectoralis major
clavipectoral/deltopectoral groove/triangle bordered by i. pectoralis major ii. deltoid and iii. Clavicle
deltopectoral groove contains cephalic vein
Pectoralis major innervation lateral pectoral nerve and medial pectoral nerve
Describe lateral pectoral nerve innervation of pectoralis major lateral pectoral nerve pierces clavipectoral fascia and innervates upper part of muscle
Describe medial pectoral nerve innervation of pectoralis major goes through pectoralis minor before innervating pectoralis major
Clavipectoral fascia position deep to pectoralis major
Describe lateral pectoral nerve course and neurovascular bundle pierces the clavipectoral fascia and runs below the clavicle and above the pectoralis minor with the thoracoacromial artery and thoracoacromial vein
The thoracoacromial artery branches off axillary artery
thoracoacromial vein drains into axillary vein
Pectoralis minor position imbedded in clavipectoral fascia
Pectoralis minor attaches at coracoid process and to the upper ribs (2-5)
Pectoralis minor action Raises the ribs (secondary respiratory) and droops the shoulder
Pectoralis minor innervation medial pectoral nerve – pierces pectoralis minor to innervate lower part of pectoralis major as well
Breast located in what fascia? Superficial fascia
Axillary tail breast extension into the axilla (armpit)
Male nipple location 4th intercostal space
Female nipple location varies; lower than male nipples
Areola circular pigmented area around nipple
Nipple elevated area in middle of areola that contains 15
Areolar glands small bumps around the nipple in the areola that keep the nipple supple and moist
Mammallary crease area where the breast attaches to the anterior chest wall (around the 6th rib), does not move with aging even if the breasts themselves become more pendulous
Glands of Montgomery Areolar glands
Retromamallary space space between the deep fascia of the pectoralis major and the breast upon which the breast is relatively mobile
Suspensory ligaments holds breast in contour and attaches to the dermis of the skin and breast tissue but doesn’t attach to the deep fascia
Ligaments of Cooper Suspensory ligaments
Internal anatomy of breast 15-20 secretory units arranged radially with lactiferous sinuses toward the nipple
Milk line Mammals can develop breast tissue on a line from the chest to the groin (e.g. cats and cows)
Polymastia extra breasts – commonly alng axilla
Polythelia extra nipples (most common)
Gynecomastia male breasts (feminization)
Blood supply to the breast Lateral thoracic artery - left lateral side of breast; internal thoracic (mammary) artery - medial side of breast
Lateral thoracic artery comes off axillary artery laterally and supplies lateral side of breast
Axillary artery subclavian artery after it runs past the first rib
Internal thoracic (or mammary) artery comes off subclavian artery medially and supplies medial side of breast (located inside chest plate)
Best exam: Lump tumor (or abscess or cyst)
Best exam: Dimpling invasion of suspensory ligaments (or injury)
Best exam: Inverted (retracted) nipple inversion of lactiferous ducts (occurs naturally in 10% of women)
Best exam: Peu d’orange (rough, hard, yellow skin resembling an orange peel) blockage of subcutaneous lymphatics; sweat glands become more prominent
Best exam: Warmth vascular signs (secondary to tumor recruiting blood vessels)
Best exam: Less mobile invasion of underlying deep fascia of pectoral muscles
Breast Lymphatics (2 major drainages) Axillary lymph drainage (more important), Parasternal lymph drainage
Which breast lymph drainage is more important? Why? Axillary lymph drainage because breast cancer has a tendency to metastasize here
Parasternal lymph drainage runs with the internal thoracic artery and vein
Where do the breast lymphatic drainages drain? into the clavicular nodes
Where do the clavicular lymphatic nodes drain? into the large veins of the neck
Pectoralis minor location deep to pectoralis major and clavipectoral fascia
Pectoralis major origin Sternal 1/2 of clavicle, sternum to 7th rib, aponeurosis of external oblique muscle
Pectoralis major insertion Crest of greater tubercle of humerus: Lateral lip of bicipital grove.
Pectoralis major action Clavicular (upper) fibers = flexion of humerus; Sternocostal (middle and lower) fibers = extension of humerus returning from flexion; Adduction, medial rotation
Pectoralis minor origin Ribs 3-5
Pectoralis minor insertion Coracoid process of scapula
Pectoralis minor action Tilts scapula forward, depresses and abducts scapula, Pulls shoulder forward when rhomboids are weak
Innermost intercostal muscles give rise to transversus thoracis muscles
transversus thoracis muscles function hold down the internal thoracic artery
Nerves that supply the intercostal muscles run between innermost intercostals and the internal intercostals
Created by: paul411