1 / 28

Lecture 3

Lecture 3. Axilla, Brachial Plexus, Subscapular Regions . Axilla . pyramid between arm and thorax – contains brachial plexus, axillary vessels and lymph node . Landmarks. Apex: entrance to axilla, passage way from neck superior convergence point of: clavicle, scapula, 1st rib

materia
Download Presentation

Lecture 3

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Lecture 3 Axilla, Brachial Plexus, Subscapular Regions

  2. Axilla • pyramid between arm and thorax – contains brachial plexus, axillary vessels and lymph node

  3. Landmarks • Apex: entrance to axilla, passage way from neck • superior convergence point of: clavicle, scapula, 1st rib • Base: concave inferior border = fascia and skin • Anterior border: clavicle = pectoral muscles • Posterior border: subscapularis, teres major, latissimus dorsi • Medial border: ribs, intercostal muscles, serratus anterior • Lateral border: humerus – intertubercular groove (holds long head of biceps brachii)

  4. Axillary artery • continuation of subclavian artery. • segment in between 1st rib and teres major

  5. Segments • A. First part of axillary artery • between the lateral border of the 1st rib and medial of pectoralis minor • inside axillary sheath, along with branch plexus and axillary vein • superior thoracic artery = the only branch of this section • supplies 1st, 2nd intercostal spaces; superior part of serratus anterior

  6. Segments • Second part, deep to pectoralis minor • Branches: • 1. thoracoacromial artery: goes through clavipectoral fascia and divides deep to pect major into a. acromialb. clavicularc. deltoidd. pectoral • 2. lateral thoracic artery: to pectoral muscles and axillary lymph nodes; * esp. large in women provides blood to breasts

  7. Segments • Third part, axillary artery: from inferior edge of pectoralis minor to inferior edge of teres major • 1. anterior humeral circumflex: • anastomoses with posterior circumflex around surgical neck of humerus, can also supply biceps, coracobrachialis • 2. posterior humeral circumflex artery: • travels with axillary nerve through quadrangular space to deltoid, triceps muscles • 3. subscapular artery: • largest branch of axillary artery; along lateral edge of subscapularisbranches: a. circumflex scapular - to muscles of dorsal scapulab. thoracodorsal - to latissimus dorsi

  8. Axillary Vein • Formed by the union of basilic vein and brachial vein, becomes subclavian vein after 1st rib • receives tributaries corresponding to axillary artery branches  • Joined by cephalic vein superior to pectoralis minor

  9. Brachial Plexus • Nerve network bundle from neck into axilla to arm (C 5, 6, 7, 8 & T1) • Nerves - progress sequentially from ventral rami of spinal nerves • Rami (anterior) > trunks > divisions > cords > branches

  10. Trunk • ventral rami - from C5-C8, T1 ( emerge between scalenus anterior and scalenus medius) a. superior(upper) trunk = C5+C6b. middle trunk = C7c. inferior(lower) trunk = C8+T1

  11. Divisions • each trunk splits to form anterior and posterior divisions • a. anterior divisions - supply anterior, flexor of arm • b. posterior divisions - supply posterior / extensors of arm

  12. Cords • anterior and posterior division combine to form cords: names refer to position relative to axillay artery • a. posterior cord = all 3 posterior divisions (superior, middle, inferior) • b. lateral cord = anterior divisions of superior, middle trunk • c. medial cord = anterior of inferior (lower) division

  13. Branches • cord divide into terminal branches: ( each also has other, side branches, below) • a. posterior cord • axillary nerve and radial nerve (three smaller branches: upper, lower subscapular nerves, & throracodorsal nerve) • b. lateral cord • musculocutaneous and lateral root of median nerve (other branch: lateral pectoral nerve) • c. medial cord: • ulnar nerve and medial root of median nerve

  14. Supraclavicular Branches • Supraclavicular Branches of brachial plexus: (from ventral rami and trunks) • 1. dorsal scapular nerve - to rhomboideus major muscle, levator scapulae - from C5,C4 • 2. long thoracic nerve - to serratus anterior - from C5, C6, C7 • 3. nerve to the subclavius - from superior trunk, C5, C6 and C4 • 4. suprascapular nerve - to supra and infraspinatus - also from superior trunk, C5, C6 and C4

  15. Infraclavicular branches • 1.Lateral cord branches: a. lateral pectoral nerve (side branch) • to pectoralis major* (named after lateral cord, actually sits medial to medial pectoral nerve ) • b. musculocutaneous (terminal) : to anterior arm - coracobrachialis, biceps, brachials( moves superficial at elbow, becomes lateral antebrachial cutaneous nerve in forearm) • c. Lateral root of median nerve (=continuation of cord) join medial root to form median nerve to forearm flexors

  16. Infraclavicular branches • 2. Medial cord branches: (all from C8, T1) • a. ulnar nerve (terminal branch): to forearm, hand (C8,T1, sometimes C7) • b. medial root of median nerve (terminal branch): joins lateral root, forms median nerve to forearm flexorsc. medial pectoral nerve (side branch): to pectoralis minor (+part of major) * ( named after medial cord, actually sits lateral to lateral pectoral nerve ) • d. medial brachial cutaneous nerve (side branch): skin of medial arm • e. medial antebrachial cutaneous nerve (side branch): skin of medial forearm

  17. Infraclavicular branches • 3. Posterior cord branches: to extensors, skin of upper limb • a. axillary nerve (a terminal branch): to teres minor, deltoid (C5,C6)-- goes thru quadrangular space with post humeral circumflex artery, around neck of humerus-- ends as upper lateral brachial cutaneous to skin over inferior deltoid area • b. radial nerve (terminal branch): to upper arm, forearm extensors and skin( triceps, anconeus, brachioradialis) -- goes between long and medial ticeps heads, sits in radial groove of humerus (C5-C8, T1) • c. upper subscapualr nerve (side branch): to subscapularis (C5,C6) • d. lower subscapular nerve (side branch): to subscapularis, teres major (C5,C6) • e. thoracodorsal nerve (side branch): to latissimus dorsi(C6,C7,C8)

More Related