DISCUSSION IV. COMMITTEE

1. DISCUSSION IV. COMMITTEE kaan yücel 11.04.2014

2. BreastQuadrants

3. BreastCancer most common cancer among women, other than skin cancer second leading cause of cancer death in women, after lung cancer Chance of a womanhaving an invasive breast cancer some time during her life about 1 in 8 Understanding the lymphatic drainage of the breasts is of practical importance in predicting the metastasis (dispersal) of cancer cells from a carcinoma of the breast (breast cancer). spreads by means of lymphatic vessels (lymphogenic metastasis), which carry cancer cells from the breast to the lymph nodes, chiefly those in the axilla

5. Mammography Digital mammograms replacing conventional film mammography younger women with dense breast tissuebenefit most from this type of mammography. Surgeons use mammography as a guide when removing breast tumors, cysts, and abscesses. jagged density in the mammogram. The skin is thickened over the tumor and the nipple is depressed

6. Mastectomy breast excision simple mastectomy breast is removed down to the retromammary space. radical mastectomymore extensive surgical procedure removal of the breast, pectoral muscles, fat, fascia, and as many lymph nodes as possible in the axilla and pectoral region.

7. Polythelia accessory nipples

8. Polymastia Supernumerarybreasts • rudimentary nipple & areola • mistaken for a mole (nevus) anywhere along a line extending from the axilla to the groin—embryonic mammary crest (milk line) from which the breasts develop.

9. Polymastia

10. Amastia no breast development There may be a nipple and/or areola, but no glandular tissue.

11. 8. ..the claviopectoral fascia and triangle? Deep to the pectoral fascia & pectoralis major Descends from the clavicle Clavipectoral triangle cephalic vein can be found. formed by pectoralis major, deltoid& clavicle Deltopectoral groove

12. Where are the mammary glands? In the subcutaneous tissue overlying the pectoralis major and minor muscles. lateral border of the sternum to the midaxillary line vertically from the 2nd through 6th ribs.

14. sagital T2 MRI slices, shows an ugly posterior dislocation of 6th cervical vertebra, with fracture of the body, and a spinal cord contusion and edema up and down from the compresion. C2 Thepatient @ the E.R.! C8

16. C7

17. Tendon Reflexes & Segmental Innervation of Muscles of the Upper Limb Triceps tendon reflex C6, 7, and 8 extension of the elbow joint by tapping the triceps tendon

18. The scapular anastomosis system is a system connecting each subclavian artery and the corresponding axillary artery, forming an anastomosis around the scapula. It allows blood to flow past the joint regardless of the position of the arm. Anterior circumflex humeral artery and posterior circumflex humeral artery are both branches of the third part of the axillary artery. The posterior circumflex humeral artery anastomoses with anterior circumflex humeral artery and also with branches from profundabrachii (a branch of brachial artery), suprascapular (a branch of subclavian artery) and thoracoacromial (a branch of axillary artery) arteries, and branches of thoracic aorta as well. All these vessels anastamose or join to connect the first part of the subclavian with the third part of the axillary, providing a collateral circulation. This collateral circulation allows for blood to continue circulating if the subclavian is obstructed.

19. Principal muscles acting on the shoulder joint Abductors Supraspinatus Deltoid Adductors Pectoralis major Lattisimusdorsi Extensors Teres major Lattisimusdorsi Deltoid (posterior fibres) Flexors Pectoralis major Coracobrachialis Deltoid (anterior fibres) Medial rotators Pectoralis major Lattisimusdorsi Teres major Deltoid (anterior fibres) Subscapularis Lateral rotators Infraspinatus Teres minor Deltoid (posterior fibres)

22. Clavicular (anterior) part of deltoidmuscle flexes and medially rotates arm Axillarynerve Lateral third of clavicle-Deltoid tuberosity of humerus Teres major Adducts and medially rotates arm Inferior subscapular nerve Posterior surface of inferior angle of scapula-Medial lip of intertubercular sulcus of humerus Subscapularis Medially rotates arm; as part of rotator cuff, helps hold head of humerus in glenoid cavity Sup. & Inf. subscapular nerves Subscapular fossa (most of anterior surface of scapula)-Lesser tubercle of humerus Pectoralismajor • Adducts, flexes, and medially rotates the arm. • Clavicular head: Medial half of clavicle • Sternocostal head: • Anterior surface of sternum • Superior six costal cartilages • Aponeurosis of external oblique muscle • Latissimusdorsi • Extends, adducts, mediallyrotates humerus (arm) • Thoracodorsal nerve • Spinous processes of T7 to L5 • Sacrum • Iliac crest • Ribs 10 to 12 Lateral and medial pectoral nerves Floor of intertubercular sulcus of humerus Lateral lip of intertubercular sulcus of humerus

23. Infraspinatus Suprascapularnerve Infraspinous fossa of scapula-Middle facet of greater tubercle of humerus Teres minor Axillarynerve Middle part of lateral border of scapula-Inferior facet of greater tubercle of humerus Deltoid Spinal (posterior) part: Axillarynerve Extendsand laterally rotates arm Spine of scapula-Deltoid tuberosity of humerus

24. Clavicular (anterior) part of deltoidmuscle flexes and medially rotates arm Axillarynerve Lateral third of clavicle-Deltoid tuberosity of humerus DeltoidAcromial (middle) part:abducts arm Supraspinatus Suprascapular nerve Initiates and assists deltoid in abduction of arm and acts with rotator cuff muscles. Latissimusdorsi Extends, adducts, medially rotates humerus (arm) Thoracodorsal nerve Pectoralismajor Adducts, flexes, and medially rotates the arm. Lateral and medial pectoral nerves

26. Pronator teres Pronatesandflexesforearm (at elbow) Flexorcarpiradialis Flexesandabductshand (at wrist) Abduction of thewrist= Radialdeviationwithextensorcarpiradialislongus et brevis. Flexorcarpiulnaris Flexesandadductsthewristjoint Adductionof the wrist= Ulnardeviation with extensor carpi ulnaris Palmarislongus Flexeshand (at wrist) andtensespalmaraponeurosis Flexordigitorumsuperficialis Flexesproximalinterphalangealjoints of theindex, middle, ring, andlittlefingers; can alsoflexmetacarpophalangealjoints of thesamefingersandthewristjoint Flexordigitorumprofundus flexesthedistalphalanges of themedialfourfingersaftertheflexordigitorumsuperficialis has flexedtheirmiddlephalanges (i.e., it curlsthefingersandassistswithflexion of thehand, making a fist). Eachtendon is capable of flexingtwointerphalangealjoints, themetacarpophalangealjoint. Becausethetendonscrossthewrist, it can flexthewristjoint as well. Brachioradialis Relatively weak flexion of forearm; maximal when forearm is in midpronated position; an accessory of flexor of the elbow joint

27. Extensor carpi radialislongus extends and abducts the wrist Extensor carpi radialisbrevis extends and abducts the wrist Extensor digitorum major extensor of the four fingers (index, middle, ring, and little fingers) Extends medial four digits primarily at metacarpophalangeal joints, secondarily at interphalangeal joints ; can also extend the wrist Extensor carpi ulnaris Extends and adducts hand at wrist joint (also active during fist clenching)

28. pronatorquadratus is theprime moverforpronation.

29. CASE A terrible accident in the highway. A public bus involved. Many deaths and injured. Your patient has the following findings following a thorough neurological exam: • The patient is unable to extend the wrist. • Loss of sensation on the lateral and posterior parts of the forearm Which nerve(s) injured?

30. WHO WANTS TO STUDY ANATOMY? Innervation of the posterior compartment of the arm 1 POINT A. Ulnar nerve C. Median nerve B Radial nerve D. Axillary nerve

31. WHO WANTS TO STUDY ANATOMY? Triceps tendon reflex 2 PTS A. C6 C. C6-C7-C8 B C6 & C7 D. C7

32. WHO WANTS TO STUDY ANATOMY? A branch not from the 3rd part of the axillary artery3 PTS A. Subscapular artery C. Posterior circumflex humeral artery B Anterior circumflex humeral artery D. Lateral thoracic artery