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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

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lecture 3

Lecture 3

Axilla, Brachial Plexus, Subscapular Regions

axilla
Axilla
  • pyramid between arm and thorax – contains brachial plexus, axillary vessels and lymph node
landmarks
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)
axillary artery
Axillary artery
  • continuation of subclavian artery.
  • segment in between 1st rib and teres major
segments
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
segments1
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
segments2
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
axillary vein
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
brachial plexus
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
trunk
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
divisions
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
cords
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
branches
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
supraclavicular branches
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
infraclavicular branches
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
infraclavicular branches1
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
infraclavicular branches2
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)