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Anatomy 1: Pectoral Region, Axilla and Brachial Plexus, Shoulder and Back


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What are membranes
Epithelium + connective tissue
Cutaneous membrane
true epithelium=epidermis
Mucous membrane
exposed to outside of body. most secrete mucous
serous membrane (serosa)
mesothelium-line body cavities-serous fluid
internal epithelium. endocardium of heart
synovial membrane
membrane in joints
mixed layers of connective tissue
most superficial fascia. "upon dermis"
deep to epidermis
"under dermis" = superficial fascia. fat, nerves, superficial veins
deep fascia
aka investing fascia= stocking/sleeve, regoinal
neurovascular bundle
veins, arteries, lymphatic vessels, and nerves
What is the deltopectoral groove and what runs in it?

the deltoid branch of the thoroacromial artery and the cephalic vein.
what is the delopectoral triangle?
bordered by clavical, deltoid and pectoralis major. cephalic vein comes out here and is later joined by the deltoid branch of the thorocoacromial artery.
shoulder girdle
Clavicle and scapula
axial skeleton
cranium, vertebrae, ribs
appendicular skeleton
girdles: pectoral girdle
Atriculation: manubrium (sternum) and acromion (scapula).
Concave laterally, convex medially.
Acts as struct-fix scapula away from thorax

atriculations: clavicle and humerus
3 borders: medial, lateral, superior (suprascauplar notch)
3 angle: superior, inferios, lateral (glenoid fossa)
spine: infra/supraspinous fossa
acromion: lateral pt of spine
corachoid process-->pec minor

what muscles attache to the corachoid process?
pectoralis minor
what is the joint and articulation between the clavicle and the scapula
acromial-clavicular joing (AC) from the acromial end of the clavicle to the acromion of the scapula
what is the joint and articulations between the clavical and humerus?
the gleni-humeral joint between the glenoid cavity(fossa) of the scapula and the head of the humerus
articulations: scapula (glenoid fossa) and ulna/radius
head, anatomical neck, greater&lesser tuercles, intertubercular groove, sirgical neck and deltoid tuberocity.
epicondyles(med&lateral), supracondylar ridges, olecranon fossa, coronoid fossa, trochlea (ulna), capitulum (radius)

what is the action of the pectoralis major?
adducts and medially rotates the arm
what is between pectoralis major and pectoralis minor
the clavipectoral fascia
what is the origin of the pectoralis minor?
ribs 3-5
what is the action of the pectoralis minor?
inferior and anterior movement of the scapula. *pull up, breathing
what is the insertion of the serratus anterior?
inserts into the medial border of the scapula
what is the origin of the subclavius m.?
originates at sternal end of first rib
the loss of innervation to the serratus anterior m. causes what?
winging of the scapula=retracted
where is the breast located
in the superficial fascia, superficial to the pectoralis minor m.
what is the position of the breast?
between ribs 2-6, between border of sternum and midaxillary line, lies over portions of pectoralis major and serratus anterior
order of breast secretion
lobules (gladular part)-->
lactiferous ducts-->
lactiferous sinus-->

where would metastatic breast cancer cells be most likely to migrate? (ie where would you biopsy?)
the axillary nodes because 75% of the breast lymph drainage. parasternal nodes are 25%
what is the deltopectoral groove and what is in it?
between pectoralis major and the deltoid m. enters the deltopectoral triangle under the clavicle. the cephalic vein runs here.
what is the primary route pf lymphatic drainage in the breast?
axillary nodes
In fractures or dislocations of the clavicle, what structure protects the subclavian vessels from damage?
The subclavious m., the first rib, the clavicle and the deep cervial fascie protect these.
what is the most frequently injured bone n the body?
the clavicle
what structures peirce the clavipectoral fascia medial to the pectoralis minor?
1. cephalic vein: courses pectoralis minoar anteriorly and joins the axillary vein.
2. thoroacromial artery: emerges medial to the pectoralis minor.
3. lateral pectoral nerve

what muscles are related to the clavipectoral fascia?
1. subclavius
2. pectoralis minor
Netter 182

apex: bw first rib and clavicle
anterior:pec maj/min+deep fascia
posterior: lat dorsi, teres maj., scapular, suscapularis
medial: thoracic wall, serratus anterior,
base: concave skin + axillary fascia

what is located in the axilla?
muscles: coracobrachialis, long and short heads of biceps brachii

Axillary sheath: axillary a. and veins, cords of brachial plexus

the axillary artery is divided how?
1st part: from clavicle to medial border of pectoralis minor
2nd: under pec minor
3rd: lateral border of pectoralis minor to inferior border of teres major

what structures is the axiallry between/under?
between clavical and inferior border of teres major. divided into sections by pec. minor
what form an anastomotic loop around the surgical neck of the humerus?
the anterior and posterior circumflex humeral arteries
what is the axillary vein formed from and where is it found?
formed by union of the brachial veins and the basilic vein at the inferior border of the axilla
what is the largest branch of the axillary artery?
the subscapular trunk
how can you distinguish the anterior and posterior circumflex humeral arties from each other?
the posterior circumflex humeral artery is bigger and it runs with the axillary nerve (in the quadrangular space)
damages to the long thoracic nerve would cause what?
winging of the scapula
sensory nerve
info to spinal cord
collection of cell bodies: dorsal root ganglion

motor nerve
info out of spinal cord
multipolar neuron
collection of cell bodies=nucleus (in the spinal cord)

dorsal root
sensory neurons only
dorsal root ganglion
collection of cell bodes of sensory neurons
ventral root
motor neurons only
ventral and dorsal rami
motor and sensory nerves
what kind of nerve fiber can you find in dorsal root?
sensory only
what kind of nerve fibers are in ventral roots
only motor nerve fibers
what are in the ventral rami
sensory and motor nerves
what is the dorsal rami
sensory goes in dorsal (as always) but motor also comes out of dorsal. innervates middle of back (spinatous mm)
compare roots vs. rami
can find both sensory and motor nerves in the rami.
dorsal root: only sensory
ventralroot: only motor

what are the muscles comprising the walls of the axilla? what are some other muscles found in the axilla?
anterior: pectoralis major/minor, subclavious
medial: serratus anterior
posterior: latissimus dorsi, teres major, subscapularlis
lateral: intertubercular groove and tendon of long head biceps brachi.
other: corobrachialis, short head biceps brachi

what muscles make the posterior wall of the axilla?
latissimus dorsi+ teres major+ subscapularis
what 3 muscles attach to the coracoid process?
pectoralis minor
short head bicpes brachi
attach here

the cords of the brachial plexus are named for their proximity to what?
the axillary artery
what passes through the quadrangular space?
the axillary nerve and the posterior humeral circumflex artery
which muscle does the long thoracic nerve innervate?
serratus anterior
the thoracodorsal nerve is the same as the --- nerve?
middle subscapular nerve aka..
wrapping of nerve: mix of sensory and motor fibers
where is the clavicle in relation to the brachial plexus?
between the Trunks and divisions
what are the superficial back (posterior thoracoappendicular) muscles?
Lattisimus Dorsi
what are the intermediate back (posterior thoracoappendicular) muscles?
Levator scapula
rhomboids major and minor

what are the intrinsic (scapulohumeral) muscles?
teres minor
teres major

what muscles adduct the arm?
pectoralis major
teres major
latissimus dorsi

what muscles abduct the arm?
supraspinatus (starts)
deltoid (finishes)
what innervates the levaptor scapula m.?
dorsal scapula n. and C3-C4 nn innervate this muscle
what is the triangle of ascultation
hear breath sounds because no muscle. trapezius/latissimus dorsi/rhomboids major
what is the action of the deltoid muscle?
completes abducton of arm + everything else:
medially rotates
laterally rotates

what is the insertion of subscapularis m?
less tubercle of the humerus
what is the action of subscapularis
medially rotates arm
name the rotator cuff muscles? what do they do?
Teres minor

stabilize the head of the humerus in the glenoid cavity

tendon vs. ligamen
bone-muscle vs. bone-bone
describe the sternoclavicular joint
articulation clavicle-manubrium
saddle type synovial joint
has articular disk surrounded by fibrous capsule
moves ant/post & sup/inf
important ligaments include interclaciular and costoclavicular

describe the Acromioclavicular joint
ariculation clavicl-acrominon of scapular
plane type synovial w/ fibrous capsule
ligs: AC lig, corococlaviular lig. (trapazoid & conoid)
small degree rotation,

a shoulder separation is usually a dislocation of this joint
AC joint

describe the glenohumeral joint
articularion head humerus-glenoid cavity of scapula
shallow ball & socket synovial j
glenoid cavity deepened by glenoid labrum
stabilized by rotator cuff mm
subsacpular bursa continuous with synovial capsule
lig: glenohumeral, coracohumeral
joint is weakest inferiorly

the rotator cuff mm stabilize what joint?
glenohumeral joint stabilized by these muscles
what are the borders of the quadrangular space?
superior: teres minor
inferior: teres major
medial: triceps long head
lateral: tricaps lateral head (humerus)

what are the borders of the triangular space?
superior: teres minor
interior: teres major
lateral: triceps long head

what is seen in the triangular space?
the circumflex scapular a. is seen in this space
what are the borders of the triangular interval?
superior: teres major
medial: triceps long head
lateral: triceps lateral head

what run in the triangular interval?
radial n and the deep brachial a. found here
scapular anastomosis
Dorsal scapular a.
Suprascapular a
Posterior humeral circumflez
Acromial branch thoracoacromial a.
Circumflex scapula

what does scapular anastomosis do
allows blood to rech arm in even of occulsion of the axillary a. between suprascaupular artery (of subclavian a.) and posterior circumflex humeral a. (of axillary a.)
what nerve and artery supply the trapezus m.?
the accesory spinal nerve (CNXII) and the transverse cervial a. supply this muscle

group of back muscles that attach the upper limb to the axial skeleton
superfical back muscles (extrinsic shoulder muscles)

superficial back muscles
1. trapezuis
2. latissimus dorsi
3. rhomboids
4. levator scapula

intermediate back muscles
do respiration
1. serratus posterior superior
2. serratus posterior inferior

instrinsic muscles of the shoulder
1. deltoid muscles
teres minor
teres major

ligament connecting the coracoid process and humerus
coracohumeral ligament

ligament connecting the coracoid process and acromion
coracoacromial lig
ligament connecting the clavicle to acromion
acromioclavicular lig
set of two ligaments anchoring clavicle to coracoid process
coracoclavicular lig
spans intertubercular (bicepital) groove
transverse humeral ligament
ligament connecting sternum to the clavicle
sternoclavicular lig
ligament connecting the first rib to the clavicle
costoclavicular lig
what is the function of the coracoacromial ligament?
prevents superior discplacement of the humerus
what is the most commonly injured ligament in a should separation
acromioclavicular ligament
why does the should frequently dislocate when traumatized?
because this joint has the highest degree of mobility in the body
95% of shoulder dislocations occur where?
anterior to the glenoid fossa
how many cervical vertebrae
number of thoracic vertebrae

number of lumbar vertebrae
number of sacral vertebrae
5 fused=sacrum
number of coccygeal vertebrae
4, 3 fused 1 free
what attaches to the pedicles?
vertebral arch to the body
what are lamina
located between transverse and spinous process on each side
what do vertebral foramen do?
form vertebral canal in spinal column
which processes attach to zygopophyseal (facet) joints?
superior and inferior articular processes
what forms the intervertebral foramina?
superior and inferior notches
what are the 3 different types of vertebral joints?
synovial, fibrous and cartilaginous
describe C1
no body
no spinous processes
articulates with occipital bone
superior articular processes allow flexion and extension of skull
anterior arch allows rotation on dens

describe C2
has Dens=odontoid process
dens allows roation of C1 on C2

which vertebrae has the largest spinous process?
which vertebrae has the second largest spinous process
what degree of orientation between which joints allows for increased rotation and side bending?
45 degree zygaopopyseal joints
which vertebrae may have bifid spinous processes?
Describe Thoracic vertebrae
long, slender spinous processes that angle down
zygapophyseal j. more coconal plane for flexion and sidebending
what restricts movement of the thoracic vertebrae?
thin pedicles create a large intertubular foramen, which restricts movement. there are 4 facets that attach to the ribs. the z joints are in more coronal plane??
how do the ribs articulate with the spine
via the costovertebral joints to thoracic vertebrae: superior & inferior costal facets --head of ribs. transverse costal facet--articular facet on tubercle of rib (costotransverse lig) (synovial)
describe the lumbar vertebrae
largest-weight bearing
z-joing in sagittal plane (to limit rotation)
sup articular processes face medially and inferior face laterally
shorter spinous process project more posteriorly
accessory processes--muscles
mamillay processes (1/vertebrae)
short laminae; spaces for lumbar punctures

where do you do a lumbar puncture and why?
L3-L5. no spinal cord here, and short lamina create spaces where there is no bone
where does the spinal cord end?
L1: conus medullaris
what do the posterior median sacral crests represent?
fused articular processes
what does the posterior intermediate sacral crest represent
fused transverse processes
what does the sacrum connect with
L5 (lumbosacral &sup articular surfaces)
Ilium (articular surface laterally)
coccyx (apex)

where in relation to the vertebral column are the scapula and the iliac crest?
end of scapula is T7
top of iliac crest is L4
where do you do an epidural?
in the sacral haitus.
what runs through the suprascapular notch
the suprascapular artery runs over the transverse scapula ligament and the suprascapular nerve runs under
superficial back muscles?
latissimus dorsi
splenious capitus
splenios cervicus

extrinsic back muscles
serratus posterior superior
serratus posterior inferior
chest muscles
pectoralis major
pectoralis minor
serratus anterior

REAL superficial back muscles
latissimus dorsi
splenius capitus
splenius cervicus

intrinsic shoulder muscles
Teres major
Teres minor

Rotator Cuff muscles
REAL rotator cuff muscles
rotator cuff mm
teres minor

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