GA060808
Terms
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Axilla:
1. Definition
2. Shape
3. Origin of structures emenating from axilla -
1. Crossroads between areas from neck, structures leaving & entering thoracic cavity & arm.
2. Pyramidally shaped
3. Structures stem from neck & thorax (As come & go, come superior to 1st rib and inferior to clavicle-hence potential to compress those vessels through this region. -
Breast:
1. Definition
2. Components -
1. Modified Sweat Gland
2. Cooper's Ligaments
-Nipple
-Areola
-Lactiferous Ducts
-Mammary Lactating Glands (15-20)
-Lactiferous Sinuses (where drain into nipple) -
Cooper's Ligaments
T4 Landmark -
-Dense, connective tissue strands
-The nipple is roughly at 4th intercostal space also T4 dermatome. - Tail of spence
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Extension travelling towards axilla from breast
-Palpate tail of spence at axilla during breast exam, since masses/pathologies can go unobserved here - Position of breast
- -lies primarily over pectoralis major, lying over pectoral fascia (should be mobile against this fascia or might be pathologic if not mobile)
- What two skin areas have fibers that directly connect to the hypothalmus?
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1. Nipple
2. Perineum - Name the Vessels that supply breast.
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1. Branches of Internal thoracic artery (branch of subclavian)
2. Lateral thoracic artery (branch of axillary artery)-supplies lateral margin of breast
3. Intercostal arteries
4. Thoracoacromial artery through its pectoral branch -
Axilla
1. Boundaries -
1. Apex: 1st rib, clavicle, superior angle of scapula
2. Medial: Serratus Anterior & Intercostal muscle
3. Anterior: Pec. Major, Pec minor & claviopectoral fascia
4. Inferior (base): Skin of axilla & fascia of the region
5. Lateral border: Intertubercular groove
6. Posterior: subscapularis, latissimus dorsi, teres major - Cervicoaxillary Canal Boundaries
- Btwn 1st rib, clavicle, superior angle
- What 3 structures pierce the clavipectoral fascia? (Just medial to pectoralis minor)
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1. Cephalic Vein
2. Thoracoacromial Artery
3. Lateral Pectoral nerve -
Subscapularis
1. Location
2. Action -
1. Posterior border of axilla
2. Inserts into lesser tubercle of humerus
3. Primary internal rotator & one of rotator cuff muscles -
Serratus Anterior
1. Location
2. Action
3. Innervation -
1. Huge muscle covering 1st 8 ribs
2. Laterally runs out of vertebral border of scapula (Boxer's muscle); primary protractor; if damaged - winged scapula
3. Long thoracic nerve which is anterior to muscle (easily damaged in mastectomy). - Advantage to per-vertebral fascia
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1. extends down to axilla as axillary sheath, wrapping around the vessels & nerves
2. Clinically useful b/c you can anesthetize a brachial plexus w/o having to hit individual nerves (just bathe proximal brachial plexus) - Where does the superior thoracic artery innervate?
- First two intercostals (muscles between ribs)
- Name three veins without 'comparable' names.
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1. Cephalic Vein
2. Basilic Vein
3. Median Cubital Vein (connects basilic & cephalic) - Path of Basilic vein.
- Basilic vein (as trace cephalad) fuses w/ 2 venae comitantes of brachial artery??? to become axillary vein
- Where is location of greatest number of lymphnodes?
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Axillary lymph nodes.
-palpate for infections from other infections - Where do breast lymph nodes drain?
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-75% of brest lymph drains into lymph drainage system
- Some mammary lymph nodes drain into parasternal nodes
-Rare drainage to other breast - Name 6 different types of lymphnodes of axilla.
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1. Anterior/Pectoral (posterior to pectoralis major 3-5 & associated with Lateral thoracic vessels)
2. Central: central portion of axillary vein (3-4)
3. Lateral: Lateral side of central nodes (4-6)
4. Apical: medial side of central nodes (3-4)
5. Posterior (subscapular): 6-7 run with subscapular vessels
6. Parasternal: few nodes - Describe three regions of breast/lymphnodes.
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1. Level 1 (lateral to pectoralis minor): nodes not usually involved in cancer
2. Level 2 (posterior to pectroralis minor): can be involved in cancer
3. Level 3 (medial to pectoralis minor): can be involved in cancer - Prefixed vs postfixed plexus
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1. Prefixed = Lot of C4 contribution and little T1 contribution
2. Postfixed = Lot of T2 contribution and Little C5 contribution - Supraclavicular vs infraclavicular relating to brachial plexus.
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Supraclavicular: Rami & trunks
Infraclavicular: Divsions and all distal to divisions (branches,etc.) -
Ansa pectoralis:
Define & Locate - connects medial & lacteral pectoral nerves (hugs lateral edge of thoracoacromial artery
- What supplies medial skin of forearm & arm?
- Medial brachial & antebrachial cutaneous nerves. (primarily T1)
- What if a lesion of C5 & C6 occurs?
- 1. Suprascapular nerve would not work well & would limit first 15 degrees of abduction & would knockout external rotation
- Explain Crutch Palsy
- lesion involving posterior cord (radial nerve) Example: over using crutch and compressing radial nerve--> results in poor function of triceps and wrist extensors
- Intercostal Brachial nerve
- lateral part of lateral cutaneous branch of T2 (called brachial since runs over laterally w/ medial brachial cutaneous
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Cardiac Ischemia
why feel pain down left arm? - Dermotome of medial arm shows that the dermatome is actually T2 not T1 b/c intercostals brachial nerve is bring T2 fibers into medial arm. On left side, Hert shares a general area of spinal cord with T2, so it can convey its painto a somatic structure like the medial arm.
- Ulnar nerve/ lower trunk palsy
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-When inferior trunk of brachial plexus is deviated (strained) due to additional rib
-Remove rib to release tension on nerves -
Erb Duchene palsy
1. Define
2. Presentation -
1. Excess separation btwn neck & shoulder which is proximal brachial plexus injury
2. Arm medially rotated b/c internal rotators are pulling unopposed = "waiter's tip" -
Klumpke Palsy
1. Define
2. Presentation -
1. Lower Brachial plexus injury (some C7, but definitely C8, T1)
2. Armpit (from overstretching arm hanging from tree limb)