Axilla And Brachial Plexus PDF

FM1010 MH1010 Axilla and Brachial Plexus Dr K.A. Quane Learning Outcomes - The scaphoid bone 2  located on the ulna * bone felt ct...

FM1010 MH1010 Axilla and Brachial Plexus Dr K.A. Quane Learning Outcomes - The scaphoid bone 2  located on the ulna * bone felt ct elbow Insertion point for Long head of triceps brachii Remember ! medial = middle lateral = further side from centre of body Moore  Pyramidal space upper limb Axilla Passageway for vessels & nerves to / from UL Gray’s Anatomy for Students (Drake et al) Churchill Livingstone/Elsevier.  Borders of the axilia A = anterior wall, pectoralis major + minor end of humerus biceps brachil , coracobrachial is = lateral Wall upper , : Base and Apex of axilla chest wall and arm wall : Serratus anterior , intercostal space Base/floor : made up of skin/fascial between M = medial Apex : the entrance from neck-axilla made up by 1st rib , clavicle , sup - edge of supscapularis subscapularis latissimus dorsi , teres major ↑ = posterior wall : , Apex is green outlined point - A is anterior wall Clinically Orientated Anatomy (Moore et al). Wolters Kluwer/Lippincott  Base / Floor of axilla Skin & fascia between chest wall & arm Me  Apex of axilla Entrance from neck to axilla Rib 1 medially Clavicle in front Superior edge of subscapularis behind Clinically Orientated Anatomy (Moore et al). Wolters Kluwer/Lippincott  Anterior wall of axilla Pectoralis Major & Pectoralis Minor Pectoralis major lies superficial to pectoralis minor Human Anatomy (Marieb, Mallatt, Wilhelm) Pearson Education, Posterior wall of axilla Subscapularis on scapula Latissimus dorsi 1 Teres major 2 3 Gray’s Anatomy for Students (Drake et al) Churchill Livingstone/Elsevier. 3 Gateways through posterior wall  Medial wall of axilla Serratus anterior covering ribs Intercostal spaces Human Anatomy (Marieb, Mallatt, Wilhelm) Pearson Education,  Lateral wall of axilla Upper end of humerus Biceps brachii Coracobrachialis Human Anatomy (Marieb, Mallatt, Wilhelm) Pearson Education, Contents of Axilla axillary artery axillary vein brachial plexus LN - lymph noces Fat Atlas of Human Anatomy (Netter et al). Elsevier Orientation of image : Arteries ⑤ Summa r side o Anatomy at a Glance Fig 33.1  -supplies wasof alla has 3 different depending on names location - Axillary Artery To Subclavian a Zo axillary a 3. brachial a Lateral border of rib 1  inferior border of teres major 1 artery with 3 names depending on where it is found Palpate: medial side of arm Atlas of Human Anatomy (Netter et al). Elsevier Gray’s Anatomy for Students (Drake et al) Churchill Livingstone/Elsevier.  in the neck subclavian D - becomes arrey axillary artery nore point at the lateral at which margin of rib 1. axillary subdivided artery name artery -> into 3 parts changes ! by pec minor Fr 1st : proximal to P minor. in * generally , 6 branches aris from Axillary A. -perior thor anA - neral-thoracic A. Subscapular A 3 anterior circumflex numeral A. posterior circumflex humeral A. - brachiclvia area inferior margin of Teres major Clinically Orientated Anatomy (Moore et al). Wolters Kluwer/Lippincott  Anastomosis around scapula Collateral circulation Atherosclerosis of axillary artery Surgical ligation Subclavian A Ax A Ax A Ax A A naturally occurring bypass= an anastomosis- branches of blood vessel Atherosclerosis is the narrowing of the artery Gray’s Anatomy for Students (Drake et al) Churchill Livingstone/Elsevier. Clinically Orientated Anatomy (Moore et al). Wolters Kluwer/Lippincott  vein are always referred to in opposite Axillary Vein - direction to arteries. Referred to in terms of blood flow ↓ Y veins towards arteries away heart from heart Basilic vein  Axillary v  O subclavian vein * axillary vein lower begins O at the margin of T major muscle.. Basilic vein-axillary vein-subclavian vein it is the continuationmediacneinteriorate of basilic vein. axilla and Passes through the becomes subclavian vein as the vessel passes lateral border of rib 1 at the axillary inlet. O Receives: cephalic vein Esuperficial vein that ↳ drains lateral + posterior parts of the hand , forearm , arm. in the shoulder area passes into the , claviopectoral 1 betwe delroid pec major cericle. , and ) ↳ in superior part of c. 1 clavicular Note : Cephalic passes deep to head of pec major and pierces. veiN Typical site for clavipectoral fascia to join axillary. venous access is cephalic vein in hand. tissue OR Within veins that lie superficial of cubital fossa. Me Gray’s Anatomy for Students (Drake et al) Churchill Livingstone/Elsevier.  Axillary Sheath Connective tissue sheath enclosing: axillary artery (1st part) vein cords of brachial plexus. Brachial plexus nerve block Red colour- axillary artery Gray’s Anatomy for Students (Drake et al) Churchill Livingstone/Elsevier. Lymph Nodes APICAL Anterior / pectoral: ant TX wall breast Posterior / subscapular: Infraclavicular: Central: Apical: from all other groups of axillary LN Lateral / humeral: Infraclavicular= below Gray’s Anatomy for Students (Drake et al) Apical group are at the top Churchill Livingstone/Elsevier. Lateral group= side all against humerus  Mammary Gland Gray’s Anatomy for Students (Drake et al) Churchill Livingstone/Elsevier.  Brachial Plexus Nerves supplying muscles of UL. Union of anterior rami of spinal nerves C5, C6, C7, C8, T1 (i.e. 5 rami) Network of nerves which supply the arm 5 spinal nerves incl. All feed into this plexus Blue=plexus/network Gray’s Anatomy for Students (Drake et al) Churchill Livingstone/Elsevier. Notes The Brachial Plexus network of nerves that supplies muscles of upper limb components formed the of anterior rami (branches) of Spinal nerves (5 , C6 , C7 , C8, and TL roorse Trunks- > upper by merging trunk : (5 + CG Middle trunk : (7 lower trunk : C8 + T1 Divisions - each trunk divides into anterior and posterior divisions Anteriore Anterior division of upper trunk : C5 + CG Anterior division of middle trunk : (7 lower trunk : C8 + T1 Anterior division of Posteriore Posterior division of all 3 trunks * Anterior divisions > - anterior part of limb divisions posterior part of limb posterior > - Lords : form within the axilla located around 2nd of , part axillary artery > lateral cord - > medial - cord > posterior cord - Lord formation : lateral cord: formed by the union of anterior divisions from upper and middle trunks medial cord : formed by the anterior division of the lower trunk posterior cord : formed all posterior divisions. by * Brachial plexus from the neck , under the clavicle , and into the axilla. runs it provides motor and innervation to the upper limb it various branches. sensory through  Components of Brachial Plexus Remember! m Real Truckers Real Drink Cool Truckers Beer - Drink Cold Beer Me Branches Gray’s Anatomy for Students (Drake et al) Churchill Livingstone/Elsevier.  Brachial plexus a projecting part /elongated process/branch > Roots = merging of the rami Learn to draw!! In posterior triangle of neck Roots=coming together of spinal nerves 5,6,7,8,1 Trunks= Trunks: the roots unite to form the trunks C5 + C6  upper trunk - C7  middle trunk C8 + T1  lower trunk Trunks run under clavicle from neck  axilla Divisions: Each trunk divides into (i) anterior divisions - destined for anterior of limb (ii) posterior divisions - destined for posterior of limb / Gray’s Anatomy for Students (Drake et al) Churchill Livingstone/Elsevier. Cords: form within axilla Located around 2nd part of axillary artery - Anterior division of upper trunk | unite  lateral cord Anterior ………… middle ….. - | Anterior ………… lower …..  medial cord Posterior divisions of all 3 trunks  posterior cord Gray’s Anatomy for Students (Drake et al) Churchill Livingstone/Elsevier.  Branches of Brachial Plexus 3 Cutaneous nerves supply skin Gray’s Anatomy for Students (Drake et al) Churchill Livingstone/Elsevier.  Area of skin supplied by single spinal nerve/single segment of the spinal cord is called DERMATOME Think ! ↳ dermatology to · Dermatomes relate SKIN INNervation · myotomes relata Gray’s Anatomy for Students (Drake et al) Churchill Livingstone/Elsevier.  Notes Dermatome of Upper limb (4- shoulder tip lover the acromioclavicular joint) · · (5 - ourem part of the lupper) arm lateral aspect of lower edge , of deltoid area /muscle 16 > lateral aspect of the forearm and the thumb side of thumb palmar · - - · C7-middle finger > - palmar side (8- little finger palmar side · > - · The medial aspect of the lupper) arm-scubital fossa , proximal to medial epicondyle of humerus · T2e Apex of the axilla  Muscles supplied a spinal nerve/single segment of the spinal cord is called MYOTOME - Think ! M for muscles Gray’s Anatomy for Students (Drake et al) Churchill Livingstone/Elsevier. Gray’s Fig 7.15 Notes : myotome of upper limb (5 > - shoulder abduction(at deltoid muscle 16 > - elbow flexion (at biceps (7- elbow extension (at triceps) flexion (intrinsic muscles hand (8 -> finger of T1- finger abduction and adduction  C5 = abduction of arm Brachial Plexus Injuries: CG = Flexion of elbow Lesion of upper trunks C5,6  Erb-Duchenne palsy (Waiter’s tip) C5 > - position of hand and c6 can be stretched so much that they cannot function C5 damage= no abduction C6 damage= no flexion Common form of Brachial Birth Trauma Motor bike RTA – forced lateral flexion of head resulting in traction to opposite shoulder. Motor loss:Arm is extended & unable to flex it. UL hangs limply “Waiter's tip" position: UL medially rotated with forearm pronated. Pronated= twisting of radius and ulna Sensory loss: Loss of sensation to lateral side of arm (C5, C6) Brachial Plexus Injuries: Lesion of lower trunks C8,T1  Klumpke’s palsy Excessive abduction of arm e.g. Person falling from height Happens when there is excessive abduction of arm clutching at an object to save C8= flexion/bending of fingers C7= bending of fingers himself Damage to both= hand deformity Injury to C8 & T1 Motor loss: Hand intrinsic muscle weakness Signs: Claw hand deformity Sensory loss: medial aspect of arm, forearm, hand C8 & T1  Notes Brachial Plexus injuries trunk lesion : (5 , CG]. Erb-Duchenne 1 palsy [upper cause : Common form of brachial birth trauma motorbike accident effects : motor loss-arm extended and unable to flex , hangs limplyforearm "Waiter's tip" position upper > - limb medially rotated with pronated in the lateral side of sensory loss > arm - 2. Klumpke's palsy [lower trunk lesion - (8, T1] cause : excessive abduction of arm Eg. falling from clutching an object height while effects : motor loss > hand intrinsic muscle weakness - > claw hand sign - deformity loss- medial of arm , forearm , and hand sensory aspect Download entire document from Canvas !! Median Nerve does NOT pass Munder flexor Retinaculum Anatomy at a Glance Fig 35.3 Ulnar Nerve Anatomy at a Glance Fig 35.3 Radial Nerve ⑧ ⑳ # Y Anatomy at a Glance Fig 35.3  Notes Median Nerve from brachial plexus roors (5-T1 Originates · runs through arm , forearm , and into hand · provides motor function to most of the flexor muscles in forearm and some muscle in the hand. · pronatorteres · · flexor carpi radial is · DOES NOT SUPPLY profundus]MN · palmaris longus flexor carpi ulnaris flexor digitorum superficialis part of flexor digitorum · · flexor policis brevis abductor policis brevis * Nerve is clinically significant · in conditions like carpaltuNesyndromeSe opponens policis · lateral 2 lumbricals in hand · Tunnel Main FUNCTION : motor control for Wrist and finger FLEXION sensory input from parts of palm and fingers autonomic functions to some blood vessels+ sweet glands in hand (involuntary physiologic processes) Notes ulnar nerve from medial cord of originates plexus > (8-T1 - bone' sensation Runs down medial epicondyle of humeruse responsible for 'funny forearm and into hand continues through FUNCTION ulnar nerve innervates : motor * Clinical Relevance flexor carpi ulnaris ulnar nerve is most susceptible to injury at medial half of flexor digitorium profundus the elbow and the wrist. hyporhenar muscles Results in varying degree of motor-sensory medial 2 lumbricals loss adductor characteristic sign of injury: inability to policis grasp paper between fingers interossi of hand ulnar claw hand deformity palmaris brevis sensory : pilmarnousbrachinesSin ofmediaofhadI associated dorsal hand r a innervates medial 1 superficial branch : palmar surface of fingers  Notes Radial Nerve originates from posterior cord of brachial plexus [C7) Motor Function radial nerve innervates extensor muscles of extension of elbow , wrist and fingers UL , controlling , · triceps (all 3 heads) · anconeus · Brachialis (lateral third · extensor carpi radialis longus supinator · · extensor carpi radialis brevis extensor digitorum Deep Branch · · extensor carpi ulnaris extensor policis longus · extensor policis brevis · · extensor indicis · abductor policis longus sensoryFunction Cutaneous branches supply the skin on the back of the arm and forearm