Upload
diego-sandoval
View
133
Download
3
Tags:
Embed Size (px)
Citation preview
AXILLA
& &
BRACHIAL PLEXUS
•Axillary fossa: a pyramid-shaped space between upper arm and chest.
Boundaries-4 walls, an apex, a base
Anterior wall
Pectoralis major and
minor, clavipectoral
Posterior wall
Subscapularis, clavipectoral fascia
Floor
Axillary fascia, skin,
Subscapularis, teres major
and latissimus dorsi
AXILLA
Pectoralis
Cephalic vein Pectoralis
major
Anterior serratus
Biceps brachii
Coracoid process
minor
major
Axillary vesselsClavipectoral fascia
Teres Teres major
Lat. dorsi
Subscapularis mm
Long thoracic
Teres major
Serratus anterior
Clavicle
Axillary artery
Axillary vein
Brachial plexus
CONTENTS OF AXILLA
Axillary lymphnodes
AXILLA
BRACHIAL PLEXUS
AXILLARY ARTERYAND VEIN
Thoracic Outlet Syndrome
1
Axillary Artery
1
2
3
4
1
1st part – 1 branch
2nd part – 2 branches
Axillary Artery
1
2
3
4
branches
3rd part – 3 branches
Superior thoracic thoracic
artery
P
CA
D
Lateral thoracic
artery
Thoracoacromial artery
PD
Posterior Posterior and
anterior humeral
circumflex arteries Subscapular
artery
Circumflex scapular and thoracodorsal arteries
1
How can blood get to the arm and forearm when there is blockage or ligation of the axillary artery?
Subclavian a.
Thyrocervical a.Transverse cervical a.Suprascapular a.
Posterior and anterior humeral circumflex 1
2
3
4
circumflex aa.
Subscapular a.
Circumflex scapular a.
Branch oftransversecervical a.
Suprascapular a.
Scapular anastomosis
Circumflex scapular a.
Posterior humeralcircumflex a.
1
How can blood get to the arm and forearm when there is blockage or ligation of the axillary artery?
1
2
3
4
Circumflex scapular a.
Anterior view
subscapularis
Quadrangular space
Axillary nerve and posterior humeral circumflex
Triangular space
artery circumflex scapular artery
Posterior view Suprascapular artery and nerve
?
?
Triangular interval (radial n. and deep brachial a.)
BRACHIAL PLEXUS
Axillary sheath
C5
C6
C7
C8
5 roots
3 trunks
6 divisions
3 cords
BRACHIAL PLEXUS
C8
T15 terminal branches
C5
C6
C7
C8
5 Roots (v. rami)
3 Trunks6 Divisions
3 Cords5 terminal
Upper
Middle
LowerLat
3 ant.3 post.
Brachial Plexus
T15 terminal branches
LowerLat
Post
Medial
C5
C6
C7
C8
Small “non-terminal” Branches of the Brachial Plexus
dorsal scapular n.
n. to subclavius
suprascapular n.
lateral pectoral n.
SupraclavicularBranches
InfraclavicularBranches
C8
T1
medial pectoral n.
long thoracic
thoracodorsal n.
Lower and uppersubscapular nn.
medial cutaneous n. of the armmedial cutaneous n. of the forearm
SST
RA
Erb’s (Erb-Duchenne) Palsy
Obstetrical traumaMotorcycle accident
damage to upper part of brachial plexus
Upper Brachial Plexus C5 / C6 / C7
part of brachial plexus
“Waiter’s tip” position (arm adducted and internally rotated, forearm pronated and extended at elbow, +/- wrist flexed)
Upper Brachial Plexus C5 / C6 / C7
Lower brachial plexus C8 / T1
Klumpke’s (Klumpke-Dejerine) Palsy
Lower brachial plexus C8 / T1Cervical rib may be underlying causeKlumpke’s
(Klumpke-Dejerine) Palsy
Lower brachial plexus C8 / T1 Loss of intrinsic hand muscles (both ulnar and median)
“Ape Hand” clawing of fingers with flattening (atrophy) of thenar eminence
VENOUS DRAINAGE
Subclavian vein
Brachial vein
Cephalic vein
Median cubital vein
Axillary nodes
Basilic vein
Lymphatic vessels
Cubital (epitrochlear)
nodes
UL
Lateral Nodes (humeral)
Central Nodes
Apical Nodes
ULPosterior Nodes (scapular)
Parasternal Nodes
Anterior Nodes (pectoral)
Lymphedema following mastectomy
Lymph Drainage of the Breast
~75% to axillary nodes
~20% to ipsilateral parasternal nodes
Small % to contralateral parasternal nodesparasternal nodes
Lymphangitis - thumb/hand infectionLymphangitis - thumb/hand infection