Objectives 1.2 Breast/pectoral, axilla/brachial plexus, arm

Osteology

Sternum:

  • Manubrium
  • Jugular notch
  • Clavicular notch
  • Sternal angle (Angle of Louis)
  • Xiphoid process

Clavicle:

  • Medial end (sternal end)
  • Lateral end (acromial end)

Ribs

Humerus:

  • Head
  • Shaft (diaphysis)
  • Capitulum
  • Trochlea
  • Greater tubercle
  • Lesser tubercle
  • Intertubercular groove (bicipital groove)
  • Anatomical neck vs surgical neck
  • Radial groove (spiral groove)
  • Deltoid tuberosity
  • Medial epicondyle
  • Lateral epicondyle
  • Olecranon fossa
  • Coronoid fossa

Breast

  • Areola
  • Nipple
  • Suspensory ligaments
  • Lactiferous ducts
  • Understand location of retromammary space
  • Axillary tail of breast (Tail of Spence)

 

Muscles

  • Pectoralis major muscle (clavicular head and sternocostal head)
    • Deltopectoral triangle (deltopectoral groove)
  • Pectoralis minor muscle
  • Serratus anterior muscle
  • Latissimus dorsi m.
  • Teres major m.
  • Subscapularis m.
  • Coracobrachialis muscle
  • Brachialis muscle
  • Biceps brachii muscle
    • Short head of biceps brachii
    • Long head of biceps brachii
    • Transverse humeral ligament
    • Biceps brachii tendon
    • Bicipital aponeurosis
  • Triceps brachii muscle
    • Long head
    • Medial head
    • Lateral head

Arteries

Axillary artery:

  • First (1st) part of axillary artery; one (1) branch:
    • Superior thoracic artery
  • Second (2nd) part of axillary artery; two (2) branches:
    • Lateral thoracic artery
    • Thoracoacromial trunk (artery) and its branches:
      • Clavicular branch
      • Acromial branch
      • Deltoid branch
      • Pectoral branch
  • Third (3rd) part of axillary artery; three (3) branches:
    • Anterior circumflex humeral artery
    • Posterior circumflex humeral artery
    • Subscapular artery (understand role in collateral circulation) and its branches:
      • Circumflex scapular artery
      • Thoracodorsal artery

Brachial artery:

  • Deep artery of the arm/profunda brachii
  • Ulnar artery
  • Radial artery

 

Brachial Plexus

Understand parts of the brachial plexus:

  •  Roots (C5/C6/C7/C8/T1 nerve roots)
  •  Trunks
    • Superior
    • Middle
    • Inferior
  • Divisions
    • Anterior
    • Posterior
  • Cords
    • Lateral
    • Medial
    • Posterior
  • Terminal Branches
    • Musculocutaneous
    • Median
    • Ulnar
    • Radial
    • Axillary
  • Nerves of the Brachial Plexus
    • Dorsal scapular nerve
    • Long thoracic nerve
    • Suprascapular nerve
    • Nerve to subclavius
    • Lateral pectoral nerve
    • Medial pectoral nerve
    • Medial cutaneous nerve of the arm (medial brachial cutaneous nerve)
    • Medial cutaneous nerve of the forearm (medial antebrachial cutaneous nerve)
    • Upper subscapular nerve
    • Thoracodorsal nerve (middle subscapular nerve)
    • Lower subscapular nerve
    • Musculocutaneous nerve
      • Lateral cutaneous nerve of the forearm
    • Median nerve
    • Ulnar nerve
    • Axillary nerve
    • Radial nerve

 

Veins

  • Cephalic vein
  • Basilic vein
  • Median cubital vein

 

Clinical Correlates

  • Lymphatics of breast
    • Drainage pathways, concept of sentinel lymph nodes
    • Axillary lymph nodes
    • Importance of retromammary space
    • Carcinoma of breast, clinical signs of:
    • Invasion glandular tissue
    • Interference with lymphatic drainage
    • Cancerous invasion of lactiferous ducts
    • Invasion of retromammary space, pectoral fascia or interpectoral lymph nodes
    • Lumpectomy vs Mastectomy
    • Amastia
    • Polymastia
    • Gynecomastia
  • Dermatomes vs. peripheral cutaneous innervation
  • Surface anatomy of thoracic wall
  • Shoulder separation
  • Fracture of clavicle
  • Injury to branches of brachial plexuses: signs or syndromes
    • What movements are weakened?
    • What movements are absent?
    • What sensory deficits result?
  • Axillary lymph nodes: importance and drainage pattern
  • Axillary lymph node sampling
  • Brachial plexus injuries
  • Rupture of long head of biceps brachii tendon – Popeye deformity
  • Brachial artery
    • Ischemia – Volkmann’s contracture
    • Blood pressure
  • Complications of humerus fractures
    • Surgical neck
    • Mid-shaft
    • Supracondylar