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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.
1. Definition
2. Components
1. Modified Sweat Gland
2. Cooper's Ligaments
-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
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?
1. Nipple
2. Perineum
Name the Vessels that supply breast.
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
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)
1. Cephalic Vein
2. Thoracoacromial Artery
3. Lateral Pectoral nerve
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
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.
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?
Axillary lymph nodes.
-palpate for infections from other infections
Where do breast lymph nodes drain?
-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.
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.
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
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.
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
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
-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)

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