During a fight a man is stabbed in the lateral chest beneath the right arm. The wound does not enter the chest cavity. Physical examination reveals that the vertebral (medial) border of the patient's scapula projects posteriorly and is closer to the midline on the injured side. On return visit the patient complains that he cannot reach as far forward (such as to reach for a door knob) as he could before the injury. The nerve injured which caused these symptoms is the:

axillarylong thoracicmusculocutaneousradialsuprascapular

You are in the emergency room when a patient is brought in, the loser in a street fight. He has received a stab wound about 1.5 cm long in the right side of the chest about 1.5 cm below and 1 cm medial to the coracoid process of the scapula. He has lost a lot of bright red blood from a large (approx. 1.2 cm in diameter) severed artery found deep at this location. Intravenous fluids are immediately administered and a surgeon is called in to repair the artery. He begins by making an incision through the skin and subcutaneous tissue just below the clavicle, then cuts the clavicular head of the pectoralis major muscle and retracts it downward to obtain sufficient exposure of the area. He next encounters a partially severed muscle running downward and medially from the coracoid process. He divides the remaining fibers of the muscle and has you retract it downward. This exposes a bloody fat-filled space full of vessels and nerves.

Which space or cavity was opened when the surgeon reflected the muscles axillary spaceinfraspinatous fossaquadrangular space subdeltoid bursatriangular space

UPPER LIMB

AXILLA

DR .RAJ,

ANATOMY, WUSM

The axilla is the gateway to the upper limb, providing an area of transition between the neck and the arm.

Axilla is an irregular shaped pyramidal space with:

1.Four sides; 2.An inlet3.Floor (base)

Borders of the Axilla:

Contents:

1. Axillary artery and its branches

2. Axillary vein and its tributaries

3. Axillary lymph nodes

4. Brachial plexus

• The contents are embedded in fat and ensheathed in the axillary sheath

Branches of the Axillary arteryThe axillary artery is

separated into three parts by the pectoralis minor, which crosses anteriorly to the vessel.

First part is proximal to pectoralis minor

Second part is posterior to pectoralis minor

Third part is distal to pectoralis min.

Branches of the axillary artery

six branches arise from the axillary artery: 1 branch, the superior thoracic

artery, originates from the 1ST part.2 branches, the thoraco-acromial

artery and the lateral thoracic artery, originate from the 2ND part;

3 branches, the subscapular artery, the anterior circumflex humeral artery, and the posterior circumflex humeral artery, originate from the 3RD part.

Scapular Anastomosis

Collateral circulation: Subclavian artery-----Suprascapular artery--------circumflex

scapular artery----subscapular artery----axillary artery

Scapular Anastomosis1st part of subclavian

artery(thyrocervical)1. Transverse cervical2. suprascapular

3rd part of Axillary artery1. Subscapular artery

circumflex scapular

Axillary vein The axillary vein begins at the

lower margin of the teres major muscle and is the continuation of the basilic vein.

The axillary vein passes through the axilla medial and anterior to the axillary artery and becomes the subclavian vein.

Axillary artery The subclavian artery in the neck becomes the axillary

artery at the lateral margin of rib I and passes through the axilla, becoming the brachial artery at the inferior margin of the teres major muscle.

Tributaries of the axillary vein generally follow the branches of the axillary artery.

Other tributaries include brachial veins that follow the brachial artery, and the cephalic vein.

Axillary vein

Lymphatics All lymphatics from

the upper limb drain into lymph nodes in the axilla.

The 20-30 axillary nodes are generally divided into five groups on the basis of location

humeral / lateral nodes pectoral / anterior

nodes subscapular /

posterior nodes

central nodes apical nodes

Lymph nodes in the axilla

The cords of the brachial plexus are:

above the clavicle, medial to the scalenus anticus (anterior scalene).

above the clavicle, behind the scalenus anticus (anterior scalene).

at or below the clavicle, closely related to the axillary artery.

at or below the clavicle, closely related to the axillary vein.