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This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. Special Areas in the Upper Limb and their Borders THE AXILLA o A PYRAMIDAL space: has a flat apex, 4 walls, and a base. Superior border of scapula APEX First rib Clavicle POSTERIOR WALL Scapula Subscapularis Teres major Clavipectoral fascia LATERAL WALL Intertubercular groove of the humerus; Thus also the tendon of the long head of biceps Pectoralis minor ANTERIOR WALL Pectoralis major Anterior axillary fold MEDIAL WALL Chest wall and serratus anterior CONTENTS Axillary artery and its branches Axillary vein and its tributaries- brachial vein, basilic vein and thoracoepigastric vein Lymphatic vessels and axillary lymph nodes Cords and branches of the brachial plexus BOUNDARIES - Apex o Cervicoaxillary canal; passageway into the neck o Bounded by the 1st rib, clavicle, and superior edge of the scapula o The vessel and nerve’s gateway into the arm - Base o Axillary fossa: fat, fascia, skin - Anterior Wall– o Pectoralis major, pectoralis minor, pectoral and clavipectoral fascia o The inferior part is the anterior axillary fold - Posterior wall – o Scapula and subscapularis o Inferior border is the teres major and latissmus dorsi Medial wall – - Rib cage, chest wall – ribs 1-4 and the intercostal muscles - Serratus anterior Lateral wall – - Narrow wall; intertubercular groove of the humerus This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. The Medial Triangular Space, Lateral Triangular Space, and the Quadrangular Space These are gaps in the posterior wall of the axilla. They allow vessels and nerves to exit the axilla posteriorly. QUADRANGULAR SPACE Subscapularis and Teres Minor Surgical neck of Humerus Contents: RADIAL NERVE and POSTERIOR CIRCUMFLEX HUMERAL ARTERY Teres Major Long Head of Triceps Subscapularis and Teres Minor Surgical neck of Humerus Teres Major Long Head of Triceps LATERAL TRIANGULAR SPACE MEDIAL TRIANGULAR SPACE Contents: Teres Major Surgical neck of Humerus Circumflex scapular artery Contents: RADIAL NERVE and PROFUNDA BRACHII ARTERY (deep artery of the arm) Long Head of Triceps Border of scapula, Teres Minor and Subscapularis Long Head of Triceps Teres Major This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. THE CUBITAL FOSSA ROOF OF THE FOSSA: Antebrachial fascia, subcutaneous tissue, skin Basilic Vein CONTENTS OF THE ROOF: Bicipital aponeurosis Median cubital vein Medial cutaneous nerve of forearm Lateral cutaneous nerve of forearm Medial cutaneous antebrachial nerve SUPERIOR BORDER: An imaginary line between the two epicondyles of the humerus Cephalic vein Lateral cutaneous antebrachial nerve MEDIAL BORDER: Pronator Teres Bicipital aponeurosis LATERAL BORDER: Brachioradialis FLOOR OF THE FOSSA: Brachialis and Supinator CONTENTS OF THE FLOOR Superficial branch of the radial nerve (as it runs under the brachioradialis) Deep brach of the radial nerve Median nerve as it enters the arm between the heads of pronator teres Deep Branch of the radial nerve Superficial branch of the radial nerve Brachial artery BOUNDARIES: - SUPERIORLY: An imaginary line between the medial and lateral epicondyle LATERALLY: brachioradialis MEDIALLY: Pronator teres FLOOR: brachialis and supinator ROOF: deep fascia, bicipital aponeurosis, median cubital vein, medial and lateral cutaneous nerves of the forearm CONTENTS: - Brachial artery Deep veins of the arm which accompany the brachial artery Biceps tendon Median nerve SUPERFICIALLY: median cubital vein, medial and lateral cutaneous nerve of the forearm DEEP, in the floor: deep and superficial branches of the radial nerve This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. THE ANATOMICAL SNUFFBOX o A TRIANGULAR superficial structure APEX: The junction of the three tendons 1st metacarpal Trapezium MEDIAL BORDER: Extensor Pollicis Longus Scaphoid LATERAL BORDER: Extensor Pollicis Brevis Abductor Pollicis Longus BASE: An imaginary boder, around about where the radial styloid process is Is there an erotic mnemonic for this? No. A PLEP Be lateral? (APL, EPB lat border) EPL medial… A PLEP BEPL? APLE PBLEPL? Apple Pee BE PL? … Radius CONTENTS: Radial artery Cephalic Vein Scaphoid Trapezium Sometimes, Dorsal cutaneous branch of the radial nerve