Download Lecture 4

A patient suffers a puncture wound in the back just lateral to the 2nd
thoracic vertebra. The puncture wound courses until it hits the
erector spinae muscle group. From superficial to deep, identify the
correct order of muscles hit by the protruding object.
20% 20% 20% 20% 20%
A.
B.
C.
D.
Tr
ap
ez
iu
s,
la
Tr
tis
ap
si
ez
m
iu
us
s,
...
rh
Tr
om
ap
b
ez
oi
ds
iu
s,
...
Tr
rh
ap
o
ez
m
iu
bo
s,
id
rh
Tr
..
om
ap
ez
bo
iu
id
s,
s.
rh
..
om
bo
id
s.
..
E.
Trapezius, latissimus dorsi, rhomboids, erector
spinae m.
Trapezius, rhomboids, serratus posterior
superior, splenius ., errector spinae m.
Trapezius, rhomboids, splenius m, erector
spinae m.
Trapezius, rhomboids, serratus posterior
superior, erector spinae m.
Trapezius, rhomboids, splenius m., serratus
posterior superior, erector spinae m.
Anterior Chest Wall
• Anterior Chest Wall
-Osteology (dry lab)
-Gray’s pp. 118-126
-Gray’s Dissector pp. 49-54
-Anterior Chest Wall
-Gray’s pp. 115-135; 333-336
-Gray’s Dissector pp. 55-72
1
Skin of the Anterior Chest Wall
Syllabus p. 30
Lines of the Thoracic Wall
Syllabus p. 30
2
Breasts
Female
Male
Syllabus p. 31
Anatomy of the Female Breast
Syllabus p. 31
3
Innervation of the Breast
Blood Supply of the Breast
Syllabus p. 31
4
Lymphatics of the Breast
Syllabus p. 31
The Lymphatic System
-Capillaries
-Vessels
-Nodes
-Lymphocytes
5
Lymphatic Ducts
-Thoracic Duct
-Right Lymphatic Duct
Lymphatics of the Right Breast
6
Lymphatics of the Left Breast
Cancer develops in the right breast of a 34 year old woman. The woman
experiences a loss of sensation in her nipple. Which nerve is likely affected
by the tumor?
20%
20%
20%
20%
T5
T4
T3
T2
T1
T2
T3
T4
T5
T1
A.
B.
C.
D.
E.
20%
7
Lymphatic drainage to the right upper quadrant of the breast is also
compromised. Which of the following lymph nodes are more greatly
affected?
20% 20% 20% 20% 20%
B.
C.
D.
E.
Axillary lymph nodes - Right lymphatic
duct
Parasternal lymph nodes - Right
lymphatic duct
Intercostal lymph nodes – Right
lymphatic duct
Axillary lymph nodes – Thoracic duct
Intercostal lymph nodes – Thoracic duct
M
ax
ill
ar
y
ly
Pa
m
ra
ph
st
no
er
de
na
s.
ll
In
.
ym
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rc
p
os
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ta
..
ll
ym
A
xi
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ry
d.
ly
In
.
m
te
p
h
rc
no
os
de
ta
ll
s.
ym
.
ph
no
d.
.
A.
Muscles of the Thoracic Wall
-Pectoralis Muscles*
-Serratus Anterior Muscles*
-Subclavius*
-Intercostals*
-Transversus Thoracis
-Subcostalis
-Diaphragm
Syllabus pp. 32
8
Pectoralis Major and Minor
Innervation of the Pectoralis Major and Minor
9
Innervation of the Pectoralis Major
Serratus Anterior
10
The Lateral Thoracic Artery (Serratus Anterior)
Subclavius
11
Innervation of the Subclavius
A mastectomy is used to remove a cancerous tumor from a 46 year old
woman. The procedure involves excision of the breast tissue to the
pectoralis major muscle, associated fascia, and into the medial axillary wall.
After the procedure the woman has a noticeable winged scapula. The
following nerve is most likely damaged:
20% 20% 20% 20% 20%
Spinal accessory n.
Lateral pectoral n.
Long thoracic n.
Dorsal scapular n.
Nerve to the subclavius.
Sp
in
al
ac
ce
ss
La
or
y
te
n.
ra
lp
ec
to
ra
Lo
ln
ng
.
th
or
ac
D
or
ic
sa
n.
ls
ca
pu
M
la
ed
rn
ia
.
lp
ec
to
ra
ln
.
A.
B.
C.
D.
E.
12
Intercostal Muscles
Intercostal Nerves and Vessels
13
Clinical Correlates
FYI: Diaphragm will be discussed
in the next lecture
14
Arteries of the Thorax
Syllabus p. 33
Veins of the Thorax
Syllabus p. 34
15
SCREEN 2
Trapezius
16
Trapezius, Rhomboid m., Serratus Posterior Superior, Splenius m.
Trapezius, Rhomboid m., Serratus Posterior Superior, Splenius m.,
Deep Muscles of Back
17
Segmental Innervation of the
Anterior Skin
18
The Female Breast
19
Innervation of the Breast
Blood Supply of the Breast
20
Lymphatics of the Right Breast
21
Lymphatics of the Left Breast
22
Innervation of the Pectoralis Major and Minor
23
Serratus Anterior
Subclavius
24
Intercostal Muscles
25
Intercostal Nerves and Vessels
26