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4 L A B O R A T O R Y Axilla and Brachial Region BRACHIAL PLEXUS 5 Roots/Rami (ventral rami C5 – T1) 3 Trunks Superior (C5, C6) Middle (C7) Inferior (C8, T1) 3 Cords Lateral Cord (Anterior Superior and Anterior Middle Divisions) gives rise to median and musculocutaneous nerves Medial Cord (Anterior Inferior Division) gives rise to ulnar and median nerves Posterior Cord (Posterior Superior, Posterior Middle and Posterior Inferior Divisions) gives rise to axillary and radial nerves 5 MAJOR BRANCHES Median Nerve – Innervates forearm flexor muscles and hand musculature (thumb side) Except flexor carpi ulnaris and medial 1/2 of flexor digitorum profundus Musculocutaneous Nerve - Innervates the arm (brachium) flexor muscles Including biceps brachii, brachialis, and coracobrachialis Ulnar Nerve - Innervates flexor carpi ulnaris, medial 1/2 flexor digitorum profundus, and hand mus culature (pinkie side) Axillary Nerve - Innervates deltoid and teres minor Radial Nerve - Innervates extensor muscles of the arm (brachium) and forearm (antebrachium) 22 Laboratory 4 • Axilla and Brachial Region Supraclavicular Branches (may not be easily seen) Infraclavicular Branches Long thoracic nerve - serratus anterior Lateral pectoral nerve - pectoralis major Dorsal scapular nerve - rhomboids and levator scapulae Medial pectoral nerve - pectoralis muscles Suprascapular nerve - supraspinatus and infraspinatus Subscapular nerves – Upper - subscapularis Middle - thoracodorsal - latissimus dorsi Lower - subscapularis/teres major Nerve to subclavius - subclavius BRACHIAL REGION Identify the muscles that comprise the anterior compartment of the brachial region. Identify the attachment points and actions of the anterior brachial muscles. Identify the innervation source and the primary blood supply to these muscles. Locate and describe the anatomical significance of the bicipital aponeurosis. Anterior Brachium Muscles Muscle Origin Insertion Innervation Blood Supply Action Biceps Brachii Short: coracoid process of Scapula Long: supraglenoid tubercle of Scapula Radial tuberosity Musculoand deep cutaneous N forearm fascia (C5-C6) via bicipital aponeurosis Brachial A Circumflex Humeral A Supinates forearm, Flexes forearm at elbow Flex arm at shoulder Brachialis distal, anterior Humerus Ulnar tuberosity Musculoand coronoid cutaneous N process (C5-C6) Brachial A Ulnar A Flexes forearm at elbow Brachial A Circumflex Humeral A Flex arm at shoulder, Stabilize Scapula Coracobrachialis coracoid process Mid-medial of Scapula Humerus Musculocutaneous N (C5-C7) Identify the muscles of the posterior compartment of the brachial region. Identify the attachment points for the posterior brachial muscles. Identify the innervation source and the primary blood supply to these muscles. 23 Laboratory 4 • Axilla and Brachial Region Posterior Brachium Muscles Muscle Origin Triceps Brachii Long: infraglenoid tubercle of Scapula Lateral: posterosuperior Humerus Medial: posteroinferior Humerus Lateral epicondyle of Humerus Anconeus Insertion Innervation Blood Supply Action Extends forearm at elbow Extend arm at shoulder Proximal olecranon of Ulna forearm fascia Radial N (C6-C8) Circumflex Humeral A Profunda Brachii (deep A of arm) Lateral & posterior olecranon of Ulna Radial N (C7-T1) Profunda Brachii Resist abduction (deep A of arm) of Olecranon, Extend forearm & Stabilize elbow VASCULATURE Discuss arterial supply to the arm, including division between arteries. Subclavian Artery Axillary Artery Internal thoracic artery Superior thoracic artery Vertebral artery Thoracoacromial trunk Thyrocervical trunk deltoid suprascapular acromial transverse cervical pectoral inferior thyroid clavicular dorsal scapular artery Costocervical trunk Lateral thoracic artery Subscapular artery Circumflex scapular artery Thoracodorsal artery Circumflex humeral arteries Discuss venous drainage from the arm, including both superficial and deep veins. Deep Superficial Axial brachial vein basilic vein jugular veins axillary vein cephalic vein brachiocephalic veins subclavian vein medial cubital vein superior vena cava 24 Laboratory 4 • Axilla and Brachial Region Upper Extremity Clavicle acromial end Scapula spine Humerus conoid tubercle borders coracoid process glenoid cavity subscapular fossa infraspinous fossa supraspinous fossa suprascapular notch supra-/infra-glenoid tubercles head greater/lesser tubercle intertubercular (bicipital) groove deltoid tuberosity capitulum med/lat epicondyles Radius sternal end acromion trochlea Ulna subclavian groove radial groove med/lat supracondylar ridges olecranon trochlear notch interosseous border head head Carpal bones ulnar groove radial tuberosity radial notch olecranon fossa ulnar tuberosity styloid process coronoid process interosseous border styloid process (proximal) pisiform triquetrum lunate scaphoid (ulnar) (radial) hamate capitate (distal) Metacarpals (5) Phalanges (14) trapezoid trapezium Laboratory 4 • Axilla and Brachial Region Page Intentionally Left Blank 25 26 Page Intentionally Left Blank Laboratory 4 • Axilla and Brachial Region