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HUMERUS DARW ISH H. BADRAN Quadrangular Space Boundaries: • Inferior margin of the teres minor muscle • Surgical neck of the humerus • Superior margin of the teres major muscle • lateral margin of the long head of triceps muscle Contents: • Axillary nerve • Posterior circumflex humeral artery and vein DARW ISH H. BADRAN Triangular Space Boundaries: • Medial margin of the long head of triceps muscle • Superior margin of the teres major muscle • Inferior margin of the teres minor muscle Contents: • Circumflex scapular artery and vein. DARW ISH H. BADRAN Triangular Interval Boundaries: • lateral margin of the long head of triceps muscle • Shaft of the humerus • Inferior margin of the teres major muscle Contents: • Radial nerve • Profunda brachii artery and associated veins. DARW ISH H. BADRAN Axilla and Brachial Plexus DARW ISH H. BADRAN It is a pyramidal region between the upper part of the chest wall and the medial side of the arm. It is a transition area between the neck and the arm. The axilla possesses an apex (inlet), a floor, and 4 walls. The axillary cavity contains vessels, nerves, lymph nodes and a lot of adipose tissue. DARW ISH H. BADRAN Axillary Inlet Boundaries: • Medially: The outer border of the first rib. • Anteriorly: The posterior surface of the clavicle. • Posteriorly: The superior border of the scapula. DARW ISH H. BADRAN Anterior Wall Formed of: • Pectoralis major • Pectoralis minor • Subclavius • Clavipectoral fascia DARW ISH H. BADRAN Medial Wall Formed of: • Upper 4 ribs • Upper 4 intercostal spaces and their contents • Upper 4 digitations of the serratus anterior. DARW ISH H. BADRAN Lateral Wall Formed of: • Bicipital groove and the muscles attached to it: • Pectoralis major • Latissimus dorsi • Teres major DARW ISH H. BADRAN Posterior Wall Formed of: • Costal surface of the scapula • Subscapularis • Latissimus dorsi • Proximal part of the long head of triceps DARW ISH H. BADRAN Floor Formed of: • Fascia • Skin between the inferior margins of the walls • Supported by the clavipectoral fascia DARW ISH H. BADRAN Contents of Axilla Great vessels: • Axillary artery and vein • Cephalic vein and basilic vein • Axillary lymph nodes Nerves: • Proximal ends of terminal nerves of brachial plexus • Cords of brachial plexus • Long thoracic nerve DARW ISH H. BADRAN The anterior axillary fold is higher than the posterior. The anterior axillar fold is formed of pectoralis major. The posterior axillary fold is formed by the latissimus dorsi and the teres major. DARW ISH H. BADRAN Brachial Plexus DARW ISH H. BADRAN DARW ISH H. BADRAN It is a network of nerve fibers, running from the spine, formed by the ventral rami of the lower four cervical and first thoracic nerve roots (C5-T1). It proceeds through the neck, the axilla, and into the arm. Responsible for cutaneous and muscular innervation of the entire upper limb, with two exceptions: • The trapezius muscle innervated by the spinal accessory nerve (CN XI) and • An area of skin near the axilla innervated by the intercostobrachial nerve. DARW ISH H. BADRAN DIVISIONS ROOTS 5 BRANCHES 6 7 8 1 DARW ISH H. BADRAN Branches from the Roots of the Brachial Plexus Nerve Roots Muscles Cutaneous Dorsal scapular nerve C5 Rhomboid Levator scapulae None Long thoracic nerve C5 C6 C7 Serratus anterior None DARW ISH H. BADRAN Nerve to Subclavius Dorsal Scapular Nerve DARW ISH H. BADRAN Branches from the Upper Trunk of the Brachial Plexus Nerve Roots Muscles Cutaneous Nerve to subclavius C5 C6 Subclavius None Suprascapular nerve C5 C6 Supraspinatus Infraspinatus None DARW ISH H. BADRAN Nerve to Subclavius Dorsal Scapular Nerve DARW ISH H. BADRAN Branches from the Lateral Cord of the Brachial Plexus Nerve Lateral pectoral nerve Roots C5 C6 C7 Musculocutaneous nerve C5 C6 C7 Muscles Pectoralis Major By communication with Medial Pectoral Nerve Coracobrachialis Brachialis Biceps brachii Lateral root of median nerve DARW ISH H. BADRAN C5 C6 C7 Cutaneous Fibres of Median nerve Become the Lateral cutaneous nerve of forearm 1- Lateral pectoral nerve. 2- Musculocutaneous nerve. 3- Lateral root of the median nerve 1 2 3 DARW ISH H. BADRAN Branches from the Medial Cord of the Brachial Plexus Nerve Roots Muscles Cutaneous Medial pectoral C8 T1 Pectoralis major Pectoralis minor None Medial root of median C8 T1 Fibres to median nerve portions of hand not served by ulnar or radial Medial cutaneous nerve of arm C8 T1 None front and medial skin of the arm Medial cutaneous nerve of forearm C8 T1 None medial skin of the forearm Ulnar C8 T1 1. Flexor carpi ulnaris 2. The medial two bellies of flexor digitorum profundus 3. The intrinsic hand muscles except the thenar muscles. 4. The two most medial lumbricals the skin of the medial side of the hand medial one and a half fingers on the palmar side medial two and a half fingers on the dorsal side DARW ISH H. BADRAN 1- Medial pectoral nerve. 2- Medial root of the median nerve. 3- Medial cutaneous nerve of the arm. 4- Medial cutaneous nerve of the forearem. 5- Ulnar nerve. 1 2 3 DARW ISH H. BADRAN 5 Branches from the Posterior Cord of the Brachial Plexus Nerve Roots Muscles Cutaneous Upper subscapular C5 C6 Sub scapilaris (upper part) Thoracodorsal (Middle subscapular) C6 C7 C8 Latismus Dorsi Lower scapular C5 C6 Subscapularis (lower part) Teres major Axillary C5 C6 Ant Br: Deltoid & small area of overlying skin Post Br: Teres minor & Deltoid ms Post Branch continues as upper Lateral cutaneous nerve of the arm Radial C5 C6 C7 C8 T1 Triceps brachii Supinator Anconeus Brachioradialis Extensors of forearm Posterior cutaneous nerve of the arm DARW ISH H. BADRAN 1- Upper subscapular nerve. 2- Thoracodorsal nerve. 3- Lower subscapular nerve. 4- Axillary nerve. 5- Radial nerve. 1 3 2 5 DARW ISH H. BADRAN DARW ISH H. BADRAN Brachial Plexus Injury DARW ISH H. BADRAN Waiter’s tip position Characteristic position: adduction and internal rotation of the arm with forearm pronated Forearm extension is normal Caused by damage to the brachial plexus during delivery of the neonate. This is mostly limited to the 5th and 6th cervical nerves. DARW ISH H. BADRAN Falling on Shoulder Darwish H. Badran Darwish H. Badran Excessive Stretching Darwish H. Badran Darwish H. Badran Direct Blow Darwish H. Badran Darwish H. Badran Darwish H. Badran Axillary Artery DARW ISH H. BADRAN Supplies the walls of the axilla & related regions. It is the continuation of the Subclavian artery at the outer border of 1st rib It continues as the brachial artery at the lower border of teres major. The pectoralis minor divides the artery into 3 parts. DARW ISH H. BADRAN Throughout its course, the artery is closely related to the cords of the brachial plexus and their branches and is enclosed with them in a connective tissue sheath called the axillary sheath. If this sheath is traced upward into the root of the neck, it is seen to be continuous with the prevertebral fascia. DARW ISH H. BADRAN The 1st part gives 1 branch: • superior thoracic artery The 2nd part gives 2 branches: • Thoraco-acromial artery • lateral thoracic artery The 3rd part gives 3 branches: • subscapular artery • Anterior circumflex humeral artery • Posterior circumflex humeral artery DARW ISH H. BADRAN DARW ISH H. BADRAN Axillary Vein DARW ISH H. BADRAN it begins at the lower border of the teres major as the continuation of the basilic vein. Passes into the axilla anteromedial to the axillary artery Continues as the subclavian vein at the outer border of the first rib. Receives tributaries opposite to the branches of the axillary artery, cephalic vein and the vena comitantes of the brachial artery. DARW ISH H. BADRAN DARW ISH H. BADRAN