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Acomioclavicular joint functions
Plane type synovial joint
Connects clavicle and scapula
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 Sternoclavicular joint functions
Saddle type joint and connects the scapula to the thorax via clavicle
Functions as ball and socket to accommodate movements of the scapula
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Faciae of pectoral region 4 and location
Deltoid fascia – descends from clavicle, acromion, and scapular spine, continuous with the pectoral fascia anteriorly infraspinous fascia posteriorly
Pectoral fascia – descends from clavicle and sternum, inveting pectoralis major, become the axillary fascia laterally
Axillary fascia – continuation of pectoral fascia, forms the flood of the axilla
Clavipectoral fascia – descends from clavicle, encloses the subclavius and pectoralis minor, continuous with axillary fascia
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 Pectoralis major actions, innervation, insertion, origin
A: both heads adduct and medially rotate humerus, clavicular head flexes humerus, sternocostal head extends humerus from flexed position
IV: lateral pectoral nerve and medial pectoral nerve
IN: lateral lip of intertubercular sulcus
O: clavicular head: anterior surface of medial clavicle
Sternocostal head: anterior surface of sternum and superior 6 costal cartilages
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 Pectoralis minor actions, innervation, insertion, origin
A: stabilizes scapula by drawing it inferiorly and anteriorly against the thoracic wall
IV: medial petoral nerve
IN: coracoid process
Origin: ribs 3-5 near their costal cartilages
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 Subclavius actions, innervation, insertion, origin
A: anchor and depresses clavicle
IV: nerve to subclavius
IN: inferior middle clavicle
O: junction of the 1st rib and costal cartilage
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Serratus anterior actions, innervation, insertion, origin
A: protects scapula, holds scapula against the thoracic wall, superior rotation of the scapula
IV: long thoracic nerve
IN: anterior surface of medial border of scapula
O: lateral parts of ribs 1-8
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Fracture of clavicle cause and symptoms
C; direct fall onto shoulder, indirect due to transmission of force from arm and forearm to shoulder during fall
S: medial fragment is elevated due to sternomastoid, lateral fragment is depressed due to weight of the arm
*injured subclavian vein causing internal bleeding
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Axillary sheath define
- Sleeve like extension of the cervical fascia
- (fascia - a band or sheath of connective tissue investing, supporting, or binding together internal organs or parts of the body)
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3 contents within axillary sheath
2 contents outside of axillary sheath
W: axillary artery and branches, axillary vein and tributaries, brachial plexus (cords and branches)
O: axillary lymph nodes and lymphatic vessels, axillary fat
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 Subclavian artery characteristics 2
Arises from the brachiocephalic trunk (which arises from the aorta) on the RIGHT side, &
directly from the arch of the aorta on the LEFT
Becomes the axillary artery at the lateral border of the 1st rib
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Axillary artery break down
Subclavian artery becomes acillary artery at lateral border of 1st rib, the axillary artery can be divided into 3 parts, axillary artery becomes the brachial artery at the inferior border of teres major
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1st part of axillary artery location
**First branch:SUPERIOR THORACIC ARTERY
Located between the 1st rib & the medial border of pectoralis minor
Enclosed within the axillary sheath
1st section has 1 branch
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 2 Nd part of axillary artery location
- Lies posterior to pectoralix minor
- 2nd section as 2 branches:
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Thoracoacromial artery divides into 4 branches:
Clavicular
Acromial
Deltoid
Pectoral
Lateral thoracic artery
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3rd part of axillary artery location and branches
Rom lateral border of pectoralis minor to inferior border of teres major
3 branches are: posterior circumflex humeral artery, anterior circumflex humeral artery, subscapular artery which divides into 2 branches (circumflex (bend around something else) scapular artery, thoracodorsal artery)
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AXILLARY VEIN location
union of the brachial vein & basilic vein
changes the name at the lateral border of the 1st rib to subclavian vein (same as subclavian & axillary artery)
**union of the brachial veins & basilic Vein contains 3 parts (corresponds to 3 parts of axillary artery) becomes subclavian vein at the lateral border of the 1st rib (same as subclavian & axillary artery)
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CEPHALIC VEIN location
a superficial, subcutaneous vein of the lateral aspect of the upper limb
travels through the deltopectoral groove & pierces the clavipectoral fascia at the deltopectoral triangle draining into the axillary vein
**cephalic vein drains into axillary vein, brachial veins accompanying the brachial artery
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Common variants in breasts
Polymastia: accessory breast
Polythelia: accessory nipples
Amastia: no breast development
Gynecomastia: breast hypertrophy in males
breast tissue typically extends transversely from the lateral border of the sternum to the midaxillary line & vertically from the 2nd to 6th rib
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**at puberty, the lactiferous ducts give rise to 15-20 lobules of the mammary gland which constitute the parenchyma (functional part of the breast tissue) each gland is drained by a lactiferous duct, which dilates into a sinus (lactiferous sinus), & narrows again into a duct (lactiferous duct)
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Lateral thoracic artery location and function
Branch of axillary artery
Gives lateral mammary branches
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Internal thoracic artery location and function
Branch of subclavian atery
Gives medial mammary branches from anterior intercostal arteries
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Posterior intercostal arteries location and function
Generally branches from thoracic aorta
Gives lateral mammary branches from lateral cutaneous branches
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Nerves of breast characteristics 4
Transmitted from the anterior & lateral cutaneous branches of the 4th-6th intercostal nerves
They pierce the pectoral fascia to reach subcutaneous tissue & skin
Somatic sensory fibers to skin, sympathetic to blood vessels & smooth muscles of skin & nipples
Nipple sits at T4 dermatome (see Brachial Plexus lecture for more on dermatomes
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Lymph drainage of breast explained
Lymph passes from nipple, areola, & lobules to the Subareolar lymphatic plexus. Axillary lymph nodes receive >75% of lymph from the breast, largely from the lateral quadrants (superior lateral & inferior lateral) most common sites for mestasis from breast cancer From the medial quadrants, lymph passes mostly to the parasternal lymph nodes; lymph can travel via the parasternal lymph nodes to
the contralateral breast. Subdiaphgragmatic lymph nodes receives lymph typically from the inferior quadrant.3 sets of lymph nodes form the base (humeral, subscapular, & pectoral) which drain into central lymph nodes, draining into apical lymph nodes of the lymph traveling to the axillary lymph nodes from the breast, most travels FIRST to the pectoral lymph nodes
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**carcinomas of the breast are malignant tumors usually adenocarcinoma arising from the epithelial cell of the lactiferous ducts in the mammry gland lobules**
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Cancer interference with lymphatic drainage symptoms and Lymphedema define
Excess fluid in subcutaneous tissue, deviation of nipple leather like appearance of skin, orange peel look to skin, puffy prominent skin between dimples (dimple due to shortening of suspensory ligaments
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Cancer invading glandular tissue symptoms
Large dimple
Dimples caused by shortening or traction placed on suspensory ligaments
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Cancer invade retromammary space, pectoral fascia, or interpectoral lymph nodes symptoms
Breasts elevates when muscle contract (places hand on hips)
Sign of advanced breast cancer
Invasion of pectoral fascia characteristic of rock hard fixed nodule
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Subareolar breast cancer symptom
Retraction and deviation of nipple caused by shortening of lactiferous ducts
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2 types of breast surgery
Lumpectomy (radiation therapy)
Mastectomy (remove breast, simple, modified radical)
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Breast density of post-menopausal women, pregnant women, obese
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Less dense, increased breast density, decreased density
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**breast density on mammogram cannot be predicted by palpitation and age cannot be predictor of breast density
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