VC, Pectoral Girdle, Axilla

Vertebral Column
Intro
How many vertebrae in VC?

33

How flexible is the vertebral column?

Upper 25 bones are flexible

Last 5 sacral and 4 coccyx bones are fused

Observe the Coccyx.

Curvature
What's the significance of curves in the VC?

Increase strength and flexibility

Maintain balance and upright position

Absorb shock and prevent fractures

What are the primary curvatures?

Thoracic and sacral — concave forward

What are the secondary curvatures?

Cervical and Lumbar — convex forward

VC, Pectoral Girdle, Axilla 1

 When does the cervical curvature start?

When child holds up its feet — 34 month

When does the Lumbar curvature start?

When child starts to walk — 9 month to 1 year

What are the abnormalities?

Scoliosis

Exaggerated lateral curvature

Lordosis

Exaggerated lumbosacral angle

Kyphosis

Abnormal forward curvature

Vertebrae

VC, Pectoral Girdle, Axilla 2

 Compare each vertebrae

7.4 The Vertebral Column

By the end of this section, you will be able to: Discuss the vertebral column and regional variations in its
bony components and curvatures Describe each region of the vertebral column and the number of bones
in each region Discuss the curves of the vertebral column and how these change
https://open.oregonstate.education/aandp/chapter/74-the-vertebral-column/

Joints
What are the joints between each vertebrae?

Secondary cartilaginous joints

What are the facet joints between articular processes of vertebrae?

Synovial joints

What is special about the joint between C1 and C2?

No intervertebral disc

C1 = atlas

C2 = axis

Synovial joint for rotation

VC, Pectoral Girdle, Axilla 3

 💡 C1 vertebra does not have a body or spinous process

IV discs
What is the function of IV discs?

Strengthen the joint

Shock absorbers

1/3 of the length of VC

Where are the IV discs thickest?

Cervical and Lumbar

What is the Annulus fibrosus?

Thick outer ring of fibrocartilage

What is the Nucleus pulposus?

Inner pulp — made of water, collagen fibers and a little cartilage cells

VC, Pectoral Girdle, Axilla 4

 Movements
Flexion - extension

Cervical and Lumbar

Rotation

Cervical and thoracic

Lateral flexion

Cervical and Lumbar

VC, Pectoral Girdle, Axilla 5

 Pectoral Girdle
Joints
What is the pectoral girdle?

Scapula + clavicle

Which joints produce movements of the clavicle and scapula?

Sterno-clavicular

Acromio-clavicular

What provides greater mobility to the upper limb?

Pectoral girdle is suspended in muscles

What are parts of the scapula?

Muscles — girdle

VC, Pectoral Girdle, Axilla 6

 Which muscles move the pectoral girdle?

Vertebro-scapular muscles

What are the muscles between the VC and scapula?

Trapezius

Levator scapulae

Rhomboid major & minor

On what do they act on?

Joints of pectoral girdle not shoulder joint

Muscles — shoulder
What is the muscle around the shoulder joint?

Pectoralis major

Between ribs + clavicle + humerus

VC, Pectoral Girdle, Axilla 7

 What are the muscles between ribs + clavicle + scapula?

Subclavius

1st rib + clavicle

Pectoralis minor

3 + 4 + 5 ribs

Serratus anterior

VC, Pectoral Girdle, Axilla 8

 What are the muscles between scapula + clavicle + humerus? (IS it PTSD)

Infraspinatus

Supraspinatus

Pectoralis major

Teres major and minor

Subscapularis

VC, Pectoral Girdle, Axilla 9

 Deltoid

What is the muscle that attaches to the hip + scapula + humerus?

Latissimus Dorsi

Axilla
Intro
What is the Axilla?

VC, Pectoral Girdle, Axilla 10

 What are the boundaries of the Axilla?

Apex — cervicoaxillary canal

Base — skin, hair and sweat glands (Floor of Axilla)

Anterior wall

Posterior wall

Medial wall

Lateral wall

Apex
What are the boundaries of the Apex?

Clavicle + 1st rib + superior border of scapula

What passes through it?

Brachial plexus

Blood vessels of the UL

Anterior wall
What are the muscles of the anterior wall?

Pectoralis major & minor

Subclavius

What is Clavipectoral fascia?

Suspensory ligament attached to base of axilla

VC, Pectoral Girdle, Axilla 11

 What is the anterior axillary fold?

Formed by Pectoralis Major

Posterior wall

💡 Scapula is behind axilla

What bones are here?

Costal surface of scapula

What muscles are here?

Subscapularis

Latissimus Dorsi

Teres major

What is the posterior axillary fold?

Formed by Latissimus Dorsi + Teres major

Visualize.

Medial wall

VC, Pectoral Girdle, Axilla 12

 What bones?

Ribs 14

What muscles?

Serratus anterior

Intercostal muscles

What is the nerve supplying serratus anterior?

Long Thoracic Nerve

How can this nerve be injured?

During mammary gland surgery

Lateral wall
What boney feature?

Intertubercular sulcus of Humerus

What muscles?

Insertions of:

Teres major

Latissimus Dorsi

Pectoralis major

VC, Pectoral Girdle, Axilla 13

 Contents of axilla
What arteries are here?

Axillary artery & branches

What veins are here?

Axillary vein and tributaries

What nerves are here?

Cords & branches of Brachial plexus

What else is found here?

Axillary lymph nodes

Axillary fat

When are these contents most vulnerable?

When arm is abducted

When are these contents most protected?

When arm is adducted

What covers these contents?

Axillary sheath

What is not include in the Axillary sheath?

Axillary vein

What's the significance?

Because veins require dead space around them, due to their high compliance, they occupy more volume

The axillary sheath has a limited volume

Axillary artery
Where does it originate from?

Continuation of subclavian artery

At outer border of 1st rib

Which regions does it supply?

Shoulder

Pectoral

Upper arm

Breast — mammary glands

Parts of the Axillary artery

1st part

Between 1st rib and P.minor

2nd part

Deep to P.minor

VC, Pectoral Girdle, Axilla 14

 3rd part

Below/inferior to P.minor

Where is the vein compared to Axillary artery?

Medial

Outside sheath

What surrounds the 2nd part of the axillary artery?

Cords of brachial plexus

What are the branches of Axillary artery? (SALTS) (13313)

Superior thoracic artery

1st part of axillary artery

Anterior & Posterior circumflex humoral arteries

3rd part of axillary artery

Supplying upper arm

Lateral thoracic artery

3rd part of axillary artery

Thoracoacromial artery

1st part of axillary artery

Subscapular artery

3rd part of axillary artery

Anastomoses of the scapula

Between which arteries?

Subclavian artery and Axillary artery

VC, Pectoral Girdle, Axilla 15

 Significance?

Maintains adequate blood flow regardless of position of arm

What can cause twisting of axillary artery?

Extreme mobility of shoulder joint

How to palpate the axillary artery?

Compress the lateral wall of axilla against humerus

What is an Aneurysm of axillary artery?

Abnormal dilatation of axillary artery

Can occur in Baseball pitchers

Axillary vein
What is the Axillary vein?

Continuation of Basilic vein

What is the Axillary vein formed of?

Union of basilic vein and venae comitantes — accompanying brachial artery

Extent?

Teres major — 1st rib

What does the Axillary vein drain to?

Subclavian vein

Tributaries?

Brachial

Cephalic

Venae comitantes of brachial artery

Axillary lymphatics
Where do Axillary lymph nodes recieve lymph?

Upper limb

Mammary gland

Superficial chest wall above umbilicus

VC, Pectoral Girdle, Axilla 16

 What are the major groups?

Anterior

Along lower border of Pectoralis major

Drain anterolateral body wall & breast

Posterior

Along posterior axillary folds

Drain posterior aspect of thoracic wall & scapular region

Lateral

Lies posteromedial to axillary vein

Drain most of the upper limb

Central

Deep to Pectoralis minor

Receive lymph from anterior, posterior and lateral

Apical

Receive lymph from central

Efferent drains into subclavian lymphatic trunk

What are the percentages of lymphatic drainage of mammary glands?

Axillary lymph nodes

75%

Internal mammary group

20%

Posterior intercostal group

5%

💡 This is important in relation to spread of infection/cancer

Body lymphatic drainge

Right upper part of the body

Right lymphatic duct

Rest of body

VC, Pectoral Girdle, Axilla 17

 Thoracic duct

What is enlargement of lymph nodes is known as?

Lymphadenopathy

What is inflammation of lymph nodes is known as?

Lymphadenitis

Enlargement of axillary lymph nodes-due to infection or cancer from?

Breast

Upper limb

VC, Pectoral Girdle, Axilla 18