Upper limb Pectoral region & Axilla 黃敏銓
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Pectoral region Intercostal nerve
Anterior branch of lateral cutaneous branch
Lateral cutaneous branch
Anterior cutaneous branch
Perforating branch Anterior cutaneous branch
Sternalis muscle
Internal thoracic artery 2
Suspensory ligaments
Lactiferous ducts Lactiferous sinus
Gland lobules 3
Axilla
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Inlet (Apex)
Axillary sheath Anterior wall
Lateral wall
Posterior wall
Medial wall
Floor (Base)
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Axillary inlet (apex) Middle scalene muscle
Anterior scalene muscle 2. Superior border of the scapula
3. Rib 1
1. Clavicle
VAN (內到外) 第1肋骨上 Subclavian vein Subclavian artery Inferior trunk
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Anterior wall Subclavius
Pectoralis minor Clavipectoral fascia Pectoralis major
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Pectoralis major Clavipectoral (Deltopectoral) triangle
1. Act together: powerful adduction, medial rotation 2. Act independently: flexion of arm, extension of flexed arm 3. Inferior part: protract, depress, downward rotate scapula Clavicular head: Medial half of clavicle
Pectoralis major Insertion: lateral lip of intertubercular sulcus of humerus
Sternocostal head: Sternum 1st~6(7)th costal cartilage Aponeurosis of external oblique
Innervation: Medial and lateral pectoral nerves 8
Subclavius Origin: 1st rib
Subclavius
Insertion: groove on inferior surface of clavicle
Sternoclavicular joint
1. Depress clavicle 2. Pull clavicle medially Innervation: nerve to subclavius 9
Pectoralis minor Origin: 3rd~5th rib Insertion: coracoid process Coracoid process 1. Protract scapula, depress, downward rotate scapula 2. Elevate ribs 3. Landmark
Pectoralis minor
III
Medial pectoral nerve
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V
Innervation: Medial pectoral nerve 10
Clavipectoral fascia Cephalic vein Thoracoacromial artery
Lateral pectoral nerve
Clavipectoral fascia Medial pectoral nerve
Lateral thoracic artery
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Medial wall Long thoracic nerve
Origin: 1-8(9) ribs Insertion: costal surface of medial border of scapula
1. Protract, upward rotate and depress scapula 2. Keep scapula opposed to thoracic wall Long thoracic nerve
Serratus anterior (boxer’s muscle)
Winged scapula
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Lateral wall Intertubercular sulcus
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Posterior wall
Subscapularis Teres major
Long head of triceps brachii
Latissimus dorsi
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Long head of triceps brachii Origin: infraglenoid tubercle
on scapula Insertion: olecranon process of ulna
Arm: adduction, extension Forearm: extension Long head of triceps brachii
Innervation: radial nerve
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Subscapularis Origin: subscapular fossa (medial 2/3) Insertion: lesser tubercle of humerus
Subscapularis: rotator cuff muscle, medial rotation and adduction of arm
Innervation: superior & inferior subscapular nerves 16
Teres major Origin: posterior surface of inferior angle of scapula Insertion: medial lip of intertubercular sulcus
Teres major Medial rotation, adduction, and extension of arm Innervation: inferior subscapular nerve
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Latissimus dorsi Origin: lower 6 thoracic vertebrae, thoracolumbar fascia, iliac crest, lower 3-4 ribs. Insertion: floor of intertubercular sulcus 1. Arm (direct): powerful adduction, medial rotation, extension 2. Scapula (indirect): downward rotation
Latissimus dorsi Innervation: thoracodorsal nerve
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Gateways in the posterior wall Quadrangular space • Axillary nerve • Posterior circumflex humeral artery & vein
Triangular interval
Triangular space • Circumflex scapular artery
Teres major
• Radial nerve • Profunda brachii artery
Long head of triceps brachii
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Floor of the axilla
Posterior axillary fold
Anterior axillary fold
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Muscles pass through the axilla Long head of biceps brachii Short head of biceps brachii
Coracobrachialis
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Subclavian artery 1
Axillary artery
Lateral margin of rib I
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3
Lower border of teres major Pectoralis minor Brachial artery
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Branches of the axillary artery Superior thoracic artery
Thoracoacromial artery 2
1
Subscapular artery 3 Anterior circumflex humeral artery
3
Posterior circumflex humeral artery
3 Circumflex scapular artery
Thoracodorsal artery
Lateral thoracic artery 2 23
Subclavian vein
Axillary vein
Cephalic vein Basilic vein Paired brachial veins
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Axillary nodes Apical nodes
Right subclavian trunk
Central nodes Pectoral (anterior) nodes
Humeral (lateral) nodes Subscapular (posterior) nodes
1st part 2nd part
upper limb 26 breast
Brachial plexus Middle scalene muscle Roots Trunks
C5
Divisions Cords T1
Anterior scalene muscle
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Brachial plexus
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Branches of the roots Dorsal scapular nerve
Dorsal scapular nerve
Levator scapulae Rhomboid minor Rhomboid major
Long thoracic nerve
Serratus anterior Long thoracic nerve 29
Branches of the trunks
Suprascapular nerve
Subclavius
Nerve to subclavius
Supraspinatus Suprascapular nerve Infraspinatus Nerve to subclavius
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Branches of the lateral cord Pectoralis major
Lateral pectoral nerve
Flexor muscles of arm Musculocutaneous nerve
Median nerve
Lateral cutaneous nerve of forearm
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Branches of the medial cord
Pectoralis major and minor
Medial pectoral nerve
Medial cutaneous nerve of arm Median nerve Medial cutaneous nerve of forearm Ulnar nerve
Lateral cutaneous nerve of forearm
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Branches of the posterior cord
Superior subscapular nerve
Axillary nerve
Inferior subscapular nerve Radial nerve
Subscapularis Teres major
Thoracodorsal nerve
Latissimus dorsi
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