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AXILLARY ARTERY AND BRACHIAL PLEXUS Valentin C. Dones III, MSPT, PTRP, COMT, DMS, IMPT Masters of...
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Transcript of AXILLARY ARTERY AND BRACHIAL PLEXUS Valentin C. Dones III, MSPT, PTRP, COMT, DMS, IMPT Masters of...
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AXILLARY ARTERY AND AXILLARY ARTERY AND BRACHIAL PLEXUSBRACHIAL PLEXUSValentin C. Dones III, MSPT, PTRP, COMT, DMS, IMPTValentin C. Dones III, MSPT, PTRP, COMT, DMS, IMPT
Masters of Science in Orthopedic Physical TherapyMasters of Science in Orthopedic Physical TherapyCertified Dorn TeacherCertified Dorn Teacher
Certified Dorn SpecialistCertified Dorn SpecialistCertified in Orthopedic Manual TherapyCertified in Orthopedic Manual Therapy
Mulligan PractitionerMulligan PractitionerFunctional Fascial Taping PractitionerFunctional Fascial Taping Practitioner
Integrated NeurMuscular Taping TherapistIntegrated NeurMuscular Taping Therapist
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AXILLAAXILLA
FloorFloor Fascia and a dome of skinFascia and a dome of skin Anterior axillary fold > posterior axillary foldAnterior axillary fold > posterior axillary fold Continuous with the anterior compartment of the Continuous with the anterior compartment of the
armarm
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Contents of the AxillaContents of the Axilla
Proximal parts of biceps brachii and Proximal parts of biceps brachii and coracobrachialiscoracobrachialis
Axillary process of the breastAxillary process of the breast Collections of lymph nodesCollections of lymph nodes Major vessels and nervesMajor vessels and nerves
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Biceps BrachiiBiceps Brachii OriginOrigin
Short head: apex of coracoid processShort head: apex of coracoid process Long head: Supraglenoid tubercleLong head: Supraglenoid tubercle
InsertionInsertion Radial tuberosity in the forearmRadial tuberosity in the forearm
ActionAction Flexor of the forearmFlexor of the forearm Supinator of the forearmSupinator of the forearm Accessory flexor of GHJAccessory flexor of GHJ Prevents superior movement of the humerus on the glenoid Prevents superior movement of the humerus on the glenoid
cavitycavity InnervationInnervation
Musculocutaneous nerveMusculocutaneous nerve
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CoracobrachialisCoracobrachialis
OriginOrigin Apex of the coracoid processApex of the coracoid process
InsertionInsertion Small linear roughening on the medial aspect of Small linear roughening on the medial aspect of
the humerus, midshaftthe humerus, midshaft ActionAction
Flexes the arm at the GHJFlexes the arm at the GHJ InnervationInnervation
Musculocutaneous nerveMusculocutaneous nerve
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Axillary arteryAxillary artery
Subclavian artery Subclavian artery lateral border of rib 1 lateral border of rib 1 axillary artery axillary artery inferior margin of teres inferior margin of teres major major brachial artery brachial artery
Pectoralis minor Pectoralis minor 3 parts of the axillary 3 parts of the axillary arteryartery
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Axillary arteryAxillary artery
First partFirst part Superior thoracic arterySuperior thoracic artery
Second partSecond part Thoraco-acromial arteryThoraco-acromial artery Lateral thoracic arteryLateral thoracic artery
Third partThird part Subscapular arterySubscapular artery Anterior circumflex humeral arteryAnterior circumflex humeral artery Posterior circumflex humeral arteryPosterior circumflex humeral artery
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Superior thoracic arterySuperior thoracic artery
From the anterior surface of the first part of From the anterior surface of the first part of the axillary arterythe axillary artery
Upper regions of the medial and anterior Upper regions of the medial and anterior axillary wallsaxillary walls
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Thoraco-acromial arteryThoraco-acromial artery
From the anterior surface of the second part of From the anterior surface of the second part of the axillary arterythe axillary artery
Pierces the clavipectoral fasciaPierces the clavipectoral fascia Four branchesFour branches
PectoralPectoral Pierces the clavipectoral fasciaPierces the clavipectoral fascia
DeltoidDeltoid Accompanies the cephalic veinAccompanies the cephalic vein
Clavicular Clavicular Acromial Acromial
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Lateral Thoracic ArteryLateral Thoracic Artery
Posterior to the inferior margin of pectoralis Posterior to the inferior margin of pectoralis minorminor
Supplies the medial and anterior wallsSupplies the medial and anterior walls Supplies breastSupplies breast
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Subscapular arterySubscapular artery
Largest branch of the axillary arteryLargest branch of the axillary artery To the posterior wall of the axilla in the To the posterior wall of the axilla in the
posterior scapular regionposterior scapular region From the posterior surface of the third part of From the posterior surface of the third part of
the axillary arterythe axillary artery Follows inferior margin of the subscapular Follows inferior margin of the subscapular
arteryartery
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Subscapular arterySubscapular artery
Circumflex Scapular ArteryCircumflex Scapular Artery Enters the infraspinous fossaEnters the infraspinous fossa
Thoracodorsal ArteryThoracodorsal Artery Follows the lateral border of the scapula to the Follows the lateral border of the scapula to the
inferior angleinferior angle Vascular supply of the posterior and medial walls Vascular supply of the posterior and medial walls
of the axillaof the axilla
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Anterior Circumflex Humeral Anterior Circumflex Humeral ArteryArtery
Small compared to the posterior circumflex Small compared to the posterior circumflex humeral arteryhumeral artery
Passes anterior to the surgical neck of the Passes anterior to the surgical neck of the humerushumerus
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Posterior Circumflex Humeral Posterior Circumflex Humeral ArteryArtery
From the lateral surface of the third part of the From the lateral surface of the third part of the axillary arteryaxillary artery
Leaves the quadrangular space with the Leaves the quadrangular space with the axillary nerveaxillary nerve
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Axillary VeinAxillary Vein
Begins at the lower border of the teres majorBegins at the lower border of the teres major Continuation of the basilic veinContinuation of the basilic vein
Drains the posteromedial surface of the handDrains the posteromedial surface of the hand Penetrates the deep fascia in the middle of the armPenetrates the deep fascia in the middle of the arm
Axillary vein Axillary vein subclavian vein at lateral subclavian vein at lateral border of rib 1border of rib 1
TributariesTributaries Brachial veinsBrachial veins Cephalic veinCephalic vein
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Cephalic VeinCephalic Vein
Drains the lateral and posterior parts of the Drains the lateral and posterior parts of the hand, the forearm, and the armhand, the forearm, and the arm
Enters the clavipectoral triangleEnters the clavipectoral triangle
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Brachial PlexusBrachial Plexus
Anterior rami of C5-C8, T1Anterior rami of C5-C8, T1 Roots, trunks, divisions and cordsRoots, trunks, divisions and cords Proximal parts of the brachial plexus are Proximal parts of the brachial plexus are
posterior to the subclavian arteryposterior to the subclavian artery More distal regions of the plexus surround the More distal regions of the plexus surround the
axillary arteryaxillary artery
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RootsRoots
Receives gray rami communicantesReceives gray rami communicantes In the posterior triangle of the neckIn the posterior triangle of the neck Between the anterior and middle scalenesBetween the anterior and middle scalenes Superior and posterior to the subclavian arterySuperior and posterior to the subclavian artery
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TrunksTrunks
Superior trunk – C5 and C6Superior trunk – C5 and C6 Middle trunk – C7 rootMiddle trunk – C7 root Inferior trunk – C8 – T1Inferior trunk – C8 – T1
Lies on rib 1 posterior to the subclavian arteryLies on rib 1 posterior to the subclavian artery
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DivisionsDivisions
AnteriorAnterior PosteriorPosterior Anterior divisions Anterior divisions peripheral nerves peripheral nerves
anterior compartments of the arm and forearmanterior compartments of the arm and forearm Posterior divisions Posterior divisions peripheral nerves peripheral nerves
posterior compartmentsposterior compartments
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CordsCords
Related to the second part of the axillary arteryRelated to the second part of the axillary artery Lateral cordLateral cord
Union of upper and middle trunksUnion of upper and middle trunks Lateral to the axillary artery (2Lateral to the axillary artery (2ndnd part) part)
Medial cordMedial cord Continuation of the anterior division of the inferior Continuation of the anterior division of the inferior
trunktrunk Medial to the axillary artery (2Medial to the axillary artery (2ndnd part) part)
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CordsCords
Posterior cordPosterior cord Posterior to the axillary artery (2Posterior to the axillary artery (2ndnd part) part) Union of all three posterior divisionsUnion of all three posterior divisions
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Branches of the RootsBranches of the Roots
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Dorsal Scapular NerveDorsal Scapular Nerve
Originates from C5Originates from C5 Pierces the middle scalenePierces the middle scalene Travels the medial border of the scapulaTravels the medial border of the scapula Innervates Innervates
Rhomboid majorRhomboid major Rhomboid minorRhomboid minor
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Long Thoracic NerveLong Thoracic Nerve
Anterior rami of C5 to C7Anterior rami of C5 to C7 Down the medial wall of the axillaDown the medial wall of the axilla On the superficial aspect of the serratus On the superficial aspect of the serratus
anterior muscleanterior muscle
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LONG THORACIC NERVELONG THORACIC NERVE
C5, C6, C7C5, C6, C7 Enters the axilla by passing down over Enters the axilla by passing down over
the lateral border of the first rib behind the lateral border of the first rib behind the axillary vessels and brachial plexusthe axillary vessels and brachial plexus
Descends over the lateral surface of the Descends over the lateral surface of the serratus anterior, which it suppliesserratus anterior, which it supplies
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Suprascapular NerveSuprascapular Nerve
C5 and C6C5 and C6 From the superior trunk of the brachial plexusFrom the superior trunk of the brachial plexus Passes laterally through the posterior triangle Passes laterally through the posterior triangle
of the brachial plexusof the brachial plexus Through the suprascapular foramen Through the suprascapular foramen
posterior scapular regionposterior scapular region InnervatesInnervates
SupraspinatusSupraspinatus Infraspinatus Infraspinatus
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Nerve to the subclaviusNerve to the subclavius
From the superior trunk of the brachial plexusFrom the superior trunk of the brachial plexus Passes anteroinferiorly over the subclavian Passes anteroinferiorly over the subclavian
artery and veinartery and vein Innervates the subclavius muscleInnervates the subclavius muscle
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Lateral Pectoral NerveLateral Pectoral Nerve
Most proximalMost proximal Penetrates the pectoral branch of the thoraco-Penetrates the pectoral branch of the thoraco-
acromial artery acromial artery Innervates the pectoralis majorInnervates the pectoralis major
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Musculocutaneous nerveMusculocutaneous nerve
Large terminal branch of the lateral cordLarge terminal branch of the lateral cord Penetrates the coracobrachialis musclePenetrates the coracobrachialis muscle Passes between the biceps brachii and Passes between the biceps brachii and
brachialis musclesbrachialis muscles Lateral cutaneous nerve of the forearmLateral cutaneous nerve of the forearm
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Lateral Root of the Median NerveLateral Root of the Median Nerve
Largest terminal branch of the lateral cordLargest terminal branch of the lateral cord Joins the medial root of the medial cord Joins the medial root of the medial cord
Median NerveMedian Nerve
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Medial Pectoral NerveMedial Pectoral Nerve
Supplies the pectoralis minorSupplies the pectoralis minor Supplies the pectoralis majorSupplies the pectoralis major Most proximal branchMost proximal branch Passes in between the axillary artery and Passes in between the axillary artery and
axillary veinaxillary vein
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Medial cutaneous nerve of the armMedial cutaneous nerve of the arm
Medial brachial cutaneous nerveMedial brachial cutaneous nerve Supplies the skin over the medial side of the Supplies the skin over the medial side of the
armarm In the axilla, communicates with the In the axilla, communicates with the
intercostobrachial nerve (T2)intercostobrachial nerve (T2)
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Medial Cutaneous Nerve of the Medial Cutaneous Nerve of the ForearmForearm
Medial antebrachial cutaneous nerveMedial antebrachial cutaneous nerve Just distal to the origin of the medial cutaneous Just distal to the origin of the medial cutaneous
nerve of the armnerve of the arm Gives off a branch to the skin over the biceps Gives off a branch to the skin over the biceps
brachii musclebrachii muscle Penetrates the deep fascia with the basilic veinPenetrates the deep fascia with the basilic vein
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Medial Root of the Median NerveMedial Root of the Median Nerve
With the lateral root forms the lateral cord of With the lateral root forms the lateral cord of the brachial plexusthe brachial plexus
Median nerve is formed anterior to the third Median nerve is formed anterior to the third part of the axillary arterypart of the axillary artery
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Ulnar NerveUlnar Nerve
Large terminal branch of the medial cordLarge terminal branch of the medial cord
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Median NerveMedian Nerve
Formed anterior to the third part of the axillary arteryFormed anterior to the third part of the axillary artery Union of lateral and medial roots Union of lateral and medial roots Passes anterior to the brachial arteryPasses anterior to the brachial artery InnervatesInnervates
Thenar musclesThenar muscles Two lateral lumbricalsTwo lateral lumbricals Palmar surface of the lateral three and ½ digits and over the Palmar surface of the lateral three and ½ digits and over the
lateral side of the palm and middle of the wristlateral side of the palm and middle of the wrist
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Median NerveMedian Nerve
M over the third part of the axillary arteryM over the third part of the axillary artery Musculocutaneous nerveMusculocutaneous nerve Lateral root of the median nerveLateral root of the median nerve Medial root of the median nerveMedial root of the median nerve Ulnar nerveUlnar nerve
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Median NerveMedian Nerve
M over the third part of the axillary arteryM over the third part of the axillary artery Musculocutaneous nerve piercing the Musculocutaneous nerve piercing the
coracobrachialis musclecoracobrachialis muscle
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Branches of the Posterior CordBranches of the Posterior Cord
Superior subscapular nerveSuperior subscapular nerve Thoracodorsal nerveThoracodorsal nerve Inferior subscapular nerveInferior subscapular nerve Axillary nerveAxillary nerve Radial nerveRadial nerve
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Superior subscapular nerveSuperior subscapular nerve
ShortShort Supplies the Subscapularis muscleSupplies the Subscapularis muscle
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Thoracodorsal nerveThoracodorsal nerve
Longest Longest Passes vertically along the posterior axillary Passes vertically along the posterior axillary
wallwall Innervates the latissimus dorsiInnervates the latissimus dorsi
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Inferior subscapular nerveInferior subscapular nerve
Supplies Supplies SubscapularisSubscapularis Teres majorTeres major
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Axillary NerveAxillary Nerve
Exits the axilla through the quadrangular spaceExits the axilla through the quadrangular space Innervates the deltoid and teres minorInnervates the deltoid and teres minor Superior lateral cutaneous nerve of the arm Superior lateral cutaneous nerve of the arm
passes through the quadrangular spacepasses through the quadrangular space Accompanied by the posterior circumflex Accompanied by the posterior circumflex
humeral arteryhumeral artery
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RADIAL NERVERADIAL NERVE
Continues downward into the cubital fossa in Continues downward into the cubital fossa in front of the elbowfront of the elbow
Between the brachialis and brachioradialisBetween the brachialis and brachioradialis In the spiral groove, accompanied by the In the spiral groove, accompanied by the
profunda vessels I/C with the shaft of the profunda vessels I/C with the shaft of the humerushumerus
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RADIAL NERVE: RADIAL NERVE: BRANCHES BRANCHES IN THE AXILLAIN THE AXILLA
Long head of the tricepsLong head of the triceps Medial head of the tricepsMedial head of the triceps Posterior cutaneous nerve of the armPosterior cutaneous nerve of the arm
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RADIAL NERVE: RADIAL NERVE: In the spiral In the spiral groovegroove
Lateral head of the tricepsLateral head of the triceps Medial head of the tricepsMedial head of the triceps AnconeusAnconeus Lower lateral cutaneous nerve of the arm supplies the Lower lateral cutaneous nerve of the arm supplies the
skin over the lateral and anterior aspects of the lower skin over the lateral and anterior aspects of the lower part of the armpart of the arm
Posterior cutaneous nerve of the forearm runs down Posterior cutaneous nerve of the forearm runs down the middle of the back of the forearm as far as the the middle of the back of the forearm as far as the wristwrist
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RADIAL NERVE: RADIAL NERVE: In the anterior In the anterior compartmentcompartment
After the nerve has pierced the lateral fascial After the nerve has pierced the lateral fascial septumseptum
Gives off branches to the brachialis, Gives off branches to the brachialis, brachioradalis and extensor carpi radialis brachioradalis and extensor carpi radialis longus muscleslongus muscles
Gives articular branches to the elbow jointGives articular branches to the elbow joint
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NERVE OF THE LATERAL NERVE OF THE LATERAL COMPARTMENT OF THE COMPARTMENT OF THE
FOREARMFOREARM Pierces the lateral intermuscular septum Pierces the lateral intermuscular septum
in the lower part of the armin the lower part of the arm Passes forward into the cubital fossaPasses forward into the cubital fossa Passes downward in front of the lateral Passes downward in front of the lateral
epicondyle of the humerusepicondyle of the humerus
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NERVE OF THE LATERAL NERVE OF THE LATERAL COMPARTMENT OF THE COMPARTMENT OF THE
FOREARMFOREARM Lies between the brachialis on the medial Lies between the brachialis on the medial
side and brachioradialis and extensor side and brachioradialis and extensor carpi radialis longus on the lateral sidecarpi radialis longus on the lateral side
At the level of the lateral epicondyle, it At the level of the lateral epicondyle, it divides into superficial and deep branchesdivides into superficial and deep branches
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BRANCHESBRANCHES
Muscular branchesMuscular branches BrachioradialisBrachioradialis Extensor carpi radialis longusExtensor carpi radialis longus Small branch to the lateral part of the brachialis muscleSmall branch to the lateral part of the brachialis muscle
Articular branches to the elbow jointArticular branches to the elbow joint Deep branch of the radial nerveDeep branch of the radial nerve
Winds around the neck of the radiusWinds around the neck of the radius Within the supinator muscleWithin the supinator muscle Enters the posterior compartment of the forearmEnters the posterior compartment of the forearm
Superficial branch of the radial nerveSuperficial branch of the radial nerve
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Radial NerveRadial Nerve
Posterior cutaneous nerve of the armPosterior cutaneous nerve of the arm Posterior brachial cutaneous nervePosterior brachial cutaneous nerve Innervates the posterior surface of the armInnervates the posterior surface of the arm
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