Trochanteric Anastomosis anastomotic ring of arteries found in the trochanteric fossa and around the neck of the femur. Formed by the union of branches from: 1) medial circumflex femoral artery. 2) ascending branch of the lateral circumflex femoral artery. 3) inferior gluteal artery. 4) superior gluteal artery. 1 2 3 4 Arteries & nerves of gluteal region
Hip (coxal) joint / Arteries & nerves of gluteal region
Femoral triangle / RELATIONS Deep contents Femoral a. & v. surrounded by femoral sheath Profunda femoris a. – principal artery of thigh Lat and med. femoral circumflex aa. Deep external pudendal a. Femoral n. A few deeper lymph nodes -- Anterior view
Femoral a. & v. surrounded by femoral sheath Lat 1 and med. femoral 2 circumflex aa. Deep external pudendal a. Femoral n. A few deeper lymph nodes Profunda femoris a. 1 2 Femoral triangle / DEEP VESSELS AND NERVES Anterior view
Lat fem cir a. Ascending branches, lat fem cir. Anterio-lateral view Hip Anastomosis / FEMORAL HEAD ARTERIAL SUPPLY
Posterior view Hip collateral circulation / TROCHANTERIC ANASTOMOSIS Arterial supply to Femoral head Medial Femoral Circumflex artery Lateral Femoral Circumflex artery (acsending br.) Post. obdurator artery via artery of femoral ligament Superior and inferior gluteal arteries
Anatomy & relationships within the popliteal fossa / POPLITEAL VEIN TRIBUTARIES the small saphenous vein Several genicular veins (draining the knee joint and its associated structures) other tributaries corresponding to branches of the popliteal artery
Superior Gluteal Artery The deep branch of the superior gluteal artery lies between the gluteus medius muscle and the hip bone, dividing into superior and inferior divisions. The superior division runs along the upper border of gluteus minimus as far as the anterior superior iliac spine. It contributes to the anastomosis around the hip joint by joining with the: 1)Deep circumflex iliac artery. 2)Ascending branch of the lateral circumflex femoral artery. The inferior division crosses gluteus minimus to supply it, the gluteus medius muscle and the hip joint. It also contributes to the anastomosis around the hip joint by joining with the: 1)Lateral circumflex femoral artery. 2)Inferior gluteal artery. 3) Ascending branch of the medial circumflex artery. Arteries & nerves of gluteal region
Inferior Gluteal Artery Runs backwards and laterally between the first and second, or second and third, ventral sacral nerves. It traverses the greater sciatic foramen below the piriformis and enters the gluteal region. Inside pelvis branches to the piriformis, coccygeus and levator ani muscles, perirectal fat, the fundus of the bladder, the seminal vesicles and the prostate. Outside the pelvis; it supplies gluteus maximus, obturator internus, the gemelli, quadratus femoris and the upper hamstrings. The artery to the sciatic nerve penetrates and runs along the surface of the nerve, accompanying it as far as the lower thigh. The inferior gluteal and internal pudendal arteries may arise as a common stem from the internal iliac artery. Arteries & nerves of gluteal region
What is the Axilla? A region (the axillary space) associated with the armpit. It actually begins around the cervicoaxillary canal, at the edge of the first rib. It continues to the armpit, with the bottom being the axillary fascia. (remember? The lower attachment of the clavipectoral membrane?) It has musculoskeletal boundaries that are lateral, medial, anterior and posterior.
Medial—Serratus anterior muscle Lateral—Intertubercular sulcus. Anterior—Pectoralis major and minor MM. Posterior—Scapula with subscapularis M.; in places, latisimus dorsi M. and teres major M. Apex—clavicle. Base—Axillary fascia. Walls of the axillary space
MUSCLES Teres major M Latissimus dorsi M Subscapularis M Pectoralis major M Pectoralis minor M Serratus anterior M Major structures inside: Axillary sheath and contents! Most of the rest of the space is adipose tissue.
Axillary sheath Derived, at least in part, from anterior and middle scalene muscle fascia. Covers over a series of contents: –Axillary artery –Axillary vein –Brachial plexus and nerves derived from it. The axillary sheath is just the fascia surrounding these structures. You will open it up in lab to see them.
Subclavcian Artery. Lateral to the first rib, it becomes axillary artery. Branches you should know: Transverse cervical. Dorsal scapular. Suprascapular. Vertebral Artery
Axillary Artery: divided into three parts Part 1 (proximal) one branch Part 2 (intermediate) two branches. Part 3 (distal) three branches. Subclavian A. Brachial A.
Axillary Artery: First Part From lateral border of 1 st rib to medial border of Pectoralis Major M. Named Branch: Supreme Thoracic A. (to external thoracic body wall) Supplies blood to first and second intercostal spaces
Axillary Artery: Second part Deep to the pectoralis minor M. Thoracoacromial trunk Branches to: Clavicular area Pectoralis region Acromion of Scapula Deltoid Muscle. Lateral Thoracic Artery Bbr. to Serratus Ant. M.
Axillary Artery: third part Lateral border of Pectoralis minor M. to lateral border of Teres major M. Subscapular A.: Branches: Circumflex scapular A. (to multiple muscles associated with the scapula) 1. Thoracodorsal A. (to Latissimus dorsi M.) 2. Posterior circumflex humeral A. Anterior circumflex humeral A. How it will look in lab
Supreme thoracic A. Thoracoacromial A. Lateral thoracic A. Subscapular A. Ant. Circumflex humoral A. Post. Circumflex humoral A. Note, there is a broad anastamosis of the entire scapular region including circumflex humorals, subscapular, dorsal scapular, and suprascapular AA.
Arteries of Proximal Arm The arterial pattern has one major vessel, with several important branches, which can supply muscles: –Deep brachial A. to posterior compartment (branches to medial collateral and radial collateral AA). –Superior ulnar collateral A. –Inferior ulnar collateral A. Note, many muscles are supplied directly by unnamed muscular branches. Do not even think of giving all the vessels you see a distinct name.
The brachial artery is the primary artery supplying muscles of the arm. Its largest single branch, the deep brachial A., arises from it in the upper part of the arm and penetrates towards the extensor (posterior) compartment. There are also arteries that supply the elbow anastomosis arising from it. Note, the muscles and overlying skin are supplied by small, otherwise unnamed branches arising from it.
Axillary A. Brachial A. Deep brachial A. Superior ulnar collateral A. Inferior ulnar collateral A. Radial collateral A. (a branch of the deep brachial A.) Not seen, middle collateral A., another branch of the deep brachial A.