Presentation on theme: "During a fight a man is stabbed in the lateral chest beneath the right arm. The wound does not enter the chest cavity. Physical examination reveals."— Presentation transcript:
1During a fight a man is stabbed in the lateral chest beneath the right arm. The wound does not enter the chest cavity. Physical examination reveals that the vertebral (medial) border of the patient's scapula projects posteriorly and is closer to the midline on the injured side. On return visit the patient complains that he cannot reach as far forward (such as to reach for a door knob) as he could before the injury. The nerve injured which caused these symptoms is the:
2axillary long thoracic musculocutaneous radial suprascapular
3You are in the emergency room when a patient is brought in, the loser in a street fight. He has received a stab wound about 1.5 cm long in the right side of the chest about 1.5 cm below and 1 cm medial to the coracoid process of the scapula. He has lost a lot of bright red blood from a large (approx. 1.2 cm in diameter) severed artery found deep at this location. Intravenous fluids are immediately administered and a surgeon is called in to repair the artery. He begins by making an incision through the skin and subcutaneous tissue just below the clavicle, then cuts the clavicular head of the pectoralis major muscle and retracts it downward to obtain sufficient exposure of the area. He next encounters a partially severed muscle running downward and medially from the coracoid process. He divides the remaining fibers of the muscle and has you retract it downward. This exposes a bloody fat-filled space full of vessels and nerves.
4Which space or cavity was opened when the surgeon reflected the muscles axillary space infraspinatous fossa quadrangular space subdeltoid bursa triangular space
8Contents:1. Axillary artery and its branches2. Axillary vein and its tributaries3. Axillary lymph nodes4. Brachial plexusThe contents are embedded in fat and ensheathed in the axillary sheath
9Branches of the Axillary artery The axillary artery is separated into three parts by the pectoralis minor, which crosses anteriorly to the vessel.First part is proximal to pectoralis minorSecond part is posterior to pectoralis minorThird part is distal to pectoralis min.
11six branches arise from the axillary artery: 1 branch, the superior thoracic artery, originates from the 1ST part.2 branches, the thoraco-acromial artery and the lateral thoracic artery, originate from the 2ND part;3 branches, the subscapular artery, the anterior circumflex humeral artery, and the posterior circumflex humeral artery, originate from the 3RD part.
15Axillary veinThe axillary vein begins at the lower margin of the teres major muscle and is the continuation of the basilic vein.The axillary vein passes through the axilla medial and anterior to the axillary artery and becomes the subclavian vein.
16Axillary arteryThe subclavian artery in the neck becomes the axillary artery at the lateral margin of rib I and passes through the axilla, becoming the brachial artery at the inferior margin of the teres major muscle.
17Tributaries of the axillary vein generally follow the branches of the axillary artery. Other tributaries include brachial veins that follow the brachial artery, and the cephalic vein.
22The cords of the brachial plexus are: above the clavicle, medial to the scalenus anticus (anterior scalene).above the clavicle, behind the scalenus anticus (anterior scalene).at or below the clavicle, closely related to the axillary artery.at or below the clavicle, closely related to the axillary vein.