1. kaan yücel 11.04.2014

3. most common cancer among women, other than skin cancer second leading cause of cancer death in women, after lung cancer Chance of a woman having an invasive breast cancer some time during her life about 1 in 8 Understanding the lymphatic drainage of the breasts is of practical importance in predicting the metastasis (dispersal) of cancer cells from a carcinoma of the breast (breast cancer). chiefly those in the axilla spreads by means of lymphatic vessels (lymphogenic metastasis), which carry cancer cells from the breast to the lymph nodes, chiefly those in the axilla

5. Digital mammograms replacing conventional film mammography younger women with dense breast tissue benefit most from this type of mammography. Surgeons use mammography as a guide when removing breast tumors, cysts, and abscesses. jagged density in the mammogram. The skin is thickened over the tumor and the nipple is depressed

6. radical mastectomy more extensive surgical procedure removal of the breast, pectoral muscles, fat, fascia, and as many lymph nodes as possible in the axilla and pectoral region. breast excision simple mastectomy breast is removed down to the retromammary space.

7. accessory nipples

8. rudimentary nipple & areola mistaken for a mole (nevus) embryonic mammary crest (milk line) anywhere along a line extending from the axilla to the groin—embryonic mammary crest (milk line) from which the breasts develop.

9. Polymastia

10. There may be a nipple and/or areola, but no glandular tissue. no breast development

11. 11 Deep to the pectoral fascia & pectoralis major Descends from the clavicle Clavipectoral triangle cephalic vein can be found. pectoralis major deltoidclavicle formed by pectoralis major, deltoid & clavicle Deltopectoral groove

12. 12 In the subcutaneous tissue overlying the pectoralis major and minor muscles. lateral border of the sternum to the midaxillary line vertically from the 2nd through 6th ribs.

14. sagital T2 MRI slices, shows an ugly posterior dislocation of 6th cervical vertebra, with fracture of the body, and a spinal cord contusion and edema up and down from the compresion. C2 C8

17. Tendon Reflexes & Segmental Innervation of Muscles of the Upper Limb Triceps tendon reflex C6, 7, and 8 extension of the elbow joint by tapping the triceps tendon

18. The scapular anastomosis system is a system connecting each subclavian artery and the corresponding axillary artery, forming an anastomosis around the scapula. It allows blood to flow past the joint regardless of the position of the arm. Anterior circumflex humeral artery and posterior circumflex humeral artery are both branches of the third part of the axillary artery. The posterior circumflex humeral artery anastomoses with anterior circumflex humeral artery and also with branches from profunda brachii (a branch of brachial artery), suprascapular (a branch of subclavian artery) and thoracoacromial (a branch of axillary artery) arteries, and branches of thoracic aorta as well. All these vessels anastamose or join to connect the first part of the subclavian with the third part of the axillary, providing a collateral circulation. This collateral circulation allows for blood to continue circulating if the subclavian is obstructed.

19. Principal muscles acting on the shoulder joint Abductors Supraspinatus Deltoid Adductors Pectoralis major Lattisimus dorsi Extensors Teres major Lattisimus dorsi Deltoid (posterior fibres) Flexors Pectoralis major Coracobrachialis Deltoid (anterior fibres) Medial rotators Pectoralis major Lattisimus dorsi Teres major Deltoid (anterior fibres) Subscapularis Lateral rotators Infraspinatus Teres minor Deltoid (posterior fibres)

20. Movement of Scapula Muscles Producing Movement a Nerve to MusclesRange of Movement (Angular Rotation; Linear Displacement) ElevationTrapezius, descending part Levator scapulae Rhomboids Spinal accessory (CN XI) Dorsal scapular 10-12 cm DepressionGravity Pectoralis major, inferior sternocostal head Latissimus dorsi Trapezius, ascending part Serratus anterior, inferior part Pectoralis minor Pectoral nerves Thoracodorsal Spinal accessory (CN XI) Long thoracic Medial pectoral ProtractionSerratus anterior Pectoralis major Pectoralis minor Long thoracic Pectoral nerves Medial pectoral 40-45°; 15 cm RetractionTrapezius, middle part Rhomboids Latissimus dorsi Spinal accessory (CN XI) Dorsal scapular Thoracodorsal Upward rotation a Trapezius, descending part Trapezius, ascending part Serratus anterior, inferior part Spinal accessory (CN XI) Long thoracic 60°; inferior angle: 10-12 cm, superior angle: 5-6 cm Downward rotation b Gravity Levator scapulae Rhomboids Latissimus dorsi Pectoralis minor Pectoralis major, inferior sternocostal head Dorsal scapular Thoracodorsal Medial pectoral Pectoral nerves

21. Movement of ScapulaMuscles Producing MovementNerve to Muscles ElevationTrapezius, descending part Levator scapulae Rhomboids Spinal accessory (CN XI) Dorsal scapular DepressionGravity Pectoralis major, inferior sternocostal head Latissimus dorsi Trapezius, ascending part Serratus anterior, inferior part Pectoralis minor Pectoral nerves Thoracodorsal Spinal accessory (CN XI) Long thoracic Medial pectoral ProtractionSerratus anterior Pectoralis major Pectoralis minor Long thoracic Pectoral nerves Medial pectoral RetractionTrapezius, middle part Rhomboids Latissimus dorsi Spinal accessory (CN XI) Dorsal scapular Thoracodorsal Upward rotation a Trapezius, descending part Trapezius, ascending part Serratus anterior, inferior part Spinal accessory (CN XI) Long thoracic Downward rotation b Gravity Levator scapulae Rhomboids Latissimus dorsi Pectoralis minor Pectoralis major, inferior sternocostal head Dorsal scapular Thoracodorsal Medial pectoral Pectoral nerves

22. Clavicular (anterior) part of deltoid muscle medially rotates arm flexes and medially rotates arm Axillary nerve Lateral third of clavicle-Deltoid tuberosity of humerus Teres major Adducts and medially rotates arm Inferior subscapular nerve Posterior surface of inferior angle of scapula-Medial lip of intertubercular sulcus of humerusSubscapularis Medially rotates arm; as part of rotator cuff, helps hold head of humerus in glenoid cavity Sup. & Inf. subscapular nerves Subscapular fossa (most of anterior surface of scapula)-Lesser tubercle of humerus Latissimus dorsi Extends, adducts, medially rotates humerus (arm) Thoracodorsal nerve  Spinous processes of T7 to L5  Sacrum  Iliac crest  Ribs 10 to 12 Floor of intertubercular sulcus of humerus Adducts, flexes, and medially rotates the arm. Clavicular head: Medial half of clavicle Sternocostal head: Anterior surface of sternum Superior six costal cartilages Aponeurosis of external oblique muscle Pectoralis major Lateral and medial pectoral nerves Lateral lip of intertubercular sulcus of humerus

23. Infraspinatus Suprascapular nerve Infraspinous fossa of scapula-Middle facet of greater tubercle of humerus Teres minor Axillary nerve Middle part of lateral border of scapula-Inferior facet of greater tubercle of humerusDeltoid Spinal (posterior) part: Axillary nerve Extends and laterally rotates arm Spine of scapula-Deltoid tuberosity of humerus

24. CoracobrachialisTip of coracoid process of scapula Middle third of medial surface of humerus Musculocutaneous nerve (C5, C6, C7) Helps flex and adduct arm; resists dislocation of shoulder Clavicular (anterior) part of deltoid muscle flexes arm flexes and medially rotates arm Axillary nerve Lateral third of clavicle-Deltoid tuberosity of humerus Latissimus dorsi Extends, adducts, medially rotates humerus (arm) Thoracodorsal nerve Adducts, flexes, and medially rotates the arm. Pectoralis major Lateral and medial pectoral nerves Deltoid Acromial (middle) part: Deltoid Acromial (middle) part: abducts arm Supraspinatus Suprascapular nerve Initiates and assists deltoid in abduction of arm and acts with rotator cuff muscles.

25. BrachialisDistal half of anterior surface of humerus Coronoid process and tuberosity ulna Musculocutaneous nerve (C5, C6, C7) and small contribution by the radial nerve at the lateral part Flexes forearm in all positions Triceps brachii Long head: infraglenoid tubercle of scapula Lateral head: posterior surface of humerus, superior to radial groove Medial head: posterior surface of humerus, inferior to radial groove Proximal end of olecranon of ulna and fascia of forearm Radial nerve (C6, C7, C8) Chief extensor of forearm; long head resists dislocation of humerus; especially important during adduction

26. Pronator teres Pronates and flexes forearm (at elbow) Flexor carpi radialis Flexes and abducts hand (at wrist) Abduction of the wrist= Radial deviation with extensor carpi radialis longus et brevis. Flexor carpi ulnaris Flexes and adducts the wrist joint Adduction of the wrist= Ulnar deviation with extensor carpi ulnaris Palmaris longus Flexes hand (at wrist) and tenses palmar aponeurosis Flexor digitorum superficialis Flexes proximal interphalangeal joints of the index, middle, ring, and little fingers; can also flex metacarpophalangeal joints of the same fingers and the wrist joint Flexor digitorum profundus flexes the distal phalanges of the medial four fingers after the flexor digitorum superficialis has flexed their middle phalanges (i.e., it curls the fingers and assists with flexion of the hand, making a fist). Each tendon is capable of flexing two interphalangeal joints, the metacarpophalangeal joint. Because the tendons cross the wrist, it can flex the wrist joint as well. Brachioradialis Relatively weak flexion of forearm; maximal when forearm is in midpronated position; an accessory of flexor of the elbow joint

27. Extensor carpi radialis longus extends and abducts the wrist Extensor carpi radialis brevis extends and abducts the wrist Extensor digitorum major extensor of the four fingers (index, middle, ring, and little fingers) Extends medial four digits primarily at metacarpophalangeal joints, secondarily at interphalangeal joints ; can also extend the wrist Extensor carpi ulnaris Extends and adducts hand at wrist joint (also active during fist clenching)

28. Biceps brachiiShort head: tip of coracoid process of scapula Long head: supraglenoid tubercle of scapula Tuberosity of radius and fascia of forearm via bicipital aponeurosis Musculocutaneous nerve (C5, C6, C7) Supinates forearm and, when it is supine. flexes forearm; short head resists dislocation of shoulder pronator quadratus is the prime mover for pronation.

29. 29  The patient is unable to extend the wrist.  Loss of sensation on the lateral and posterior parts of the forearm A terrible accident in the highway. A public bus involved. Many deaths and injured. Your patient has the following findings following a thorough neurological exam: Which nerve(s) injured?

30. 30 Innervation of the posterior compartment of the arm 1 POINT A. Ulnar nerve B Radial nerve C. Median nerve D. Axillary nerve

31. 31 Triceps tendon reflex 2 PTS A. C6 B C6 & C7 C. C6-C7-C8 D. C7

32. 32 A branch not from the 3rd part of the axillary artery 3 PTS A. Subscapular artery B Anterior circumflex humeral artery C. Posterior circumflex humeral artery D. Lateral thoracic artery