THE PECTORAL REGION

AND THE AXILLA

KIMAIGA H.O
1ST YEAR MBChB(UoN)
The Pectoral Region: Introduction

trapezius
supraclavicular fossa

clavicle
Anterior axillary fold

pectoralis major
pectoralis major
STERNAL
ANGLE
is the angle formed by
the junction of the
manubrium and the
body of the sternum.
The sternal angle is an
important landmark
because it indictes the
level at which the
second rib joins the
sternum.
MID-AXILLARY
LINE
is a line
running
vertically
down the
surface of
the body
passing
from the
apex of the
axilla to
the costal
margin.
PECTORALIS MAJOR
MUSCLE
is a large triangle
muscles
consisting of a
large sternal
portion and
smaller clavicular
portion
The proximal attachment
of the pectoralis major
muscle arises from two
heads. The
STERNOCOSTAL head
from the sternum and
upper six costal cartilages
and the CLAVICULAR head
from the anterior aspect of
the clavicle.  Notice the
orientation of the fibers of
each head.
The fibers of the two heads
converge and insert into the
lateral lip of the
INTERTUBERCULAR
(BICIPITAL) SULCUS of the
humerus.

At the distal attachment the

tendon of the pectoralis major
undergoes a spiral twist so that
the lower fibers are attached at a
higher level on the humerus
than the upper fibers.
PECTORALIS MINOR MUSCLE
The is enveloped by the
clavipectoral fascia. It
arises from ribs 3,4,& 5 to
attach on the coracoid
process.
Dissect the
costocoracoid membrane
(a thickening of the
clavipectoral fascia )
 Muscles of the Pectoral Region

Muscle Origin Insertion Nerve Action

pectoralis medial clavicle, lateral stenum lateral lip of intertubercular medial and lateral pectoral Flexes, adducts and
major and 1st seven costal cartilages sulcus nerves medially rotates arm

pectoralis draws scapula down

ribs 3-5 coracoid process of scapula medial pectoral nerve
minor and forward
draws shoulder down
subclavius first rib clavicle nerve to subclavius and forward
serratus rotates scapula draws
anteriolateral surfaces ribs 1-8 vertebral border of scapula long throacic nerve
anterior scapula forward
MEDIAL PECTORAL NERVE
may pierce or extend
laterally around the
pectoralis minor muscle
before it passes into the
deep surface of the
pectoralis major muscle
which it innervates.
Preserve this attachment.
The pectoralis minor muscle
is innervated by the medial
pectoral nerve.
The DELTOID MUSCLE
froms the cap of the
shoulder. Its clavicular
head is visible in the
anterior pectoral region.
Recall the CEPHALIC
VEIN travels thorugh the
the deltopectoral
triangle.

Turning deep, it drains

into the
AXILLARY VEIN.
What structures pierce the clavipectoral
fascia?
The clavipectoral fascia is pierced by the cephalic vein,
the pectoral nerves and the deltoid and pectoral
branches of the thoracoarcomial artery.
The COSTOCORACOID
MEMBRANE is that
portion of the
clavipectoral fascia
between the pectoralis
minor muscle and the
clavicle.
The SUBCLAVIUS
MUSCLE is encased by
the costocoracoid
membrane.
The SUBCLAVIUS
MUSCLE passes from
the first rib to the distal
end of the clavicle.
DELTOPECTORAL TRIANGLE
is a triangular space
bounded by the lateral
border of the pectoralis
major muscle, medial
border of the deltoid
muscle, and clavicle.
CEPHALIC VEIN
As it enters the
deltopectoral space, the
CEPHALIC VEIN pierces
the fascia and then
passes in the groove
between the pectoralis
major muscle and
deltoid muscle to join
the axillary vein.
AXILARY VEIN
Of the structures deep
in the axilla, the
AXILARY VEIN lies
superfical and most
medial.
ANTERIOR CUTANEOUS NERVES & VESSELS
The segmentally
arranged neurovascular
bundles pierce the deep
fascia of the underlying
muscle. They enter the
superficial fascia about 1
to 2 cm lateral to the
sternum in the
intercostal spaces
In mid-axillary space the
segmentally arranged
vessels and nerves are
the LATERAL
CUTANEOUS NERVES
of the intercostal nerves
and vessels.
The LATERAL
PECTORAL NERVES
AND BRANCHES OF
THE
THORACOACROMIAL
ARTERY arise from the
deltopectoral triangle to
supply the pectoralis
major muscle.
The BRANCHES OF THE
THORACOACROMINAL
TRUNK emerge in the
deltopectoral triangle to
spread to the acromial,
clavicular, pectoral and
deltoid areas.

Trace the branches back

into the deltopectoral
triangle to identify the
THORACOACROMINAL T
RUNK
The THORACOACROMINAL
TRUNK pierces the costocoracoid
membrane to emerge from the
triangle. It divides into acromial,
clavicular, pectoral and deltoid
branches. A few which can be
identified.

Trace the
THORACOACROMINAL TRUNK
deep into the deltopectoral
triangle to identify the
AXILLARY ARTERY.
The AXILLARY ARTERY
passes posterior to the
insertion of the
pectoralis minor to enter
the arm and can be
observed in the
deltopectoral traingle.
The LATERAL
PECTORAL NERVES
emerge from the
deltopectoral triangle to
inneravte the pectoralis
major muscle.

Trace the lateral pectoral

nerve back into the
deltopectoral traingle to
its source;
What is the relationship of the medial
pectoral nerve to the pectoralis minor
muscle, the lateral pectoral nerve?
Interestingly due to the location of the brachial plexus
within the axilla, the pectoral nerves emerge in what
would appear to be the reverse of the expected. The
medial pectoral nerve emerges from the pectoralis
minor muscle more laterally than the lateral pectoral
nerve. The lateral pectoral nerve does not pierce the
pectoralis minor, but rather emerges superomedial to
the muscle.
The LATERAL CORD
OF THE BRACHIAL
PLEXUS lies just lateral
to the axillary artery. It
will be studied in detail
with the brachial plexus
at a later dissection.
The Clavicle
Gross features
Sigmoid bone.
Medial 2/3 convex
anteriorly.
Lateral 1/3 concave
anteriorly.
Sternal articular surface
more rounded.
Inferior surface rougher
due to muscle and
ligamentous attachments.
Muscular attachments
Some unique features of
Functions of the clavicle
the clavicle
 Starts ossification during week 5, while  Hold the upper limb away
the others commence during week 8.
Ossification is completed around 25
from the trunk and increase
years, while for the others, it is about the range of movement,
18-21 years. especially abduction.
 It runs a sigmoid horizontal course.
 Transmit weight from the
Most long bones are vertical and
straight. (Compare with the femur or upper limb to axial skeleton.
tibia)  Provide attachment for
 It does not have a marrow cavity; its
muscles.
core is occupied by spongy bone.
 The medial 2/3 ossifies endochondrally
while the lateral 1/3 ossifies
intramembranously.
Sternum
The sternum is made up
of three parts i.e
1. The manubrium
2. The body
3. The xiphoid process
What is the importance
of the sternum in clinical
practice?
The Mammary Gland:
Position Pectoral region

Subcutaneous

From lateral border of the sternum to mid-

axillary line.

Axillary tail extends further into axilla.

From 2 nd to 6 th ribs.

Nipple in 4 th intercostals space about

midclavicular line.
Relations  
Overlies fascia covering 4 muscles
Pectoralis major.

Serratus anterior.

External oblique abdominis aponeurosis.

Rectus abdominis
Separated from this fascia by submammary space (retro
mammary space) with loose connective tissue. This is the
basis for free mobility of the breast over chest wall.
Blood supply
The breast receives its blood supply from the following arteries:
1. Lateral thoracic

2. Perforating branch of internal thoracic

3. Perforating branch of posterior intercostal arteries

4. Twigs from superior thoracic and pectoral branch of tharacoacromial.

Veins correspond and end in the axillary vein, or subclavian vein directly.
Veins which accompany the intercostal veins, end in the azygous venous system.
The intercostal veins communicate with the external and from thence to the
internal vertebral venous plexus.
Lymphatic drainage
There are two plexuses of lymphatic vessels i.e. the subareoalar and the
perilobular. These anastomoses freely. Their efferents are shown.
78-80% to the axillary lymph nodes

20% to the parasternal nodes

Communicate with:
Opposite breast

Infraclavicular and supraclavicular nodes

Subperitoneal and subdiaphragmatic nodes 

What is the importance of the lymphatic drainage in breast cancer metastasis?
Clavipectoral Fascia
Clavipectoral fascia arises
from the clavicle,
encloses subclavius,
pectoralis minor and
attaches to axillary fascia
Pierced by
1. Cephalic vein
2. Thoracoacromial artery
3. Lymphatics
4. Lateral pectoral nerve
 Cephalic vein

Cephalic vein
Lateral pectoral nerve

Thoracoacromial artery
Muscles in the Pectoral Region

Pectoralis Major
(1) Origin Medial half of the clavicle
Anterior surface of the sternum
First six costal cartilages
 
Insertion External oblique.
Lip of bicipital (intertubacular) groove of humerus
 
Actions Adduction of the extended limb
Medial rotator of the arm
Flexion of the upper limb (Clavicular portion)
Depression of the arm and shoulder (sternocostal
head)
Elavation of the ribs (used in artificial respiration)

Innervation
Medial pectoral nerve
Lateral pectoral nerve
Identify muscles 2 and 3
Pectoralis minor (2)
Origin
3 rd -5 th ribs
fascia covering the intercostal muscles

Insertion
Coracoid process of the scapula
Rarely the tendon of insertion passes upwards to
blend with the coracohumeral ligament

Innervation
Medial pectoral nerve(from the medial cord of
the brachial plexus)

Actions
Depresses the point of the shoulder
With the serratus anterior, it draws the scapula
forwards round the thoracic wal
Serratus anterior (3)
Origin
Upper 8 sibs anterolaterally  

Insertion
First slip: inferior angle of scapula
Next three: medial border of the scapula
Last four: inferior angle of scapula

Innervation
Long thoracic nerve (C5,C6 C7)
 
Actions
Protraction of the scapula
Lateral rotation of the scapula
Subclavius
Origin
Junction of the first rib and its costal
cartilage
 
Insertion
Inferior aspect of clavicle (Area marked [C])

Innervation
Upper trunk of brachial plexus (C5, C6)
 
Actions
Depresses lateral part of clavicle
Note: The subclavius acts as a buffer
between a fractured clavicle and subclavian
artery
The Axilla
Location and importance
Pyramid-shaped space between the
upper part of the arm, and the side
of the upper chest.
Provides passage for nerves, blood
and lymph vessels from the root of
the neck to the upper limb.
 
Note the boundaries:
Anterior axillary fold [D]
Posterior axillary fold [B]
Base formed by skin [C]
Lateral border [A] formed by
humerus
Boundaries
Apex:
Anterior: the lateral part of the clavicle.
Posterior: upper part of the scapula.
Medially: outer border of the first rib.
 
Walls:
Anterior: pectoralis major, minor and subclavius
Posterior: subscapularis, latissimus dorsi and teres
major
Medial: upper 5 ribs and intercostal muscles covered
by serratus anterior.
Lateral: biceps brachii and coracobrachialis.

Base:
Anterior: lower border of pectoralis major.
Posterior: tendons of latissimus dorsi and teres major
muscle
Medial: chest wall
Floor: axillary fascia and skin stretching between the
anterior and posterior walls.
Contents
Axillary artery and its branches
Axillary veins and its proximal tributaries
Brachial plexus - cords
Axillary lymph nodes
The Axillary Artery
Extents: Lateral border of first rib as a continuation of
subclavian artery to the lower border of teres major where
it continues as brachial artery  
Parts: Divided into three by pectoralis minor muscle.
Part 1 is proximal to the muscle.
Part 2 is posterior to the muscle.
Part 3 is distal to the muscle.
The Axillary Artery parts and Branches
Part Branch Branches and distribution
 
First Part •Supreme thoracic Upper chest wall
Second part •Lateral thoracic Runs with long thoracic
nerve to supply serratus
anterior and lateral breast

  •Thoracoacromial •Deltoid branch-deltoid

muscle
•Acromial branch-
thoracoacromial joint
•Clavicular branch-clavicle
•Pectoral branch-pectoralis
major and breast

Third Part •Subscapular •Circumflex scapular-

scapular region
•Thoracodorsal-scapular
region and latissimus dorsi

  •Anterior humeral •Shoulder joint

circumflex
  •Posterior humeral •Deltoid, humerus and
circumflex shoulder joint.
Axillary Vein
Extends from the lower border of teres major where it is
formed by union of basilic vein and “brachial vein” to the
lateral border of 1 st rib where it continues as subclavian
vein

Located medial to the axillary artery

Receives tributaries corresponding to the branches of the

axillary artery; and the cephalic vein.
Brachial plexus
Origins  
 Vertical rami of C5-T1 Occasionally it
is prefixed i.e. C4 contributes; or it is
post fixed i.e. T2 contributes
Parts   Roots, trunks, divisions, cords
and branches.
In relation to the clavicle, there are 3
parts namely
1. Supraclavicular (cervical)-  Roots
and trunks
2. Clavicular (retroclavicular) –
Divisions
3. Infraclavicular (axillary) – Cords and
branches
 
The ROOTS AND
TRUNKS OF THE
BRACHIAL PLEXUS
emerge from the interval
between the scalene
anterior and scalene
medius & posterior
muscles.
The TRUNKS OF THE
BRACHIAL PLEXUS
descend through the
posterior traingle to pass
under the clavicle and
subclavius muscles.
UPPER TRUNK
MIDDLE TRUNK
LOWER TRUNK
The UPPER TRUNK
gives a number of
branches within the
posterior triangle.
The SUPRASCAPULAR
NERVE arises from the
upper trunk. It passes
laterally to the upper
border of the scapular.
The SUPRASCAPULAR
ARTERY & VEIN
accompanies the
suprascapular nerve to
pass posteriolaterally
reach the posterior
aspect of the scapular.
The UPPER TRUNK is
formed by the union of
the ventral rami of the
fifth and sixth cervical
nerves.
The VENTRAL RAMI
OF THE FIFTH & SIXTH
CERVICAL NERVES
come together to give
rise to the upper trunk.
The DORSAL
SCAPULAR NERVE is a
branch of C5. It passes
along the levator
scapulae muscle to exit
the floor of the posterior
triangle.
The DORSAL
SCAPULAR ARTERY
arises directly off the
subclavian artery. It
passes posteriorly with
the dorsal scapular nerve
to reach the dorsal
surface of the scapula.
The MIDDLE TRUNK
OF THE BRACHIAL
PLEXUS has no branches
in the posterior triangle.
The VENTRAL RAMI
OF THE SEVENTH
CERVICAL NERVE (C7)
emerges from under the
anterior scalene muscle.

The upper trunk is the

direct continuation of
the seventh cervical
nerve.
The LOWER TRUNK in
the posterior triangle has
no branches.
The UPPER TRUNK
gives divisions to the
lateral and posterior
cords
The ANTERIOR DIVISION
OF THE UPPER TRUNK The POSTERIOR DIVISION OF THE UPPER
TRUNK contributes to the posterior cord.
contributes to the lateral
cord.
The ANTERIOR DIVISION
OF THE MIDDLE TRUNK The POSTERIOR DIVISION OF THE MIDDLE TRUNK also

joins with the anterior contributes to the posterior cord along with the psoterior
division of the upper trunk.

division of the upper trunk

to form the lateral cord.
The ANTERIOR DIVISION
OF THE LOWER TRUNK The POSTERIOR DIVISION OF THE LOWER TRUNK
joins with the posterior divisions of the upper and
continues distally as the middle trunks to form the posterior cord.

medial cord.
The POSTERIOR CORD
is formed by
contributions from the
posterior divisions of the
upper, middle and lower
trunks.
Formation
Formation of trunks
Roots C5 and C6 unite to form the superior trunk [s.t]

Root C7 continues as the middle trunk [m.t]

Roots C8 and T1 unite to form the inferior trunk [i.t]

Formation of divisions and cords

Each trunk divides into an anterior and posterior
division

The anterior divisions of the upper and middle trunk

from the lateral cord [l.c].

The anterior division of the lower trunk continues as

the medial cord [m.c]

All the posterior divisions form the posterior cord [p.c]

The LONG THORACIC
NERVE originates from
the ventral rami of C5-7.
It takes a vertical course,
pasing posterior to the
trunks of the brachial
plexus, to reach the
serratus anterior muscle
in the axilla.

The SUPRASCAPULAR
NERVE passes posterior
to the scapula through
the SUPRASCAPULAR
FORAMEN.

The TRANSVERSE
SCAPULAR LIGAMENT
spans the notch creating
the suprascapular
foramen.
Note the
SUPRASCAPULAR
ARTERY (probe) passes
over the transverse
scapular ligament, while
the SUPRASCAPULAR
NERVE (forceps) passes
through the foramen.
Part Branch Distribution

Roots Dorsal scapular (c5) •Levator scapulae

•Rhomboids

Long thoracic (C5, 6,7) •Serratus anterior

Phrenic (C3, 4, 5) •Thoracic diaphragm

Trunks Nerve to subclavius (C5, 6) •Subclavius muscle

Suprascapular (c5, 6) •Supraspinatus

•Infraspinatus

Lateral cord Lateral pectoral (C5,6,7) •Pectoralis major

Musculocutaneous (C5,6,7) •Biceps brachii, coracobrachialis, brachialis

Lateral root of median nerve •See median nerve

Medial cord Medial pectoral (C8, T1) •Pectoralis major and minor

Medial cutaneous nerve of the arm (C8-T1) •Medial arm

Medial cutaneous nerve of the forearm (C8-T1) •Medial forearm

Medial root of median nerve (C8-T1) •See median nerve

Ulnar nerve (C8-T1) •Forearm and hand

Posterior cord Upper Subscapular •Subscapularis

Lower Subscapular •Subscapularis and teres major

Axillary nerve •Deltoid, teres minor, shoulder joint, skin over deltoid

Thoracodorsal •Latissimus dorsi

Radial nerve •Extensor muscles of arm and of forearm

Communications of the brachial
plexus
Sympathetic from the inferior cervical ganglion
Intercosto-brachial nerve from T2
Phrenic nerve
Cervical plexus
Axillary lymph nodes

They number 20-30,and drain lymph

from the following:
1. Lateral quadrants of the breast

2. Superficial lymph vessels from

thoracoabdominal walls above the
umbilicus

3. The back

4. Upper limb

5. Lower neck
They are arranged in 6 groups:
Group Location Drainage
1) Anterior (pectoral group) Along lower border of pectoralis minor •Lateral quadrants of breast
•Anterolateral abdominal wall

2) Posterior scapular) group In front of subscapularis The back down to the iliac crest

3) Lateral group Medial side of axillary vein Upper limb except superficial vessels
from lateral side

4) Central group Axillary fat in the center From the above three groups

5) Infraclavicular (deltopectoral) Between pectoralis major and deltoid Superficial lateral hand, forearm and
group arm

6) Apical group Apex, at lateral border of the first rib All the other axillary nodes

Efferents
The apical nodes drain into the subclavian trunk. On the left side, this trunk drains into
the thoracic duct; on the right side, it drains into the right lymphatic trunk. The lymph
trunks may drain directly into one of the large veins at the root of the neck
Applied Anatomy
1.0 Fracture of the clavicle
The clavicle is most commonly fractured bone in the body.
It is more commonly fractured than dislocated because:
Runs a sigmoid course
Held in place by strong ligaments
Presents areas of relative weakness
The fractures usually occur as a result of a fall on the shoulder or
outstretched hand.

The commonest site of fractures is between the distal and middle thirds.

The lateral fragment is depressed the weight of the arm and the deltoid,
and is also pulled medially and forward by pectoralis major.

The medial end is tilted upwards by the sternomastoid muscle.

The brachial plexus and axillary vessels are in danger of injury.

The close relationship of the supraclavicular nerves to the clavicle may

result in their involvement in callus formation after fracture of the bone.

This may be the cause of persistent pain over the side of the neck.

The clavicle's subcutaneous position impairs its blood supply, thus delaying
union following fracture.
Compression of the subclavian
Dislocation of the
vessels and brachial plexus
The interval between the clavicle and acromioclavicular joint
the first rib in some patients may
become narrowed, causing
Falls on the shoulder
compression of neurovascular may dislocate the
structures there.
Most of the symptoms are caused by
acromioclavicular joint,
pressure on the lower trunk of the forcing the acromion
plexus producing pain down the medial
side of the forearm and hand, and under the clavicle and
wasting of the small muscles of the
hand.
tearing the
coracoclavicular
Pressure on the vessels may compromise
the circulation of the upper limb.
ligament.
Breast Cancer  
Cancer of the breast can spread via lymphatics, or venous channels. During
haematogenous spread, the communication with the vertebral venous plexus
provides a route for spread to the central nervous system.
Because of the axillary tail , and early involvement of the axillary lymph nodes
in breast cancer, always examine the axilla whenever you do breast examination

Accessory mammary tissue  

Accessory breasts or nipples may occur above or below the normal breast in
either sex.
Commonly, these accessory or supernumerary “breasts” consist only of a nipple
and an areola, but sometimes, true glandular tissue is present also.
Supernumerary breasts are usually found along a line extending from the axilla
through the normal breast to the groin, this being regarded as the milk line , or
line along which mammals with multiple breasts usually develop them.
Occasionally, supernumerary breasts are found beyond the usual extent of the
milk line, for instance, on the neck or on the vulva or femoral triangle.
Mammography

This is radiographic
examinaion of the breast.
Extensively used for
screening breasts for
benign annd malignant
tumors and cysts. It can
detect very small lesions
unnoticed by clinical
examination. Because the
process is usually repeated
often, only very small doses
are used.
Suspensory ligaments and skin dimpling
The breast tissue is divided into 15- 20 compartments
that radiate from the nipple by fibrous septa that
extend from the skin to the underlying fascia.
If the fibrous tissue gets involved in malignant disease,
or inflammation or abcess,they may contract and pull
on the skin, causing its dimpling to give an orange peel
appearance(peau de orange)
Radical mastectomy  
Operation done on patients with localized cancer of the breast with early spread to
lymph nodes
It comprises of removal of the breast together with lymph vessels and nodes that drain
the area. The excised mass consists of the following;
A large area of the skin overlying the tumor and including the nipple
All the breast tissue
Pectoralis major and associated fascia
Pectoralis minor and associated fascia
All the fat, fascia and lymph nodes in the axilla
Fascia
The following must be spared
Axillary vessels
Brachial plexus
Nerves to serratus anterior and latismus dorsi
Postoperative edema of the upper limb is due to removal of lymph vessels/nodes draining the
upper limb
Modified radical mastectomy
 Done to patients with clinically localized cancer
The primary tumor is removed together with axillary
lymph nodes, fat and fascia
The pectoral muscles are left intact
Mastitis  
This is acute infection of the breast common during
lactation. Bacteria gain entrance into breast tissue
through a crack in the nipple. Initially, the fibrous
septa contain the infection in one lobe Abcess
drainage Radially arranged ducts usually drain these.
Simple mastectomy  
 This is removal of the beast, done usually in localized cancer of the
breast.
Usually combined with radiotherapy and/or hormonal therapy of
axillary lymph nodes

Clavicle  
Abnormal development of the clavicle may result in the absence of
most of each clavicle. The shoulders will be very narrow and the
individual may be able to bring the shoulders together in the midline.
The clavicle results from fusion of two ossification centers. Sometimes
fusion fails, resulting in a defect that separates the outer third and the
inner two thirds. Following upper limb trauma, this defect may be
confused for a fracture
Injuries of brachial plexus
Can be caused by
Violent separation of the head and shoulder as may occur in a fall from a motorcycle or during delivery

Violent stretching of the arm above the head as in breech delivery, fall from a tree, skidding, e.t.c.

Wounds in the neck or axilla

Surgery in the lower neck or axilla

Chronic irritation by heavy loads carried on the side of the neck

Compression by a tumor, abnormal rib, or contracting muscle.

Fractured clavicle, and in the case of nerves, any other bone.

The injuries may be classified into two:

 Upper type, which involves the roots C5, 6, and results in unopposed medial rotation and in adduction of the upper
limb. This position is sometimes referred to as “porter's, waiters' or policeman's hand”. The paralysis “Erb's or Erb-
duchenne paralysis) affects mainly the shoulder and arm.

 Lower type, which involve C8,T1 and result in claw hand. This is also called Lampe's or Klumpke-Dejerine paralysis.
Summary of nerve injuries in the upper limb
Nerve Common site and Effects
causes
Radial 1.Fracture humeral 1.Wrist drop
shaft 2.Sensory loss over 1st dorsal interosseous
2.Axilla by poorly
fitting crutches
(Crutch palsy)
3.Saturday night palsy
– draping arm over
chair while drunk
4.Supracondylar
humeral fracture

Axillary 1.Shoulder dislocation 1.Weakened shoulder abduction

2.Fracture surgical 2.Anaesthesia over lower part of deltoid
neck humerus
3.Misplaced injections
into deltoid
Summary of nerve injuries in the upper limb
Ulna 1.Behind medial 1.Claw hand
humeral epicondyle by 2.‘Guttering’ between metacarpals due to
fracture or wasting of interossei
compression or 3.Sensory loss on ulna side of hand
traction in cubitus
valgus
2.Supracondylar
humeral fracture
3.Wrist

Median 1.Wrist- by cuts or 1.Wasting of flexor muscles

compression in carpal 2.Wasting of thenar muscles
tunnel 3.Hand with index finger straight ’Pointing
2.At elbow by finger position’
compression in cubital 4.Sensory impairement over radial 3/5th of
fossa palmar surface of hands
3.Struther’s ligament
4.Supracondylar
humeral fracture/
brachial artery
aneurysms
Radical mastectomy
involved removal of the entire breast, nipple/areolar
region, the pectoral major and minor muscles, and
lymph nodes. Patients who received radical
mastectomy often complained the inability to comb
their hair or put on make-up. This was due to the loss
of the flexion and medial rotation actions of the
pectoralis major on the shoulder joint. This procedure
is rarely performed today
Review Questions
Describe the features, relations, muscle attachments and applied anatomy of
the clavicle

Describe the position, relations, blood supply, lymphatic drainage and applied
anatomy of mammary gland

Describe the boundaries and contents of axilla

Write short notes on extents, branches and distribution of axillary artery

Describe the formation, branches, distribution and injuries of brachial plexus

Describe the organization and respective territory of drainage of axillary

lymph nodes