Anterior Chest Wall - University of Utah · 2008-09-03 · C. Intercostal lymph nodes – Right...
Transcript of Anterior Chest Wall - University of Utah · 2008-09-03 · C. Intercostal lymph nodes – Right...
1
A patient suffers a puncture wound in the back just lateral to the 2nd
thoracic vertebra. The puncture wound courses until it hits the
erector spinae muscle group. From superficial to deep, identify the
correct order of muscles hit by the protruding object.
Tra
peziu
s, la
tissi
mus.
..
Tra
peziu
s, rhom
boids.
..
Tra
peziu
s, rhom
boid..
Tra
peziu
s, rhom
boids.
..
Tra
peziu
s, rhom
boids.
..
20% 20% 20%20%20%
A. Trapezius, latissimus dorsi, rhomboids, erectorspinae m.
B. Trapezius, rhomboids, serratus posteriorsuperior, splenius ., errector spinae m.
C. Trapezius, rhomboids, splenius m, erectorspinae m.
D. Trapezius, rhomboids, serratus posteriorsuperior, erector spinae m.
E. Trapezius, rhomboids, splenius m., serratusposterior superior, erector spinae m.
Anterior Chest Wall
• Anterior Chest Wall
-Osteology (dry lab)
-Gray’s pp. 118-126
-Gray’s Dissector pp. 49-54
-Anterior Chest Wall
-Gray’s pp. 115-135; 333-336
-Gray’s Dissector pp. 55-72
2
Skin of the Anterior Chest Wall
Syllabus p. 30
Lines of the Thoracic Wall
Syllabus p. 30
3
Breasts
Female Male
Syllabus p. 31
Anatomy of the Female Breast
Syllabus p. 31
4
Innervation of the Breast
Blood Supply of the Breast
Syllabus p. 31
5
Lymphatics of the Breast
Syllabus p. 31
The Lymphatic System
-Capillaries-Vessels-Nodes-Lymphocytes
The Lymphatic System
-Capillaries-Vessels-Nodes-Lymphocytes
6
Lymphatic Ducts
-Thoracic Duct-Right Lymphatic Duct
Lymphatics of the Right Breast
7
Lymphatics of the Left Breast
Cancer develops in the right breast of a 34 year old woman. The woman
experiences a loss of sensation in her nipple. Which nerve is likely affected
by the tumor?
T1
T2
T3
T4
T5
20% 20% 20%20%20%
A. T1
B. T2
C. T3
D. T4
E. T5
8
Lymphatic drainage to the right upper quadrant of the breast is also
compromised. Which of the following lymph nodes are more greatly
affected?
Max
illar
y ly
mph n
odes..
Par
aste
rnal
lym
ph n...
Inte
rcost
al ly
mph n
od..
Axi
llary
lym
ph nodes
..
Inte
rcost
al ly
mph n
od..
20% 20% 20%20%20%
A. Axillary lymph nodes - Right lymphaticduct
B. Parasternal lymph nodes - Rightlymphatic duct
C. Intercostal lymph nodes – Rightlymphatic duct
D. Axillary lymph nodes – Thoracic duct
E. Intercostal lymph nodes – Thoracic duct
Muscles of the Thoracic Wall
-Pectoralis Muscles*-Serratus Anterior Muscles*-Subclavius*-Intercostals*-Transversus Thoracis-Subcostalis-Diaphragm
Syllabus pp. 32
9
Pectoralis Major and Minor
Innervation of the Pectoralis Major and Minor
10
Innervation of the Pectoralis Major
Serratus Anterior
11
The Lateral Thoracic Artery (Serratus Anterior)
Subclavius
12
Innervation of the Subclavius
A mastectomy is used to remove a cancerous tumor from a 46 year old
woman. The procedure involves excision of the breast tissue to the
pectoralis major muscle, associated fascia, and into the medial axillary wall.
After the procedure the woman has a noticeable winged scapula. The
following nerve is most likely damaged:
Spin
al a
cces
sory
n.
Lat
eral
pec
tora
l n.
Long th
oraci
c n.
Dors
al s
capula
r n.
Med
ial p
ecto
ral n
.
20% 20% 20%20%20%
A. Spinal accessory n.
B. Lateral pectoral n.
C. Long thoracic n.
D. Dorsal scapular n.
E. Nerve to the subclavius.
13
Intercostal Muscles
Intercostal Nerves and Vessels
14
Clinical Correlates
FYI: Diaphragm will be discussed
in the next lecture
15
Arteries of the Thorax
Syllabus p. 33
Veins of the Thorax
Syllabus p. 34
16
SCREEN 2
Trapezius
17
Trapezius, Rhomboid m., Serratus Posterior Superior, Splenius m.
Trapezius, Rhomboid m., Serratus Posterior Superior, Splenius m.,
Deep Muscles of Back
18
Segmental Innervation of the
Anterior Skin
19
The Female Breast
20
Innervation of the Breast
Blood Supply of the Breast
21
Lymphatics of the Right Breast
22
Lymphatics of the Left Breast
23
Innervation of the Pectoralis Major and Minor
24
Serratus Anterior
Subclavius
25
Intercostal Muscles
26
Intercostal Nerves and Vessels