2 rotator cuff

8/2/2019 2 Rotator Cuff

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Rotator Cuff

The rotator cuff is the name given to the tendons of

the subscapularis, supraspinatus, infraspinatus, andteres minor muscles, which are fused to theunderlying capsule of the shoulder joint.

The cuff plays a very important role in stabilizing the

shoulder joint. The tone of these muscles assists in holding the head

of the humerus in the glenoid cavity of the scapuladuring movements at the shoulder joint.

The cuff lies on the anterior, superior, and posterioraspects of the joint.

The cuff is deficient inferiorly, and this is a site ofpotential weakness.


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Clinical Notes

Shoulder Dislocation

The shoulder joint is the most commonly

dislocated large joint, either anterior or

posterior.

Anterior inferior dislocation is the most

common.

Posterior dislocations are rare. It can causedamage to the axillary nerve.


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2- Sternoclavicular joint

Occurs between the sternal end of the

clavicle, the manubrium sterni, and the 1st

costal cartilage.

It is a synovial double plane joint

The joint is innervated by the supraclavicular

nerve and the nerve to subclavius muscle.

Movements are forward and backward,

elevation and depression.


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3- Acromioclavicular joint

Occurs between the acromion process ofscapula and the lateral end of the clavicle.

It is a synovial plane joint.

The joint is innervated by the suprascapularnerve.

Movement is a gliding movement takes place

when the scapula rotates, or when the clavicleis elevated or depressed.


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3

AXILLA


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The axilla, or the armpit, is a pyramid-shapedspace between the upper part of the arm and

the side of the chest.

It forms an important passage of nerves,blood, and lymph vessels as they travel from

the root of the neck to the upper limb.


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We have to discuss:

APEX

BASE

MEDIAL WALL LATERAL WALL

ANTERIOR WALL

POSTERIOR WALL


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Apex

It is the upper end of axilla.

It is directed into the root of the neck and is

bounded in front by the clavicle, behind by the

upper border of the scapula, and medially by

the outer border of the 1st rib.


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Base

It is the lower end of axilla.

It is formed by the skin stretching between the

anterior and posterior walls.

It is bounded in front by the anterior axillary fold (formed by the lower border of pectoralis major

muscle ), behind by the posterior axillary fold

(formed by the tendon of latissimus dorsi and the

teres major muscle ) , and medially by the chest wall.


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Anterior wall

It is formed by the pectoralis major,

subclavius, and pectoralis minor muscles, theclavipectoral fascia, and the suspensory

ligament of the axilla.


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Posterior wall

It is formed by the subscapularis, latissimus

dorsi, and teres major muscles from above

down.


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Medial wall

It is formed by the upper four ribs and the

intercostal spaces covered by the serratus

anterior muscle.


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Lateral wall

It is formed by the coracobrachialis and biceps

muscles in the bicipital groove of the

humerus.


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Contents of the axilla

Axillary artery and its branches.

Axillary vein and its tributaries.

Lymph vessels and lymph nodes

Brachial plexus


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Axillary artery

It begins at the lateral border of the 1st rib as acontinuation of the subclavian, and ends at the lower

border of teres major muscle, where it continues as

the brachial artery.

Throughout its course, the artery is closely related to

the cords of brachial plexus and their branches and is

enclosed with them in a connective tissue sheath,

called the axillary sheath. This sheath is acontinuation of the prevertebral fascia.


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Axillary artery is divided into three parts

according to its relations with pectoralis

minor muscle.


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1st part of axillary artery

It extends from the lateral border of the 1st rib

to the upper border of the pectoralis minor.


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2nd part of axillary artery

It lies behind the pectoralis minor muscle.


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3rd part of axillary artery

It extends from the lower border of the

pectoralis minor to the lower border of teres

major.


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Branches The branches of the axillary artery supply the chest

wall and shoulder.

the 1st, 2nd and 3rd parts give off one, two andthree branches respectively:

1st part: (1) superior thoracic artery2nd part: (1) thoracoacromial trunk

(2) lateral thoracic artery

3rd part: (1) subscapular artery

(2) anterior circumflex humeral artery

(3) posterior circumflex humeral artery


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Axillary vein

It is formed in the region of the lower border of theteres major muscle by the union of the venae

comitantes of the brachial artery and the basilic vein.

It runs upward on the medial side of the axillary

artery and ends at the outer border of the 1st rib bybecoming the subclavian vein.

The vein receives tributaries, which correspond to

the branches of axillary artery, and, in addition, it

receives the cephalic vein.


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4

Brachial Plexus


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Nerves entering the upper limb provides the

following functions:

1- sensory innervation to the skin and deep

structures, such as joints.

2- motor innervation to the muscles.

3- sympathetic vasomotor nerves.

4- sympathetic secretomotor supply to the

sweat glands.


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The brachial plexus is formed in the posterior triangleof the neck by the union of the anterior rami of the

5th

, 6th

, 7th

, and 8th

cervical and the 1st

dorsal spinalnerves.

Roots, trunks and divisions lie in the posteriortriangle.

The roots lie between the anterior and middlescalene muscles.

The trunks traverse the posterior triangle of theneck.

The divisions lie behind the clavicle.

The cords lie in the axilla.


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The plexus is formed as follows:

1- five roots derived from the anterior rami of

C5, 6, 7, 8 and T1; link up into:

2- three trunks formed by the union of

C5 and 6 (upper)C7 alone (middle)

C8 and T1 (lower) ( lower trunk lies behind

the 3rd

part of subclavian artery)trunks split into:


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3- six divisions formed by each trunk dividinginto an anterior and posterior

division; which link up again into:

4- three cords

a lateral, from the fused anterior divisions of

the upper and middle trunks; a medial, from the anterior division of thelower trunk;

a posterior, from the union of all threeposterior divisions.


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The three cords lie above and lateral to the 1st part of

the axillary artery.

The medial cord crosses behind the artery to reach themedial side of the 2nd part of the artery.

The posterior cord lies behind the 2nd part of the artery.

The lateral cord lies on the lateral side of the 2nd part of

the artery.

Thus, the cords of the plexus have the relationship to

the 2nd part of the axillary artery that is indicated by

their names.


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Branches of the different parts of the

brachial plexus

A- Branches of the roots:

1- Dorsal scapular nerve (C5)

2- Long thoracic nerve (C5,6,7)

B- Branches of the upper trunk:

1- Nerve to subclavius (C5,6).

2- Suprascapular nerve (C5,6).


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C- Branches of the lateral cord:

1- Lateral pectoral nerve (C5-7)

2- Musculocutaneous nerve (C5-7)

3- lateral root of median nerve median nerve

gives off no branches in the axilla.


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D- Branches of the medial cord:

1- Medial pectoral nerve (C8-T1).2- Medial cutaneous nerve of arm.

3- Medial cutaneous nerve of forearm.

4- Ulnar nerve it gives off no branches in theaxilla.

5- medial root of median nerve.


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E- Branches of the posterior cord:

1- Upper subscapular nerve.

2- lower subscapular nerve.

3- Thoracodorsal nerve.( N. to Latissimus dorsi

).

4- Axillary nerve (C5,6).

5- Radial nerve the direct continuation, the

largest branch of brachial plexus.


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5

Female Breast and lymph nodes of the

axilla


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The Female Breast

It is a specialized accessory gland of the skinthat is capable of secreting milk.

Its base overlies the 2nd to the 6th rib andfrom the lateral margin of the sternum to themidaxillary line.

Two-thirds of it rests on pectoralis major, one-third on serratus anterior.

Its lower medial edge just overlaps the upperpart of the rectus sheath.


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The greater part of the gland lies in thesuperficial fascia.

A small part the axillary tail extends

upward and laterally, pierces the deep fasciaat the lower border of the P. major muscle,

and comes into close relationship with the

axillary vessels.


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Structure

The breast is made up of 1520 lobules of

glandular tissue embedded in fat.

The latter accounts for its smooth contour and

most of its bulk.

These lobules are separated by fibrous septa,

running from the subcutaneous tissues to the

fascia of the chest wall, serve as suspensory

ligaments (the ligaments of Cooper).


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Each lobule drains by its lactiferous duct on to

the nipple and possesses a dilated ampulla

just prior to its termination.

The nipple is surrounded by the pigmented

areola.

Breasts reach their maximum size during

lactation.


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Blood supply

1- From the axillary artery via its lateralthoracic and acromiothoracic branches.

2- From the internal thoracic (internal

mammary) artery via its perforating branches3- From the intercostal arteries via their lateral

perforating branches.

The venous drainage is to the correspondingveins.

2 rotator cuff

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