Triangles of the anterior wall of the axilla. Axillary cavity. A. Clavipectoral triangle

Axillary cavity has four walls and two holes.

Openings of the axillary cavity:

top– between the collarbone, the first rib and the upper edge of the scapula;

lower- the boundaries of which coincide with the edges of the axillary fossa.

Walls of the axillary cavity:

Front the wall is formed pectoralis major and minor muscles with conditionally distinguished triangles: clavipectoral, thoracic, inframammary, the boundaries of which correspond to the edges of the muscles and clavicle. (a neurovascular bundle consisting of a medially located axillary vein, a laterally located axillary artery and the horseshoe-shaped bundles of the brachial plexus surrounding it, as well as lymph nodes filling the cavity.)

Rear the wall is formed by the latissimus dorsi, teres major and subscapularis muscles. In it, between the surgical neck of the humerus and the muscles: the large round, subscapular, long head of the triceps is located four-way a hole that passes the posterior artery surrounding the shoulder with the vein of the same name and the axillary nerve. Second the hole lies medially and is limited only by the above muscles - this is tripartite the opening through which the artery and vein surrounding the scapula pass.

Medial wall represented by the serratus anterior muscle. The lateral thoracic vessels and the long.

pectoral nerve Lateral wall

represented by the humerus with the tendons of the biceps and coracobrachialis muscles. Axillary cavity

filled with the axillary vein, lying medially and superficially; axillary artery with a lateral and deeper position; lymph nodes.

19 Osteofibrous canals and synovial sheaths of the hand. Extensor retinaculum and carpal bones are formed for tendons six osteofibrous canals

, in which there are synovial vaginas: common and separate.

From the radius to the ulna they are located as follows: first – for abductor longus tendons thumb

muscles and short extensor pollicis; second

– for the tendons of the short and long extensor carpi; third – for tendon extensor longus

thumb; fourth

– for the extensor tendons of the fingers and the extensor tendon of the index finger; fifth

– for the extensor tendon of the little finger;– for the extensor carpi ulnaris tendon.

The synovial tendon sheaths protrude beyond the edges of the extensor retinaculum more in the distal direction and slightly in the proximal direction, i.e. in the back of the forearm. They are absent in the posterior palmar region and on the back of the fingers. The greatest length is the synovial sheath for the extensor tendon of the little finger (6-8 cm), the greatest width is the synovial sheath of the common extensor digitorum.

20 Inguinal canal.

Inguinal canal– a natural oblique gap 4-5 cm long, which is located in the anterior groin area abdominal wall, located in an oblique direction over the medial third of the inguinal ligament.

Its four walls are formed:

top– the lower edges of the inner braid and transverse muscles belly;

lower– inguinal ligament, an important clinical and anatomical landmark, especially when distinguishing an inguinal hernia from a femoral hernia and vice versa;

front– external aponeurosis oblique muscle;

back– transverse fascia, loosely adjacent to the parietal peritoneum.

The transversalis fascia covers the muscle of the same name and is part of the intra-abdominal fascia.

Openings of the inguinal canal:

Deep inguinal ring located in the posterior wall of the canal in the form of a funnel-shaped depression, which corresponds to the lateral inguinal fossa, located outward from the lateral umbilical fold of the peritoneum.

Superficial inguinal ring located in the anterior wall and limited above by the medial leg of the aponeurosis of the external oblique muscle, attached to the anterior surface of the pubic symphysis, below by the lateral leg of the same aponeurosis, but attached to the pubic tubercle.

The medial-inferior end of the ring is formed by a curved ligament from the lateral leg of the aponeurosis and the inguinal ligament; the lateral superior roundness consists of interpeduncular fibrous fibers of the fascia propria. The superficial ring can be easily palpated above the pubic symphysis and is projected onto the medial inguinal fossa of the peritoneum, which is located above the pubic crest between the medial and lateral umbilical folds of the peritoneum. The medial fossa is considered the most weak point

posterior wall of the inguinal canal.

In embryogenesis, the formation of the inguinal canal in men is associated with the descent of the testicle, which, if development is disrupted, can stop in the canal (cryptorchidism). When the processus vaginalis of the peritoneum does not heal in the canal, a congenital oblique inguinal hernia occurs. In women, the canal appears under the influence of the round ligament of the uterus, which, having passed through it, grows with its fibers into the labia majora and the pubic symphysis.

Axillary cavity has four walls and two holes.

Openings of the axillary cavity:

top– between the collarbone, the first rib and the upper edge of the scapula;
lower- the boundaries of which coincide with the edges of the axillary fossa.

Walls of the axillary cavity:

Front the wall is formed pectoralis major and minor muscles with conditionally distinguished triangles: clavipectoral, thoracic, inframammary, the boundaries of which correspond to the edges of the muscles and clavicle. (a neurovascular bundle consisting of a medially located axillary vein, a laterally located axillary artery and the horseshoe-shaped bundles of the brachial plexus surrounding it, as well as lymph nodes filling the cavity.)
Rear the wall is formed by the latissimus dorsi, teres major and subscapularis muscles. In it, between the surgical neck of the humerus and the muscles: the large round, subscapular, long head of the triceps is located four-way a hole that passes the posterior artery surrounding the shoulder with the vein of the same name and the axillary nerve. Second the hole lies medially and is limited only by the above muscles - this is tripartite the opening through which the artery and vein surrounding the scapula pass.
Medial wall represented by the serratus anterior muscle. The lateral thoracic vessels and the long thoracic nerve pass through it.
Lateral wall represented by the humerus with the tendons of the biceps and coracobrachialis muscles.

The axillary cavity is filled with the axillary vein, which lies medially and superficially; axillary artery with a lateral and deeper position; lymph nodes.

Osteofibrous canals and synovial sheaths of the hand.

Extensor retinaculum and carpal bones are formed for tendons six osteofibrous canals, in which there are synovial vaginas: common and separate.

From the radius to the ulna they are located as follows:

From the radius to the ulna they are located as follows:– for the tendons of the abductor pollicis longus muscle and extensor brevis thumb;
muscles and short extensor pollicis;– for the tendons of the short and long extensor carpi;
– for the tendons of the short and long extensor carpi;– for the tendon of the long extensor pollicis;
thumb;– for the extensor tendons of the fingers and the extensor tendon of the index finger;
– for the extensor tendons of the fingers and the extensor tendon of the index finger;– for the extensor tendon of the little finger;
– for the extensor tendon of the little finger;– for the extensor carpi ulnaris tendon.

Inguinal canal.

Inguinal canal- a natural oblique gap 4-5 cm long, which is located in the inguinal region of the anterior abdominal wall, located in an oblique direction above the medial third of the inguinal ligament.

Its four walls are formed:

top– the lower edges of the internal oblique and transverse abdominal muscles;
lower– inguinal ligament, an important clinical and anatomical landmark, especially when distinguishing an inguinal hernia from a femoral hernia and vice versa;
front– aponeurosis of the external oblique muscle;
back– transverse fascia, loosely adjacent to the parietal peritoneum.

The transversalis fascia covers the muscle of the same name and is part of the intra-abdominal fascia.

Openings of the inguinal canal:

Deep inguinal ring located in the posterior wall of the canal in the form of a funnel-shaped depression, which corresponds to the lateral inguinal fossa, located outward from the lateral umbilical fold of the peritoneum.
Superficial inguinal ring located in the anterior wall and limited above by the medial leg of the aponeurosis of the external oblique muscle, attached to the anterior surface of the pubic symphysis, below by the lateral leg of the same aponeurosis, but attached to the pubic tubercle. The medial-inferior end of the ring is formed by a curved ligament from the lateral leg of the aponeurosis and the inguinal ligament; the lateral superior roundness consists of interpeduncular fibrous fibers of the fascia propria.

The superficial ring can be easily palpated above the pubic symphysis and is projected onto the medial inguinal fossa of the peritoneum, which is located above the pubic crest between the medial and lateral umbilical folds of the peritoneum. The medial fossa is considered the weakest point of the posterior wall of the inguinal canal.

In the inguinal canal in men there is a spermatic cord - a round cord 15-20 cm long, in women - a round uterine ligament with vessels and nerves supplying it.

Muscular and vascular lacunae.

The space between the inguinal ligament and the pubic and ilium bones is divided by the iliopectineal arch (ligament) into gaps - medially located vascular And lateral - muscular. Femoral vessels pass through the vascular lacuna: vein, artery, efferent lymphatic vessels. The femoral nerve and the iliopsoas muscle pass through the muscle lacuna.

Femoral canal.

The femoral canal refers to the femoral triangle, which is located in the anterior region of the thigh and is formed medially by the adductor longus muscle, laterally by the sartorius muscle, from above - the inguinal ligament. The fascia lata within the triangle forms two leaves: superficial and deep.

deep ring The femoral canal is located in the medial part of the vascular lacuna under the inguinal ligament and is limited to:

above– the inguinal ligament at the place of its attachment to the pubic tubercle and symphysis;
from below– the pubic crest and the pectineal ligament covering it;
medially– lacunar ligament, filling the inner corner of the vascular lacuna;
laterally- wall of the femoral vein.

The diameter of the ring does not exceed 1 cm, it is filled with a connective tissue membrane; belonging to the lata fascia of the thigh. The ring often contains a deep lymph node. On the side of the abdominal cavity, the parietal peritoneum is adjacent to the deep ring, forming a small depression - femoral fossa.

Surface ring(subcutaneous fissure) lies in the femoral triangle 5-6 cm below the inguinal ligament. It is called subcutaneous and corresponds to a hidden fissure (oval fossa) located in the superficial layer of the fascia lata, which forms a thickened crescent-shaped edge with the upper and lower horns around the subcutaneous fissure. The arcuate edge is convexly facing the lateral side, and its horns are directed medially. The gap itself is filled with cribriform fascia, which passes through its openings the branches of the femoral artery - the superficial pudendal, superficial epigastric, superficial surrounding ilium, great hidden (saphenous) vein, afferent medial lymphatic vessels, anterior cutaneous branches of the femoral nerve and the hidden nerve. Because of this, the fascia becomes perforated (fascia cribrosa).

Subcutaneous fissure ( surface ring) can be easily palpated as fossa oval, which is found in the anterior region of the thigh (femoral triangle) 5-7 cm below the inguinal ligament. A superficial lymph node is palpable next to it.

In a healthy person, only rings are present in the femoral canal: superficial and deep. The canal appears in the patient when a femoral hernia develops.

His walls become:

front- superficial layer of fascia lata;
rear- deep leaf of fascia lata;
lateral- fascial sheath of the femoral vein.

In practice, a well-palpable inguinal ligament acts as an important clinical and anatomical landmark that allows one to distinguish a femoral hernia from an inguinal hernia, since the femoral hernial sac lies under the inguinal ligament on the thigh, and the inguinal sac lies above the ligament on the anterior abdominal wall.

Around the deep femoral ring, 30% of people have a vascular anomaly, when the obturator artery, starting from the inferior epigastric, is adjacent to the ring from above. In another option, a vascular anastomosis occurs around the ring between the obturator and inferior epigastric arteries. Both options have been known in practice since the Middle Ages as “ crown of death ", which can cause severe bleeding and death of the patient if the operation is performed inappropriately.

Adductor channel.

Femoropopliteal (adductor) canal.

The channel is formed by the following structures:

medial wall - adductor magnus muscle;
lateral- vastus medialis muscle;
front - fibrous plate (lamina vastoadductoria) - from a deep layer of fascia lata, stretched between the above muscles.

Input (top) the opening of the canal lies under the sartorius muscle, output (lower) located in the popliteal fossa in the form of a gap in the adductor magnus tendon; the anterior opening is located in the fibrous plate (vastoadductor) at the level of the lower third of the thigh. The lower opening (exit from the canal) opens into the popliteal fossa.

The femoral artery, vein, greater hidden nerve pass through the iliopectineal, femoral grooves and the adductor canal, and the hidden nerve and the branch of the femoral artery - the descending knee - leave the canal through the anterior opening.

Channels of the leg.

Leg-popliteal (Gruber's canal) runs from the popliteal fossa to the medial malleolus. Its anterior wall is formed by the posterior tibialis muscle and flexor pollicis longus, posterior soleus muscle. The canal contains the posterior tibial artery and veins and the tibial nerve. Through its anterior opening at the top of the interosseous membrane, the anterior tibial artery and accompanying veins emerge.
In the middle third of the tibia it branches off in the lateral direction inferior musculofibular channel. It is located between the fibula and the flexor pollicis longus. The peroneal artery and vein pass through it.
Superior musculofibular canal located between the long peroneal muscle and the fibula, contains the superficial peroneal nerve.

Axillary cavity has four walls and two holes.

Openings of the axillary cavity:

top– between the collarbone, the first rib and the upper edge of the scapula;

lower- the boundaries of which coincide with the edges of the axillary fossa.

Walls of the axillary cavity:

Medial wall represented by the serratus anterior muscle.

pectoral nerve Lateral wall

The lateral thoracic vessels and the long thoracic nerve pass through it.

filled with the axillary vein, lying medially and superficially; axillary artery with a lateral and deeper position; lymph nodes.

19 Osteofibrous canals and synovial sheaths of the hand. Extensor retinaculum and carpal bones are formed for tendons six The axillary cavity is filled with the axillary vein, which lies medially and superficially; axillary artery with a lateral and deeper position; lymph nodes.

, in which there are synovial vaginas: common and separate.

From the radius to the ulna they are located as follows: From the radius to the ulna they are located as follows:

muscles and short extensor pollicis; second

– for the tendons of the short and long extensor carpi;– for the tendons of the abductor pollicis longus and extensor pollicis brevis muscles;

thumb; fourth

– for the extensor tendons of the fingers and the extensor tendon of the index finger; fifth

– for the extensor tendon of the little finger;– for the extensor carpi ulnaris tendon.

20 Inguinal canal.

– for the tendon of the extensor pollicis longus; Inguinal canal

- a natural oblique gap 4-5 cm long, which is located in the inguinal region of the anterior abdominal wall, located in an oblique direction above the medial third of the inguinal ligament.

top Its four walls are formed:

lower– inguinal ligament, an important clinical and anatomical landmark, especially when distinguishing an inguinal hernia from a femoral hernia and vice versa;

front– the lower edges of the internal oblique and transverse abdominal muscles;

back– transverse fascia, loosely adjacent to the parietal peritoneum.

– aponeurosis of the external oblique muscle;

The transversalis fascia covers the muscle of the same name and is part of the intra-abdominal fascia.

Openings of the inguinal canal: located in the posterior wall of the canal in the form of a funnel-shaped depression, which corresponds to the lateral inguinal fossa, located outward from the lateral umbilical fold of the peritoneum.

In the inguinal canal in men there is a spermatic cord - a round cord 15-20 cm long, in women - a round uterine ligament with vessels and nerves supplying it.

A. Pectoralis major and minor muscles (mm. pectoral-les major et minor).

B. Serratus anterior muscle (m. serratus anterior).

B. Latissimus dorsi (m. latissimus dorsi), subscapularis (m. subscapularis) and teres major (m. teres major).

D. Short head of the biceps brachii muscle (caput brevis m. bicepitis brachii) and coracobrachialis muscle (m. coracobrachialis).

D. Long head triceps brachii muscle (caput longum m. tricepitis brachii).

What makes up the contents of the axillary cavity?

A. Axillary artery (a. axillaris) with its branches.

B. Axillary vein (v. axillaris) with its branches.

B. Saphenous vein of the arm (v. cephalica).

D. Loose fatty tissue.

D. Lymph nodes.

E. Axillary nerve (n. axillaris) and its branches.

Specify the ligaments of the shoulder joint.

A. Articular-brachial ligaments (ligg. glenohumeralia).

B. Coracoacromial ligament (lig. coacromiale).

B. Acromioclavicular ligament (lig. acromio-claviculare).

G. Coracohumeral ligament (lig. coracohumerale).

D. Coracoclavicular ligament (lig. coracoclaviculare).

What bursae and synovial sheaths open into the cavity of the shoulder joint?

A. Intertubercular synovial vagina (gina sinovialis intertubercularis).

B. Subtendinous bursa of the subscapularis muscle (bursa subtendinea m. subscapularis).

B. Subdeltoid bursa (bursa subdeltoidea).

G. Subtendinous bursa trapezius muscle(bursa subdeltoidea m. trapezii).

Name the nerves located in the cubital fossa.

A. Muscular cutaneous nerve(n. musculocutaneus).

B. Ulnar nerve (n. ulnaris).

D. Medial cutaneous nerve of the shoulder (n. Cutaneus brachii medialis).

D. Median nerve (n. medianus).

What are the limitations of the “anatomical snuff box”?

A. Tendon of the extensor carpi radialis (m. extensor carpi radialis).

B. Tendon of the long extensor pollicis longus (m. extensor pollicis longus).

B. Tendon of the short extensor pollicis brevis (m. extensor pollicis brevis).

G. Tendon longus muscle abductor pollicis longus (m. abductor pollicis longus).

D. Tendon of the short extensor carpi radialis (m. extensor carpi radialis brevis).

8. Indicate the formations passing through the carpal tunnel (glanders/is carpalls).

A. Ulnar nerve (n. ulnaris).

B. Radial nerve (n. radialis).

B. Median nerve (n. medianus).

G. Palmar interosseous artery (a. interossea anterior).

D. Tendons of the superficial and deep digital flexors.

Name the branches of the deep palmar arch (arcus palmaris profundus).

A. Common palmar digital arteries (aa. digi-tales palmares communes).

B. Own digital arteries (aa. digitales palmares propriae).

B. Ulnar artery(a. ulnaris).

G. Palmar metacarpal arteries (aa. metacarpeae palmares).

D. Dorsal digital arteries (aa. Digitales dorsales).

Name the outer border of the subdeltoid cellular space.

A. Short head of the biceps brachii muscle (m. biceps brachii).

B. Humerus (os humerus).

IN. Deltoid(m. deltoideus), covered with a deep plate of deltoid fascia.

G. Shoulder joint(articulatio humeri).

D. Supraspinatus muscle (m. supraspinatus).

Indicate the branches of the first segment of the axillary artery (a. axillaris).

A. Subclavian artery (a. subscapularis).

B. Artery surrounding the scapula (a. circumflexa scapulae).

B. Internal thoracic artery (a. thoracica interna).

G. Lateral thoracic artery (a. thoracica lateralis).

D. Superior thoracic artery (a. thoracica superior).

E. Thoracoacromial artery (a. thoracoacromialis).

12. Which statement is true for the ulnar vessels (vasa ulnaria) in the upper third of the forearm?

A. Located between the flexor carpi ulnaris (m. flexor carpi ulnaris) and the superficial flexor of the fingers (m. flexor digitorum superflcialis).

B. Located on the anterior surface of the deep flexor of the fingers (m. flexor digitorum profundus).

B. Located on the pronator quadratus (m. pronator quadratus).

D. Covered in front by the pronator teres (m. pronator teres) and the superficial flexor of the fingers (m. flexor digitorum superficialis).

Where is the median nerve (n. medianus) located in the upper third of the forearm?

A. Between flexor radialis wrist (m. flexor carpi radialis) and superficial flexor of the fingers (m. flexor digitorum superficialis).

B. Between the deep flexor of the fingers (m. flexor digitorum profundus) and the superficial flexor of the fingers (m. flexor digitorum superficialis).

B. Between the pronator teres (m. pronator teres) and the flexor carpi radialis (m. flexor carpi radialis).

D. Between the heads of the pronator teres (m. pronator teres).

D. Between long palmaris muscle(m. palmaris longus) and deep flexor of the fingers (m. flexor digitorum profundus).

E. Between the brachioradialis muscle (m. brachioradialis) and the pronator teres (m. pronator teres).

Where is the musculocutaneous nerve (n. musculocutaneus) located in the lower third of the shoulder?

A. Between the tendon of the biceps brachii muscle (m. biceps brachii) and the coracoid brachialis muscle(m. coracobrachialis).

B. Between the biceps brachii muscle (m. biceps brachii) and the brachialis muscle (m. brachialis).

B. Knugri from the brachial artery (a. brachialis).

D. At the medial edge of the intermuscular gap.

Topography of the radial nerve (n. radialis) in the upper third of the shoulder.

A. The tendon of the latissimus dorsi muscle is located below.

B. Medial head triceps brachii muscle (caput mediate m. tricepitis brachii) is located anteriorly.

B. The long head of the biceps brachii muscle (caput longum m. bicepitis brachii) is located above.

D. The long head of the triceps brachii muscle (caput longum m. tricepitis brachii) is located posteriorly.

D. Located between the long (caput longum) and lateral (caput laterale) heads of the triceps brachii muscle (m. tricepis brachii).

Indicate the elements of the main neurovascular bundle in the clavipectoral triangle (trigo-pit clavipectorale).

A. Trunks of the brachial plexus (plexus brachialis).

B. Medial saphenous vein of the arm (v. basilica) and medial cutaneous nerve of the forearm (n. cutaneus antebrachii medialis).

B. Axillary vein (v. axillaris).

D. Axillary artery (a. axillaris).

Indicate the elements of the main neurovascular bundle in the submammary triangle (trigonum subpectorale).

A. Median nerve (n. medianus).

B. Axillary nerve (n. axillaris).

B. Lateral saphenous vein of the arm (v. cephalica).

G. Musculocutaneous nerve (n. musculocutaneus).

D. Ulnar nerve (n. ulnaris).

E. Axillary vein (v. axillaris).

G. Medial saphenous vein of the arm (v. basilica).

Where is the ulnar nerve (n. ulnaris) located in the middle third of the shoulder?

A. Behind the saphenous vein of the arm (v. basilica).

B. Inward from the brachial artery (a. brachialis).

B. Outward from the basilar artery (a. basilaris).

D. In the bed of the biceps brachii muscle (m. biceps brachii).

D. Between brachial artery(a. brachialis) and brachial vein (v. brachialis).

Where is the median nerve (n. medianus) located in the middle third of the forearm?

A. Between the superficial flexor of the fingers (m. flexor digitorum superficialis) and the deep flexor of the fingers (m. flexor digitorum profundus).

B. Between the superficial flexor of the fingers (m. flexor digitorum superflcialis) and the palmaris longus muscle (m. palmaris longus).

B. Between the deep flexor of the fingers (m. flexor digitorum profundus) and the long palmaris muscle (m. palmaris longus).

D. Between the pronator teres (m. pronator teres) and the flexor carpi radialis (m. flexor carpi radialis).

D. Between the two heads of the pronator teres (m. pronator teres).

Indicate the terminal branches of the superficial peroneal nerve (n. peroneus superflcialis).

A. Medial dorsal cutaneous nerve (n. cutaneus dorsalis medialis).

B. Intermediate dorsal cutaneous nerve (n. cutaneus dorsalis intermedius).

B. Lateral dorsal cutaneous nerve (n. cutaneus dorsalis lateralis).

G. Subcutaneous nerve (n. saphenus).

D. Sural nerve (n. suralis).

21. What muscles begin from the ischial tuberosity (tuber ischiadlcum)!

A. Semitendinosus muscle (m. semitendinosus).

B. Semimembranosus muscle (m. semimembranosus).

B. Bottom Gemini muscle(m. gemellus inferior).

D. Large adductor muscle (m. adductor magnus).

D. Biceps thighs (m. biceps femoris).

On the upper limb there are areas: scapular, deltoid, subclavian, axillary, shoulder area (anterior and posterior), ulnar area (anterior and posterior), forearm area (anterior and posterior), hand area (wrist, wrist and fingers area).

Between the deltoid and pectoralis major muscles is located deltoid pectoral groove (sulcusdeltoideopectoralis) , in the area of which the deltoid and pectoral fascia connect with each other, the lateral saphenous vein of the arm (vena cephalica) runs in the groove.

In the upper section the groove passes into deltoid-thoracic triangle (trigonumdeltoideopectorale) , which is limited above by the lower part of the clavicle, medially by the pectoralis major muscle, and laterally by the deltoid muscle.

On the skin the triangle corresponds subclavian fossa (fossainfraclavicularis), or the fossa of Morenheim, in the depths of which the coracoid process of the scapula can be palpated.

In the area of the upper edge of the scapula there is a suprascapular foramen, formed by the notch of the scapula and the superior transverse scapular ligament stretched over it. This hole connects the neck area with the scapula area. The suprascapular nerve passes through the foramen; the suprascapular artery and vein usually pass over the transverse scapular ligament.

Axillary fossa (fossaaxillaris). With the upper limb abducted, the axillary region has the shape of a pit, which, after removing the skin and fascia, turns into a cavity.

Boundaries of the axillary fossa:

front– a fold of skin corresponding to the lower edge of the pectoralis major muscle;

back– a fold of skin corresponding to the lower edge of the latissimus dorsi muscle;

medial– a conditional line connecting the edges of the indicated muscles on the lateral surface of the chest;

lateral- a conditional line connecting these same muscles to inner surface shoulder

Axillary cavity (cavitasaxillaris) has 4 walls and 2 holes (apertures).

Walls of the axillary cavity:

1) front wall formed by large and small pectoral muscles and clavipectoral fascia (fascia clavipectoralis);

2) back wall formed by the latissimus dorsi, teres major and subscapularis muscles;

3) medial wall formed by the first four ribs, intercostal muscles, top part serratus anterior muscle;

4) lateral wall very narrow, since the anterior and posterior walls of the axillary cavity come closer together in the lateral direction; it is formed by the intertubercular groove (sulcus intertubercularis) of the humerus, covered by the biceps brachii muscle and the coracobrachialis muscle.

Openings of the axillary cavity.

1. Top hole (aperturesuperior) , directed upward and medially, limited front collarbone, behind- the upper edge of the shoulder blade, medially– the first rib, connects the axillary cavity with the base of the neck, blood vessels and nerves pass through it; the superior opening is also called the cervical-axillary canal.

2. Bottom hole (apertureinferior) directed downward and laterally, corresponds to the boundaries of the axillary fossa.

Contents of the axillary cavity:

Axillary artery (a.axillaris) and its branches;

Axillary vein (v.axillaris) and its tributaries;

Brachial plexus (plexus brachialis) with nerves extending from it;

Lymph nodes and lymphatic vessels;

Loose fatty tissue;

In most cases, part of the mammary gland;

Cutaneous branches of the II and III intercostal nerve.

To more accurately describe the topography of the branches of the axillary artery on the anterior wall of the axillary cavity, three triangles:

1) clavipectoral triangle (trigonumclavipectorale), bounded above by the clavicle, below by the upper edge of the pectoralis minor muscle;

2) thoracic triangle (trigonumpectorale), corresponds to the contours of the pectoralis minor muscle;

3) inframammary triangle (trigonumsubpectorale) bounded above by the lower edge of the pectoralis minor muscle, below by the lower edge of the pectoralis major muscle.

On the posterior wall of the axillary cavity there are two openings for the passage of blood vessels and nerves:

1) three-way hole (foramentrilaterum) limited above inferior border of the subscapularis muscle , below- big teres muscle, laterally– long head of the triceps muscle;

Pass through the three-sided hole artery surrounding the scapula ( a . circumflexa scapulae ), and accompanying veins of the same name ;

2) four-sided hole (foramenquadrilaterum) limited above the lower edge of the subscapularis muscle, from below- teres major muscle medially– long head of the triceps muscle, laterally– surgical neck of the humerus;

Through the four-sided hole pass axillary nerve ( n . axillaris ), the posterior artery surrounding the humerus ( a . circumflexa humeri posterior ), and accompanying veins of the same name.

Behind the upper border of both openings is formed by the teres minor muscle.

Shoulder topography.

The boundaries of the shoulder are considered to be at the top - a line connecting the lower edges of the pectoralis major and latissimus dorsi muscles on the shoulder, at the bottom - a line passing two transverse fingers above the epicondyles of the humerus.

The area is divided into anterior and posterior by two vertical lines drawn to the top of their epicondyles.

In the anterior region of the shoulder, on both sides of the biceps brachii muscle, there are two grooves:

medial groove of the shoulder (sulcusbicipitalismedialis);

lateral groove of the shoulder (sulcusbicipitalislateralis).

The medial groove communicates at the top with the axillary cavity, at the bottom with the medial anterior ulnar groove, and contains the main neurovascular bundle of the shoulder.

In the lateral groove in the lower third of the shoulder is projected radial nerve, the groove continues into the lateral anterior ulnar groove.

On back surface shoulder between the heads of the triceps brachii muscle on one side and the groove of the radial nerve (sulcus nervi radialis) on the other radial nerve canal (canalisnerviradialis).

Channel inlet located on the medial side on the border of the upper and middle thirds of the shoulder, it is limited above the inferior edge of the teres major muscle, laterally– body of the humerus , medially– long head of the triceps brachii muscle.

Channel outlet located on the lateral side on the border between the lower and middle thirds of the shoulder in the depth of the lateral anterior ulnar groove.

Pass in the channel radial nerve ( n . radialis ) and deep brachial artery ( a . profunda brachii ).