UPPER LIMBREGIONAL ANATOMY

DR SURAJIT KUNDUSR. LECTURER

DEPT. OF ANATOMYMAITRI INSTITUTE OF DENTAL SCIENCES & RESEARCH

CENTREANJORA, DURG

CHHATTISHGARH, INDIA

INTRODUCTIONPARTS OF THE HUMAN

BODY: HEAD NECK AND BRAIN, THORAX,

ABDOMEN, EXTREMITIES (UPPER LIMB AND LOWER LIMB)

UPPER LIMBHAS 4 PARTS- SHOULDER, ARM, FOREARM

AND HAND

THE PECTORAL

REGION

THE MAMMA

RY GLAND

OR

THE BREAST

INTRODCTION PRESENT BILATERALLY IN BOTH SEXES

MALE AND IMMATURE FEMALES- RUDIMENTARY

MATURE FEMALES- WELL DEVELOPED AND BECOMES MORE PROMINENT DURING PREGNANCY AND LACTATION

MOST IMPORTANT STRUCTURE OF THE PECTORAL REGION

IT IS A MODIFIED SWEAT GLAND (APOCRINE TYPE).

POSITION

LIES IN THE SUPERFICIAL FASCIA OF THE PECTORAL REGION

BUT

A SMALL EXTENSION KNOWN AS AXILLARY TAIL OF SPENCE PIERCESTHE AXILLARY FASCIA THROUGH A SMALL FORAMEN

KNOWN FORAMEN OF LANGER AND LIES IN THE AXILLA

EXTENT

VERTICALLYFROM SECOND TO SIXTH RIB IN THE

MID CLAVICULAR LINE

HORIZONTALLYFROM LATERAL BORDER OF STERNUM TO

THE MID AXILLARY LINE ALONG THE FOURTH RIB

RELATIONSTHE BASE OF THE MAMMARY GLAND CALLED

AS MAMMARY BED RESTS UPON THE FOLLOWING STRUCTURES (FROM SUPERFICIAL TO DEEP)

(a) RETROMAMMARY SPACE(b) DEEP FASCIA (PECTORAL FASCIA)(c) MUSCLES- PECTORALIS MAJOR, SERRATUS

ANTERIOR, EXTERNAL OBLIQUE

RETROMAMMARY SPACEA SPACE DEEP TO THE BASE OF THE GLAND,

LIES SUPERFICIAL TO DEEP FASCIA, CONTAINS LOOSE AREOLAR TISSUE, MAKES THE GLAND FREELY MOVABLE.

RETROMAMMARY SPACE

PRESENTING PARTS

(A) NIPPLECONICAL PROJECTION IN THE CENTRE OF THE

ANTERIOR PART OF THE BREAST, LIES IN THE FOURTH INTERCOSTAL SPACE, PINK IN COLOUR, HAS HIGH NERVOUS INNERVATION AND OPENINGS OF 15-20 LACTIFEROUS DUCTS.

(B) AREOLA CIRCULAR PIGMENTED AREA OF SKIN AROUND THE

BASE OF THE NIPPLE, BECOMES DARKER DURING PREGNANCY AND LACTATION, CONTAINS MODIFIED SEBACIOUS GLANDS WHICH BECOMES ENLARGED DURING PREGNANCY AND LACTATION FORMING TUBERCLES OF MONTGOMERRY

STRUCTURE

3 COMPONENTS

(A) FIBROUS TISSUE(B) GLANDULAR TISSUE

(C) AREOLAR TISSUE

(A) FIBROUS TISSUE

SUPPORTS THE ENTIRE GLAND FORMS SEPTA (SUSPENSORY

LIGAMENTS OF COOPER) WHICH ANCHORS THE GLAND TO THE OVERLYING SKIN AND TO THE UNDERLYING DEEP FASCIA (PECTORAL FASCIA) AND DIVIDES THE GLAND INTO 15-20 LOBES

(B) GLANDULAR TISSUE

CONSIST OF 15-20 LOBES LOBES ARE OF TUBULOALVEOLAR TYPE EACH LOBE HAS ONE LACTIFEROUS

DUCT LOBES ARE ARRANGED IN A RADIATING

MANNER ARROUND THE AREOLA THE LACTIFEROUS DUCT DILATES NEAR

ITS OPENING IN THE NIPPLE TO FORM LACTIFEROUS SINUS WHICH ACT AS RESERVOIR OF MILK

DUCTS ARE SURROUNDED BY MYOEPITHELIAL CELLS

STRUCTURE OF THE MAMMARY GLAND

NEUROVASCULAR SUPPLY

ARTERIAL SUPPLYBREAST IS HIGHLY VASCULAR ORGAN.

SUPPLIED BY THE FOLLOWING SETS OF ARTERIES:

1. AXILLARY ARTERY- LATERAL THORACIC BRANCH AND SUPERIOR THORACIC BRANCH

2. INTERNAL THORACIC ARTERY- PERFORATING BRANCH

3. POSTERIOR INTERCOSTAL ARTERY (2ND , 3RD, 4TH )- LATERAL BRANCH.

VENOUS DRAINAGE

VEINS FORM AN ANASTOMOTIC VENOUS CIRCULAR PLEXUS ARROUND THE MAMMARY GLAND KNOWN AS CIRCULAR VENOSUS.

VEINS FROM THIS PLEXUS ENDS IN AXILLARY, INTERNAL THORACIC AND POSTERIOR INTERCOSTAL VEINS.

NERVE SUPPLY

INTERCOSTAL NERVES (4TH- 6TH )- ANTERIOR AND LATERAL CUTANEOUS BRANCHES.

LYMPHATIC DRAINAGE

CLINICAL ANATOMY SKIN INCISIONS FOR BREAST SURGERIES GIVEN

ALONG THE SKIN CREASES AND IN A RADIAL MANNER.

BREAST IS A COMMON SITE FOR TUMOUR.

TUMOUR IN THE BREAST CAN BENIGN OR MALIGNANT

BENIGN TUMOUR- PAPPILOMA- TREATED BY SURGICAL EXCISION OF THE GROWTH.

MALIGNANT TUMOUR- BREAST CANCER/ CARCINIMA

BREAST CANCER TREATED BY REMOVAL OF THE AFFECTED (ONE OR BOTH) BREAST- SURGICAL PROCEDURE KNOWN AS RADICAL MASTECTOMY

DIAGNOSIS OF BREAST CANCER DONE BY EXAMINATION OF THE AFFECTED BREAST LUMP

CLINICAL ANATOMY (CONT.)

BREAST CANCER- SIGNS AND SYMPYOMS:1. A HARD NON-MOVABLE BREAST WITH A SOLID PALPABLE

LUMP

2. RETRACTION OF THE OVERLYING SKIN DUE TO INFILTERATION OF CANCER CELLS ALONG THE SUSPENSORY LIGAMENTS OF COOPER

3. RETRACTION AND FLATTENING OF THE NIPPLE DUE TO AFFECTION OF THE LACTIFEROUS DUCTS

4. SKIN ARROUND THE BREAST- PEAU D ORANGE DUE TO RETRACTION OF THE HAIR FOLLICLES AND OEDEMATOUS SKIN

5. DIAGNOSIS CAN BE CONFIRMED BY FNAC (FINE NEEDLE ASPIRATION CYTOLOGY), MAMMOGRAPHY AND USG (ULTRASONOGRPHY)

KRUKENBURG TUMOUR

QUESTIONS LONG QUESTION

DESCRIBE THE MAMMARY GLAND

OR

DESCRIBE THE MAMMARY GLAND (BREAST) UNDER THE FOLLOWING HEADINGS-(a) location and extent (b) important relations (c) structure (d) blood supply (e) lymphatic drainage (f) applied anatomy.

SHORT NOTES(1) MAMMARY BED

(2) LYMPHATIC DRAINAGE OF THE MAMMARY GLAND

(3) STRUCTURE OF MAMMARY GLAND

SHORT ANSWERS(4) RETROMAMMARY SPACE

(5) TAIL OF SPENCE

(6) FORAMEN OF LANGER

(7) LIGAMENT OF COOPER