Fig" 11' Posterior Relations of the Shoulder-Joint. 



Skin and Fascia have been removed over the posterior lialf of the Deltoid, of 

 which a large portion has also been cut away. 



The Anterior and the Posterior Circumflex Arteries arise, opposite each 

 other, from the last part of the Axillary Artery and wind round the Surgical 

 Neck of the Humerus, the former from in front, the latter from behind. The 

 Posterior Circumflex Artery passes through the Quadrilateral Space formed by 

 the Teres Minor (above), the Teres Major (below), the Humerus (anteriorly) and the 

 Long Head of the Triceps (posteriorly). It supplies the Teres Minor, Deltoid etc., 

 and ends by anastomosing with the Anterior Circumflex. With it run its 2 Venae 

 Comites of which onh^ the larger is shewn in the figure. Taking a similar course, 

 but somewhat posterior, the Circumflex Nerve passes to innervate the Deltoid 

 and Teres Minor Muscles and the skin over this region. Its large cutaneous branch 

 emerges at the posterior border of the Deltoid Muscle and divides into an as- 

 cending and a descending branch. 



On the Teres Major, below the Deltoid is a lymphatic gland which is prob- 

 ably constant, — the Posterior Axillar}- Gland (FroHSE) — , it is usually subcutaneous ; 

 in pathological cases, we have also found deep glands which lie on the blood 

 vessels. Their efferent vessels pass through the triangular space, between the 

 Teres Major, Minor, and Long Head of the Triceps, forwards to the Axilla. 



On the dorsal aspect of the trunk there are other subcutaneous lymphatic 

 glands which are neither constant in position nor in number (cf. Fig. 145 and text). 



The Superficial Glands of the Thorax and Abdomen may be divided into 

 Anterior, Posterior and External, according to their position. 



Anterior Glands: Clavicular Glands lying on the Clavicle, above the 

 Deltoideo-Pectoral Fossa, sometimes also on the origin of the Sterno-Cleido-Mastoid 

 Muscle. (Cf. Fig. 115.) 



Internal Pectoral Glands, usually at the level of the 2nd rib, along the 

 inner border of the Breast (the blue gland in Fig. 114). 



The Xiphoid Gland, at the base of the Xiphoid Process (cf . Fig. 1 1 4). 



External Glands (i. e. external to the nipple line): 



External Pectoral or Paramammary Glands, outside the Nipple, and along 

 the outer border of the Breast. The}- are intermediate glands for the lymphatics 

 of the nipple (cf . Figs. 1 1 4 and 1 1 5). 



Thoraco-epigastric Glands (i — 4) along the External Mammary Vessels. 

 One of these glands is nearly always palpable and sometimes visible through 

 the skin. 



The most important of these glands are the Thoraco-epigastric. Para- 

 mammar}' and Posterior Axillar}'. The subcutaneous position of the first mentioned 

 is especially well noticeable when Langer's Muscle (i. e. a muscular connection 

 between Latissimus Dorsi and Pectoralis Major) is present. Their efferent vessels 

 run in this case along the free border of the AxiUary Fascia, where it is bounded 

 by that muscle, before they open into the AxiOary Glands. 



The Shoulder-Joint is accessible for (operations) surgical measures from in 

 front, and from behind. The Circumflex Nerve has, however, to be avoided on 

 the posterior aspect, because injury would produce paralysis and atrophy of the 

 Deltoid Muscle. 



