Dr.
Amjad Shatarat, MD, PhD
Dr. Amjad Shatarat, MD, PhD
Dr. Amjad Shatarat, MD, PhD
It is a
The Axilla
or armpit
pyramid-
shaped space
between the
upper part of
the arm and
the side of the
chest
It forms an important
passage for nerves, blood,
and lymph vessels as they
travel from the root of the
neck to the upper limb
Dr. Amjad Shatarat, MD, PhD
A-Apex (cervico-axillary canal):
The upper end of the axilla
The axilla has:
is directed into the root of the neck A- An apex
Boundaries:
1. Front : clavicle B- Base
2. Behind: upper border of the scapula
3. Medially: the outer border of the first rib
C- Walls
D-Contents
Behind: upper border of the scapula
Medially: the
outer border of
1. Front : clavicle
the first rib
Dr. Amjad Shatarat, MD, PhD
B-Base of the
Axilla
or
The lower end of the axilla
Boundaries:
1. Front : pectoralis major muscle
(anterior axillary fold)
2. Behind : by the tendon of latissimus dorsi and
the teres major muscle
(the posterior axillary fold)
3.Medially : chest wall
Dr. Amjad Shatarat, MD, PhD
Dr. Amjad Shatarat, MD, PhD
C-Walls of the Axilla
The walls of the axilla are made up as follows:
Anterior wall: •
By the pectoralis major, •
subclavius, and pectoralis minor
muscles
Medial wall: •
Lateral wall: •
By the upper four or five ribs and •
By the coracobrachialis and •
the intercostal spaces covered by
biceps muscles in the bicipital
the serratus anterior muscle
groove of the humerus
Posterior wall: •
By the subscapularis, latissimus dorsi, •
and teres major muscles from above
down
Dr. Amjad Shatarat, MD, PhD
D-Contents of
the Axilla:
1- Axillary artery and its
branches
2-Axillary vein
3-Lymph vessels and lymph
nodes
4- Brachial plexus
Dr. Amjad Shatarat, MD, PhD
1-Axillary artery
Begins:
at the lateral border of the 1st rib
as a continuation of the subclavian
artery
Ends:
at the lower border of the teres
major muscle, where it continues as
the brachial artery
Throughout its course, the artery is
closely related to the cords of the
brachial plexus and their branches and
is enclosed with them in a connective
tissue sheath called
THE AXILLARY SHEATH
Dr. Amjad Shatarat, MD, PhD
The Pectoralis
minor muscle
crosses in front of the
axillary artery and
divides it into three
parts: -
Dr. Amjad Shatarat, MD, PhD
A. The first part of the axillary artery:
Extends from the lateral border of the 1st rib to the upper border of the
pectoralis minor.
Dr. Amjad Shatarat, MD, PhD
First part gives off one branch
The highest thoracic
artery which is a
small artery that runs
along the upper
border of the
pectoralis minor
highest thoracic artery
Relations
Laterally:
The three cords of the brachial plexus
Medially:
Dr. Amjad Shatarat, MD, PhD
The axillary vein
B. The second part of the axillary artery:
This lies behind the pectoralis minor
muscle
Branches of the second part of the
axillary artery:
The thoracoacromial artery
The lateral thoracic artery
Relations:
Anteriorly:
The pectoralis minor
The pectoralis major and the skin
Dr. Amjad Shatarat, MD, PhD
Posteriorly:
The posterior cord of the brachial plexus
The subscapularis muscle
Laterally:
The lateral cord of the brachial Medially:
plexus The medial cord of the brachial plexus
The axillary vein
Dr. Amjad Shatarat, MD, PhD
C. The third part of
the axillary artery:
This extends from the
Branches:
lower border of the
pectoralis minor to the
lower border of the 1-The subscapular artery
teres major.
runs along the lower border of the
subscapularis muscle
2-posterior circumflex humeral
artery
3-anterior circumflex humeral
artery
both arteries wind around the front and
the back of the surgical neck of the
humerus, respectively
Dr. Amjad Shatarat, MD, PhD
2. The axillary
vein
Formed at the lower border of the
teres major muscle by the union of
venae comitantes of
the
the brachial artery and
the basilic vein.
Runs upward on the medial side of the
axillary artery and ends at the lateral
border of the 1st rib by becoming the
subclavian vein.
Dr. Amjad Shatarat, MD, PhD
The vein receives
tributaries, which
correspond to the branches
of the axillary artery, and
the cephalic vein
Dr. Amjad Shatarat, MD, PhD
Contents of the Axilla…..
3. Brachial plexus
Dr. Amjad Shatarat, MD, PhD
formed in the posterior triangle of the neck by the union of the anterior rami of the
5th, 6th, 7th, and 8th cervical and the 1st thoracic spinal nerves
Roots Trunks Divisions Cords Terminal branches
Dr. Amjad Shatarat, MD, PhD
Branches of the brachial plexus
Roots:
1. Dorsal scapular nerve (C5)
2. Long thoracic nerve (C5, 6, 7)
Upper Trunk
- Suprascapular nerve (C5, 6)
- Nerve to subclavius (C5, 6)
The nerve to the subclavius (C5 and 6) supplies the subclavius muscle.
It is important clinically because it may give a contribution (C5) to the phrenic
nerve; this branch, when present, is referred to as the accessory phrenic nerve.
Dr. Amjad Shatarat, MD, PhD
: Lateral Cord
1. Lateral pectoral nerve
2. Musculocutaneous nerve (C5,C6,C7)
3. Lateral root of median nerve
Posterior Cord:
1. Upper subscapular nerve
2. Thoracodorsal nerve
3. Lower subscapular nerve
4. Axillary nerve (C5,C6)
5. Radial nerve(C5,C6,C7,C8,T1)
Medial Cord:
1. Medial pectoral nerve
2.Medial cutaneous nerve of arm
3. Medial cutaneous nerve of forearm
4. Ulnar nerve(C7,C8,T1)
5. Medial root of median nerve Dr. Amjad Shatarat, MD, PhD
The brachial plexus
Terminal branches
Dr. Amjad Shatarat, MD, PhD
Lateral cord
1-Lateral pectoral nerve
2- Musculocutaneous nerve
3- Lateral root of median nerve
Lateral root of median nerve
Dr. Amjad Shatarat, MD, PhD
Medial cord
1-Medial pectoral nerve
2-Medial cutaneous nerve of arm
3-Medial cutaneous nerve of forearm
4-Ulnar nerve
5-Medial root of median nerve
Dr. Amjad Shatarat, MD, PhD
Medial root of medial nerve
Posterior cord
1-Upper subscapular nerves
2- Lower subscapular nerves
3-Thoracodorsal nerve (NERVE to
latissimus dorsi
4-Axillary nerve
5-Radial nerve
Dr. Amjad Shatarat, MD, PhD
Musculocutaneous nerve (C5, 6,7)
Anterior divisions
Median nerve (C6, 7, 8, T1)
Ulnar nerve (C7, C8, T1)
Axillary nerve (C5, 6)
Posterior divisions
Radial nerve (C5, 6, 7, 8, T1)
Dr. Amjad Shatarat, MD, PhD
4. The axillary
lymph nodes
(20 to 30 in number) drain lymph
vessels from :
A. the lateral quadrants of the breast
B. The superficial lymph vessels
C. the thoracoabdominal walls above the
level of the umbilicus
D. the vessels from the upper limb.
The lymph nodes are arranged in six
groups:
1. Anterior (pectoral) group
2. Posterior (subscapular) group
3. Lateral group
4. Central group
5. Infraclavicular (deltopectoral) group
6. Apical group
Dr. Amjad Shatarat, MD, PhD
