THE AXILLA
DEPARTMENT OF ANATOMY, FACULTY OF BASIC MEDICAL
SCIENCE, UNIVERSITY OF ILESA.
INTRODUCTION
• The axilla is a three dimensional pyramidal space which changes shape due to its
location and the arm movement.
• The axilla is an area that lies underneath the glenohumeral joint, at the junction of
the upper limb and the thorax
• It is a passageway by which neuromuscular and muscular structures can enter and
leave the upper limb.
THE BORDERS
• The axilla consists of four sides, an open apex and base.
• Apex : it also known as the axillary inlet, it is formed by the lateral border of the
first rib, the superior border of the clavicle and the posterior border of the clavicle.
• Lateral wall : it is formed by the intertubercular groove of the humerus.
• Medial wall : consists of the serratus anterior and the thoracic wall ( ribs and
intercostal muscles).
• Anterior wall : contains the pectoralis major and the underlying pectoralis minor.
CONT’D
• Posterior wall : formed by the subscapularis superiorly, and the latissimus dorsi
and teres major inferiorly.
• The floor or base : is the axillary fascia and its skin on the surface of the axilla ,
also known as the ‘armpit’
CONTENTS OF THE AXILLA
The contents of the axilla region includes muscles, nerves, vessels and lymphatic's.
• Axillary artery : the subclavian artery is renamed the axillary artery once it passes
the lateral border of the first rib. The axillary artery supplies the upper limb and is
divided into three sections: the region proximal to the pectoralis minor, the region
posterior to the pectoralis minor and the region distal to the pectoralis minor.
i. The first part gives rise to the superior thoracic artery which supplies the first and
second intercostal space.
ii. The second part gives rise to the lateral thoracic artery and thoracoacromial
artery, which has a acromial branch (supplies the deltoid and anastomoses with the
arteries around the shoulder), pectoral branch (supplies the pectoral muscles and
anastomoses with the internal and lateral thoracic arteries), clavicular branch
(supplies the subclavius and the sternoclavicular joint) and deltoid branch (runs in
the deltopectoral groove and supplies the deltoid and the pectoralis major muscle).
iii. The third section gives rise to the subscapular artery (supplies the supraspinatus
and the infraspinatus muscle), anterior circumflex humeral artery and the posterior
circumflex humeral artery (supplies the muscles near the surgical neck of the
humerus).
CONT’D
• Axillary vein: the axillary vein drains the upper limb and is formed by the
unification of the basilic and brachial veins. The cephalic vein joins at the
proximal region of the vein. It is renamed the subclavian vein once it passes the
lateral border of the first rib.
• Brachial plexus and branches: a collection of spinal nerves that form the
peripheral nerve of the upper limb.
• Axillary lymph nodes: they filter the lymphatic fluid that has drained from the
upper limb and the pectoral region. Axillary lymph nodes is a non-specific
indicator of breast cancer.
CONT’D
• Biceps brachii (short head) and Coracobrachialis: these muscles tendons move
through the axilla, where they attach to the coracoid process of the scapula.
CLINICAL SIGNIFICANCE
• Thoracic Outlet Syndrome: This condition can occur when nerve or blood
vessels are compressed in the apex of the axilla, leading to pain, weakness or
tingling in the arm. Causes may include trauma (fracture clavicle) or anatomical
variations such as cervical ribs (an extra ribs which arises from the seventh
cervical vertebra).
• Lymph nodes biopsy: Approximately 75% of lymph from the breast drains into
the axilla lymph nodes, so can be biopsied if breast cancer is suspected. If breast
cancer is confirmed, the axillary nodes may need to be removed to prevent the
cancer spreading. This is known as axillary clearance.
CONT’D
• Winged Scapula: The long thoracic nerve (arises from the C5-7 nerve roots)
supplies the serratus anterior. This nerve descends in the axillary region and
compression or damage of the nerve may give rise to winged scapula deformity.
The serratus anterior is no longer able to protract or stabilize the scapula against
the thoracic wall. Compression of the nerve may be a result from a tumour, an
enlarged lymph node, or an aneurysm.
• Infections and Lymphadenopathy: The presence of lymph nodes makes this
region susceptible to infections that can cause swelling or tenderness in cases like
lymphadenitis or systemic infections
