AXILLA

DR. SAI IYER

ASSISTANT PROFESSOR
BALAJI COLLEGE OF PHYSIOTHERAPY
 INTRODUCTION
1. The axilla (armpit) is a pyramidal space situated between the upper part of
the arm and the chest wall.
1. It resembles a four-sided pyramid, and has the following.
i. An apex
ii. A base
iii. Four walls: Anterior, posterior, medial and lateral.
1. The axilla is disposed obliquely in such a way that the apex is directed
upwards and medially towards the root of the neck, and the base is directed
downwards.
 BOUNDARIES
1. Apex/Cervico-Axillary Canal
• It is directed upwards and medially towards the root of the neck.
i. Anteriorly by clavicle,
ii. Posteriorly by the superior border of the scapula
iii. Medially it is bounded by the outer border of the first rib.
• This oblique passage is called the cervicoaxillary canal
• The axillary vessels, axillary vein and the brachial plexus enter the axilla
through this canal.
 BASE OR FLOOR
• It is directed downwards, and is formed by skin, superficial and
axillary fasciae.
Posterior Wall
• It is formed by Subscapularis muscle, Teres Major and Latisimus Dorsi.
Medial Wall
• Upper four ribs with their intercostal muscles.
• Upper part of the serratus anterior muscle.
Lateral wall
• Upper part of the shaft of the humerus in the region of the bicipital
groove, and
• Coracobrachialis and short head of the biceps brachii
 AXILLARY ARTERY
• Axillary artery is the continuation of the subclavian artery.
• It extends from the outer border of the first rib to the lower border of the
teres major muscle where it continues as the brachial artery.
• The pectoralis minor muscle crosses the artery and divides it into three parts
i. First part, superior (proximal) to the muscle.
ii. Second part, posterior (deep) to the muscle.
iii. Third part, inferior (distal) to the muscle.
PARTS OF ARTERY
1st part: Superior Thoracic artery
2nd part:
1. Acromiothoracic artery
2. Lateral Thoracic artery
3rd part:
3. Subscapular artery
4. Ant circumflex humeral artery
5. Post circumflex humeral artery
 Superior Thoracic artery
• Small branch
• Between Pect. Major & Minor
• Supplies them & thoracic wall
 Acromio-thoracic artery

• Branch from 2nd part of Axillary Artery.

• Starts from Upper Border of Pectoralis Minor Muscle
• Pierces the Clavi-Pectoral Fascia.
 Acromio-thoracic artery
1. Pectoral – supplies pectoral muscles as well as breast
2. Deltoid – runs along with Cephalic Vein and Delto-pectoral Groove.
3. Acromial - joins the anastomosis over acromian process
4. Clavicular – supplies Acromio-clavicular joint and subclavius
 LATERAL THORACIC ARTERY
• Emerges from the Lower border of pectoralis minor Muscle
• Ant. Axillary Lymph Nodes lies along it
• Larger in females, supplies breast tissue
 SUBSCAPULAR ARTERY
• Largest branch of Axillary artery.
• Arising from 3rd part.
• Runs along Lower border of subscapularis muscle and terminate near the
Inferior angle of scapula.
• Supplies latissimus Dorsi and Serratus Anterior.
• Gives largest branch – circumflex scapular artery.
• It passes through the upper Triangular Intramuscular space winds around the
lateral border of scapula and gives a branch to subscapular fossa, infraspinatus
fossa, both of them take part in scapular anastomosis.
 ANTERIOR CIRCUMFLEX HUMERAL
ARTERY
• Small branch from 3rd part at lower border of Subscapularis Muscle.
• Passes through the intertubercular sulcus laterally and Anastomoses with post
circumflex humeral Artery to form arterial circle around the surgical neck of
humerus.
• It gives off an ascending branch which runs in the intertubercular sulcus, and
supplies the head of the humerus and shoulder joint.
 Musculotendinous Cuff of The Shoulder or
Rotator Cuff
• Musculotendinous cuff of the shoulder is a fibrous sheath formed by the
four flattened tendons which blend with the capsule of the shoulder joint
and strengthen it.
• The muscles which form the cuff arise from the scapula and are inserted
into the lesser and greater tubercles of the humerus.
• They are the subscapularis, the supraspinatus, the infraspinatus and the
teres minor
• Their tendons, while crossing the shoulder joint, become flattened and blend
with each other and with the capsule on other hand before reaching their points
of insertion.
• The cuff gives strength to the capsule of the shoulder joint all around except
inferiorly.
• This explains why dislocations of the humerus occur most commonly in a
downward direction
 Subacromial Bursa
• Subacromial bursa is the largest bursa of the body, situated below the
coracoacromial arch and the deltoid muscle.
• Below the bursa there are the tendon of the supraspinatus and the greater
tubercle of the humerus.
• The subacromial bursa is of great value in the abduction of the arm at the
shoulder joint.
i. It protects the supraspinatus tendon against friction with the acromion.
ii. During overhead abduction the greater tubercle of the humerus passes under
the acromion; this is facilitated by the presence of this bursa.
 INTERMUSCULAR SPACES
• The quadrangular intermuscular space is a space in between the scapular
muscles.
• The quadrangular space is bounded by teres minor above and teres major
below; by the long head of triceps muscle medially and the surgical neck of
humerus laterally.
• The axillary nerve accompanied with posterior circumflex humeral vessels lie
in this space.
• Another intermuscular space, the upper triangular space, lt is bounded by the
teres minor muscle medially, long head of triceps laterally, and teres major
muscle below.
 AXILLARY NERVE
• Axillary or circumflex nerve is an important nerve because it supplies the
deltoid muscle which is the main abductor of the arm.
• Surgically it is important, because it is commonly involved in dislocations of
the shoulder and in fractures of the surgical neck of the humerus.
• The axillary nerve is a smaller terminal branch of the posterior cord of the
brachial plexus (C5, C6).
 Course
• Axillary nerve courses through lower part of axilla into the quadrangular
space where it terminates by dividing into two branches.
• Relations and Branches
a. In the lower part of the axilla, the nerve runs downwards behind the third
part of the axillary artery.
b. Here it lies on the subscapularis muscle. It is related medially to median
nerve and laterally to Coracobrachialis Muscle.
• The nerve leaves the axilla by winding round the lower border of the
subscapularis in close relation to the lowest part of the capsule of the shoulder
joint where it gives a branch to the capsule of the joint and enters the
quadrangular space
b. The nerve then passes backwards through the quadrangular space.
• Here it is accompanied by the posterior circumflex humeral vessels and has the
following relations.
• Superiorly: i. Subscapularis or teres minor. Lowest part of the capsule of the
shoulder joint.
• Laterally: Surgical neck of humerus.
• lnferiorly; Teres major.
• Medially: Long head of the triceps brachii. In the quadrangular space, the
nerve divides into anterior and posterior branches in relation to the deltoid
muscle (Fig. 6.6
• The anterior branch is accompanied by the posterior circumflex humeral
vessels. It winds round the surgical neck of the humerus, deep to the deltoid,
reaching almost up to the anterior border of the muscle. It supplies the deltoid
and the skin over its anteroinferior part.
• The posterior branch supplies the teres minor and the posterior part of the
deltoid.
• The nerve to the teres minor bears a pseudoganglion, i.e. fibrous tissue and fat
without any neurons.
• The posterior branch then pierces the deep fascia at the lower part of the
posterior border of the deltoid and continues as the upper lateral cutaneous
nerve of the arm.