Uncle Snell’s Notes on Gross Anatomy o It is used when describing the axillary

The Axilla artery to divide it into three parts

Clavipectoral Fascia
Axilla − A strong sheet of connective tissue that is attached
− Armpit above to the clavicle
− A pyramid shaped space between the upper part of − Below, it splits to enclose the pectoralis minor
the arm and the side of the chest muscle and then continues downward as the
− It forms an important passage for nerves, blood, suspensory ligament of the axilla and joins the
and lymph vessels as they travel from the root of fascial floor of the armpit
the neck to the upper limb Contents of the Axilla
Apex of Axilla − Axillary artery and its branches
− Upper end of axilla o Supply blood to the upper limb
− Directed into the root of the neck and is bounded − Axillary vein and its tributaries
o Anterior- clavicle o Which drain blood from the upper limb
o Posterior- upper border of the scapula − Lymph vessels and lymph Nodes
o Medial- outer border of the first rib o Drain lymph from the upper limb and the
Base of Axilla breast from the skin of the trunk, down as
− Boundaries far as the level of umbilicus
o Anterior- anterior axillary fold formed by the − Brachial Plexus
lower border of the pectoralis major muscle o Innervates the upper limb
o Posterior- posterior axillary fold formed by − These structures are embedded in fat
the tendon of the latissimus dorsi and teres
major muscle Axillary Artery
o Medial- chest wall − Begins at the lateral border of the first rib as a
Walls of Axilla continuation of the subclavian artery
1. Anterior wall − Ends at the lower border of the teres major muscle,
− By pectoralis major where it continues as the brachial artery
− Subclavius − The artery is closely related to the cords of the
− Pectoralis minor brachial plexus and their branches and is enclosed
2. Posterior Wall with them in a connective tissue sheath called the
− Subscapularis axillary sheath
− Latissimus dorsi − If this sheath is traced upward into the root of the
− Teres major muscle from above down neck, it seems to be continuous with the
3. Medial wall prevertebral fascia
− Upper four or five ribs − PECTORALIS MINOR
− Intercostal spaces o Muscle that crosses in front of the axillary
− Serratus anterior muscle artery and divides it into three parts
4. Lateral wall
− Coracobrachialis 1st part of the Axillary Artery
− Extends from the lateral border of the first rib to the
− Biceps muscle
upper border of the pectoralis minor muscle
− Bicipital groove of humerus
− Relations
Base
o Anterior
− Formed by the skin stretching between the anterior
 Pectoralis major and the skin
and posterior walls
 Cephalic vein crosses the artery
Contents
o Posterior
− Principal vessels
 Long thoracic nerve (nerve to
− Nerves
serratus anterior)
− Lymph nodes
o Laterally
 Three cords of the brachial plexus
Key Muscles in the Axilla
o Medially
− Pectoralis Minor
 Axillary vein
o Thin triangular muscle that lies beneath the
2nd part of the Axillary Artery
pectoralis major
− Lies behind the pectoralis minor muscle
o Arises from the 3rd, 4th, and 5th ribs
− Relations
o Runs upward and laterally to be inserted by
o Anterior
its apex into the coracoid process of the
 Pectoralis minor
scapula
 Pectoralis major
o It crosses the axillary artery and the
 Skin
brachial plexus of nerves o Posterior
  Posterior cord of the brachial − It runs upward on the medial side of the axillary
plexus artery and ends at the lateral border of the 1 st rib by
 Subscapularis muscle becoming the subclavian vein
 Shoulder joint − The vein receives tributaries, which correspond to
o Laterally the branches of the axillary artery, and the cephalic
 Lateral cord of the brachial plexus vein
o Medially
 Medial cord of the brachial plexus Brachial Plexus
 Axillary vein − The nerves entering the upper limb provide the
3rd part of the Axillary Artery following important functions
− Extends from the lower border of the pectoralis o Sensory innervation to the skin and deep
minor to the lower border of the teres major structures such as the joints
− Relations o Motor innervation to the muscles
o Anteriorly o Influence over the diameters of the blood
 Pectoralis major for a short vessels by the sympathetic vasomotor
distance nerves
 Lower down the artery, it is crossed o Sympathetic secretomotor supply to the
by the medial root of the median sweat gland
nerve − At the root of the neck, the nerves form a
o Posteriorly complicated plexus (BRACHIAL PLEXUS)
 Subscapularis − This allows the nerve fibers derived from different
 Latissimus dorsi segments of the spinal cord to be arranged and
 Teres major distributed efficiently in different nerve trunks to the
 Axillary and radial nerve various parts of the upper limb
o Laterally − It is formed in the posterior triangle of the neck by
 Coracobrachialis the union of the anterior rami of the 5th, 6th, 7th, and
 Biceps 8th cervical and 1st thoracic spinal nerves
 Humerus − The plexus is divided into
 Lateral root of the median and the o Roots
musculocutaneous nerves o Trunks
o Medially o Divisions
 Ulnar nerve o Cord
 Axillary vein
 Medial cutaneous nerve
− Upper trunk
o Roots of C5 and 6
Branches of the Axillary Artery − Middle trunk
− From the 1st part o Root of C7
o Highest thoracic artery − Lower Trunk
 Small and runs along the border of o Roots of C8 and T1
the pectoralis minor − Each trunk then divides into anterior and posterior
− From the 2nd part division
o Thoracoacromial artery o Lateral Cord
 Immediately divides into lateral  From the anterior division of the
branches upper and middle trunks
o Lateral thoracic artery o Medial cord
 Runs along the lower border of the  From anterior division of the lower
pectoralis minor trunk
− From the 3rd part o Posterior Cord
o Subscapular artery  From the posterior divisions of all
 Runs along the lower border of the three trunks
subscapularis muscle − Roots, trunk, and division of the brachial plexus
o Anterior and posterior circumflex reside in the lower part of the posterior triangle of
humeral arteries the neck
 Wind around the front and the back − The cord become arranged around the axillary
of the surgical neck of the humerus artery in the axilla
o Here, the brachial plexus and the axillary
Axillary Vein artery and vein are enclosed in the axillary
− Formed at the lower border of the teres major sheath
muscle by the union of the venae comitantes of the
brachial artery and the basilic vein Cords of the Brachial Plexus
 − All three cords of the brachial plexus lie above and
lateral to the first part of the axillary artery
− Medial cord
o Crosses behind the artery to reach the
medial side of the second part of the artery
− Posterior cord
o Lies behind the second part of the artery
− Lateral cord
o Lies on the lateral side of the second part
of the artery
− The cords of the plexus have the relationship to the
second part of the axillary artery that is indicated by
their names
− Most branches of the cords that form the main
nerve trunks of the upper limb continue this
relationship to the artery in its third part
Branches of the Brachial Plexus
− Roots
o Dorsal Scapular Nerve (C5)
o Long thoracic nerve (C5,6, and 7)
− Upper Trunk
o Nerve to subclavius (C5 and 6)
o Suprascapular nerve (supplies
supraspinatus and infraspinatus muscle)
− Lateral Cord
o Lateral pectoral nerve
o Musculocutaneous nerve
o Lateral root of the median nerve
− Medial Cord
o Medial pectoral nerve
o Medial cutaneous nerve of arm and
forearm
o Ulnar nerve
o Medial root of the median nerve
− Posterior Cord
o Upper and lower subscapular nerves
o Thoracodorsal nerve
o Axillary artery
o Radial nerve
Branches of the Brachial Plexus Found in the Axilla
1. Nerve to subclavius
− Supplies the subclavius muscle
− Important: it may give contribution (C5) to
the phrenic nerve, when present, it is
referred to as the accessory phrenic nerve
2. Long thoracic nerve
− C5,6, and 7
− Arises from the roots of the brachial plexus
in the neck and enters the axilla by passing
down over the lateral border of the 1st rib
behind the axillary vessels and brachial
plexus
− It descends over the lateral surface of the
serratus anterior muscle, which it supplies
3. Lateral pectoral nerve
− Arises from the lateral cord of the brachial
plexus
− Supplies the coracobrachialis muscle
− Leaves the axilla by piercing
coracobrachialis muscle
4. Lateral root of the median nerve
− The direct continuation of the lateral cord of
the brachial plexus
− It is joined by the medial root to form the
median nerve trunk, and this passes
downward on the lateral side of the axillary
artery
− The median nerve gives off NO
BRANCHES in the axilla
5. Medial pectoral nerve
− Arises from the medial cord of the brachial
plexus
− Supplies and pierces the pectoralis minor
muscle
− Supplies the pectoralis major muscle
6. Medial cutaneous nerve of the arm
− T1
− Arises from the medial cord of the brachial
plexus
− Is joined by the intercostobrachial nerve
(lateral cutaneous branch of the 2nd
intercostal nerve
− It supplies the skin on the medial side of
the arm
7. Medial cutaneous nerve of the forearm
− Arises from the medial cord of the brachial
plexus and descends in front of the axillary
artery
8. Ulnar nerve
− C8 and T1
− Arises from the medial cord of the brachial
plexus and descends in the interval
between the axillary artery and vein
− It gives off NO BRANCHES in the axilla
9. Medial root of the median nerve
− Arises from the medial cord of the brachial
plexus
− Crosses in front of the 3rd part of the axillary
artery to join the lateral root of the median
nerve
10. Upper and lower subscapular nerves
− Arise from the posterior cord of the brachial
plexus and supply the upper and lower
parts of the subscapularis muscle
− The lower subscapular nerve supplies the
teres muscle
11. Thoracodorsal nerve
− Arises from the posterior cord of the
brachial plexus and runs downward to
supply the latissimus dorsi muscle
12. Axillary Nerve
− One of the terminal branches of the
posterior cord of the brachial plexus
− It turns backward and passes through the
quadrangular space
− Having given off a branch to the shoulder
joint, it divides into anterior and posterior
branches
13. Radial Nerve
 − Largest branch of the brachial plexus o Alternatively, the lymph trunks may
− Lies behind the axillary artery drain directly into one of the large
− It gives off branches to the long and the veins at the root of the neck
medial heads of the triceps muscle and the
posterior cutaneous nerve of the arm
− The latter branch is distributed to the skin
on the middle of the back of the arm

Lymph Nodes of the Axilla

Axillary Lymph Node
− 20 to 30 in number
− Drain lymph vessels from the lateral quadrants of
the breast, the superficial lymph vessels from the
thoracoabdominal walls above the level of the
umbilicus, and the vessels from the upper limb
− Arranged in six groups
1. Anterior (pectoral) Group
− Lying along the lower border of the
pectoralis minor behind the pectoralis major
− These nodes receive lymph vessels from
the lateral quadrants of the breast and
superficial vessels from the anterolateral
abdominal wall above the level of the
umbilicus
2. Posterior (subscapular) Group
− Lying in front of the subscapularis muscle
− These nodes receive superficial lymph
vessels from the back, down as far as the
level of the iliac crests
3. Lateral Group
− Lying along the medial side of the axillary
vein
− These nodes receive most of the lymph
vessels of the upper limb except those
superficial vessels draining the lateral side
4. Central Group
− Lying in the center of the axilla in the
axillary fat
− These nodes receive lymph from the above
three groups
5. Infraclavicular (deltopectoral) group
− These nodes are not strictly axillary nodes
because they are located outside the axillar
− They lie in the groove between the deltoid
and pectoralis major muscle
− Receive superficial lymph vessels from the
lateral side of the hand, forearm, and arm
6. Apical Group
− Lying at the apex of the axilla at the lateral
border of the first rib
− These nodes receive the efferent lymph
vessels from all the other axillary nodes

− The apical nodes drain into the SUBCLAVIAN

LYMPH TRUNK
o On the left side- this trunk drains
into the thoracic duct
o On the right side- this trunk drains
into the right lymph trunk