AXILLA

LEARNING OBJECTIVES
At the end of the lecture, the student
should be able to;
• Tell about the position and shape of axilla
• Mention the boundaries and muscle
forming the boundaries of axilla
• Discuss the formation, course and
relations of axillary vessels
• Describe arrangement and groups axillary
lymph nodes
 AXILLA
• Area of transition
between neck and
arm
• An irregularly shaped
pyramidal space
with:
– 4 sides
– An inlet
– A base or floor
• Axillary inlet is
connected with neck
superiorly and with
arm inferiorly
 AXILLARY INLET
• Margins of inlet are
completely formed by
bone
• Medially - lateral
border of rib1
• Anterior - posterior
Surface of clavicle
• Posterior - superior
border of scapula
 ANTERIOR WALL
• Lateral part of
Pectoralis Major
• Pectoralis Minor
• Subclavius
• Clavipectoral fascia
 MEDIAL WALL

• Upper ribs
• Serratus Anterior
• Long thoracic nerve
 LATERAL WALL

• Narrow
• Formed
completely by
intertubercular
sulcus of humerus
 POSTERIOR WALL
• Costal surface of
scapula and
subscapularis muscle
• Latissimus dorsi and
Teres Major

• Gaps between
posterior wall forms
apertures
 FLOOR
• Fascia
• Dome of skin
connecting inferior
margins of walls
• Supported by
clavipectoral fascia
 CONTENTS
• Axillary artery and its branches.
• Axillary vein and its tributaries.
• Brachial plexus.
• Nerves - long thoracic nerve, and
intercostobrachial nerve.
• Collection of lymph nodes.
• Connection of the breast with axilla.
• Proximal parts of biceps brachii and
coracobrachialis.
 AXILLARY ARTERY
• First portion:
– Outer border 1st rib to
medial edge of
pectoralis minor
• Second portion:
– behind pectoralis
minor
• Third portion:
– lateral edge of
pectoralis minor to
lower border of teres
major
 Branches Of The Axillary Artery
• First part –
– Highest Thoracic
• Second part –
– Thoracoacromial
– Lateral Thoracic
• Third part –
– Subscapular.
– Posterior Humeral
Circumflex.
– Anterior Humeral
Circumflex
 AXILLARY VEIN
• Origin:
– basilic vein (lower
border of Teres
major)

• Outflow:
– subclavian vein
(outer border of first
rib)

• Tributaries:
– brachial veins
– cephalic vein
– Venae commitantes
to correspond with
branches of axillary
artery
 AXILLARY VEIN
• Course:
– It lies on medial side of artery
– between two vessels are medial cord of
brachial plexus, median, ulnar, and medial
anterior thoracic nerves.

• Valves:
– A pair of valves opposite the lower border
of subsacpularis
– At ends of cephlaic vein and subscapular
vein (the venae commitantes of
subscapular artery)
 Brachial Plexus
• Each trunk divides into anterior
and posterior divisions behind the
middle of clavicle at apex of axilla
– Three posterior divisions join to form
posterior cord
– Anterior divisions of upper and middle
trunks form lateral cord
– Anterior division of lower trunk
continues as medial cord
• Cords lie around axillary artery
• Posterior cord - axillary and radial
nerves.
• Lateral cord - musculocutaneous
and lateral head of median nerves
• Medial cord - ulnar and medial
head of median nerves
 NERVES
• Long thoracic nerve:
– supplies serratus anterior
– arises by three roots from C5-C7
– descends behind brachial plexus
and axillary vessels, resting on
outer surface of serratus anterior.
– It extends along side of thorax to
lower border of serratus anterior
giving its branches.
– Injury:
during surgery for breast
cancer, specifically radical
mastectomies involving
removal of axillary lymph nodes
from a blow to ribs on an
outstretched arm
gives rise to “winged scapula”
• Intercostobrachial nerve:
– pierces external intercostals and
Serratus anterior, crosses axilla
to medial side of arm
– joins with a branch from medial
brachial cutaneous nerve.
– supplies skin of upper half of
medial and posterior part of arm,
communicating with posterior
brachial cutaneous branch of
radial nerve.
– Injury:
During lymphectomy e.g in
breast surgery
Hypothesia of skin covering
axilla and medial side of arm
 AXILLARY LYMPH NODES
• They drain upper limb,
upper abdominal wall and
pectoral region and receive
most of lymphatic drainage
of breast.
• Arranged in five groups:
– anterior group - deep to
pectoralis major and drain
lateral and anterior chest wall,
breast and upper abdominal
wall.
 lateral group - lateral wall of axilla. Drain
whole arm with exception of that portion whose
vessels accompany cephalic vein

 posterior group - lateral edge of

subscapularis muscle on posterior wall of
axilla. Drain skin and muscles of lower part of
back of neck and of posterior thoracic wall

 central group - arranged around axillary

vessels in axillary fat. Drains above 4 groups

 apical group (median) - apex of axilla

immediately behind clavicle, are continuous
with inferior deep cervical nodes. Receive
drainage from all preceding groups.
CONNECTION OF BREAST WITH AXILLA

• Lymphatic drainage of breast

• Breast cancer and its staging
• Surgery of breast cancer
– Lymph node biopsy
– Lymphectomy
– Damage to the nerves during surgery (Long
thoracic nerve, Intercostobrachial nerve)
 REFERENCES
• CLINICALLY ORIENTED ANATOMY OF
K.L.M
SIXTH EDITION

REVIEWED BY
DR. KHALIDA PARVEEN
Professor Of Anatomy DIMC
Thank You….