Pre Med 101 Anatomy 06

Axilla
Definition

• Pyramidal shaped region situated between the upper part of arm and side of chest wall.

Boundaries

• Apex - truncated & bounded by,

Clavicle-upper border
Scapula-superior border
1st rib-outer border
- directed towards root of neck
- Also known as cervicoaxillary canal

• Base - directed downwards

- Skin, axillary fascia

• Anterior wall - Pec. Major

- clavipectoral fascia enclosing subclavius and
pec. Minor

• Pos. wall - Subscapularis

- Teres Major
- Lat. Dorsi

• Ant & post walls converge laterally.

• Lat. Wall - upper part of the shaft of the humerus
- coracobrachialis, short head of biceps
• Med. Wall - upper 4 ribs, their intercostals muscles
- Serratus ant.

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Contents of the Axilla

• Axillary artery and its branches
• Axillary vein and its tributaries
• Infraclavicular part of the brachial plexus
• 5 groups of axillary lymph nodes and
associated lymphatics

Axillary artery
• Continuation of Subclavian artery.
• Extends from outer border of 1st rib to lower border of Teres major.
• Continues as Brachial artery.
• Enclosed within axillary sheath with cords of brachial plexus.
• 3 parts – divided by Pec. Minor – 1st part above, 2nd part behind and 3rd part below Pec. Minor
Branches
SALSAP
• st
1 part -Superior Thoracic Artery
• 2nd part- Acromiothoracic Artery Acromial APCD
(Also thoracoacromial Artery) Pectoral
Clavicular
Deltoid
-Lateral Thoracic Artery

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• 3rd part -Subscapular
➢ Circumflex scapular
➢ Continuation - thoracodorsal artery
-Anterior circumflex humeral Artery
➢ Ascending branch
-Posterior circumflex humeral artery
➢ Descending branch

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Anteriorly Posteriorly Laterally Medially

1st part -skin -Serratus anterior -lateral & posterior -axillary vein
-superficial fascia -Medial cord of cord of brachial
-deep fascia brachial plexus with plexus
-pec major medial pectoral nerve
-clavipectoral fascia -1st intercostal space
2nd part skin -posterior cord of -lateral cord of - axillary vein
-superficial fascia brachial plexus brachial plexus
-deep fascia -subscapularis -coracobrachialis
-pec major
-pec minor
3rd part skin -radial nerve -median nerve - axillary vein
-superficial fascia -axillary nerve -musculocutaneous -ulnar nerve
-deep fascia -subscapularis nerve -medial cutaneous
-pec major -tendons of lat. Dorsi - coracobrachialis nerves of & forearm
-medial root of & teres major
median nerve

2nd part

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Axillary vein
• The axillary vein begins at the lower margin of the teres major.
• the continuation of the basilic vein.
• passes through the axilla medial and anterior to the axillary artery
• becomes the subclavian vein as the vessel crosses the lateral border of rib I
• Tributaries follow the branches of the axillary artery.
The cephalic vein
• superficial vein that drains the lateral and posterior parts of the hand, the forearm, and the arm.
• In the shoulder, it passes into the clavipectoral triangle
• Then pierces the clavipectoral fascia to join the axillary vein.

Brachial plexus
• Plexus of nerves formed by the ant. Primary rami of the C5, C6, C7, C8, T1 nerve roots with
contributions from the C4 and T2 nerve roots.

Roots – ant. Primary rami of C5 to T1

Trunks – upper, middle, lower
Divisions – ventral and dorsal divisions of each trunk
Cords – lateral, medial, posterior

Prefixed plexus -contribution by C4 is large

- T₁ is reduced in size
-T2 is often absent
post fixed plexus -contribution by T1 is large
-T2 is always present
-C4 is absent
-C5 is reduced in size
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ROOTS between ant. & middle scaleni

TRUNKS Posterior triangle of neck

DIVISIONS behind middle 1/3 of clavicle

CORDS & BRANCHES axilla (within the axillary sheath so UL anesthesia)

Erb’s Duchenne Paralysis Klumpke’s Paralysis

Site Erb’s point – upper trunk – lower trunk

Cause Undue separation of head from - undue abduction of arm due

shoulders to- birth injury (breech delivery)
Due to –birth injury -clutching something after fall
fall on shoulder from a height
a anaesthesia
Nerve roots • C5, C6 • T1, C8

Muscles paralyzed Biceps,

Deltoid, • Intrinsic muscles of the
Brachialis, hand (T1)
Brachioradialis • ulnar flexors of wrist and
fingers (C8)
Supraspinatus,
Infraspinatus,
Supinator
Deformity Arm- adducted, medially rotated complete claw hand
Forearm- extended, pronated

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Appearance Porters Tip Hand

Disability Lost movements, 1. Claw hand (unopposed

1. Abduction, lat. Rotation of
arm
2. Flexion, supination of
forearm
3. Biceps and supinator jerks
lost
4. Sensation lost of lower part
of deltoid & lateral side of
arm & forearm
action of long flexors &
extensors)
2. Cutaneous anaesthesia-
ulnar border of forearm and
hand, lower medial arm
3. Horner’s syndrome- ptosis,
miosis, anhidrosis,
enophthalmos

Injury to nerve to Serratus Ant. (Long thoracic nerve / Nerve of Bell)

Causes - sudden pressure on shoulder from above

- carrying heavy loads on shoulder

Deformity winging of scapula – inferior angle and medial border

of scapula are unduly prominent

Deformity -Pushing and punching actions absent, when trying –

winging of scapula
-Arm can’t be raised beyond 90° (overhead abduction)

Axillary Lymph Nodes

Anterior group Lateral thoracic vein

Posterior group subscapular artery
Lateral group Axillary vein
Central group in the axillary fat
Apical group Axillary vein behind the clavicle

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Anterior, Posterior, lateral groups drain into the central group which in turn drains into the
apical group.

• Long thoracic and intercostobrachial (supplies skin of upper medial side of arm and axilla) nerves
(These two nerves and thoracodorsal nerve can
Get damaged in surgeries of the axilla)
• Axillary fat and areolar tissue

Levels of axillary lymph nodes

• Level 1 – lateral to lower border of pec. minor
• Level 2 – behind pec. minor
• Level 3 – medial to upper border of pec. minor