Axilla(the armpit)

Prof. Dr. Selda ÖnderoğluDepartment of Anatomy

borders

Anterior wallpectoralis major m.pectoralis minor m.Clavipectoral fascia

PosteriorSubscapularis m.teres major m.latissimus dorsi m.

Medial1-4 ribsİntercostal mm.serratus anterior m.

Lateralıntertubercular Sulcus

apexClavicula (anterior)1st rib (medial)superior border of scapula (post.)

BaseAxillary fasciaskin

contentsLoose connective tissueAxillary arteryAxillary veinAxillary lymph nodesbrachial Plexus (infraclavicular part)

Borders of Axillary Fossa

Prof. Dr. H. Selçuk Sürücü

Base

Skin and axillary fascia

Apex

Anterior wall

Pectoralis majorPectoralis minorClavi-pectoral fascia

Posterior wall

SubscapularTeres majorLatissimus dorsi

Prof. Dr. H. Selçuk Sürücü

Medial wall

Ribs 1-4Intercostal mm.Serratus ant. M.

Lateral wall

Intertubercular sulcus (groove)

What is inside the fossa?

Loose connective tissueAxillary a-vAxillary lymph nodesbrachial plexus (Infraclavicular part )

Axillary artery

Axillary Artery(continuation of subclavian a.)

subclavian a.after 1st rib becomesAxillary artery

After teres major m. becomes

brachial a.

axillary artery is divided into 3 parts according to its position to pectoralis minor m.

1st part - 1 branchSupreme ( highest) thoracic a.

2nd part – 2 brs.Thoracoacromial a.Lateral thoracic a.

3rd part - 3 brs.Subscapular a. (the thickest br. of axill.a.

circumflex scapular a.Thoracodorsal a.

Ant. humeral circumflex a.post. humeral circumflex a.

Ist part of axillary artery

Superior (highest) (supreme) thoracic

a

2nd part of axillary artery

Thoraco-acromial aLateral thoracic a

3rd part of axillary artery

Anterior circumflex humeral aPosterior circumflex humeral aSubscapular a(Thickest branch)

Thorocodorsal aCircumflex scapular a

Thoracodorsal a

axillary vein

Basilic veinAfter:teres major m.continues as the

Axillary vein1st ribContinues as the

Subclavian vein

Cephalic vein joins the axillary vein

Structures piercing clavipectoral fascia

Cephalic vThoraco-acromial aLymph vessLat pectoral n

Axillary Lymph Nodes

Anterior group (pectoral) 4-5Posterior group (subscapular) 6-7Lateral group 4-6Central group 3-4Apical Group 6-12

central

anterior

posterior

lateralapical Subclavian trunk

Lymph vessels accompanying cephalic vein

Axillary lymph nodes: which group drains where

Axillary sheath

deep cervical fasciaSuperficial LaminaPretracheal LaminaPrevertebral Lamina

Axillary sheath

carotid sheath

Axillary sheath encloses:Axillary a.Axillary v.brachial plexus (infraclavicular part)

So: axillary sheath is a part of deep cervical fascia

BRACHIAL PLEXUS

Network of nerves extending from the neck into the axilla It innervates the structures in upper limbFormed by the union of anterior rami of spinal nerves from C5 to T1

Nerves From spinal cord to brachıal plexus

Ant. Root+ post. root

Unite&form spinal nerve

Spinal nerve divides into 2 rami (branches)

Anterior ramus and posterior ramus

From Spinal cord emerges

Ant. Rami of C5-T1 unite and form the brachial plexus

Rami: plural of “ramus”

Prof. Dr. H. Selçuk Sürücü

C5 + C6 Sup. trunk

C7 Middle trunk

C8+T1 Inf.trunk

roots trunks

Brachial plexus

divisionsAntPost

Ant post

Antpost

cords

posterior

lateral

medial

nerves

Trunks

Ant.rami of spinal nn

cordsAnt+post divisions

C4

C5

C6

C7

C8

T1

superior trunk middle trunk inferior trunk

lateral cordMedial cordPosterior cord

clavicle

Parts of brachial plexus

Supraclavicular part- located in the neck

Infraclavicular part-Located in the axilla

clavicle

Nn from Roots

Dorsal scapular n (C5) Rhomboids, levator scapulaeLong thoracic n (C 5-7)

Prof. Dr. H. Selçuk Sürücü

Nn from Trunks (C 5-6)

N to subclaviusSuprascapular n(Accessory phrenic n)

Nn from Lat Cord (C 5-7)

Lat pectoral n - Pectoralis major mMusculocutaneous nLateral root to median n

Nn form Medial Cord (C 8- T1)

Medial root of median nMedial pectoral n- Pectoralis musclesMedial cutaneous n of arm Medial cutaneous n of forearmUlnar n

Nn from post cord

Subscapular nn (C 5-6) Subscapular & teres major mThoracodorsal n (C 5-8)Axillary n ( C5-6)Radial n (C5-T1)

Prof. Dr. H. Selçuk Sürücü

Prof. Dr. H. Selçuk Sürücü

Erb-Duchenne Paralysis(C5-C6)

Klumpke’s paralysis (C8-T1)

Winged scapula: result of damaged long thoracic nerve