The Axilla

(Part of the Upper Extremity)

by
Dr.Gun Anantasomboon
Human Gross Anatomy I (ANA 227)
for Dental students
June 24, 2013.
Anatomy Unit, Department of Medical Science,
Faculty of Science RSU.
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The Axilla
Lecture outline:
+ Location, Surface Anatomy &
Boundary of the axilla
+ Cervicoaxillary canal
+ Axillary fascia & Axillary sheath
+ Contents in the axillary sheath:
1. Brachial plexus
- formation of the brachial plexus
- nerve branches of the brachial plexus
A) supraclavicular branches (4 branches)
B) infraclavicular branches (13 branches)
2. Axillary artery & its branches
3. Axillary vein & its tributaries
+ Axillary lymph node & Lymphatic drainage pass through the axilla
Axilla
locates between the thorax and the arm/ brachium
pyramidal shape, is filled with nervo-vascular & lymphatic contents.
Its apex directs to the root of neck.
Its base is free skin with axillary hair and axillary fascia.
contains axillary fascias and fat, BP & its nerve-branches,
axillary vessels, lymph nodes and lymph vessels
Axilla = Arm pit,
Axillary hair
- at base of the axilla
Sudoriferous gland
(modified sweat gland)
Anterior axillary fold
Anterior axillary line
Posterior axillary fold
Postrior axillary line
Mid-axillary line
anterior edge of serratus
anterior m.
Base of axilla (arm pit)
Mid-clavicular line nipple in male
Notified the structures & lines:
Pectus
Back
Boundary & Surface anatomy of the Axilla
post.
apex
base
med.
lat.
ant.
Sup.
r
: root of the neck
- body of T
1
- 1
st
rib
- manubrium sterni
Clavicle
Inf.
r
: free skin with axillary hair
Ant.
r
: anterior axillary fold:
pectoralis major & minor m.
Post.
r
: posterior axillary fold:
latissimus dorsi & teres major m.
- scapula & subscapularis m.
Med.
l
: lat. thoracic wall: 1-5 ribs, intercostal m. that is covered by
anterior part of serratus anterior m.
Lat.
l
: med. side of proximal humerus
Cervicoaxillary canal*
(filled-space of the axilla)
+ contains (contents): axillary fascias and Connective tissue fat,
BP & its nerve branches, Axillary vessels, and Axillary lymph nodes.
*
apex
base
med.
lat.
ant.
Apex
Base
Cervicoaxillary
canal
C
C
C
Neuro-vascular structures found in the
Cervicoaxillary canal
Apex of the axilla
Major contents of the axilla
Serratus anterior m.
Supply the:
Connective tissues & Lymph nodes
Axillary artery & its branches
Axillary vein & its tributaries
Brachial plexus & its nerve branches
Axillary fascia:
= deep fascia of axilla
2. Axillary sheath*
- cover the Brachial plexus, axillary artery, and axillary vein
- extend from the prevertebral fascia of the neck
1. Axillary fascia connects to the Clavipectoral
fascia of pectoral region
Contents of the axilla
Long thoracic nerve
Connective tissues & Lymph nodes
Axillary artery & its branches
Axillary vein & its tributaries
Brachial plexus & its nerve branches
The Axillary artery
is the continuation of subclavian a.
is transformed at the outer border of 1
st
rib).
is terminated at the lower border of teres major m. as the brachial a.
brachial a.
subclavian a.
axillary a.
subclavian a.
1
st
2
nd
3
rd
1
st
part has 1 branch:
1. supreme (highest) thoracic a.
2
nd
part has 2 branches (locates post. to the pectoralis minor m.:
1. thoracoacromial trunk (give rise 4 branches):
pectoral; humeral (deltoid); clavicular;
and acromial branches
pierces the costocoracoid membrane
at deltopectoral triangle
2. lateral thoracic (mammary) a.
3
rd
part has 3 branches:
1. subscapular a. (give rise 2 branches):
= circumflex scapular a., and thoracodorsal a.
2. anterior humeral circumflex a.
3. posterior humeral circumflex a.
Axillary artery has 3 parts, divided by pectoralis minor m.
O
5
O
6
4
O
Beginning of axillary artery
The end of
axillary artery
Long thoracic nerve
lateral thoracic a.
thoracoacromial a.
thoracodorsal a.
The Axillary vein
receive main tributaries from Venaecomitantes of brachial a. (origin
at lower border of teres major m.); continuing basilic v. and its
tributaries (have similar name as branches of axillary a.)
terminates (ends) at outer border of 1
st
rib as the subclavian v.
lies anteromedial side of the axillary a. within the axillary sheath.
it also receives venous drainage from the cephalic v. at its termination.
Venaecomitantes of the brachial a.
(brachial vein???)
subclavian v.
axillary v.
superficial vein of the UE
cephalic v.
basilic v.
median cubital v.
antebrachial v.
(median vein of forearm)
deep vein of the UE
cephalic v.
The Brachial Plexus
lies partly from the neck to partly in axilla, run along the cervicoaxillary canal.
is wrapped by the axillary sheath, accompany with axillary a. and v.
This plexus supplies motor, sensory and autonomic fibers to the UE.
Its branches can be separated as:
- supraclavicular branches (4)
arise from roots & upper trunk
ie. dorsal scapular n.,
long thoracic n.,
n. to subclavious, and
suprascapular n.
- infraclavicular branches (13)
branches
- from the lateral cord (3)
- from the medial cord (5)
- from the posterior cord (5)
The Brachial Plexus
has 5 roots from anterior primary rami of spinal nerve level of C
5
T
1.
is serially divided into:
- root (locates between scalenus anterior. and s. medius m.),
- trunks (locate superior to the clavicle, in post, triangle of neck),
there is 3 trunks: upper (C
5-6
), middle (C
7
), and
lower trunks (C
8
-T
1
)
- divisions* (locate under the clavicle),
Each trunks are divided as anterior and posterior divisions.
Ant. division supply flexor muscles of UE.
Post. division supply extensor muscles of UE.
- cords (behind the pectoralis minor m./ inferior to the clavicle/
distal to outer border of 1
st
rib)
lateral cord
medial cord
lateral cord* (originate from post. division of 3 trunks,
supply extensor m. of UE)
- terminal branches or nerves (17 branches)
Intercosto- brachial n.
(T2)
(additional
sensory n.)
Brachial plexus
axillary a.
- Root
- Trunk
- Division
- Cord
- Terminal branches
root
Diagram of the Brachial Plexus
Experience: Drawing diagram of the Brachial plexus by yourself.
Lets you thinking about all muscles that are
innervated by branches of the Brachial plexus
? ? ?
The Axillary Lymph Nodes
C
C
C
C
C
Axillary Lymph Nodes
(there is 5 groups)
Subclavian lymph trunk
junction between
subclavian v. and
internal jugular v.
Lymphatic Drainage at the Axilla
(there is 5 groups)
1
5
4
2
3
4
3. Humeral (lateral)
group
1. Pectoral (anterior) group
5. Apical group
2. Subscapular (posterior)
group
4. Central group
subclavian lymphatic trunk
- Rt. lymphatic duct
- thoracic duct (Lt.)
venous
blood*
*junction between subclavian v. and internal jugular v.
Breast & Pectus
Upper limb
Back & Thorax
base of neck
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Staffs of Anatomy unit
Anatomy unit
ANATOMY!
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