10th P.A.

Axilla - walls, content, gateways. Axillary artery and vein. Axillary lymph nodes. Surface anatomy.
Clinical significance.

Borders

 Irregularly shaped pyramidal space;

 Consists of 4 sides and a base with an opening at the apex:
 Apex/axillary inlet formed - upwards and medially into root of neck
→
cervico-axillary canal - same what triangular in shape
- margins of the inlet = completely formed by
bone:

 Medial margin = lateral border of 1st rib;

 Anterior margin = posterior surface of clavicle;
 Posterior margin = superior border of scapula, up to the coracoid
process.

- continuous with the inferior deep cervical

nodes .

 Anterior wall
- contains the lateral part of Pectoralis Major m.
the underlying Pectoralis Minor m.
Subclavius m.

 Medial wall
- consists of upper thoracic wall ( upper 4-5 ribs and intercostal m.)
Serratus anterior m.

 Lateral wall
- formed by intertubercular groove of the humerus whose lips give
attachment to the muscles of the anterior and posterior axillary
wall.
Tendon of Biceps Brachii (in bicipital groove of humerus
Choracobrachialis m. )
Short head of Biceps brachii.
  Posterior wall formed by the costal surface of the scapula;
muscles of the wall are:
 Subscapularis m. (costal surface of scapula)
(above)
 Latissimus Dorsi m. (distal part) (below)
 Teres Major m. (distal part) (below)
 Long head of Triceps Brachii m. (proximal part)

 Floor/ Base formed by axillary fascia and a dome of skin that spans the
distance between the inferior margin of the walls
supported by the Clavipectoral Fascia
inferiorly - structures pass into & out of the axilla immediately
lateral to the floor where the ant.&post. walls of
the axilla converge
- where the axilla continuous with the anterior
compartiment of the arm.

Content of the Axilla

- major vessels, nerves and lymphatics of the upper limb.

 Axillary artery main artery supplying the upper limb/walls of the axilla
and its branches and related regions
referred as having 3 parts:
1. medial to the Pectoralis Minor
( proximal to superior )
2. posterior to the Pectoralis Minor
( deep )
3. lateral to the Pectoralis Minor
( distal to inferior )
* medial & posterior parts travel in the axilla *
Subclavian artery in the neck becomes the axillary
artery at the lateral margin of 1 st rib which passes
through axilla becoming Brachial artery
( inferior margin of Teres Major m.)
Branches of the Axillary artery

- 6 branches arise from the axillary artery;

1st part - superior thoracic artery v. small branch

near Subclavius m.
passes between Pectoralis Major m. and Pectoralis
Minor m.

2nd part - Thoraco - acromial artery - upper border Pectoralis Minor m. pierces clavipectoral
fascia Pectoral b.
Deltoid b.
Acromial b.
Clavicular b.

- Lateral Thoracic artery - inferior border of Pectoralis Minor m. Pectoralis Major

Pectoralis Minor
Serratus Anterior

3rd part - Subscapular artery

- Circumflex Humeral artery
- Posterior Circumflex Humeral artery
Axillary vein and its tributaries

 Begins -> lower margin of Teres Major m.

 Is the continuation of the Basilic vain (superficial vein) drains the posteromedial surface
of the hand and forearm and penetrates the deep fascia in the middle of the arm.
 Main vain draining the upper limb
 2 largest tributaries Cephalic vein - lateral vein of the arm
Basilic vein - the medial vein of the arm
 Cephalic vein = superficial; drains lat.&post. parts of the upper limb; passes through/into
an inverted triangular cleft (the clavipectoral triangle) between Deltoid,
Pectoralis Major and clavicle.

Tributaries

1. Veins which correspond to the branches of axillary a.

Lateral Thoracic vein
Subscapular vein
2. Cephalic vein joins it after piercing the Clavipectoral Fascia .
Relations of the axillary artery
 Axillary vein = medial to axillary a. throughout its course.
st
1 part

- anterior Pectoralis Major m. ( clavicular part )

Loop of communication between lateral and medial Pectoral m.

- posterior Medial cord of Brachial Plexus

Long Thoracic n.
Serratus anterior m. ( 1 st digitation )

- medial Axillary vein

- lateral lateral and posterior cords of Brachial Plexus

2nd part

- anterior Pectoralis Minor m.

- posterior Posterior cord of Brachial Plexus

Subscapularis m.

- medial Medial cord of Brachial Plexus

Axillary vein

- lateral Lateral cord of Brachial Plexus

3rd part

- anterior Medial root of median nerve

- posterior Radial nerve

Axillary nerve
Subscapularis m. (upper part)
Teres Major m. (lower part)

- medial Axillary vein

Medial cutaneous nerve
Ulnar nerve
- lateral Musculocutaneous nerve
Axillary Lymph nodes

 Filter lymph that has drained from the upper limb and pectoral region;
 Receive drainage from ~ 75% of the mammary gland;
 20-30 axillary nodes are divided into 5 groups on the basis of location

 Humeral (lateral) nodes

- long brachial and axillary vein;
- posteromedial to the axillary vein;
- receive most of the lymphatic drainage upper limb.

 Pectoral (anterior) nodes

- along inferior margin of Pectoralis Minor;
- drainage abdominal wall, chest, mammary gland.

 Subscapular (posterior) nodes

- posterior axillary wall with subscapular vessels;
- receive lymphatics from back, shoulder, neck.

 Central nodes
- embedded in axillary fat ;
- tributaries from humeral, subscapular, pectoral nodes.

 Apical nodes ( the tip )

- most superior ;
- drain all other groups of nodes.
Gateways in the posterior wall-Axilla

- 3 main routs through which structures leave the axilla

Quadrangular space

-passage way for nerves and vessels passing between the axilla and the more posterior scapular and
deltoid region.

- anteriorly = bondaries:
 Inferior margin of the subscapularis m.
 Surgical neck of the humerus
 Superior margin of the Teres Major m.
 Latera margin of the long head of the Triceps Brachii m.

- passing through -> axillary nerve

-> posterior circumflex humeral artery and vein

Triangular space

- area of communication between the axilla and posterior scapular region;

- anteriorly, formed by:

 Medial margin - long head - Triceps Brachii m.
 Superior margin - Teres Major m.
 Inferior margin - Subscapularis m.

- passing through -> circumflex scapular artery and vein

Triangular intervals

- formed by :
 Lateral margin - long head - Triceps Brachii m.
 Shaft of the humerus
 Inferior margin - Teres Major m.

- passing through radial nerve