AXILLA, BREAST AND

ROTATOR CUFF
Dr. Amtul Sughra…
ROTATOR CUFF
 It is musculotendinous cuff of shoulder.
 Fibrous sheath formed by four flattened

tendons.
 They blends with capsule of shoulder joint

and strengthen it.

 The muscles which forms the cuff arises from

scapula and are inserted into lesser and

greater tubercle of humerus.
ROTATOR CUFF
 The muscles are:
1. Subscapularis.
2. Supraspinatus.
3. Infraspinatus.
4. Teres minor.
FUNCTIONS OF ROTATOR CUFF
 The rotator cuff basically provides strength to
the shoulder joint.
 MOVEMENTS
 Subscapularis is an internal rotator of the
arm.
 Supraspinatus assists the deltoid in
abducting the arm, with its greatest
contribution being the initiation of
abduction.
 Infraspinatus and teres minor muscles both
externally rotate the arm

INTRAMUSCULAR SPACES
 These are:

 Quadrangular space
 Upper triangular space
 Lower triangular space
BREAST
BREAST:
Superficial structure
- skin & derivative of skin (breast)
modified sweat gland

Breast : lies in superficial fascia of

pectoral region .A small extension
called axillary tail pierce deep fascia
and lies in axilla
Extend:from 2nd to 6th rib vertically
From lateral border of sternum to
mid axillary line horizontally.
 The majority of the breast is in the superficial fascia, except the tail part
(Tail of Spence) extends upward laterally into deep fascia at the lower border of
pectoralis major.
2/3 of the gland lies on pectoralis major
1/3 of the gland lies on serratus anterior
2. Components :
- subcutaneous fat, mammary gland
- Lactiferous duct.
- Cooper’s ligament (suspensory
ligament)
- Retinaculum cutis fascia
BREAST
 There are 3components:
 SKIN: there is conical projection called

nipple at the level of 4th intercostal space

which is pierced by 15-20 lactiferous ducts.
It consists of circular and longitudinal
muscle fibres
 . It is rich in nerve supply. It has few sweat

and sebaceous glands

 A circular pigmented area surrounds the

base of nipple called AREOLA .rich in

modified sweat gland in outer margin.
 PARENCHYMA: it consists of 15-20 lobes which
have lactiferous ducts and at termination there is
lactiferous sinus, it has glandular tissue which
secretes milk.
 STROMA: it forms supporting network of gland.
 Fibrous stroma: it forms suspensory ligaments of
cooper.
 Fatty stroma: it forms main bulk of gland.
BREAST:
 BLOOD SUPPLY: extremely vascular. Supplied by:
1. Internal thoracic artery.
2. Lateral thoracic artery.
3. Superior thoracic artery.
4. Acromiothoracic artery.
5. Lateral branches of posterior intercostal arteries.

 Superficial veins: drain into internal thoracic

veins.
 Deep veins: drain into internal thoracic, axillary
and posterior intercostal veins.
BREAST:
 NERVE SUPPLY:
 Supplied by anterior and lateral cutaneous

branches of 4th to 6th intercostal nerves.

 Secretion of glands is controlled by hormone

prolactin.
 Lymphatic drainage of the breast

1. Superficial
-around the mammary gland, lymphatic network is highly anastomosed / drainage
is parallel the venous drainage.
-It drains the skin over the breast except nipple and areola.

2. Deep
-lymph nodes are formed along
the lymphatic vessels.
-They drains the parenchyma of
breast and nipple and areola.
A. from lateral side of the breast, drains
into the anterior group of the axillary
lymph node (the pectoral node).

B. from medial side of the breast, drains

into the parasternal node (the internal
thoracic node)
AXILLA
 Axilla

(Arm pit – Pyramid)

It consists of:
An apex
A base
4Walls / Folds:
.Anterior : pectoralis maj. & min., subclavious,
clavipectoral fascia
.Posterior : latissimus dorsi, teres major,
subscapularis
.Lateral : humerus, tendon of long head of biceps
brachii, tendon of coracobrachialis
.Medial : rib 1-3 & intercostal muscles, serratus
anterior (superior part)
Boundaries of Base of Axilla
 Anterior:
Pectoralis major muscle
 Posterior:

Latissimus dorsi muscle

 Medial:

Thoracic wall
 Lateral:

Humerus
Boundaries of Apex of Axilla
 Anterior:
Clavicle
 Posterior:

Superior border of the scapula

 Medial:

First rib
Contents of Axilla
 Great vessels:
Axillary vein and artery
Cephalic vein and basilic vein
Axillary lymph nodes
 Nerves:

Long thoracic nerve

Cords of brachial plexus
Proximal ends of terminal nerves of
brachial plexus
Contents of the Axilla

1. Axillary a. & branches 2.

Axillary v. & tributaries
3. Brachial plexus

Axillary sheath – deep fascia that wrap around the axillary vessels and the
brachial plexus
-formed by part of cervical fascia
Axillary lymph nodes
- received vessels drainage
from the upper limb, lateral
part of the breast, superficial
of thorax and abdomen (above
the umbilicus) and the back.
 Axillary lymph nodes

- divided into 6 groups:

1. Anterior group
2. Posterior group
3. Lateral group
4. Central group
5. Apical group
6. Subclavian lymph trunk
Node & Vessel Locations:
1. Anterior group
– at the lower border of pectoralis minor
- drinage parallel the lateral thoracic v.
2. Posterior group
– anterior to subscapularis m.
- drainage parallel the subscapular v.
3. Lateral group
- at the lower border of teres major
- drainage parallel medial side of axillary v.
4. Central group
- the outer border of 1st rib
5. Apical group
– at the apex of the axilla
6. Subclavian lymph trunk
THANK YOU…
Dr. Amtul Sughra…