Axillary Contents

AXILLARY CONTENTS
Dr. AMTUL
AXILLA
 Axilla is space between upper arm and side of
thorax.
 Resembles a four-sided pyramid, and has:
 An apex: It is channel of communication
between axilla and posterior triangle of neck.
Axillary artery and brachial plexus enters axilla
through apex.
 The base/floor: It is formed by skin, superficial
fascia and axillary fascia.
 Four walls: Anterior, Posterior, Medial and
Lateral.
CONTENTS OF AXILLA
 Axilllary artery and its branches.
 Axillary vein and its tributaries.
 Brachial plexus (infraclavicular part).
 Axillary lymph nodes and their lymphatics.
 Axillary fat and areolar tissue.
 Long thracic nerve and intercostobrachial
nerve.
AXILLARY ARTERY
 This is the main arterial stem of upper limb.
 It is direct continuation of subclavian artery.
 It commences at outer border of first rib and at
lower border of teres major it becomes brachial
artery.
 Axillary artery and cords of brachial plexus are
enclosed within axillary sheath.
 Artery is divided into 3parts by pectoralis
minor which crosses in front of it.
PARTS OF AXILLARY ARTERY
 FIRST PART: superior (proximal) to muscle.
 SECOND PART: posterior (deep/behind) the
muscle.
 THIRD PART: inferior (distal) to muscle.
AXILLARY ARTERY
 Axillary artery gives 6branches.
 FIRST PART:
1. Superior thoracic artery.
 SECOND PART:
1. Thoracoacromial artery.
2. Lateral thoracic artery.
 THIRD PART:
1. Subscapular artery.
2. Anterior circumflex humeral artery.
3. Posterior circumflex humeral artery.
SUPERIOR THORACIC ARTERY
 It arises from
first
part of axillary
artery.
 Passes between
two pectoral
muscles
and ends by
supplying
them.
THORACOACROMIAL ARTERY
 It arises from second part of axillary arter.
 It emerges from upper border of pectoralis
minor, pierces clavipectoral fascia and divides
into four terminal branches:
1. Pectoral branch.
2. Deltoid branch.
3. Acromial branch.
4. Clavicular branch.
LATERAL THORACIC ARTERY
 Arises from second part of axillary artery.
 It follows lower border of pectoralis minor.
 Gives supplying branches to pectoralis and
serratus anterior muscles.
 In females, this is an important contributor of
blood supply to breast.
SUBSCAPULAR ARTERY
 It arises from third part of axillary artery.
 It is the largest branch of axillary artery.
 It runs along lower border of subscapularis and
gives a branch, the circumflex scapular artery.
 Circumflex scapular artery winds around
lateral border of scapula, gives branches to
subscapular and infraspinous fossa, which
takes part in anastomosis around scapula.
 Subscapular artery supplies latissimus dorsi
and serratus anterior.
ANTERIOR CIRCUMFLEX HUMERAL
ARTERY
 It passes laterally in front of intertubercular
sulcus of humerus and anastomose with
posterior circumflex humeral artery to form
arterial circle around surgical neck of humerus.
 It gives off ascending branch which runs in the
intertubercular sulcus and supplies head of
humerus and shoulder joint.
POSTERIOR CIRCUMFLEX
HUMERAL ARTERY
 It passes through quadrangular space
accompanied by axillary nerve.
 It ends by anastomosing with anterior
circumflex humeral artery around surgical
neck of humerus.
 It supplies shoulder joint, deltoid and muscles
forming quadrangular space.
 It gives descending branch which anastomose
with a branch of profunda brachii artery.
COLLATERAL CIRCULATION
 The branches of axillary artery anastomose
with one another and with neighbouring
arteries.
 When axillary artery is blocked collateral

circulation is formed through anastomosis
around scapula between 1st part of subclavian
artery and 3rd part of axillary artery.
AXILLARY VEIN
 It commences at lower border of teres major as
continuation of the basilic vein.
 At the outer border of first rib it becomes
subclavian vein.
 The venae commitantes of brachial artery join the
axillary vein and cephalic veins drains into it in
upper part.
 Other tributaries correspond to branches of
axillary artery.
 It lies on medial side of artery.
 It is not covered by axillary sheath, hence free to
expand during times of increased blood flow.
BRACHIAL PLEXUS
 Nerves network for upper limb.
 It consists of:
1. Roots.
2. Trunks.
3. Divisions.
4. Cords.
ROOTS
 They are formed by ventral rami of C5, C6, C7,
C8, and T1 with contributions from C4 and T2.
 They exit neck between scalenus anterior and

scalenus medius muscle.
 PREFIXED PLEXUS: Significant contribution

from C4 and reduction in contribution from T1.
 POSTFIXED PLEXUS: significant contribution

from T2 and reduced contribution from C5.
TRUNKS
 Located superior to clavicle above and behind
subclavian artery.
 Roots C5 and C6 joins to form UPPER trunk.
 Root C7 forms MIDDLE trunk.
 Roots C8 and T1 joins to form LOWER trunk.
 Trunks lie in the posterior triangle of neck.

DIVISIONS
 Each trunk divide into anterior and posterior
division.
 Anterior divisions:
Carry fibers from trunks to anterior
compartments of upper extremity.
 Posterior Divisions:
Carry fibers from trunks to posterior
compartments of upper extremity.
 They are present behind the clavicle.

CORDS
 Named for relationship to axillary artery.
 Lateral: From anterior divisions of upper and
middle trunks.
 Posterior: From posterior divisions of all
trunks.
 Medial: From anterior divisions of lower
trunk.
CORDS
 Formed from divisions.
 Accompany axillary artery.
 Cords are present in the axilla.
 Axillary artery and cords of brachial plexus are
covered by axillary sheath.
 Local anesthetics are injected into this axillary
sheath to produce brachial plexus nerve block.
BRANCHES OF ROOTS
 DORSAL SCAPULAR NERVE:
Root value: C5
Supply both rhomboids muscle.
 LONG THORACIC NERVE:

Root value: C5, C6, and C7.
Supply serratus anterior.
BRANCHES OF TRUNKS
 SUPRASCAPULAR NERVE:
Root value: C5, C6.
Supply supraspinatus and infraspinatus
muscles.
 NERVE TO SUBCLAVIUS:
Root value: C5, C6.
Supply subclavius.
BRANCHES OF LATERAL CORD
1. LATERAL PECTORAL NERVE:
Root value: C5, C6, C7.
Supply pectoralis major and pectoralis minor.
2. MUSCULOCUTANEOUS NERVE:
3. LATERAL ROOT OF MEDIAN NERVE:

BRANCHES OF MEDIAL CORD
1. MEDIAL PECTORAL NERVE:
Root value: C8, T1.
Supply pectoralis major and pectoralis minor.
2. MEDIAL CUTANEOUS NERVE OF ARM:
Root value: C8, T1.
Supply skin of front and medial side of arm.
3. MEDIAL CUTANEOUS NERVE OF FOREARM:
Root value: C8, T1.
Supply skin of lower arm and medial side of
forearm.
BRANCHES OF MEDIAL CORD
4. ULNAR NERVE:
Root value: C7, C8, T1.
5. MEDIAL ROOT OF MEDIAN:

Root value: C8, T1.
BRANCHES OF POSTERIOR CORD
1. UPPER SUBSCAPULAR NERVE:

Root value: C5, C6.
Supply upper part of subscapularis.
2. THORACODORSAL NERVE:
Supply latissimus dorsi.
3. LOWER SUBSCAPULAR NERVE:
Root value: C5, C6.
Supply lower part of subscapularis and teres
major.
BRANCHES OF POSTERIOR CORD
4. AXILLARY NERVE:
Root value: C5, C6.
5. RADIAL NERVE:
Root value: C5, C6, C7, C8, T1.
THANK YOU…

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AXILLARY CONTENTS

 When axillary artery is blocked collateral

 They exit neck between scalenus anterior and

 PREFIXED PLEXUS: Significant contribution

 POSTFIXED PLEXUS: significant contribution

 Roots C5 and C6 joins to form UPPER trunk.

 Root C7 forms MIDDLE trunk.

 Roots C8 and T1 joins to form LOWER trunk.

 Trunks lie in the posterior triangle of neck.

 They are present behind the clavicle.

 LONG THORACIC NERVE:

3. LATERAL ROOT OF MEDIAN NERVE:

5. MEDIAL ROOT OF MEDIAN:

1. UPPER SUBSCAPULAR NERVE:

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