1. AXILLARY ARTERY AND BRACHIAL PLEXUS
Valentin C. Dones III, MSPT, PTRP, COMT, DMS, IMPT
Masters of Science in Orthopedic Physical Therapy
Certified Dorn Teacher
Certified Dorn Specialist
Certified in Orthopedic Manual Therapy
Mulligan Practitioner
Functional Fascial Taping Practitioner
Integrated NeurMuscular Taping Therapist

2. AXILLA Floor Fascia and a dome of skin
Anterior axillary fold > posterior axillary fold
Continuous with the anterior compartment of the arm

3. Contents of the Axilla
Proximal parts of biceps brachii and coracobrachialis
Axillary process of the breast
Collections of lymph nodes
Major vessels and nerves

4. Biceps Brachii Origin Insertion Action Innervation
Short head: apex of coracoid process
Long head: Supraglenoid tubercle
Insertion
Radial tuberosity in the forearm
Action
Flexor of the forearm
Supinator of the forearm
Accessory flexor of GHJ
Prevents superior movement of the humerus on the glenoid cavity
Innervation
Musculocutaneous nerve

5. Coracobrachialis Origin Insertion Action Innervation
Apex of the coracoid process
Insertion
Small linear roughening on the medial aspect of the humerus, midshaft
Action
Flexes the arm at the GHJ
Innervation
Musculocutaneous nerve

6. Axillary artery
Subclavian artery  lateral border of rib 1  axillary artery  inferior margin of teres major  brachial artery
Pectoralis minor  3 parts of the axillary artery

7. Axillary artery First part Second part Third part
Superior thoracic artery
Second part
Thoraco-acromial artery
Lateral thoracic artery
Third part
Subscapular artery
Anterior circumflex humeral artery
Posterior circumflex humeral artery

8. Superior thoracic artery
From the anterior surface of the first part of the axillary artery
Upper regions of the medial and anterior axillary walls

9. Thoraco-acromial artery
From the anterior surface of the second part of the axillary artery
Pierces the clavipectoral fascia
Four branches
Pectoral
Deltoid
Accompanies the cephalic vein
Clavicular
Acromial

10. Lateral Thoracic Artery
Posterior to the inferior margin of pectoralis minor
Supplies the medial and anterior walls
Supplies breast

11. Subscapular artery Largest branch of the axillary artery
To the posterior wall of the axilla in the posterior scapular region
From the posterior surface of the third part of the axillary artery
Follows inferior margin of the subscapular artery

13. Subscapular artery Circumflex Scapular Artery Thoracodorsal Artery
Enters the infraspinous fossa
Thoracodorsal Artery
Follows the lateral border of the scapula to the inferior angle
Vascular supply of the posterior and medial walls of the axilla

15. Anterior Circumflex Humeral Artery
Small compared to the posterior circumflex humeral artery
Passes anterior to the surgical neck of the humerus

17. Posterior Circumflex Humeral Artery
From the lateral surface of the third part of the axillary artery
Leaves the quadrangular space with the axillary nerve

18. Axillary Vein Begins at the lower border of the teres major
Continuation of the basilic vein
Drains the posteromedial surface of the hand
Penetrates the deep fascia in the middle of the arm
Axillary vein  subclavian vein at lateral border of rib 1
Tributaries
Brachial veins
Cephalic vein

19. Cephalic Vein
Drains the lateral and posterior parts of the hand, the forearm, and the arm
Enters the clavipectoral triangle

20. Brachial Plexus Anterior rami of C5-C8, T1
Roots, trunks, divisions and cords
Proximal parts of the brachial plexus are posterior to the subclavian artery
More distal regions of the plexus surround the axillary artery

21. Roots Receives gray rami communicantes
In the posterior triangle of the neck
Between the anterior and middle scalenes
Superior and posterior to the subclavian artery

22. Trunks Superior trunk – C5 and C6 Middle trunk – C7 root
Inferior trunk – C8 – T1
Lies on rib 1 posterior to the subclavian artery

24. Divisions Anterior Posterior
Anterior divisions  peripheral nerves  anterior compartments of the arm and forearm
Posterior divisions  peripheral nerves  posterior compartments

26. Cords Related to the second part of the axillary artery Lateral cord
Union of upper and middle trunks
Lateral to the axillary artery (2nd part)
Medial cord
Continuation of the anterior division of the inferior trunk
Medial to the axillary artery (2nd part)

28. Cords Posterior cord Posterior to the axillary artery (2nd part)
Union of all three posterior divisions

29. Branches of the Roots

30. Dorsal Scapular Nerve Originates from C5 Pierces the middle scalene
Travels the medial border of the scapula
Innervates
Rhomboid major
Rhomboid minor

32. Long Thoracic Nerve Anterior rami of C5 to C7
Down the medial wall of the axilla
On the superficial aspect of the serratus anterior muscle

33. LONG THORACIC NERVE C5, C6, C7
Enters the axilla by passing down over the lateral border of the first rib behind the axillary vessels and brachial plexus
Descends over the lateral surface of the serratus anterior, which it supplies

35. Suprascapular Nerve C5 and C6
From the superior trunk of the brachial plexus
Passes laterally through the posterior triangle of the brachial plexus
Through the suprascapular foramen  posterior scapular region
Innervates
Supraspinatus
Infraspinatus

36. Nerve to the subclavius
From the superior trunk of the brachial plexus
Passes anteroinferiorly over the subclavian artery and vein
Innervates the subclavius muscle

37. Lateral Pectoral Nerve
Most proximal
Penetrates the pectoral branch of the thoraco-acromial artery
Innervates the pectoralis major

39. Musculocutaneous nerve
Large terminal branch of the lateral cord
Penetrates the coracobrachialis muscle
Passes between the biceps brachii and brachialis muscles
Lateral cutaneous nerve of the forearm

41. Lateral Root of the Median Nerve
Largest terminal branch of the lateral cord
Joins the medial root of the medial cord  Median Nerve

42. Medial Pectoral Nerve Supplies the pectoralis minor
Supplies the pectoralis major
Most proximal branch
Passes in between the axillary artery and axillary vein

43. Medial cutaneous nerve of the arm
Medial brachial cutaneous nerve
Supplies the skin over the medial side of the arm
In the axilla, communicates with the intercostobrachial nerve (T2)

44. Medial Cutaneous Nerve of the Forearm
Medial antebrachial cutaneous nerve
Just distal to the origin of the medial cutaneous nerve of the arm
Gives off a branch to the skin over the biceps brachii muscle
Penetrates the deep fascia with the basilic vein

45. Medial Root of the Median Nerve
With the lateral root forms the lateral cord of the brachial plexus
Median nerve is formed anterior to the third part of the axillary artery

46. Ulnar Nerve
Large terminal branch of the medial cord

47. Median Nerve Formed anterior to the third part of the axillary artery
Union of lateral and medial roots
Passes anterior to the brachial artery
Innervates
Thenar muscles
Two lateral lumbricals
Palmar surface of the lateral three and ½ digits and over the lateral side of the palm and middle of the wrist

48. Median Nerve M over the third part of the axillary artery
Musculocutaneous nerve
Lateral root of the median nerve
Medial root of the median nerve
Ulnar nerve

49. Median Nerve M over the third part of the axillary artery
Musculocutaneous nerve piercing the coracobrachialis muscle

50. Branches of the Posterior Cord
Superior subscapular nerve
Thoracodorsal nerve
Inferior subscapular nerve
Axillary nerve
Radial nerve

51. Superior subscapular nerve
Short
Supplies the Subscapularis muscle

52. Thoracodorsal nerve Longest
Passes vertically along the posterior axillary wall
Innervates the latissimus dorsi

53. Inferior subscapular nerve
Supplies
Subscapularis
Teres major

54. Axillary Nerve Exits the axilla through the quadrangular space
Innervates the deltoid and teres minor
Superior lateral cutaneous nerve of the arm passes through the quadrangular space
Accompanied by the posterior circumflex humeral artery

55. RADIAL NERVE
Continues downward into the cubital fossa in front of the elbow
Between the brachialis and brachioradialis
In the spiral groove, accompanied by the profunda vessels I/C with the shaft of the humerus

56. RADIAL NERVE: BRANCHES IN THE AXILLA
Long head of the triceps
Medial head of the triceps
Posterior cutaneous nerve of the arm

57. RADIAL NERVE: In the spiral groove
Lateral head of the triceps
Medial head of the triceps
Anconeus
Lower lateral cutaneous nerve of the arm supplies the skin over the lateral and anterior aspects of the lower part of the arm
Posterior cutaneous nerve of the forearm runs down the middle of the back of the forearm as far as the wrist

58. RADIAL NERVE: In the anterior compartment
After the nerve has pierced the lateral fascial septum
Gives off branches to the brachialis, brachioradalis and extensor carpi radialis longus muscles
Gives articular branches to the elbow joint

59. NERVE OF THE LATERAL COMPARTMENT OF THE FOREARM
Pierces the lateral intermuscular septum in the lower part of the arm
Passes forward into the cubital fossa
Passes downward in front of the lateral epicondyle of the humerus

60. NERVE OF THE LATERAL COMPARTMENT OF THE FOREARM
Lies between the brachialis on the medial side and brachioradialis and extensor carpi radialis longus on the lateral side
At the level of the lateral epicondyle, it divides into superficial and deep branches

61. BRANCHES Muscular branches Articular branches to the elbow joint
Brachioradialis
Extensor carpi radialis longus
Small branch to the lateral part of the brachialis muscle
Articular branches to the elbow joint
Deep branch of the radial nerve
Winds around the neck of the radius
Within the supinator muscle
Enters the posterior compartment of the forearm
Superficial branch of the radial nerve

62. Radial Nerve Posterior cutaneous nerve of the arm
Posterior brachial cutaneous nerve
Innervates the posterior surface of the arm

63. THANK YOU!