Axilla (the armpit) Prof. Dr. Selda Önderoğlu Department of Anatomy

borders Anterior wall pectoralis major m. pectoralis minor m. Clavipectoral fascia Posterior Subscapularis m. teres major m. latissimus dorsi m. Medial 1-4 ribs İntercostal mm. serratus anterior m. Lateral ıntertubercular Sulcus

apex Clavicula (anterior) 1st rib (medial) superior border of scapula (post.) Base Axillary fascia skin contents Loose connective tissue Axillary artery Axillary vein Axillary lymph nodes brachial Plexus (infraclavicular part)

Borders of Axillary Fossa Prof. Dr. H. Selçuk Sürücü

Base Skin and axillary fascia

Apex

Anterior wall Pectoralis major Pectoralis minor Clavi-pectoral fascia

Posterior wall Subscapular Teres major Latissimus dorsi

Prof. Dr. H. Selçuk Sürücü

Medial wall Ribs 1-4 Intercostal mm. Serratus ant. M.

Lateral wall Intertubercular sulcus (groove)

What is inside the fossa? Loose connective tissue Axillary a-v Axillary lymph nodes brachial plexus (Infraclavicular part )

Axillary artery

Axillary Artery ( continuation of subclavian a.) subclavian a. after 1 st rib becomes Axillary artery After teres major m. becomes brachial a. axillary artery is divided into 3 parts according to its position to pectoralis minor m. 1st part - 1 branch Supreme ( highest) thoracic a. 2nd part – 2 brs. Thoracoacromial a. Lateral thoracic a. 3 rd part - 3 brs. Subscapular a. (the thickest br. of axill.a. circumflex scapular a. Thoracodorsal a. Ant. humeral circumflex a. post. humeral circumflex a.

Ist part of axillary artery Superior (highest) (supreme) thoracic a

2nd part of axillary artery Thoraco-acromial a Lateral thoracic a

3rd part of axillary artery Anterior circumflex humeral a Posterior circumflex humeral a Subscapular a (Thickest branch) Thorocodorsal a Circumflex scapular a

Thoracodorsal a

axillary vein Basilic vein After:teres major m. continues as the Axillary vein 1st rib Continues as the Subclavian vein Cephalic vein joins the axillary vein

Structures piercing clavipectoral fascia Cephalic v Thoraco-acromial a Lymph vess Lat pectoral n

Axillary Lymph Nodes Anterior group (pectoral) 4-5 Posterior group (subscapular) 6-7 Lateral group 4-6 Central group 3-4 Apical Group 6-12

central anterior posterior lateral apicalSubclavian trunk Lymph vessels accompanying cephalic vein Axillary lymph nodes: which group drains where

Axillary sheath deep cervical fascia Superficial Lamina Pretracheal Lamina Prevertebral Lamina Axillary sheath carotid sheath Axillary sheath encloses: Axillary a. Axillary v. brachial plexus ( infraclavicular part) So: axillary sheath is a part of deep cervical fascia

BRACHIAL PLEXUS Network of nerves extending from the neck into the axilla It innervates the structures in upper limb Formed by the union of anterior rami of spinal nerves from C5 to T1

Nerves From spinal cord to brachıal plexus Ant. Root+ post. root Unite&form spinal nerve Spinal nerve divides into 2 rami (branches) Anterior ramus and posterior ramus From Spinal cord emerges Ant. Rami of C5-T1 unite and form the brachial plexus Rami: plural of “ramus”

Prof. Dr. H. Selçuk Sürücü

C5 + C6Sup. trunk C7Middle trunk C8+T1Inf.trunk roots trunks Brachial plexus divisions Ant Post Ant post Ant post cords posterior lateral medial nervesnerves

Trunks Ant.rami of spinal nn cords Ant+post divisions C4 C5 C6 C7 C8 T1 superior trunk middle trunk inferior trunk lateral cord Medial cord Posterior cord

clavicle

Parts of brachial plexus Supraclavicular part - located in the neck Infraclavicular part -Located in the axilla

clavicle

Nn from Roots Dorsal scapular n (C5) Rhomboids, levator scapulae Long thoracic n (C 5-7)

Prof. Dr. H. Selçuk Sürücü

Nn from Trunks (C 5-6) N to subclavius Suprascapular n (Accessory phrenic n)

Nn from Lat Cord (C 5-7) Lat pectoral n - Pectoralis major m Musculocutaneous n Lateral root to median n

Nn form Medial Cord (C 8- T1) Medial root of median n Medial pectoral n- Pectoralis muscles Medial cutaneous n of arm Medial cutaneous n of forearm Ulnar n

Nn from post cord Subscapular nn (C 5-6) Subscapular & teres major m Thoracodorsal n (C 5-8) Axillary n ( C5-6) Radial n (C5-T1)

Prof. Dr. H. Selçuk Sürücü

Erb-Duchenne Paralysis (C5-C6)

Klumpke’s paralysis (C8-T1)

Winged scapula: result of damaged long thoracic nerve