A space situated between the upper
part of arm and chest wall.
Boundaries of the Axilla
is bounded, by 3 bones:
• Clavicle anteriorly.
• Upper border of the
• Outer border of the
first rib medially.
• It is called
C L E
Is formed by
• Pectoralis major
• Pectoralis minor
• Clavipectoral fascia:
• Posterior wall:
• Is formed by:
• Latissimus dorsi.
• Teres major
The medial wall:
Is formed by:
• Upper 4-5 ribs
The lateral wall:
Is formed by:
• Biceps brachii.
groove of the
Contents of The
Axillary artery and its
Axillary vein and its
Infraclavicular part of
and long thoracic
Axillary lymph nodes
Loose areolar tissue
The neurovascular bundle is enclosed in connective tissue sheath,
called ‘axillary sheath’
Axillary a. & v.
What is a Brachial Plexus ?
Brachial Plexus is a network of nerves present at
the root of the neck to enter the upper limb .
Brachial Plexus supplies muscles and skin of upper
limb except trapezius supplied by spinal accessory
nerve and an area of skin of axilla supplied by
It is formed by the union of the anterior Rami of the
and the 1st
thoracic spinal nerve.
Organization of brachial plexus
5 Roots unite into 3 trunks in the neck:
• Roots of C5 & C6 unite - Upper trunk
• Root of C7 continues ---Middle trunk
• Roots of C8 & T1 unite - Lower trunk
Each trunk divides into anterior(flexor)and a
• Anterior divisions of the superior and
middle trunks unite to form the lateral
• Anterior division of the inferior trunk
form the medial cord.
• Posterior divisions of all 3 trunks unite to
form the posterior cord.
Supraclavicular branches (4)
The dorsal scapular nerve
(C5), posterior to the roots –
Supplies rhomboids major,
rhomboid minor and levator
The nerve to subclavius (C5,
6), anterior to the roots –
The long thoracic nerve (C5,
6, 7) posterior to the roots-
supplies serratus anterior
The suprascapular nerve (C5,
6) –supplies supraspinatus
The roots lie between
The trunks in the
The divisions are
behind the clavicle.
The cords and
branches are situated
Cords and their
Branches of Lateral Cord
lateral pectoral nerve (C5, 6, 7) pectoralis major
musculocutaneous nerve (C5, 6,7)coracobrachiais,
brachialis and bicep brachii.
lateral root of the median nerve (C5, 6, 7)
Branches of Medial cord
Medial pectoral nerve (C8, T1)
Medial root of the median nerve (C8, T1)
Ulnar nerve (C7, 8, T1)
Medial cutaneous nerve of the arm (or
medial brachial cutaneous nerve; C8, T1)
Medial cutaneous nerve of the forearm (or
medial antebrachial cutaneous nerve; C8, T1)
Branches of Posterior cord
The Upper subscapular nerve (C5, 6) –supplies
Thoracodorsal nerve (C5, 6, 7) –supplies
Lower subscapular nerve (C5, 6)-supplies
subscapularis and teres major.
Axillary nerve (C5, 6)-supplies deltoid and
Radial nerve (C5, 6, 7, 8, T1)-nerve of extensor
compartment of arm and forearm.
The lateral cutaneous branchof
the second intercostal nerve does
it is named the
It pierces the external intercostal
and Serratus anterior, crosses
the axilla to the medial side of
the arm, and joins with a filament
from the medial brachial
It supplies the skin of the upper
half of the medial and posterior
part of the arm.
The intercostabrachial nerve is
also sometimes divided in axillary
Arises as a continuation of
the subclavian artery at the
lateral border of first rib
Ends at the lower border of
the teres major muscle to
continue as the brachial
Closely related to the cords
of the brachial plexus and
their branches and is
enclosed with them in the
The pectoralis minor divides
it into three parts .
Branches of Axillary
• First part-One
artery; Supplies upper
• Second Part -Two
artery, has clavicular,
acromial, humeral and
It pierces the
Lateral thoracic artery
supplies mainly the
breast through lateral
Branches of Axillary Artery-Third Part
Subscapular artery Largest branch:
divides into thoracodorsal and
circumflex scapular arteries.
The thoracodorsal artery accompanies
the nerve and supplies latissimus
The circumflex scapular artery passes
into the triangular space
Posterior humeral circumflex artery runs
posteriorly with axillary nerve
through quadrangular space.
Anastomoses with anterior circumflex
Anterior humeral circumflex artery
Passes anteriorly around surgical neck of
humerus and anastomoses with
posterior circumflex artery
Formed by the union of the
venae comitantes of the
brachial artery and the basilic
It runs upward on the medial
side of the axillary artery and
ends at the lateral border of
the first rib by becoming the
The vein receives tributaries,
which correspond to the
branches of the axillary artery,
and the cephalic vein
Anterior or Pectoral group
receive lymph from upper half
of anterior wall trunk and from
major part of breast.
Posterior or Scapular group
receive lymph from posterior
wall of upper half of trunk and
from axillary tail of breast.
Lateral group receives lymph
from upper limb.
Central group receives lymph
from preceding groups and
drains into apical group.
Apical or infraclavicular
(subclavian) group lie deep to
clavipectoral fascia. They
receive lymph from the central
group, from upper part of
breast and from the thumb.
Applied Aspect : Erbs Palsy
Injury to the Upper trunk
paralysis or Erbs palsy is
caused by birth injury
during a breech delivery or
violent displacement of
head from shoulder such as
from fall from motorcycle
Patient presents with loss
of abduction, flexion and
lateral rotation of arm,
producing a waiter’s tip
hand or porter’s hand.
Applied aspect: The Cervical rib
A cervical rib represents a persistent ossification of the
C7 lateral costal element.
The presence of a cervical rib can cause compression
of the lower trunk of the brachial plexus or subclavian
Symptoms are weakness of the muscles around the
muscles in the hand, near the base of the thumb.
Compression of the subclavian artery is often
diagnosed by finding a positive Adson's sign on
examination, where the radial pulse in the arm is lost
during abduction and external rotation of the
Klumpke’s Palsy or Dejerine-Klumpke palsy
Lower trunk injury (C8,T1)may be caused by
a difficult breech delivery, by a cervical rib
or abnormal insertion of the anterior and
middle scalene muscles.
Symptoms include paralysis of intrinsic
hand muscles, flexors of the wrist and
fingers (notably flexor carpi ulnaris and
ulnar half of the flexor digitorum
profundus) and C8/T1 Dermatome
The patient presents with a Claw Hand.
Involvement of T1 may result in Horner's
syndrome, with ptosis, and miosis.
Weakness or lack of ability to use specific
muscles of the shoulder or arm.