axilla , arterial supply to the shoulder and brachial plexus basic concepts

1. university of Holy Karbala
College of medicine
Axilla, Arterial Supply to the shoulder and Brachial plexus
By
Mohammed Hasan Abed

2. axilla
is a pyramid-shaped space between the upper part of the arm and
the side of the chest. It forms an important passage for nerves,
blood, and lymph vessels as they travel from the root of the neck to
the upper limb.

3. Apex of the axilla
• it is a narrow triangular gap which
is bounded by the clavicle
anteriorly, scapula posteriorly,
and the first rib medially.

4. Apex of the axilla
• The apex is also called the inlet
since it allows the entrance to the
axilla of nerves and vessels

5. Base of the axilla
• The base faces inferiorly
and is formed by fascia
and skin, the fascia is
supported by the
suspensory ligament of
the axilla which renders
the base hollow

6. Anterior wall of the axilla
• This is formed by the
clavicle, pectoralis major,
pectoralis minor, subclavius,
and the clavipectoral fascia
Pectoralis major
Pectoralis
minor

7. Posterior wall of the axilla
scapula
subscapularis
Latissimus dorsi

8. Medial wall of axilla
• The medial wall is formed by the
upper ribs and intercostal muscles
covered by serratus anterior
muscle

9. Lateral wall of axilla
• The lateral wall is narrow and is formed
by the floor of the intertubercular
groove of the humerus to which is
attached the tendon of latissimus dorsi
and in which runs the tendon of the
long head of biceps

10. Arterial Supply to the shoulder

11. Axillary artery
• Begins at the outer border of the
first rib as the continuation of the
subclavian artery

12. Axillary artery
• Ends by becoming the brachial
artery at the lower border of
teres major

13. Axillary artery
• For descriptive purposes it is
divided into three parts by
pectoralis minor muscle

15. 1. Brachial artery
2. Subscapular artery
3. Posterior and anterior
humeral circumflex artery
4. Axillary artery
5. Dorsal scapular artery
6. Suprascapular artery
7. Thyrocervical trunk
8. Subclavian artery
9. Thoracoacromial artery
10. Acromial branch
11. Deltoid branch
12. Pectoral branch

16. Branches of the 1st part of the axillary artery
• Superior thoracic artery

17. Branches of the 2nd part of the axillary artery
• Thoraco-acromial artery
• lateral thoracic artery

18. Branches of the 3rd part of the axillary artery
• Anterior circumflex humeral
artery
• posterior circumflex humeral
artery
• subscapular artery

19. Subscapular artery
• descends along the lateral border
of the scapula and ends as the
circumflex scapular and
thoracodorsal arteries
Circumflex scapular
Thoraco-dorsal

20. Subscapular artery
• the circumflex scapular artery
passes around the lateral border of
the scapula to supply muscles on
the dorsal aspect of the scapula.
• The thoracodorsal artery is the
continuation of the subscapular
artery along the lateral border of
the scapula

23. 1 Pectoralis minor muscle (reflected)
2 Anterior circumflex humeral artery
3 Musculocutaneous nerve (divided)
4 Axillary artery
5 Posterior circumflex humeral artery
6 Profunda brachii artery
7 Median nerve (var.)
8 Brachial artery
9 Biceps brachii muscle
10 Thoraco-acromial artery
11 Suprascapular artery
12 Descending scapular artery
13 Brachial plexus (middle trunk)
14 Transverse cervical artery
15 Anterior scalene muscle and
phrenic nerve
16 Right internal carotid artery
17 Right external carotid artery
18 Carotid sinus
19 Superior thyroid artery
20 Right common carotid artery
21 Ascending cervical artery
22 Thyroid gland
23 Inferior thyroid artery
24 Internal thoracic artery
25 Right subclavian artery
26 Brachiocephalic trunk
27 Left brachiocephalic vein
(divided)
28 Left vagus nerve
29 Superior vena cava (divided)
30 Ascending aorta
31 Median nerve (divided)
32 Phrenic nerve
33 Right lung (divided) and
pulmonary pleura
34 Thoracodorsal artery
35 Subscapular artery
36 Lateral mammary branches (var.)
37 Lateral thoracic artery
38 Thyrocervical trunk
39 Supreme intercostal artery
40 Superior ulnar collateral artery
41 Inferior ulnar collateral artery
42 Middle collateral artery
43 Radial collateral artery
44 Radial recurrent artery
45 Radial artery
46 Anterior and posterior
interosseous arteries
47 Princeps pollicis artery
48 Deep palmar arch
49 Common palmar digital arteries
50 Ulnar recurrent artery
51 Recurrent interosseous artery
52 Common interosseous artery
53 Ulnar artery
54 Superficial palmar arch
55 Median nerve and brachial artery
56 Biceps brachii muscle
57 Ulnar nerve
58 Flexor pollicis longus muscle
59 Proper palmar digital arteries
60 Anterior interosseous artery
61 Flexor carpi ulnaris muscle
62 Superficial palmar branch of radial
artery

24. Brachial plexus

25. The nerves entering the upper limb provide the following important
functions:
1- sensory innervation to the skin and deep structures, such as the
joints;
2- motor innervation to the muscles;
3- influence over the diameters of the blood vessels by the
sympathetic vasomotor nerves;
4- and sympathetic secretomotor supply to the sweat glands.

27. 1. Roots
2. Trunks
3. Superior trunk
4. Middle trunk
5. Inferior trunk
6. Divisions (posterior and anterior)
7. Cords
8. Lateral cord
9. Lateral pectoral nerve
10. Posterior cord
11. Upper, middle, and lower subscapular nerves
12. Medial cord
13. Medial pectoral nerve
14. Medial brachial cutaneous nerve
15. Medial antebrachial cutaneous nerve
16. Terminal branches
17. Musculocutaneous nerve
18. Axillary nerve
19. Radial nerve
20. Median nerve
21. Ulnar nerve

29. Muscles or Skin Innervated
root
Dorsal scapular nerve (C5) Rhomboids and The levator scapulae
Long thoracic nerve (C5, 6, and 7) Serratus anterior
Upper trunk
Nerve to subclavius (C5 and 6)
Suprascapular nerve Supraspinatus, lnfraspinatus
Lateral cord
Lateral pectoral nerve Pectoralis major
Musculocutaneous nerve All the muscles of the anterior compartment of the
arm
Lateral root of median nerve
Medial cord
Medial pectoral nerve Pectoralis major and minor
Medial cutaneous nerve of arm and medial cutaneous
nerve of forearm
Skin of medial arm and medial forearm
Ulnar nerve
Medial root of median nerve
Posterior cord
Upper subscapular nerve Subscapularis
Middle subscapular (Thoracodorsal) nerve Latissimus dorsi
lower subscapular nerve Subscapularis and teres major
Axillary nerve (C5-6) Deltoid and teres minor
Radial nerve (C5-T1) Posterior compartment muscles
of the arm and forearm

31. 1 Accessory nerve
2 Dorsal scapular artery
3 Suprascapular nerve
4 Clavicle and pectoralis minor muscle
5 Lateral cord of brachial plexus
6 Musculocutaneous nerve
7 Axillary nerve
8 Median nerve
9 Brachial artery
10 Radial nerve
11 Cervical plexus
12 Common carotid artery
13 Roots of brachial plexus (C5–Th1)
14 Phrenic nerve
15 Transverse cervical artery
16 Subclavian artery
17 Posterior cord of brachial plexus
18 Medial cord of brachial plexus
19 Subscapular artery
20 Long thoracic nerve
21 Ulnar nerve
22 Medial cutaneous nerve of forearm
23 Thoracodorsal nerve
24 Intercostobrachial nerves
25 Medial cutaneous nerves
of arm and forearm
26 Anterior scalene muscle
27 Middle scalene muscle
28 Intercostal nerve (Th3)
29 Axillary artery
30 Suprascapular artery

32. Thank you