AXILA

Mesole Samuel Bolaji (B.sc M.sc PhD (in-view))

Course: Anatomy
Course Code : HAN 3010
 INTRODUCTION

• The axilla is the pyramidal space inferior to the glenohumeral joint

• superior to the axillary fascia at the junction of the arm and thorax
• The axilla provides a passageway or a distribution center, usually
protected by the adducted upper limb, for the neurovascular structures
that serve the upper limb.
• The following neurovascular structure pass through the axila
a. superiorly via the cervicoaxillary canal to (or from) the root of the neck
b. Anteriorly via the clavipectoral triangle to the pectoral region
c. Inferiorly and laterally into the limb itself.
d. posteriorly via the quadrangular space to the scapular region
e. inferiorly and medially along the thoracic wall to the inferiorly placed
axioappendicular muscles (serratus anterior and latissimus dorsi).
• The shape and size of the axilla varies, depending on the position of the
arm

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 Axilla and it’s walls

• The axilla has an apex, a base, and four walls, three of which are
muscular
• The apex of axilla is the cervicoaxillary canal, the passageway between
the neck and the axilla, bounded by the 1st rib, clavicle, and superior
edge of the scapula.
• The base of axilla is formed by the concave skin, subcutaneous tissue,
and axillary (deep) fascia extending from the arm to the thoracic wall
(approximately the 4th rib level), forming the axillary fossa (armpit).
• The anterior wall of axilla has two layers, formed by the pectoralis
major and pectoralis minor and the pectoral and clavicopectoral fascia
associated with them also the subclavius.
• The posterior wall of axilla is formed chiefly by the scapula and
subscapularis on its anterior surface and inferiorly by the teres major
and latissimus dorsi.
 Axilla and it’s walls Cont’d
• The medial wall of axilla is
formed by the thoracic wall (1st to
4th ribs and intercostal muscles)
and the overlying serratus
anterior .
• The lateral wall of axilla is a
narrow bony wall formed by the
intertubercular groove in the
humerus
• Narrowing is a s a result of the
walls of anterior and posterior
walls converge on it
• Tendon of the long head of biceps
brachii
• short head of biceps brachii and
coracobrachalis
Axila Cont’d
 Contents of the Axila
• Axillary artery and its branches.
• Axillary vein and its tributaries
• Lymphatic vessels
• Axillary lymph nodes within the fat substance
• Nerves that make up the cords and branches of the brachial
plexus.
• Long thoracic nerve
• Intercosto-brachial nerve
• These neurovascular structures are ensheathed in a sleeve-
like extension of the cervical fascia, the axillary sheath
 Axillary Artery
• The axillary artery begins at the lateral border of
the 1st rib as the continuation of the subclavian
artery.
• Ends at the inferior border of the teres major
• It passes posterior to the pectoralis minor into
the arm and becomes the brachial artery when it
passes the inferior border of the teres major
• The axillary artery is divided into three parts by
the pectoralis minor
 BRANCHES OF THE AXILLARY ARTERY
The first part of the axillary artery is located between the lateral border of
the 1st rib and the medial border of the pectoralis minor; it is enclosed in
the axillary sheath and has one the superior thoracic artery(1)
The second part of the axillary artery lies posterior to pectoralis minor
and has two branches the thoracoacromial(2) and lateral thoracic(3)
arteries which pass medial and lateral to the muscle.
The third part of the axillary artery extends from the lateral border of
pectoralis minor to the inferior border of teres major and has three
branches.
• Subscapular artery(4) is the largest branch of the axillary artery.
Opposite the origin of this artery.
• Anterior circumflex humeral (6)
• Posterior circumflex humeral(5) arteries arise, sometimes by
means of a common trunk.
 AXILLARY ARTERY

2 1

3
4
5

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 Branches of the Axillary cont’d
• The superior thoracic artery: supplies
the subclavius, muscles in the 1st and
2nd intercostal spaces.
• Thoracoacromial artery: divides into
four branches acromial, deltoid,
pectoral, and clavicular
• subscapular artery: circumflex
scapular and thoracodorsal arteries.
• circumflex scapular artery:
participates in the anastomoses
around the scapula
• The circumflex humeral arteries
encircle the surgical neck of the
humerus anastomosing with each
other.
Clinical correlates of the Axillary artery
• Compression of the Axillary Artery:Compression of the third part of this
artery against the humerus may be necessary when profuse bleeding
occurs
• Arterial Anastomoses around the Scapula
• Aneurysm of the Axillary Artery:The first part of the axillary artery may
enlarge (aneurysm of the axillary artery) and compress the trunks of the
brachial plexus
• causing pain and anesthesia (loss of sensation) in the areas of the skin
supplied by the affected nerves.
• Aneurysm of the axillary artery may occur in baseball pitchers because of
their rapid and forceful arm movements.
 Axillary Vein
• The axillary vein lies initially
(distally) on the anteromedial
side of the axillary artery.
• Its terminal part is anteroinferior
to the axillary artery
• The vein is formed by the union of
the brachial vein of the and the
basilic vein.
• The axillary vein ends at the
lateral border of the 1st rib, where
it becomes the subclavian vein.
CLINICAL CORRELATE OF THE AXILLA
• Injuries to the Axillary Vein:Wounds in the axilla often involve the
axillary vein because of its large size and exposed position
• When the arm is fully abducted, the axillary vein overlaps the axillary
artery anteriorly.
• Injury to the axillary vein is particularly dangerous because of risk of air
entering it and producing air emboli (air bubbles) in the blood.
• The Role of the Axillary Vein in Subclavian Vein Puncture
• Punch to the armpit in martial arts
• The following structures are at risk during excision: Intercostobrachial
nerve, long thoracic, thoracodorsal nerve and thoracodorsal artery
 Axillary Lymph Nodes
• The fibrofatty connective tissue of the axilla (axillary fat) contains many
lymph nodes.
• The axillary lymph nodes are arranged in five principal groups: pectoral,
subscapular, humeral, central, and apical.
• The groups are arranged in a manner that reflects the pyramidal shape
of the axilla
CLINICAL CORRELATES
• Enlargement of the Axillary Lymph Nodes:The humeral group of nodes
is usually the first to be involved.
• Lymphangitis is characterized by the development of warm, red, tender
streaks in the skin of the limb
• Infections in the pectoral region and breast, including the superior part
of the abdomen, can also produce enlargement of axillary nodes.
• Axillary Abscess caused by infection of the axillary nodes