The Upper ggUpper limbs stuffAXILLA.pptx

Axilla

1. AXILLA

2. OUTLINE INTRODUCTION BOUNDARIES CONTENTS APPLIED ANATOMY END

3. INTRODUCTION 4- sided pyramidal space Lateral to the thoracic wall Inferior to the scapulo- humeral (Shoulder) joint. Area of transition for structures to & fro the upper limb Particularly for nerves and vessels. Colloquially referred to as the armpit. Important structures lie close together.

4. BOUNDARIES The axilla is bounded by: Four walls Anterior Posterior Medial Lateral It also has - An Apex -A Base

5. ANTERIOR WALL Formed by Pectorales M s . Pect major covers the whole wall Pect. Minor –the intermediate part Enclosed in clavipectoral fascia Wider medially

6. POSTERIOR WALL Formed by more muscles Above Subscapularis Below Teres major Latissimus dorsi

7. MEDIAL WALL Formed by Ribs 1- 4 Intercoastal Mles in space 1- 3 Upper part of serratus anterior Mle Convex laterally

8. LATERAL WALL Formed by- Intertubercular groove of humerus @ the meeting of the Ant. & Post. Walls Quite narrow

9. APEX Corresponds to the interval between: Outer border of 1 st rib- medially Posterior surface of clavicle- anteriorly Superior border of scapula - posteriorly Termed the Cervico- axillary canal Directed upwards into the root of the neck

10. BASE Formed by: Skin Subcutaneous tissue Axillary fascia Directed downwards Broad medially, Narrow laterally Convex upwards Forms the concavity of the armpit.

11. CONTENTS Vessels Axillary A. + Branches Axillary V. + Tributaries Nerves Infraclavicular part of B. plexus + Braches Lymph nodes/Vessels Muscles Fat Axillary Sheath

12. AXILLARY ARTERY Continuation of the subclavian artery. Begins @ the lateral border of the first rib and ends at the lower boader of the teres major. Divided to 3 parts by the Pectoralis minor. How? The first part has one branch , Superior thoracic artery , course down the thoracic wall supply the first two intercostals spaces the highest parts of the serratus anterior. •

13. Cont’d… The second part has two branches : T horacoacromial artery runs over the medial end of the pectoralis minor has four branches Acromial Deltoid pectoral clavicular The lateral thoracic . Runs vertically along the surface of the serratus anterior. Supplies Pectoralis muscles Serratus anterior Branches that supply the breast .

14. CONTD The 3 RD part has 3 branches. – The subscapular . The largest of the branches Runs vertically on the anterior surface of the subscapularis. Supplies subscapularis, teres major, serratus anterior and latissimus dorsi Branches Circumflex scapular (supplies the dorsum of the scapula) Thoracodorsal (primarily supplies the latissimus dorsi). The 2nd and 3rd branches Anterior circumflex humeral Posterior circumflex humeral . » They surround the surgical neck of the humerus. » The posterior artery runs with the axillary nerve.

15. Axillary Artery: divided into three parts Part 1 (proximal) one branch Part 2 (intermediate) two branches. Part 3 (distal) three branches. Subclavian A. Brachial A.

16. Axillary Artery: First Part From lateral border of 1 st rib to medial border of Pectoralis Major M. Named Branch: Supreme Thoracic A . (to external thoracic body wall) Supplies blood to first and second intercostal spaces

17. Axillary Artery: Second part Deep to the pectoralis minor M. Thoracoacromial trunk Branches to: Clavicular area Pectoralis region Acromion of Scapula Deltoid Muscle. Lateral Thoracic Artery Bbr. to Serratus Ant. M.

18. Axillary Artery: third part Lateral border of Pectoralis minor M. to lateral border of Teres major M. Subscapular A.: Branches: 1. Circumflex scapular A . (to multiple muscles associated with the scapula) 2. Thoracodorsal A. (to Latissimus dorsi M.) Posterior circumflex humeral A. Anterior circumflex humeral A. How it will look in lab

19. AXILLARY VEIN Begins @ the lower border of the teres major Anterior and medial to the Artery. Continuation of Brachial Vein Formed from the union of the brachial veins and the basilic vein. Ends at lateral border of 1st rib -the subclavian vein The cephalic vein enters the axillary vein close to its transition to subclavian vein

20. NERVES BRACHIAL PLEXUS DIVISIONS 3 post. 3 ant. @ the apex. CORDS Related to 2 nd part of axillary A. BRANCHES Musculocutaneous Radial Medial Ulnar

21. LYMPH NODES Five principal groups . – Apical, Pectoral (anterior), Humeral (lateral/brachial), Subscapular (posterior) and Central. The apical group is found in the apex. Receives lymph from all other groups of axillary lymph node s. The pectoral (anterior) nodes lie along the medial wall Receive lymphatics from the lateral thoracic wall and lateral breast region. Drain to the central nodes and eventually to the apical group.

22. Cont’d… The humeral (lateral or brachial) nodes found in the lateral wall along the distal part of the axillary vein. Receive almost all of the lymph from the upper limb Drain to the central nodes. The subscapular (posterior) nodes lie along the posterior axillary fold drain to the central nodes. The central nodes located in the center of the axilla. Receive lymph from the pectoral, subscapular, and humeral groups of the axillary lymph nodes and then pass the collected lymph to the apical group of nodes.

23. OTHERS MUSCLES Short head of biceps Subclavius Clavipectoral fascia FAT Nodes embedded in it. AXILLARY SHEATH Prolongation of the prevertebral layer of cervical fascia Covers Axillary A, Cords of B. plexus.

24. APPLIED ANATOMY Aneurysm of the Axillary Artery This can result in compression of the trunks of the brachial plexus, causing pain and loss of feeling or sensation (anesthesia) in the area supplied by the affected nerves. Injuries to the Axillary Vein The axillary vein is large and is in an exposed position. This makes it susceptible to injury when the axilla is injured. Enlargement of the Axillary Nodes When infections of the upper limb occur, the axillary lymph nodes can become tender. Enlargement of the apical group of nodes may obstruct the cephalic vein superior to the pectoralis minor.

25. Cont’d…. Axillary Lymph Node Dissection The excision and pathologic analysis of the axillary lymph nodes is often required for staging and treatment of malignancies such as breast cancer. When a dissection of the axillary lymph node is done, the long thoracic nerve and the thoracodorsal nerves are in danger. Variations of the Brachial Plexus Variations in the brachial plexus are common . Brachial Plexus Injuries Affect movements and cutaneous sensations in the upper limb. Occur secondary to disease or trauma in the neck or axilla..

26. APPLIED ANATOMY CONTD. Brachial Plexus Block An injection of an anesthetic solution into the angle between the posterior border of the sternocleidomastoid and the clavicle. This surrounds the thin axillary sheet that contains the cords of the brachial plexus and axillary vessels. The anesthetic interrupts nerve impulses and produces anesthesia in the structures supplied by the branches of the cords of the plexus. This procedure, in combination with an occlusive tourniquet technique, helps surgeons to operate on the upper limb without using general anesthetic.