Lecture Upper Limb (Axilla) PDF

Prepared by: Dr. Eman El Sawaf Anatomy & Embryology Department Faculty Of Medicine, Helwan University Presented by: Dr. Naser El Sawy Anatomy & Embryology Department Faculty Of Medicine, Zagazig University Upper Limb Bones Of The Regions Of The Upper Limb Upper Limb The Axilla ...

Prepared by: Dr. Eman El Sawaf Anatomy & Embryology Department Faculty Of Medicine, Helwan University Presented by: Dr. Naser El Sawy Anatomy & Embryology Department Faculty Of Medicine, Zagazig University Upper Limb Bones Of The Regions Of The Upper Limb Upper Limb The Axilla  Objectives By the end of this lecture student should be able to: Describe the anatomy of the axilla.  Contents - Definition of the axilla. - Boundaries of the axilla. - Contents of the axilla. Definition Definition The Axilla It is a pyramidal space between the upper part of the chest and the upper part of the arm. Definition The Axilla It is a pyramidal space between the upper part of the chest and the upper part of the arm. Definition The Axilla - It is the area of transition between the neck and the arm. - All major structures (vessels & nerves) passing into and out of the upper limb through the axilla. Boundaries Boundaries The Axilla - Apex (axillary inlet). - Base (Floor). - Anterior wall. - Posterior wall. - Medial wall. - Lateral wall. Boundaries The Axilla - Apex (axillary inlet). - Base (Floor). - Anterior wall. - Posterior wall. - Medial wall. - Lateral wall. Boundaries: Axillary inlet The Axilla It is triangular in shape. Boundaries: Axillary inlet The Axilla 1-Medial margin: The first rib. 2-Posterior margin: Superior border of the scapula. 3-Anterior margin: The clavicle. Boundaries: Axillary inlet The Axilla 1-Medial margin: The first rib. 2-Posterior margin: Superior border of the scapula. Medial Lateral 3-Anterior margin: The clavicle. Boundaries: Axillary inlet The Axilla Major blood vessels and nerves pass between the neck and the axilla through the axillary inlet. Boundaries: Anterior wall The Axilla Boundaries: Anterior wall The Axilla The anterior wall is formed by: - Pectoralis major muscle. - Pectoralis minor and subclavius muscles. - Clavipectoral fascia. Boundaries: Anterior wall The Axilla The anterior wall is formed by: 1- Pectoralis major. 2- Pectoralis minor. 3- Subclavius muscles. 4- Clavipectoral fascia. Boundaries: Anterior wall The Axilla The anterior wall is formed by: 1- Pectoralis major. 2- Pectoralis minor. 3- Subclavius muscles. 4- Clavipectoral fascia. Boundaries: Anterior wall The Axilla -The lower border of the anterior wall is called the anterior axillary fold. -It is formed by the pectoralis major muscle. Boundaries: Medial wall The Axilla  Boundaries: Medial wall The Axilla The medial wall is formed by: -The upper thoracic wall. - Serratus anterior muscle  Boundaries: Medial wall The Axilla The medial wall is formed by: Intercostal muscles - The upper thoracic wall. - Serratus anterior muscle Serratus anterior muscle Boundaries: Lateral wall The Axilla  Boundaries: Lateral wall The Axilla - The lateral wall is formed by: The bicipital groove of the humerus and the muscles attached to it.  Boundaries: Lateral wall The Axilla - The lateral wall is formed by: The bicipital groove of the humerus and the muscles attached to it.  Boundaries: Posterior wall The Axilla  Boundaries: Posterior wall The Axilla The posterior wall is formed by: - The scapula. - Muscles: Subscapularis muscle (1) Teres major muscle (2) Latissimus dorsi muscle (3)  Boundaries: Posterior wall The Axilla The posterior wall is formed by: - The scapula (S) - Muscles: Subscapularis muscle (1) Teres major muscle (2) Latissimus dorsi muscle (3)  Boundaries: Posterior wall The Axilla - The lower border of the posterior wall is called the posterior axillary fold. - It is formed by teres major and latissimus dorsi muscles Boundaries: Floor (Base) The Axilla Boundaries: Floor (Base) The Axilla The floor is formed by: - Skin & fascia (axillary fascia). Floor of the axilla  The Axilla Boundaries Inlet (Apex) It is triangular in shape. 1-Medial margin: The first rib. 2-Posterior margin: Superior border of the scapula. 3-Anterior margin: The clavicle. Base Skin & fascia. Anterior wall - Pectoralis major muscle. - Pectoralis minor and subclavius muscles. - Clavipectoral fascia. Posterior wall - The scapula. - Muscles: Subscapularis muscle. Teres major muscle. Latissimus dorsi muscle. Medial wall - The upper thoracic wall. - Serratus anterior muscle Lateral wall -The bicipital groove of the humerus and the muscles attached to it. Contents Contents The Axilla Cords of the brachial plexus Biceps & Coracobrachialis muscles Axillary a. Axillary v. Lymph nodes Contents The Axilla Cords of the brachial plexus Axillary a. Biceps & Coracobrachialis muscles Axillary v. Lymph nodes Origin First rib Axillary artery End Subclavian a. Origin At the lateral (outer) border of first rib the subclavian artery becomes the axillary artery. End At the inferior margin of the teres major muscle the axillary artery becomes the brachial artery. Teres Brachial a. major Course Axillary artery The axillary artery is divided into three parts by the pectoralis minor muscle, which crosses anterior to the artery: First part Above the pectoralis minor muscle. Second part Posterior to the pectoralis minor muscle. Third part Below the pectoralis Pectoralis minor minor muscle. Axillary artery Branches Axillary artery 1 2 3 First - Superior thoracic artery part Second - Thoraco-acromial artery part - Lateral thoracic artery Third - Subscapular artery part - Anterior circumflex humeral artery - Posterior circumflex humeral artery Branches Axillary artery 1 2 3 Posterior circumflex humeral Superior thoracic Anterior Thoraco circumflex acromial humeral Lateral thoracic Subscapular Branches Axillary artery -They supply the axillary walls and the thoracic wall. 1-Superior thoracic artery. 2-Thoracoacromial artery: - At the sup. margin of pectoralis minor m. - It penetrates the clavipectoral fascia. 3-Lateral thoracic artery: - At the inf. margin of pectoralis minor m. 4-Subscapular artery: - It is the largest branch of the axillary artery. - It follows the inferior margin of the subscapularis muscle. 5-Anterior & 6-posterior circumflex humeral arteries: - They pass anterior and posterior to the surgical neck of the humerus respectively and anastomose together. - They supply the shoulder joint.  Axillary vein Beginning - The axillary vein begins at the lower margin of the teres major muscle as the continuation of the basilic vein. End - It becomes the subclavian vein at the lateral border of the first rib. Course - The axillary vein passes through the axilla medial and anterior to the axillary artery. Tributaries - Tributaries that follow the branches of the axillary artery. - Brachial veins. - Cephalic vein. - Beginning - End Axillary vein - Course - Tributaries Subclavian vein Axillary vein Basilic vein Remember Contents of the axilla Axillary artery -Subclavian artery -Brachial artery -First rib -Teres major -Pectoralis minor -1-2-3 Axillary vein -Subclavian vein -Basilic vein -Cephalic vein  Complete the following -The medial margin of the inlet of the axilla is formed by the ……………. -The anterior axillary fold is formed by the ………… ………. -The axillary artery is the continuation of the ……… ………. at the lateral border of ………... -The cephalic vein ends in the …………..  Complete the following -The medial margin of the inlet of the axilla is formed by the first rib. -The anterior axillary fold is formed by the pectoralis major muscle. -The axillary artery is the continuation of the subclavian artery at the lateral border of first rib. -The cephalic vein ends in the axillary vein.  MCQ -Which one of the following forms the lateral wall of the axilla? a. Humerus. b. Ribs. c. Clavicle. d. Scapula.  MCQ -Which one of the following forms the lateral wall of the axilla? a. Humerus. b. Ribs. c. Clavicle. d. Scapula.  MCQ -Which one of the following arteries originates from the third part of axillary artery? a. Thoraco acromial. b. Superior thoracic. c. Subscapular. d. Lateral thoracic.  MCQ -Which one of the following arteries originates from the third part of axillary artery? a. Thoraco acromial. b. Superior thoracic. c. Subscapular. d. Lateral thoracic.  Reference Gray's Anatomy for Students, 3rd Ed. with STUDENT CONSULT Online Access Drake, Vogl & Mitchell 2014. ISBN: 978-0-7020-5131-9 Thank You