Axilla Anatomy PDF

Mohamed Osman Mohamed Idres MBBS, Msc, MRCS ⦿ Todefine the location of the axilla. ⦿ To name the structures that form the boundaries of the axilla. ⦿ The name the content s of the axilla. ⦿ To define the anatomical...

Mohamed Osman Mohamed Idres MBBS, Msc, MRCS ⦿ Todefine the location of the axilla. ⦿ To name the structures that form the boundaries of the axilla. ⦿ The name the content s of the axilla. ⦿ To define the anatomical 2 ⦿ Ibraheem is a resident doctor in Omdurman military hospital, he was reading a medical file of a 40 years old lady written by his junior doctor, the patient was presented with a breast lump , but h e n ot i ced that the report about examination of i m por t a n t group of lymph nodes was missed, f o r a t ea ch i n g p u r p os e, h e a s k the junior doctor the following questions: ⦿ Questions: ⦿ Mention the lymphatic drainage of the breast. ⦿ M enti on the f iv e grou ps of the a xi l l a r y lymph nodes. ⦿ M en t i on t h e a n a t om i c a l relations for e a c h group 3 ⦿ Boundaries of the axilla. ⦿ Contents of the axilla. 4  BOUNDARIES: C O NTE NTS: ⦿ Inlet. ⦿ Anterior. ⦿ Axillary arter y. ⦿ Posterior. ⦿ Axillary vein. ⦿ Axillary lymph ⦿ Medial. nodes. ⦿ Lateral. ⦿ Brachial plexus. ⦿ Floor. 5 ⦿ The axilla is the pyramidal space inferior to the glenohumeral joint and superior to the axillary fascia at the junction of the arm and thorax. 6 Axilla : Location I mag e from: Richard L. D rake, Wayne Vog l,A d am W. M. M itch ell, G RAYS anatomy for students, Elsevier I n c. 2007 7 I m ag e from: Richard S.Sn ell, C lin ical Anatomy by Reg ion s, 8 th E d. Lippincott Williams & Wilkins. 8 ⦿ Medial margin : The lateral border of 1st rib. ⦿ Anterior margin : The posterior surface of the clavicle; ⦿ Posterior margin: The superior border of the scapula. I m ag e from: Richard S.Sn ell, C lin ical Anatomy by Reg ion s, 8 th E d. Lippincott Williams & Wilkins. 9  Boundaries I mag e from: Richard L. D rake, Wayne Vog l,A d am W. M. M itch ell, G RAYS anatomy for students, Elsevier I n c. 2007 10  BOUNDARIES: C O NTE NTS: ⦿ Inlet. ⦿ Anterior. ⦿ Axillary arter y. ⦿ Posterior. ⦿ Axillary vein. ⦿ Axillary lymph ⦿ Medial. nodes. ⦿ Lateral. ⦿ Brachial plexus. ⦿ Floor. 11 ⦿ It is formed by: Pectoralis major muscle. Pectoralis minor muscle. Subclavius muscle. 12  I mag e from: http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/pectoralis-major Origin Insertion Innervation Function Clavicular head : anterior surface Lateral lip Medial and Flexion, adduction, of medial half of clavicle; of inter- lateral and medial rotation of sternocostal head : anterior surface tubercular pectoral arm at gleno-humeral of sternum; upper costal cartilages sulcus of nerves joint, extension of and aponeurosis of external humerus flexed arm oblique 13  Pectoralis major I mag e from: Richard L. D rake, Wayne Vog l,A d am W. M. M itch ell, G RAYS anatomy for students, Elsevier I n c. 2007 14  I mag e from: http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/pectoralis-minor Origin Insertion Innervation Function Anterior surfaces and Coracoid process of Medial pectoral Pulls tip of superior borders of ribs scapula nerve shoulder down; III to V protracts scapula 15  Pectoralis minor I mag e from: Richard L. D rake, Wayne Vog l,A d am W. M. M itch ell, G RAYS anatomy for students, Elsevier I n c. 2007 16  I mag e from: http://www.fotosearch.com/photos-images/subclavius.html#comp.asp?recid=1542289&xtra= Origin Insertion Innervation function Pulls tip of shoulde r First rib at junction Groov e on inferior Nerve to down; pu lls cla v icle between rib and su r fa ce of m i d d l e subclavius m e dia lly to stabilize costal cartilage one-third of clavicle sternoclavicular joint 17  CLAVI-PE CTO R A L FASCI A I m ag e from: Richard S.Sn ell, C lin ical Anatomy by Reg ion s, 8 th E d. Lippincott Williams & Wilkins. 18  BOUNDARIES: C O NTE NTS: ⦿ Inlet. ⦿ Anterior. ⦿ Axillary arter y. ⦿ Posterior. ⦿ Axillary vein. ⦿ Axillary lymph ⦿ Medial. nodes. ⦿ Lateral. ⦿ Brachial plexus. ⦿ Floor. 19 ⦿ Subscapularis. ⦿ Teres major. ⦿ Latissimus dorsi. ⦿ Long head of triceps brachii. 20  I mag e from: http://www.rad.washington.edu/academics/academic- sections/msk/muscle-atlas/upper-body/subscapularis I mag e from: http://www.exrx.net/Muscles/Subscapularis.html Origin Insertion Innervation Function Lesser tubercle , Upper Medial rotetion , Subscapular fossa humerus subscapular nerve shoulder joint 21  I mag e from: http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/teres-minor Origin Insertion Innervation Function Medial lip of the The posterior Medial rotation and intertubercular surface of the Inferior subscapular extension of the arm sulcus on the inferior angle of the nerve [C5 to C7] at the glenohumeral anterior surface of scapula joint the humerus 22 I mag e from: Richard L. D rake, Wayne Vog l,A d am W. M. M itch ell, G RAYS anatomy for students, Elsevier I n c. 2007 23  Latissimus dorsi Origin Insertion Innervation Function Spinous processes of lower six thoracic vertebrae Adduction, Related interspinous medial rotation, ligaments Floor of Thoracodorsal and extension The thoracolumbar intertuber nerve [C6,C7,8] of the arm at fascia to the spinous cular the processes of the sulcus glenohumeral lumbar vertebrae joint Iliac crest. Lower 3-4 ribs 24 Video from: Acland's video Atlas of Human Anatomy, Robert D. A clan d M. D , F RC S. 25  I mag e from: http://www.completef itness.com.au/articles/strength/triceps.php Triceps brachii Muscle Origin Insertion Innervation Function Extension of the Common tendon of in- forearm at the elbow Long head of Infraglenoid sertion with medial and Radial nerve joint; accessory triceps tubercle on lateral heads on the [C6,C7,C8] adductor and extensor brachii scapula olecranon process of of the arm at the ulna glenohumeral joint 26  BOUNDARIES: C O NTE NTS: ⦿ Inlet. ⦿ Anterior. ⦿ Axillary arter y. ⦿ Posterior. ⦿ Axillary vein. ⦿ Axillary lymph ⦿ Medial. nodes. ⦿ Lateral. ⦿ Brachial plexus. ⦿ Floor. 27  I mag e from: Richard S.Sn ell, C lin ical Anatomy by Region s, 8 th E d. Lippincott Williams & Wilkins. Muscle Origin Insertion Innervation Function Costal surface Protraction and Serratus Lateral surfaces of medial Long thoracic rotation of the anterior of upper 8 ribs border of nerve scapula scapula 28 Video from: Acland's video Atlas of Human Anatomy, Robert D. A clan d M. D , F RC S. 29 I mag e from: Richard L. D rake, Wayne Vog l,A d am W. M. M itch ell, G RAYS anatomy for students, Elsevier I n c. 2007 Hosam Eldeen Elsadig MBBS , 12/11/2012 M.Sc. 30  BOUNDARIES: C O NTE NTS: ⦿ Inlet. ⦿ Anterior. ⦿ Axillary arter y. ⦿ Posterior. ⦿ Axillary vein. ⦿ Axillary lymph ⦿ Medial. nodes. ⦿ Lateral. ⦿ Brachial plexus. ⦿ Floor. 31 ⦿ Lateral wall: Narrow bony wall for med by the humerus. ⦿ Floor: It is formed by: T She concave skin. ubcutaneous tissue (Deep fascia) extending from the arm to the thoracic wall. 32  BOUNDARIES: C O NTE NTS: ⦿ Inlet. ⦿ Anterior. ⦿ Axillary arter y. ⦿ Posterior. ⦿ Axillary vein. ⦿ Axillary lymph ⦿ Medial. nodes. ⦿ Lateral. ⦿ Brachial plexus. ⦿ Floor. 33 ⦿ Axillary artery. ⦿ Axillary vein. ⦿ Axillary lymph nodes. ⦿ Brachial plexus. I mag e from: Richard L. D rake, Wayne Vog l,A d am W. M. M itch ell, G RAYS anatomy for students, Elsevier I n c. 2007 34 ⦿ Divided according to its relation to the pectoralis minor muscle into three parts : First. Second. Third. 35 Relations of the axillary artery to the pectoralis minor muscle I mag e from: Richard L. D rake, Wayne Vog l,A d am W. M. M itch ell, G RAYS anatomy for students, Elsevier I n c. 2007 36 ⦿ 1st part: Superior thoracic artery. ⦿ 2nd part: Thoraco-acromial artery Lateral thoracic artery. ⦿ 3rd part: Subscapular artery Anterior circumflex humeral artery Posterior circumflex humeral artery 37 Relations of the axillary artery to the pectoralis minor muscle I mag e from: Richard L. D rake, Wayne Vog l,A d am W. M. M itch ell, G RAYS anatomy for students, Elsevier I n c. 2007 38 ⦿ Even with complete vessel transection, arm is rarely rendered the completely ischemic. ⦿ Why? 39 ⦿T here are anastomotic connections between branches of the subclavian a r tery a n d the axillary artery, which form a network around the scapula and proximal end of the humerus;. 40 ⦿ Some structures pass the axilla to from the arm through gaps in the posterior wall. ⦿ Gaps are: Quadrangular space. Triangular interval. 41 I mag e from: Richard L. D rake, Wayne Vog l,A d am W. M. M itch ell, G RAYS anatomy for students, Elsevier I n c. 2007 Hosam Eldeen Elsadig MBBS , 12/11/2012 M.Sc. 42 ⦿ Boundaries: The inferior margin of the subscapularis muscle. The surgical neck of the humerus. The superior margin of the teres major muscle. The lateral margin of t he long head of the tri ceps brachii muscle. ⦿ Structures that pass through: The axillary nerve. 43 I mag e from: Richard L. D rake, Wayne Vog l,A d am W. M. M itch ell, G RAYS anatomy for students, Elsevier I n c. 2007 44 ⦿ Boundaries: The lateral margin of the long head of the triceps brachii muscle. The shaft of the humerus. The inferior margin of the teres major muscle. ⦿ Structures that pass: Radial nerve. Profunda brachii artery. 45 I mag e from: Richard L. D rake, Wayne Vog l,A d am W. M. M itch ell, G RAYS anatomy for students, Elsevier I n c. 2007 46 ⦿ Axillary artery. ⦿ Axillary vein. ⦿ Axillary lymph nodes. ⦿ Brachial plexus. I mag e from: Richard L. D rake, Wayne Vog l,A d am W. M. M itch ell, G RAYS anatomy for students, Elsevier I n c. 2007 47 ⦿ Begins at the lower margin of the teres major muscle and b ec o m es the subclavian vein as the vessel crosses st the lateral border of 1 rib. ⦿ It is the continuation of the basilic vein 48 I mag e from: Richard L. D rake, Wayne Vog l,A d am W. M. M itch ell, G RAYS anatomy for students, Elsevier I n c. 2007 49 ⦿The basilic vein is a superf ic ial vein that drains the posteromedial surface of the han d and forearm. 50 I mag e from: Richard L. D rake, Wayne Vog l,A d am W. M. M itch ell, G RAYS anatomy for students, Elsevier I n c. 2007 51 ⦿The cephalic vein is a superf ic ial vein that drains the lateral and posterior parts of the hand, the forearm, and the arm. 52 I mag e from: Richard L. D rake, Wayne Vog l,A d am W. M. M itch ell, G RAYS anatomy for students, Elsevier I n c. 2007 53 Video from: Acland's video Atlas of Human Anatomy, Robert D. A clan d M. D , F RC S. 54 ⦿ Axillary artery. ⦿ Axillary vein. ⦿ Axillary lymph nodes. ⦿ Brachial plexus. I mag e from: Richard L. D rake, Wayne Vog l,A d am W. M. M itch ell, G RAYS anatomy for students, Elsevier I n c. 2007 55 ⦿ They are arranged in five principal groups: Pectoral (anterior) nodes. Subscapular (posterior) nodes. Humeral (lateral) nodes. Central nodes. Apical nodes. 56 I mag e from: Moore, Keith L. ; D alley, Arthur F, C lin ically Oriented Anatomy, 5 th E d. Lippincott Williams & Wilkins; 2006. 57 ⦿ The pectoral (anterior) nodes: Lie along the medial wall of the axilla, at the inferior border of the pectoralis minor. ⦿ The subscapular (posterior) nodes: Lie along the posterior axillary fold. ⦿ The humeral (lateral) nodes: Lie along the lateral wall of the axilla. ⦿ The central nodes: Situated deep to the pectoralis minor. ⦿ The apical nodes: Are located at the apex of the axilla 58  INLE T F LO O R ⦿ Medial margin : The lateral border of 1st rib. ⦿ Anterior margin : Skina d n The posterior surface of sub the clavicle; cutaneous ⦿ Posterior margin: The superior border of the tissues. scapula. 59  ANTE R IOR WALL POSTE R IOR WALL Pectoralis ⦿ Subscapularis. major muscle. Pectoralis minor ⦿ Teres major. muscle. ⦿ Latissimus Subclavius dorsi. muscle. ⦿ Long head of Clavipectoral fascia. triceps brachii. 60 ME DI AL WALL LATERAL WALL ⦿ Serratus ⦿ The humerus. anterior. 61 ⦿ Axillary artery. ⦿ Axillary vein. ⦿ Axillary lymph nodes. ⦿ Brachial plexus. I mag e from: Richard L. D rake, Wayne Vog l,A d am W. M. M itch ell, G RAYS anatomy for students, Elsevier I n c. 2007 62 ⦿ Next lecture. 63  R.M.H.McMinn, LAST‘S anatomy regional and applied, 9th Ed. Churchill livingstone; 1997  Richard L.Drake, Wayne Vogl,Adam W.M.Mitchell,  Harold Ellis, Clinical Anatomy,AppliedGR AYS anatomy for students anatomy and juniorfor students, doctors, 11thElsevier Inc. 2007 Ed, Blackwell Publishing Ltd, 2006  Richard S.Snell, Clinical Anatomy 8th by Lippincott Williams & Wilkins. Regions,  Moore, Keith L.; Dalley, Arthur F, Clinically Oriented Ed. Anatomy, 5th Ed. Lippincott Williams & Wilkins; 2006.  Agur, Anne M.R.; Dalley, Arthur F. Grant’s Atlas of Human Anatomy. 12th Ed. Lippincott Williams & Wilkins; 2009.  Abraham's et al , Mc Minn clinical atlas.  Videos from: Acland's video Atlas of Human Anatomy, Robert D.Acland M.D , FRCS. 64 Thank you