Axilla (Part 1) 2024-2025 PDF

MMB Axilla (1) Boundaries, axillary artery, axillary vein & lymph nodes Anatomy Division Staff 2024-2025  Objectives Aims: To review the clinical anatomy of the axilla Objectives At the e...

MMB Axilla (1) Boundaries, axillary artery, axillary vein & lymph nodes Anatomy Division Staff 2024-2025  Objectives Aims: To review the clinical anatomy of the axilla Objectives At the end of the sessions you should be able to: Define the boundaries of the axilla and list its contents. Delineate the extent and relationships of the axillary artery and vein, including their branches and tributaries. Discuss the functional importance of the arterial anastomosis around the scapula. Identify the location and drainage patterns of the axillary group of lymph nodes and vessels, showing its relationships to the axillary blood vessels. Complete the related tasks on the surface anatomy schedule.  Axilla (Arm pit) Definition: Four-sided pyramidal space between upper part of thoracic wall & medial side of arm Boundaries: Apex Base (or floor) Four walls (anterior, posterior, lateral and medial). Source: Anne M.R. Agur. Aurther F. Dalley - Grant Atlas of Anatomy – 13th edition  Boundaries Outer Superior border border of of scapula the first rib Source: Anne M.R. Agur. Aurther F. Dalley - Grant Atlas of Anatomy – 13th edition Posterior Source: Gray's Basic Anatomy - Richard L. Drake, Wayne Vogl, Adam W.M. Mitchell surface of clavicle It is the site where nerves & vessels pass between neck & upper limb. Is directed upwards & medially to the root of the neck. Apex (Cervico- It is bounded, by three bones: axillary canal) 1. Clavicle anteriorly. 2. Upper border of the scapula posteriorly. 3. Outer border of the first rib medially.  Base (floor) Source: Anne M.R. Agur. Aurther F. Dalley - Grant Atlas of Anatomy – 13th edition Formed of: Skin. Superficial fascia. Axillary fascia. Skin Source: Atlas of Human Anatomy, Sixth Edition- Deep (axillary) Frank H. Netter, M.D fascia Superficial fascia  Clavipectoral fascia Subclavius Pectoralis Pectoralis Subclavius major muscle minor muscle Source: Anne M.R. Agur. Aurther F. Dalley - Grant Atlas of Anatomy – 13th edition Pectoralis major muscle Source: Gray's Basic Anatomy - Richard L. Drake, Wayne Vogl, Pectoralis minor Source: Atlas of Human Anatomy, Sixth Edition- Adam W.M. Mitchell Frank H. Netter, M.D Anterior 1. Superficial layer: is formed by pectoralis major muscle. wall 2. Deep layer: is formed by subclavius, clavipectoral fascia & pectoralis minor muscle.  Subscapularis Subscapularis Source: Anne M.R. Agur. Aurther F. Dalley - Grant Atlas of Anatomy – 13th edition Teres Latissimus major dorsi Source: Gray's Basic Anatomy - Richard L. Drake, Wayne Vogl, Teres Source: Atlas of Human Anatomy, Sixth Edition- major Adam W.M. Mitchell Frank H. Netter, M.D - Subscapularis. Latissimus Posterior - Teres major. dorsi wall - Latissimus dorsi muscle.  Pectoralis major Anterior fold of axilla Twisted fibers of lower border of pectoralis major. Posterior fold of axilla Tendon of latissimus dorsi Teres major winds around the lower border of teres major. Latissimus dorsi  Short head Coracobrachialis of biceps Source: Anne M.R. Agur. Aurther F. Dalley - Grant Atlas of Anatomy – 13th edition Latissimus Intercostal dorsi muscles Teres major Upper 4-5 ribs Subscapularis Serratus anterior Lateral wall Medial wall It is narrow and formed by: It is wide and formed by: - Coracobrachialis. - Serratus anterior. - Biceps brachii. - Upper 4-5 ribs. - Bicipital groove of the humerus. - Intercostal muscles.  Contents Axillary Axillary artery lymph nodes Cords of brachial plexus Axillary vein Source: Anne M.R. Agur. Aurther F. Dalley - Grant Atlas of Anatomy – 13th edition 1- Vessels: Axillary artery & axillary vein. Source: Atlas of Human Anatomy, Sixth Edition- Frank H. Netter, M.D 2- Nerves: cords and branches of brachial plexus. 3- Axillary lymph nodes. 4- Axillary fat. 5- Tail of the breast.  Axillary artery Axillary artery Beginning: as the continuation of subclavian artery at outer border of first rib. 1 End: at lower border of teres major by becoming 2 3 brachial artery. Course: divided by pectoralis minor into three parts: ✓ 1st part: above pectoralis minor. Pectoralis ✓ 2nd part: behind or deep to pectoralis minor. minor ✓ 3rd part: below pectoralis minor. Source: Gray's Basic Anatomy - Richard L. Drake, Wayne Vogl, Adam W.M. Mitchell  Thoraco- c. Clavicular acromial artery Branches: branch Superior thoracic artery First part: One branch: a. Acromial Superior thoracic artery. branch Second part: Two branches: 1 1. Thoraco-acromial artery: short trunk that divides into: 2 a. Acromial branch. d. Deltoid branch 3 b. Pectoral branch. c. Clavicular branch. d. Deltoid branch. 2. Lateral thoracic artery: to thoracic wall, in females, it is enlarged & supplies breast. Source: Atlas of Human Anatomy, Sixth Edition- Lateral Frank H. Netter, M.D thoracic b. Pectoral artery branch  Subscapular Posterior circumflex artery humeral artery Anterior circumflex 1 humeral artery 22 33 Circumflex scapular artery Branches: Circumflex Source: Atlas of Human Anatomy, Sixth Edition-Frank H. Netter, M.D scapular artery Third part: Three branches: 1. Subscapular artery: Largest branch of axillary artery, follows lateral border of scapula till inferior angle, accompanies thoracodorsal nerve # around scapula → gives circumflex scapular artery → # around scapula. 2. Anterior circumflex humeral artery: Passes anterior to surgical neck of humerus & anastomoses with posterior circumflex humeral artery. 3. Posterior circumflex humeral artery: it accompanies axillary nerve & anastomoses with anterior circumflex forming a circular anastomosis around surgical neck. Surface anatomy: Arm abducted & laterally rotated. Draw a line joining mid-clavicular point with a point at the middle of the medial side of the arm.  Anastomosis around scapula Definition: Anastomosis between 1st part of subclavian artery & 3rd part of axillary artery. Value: It carries adequate blood to the upper limb when there is an occlusion between the two arteries. Site: On the fossae of scapula, deep to the muscles. Arterial Anastomosis: Connection between the arteries, which is present mainly around the joints. Joint movement Source: Atlas of Human Anatomy, Sixth Edition- leads to temporary occlusion of blood vessels. Anastomosis Frank H. Netter, M.D provides alternative routes for blood to upper limb.  Thyrocervical trunk Arteries sharing in the anastomosis: Subclavian artery From 1st part of subclavian artery: 1. Dorsal scapular (deep branch of transverse cervical artery). Suprascapular Circumflex 2. Suprascapular artery. artery subscapular artery From 3rd part of axillary artery: 1. Subscapular artery. 2. Circumflex scapular artery. Third part of Dorsal scapular axillary artery artery Subscapular artery Source: Atlas of Thorax– Dr. Fawzy Gaballah - Professor of Anatomy, Cairo University  Axillary vein Axillary vein Cephalic vein Beginning: Cephalic vein Axillary As the continuation of the basilic vein vein at the lower border of teres major. End: At the outer border of the 1st rib by forming the subclavian vein. It runs medial to the axillary artery. Tributaries: a. Tributaries corresponding to the branches of the axillary artery. b. Cephalic vein at its upper part. c. The two venae comitantes of the brachial artery (brachial veins). Venae comitantes of the brachial artery Basilic vein Source: Gray's Basic Anatomy - Richard L. Drake, Wayne Vogl, Adam W.M. Mitchell  Axillary lymph nodes Apical group Number: 20 to 30 Site: They are arranged in 5 groups in relations to the wall and apex of axilla: Posterior 1. Anterior (pectoral) group. (subscapular) 2. Posterior (subscapular) group. group 3. Lateral (humeral) group. 4. Central group. 5. Apical group. In cases of suspected breast cancer, axillary Lateral lymph nodes examination is mandatory. Breast (humeral) cancer send lymphatic metastasis to axillary group lymph nodes. In case of mastectomy (surgical Central Anterior breast removal) axillary lymph nodes must also group (pectoral) be removed. group Source: Atlas of Thorax– Dr. Fawzy Gaballah - Professor of Anatomy, Cairo University  Apical Apical Apical Central Central group Pectoralis group Central group group group minor Sub- group scapularis Anterior Axillary group vein Breast Lateral group Umbilicus Posterior group Anterior (Pectoral group) Posterior (subscapular group) Lateral (brachial group) Afferent: Afferent: Afferent: Central part and lateral quadrant Posterior wall of the trunk as The whole of the upper limb except of the breast. far as the iliac crest. the areas drained by the lymphatics Anterolateral wall of the trunk The back of the shoulder accompanying the cephalic vein. above the level of the umbilicus region. Efferent: Apical, posterior and lateral LNs drain to central and apical groups of axillary LNs  Infraclavicular Apical Apical LNs group Central Central Lateral group Lateral group (humeral) (humeral) group group group Posterior Posterior (subscapular) (subscapular) group group Anterior Anterior (pectoral) group (pectoral) group Central group Apical group Afferent: Afferents: From anterior, posterior & All the other groups of axillary LNs. lateral groups. Directly from the upper & peripheral part of the Efferent: To apical group of axillary LNs. breast. Infra-clavicular LNs. Efferent: Subclavian lymph trunk.  Infra-clavicular LNs Apical Infra- group clavicular LNs Cephalic Infra-clavicular LNs: vein Afferents: Few lymph vessels from the lateral side of upper limb. Efferent: To apical group of axillary LNs. Thank you