Axilla & Brachial Plexus PDF

Axilla (axillary fossa;the armpit) Prof. Dr. Selda Önderoğlu Near East University, Faculty of Medicine Department of Anatomy the armpit area, pyramidal shaped, apex directed upwards&medially Base: laterally&downwards borders Anterior wall pectoralis major m....

Axilla (axillary fossa;the armpit) Prof. Dr. Selda Önderoğlu Near East University, Faculty of Medicine Department of Anatomy the armpit area, pyramidal shaped, apex directed upwards&medially Base: laterally&downwards borders Anterior wall pectoralis major m. Medial pectoralis minor m. 1-4 ribs Clavipectoral fascia intercostal mm. Posterior serratus anterior m. Subscapularis m. Lateral teres major m. ıntertubercular latissimus dorsi m. Sulcus (of humerus)  contents apex Loose connective Clavicle(anterior) tissue 1st rib (medial) Axillary artery superior border of Axillary vein scapula (post.) Axillary lymph Base nodes brachial Plexus Axillary fascia (infraclavicular skin part) Borders of Axillary Fossa Base Skin and axillary fascia Apex  Anterior wall Pectoralis major Pectoralis minor Clavi-pectoral fascia Posterior wall Subscapular Teres major Latissimus dorsi Prof. Dr. H. Selçuk Sürücü Medial wall Ribs 1-4 Intercostal mm. Serratus ant. M. Lateral wall Intertubercular sulcus (groove) What is inside the axillary fossa? Loose connective tissue Axillary a-v Axillary lymph nodes brachial plexus (Infraclavicular part ) Axillary artery Axillary a: 1st rib-teres major m. Axillary Artery 1st part - 1 branch (continuation of subclavian a.) Supreme ( subclavian a. highest) thoracic a. after 1st rib becomes 2nd part – 2 brs. Axillary artery Thoracoacromial After teres major m. becomes a. brachial a. Lateral thoracic a. axillary artery is divided into 3 parts 3rd part - 3 brs. according to its position to pectoralis minor m. Subscapular a. (the thickest br. of axill.a. circumflex scapular a. Thoracodors al a. Ant. humeral circumflex a. post. humeral circumflex a. 1st part of axillary artery Superior (highest) (supreme) thoracic a 2nd partof axillary artery Thoraco-acromial a. And Lateral thoracic a.  3rd part of axillary artery Anterior circumflex humeral a Posterior circumflex humeral a Subscapular a (Thickest branch) Thorocodorsal a Circumflex scapular a Thoracodorsal a  axillary vein Basilic vein After:teres major m. continues as the Axillary vein After 1st rib Continues as the Subclavian vein Cephalic vein Drains into the the axillary vein Cephalic v. Courses to deep from the interval called the: deltopectoral triangle ,pierces the clavipectoral fascia and then drains into axillary v. Structures piercing the clavipectoral fascia Cephalic v Thoraco-acromial a Lymph vessels Lateral pectoral n Axillary Lymph Nodes Anterior group (pectoral) 4-5 in no. Posterior group (subscapular) 6-7 Lateral group 4-6 Central group 3-4 Apical Group 6-12  Anterior group (pectoral) 4-5 in Axillary lymph nodes no. Posterior group (subscapular) 6-7 Lateral group 4-6 Central group 3-4 Apical Group 6-12 Axillary lymph nodes: which group drains where anterior posterior central apical Subclavian trunk lateral Lymph vessels accompanying cephalic vein Axillary lymph nodes receive lymph from: umbilicus Axillary lymph nodes receive lymph from upper extremity Axillary sheath deep cervical fascia Axillary sheath Superficial Lamina encloses: Pretracheal Lamina Axillary a. Prevertebral Lamina Axillary v. Axillary sheath carotid sheath brachial plexus (infraclavicular part) So: axillary sheath is a part of deep cervical fascia BRACHIAL PLEXUS Network of nerves extending from the neck into the axilla It innervates the structures in upper limb Formed by the union of anterior rami of spinal nerves from C5 to T1  Nerves From spinal cord to brachıal plexus From Spinal cord emerges Ant. Root+ post. root Unite&form spinal nerve Spinal nerve divides into 2 rami (branches) Rami: plural of “ramus” Anterior ramus and posterior ramus Ant. Rami of C5-T1 unite and form the brachial plexus Prof. Dr. H. Selçuk Sürücü roots trunks divisions cords C5 + C6 Sup. trunk Ant Post posterior n e r C7 Middle trunk Ant v lateral post e s C8+T1 Inf.trunk Ant medial post Formation of Brachial plexus  C4 C5 C6 C7 C8 T1 superior trunk middle trunk inferior trunk lateral cord Medial cord Posterior cord clavicle Parts of brachial plexus (clavicle is the reference structure) Supraclavicular part - located in the neck Infraclavicular part -Located in the axilla (armpit) clavicle is the reference structure clavicle clavicle There are many nerves that exit from brachial plexus Those nn. are formed by the combination of branches from ant.rami of different spinal nerves or just from one segment Examples: radial n. (C5,6,7,8) Dorsal scapular n. (C5) Long thoracic n.(C5,6,7) Some arise directly at roots level of brachial plexus(ex: dorsal scapular n.) Some arise from trunk/s level (suprascapular n.) Some arise from cords’ level (ex:lat.pect.n..)  Nn from Roots Dorsal scapular n (C5) inn. Rhomboids, levator scapulae Long thoracic n (C 5-7)  Long thoracic nerve innervating the serratus anterior Muscle Prof. Dr. H. Selçuk Sürücü Nn from Trunks (C 5-6) N to subclavius Suprascapular n Nn from Lateral Cord (C 5-7) Lat pectoral n – innervates Pectoralis major m Musculocutaneous n Lateral root to median n Musculocutaneous n. Skin area innervated by the musculocutaneous n. Median n.  Nn form Medial Cord (C 8- T1) Medial root of median n Medial pectoral n- inn.Pectoralis muscles Medial cutaneous n of arm Medial cutaneous n of forearm Ulnar n Course of Median n.& ulnar n. in the arm region Ulnar nerve in the forearm &hand Groove region for the ulnar n  Nn from post cord Subscapular nn (C 5-6) inn:Subscapular & teres major m Thoracodorsal n (C 5-8) Axillary n ( C5-6) Radial n (C5-T1) Brachial plexus is responsible for the skin sensation of upper extremity Some accidents may cause Injury to certain parts of brachial plexus result/s: sensory loss+patient can not achieve certain movements Erb-Duchenne Paralysis Damage to (C5-C6) superior trunk damage to radial n. Result: Wrist drop: Klumpke’s paralysis (C8-T1) Damage to inferior trunk clawhand Winged scapula: result of damaged long thoracic nerve Serratus anterior m. is effected) Video links https://www.youtube.com/watch?v=SvcvhLrA-_E axilla+brachial plexus https://www.youtube.com/watch?v=RLJ8aUw468 M brachial plexus https://www.youtube.com/watch?v=KNjueT3tU6M axillary artery https://www.youtube.com/watch?v=C-om_Ubz6jU axilla+BP https://www.youtube.com/watch?v=WJ2qT2XONP Y axill. Lymph nodes Acknowledgement: I thank you to all the scientists who for their efforts of providing and sharing the information/knowledge used in this ppt.