• The axilla, or armpit, is a

pyramid-shaped space
between the upper part of
the arm and the side of the
chest.
• It forms an important
passage for nerves, blood,
and lymph vessels as they
travel from the root of the
neck to the upper limb.
• The upper end of the axilla, or
apex, is directed into the root
of the neck and is bounded in
front by the clavicle, behind by
the upper border of the
scapula, and medially by the
outer border of the first rib.
• The lower end, or base, is
bounded in front by the
anterior axillary fold (formed
by the lower border of the
pectoralis major muscle),
behind by the posterior axillary
fold (formed by the tendon of
latissimus dorsi and the teres
major muscle), and medially by
the chest wall.
• The walls of the axilla are made up as follows:
 Anterior wall: By the pectoralis major, subclavius,
and pectoralis minor muscles
 Posterior wall: By the subscapularis, latissimus
dorsi, and teres major muscles from above down
 Medial wall: By the upper four ribs and the
intercostal spaces covered by the serratus anterior
muscle
 Lateral wall: By the coracobrachialis and biceps
muscles in the bicipital groove of the humerus
• Passing through the axilla are:
1) The major vessels, nerves, and lymphatics of the upper
limb.
2) Proximal parts of biceps and coracobrachialis.
3) Axillary process of the breast.
4) Axillary lymph nodes
• It is the continuation of
subclavian artery after
the lateral margin of first
rib.
• Becoming the brachial
artery at the inferior
margin of the teres
major muscle.
• It is divided into three
parts by pectoralis minor
muscle.
• One branch: Superior
thoracic artery, originates
from the first part.
• Two branches: Thoraco-
acromial artery and the
Lateral thoracic artery,
originate from the second
part.
• Three branches: the
Subscapular artery, the
Anterior circumflex
humeral artery, and the
Posterior circumflex
humeral artery, originate
from the third part.
1) Superior thoracic A. supplies the upper regions of anterior
and medial axillary walls.
2) Thoracoacromial A. penetrates the clavipectoral fascia
and divides into four branches; pectoral, deltoid, clavicular
and acromial branches which supply the anterior axillary
wall and related regions.
3) Lateral thoracic A. supplies anterior and medial walls of
axilla. In women, it gives branches for the breast.
4) Subscapular A. largest branch that supplies posterior
axillary wall and scapular region. It ends into two
branches: Circumflex Scapular A. and Thoracodorsal A.
5) Anterior and Posterior circumflex humeral Aa. Form
anastomosis around surgical neck of humerus and supply
shoulder joint.
• It begins at the lower
margin of the teres major
muscle and is the
continuation of the basilic
vein.
• It passes through the axilla
medial and anterior to the
axillary artery and
becomes the subclavian
vein as the vessel crosses
the lateral border of rib I
at the axillary inlet.
• Tributaries of the axillary
vein generally follow the
branches of the axillary
artery.
• Other tributaries include
brachial veins that follow
the brachial artery, and the
cephalic vein.
• All lymphatics from
the upper limb drain
into lymph nodes in
the axilla, in addition
to lower neck, upper
back, chest, upper
abdominal wall and
breast.
• The 20-30 axillary
nodes are generally
divided into five
groups on the basis
of location:
• Humeral (lateral) nodes posteromedial to
the axillary vein receive most of the
lymphatic drainage from the upper limb.
• Pectoral (anterior) nodes occur along the
inferior margin of the pectoralis minor and
receive drainage from the abdominal wall,
the chest, and the mammary gland.
• Subscapular (posterior) nodes on the
posterior axillary wall drain the posterior
axillary wall and receive lymphatics from
the back, the shoulder, and the neck.
• Central nodes are embedded in axillary fat
and receive tributaries from the above
nodes.
• Apical nodes are the most superior group
of nodes in the axilla and drain all other
groups of nodes in the region.
• Although the mammary gland is
in superficial fascia overlying
the thoracic wall, its
superolateral region extends
along the inferior margin of the
pectoralis major muscle toward
the axilla.
• In some cases, this may pass
around the margin of the
muscle to penetrate deep fascia
and enter the axilla.
• This axillary process rarely
reaches as high as the apex of
the axilla.
 Brachial Plexus
• A major nerve network
begins in the neck and
extends into the axilla,
supplying the upper
limb with motor, sensory
and autonomic
innervation.
 Formation:
• Brachial plexus is formed by
the union of the anterior
rami of the last four cervical
and the first thoracic spinal
nerves that constitute the
roots.
• The roots usually pass
through the gap between the
anterior and the middle
scalene (scalenus anterior
and medius) muscles with
the subclavian artery.
 Formation:
• In the inferior part of the
1
neck, the roots of the 2
brachial plexus unite to form
three trunks:
1. A superior trunk, from the
union of the C5 and C6
roots.
2. A middle trunk, which is a
continuation of the C7 root. 3
3. An inferior trunk, from the
union of the C8 and T1
roots.
• Each trunk of the brachial
plexus divides into anterior and
posterior divisions as the plexus
passes through the 1
cervicoaxillary canal posterior
to the clavicle. The divisions of 3
the trunks form three cords of
the brachial plexus:
1. Anterior divisions of the
superior and middle trunks
unite to form the lateral cord.
2. Anterior division of the 2
inferior trunk continues as the
medial cord.
3. Posterior divisions of all three
trunks unite to form the
posterior cord.
Schematic drawing of Brachial Plexus
 Branches of Brachial Plexus
 Branches from the roots:
1. Dorsal Scapular N. (C5):  Rhomboids & Levator Scapulae
2. Long Thoracic N. (C5,6,7):  Serratus anterior

 Branches from the trunks (Superior only):

1. Suprascapular N. (C5,6):  Supra & Infraspinatus
2. N. to Subclavius (C5,6)

 Branches from Lateral Cord:

1. Lateral Pectoral N. (C5,6,7)  Pectoralis major
2. Musculocutaneous N. (C5,6,7)  B.B.C.
3. Lateral root of Median N. (C5,6,7)
 Branches of Brachial Plexus
 Branches from Medial Cord:

1. Medial Pectoral N. (C8-T1)  Pectoralis minor & major

2. Medial Cutaneous N. of arm (C8-T1)

3. Medial Cutaneous N. of forearm (C8-T1)

4. Medial root of Median N. (C8-T1)

5. Ulnar N (C8-T1)  Flexor carpi ulnaris and ulnar half of

flexor digitorum profundus (forearm); most intrinsic
muscles of hand
 Branches of Brachial Plexus
 Branches from Posterior Cord:

1. Upper Subscapular N. (C5,6)  Subscapularis

2. Lower Subscapular N. (C5,6)  Subscapularis & Teres

major

3. Thoracodorsal N. (C6,7,8)  Latissimus dorsi

4. Axillary N. (C5,6)  Deltoid & Teres minor

5. Radial N. (C5-T1)  All muscles of posterior

compartment of arm & forearm
Roots, trunks, divisions, cords, and terminal
branches of the brachial plexus.