AXILLA
YUGESH K
Assistant Professor
Anatomy, SRIHER(DU)
OBJECTIVES
• Boundaries
• Contents
Introduction
• Axilla – armpit
• Hallow Pyramidal space
• Between upper part of arm &
chest wall
Features
• Apex
• Base
• Four walls
• Anterior wall
• Posterior wall
• Medial wall
• Lateral; wall
• Axilla is oblique
• Apex is directed upwards
medially towards root of neck
• Base is directed downwards
Apex
• Directed upwards and medially
towards root of neck
• Truncated and corresponds to a
triangular gap
• Cervico-axillary canal
• Boundaries
Base
• Directed downwards
• Formed by
• Skin
• Superficial fascia
• Axillary fascia
Anterior wall
• Formed by
• Skin
• Superficial fascia
• Deep (Pectoral) fascia
• Pectoralis major
• Subclavius
• Pectoralis minor
• Clavipectoral fascia
Posterior wall
• Formed by
• Subscapularis
• Teres major
• Latissimus dorsi
Medial wall
• Upper four ribs with intercostal
spaces (1 to 4)
• Upper part of serratus anterior
Lateral wall
• Neck of humerus
• Shaft of humerus (upper part)
• Coracobrachilis
• Short head of biceps brachii
CONTENTS
• Axillary artery & its branches
• Axillary vein & tributaries
• Infra-clavicular part of brachial plexus
• Axillary group of lymph nodes
• Long thoracic nerve
• Inter costobranchial nerve
• Axillary pad & Areolar tissue
The neurovascular bundle is enclosed in connective tissue sheath,
called ‘axillary sheath’
Brachial Plexus
• The Brachial plexus is a network of nerve fibers, passing through the
cervico-axillary canal to reach axilla and innervates brachium,
antebrachium and hand.
• It is formed by the ventral rami of the lower four cervical and first
thoracic nerve roots (C5-C8, T1).
THE LONG THORACIC NERVE
• The long thoracic nerve ( Nerve of Bell ) supplies the serratus
anterior.
• The nerve descends behind the brachial plexus and the axillary
vessels, resting on the outer surface of the serratus anterior.
• It extends along the side of the thorax to the lower border of
that muscle, supplying filaments to each of its digitations
WINGING OF SCAULA
• A lesion of the nerve paralyses the serratus anterior muscle to
produce winged scapula.
• Damage to the nerve can be caused by a contusion or blunt trauma of
the shoulder, heavy weight lifting, repetitive throwing, traction of the
neck.
INTERCOSTOBRACHIAL NERVE
• The second intercostal nerve does not
divide, like the others, into an anterior
and a posterior branch; it is named
the intercostobrachial nerve.
• It pierces the Intercostalis
externus and the Serratus anterior,
crosses the axilla to the medial side of
the arm, and joins with a filament
from the medial brachial cutaneous
nerve.
AXILLARY ARTERY
• Chief artery of axilla
• Continuation of subclavian
artery
• Extension – outer border of first
rib to lower border of Teres
Major
• Continues – Brachial artery
• Conveys oxygenated blood to the
lateral aspect of the thorax,
the axilla (armpit) and the upper
limb.
AXILLARRY VEIN
• CONTINUATION – basilic vein
• At its terminal part, it is also joined by the cephalic vein
AXILLARY VEIN
• It is also joined by Other tributaries include
the subscapular vein, circumflex humeral vein, lateral
thoracic vein and thoraco-acromial vein.
• It terminates at the lateral margin of the first rib, at
which it becomes the subclavian vein.
• It is accompanied along its course by the axillary artery.
AXILLARY LYMPH NODES
• The axillary lymph nodes are 20 to 30 in number.
• Scattered – fibro fatty tissue of axilla
• They drain lymph vessels from
• The lateral quadrants of the breast.
• The superficial lymph vessels from the walls of the chest’
• The abdomen above the level of the umblicus.
• And the vessels from the upper limb.
• They are divided in several groups according to their location in
the armpit.
AXILLARY NODES
Five groups
• Anterior (pectoral)
• Posterior (scapular)
• Lateral
• Central
• Apical(infraclavicular)
Lymphatic drainage of Axilla
• Anterior nodes
• Lie – lateral thoracic vessels
• Receive lymph from upper half of the anterior wall of the trunk and
from major part of the mammary gland
• Posterior nodes
• Lie subscapular vessels
• Drain the posterior wall of the upper half of the trunk and the axillary
tail of breast
Lymphatic drainage of Axilla
• Lateral nodes
• Lie – upper part of the humerus
• Receive lymph from the upper limb
• Central nodes
• Receive lymph from other nodes and drain in to apical nodes
Lymphatic drainage of Axilla
• Apical nodes
• Lie deep to clavipectoral fascia ,
• Receive lymph from the central group,upper part of breast and from
the thumb and its first web
AXILLARY NODES
CLINICAL IMPORTANCE
• INFECTIONS
Skin or lymph nodes .
The most frequent cause of these infections is shaving the hair of the armpits which can result in small
irritated bumps or cut skin.
These bumps or cuts may then be subject to bacterial invasion, causing infections.
• BOILS
Armpit boils can be caused by a condition called ‘hidradenitis suppurativa’
Hidradenitis is caused by blockage of the hair follicles.
• SUPPURATIONS - Pus formation
• Thoracic Outlet Syndrome
Compression of vessels and nerves in the apex
Common cause trauma – fracture of clavicle
CLINICAL IMPORTANCE
• Breast cancer
• 75% of lymph from the breasts drains into the axillary lymph
nodes
• Lymph Node Biopsy
• If breast cancer is confirmed, the axillarynodes are to be removed to
prevent the cancer spreading. This is known as axillary clearance.
During this procedure, the long thoracic nerve may be damaged,
resulting in winged scapula.
