Dr.
smita shinde
Assist..prof.
[Link] anatomy
Identify & describe origin, extent ,course &
parts of axillary artery.
Enumerate branches of axillary artery.
Describe scapular anastomosis.
Enumerate axillary group of lymph node
with it’s clinical importance.
AXILLA( ARMPIT)
• Definition-
• PYRAMIDAL SPACE BETWEEN THE
UPPER LATERAL CHEST AND THE
INNERSIDE OF THE ARM
-
Apex-
directed upwards & medially
It is called Cervicoaxillary
canal.
•bounded by
• outer border of first rib,
• superior border of scapula
•posterior border of clavicle
floor/base:
by the skin
(visible surface
of armpit)
Superficial
facia
Axillary facia
• by the pectoralis major
• pectoralis minor
• Clavipectoral facia
• Suspensory ligament
by the subscapularis
above,
teres major
latissimus dorsi
below
medially:
•serratus
anterior
•ribcage [first 4
ribs]
by the intertubercular
sulcus with tendon of
long head of biceps.
coracobrachialis and
the short head of the
biceps brachii
Contents of the axilla
[Link] artery and its branches.
[Link] vein and its tributaries.
[Link] part of the brachial plexus.
[Link] groups of axillary lymph nodes and
the associated lymphatics.
[Link] long thoracic and intercostobrachial
nerves.
[Link] fat and areolar tissue
[Link] tail of spence
Extent
Axillary sheath
Parts
Relations
Branches
Scapular
anastomosis
Applied anatomy
Origin
begins at the outer border of the
first rib as a continuation of the
subclavian artery.
Termination
It terminates at the lower border of
the teres major muscle and then
continues downward in the arm as the
brachial artery.
Subclavian artery lateral
border of rib 1 axillary artery
inferior margin of teres major
brachial artery
RELATIVE POSITION IN RELATION OF
ARM
[Link] by the side-
Bold convex curve direct upward and laterally
2. Arm abducted to 90 degree-
artery has straight course
3. Arm raised above head
Artery is concave upwards
AXILLARY SHEATH
Derived from prevertebral layer of deep
cervical facia
Encloses axillary artery and brachial plexus
Axillary vein lie outside the sheath, to have
space for expansion during venous
return.
three parts, based on its
location relative to the
pectoralis minor muscle,
First part - the part of the
artery medial to pectoralis
minor
Second part - the part of the
artery that lies behind
pectoralis minor
Third part - the part of the
artery lateral to pectoralis
minor
First part (1 branch)
Superior thoracic artery
Second part (2 branches)
Thoraco-acromial artery
Lateral thoracic artery
Alar thoracic [occationally]
Third part (3 branches)
Subscapular artery
Anterior humeral circumflex artery
Posterior humeral circumflex artery
[Sometimes Life Seems A Pain]
Superior thoracic artery
From the anterior surface of the first part of the axillary
artery
Upper regions of the medial and anterior axillary walls
Thoraco-acromial artery
From the anterior surface of the second part of the axillary
artery
Pierces the clavipectoral fascia
Four branches
◦ Pectoral
Pierces the clavipectoral fascia
◦ Deltoid
Accompanies the cephalic vein
◦ Clavicular
◦ Acromial
Lateral Thoracic Artery
Posterior to the inferior margin of pectoralis minor
Supplies the medial and anterior walls
Supplies breast
Subscapular artery
Largest branch of the axillary artery
To the posterior wall of the axilla in the posterior scapular
region
Circumflex Scapular Artery
◦ Enters the infraspinous fossa
Thoracodorsal Artery
◦ Follows the lateral border of the scapula to the inferior angle
Anterior Circumflex Humeral Artery
Small compared to the posterior circumflex humeral artery
Passes anterior to the surgical neck of the humerus.
gives branch-head of humerus & shoulder joint.
Posterior Circumflex Humeral Artery
From the lateral surface of the third part of the axillary
artery
Leaves the quadrangular space with the axillary nerve
Anastomosis between branches of 1st part
of subclavian artery and 3rd part of
axillary artery in supraspinous,
infraspinous and subscapular fossa.
Formed by
1. Suprascapular artery
2. Circumflex scapular artery
3. Deep branch of transverse cervical artery
The anastomotic network surrounding the scapula provides an
alternate path for collateral circulation to the arm
Continuation of basilic vein.
the axillary vein is a large blood
vessel that conveys blood from
the lateral aspect of
the thorax, axilla and upper limb toward
the heart.
20-30 in number
Drains
. Upper limb
.most of mammary gland [75%]
.lymphatics from trunk above the level of
umblicus anteriorly and up to iliac crest
posteriorly
•Axillary Group of L.N.-
•5 groups
•Anterior [Pectoral]
•Posterior [subscapular]
•Lateral [humeral]
•Central (floor of axilla)
•Apical (infraclavicular)
Clinicians define metastatic axillary node spread
simply into three levels:
◦ level I [LOW NODES] —nodes inferior to
pectoralis minor;
◦ level II [MIDDLE NODES]—nodes behind
pectoralis minor;
◦ level III [UPPER NODES]—nodes above
pectoralis minor.
◦ ROTTERS NODES [interpectoral]– between
pectoralis major and pectoralis minor
Axillary artery pulsations
Compression of Axillary artery
Pulsatile scapula
In cases of coarctation
of the aorta distal to
the origin of subclavian
artery, blood will
be diverted to the
subclavian
artery then get back
to the descending
aorta through the
intercostal arteries in
the scapula
anastomosis.
Four cases of axillary
artery thrombosis
from humeral neck
fracture are reported.
Each of the first 2
patients presented
with a pulseless and
acutely ischemic limb
acute swelling and
pain in the upper limb
due to occlusion of the
axillary and/or
subclavian veins by
thrombus.
the operation of dissecting out and
removing all the lymph nodes that provide
lymphatic drainage for a cancerous area to
prevent lymphatic spread of cancer cells
Sentinel group of lymph node-first receive
lymph from area of breast involved in
cancer.
Usually level 1
Confirmed by injecting radioactive
substance in affected area of breast.
