Transcript 9371aa537b1343d

‫بسم هللا الرحمن الرحيم‬
‫” و فى أنفسكم أفال تبصرون“‬
The Upper limb
Axilla
Definition: Pyramidal space between the
upper part of the arm and chest.
It has the following boundaries:
 Apex
 Base
 Anterior wall
 Posterior wall
 Lateral wall
 Medial wall
Axilla
Definition: Pyramidal space
between the upper part of
the arm and chest.
It has the following
boundaries:
 Apex (cervicoaxillary
canal).
Triangular.
Bounded by:
1.Clavicle, anterior.
2.Upper border od scapula,
posterior.
3.Outer border of 1st rib,
medially
Apex
Axilla
Definition: Pyramidal space between the
upper part of the arm and chest.
It has the following boundaries:
 Base:
Skin & fascia
Axilla
Pectoralis major:
Axilla
Pectoralis major:
Axilla
Pectoralis major:
Axilla
Pectoralis major:
Origin:
 Anterior surface of medial half of
clavicle
 Front of sternum, front of upper 6 costal
cartilages.
Insertion:
 Lateral lip of bicipital groove of the
humerus
Nerve supply:
 Medial pectoral nerve
 Lateral pectoral nerve
Action (joint):
 Adduction, flexion and medial rotation of
arm at the shoulder joint.
 The sternocostal fibers can extened the
flexed arm.
Axilla
Pectoralis minor:
Origin:The 3rd, 4th and 5th ribs
Insertion: Medial border and upper
surface of coracoid process of scapula
Nerve supply:Medial pectoral nerve
Action (girdle): Depression and
protraction of scapula.
Axilla
Subclavius:
Origin: 1st costal cartilage and 1st rib.
Insertion: groove on inferior surface of
clavicle
Nerve supply: Nerve to subclavius
Action (joint):
 Depress the clavicle.
 Steadies clavicle during movements of
shoulder joint.
Axilla
Clavipectoral fascia:
Definition:A strong fibrous sheet of
connective tissue lies deep to pectoralis
major.
Attachment:
 Its upper border splits to enclose
subclavius to be attached to the clvicle.
 Its lower border splits to enclose the
pectoralis minor , along lower border of
subclavius, thickened to form costocoracoid ligament that extends from
anterior end of 1st rib and contenues
downward as the
Suspensory ligament of axilla.
Axilla
Clavipectoral fascia:
Structures piercing it:
 Cepalic vein, ends in axillary vein
 Acromio-thoracic artery, branch of 2nd
part of axillary artery
 Lateral pectoral nerve, supplies pectoralis
major
 Lymph vessels.
Axilla
Anterior wall of Axilla:
1.
2.
3.
4.
Pectoralis major.
Pectoralis minor.
Subclavius.
Clavipectoral fascia.
Axilla
Subscapularis:
Origin: Subscapular fossa.
Insertion: Lesser tuberosity of the humerus.
Nerve supply: Upper and lower subscapular
nerves.
Action:
 Adduction and medial rotation of the
arm.
 Stabilizes the shoulder joint.
Axilla
Latissimus dorsi:
Axilla
Latissimus dorsi:
Origin:
1. Posterior part of iliac crest.
2. Lumbar fascia.
3. Lower thoracic spines and
supraspinous ligaments.
4. Lower 3 or 4 ribs.
5. Back of inferior angle of scapula.
Insertion:
 Wrap around the teres major (Triple
relation.
 Floor of intertubercular groove of the
humerus
Nerve supply:Thoracodorsal nerve.
Action (joint): Powerful adductor,
extensor and medial rotator of the
arm.
Axilla
Latissimus dorsi:
Origin:
1. Posterior part of iliac crest.
2. Lumbar fascia.
3. Lower thoracic spines and
supraspinous ligaments.
4. Lower 3 or 4 ribs.
5. Back of inferior angle of scapula.
Insertion:
 Wrap around the teres major (Triple
relation.
 Floor of intertubercular groove of the
humerus
Nerve supply:Thoracodorsal nerve.
Action (joint): Powerful adductor,
extensor and medial rotator of the
arm.
Axilla
Latissimus dorsi:
Origin:
1. Posterior part of iliac crest.
2. Lumbar fascia.
3. Lower thoracic spines and
supraspinous ligaments.
4. Lower 3 or 4 ribs.
5. Back of inferior angle of scapula.
Insertion:
 Wrap around the teres major (Triple
relation.
 Floor of intertubercular groove of the
humerus
Nerve supply:Thoracodorsal nerve.
Action (joint): Powerful adductor,
extensor and medial rotator of the
arm.
Axilla
Latissimus dorsi:
Axilla
Teres major:
Origin: Lower 1/3 of back of
lateral border of scapula
Insertion: Medial lip of bicipital
groove of the humerus
Nerve supply: Lower subscapular
nerve.
Action: Adduction and medial
rotation and extension of the arm.
Axilla
Teres major:
Origin: Lower 1/3 of back of
lateral border of scapula
Insertion: Medial lip of bicipital
groove of the humerus
Nerve supply: Lower subscapular
nerve.
Action: Adduction and medial
rotation and extension of the arm.
Axilla
Teres major:
Axilla
Posterior wall of axilla:
1. Subscapularis.
2. Teres major.
3. Latissimus dorsi.
Axilla
Medial wall of Axilla:
1. Upper 5 ribs and intercostal spaces.
2. Serratus anterior
Origin: 8 digitations from outer surfaces
of upper 8 ribs
Insertion: Ventral surface of medial
border of scapula. Most of the
digitations into inferior angle
Nerve supply: Long thoracic nerve
Action (Girdle):
1. Protraction of scapula.
2. Upward rotation (Abduction above 90°.
3. Forced inspiration.
4. Keep the medial border of scapula
applied to the chest wall.
Paralysis of Serratus anterior leads to
Winging Scapula.
Axilla
Medial wall of Axilla:
1. Upper 5 ribs and intercostal spaces.
2. Serratus anterior
Origin: 8 digitations from outer surfaces
of upper 8 ribs
Insertion: Ventral surface of medial
border of scapula. Most of the
digitations into inferior angle
Nerve supply: Long thoracic nerve
Action (Girdle):
1. Protraction of scapula.
2. Upward rotation (Abduction above 90°.
3. Forced inspiration.
4. Keep the medial border of scapula
applied to the chest wall.
Paralysis of Serratus anterior leads to
Winging Scapula.
Axilla
Medial wall of Axilla:
1. Upper 5 ribs and intercostal spaces.
2. Serratus anterior
Origin: 8 digitations from outer surfaces
of upper 8 ribs
Insertion: Ventral surface of medial
border of scapula. Most of the
digitations into inferior angle
Nerve supply: Long thoracic nerve
Action (Girdle):
1. Protraction of scapula.
2. Upward rotation (Abduction above 90°)
3. Forced inspiration.
4. Keep the medial border of scapula
applied to the chest wall.
Paralysis of Serratus anterior leads to
Winging Scapula.
Axilla
Medial wall of Axilla:
1. Upper 5 ribs and intercostal spaces.
2. Serratus anterior
Origin: 8 digitations from outer surfaces
of upper 8 ribs
Insertion: Ventral surface of medial
border of scapula. Most of the
digitations into inferior angle
Nerve supply: Long thoracic nerve
Action (Girdle):
1. Protraction of scapula.
2. Upward rotation (Abduction above 90°.
3. Forced inspiration.
4. Keep the medial border of scapula
applied to the chest wall.
Paralysis of Serratus anterior leads to
Winging Scapula.
Axilla
Medial wall of Axilla:
1. Upper 5 ribs and intercostal spaces.
2. Serratus anterior
Axilla
Lateral wall of Axilla:
1. Upper part of the humerus.
2. Coracobrachialis and bicips muscles.
Axilla
Contents of Axilla:
1.
2.
3.
4.
5.
6.
Axillary Artery.
Axillary Vein.
Brachial Plexus (cords + branches).
Axillary Lymph nodes.
Fat.
Axillary tail of Breast.
Axillary Artery
Beginning: Begins at the lateral border
of the first rib as continuation of the
subclavian artery.
Termination: at the lower border of
the teres major muscle, where it
continues as brachial artery.
Divisions: Divided by pectoralis minor
into three parts
Enclosed with other structures in C.T
sheath called axillary sheath which is
continuous with the prevertebral
fascia of the neck.
Axillary Artery
Beginning: Begins at the lateral border
of the first rib as continuation of the
subclavian artery.
Termination: at the lower border of
the teres major muscle, where it
continues as brachial artery.
Divisions: Divided by pectoralis minor
into three parts
Enclosed with other structures in C.T
sheath called axillary sheath which is
continuous with the prevertebral
fascia of the neck.
Axillary Artery
Axillary Artery
Axillary Artery
Axillary Artery
Axillary Artery
Axillary Artery
Axillary Artery
Axillary Artery