Transcript From the medial cord

Contents of the Axilla
1. Axillary artery and its branches.
2. Axillary vein and its tributaries.
3. Cords of the brachial plexus and their
branches.
4. Axillary lymph nodes and lymph
vessels.
5. Axillary tail of the mammary gland.
6. Axillary fat.
1. Axillary Artery
It is the only artery which supplies the upper
limb.
Beginning: at the outer border of the first rib as
a continuation of the subclavian artery.
End: at the lower border of the teres major
muscle, where it continues as the brachial
artery.
Course:
– It is surrounded with cords and branches of
brachial plexus inside the axillary sheath.
– Pectoralis minor muscle passes in front of the
artery and divides it into 3 parts.
Relations the First part
Anteriorly: Skin, Fascia (superficial and
deep), pectoralis major muscle and clavipectoral fascia.
Posteriorly: 1st intercostal space, 1st
digitation of serratus anterior, long thoracic
nerve and medial cord of brachial plexus.
Laterally: Lateral and posterior cords of
the brachial plexus.
Medially: Axillary vein.
Relations the Second part
Anteriorly: Skin, Fascia (superficial and
deep), pectoralis major and minor
muscles.
Posteriorly: Posterior cord of brachial
plexus and subscapularis muscle.
Laterally: Lateral cords of the brachial
plexus and coraco-brachialis muscle.
Medially: Medial cord of brachial plexus
and axillary vein.
Relations the Third part
Anteriorly: Skin, Fascia (superficial and
deep), pectoralis major and medial root of
median nerve.
Posteriorly: Subscapularis, latissimus dorsi
and teres major muscles, radial and axillary
(circumflex) nerves.
Laterally: Coraco-brachialis and biceps
muscle, humerus, lateral root of median nerve
and musculo-cutaneous nerve.
Medially: Axillary vein, ulnar nerve and
medial cutaneous nerves of arm and forearm.
Branches of the Axillary artery
From 1st part:
1. Highest (superior) thoracic artery.
From 2nd part:
2. Thoracoacromial artery.
3. Lateral thoracic artery.
From 3rd part:
4. Subscapular artery.
5. Anterior circumflex humeral artery.
6. Posterior circumflex humeral artery.
Highest thoracic artery
It is a branch of the 1st part of
axillary artery.
It runs along the upper border of
pectoralis minor.
It supplies the pectoral muscles
and thoracic wall.
Thoraco-acromial artery
It is a branch of the 2nd part of
axillary artery.
It is a short artery that pierces the
clavipectoral fascia and divides into 4
branches (acromial, pectoral,
clavicular and deltoid).
It supplies the pectoral region,
thoracic wall and mammary gland.
Lateral thoracic artery
It is a branch of the 2nd part of
axillary artery.
It runs along the lower border of
pectoralis minor.
It supplies the pectoral muscles, and
thoracic wall.
In females, it is larger and gives
lateral mammary branches.
Subscapular artery
It is a branch of the 3rd part of axillary
artery.
It is the largest branch of the axillary
artery
It runs along the lower border of
subscapularis muscle.
It gives off circumflex scapular branch.
It shares in anastomosis around the
scapula.
Anterior circumflex humeral artery
It is a branch of the 3rd part of axillary
artery.
It is a small artery that runs laterally
in front of the surgical neck of the
humerus.
It anastomoses with the posterior
circumflex humeral artery around the
surgical neck of the humerus.
Posterior circumflex humeral artery
It is a branch of the 3rd part of axillary
artery.
It is larger than the anterior one and runs
with the axillary nerve to enter the
quadrangular muscular space.
Then it passes behind the surgical neck of
the humerus.
It anastomoses with the anterior circumflex
humeral artery around the surgical neck of
the humerus.
2. Axillary Vein
Beginning (Formation): at the lower
border of the teres major muscle, by union
of the basilic vein with the venae
comitantes of the brachial artery.
End: at the outer border of the first rib
where it continues as the subclavian vein.
Course: It runs upward on the medial side
of the axillary artery.
Tributaries:
1. Veins correspond to branches of axillary
artery.
2. Cephalic vein (near its termination).
3. Brachial Plexus
Definition: It is a network of nerves
concerning with the nerve supply of upper
limb.
Origin: from the ventral rami of C5,6,7,8 +T1.
Composition and site:
– Root: in the posterior triangle of the neck
– Trunks: in the posterior triangle of the neck.
– Divisions: behind the clavicle.
– Cords: in the axilla (related to 1st and 2nd
parts of axillary artery.
– Branches: in the axilla (related to the 3rd
part of axillary artery).
Formation of the
plexus
ROOTS
They are formed by the ventral rami of the
5th, 6th, 7th, 8th cervical and 1st thoracic
spinal nerves.
It may take origin from the 4th cervical
nerve (prefixied plexus), or from the 2nd
thoracic nerve (postfixed plexus).
They lye in the posterior triangle of the
neck.
They unites together to form the trunks.
Trunks
They are formed by the roots of the plexus.
They are 3 (upper, middle and lower).
Upper trunk (C5,6) is formed by the union of
the ventral rami of the 5th and 6th cervical
nerves.
Middle trunk (C7) is formed by the ventral
ramus of the 7th cervical nerve alone.
Lower trunk (C8, T1) is formed by the union
of the ventral rami of 8th cervical and 1st
thoracic nerves.
They lye in the posterior triangle of the neck.
Each trunk divides to give anterior and
posterior division.
Divisions
They are formed from the trunks.
They are 6 in number (3 anterior and
3 posterior).
They lye behind the middle third of
the clavicle (apex of the axilla).
The divisions unite to form the cords
of the brachial plexus.
Cords
They are formed by union of the divisions of the
plexus.
They are 3 (lateral, medial and posterior).
Lateral Cord (C5,6,7) is formed by the union of
the anterior divisions of the upper and middle
trunks.
Medial Cord (C8, T1) is formed by the anterior
division of the lower trunk alone.
Posterio Cord (C5,6,7,8, T1) is formed by the
union of the posterior divisions of the upper,
middle and lower trunks.
They lye in the axilla (opposite 1st and 2nd parts
of axillary artery).
Each cord gives off the braches of the plexus.
Relations of the Cords to
the axillary artery
Lateral Cord:
 Lateral to the 1st and 2nd parts of the
artery.
Medial Cord:
 Posterior to the 1st part of the artery.
 Medial to the 2nd part of the artery
Posterio Cord:
 Lateral to the 1st part of the artery.
 Posterior to the 2nd part of the artery.
Branches of the
brachial plexus
Branches of the Brachial plexus
From the Roots:
1. Dorsal scapular nerve (C5) supplies the
levator scapulae and rhomboid muscles (major
and minor).
2. Long thoracic nerve (C5,6,7) descends
superficial to the serratus anterior muscle
which it supplies.
From the trunks:
1. Nerve to subclavius (5,6) which sometimes
gives off accessory phrenic nerve (C5).
2. Suprascapular nerve (C5,6) which supplies
suprasinatus and infraspinatus muscles.
Branches of the Brachial plexus
From the lateral cord:
1. Lateral pectoral nerve (C5,6,7) pierces the
clavipectoral fascia and supplies the
pectoralis major muscle.
2. Musculocutaneous nerve (C5,6,7)
supplies corachobrachialis, biceps brachii
and brachialis muscles and ends as the
lateral cutaneous nerve of the forearm.
3. Lateral root of median nerve (C5,6,7)
which receives the medial root to form the
median nerve on the lateral side of the
Branches of the Brachial plexus
From the medial cord:
1. Medial pectoral nerve (C8, T1) supplies
and pierces the pectoralis minor muscle
then supplies the pectoralis major muscle.
2. Medial cutaneous nerve of the arm (C8,
T1) supplies the skin of the medial side of
the arm. It may communicate with the
intercostobrachial nerve (T2).
3. Medial cutaneous nerve of the forearm
(C8, T1) runs on the medial side of the
axillary artery, it supplies the medial side of
Branches of the Brachial plexus
From the medial cord:
4. Ulnar nerve (C7,8, T1) runs on the
medial side of the axillary artery and
supplies some muscles and skin of the
forearm and hand.
5. Medial root of median nerve (C8, T1)
crosses in front of the 3rd part of axillary
artery (from medial to lateral) to join the
lateral root and forms the median nerve
which supplies some muscles and skin of
the forearm and hand
Branches of the Brachial plexus
From the posterior cord:
1. Upper subscapular nerve (C5,6) supplies
the upper part of the subscapularis muscle.
2. Lower subscapular nerve (C5,6) supplies
the lower part of the subscapularis and the
teres major muscles.
3. Thoracodorsal nerve (C6,7,8) supplies the
latissimus dorsi muscle.
4. Axillary nerve (C5,6) and.
5. Radial nerve (C5,6,7,8, T1) are the two
terminal branches of the posterior cord.
4. Axillary Lymph
Nodes
They about 20-30 small nodes arranged into 6
groups that drain the lymph from:
1.The upper limb.
2.Anterior thoracic and abdominal wall till the
level of the umbilicus.
3.Posterior thoracic and abdominal wall till the
level of the iliac crest.
4.Lateral quadrants of the mammary gland.
They are grouped into (1) Anterior (pectoral),
(2) Posterior (subscapular), (3) Lateral
(humeral), (4) Central, (5) Infraclavicular
(deltopectoral) and (6) Apical groups.
Axillary Lymph Nodes
1. Anterior (pectoral) group:
Site: Behind the pectoralis major,
along the lower border of the pectoralis
minor.
Afferent: It receives lymph vessels
from the lateral quadrants of the
mammary gland and from the
anterolateral aspect of the trunk wall till
the level of the umbilicus.
Efferent: It sends to the central and
apical groups.
Axillary Lymph Nodes
2. Posterior (subscapular) group:
Site: on the subscapular muscle
along the course of the
subscapular vessels.
Afferent: It receives lymph vessels
from the posterior aspect of the
trunk wall till the level of the iliac
crest.
Efferent: It sends to the central
and apical groups.
Axillary Lymph Nodes
3. Lateral (humeral) group:
Site: along the medial side of the
axillary vein.
Afferent: It receives lymph vessels
from the whole upper limb, except
the lateral superficial part.
Efferent: It sends to the central
and apical groups.
Axillary Lymph Nodes
4. Central group:
Site: in the center of the axilla
within the axillary fat.
Afferent: It receives lymph vessels
from the anterior, posterior and
lateral groups.
Efferent: It sends to the apical
group.
Axillary Lymph Nodes
5. Infraclavicular (deltopectoral)
group:
Site: in the deltopectoral groove.
Afferent: It receives superficial
lymph vessels from the lateral side
of the hand, forearm and arm.
Efferent: It sends to the apical
group.
Axillary Lymph Nodes
6. Apical group:
Site: in the apex of the axilla at the
lateral border of the first rib.
Afferent: It receives lymph vessels
from the above mentioned groups.
Efferent: It forms the subclavian
lymph trunk, which drains into:
 On the right side: right lymph trunk.
 On the left side: thoracic duct.
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