Now that we have identified the structures making up the various walls of

the axilla, it is time to take a look at its contents. We will first examine the
blood vessels, then the nerves and finally, the lymphatics, in that order.

Axillary Artery

The axillary artery begins at the lateral border of

the first rib as a continuation of the subclavian
artery. It changes its name to brachial artery at
lower (inferior) border of the teres major muscle.
For purposes of description, it is broken up into
three parts by its relation to the pectoralis minor
muscle. The first part is between the lateral
border of the first rib and the medial border of
the pectoralis minor, the second part is behind
the pectoralis minor and the third part is between
the lateral border of the pectoralis minor and the
inferior border of the teres major.

Branches
First Third
Second Part
Part Part
(1 (3
(2
branch branches
branches)
) )
4
1
subscapul
superior
ar a.
thoracic
5 anterior
a. 2
humeral
(supre thoracoacrom
circumflex
me ial a.
a.
thoracic 3 lateral
6
a.) thoracic a.
posterior
(highest
humeral
thoracic
circumflex
a.)
a.
 4a thoracodorsal branch
of subscapular
 4b scapular circumflex
 branch of subscapular
 8 brachial artery
(continuation of the
axillary) below lower
border of teres major (tm)

Axillary Vein
The axillary vein lies along the medial side of the artery and is a continuation
of the basilic vein. It begins at the inferior border of the teres major m. and
ends at the lateral border of the first rib, where it becomes the subclavian v.
It receives tributaries that parallel the branches of the axillary artery. The
cephalic v. joins the axillary v. just before it becomes the subclavian. We
won't give any further details here. This doesn't mean that it isn't important
for maintaining proper function of the upper limb. I may be injured in sports
as well as when a person uses a crutch. Penetrating wounds in the larger
upper part are serious because air might enter into the venous system.

Vena comitans

The veins that run with their corresponding arteries

are frequently multiple
(2 or 3 interconnected veins). This interconnected
venous network is
called the vena commitantes.

Axillary Walls

Brachial
Plexus

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TABLE OF MUSCLES OF PECTORAL REGION

MUSCLE ORIGIN INSERTION ACTION NERVE
 SUPPLY

medial half of
clavicle
medial and
sternum lateral lip of flexes, adducts,
pectoralis lateral pectoral
costal cartilages intertubercular and rotates arm
major nerves
aponeurosis of groove of humerus medially
brachial plexus
external oblique
muscle

protracts the
medial pectoral
pectoralis anterior aspect of coracoid process of scapula
nerve
minor 2nd-5th ribs scapula pulls it forward
brachial plexus
and down

junction of the 1st pulls clavicle nerve to

inferior surface of
subclavius rib with towards the subclavius
clavicle
its costal cartilage sternum brachial plexus

Vessels & Nerves of Pectoral Region

 
Superficial Veins of
Upper Limb

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Axillary Artery Diagram

 Key to Diagram:

First division - one

branch:
    (1)  Supreme
Thoracic Artery

Second division - two

branches:
    (2)  Thoracoacromial
(with four smaller
branches)
        A.  Pectoral
Branch
        B.  Deltoid
Branch
        C.  Acromial
Branch
        D.  Clavicular
Branch
    (3)  Lateral Thoracic
Artery

Third division - three branches:

    (4)  Subscapular Artery (branches to the Circumflex Scapular Artery and
            the Thoracodorsal Artery)
    (5)  Anterior Humeral Circumflex Artery
    (6)  Posterior Humeral Circumflex Artery (which passes through the
            quadrangular space)

Reference Netter Plates 398 and 405.

Nerves in the Axilla

Brachial Plexus

With one exception, all of the muscles of the upper limb are supplied by branches of
the brachial plexus. The exception is the trapezius m. which is supplied by the
cranial nerve (XI), spinal accessory.
Although only part of the brachial plexus is found in the axilla, we will
present a general layout of the plexus before covering the parts that are
found in the axilla. Whoever first described the brachial plexus must have
been a nature lover, or at least a tree lover, because the various parts of the
plexus are named according to various parts of a tree, starting from the
roots.
The brachial plexus starts in
the neck from the ventral rami
of spinal nerves C5 - T1 (5th
cervical to 1st thoracic spinal
cord segments). These rami are
called roots. The roots will
continue through the neck and,
some of them merge, to form
trunks. C5 and C6 form the
upper trunk, C7 continues as
the middle trunk and C8 and T1
for the lower trunk. While still
in the neck, the trunks divide
into anterior and posterior
divisions. The divisions then
reunite in different patterns.
The anterior divisions of the
upper and middle trunks merge
to form the lateral cord. The
anterior division of the lower
trunk continues as the medial
cord. The posterior divisions of
all trunks merge to form the
posterior cord. At this point,
the cords are in the axilla. The
cords are named according to
their relationship with the
axillary artery. Medial to it,
lateral to it or posterior to it.
Finally, the cords give rise to
various branches that supply
the upper limb structures. I
want to point out that although
most of the branches to the
upper limb muscles arise from
the plexus in the axilla, some
arise from the cervical (neck)
part of the plexus. These
nerves are the dorsal scapular,
nerve to subclavius, long
thoracic, and suprascapular.
Needless to say, the brachial
plexus is a very important
structure in the axilla and
can be injured here through
various types of trauma
(athletic injuries, humeral
dislocations, crutch injuries,
surgical injuries), carcinomas
and other pathological
problems.

Branches of Brachial Plexus

Roots Trunks Cords

Lateral Medial Posterior

dorsal suprasca lateral medial upper

scapul pular (4) pectoral (5) pectoral subscapular
ar (2) (8) (14)
long lateral head medial thoracodors
thoraci of median cutaneo al(15)
c (1) n. (6) us of lower
nerve musculocut arm (9) subscapular
to aneous
subcla medial axillary(17)
vius cutaneo
(3) us of radial(18)
forearm
(10)
medial
head of
median
n.(11)
ulnar(1
2)
Axillary Arteries & Veins

Axillary
Lymph Nodes

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PhD, DSc

Muscle Details
Muscle Origin Insertion Nerve supply Action

medial half of
clavicle medial and
lateral lip of flexes, adducts,
pectoralis sternum lateral
intertubercular and rotates arm
major costal cartilages pectoral
sulcus medially
aponeurosis of nerves
external oblique

protracts
scapula
pulls it
anterior surface coracoid process forward
pectoralis medial pectoral
of of onto the
minor nerve
2nd thru 5th ribs scapula thorax
elevates ribs
when scapula
is held steady
 depresses lateral
end of clavicle
costal cartilage lower surface of nerve to pulls clavicular
subclavius
of first rib clavicle subsclavius head into
sternoclavicular
joint

lateral surface of protract scapula

serratus vertebral (medial) pulls it forward
long thoracic
anterior 1st to 8th or 9th border of scapula rotates scapula
ribs laterally

inferior aspect
axillary (lateral) rotates arm
teres minor greater tubercle axillary
border of scapula laterally
of humerus

posterior aspect crest of lesser adducts and

lower
teres major inferior angle of tubercle rotates arm
subscapular
scapula of humerus medially

spinous
processes
floor of adducts, extends
latissimus lower 6 vertebra
intertubercular thoracodorsal medially rotates
dorsi thoracolumbar
fossa humerus
fascia
iliac crest

Bones of the Arm and Forearm

The arm bone is the humerus and the forearm bones are the radius and ulna.
The details of the humerus are
shown in the adjacent
diagram.
The structures you should be
able to identify are:

 head
 anatomical neck
 greater tubercle
 lesser tubercle
 crest of the greater
tubercle
 crest of the lesser
tubercle
 intertubercular sulcus
(groove)
 deltoid tuberosity
 medial epicondyle
 lateral epicondyle
 capitulum
 trochlea
 coronoid fossa
 olecranon fossa
The details of the radius and ulna are
shown in the diagram.
The structures you should be able to
identify are:

Radius

 head
 neck
 radial tuberosity
 styloid process

Ulna

 coronoid process
 olecranon process
 ulnar tuberosity
 slyloid process

Interosseous Membrane

Summary of Items in Axilla

Muscles of
Anterior Arm

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