2. بسم الله الرحمن الرحيم ” و فى أنفسكم أفلا تبصرون“

3. The Upper limb

4. 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

5. 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 1 st rib, medially Apex

6. Axilla Definition: Pyramidal space between the upper part of the arm and chest. It has the following boundaries:  Base: Skin & fascia

7. Axilla Anterior wall of Axilla: 1.Pectoralis major. 2.Pectoralis minor. 3.Subclavius. 4.Clavipectoral fascia.

8. Axilla Posterior wall of axilla: 1.Subscapularis. 2.Teres major. 3.Latissimus dorsi.

9. 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.

10. Axilla Lateral wall of Axilla: 1.Upper part of the humerus. 2.Coracobrachialis and bicips muscles.

11. Axilla Contents of Axilla: 1.Axillary Artery. 2.Axillary Vein. 3.Brachial Plexus (cords + branches). 4.Axillary Lymph nodes. 5.Fat. 6.Axillary tail of Breast.

12. 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.

13. 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.

14. Axillary Artery

16. Relations of 1 st part Anterior: 1.Pectoralis Major. 2.Clavipectoral Fascia. 3.Cephalic Vein. Posterior: 1.Serratus anterior (+long thoracic nerve). 2.Medial Cord. Lateral: 1.Lateral Cord 2.Posterior Cord Medial: 1.Axillary Vein

17. Axillary Artery Relations of 1 st part Anterior: 1.Pectoralis Major. 2.Clavipectoral Fascia. 3.Cephalic Vein. Posterior: 1.Serratus anterior (+long thoracic nerve). 2.Medial Cord. Lateral: 1.Lateral Cord 2.Posterior Cord Medial: 1.Axillary Vein

18. Axillary Artery Relations of 1 st part Anterior: 1.Pectoralis Major. 2.Clavipectoral Fascia. 3.Cephalic Vein. Posterior: 1.Serratus anterior (+long thoracic nerve). 2.Medial Cord. Lateral: 1.Lateral Cord 2.Posterior Cord Medial: 1.Axillary Vein

19. Axillary Artery Relations of 2 nd part Anterior: 1.Pectoralis Major. 2.Pectoralis Minor. Posterior: 1.Subscapularis. 2.Posterior Cord. Lateral: 1.Lateral Cord Medial: 1.Medial Cord 2.Axillary Vein

20. Axillary Artery Relations of 2 nd part Anterior: 1.Pectoralis Major. 2.Pectoralis Minor. Posterior: 1.Subscapularis. 2.Posterior Cord. Lateral: 1.Lateral Cord Medial: 1.Medial Cord 2.Axillary Vein

21. Axillary Artery Relations of 2 nd part Anterior: 1.Pectoralis Major. 2.Pectoralis Minor. Posterior: 1.Subscapularis. 2.Posterior Cord. Lateral: 1.Lateral Cord Medial: 1.Medial Cord 2.Axillary Vein

22. Axillary Artery Relations of 3 rd part Anterior: 1.Pectoralis Major (upper part only). 2.Medial root of median nerve. Posterior: 1.Subscapularis. 2.Latissimus dorsi. 3.Teres Major. 4.Radial Nerve. 5.Axillary Nerve. Lateral: 1.Lateral root of median nerve 2.Median nerve 3.Musculocutaneous nerve 4.Coracobrachialis 5.Biceps Medial: 1.Ulnar Nerve 2.Medial cutaneous nerve of forearm 3.Axillary vein 4.Medial cutaneous nerve of arm

23. Axillary Artery Relations of 3 rd part Anterior: 1.Pectoralis Major (upper part only). 2.Medial root of median nerve. Posterior: 1.Subscapularis. 2.Latissimus dorsi. 3.Teres Major. 4.Radial Nerve. 5.Axillary Nerve. Lateral: 1.Lateral root of median nerve 2.Median nerve 3.Musculocutaneous nerve 4.Coracobrachialis 5.Biceps Medial: 1.Ulnar Nerve 2.Medial cutaneous nerve of forearm 3.Axillary vein 4.Medial cutaneous nerve of arm

24. Axillary Artery Relations of 3 rd part Anterior: 1.Pectoralis Major (upper part only). 2.Medial root of median nerve. Posterior: 1.Subscapularis. 2.Latissimus dorsi. 3.Teres Major. 4.Radial Nerve. 5.Axillary Nerve. Lateral: 1.Lateral root of median nerve 2.Median nerve 3.Musculocutaneous nerve 4.Coracobrachialis 5.Biceps Medial: 1.Ulnar Nerve 2.Medial cutaneous nerve of forearm 3.Axillary vein 4.Medial cutaneous nerve of arm

25. Axillary Artery Branches: 1 st Part: 1.Superior thoracic artery 2 nd Part: 2. Thoracoacromial artery (breast) 3. Lateral Thoracic artery (breast) 3 rd Part: 4. Subscapular artery 5. Ant. circumflex humeral 6. Post. circumflex humeral

26. Axillary Artery Branches: 1 st Part: 1.Superior thoracic artery: Supplies the medial wall of the axilla.

27. Axillary Artery Branches: 2 nd Part: 2. Thoracoacromial artery (breast) Peirce the clavipectoral fascia. Supplies the muscles and breast. 3. Lateral Thoracic artery (breast) Supplies the medial wall of the axilla and breast.

28. Axillary Artery Branches: 3 rd Part: 4. Subscapular artery Passes along the lower border of scapula. Gives Circumflex scapular artery which anastomose with 2 branches of subclavian artery in the infraspinous fossa. 5. Ant. circumflex humeral 6. Post. circumflex humeral Anastomose with each other around the surgical neck of humerus. The posterior circumflex humeral also anastomose with Ascending branch of profunda brachii artery.

29. Axillary Artery

33. Axillary Vein Beginning: Continuation of Basilic vein at the lower border of teres major Termination: Continues as subclavian vein at the outer border of first rib Relations: it lies on the medial side of axillary artery, separated from: 3 rd part by: ulnar nerve and medial cutaneous nerve of forearm. 2 nd part by medial cord of brachial plexus. 1 st part: closely related. Tributaries: 1. Correspond to branches of the artery. 2. Cephalic vein.

34. Brachial Plexus

36. Brachial plexus can be divided into: 1. Roots 2. Trunks 3. Divisions 4. Cords 5. Branches

37. Brachial Plexus TrunksDivisionsCords - Upper Anterior Lateral Cord Posterior Posterior - Middle Anterior Posterior Posterior - Lower Anterior Posterior Posterior Posterior Cord Medial Cord

38. Brachial Plexus Brachial plexus can be divided into: 1. Roots (5): Anterior rami of C5,6,7,8,T1 It gives: a.Phrenic nerve. b.Dorsal scapular nerve. c.Long thoracic nerve.

39. Brachial Plexus Brachial plexus can be divided into: 2. Trunks (3): 1. Upper trunk: Union of C 5 and 6. 2. Middle trunk: C 7 root only 3. Lower trunk: Union of C 8 and T 1. It gives: a.Suprascapular nerve. b.Nerve to subclavius.

40. Brachial Plexus Brachial plexus can be divided into: 3. Divisions (6): 1.Anterior. 2.Posterior.

41. Brachial Plexus Brachial plexus can be divided into: 4. Cords (3): 1.Lateral cord. 2.Medial cord. 3.Posterior cord. It gives: A. Lateral cord. 1.Lateral pectoral. 2.Lateral root of median. 3.Musculocutaneus. B. Medial cord. 1.Medial pectoral. 2.Medial root of median. 3.Medial Cut. Nerve of arm 4.Medial cut. Nerve of forearm. 5.Ulnar nerve. C. Posterior cord. 1.Upper subscapular. 2.Lower subscapular. 3.Thoracodorsal. 4.Axillary. 5.Radial.

42. Brachial Plexus

43. Axillary Lymph Nodes

44. Lateral Posterior Anterior Central Anterior abdominal wall above the umbilicus. Lateral part of the breast The back as far as the iliac crest From the whole upper limb except few lymphatics accompany cephalic vein. Apical From lymphatic accompany cephalic vein which ends in the infraclavicular Lymph nodes. Subclavian lymph trunk Axillary Lymph Nodes

45. Subclavian lymph trunk Apical Right lymphatic duct Thoracic duct Right sideLeft side