1. Axilla (the armpit) Prof. Dr. Selda Önderoğlu Department of Anatomy

3. borders Anterior wall pectoralis major m. pectoralis minor m. Clavipectoral fascia Posterior Subscapularis m. teres major m. latissimus dorsi m. Medial 1-4 ribs İntercostal mm. serratus anterior m. Lateral ıntertubercular Sulcus

4. apex Clavicula (anterior) 1st rib (medial) superior border of scapula (post.) Base Axillary fascia skin contents Loose connective tissue Axillary artery Axillary vein Axillary lymph nodes brachial Plexus (infraclavicular part)

5. Borders of Axillary Fossa Prof. Dr. H. Selçuk Sürücü

7. Base Skin and axillary fascia

8. Apex

9. Anterior wall Pectoralis major Pectoralis minor Clavi-pectoral fascia

11. Posterior wall Subscapular Teres major Latissimus dorsi

12. Prof. Dr. H. Selçuk Sürücü

13. Medial wall Ribs 1-4 Intercostal mm. Serratus ant. M.

14. Lateral wall Intertubercular sulcus (groove)

15. What is inside the fossa? Loose connective tissue Axillary a-v Axillary lymph nodes brachial plexus (Infraclavicular part )

19. Axillary artery

20. Axillary Artery ( continuation of subclavian a.) subclavian a. after 1 st rib becomes Axillary artery After teres major m. becomes brachial a. axillary artery is divided into 3 parts according to its position to pectoralis minor m. 1st part - 1 branch Supreme ( highest) thoracic a. 2nd part – 2 brs. Thoracoacromial a. Lateral thoracic a. 3 rd part - 3 brs. Subscapular a. (the thickest br. of axill.a. circumflex scapular a. Thoracodorsal a. Ant. humeral circumflex a. post. humeral circumflex a.

21. Ist part of axillary artery Superior (highest) (supreme) thoracic a

22. 2nd part of axillary artery Thoraco-acromial a Lateral thoracic a

23. 3rd part of axillary artery Anterior circumflex humeral a Posterior circumflex humeral a Subscapular a (Thickest branch) Thorocodorsal a Circumflex scapular a

24. Thoracodorsal a

25. axillary vein Basilic vein After:teres major m. continues as the Axillary vein 1st rib Continues as the Subclavian vein Cephalic vein joins the axillary vein

29. Structures piercing clavipectoral fascia Cephalic v Thoraco-acromial a Lymph vess Lat pectoral n

31. Axillary Lymph Nodes Anterior group (pectoral) 4-5 Posterior group (subscapular) 6-7 Lateral group 4-6 Central group 3-4 Apical Group 6-12

34. central anterior posterior lateral apicalSubclavian trunk Lymph vessels accompanying cephalic vein Axillary lymph nodes: which group drains where

38. Axillary sheath deep cervical fascia Superficial Lamina Pretracheal Lamina Prevertebral Lamina Axillary sheath carotid sheath Axillary sheath encloses: Axillary a. Axillary v. brachial plexus ( infraclavicular part) So: axillary sheath is a part of deep cervical fascia

39. BRACHIAL PLEXUS Network of nerves extending from the neck into the axilla It innervates the structures in upper limb Formed by the union of anterior rami of spinal nerves from C5 to T1

40. Nerves From spinal cord to brachıal plexus Ant. Root+ post. root Unite&form spinal nerve Spinal nerve divides into 2 rami (branches) Anterior ramus and posterior ramus From Spinal cord emerges Ant. Rami of C5-T1 unite and form the brachial plexus Rami: plural of “ramus”

41. Prof. Dr. H. Selçuk Sürücü

43. C5 + C6Sup. trunk C7Middle trunk C8+T1Inf.trunk roots trunks Brachial plexus divisions Ant Post Ant post Ant post cords posterior lateral medial nervesnerves

44. Trunks Ant.rami of spinal nn cords Ant+post divisions C4 C5 C6 C7 C8 T1 superior trunk middle trunk inferior trunk lateral cord Medial cord Posterior cord

45. clavicle

46. Parts of brachial plexus Supraclavicular part - located in the neck Infraclavicular part -Located in the axilla

47. clavicle

50. Nn from Roots Dorsal scapular n (C5) Rhomboids, levator scapulae Long thoracic n (C 5-7)

52. Prof. Dr. H. Selçuk Sürücü

54. Nn from Trunks (C 5-6) N to subclavius Suprascapular n (Accessory phrenic n)

56. Nn from Lat Cord (C 5-7) Lat pectoral n - Pectoralis major m Musculocutaneous n Lateral root to median n

59. Nn form Medial Cord (C 8- T1) Medial root of median n Medial pectoral n- Pectoralis muscles Medial cutaneous n of arm Medial cutaneous n of forearm Ulnar n

62. Nn from post cord Subscapular nn (C 5-6) Subscapular & teres major m Thoracodorsal n (C 5-8) Axillary n ( C5-6) Radial n (C5-T1)

64. Prof. Dr. H. Selçuk Sürücü

67. Erb-Duchenne Paralysis (C5-C6)

70. Klumpke’s paralysis (C8-T1)

71. Winged scapula: result of damaged long thoracic nerve