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 Pectoralis major:

8. Axilla Pectoralis major:

9. Axilla Pectoralis major:

10. 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.

11. Axilla Pectoralis minor: Origin:The 3 rd, 4 th and 5 th ribs Insertion: Medial border and upper surface of coracoid process of scapula Nerve supply:Medial pectoral nerve Action (girdle): Depression and protraction of scapula.

12. Axilla Subclavius: Origin: 1 st costal cartilage and 1 st 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.

13. 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 costo- coracoid ligament that extends from anterior end of 1st rib and contenues downward as the Suspensory ligament of axilla.

14. Axilla Clavipectoral fascia: Structures piercing it:  Cepalic vein, ends in axillary vein  Acromio-thoracic artery, branch of 2 nd part of axillary artery  Lateral pectoral nerve, supplies pectoralis major  Lymph vessels.

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

16. 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.

17. Axilla Latissimus dorsi:

18. 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.

19. 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.

20. 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.

21. Axilla Latissimus dorsi:

22. 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.

23. 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.

24. Axilla Teres major:

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

26. 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.

27. 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.

28. 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.

29. 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.

30. Axilla Medial wall of Axilla: 1.Upper 5 ribs and intercostal spaces. 2.Serratus anterior

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

32. 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.

33. 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.

34. 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.

35. Axillary Artery