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Reech Bol Kuol Reech
1. Axilla (Armpit)
The axilla is a pyramidal space located between the upper arm and the side of the thorax (chest
wall).
It serves as a passageway for nerves, blood vessels, and lymphatics that travel from the neck
and thorax to the upper limb.
The axilla is an important region for both clinical examination and surgical procedures due to
the concentration of vital structures.
2. Boundaries of the Axilla
Apex: Directed towards the root of the neck; bounded by the clavicle, the first rib, and the
superior border of the scapula.
Base: Formed by the skin, subcutaneous tissue, and deep fascia extending from the thorax to
the arm.
Anterior Wall: Formed by the pectoralis major and minor muscles, and the clavipectoral fascia.
Posterior Wall: Formed by the scapula, subscapularis muscle, teres major, and latissimus dorsi
muscles.
Medial Wall: Formed by the serratus anterior muscle and the thoracic wall (ribs 1-4 and
associated intercostal muscles).
Lateral Wall: Formed by the intertubercular sulcus (bicipital groove) of the humerus.
3. Contents of the Axilla
Axillary Artery: Continuation of the subclavian artery, becomes the brachial artery after passing
the inferior border of the teres major.
Divided into three parts based on its relation to the pectoralis minor muscle:
First Part: Proximal to the pectoralis minor, gives off the superior thoracic artery.
Second Part: Posterior to the pectoralis minor, gives off the thoracoacromial artery and lateral
thoracic artery.
Third Part: Distal to the pectoralis minor, gives off the subscapular artery, anterior circumflex
humeral artery, and posterior circumflex humeral artery.
Axillary Vein: Formed by the union of the brachial veins and the basilic vein; lies medial to the
axillary artery and drains into the subclavian vein.
Brachial Plexus: A network of nerves formed by the anterior rami of C5-T1 spinal nerves;
innervates the upper limb.
Axillary Lymph Nodes: Grouped into five categories based on their location:
Pectoral (Anterior) Nodes: Located along the lower border of the pectoralis minor.
Subscapular (Posterior) Nodes: Located along the posterior axillary fold.
Humeral (Lateral) Nodes: Located along the lateral wall of the axilla.
Central Nodes: Located near the base of the axilla, embedded in the fat.
Apical Nodes: Located at the apex of the axilla, near the first part of the axillary artery.
Fat and Connective Tissue: Surrounds and supports the other structures within the axilla.
4. Clinical Significance
Axillary Lymph Node Dissection: Performed during the surgical treatment of breast cancer to
check for metastasis.
Axillary Nerve Injury: Can occur due to shoulder dislocation or fractures of the proximal humerus,
leading to weakness in shoulder abduction.
Thoracic Outlet Syndrome: Compression of the neurovascular structures passing through the
axilla, leading to pain and weakness in the upper limb.
Brachial Plexus
The brachial plexus is a network of nerves that originates from the spinal cord in the neck and
extends through the axilla (armpit) to the arm. It is responsible for motor and sensory
innervation to the upper limb.
Formation:
Roots: The brachial plexus is formed by the anterior rami of the C5, C6, C7, C8, and T1 spinal
nerves.
Trunks: These roots combine to form three trunks:
Upper Trunk: C5 and C6 roots.
Middle Trunk: C7 root.
Lower Trunk: C8 and T1 roots.
Divisions: Each trunk splits into an anterior and a posterior division:
Anterior Divisions: Supply flexor muscles of the arm.
Posterior Divisions: Supply extensor muscles of the arm.
Cords: The divisions regroup to form three cords named based on their position relative to the
axillary artery:
Lateral Cord: Formed by the anterior divisions of the upper and middle trunks.
Posterior Cord: Formed by the posterior divisions of all three trunks.
Medial Cord: Formed by the anterior division of the lower trunk.
Branches:
Terminal Branches:
Musculocutaneous Nerve: Arises from the lateral cord; innervates the flexor muscles of the arm
(biceps brachii, brachialis) and provides sensory innervation to the lateral forearm.
Axillary Nerve: Arises from the posterior cord; innervates the deltoid and teres minor muscles,
and provides sensory innervation to the skin over the shoulder.
Radial Nerve: Arises from the posterior cord; innervates the extensor muscles of the arm and
forearm and provides sensory innervation to the posterior arm, forearm, and hand.
Median Nerve: Formed by contributions from the lateral and medial cords; innervates most of
the flexor muscles in the forearm, the thenar muscles, and provides sensory innervation to the
lateral palm and fingers.
Ulnar Nerve: Arises from the medial cord; innervates some flexor muscles in the forearm and
most of the intrinsic muscles of the hand, and provides sensory innervation to the medial hand
and fingers.
Other Branches:
Dorsal Scapular Nerve: Arises from the C5 root; innervates the rhomboid major and minor
muscles.
Long Thoracic Nerve: Arises from C5, C6, and C7 roots; innervates the serratus anterior muscle.
Suprascapular Nerve: Arises from the upper trunk; innervates the supraspinatus and
infraspinatus muscles.
Lateral Pectoral Nerve: Arises from the lateral cord; innervates the pectoralis major muscle.
Medial Pectoral Nerve: Arises from the medial cord; innervates the pectoralis major and minor
muscles.
Medial Cutaneous Nerve of Arm and Forearm: Arises from the medial cord; provides sensory
innervation to the skin of the medial arm and forearm.
Thoracodorsal Nerve: Arises from the posterior cord; innervates the latissimus dorsi muscle.
Subscapular Nerves (Upper and Lower): Arise from the posterior cord; innervate the
subscapularis and teres major muscles.
Clinical Relevance:
Injuries: Brachial plexus injuries can result from trauma, compression, or over-stretching,
leading to motor and sensory deficits in the upper limb.
Erb's Palsy: Results from damage to the upper trunk (C5-C6), leading to weakness or paralysis
of the shoulder and upper arm muscles.
Klumpke's Palsy: Results from damage to the lower trunk (C8-T1), leading to weakness or
paralysis of the forearm and hand muscles.
Function:
The brachial plexus provides the entire motor innervation to the muscles of the upper limb and
the majority of the sensory innervation to the skin of the upper limb.

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Reech Bol Kuol Reech

2. Boundaries of the Axilla

3. Contents of the Axilla

Subscapular (Posterior) Nodes: Located along the posterior axillary fold.

Trunks: These roots combine to form three trunks:

Upper Trunk: C5 and C6 roots.

Middle Trunk: C7 root.

Lower Trunk: C8 and T1 roots.

Divisions: Each trunk splits into an anterior and a posterior division:

Anterior Divisions: Supply flexor muscles of the arm.

Posterior Divisions: Supply extensor muscles of the arm.

Posterior Cord: Formed by the posterior divisions of all three trunks.

Medial Cord: Formed by the anterior division of the lower trunk.

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