Axilla and Brachial Plexus: Anatomy

Boundaries of the Axilla

The axilla is a pyramid-shaped space below the glenohumeral joint that is the passageway for nerves and vessels to pass into the upper arm Upper Arm The arm, or “upper arm” in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm: Anatomy.

• Base: hair and sweat gland–bearing axillary skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions
• Apex (axillary inlet): between the 1st rib, scapula, and clavicle Clavicle A bone on the ventral side of the shoulder girdle, which in humans is commonly called the collar bone. Clavicle Fracture
• 4 converging walls:
  • Anterior wall: pectoralis major and minor
  • Medial wall: serratus anterior, thoracic wall
  • Lateral wall: intertubercular sulcus Intertubercular sulcus Arm: Anatomy of the humerus Humerus Bone in humans and primates extending from the shoulder joint to the elbow joint. Arm: Anatomy
  • Posterior wall: subscapularis, latissimus dorsi, teres major muscles

Contents of the Axilla

The contents of the axilla are structures enclosed in the axillary sheath.

Axillary artery

The axillary artery is a direct continuation of the subclavian artery and is composed of 3 parts:

• 1st part:
  • Superior to the pectoralis minor muscle
  • Branches: superior thoracic artery
• 2nd part:
  • Deep to the pectoralis minor muscle
  • Branches: thoracoacromial and lateral thoracic artery
• 3rd part:
  • Inferior to the pectoralis minor muscle and extending to the lower border of the axilla
  • Branches: subscapular artery, anterior, and posterior circumflex humeral artery

Axillary vein

The axillary vein is the primary venous drainage of the upper arm Upper Arm The arm, or “upper arm” in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm: Anatomy, formed by the cephalic and basilic veins Veins Veins are tubular collections of cells, which transport deoxygenated blood and waste from the capillary beds back to the heart. Veins are classified into 3 types: small veins/venules, medium veins, and large veins. Each type contains 3 primary layers: tunica intima, tunica media, and tunica adventitia. Veins: Histology.

Axillary lymph nodes Lymph Nodes They are oval or bean shaped bodies (1 – 30 mm in diameter) located along the lymphatic system. Lymphatic Drainage System: Anatomy

There are 5 groups of axillary lymph nodes Lymph Nodes They are oval or bean shaped bodies (1 – 30 mm in diameter) located along the lymphatic system. Lymphatic Drainage System: Anatomy draining to the apical lymph nodes Lymph Nodes They are oval or bean shaped bodies (1 – 30 mm in diameter) located along the lymphatic system. Lymphatic Drainage System: Anatomy:

1. The anterior or pectoral group drains the anterolateral abdominal wall Abdominal wall The outer margins of the abdomen, extending from the osteocartilaginous thoracic cage to the pelvis. Though its major part is muscular, the abdominal wall consists of at least seven layers: the skin, subcutaneous fat, deep fascia; abdominal muscles, transversalis fascia, extraperitoneal fat, and the parietal peritoneum. Surgical Anatomy of the Abdomen and lateral quadrants of the breast.
2. The posterior or subscapular group drains the superficial layers of the back.
3. The lateral group drains the upper limb.
4. The central group drains the anterior, posterior, and lateral groups, which drain into the apical or subclavicular group at the apex of the axilla (apical → subclavian lymph Lymph The interstitial fluid that is in the lymphatic system. Secondary Lymphatic Organs trunk → thoracic duct Thoracic Duct The largest lymphatic vessel that passes through the chest and drains into the subclavian vein. Lymphatic Drainage System: Anatomy on the left and right lymphatic trunk on the right).
5. The infraclavicular or deltoid group (not found within the axilla) drains the superficial layers of the upper limb.

These lymph nodes Lymph Nodes They are oval or bean shaped bodies (1 – 30 mm in diameter) located along the lymphatic system. Lymphatic Drainage System: Anatomy filter lymph Lymph The interstitial fluid that is in the lymphatic system. Secondary Lymphatic Organs fluid from the arm Arm The arm, or “upper arm” in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm: Anatomy and pectoral region, including the breast (important in the diagnosis and management of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer).

Brachial plexus Brachial Plexus The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (c5-c8 and T1), but variations are not uncommon. Peripheral Nerve Injuries in the Cervicothoracic Region

The brachial plexus Brachial Plexus The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (c5-c8 and T1), but variations are not uncommon. Peripheral Nerve Injuries in the Cervicothoracic Region is formed from the anterior rami of spinal cord Spinal cord The spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord: Anatomy segments C5–T1, which are the roots of the brachial plexus Brachial Plexus The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (c5-c8 and T1), but variations are not uncommon. Peripheral Nerve Injuries in the Cervicothoracic Region and the network of nerves that supply the upper arm Upper Arm The arm, or “upper arm” in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm: Anatomy.

The Brachial Plexus

The brachial plexus Brachial Plexus The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (c5-c8 and T1), but variations are not uncommon. Peripheral Nerve Injuries in the Cervicothoracic Region is a nerve plexus formed by intercommunication of the ventral rami of C5–T1 nerves. The brachial plexus Brachial Plexus The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (c5-c8 and T1), but variations are not uncommon. Peripheral Nerve Injuries in the Cervicothoracic Region serves as the origin of all the peripheral nerves Peripheral Nerves The nerves outside of the brain and spinal cord, including the autonomic, cranial, and spinal nerves. Peripheral nerves contain non-neuronal cells and connective tissue as well as axons. The connective tissue layers include, from the outside to the inside, the epineurium, the perineurium, and the endoneurium. Nervous System: Histology that innervate the upper limb and shoulder.

Axillary Spaces

The axillary spaces are anatomic spaces in the axilla where important nerves and vessels exit the axilla.

Clinical Relevance

The following are common conditions and pathologies associated with the axilla:

• Axillary lymphadenopathy Axillary Lymphadenopathy Lymphadenopathy: inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation or disease of the lymph nodes Lymph Nodes They are oval or bean shaped bodies (1 – 30 mm in diameter) located along the lymphatic system. Lymphatic Drainage System: Anatomy. Common causes include infection and breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer; lymph Lymph The interstitial fluid that is in the lymphatic system. Secondary Lymphatic Organs node dissection is often part of the staging Staging Methods which attempt to express in replicable terms the extent of the neoplasm in the patient. Grading, Staging, and Metastasis of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer disease.
• Axillary nerve injury Nerve Injury Surgical Complications: The axillary nerve innervates the deltoid and teres minor muscles and the skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions of the upper lateral and dorsal areas of the upper arm Upper Arm The arm, or “upper arm” in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm: Anatomy through the superior lateral brachial cutaneous nerve. Common causes of injury include shoulder dislocation, fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures of the surgical neck Neck The part of a human or animal body connecting the head to the rest of the body. Peritonsillar Abscess of the humerus Humerus Bone in humans and primates extending from the shoulder joint to the elbow joint. Arm: Anatomy, and scapular fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures. 
• Radial nerve injury: commonly injured in the upper arm at the spiral groove of the humerus after fracture, or from pressure on the axilla from a chair (also known as “Saturday night palsy”) or from crutches. 
• Brachial plexus Brachial Plexus The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (c5-c8 and T1), but variations are not uncommon. Peripheral Nerve Injuries in the Cervicothoracic Region injuries:
  • Erb’s palsy Palsy paralysis of an area of the body, thus incapable of voluntary movement Cranial Nerve Palsies: a type of obstetrical palsy Palsy paralysis of an area of the body, thus incapable of voluntary movement Cranial Nerve Palsies; obstetrical palsy Palsy paralysis of an area of the body, thus incapable of voluntary movement Cranial Nerve Palsies is an injury due to trauma during childbirth. Erb’s palsy Palsy paralysis of an area of the body, thus incapable of voluntary movement Cranial Nerve Palsies is a stretch injury Stretch Injury Brachial Plexus Injuries to the brachial plexus Brachial Plexus The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (c5-c8 and T1), but variations are not uncommon. Peripheral Nerve Injuries in the Cervicothoracic Region, specifically C5–C6, during labor and delivery. 
  • Klumpke’s palsy Palsy paralysis of an area of the body, thus incapable of voluntary movement Cranial Nerve Palsies: another type of obstetrical palsy Palsy paralysis of an area of the body, thus incapable of voluntary movement Cranial Nerve Palsies that results in injury to the lower trunk of the brachial plexus Brachial Plexus The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (c5-c8 and T1), but variations are not uncommon. Peripheral Nerve Injuries in the Cervicothoracic Region.