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It is a pyramid shaped space between the upper part of the arm and the side of the chest Important Nerves, Blood and Lymph vessels travel through it from root of the neck to the upper limb
BOUNDARIES
BOUNDARIES :
APEX : DIRECTED UPWARD AND MEDIAL WARD, ENDING IN THE CERVICOAXILLARY CANAL, WHICH LEADS INTO POSTERIOR TRIANGLE OF NECK.
BOUNDARIES :
Anterior wall: By the pectoralis major, Subclavius and pectoralis minor muscles Posterior wall: By the subscapularis, Latissimus dorsi and teres major muscles
BOUNDARIES :
Medial wall: By the upper 4 or 5 ribs and intercostal spaces covered by serratus anterior muscle Lateral wall: By the coracobrachialis and biceps muscles in the bicipital groove of humerus
BOUNDARIES :
Base : The Base of axilla is formed by the axillary fascia and the skin stretching between the anterior and posterior walls
Contents of Axilla
Axillary artery and its branches Axillary vein and its tributaries
Axillary Artery
Is a continuation of subclavian artery Begins at the lateral border of the 1st rib Ends at the lower border of teres major It continues as the brachial artery Closely related to brachial plexus cords Enclosed with them in the axillary sheath Axillary sheath is continuous with the prevertebral fascia Pectoralis minor divides it into 3 parts Branches of axillary artery supply the thoracic wall and the shoulder region
Relation
Anterior: Pectoralis major, covering fascia, skin, cephalic vein Posterior: Long thoracic nerve Lateral: Three cords of brachial plexus Medial: Axillary vein
Relation
Anterior: Pectoralis minor and major, covering fascia and skin Posterior: Posterior cord of brachial plexus Lateral: Lateral cord of brachial plexus Medial: medial cord of brachial plexus and axillary vein
Relation
Anterior: Pectoralis major, medial root of the median nerve Posterior: subscapularis, latissimus dorsi and teres major Lateral: Coracobrachialis, biceps, humerus Medial: Ulnar nerve, axillary vein, medial cutaneous nerve of the arm
AXILLARY VEIN
BEGINS AT UNION OF BASILIC AND BRACHIAL VEINS AND TERMINATES AT 1ST RIB AS SUBCLAVIAN VEIN. LIES MEDIAL TO AND PARTLY OVERLAPS AXILLARY ARTERY WITH MEDIAL CORD AND ITS BRANCHES. RECEIVES TRIBUTARIES CORRESPONDING TO BRANCHES OF ARTERY PLUS THE CEPHALIC VEIN.
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Brachial Plexus
Brachial Plexus
Roots
C5 C6 C7 C8 T1
Divisions
Anterior primarily flexors Posterior primarily extensors
Trunks
Upper 5,6 Middle 7 Lower 8,1
Cords
Lateral C5,6,7 Posterior C5,6,7,8 Medial C8,T1
C5 C6 C7 C8 T1
Upper
Middle Lower
Anterior Posterior
Anterior Posterior Anterior Posterior
U M
A P A P A P
LATERAL CORD
MEDIAL CORD
POSTERIOR CORD
Posterior
8th cervical nerve exits BELOW C7 vertebra Note: There are 7 cervical vertebrae There are 8 cervical nerves
(1) Roots
C5 C6 C7 C8 T1
(2) Long thoracic nerve : Spinal Cord Segments C5, C6, C7 Muscles Innervated Serratus
(3) Dorsal scapular nerve : Spinal Cord Segment C5 (C4 is variable) Muscles Innervated Levator Rhomboids
TRUNCUS SUPERIOR
(4) Nerve to subclavius : Spinal Cord Segments C5, C6 Muscles Innervated
SC
(5) Suprascapular nerve :
Muscles Innervated
PT, FCR, PL, FDS, FDP (2,3), FPL, FPB, APB, OP, PQ, LUM (2,3).
Injuries (Median)
Fracture Dislocation Compression Sites Low lesion Ant. Interosseous lesion Lesion proximal to elbow
Injuries (Median)
Fracture Dislocation Compression Sites Low lesion Ant. Interosseous lesion Lesion proximal to elbow
Cubital tunnel
Guyons canal
Midpalm
Deltoid tuberosity
Summary
Brachial plexopathies require thorough understanding of anatomy Specialized sensory and motor testing can help localize the pathology
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