AXILLA

The axilla, or armpit, is a pyraidal-shaped space between the upper part of the arm and

the side of the chest. It forms an important passage for nerves, blood and lymph vessels

as they travel from the root of the neck to the upper limb.

Walls, Floor and Roof of the Axilla

The walls, Floor and Roof of the Axilla are made up as follows:

Apex: The upper end of the axilla, is directed into the root of the neck and is bounded

infront by the clavicle, behind by the upper border of the scapula, and medially by the

outer border of the first rib.

Base: The lower end is formed by the skin stretching between the anterior and posterior

walls. It is bounded in front by the anterior axillary fold (formed by the lower border of

pectoralis major muscle), behind by the posterior axillary fold (formed by the tendon of

latissimus dorsi and teres major muscles), and medially by the chest wall.

Anterior wall: By the pectoralis major, subclavius, and pectoralis minor muscles

Posterior wall: By the subscapularis, latissimus dorsi, and teres major muscles, from

above down.

Medial wall: By the upper four or five ribs and their costal spaces covered by the

serratus anterior muscle

Lateral wall: By coracobrachialis and biceps muscles related to the upper portion of the

humerus.

Contents of the Axilla

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The axilla contains:

 Axillary artery and its branches, which supply blood to the upper limb;

 Axillary vein and its tributaries, which drain blood from the upper limb

 And lymph vessels and lymph nodes, which drain lymph from the upper limb and

the breast and from the skin of the trunk, down as far as the level of the umbilicus.

 Lying among these among the structures in the axilla is an important nerve

plexus, the brachial plexus, which innervates the upper limb.

These structures are embedded in fat.

Axillary artery

The axillary artery begins at the lateral border of the first rib as a continuation of the

subclavian artery and ends at the lower border of the teres major muscle, where it

continues as the brachial artery. Throughout its course the artery is closely related to the

cords of the brachial plexus and their branches; and enclosed with them in a connective

tissue sheath called the axillary sheath, which is continuous with prevertebral fascia. The

pectoralis minor muscle crosses in front of the axillary artery and divides it into three

parts as follows:

 First part of the Axillary Artery: extends from the lateral border of the first rib to

the upper border of the pectoralis minor

 Second part of the Axillary Artery: lies behind the pectoralis minor muscle

 Third part of the Axillary Artery: lies between the lower border of pectoralis

minor muscle and lower border of teres major.

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Branches: the branches of the axillary artery supply the thoracic wall and the shoulder

region. They are:

 The first part of the artery gives off one branch (the highest thoracic artery),

 The second part off two branches (the thoracoacromial artery and the lateral

thoracic artery),

 And the third part gives off three branches (the subscapular artery, the anterior

circumflex humeral artery, and the posterior circumflex humeral artery)

The highest thoracic artery is small and runs along the upper border of the pectoralis

minor. The thoracoacromial (acromio-thoracic) artery immediately divides into terminal

branches (CHAP; Clavicular, Humeral (Deltoid?), Acromial and Pectoral). The lateral

thoracic artery runs along the lower border of the pectoral minor. The subscapular artery

runs along the lower border of the subscapularis muscle. The anterior and posterior

circumflex humeral arteries wind around the front and the back of the surgical neck of the

humerus respectively.

Axillary vein

The axillary vein is formed at the lower border of the teres major muscle by the union of

the venae comitantes of the brachial artery and the basilic vein. It runs upward on the

medial side of the axillary artery and ends at the lateral border of the first rib by

becoming the subclavian vein.

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The vein receives the cephalic vein and tributaries, which correspond to the branches of

the axillary artery.

Clinical notes

1. BRACHIAL NERVE BLOCK

Because the axillary sheath encloses the axillary vessels and the brachial plexus, a

brachial plexus nerve block can easily be obtained. The distal part of the sheath is closed

with finger pressure, and a syringe needle is inserted into the proximal part of the sheath.

The anesthetic solution is then injected into the sheath. And the solution is massaged

along the sheath to produce the nerve block. The position of the sheath can be verified by

feeling the pulsations of the third part of the axillary artery.

2. SPONTANEOUS THROMBOSIS OF THE AXILLARY VEIN

Spontaneous thrombosis of the axillary vein occasionally occurs after excessive and

unaccustomed movement of the arm at the shoulder joint.

LYMPH NODES OF THE AXILLA

The axillary lymph nodes drain lymph vessels from the lateral quadrants of the breast, the
superficial lymph vessels from the thoracoabdominal walls above the levels of the
umbilicus, and the vessels from the upper limb. The lymph nodes are arranged in six
groups.

1. Anterior (pectoral) group: Lying along the lower border of the pectoralis
minor behind the pectoralis major, these nodes receive lymph vessels from the

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 lateral quadrants of the breast and superficial vessels from the anterolateral
abdominal wall above the level of the umbilicus.
2. Posterior (subscapular) group: Lying in front of the suscapularis muscle,
these nodes receive superficial lymph vessels from the back, down as far as
the level of the iliac crests.
3. Lateral group: lying along the medial side of the axillary vein, these nodes
receive most of the lymph vessels of the upper limb (except those superficial
vessels draining the lateral side.
4. Central group: lying in the center of the axilla in the axillary fat, these nodes
receive lymph from the above three groups.
5. Infraclavicular (deltopectoral) group: these nodes are not strictly axillary
nodes because they are located outside the axilla. They lie in the groove
between the deltoid and pectoralis major muscles and receive superficial
lymph vessels from the lateral side of the hand, forearm and arm.
6. Apical group: lying at the apex of the axilla at the lateral border of the first
rib, these nodes receive the efferent lymph vessels from all the other axillary
nodes.

The apical nodes drain into the subclavian lymph trunk. On the left side, this trunk drains
into the thoracic duct; on the right side, it drains into the right lymph trunk, the lymph
trunks may drain directly into one of the veins at the root of the neck.