Download By the name of Allah

By the name of Allah
 Quick revision :
- Axilla is a pyramidal shaped space between the arm and the chest wall.
- Contents of the Axilla :
1- Axillary artery: the main arterial supply of the upper limb.
2- Axillary vein.
3- Axillary sheath.
4- Axillary lymph nodes.
5- Brachial plexus of nerves: (because the axillary nerves are oriented towards the brachium
they are called brachial plexus)
6- Fat: we have multiple vital structures (arteries, veins, nerves),and since the shoulder and the
arm perform excessive movements sometimes, the axillary fat prevent / minimize the occlusion
of the artery or the vein.
-Axillary artery in detalils :
Brachial
artery
Axillary
artery
Subclavian
artery
- It is a continuation of the subclavian artery , Begins at the outer border of the first rib ,
Ends at lower border teres major and Continues as brachial artery.
- Through its course it is crossed by pectoralis minor which divides it into 3 parts , Each
part gives branches according to it's number .
- Located inside carotid sheath and related directly to cords of brachial plexus throughout
it's course .
- A table illustrating the Axillary artery divisions :
1
Parts
First part “ one branch “
( above P minor )
Second part “ two branches “
( behind P minor )
Branch/branches
Highest thoracic A.
- Thoracoacromial A .
- lateral thoracic A.
Third part “ three branches “
( below P minor )
Note :
Ant.circumflex humeral A. and
the post. Circumflex humeral A.
anastomose with each other
around the surgical neck of
humerus.
- Subscapular A.
- anterior circumflex
humeral A.
- and the posterior
circumflex humeral A.
2
Function of the branch /
branches
Supply the first and the
second intercostal spaces.
-thoracoacromial A.:
pierce clavipectoral fascia
and gives 4 branches :
1- pectoral branches ( to P
major and P minor )
2- deltoid branch
3- acromial branch
4- clavicular branch
.
-lateral thoracic A. : pass
along the lateral border
and below the lower
border of pectoralis minor
and supply lateral part of
breast.
- subscapular A. : large in
diameter and pass along
the lateral and lower
borders of subscapularis
muscle
It’d is divided into:
a) circumflex scapular
artrey (posterior toward
the infraspinous fossa, at
the lower border of
subscapularis), and passes
through the triangular
space.
b) Thoracodorsal A.
-anterior circumflex
humeral A. : smaller and
wind around the surgical
neck of humerus
-posterior circumflex
humeral A. : larger and
wind around the surgical
neck of humerus
- Located inside carotid sheath and related directly to cords of brachial plexus throughout
it's course.
- Cords of brachial plexus are named according to their relation to the second part of the
axillary artery( medial cord, lateral cord, posterior cord).
First part of
the axillary
artery
Second part
Third part
anterior
Posterior
Pectoralis major Long thoracic
and the skin
nerve
Lateral
3 cords of the
brachial plexus
medial
Axillary vein
Pectoralis
major,pectoralis
minor and the
skin
Lateral cord of
brachial plexus
Medial cord of
brachial plexus
and axillary
vein
the lateral root of
the median nerve
Coracobrachialis ,
biceps , humerus
and the
musculocutaneous
nerves
axillary vein
Ulna nerve,
and medial
custaneous
nerve of arm
Posterior cord
of brachial
plexus ,
subscapularis
and the
shoulder joint
Pectoralis major Subscapularis,
and medial root latissimus
of the median
dorsi, teres
nerve
major, axillary
and radial
nerve
- Note: when removing the breast (this is called mastectomy) in some cases, the lateral
thoracic nerve is also removed or ligated .
Don't aim for success if you want it; just do what you love
and believe in, and it will come naturally
Arterial anastomosis around the scapula :
- An arterial networks form on the anterior and posterior surfaces of the scapula
between many branches from subclavian artrey and axillary artrey to compensate for
temporary occlusion of the axillary artrey during excessive movements.
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We call this “Detour” : ‘collateral circulation’. This circulation also happens with the patients
having a disease called ‘atherosclorosis’.
- The most important collateral circulation occurs in the heart. Because the blood
vessels profusely anastomose with each other, that’s why Heart attack doesn’t occure
quickly.
- from subclavian A. :
- from axillary A . :
a) suprascapular A.
b) Deep branch of transverse cervical artery
A) subscapular A.
B) Ant and post. Circumflex humeral
arteries.
- oclussion causes low pressure
- if a part of the axillary artrey (narrowed, injured, occlused) the blood will come from the
arterial anastomoses around the scapula.
For example :
sometimes due to excessive movement you may kink the second part of the axillary artrey or if
there is a mass which will obstruct the second part, blood will come to the third part through
the suprascapular artrey over the suprascapular ligament to the infraspinous fossa then to the
cicumflex scapular A. (the blood is now flowing in the opposite direction) then to the
subscapular artrey then to the brachial artery.
- Suprascapular artrey
brachial artrey
, infraspinous fossa, circumflex scapular A.
, subscapular A.
,
- Also there is another “detour” which is as the following:
Transverse cervical artery > its deep branch passes along the medial border of the scapula>> to
the inferior border of it >> then it will anastomose with the circumflex scapular artery.
Note: transverse cervical A. gives : A) superficial branch b) Deep branch (medial border of the scapula)
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- There are no valves in arteries .on the other hand veins have many valves
- If someone stands a lot or if the woman is pregnant the blood will be congested in the veins of
the lower limb causing a disease called ‘varicose veins’.
- Axillary vein :
- Begins at lower border of teres major by the union of basilic vein and veins of brachial artery ,
Passes upward medial to axillary artery , ends at outer border of the 1st rib to continue as the
subclavian vein and it Receives the cephalic vein at its end.
- The clavipectoral facsia is pierced by each of the following:
1)
2)
3)
4)
Cephalic vein.
Lateral pectoral nerve.
Thoracoacromial artery.
Lymph.
Central line catheterization :
In some chronic cases (e.g : cancer patient who is being treated by chemotherapy ) we
are forced to insert a catheter (a needle in the subclavian vein just below the clavicle) in
order to give fluids, drugs, monitor central venus pressure, monitor blood gases or to
take a sample of blood.
Procedure:
1) Put your index finger on the superior end of the sternum (sternal notch)
2) Put the thumb on the mid point of the clavicle.
3) Below your thumb, insert the needle
- Note: if the needle inserted too far posteriorly, it may injure the subclavian artery causing
severe bleeding.
A successful man is one who can lay a firm foundation with
the bricks others have thrown at him
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