Download Axillary artery

AXILLARY ARTERY AND
BRACHIAL PLEXUS
Valentin C. Dones III, MSPT, PTRP, COMT, DMS, IMPT
Masters of Science in Orthopedic Physical Therapy
Certified Dorn Teacher
Certified Dorn Specialist
Certified in Orthopedic Manual Therapy
Mulligan Practitioner
Functional Fascial Taping Practitioner
Integrated NeurMuscular Taping Therapist
AXILLA
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Floor
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Fascia and a dome of skin
Anterior axillary fold > posterior axillary fold
Continuous with the anterior compartment of the
arm
Contents of the Axilla
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Proximal parts of biceps brachii and
coracobrachialis
Axillary process of the breast
Collections of lymph nodes
Major vessels and nerves
Biceps Brachii
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Origin
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Insertion
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Radial tuberosity in the forearm
Action
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Short head: apex of coracoid process
Long head: Supraglenoid tubercle
Flexor of the forearm
Supinator of the forearm
Accessory flexor of GHJ
Prevents superior movement of the humerus on the glenoid
cavity
Innervation
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Musculocutaneous nerve
Coracobrachialis
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Origin
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Insertion
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Small linear roughening on the medial aspect of
the humerus, midshaft
Action
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Apex of the coracoid process
Flexes the arm at the GHJ
Innervation
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Musculocutaneous nerve
Axillary artery
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Subclavian artery  lateral border of rib 1 
axillary artery  inferior margin of teres
major  brachial artery
Pectoralis minor  3 parts of the axillary
artery
Axillary artery
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First part
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Second part
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Superior thoracic artery
Thoraco-acromial artery
Lateral thoracic artery
Third part
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Subscapular artery
Anterior circumflex humeral artery
Posterior circumflex humeral artery
Superior thoracic artery
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From the anterior surface of the first part of the
axillary artery
Upper regions of the medial and anterior
axillary walls
Thoraco-acromial artery
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From the anterior surface of the second part of
the axillary artery
Pierces the clavipectoral fascia
Four branches
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Pectoral
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Deltoid
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Pierces the clavipectoral fascia
Accompanies the cephalic vein
Clavicular
Acromial
Lateral Thoracic Artery
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Posterior to the inferior margin of pectoralis
minor
Supplies the medial and anterior walls
Supplies breast
Subscapular artery
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Largest branch of the axillary artery
To the posterior wall of the axilla in the
posterior scapular region
From the posterior surface of the third part of
the axillary artery
Follows inferior margin of the subscapular
artery
Subscapular artery
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Circumflex Scapular Artery
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Enters the infraspinous fossa
Thoracodorsal Artery
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Follows the lateral border of the scapula to the
inferior angle
Vascular supply of the posterior and medial walls
of the axilla
Anterior Circumflex Humeral
Artery
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Small compared to the posterior circumflex
humeral artery
Passes anterior to the surgical neck of the
humerus
Posterior Circumflex Humeral
Artery
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From the lateral surface of the third part of the
axillary artery
Leaves the quadrangular space with the
axillary nerve
Axillary Vein
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Begins at the lower border of the teres major
Continuation of the basilic vein
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Drains the posteromedial surface of the hand
Penetrates the deep fascia in the middle of the arm
Axillary vein  subclavian vein at lateral
border of rib 1
Tributaries
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Brachial veins
Cephalic vein
Cephalic Vein
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Drains the lateral and posterior parts of the
hand, the forearm, and the arm
Enters the clavipectoral triangle
Brachial Plexus
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Anterior rami of C5-C8, T1
Roots, trunks, divisions and cords
Proximal parts of the brachial plexus are
posterior to the subclavian artery
More distal regions of the plexus surround the
axillary artery
Roots
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Receives gray rami communicantes
In the posterior triangle of the neck
Between the anterior and middle scalenes
Superior and posterior to the subclavian artery
Trunks
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Superior trunk – C5 and C6
Middle trunk – C7 root
Inferior trunk – C8 – T1
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Lies on rib 1 posterior to the subclavian artery
Divisions
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Anterior
Posterior
Anterior divisions  peripheral nerves 
anterior compartments of the arm and forearm
Posterior divisions  peripheral nerves 
posterior compartments
Cords
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Related to the second part of the axillary artery
Lateral cord
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Union of upper and middle trunks
Lateral to the axillary artery (2nd part)
Medial cord
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Continuation of the anterior division of the inferior
trunk
Medial to the axillary artery (2nd part)
Cords
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Posterior cord
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Posterior to the axillary artery (2nd part)
Union of all three posterior divisions
Branches of the Roots
Dorsal Scapular Nerve
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Originates from C5
Pierces the middle scalene
Travels the medial border of the scapula
Innervates
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Rhomboid major
Rhomboid minor
Long Thoracic Nerve
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Anterior rami of C5 to C7
Down the medial wall of the axilla
On the superficial aspect of the serratus
anterior muscle
LONG THORACIC NERVE
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C5, C6, C7
Enters the axilla by passing down over
the lateral border of the first rib behind
the axillary vessels and brachial plexus
Descends over the lateral surface of the
serratus anterior, which it supplies
Suprascapular Nerve
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C5 and C6
From the superior trunk of the brachial plexus
Passes laterally through the posterior triangle
of the brachial plexus
Through the suprascapular foramen 
posterior scapular region
Innervates
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Supraspinatus
Infraspinatus
Nerve to the subclavius
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From the superior trunk of the brachial plexus
Passes anteroinferiorly over the subclavian
artery and vein
Innervates the subclavius muscle
Lateral Pectoral Nerve
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Most proximal
Penetrates the pectoral branch of the thoracoacromial artery
Innervates the pectoralis major
Musculocutaneous nerve
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Large terminal branch of the lateral cord
Penetrates the coracobrachialis muscle
Passes between the biceps brachii and
brachialis muscles
Lateral cutaneous nerve of the forearm
Lateral Root of the Median Nerve
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Largest terminal branch of the lateral cord
Joins the medial root of the medial cord 
Median Nerve
Medial Pectoral Nerve
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Supplies the pectoralis minor
Supplies the pectoralis major
Most proximal branch
Passes in between the axillary artery and
axillary vein
Medial cutaneous nerve of the arm
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Medial brachial cutaneous nerve
Supplies the skin over the medial side of the
arm
In the axilla, communicates with the
intercostobrachial nerve (T2)
Medial Cutaneous Nerve of the
Forearm
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Medial antebrachial cutaneous nerve
Just distal to the origin of the medial cutaneous
nerve of the arm
Gives off a branch to the skin over the biceps
brachii muscle
Penetrates the deep fascia with the basilic vein
Medial Root of the Median Nerve
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With the lateral root forms the lateral cord of
the brachial plexus
Median nerve is formed anterior to the third
part of the axillary artery
Ulnar Nerve
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Large terminal branch of the medial cord
Median Nerve
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Formed anterior to the third part of the axillary artery
Union of lateral and medial roots
Passes anterior to the brachial artery
Innervates
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Thenar muscles
Two lateral lumbricals
Palmar surface of the lateral three and ½ digits and over the
lateral side of the palm and middle of the wrist
Median Nerve
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M over the third part of the axillary artery
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Musculocutaneous nerve
Lateral root of the median nerve
Medial root of the median nerve
Ulnar nerve
Median Nerve
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M over the third part of the axillary artery
Musculocutaneous nerve piercing the
coracobrachialis muscle
Branches of the Posterior Cord
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Superior subscapular nerve
Thoracodorsal nerve
Inferior subscapular nerve
Axillary nerve
Radial nerve
Superior subscapular nerve
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Short
Supplies the Subscapularis muscle
Thoracodorsal nerve
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Longest
Passes vertically along the posterior axillary
wall
Innervates the latissimus dorsi
Inferior subscapular nerve
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Supplies
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Subscapularis
Teres major
Axillary Nerve
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Exits the axilla through the quadrangular space
Innervates the deltoid and teres minor
Superior lateral cutaneous nerve of the arm
passes through the quadrangular space
Accompanied by the posterior circumflex
humeral artery
RADIAL NERVE
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Continues downward into the cubital fossa in
front of the elbow
Between the brachialis and brachioradialis
In the spiral groove, accompanied by the
profunda vessels I/C with the shaft of the
humerus
RADIAL NERVE: BRANCHES
IN THE AXILLA
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Long head of the triceps
Medial head of the triceps
Posterior cutaneous nerve of the arm
RADIAL NERVE: In the spiral
groove
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Lateral head of the triceps
Medial head of the triceps
Anconeus
Lower lateral cutaneous nerve of the arm supplies the
skin over the lateral and anterior aspects of the lower
part of the arm
Posterior cutaneous nerve of the forearm runs down
the middle of the back of the forearm as far as the
wrist
RADIAL NERVE: In the anterior
compartment
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After the nerve has pierced the lateral fascial
septum
Gives off branches to the brachialis,
brachioradalis and extensor carpi radialis
longus muscles
Gives articular branches to the elbow joint
NERVE OF THE LATERAL
COMPARTMENT OF THE
FOREARM
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Pierces the lateral intermuscular septum
in the lower part of the arm
Passes forward into the cubital fossa
Passes downward in front of the lateral
epicondyle of the humerus
NERVE OF THE LATERAL
COMPARTMENT OF THE
FOREARM
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Lies between the brachialis on the medial
side and brachioradialis and extensor
carpi radialis longus on the lateral side
At the level of the lateral epicondyle, it
divides into superficial and deep branches
BRANCHES
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Muscular branches
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Articular branches to the elbow joint
Deep branch of the radial nerve
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Brachioradialis
Extensor carpi radialis longus
Small branch to the lateral part of the brachialis muscle
Winds around the neck of the radius
Within the supinator muscle
Enters the posterior compartment of the forearm
Superficial branch of the radial nerve
Radial Nerve
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Posterior cutaneous nerve of the arm
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Posterior brachial cutaneous nerve
Innervates the posterior surface of the arm
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