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HUMERUS
DARW ISH H. BADRAN
Quadrangular Space
Boundaries:
• Inferior margin of the teres
minor muscle
• Surgical neck of the humerus
• Superior margin of the teres
major muscle
• lateral margin of the long
head of triceps muscle
Contents:
• Axillary nerve
• Posterior circumflex humeral
artery and vein
DARW ISH H. BADRAN
Triangular Space
Boundaries:
• Medial margin of the long
head of triceps muscle
• Superior margin of the
teres major muscle
• Inferior margin of the teres
minor muscle
Contents:
• Circumflex scapular artery
and vein.
DARW ISH H. BADRAN
Triangular Interval
Boundaries:
• lateral margin of the long
head of triceps muscle
• Shaft of the humerus
• Inferior margin of the
teres major muscle
Contents:
• Radial nerve
• Profunda brachii artery
and associated veins.
DARW ISH H. BADRAN
Axilla and
Brachial
Plexus
DARW ISH H. BADRAN
It is a pyramidal region
between the upper part of the
chest wall and the medial side
of the arm.
It is a transition area between
the neck and the arm.
The axilla possesses an apex
(inlet), a floor, and 4 walls.
The axillary cavity contains
vessels, nerves, lymph nodes
and a lot of adipose tissue.
DARW ISH H. BADRAN
Axillary Inlet
Boundaries:
• Medially: The
outer border of
the first rib.
• Anteriorly: The
posterior surface
of the clavicle.
• Posteriorly: The
superior border
of the scapula.
DARW ISH H. BADRAN
Anterior Wall
Formed of:
• Pectoralis
major
• Pectoralis
minor
• Subclavius
• Clavipectoral
fascia
DARW ISH H. BADRAN
Medial Wall
Formed of:
• Upper 4 ribs
• Upper 4
intercostal
spaces and their
contents
• Upper 4
digitations of the
serratus anterior.
DARW ISH H. BADRAN
Lateral Wall
Formed of:
• Bicipital groove
and the muscles
attached to it:
• Pectoralis
major
• Latissimus
dorsi
• Teres major
DARW ISH H. BADRAN
Posterior Wall
Formed of:
• Costal surface
of the scapula
• Subscapularis
• Latissimus
dorsi
• Proximal part
of the long
head of triceps
DARW ISH H. BADRAN
Floor
Formed of:
• Fascia
• Skin between the
inferior margins
of the walls
• Supported by the
clavipectoral
fascia
DARW ISH H. BADRAN
Contents of Axilla
Great vessels:
• Axillary artery and vein
• Cephalic vein and basilic
vein
• Axillary lymph nodes
Nerves:
• Proximal ends of terminal
nerves of brachial plexus
• Cords of brachial plexus
• Long thoracic nerve
DARW ISH H. BADRAN
The anterior axillary fold is higher than the
posterior.
The anterior axillar fold is formed of
pectoralis major.
The posterior axillary fold is formed by the
latissimus dorsi and the teres major.
DARW ISH H. BADRAN
Brachial
Plexus
DARW ISH H. BADRAN
DARW ISH H. BADRAN
It is a network of nerve fibers, running from the spine,
formed by the ventral rami of the lower four cervical
and first thoracic nerve roots (C5-T1). It proceeds
through the neck, the axilla, and into the arm.
Responsible for cutaneous and muscular innervation
of the entire upper limb, with two exceptions:
• The trapezius muscle innervated by the spinal accessory nerve (CN
XI) and
• An area of skin near the axilla innervated by the intercostobrachial
nerve.
DARW ISH H. BADRAN
DIVISIONS
ROOTS
5
BRANCHES
6
7
8
1
DARW ISH H. BADRAN
Branches from the Roots of the Brachial Plexus
Nerve
Roots
Muscles
Cutaneous
Dorsal scapular nerve
C5
Rhomboid
Levator scapulae
None
Long thoracic nerve
C5 C6 C7
Serratus anterior
None
DARW ISH H. BADRAN
Nerve to Subclavius
Dorsal Scapular Nerve
DARW ISH H. BADRAN
Branches from the Upper Trunk of the Brachial Plexus
Nerve
Roots
Muscles
Cutaneous
Nerve to subclavius
C5 C6
Subclavius
None
Suprascapular nerve
C5 C6
Supraspinatus
Infraspinatus
None
DARW ISH H. BADRAN
Nerve to Subclavius
Dorsal Scapular Nerve
DARW ISH H. BADRAN
Branches from the Lateral Cord of the Brachial Plexus
Nerve
Lateral pectoral nerve
Roots
C5 C6 C7
Musculocutaneous nerve C5 C6 C7
Muscles
Pectoralis Major By
communication
with Medial
Pectoral Nerve
Coracobrachialis
Brachialis
Biceps brachii
Lateral root of median
nerve
DARW ISH H. BADRAN
C5 C6 C7
Cutaneous
Fibres of Median
nerve
Become the Lateral
cutaneous nerve of
forearm
1- Lateral pectoral nerve.
2- Musculocutaneous nerve.
3- Lateral root of the median nerve
1
2
3
DARW ISH H. BADRAN
Branches from the Medial Cord of the Brachial Plexus
Nerve
Roots
Muscles
Cutaneous
Medial pectoral
C8 T1
Pectoralis major
Pectoralis minor
None
Medial root of median
C8 T1
Fibres to median
nerve
portions of hand not served
by ulnar or radial
Medial cutaneous nerve of
arm
C8 T1
None
front and medial skin of the
arm
Medial cutaneous nerve of
forearm
C8 T1
None
medial skin of the forearm
Ulnar
C8 T1
1. Flexor carpi
ulnaris
2. The medial two
bellies of flexor
digitorum profundus
3. The intrinsic
hand muscles except
the thenar muscles.
4. The two most
medial lumbricals
the skin of the medial side
of the hand
medial one and a half
fingers on the palmar side
medial two and a half
fingers on the dorsal side
DARW ISH H. BADRAN
1- Medial pectoral nerve.
2- Medial root of the median nerve.
3- Medial cutaneous nerve of the arm.
4- Medial cutaneous nerve of the forearem.
5- Ulnar nerve.
1
2
3
DARW ISH H. BADRAN
5
Branches from the Posterior Cord of the Brachial Plexus
Nerve
Roots
Muscles
Cutaneous
Upper subscapular
C5 C6
Sub scapilaris
(upper part)
Thoracodorsal
(Middle subscapular)
C6 C7 C8
Latismus Dorsi
Lower scapular
C5 C6
Subscapularis
(lower part)
Teres major
Axillary
C5 C6
Ant Br: Deltoid & small
area of overlying skin
Post Br: Teres minor &
Deltoid ms
Post Branch
continues as upper
Lateral cutaneous
nerve of the arm
Radial
C5 C6 C7
C8 T1
Triceps brachii
Supinator
Anconeus
Brachioradialis
Extensors of forearm
Posterior cutaneous
nerve of the arm
DARW ISH H. BADRAN
1- Upper subscapular nerve.
2- Thoracodorsal nerve.
3- Lower subscapular nerve.
4- Axillary nerve.
5- Radial nerve.
1
3
2
5
DARW ISH H. BADRAN
DARW ISH H. BADRAN
Brachial
Plexus
Injury
DARW ISH H. BADRAN
Waiter’s tip
position
Characteristic position:
adduction and internal
rotation of the arm with
forearm pronated
Forearm extension is normal
Caused by damage to the
brachial plexus during
delivery of the neonate. This
is mostly limited to the 5th
and 6th cervical nerves.
DARW ISH H. BADRAN
Falling on Shoulder
Darwish H. Badran
Darwish H. Badran
Excessive Stretching
Darwish H. Badran
Darwish H. Badran
Direct Blow
Darwish H. Badran
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Axillary
Artery
DARW ISH H. BADRAN
Supplies the walls of the
axilla & related regions.
It is the continuation of the
Subclavian artery at the
outer border of 1st rib
It continues as the brachial
artery at the lower border
of teres major.
The pectoralis minor
divides the artery into 3
parts.
DARW ISH H. BADRAN
Throughout its course,
the artery is closely
related to the cords of
the brachial plexus
and their branches and
is enclosed with them
in a connective tissue
sheath called the
axillary sheath.
If this sheath is traced
upward into the root
of the neck, it is seen
to be continuous with
the prevertebral fascia.
DARW ISH H. BADRAN
The 1st part gives 1
branch:
• superior thoracic artery
The 2nd part gives
2 branches:
• Thoraco-acromial
artery
• lateral thoracic artery
The 3rd part gives 3
branches:
• subscapular artery
• Anterior circumflex
humeral artery
• Posterior circumflex
humeral artery
DARW ISH H. BADRAN
DARW ISH H. BADRAN
Axillary
Vein
DARW ISH H. BADRAN
it begins at the lower border of
the teres major as the
continuation of the basilic vein.
Passes into the axilla
anteromedial to the axillary
artery
Continues as the subclavian
vein at the outer border of the
first rib.
Receives tributaries opposite to
the branches of the axillary
artery, cephalic vein and the
vena comitantes of the brachial
artery.
DARW ISH H. BADRAN
DARW ISH H. BADRAN