AXILLARY ARTERY AND AXILLARY ARTERY AND BRACHIAL PLEXUSBRACHIAL PLEXUSValentin C. Dones III, MSPT, PTRP, COMT, DMS, IMPTValentin C. Dones III, MSPT, PTRP, COMT, DMS, IMPT

Masters of Science in Orthopedic Physical TherapyMasters of Science in Orthopedic Physical TherapyCertified Dorn TeacherCertified Dorn Teacher

Certified Dorn SpecialistCertified Dorn SpecialistCertified in Orthopedic Manual TherapyCertified in Orthopedic Manual Therapy

Mulligan PractitionerMulligan PractitionerFunctional Fascial Taping PractitionerFunctional Fascial Taping Practitioner

Integrated NeurMuscular Taping TherapistIntegrated NeurMuscular Taping Therapist

AXILLAAXILLA

FloorFloor Fascia and a dome of skinFascia and a dome of skin Anterior axillary fold > posterior axillary foldAnterior axillary fold > posterior axillary fold Continuous with the anterior compartment of the Continuous with the anterior compartment of the

armarm

Contents of the AxillaContents of the Axilla

Proximal parts of biceps brachii and Proximal parts of biceps brachii and coracobrachialiscoracobrachialis

Axillary process of the breastAxillary process of the breast Collections of lymph nodesCollections of lymph nodes Major vessels and nervesMajor vessels and nerves

Biceps BrachiiBiceps Brachii OriginOrigin

Short head: apex of coracoid processShort head: apex of coracoid process Long head: Supraglenoid tubercleLong head: Supraglenoid tubercle

InsertionInsertion Radial tuberosity in the forearmRadial tuberosity in the forearm

ActionAction Flexor of the forearmFlexor of the forearm Supinator of the forearmSupinator of the forearm Accessory flexor of GHJAccessory flexor of GHJ Prevents superior movement of the humerus on the glenoid Prevents superior movement of the humerus on the glenoid

cavitycavity InnervationInnervation

Musculocutaneous nerveMusculocutaneous nerve

CoracobrachialisCoracobrachialis

OriginOrigin Apex of the coracoid processApex of the coracoid process

InsertionInsertion Small linear roughening on the medial aspect of Small linear roughening on the medial aspect of

the humerus, midshaftthe humerus, midshaft ActionAction

Flexes the arm at the GHJFlexes the arm at the GHJ InnervationInnervation

Musculocutaneous nerveMusculocutaneous nerve

Axillary arteryAxillary artery

Subclavian artery Subclavian artery lateral border of rib 1 lateral border of rib 1 axillary artery axillary artery inferior margin of teres inferior margin of teres major major brachial artery brachial artery

Pectoralis minor Pectoralis minor 3 parts of the axillary 3 parts of the axillary arteryartery

Axillary arteryAxillary artery

First partFirst part Superior thoracic arterySuperior thoracic artery

Second partSecond part Thoraco-acromial arteryThoraco-acromial artery Lateral thoracic arteryLateral thoracic artery

Third partThird part Subscapular arterySubscapular artery Anterior circumflex humeral arteryAnterior circumflex humeral artery Posterior circumflex humeral arteryPosterior circumflex humeral artery

Superior thoracic arterySuperior thoracic artery

From the anterior surface of the first part of From the anterior surface of the first part of the axillary arterythe axillary artery

Upper regions of the medial and anterior Upper regions of the medial and anterior axillary wallsaxillary walls

Thoraco-acromial arteryThoraco-acromial artery

From the anterior surface of the second part of From the anterior surface of the second part of the axillary arterythe axillary artery

Pierces the clavipectoral fasciaPierces the clavipectoral fascia Four branchesFour branches

PectoralPectoral Pierces the clavipectoral fasciaPierces the clavipectoral fascia

DeltoidDeltoid Accompanies the cephalic veinAccompanies the cephalic vein

Clavicular Clavicular Acromial Acromial

Lateral Thoracic ArteryLateral Thoracic Artery

Posterior to the inferior margin of pectoralis Posterior to the inferior margin of pectoralis minorminor

Supplies the medial and anterior wallsSupplies the medial and anterior walls Supplies breastSupplies breast

Subscapular arterySubscapular artery

Largest branch of the axillary arteryLargest branch of the axillary artery To the posterior wall of the axilla in the To the posterior wall of the axilla in the

posterior scapular regionposterior scapular region From the posterior surface of the third part of From the posterior surface of the third part of

the axillary arterythe axillary artery Follows inferior margin of the subscapular Follows inferior margin of the subscapular

arteryartery

Subscapular arterySubscapular artery

Circumflex Scapular ArteryCircumflex Scapular Artery Enters the infraspinous fossaEnters the infraspinous fossa

Thoracodorsal ArteryThoracodorsal Artery Follows the lateral border of the scapula to the Follows the lateral border of the scapula to the

inferior angleinferior angle Vascular supply of the posterior and medial walls Vascular supply of the posterior and medial walls

of the axillaof the axilla

Anterior Circumflex Humeral Anterior Circumflex Humeral ArteryArtery

Small compared to the posterior circumflex Small compared to the posterior circumflex humeral arteryhumeral artery

Passes anterior to the surgical neck of the Passes anterior to the surgical neck of the humerushumerus

Posterior Circumflex Humeral Posterior Circumflex Humeral ArteryArtery

From the lateral surface of the third part of the From the lateral surface of the third part of the axillary arteryaxillary artery

Leaves the quadrangular space with the Leaves the quadrangular space with the axillary nerveaxillary nerve

Axillary VeinAxillary Vein

Begins at the lower border of the teres majorBegins at the lower border of the teres major Continuation of the basilic veinContinuation of the basilic vein

Drains the posteromedial surface of the handDrains the posteromedial surface of the hand Penetrates the deep fascia in the middle of the armPenetrates the deep fascia in the middle of the arm

Axillary vein Axillary vein subclavian vein at lateral subclavian vein at lateral border of rib 1border of rib 1

TributariesTributaries Brachial veinsBrachial veins Cephalic veinCephalic vein

Cephalic VeinCephalic Vein

Drains the lateral and posterior parts of the Drains the lateral and posterior parts of the hand, the forearm, and the armhand, the forearm, and the arm

Enters the clavipectoral triangleEnters the clavipectoral triangle

Brachial PlexusBrachial Plexus

Anterior rami of C5-C8, T1Anterior rami of C5-C8, T1 Roots, trunks, divisions and cordsRoots, trunks, divisions and cords Proximal parts of the brachial plexus are Proximal parts of the brachial plexus are

posterior to the subclavian arteryposterior to the subclavian artery More distal regions of the plexus surround the More distal regions of the plexus surround the

axillary arteryaxillary artery

RootsRoots

Receives gray rami communicantesReceives gray rami communicantes In the posterior triangle of the neckIn the posterior triangle of the neck Between the anterior and middle scalenesBetween the anterior and middle scalenes Superior and posterior to the subclavian arterySuperior and posterior to the subclavian artery

TrunksTrunks

Superior trunk – C5 and C6Superior trunk – C5 and C6 Middle trunk – C7 rootMiddle trunk – C7 root Inferior trunk – C8 – T1Inferior trunk – C8 – T1

Lies on rib 1 posterior to the subclavian arteryLies on rib 1 posterior to the subclavian artery

DivisionsDivisions

AnteriorAnterior PosteriorPosterior Anterior divisions Anterior divisions peripheral nerves peripheral nerves

anterior compartments of the arm and forearmanterior compartments of the arm and forearm Posterior divisions Posterior divisions peripheral nerves peripheral nerves

posterior compartmentsposterior compartments

CordsCords

Related to the second part of the axillary arteryRelated to the second part of the axillary artery Lateral cordLateral cord

Union of upper and middle trunksUnion of upper and middle trunks Lateral to the axillary artery (2Lateral to the axillary artery (2ndnd part) part)

Medial cordMedial cord Continuation of the anterior division of the inferior Continuation of the anterior division of the inferior

trunktrunk Medial to the axillary artery (2Medial to the axillary artery (2ndnd part) part)

CordsCords

Posterior cordPosterior cord Posterior to the axillary artery (2Posterior to the axillary artery (2ndnd part) part) Union of all three posterior divisionsUnion of all three posterior divisions

Branches of the RootsBranches of the Roots

Dorsal Scapular NerveDorsal Scapular Nerve

Originates from C5Originates from C5 Pierces the middle scalenePierces the middle scalene Travels the medial border of the scapulaTravels the medial border of the scapula Innervates Innervates

Rhomboid majorRhomboid major Rhomboid minorRhomboid minor

Long Thoracic NerveLong Thoracic Nerve

Anterior rami of C5 to C7Anterior rami of C5 to C7 Down the medial wall of the axillaDown the medial wall of the axilla On the superficial aspect of the serratus On the superficial aspect of the serratus

anterior muscleanterior muscle

LONG THORACIC NERVELONG THORACIC NERVE

C5, C6, C7C5, C6, C7 Enters the axilla by passing down over Enters the axilla by passing down over

the lateral border of the first rib behind the lateral border of the first rib behind the axillary vessels and brachial plexusthe axillary vessels and brachial plexus

Descends over the lateral surface of the Descends over the lateral surface of the serratus anterior, which it suppliesserratus anterior, which it supplies

Suprascapular NerveSuprascapular Nerve

C5 and C6C5 and C6 From the superior trunk of the brachial plexusFrom the superior trunk of the brachial plexus Passes laterally through the posterior triangle Passes laterally through the posterior triangle

of the brachial plexusof the brachial plexus Through the suprascapular foramen Through the suprascapular foramen

posterior scapular regionposterior scapular region InnervatesInnervates

SupraspinatusSupraspinatus Infraspinatus Infraspinatus

Nerve to the subclaviusNerve to the subclavius

From the superior trunk of the brachial plexusFrom the superior trunk of the brachial plexus Passes anteroinferiorly over the subclavian Passes anteroinferiorly over the subclavian

artery and veinartery and vein Innervates the subclavius muscleInnervates the subclavius muscle

Lateral Pectoral NerveLateral Pectoral Nerve

Most proximalMost proximal Penetrates the pectoral branch of the thoraco-Penetrates the pectoral branch of the thoraco-

acromial artery acromial artery Innervates the pectoralis majorInnervates the pectoralis major

Musculocutaneous nerveMusculocutaneous nerve

Large terminal branch of the lateral cordLarge terminal branch of the lateral cord Penetrates the coracobrachialis musclePenetrates the coracobrachialis muscle Passes between the biceps brachii and Passes between the biceps brachii and

brachialis musclesbrachialis muscles Lateral cutaneous nerve of the forearmLateral cutaneous nerve of the forearm

Lateral Root of the Median NerveLateral Root of the Median Nerve

Largest terminal branch of the lateral cordLargest terminal branch of the lateral cord Joins the medial root of the medial cord Joins the medial root of the medial cord

Median NerveMedian Nerve

Medial Pectoral NerveMedial Pectoral Nerve

Supplies the pectoralis minorSupplies the pectoralis minor Supplies the pectoralis majorSupplies the pectoralis major Most proximal branchMost proximal branch Passes in between the axillary artery and Passes in between the axillary artery and

axillary veinaxillary vein

Medial cutaneous nerve of the armMedial cutaneous nerve of the arm

Medial brachial cutaneous nerveMedial brachial cutaneous nerve Supplies the skin over the medial side of the Supplies the skin over the medial side of the

armarm In the axilla, communicates with the In the axilla, communicates with the

intercostobrachial nerve (T2)intercostobrachial nerve (T2)

Medial Cutaneous Nerve of the Medial Cutaneous Nerve of the ForearmForearm

Medial antebrachial cutaneous nerveMedial antebrachial cutaneous nerve Just distal to the origin of the medial cutaneous Just distal to the origin of the medial cutaneous

nerve of the armnerve of the arm Gives off a branch to the skin over the biceps Gives off a branch to the skin over the biceps

brachii musclebrachii muscle Penetrates the deep fascia with the basilic veinPenetrates the deep fascia with the basilic vein

Medial Root of the Median NerveMedial Root of the Median Nerve

With the lateral root forms the lateral cord of With the lateral root forms the lateral cord of the brachial plexusthe brachial plexus

Median nerve is formed anterior to the third Median nerve is formed anterior to the third part of the axillary arterypart of the axillary artery

Ulnar NerveUlnar Nerve

Large terminal branch of the medial cordLarge terminal branch of the medial cord

Median NerveMedian Nerve

Formed anterior to the third part of the axillary arteryFormed anterior to the third part of the axillary artery Union of lateral and medial roots Union of lateral and medial roots Passes anterior to the brachial arteryPasses anterior to the brachial artery InnervatesInnervates

Thenar musclesThenar muscles Two lateral lumbricalsTwo lateral lumbricals Palmar surface of the lateral three and ½ digits and over the Palmar surface of the lateral three and ½ digits and over the

lateral side of the palm and middle of the wristlateral side of the palm and middle of the wrist

Median NerveMedian Nerve

M over the third part of the axillary arteryM over the third part of the axillary artery Musculocutaneous nerveMusculocutaneous nerve Lateral root of the median nerveLateral root of the median nerve Medial root of the median nerveMedial root of the median nerve Ulnar nerveUlnar nerve

Median NerveMedian Nerve

M over the third part of the axillary arteryM over the third part of the axillary artery Musculocutaneous nerve piercing the Musculocutaneous nerve piercing the

coracobrachialis musclecoracobrachialis muscle

Branches of the Posterior CordBranches of the Posterior Cord

Superior subscapular nerveSuperior subscapular nerve Thoracodorsal nerveThoracodorsal nerve Inferior subscapular nerveInferior subscapular nerve Axillary nerveAxillary nerve Radial nerveRadial nerve

Superior subscapular nerveSuperior subscapular nerve

ShortShort Supplies the Subscapularis muscleSupplies the Subscapularis muscle

Thoracodorsal nerveThoracodorsal nerve

Longest Longest Passes vertically along the posterior axillary Passes vertically along the posterior axillary

wallwall Innervates the latissimus dorsiInnervates the latissimus dorsi

Inferior subscapular nerveInferior subscapular nerve

Supplies Supplies SubscapularisSubscapularis Teres majorTeres major

Axillary NerveAxillary Nerve

Exits the axilla through the quadrangular spaceExits the axilla through the quadrangular space Innervates the deltoid and teres minorInnervates the deltoid and teres minor Superior lateral cutaneous nerve of the arm Superior lateral cutaneous nerve of the arm

passes through the quadrangular spacepasses through the quadrangular space Accompanied by the posterior circumflex Accompanied by the posterior circumflex

humeral arteryhumeral artery

RADIAL NERVERADIAL NERVE

Continues downward into the cubital fossa in Continues downward into the cubital fossa in front of the elbowfront of the elbow

Between the brachialis and brachioradialisBetween the brachialis and brachioradialis In the spiral groove, accompanied by the In the spiral groove, accompanied by the

profunda vessels I/C with the shaft of the profunda vessels I/C with the shaft of the humerushumerus

RADIAL NERVE: RADIAL NERVE: BRANCHES BRANCHES IN THE AXILLAIN THE AXILLA

Long head of the tricepsLong head of the triceps Medial head of the tricepsMedial head of the triceps Posterior cutaneous nerve of the armPosterior cutaneous nerve of the arm

RADIAL NERVE: RADIAL NERVE: In the spiral In the spiral groovegroove

Lateral head of the tricepsLateral head of the triceps Medial head of the tricepsMedial head of the triceps AnconeusAnconeus Lower lateral cutaneous nerve of the arm supplies the Lower lateral cutaneous nerve of the arm supplies the

skin over the lateral and anterior aspects of the lower skin over the lateral and anterior aspects of the lower part of the armpart of the arm

Posterior cutaneous nerve of the forearm runs down Posterior cutaneous nerve of the forearm runs down the middle of the back of the forearm as far as the the middle of the back of the forearm as far as the wristwrist

RADIAL NERVE: RADIAL NERVE: In the anterior In the anterior compartmentcompartment

After the nerve has pierced the lateral fascial After the nerve has pierced the lateral fascial septumseptum

Gives off branches to the brachialis, Gives off branches to the brachialis, brachioradalis and extensor carpi radialis brachioradalis and extensor carpi radialis longus muscleslongus muscles

Gives articular branches to the elbow jointGives articular branches to the elbow joint

NERVE OF THE LATERAL NERVE OF THE LATERAL COMPARTMENT OF THE COMPARTMENT OF THE

FOREARMFOREARM Pierces the lateral intermuscular septum Pierces the lateral intermuscular septum

in the lower part of the armin the lower part of the arm Passes forward into the cubital fossaPasses forward into the cubital fossa Passes downward in front of the lateral Passes downward in front of the lateral

epicondyle of the humerusepicondyle of the humerus

NERVE OF THE LATERAL NERVE OF THE LATERAL COMPARTMENT OF THE COMPARTMENT OF THE

FOREARMFOREARM Lies between the brachialis on the medial Lies between the brachialis on the medial

side and brachioradialis and extensor side and brachioradialis and extensor carpi radialis longus on the lateral sidecarpi radialis longus on the lateral side

At the level of the lateral epicondyle, it At the level of the lateral epicondyle, it divides into superficial and deep branchesdivides into superficial and deep branches

BRANCHESBRANCHES

Muscular branchesMuscular branches BrachioradialisBrachioradialis Extensor carpi radialis longusExtensor carpi radialis longus Small branch to the lateral part of the brachialis muscleSmall branch to the lateral part of the brachialis muscle

Articular branches to the elbow jointArticular branches to the elbow joint Deep branch of the radial nerveDeep branch of the radial nerve

Winds around the neck of the radiusWinds around the neck of the radius Within the supinator muscleWithin the supinator muscle Enters the posterior compartment of the forearmEnters the posterior compartment of the forearm

Superficial branch of the radial nerveSuperficial branch of the radial nerve

Radial NerveRadial Nerve

Posterior cutaneous nerve of the armPosterior cutaneous nerve of the arm Posterior brachial cutaneous nervePosterior brachial cutaneous nerve Innervates the posterior surface of the armInnervates the posterior surface of the arm

THANK YOU!THANK YOU!