Boundaries of the Axilla:

Anterior wall of Axilla

Posterior wall of Axilla
Medial wall of Axilla

Pectoralis Major Pectoralis Minor Subclavius

Subscapularis Teres Major Latissimus Dorsi
Serratus Anterior upper ribs

Quadrangular space:
Superior bounder
Inferiorly

Teres minor
Teres major

Laterally

Surgical neck of humerus

Medially
Structures that pass through it

Long head of triceps

1- Axillary nerve.
2- Posterior circumflex humeral artery and vein

Triangular space:
Superiorly
Inferiorly
Laterally
Structures that pass through it
Triangular interval:
Superiorly
Medially
Laterally
Structures that pass through it

Shoulder joint:
Location
Type
Reinforced by:

Sternoclavicular joint:
Location
Type
Reinforced by few ligaments:

Allows
Mohammed Al-Azmah

Teres minor
Teres major
Long head of triceps
Circumflex scapular artery and vein.

Teres major
Long head of triceps
Medial head of triceps
1- Radial nerve.
2- Profunda brachii artery.

Between head of humerus and glenoid cavity of the scapula.

Synovial - ball and socket
Rotator cuff muscles and several ligaments:
1- Coracohumeral: from coracoid process to greater tubercle.
2- Transvers humeral: between greater & lesser tubercle.
3- Superior, middle and inferior glenohumeral ligaments.
Between proximal end of clavicle and clavicular notch
of the manubrium of sternum
Synovial - Plane
1- Anterior & posterior sternoclavicular
2- Interclavicular.
3- Costoclavicular.
Elevation, depression, protraction, retraction and
circumduction.
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Acromioclavicular joint:
Location
Type
Reinforced by few ligaments:

Between an oval facet on medial surface of acromion

and similar facet on acromial end of clavicle.
Synovial - Plane
1- Acromioclavicular.
2- Coracoclavicular: the strongest one at shoulder
consists of the conoid and trapezoid ligaments.
- If gets torn, it will cause shoulder separation

Wrist joint
Location

Between the radius (articular disc) and the proximal row

of carpal bones (scaphoid, lunate & triquetrium)
Type
Synovial - condylar
Reinforced by some ligaments; 1- Palmar radiocarpal.
2- Dorsal radiocarpal.
3- Ulnar and radial collateral ligaments of the wrist
Fracture of the Hamte: May injure the Ulnar nerve and artery.
Cubital tunnel syndrome: results from compression on the ulnar nerve in the
cubital tunnel behind the medial epicondyle (funny bone), causing numbness
and tingling in the ring and little fi ngers. The tunnel is formed by the medial epicondyle,
ulnar collateral ligament, and two heads of the fl exor carpi ulnaris muscle and transmits
the ulnar nerve and superior ulnar collateral or posterior ulnar recurrent artery.
Elbow joint: There are three separate articulations;
1- Joint between trochlear notch of ulna & the trochlea of humerus.
2- Joint between head of radius & capitulum of humerus.
- Together are the principal articulations of elbow and are primarily involved with
hinge, which allows flexion and extension.
3- Proximal radio-ulnar joint: between the head of radius and the radial notch of
ulna. This is a synovial pivot, which allows pronation and supination.
- These three articulations share a common synovial cavity.
- Has three ligaments:
1- Anular ligament of radius. 2- Radial collateral ligament. 3- Ulnar collateral ligament.
Clinical:
Tennis elbow (lateral epicondylitis) is caused by a chronic infl ammation or irritation
of the origin (tendon) of the extensor muscles of the forearm from the lateral
epicondyle of the humerus as a result of unusual or repetitive strain. It is a painful
condition and common in tennis players and violinists.

Mohammed Al-Azmah

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Distal radio-ulnar joint:

Location
Type
Allows

Between the head of ulna and the ulnar notch of

radius
Synovial pivot
Pronation and supination

Parts of the Humerus :

1- Greater tubercle: it provides attachments for most of the rotator cuff muscles
(supraspinatus, infraspinatus and teres minor).
2- Lesser tubercle; provides an insertion for subscapularis muscle, which is one of the
rotator cuff muscles.
-clinical aspect: its fracture is accompanied with posterior dislocation.
3- Surgical neck: it is a common site of fracture. If fractured, the axillary nerve and the
posterior circumflex humeral artery are commonly affected.
4- Medial epicondyle: has a groove for the ulnar nerve and superior ulnar collateral
artery. If fractured, the ulnar nerve may be damaged.
Clinical:
- Falling onto an outstretched hand; might cause
1- Radius fracture: a break in the lower part of radius near the wrist joint.
2- Clavicle fracture: this mostly causes shoulder separation.
3- Supracondylar fracture: is a fracture of the distal end of humerus, it may
injure the median nerve.
4- Scaphoid fracture: It may injure the radial artery.
- Inferoanterior shoulder dislocation: it is the most common case due to:
1- Absence of ligaments.
2- Presence of weak tone of muscles.
Complications of the injury:
a) Compression of the axillary nerve as the head of the humerus directly goes
down and presses on this nerve in its quadrangular space.
b) The downward dislocation causes a lengthening effect on the radial nerve, as in
causing a stretch of the radial nerve since it is tightly bound to the humerus in the
radial groove.
-

Winging scapula: An injury affecting the long thoracic nerve that innervates the
serratus anterior muscle.

Mohammed Al-Azmah

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Brachial Plexus:
Branches of the roots:
1- Dorsal scapular nerve: originates from the C5 root.
2- Long thoracic nerve: originates from the anterior rami of C5-C7.
Branches of the trunks: they originate from the superior one only:
1- Suprascapular nerve.
2- The nerve to Subclavious.
Branches of the cords:
Lateral cord

Lateral pectoral, musculocutaneous and the

lateral root of median nerve.
Medial cord
Medial pectoral, medial brachial cutaneous,
medial antebrachial cutaneous, ulnar and
medial root of median nerve
Posterior cord
Superior subscapular, thoracodorsal,
inferior subscapular, axillary and radial
nerve.
Note: The median nerve is formed by union of lateral and median roots originating from
the lateral and medial cords.
-Erbs palsy: is caused by an injury to the upper parts of brachial plexus.
-Clinical signs: adduction and internal rotation of arm with forearm pronated.
Cubital fossa:
Medial bounder
Lateral bounder
Base (upper limit)

Pronator teres
Brachioradialis
An imaginary horizontal line, which connects the
epicondyles with the roof.
Roof: made up by
Brachialis
Contents(medial to lateral)
1- Median nerve.
2- Brachial artery.
3- Biceps tendon.
- Note: ulnar nerve does not pass through cubital fossa.
- Importance of cubital fossa: blood pleasure measurement.

Mohammed Al-Azmah

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Veins:

Basilic vein: Originates from the medial (Ulnar) side of dorsal venous network of
hand, drains into the posteriomedial surface of hand forearm and penetrates the deep
fascia in the middle of arm.
Axillary vein: is the continuation of the basilic vein, begins at the lower margin of
teres major muscle. This vien passes through the axilla; medial and anterior to the
axillary artery.
Subclavian vein: is the continuation of the axillary vein as the vessel crosses the
lateral border of the first rib.
Basilic vein ----- (Teres major) ------ Axillary ------ (First rib) ----- Subclavian
Cephalic vein Begins as a radial continuation of the dorsal venous network of the
elbow, often connected with the basilica vein by the median cubital vein in front of
the elbow, it drains to the axillary and the median cubital vein.

Arteries:

Subclavian arteries located in the neck, becomes the axillary artery as the lateral
margin of the first rib.
Brachial artery: Begins as a continuation of the axillary artery at the lower border of
teres major, terminates distal to elbow joint where it divides into the radial and ulnar
artery.
Profunda brachii artery: Largest branch of brachial artery enters the posterior
compartments of the arm with the radial artery through triangular interval.
Axillary artery: Superior the walls of axilla related regions, separated into three parts
by the pectoralis minor muscle:
First part: Proximal to pectoralis minor
Gives:
Superior thoracic artery

Second part: Posterior to the pectoralis minor

Gives:

Third part: Distal to the pectoralis minor

Gives:

Mohammed Al-Azmah

Thoraco acromial artery

Lateral thoracic artery
Anterior circumflex humeral
Posterior circumflex humeral
Subscapular artery

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