Axillary Space

I. Walls
Walls Muscles/Comp. Origin Insertion Nerve Supply Actions Disease
1. Subscapularis muscle Subscapular fossa Lesser Tuberosity of Upper & Lower Medial rotation of the
Humerus Subscapular nerve arm

2. Teres Major Muscle Lower 1/3 of Lateral Medial lip of Lower Subscapular Adduction & medial
border of the scapula intertubercular groove of nerve rotation of the arm
the Humerus
Posterior
wall 3. Latissimus dorsi - Iliac crest Floor & medial lip of Thoracodorsal nerve - Extension
muscle - Lumbar fascia intertubercular groove of - Adduction
- Spines of lower Humerus - Medial
thoracic vertebrae rotation of the
- Lower 3 or 4 ribs arm
- Inferior angle of
scapula
Medial Upper 8 ribs by muscle Protraction of the Winging of the scapula
Serratus anterior muscle Medial border of scapula Long thoracic nerve
wall slips scapula
1. Coracobrachialis Coranoid process of Middle part of the medial Flexion of the arm Diseases caused by the
muscle scapula surface of the shaft of damage of the nerve:
Humerus  Function
2. Long head of the deficiency
Biceps Brachii  Loss of actions
Long head – Radial tuberosity & by - Flexion of the  Loss of
Lateral 2.1 Biceps Brachii Supraglenoid tubercle means of bicipital arm sensation
wall muscle of scapula aponeurosis to the deep Musculo- - Supination of  Pronated
Short head – coracoid fascia of the medial side cutaneous the forearm forearm
process of scapula of the forearm nerve  Paralysis

2.2 Brachialis muscle Anterior surface of Coronoid process of the

lower ½ of the shaft of ulna Flexion of the elbow
the Humerus
1. Pectoralis Minor 3rd, 4th, 5th ribs Coracoid process of the Medial Pectoral nerve Depression of the
muscle scapula shoulder
Nerve to subclavian
2. Subsclavian muscle Central cartilage of the Inferior surface of muscle Depression of the
first rib clavicle clavicle
Anterior
3. Clavipectoral fascia
wall
4. Pectoralis Major - Medial ½ of clavicle Lateral lip of the Medial & Lateral - Adduction
muscle - Central cartilage of intertubercular groove of Pectoral nerve - Medial
mid 6th rib the Humerus rotation
- Lateral border of - Flexion of the
sternum arm
 Apex (ceruico-axillary canal) Base
Boundaries: bounded by:
1. Posterior = superior border of scapula - Skin
2. Anterior = Clavicle - Superficial Fascia – loose connective tissue
3. Medial = Lateral border of the first rib - Deep Fascia – dense connective tissue

II. Contents
Contents Origin Commencement Termination Collateral Branches
 1st part – superior thoracic
artery
 2nd part – thoracoaromial
artery & lateral thoracic
artery
Lower border of Teres Major
Axillary artery Subsclavian artery Lateral border of first rib  3rd part:
muscle
1. subscapular artery
2. anterior circumflex humeral
artery
3. posterior circumflex
humeral artery
Tributaries:
Venae comitantes of brachial - Corresponds to the branches
Axillary vein Lower border of Teres Major Lateral border of the first rib
artery & basilic vein of the axillary artery
- Cephalic artery

- Brachial Plexus is formed from anterior rami of C5 – C8 and T1

- Lymph nodes
Axillary lymph nodes
- below the pectoralis minor
- lateral side of the breast
- the location where breast cancer occurs
Posterior group of lymphy nodes
- behind the subscapular muscle
- lymph coming from the back side
Lateral lymph nodes Deltapectoral lymph nodes
- medial to axillary vein - drain lymph to the Apical lymph nodes
Central lymph nodes Apical lymph nodes
- collects lymph from all above lymph - close to the lateral border of the first rib
nodes - gains lymph from the central lymph nodes
- drains lymph into the blood

- Connective tissue & Fat

Hands
I. Bones: Metacarpal bones (5 pcs. each side)
II. Fingers (digits)  phalanges (14 altogether for each side)
III. Muscles
 A. Dorsal Interossei – 4 muscles
Muscles Origin Insertion Nerve Supply Actions
Lateral side of the base of the
Contigous side of 1st and 2nd
1st dorsal interosseus muscle proximal phalanx of the 2nd
metacarpal bones
finger
Contigous side of the “shaft” of Lateral side of the proximal
2nd dorsal interosseus muscle
2nd and 3rd metacarpal bones phalanx of the 3rd finger
Medial side of the base of the
Contigous side of the “shaft” of
3rd dorsal interosseus muscle proximal phalanx of the 3rd Abduction of the finger
3rd and 4th metacarpal bones
finger
Ulnar nerve
Medial side of the base of the (finger spreader)
Contigous side of the “shaft” of
4 dorsal interosseus muscle
th
proximal phalanx of the 4th
4th and 5th metacarpal bones
finger

B. Palmar Interossei – 4 muscles

Muscles Origin
The base of 1st metacarpal
1 palmar interosseus muscle
st
bones
Anterior surface of the “shaft” of
2nd palmar interosseus muscle
2nd metacarpal bones
Anterior surface of the “shaft” of
3rd palmar interosseus muscle 4th metacarpal bones
Anterior surface of the “shaft” of
4 palmar interosseus muscle
th
5th metacarpal bones
Insertion Nerve Supply Actions
Medial side of the base of the
proximal phalanx of the thumb
Medial side of the base of the
proximal phalanx of the 2nd
finger
Lateral side of the base of the
proximal phalanx of the 4th Adduction of the finger
finger
Ulnar nerve
Lateral side of the base of the (finger spreader)
proximal phalanx of the 5th
finger

Muscles Origin Insertion Nerve Supply Actions

1. Oblique head – from the
bases of 2nd & 3rd metacarpal
bones Medial side of the “blade” of
Adductor pallicis muscle Adduction of the thumb
2. Transverse head – anterior proximal phalanx of the thumb Ulnar nerve
surface of the shaft of the 3rd
metacarpal bone
Thenar muscle
Lateral side of the shaft of the
1. Opponens pallicis muscle Helps picking up objects
1st metacarpal bone
2. Flexor pallicis brevis Flexor retinaculum
Flexion of the thumb
muscle
(3. also includes
Lateral side of the base of
3. Abductor pallicis brevis Scaphoid,
proximal phalanx of the Median Nerve Abduction of thumb
muscle trapezium)
thumb

1. Opponens digiti minimi
muscle
2. Flexor digiti minimi
muscle
3. Abductor digiti minimi
brevis muscle
Forearms
3 compartments: anterior, lateral and posterior
I. Anterior compartment
A. Deep layer
Muscles
Pronator quadratus muscle
Flexor pallicis longus muscle
Flexor digitorum profundus
muscle
Lumbrical muscles - 4
B. Intermediate layer
Muscles
Flexor digitorum superficial
muscle
Flexor retinaculum
Pisi form bone
Origin
Distal ¼ of the shaft of the ulna
Middle of the shaft of radius &
adjoining interosseus membrane
Upper ¾ of the shaft of ulna &
adjoining interosseus membrane
Tendon of flexor digitorum
profundus muscle
Origin
 Humeral - ulnar head:
medial epicondyle of
Humerus & medial side of
coronoid process of the
ulna
 Radial head: oblique line of
radius
Hypothenar muscle
Medial side of the shaft of the
5th metacarpal bone
Medial side of the base of
proximal phalanx of 5th
finger
Insertion
Distal ¼ of the shaft of the
radius
Base of distal phalanx of thumb
Base of distal phalanx of other 4
fingers
Extensor expansion of fingers
Insertion
Base of middle phalanx of other
fingers
Hand cupping
Flexion of 5th finger
Ulnar Nerve
Abduction of 5th finger
Nerve Supply Actions
Pronation of forearm
Flexion of distal phalanx of the
Median nerve
thumb
- medial ½ part : ulnar Flexion of distal phalanx of the
nerve (if injured  other 4 fingers
craw hand)
 Flexion of metacarpo-
phalangeal joints
- Lateral ½ part :
 Extension of inter-
median nerve
phalangeal joints
Nerve Supply Actions
Flexion of middle phalanx of
Median nerve
other 4 fingers
 C. Superficial layer
Muscles Origin Insertion Nerve Supply Actions
 Humeral head: medial
epicondyle of Humerus
1. Pronator Teres muscle Pronator tuberosity of radius Pronation of forearm
Ulnar head: medial side of
coronoid process of ulna
2. Flexor capi radialis Base of 2nd and 3rd of
Flexion & abduction of the wrist
muscle metacarpal bones Median nerve
Medial epicondyle of
3. Palmous longus muscle Humerus Palmous apomeurons Flexion of wrist

4. Flexor capi ulnaris (4. includes medial side of Pisi form, hamate & base of 5th Adduction & flexion of the hand
Ulnar nerve
muscle olecranoid process) metacarpal bone at the wrist

Cubital fossa
Boundaries: Contents:
1. lateral : brachioradialis muscle - median nerve
2. medial : pronator teres muscle - brachial artery & its bifurcate into radial & ulnar arteries
3. base : connecting medial & lateral epicondyle of the humerus - tendon of the biceps brachii muscle
4. floor : supinator muscle, brachialis muscle - radial nerve & its deep branch
5. roof : skin & fasciae reinforced by the bicipital aponeurosis

Posterior compartment of the arm

Muscles Origin Insertion Nerve Supply Actions

Triceps brachii muscle
- Long head: infraglenoid
tubercle of scapula
- Lateral head: posterior
surface of the shaft of humerus
Upper surface of olecranoid
above the spiral groove Radial Nerve Extension of the elbow
process of ulna
- Medial head: posterior
surface of the shaft of humerus
below the spiral groove of
humerus

Scapular muscles

Muscles Origin Insertion Nerve Supply Actions

Upper surface of the greater
Supraspinatus muscle Supraspinous fossa Initiates abduction of the arm
tuberosity
Suprascapular nerve
Infraspinatus muscle Infraspinous fossa Greater tuberosity of
the humerus “below”
The upper 2/3 of the lateral Lateral rotation of the
Teres minor muscle the insertion of Axillary nerve
border of the scapula arm
supraspinatous muscle
Spaces at shoulder region
1. quadrilateral space 2. triangular space
Boundaries: Boundaries:
- Superior: subscapularis muscle (front)  Superior: teres major muscle
- Teres minor muscle (hind)  Inferior: teres minor muscle
- Inferior: teres major muscle  Lateral: long head of triceps brachii
- Lateral: surgical neck of humerus Contents:
- Medial: long head of triceps brachium  circumflex scapular artery
Contents:
- axillary nerve
- posterior circumflex humerus artery

Muscles attached to the scapula

Muscles Origin Insertion Nerve Supply Actions

Levator scapulae muscle
Rhombordeus minor muscle
Rhombordeus major muscle
Trapezius muscle
Deltoid
Posterior surface of the lateral
Anconeus
Medial border of scapula
Transverse process of the
opposite the supraspinous
upper 4 cervicle vertebrae
fossa
o lower part of
ligamenturum nuclae Medial border of scapula
o spine of C7 vertebra opposite the root of the spine
o spine of T1 vertebra Pulls the scapula
Dorsal scapular nerve
Medial border of scapula upwards & medially
Spines of T2-T5 vertebrae
opposite the infraspinous fossa
o medial 1/3 of superior
o Posterior surface of
nuchal line external
the lateral 1/3 of
occipital
clavicle
protruberance (inion)
o Medial border of the
o ligamenturum nuchae
acromion and upper Spinal accessory nerve (CN XI)
o C7 spine
border of the spine of
o Spine of all the
the scapula
thoracic vertebrae o Medial end of the
(T1-T12)
spine of scapula
o Anterior surface of the
lateral 1/3 of clavicle
o Lateral border of
Deltoid tuberosity of the Axillary nerve (same as teres
acromion process of Abduction of arm
humerus minor)
scapula
o Inferior border of
spine of scapula
Lateral surface of the Assists the triceps brachii to
Radial nerve
epicondyle of humerus olecranoid process of ulna extend the elbow
Forearm (antebrachium)
o Posterior compartment
1. Deep layer
Muscles
Supinator muscle
Abductor pallicis longus
muscle
Extensor pallicis brevis Shaft of radius & interosseus
muscle
Extensor pallicis longus
muscle
Extensor indicis muscle
2. Superficial layer
Muscles
Extensor carpi radialis
muscle
Extensor digitorum muscle
Extensor digiti minimi
muscle
Extensor carpi ulnaris
muscle
o Lateral compartment
Muscles
Extensor carpi radialis
longus muscle
Brachioradialis muscle
Origin Insertion Nerve Supply Actions
o Lateral epicondyle of
the humerus
o Lateral ligament of Fibers wrap around the neck &
elbow joint shaft of radius & insert at the Supinates of the forearm
o Annular ligament shaft above the oblique line
o Supinator fossa &
crest
Middle of the shaft of ulna
& radius together with Posterior surface of base of 1st
Abduction of the thumb
intervening interosseus metacarpal bone
membrane
Posterior surface of base of the Extension of proximal phalanx
membrane proximal phalanx of the thumb Radial nerve of thumb
Shaft of ulna & interosseus Posterior surface of base of the Extension of distal phalanx of
membrane distal phalanx of the thumb thumb
Extensor expansion of the
Shaft of ulna Extension of index finger
index finger
Origin Insertion Nerve Supply Actions
Posterior surface of base of the Abduction & extension of
3rd metacarpal bone hand at the wrist
Extensor expansion of the 4
Extension of the 4 small fingers
fingers
Extensor expansion of the 5th Radial nerve
Lateral epicondyle of Extension of 5th finger
finger
the humerus
Posterior surface of base of 5th Extension & adduction of head
metacarpal bone of wrist
Origin Insertion Nerve Supply Actions
Lower 1/3 of lateral Posterior surface of base of the Abduction & extension of
supracondylar ridge 2nd metacarpal bone hand at the wrist
Radial nerve o Flexion of elbow
Upper 2/3 of the lateral Base of styloid process of
o Pull the forearm of
supracondylar ridge radius
mid-pronation