Session 1: The Axilla

Question 1

What is the significance of the axilla?

Answer 1

Communication between the neck and the upper limb.

Nerves and blood supply to upper limb.

Superficial space, protected in adduction and vulnerable in abduction

Question 2

Describe the axillary apex.

Answer 2

Border of rib one medially, posterior margin of clavicle anteriorly, superior margin of the scapula posteriorly.

All major vessels and nerves of the limb pass into the axilla through the axillary apex.

Question 3

Does the axilla increase in size in abduction?

Answer 3

No, decreases

Question 4

Describe the lateral wall of the axilla

Answer 4

Intertubercular groove of the humerus

Question 5

Describe the medial wall of the axilla

Answer 5

Serratus anterior and thoracic wall (ribs and intercostals)

Question 6

Describe the anterior wall of the axilla

Answer 6

Pec major and pec minor, subclavius

Question 7

Describe the posterior wall of the axilla

Answer 7

Subscapularis
Teres major
Lat dorsi

Question 8

Describe the contents of the axilla

Answer 8

Axillary artery (medial and posterior to pec minor)

Axillary vein - cephalic and basilic

Brachial plexus

Biceps brachii and coracobrachialis

Axillary lymph nodes - non-specific indicator of breast Ca when enlarged

Question 9

What is the quadrangular space?

Answer 9

Gap in posterior wall of axilla

Axillary nerve and posterior circumflex artery

Question 10

What is the clavipectoral triangle?

Answer 10

Anterior wall opening

Cephalic vein enters, medial and lateral pectoral nerves leave

Question 11

What is thoracic outlet syndrome?

Answer 11

Vessel and nerve compression in the apex between the clavicle, first rib and scapula.

Trauma e.g. clavicular fracture, repetitive strain.

Pain, tingling, muscle weakness, discolouration.

Question 12

What is axillary clearance? What are the risks?

Answer 12

Lymph nodes can be removed to stop breast Ca spreading.

Long thoracic nerve may be damaged –> winged scapula