Blood Supply Of The Upper Limbs Flashcards
SUBCLAVIAN ARTERY
RIGHT SUBLCAVIAN ARTER
LEFT SUBLCAVIAN ARTERY
Arises from 💡brachiocephalic artery, behind the sternoclavicular joint
Arches upward and laterally over the pleura and between the scalene anterior and medius muscle
Becomes the 💡axillary artery at the outer border of 💡1st rib
RIGHT SUBLCAVIAN ARTERY
Arises from 💡arch of aorta in the thorax
Ascends to the root of the neck and arches
laterally (similar to the right subclavian artery)
LEFT SUBLCAVIAN ARTERY
The __ passes anterior to this artery on each side and divides it to 3 parts
Anterior scalene muscles
FIRST PART:
Extends from the origin of the subclavian artery to the medial border of the scalenius anterior muscle
BRANCHES:
o Vertebral Artery
o Thyrocervical trunk
o Internal Thoracic Artery
SECOND PART:
Lies behind the scalenius anterior muscle
BRANCHES:
o Costocervical trunk
Superior intercostal artery
Deep cervical artery
Extends from lateral border of scalenius anterior muscle across the posterior triangle of the neck to the lateral border of 1st rib
No branch (usually)
Superficial cervical arteries, suprascapular
arteries or both (ocassionally)
THIRD PART:
Begins at lateral border of 💡1st rib
Ends at lower border of 💡teres major
o Continues as the brachial artery Closely related to the cords of brachial
plexus and its branches
Enclosed by 💡axillary sheath (connective
tissue sheath)
AXILLARY ARTERY
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crosses in front and divides it into 3 parts
Pectoralis minor muscles
FIRST PART:
Extends from lateral border of the 1st rib to the upper border of pectoralis minor.
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SECOND PART:
Lies behind pectoralis minor
RELATIONSHIPS:
o ANTERIORLY: pectoralis minor, major and skin
o POSTERIORLY: posterior cord of brachial plexus, subscapularis muscle and shoulder joint
o LATERALLY: lateral cord of brachial plexus
o MEDIALLY: medial cord of brachial plexus and axillary nerve
BRANCHES
o Thoracoacromial artery
o Lateral thoracic artery
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THIRD PART:
Extend from lower border of pectoralis minor to lower border of teres major RELATIONSHIPS: o ANTERIORLY: pectoralis major, median nerve o POSTERIORLY: subscapularis, latissimus dorsi & teres major. Axillary and radial nerves o LATERALLY: coracobrachialis, biceps brachii, humerus. Lateral root of median nerve o MEDIALLY: ulnar nerve, axillary vein and medial cutaneous nerve of the arm BRANCHES o Subscapular artery o Anterior and posterior circumflex humeral artery
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Between branches of subclavian and axillary artery BRANCHES FORM SUBCLAVIAN ARTERY o Suprascapular artery o Superficial cervical artery BRANCHES FROM AXILLARY ARTERY o Subscapular artery o Anterior and posterior circumflex humeral artery
ANTERIAL ANASTOMOSIS AROUND ELBOW JOINT
o The existence of anastomosis around shoulder joint is vital to preserving the upper limb necessary to ligate the axillary artery
ARTERIAL ANASTOMOSIS AND LIGATION OF THE AXILLARY ARTERY
Begins at 💡lower border of teres major
Main arterial supply to the arm
Terminates opposite of neck of the radius
by dividing into 💡radial and ulnar arteries
BRACHIAL ARTERY
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RELATIONS OF BRACHIAL ARTERY
o ANTERIORLY:
Vessel is superficial and is
overlapped from lateral side by coracobrachialis and biceps
Medial cutaneous nerve of the forearm lies in front of the upper part;
Median nerve crosses its medial part Bicipital aponeurosis crosses its lower part o POSTERIORLY: Artery lies on triceps, the corabrachialis insertion and the brachialis muscle o MEDIALLY: Ulnar nerve and basilic vein in the upper part; median nerve lies on its medial part of the lower arm o LATERALLY: Median nerve and coracobrachialis and biceps above Tendon of the biceps lies lateral to the artery in the lowest part
BRANCHES OF BRACHIAL ARTERY
o Muscular arteries o Nutrient artery to the humerus o Profunda artery beginning o Superior ulnar collateral artery middle o Inferior ulnar collateral artery Termination
Larger of the two terminal branches of the brachial artery
Begins in the cubital fossa at the level of the neck of the radius
In the upper part of its course, it lies deep to the most flexor muscles
Below, becomes superficial (lies between the tendons of FCU and FDS)
In front of the flexor retinaculum, it lies lateral
to the pisiform bone.
ULNAR ARTERY
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ULNAR ARTERY ends by forming the __, often anastomosing with the superficial palmar branch of the radial artery
superficial palmar arch
Ulnar artery branches
Muscular branches Recurrent branches
Branches that take part in the arterial anastomosis around the wrist joint
Common interosseous artery Anterior and posterior
interosseous artery
Smaller
Begins at the cubital fossa at the level of the
neck of the radius
Passes downward and laterally, beneath the brachioradialis muscle and resting on the deep muscles of the forearm
In the middle third of its course, the superficial branch of radial nerve lies on its lateral side
In the distal part of the forearm, the radial artery lies on the anterior surface of the radius,
💡 Between the tendons of FCR and brachioradialis -> radial pulse
It leaves the forearm by winding around the lateral aspect of the wrist to reach the posterior surface of the hand
RADIAL ARTERY
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Branches of radial artery
o Muscular branches o Recurrent branches o Superficial palmar branch Arises just above the wrist Joins the ulnar artery to form the superficial palmar arch
Used to determine the patency of the ulnar and radial arteries
Allen’s Test
Anastomosis between the radial and ulnar arteries, called __
deep and superficial palmar arches
arise to supply the structures in the hand and fingers
Palmar metacarpal and digital arteries
Ulnar Artery Enters the hand anterior to the flexor retinaculum on the lateral side of the ulnar nerve and the pisiform bone
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Ulnar Artery Gives off deep branch and then continues into the palm as the superficial palmar arch
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Direct continuation of the ulnar artery Curves laterally behind the palmar aponeurosis and in front of the long flexor tendons
Arch is completed on the lateral side by one of the branches of the radial artery
Curve of the arch lies across the palm, at the level of the distal border of the fully extended thumb
Superficial Palmar Arch
ARTERIES OF THE PALM
FOUR DIGITAL ARTERIES
DEEP BRANCH OF THE ULNAR ARTERY
RADIAL ARTERY
PRINCEPS POLLICIS ARTERY
RADIALIS INDICIS ARTERY
Arise from the convexity of the arch and
pass to the fingers
FOUR DIGITAL ARTERIES
Arises in front of the flexor retinaculum
Passes between the abductor digiti
minimi and flexor digiti minimi
Joins the radial artery to complete the
deep palmar arch
DEEP BRANCH OF THE ULNAR ARTERY
Leaves the dorsum of the hand by
turning forward between the proximal ends of the 1st and 2nd metacarpal bones and the two heads of the first dorsal interosseous muscle
On entering the palm, it curves medially between the oblique and transverse heads of the adductor pollicis and continues as the deep palmar arch
RADIAL ARTERY
Direct continuation of the radial artery
Curves medially beneath the long flexor
tendons and in front of the metacarpal
bones and the interosseous muscles
Completed on the medial side by the
deep branch of the ulnar artery
Curve of the arch lies at the level with
the proximal border of the extended
thumb
Sends branches superiorly, which take
part in the wrist joint anastomosis and inferiorly, to join the digital branches of the superficial palmar arch
DEEP PALMAR ARCH
Supplies the lateral side of the index
finger
RADIALIS INDICIS ARTERY
Divides into two and supplies the lateral
and medial sides of the thumb
PRINCEPS POLLICIS ARTERY
Can be palpated in the root of the
posterior triangle.
Can be compressed here against the
first rib to stop catastrophic hemorrhage
SUBCLAVIAN ARTERY
Can be palpated in the arm as it lies on
the brachialis and is overlapped from the lateral side by the biceps brachii
BRACHIAL ARTERY
DEEP VEINS
Palmar Metacarpal vein , Deep venous palmar arch , Radial veins ,Ulnar veins ,brachial vein , axillary vein , subclavian vein .
It drains the metacarpal region of the palm and then eventually draining into the deep veins of the arm
PALMAR METACARPAL VEIN
It drains the metacarpal region of the palm and then eventually draining into the deep veins of the arm .
Deep veins arise from deep palmar venous arch in the hand .
Drains the deep palmar venous arch in the hand
DEEP PALMAR VENOUS ARCH
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Smaller than ulnar vein
Receives the dorsal metacarpal veins
RADIAL VEIN
Drains the superficial palmar venous arch in the hand
At the elbow, they receive further branches from the anterior and posterior interosseous veins
ULNAR VEIN
formed by the unification of the 💡ulnar and radial veins at the elbow.
▪ It accompanies the brachial artery in the region of the arm.
Its perforating branches drain the anterior
Brachial Vein
It is formed at the lower border of the teres major muscle by the 💡union of the brachial vein and the basilic vein.
▪ Has three parts, analogous to the three parts of the axillary artery.
Runs upward on the medial side of the axillary artery and ends at the lateral border
Axillary Vein
Occurs occasionally after excessive and unaccustomed movements of the arm at the shoulder joint.
Spontaneous Thrombosis of the Axillary/ Subclavian Vein
- Branch of the cephalic vein in the cubital fossa
- Runs upward and medially then joins the basilic vein -Crosses in front of the brachial artery and median nerve - Separated by the bicipital aponeurosis
- Common site for venipuncture
MEDIAN CUBITAL VEIN
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Ascends in the superficial fascia on the lateral side of the biceps
On the infraclavicular fossa, it drains into the axillary vein
Arises from the lateral side of the dorsal venous arch on the back of the hand and winds around the lateral border of the forearm
CEPHALIC VEIN
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Arises from the medial side of the dorsal venous arch on the back of the hand and winds around the medial border of the forearm
Ascends in the superficial fascia on the medial side of the biceps
Halfway up, it pierces the deep fascia and at the lower border of the teres major joins the venae commitantes of the brachial vein to form axillary vein
It receives the median cubital vein
BASILIC VEIN
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Superficial veins are clinically important and are used for venipuncture, transfusion and cardiac catherization
VENIPUNCTURE AND BLOOD TRANSFUSION
Veins of choice for central venous catherization
BASILIC AND CEPHALIC VEIN CATHERIZATION
20 to 30 in number Drains lymph vessels from o Lateral quadrant of the breast o Superficial lymph vessels from the thoracoabdominal wall above the level of the umbilicus o Lymph vessels of the upper limb Divided into 6 groups: o Anterior (Pectoral) groups o Posterior (Subscapular) groups o Lateral group o Central group o Infraclavicular (Deltopectoral) o Apical group
AXILLARY NODES
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Drains the superficial tissues of the upper arm
o Passes upward to the axilla Lateral Side
o Follows the cephalic vein to the infraclavicular group
Medial Side
o Follows the basilic vein to the
lateral group of axillary nodes
SUPERFICIAL LYMPHATIC VESSELS
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Drains the muscles and deep structures of the arm
Drains into the lateral group of axillary nodes
DEEP LYMPHATIC VESSELS
The lymph from the medial side of the hand ascends in vessels that accompany the basilica vein
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The lymph from the medial side of the hand
drain into the __ and then ascend to drain into the __
supratrochlear nodes
lateral axillary nodes
The lymph from the lateral side of the hand ascends in vessels that accompany the cephalic vein
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The lymph from the lateral side of the hand drain into the __, and some drain into the __
infraclavicular nodes
lateral axillary nodes
o Infection of the lymph vessels of the arm o Red streaks along the course of the lymph vessels are characteristics of the condition
Lymphangitis
o If the infection reaches the lymph
nodes
o Enlarge and tender
Lymphadenitis
