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Anatomy > brachial plexus/ vascular anatomy/ nerve of uppere limb > Flashcards

brachial plexus/ vascular anatomy/ nerve of uppere limb Flashcards

1
Q

is a Big network of nerves supplying the (Skin& muscles) of the upper limb​

A

brachial plexus:

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2
Q

brachial plexus: begins?

A

it begins in the neck and extends into the axilla. ​

Most of its branches arise in the axilla​

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3
Q

The brachial plexus is formed by?

A

anterior primary rami of C5 C6,C7,C8, and T1 ​

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4
Q

Stages of the formation of the Brachial Plexus:​

A

1- Roots​

2- Trunks​

3- Divisions​

4- Cords​

5- Branches​

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5
Q

Roots of THE BRACHIAL PLEXUS​ are? Its Origin may shift up by one segment (C4-C8) and called? its may shift down by one segment (C6-T2)? roots pass betwee?

A

Are the anterior primary rami of C5 C6,C7,C8, and T1

Prefixed Plexus​

Postfixed Plexus​

these roots pass between the anterior and middle scalene muscles to enter the base of the neck.​

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6
Q

Trunks of THE BRACHIAL PLEXUS​ are called? each formed by? where does the trunk lie?

A

The Brachial Plexus has 3 Trunks: ​

1- The upper trunk: is formed by the union of C5 and C6 roots​

2- The middle trunk: is a continuation of the C7 root​

3- The lower trunk: is formed by the union of the C8 and T1 roots.​

Trunks lies in the neck above the clavicle​

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7
Q

Divisions of THE BRACHIAL PLEXUS​ are? and they generally supply?

A

Each of the three trunks of the brachial plexus divides into an anterior and a posterior division​

The anterior divisions usually supply flexor muscles ​

The posterior divisions usually supply extensor muscles​

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8
Q

Cords of THE BRACHIAL PLEXUS​ are? and originate from?

A

The Brachial Plexus has 3 Cords: ​

1- The lateral cord originates from the union of the anterior divisions of the upper and middle trunks .​

2- The medial cord is the continuation of the anterior division of the lower trunk.​

3- The posterior cord originates from the union of the posterior divisions of the 3 trunks.​

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9
Q

The cords are arranged around the Axillary artery as follow:​
1-2-3 part of the axillary artery

A

1ST Part of Axillary artery:​

Medial cord: behind the artery​

Lateral &Posterior cords: lateral to the artery​

2ND Part of Axillary artery :​

Medial cord: medial to the artery​

Lateral cord: lateral to the artery​

Posterior cord: behind the artery​

3RD Part of Axillary artery :​

  • Has the same relationship with the terminal branches of the brachial plexus.​

​

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10
Q

Branches from the Roots​? and supply?

A

1- Dorsal scapular nerve (C5)​

Supplies the following muscles: levator scapulae, rhomboids (MAJOR-MINOR)​

​

2- Long thoracic nerve (C5, 6, and 7): Supply Serratus anterior muscle​

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11
Q

Branches from the Upper Trunk​

A

Nerve to Subclavius (C5 and 6): Supplies the Subclavius muscle​

2- Suprascapular nerve (C5 and 6): Supplies the Supraspinatus and Infraspinatus muscles​

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12
Q

Branches from the Lateral Cord​

A

1- Lateral pectoral N.(C5-7): supplies Pectoralis major​

2- Musculocutaneous N. (C5-7): supplies All muscles in the anterior compartment of the arm (flexors), sensory to the Skin on lateral side of forearm ​

3- Lateral root of median N. (C5-7):

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13
Q

Branches from the Medial Cord​

A

1- Medial pectoral nerve(C8,T1): Pectoralis major, pectoralis minor​

2- Medial cutaneous nerve of arm(C8,T1): to Skin on medial side of distal one-third of arm​

3- Medial cutaneous nerve of forearm(C8,T1)​

To Skin on medial side of forearm​

4- Medial root of median nerve (C8,T1): ​

Median N. gives All muscles in the anterior compartment of the forearm (flexors) except muscles supplied by Ulnar N (1& 1/2 ms.)​

  • Also, some muscles in the hand​

5- Ulnar nerve(C7,8,T1)​

To flexor carpi ulnaris and the medial half of flexor digitorum profundus in the forearm, some muscles in the hand​

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14
Q

Branches from the Posterior Cord​

A

1- Upper subscapular N (C5,6): Subscapularis muscle​

2- Lower subscapular N (C5,6) : Subscapularis& Teres major muscles​

3- N. to Lattisimus dorsi (Thoracodorsal N.) (C6-8) : Supplies Latissimus dorsi muscle​

4- Axillary N.(C5,6): ​

Deltoid& Teres minor muscles​

Sensory to Skin over upper lateral part of arm​

5- Radial N. (C5-8,T1): ​

All muscles in the posterior compartments of arm and forearm (Extensors)​

Sensory to Skin on the posterior aspects of the arm and forearm, the lower lateral surface of the arm, and the dorsal lateral surface of the hand​

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15
Q

Damage to the whole plexus​? happens when? what results?

A

it is rare​

It can occur with : motorbike accidents ​

If all roots are damaged : the whole limb is immobile and anesthetic​

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16
Q

It is the most common traction injury​
It includes Birth injury​
Person fall on shoulder with undue separation of head and shoulder​
Leads to paralysis of: ​
Abductors (deltoid& supraspinatus) and lateral rotators (teres minor& infraspinatus) of the shoulder and supinators are paralyzed​ ?

A

Traction injury to the upper roots (C5& C6) and trunk (Erb’s paralysis) (Erb-Duchenne paralysis)​

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17
Q

result in sensory loss over lower part of deltoid (supplied by axillary)​
Deformity: (policeman’s tip hand) or Waiter taking tip?

A

Erb’s

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18
Q

In which the arm hangs by the side(adducted) and is rotated medially. The forearm is extended and pronated at the elbow

A

(Erb’s paralysis) (Erb-Duchenne paralysis)​

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19
Q

Can be caused by:​
1- A cervical rib​
2- birth injury​
3- excessive abduction of the arm with undue separation from trunk​
Small muscles of the hand are mainly affected ​
Deformity: (Claw hand)​
In which there is hyperextension of metacarpophalangeal joints & flexion of interphalangeal joints​

A

Injury to the Lowest roots (C8& T1) or lower trunk (Klumpke’s paralysis)​

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20
Q

The serratus anterior is paralyzed due to injury of the?

A

long thoracic nerve .

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21
Q

The long thoracic nerve may be injured as a result of: ​? deformity?

A

1- Direct trauma or stretch​

2- A blow to the ribs underneath outstretched arm. ​

3- During surgery of Breast Cancer (mastectomy)​

​

Deformity: (Winged Scapula)​

In which the medial border and inferior angle of the scapula pull away from the posterior thoracic wall (like a Wing) when the arm is raised and pushes against a wall​

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22
Q

Axillary nerve origin?

A

branch of posterior cord of the brachial plexus. It is mixed

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23
Q

Axillary nerve course ?

A
  1. nerve leaves axilla by passing through the quadrangular space (
  2. in company with posterior circumflex humeral vessels) close to the surgical neck of the humerus.
    • It ends deep to deltoid by dividing into anterior and posterior branches.
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24
Q 
Axillary nerve (C5,6)
• Branches and distribution?
A
  • Anterior branch supplies :
    1. anterior part of deltoid.
  • Posterior branch supplies :
    1. posterior part of deltoid
    2. teres minor ms.
    3. upper lateral cutaneous N. of arm which supplies skin over upper lateral part of the arm (skin
    over the lower half of deltoid
    muscle)
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25
Q

fractures of the humeral surgical
neck or dislocations of shoulder.
M,ay injure which nerve ?

A

axillary N. may be injured

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26
Q

The axillary N. Is injured what happens?

A 
The deltoid is  paralyzed with loss of
power of abduction at the shoulder
and flattened shoulder.
 There  is  sensory  loss  over  upper
lateral part of the arm (skin over the
lower half of deltoid muscle).
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27
Q

Median nerve course ?

A
  1. In the upper part of the arm = lateral to the brachial A.
  2. Midarm, it crosses the brachial artery to become medial to it down to the cubital fossa.
  3. Pass between the two heads of pronator teres.
  4. Descends behind flexor digitorum superficialis adherent to its fascia.
  5. Appears lateral to the flexor digitorum
    In superficial position.
  6. Pass deep to the flexor retinaculum .
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28
Q

Which nerve Pass deep to the flexor retinaculum .

?

A

Median nerve

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29
Q

Branches of median nerve and what do they supply?

A

In the arm: • No branches in the arm. • Communication from its lateral root to the ulnar n (c7 fibres).
• In the forearm: gives
1. Muscular branches: to superficial and intermediate flexors except flexor carpi ulnaris
2. anterior interosseus nerve supplies all the deep flexors except medial 1/2 of the
flexor digitorum profundus.

  1. Palmar cutaneous branch : arise above the flexor retinaculum and superficial to it, to supply the skin of the lateral 2/3 of the palm of the hand (This palmar branch is spared in carpal tunnel syndrome because it passes into the hand superficial to the flexor retinaculum of the wrist)

• In the hand: 1. Recurrent branch: supplies thenar muscles. 2. Palmar digital nerves: supply • Two lateral lumbricals and • Skin of the lateral 3and ½ digits (palmar surface and nail beds)

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30
Q

Injury of the median nerve at the elbow

A
  1. Superficial and intermediate flexors of the forearm (except flexor carpi ulnaris) ( muscular branches )
  2. # Pronator teres. 2. Flexor carpi radialis. 3. Palmaris longus. 4. Flexor digitorum superficialis.Their paralysis leads to 1. Loss of pronation 2. Weakness of flexion at the wrist. 3. Loss of flexion at the proximal and
    middle phalanges (prominent in the 2
    nd and 3rd fingers). (Hand of benediction).
    IN ADDITION TO ULNAR DEVIATION
  3. II) Deep flexors of the forearm (except medial ½ of the flexor digi. profundus) ( Ant. interosseous ) .
    (1. Lateral half of flexor digitorum profundus. 2. Flexor pollicis longus. 3. Pronator quadratus.)
    =

Their paralysis leads to. 1. Loss of flexion of the distal
phalanges of the index and
middle fingers. 2. Loss of the flexion of the
thumb. 3. Loss of pronation

  1. Thenar muscles and lateral two lumbrical
    ( Recurrent and palmar digital nerves)
    ( 1. Abductor pollicis brevis. 2. Flexor pollicis brevis. 3. Opponens pollicis. 4. Two lateral lumbricals)
    =

Their paralysis leads
1. Weakness of abduction of the thumb. 2. Loss of flexion of the thumb. 3. Loss of opposition of the thumb. 4. loss of flexion of the index and middle
at the MP. Atrophy of thenar eminence
Action of the In addition to adduction of the thumb lumbricals

  1. Injury of the median nerve at the elbow (sensory loss)
    (Palmar cutaneous and palmar digital)
    (Loss of sensation of
  2. lateral 2 /3 of the palm. 2. Palmar surface of the lateral 3 and ½ fingers
    &nail bed.
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31
Q

Injury of the median nerve at the wrist ?

A
  1. Motor loss
    Recurrent and palmar digital nerves
    ( 1. Abductor pollicis brevis (APB) . 2. Flexor pollicis brevis. 3. Opponens pollicis. 4. Two lateral lumbricals)
    = Their paralysis leads to
  2. Weakness of abduction of the thumb.
  3. Weakness of flexion of the thumb.
  4. Loss of opposition of the thumb.
  5. Weakness of flexion of the index and
    middle at the MP joints. Atrophy of thenar eminence
    In addition to adduction of the Action of the lumbricals
    thumb ()
  6. sensory loss:

Palmar digital nerves

Palmar surface of the lateral 3 and ½ fingers &nail bed.

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32
Q

This condition is often obscure, though in some instances it may be a direct effect of increased pressure on the median nerve caused by overuse, swelling of the tendons and tendons sheaths (e.g. rheumatoid arthritis), and cysts arising from the carpal joints. The median nerve is the most sensitive structure in the tunnel.
?

A

Carpal tunnel syndrome

33
Q

Pain and pins-and-needles in the distribution of the
median nerve.
• Gently tapping over the median nerve (in the region of the
flexor retinaculum) readily produces the previous
symptoms (Tinel’s sign).
• Weakness and loss of muscle bulk of the thenar muscles
may also occur.
• difficulty buttoning a shirt or blouse as well as gripping
things such as a comb ( weakness of the APB and loss of
function of opponens pollicis ).
?

A

Carpal tunnel syndrome

34
Q

difficulty buttoning a shirt or blouse as well as gripping
things such as a comb ( weakness of the APB and loss of
function of opponens pollicis ).
?

A

Carpal tunnel syndrome

35
Q

The ability to grasp an object between the pad of the thumb and the pad of one of the fingers (opposition) depends on normal functioning of the?

A

thenar muscles, which are innervated by the recurrent branch of the median nerve.

36
Q

Injury of the musculocutaneous nerve

uncommon in this protected position) is typically inflicted by a weapon such as a knife.

A

1- Weakness of flexion of the elbow joint and supination of the forearm.
Flexion and supination are still possible, produced by the brachioradialis and supinator, respectively, both of which are supplied by the radial nerve.
2- Loss of sensation may occur on the lateral surface of the forearm supplied by the lateral cutaneous nerve of the forearm, the continuation of the musculocutaneous nerve

37
Q

Radial Nerve origin?

A 
continuation of the
posterior cord of brachial
plexus and enters the
arm by crossing the
inferior margin of the
teres major muscle
38
Q

Radial Nerve course?

A
  1. In the axilla it lies behind 3rd part of axillary artery
  2. runs in the spiral groove of humerus.
  3. In the spiral groove, lies directly in contact with the shaft of the humerus (Dangerous Position).
  4. After leaving the spiral groove
  5. The nerve enters the anterior compartment on the lateral side of the arm
  6. Enter arm
  7. Give branch post. Inters
  8. Pierces supinator muscles
  9. Turns around neck of radius
  10. Reach back of forearms
  11. Superficial radial nerve in front of lateral side of forearms
  12. Reach dorsum of hand
39
Q

Radial nerve and branches and muscles it supplies ?

A
  1. Radial N: brachioradialis/ triceps / anconeus / ECRL
  2. Posterior interosseous nerve : (extensor of forearm )
    3.superficial radial n : • skin of lateral 2/3 of back of hand. • Skin over the back of proximal phalanges of lateral 3
    ½ fingers.
40
Q

Injuries of Radial Nerve

A 
Motor;
• Triceps, anconeus and long
extensors of the wrist are
paralyzed
• Unable to extend the elbow joint,
wrist joint and fingers
• Wrist drop
• Unable to flex the fingers firmly
for gripping
• sensory
• Sensory loss on the lateral part of
dorsum of the hand
• Sensory loss on the dorsal surface
of the roots of the lateral 3 & ½
fingers
41
Q

ULNAR NERVE

Origin?

A

From the medial cord of

the brachial plexus.

42
Q

ULNAR NERVE

Course?

A
  1. It runs downward on the medial side of the brachial
    artery middle of the arm.
  2. enters the posterior compartment of the arm.
  3. has no branches in the
    arm.
  4. At the elbow, it passes behind the medial epicondyle.
  5. Go to forearm
  6. Enters between the heads of flexor carpi ulnaris
  7. medial to ulnar artery
  8. Branch in arm
  9. Branch in forearm cutanous
  10. Enters the palm superficial to the flexor retinaculum
  11. Ends by dividing into: superficial deep branches
43
Q

Ulnar nerve and branch’s supply?

A
  • Ulnar nerve:
    1. Flexor Carpi ulnaris
    2. Medial ½ Flexor Digitorum Profundus
  • palmar cutaneous branch ( sensory):
    1. supply skin over hypothenar eminence
  • Superficial branch:
    1. Cutaneous: Skin over the Palmar aspect of the medial 1+ ½ fingers (including nail beds).
  • Deep branch :
It supplies 13 muscles : 
1. Three hypothenar
muscles. 
2. Adductor pollicis.(near
thenar ) 
3. All dorsal & palmar
interossei. 
4. Medial 2 lumbrical.
44
Q

LESION OF ULNAR NERVE ABOVE ELBOW

?

A 
Motor deficit:
• loss of flexion of the 4th and 5th
digits
• Atrophy of hypothenar muscles. •  Loss of adduction  of hand &
thumb
• Sensory deficit:
•  Loss of sensation in ulnar half of
the palm and dorsum of hand, and
the medial 1½ digits on both palmar
and dorsal aspects of the hand
45
Q

LESION OF ULNAR NERVE ABOVE WRIST

?

A 
• 1- Inability to adduct
thumb • 2- Inability to put the
hand in writing position • - Sensory loss to fingers
only • - Partial claw hand
deformity is more
prominent
46
Q

Adducting the fingers to grasp an object placed between

them are innervated by th?

A

deep branch of the ulnar nerve

47
Q

The ability to grasp an object between the pad of the thumb
and the pad of one of the fingers depends on normal
functioning of the thenar muscles, which are innervated by
the ?

A

recurrent branch of the median nerve

48
Q

The Subclavian Artery- Origin?

A

Origin: Right subclavian artery arises from the brachiocephalic trunk.
Left subclavian branches directly off the arch of aorta.

49
Q

The Subclavian Artery- Course

?

A

Both subclavian arteries are divided into 3 parts by the anterior scalene muscle:
1. 1st part: from origin of artery to anterior scalene
muscle.
2. 2nd part: posterior to the muscle.
3. 3rd part: lateral to the muscle and before the artery
reaches the lateral border of 1st rib.

50
Q

The Subclavian Artery- Branches?

A

Branches: 1. Vertebral artery 2. Thyrocervical trunk 3. Internal thoracic artery 4. Costocervical trunk

51
Q

The Subclavian Artery Termination?

A

Termination:
When the subclavian arteries cross the lateral edge of the 1st rib, they enter the axilla, and are called axillary arteries.

52
Q

The Axillary Artery- Origin, Course Termination?

A

The subclavian artery in the neck becomes the axillary
artery at the lateral margin of first rib, and passes
through axilla, becoming the brachial artery at the
inferior margin of the teres major muscle.
 Is closely related to the cords of brachial plexus and their
branches.
 Is enclosed within the axillary sheath.

53
Q

Axillary Artery is separated into 3 parts by the

??

A

PECTORALIS MINOR MUSCLE, which crosses anteriorly
to the vessel:
1. First part is proximal to pectoralis minor. 2. Second part is posterior to pectoralis minor. 3. Third part is distal to pectoralis minor.

54
Q

The Axillary Artery- 1st part extends ? Related ant. And lat? Branches?

A

Extends from the lateral border of 1st rib to upper
border of the pectoralis minor muscle.
 Related: Anteriorly: to the pectoralis major muscle Laterally: to the cords of the brachial plexus.
 Gives ONE branch:
The superior thoracic artery (Highest thoracic artery).

55
Q

The Axillary Artery- 2nd part extends ? Related ant. , post. And lat? Branches?

A

Lies behind the pectoralis minor muscle.
 It is related medially, laterally, and posteriorly to the
corresponding cords of the brachial plexus.
 Gives TWO branches:
1. The thoracoacromial artery → divides into 4
branches: Pectoral, deltoid, clavicular, and acromial
branches.
2. The lateral thoracic artery.

56
Q

The Axillary Artery- 3rd part extends ? Related ant. , post. And lat? Branches?

A

Extends from the lower border of pectoralis minor muscle to the lower border teres major muscle.
 Related medially, laterally, and posteriorly, to the
branches of the cords of the brachial plexus.
 Gives THREE branches:

1.The subscapular artery
2.The anterior circumflex humeral artery → passes
anterior to the surgical neck of humerus.
3.The posterior circumflex humeral artery → passes
posterior to the surgical neck of humerus.

57
Q

Anastomosis around shoulder joint?

A

Branches from Subclavian Artery:
a. Suprascapular artery b. Superficial cervical artery
 Branches from Axillary Artery:
a. Subscapular artery b. Anterior circumflex humeral artery
c. Posterior circumflex humeral artery
And they form an interconnected vascular network around the scapula.

58
Q

Brachial Artery- Origin, Termination & Relations ant. Post, med. lat.

A

 Is a continuation of the axillary artery at the lower
border of teres major muscle.  Provides main arterial supply for the arm.  Terminates opposite neck of radius by dividing into
radial & ulnar arteries.
Relations:  Anteriorly: median nerve, and bicipital aponeurosis.  Posteriorly: triceps, coracobrachialis and brachialis.  Medially: basilic vein, ulnar and median nerves.  Laterally: coracbrachialis and biceps muscles.

59
Q

The Brachial Artery- Branches

?

A

Muscular.
 Nutrient to humerus.
 Profunda brachii → largest branch, supplies posterior
compartment of arm.
 Superior ulnar collateral → share in anastomosis
around elbow joint.
 Inferior ulnar collateral → share in anastomosis around
elbow joint.

60
Q

The larger of the two terminal branches of the brachial

artery. ?

A

Ulnar Artery

61
Q

Ulnar Artery

Course?

A

Begins in the cubital fossa at the level of neck of radius.  Descends through the anterior compartment of the
forearm.  Enters the palm, in front of the flexor retinaculum, with
the ulnar nerve.  Ends by forming the superficial palmer arch, by
anastomosing with superficial palmer branch of radial
artery.

62
Q

The smaller of the two terminal branches of the
brachial artery.
?

A

Radial Artery

63
Q

Radial Artery

Course?

A

Begins in the cubital fossa at the level of neck of radius.
 Descends downward and laterally.
 Leaves the forearm by winding around the lateral
aspect of the wrist to reach the dorsum of the hand.

64
Q

Anastomosis around elbow joint?

A

between branches of Brachial, Radial and Ulnar arteries:
 Branches from Brachial Artery:
a. Profunda Brachii artery
b. Superior ulnar collateral artery
c. Inferior ulnar collateral artery
 Branches from Ulnar and Radial Arteries:
a. Radial & ulnar recurrent arteries
b. Posterior interosseous recurrent artery

65
Q

➢ Enters the hand anterior to the flexor retinaculum, on the lateral side
of the ulnar nerve and pisiform bone.
➢ Gives a deep branch.
➢ Continue as the superficial palmar arch.

Which artery ?

A

Ulnar Artery:

66
Q

Leaves dorsum of the hand and on entering the palm, it continues as
deep palmar arch. ➢ Gives a superficial branch.
Which artery?

A

Radial Artery:

67
Q

Is the direct continuation of the ulnar artery
 Is completed by branch from the radial artery.
 Lies approximately at the level of the distal border of the
extended thumb.
 Gives: digital arteries from its convexity to supply the
fingers.
Which arch?

A

Superficial Palmar Arch

68
Q

a continuation of the radial artery.
 Is completed by deep branch of ulnar artery.
 Lies at a level of the proximal border of extended
thumb.
 It sends branches: superiorly to share in anastomosis
around the wrist joint & inferiorly to join branches of
the superficial palmar arch.

Which arch?

A

Deep Palmar Arch

69
Q

accompany the arteries and
constitute the vena comitantes of those vessels.
Are?

are placed immediately beneath
the skin, in the superficial fascia.
Are?

A
  1. deep veins

2. superficial veins

70
Q 
lies on the dorsum of the
hand, in the  subcutanous tissue.
 Drains into the  cephalic  vein laterally, and basilic
vein medially
Which vein?
A
  1. Dorsal Venous Arch (network):
71
Q

Arises from the lateral end of
the dorsal venous arch of
hand.

A

Cephalic Vein

72
Q 
Ascends on radial side of the
forearm to the elbow and
continues up the arm in the
deltopectoral groove.
 Pierces clavipectoral  fascia to
drain into the axillary vein.
?
A

Cephalic Vein

73
Q

Arises from the medial side of
the dorsal venous arch of
hand. ?

A

Basilic Vein

74
Q 
Ascends on the ulnar side of
forearm to the elbow o In the  middle of the arm, it
pierces the deep fascia and
joins the brachial vein or
axillary vein.
?
A

Basilic Vein

75
Q

Links cephalic vein and basilic vein in the
cubital fossa. ❑ Is a frequent site for venipuncture.
?

A

Median Cubital Vein

76
Q

Accompany the arteries of the same region and

bear similar names.

A

Venae commitantes:

77
Q

placed one on either side of the brachial artery.

?

A

Brachial veins:

78
Q

Begins at the lower border of the Teres major, as the
continuation of the basilic vein.
➢ Ends at the outer border of the first rib as the
subclavian vein.
➢ Receives the brachial veins and tributaries.
➢ close to its termination, the cephalic vein.
?>

A

Axillary vein:

79
Q

Is the continuation of the axillary vein.
 Extends from the outer border of the first
rib to the sternal end of the clavicle,
where it unites with the internal jugular to
form the brachiocephalic (innominate)
vein.
?

A

Subclavian Vein

Anatomy (7 decks)

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