Ch 51 Consolidated Neurovasculature of Upper Limb Flashcards
The brachial plexus is a network of intermingling and intertwining nerves supplying structures in the _ _
upper arm
Spinal nerve plexuses are only derived from _ rami and never _ rami
ventral
dorsal
The brachial plexus is formed directly from the ventral rami of spinal nerves : ( 5 items)
C5, C6, C7, C8, and T1
Ventral rami make up 3 trunks that form the brachial plexus which are found in the _
neck
The ventral rami of _ and _ join and form the upper trunk of the brachial plexus
C5 and C6
The ventral rami of _ continues as the middle trunk of the brachial plexus
C7
The ventral rami of _ and _ form the lower trunk of the brachial plexus
C8 and T1
Each trunk of the brachial plexus divides into an _ and a _ division
anterior and posterior division
The anterior divisions of the upper and middle trunks form the _ cord of the brachial plexus
lateral cord
The anterior divisions of the lower trunk continue to form the _ _ of the brachial plexus
medial cord
The posterior divisions of all 3 trunks form the _ _ of the brachial plexus
posterior cord
Cords of the brachial plexus are found in the _
axilla
The names of the cords of the brachial plexus are named as such because of their location in regards to the _ _
axillary artery
The cords of the brachial plexus give off _ nerves and then continue distally as the _ major nerves of the upper limb
8
4
2 nerves coming off the ventral rami of brachial plexus:
Dorsal Scapular n
Long Thoracic n.
2 nerves coming off the trunks of brachial plexus:
nerve to subclavius
suprascapular n.
8 branches of the cords of brachial plexus:
lateral pectoral n
medial pectoral n
medial brachial cutaneous n
medial antebrachial cutaneous n
upper subscapular n
lowersubscapular n
thoracodorsal n
axillary n
4 main nerves from cords of the brachial plexus (primary nerves)
musculocutaneous n
ulnar n
radial n
median n
The dorsal scapular nerve originates from the ventral ramus _.
C5
The dorsal scapular nerve supplies the _ _ and _ muscles of the back
rhomboid major and minor muscles
The long thoracic nerve originates from the ventral rami of _, _ , and _.
C5, C6, C7
The long thoracic nerve supplies the _ surface of the _ _ muscle.
external surface
serratus anterior
The nerve to the subclavius originates from the _ _ of the brachial plexus
upper trunk
The nerve to the subclavius supplies the _ muscle
subclavius
The suprascapular nerve originates from the _ _ of the brachial plexus
upper trunk
The suprascapular nerve supplies the _ and _ muscles
supraSPINATUS and inFRASPINATUS muscles
The lateral pectoral nerve originates from the _ _ of the brachial plexus
lateral cord
The lateral pectoral nerve courses deep to the surface of the _ _ muscle which it supplies
pectoralis major
The medial pectoral nerve originates from the _ _ of the brachial plexus
medial cord
The medial pectoral nerve pierces the deep surface of the _ _ and _ muscles which it supplies
pectoralis minor and major
The medial brachial cutaneous nerve originates from the _ _ of the brachial plexus
medial cord
The medial brachial cutaneous nerve pierces the fascia of the _ arm and supplies the skin on the lower _ arm.
proximal
medial
The medial antebrachial cutaneous nerve originates from the _ _
medial cord
The medial antebrachial cutaneous nerve descends towards the middle of the _ where it pierces the antebrachial fascia and supplies the skin of the _ _.
forearm
medial forearm
The upper subscapular nerve originates from the _ _
posterior cord
The upper subscapular nerve courses into and supplies the _ muscle
subscapularis muscle
The thoracodorsal nerve originates from the _ cord
posterior cord
The thoracodorsal nerve courses inferiorly and posteriorly to the deep surface of the _ _ muscle which it innervates
latissimus dorsi
The lower subscapular nerve originates from the _ _
posterior cord
The lower subscapular nerve divides in to 2 muscular branches, one supplying the _ muscle and the other supplying the _ _ muscle
subscapularis muscle
teres major muscle
The axillary nerve originates from the _ cord
posterior cord
The axillary nerve courses inferiorly to the shoulder, passes around the _ _ of the _
Surgical neck of the humerus
The musculocutaneous nerve is the continuation of the _ _ of the brachial plexus, beginning after the _ _ to the median nerve is given off
Lateral cord
Lateral root
The ulnar nerve is the continuation of the _ _ of the brachial plexus, beginning after the _ _ to the median nerve is given off
Medial cord
Medial root
The radial nerve is the continuation of the _ cord of the brachial plexus, beginning after the _nerve is given off
Posterior cord
Axillary nerve
The median nerve is derived from the _ and _ _ of the _ nerve
Lateral and medial root of the median nerve
The 4 primary nerves of the upper limb are:
musculocutaneous nerve
median nerve
ulnar nerve
radial nerve
The musculocutaneous nerve typically pierces the _ muscle
coracobrachialis muscle
The musculocutaneous nerve descends thru the _ compartment of the arm coursing between the _ _ and _ muscles.
anterior compartment
biceps brachii and brachialis muscles
The musculocutaneous nerve innervates 3 muscles in the arm:
coracobrachialis
biceps brachii
brachialis
The musculocutaneous nerve emerges _ to the tendon of the _ _ muscle and becomes the _ _ _ nerve
laterally
biceps brachii
lateral antebrachial cutaneous nerve
The lateral antebrachial cutaneous nerve supplies the _ of the _ _.
skin of the lateral forearm
The median nerve descends thru the _ compartment of the arm where it has _ muscular or cutaneous innervation
medial compartment
no
The median nerve courses thru the _ _ where it is found medial to the _ artery
cubital fossa
brachial artery
In the cubital fossa, the median nerve gives off a branch called the _ _ nerve
anterior interosseus nerve
As the median nerve enters the forearm it courses between the 2 heads of origin of the _ _ muscle
pronator teres muscle
In the proximal forearm, the median nerve passes _ to the _ of the flexor digitorum superficialis muscle with the _ artery
deep to the arch
ulnar artery
Thru the forearm, the median nerve descends between the _ _ _ and the _ _ _ muscles
flexor digitorum superficialis
flexor digitorum profundus
The median nerve innervates 4 muscles in the forearm:
pronator teres
flexor carpi radialis
palmaris longus
flexor digitorum superficialis
Proximal to the flexor retinaculum the median nerve gives off a _ branch coursing anterior to the flexor retinaculum
palmar branch
The palmar branch of the median nerve _ innervates the skin of the _ _
cutaneously innervates
skin of the lateral palm
The median nerve enters the hand by coursing thru the _ _
carpal canal
After entering the hand, the median nerve divides into its terminal branches at the _ border of the flexor retinaculum
distal border
Direct branches of the median nerve innervate the _ and _ lumbricals
1st and 2nd
Digital branches of the median nerve give cutaneous innervation to the lateral _ digits anteriorly and their _ posteriorly
lateral 3.5
tips
The recurrent branch of the median nerve courses proximally into the thenar area, supplying 2.5 muscles:
ABductor Pollicis Brevis
Flexor Pollicis Brevis (superificial head)
Opponens Pollicis
The anterior interosseus nerve arises as a branch of the median nerve within the _ _
cubital fossa
The anterior interosseus nerve courses distally along the _ _ of the interosseus membrane
anterior surface
The anterior interosseus nerve innervates 2.5 muscles in the forearm:
Flexor Digitorum Profundus (lateral half)
Flexor Pollicis Longus
Pronator Quadratus
The ulnar nerve is the continuation of the _ _ of the brachial plexus
medial cord
The ulnar nerve begins after the _ root of the _ nerve is given off.
medial root
median nerve
The ulnar nerve descends through the _ compartment if the arm where it has no muscular or cutaneous innervation
medial
The ulnar nerve pierces the _ lamina of the _ intermuscular septum and passes into the _ compartment from the medial compartment.
posterior lamina
medial intermuscular septum
posterior compartment
The ulnar nerve, after reaching the posterior compartmentin the arm, courses _ to the _ _
posteriorly
medial epicondyle
The ulnar nerve enters the forearm by passing _ the 2 heads of origin of the _ _ _ muscle
between
Flexor Carpi Ulnaris muscle
The ulnar nerve courses thru the forearm between the _ _ _ and _ _ _ muscles
Flexor Carpi Ulnaris
Flexor Digitorum Pofundus
The ulnar nerve innervates 1.5 muscles in the forearm
Flexor Carpi Ulnaris
Flexor Digitorum Profundus (medial half)
The ulnar nerve courses with the _ artery in the _ half of the forearm.
ulnar artery
distal half
In the distal forearm the ulnar nerve gives off a _ branch which cutaneously innervates the dorsum of he medial _ digits and _.
dorsal branch
1.5 digits
hands
Proximal to the flexor retinaculum, the ulnar nerve gives off a _ branch that courses _ to the to the flexor retinaculum.
palmar
anterior
In the wrist the ulnar nerve is accompanied by the _ artery as it enters the hand by passing _ to the flexor retinaculum, outside the carpal canal and thru the _ _.
ulnar artery
anterior
Guyon’s canal
The ulnar nerve divides into its 2 terminal branches, the superficial and deep branches _ to the pisiform bone
laterally
The superficial branch of the ulnar nerve courses _ to the palmaris brevis muscle
deep
The superficial branch of the ulnar nerve innervates one muscle in the hand, the _ _ muscle, and it has cutaneous digital branches supplying the _ _ digits anteriorly.
palmaris brevis
medial 1.5 digits
The deep branch of the ulnar nerve courses between 2 _ muscles in the hand.
hypothenar
The deep branch of the ulnar nerve courses _ the hook of the hamate to pass _ across the palm just anterior to the interossei muscles
around
laterally
The deep branch of the ulnar n innervates 14.5 muscles of the hand:
Abductor digiti minimi
Flexor digiti minimi brevis
opponens digiti minimi
lumbricals 3 and 4
dorsla interrosei 1-4
palmar interossei 1-4
Adductor pollicis
Flexor pollicis brevis (deep head portion)
The radial nerve is a continuation of the _ cord of the brachial plexus, beginning after the _ nerve is given off
posterior
axillary
The radial nerve courses from _ to _ in the radial groove of the humerus, which is found in the _ compartment of the arm
medially to laterally
posterior
Inthe arm, the radial nerve courses with the _ _ artery and innervates the _ _ muscle
profunda brachii artery
triceps brachii muscle
The radial nerve pierces the _ _ _ as it passes from the _ to the _ compartment of the arm
lateral intermuscular septum
posterior to anterior
The radial nerve passes thru the _ side of the cubital fossa to the forearm
lateral
The radial nerve innervates 3 muscles in the forearm:
Brachioradialis m
Extensor Carpi Radialis Longus m
Anconeus m
_ the brachialis and brachioradialis muscles, the radial nerve branches into its 2 terminal branches, the _ and _ branches.
Between
superficial and deep branches
The superficial branch of the radial nerve courses distally with the _ artery, _ to the brachioradialis muscle
radial artery
deep
The superficial branch of the radial nerve passes over the tendons in the wrist on the _ _ and enters the hand.
anatomical snuffbox (ok this is the most ridiculous name they could have given this)
The superficial branch of the radial artery cutaneously innervates the skin of the _ half of the _ of the hand and the proximal portion of the lateral _ digits posteriorly.
lateral half
dorsum
3.5
The superficial branch of the radial nerve innervates _ muscles in the hand
0
The deep branch of the radial nerve innervates the _ _ _ _ muscle in the forearm
Extensor Carpi Radialis Brevis m
As the deep branch of the radial nerve enters the _ border of the supinator muscle, its name becomes the _ _ nerve (PIN)
Superior border
Posterior Interosseus Nerve (PIN)
The posterior interosseus neve innervates 8 muscles of the forearm:
Extensor Digitorum - *
Extensor Digiti Minimi - *
Extensor Carpi Ulnaris -*
Supinator
Abductor Pollicis Longus
Extensor Pollicis Brevis
Extensor Pollicis Longus
Extensor Indicis
(6 extensors, 2 others)
[All deep post. and 3 superficial post. -*]
T/F the posterior interosseus nerve enters the hand
false
The _ is the main artery that carries blood from the heart to the body
aorta
The aorta initially _ then arches _ and to the left forming the _ _
ascends
posteriorly
aortic arch
The 3 branches of the aortic arch are:
Brachiocephalic Trunk (innominate artery)
Left Common Carotid Artery
Left Subclavian Artery
The brachiocephalic trunk branches into the _ _ _ and the _ _ artery
right common carotid
right subclavian
The majority of the branches of the subclavian arteries supply the _ _ while the common carotids supply the _ and _
upper limbs
head and neck
The aortic arch continues as the _ _, coursing _ thru the thorax and abdomen
descending aorta
inferiorly
T/F The left subclavian artery is a branch of the brachiocephalic trunk and the right is a branch of the aortic arch
false, right subclav-brach trunk, left subclav-arch
The subclavian artery ascends thru the _ and _ to the upper limb
thorax and neck
The 4 main branches of the subclavian artery are:
Vertebral a
Internal Mammary a (Internal Thoracic)
Thyrocervical Trunk
Costocervical Trunk
The subclavian artery becomes the _ artery at the _ border of the _ rib
axillary artery
lateral border
1st rib
T/F the axillary artery begins as a continuation of the subclavian artery at the medial border of the 1st rib
false, LATERAL border
The axillary artery courses _ and _ thru the axilla
laterally and inferiorly
The axillary artery terminates at the _ border of the _ _ muscle by continuing as the _ artery
inferior border
teres major m
brachial a
The axillary artery has 6 main branches:
Highest (supreme) thoracic a
Thoracoacromial Trunk
Lateral Thoracic a
Subscapular a
Anterior Circumflex Humeral a
Posterior Circumflex Humeral a
Hi There Ladies, Seen -the- Pacific Coast Highway (PCH) -and the- Atlantic Coast Highway (ACH)?
The brachial artery is a continuation of the axillary artery distal to the _ border of the teres major muscle
inferior
The brachial artery descends thru the _ compartment of the arm with the _ and _ nerves
medial
median and ulnar nerves
The brachial artery has 3 main branches in the arm:
Posterior brachii a
Superior ulnar collateral a
Inferior ulnar collateral a
The posterior brachii artery is _ to the humerus and it courses with the _ nerve
posterior
radial
The 3 main branches of the brachial artery supply muscles in the arm and provide _ circulation to the _ region
collateral
elbow
The brachial artery courses distally after giving off its branches and enters the _ _ where it sits _ to the median nerve and it sits _ to the tendon of the biceps brachii muscle
cubital fossa
laterally
medially
Within the cubital fossa the brachial artery gives off its 2 terminal branches:
Radial a
Ulnar a
The radial artery arises as a terminal branch of the _ artery in the _ _
brachial a
cubital fossa
The radial artery courses distally in the forearm with the _ branch of the _ nerve, _ to the brachioradialis muscle.
superficial branch
radial n
deep
The radial artery passes _ the anatomical snuffbox and enters the _ of the hand
thru
dorsum
The anatomical snuffbox is the deep depression found _ to the thumb and on the _ side of the hand
proximal
posterolateral
The radial artery terminates by forming the _ _ _
deep palmar arch
The deep palmar arch typically anastomoses with branches of the _ artery
ulnar a
The deep palmar arch gives of the _ arteries
metacarpal a
The metacarpal arteries of the deep palmar arch join the metacarpal arteries of the _ palmar arch to form the _ arteries on the medial and lateral side of each _.
join
superficial
digital
digit
The ulnar artery arises as the terminal branch of the _ artery within the _ _
brachial a
cubital fossa
In the proximal forearm, the ulnar artery gives off the _ _ artery
common interosseus a
The ulnar artery courses _ to the _ of the flexor digitorum superficialis muscle with the _ nerve
deep
arch
median n
In the distal half of the forearm, the ulnar artery courses with the _ nerve, _ the flexor carpi ulnaris and the flexor digitorum profundus muscles
ulnar n
between
In the wrist, the ulnar artery is paired with the _ nerve as it enters the hand by passing thru _ _
ulnar n
Guyon’s canal
The ulnar artery terminates by forming the _ _ _
superficial palmar arch
The superficial palmar arch typically anastomoses with branches of the _ artery and it gives off _ arteries
radial a
metacarpal aa
The metacarpal arteries of the superficial palmar arch _ the metacarpal arteries of the _ palmar arch to form the _ arteries on the medial and lateral side of each digit
join
deep
digital
The common interosseus artery arises from the _ artery in the _ forearm
ulnar a
proximal
The common interosseus artery courses a short distance then divides into its 2 terminal branches in the forearm:
Anterior interosseus a
Posterior interosseus a
The most variable structures in the body are _.
veins
Veins begin distally as _ and they course proximally
tributaries
T/F Origins and terminations of blood vessels are described in terms of muscles surrounding them.
False, they are described in terms of the course of blood flow thru the vessel
In limbs, typically arteries originate _ and terminated _ and veins do the opposite
proximally
distally
Blood returns to the upper limb via _ and _ veins.
deep
superficial
T/F Deep veins course with an artery of the same name but typically drain a different area than that artery supplies.
False, they drain the same area the deep artery supplies
Distal to the axilla, deep veins are paired up until the the axillary vein, this arrangement is called _ _.
Venae comitantes
Superficial veins are found in the _ _
subcutaneous tissue
Palmar digital veins are superficial and are found on the palmar aspects of the _ and drain into _ veins
fingers
intercapitular
Intercapitular veins connect _ and _ digital veins
palmar
dorsal
Dorsal digital veins are found on the dorsal aspects of the _ and branch together to form _ _ veins
fingers
dorsal metacarpal v
Dorsal Metacarpal veins are found on the dorsum of _ and drain into the _ _ _.
hands
dorsal venous arch
The Dorsal Venous Arch is found on the dorsal part of the proximal portion of the hand and it gives origin to the _ and _ veins.
cephalic and basilic v
The cephalic vein pathway:
1) originates as a continuation of the _ side of the dorsal venous arch
2) ascends on the lateral side of the _ surface of the proximal forearm.
3) courses thru the subcutaneous tissue anterior to the _ _ then continues on the _ side of the arm
4) enters the _ _ between the deltoid and pectoralis major muscles
5) courses deep thru the _ _ above the pectoralis _ muscle
6) terminates by joining the _ vein
1) lateral
2) anterior
3) cubital fossa, lateral
4) deltopectoral groove
5) clavipectoral fascia, pectoralis minor muscle
6) axillary
The basilic vein pathway:
1) originates as a continuation of the _ side of the dorsal venous arch
2) ascends on the medial side of the _ surface of the proximal forearm.
3) courses thru subcutaneous tissue anterior to the _ _ and then continues on the _ side of the arm.
4) at the middle of the arm it courses deep, piercing the _
5) terminates by joining the _ veins and becoming the _ vein
6) The _ vein is deep and therefore courses with the _ artery.
1) medial
2) anterior
3) cubital fossa, medial
4) fascia
5) brachial veins, axillary vein
6) axillary x 2
T/F The axillary vein is deep and drains just the area the axillary artery supplies.
false, it drains both the deep and superficial venous systems of the arm
The median cubital vein is a cross connection that usually ascends passing _ to _ from the cephalic to the basilic vein anterior to the _ _.
laterally to medially
cubital fossa
The vein commonly used for blood draws is the _ _ vein
median cubital vein
