L05 - DISTRIBUTION AND NERVR SUPPLY TO UPPER LIMB Flashcards
Where is arterial supply to the upper limb derived from?
The aorta
Fill in the gap:
There is important anatomical ………. between the supply to the upper limb on the …… side compared to that on the …… side.
- asymmetry
- right
- left
What are the origins of the right upper limb supply?
- First branch of the aortic arch - the brachiocephalic artery
- The brachiocephalic artery then branches into the right subclavian artery and the right upper limb
- Right subclavian artery supplies right upper limb
What are the origins of the left upper limb supply?
The third branch of the aortic arch which is the left subclavian artery which supplies arterial blood to the left upper limb
What is the clinical use of the arterial tree of the upper limb?
They can be used for multiple pulse points in the upper limb
What are the 3 systems of venous drainage of blood from the upper limb?
- Superficial venous drainage
- Deep venous drainage
- Perforating veins
How is the venous drainage of the upper limb organised?
- Superficial and deep veins are organised along parallel lines
- Perforating veins join superficial veins to deep veins
What is the function of superficial veins?
They drain the skin and superficial structures and conduct venous blood against gravitational pull
What do the valves in superficial veins do?
They ensure the one way passage of blood
Name 2 superficial veins and the structure that joins them
- Cephalic vein (lateral)
- Basilic vein (medial)
- Joined by the median cubital vein
How are superficial veins of the upper limb terminated?
Terminate by joining axillary vein
Name the 5 deep veins of the upper limb
- Ulnar and radial veins
- Brachial vein
- Axillary vein
- Subclavian vein
What are axial lines?
Boundaries between flexor and extensor compartments of the limbs. There are pre and post axial lines and borders. They are marked out by superficial veins
What are the clinical importance of venous drainage of the upper limb?
Provides sites for:
- Harvesting blood for analysis
- Administration of IV
- Blood transfusion
- Fluid replacement
- Venae puncture
- Lymphoedema
Where does the lymphatic drainage start
At the tips of the fingers
Where do upper limb lymphatics drain into?
Clavicular lymph vessels
Where is the lymphatic drainage in the upper limb through?
- Superficial lymph channels
- Deep lymphatic channels
What is lymphoedema and how is it caused?
Localised swelling caused by abnormal accumulation of lymphs. This can often be caused by disturbed axillary drainage.
Where does the upper limb receive all of its nerve supply from?
The spinal cord - mainly cervical spinal segments C5-T1. The rest is from T2 roots
What is the network of nerves formed by spinal nerves called?
The brachial plexus
What are the roots of the brachial plexus?
Anterior Rami C5-T1
What does the anterior rami divide into?
- Upper trunk (C5, C6)
- Middle trunk (C7)
- Lower trunk (C8, T1)
- Each trunk divides into an anterior and posterior division
What are the cords that are produced by brachial plexus divisions?
- Medial cord
- Lateral cord
- Posterior cord
What do the anterior divisions of the brachial plexus supply?
The anterior musculo fascial compartment of the limb - the flexor compartment
What do the posterior divisions of the brachial plexus supply?
Posterior musculo fascial compartment of the limb - the extensor compartment
What is the major nerve of the extensor compartment?
The radial nerve
What are the 3 main nerves of the flexor compartment?
- Musculocutaneous nerve
- Ulnar nerve
- Median nerve
What is ape thumb?
An upper limb nerve palsy where the movements of the thumb are severely limited. This is related to the median nerve
What are 3 median nerve related upper limb nerve palsies?
- Ape thumb
- Hand of benediction
- Pointing index
What is the upper limb nerve palsies related to the ulnar nerve?
Ulnar claw hand
What is the upper limb nerve palsy related to the radial nerve?
Wrist drop
What are sensory nerve territories?
Sensory divisions of terminal nerves of the brachial plexus supply the skin in territorial domains. These are NOT dermatomes
