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MJM > L06 - Distribution of nerves and vessels in the upper limb > Flashcards

L06 - Distribution of nerves and vessels in the upper limb Flashcards

1
Q

Arterial supply to the upper limb is derived from what?

A

Arterial supply to the UL is derived from the aorta

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2
Q

What is the branches of the aorta?

A

From the aortic arch:

  1. Brachiocephalic artery –> right subclavian artery and right common carotid artery
  2. Left common carotid artery
  3. Left subclavian artery
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3
Q

At what level does the brachiocephalic artery divide?

A

At level of sternoclavicular articulation

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4
Q

What does the right subclavian artery supply?

A

Supplied right upper limb

- Runs beneath the clavicles

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5
Q

What are the key anatomical segments of the upper limb’s arterial tree?

A
  1. Subclavian artery
  2. Axillary artery
  3. Brachial artery (profunda brachii - branch of brachial artery)
  4. Ulnar and radial arteries
  5. Deep and superficial palmar arches
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6
Q

Which border does the axillary artery form?

A

Lateral border of rib

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7
Q

Which border does the brachial artery form?

A
  • Inferior border of teres major and radial tuberosity
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8
Q

Where is the anterior humeral circumflex artery located?

A
  • Anterior humeral circumflex artery runs horizontally
  • Beneath the coracobrachialis and short head of the biceps brachii muscle
  • In front of the neck of the humerus
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9
Q

Where is the posterior humeral circumflex artery located?

A
  • Arises from the third part of axillary artery
  • At the lower border of the subscapularis
  • Runs posteriorly with the axillary nerve through the quadrangular space
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10
Q

Where is the profunda brachii located?

A

Deep brachial artery

- Arises from lateral and posterior part of brachial artery (back of humerus)

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11
Q

What does the anterior humeral circumflex artery supply?

A
  1. Proximal humerus muscles
    - Deltoid
    - Biceps brachii
    - Coracobrachialis
  2. Glenohumeral joint
  3. Proximal humeral head
  4. Skin overlying the anterior aspect of the proximal humerus
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12
Q

What does the posterior humeral circumflex artery supply?

A
  1. Deltoid
  2. Teres major
  3. Teres minor
  4. Longa nd lateral heads of the triceps brachii
  5. Glenohumeral joint
  6. Cutaneous tissue overlying the posterolateral aspect of the proximal humerus
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13
Q

What are the different pulse points of the upper limb?

A
  1. Axillary pulse
  2. Radial pulse in distal forearm
  3. Radial pulse in the anatomical snuffbox
  4. Brachial pulse in mid-arm
  5. Brachial pulse in cubital fossa
  6. Ulnar pulse in distal forearm
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14
Q

What are the 3 systems in which the venous drainage from the upper limb is arranged into?

A
  1. Superficial venous drainage
  2. Deep venous drainage
  3. Perforating veins
    - Superficial and deep veins organised along parallel lines
    - Perforating veins join superficial veins to deep veins (one way) - runs between the deep and superficial
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15
Q

What are the different veins of the upper limb?

A
  1. Subclavian vein
  2. Axillary vein (deep)
  3. Cephalic vein (superficial)
  4. Brachial vein (deep); branch of axillary vein –> radial and ulnar
  5. Basilic vein (superficial)
  6. Ulnar and radial veins (deep)
  7. Interosseous veins (deep)
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16
Q

Describe the features of the superficial veins of the upper limb

A
  • Drain the skin and superficial structures
  • They have valves that ensure one way passage of blood
  • Conduct venous blood against gravitational pull
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17
Q

Which veins are the superficial veins of the upper limb?

A
  1. Cephalic vein
  2. Basilic vein
    - Joined by median cubital vein
    - Terminate by joining axillary vien
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18
Q

Which veins are the deep veins of the upper limb?

A
  1. Deep and superficial palmar venous arches
  2. Ulnar and radial veins
  3. Brachial vein
  4. Axillary vein
  5. Subclavian vein
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19
Q

What are axial lines?

A
  • The boundary line between dermatomes supplied from discontinuous spinal levels
  • Boundaries between flexor and extensor compartments of limb are defined as axial lines
  • Pre-axial or post-axial lines or borders
  • These borders are marked out by superficial veins
  • Cephalic and basilic veins (upper limb)
  • Greater and lesser saphenous veins (lower limb)
  • At axial lines, adjacent dermatomes do not overlap
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20
Q

What is the clinical importance of venous drainage of upper limb/

A
  1. Lymphoedema
  2. Venae puncture - the practice of obtaining intravenous access
  3. Provide sites for
    - Harvesting blood for analysis
    - Administration of IV drugs
    - Fluid replacement for hydration status of body
    - Blood transfusion
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21
Q

Where is the common site for venepuncture?

A

Median cubital vein

  • Superficial vein located anteriorly to the cubital fossa region
  • Ease of access, fixed position and superficial position make it good site for venepuncture
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22
Q

What is the nerve supply to the upper limb?

A
  • Receives all its nerve supply from the spinal cord
  • Most of its supply is derived from cervical spinal segments (C5-T1) - BRACHIAL PLEXUS
  • Rest from T2 roots
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23
Q

How is the brachial plexus divided up?

A 
R - Roots
T - Trunks
D - Divisions 
C - Cords
B - Branches
24
Q

What is included in the roots of the brachial plexus?

A
  • From anterior rami C5-T1

- Unite and divide to give TDCB

25
Q

What in included in the trunks of the brachial plexus?

A
  1. Upper trunk - C5 and C6
  2. Middle trunk - C7
  3. Lower trunk - C8 and T1
26
Q

What is included in the divisions of the brachial plexus?

A
  1. Anterior (3 anterior divisions)
  2. Posterior (3 posterior divisions)
    - Each trunk divides into two branches within the posterior triangle of the neck
    - These divisions leave the posterior triangle and pass into the axilla, they recombine into the cords of the brachial plexus
27
Q

What is included in the cords of the brachial plexus?

A
  1. Medial cord
  2. Lateral cord
  3. Posterior cord
    - Once the ant and post divisions enter the axilla, they combine to form three cords
    - Named by position relative to axillary artery
28
Q

What does the anterior division of the brachial plexus supply?

A

Ant division supplies all muscles of the anterior musculo-fascial compartment of the limb
- The FLEXOR compartment

29
Q

What does the posterior division of the brachial plexus supply?

A

Post division supplies all muscles of the posterior musculo-fascial compartment of the limb
- The EXTENSOR compartment

30
Q

Which muscles do the spinal nerves of the brachial plexus pass in order to enter the base of the neck?

A

After formation by anterior rami. the spinal nerves C5-T1 pass between the anterior and medial scalene muscles to enter the base of the neck

31
Q

What does posterior rami innervate?

A

Posterior divisions innervate the skin and musculature of the intrinsic back muscles

32
Q

What is the lateral cord of the brachial plexus formed by?

A
  1. The anterior division of the superior trunk

2. The anterior divisions of the middle trunk

33
Q

What is the posterior cord of the brachial plexus formed by?

A
  1. The posterior division of the superior trunk
  2. The posterior division of the middle trunk
  3. The posterior division of the inferior trunk
34
Q

What is the medial cord of the brachial plexus formed by?

A
  1. The anterior division of the inferior trunk
35
Q

What are the terminal nerves of the brachial plexus?

A
  1. Musculocutaneous nerve
  2. Axillary nerve
  3. Median nerve
  4. Radial nerve
  5. Ulnar nerve
36
Q

What are the roots of the musculocutaneous nerve?

A

C5, C6 and C7

37
Q

What are the motor innervations of the musculocutaneous nerve?

A

Innervates the:

  1. Brachialis
  2. Biceps brachii
  3. Coracobrachialis
38
Q

What are the motor innervations of the axillary nerve?

A

Innervates the:

  1. Teres minor
  2. Deltoid
39
Q

What are the motor innervations of the median nerve?

A

Innervates the:

  1. Thenar eminence
  2. The two lateral lumbricals assoc with index and middle fingers
  3. Anterior compartment of the forearm
40
Q

What are the motor innervations of the radial nerve?

A

Innervates the:

  1. Triceps brachii
  2. Posterior compartment of forearm
41
Q

What are the motor innervations of the ulnar nerve?

A

Innervates the:

  1. Flexor carpi ulnaris
  2. Medial half of flexor digitorum profunudus
  3. Muscles of hand except thenar eminence and the two lateral lumbricals
42
Q

What are the roots of the axillary nerve?

A

C5 and C6

43
Q

What are the roots of the median nerve?

A

C6 - T1

may also contain fibres from C5 in some individuals

44
Q

What are the roots of the radial nerve?

A

C5 - T1

45
Q

What are the roots of the ulnar nerve?

A

C8 and T1

occasionally C7

46
Q

What are the sensory innervations of the ulnar nerve?

A

Innervates:

1. The anterior and posterior surfaces of the medial one and a half fingers and assoc palm area

47
Q

What are the sensory innervations of the musculocutaneous nerve?

A

Gives off the lateral cutaneous branch of forearm which innervates the:

  1. Lateral half of the anterior forearm
  2. Small lateral portion of the posterior forearm
48
Q

What are the sensory innervations of the radial nerve?

A

Innervates:

  1. The posterior aspect of the arm and forearm
  2. The posterolateral aspect of the hand
49
Q

What are the sensory innervations of the median nerve?

A

Gives off the palmar cutaneous branch which innervates:
1. The lateral part of the palm
Gives off the digital cutaneous branch which innervates:
1. The lateral three and a half fingers on the anterior (palmar) surface of the hand

50
Q

What are the sensory innervations of the axillary nerve?

A

Gives off the superior lateral cutaneous nerve of arm which innervates:
1. The inferior region of the deltoid ‘regimental badge area’

51
Q

Which nerve is damaged in ‘ape thumb’?

A

Median nerve lesion

  • Inability to abduct thumb
  • Damage to thenar eminence
52
Q

Which nerve is damaged in ‘hand of benediction’?

A

Median nerve lesion at the wrist of elbow

  • Cannot flex index and middle finger
  • Damage to lumbricals and flexor digitorum profundus tendons to index and middle finger paralysed
53
Q

Which nerve is damaged in pointing index?

A

Median nerve lesion

54
Q

Which nerve is damaged in ulnar claw hand?

A

Ulnar nerve lesion at the wrist

  • Lumbricals to fourth and fifth digits paralysed
  • Loss of flexion at MCP joint
  • Loss of extension at IP joint
  • Leading to hyperextension of MCP joints by unopposed extensor digitorum
  • Flexion of IP joints by unopposed flexor digitorum profundus and superficialis
55
Q

Which nerve is damaged in wrist drop?

A

Radial nerve lesion

56
Q

What is a dermatome?

A

An area of the skin supplied by sensory nerve fibres from a single spinal nerve (neural level)

  • Arranged as highly ordered slices of skin
  • Spinal nerve root supplies 1 dermatome
  • 1 dermatome receives sensory supply from 1 spinal nerve root
57
Q

What are sensory nerve territories?

A

Sensory divisions of terminal nerves of the brachial plexus supply the skin in territorial domains
[NOT DERMATOMES]

MJM (31 decks)

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