L2 - Nerve & blood supply upper limb Flashcards
SUBCLAVIAN ARTERY - LOCATION
i) what does it supply? where does the right subclavian branch from?
ii) where does the left subclavian come from? which rib does it pass under to enter the limb? which structure does it pass through?
iii) which muscle divides it into three parts? where does each part sit in relation to the muscle?
iv) label diagram
v) where does the SC end? what does it then become?
i) supplies the upper limb and branches from right SC from the braciocephalic trunk
ii) left SC from aorta > passes under 1st rib > through scalene triangle
iii) SC divided into three parts by scalenus anterior muscle
- 1st part medial to muscle, 2nd part behind muscle
3rd part lateral to muscle
iv) A = RCC, B = R SC, C = BC trunk, D = LCC, E = LSC,
F = scalenus anterior
v) ends when it crosses the first rib and becomes axillary artery
SUBCLAVIAN ARTERY BRANCHES
i) where does the right subclavian branch from?
ii) which artery branches first from the 1st part of the SC? where does this artery go to?
iii) which three arteries branch from the thyrocervical trunk? which part of the subclavian does this come from?
iv) which artery branches from the 2nd/3rd part of subclavian?
v) name two arteries that branch from the subclavian and contribute to the scapula anatomosis
i) the brachiocephalic trunk
ii) vertebral artery > head
iii) thyrocervical trunk = thyroid, cervical and suprascapula artery (comes from 1st part SC)
iv) dorsal scapular artery branches from 2nd/3rd part SC
v) dorsal scapular and supra scapula > scapula anatomoses
LABEL DIAGRAM - BRANCHES OF SUBVCLAVIAN
A - braciocephalic trunk
B - vertebral artery
C - thyrocervical trunk
D - dorsal scapular artery
AXILLARY ARTERY
i) which muscle divides it into three parts? where does each part sit in relation to the muscle?
ii) which nerve plexus are the first and second parts closely associated to?
iii) where does it end? what does it become after this point?
iv) label A and B - what is the relevance of each of these muscles?
i) pectoralis minor
- 1st part medial to musc, 2nd part behind musc, 3rd part lateral
ii) close to brachial plexus
iii) ends at the lower border of the teres major
iv) A = pec minor (divides axil artery to three parts)
B = teres major (where axil becomes brachial)
BRANCHES OF AXILLARY ARTERY
i) where does the branch from first and second part of axillary artery go to?
ii) which part of the axillary artery does the subscapular artery come from? where does this go to?
iii) which two arteries circle round the surgical neck of the humerus? what injury can cause trauma to these?
iv) label diagram
i) first part > thorax
second part > axillary region
ii) subscapular artery comes from 3rd part axillary artery
- contributes to scapular anatomosis
iii) anterior and posterior circumflex humeral arteries circle surgical neck of the humerus
- fracture of humerus can cause trauma to these
iv) A - subscapular artery
B - anterior posterior circumflex
C - surgical neck of humerus
BRACHIAL ARTERY
i) what muscle does the axillary artery cross to become the brachial?
ii) which side of the arm does it pass down? which nerve does it run in a nerve bundle with?
iii) which group of muscles does it supply? give three examples
iv) which artery is a large branch off the brachial? where does this artery pass and what does it supply?
v) which anatomical area does the brachial artery divide in? which two arteries does it become?
i) axillary passes the teres major and becomes brachial
ii) passes superficially down the medial side of the arm
- runs in a bundle with the median nerve
iii) supplies flexors eg brachialis, coracobracialis and biceps
iv) branch of bracial > profunda brachii artery
- passes in the spiral/radial groove to supply extensors
v) brachial artery divides in the cubital fossa to ulna and radial artery
BRACHIAL ARTERY BRANCHES
i) where does the profunda brachii run? what does it contribute to?
ii) which tissue seperates flexors and extensors?
iii) what does the brachial bifurcate into a) medially and b) laterally in the cubital fossa?
iv) label the US - is this taken above or below cubital fossa?
i) runs in the spiral/radial groove
- contributes to anastomosis around elbow
ii) medial septa is a fascial plane that seperates flex and extens
iii) brachial > ulna medially and radial artery laterally
iv) A - bicep short head, B - bicep long head, C - brachialis,
D - humerus, E - brachial artery, F - median nerve
PROFUNDA BRACHII ARTERY
i) which nerve does it accompany in the spiral groove?
ii) what forms the spiral groove?(2)
iii) fracture to which bone can cause trauma to the profunda brachii? what muscle would this affect blood supply to?
iv) label diagram
v) which nerve and artery runs through the quadrangular space?
i) accompnies radial nerve in spiral groove
ii) lateral and medial head of triceps
iii) fracture to humerus can affect PB artery which would affect blood supply to the triceps
iv) A - posterior circumflex humeral artery, B - PB artery,
C - radial nerve, D - quadrangular space
v) axillary nerve and post circumflex humeral artery
RADIAL ARTERY
i) which side of the forearm does it run down?
ii) which muscle covers it?
iii) what does it form when it reaches the hand? what does this run deep to? what muscle does it pierce to do this?
iv) what structure does it pass through in the hand?
v) what does it eventually anastomose with?
vi) name structures A,B,C
i) lateral side
ii) covered by brachioradialis
iii) forms deep palmar arch when it reaches the hand which runs deep to the flexor tendons
- pierces the first interosseus muscle to get there
iv) passes through anatomical snuff box
v) eventually anastomoses with the ulna artery
vi) A - brachioradialis, B - first interosseus muscle, C - deep palmar arch
ULNAR ARTERY
i) which side of the forearm does it run down? which muscle covers it?
ii) which artery runs off as a deep branch?
iii) what does it form in the hand? what is this found above? what does it eventually anastomose with?
iv) which arteries branch off and supply the fingers?
v) label diagram
i) runs down the medial side of the forearm - covered by flexor carpi ulnaris
ii) deep branch = common interosseus artery
iii) forms the superficial palmar arch in the hand - found above the flexor tendoms > eventually anastomoses with the radial artery
iv) palmer digital arteries
v) A - ulnar artery, B - branch to deep palmar arch, C - superficial palmar arch, D - palmar digital arteries
VENOUS RETURN
i) which vein do all veins in the upper limb drain to? what large vessel does this then drain into?
ii) what two types of veins are found deep?
iii) name two superficial veins? which runs medial and which runs lateral in the arm? what do they arise from?
i) all veins drain into the axillary vein > subclavian vein
ii) deep veins = paired veins and venae comitantes
iii) superficial = cephalic (lateral forearm)
- basilic (medial forearm)
> arise from the dorsal venous arch in the back of the hand
SUPERFICIAL VEINS
i) name the two superficial veins and what they drain into?
ii) which one runs in the deltopectoral groove? which two muscles is this groove between?
iii) which one pierces the fascia of the upper arm?
iv) label diagrams
i) basilic and cephalic > axillary vein
ii) cephalic runs in DP groove - between deltoid and pec major
iii) basilic pierces fascia of upper arm
iv) A - basilic, B - cephalic, C - dorsal venous arch, D - medial cubital vein
LYMPHATIC DRAINAGE
i) are there lots or few LNs in the upper limb?
ii) what nodes do they all drain to? which vein are these close to?
iii) label diagram
i) few LNs in upper limb
ii) all drain into axillary nodes
- close to axillary vein
iii) A - deltopectoral node, B - axillary nodes, C - cubital nodes
BRACHIAL PLEXUS
i) what does it innervate?
ii) which spinal nerves is it formed from? (5)
iii) what three types of axons does it carry
iv) what is a mixed nerve? what are these important for?
v) what five things is it divided into?
i) innervates all structures in the upper limb
ii) formed from C5,6,7,8,T1
iii) carries motor, sensory and autonomic sympathetic
iv) mixed nerve = contain axons from multiple spinal nerves
- important to supply large muscle groups in the upper limb
v) divided into roots, trunks, divisions, cords, branches
= mixed nerves
ROOTS
i) what are they? which spinal levels do they come from?
ii) name a nerve that branches off from C5 root?
iii) which foramen do the nerves pass through?
iv) name a nerve that branches off rom C5/6/7
i) ventral primary rami of C5-T1
- come from C5,6,7,8,T1
ii) dorsal scapular nerve (to rhomboids and lev scap) branches from C5
iii) nerves pass through the intervertebral foramen
iv) C5,6,7 - long thoracic nerve > serratus anterior
MOTOR INNERVATION
i) what do motor axons within each root innervate? what is this known as?
ii) name what is innervated by C5,6,7,8,T1
iii) which level of the spinal cord do motor axons come from to allow movements A-E?
i) motor axons in each root innervate a different functional group of muscles = myotome
ii) C5 - deltoid, C6 - forearm flextors (biceps), C7 forearm extensors (triceps), wrist flexors and extensors, C8 - digit flexors/extensors, T1 - intrinsic hand muscles
iii) A - arm abduc = C5
B - forearm flexion = C6, forearm extension = C7
C - wrist flex/extend = C7
D - digit flex/extend = C8
E - fingers ab/adduct = T1
CORDS
i) which two cords come from the anterior division?
ii) which cord comes from the posterior division?
iii) which muscle do the cords sit under?
iv) what are they named in relation to?
v) label diagram
i) lateral and medial cords come from ant division
ii) posterior cord comes from the post division
iii) cords sit under the pec minor
iv) named in relation to the axillary artery
v) A - axillary artery, B - lateral cord, C - medial cord, D - median nerve
LATERAL CORD
i) what two nerves does it terminate as?
ii) name a nerve that comes off the lateral cord? what muscle does it innervate?
iii) label diagram
i) terminates as musculocutaneous nerve and lateral part of median nerve
ii) lateral pectoral nerve comes off lateral cord > pectoralis muscles
iii) A - musculocutaneous
B - lateral part of median nerve
C - lateral pectoral nerve
MUSCULOCUTANEOUS NERVE
i) what area of the arm does it supply? name three muscles
ii) which cord does it branch from?
iii) what does it become when it reaches the forearm? what side does it run down?
iv) what is it motor to? what is it sensory to?
v) label diagram
i) supplies anterior compartment of the arm eg coracobrachialis, biceps and brachialis
ii) branches from lateral cord
iii) becomes lateral cutaneous nerve in the forearm and runs down the lateral side
iv) motor to the anterior arm and sensory to the lateral forearm
v) A - biceps, B - coracobrachialis, C - lateral cutaneous nerve to forearm, D - MC nerve
MEDIAL CORD
i) what does two nerves does it terminate as?
ii) name two nerves that branch off it?
iii) label diagram
i) median part of the median nerve and the ulnar nerve
ii) cutaneous nerves > skin of forearm and medial pectoral nerve
iii) A - medial part of the median nerve
B - ulnar nerve
POSTERIOR CORD
i) which two nerves does it terminate as?
ii) what area does it innervate?
iii) label diagram
i) terminates as radial and axillary
ii) innervates posterior axilla
iii) A - radial, B - axillary
RADIAL NERVE
i) what compartment of the arm does it innervate? what groove does it pass in?
ii) what does the deep branch innervate? what does the superficial branch innervate?
iii) which muscle does it enter the forearm from under?
iv) what is it motor to? what is it sensory to?
v) label diagram
i) innervates extensor compartment and passes in the spiral groove of the humerus
ii) deep branch innervates the extensors of the forearm
- superficial branch travels to the hand and innervates the lateral aspect skin
iii) enters the forearm from under the brachioradialis
iv) motor to posterior arm and forearm
sensory to posterior arm, forearm and lateral dorsum of the hand
v) A - radial nerve, B - spiral groove of humerus, C - triceps,
D - supinator muscle, E - deep branch, F - superficial branch
TERMINAL BRANCHES
i) label the diagram
A - musculocutaneous, B - axillary, C - medial, D - radial, E - ulna nerve
CUTANEOUS INNERVATION BY TERMINAL BRANCHES
i) is it the same or different to the dermatome map?
ii) what do terminal branches contain?
iii) what does altered sensation in one of these areas indicate?
iv) label diagram
i) different - reflects mixed nerves
ii) TBs contain axons from multiple spinal nerves
iii) altered sensation > damage to a more distal nerve segment
iv) A - axillary, B - radial, C - medial cutaneous, D - musculocutaneous, E - median, F - ulna
