L9 Flashcards
What is the origin of the subclavian artery?
- RHS Brachiocephalic artery
- LHS origin arch of the aorta
What is the course of the subclavian artery?
→ (P) to sternoclavicular joint → (P) to scalenus anterior muscle → over lung apex on suprapleural membrane → over 1st rib → Axillary artery
What are the three parts of the subclavian artery?
- Medial
- Behind
- Lateral in relation to scalenus anterior
What are the branches of the subclavian artery?
- Vertebral
- Internal thoracic
- Thyrocervical trunk in the root of the neck (M) to Scalenus anterior.
- Costo-cervical trunk
Where do the highest intercostal and deep cervical arteries arise
from?
From behind scalenus anterior
What is the origin of the axillary artery?
From subclavian artery at outer border of 1st rib
What is the end of the axillary artery?
Lower border of teres major - brachial artery
What are the three parts of the axillary artery?
- Pectoralis minor 1st: (S) thoracic artery
- 2nd: Thoracoacromial & (L) thoracic artery
- 3rd: (A) & (P) circumflex humeral and subscapular artery
Scapular anastomosis of the axillary artery
1st part of subclavian artery to brs. 3rd part of axillary artery
What is the origin of the brachial artery?
From axillary artery at lower border of teres major
What are the branches of the brachial artery?
- Profunda brachii artery
- Superior / inferior ulna
- Collaterals nutrient artery of humerus muscular and articularc branches
What is the course of the brachial artery?
Lower border of teres major - ventral surface of the arm - the cubital fossa. Then divides into its terminal branches: the radial and ulnar arteries of the forearm.
What is the origin of radial artery?
Terminal branch of brachial artery at apex of cubital fossa
What is the course of radial artery?
Anterior forearm → deep to brachioradialis close to radial forearm muscles → lower forearm on anterior radius → (L) aspect of wrist → floor of anatomical snuffbox → 1st web space → 2 heads of 1ST dorsal interosseous → 2 heads adductor policis
Where is the radial artery palpated?
At lower forearm on anterior radius
Where does the radial artery end?
At the deep palmar arch artery
What are the branches of the radial artery?
- Radial recurrent artery.
- Palmar carpal branch.
- Dorsal carpal branch.
- Muscular branches.
- Superficial palmar branch.
What is the origin of the ulna artery?
Terminal branch of the brachial artery in cubital fossa along with radial A3
What is the course of the ulna artery?
Deep to CFO muscles → then deep to flexor carpi ulnaris with ulnar nerve on medial side → anterior forearm → lying on FDP → crosses anterior to wrist between flexor digitorum profundus and flexor carpi ulnaris tendons → lateral side of pisiform
What does the ulnar artery end as?
As superficial palmar arch artery
What are the branches of the ulnar artery?
- Common interosseous artery
- Anterior interosseous artery
- Posterior interosseous artery
Describe the anterior interosseous artery
- Lies on interosseous membrane between flexor digitorum profundus and flexor pollicis longus → perforating branches supply deep extensors gives nutrient branches to radius / ulna at upper border of pronator quadratus → posterior
compartment
Describe the posterior interosseous artery
- Smaller vessel from ulnar artery /common interosseous artery
between oblique cord and interosseous membrane → with
posterior interosseous nerve / supplies deep extensors ends at
back of wrist → dorsal carpal anastamosis
Give details of scapular arterial anastomosis
Between branches of the 1st part of the subclavian artery with 3rd part of axillary artery
Give details of arterial anastomosis at the elbow joint
Recurrent branches of radial, ulnar and interosseous artery passing up anteriorly and posteriorly to elbow → anastomose with descending branches of posterior brachial artery and superior and inferior ulnar collateral branches of brachial artery.
Give details of arterial anastomosis at the wrist joint
Dorsal and palmar carpal branches of radial and ulnar arteries above the wrist joint freely anastomose.
Give details of arterial anastomosis at the deep and superficial palmar
Radial and ulna arteries giving their deep and
superficial arch arteries eventually unite with one another
Give the organisation of venous drainage
Organised into deep and superficial systems.
Give the perforating vessels of the venous drainage.
Pass venous blood to deep veins which accompany arteries. Important perforators at the mid medial biceps (basilic vein) and in cubital fossa (median cubital vein)
Give the venous drainage of the arm
Similarly named vessels to arteries in the drain proximally to axillary vein.
Give the venous drainage of the forearm
Distal to the elbow main
arteries have venae commitantes a dual set of veins in close proximity.
Give clinical importance of venous drainage
Superficial veins of the
upper limb are very important sites for IV access for drug delivery and fluid and blood replacement. NB cephalic vein and pacing wires
Why are artery and veins proximal to eachother?
To pump venous blood back to heart
What is the function of superficial lymph vessels?
To drain the skin
Give details of superficial lymphatic drainage.
- Medial vessels drain with basilic vein to epitrochlear and axillary nodes.
- Lateral vessels drain with cephalic vein to infraclavicular and
axillary nodes
Give details of deep lymphatic drainage
They drain with
arteries to lateral axillary nodes
Where do epitrochlear nodes lie?
At medial elbow
What are the 5 groups of axillary nodes?
- Pectoral
- Lateral
- Central
- Apical
- Infraclavicular
What do pectoral nodes drain?
Lateral and anterior chest wall, breast ad anterior abdominal wall
Where do lateral axillary nodes receive efferents from?
From upper limb
What does the subscapular node drain?
The back of the trunk
Where is the central axillary node situated?
Around axillary vessels
Give details of the apical axillary node.
Receive from other groups, blockage →
lymphoedema
Where are the infraclavicular nodes present?
They lie around end of cephalic vein → apical group
Cephalic vein details
Pierces the clavipectoral fascia at upper end of the deltopectoral groove to enter axillary vein
Where is the radial artery pulse?
Lateral to the tendon of flexor carpi radialis
What is the course of the basilic vein
Pierces the fascia in the medial mid arm to jon the venae commitantes which together, at the inferior border of teres major, become the axillary vein
Where is the brachia; artery pulse?
In the cubital fossa, lateral to the median nerve
What should be performed before taking an arterial sample?
An Allen test
What are the steps in the Allen test?
- Patient clenches fist
- Use finger to obstruct blow flow at ulnar and radial arteries
- Release the ulnar artery - if hand flushes - good blood flow, if not bad blood flow
What is the radial artery used for?
Radial cannulation
