MSK Blood supply and lymphatics of the upper limb Flashcards
Name the arteries in the axilla and state the levels in which the arteries change names
Subclavian arteries - right arises from brachiocephalic trunk and left arises directly off aortic arch
At the lateral edge of 1st rib the subclavian becomes the axillary artery.
The axillary artery passes under pec minor,
At the level of the humeral surgical neck the axillary artery branches into the ant and post circumflex humeral arteries (supply shoulder region) and the subscapular artery.
At the level of the teres major the axillary artery becomes the brachial artery.
Name the arteries in the upper arm and state the levels in which the arteries change names
Immediately the brachial artery gives rise to profunda brachii which runs in the radial groove (supplies posterior upper arm and elbow joint).
The brachial artery descends down the arm immediately posterior to median nerve.
It passes through cubital fossa underneath brachialis and terminates by giving off radial and ulnar arteries.
Name the arteries in the forearm and state the levels in which the arteries change names
The radial artery supplies posterior forearm and the ulnar artery supplies anterior forearm.
The two arteries anastamose in the hand by forming 2 arches - superficial and deep palmar arches.
Name the arteries in the hand and state the levels in which the arteries change names
Ulnar artery moves into hand anteriorly to the flexor retinaculum and lateral to ulnar nerve.
In the hand it divides into superficial and deep palmar branches.
The radial artery enters the hand dorsally crossing the floor of the anatomical snuffbox. It then anastamoses with deep palmar branch to form deep palmar arch.
Deep palmar arch supplies thumb and lateral half of index
Superficial palmar arch supplies medial half of index and the other 3 fingers
What is the consequence of an occlusion or laceration to the brachial artery?
Arm has good anastamotic supply which protects it from temporary occlusion of brachial artery.
If artery completed blocked or severed it is an emergency - ischaemia can cause necrosis and paralysis of forearm muscles. The muscles are partially replaced by short fibrous scar tissue causing flexion - Volkmanns contracture.
What is the consequence of an axillary artery aneurysm?
Rare
Dilates portion of axillary artery can compress the brachial plexus producing paresthesia and muscle weakness.
Treatment is surgical - reconstructing wall using a graft
What are the superficial veins of the upper limb and what is their anatomical course?
- cephalic and basilic, located in subcutaneous tissue and both originate from dorsal network of hand. Connect at the elbow by the medial cubital vein
Basilic vein travels along the medial side. At the teres major it combines with brachial veins to form the axillary vein.
Cephalic vein travels antero-lateral passing anteriorly at the elbow. Travels between the deltoid and pec major and enters axilla. Terminates by joining the axillary vein
What are the deep veins of the upper limb and what is their anatomical course?
Situated under the deep fascia.
Deep veins are paired veins that lie either side of an artery. The brachial veins are the largest and situated either side of the brachial artery (pulsations help venous return).
Veins structured this well are called vena comitantes
Perforating veins connect the deep and superficial veins
What is the best site of venepuncture in the upper limb?
The medial cubital vein - accesible superficial position
What are the superficial lymphatic vessels of the upper limb and what is their anatomical course?
They arise from lymphatic plexuses in the skin of the hand, they then ascend up the arm close to major veins.
The lymphatic vessels shadowing the basilic vein enter the cubital lymph nodes (medial to vein and proximal to medial epicondyle). Vessels carry on from these nodes and terminate in the axillary lymph nodes.
The lymphatic vessels shadowing the cephalic vein cross the proximal part of the arm to enter the apical axillary lymph nodes.
What are the deep lymphatic vessels of the upper limb and what is their anatomical course?
Follow the major deep veins (radial, ulnar, brachial veins), terminating in the humeral axillary lymph nodes. They drain lymph from joint capsules, periosteum, tendons and muscles
What are the lymph nodes of the upper limb?
Majority located in the axilla.
5 groups:
- Pectoral (anterior) 3-4 nodes, receive lymph from thoracic wall and breast
- Subscapular (posterior) 6-7 nodes, receive lymph from posterior thoracic wall and scapular region
- humeral (lateral) 4-6 nodes, posterior to axillary vein and receive lymph from most of upper limb
- central 3-4 large nodes, located at base of axilla, receive lymph from pectoral, subscapular and humeral lymph nodes
- apical, apex of axilla, receive lymph from all lymph node groups
What is the cause of enlarged axillary lymph nodes?
Infection of upper limb, usually red warm and tender streaks visible in upper limb
Infection of pectoral region or breast
Breast cancer
What is the course of action if there is enlargement of axillary lymph nodes due to breast cancer?
Axillary lymph node dissection (removal)
- vital tool for staging breast cancers
- interruption to lymphatic drainage from upper limb can result in lymphoedema (accumulated lymph causing painful swelling)
- risk of damage to long thoracic nerve
