Muscles, Nerves, Arteries, Veins Upper Limb Flashcards
Erb’s Palsy
- C5
* stretching injury of neck usually during difficult delivery
Klumke Paralysis
- C8
- injury to brachial plexus during difficult birth
- usually affects lower arm and hand
Claw Hand
- paralysis of lumbricals due to wrist injury
* deep branch of ulnar n., cannot extend digits 4 and 5
Pope’s Blessing
- compression of median n. at forearm or elbow
* lateral half of FDP not innervated, digits 2 and 3 cannot flex (cannot make a fist)
Dupuyen’s
- John Elway
- gradual thickening and tightening under the skin of the hand
- 4th and 5th fingers
Dorsal scapular n.
- Levator scapulae, rhomboideus major and minor
- deep branch of the transverse cervical artery (dorsal scapular artery)
- C5 root
- injury: compression or entrapment within middle scalene
Long thoracic n.
- serratus anterior
- C5, C6, C7 roots
- injury: axillary lymph node node resection
Suprascapular n.
- supraspinatous, infraspinatous
- suprascapular a. - Nerve passes under suprascapular notch, artery passes over - both go through spinoglenoid note to enter infraspinatous
- superior trunk
- injury: cyst at either the scapular or sphenoglenoid notch
Superior Trunk
•C5 + C6
Middle Trunk
•C7
Inferior Trunk
•C8 + T1
Lateral cord
•anterior of superior and middle trunks
Medial cord
•anterior of inferior trunk
Posterior cord
•posterior of superior, middle and inferior trunks
Lateral pectoral n.
- pectoralis major and minor
- more medially positioned, larger found in deltopectoral triangle, see between pec major and minor (top!)
- lateral cord
Medial pectoral n.
- pectoralis major and minor
- more laterally positioned, pierces pectoralis minor, see between pec major and minor (bottom!)
- medial cord
Upper subscapular n.
- subscapularis
* posterior cord
Middle subscapular n. (Thoracodorsal n.)
- latissimus dorsi
- injury: axillary lymph node resection
- posterior cord
Lower subscapular n.
- subscapularis and teres major
* posterior cord
Medial antebrachial cutaneous n.
- skin of medial forearm
- runs parallel and superficial to the ulnar n., basilic vein
- medial cord
Musculocutaneous n.
- muscles of the anterior arm
- branch: lateral ante brachial cutaneous
- terminal branch of the lateral cord, pierces corachobrachialis to lie on deep surface of biceps brachii
- injury: iatrogenic
- lateral cord
Axillary n.
- deltoideus, teres minor,p arch on skin of superior lateral arm
- posterior circumflex a.
- terminal branch of the posterior cord, dives posteriorly thru the quadrangular space
- injury: poorly positioned injection, fracture at surgical neck of humerus, shoulder dislocation, improper crutch use
- posterior cord
Radial n.
- triceps brachii, posterior forearm, skin of posterior forearm and dorsum of hand
- in the posterior compartment of arm - deep brachial a.
- terminal branch of posterior cord, slips into posterior arm just inferior to the edge of teres major (inferior to the quadrangular space)
- injury: humerus fracture, misuse of crutches, Saturday night palsy
- posterior cord
Median n.
- muscles of anterior forearm- flexor carpi radial is, palmaris longus, pronator teres, flexor digitorum superficialis, 1/2 flexor digitorum profundus, muscles and skin of palm
- brachial a.
- travels along medial aspect of arm but DOES NOT provide branches to arm, dives below the bicipital aponeurosis, passes through carpal tunnel
- injury: supracondylar humeral fracture, carpal tunnel syndrome
- lateral and medial cord
Ulnar n.
- muscles of anterior forearm - flexor carpi ulnaris, 1/2 flexor digitorum profundus, muscles of palm, skin of hand
- ulnar a.
- travels along medial aspect of arm but does NOT provide branches to arm, crosses posterior to the medial epicondyle, does not pass through carpal tunnel
- injury: Claw Hand, Pope’s Blessing, fracture of humeral medial epicondyle, fracture of hamate or pisiform, handlebar palsy
- medial cord
Accessory n.
- trapezius
- superficial branch of the transverse cervical artery
- travels superficial to the levator scapulae and rhomboid muscles and deep to the trapezius, travels from skull to neck and emerges in the posterior triangle
- injury: cervical lymph node resection
- 11th cranial nerve
Lateral antebrachial cutaneous n.
- lateral aspect of forearm into wrist
- emerges from lateral edge of biceps brachii
- musculocutaneous
Anterior interosseous n.
- flexor pollicis longus
- does not pass through carpal tunnel
- median
Palmar n.
- does not pass through carpal tunnel
* median
Recurrent branch n.
- thenar eminence, 2 lumbricals
- injury: vulnerable due to superficial position, loss of function of 2 lumbricals and thenar eminence (ape hand)
- median
Common —> proper branch of median n.
•skin of lateral 3 1/2 digits
Superficial branch of radial n.
•dorsum of hand, lateral 3 1/2 digits
Deep branch of radial n.
- posterior forearm
- splits in forearm, after radial n. travels anterior to lateral epicondyle
- radial
Dorsal branch of ulnar n.
- skin of medial forearm, skin of dorsum, pinkie, 1/2 of ring finger
- does not pass through carpal tunnel, ulnar n. branches in forearm
Superficial branch of ulnar n. —-> common —-> proper
- two muscles and is sensory to the palmar surface of the medial palm, pinkie and 1/2 of the ring finger
- does not pass through carpal tunnel
Deep branch of ulnar n.
- majority of palm muscles
* does not pass through carpal tunnel
Subclavian a.
•major artery of upper thorax
Axillary a.
•subclavian becomes axillary after it enters axilla
Thyrocervical trunk
•branch of subclavian
Transverse cervical a.
- branch off thyrocervical trunk
* superior to suprascapular a.
Superficial branch of transverse cervical a.
- accessory n.
* travels superficial to the levator scapulae and rhomboid muscles and deep to the trapezius
Deep branch of the transverse cervical a.
- dorsal scapular n.
- travels deep to levator scapulae and rhomboideus muscles; not always present, in this case the artery branches directly off the subclavian and is called the dorsal scapular a.
Suprascapular a.
- branch of thyrocervical trunk
- suprascapular n.
- passes above suprascapular notch to get to supraspinatous m. and around spinoglenoid notch to reach infraspinatous m.
- forms anastomotic complex with scapular a. and deep branch of the transverse cervical/dorsal a. which ensures blood supply to the shoulder regardless of position of arm
Thoracoacromial a.
- 1st branch of axillary a.
- medial and lateral pectoral n.
- splits into 4 branches that supply the shoulder area, between medial and lateral pectoral n.
Subscapular a.
- 3rd branch of axillary a.
* splits almost immediately into thoracodorsal a. and circumflex scapular a.
Thoracodorsal a.
- branch of axillary —> subscapular a.
- Thoracodorsal n.
- descends between the serratus anterior and latissimus dorsi