Nerve and Blood Supply of the Upper Limb Flashcards
The blood that supplies the left and right upper limbs originates from which parts of the aortic arch?
1 - left = left subclavian artery, right = brachiocephalic into right subclavian artery
2 - left = brachiocephalic, right = brachiocephalic into right subclavian artery
3 - left = left subclavian artery, right = right subclavian artery
4 - left = left subclavian artery, right = brachiocephalic
1 - left = left subclavian artery, right = brachiocephalic into right subclavian artery
As the subclavian artery travels to the left and right upper limbs it must go past the 1st rib. Does the subclavian artery pass under or over the 1st rib?
- over the 1st rib
As the subclavian artery travels to the left and right upper limbs it must pass over the 1st rib. Which muscle for descriptive purposes divides the subclavian artery into 3 parts?
1 - scalenus anterior muscle
2 - trapezius muscle
3 - sternocleidomastoid muscle
4 - latissimus dorsi muscle
1 - scalenus anterior muscle
Label the 3 parts of the subclavian artery using the labels below that are divided by the scalenus anterior muscle:
- 1st Medial to scalenus anterior muscle
- 2nd Deep to scalenus anterior muscle
- 3rd Lateral to scalenus anterior muscle
1 - 1st Medial to scalenus anterior muscle
2 - 2nd Deep to scalenus anterior muscle
3 - 3rd Lateral to scalenus anterior muscle
After the 3rd part of the subclavian artery, where does the subclavian artery end and what does the artery become that supplies the upper limbs?
1 - ends at clavicle becoming axilla artery
2 - ends at clavicle becoming brachial artery
3 - ends at 1st rib becoming axilla artery
4 - ends at clavicle becoming brachial artery
3 - ends at 1st rib becoming axilla artery
Label the anastomoses of the subclavian vein that contribute to the upper limbs using the labels below:
Brachiocephalic trunk Thyrocervical trunk Vertebral artery Internal thoracic artery Costocervical Trunk Dorsal scapular artery
1 - Dorsal scapular artery 2 - Thyrocervical trunk 3 - Vertebral artery 4 - Brachiocephalic trunk 5 - Costocervical Trunk 6 - Internal thoracic artery
Once the axillary artery leaves the axilla area what does the artery then become?
1 - radial artery
2 - profundus/brachial artery
3 - ulnar artery
4 - brachial plexus
2 - profundus/brachial artery
The axillary artery can be divided into 3 regions based on its location to which muscle?
1 - pectoralis major
2 - teres minor
3 - teres major
4 - pectoralis minor
4 - pectoralis minor
The axillary artery can be divided into 3 regions based on its location to the pectoralis minor muscle. Using the labels below, label the 3 parts of the axillary artery:
- 1st Medial to muscle
- 2nd Behind muscle
- 3rd Lateral to muscle
- 1st Medial to muscle
- 2nd Behind muscle
- 3rd Lateral to muscle
Once the axillary artery leaves the axilla area it becomes the brachial artery. Which muscle generally marks where this artery ends?
1 - teres major muscle
2 - teres minor muscle
3 - pectoralis major
4 - long head of triceps
- teres major muscle
If the surgical neck of the humerus is fractured, which artery is at risk of rupture due to its close proximity?
1 - biracial artery and posterior and anterior circumflex arteries
2 - pectorals artery and posterior and anterior circumflex arteries
3 - axillary artery and posterior and anterior circumflex arteries
4 subscapular artery and posterior and anterior circumflex arteries
3 - axillary artery and posterior and anterior circumflex arteries
The axillary artery once it reaches the teres major then becomes what?
1 - brachial artery that supplies the flexors
2 - pectorals artery that supplies the flexors
3 - brachial artery that supplies the extensors
4 - subscapular artery and posterior supplying the extensors
1 - brachial artery that supplies the flexors
What is the cubital fossa?
- a triangular-shaped depression/pit over the anterior aspect of the elbow joint
- transition between the anatomical arm and the forearm
The brachial artery divides at the cubital fossa (essentially a depression in the elbow) into what 2 terminal blood vessels?
1 - brachioradialis artery (lateral) and ulnar artery (medial)
2 - radial artery (lateral) and ulnar artery (medial)
3 - brachioradialis (lateral) and radial artery (medial)
4 - radial artery (lateral) and brachioradialis (medial)
2 - radial artery (lateral) and ulnar artery (medial)
What is the largest blood vessel that branches off the brachial artery?
1 - Profunda Brachii/ Deep Brachial Artery 2 - Superior Ulnar Collateral Artery 3 - Inferior Ulnar Collateral Artery 4 - Ulnar Artery 5 - Radial Artery
- profunda Brachii/ Deep Brachial Artery
- at radial groove of humeral bone
What is the anatomical part of the humerus where the largest artery, the profunda brachial artery, runs and which nerve is this accompanied by?
1 - bicipital groove accompanied by radial nerve
2 - spiral/radial groove accompanied by radial nerve
3 - crest of lesser tubercle accompanied by ulnar nerve
4 - crest of greater tubercle accompanied by ulnar nerve
2 - spiral/radial groove accompanied by radial nerve
The brachial artery divides at the cubital fossa (essentially a depression in the elbow) into the radial and ulnar arteries. What muscle covers the radial artery?
1 - flexor digitorum superficialis
2 - flexor digitorum profundus
3 - pronator teres
4 - brachioradialis muscle
4 - brachioradialis muscle
The brachial artery divides at the cubital fossa (essentially a depression in the elbow) into the radial and ulnar arteries. The radial artery is covered by the brachioradialis muscle and runs into the hand forming what?
1 - superficial palmer arch
2 - anterior palmer arch
3 - posterior palmer arch
4 - deep palmer arch
4 - deep palmer arch
- provides blood supply to hand
The radial artery passes into the hand through an anatomical muscle space called what?
- anatomical snuff box
The radial artery enters the hand and merges with which other blood vessel to that forms the superficial palmer arch. What is this other blood vessel?
1 - ulnar artery
2 - median artery
3 - interosseus artery
4 - polices artery
1 - ulnar artery
- provides blood supply to hand
The brachial artery divides at the cubital fossa (essentially a depression in the elbow) into the radial and ulnar arteries. The ulnar artery runs medially close to the medial epicondyle and is covered by which muscle of the anterior forearm?
1 - flexor carpi radialis muscle
2 - flexor carpi ulnaris muscle
3 - pronator teres
4 - palmaris longus
2 - flexor carpi ulnaris muscle
The brachial artery divides at the cubital fossa (essentially a depression in the elbow) into the radial and ulnar arteries. The ulnar artery meets with the radial artery to form the deep palmer arch. What else does the ulnar artery go on to form in the hand?
- superficial palmer arch
The brachial artery divides at the cubital fossa (essentially a depression in the elbow) into the radial and ulnar arteries. The ulnar artery meets with the radial artery to form the deep palmer arch and the superficial palmer arch. Which of these is above and below the flexor tendons?
- deep palmer arch = below flexor tendons
- superficial palmer arch = above flexor tendons
What anatomical landmark can we use to identify the start of the superficial palmer arch?
1 - scaphoid bone
2 - little finger when extended
3 - trapezoid bone
4 - thumb when is extended
4 - thumb when is extended
The venous blood draining from the arm drains into one vein near the armpit and then another following this, what are they both called?
1 - basilic and subclavian vein
2 - basilic and axillary vein
3 - axillary and subclavian vein
4 - subclavian and cephalic vein
3 - axillary and subclavian vein
All the deep veins of the upper limbs are paired with arteries. What is the term used to describe this?
- venae comitantes
What are the 2 superficial veins of the forearm that eventually drain into axillary vein?
1 - cephalic and basilic veins
2 - brachial and basilic veins
3 - brachial and cephalic veins
4 - axillary and basilic veins
1 - cephalic and basilic veins
- cephalic = lateral forearm
- basilic = medial forearm
BOTH drain into the axillary vein
The 2 superficial veins of the forearm that eventually drain into axillary vein are the:
1 - cephalic vein in lateral forearm
2 - basilic vein medial forearm
Which vein meets both of these veins at the cubital fossa?
- median cubital vein
- cubital because it is close to the cubital fossa
Label the 3 main lymphatic drainage points in the upper limb using the labels below:
Cubital nodes
Deltopectoral node
Axillary nodes
1 - Deltopectoral node
2 - Axillary nodes
3 - Cubital nodes
Label the main lymph node drainage of the upper limbs using the labels below:
Pectoral (anterior) nodes Subscapular (posterior) nodes Humeral (lateral) nodes Central nodes Apical nodes Interpectoral (Rotter’s) nodes & Parasternal nodes
1 - Humeral (lateral) nodes 2 - Subscapular (posterior) nodes 3 - Pectoral (anterior) nodes 4 - Apical nodes 5 - Central nodes 6 - Interpectoral
A nerve plexus is an intersection of nerves. Label the regions of the brachial plexus using the labels below:
- roots
- trunks
- terminal branches
- cords
- division
1 - roots 2 - trunks (3 of them) 3 - division 4 - cords (3 of them) 5 - branches (terminal)
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What nerve roots supply the brachial plexus?
- C5-C8 and T1
- called ventral rami
There are 2 important nerves that we need to be aware of that leave the roots of the brachial plexus?
1 - long thoracic nerve and brachial nerve
2 - dorsal scapular nerve and medial pectoral nerve
3 - dorsal scapular nerve and supracircular nerve
4 - long thoracic nerve and dorsal scapular nerve
4 - long thoracic nerve and dorsal scapular nerve
There are 2 important nerves that we need to be aware of that leave the roots of the brachial plexus called the long thoracic nerve and dorsal scapular nerve. What is the clinical importance of the long thoracic nerve?
- innervates the serratus anterior muscle (forms from C5-T1)
- serratus anterior muscle pull scapula against the rib cage
- if the nerve is damaged the scapula protrudes when pushing the arm
There are 2 important nerves that we need to be aware of that leave the roots of the brachial plexus called the long thoracic nerve and dorsal scapular nerve. What is the clinical importance of the dorsal scapular nerve?
We can use Life Runs Rings mnemonic to help with this
- originates from C5 and innervates the rhomboids and levator scapulae
- Life Runs Rings = Levator scapulae, Runs = Rhomboid Minor and Rings = Rhomboid Major
Once the nerve roots leave the spine they become the nerve trunks. What are the 3 divisions and which nerve roots do they originate from?
- superior = C5 and C6
- middle = C7
- inferior = C8 and T1
Once the nerve roots leave the spine they become the nerve trunks. There are 3 divisions:
- superior = C5 and C6
- middle = C7
- inferior = C8 and T1
The trunk part of the brachial plexus is covered by which muscle?
- scalene muscle
Once the nerve roots leave the spine they become the nerve trunks. There are 3 divisions which are covered by the scalene triangle:
- superior = C5 and C6
- middle = C7
- inferior = C8 and T1
The next region of the brachial plexus is called the divisions and forms from each of the trunks. What are the 2 categories of divisions and why are they given this name?
- anterior = forms lateral and medial cords
- posterior = forms posterior cord
The divisions of the brachial plexus will then continue and form the cords of the brachial plexus, making 3 categories. These cords are given their names base on their location relative to the axillary artery. What are the 3 names?
1 - inferior, superior, medial
2 - lateral, medial, posterior
3 - inferior, superior and lateral
4 - lateral, medial, superior
2 - lateral, medial, posterior
- lateral to axillary artery
- medial to axillary artery
- posterior to axillary artery
The divisions of the brachial plexus will then continue and form the cords of the brachial plexus, making 3 categories:
1 - lateral
2 - medial
3 - posterior
In relation to the upper limbs where can the cords be located?
1 - axilla and deltoid
2 - axilla and triceps
3 - axilla and pectoralis minor
4 - axilla and pectoralis major
3 - axilla and pectoralis minor
The lateral cord of the brachial plexus will go on to form 3 key nerves, which nerves are those?
1 - Musculocutaneous, radial and pectoral nerve
2 - Axillary, median and cutaneous nerves
3 - Musculocutaneous, median and cutaneous nerve
4 - Axillary, musculocutaneous and cutaneous nerve
3 - Musculocutaneous, median and cutaneous nerve
The musculocutaneous nerve originates from nerve roots C5-C7 and eventually from the lateral cord of the brachial plexus. What motor and sensory information does this provide?
1 - motor = triceps and sensory = lateral forearm
2 - motor = biceps and sensory = lateral forearm
3 - motor = deltoids and sensory = lateral forearm
4 - motor = pectoralis minor and sensory = lateral forearm
2 - motor = biceps and sensory = lateral forearm
The medial cord of the brachial plexus will go on to form 5 key nerves, which nerves are those?
1 - Musculocutaneous, radial, pectoral, ulnar and cutaneous nerve
2 - Medial pectoral, median, cutaneous arm, cutaneous forearm and ulnar nerves
3 - Medial pectoral, median, brachial, ulnar and cutaneous nerve
4 - Axillary, musculocutaneous, pectoral median, ulnar and cutaneous nerve
2 - Medial pectoral, median, cutaneous arm, cutaneous forearm and ulnar nerves
The median nerve originates from nerve roots C5 to T1 and eventually from the medial cord of the brachial plexus. What motor and sensory information does this provide?
1 - motor = anterior forearm and lateral hand, sensory = lateral palm hand, d1, 2, 3 + half d4
2 - motor = posterior forearm and lateral hand, sensory = lateral palm hand, d1, 2, 3 + half d4
1 - motor = anterior forearm and lateral hand, sensory = all of lateral palm hand
1 - motor = posterior forearm and lateral hand, sensory = all of lateral palm hand
1 - motor = anterior forearm and lateral hand, sensory = lateral palm hand, d1, 2, 3 + half d4
The ulnar nerve, also referred to as the musicians nerve originates from nerve roots C8 and T1 and eventually from the medial cord of the brachial plexus. What motor and sensory information does this provide?
1 - motor = lateral side anterior forearm and hand, sensory = palmer and dorsal lateral hand + half d4 + d5
2 - motor = medial side anterior forearm and hand, sensory = palmer and dorsal lateral hand + half d4 + d5
3 - motor = lateral side anterior forearm and hand, sensory = palmer and dorsal medial hand + half d4 + d5
4 - motor = medial side anterior forearm and hand, sensory = palmer and dorsal medial hand + half d4 + d5
4 - motor = medial side anterior forearm and hand, sensory = palmer and dorsal medial hand + half d4 + d5
Which is the largest cord of the brachial plexus?
- posterior cord
- all 3 divisions have branches that form this cord, hence why its the largest
The posterior cord of the brachial plexus will go on to form 4 key nerves, which nerves are those?
1 - Subscapular, radial, axillary and thoracodorsal nerve
2 - Medial pectoral, subscapular, median and ulnar nerves
3 - Medial pectoral, sub-scapular, brachial and radial nerves
4 - Axillary, subscapular, ulnar and cutaneous nerves
1 - Subscapular, radial, axillary and thoracodorsal nerve
The axillary nerve originates from nerve roots C5 and C6 and eventually from the largest cord, the posterior cord of the brachial plexus. What motor and sensory information does this provide?
1 - motor = deltoid and teres minor, sensory = badge area of arm
2 - motor = biceps and triceps minor, sensory = badge area of arm
3 - motor = deltoid and teres minor, sensory = lateral arm
4 - motor = pectoralis minor, sensory = badge area of arm
1 - motor = deltoid and teres minor, sensory = badge area of arm
The axillary nerve passes through a space to be able to innervate the posterior deltoid and teres minor. What is this space called?
1 - foreman ovalis
2 - Popliteal fossa
3 - Caudate fossa
4 - Quadrangular space
4 - Quadrangular space
The radial nerve, the largest nerve of the posterior cord, originates from nerve roots C5 to T1 and eventually from the largest cord, the posterior cord of the brachial plexus. What motor and sensory information does this provide?
1 - motor = posterior arm and posterior forearm, sensory = anterior arm and posterior forearm + lateral dorsum hand
2 - motor = anterior arm and posterior forearm, sensory = anterior arm and posterior forearm + lateral dorsum hand
3 - motor = posterior forearm, sensory = posterior arm and posterior forearm + lateral dorsum hand
4 - motor = posterior arm and posterior forearm, sensory = posterior arm and posterior forearm + lateral dorsum hand
4 - motor = posterior arm and posterior forearm, sensory = posterior arm and posterior forearm + lateral dorsum hand
What does cutaneous innervation mean?
- cutaneous refers to the skin
- a specific nerve that supplies a particular part of the skin
What is the difference between cutaneous innervation and the dermatome?
- both relate to the skin
- cutaneous = individual nerve for individual part of skin
- dermatome = individual nerve root for individual part of the skin
Which nerve root plays the main role in shoulder (deltoid) abduction?
1 - C5
2 - C6
3 - C7
4 - C8
1 - C5
Which nerve root plays the main role in forearm flexion?
1 - C5
2 - C6
3 - C7
4 - C8
2 - C6
Which nerve root plays the main role in forearm extensors (triceps) and wrist flexors/extensors?
1 - C5
2 - C6
3 - C7
4 - C8
3 - C7
Which nerve root plays the main role in digit flexors/extensors?
1 - C5
2 - C6
3 - C7
4 - C8
4 - C8
Which nerve root plays the main role in intrinsic hand muscles?
1 - C5
2 - C6
3 - C7
4 - T1
4 - T1
Which nerve roots make up the upper trunk of the brachial plexus?
1 - C5 and C6
2 - C6 and C7
3 - C7 and C8
4 - C8 and T1
1 - C5 and C6
Which nerve roots make up the middle trunk of the brachial plexus?
1 - C5
2 - C6
3 - C7
4 - C8
3 - C7
Which nerve roots make up the lower trunk of the brachial plexus?
1 - C5 and C6
2 - C6 and C7
3 - C7 and C8
4 - C8 and T1
4 - C8 and T1
When looking at the brachial plexus, each trunk divides into how many divisions?
1 - 2
2 - 2
3 - 3
4 - 4
2 - 2
- each divides into anterior and posterior
- this relates to where the division goes not what it innervates (so front or back of the body)
The mnemonic Lucy Loves Me can be used to identify the major branches from the lateral cord. What are they using the mnemonic here?
- Lucy = Lateral Pectoral Nerve
- Loves = Lateral Root of Median Nerve
- Me = Musculocutaneous Nerve
The mnemonic Most Medical Men Use Morphine can be used to identify the major branches from the medial cord. What are they using the mnemonic here?
- Most = Medial pectoral nerve
- Medical = Medial cutaneous nerve or arm
- Men = Medial cutaneous nerve of forearm
- Use = Ulnar nerve
- Morphine = Medial root of median nerve
The mnemonic ULTRA can be used to identify the major branches from the posterior cord. What are they using the mnemonic here?
- U = Upper subscapular nerve
- L = Lower subscapular nerve
- T = Thoracodorsal nerve
- R = Radial nerve
- A = Axillary nerve
Most Alcoholics Must Really Urinate is a mnemonic that can be used to identify the 5 major terminal branches of the brachial plexus. Using the mnemonic what nerve are these?
- Most = Musculocutaneous Nerve
- Alcoholics = Axillary Nerve
- Must = Median Nerve
- Really = Radial Nerve
- Urinate = Ulnar Nerve
