Nerve and Blood Supply to the Upper Limb

Question 1

The surgical neck of the humerus is at risk of …, and if this happens, it can cause trauma to which arteries?

Answer 1

The surgical neck of the humerus is at risk of fracture, and if this happens, it can cause trauma to the anterior/posterior circumflex humeral arteries

Question 2

Brachial artery

• The brachial artery is a continuation of the axillary artery past the lower border of the … major.
• It is the main supply of blood for the arm.
• Supplies … muscles (biceps brachii, coracobrachialis, brachialis muscle in … compartments)
• Immediately distal to the teres major, the brachial artery gives rise to the … brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the … aspect of the upper arm (…, e.g. triceps brachii).
  
  • It terminates by contributing to an … network around the elbow joint.
• The brachial artery proper descends down the arm. As it moves through the … fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the … and … arteries.​

Answer 2

• The brachial artery is a continuation of the axillary artery past the lower border of the teres major.
• It is the main supply of blood for the arm.
• Supplies flexor muscles (biceps brachii, coracobrachialis, brachialis muscle in anterior compartments)
• Immediately distal to the teres major, the brachial artery gives rise to the profunda brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the posterior aspect of the upper arm (extensors, e.g. triceps brachii).
  
  • It terminates by contributing to an anastomotic network around the elbow joint.
• The brachial artery proper descends down the arm. As it moves through the cubital fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the radial and ulnar arteries.​

Question 3

Motor Functions of the Median Nerve

• Innervates the … and … muscles in the … compartment of the forearm (except the flexor carpi ulnaris and medial 2 bellies of the flexor digitorum profundus, innervated by the ulnar nerve). Also supplies innervation to the thenar muscles and lateral two lumbricals in the hand (lateral hand)

Answer 3

• Innervates the flexor and pronator muscles in the anterior compartment of the forearm (except the flexor carpi ulnaris and medial 2 bellies of the flexor digitorum profundus, innervated by the ulnar nerve). Also supplies innervation to the thenar muscles and lateral two lumbricals in the hand (lateral hand)

Question 4

Motor innervation - (Brachial Plexus roots)

• Motor axons within each root innervate a different functional group of muscles (myotomes)
  
  • C5 Motor root innervate Arm abductor (the …)
  • C6 innervate Forearm flexors (the …)
  • C7 innervate Forearm extensors (the …) and Wrist flexors/extensors
  • C8 innervate … flexors/extensors
  • T1 innervate … hand muscles

Answer 4

• Motor axons within each root innervate a different functional group of muscles (myotomes)
  
  • C5 Motor root innervate Arm abductor (Deltoid)
  • C6 innervate Forearm flexors (Biceps)
  • C7 innervate Forearm extensors (Triceps) and Wrist flexors/extensors
  • C8 innervate Digit flexors/extensors
  • T1 innervate Intrinsic hand muscles

Question 5

Lateral cord of the Brachial Plexus

• Terminates as … nerve and lateral part of … nerve

Answer 5

• Terminates as musculocutaneous nerve and lateral part of median nerve

Question 6

Cutaneous innervation by terminal branches

• Map looks different to … map
• Terminal branches contain axons from … spinal nerve

Answer 6

• Map looks different to dermatome map
• Terminal branches contain axons from multiple spinal nerve

Question 7

What artery supplies the upper limb?

Answer 7

Subclavian artery supplies the upper limb

Question 8

The axillary artery ends at the lower border of … major

Answer 8

teres major

Question 9

The map shows the cutaenous innervation by terminal branches - match the colour to a nerve

• Grey =
• Pink =
• Green =
• Purple = (from the … cord)
• Blue =
• Yellow =

Answer 9

• Grey = axillary
• Pink = radial
• Green = musculocutaneous
• Purple = medial cutaneous (from the medial cord)
• Blue = ulnar
• Yellow = median

Question 10

Muculocutaenous nerve

• The musculocutaneous nerve is the terminal branch of the … cord of the brachial plexus and emerges at the inferior border of pectoralis minor muscle
• It pierces the … muscle near its point of insertion on the humerus. It gives a branch to this muscle.
• The musculocutaneous nerve then passes down the flexor compartment of the upper arm, superficial to … but deep to the … … muscle.
  
  • It innervates both these muscles and gives articular branches to the humerus and the elbow.
• The nerve continues into the forearm as the lateral … nerve and provides sensory innervation to the lateral aspect of the forearm.

Answer 10

• The musculocutaneous nerve is the terminal branch of the lateral cord of the brachial plexus (C5, C6 and C7) and emerges at the inferior border of pectoralis minor muscle
• It pierces the coracobrachialis muscle near its point of insertion on the humerus. It gives a branch to this muscle.
• The musculocutaneous nerve then passes down the flexor compartment of the upper arm, superficial to brachialis but deep to the biceps brachii muscle.
  
  • It innervates both these muscles and gives articular branches to the humerus and the elbow.
• The nerve continues into the forearm as the lateral cutaneous nerve and provides sensory innervation to the lateral aspect of the forearm.

Question 11

Sensory Functions of the Axillary Nerve

• Gives rise to the upper lateral cutaneous nerve of arm, which innervates the skin over the lower deltoid (‘regimental … area’).

Answer 11

• Gives rise to the upper lateral cutaneous nerve of arm, which innervates the skin over the lower deltoid (‘regimental badge area’).

Question 12

Cephalic and basilic veins drain into what vein?

Answer 12

Cephalic and basilic veins drain into axillary vein

Question 13

C… Motor Axon innervates Arm abductor (Deltoid)

Answer 13

C5 Motor Axon innervate Arm abductor (Deltoid)

Question 14

The brachial artery gives rise to the … brachii

Answer 14

The brachial artery gives rise to the profunda brachii

Question 15

Medial Cord of the Brachial Plexus

• The medial cord is formed by:
  
  • The anterior division of the … trunk.

Answer 15

• The medial cord is formed by:
  
  • The anterior division of the inferior trunk.

Question 16

The axillary artery can be divided into three parts based on its position relative to the … … muscle

Answer 16

The axillary artery can be divided into three parts based on its position relative to the pectoralis minor muscle

Question 17

These are the 5 … branches

Answer 17

These are the 5 terminal branches

Question 18

The median nerve is derived from the … and … … of the brachial plexus

Answer 18

The median nerve is derived from the medial and lateral cords of the brachial plexus

Question 19

Axillary Nerve

• Axillary nerve goes through the … space (teres minor above, teres major below, long head of tricep, shaft of humerus)
• Also passing through this space with the axillary nerve is the posterior … humeral artery which weaves around surgical neck
• Supplies … muscle and the teres … muscle as it’s passing through
• Also supples region of skin on lateral aspect of arm - military … area of arm

Answer 19

• Axillary nerve goes through the quadrangular space (teres minor above, teres major below, long head of tricep, shaft of humerus)
• Also passing through this space with the axillary nerve is the posterior circumflex humeral artery - weaves around surgical neck
• Supplies deltoid muscle and the teres minor muscle as it’s passing through
• Also supples region of skin on lateral aspect of arm - military badge area of arm

Question 20

Cephalic Vein

• Like the basilic vein, the cephalic vein also arises from the … venous network of the hand. It ascends the antero-… aspect of the upper limb, passing anteriorly at the elbow.
• At the shoulder, the cephalic vein travels between the deltoid and pectoralis major muscles (known as the deltopectoral groove), and enters the axilla region via the clavipectoral triangle. Within the axilla, the cephalic vein empties into … vein.
• The cephalic and basilic veins are connected at the elbow by the median cubital vein.

Answer 20

• The cephalic vein also arises from the dorsal venous network of the hand. It ascends the antero-lateral aspect of the upper limb, passing anteriorly at the elbow.
• At the shoulder, the cephalic vein travels between the deltoid and pectoralis major muscles (known as the deltopectoral groove), and enters the axilla region via the clavipectoral triangle. Within the axilla, the cephalic vein empties into axillary vein.
• The cephalic and basilic veins are connected at the elbow by the median cubital vein.

Question 21

Median nerve

• Runs down the arm with the … artery
• Doesn’t innervate anything in the upper arm
• Passes into forearm through the … fossa
• Nerve roots: C6 – T1 (also contains fibres from C5 in some individuals).
• Motor functions: Innervates … forearm and lateral hand
• Sensory functions: Innervates … palm hand and what digits?

Answer 21

• Runs down the arm with the brachial artery
• Doesn’t innervate anything in the upper arm
• Passes into forearm through the cubital fossa ->
• Nerve roots: C6 – T1 (also contains fibres from C5 in some individuals).
• Motor functions: Innervates anterior forearm and lateral hand
• Sensory functions: Innervates lateral palm hand (near thumb), D1,D2,D3 and half of D4

Question 22

The map shows the cutaenous innervation by terminal branches - match the colour to a nerve

• Grey =
• Pink =
• Green =
• Purple = (from the … cord)
• Blue =
• Yellow =

Answer 22

• Grey = axillary
• Pink = radial
• Green = musculocutaneous
• Purple = medial cutaneous (from the medial cord)
• Blue = ulnar
• Yellow = median

Question 23

Medial Cord of the Brachial Plexus

• Terminates as … part of median nerve and the … nerve

Answer 23

• Terminates as medial part of median nerve and the ulnar nerve

Question 24

Lymphatic drainage of the Upper Limb

• Relatively … lymph nodes in upper limb
• Some lymph nodes around elbow beside basilic vein - … nodes
• Some lymph nodes sit beside cephalic vein in the … groove - … node
• Lymph drains to … nodes

Answer 24

• Relatively few lymph nodes in upper limb
• Some lymph nodes around elbow beside basilic vein - cubital nodes
• Some lymph nodes sit beside cephalic vein in the deltopectoral groove - deltopectoral node
• Lymph drains to axillary nodes - sit around our axillary vein

Question 25

Veins of the upper limb drain into what vein?

Answer 25

axillary vein (into subclavian vein)

Question 26

Median nerve passes through ... ... - If this nerve is compressed it can cause what syndrome?

Answer 26

* Median nerve passes through **carpal tunnel** * Can become compressed in the carpal tunnel - **carpal tunnel syndrome**

Question 27

_Dermatomes_ * “An individual area of ... innervated by a single ... nerve” * Established during development * Lots of overlap/variation

Answer 27

* “An individual area of **skin** innervated by a single **spinal** nerve” * Established during development * Lots of overlap/variation

Question 28

What plexus innervates the structures of the upper limb?

Answer 28

Brachial plexus

Question 29

T... Motor Axon innervates Intrinsic hand muscles

Answer 29

T**1** Motor Axon innervates Intrinsic hand muscles

Question 30

_Divisions - Brachial Plexus_ * Each ... divides into ... and ... divisions * The ... divisions forms the lateral and medial cords * These divisions mainly contain axons that are going to innervate the ... compartment of upper limb * The ... divisions forms the posterior cord * These divisions mainly contain axons that are going to innervate the ... compartment of upper limb

Answer 30

* Each **trunk** divides into **anterior** and **posterior** divisions * The **anterior** divisions forms the lateral and medial cords * These divisions mainly contain axons that are going to innervate the **flexor** compartment of upper limb * The **posterior** divisions forms the posterior cord * These divisions mainly contain axons that are going to innervate the **extensor** compartment of upper limb

Question 31

_Roots of Brachial Plexus - Nerves_ * Coming off of the ... cervical root is the **dorsal scapular** nerve which supplies the rhomboids and levator scapulae * Coming off of C...,C...,C... is the **long thoracic** nerve which innervates serratus anterior

Answer 31

* Coming off of the **5th** cervical root is the **dorsal scapular** nerve which supplies the rhomboids and levator scapulae * Coming off of **C5,C6,C7** is the **long thoracic** nerve which innervates serratus anterior

Question 32

_Cords of the Brachial Plexus_ * Anterior and posterior ... form cords * They sit under our ... ... muscle (3rd,4th,5th rib - inserts into coracoid process) * Cords are named lateral, posterior, medial (named in position to ... artery - posterior cord sits behind it)

Answer 32

* Anterior and Posterior **divisions** form cords * They sit under our **pectoralis minor** muscle (3rd,4th,5th rib - inserts into coracoid process) * Cords are named lateral, posterior, medial (named in position to **axillary** artery - posterior cord sits behind it)

Question 33

The Right Subclavian artery comes directly from where?

Answer 33

The Right Subclavian artery comes directly from the **Brachiocephalic Trunk**

Question 34

The Median Nerve innervates all of the flexor and pronator muscles in the anterior compartment of the forearm - except for which two muscles?

Answer 34

**Flexor carpi ulnaris & medial 2 bellies of the flexor digitorum profundus**

Question 35

The map shows the cutaenous innervation by terminal branches - match the colour to a nerve * Grey = * Pink = * Green = * Purple = (from the ... cord) * Blue = * Yellow =

Answer 35

* Grey = axillary * Pink = radial * Green = musculocutaneous * Purple = medial cutaneous (from the medial cord) * Blue = ulnar * Yellow = median

Question 36

When the radial artery reaches the hand, it forms a deep ... arch

Answer 36

When the radial artery reaches the hand, it forms a deep **palmer** arch

Question 37

_Ulnar artery_ * ... side of the forearm * Covered by flexor ... ulnaris muscle * Deep branch - common ... artery * Forms ... palmer arch

Answer 37

* **Medial** side of the forearm * Covered by flexor **carpi** ulnaris muscle * Gives off a deep branch - common **interosseous** artery * Forms **superficial** palmer arch

Question 38

Clinical: Altered sensation in the region of a ... indicates damage to specific spinal nerve of spinal cord segment (i.e. proximal nerve injury)

Answer 38

Clinical: Altered sensation in the region of a **dermatome** indicates damage to specific spinal nerve of spinal cord segment (i.e. proximal nerve injury)

Question 39

_Axillary Artery_ * Fill in the missing blanks

Answer 39

* Risk of **fracture** * Anterior/posterior **circumflex** humeral * **Subscapular** artery

Question 40

_Ulnar artery in the hand_ * The ulnar artery passes into hand from ... palmer arch * Anastomoses with our radial artery on the lateral side * Branches given off the supercial palmer arch - palmer ... arteries

Answer 40

* The ulnar artery passes into hand from **superficial** palmer arch * Anastomoses with our radial artery on the lateral side * Branches given off the supercial palmer arch - palmer **digital** arteries

Question 41

The map shows the cutaenous innervation by terminal branches - match the colour to a nerve * Grey = * Pink = * Green = * Purple = (from the ... cord) * Blue = * Yellow =

Answer 41

* Grey = axillary * Pink = radial * Green = musculocutaneous * Purple = medial cutaneous (from the medial cord) * Blue = ulnar * Yellow = median

Question 42

The Subclavian artery ends as it crosses outer border of ... ... and becomes the axillary artery

Answer 42

The Subclavian artery ends as it crosses outer border of **first rib** and becomes the axillary artery

Question 43

The yellow divisions are ... and the green divisions are ...

Answer 43

The yellow divisions are **posterior** and the green divisions are **anterior**

Question 44

_Subclavian Artery_ * Passes through scalene ... (over first rib) * Divided into 3 parts by scalenus anterior: * 1st is ... to muscle * 2nd is ... muscle * 3rd is ... to muscle

Answer 44

* Passes through scalene **triangle** (over first rib) * Divided into 3 parts by scalenus anterior: * **1st is Medial to muscle** * **2nd is Behind muscle** * **3rd is Lateral to muscle**

Question 45

C... Motor Axon innervates Forearm flexors (Biceps)

Answer 45

C**6** innervates Forearm flexors (Biceps)

Question 46

The Subclavian artery ends as it crosses outer border of first rib and becomes what artery?

Answer 46

axillary artery

Question 47

_Radial nerve_ * The radial nerve is the terminal continuation of the ... cord of the brachial plexus. * It Passes ... in the arm * Enters our ... compartment and passes through our ... groove ( * (lies between the humeral attachments of the lateral and medial heads of the ... ... muscle) * Enters the forearm just under ... muscle and then terminates by dividing into two branches: * ... branch (motor) – innervates the muscles in the posterior compartment of the forearm (innervates all of ... muscles) * ... branch (sensory) – contributes to the cutaneous innervation of the dorsal hand and fingers.

Answer 47

* The radial nerve is the terminal continuation of the **posterior** cord of the brachial plexus. * It Passes **posterially** in the arm * Enters our **extensor** compartment and passes through our **radial** groove (lies between the humeral attachments of the lateral and medial heads of the **triceps brachii)** * Enters the forearm just under **brachioradialis** muscle and then terminates by dividing into two branches: * **Deep** branch (motor) – innervates the muscles in the posterior compartment of the forearm (innervates all of **extensor** muscles) * **Superficial** branch (sensory) – contributes to the cutaneous innervation of the dorsal hand and fingers.

Question 48

* Cutaneous innervation of the shoulder and upper limb comes from multiple peripheral nerves originating from cervical and thoracic nerve roots, with most of the nerves originating from the brachial plexus. * Clinical: Altered sensation in one of the above areas indicates damage to a more ... nerve segment

Answer 48

* Cutaneous innervation of the shoulder and upper limb comes from multiple peripheral nerves originating from cervical and thoracic nerve roots, with most of the nerves originating from the brachial plexus. * Clinical: Altered sensation in one of the above areas indicates damage to a more **distal** nerve segment

Question 49

_Musculocutaneous nerve - overview_ * Nerve roots – ... - ... * Motor functions – muscles in the anterior compartment of the arm (..., ... ... and the ...). * Sensory functions – gives rise to the lateral ... nerve of forearm, which innervates the lateral aspect of the forearm.

Answer 49

* Nerve roots – **C5-C7.** * Motor functions – muscles in the anterior compartment of the arm (**coracobrachialis, biceps brachii and the brachialis**). * Sensory functions – gives rise to the lateral **cutaneous** nerve of forearm, which innervates the lateral aspect of the forearm.

Question 50

Subclavian artery can be split into ... parts depending on the position of the vessel in relation to ... ...

Answer 50

Subclavian artery can be split into **three** parts (1st, 2nd, 3rd) depending on the position of the vessel in relation to **scalenus anterior**

Question 51

_Terminal branches of the bracial plexus_ * The 5 terminal branches of the brachial plexus are the ..., ..., ..., ..., and ... nerves

Answer 51

* The 5 terminal branches of the brachial plexus are the **musculocutaneous, median, ulnar, axillary, and radial** nerves

Question 52

_Quadrangular space_ * Borders: Teres ... above, Teres ... below, long head of ..., shaft of ... * What passes through it? (one nerve, one artery)

Answer 52

* Borders: Teres **minor** above, Teres **major** below, long head of **tricep**, shaft of **humerus** * What passes through it? - axillary nerve and the posterior circumflex humeral artery

Question 53

_Radial artery_ * ... side of forearm * ... of the two terminal branches * Covered by ... muscle * Forms ... palmer arch

Answer 53

* **Lateral** side of forearm * **Smaller** of the two terminal branches * Covered by **brachioradialis** muscle * Forms **deeper** palmer arch

Question 54

_Motor and Sensory Functions of the Median Nerve_ * Motor functions: Innervates the flexor and pronator muscles in the ... compartment of the forearm (except the flexor carpi ulnaris and medial 2 bellies of the flexor digitorum profundus, innervated by the ulnar nerve). Also supplies innervation to the thenar muscles and lateral two lumbricals in the hand (lateral hand) * Sensory functions: Gives rise to the palmar cutaneous branch, which innervates the ... aspect of the palm, and the digital cutaneous branch, which innervates the lateral ... fingers on the anterior (palmar) surface of the hand (skin)

Answer 54

* Motor functions: Innervates the flexor and pronator muscles in the **anterior** compartment of the forearm (except the flexor carpi ulnaris and medial 2 bellies of the flexor digitorum profundus, innervated by the ulnar nerve). Also supplies innervation to the thenar muscles and lateral two lumbricals in the hand (lateral hand) * Sensory functions: Gives rise to the palmar cutaneous branch, which innervates the **lateral** aspect of the palm, and the digital cutaneous branch, which innervates the lateral **three and a half fingers** on the anterior (palmar) surface of the hand (skin)

Question 55

What is circled in this image?

Answer 55

Cords of the brachial plexus

Question 56

How do we find our deep palmer arch and superficial palmer arch?

Answer 56

* Extend thumb - line across = approx location of deep palmer arch * one finger breadth distal = approx location of superficial palmer arch

Question 57

C... Motor Axon innervates Forearm extensors (Triceps) and Wrist flexors/extensors

Answer 57

C**7** Motor Axon innervates Forearm extensors (Triceps) and Wrist flexors/extensors

Question 58

In carpal tunnel syndrome, what nerve is compressed?

Answer 58

median nerve

Question 59

_Radial Nerve branches_ * The nerve terminates in the forearm by dividing into two branches: * Deep branch (...) – innervates the muscles in the posterior compartment of the forearm. * Superficial branch (...) – contributes to the cutaneous innervation of the dorsal hand and fingers.

Answer 59

* The nerve terminates in the forearm by dividing into two branches: * Deep branch (**motor**) – innervates the muscles in the posterior compartment of the forearm. * Superficial branch (**sensory**) – contributes to the cutaneous innervation of the dorsal hand and fingers.

Question 60

_Trunks - Brachial Plexus_ * At the base of the neck, the ... of the brachial plexus converge to form three trunks. These structures are named by their relative anatomical location: * Superior trunk – a combination of ... and ... roots. * Middle trunk – continuation of ... * Inferior trunk – combination of ... and ... roots. * Trunks pass through the ... triangle

Answer 60

* At the base of the neck, the **roots** of the brachial plexus converge to form three trunks. These structures are named by their relative anatomical location: * Superior trunk – a combination of **C5** and **C6** roots. * Middle trunk – continuation of **C7**. * Inferior trunk – combination of **C8** and **T1** roots. * Trunks pass through the **scalene** triangle

Question 61

_Profunda brachii artery_ * The ... artery gives rise to the profunda brachii (deep artery), which travels with the ... nerve in the ... groove of the humerus and supplies structures in the posterior aspect of the upper arm (e.g. triceps brachii). * The profunda brachii terminates by contributing to an anastomotic network around the elbow joint.

Answer 61

* The **brachial** artery gives rise to the profunda brachii (deep artery), which travels with the **radial** nerve in the **radial** groove of the humerus and supplies structures in the posterior aspect of the upper arm (e.g. triceps brachii). * The profunda brachii terminates by contributing to an anastomotic network around the elbow joint.

Question 62

Label the diagram (Superficial veins of the upper limb)

Answer 62

Left = **Cephalic** vein, Right = **Basilic** vein

Question 63

_Sensory Functions of the Median Nerve_ * Sensory functions: Gives rise to the palmar cutaneous branch, which innervates the ... aspect of the palm, and the digital cutaneous branch, which innervates the lateral ... fingers on the anterior (palmar) surface of the hand (skin)

Answer 63

* Sensory functions: Gives rise to the palmar cutaneous branch, which innervates the **lateral** aspect of the palm, and the digital cutaneous branch, which innervates the lateral **three and a half fingers** on the anterior (palmar) surface of the hand (skin)

Question 64

_Medial Cord of the Brachial Plexus_ * The medial cord is formed by: * The ... division of the inferior trunk.

Answer 64

* The medial cord is formed by: * The anterior division of the inferior trunk.

Question 65

_Basilic Vein_ * The basilic vein originates from the ... venous network of the hand and ascends the ... aspect of the upper limb. * At the border of the teres major, the vein moves deep into the arm. Here, it combines with the brachial veins from the deep venous system to form the ... vein.

Answer 65

* The basilic vein originates from the **dorsal** venous network of the hand and ascends the **medial** aspect of the upper limb. * At the border of the teres major, the vein moves deep into the arm. Here, it combines with the brachial veins from the deep venous system to form the **axillary** vein.

Question 66

The cephalic and basilic veins are connected at the elbow by the ... ... vein.

Answer 66

The cephalic and basilic veins are connected at the elbow by the **median cubital** vein.

Question 67

The ... nerve is derived from the medial and lateral cords of the brachial plexus

Answer 67

The **median** nerve is derived from the medial and lateral cords of the brachial plexus

Question 68

The brachial plexus is divided into five parts; ..., ..., ..., ... and ... (a good mnemonic for this is Read That Damn Cadaver Book). There are no functional differences between these divisions – they are simply used to aid explanation of the brachial plexus.

Answer 68

The brachial plexus is divided into five parts; **roots, trunks, divisions, cords and branches** (a good mnemonic for this is Read That Damn Cadaver Book). There are no functional differences between these divisions – they are simply used to aid explanation of the brachial plexus.

Question 69

What digits does the median nerve innervate? (sensory - skin innervation)

Answer 69

**D1,D2,D3 and half D4**

Question 70

The anterior humeral ... artery is a vessel arising from the axillary artery at the proximal part of the arm.

Answer 70

The anterior humeral **circumflex** artery is a vessel arising from the axillary artery at the proximal part of the arm.

Question 71

Label the diagram

Answer 71

* Spinal/radial groove * Posterior circumflex humeral artery * Profunda brachii artery * Radial nerve

Question 72

_Radial Nerve branches_ * The nerve terminates in the forearm by dividing into two branches: * Deep branch (motor) – innervates the muscles in the ... compartment of the forearm. * Superficial branch (sensory) – contributes to the cutaneous innervation of the ... hand and fingers.

Answer 72

* The nerve terminates in the forearm by dividing into two branches: * Deep branch (motor) – innervates the muscles in the **posterior** compartment of the forearm. * Superficial branch (sensory) – contributes to the cutaneous innervation of the **dorsal** hand and fingers.

Question 73

_Posterior cord of the Brachial Plexus_ * Sits directly behind our ... artery * Terminates as ... nerve and the ... nerve

Answer 73

* Sits directly behind our **axillary** artery * Terminates as **radial** nerve and the **axillary** nerve

Question 74

Label the arteries (upper arm)

Answer 74

* top left = profunda brachii * top right = brachal artery * bottom left = radial artery * bottom right = ulnar artery

Question 75

_Ulnar nerve_ * Passes down the medial side - behind brachial artery and median nerve * Passes down the back of the elbow joint * Passes through the cubital ... -\> formed between medial epicondyle and olecranon of ulnar * Sits under flexor carpi ulnaris muscle with the ulnar artery * In forearm, nerve innervators flexor carpi ulnaris muscle and the two bellies of flexor ... ... (anterior flexor compartments of forearm are mainly innerated by median nerve except for these two) * Median nerve passes across the wrist and enters the hand on the medial side - innervates the medial intrinsic muscles and skin on medial side - what digits?

Answer 75

* Passes down the medial side - behind brachial artery and median nerve * Passes down the back of the elbow joint * Passes through the cubital **tunnel** -\> formed between medial epicondyle and olecranon of ulnar * Sits under flexor carpi ulnaris muscle with the ulnar artery * In forearm, nerve innervators flexor carpi ulnaris muscle and the two bellies of flexor **digitorum profundus** (anterior flexor compartments of forearm are mainly innerated by median nerve except for these two) * Median nerve passes across the wrist and enters the hand on the medial side - innervates most of the intrinsic muscles and skin on medial side **(half of D4 and D5)**

Question 76

_Brachial artery_ * The brachial artery is a continuation of the axillary artery past the lower border of the ... major. * It is the main supply of blood for the arm. * Supplies ... muscles (biceps brachii, coracobrachialis, brachialis muscle in ... compartments) * Immediately distal to the teres major, the brachial artery gives rise to the ... brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the ... aspect of the upper arm (..., e.g. triceps brachii). * It terminates by contributing to an ... network around the elbow joint. * The brachial artery proper descends down the arm. As it moves through the ... fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the ... and ... arteries.​

Answer 76

* The brachial artery is a continuation of the axillary artery past the lower border of the **teres** major. * It is the main supply of blood for the arm. * Supplies **flexor** muscles (biceps brachii, coracobrachialis, brachialis muscle in **anterior** compartments) * Immediately distal to the teres major, the brachial artery gives rise to the **profunda** brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the **posterior** aspect of the upper arm (**extensors**, e.g. triceps brachii). * It terminates by contributing to an **anastomotic** network around the elbow joint. * The brachial artery proper descends down the arm. As it moves through the **cubital** fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the **radial** and **ulnar** arteries.​

Question 77

_Brachial artery_ * The brachial artery is a continuation of the axillary artery past the lower border of the ... major. * It is the main supply of blood for the arm. * Supplies ... muscles (biceps brachii, coracobrachialis, brachialis muscle in ... compartments) * Immediately distal to the teres major, the brachial artery gives rise to the ... brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the ... aspect of the upper arm (..., e.g. triceps brachii). * It terminates by contributing to an ... network around the elbow joint. * The brachial artery proper descends down the arm. As it moves through the ... fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the ... and ... arteries.​

Answer 77

* The brachial artery is a continuation of the axillary artery past the lower border of the **teres** major. * It is the main supply of blood for the arm. * Supplies **flexor** muscles (biceps brachii, coracobrachialis, brachialis muscle in **anterior** compartments) * Immediately distal to the teres major, the brachial artery gives rise to the **profunda** brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the **posterior** aspect of the upper arm (**extensors**, e.g. triceps brachii). * It terminates by contributing to an **anastomotic** network around the elbow joint. * The brachial artery proper descends down the arm. As it moves through the **cubital** fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the **radial** and **ulnar** arteries.​

Question 78

_Radial artery in the hand_ * The radial artery enters the hand dorsally, crossing the floor of the ... ... * Pierces first dorsal ... muscle (allows abduction of index finger) * Reaches palmer aspect of hand - forms ... palmer arch (below flexor tendons)

Answer 78

* The radial artery enters the hand dorsally, crossing the floor of the **anatomical snuffbox.** * Pierces first dorsal interosseous muscle (abduct index finger) * Reaches palmer aspect of hand - forms **deep** palmer arch (below flexor tendons)

Question 79

What muscle is this?

Answer 79

Teres major

Question 80

What is the radial groove?

Answer 80

the shallow groove that passes around the shaft of the **humerus**; it lies between the humeral attachments of the lateral and medial heads of the **triceps** **brachii**; the **radial** nerve and deep **brachial** artery course within the groove.

Question 81

_Subclavian Artery - Divisions_ * 1st part is ... to scalenus anterior - it has lots of branches - (Vertebral artery, internal thoracic artery) but the most important is the **... trunk** (supplies thyroid, cervical, scapular) * 2nd part is ... scalenus anterior - costocervical trunk (don't need to remember) * 3rd part is ... to scalenus anterior - **... ... artery**

Answer 81

* 1st part is medial to scalenus anterior - it has lots of branches - (Vertebral artery, internal thoracic artery) but the most important is the **thyrocervical trunk** (supplies thyroid, cervical, scapular) **contributes to scapular anastomosis** * 2nd part is behind scalenus anterior - costocervical trunk (don't need to remember) * 3rd part is lateral to scalenus anterior - **dorsal scapular artery - contributes to scapular anastomosis**

Question 82

The Left Subclavian artery comes directly from where?

Answer 82

The Left Subclavian artery comes directly from the **arch of aorta**

Question 83

At the shoulder, the cephalic vein travels between the ... and ... major muscles (known as the ... groove), and enters the axilla region via the clavipectoral triangle. Within the axilla, the cephalic vein empties into ... vein.

Answer 83

At the shoulder, the cephalic vein travels between the **deltoid** and **pectoralis** major muscles (known as the **deltopectoral** groove), and enters the axilla region via the clavipectoral triangle. Within the axilla, the cephalic vein empties into **axillary** vein.

Question 84

The 1st and 2nd parts of the axillary artery are closely associated with what plexus?

Answer 84

brachial plexus

Question 85

_Roots of Brachial Plexus - Nerves_ * Coming off of the 5th cervical root is the ... ... nerve which supplies the rhomboids and levator scapulae * Coming off of C5,C6,C7 is the ... ... nerve which innervates serratus anterior

Answer 85

* Coming off of the 5th cervical root is the **dorsal scapular** nerve which supplies the rhomboids and levator scapulae * Coming off of C5,C6,C7 is the **long thoracic** nerve which innervates serratus anterior

Question 86

The major superficial veins of the upper limb are the ... and ... veins. They are located within the subcutaneous tissue of the upper limb.

Answer 86

The major superficial veins of the upper limb are the **cephalic** and **basilic** veins. They are located within the subcutaneous tissue of the upper limb.

Question 87

Altered sensation in the region of a dermatome indicates damage to ... spinal nerve of spinal cord segment whereas altered sensation in one of the cutaneous innervation areas indicates damage to a more ... nerve segment

Answer 87

Altered sensation in the region of a dermatome indicates damage to **specific** spinal nerve of spinal cord segment (i.e. proximal nerve injury) whereas altered sensation in one of the cutaneous innervation areas indicates damage to a more **distal** nerve segment (i.e. distal nerve injury)

Question 88

_Profunda brachii artery_ * Accompanies ... nerve in spiral groove * The spiral/radial groove is formed between the ... and ... heads of the ... muscle * If we were to ... the humerus at the shaft at this point we may damage this artery which would affect the blood supply to the triceps muscle

Answer 88

* Accompanies **radial** nerve in spiral groove * The spiral/radial groove is formed between the **lateral** and **medial** heads of the **triceps** muscle * If we were to **fracture** the humerus at the shaft at this point we may damage this artery which would affect the blood supply to the triceps muscle

Question 89

Match the colours to a nerve

Answer 89

Question 90

_Brachial Plexus - Division Overview_ * Divided into r..., t..., d..., c..., ... branches (contain axons from multiple spinal nerves - ... nerves)

Answer 90

* **Divided into roots, trunks, divisions, cords, terminal** branches (contain axons from multiple spinal nerves - **mixed** nerves)

Question 91

Fill in the blanks

Answer 91

* anterior - axons to flexor compartments * posterior - axons to extensor compartments

Question 92

The arterial supply to the upper limb begins as the subclavian artery. On the right, the subclavian artery arises from the ... trunk. On the left, it branches directly from the ... of ...

Answer 92

The arterial supply to the upper limb begins as the subclavian artery. On the right, the subclavian artery arises from the **brachiocephalic** trunk. On the left, it branches directly from the **arch of aorta.**

Question 93

_Superficial veins of Upper Limb_ * Fill in the blanks

Answer 93

* Left = **basilic** vein, Middle = **cephalic** vein, Below = **dorsal venous arch** * Right = **basilic** vein

Question 94

_Brachial artery_ * The brachial artery is a continuation of the axillary artery past the lower border of the ... major. * It is the main supply of blood for the arm. * Supplies ... muscles (biceps brachii, coracobrachialis, brachialis muscle in ... compartments) * Immediately distal to the teres major, the brachial artery gives rise to the ... brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the ... aspect of the upper arm (..., e.g. triceps brachii). * It terminates by contributing to an ... network around the elbow joint. * The brachial artery proper descends down the arm. As it moves through the ... fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the ... and ... arteries.​

Answer 94

* The brachial artery is a continuation of the axillary artery past the lower border of the **teres** major. * It is the main supply of blood for the arm. * Supplies **flexor** muscles (biceps brachii, coracobrachialis, brachialis muscle in **anterior** compartments) * Immediately distal to the teres major, the brachial artery gives rise to the **profunda** brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the **posterior** aspect of the upper arm (**extensors**, e.g. triceps brachii). * It terminates by contributing to an **anastomotic** network around the elbow joint. * The brachial artery proper descends down the arm. As it moves through the **cubital** fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the **radial** and **ulnar** arteries.​

Question 95

_Muculocutaenous nerve_ * The musculocutaneous nerve is the terminal branch of the ... cord of the brachial plexus and emerges at the inferior border of pectoralis minor muscle * It pierces the ... muscle near its point of insertion on the humerus. It gives a branch to this muscle. * The musculocutaneous nerve then passes down the flexor compartment of the upper arm, superficial to ... but deep to the ... ... muscle. * It innervates both these muscles and gives articular branches to the humerus and the elbow. * The nerve continues into the forearm as the lateral ... nerve and provides sensory innervation to the lateral aspect of the forearm.

Answer 95

* The musculocutaneous nerve is the terminal branch of the lateral **cord** of the brachial plexus (C5, C6 and C7) and emerges at the inferior border of pectoralis minor muscle * It pierces the **coracobrachialis** muscle near its point of insertion on the humerus. It gives a branch to this muscle. * The musculocutaneous nerve then passes down the flexor compartment of the upper arm, superficial to **brachialis** but deep to the **biceps brachii** muscle. * It innervates both these muscles and gives articular branches to the humerus and the elbow. * The nerve continues into the forearm as the lateral **cutaneous** nerve and provides sensory innervation to the lateral aspect of the forearm.

Question 96

_Posterior Cord of the Brachial Plexus_ * The posterior cord is formed by: * The posterior division of the ... trunk * The posterior division of the ... trunk * The posterior division of the ... trunk

Answer 96

* The posterior cord is formed by: * The posterior division of the **superior** trunk * The posterior division of the **middle** trunk * The posterior division of the **inferior** trunk

Question 97

C... Motor Axon innervates Digit flexors/extensors

Answer 97

C**8** Motor Axon innervates Digit flexors/extensors

Question 98

_Motor functions of the Ulnar Nerve_ * Two muscles of the ... forearm – flexor carpi ulnaris and medial half of flexor digitorum profundus * ... muscles of the hand (apart from the thenar muscles and two lateral lumbricals - innervated by median nerve)

Answer 98

* Two muscles of the **anterior** forearm – flexor carpi ulnaris and medial half of flexor digitorum profundus * **Intrinsic** muscles of the hand (apart from the thenar muscles and two lateral lumbricals - innervated by median nerve)

Question 99

_Axillary Artery_ * Divided into three parts by ... ...: * 1st ... to muscle * 2nd ... muscle * 3rd ... to muscle * First and second parts closely associated with the ... plexus * Ends at lower border of teres ... * Becomes ... artery

Answer 99

* Divided into three parts by **pectoralis minor**: * 1st **Medial** to muscle * 2nd **Behind** muscle * 3rd **Lateral** to muscle * First and second parts closely associated with the **brachial** plexus * Ends at lower border of teres **major** * Becomes **brachial** artery

Question 100

_Radial nerve_ * The radial nerve is the terminal continuation of the ... cord of the brachial plexus. * It Passes ... in the arm * Enters our ... compartment and passes through our ... groove ( * (lies between the humeral attachments of the lateral and medial heads of the ... ... muscle) * Enters the forearm just under ... muscle and then terminates by dividing into two branches: * ... branch (motor) – innervates the muscles in the posterior compartment of the forearm (innervates all of ... muscles) * ... branch (sensory) – contributes to the cutaneous innervation of the dorsal hand and fingers.

Answer 100

* The radial nerve is the terminal continuation of the **posterior** cord of the brachial plexus. * It Passes **posterially** in the arm * Enters our **extensor** compartment and passes through our **radial** groove (lies between the humeral attachments of the lateral and medial heads of the **triceps brachii)** * Enters the forearm just under **brachioradialis** muscle and then terminates by dividing into two branches: * **Deep** branch (motor) – innervates the muscles in the posterior compartment of the forearm (innervates all of **extensor** muscles) * **Superficial** branch (sensory) – contributes to the cutaneous innervation of the dorsal hand and fingers.

Question 101

_Superficial Lymphatic Vessels of the Upper Limb_ * The vessels shadowing the basilic vein go on to enter the ... lymph nodes. These are found medially to the vein, and proximally to the medial epicondyle of the humerus. Vessels carrying on from these nodes then continue up the arm, terminating in the lateral axillary lymph nodes. * The vessels shadowing the cephalic vein generally cross the proximal part of the arm and shoulder to enter the apical axillary lymph nodes, though some exceptions instead enter the more superficial ... lymph nodes.

Answer 101

* The vessels shadowing the basilic vein go on to enter the **cubital** lymph nodes. These are found medially to the vein, and proximally to the medial epicondyle of the humerus. Vessels carrying on from these nodes then continue up the arm, terminating in the lateral axillary lymph nodes. * The vessels shadowing the cephalic vein generally cross the proximal part of the arm and shoulder to enter the apical axillary lymph nodes, though some exceptions instead enter the more superficial **deltopectoral** lymph nodes.

Question 102

_Lateral Cord of the Brachial Plexus_ * The lateral cord is formed by: * The ... division of the superior trunk * The ... division of the middle trunk

Answer 102

* The lateral cord is formed by: * The **anterior** division of the superior trunk * The **anterior** division of the middle trunk

Question 103

_Motor Functions of the Axillary Nerve_ * Innervates the teres ... and ... muscles

Answer 103

* Innervates the teres **minor** and **deltoid** muscles

Question 104

Altered sensation in the region of a dermatome indicates damage to specific spinal nerve of spinal cord segment (i.e. ... nerve injury) whereas altered sensation in one of the cutaneous innervation areas indicates damage to a more distal nerve segment (i.e. ... nerve injury)

Answer 104

Altered sensation in the region of a dermatome indicates damage to specific spinal nerve of spinal cord segment (i.e. **proximal** nerve injury) whereas altered sensation in one of the cutaneous innervation areas indicates damage to a more distal nerve segment (i.e. **distal** nerve injury)

Question 105

The brachial artery proper descends down the arm. As it moves through the ... fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the ... and ... arteries

Answer 105

The brachial artery proper descends down the arm. As it moves through the **cubital** fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the **radial** and **ulnar** arteries

Question 106

_Brachial artery_ * The brachial artery is a continuation of the axillary artery past the lower border of the ... major. * It is the main supply of blood for the arm. * Supplies ... muscles (biceps brachii, coracobrachialis, brachialis muscle in ... compartments) * Immediately distal to the teres major, the brachial artery gives rise to the ... brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the ... aspect of the upper arm (..., e.g. triceps brachii). * It terminates by contributing to an ... network around the elbow joint. * The brachial artery proper descends down the arm. As it moves through the ... fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the ... and ... arteries.​

Answer 106

* The brachial artery is a continuation of the axillary artery past the lower border of the **teres** major. * It is the main supply of blood for the arm. * Supplies **flexor** muscles (biceps brachii, coracobrachialis, brachialis muscle in **anterior** compartments) * Immediately distal to the teres major, the brachial artery gives rise to the **profunda** brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the **posterior** aspect of the upper arm (**extensors**, e.g. triceps brachii). * It terminates by contributing to an **anastomotic** network around the elbow joint. * The brachial artery proper descends down the arm. As it moves through the **cubital** fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the **radial** and **ulnar** arteries.​

Question 107

The map shows the cutaenous innervation by terminal branches - match the colour to a nerve * Grey = * Pink = * Green = * Purple = (from the ... cord) * Blue = * Yellow =

Answer 107

* Grey = axillary * Pink = radial * Green = musculocutaneous * Purple = medial cutaneous (from the medial cord) * Blue = ulnar * Yellow = median

Question 108

_Roots of the Brachial Plexus_ * Roots are ... primary rami of C...-T...

Answer 108

* **Roots are ventral primary rami of C5-T1**

Question 109

_Motor Functions of the Ulnar Nerve_ * Two muscles of the anterior forearm – flexor ... ... and medial half of flexor .. ... * Intrinsic muscles of the hand (apart from the thenar muscles and two lateral lumbricals - innervated by median nerve)

Answer 109

* Two muscles of the anterior forearm – **flexor** **carpi ulnaris** and medial half of **flexor digitorum** **profundus** * Intrinsic muscles of the hand (apart from the thenar muscles and two lateral lumbricals - innervated by median nerve)

Question 110

_Lateral Cord of the Brachial Plexus_ * The lateral cord is formed by: * The anterior division of the ... trunk * The anterior division of the ... trunk

Answer 110

* The lateral cord is formed by: * The anterior division of the **superior** trunk * The anterior division of the **middle** trunk

Question 111

_Axillary artery - Underneath Pec minor_ * Lots of branches given off of the axillary artery * 1st part - branch to supply thorax * 2nd part - branch to supply axillary region * **3rd part: (need to know)** * ... artery - contributes to scapular ... * anterior and posterior ... h... arteries - form a circle around ... neck of humerus (prone to ... - so risk damaging these arteries)

Answer 111

* Lots of branches given off of the axillary artery * 1st part - branch to supply thorax * 2nd part - branch to supply axillary region * 3rd part: * **subscapular** artery - contributes to scapular anastomosis * anterior and posterior **circumflex humeral** arteries - form a circle around **surgical** neck of humerus (prone to *fracture* - so risk damaging these arteries)

Question 112

_Venous Return of Upper Limb - Deep and Superficial Veins_​ * Deep veins tend to follow arteries: * ... veins * Venae comitantes * Superficial veins: * ... - runs up the lateral forearm and lateral side of arm * ... - runs up the medial forearm and medial side of arm arm * Both arise from ... ... arch

Answer 112

* Deep veins tend to follow arteries: * **Paired** veins * Venae comitantes * Superficial veins: * **Cephalic** - runs up the lateral forearm and lateral side of arm * **Basilic** - runs up the medial forearm and medial side of arm arm * Both arise from **dorsal venous arch**

Question 113

The axillary artery ends at the lower border of teres major and becomes what artery?

Answer 113

brachial artery

Question 114

_Roots of Brachial Plexus - Nerves_ * Coming off of the 5th cervical root is the **dorsal scapular** nerve which supplies the ... and ... scapulae * Coming off of C5,C6,C7 is the **long thoracic** nerve which innervates ... ...

Answer 114

* Coming off of the 5th cervical root is the **dorsal scapular** nerve which supplies the **rhomboids** and **levator scapulae** * Coming off of C5,C6,C7 is the **long thoracic** nerve which innervates **serratus anterior**

Question 115

_Venous return of Upper limb_ * Considerably variable * Veins in upper limb all drain into ... vein which drains into ... vein * Veins can be divided into ... veins and ... veins

Answer 115

* Considerably variable * Veins in upper limb all drain into **axillary** vein into **subclavian** vein * Veins can be divided into **deep** veins and **superficial** veins

Question 116

_Brachial Plexus_ * The plexus is formed by the anterior rami (divisions) of cervical spinal nerves C..., C..., C... and C..., and the first ... spinal nerve. * Nerve supply to the ... limb * Carries motor, sensory and ... axons * Produces ... nerves (i.e. contains axons from multiple spinal nerves) * Important to supply ... muscle groups

Answer 116

* The plexus is formed by the anterior rami (divisions) of cervical spinal nerves **C5, C6, C7 and C8,** and the first **thoracic** spinal nerve. * Nerve supply to the **upper limb** * Carries motor, sensory and **sympathetic** axons * Produces **mixed** nerves (i.e. contains axons from multiple spinal nerves) * Important to supply **large** muscle groups

Question 117

_Dermatomes of the upper limb_ * C4: over the ... joint. * C5: the ... aspect of the lower edge of the ... muscle (known as the “regimental ...”). * C6: the palmar side of the .... * C7: the palmar side of the ... finger. * C8: the palmar side of the ... finger. * T1: the ... aspect of ... and ...

Answer 117

* C4: over the **acromioclavicular** joint. * C5: the **lateral** aspect of the lower edge of the **deltoid** muscle (known as the “regimental **badge**”). * C6: the palmar side of the **thumb**. * C7: the palmar side of the **middle** finger. * C8: the palmar side of the **little** finger. * T1: T1: the **medial** aspect of **forearm** and **arm**

Question 118

_Lateral cord_ * The lateral cord gives rise to the lateral ... nerve, which supplies the ... muscles. The terminal branches of the lateral cord are the lateral head of the median nerve and the ... nerve.

Answer 118

* The lateral cord gives rise to the lateral **pectoral** nerve, which supplies the **pectoral** muscles. The terminal branches of the lateral cord are the lateral head of the median nerve and the **musculocutaneous** nerve. *(The musculocutaneous nerve pierces coracobrachialis approximately 5cm distal to the conjoint tendon. Trace the musculocutaneous nerve as it pierces this muscle and follow the nerve deep to biceps until it emerges on its lateral aspect just above the elbow. Its terminal branch is the lateral cutaneous nerve of the forearm, which supplies the skin of the lateral forearm on both the dorsal and ventral aspects.)*

Question 119

The musculocutaneous nerve pierces ... approximately 5cm distal to the conjoint tendon. Its terminal branch is the lateral ... nerve of the forearm, which supplies the skin of the lateral forearm on both the dorsal and ventral aspects.

Answer 119

The musculocutaneous nerve pierces **coracobrachialis** approximately 5cm distal to the conjoint tendon. Its terminal branch is the lateral **cutaneous** nerve of the forearm, which supplies the skin of the lateral forearm on both the dorsal and ventral aspects.

Question 120

Which structures does the musculocutaneous nerve supply?

Answer 120

The musculocutaneous nerve innervates the three muscles of the anterior compartment of the arm: the coracobrachialis, biceps brachii, and brachialis. It is also responsible for cutaneous innervation of the lateral forearm

Question 121

_Medial cord_ * The medial cord gives rise to the medial ... nerve, which supplies the ... muscles, and the ... nerves of the arm and forearm. The terminal branches of the medial cord are the medial head of the median nerve and the ulnar nerve.

Answer 121

* The medial cord gives rise to the medial **pectoral** nerve, which supplies the **pectoral** muscles, and the **cutaneous** nerves of the arm and forearm. The terminal branches of the medial cord are the medial head of the median nerve and the ulnar nerve.

Question 122

_Medial cord_ * The medial cord gives rise to the medial pectoral nerve, which supplies the pectoral muscles, and the cutaneous nerves of the arm and forearm. The terminal branches of the medial cord are the medial head of the ... nerve and the ... nerve.

Answer 122

* The medial cord gives rise to the medial pectoral nerve, which supplies the pectoral muscles, and the cutaneous nerves of the arm and forearm. The terminal branches of the medial cord are the medial head of the **median** nerve and the **ulnar** nerve.

Question 123

Which area of skin in the hand does the ulnar nerve supply?

Answer 123

* The ulnar nerve provides sensory supply to the following areas of the hand: * The skin of the palmar and dorsal aspects of the medial 1½ digits and adjacent palm. * The skin on the medial side of the dorsum of hand.

Question 124

_Ulnar nerve_ * The ulnar nerve gives a limited supply to the ... muscles of the forearm and it’s the main supply to the ... muscles of the hand. The nerve lies ... to the brachial artery in the arm and passes behind the medial epicondyle of the humerus at the elbow joint (the cubital tunnel) to gain access to the forearm. It can be easily damaged at the region of the medial .... At this point, if it is hit, it may cause shooting sensation that radiates down the forearm to the little and ring fingers – hence the lay term of the ‘funny bone’ for the bone on the medial side of the forearm.

Answer 124

* The ulnar nerve gives a limited supply to the **flexor** muscles of the forearm and it’s the main supply to the **intrinsic** muscles of the hand. The nerve lies **medial** to the brachial artery in the arm and passes behind the medial epicondyle of the humerus at the elbow joint (the cubital tunnel) to gain access to the forearm. It can be easily damaged at the region of the medial **epicondyle**. At this point, if it is hit, it may cause shooting sensation that radiates down the forearm to the little and ring fingers – hence the lay term of the ‘funny bone’ for the bone on the medial side of the forearm.

Question 125

_Median nerve_ * The median nerve receives contributions from both ... and ... cords. * It supplies almost all of the muscles of the ... compartment of the forearm and several of the ... muscles of the hand. To locate the median nerve firstly locate the ‘M’ configuration formed by lateral and medial cord contributions to the median nerve (central leg of the M), the ulnar nerve (medial leg of the M) and musculocutaneous nerve (lateral leg of the M).

Answer 125

* The median nerve receives contributions from both **lateral** and **medial** cords. * It supplies almost all of the muscles of the **anterior** compartment of the forearm and several of the **intrinsic** muscles of the hand. To locate the median nerve firstly locate the ‘M’ configuration formed by lateral and medial cord contributions to the median nerve (central leg of the M), the ulnar nerve (medial leg of the M) and musculocutaneous nerve (lateral leg of the M).

Question 126

Which area of skin in the hand does the median nerve supply?

Answer 126

* The sensory supply of the median nerve includes: * The skin of the palmar and distal dorsal aspects of the lateral three-and-the-half digits and adjacent palm. * The skin of the palmar and distal dorsal aspects of the thumb and radial half of 2nd digit.

Question 127

_Posterior cord_ * The posterior cord, which lies posterior to the ... artery, gives rise to the upper subscapular, thoracodorsal (middle subscapular) and lower subscapular nerves. These nerves supply the subscapularis, teres major and latissimus dorsi muscles. The terminal branches of the posterior cord are the ... nerve and the ... nerve.

Answer 127

* The posterior cord, which lies posterior to the **axillary** artery, gives rise to the upper subscapular, thoracodorsal (middle subscapular) and lower subscapular nerves. These nerves supply the subscapularis, teres major and latissimus dorsi muscles. The terminal branches of the posterior cord are the **radial** nerve and the **axillary** nerve.

Question 128

_Radial nerve_ * The radial nerve supplies muscles and skin over the whole ... aspect of the upper limb. The nerve spirals laterally around the shaft of the ... (in the spiral or radial groove) lying on the ... head of triceps. After passing through the spiral groove, the nerve enters the ... compartment of the forearm lying under cover of the muscles on the lateral side of the forearm. The radial nerve supplies the ... muscles and the ... muscles of the forearm.

Answer 128

* The radial nerve supplies muscles and skin over the whole **posterior** aspect of the upper limb. The nerve spirals laterally around the shaft of the **humerus** (in the spiral or radial groove) lying on the **medial** head of triceps. After passing through the spiral groove, the nerve enters the **anterior** compartment of the forearm lying under cover of the muscles on the lateral side of the forearm. The radial nerve supplies the **triceps** muscles and the **extensor** muscles of the forearm.

Question 129

Which area of skin in the hand does the radial nerve supply?

Answer 129

* Thenar eminence and dorsal aspect of the radial 3 and a half digits of the hand.

Question 130

_Axillary nerve_ * The axillary nerve supplies teres ... and the ... muscles. It can be seen passing posteriorly through a quadrangular space with the posterior circumflex humeral artery, formed between the borders of teres minor, teres major, the humerus and the long head of triceps.

Answer 130

* The axillary nerve supplies teres **minor** and the **deltoid** muscles. It can be seen passing posteriorly through a quadrangular space with the posterior circumflex humeral artery, formed between the borders of teres minor, teres major, the humerus and the long head of triceps.

Question 131

Which area of skin does the axillary nerve supply?

Answer 131

* It innervates the skin over the inferior portion of the deltoid (the ‘regimental badge area’).

Question 132

The stem artery of the upper limb is the ... artery

Answer 132

The stem artery of the upper limb is the **subclavian** artery

Question 133

_Arterial Supply to the Upper Limb_ * The stem artery of the upper limb is the subclavian artery. * The origin of this artery differs on the two sides of the body. * On the right side, it is a branch of the ... trunk. * On the left hand side it normally arises directly off the .... * As the subclavian artery passes over the first rib it changes its name to the ... artery (see figure below). * In the axilla, the ... artery is accompanied by the cords of the brachial plexus. Once this artery crosses the lower border of teres major it changes its name again to become the ... artery, which is the main artery within the arm. This artery gives off many small muscular branches and also the ... (or deep) brachii artery, which accompanies the radial nerve in the spiral groove of the humerus to supply triceps and the elbow joint.

Answer 133

* The stem artery of the upper limb is the subclavian artery. * The origin of this artery differs on the two sides of the body. * On the right side, it is a branch of the **brachiocephalic** trunk. * On the left hand side it normally arises directly off the **aorta**. * As the subclavian artery passes over the first rib it changes its name to the **axillary** artery (see figure below). In the axilla, the axillary artery is accompanied by the cords of the brachial plexus. Once the axillary artery crosses the lower border of teres major it changes its name again to become the **brachial** artery, which is the main artery within the arm. The brachial artery gives off many small muscular branches and also the **profunda** (or deep) brachii artery, which accompanies the radial nerve in the spiral groove of the humerus to supply triceps and the elbow joint.

Question 134

Distal to the cubital fossa in the forearm, the brachial artery divides into the ... and ... arteries.

Answer 134

Distal to the cubital fossa in the forearm, the brachial artery divides into the **radial** and **ulnar** arteries.