Nerve and blood supply to the upper limb Flashcards
what are the arteries in the upper limb
- Axillary artery
- Brachial artery
- Radial artery
- Ulnar artery
- Palmar arches and digital branches
where does the subclavian artery travel
- it travels underneath the clavicle
where does the axillary artery start and end
- Axillary artery 1st rib to inferior edge of teres major
what is the axilla
space between thoracic cage and shoulder joint
where does the brachial artery start and end
starts at the inferior edge of teres major and runs through the cubital fossa where it then splits into the radial and ulnar artery
where does the brachial artery run
- Brachial artery is on the medial aspect of the anterior compartment, lateral to the biceps
what artery does the axillary artery gives off
- gives of the anterior circumflex and the posterior circumflex humeral artery
- these anatomise with each other
what artery does the brachial artery give off
– gives of profunda brachial
– this blood vessel passes into the posterior compartment of the arm and supplies the triceps in the posterior part of the arm
what are collateral arteries
- Around the elbow there are collateral arteries – these are smaller blood vessels that run around the joint and are an alternative root for blood to flow around, they allow continuous blood supply during movement at the joint
what does the brachial arteries split into
- splits into the radial and the ulnar arteries
where is the radial and ulnar arteries
- they are in the anterior compartment
- radial runs superficial to the radius
- ulnar runs superficial to the ulnar artery
what artery does the ulnar artery give off
anterior interosseous artery
what does the ulnar artery form in the hand
- Ulnar artery runs superficial to the carpal bones then enters the hand and forms the superficial palmer artery
what does the radial artery form in the hand
- radial artery runs posterior to the thumb b and runs through the anatomical snuff box and forms the deeper planar arches
what do the deep and superficial palmar arteries do and why is this important
- They both anatomise with each other- this is important in terms of the forearm as you can twist the forearm therefore when you pronate the arm you twist the radial artery and compress it therefore it allows continuity of flow to the fingers
what type of veins are in the arm
- Deep veins- in the deep muscle compartments themselves and have the same name as the arteries
- Superficial – these are veins that are in the superficial fascia
what are the superficial veins in the upper limb
- Cephalic – runs along the lateral aspect of the upper limb then between the deltoid
- Basilic
what joins the cephalic and basilica arteries together
- the median cubital
what is the brachial plexus
- This is a major network of nerves that provide sensory and motor innervation to the upper limb
what spinal segments is the brachial plexus from
C5-T1
what nerves form the brachial plexus and what is the spinal segments
- MOST ALCOHOLICS MUST REALLY URINATE
- Musculocutaenous – C5-C7
- Axillary – C5-C6
- Medial – C5-T1
- Radial – C5-T1
- Ulnar – C8-T1
what does the musculocutaneous nerve innervate
- They supply the flexor compartment of the arm
- biceps brachialis
- Brachialis
- Coracobrachialis
- therefore they innervate the muscles that are in the anterior compartment of the arm
what is the sensory innervation of the musculocutaneous nerve
- The sensory fibres of the musculocutaneous nerve are sensory fibres innervate het skin of the lateral forearm
what does the axillary nerve provide innervation to
- The axillary nerve provides motor innervation to deltoid and teres minor (rotator cuffs) and sensory innervation to the skin over the deltoid muscle
- involved in abduction and external rotation
describe the pathway of the axillary nerve
- Goes underneath the shoulder joint and emerges posteriorly between the two heads of the biceps
what can cause damage to the axillary nerve
dislocation of shoulder or fracture of humeral neck
what does damage to the axillary nerve cause
- Resulting in a loss of shoulder abduction beyond 15 degrees
- a sensory loss on the lateral aspect of the proximal part of the arm - regimental patch
- wasting of deltoid muscle due to damage of the axillary nerve
what does the median nerve innervate
- It then innervates muscles in the forearm
- Innervates the majority flexors of the forearm
- 1 and a half of flexors in the forearm are not innervated by the median nerve
- therefore it is in the anterior compartment of the forearm
describe the pathway of the median nerve
- travels through he brachial artery through the arm but it does not innervate the arm
- It runs with the brachial artery anterior to the elbow join through the cubital fossa
- Then travels through the carpal tunnel to reach the hand where it supplies the muscles of the thumb
what is the sensory innervation of the median nerve
- Sensory fibres innervate the skin over lateral palm, digits 1-3.5 (thumb to half of the ring finger)
what can effect the median nerve and cause damage
- the median never goes through the carpal tunnel, this is a compact and tight space
- inflammation of any of the tendons can effect the median nerve
what does the radial nerve innervate
- It innervates the posterior comparmetn of the arm and the forearm (extensors of the elbow and wrist)
where does the radial nerve run
- Passes into the posterior compartment of the arm and runs in the radial groove deep to the triceps brachii
what is the sensory innervation of the radial nerve
- Sensory fibres innervate the skin over posterior arm to wrist, dorsal hand
- Base of digits 1-3 & thumb
what does the ulnar nerve innervate
- Innervates 1 and a half muscles
- It innervates all of flexor carpi ulnaris and half of flexor digitorum profundus
where does the ulnar nerve run
- Runs medially in the arm travels with the brachial artery
- Posterior to the medial epicondyle and then enters the forearm
- It then runs into the hand and innervates most of the intrinsic muscles of the hand
what is the sensory innervation of the ulnar nerve
- The sensory fibres innervate the skin over medial dorsal and plantar hand,
- Digits 3.5 – 5
where does damage to the ulnar artery present itself
Any damage to the ulnar nerve presents in the hand as it tends to innervate the hand
what is effected if there is damage to the superior trunk
- damage is to the superior trunk between C5-C6 roots this effects the musculatenous nerve, axillary nerve and medial nerve and can effect the radial nerve
- this can lead to erbs palsy
what is Erb’s Palsy
- this is when there is damage to the superior trunk
- this is caused by an excessive angle between the shoulder and neck
what are the presentations of Erb’s Palsy
- adducted shoulder
- medially rotated arm
- extended elbow
- pronated forearm
- wrist flexed
what is effected when the inferior trunk is damaged
- effects C8-T1
- ulnar nerve
- medial nerve
- radial nerve
what is klumpke palsy
- Inferior trunk damaged
- Avulsion of the lower roots affect the small muscles within the hands and a claw hand results
what are the 3 important branches of the brachial plexus
- Long throaicic nerve – C5,C6,C7
- Throacodosral nereve – comes from posterior nerve trunk
- Suprascapular nerve – C5-C6
what muscles does the long thoracic innervate
- C5, C6, C7
* Innervates Serratus anterior – keeps scapula close to back
what muscles do the thoracodorsal innervate
- C6, C7, C8
* Innervates Latissimus dorsi
what muscles do the supra scapular innervate
- C5, C6
- Innervates Supraspinatus, infraspinatus (both from rotator cuff)
- Damage leads to wasting
what happens when there is damage to the long thoracic nerve
- Damage to this nerve causes wings to develop in the scapula
- C5,C6,C7 wings to heaven
