Nerves and vessels Flashcards
Discuss route and course of the brachial plexus
Formed by the ventral rami of C5-8
Anterior rami of T1
Roots and Trunks lie in the posterior triangle of the neck. They run between the anterior and middle scalene muscles. Run posterior and superior to the subclavian artery.
Division run under the clavicle and over the first rib
Cords lie in the axillary region- run with the second part of the axillary artery. Lateral cord runs lateral, medial runs medial and posteior runs posterior
Describe the course of the median nerve
Formed at lower border of axilla by the union of the medial and lateral cords of the brachial plexus
Does not give branches in the arm
Initially sits laterally to the brachial artery then crosses to sit medially in the arm
lies on corachobrachialis and brachialis
Crosses over into the forearm via the cubital fossa between the two heads of pronator terres
runs between the FDP and FDS
AIN branches in the forearm and supplies the deep flexor muscles
Plamar cutaenous nerve of the median nerve passes over the flexor retinaculm to supply the palmar 3 and a half fingers
Becomes superficial at the wrist passing between FDS and flexor carpi radialis
Median nerve passes through the carpal tunnel (most superficial nerve)
In the hand branches into the recurrent branch which innervates the thenar musles and digital branches which supply the cutaneous nerve
Describe the course of the radial nerve
Continuation of the posterior cord of the brachial plexus
Arising in the axilla exiting posteriorly to the brachial artery
Passes with the profunda brachia artery through the lateral triangular space into the posterior compartment of the arm
Descends down the arm in the radial groove
Accompanied by produna brachia
Passes through the lateral intermuscualr septum to enter the anterior compartment
Runs between brachialis and bracioradialis and then extensor carpi radialus longus to enter the lateral part of the cubital fossa
In the arm branches into the deep and superficial branches
Superficial branch is sensory - descends deep to the brachioradialis muscle and curves laterally passing over the anatomical snuff box
Describe the branches of the radial nerve
Axilla
-Muscular branch to the long, lateral and medial heads of tricpes
Radial groove
-posterior cutaneous nerve of arm
-lower lateral cutaneous nerve of arm
-posterior cutaneous nerve of the forearm
anterior compartment
-muscular branches to extensor compartment
-terminal superfical cutaneous branch : supplies dorsum of the radial 3 and a half digits
PIN
-passes between the 2 head of supinator to enter the posterior compartment to supply the extensor muscles and wrist joint
Describe the course and branches of MSK nerve
Branch of the lateral cord of the brachial plexus
runs obliquely down to enter coracobrachialis
passes through coracobrachialis to lie between biceps and brachialis
appears at lateral margin of the biceps tendon to become the lateral cutaneous nerve of the forearm
Branches
- biceps
- corocobrachialis
- brachialis
- lateral cutaneous nerve of the forearm
Describe the course of the ulnar nerve
Arises from the medial cord of the brachial plexus
Lies medial to the brachial artery on coracobrachialis to the mid point of the humerus
Pierces the medial intermuscular septum to enter the posterior compartment
Courses through lower part of extensor compartment between intermuscular septum and medial head of triceps
runs on bone in groove of medial epicondyle posteriorly
enters the forearm by passing between humeral and ulnar heads of FCU
Lies medial to the conoid process of the ulna
Lies on FDP and lateral to FCU accompanied by ulnar artery
Passes superficail to the retinaculum through canal of guyun
Divides into terminal branches at the pisiform bone
Describe the branches of the ulnar nerve
Superficial terminal branch
-supplies plamaris brevis and 2 digital nerve to medial 1 and a half fingers
Deep terminal branchs
- hypothena muscles
- 2 lumbrical on ulnar side
- booth heads of adductor policis
Dorsal cutanous branch
Describe the course of the axillary nerve
branch of the poserior cord of the brachial plexus
passes posterior to the axillary artery lies between subscapularis and axillary artery
passes through the quadrangular space with posterior circumflex artery
Supplies deltoid and terres minor
superior lateral cutaneous nerve to the arm
Describe axillary artery and its branches
Branch of the subclavian artery at the level of the 1st rib
Divided into three parts by pec minor
1st part before pec minor
-superior thoracic branch
2nd part under the pec minor
- thorco-acromian branch
- lateral thoracic branch
3rd part distal to the pec minor
- anterior circumflex of the humerus
- posterior circumflex of the humerus
- sub-scapular artery (largest branch)
Describe course of brachial artery and its branches
continuation of axillary artery at the level of terres major
superficial course just below the deep facia
lies medial to humerus then spirals to lie anteriorly
crossed from lateral t medial by median nerve in the mid arm
Branches
profunda brachii
-runs in the radial groove with the radial nerve to supply
triceps humerus and elbow
-two branches the radial and middle colateral artery
superior ulnar collateral
-accompanies ulnar nerve
inferior ulnar collateral
-divides into anterior and posterior branch and forms cubital anastomosis
-nutrient artery to the humerus
Describe the course of the radial artery
Direct continuation of the brachial artery
Passes medial to biceps tendon
crosses supinator and tendon of insertion of pronator teres
runs on flexor pollicis longus
passes underneath tendons of abductor policis longus and extensor polis brevis to cross the anatomical snuffbox on scaphoid and trapezium
passes under tendon of extensor policis longus then between 2 heads of first dosal interosseus and bewteen the 2 heads of adductor pollicis to enter the plam of the hand and form the deep palmar arch
Describe branches of radial artery
Proximal
-the radial recurrent artery which anastomoses with the radial collateral artery
Distally
- palmar carpal branch of the radial artery
- dorsal carpal branch of the radial artery
- superifical radial branch to form the superfical palmar arch
- terminates in the deep palmar arch
- princeps pollicis artery runs along the palmar acpect of the 1st metacarpal
- radialis indicis artery
Descirbe the course of the ulnar artery
Arises as the terimnal bifurcation of the rbachial artery in the cub fossa
leaves the cub foss passing medially, deep to the deep head of pronator terres and deep to the bribous arch of FDS
Runs on FDP and lateral to FCU accompanied by the ulnar nerve
passes superficial to the flexor retinaculum through the canal of guyon
Describe the branches of the ulnar artery
Proximal
- anterior and posterior recurrent ulnar arteries
- common interoussous artery which divides into anterior and posterior branch
Distal:
- palmar carpal branch of the ulnar artery
- dorsal carpal branch of the ulnar artery
- deep palmar branch anastomosis with a branch of the radial artery to form the deep palmar arch
- terminates into the superifical palmar arch
Describe superficial palmar arch
Lies superifical to flexor tendons and deep to palmar aponeurosis branches -common palmar digital arteries -proper palmar digital arteries -
Deep palmar arch between flexor tendons and metacarpal bones
branches
-palmar metacarpal arteries
