Nerves & Vasculature Flashcards
Where does the Brachial Plexus travel?
travels between anterior and middle scalenes, deep to clavicle, deep to pec minor, through axilla to branch out into the arm
The nerves of the arm are the 5 terminal branches of the brachial plexus, which are the:
- musculocutaneous
- axillary
- radial
- median
- ulnar
What’s Thoracic Outlet Syndrome?
dysfunction of the upper arm, shoulder – it doesn’t tell us exactly what is impinged
What does the radial nerve supply?
triceps, anconeus, brachioradialis, supinator, forearm extensors, snuff box muscles, dorsum of hand
What does the ulnar nerve innervate?
flexor carpi ulnaris and medial 1/2 of flexor digitorum profundus, hypothenar muscles, medial lumbricals (3 and 4), adductor pollicis, palmaris brevis, the interossei (all)
What nerve is superficially exposed between the olecranon and medial epicondyle?
ulnar nerve (funny bone) (it’s around hook of hamate, so long sustained pressure, FOOSH, etc. can affect it)
What innervates the hypothenar eminence and 3rd-4th lumbricals?
ulnar nerve
What’s the only nerve that travels through the carpal tunnel?
median nerve
What does the median nerve supply?
(almost all the anterior forearm muscles), wrist and hand, thenar muscles (thenar emminence), lateral lumbricals (1 and 2), lateral FDP
What’s the most common impairment caused by impingement of the median nerve?
carpal tunnel syndrome
What kind of deformity can be caused by injury of median nerve?
Ape Hand deformity (loss of opposition where thumb aligns with other digits)
Where does the musculocutaneous nerve travel and what does it supply?
- passes through the coracobrachialis down the arm between the biceps and brachialis muscles
- biceps brachii, brachialis, coricobrachialis (basically anterior arm)
Where does the axillary nerve travel?
passes below the GH joint capsule around the surgical neck of the humerus (under head of humerus) (regimental badge area)
What does the axillary nerve supply?
supplies deltoid, teres minor, long head of triceps (along with radial nerve)
Which nerve is likely to be injured with dislocation of humerus?
axillary nerve
What does the long thoracic nerve supply?
serratus anterior (injury might result in scapular winging (this is especially visible during pushup)
What does dorsal scapular nerve supply?
levator scapula and rhomboids (with injury, might see protraction of scapula, depression of scapula)
Where does the radial nerve travel?
passes along the posterior humerus in the radial groove (deep to triceps) and into the posterior forearm
Where does the median nerve travel?
passes down the medial arm (with no branches in the axilla or arm) through the cubital fossa, deep into the forearm, through the carpal tunnel and into the hand
Where does the ulnar nerve travel?
passes down the medial arm, through the cubital tunnel (the tunnel formed by the medial epicondyle anteriorly and the olecranon posteriorly), into the anterior forearm (medial side), and into the hand between the pisiform and the hook of the hamate (the tunnel of Guyon)
Generally what is the brachial plexus divided into?
roots trunks divisions cords branches
Where does the femoral artery start, what does it branch into, and where is it superficially exposed?
- starts around L4 then branches into external and internal iliac arteries
- superficially exposed around the femoral triangle
The abdominal aorta travels down the midline before splitting into the:
left and right common iliac arteries
Where does the popliteal artery start and what does it supply?
- starts at the adductor hiatus
- supplies knee joint
Where do the anterior and posterior tibial arteries start and where do they travel?
- start at the inferior border of the popliteus
- travel anteriorly and posteriorly to the tibia
Which artery passes posteriorly to the medial malleolus and supplies the sole of the foot?
posterior tibial artery (palpable pulse behind medial malleolus)
After the anterior tibial artery passes over the ankle joint, it becomes the:
dorsalis pedis artery (palpable pulse over navicular)
Where can pulses be palpate in the leg and what arteries are being palpated?
- femoral triangle; femoral artery
- behind the knee; popliteal artery
- over the navicular; dorsalis pedis artery
- behind medial malleolus; posterior tibial artery
Which arteries supply the head and neck of the femur?
medial and lateral circumflex femoral arteries and the artery in the ligament of the head of the femur
What % of blood volume is in veins
60%
What are the two main superficial veins of the leg?
- great saphenous vein (most important in lower limb)
- small saphenous vein
Where is the lumbar plexus?
braiding of nerves embedded in psoas muscle (T12-L4)
What does the lumbar plexus supply?
psoas
What does the lumbar plexus branch into?
branches into the femoral and obturator nerve
What does the femoral nerve supply?
supplies iliacus, quadriceps, articularis genus, sartorius, pectineus
What does the obturator nerve supply?
supplies adductors (except posterior fibres of adductor magnus), obturator externus
What does the sciatic nerve branch into?
-branches into: just above popliteal fossa – common peroneal and tibial nerves in same sheath
Where does the sciatic nerve travel?
- all fibres pass anteriorly to the piriformis through the greater sciatic foramen
- common peroneal passes trough the piriformis (tibial anterior to piriformis)
- common peroneal passes above the piriformis (tibial anterior to piriformis)
- whole sciatic nerve passes through the piriformis
What are the two main causes of sciatic nerve problems?
lumbar spine disc herniation or piriformis spasm
What does the tibial nerve supply?
supplies: posterior compartments of the leg, plantar intrinsic muscles of the foot
Where does the common peroneal nerve travel?
- wraps around the head of the fibula (through the peroneal tunnel)
- enters the peroneus longus m where it divides into the superficial and deep peroneal nerves
Where is the common peroneal nerve palpable?
through the peroneal tunnel (around head of fibula)
What does the superficial peroneal nerve supply?
lateral compartment of hte leg
Where does the deep peroneal nerve travel and what does it supply?
- travels down the anterior aspect of the interosseous membrane
- supplies anterior compartment, extensor digitorum brevis
What are the most clinically important gluteal nerves?
deep gluteal nerves
What does the superior gluteal nerve supply?
supplies: gluteus medius, gluteus minimus, TFL
What does the inferior gluteal nerve supply?
supplies: gluteus maximus
What does the pudendal nerve supply?
supplies: external genitalia, sphincters of the bladder and rectum
Where does the subclavian artery travel?
travels under the clavicle with the brachial plexus
Where does the vertebral artery travel?
travels up the transverse foramina of C6-C1, across the atlas, and then turns into the basilar artery
Where does the axillary artery travel?
- passes under pec minor
- at the outer border of the 1st rib, the axillary artery becomes the subclavian artery
Where does the brachial artery travel?
- starts at the inferior border of teres major
- divides into the ulnar and radial arteries
Where does the ulnar artery travel?
- starts at the neck of the radius, then travels down medial forearm
- in the hand it sends off branches/arches into the hand
Where does the radial artery travel?
- starts at the neck of the radius, then travels down lateral forearm
- in the hand it sends off branches/arches into the hand
Where does the common carotid artery branch into internal and external?
branches at C4
The 2 carotid and 2 vertebral arteries merge in the midline to form:
the basilar artery
What do 2 carotid, 2 vertebral (combined to form basilar artery) ultimately supply?
supply brainstem
The veins in the hand combine to form the ___ and ___ veins (the 2 main superficial veins in the forearm.
basilic; cephalic
The ___ ___ vein forms the communication between the basilic and cephalic veins.
median cubital
The basilic vein becomes the ___ vein at the inferior border of teres major.
axillary
The axillary vein becomes the ___ vein at the outer border of the 1st rib.
subclavian
A branch of the femoral nerve that innervates skin on lateral side of leg is called:
the lateral femoral cutaneous nerve (when impinged, symptoms could be hair loss and feel like bee stings, burning, bugs crawling – this is called meralgia parasthetica) (this could show up in pregnancy clinic)
What does mero translate to?
thigh
What does parasthetical mean?
abnormal sensation
What’s the aka for axis?
fulcrum
What’s the force arm (FA)?
the distance between the force being applied and the axis
What’s the resistance arm (RA)?
the distance between the resistance and the axis
What are first, second and third class levers?
1st: force, axis, resistance (FAR)
2nd: axis, resistance, force (ARF)
3rd: axis, force, resistance (AFR)
(you stay FAR away from dogs [and dogs say ARF] because you’re AFRaid)
