neurovasculature of the upper limb Flashcards
Name the branches of the arteries in the upper limb (in order)
Subclavian artery
Axillary artery
Brachial artery
Radial artery
Ulnar artery
Where does the subclavian artery originate from in the left and right arm
Left-arch of aorta
Right-brachiocephalic trunk
When does the subclavian artery become the axilla
lateral border of the first rib
What is formed around the surgical neck of the humerous and is prone to damage during a fracture?
Anterior and posterior circumflex humeral arteries
When does the axilla become the brachial artery?
Lower border of the teres major muscle,
Name an important branch of the brachial artery. What does it travel with and through where? What does it supply?
Profunda brachii
Travels with radial nerve- Through radial groove of humerous
Supplies structures in posterior aspect of the arm
Where will you find the brachial pulse?
Medial to the distal tendon of biceps brachii. In the cubital fossa
When does the brachial artery form the Radial and Ulnar arteries?
At the cubital fossa underneath bicipital aponeurosis
What does the ulnar artery give rise to? What does this supply?
Gives rise to the anterior and posterior interosseous arteries, which supply deeper structures in the forearm.
What does the ulnar and radial artery produce in the hand?
Deep and superficial palmer arch
Which artery- radial or ulnar contributes the most to each palmer arch?
Ulnar- deep
Radial- superficial
Where are the radial and ulnar pulses located?
Radial- Lateral to tendon of felxor carpi radialis
Ulnar- Lateral to tendon of flexor carpi ulnaris
Which pulse out of the ulnar and radial, is easier to palpate and why?
Radial pulse is easier
Ulnar pulse runs deeper and lies under pisiform bone
Where else can you palpate the radial pulse?
Anatomical snuff box
What are collateral arteries? Name the 4 in the arm
They are found around joints to allow continuouse supply of blood during movments at the joint.
- Anterior and posterior circumflex arteries
- superior ulnar collateral artery
- Inferior ulnar collateral artery
- Radial collateral artery
Name the superficial veins?
Which is more medial and which is more lateral?
Where are they located?
Basilic- Medial
cephalic - Lateral
Median antecubital- connects across anterior of cubital fossa
Located in the superficial fascia
Name the deep veins
Which compartment are they located in?
Deep veins take the name of accompanying arteries
Subclavian artery and vein
Axillary artery and vein
Brachial artery and vein
Radial artery and vein
Ulnar artery and vein
Located in the deep fascia (muscular compartments)
What is the brachial plexus? What is its function?
Network of nerves
Supplies sensory and motor innervation to the upper limb
Draw and label the brachial plexus
Where can the brachial plexus be palpated?
superior border of clavicle
What are the fibers for the brachial plexus?
C5-T1
What are the anterior branches of the brachial plexus?
Musculocutaneous
Median
Ulnar
What are the posterior branches of the brachial plexus?
Axillary and radial
What does the musculocutaneous nerve supply? Name the muscles and location of sensory innervation.
Flexor compartment of the arm
- Biceps brachialis
- Brachialis
- Coracobrachialis
Sensory to- lateral formarm
Where on the skin is the sensory innervation for Musculocutaneous nerve?
Lateral forarm
Which muscles does the axillary nerve suppy? Where is the sensory innervation?
Motor- Deltoid and teres minor
Sensory- skin over deltoid mucles
How is the axillary nerve often injured? If injured what is the consequnece?
Shoulder dislocation
Fracture to the humeral neck
Consequnce- Loss of shoulder abduction beyond 15 degrees
Sesnory loss over deltoids
Name the nerve roots for the median nerve
Motor innervation?
Sensory innervation?
C5-T1
Anterior forarm (flexor) compartment
Passes through carpal tunnel and supplyes thenar mucles
Sensory- lateral palm digits 1,2,3.5
What happens when the median nerve is damaged or compressed? (low median nerve injury)
Paralysis of most didgit fexors and muscles moving thumb
Long term- thenar wasting
What happens when a high median nerve injury occurs?
What could cause a high median nerve injury?
Hand of benadiction
occurs when a patient is asked to make a fist
thumb and digits 1-2 stay straight
Elbow dislocation, forarm fracture
Radial nerve motor and sensory innovation- also root fibers
Motor to muscles in the posterior compartment of the forarm
runs through radial groove
Sensory- Skin over posterior arm- wrist
Dorsal hand, base of digits 1-3 and thumb
Nerve roots c5-T1
Ulnar nerve
Nerve roots?
Sensory?
Motor?
Roots- C8-T1
Motor- Most of the intrinsuc muscles of the hand
Medial half of deep forarm muscles- Flexor carpi ulnaris and the ulnar half of flexor digitorum profundus in the forearm.
Sensory- Medial and dorsal planter hand
Digits 3.5-5
Consequnce of Musculocutaneous nerve damage
Paralysis of coracobrachialis, biceps and brachialis(anterior muscle compartment)
Consequnce of ulnar nerve damage. What can cause it?
Paralysis of intrinsic muscles of the hand
(claw hand)
Loss of sensation to little finger
cause- frature of medial epicondyle of humerous (nerve runs lateral to it)
Consequence of radial nerve injury
wrist drop
No extension of wrist and digits
Unapposed action of strong flexor mucles FDS and FDP
Cause and consequence of superior brachial plexus injury?
C5-C6
Erb-Duchenne Palsy
Loss of sensation lateral aspect of arm
Paralysis of muscles of shoulder and arm supplied by these nerve roots (Deltoid, infraspinatus, biceps, brachialis)
Cause- Extensive stretching of neonates head during birth
Back packers
Apparence of somone with superior brachial plexus injury
- Adducted shoulder
- Medially rotated arm
- Extended elbow
Cause and consequnce of inferior brachial plexus injury
C8-T1
Klumpke Palsy
Consequnce- paralysis of small muscles of the hand
claw hand
Upper limbed excessively pulled anteriorly
Roots for long thoracic nerve. Which muscle does it innervate? Consequence of damage?
- C5, C6, C7
- Serratus anterior
Winged scapula
What are the nerve roots for Thoracodorsal nerve? Which muscle does it innervarte?
C6, C7, C8
Latissimus dorsi
What are the nerve roots for Suprascapular? Which msucle does it innervate? Consequnce of damage?
–C5, C6
–Supraspinatus, infraspinatus
Mucsle wasting- indent in scapula
How can Klumpke palsey lead to Horners syndrom?
When T1 is affected
What is Horners syndrom and what are the symptoms?
Syndrome of sympethetic nerve causes constriction of pupils and drooping eye lids
