Neurovasculature of the upper limb

Question 1

Learning outcomes

Answer 1

• Describe the anatomy of the brachial plexus and identify the roots, trunks, divisions, cords and 5 main terminal branches of the brachial plexus
• Describe the anatomy of the axillary artery in terms of location and parts of this vessel
• Describe the anatomy of the brachial and profunda brachii arteries
• Describe the venous drainage and lymphatic drainage of the upper limb

Question 2

Axilla

Answer 2

Axilla – armpitActs as a ‘gateway’

• Transition zone between the neck and the arm
• Contains the neurovasculature structures that serve the upper limb
• The axilla is protected by the adducted upper limb
• Formed by clavicle, scapula, thoracic wall, humerus and associated muscles

Question 3

The axilla- borders

Answer 3

Irregular shaped pyramidal space
Apex/Inlet: formed by 1st rib, scapula and clavicle: pectoralis major, pectoralis minor and subclavius: Thoracic wall (first 4 ribs) and serratus anterior
Posterior wall: subscapularis, teres major, latissimus dorsi
Lateral wall: intertubercular groove of humerus
Base/Floor: skin and fascia

Question 4

Axilla

Answer 4

Apex/Inlet
Cervicoaxillary canal
Acts as a passageway between neck and axilla
Arteries, veins, lymphatics and nerves transverse this opening (inbetween mid and ant. scalenes and under 1'st rib)
ARTERIAL SUPPLY
Subclavian artery 
Axillary Artery
Brachial
Radial
Ulnar
Superficial and deep palmar arc

Question 5

Arterial supply- aortic arch

Answer 5

Aortic arch
-Brachiocephalic trunk
-Left common carotid artery
-Left subclavian artery 
Branches of the subclavian artery:
VIT C D 
Vertebral, Internal thoracic, Thyrocervical trunk, Costocervicaltrunk, Dorsal scapular

Question 6

Axillary artery

Answer 6

-Supplies the walls of the axilla & related regions
-Continuous with the subclavian artery and brachial artery
-Closely related to the cords of the brachial plexus
1st part: From lateral aspect of 1st rib to medial aspect of pec. Minor
2nd part: From medial aspect of pec. minor to lateral aspect of pec. minor
3rd part: From lateral aspect of pec. minor to inferior border of teres major

1stpart: 1 branch –superior thoracic artery
2ndpart: 2 branches – thoracoacromialartery, lateral thoracic artery
3rdpart: 3 branches – subscapular artery, anterior circumflex humeral artery, posterior circumflex humeral artery
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Question 7

Brachial artery

Answer 7

Continuation of the axillary artery
Main supply of blood for the arm
Immediately gives the profunda brachii(deep artery) (runs posteriorly, radial collateral, inferior collateral anastamose at elbow)
•radial groove of the humerus
The brachial artery terminates by bifurcating into the radial and ulnar arteries