Neurovasculature - Upper Limb Flashcards
Where can you find pulses in the upper limb?
Brachial pulse
Radial pulse (at wrist and anatomical snuff box)
Ulnar pulse
When does the subclavian artery become the axillary artery?
Lateral border of the 1st rib
What arteries branch off of the axillary artery at the surgical neck of humerus?
Posterior and anterior circumflex arteries
Subscapular artery
At what point does the axillary artery become the brachial artery?
Inferior border of teres major
What can an axillary artery aneurysm result in?
Pain and loss of sensation in the arm due to brachial plexus pressure
Who is likely to get an axillary artery aneurysm?
Patients with Marfan’s syndrome
Patients with high blood pressure
(Baseball pitchers)
What branch arises just distal to teres major from the brachial artery and where does it travel?
Profunda brachii
Runs down radial groove with radial nerve
Is partial or temporary occlusion of the brachial artery a problem?
No, as the anastomotic supply protects the arm
What can happen with total blockage of the brachial artery or it being severed?
Ischaemia of the forearm causing necrosis and paralysis of muscles of forearm
The muscles shorten and cause a flexion deformity called Volkmann’s contracture
Which artery supplies the anterior and posterior of the forearm?
Radial artery - posterior forearm
Ulnar artery - anterior forearm
The radial and ulnar arteries anastamose in the hand to form what?
Superficial palmar arch
Deep palmar arch
What arteries arise from the superficial palmar arch?
Common palmar digital arteries
What are the two superficial veins of the upper limb called?
Basilic
Cephalic
What does the basilic vein drain into?
Forms the axillary vein by combining with deep brachial veins
Where does the cephalic vein drain?
Axillary vein in the axilla
What connects the cephalic and basilic veins at the elbow?
Median cubital vein
The brachial veins lie either side of the brachial artery and use its pulsations to aid return, what are these types of veins called?
Vena comitantes
What veins connect the deep and superficial veins?
Perforating veins
Where is the main site for venepuncture at the upper limb?
Median cubital vein anteriorly at the elbow
What roots make up the brachial plexus?
C5 C6 C7 C8 T1
What roots form the superior trunk?
C5 and C6
What roots form the middle trunk?
C7
What roots form the inferior trunk?
C8 and T1
What roots contribute to the musculocutaneous nerve?
C5
C6
C7
What roots contribute to the axillary nerve?
C5
C6
What roots contribute to the median nerve?
C6
C7
C8
T1
What roots contribute to the radial nerve?
C5 C6 C7 C8 T1
What roots contribute to the ulnar nerve?
C8
T1
What is Erb’s palsy?
Excessive increase in angle between neck and shoulder damaging roots C5 and C6
Leads to waiter’s tip position
What is Klumke palsy?
Excessive abduction of the arm leading to damage of the T1 root
Leads to paralysis of muscles in the hand - full claw of the hand
What motor functions does the axillary nerve have?
Teres minor
Deltoid
What sensory functions does the axillary nerve have?
Regimental badge area
What injury can cause axillary nerve damage?
Surgical neck of humerus fracture
Dislocation of the humerus
What is the motor function of the musculocutaneous?
Anterior compartment of the arm:
Brachialis
Biceps brachii
Coracobrachialis
What is the sensory function of the musculocutaneous nerve?
Skin on the lateral surface of the forearm
How can the musculocutaneous nerve be damaged?
Stab wound to the axilla
What is the motor function of the median nerve?
Anterior flexors of the forearm (except flexor carpi ulnaris and part of flexor digitorum profundus)
Thenar muscles in the hand
Lateral 2 lumbricals
What is the sensory function of the median nerve?
Lateral part of the palm
Lateral 3.5 fingers of anterior surface of hand
Lateral 3.5 fingertips of posterior surface of hand
What is the course of the median nerve at the elbow?
Through the cubital fossa
What can cause median nerve damage?
Carpal tunnel syndrome
Supracondylar fracture
Lacerations at the wrist
What is the characteristic sign of median nerve damage?
Hand of benediction
What are the motor functions of the radial nerve?
Triceps brachii
Posterior compartment of the forearm
What is the sensory function of the radial nerve?
Lower lateral and posterior aspects of upper arm
Posterior forearm
Dorsal palm and 3.5 digits (apart from fingertips)
What is the course of the radial nerve at the elbow?
Anterior to the lateral epicondyle of humerus
How does radial nerve damage present?
Wrist drop
What is the motor function of the ulnar nerve?
Flexor carpi ulnaris, part of flexor digitorum profundus Hypothenar muscles Medial lumbricals Adductor pollicis Interossei muscles
What is the sensory function of the ulnar nerve?
Medial palm
Medial 1.5 fingers anteriorly and posteriorly
What is the course of the ulnar nerve at the elbow?
Posterior to medial epicondyle
How can the ulnar nerve be damaged?
Medial epicondyle fracture
Lacerations to wrist
How does ulnar nerve damage present?
Ulnar claw
What can cause damage to the radial nerve?
Midshaft fracture of humerus
Fractures of the radial head
Stabbing in the forearm
