Overview of Upper Extremity

Question 1

Fascia of the upper extremity

• What are the two types of fascia in UE?
• Which one is strong, dense connective tissue?
• How are the arm, forearm, and wrist/hand divided?

Answer 1

Fascia of the upper extremity

• Superficial fascia
  
  • Contains: fat, cutaneous nerves, superficial veins, lymphatic vessels, and lymph nodes
• Deep fascia
  
  • Dense connective tissue, very strong
  • Includes following subdivisions: pectoral, deltoid, axillary, brachial, antebrachial, and palmar fascias (palmar has a central thickening called the palmar aponeurosis)
  • In the arm, the brachial fascia gives rise to two septa that divide the arm into anterior and posterior
  • In the forearm, the antebrachial fascia gives rise to a septum, which in combination with the interosseous membrane divide the foream into anterior and posterior
  • Near the wrist joint, the antebrachial fascia forms flexor (palmar surface) and extensor (dosal surface) retinacula, which keep tendons in place

Question 2

Veins of the upper extremity

• What is on the dorsal aspect of the hand?
• What drains lateral veins and where does this vein enter and drain into?
• What drains medial veins and what does this vein join to form?
• Where is the site of venipuncture?
  
  • Arises from what vein?
  • Drains into?
  • What is a common variation of this?

Answer 2

Veins of the upper extremity

• There are superficial and deep veins in the UE
• Perforating veins connect them
• Deep veins parallel the arteries

Superficial veins

• Dorsal venous network (dorsal aspect of hand)
• Cephalic vein
  
  • Drains lateral veins
  • Arises from lateral aspect of the dorsal venous network
  • Travels along the lateral aspect of the forearm and arm
  • Enters the deltopectoral triangle (between deltoid, pectoralis major, and clavicle) and drains into the axillary vein
• Basilic vein
  
  • Drains medial veins
  • Arises from medial aspect of the dorsal venous network
  • Courses along the medial aspect of the forearm and arm
  • Joins the brachial veins to form the axillary vein
• Median cubital vein (site of venipuncture)
  
  • Arises from the cephalic vein
  • Crosses superficial in the cubital fossa
  • Empties in the basilic vein
  • A common variation: some people have median antebrachial vein, which divides into median cephalic and median basilic veins (know for venipuncture)

Question 3

Lymphatics of the upper extremity

• Where does lymph drain to for lymphatic vessels accompanying:
  
  • Cephalic vein
  • Basilic vein
  • Deep veins
• What should you be concerned about with inflammation of the axillary lymph nodes?

Answer 3

Lymphatics of the upper extremity

• Superficial lymphatic vessels accompanying the cephalic vein first drain into the deltopectoral or axillary lymph nodes (if drainage is first to the deltopectoral nodes, the lymph then drains into the axillary nodes)
• Superficial lymphatic vessels accompanying the basilic vein first drain into the cubital lymph nodes, then drain into the axillary lymph nodes
• Deep lymphatic vessels accompanying the deep veins drain into the axillary lymph nodes
• Inflammation of the axillary lymph nodes may indicate infections of the UE, but are also a site for metastatsis of breast cancer (remember that superficial tissues superior to the umbilicus drain towards the axillar lymph nodes)

Question 4

Dermatomes of the upper extremity

• What are the general trends?

Answer 4

Dermatomes of the upper extremity

• General trend:
  
  • Superior cervical (C4-5) are near shoulder
  • Inferior cervical (C6-8) are near hand