SPR L1 Neurovascular Anatomy of the Upper Limb

Question 1

Learning Outcomes (for general perusal)

Answer 1

• Describe the superficial veins of the upper limb
• Describe the axillary artery and branches of this vessel
• Describe the formation of the brachial plexus of nerves

Question 2

Describe the nomenclature of the upper limb

Answer 2

Shoulder to elbow = arm

elbow to fingers = forearm

Question 3

Describe the compartments in the

1. Upper Limbs
2. Lower Limbs

Answer 3

1. Anterior Cs contain flexor muscles, Posterior Cs contain extensor muscles
2. Anterior Cs contain extensor muscles Posterior Cs contain flexor muscles

OPPOSITE WAY AROUND

Question 4

Limb Rotation

Describe limb rotation in the following stages of gestation

1. 5 Weeks
2. 6 Weeks
3. 7 and 8 Weeks

Answer 4

1. Upper and lower limbs have formed as ‘finlike’ projections, point laterally and caudally
2. The upper and lower limbs have become flexed anteriorly which results in the elbow and knee joints pointing laterally; the palmar aspect of the hands and plantar aspect (sole) of the feet face the trunk. (within 1 week, digits have formed)
3. The upper and lower limbs have undergone 90-degree torsion, however, in opposite directions: the elbows point caudally and the knees point cranially

Question 5

At what point in gestation does limb rotation occur?

Answer 5

Weeks 5-8

Question 6

Venous Drainage of the Upper Limb

1. Outline the main Veins in the upper limb
2. Which runs laterally?
3. Which runs medially?
4. Which joins the above two veins?

Answer 6

1. Cephalic, Basilic and Median Cubital Vein
2. Cephalic Vein
3. Basilic Vein
4. Median Cubital Vein

Question 7

Where does the cephalic vein run?

Answer 7

In the Deltopectoral groove between the deltoid and pectoralis major

Question 8

Arterial Supply of the Upper Limb

​Name the main arteries in the upper limb

Answer 8

• Axillary Artery
• Brachial Artery (very superficial)
• Ulnar Artery
• Radial Artery
• Superficial Palmar Arch
• Deep Palmar Arch

(R and U involved in formation of palmar arches

Question 9

What are the branches of the 1st part of the axillary artery?

Answer 9

Superior Thoracic Artery

Question 10

What are the branches of the 2nd part of the axillary artery?

Answer 10

Acromiothoracic artery (thoracoacromial artery)

Lateral Thoracic Artery

Question 11

What are the branches of the 3rd part of the axillary artery?

Answer 11

Anterior and Posterior Circumflex Humoral Arteries

Subscapular Artery

Question 12

Name the branches of the axillary artery

Answer 12

Superior Thoracic (1st part)

Acromiothoracic Artery (2nd part)

Lateral Thoracic Artery (2nd Part)

Subscapular Artery (3rd Part)

Anterior Circumflex Humoral Artery (3rd Part)

Posterior Circumflex Humoral Artery (3rd Part)

Question 13

What are the boundaries to each part of the Axillary Artery?

Answer 13

Medial to Pectoralis Minor = 1st Part

Just behind Pectoralis Minor = 2nd Part

Lateral to Pectoralis Minor = 3rd Part

Question 14

What is the beginning of the axillary artery?

Answer 14

Axillary continuous with subclavian artery

Become axillary once the SC passes over the lower border of the first rib

Question 15

Where does each of these supply?

1. 1st part of the axillary artery?
2. 2nd part
3. 3rd part

Answer 15

1. Upper anterior part of the chest wall
2. Acromial region, clavicle and pectoral region, deltoid region
3. Humerous, glenohumoral joint (circumflex arteries) and subscapular region (subscapular artery)

Question 16

Brachial Plexus

Material covered (for general perusal)

Answer 16

• —The discrete components of the brachial plexus and how the plexus is formed
• —Where these discrete components are located
• —The five main terminal branches of the plexus
• —Important anatomical relations

Question 17

Brachial Plexus

Describe the

1. Roots
2. Trunks
3. Divisions
4. Cords
5. (Branches)

Answer 17

1. Anterior Rami of spinal nerves C5, C6, C7, C8, T1
2. Upper, middle and lower
3. Anterior and Posterior
4. Medial, lateral and posterior

Nb. each trunk gives off an anterior and posterior division

Question 18

What are the 5 main terminal branches of the brachial plexus?

Answer 18

Musculocutaneous Nerve

Median Nerve

Ulnar Nerve

Axillary Nerve

Radial Nerve

Question 19

Where do the roots of the brachial plexus come from?

Answer 19

Anterior Rami of C5, C6, C7, C8 and T1

Coming off the spinal cord in an ant and post root (not the roots previously mentioned), then spinal nerve is formed then ant ramus and post ramus

Question 20

Brachial Plexus

1. Where can the roots be found?
2. What is the upper trunk formed by?
3. How does the C7 root travel?
4. What is the lower trunk formed by?
5. Where are the trunks located?
6. What all converge?
7. What forms the lateral cord?
8. With what are the cords of the BC closely related?
9. What are the cords?
10. What does the radial nerve innervate?

Answer 20

1. In the prevertebral area of the neck
2. C5,C6 roots
3. By itself
4. C8 and T1 roots
5. In the Posterior Triangle of the neck
6. The 3 posterior trunk divisions
7. Upper two Anterior Divisions (of the Upper and middle trunk)
8. The second part of the axillary artery (named accordingly)
9. Lateral, posterior, and medial cord. (all in relation to 2nd part of axillary artery)
10. Posterior compartment of arm and forearm

Question 21

Discuss the important relations of the brachial plexus

identify the 1st, 2nd & 3rd parts of the axillary artery

Can you locate the medial & lateral cords of the brachial plexus?

Answer 21

Medial to Pectoralis minor is first part, Just Behind Pminor is second part, Just lateral to Pminor is the third part

Medial and lateral cords are labelled (named according to relation with axillary artery)

Question 22

Give examples of ways the brachial plexus can be damaged?

Answer 22

• Falling on outstretched palms
• During birth
• Swinging from a tree

Question 23

Additional Info Source (for general perusal)

Answer 23

Clinically Oriented Anatomy

7th Edition: Pages 726 – 730