Superficial Structures Of Upper Limb Flashcards
Axillary fascia
Pectoral fascia leaves lateral border of pectoralis major and becomes axillary fascia which forms the floor of the axilla
Pectoral fascia
Invests the pectoralis major and is continuous inferiorly with the fascia of the anterior abdominal wall
Clavipectoral fascia
Deep to pectoral fascia and pectoralis major
Descends from the clavicle enclosing the subclavius and then the pectoralis minor, becoming continuous inferiorly with the axillary fascia
Costocoracoid membrane
Part of Clavipectoral fascia between pectoralis minor and subclavius
Pierced by lateral pectoral nerve which primarily supplies pectoralis major
Suspensory ligament of axilla
Part of Clavipectoral fascia inferior to pectoralis minor
Supports axillary fascia and pulls it and the skin inferior to it upward during abduction of arm, forming axillary fossa
Deltoid fascia
Invests the deltoid and is continuous with the pectoral fascia anteriorly and the dense infra spinous fascia posteriorly
Brachial fascia
Sheath of deep fascia, encloses arm like a snug sleeve
Continuous superiorly with deltoid, pectoral, axillary and infra spinous fasciae
Attached inferiorly to the epicondyles of the humerus and the olecranon of the ulna and is continuous with the antebrachial fascia. The deep fascia of the forearm
Inter muscular septa
Medial and lateral inter muscular septa
Extend from the deep surface of the brachial fascia and attach to the central shaft and medial and lateral supra epicondylar ridges of the humerus
Divide arm into anterior (flexor) and posterior (extensor) fasciae compartments
Each of which contains muscles serving similar functions and sharing common Innervation
Antebrachial fascia
Fascial compartments in the forearm surrounded by antebrachial fascia
Separated by interosseus membrane, connecting radius and ulna
Extensor retinaculum
Antebrachial fascia Thickens posteriorly over the distal ends of the radius and ulna to form a transverse band
Holds extensor tendons in position
Flexor retinaculum
Antebrachial fascia continues distal but deeper than palmar carpal ligament
Transverse carpal ligament
Extends between the anterior prominences of the outer carpal bones and converts to carpal tunnel
Palmar carpal ligament
Anterior thickening of antebrachial fascia
Continuous with extensor retinaculum
Carpal tunnel
Converted by flexor retinaculum: anterior concavity of the carpus into the carpal tunnel through which flexor tendons and median nerve pass
Palmar fascia
Deep fascia of the upper limb continues beyond the extensor and flexor retnacula
Palmar aponeurosis
Central part of palmar fascia
Thick, tendinous and triangular
Forms four distinct thickenings that radiate to the bases of the fingers and become continuous with the fibrous tendon sheaths of the digits
Superficial transverse metacarpal ligament
Bands transversed distally
Form the base of the palmar aponeurosis
Brachial plexus
Anterior rami of c5 to t1 spinal nerves
Cervical plexus
Series of nerve loops formed between adjacent anterior rami of the first four cervical nerves
Deep to SCM on lateral aspect of neck
Supra clavicular nerves
C3 c4
Pass anterior to clavicle, immediately deep to platysma and supply skin over clavicle and superolaterally aspect of pectoralis major
Posterior cutaneous nerve of the arm
C5-c8
Branch of radial nerve, supplies skin on the posterior surface of the arm
Posterior cutaneous nerve of forearm
C5 to c8
Also a branch of radial nerve
Supplies skin on posterior surface of forearm
Superior lateral cutaneous nerve of the arm
C5-c6
Terminal branch of axillary nerve, emerges from beneath posterior margin of the deltoid to supply the skin over the lower part of this muscle and on the lateral surface of the midarm
Inferior lateral cutaneous nerve of the arm
C5c6
Branch of radial nerve
Supplies skin over infero lateral aspect of the arm
Frequently a branch of the posterior cutaneous nerve of the forearm
Lateral cutaneous nerve of the forearm
C6c7
Terminal branch of musculocutaneous nerve
Supplies skin on lateral side of forearm
Medial cutaneous nerve of arm
C8-t2
Arises from medial cord of brachial plexus, often uniting in the axillary with the lateral cutaneous branch of the 2nd intercostal nerve
Supplies skin on medial side of the arm
Intercostobrachial nerve
T2
Lateral cutaneous branch of 2nd intercostal nerve
Also contributes to Innervation of skin on medial surface of the arm
Medial cutaneous nerve of the forearm
C8, t1
Arises from medial cord of brachial plexus and supplies skin on the anterior and medial surfaces of the forearm
Dorsal venous network
Dorsum of the hand
From which cephalon and basilic veins originate
Perforating veins
Form communications between the superficial and deep veins
Cephalic vein
Ascends on subcutaneous tissue from the lateral aspect of the dorsal venous network, proceeding along the lateral border of the wrist and the anterolateral surface of the forearm and arm
Median cubital vein
Anterior to elbow, communicates with Cephalic vein
Passes obliquely across anterior aspect of the elbow and joins the basilic vein
Cephalic vein superiorly
Cephalic vein passes between the deltoid and pectoralis muscles and enters Clavipectoral triangle, where it pierces Costocoracoid membrane, part of the Clavipectoral fascia, and joins terminal part of axillary vein
Basilic vein
Ascends in subcutaneous tissue from the medial end of the dorsal venous network, along the medial end of the dorsal venous network along the medial side of the forearm and inferior part of the arm
Then passes deeply near junction of the middle and inferior thirds of the arm, piercing the brachial fascia, and running superiorly parallel to the brachial artery, where it merges with accompanying veins of brachial artery to form axillary vein
Median antebrachial vein
Median vein of forearm
Ascends in the middle of anterior aspect of forearm
Deep veins
Lie internal to deep fascia and usually occur as paired, continually interanastomosing, accompanying veins that travel with and bear the same name as the major arteries of the upper limb
Superficial lymphatic vessels
Arise from lymphatic plexuses in the skin of the fingers, palm and dorsum of the hand and ascend mostly with superficial veins, such as the Cephalic and basilic veins
Cubital lymph nodes
Some lymphatic vessels accompanying basilic vein enter
Located proximal to medial epicondyle
Humeral (lateral) axillary lymph nodes
Efferent vessels from cubital lymph nodes ascend in the arm and terminate here
Apical axillary lymph nodes
Most lymphatic vessels accompanying Cephalic vein cross proximal part of the arm and anterior aspect of shoulder to enter here
Deltopectoral lymph nodes
Some vessels enter
More superficial
Deep lymphatic vessels
Less numerous than superficial
accompany major deep veins and terminate in Humeral (lateral) axillary lymph nodes
Injury to axillary nerve
Atrophy of the deltoid occurs when the axillary nerve is damaged
Rounded contour of shoulder disappears
Slight hollow inferior to acromion
To test deltoid, abduct against resistance starting at 15 degrees
C3 c4 dermatome
Supply region at the base of the neck, extending laterally over the shoulder
C5 dermatome
Supplies arm laterally (ie superior aspect of abducted limb
C6 nerve dermatome
Supplies forearm laterally and the thumb
C7 dermatome
Supplies middle and ring fingers (or middle three fingers) and the middle of the posterior surface if the limb
C8 dermatome
Little finger, medial side of the hand and the forearm (ie the inferior aspect of the abducted limb)
T1 dermatome
Middle of the forearm to the axilla
T2 dermatome
Supplies a small part of the arm and the skin of the axilla
