UL2 - Neurovasculature to forearm, wrist & elbow

Question 1

what veins do the deep veins drain into before joining with the basilic/axillary vein?

Answer 1

brachial vein - paired veins that surround the brachial artery

Question 2

through which anatomical structure does the cephalic vein pass before draining into WHAT vein?

Answer 2

axillary vein - passes through the deltopectoral groove before draining into the axillary vein within the clavipectoral triangle/fascia

Question 3

describe the origin and course of the basilic vein & what vein it drains into

Answer 3

originates from the dorsal venous arch

ascends the medial aspect of the UL as a superficial vein

drains into the axillary vein

Question 4

what vein does the axillary vein drain into?

Answer 4

subclavian vein - which drains into superior vena cava

Question 4

describe the origin and course of the cephalic vein & what vein it drains into

Answer 4

originates from the lateral side of the dorsal venous arch of the hand

ascends the lateral aspect of the UL as a superficial vein

travels through the deltopectoral groove (between the deltoid & pectoralis major) - drains into the axillary vein at the clavipectoral triangle

Question 5

what vein bridges the basilic & cephalic veins at the level of the cubital fossa?

Answer 5

median cubital vein

Question 6

what arteries do the deep veins of the upper limb follow? what do they drain into?

Answer 6

the radial and ulnar arteries - drain into the paired brachial veins

Question 7

how do the brachial veins contribute to venous drainage in the upper limb?

Answer 7

paired veins that surround the brachial artery - drain into the basilic or axillary artery

Question 8

what veins arise from the dorsal venous arch of the hand?

Answer 8

palmar and metacarpal venous tributaries

Question 9

at which anatomical point does the brachial artery bifurcate? what are the two branches it forms?

Answer 9

at the level of the neck of the radius - bifurcates into the radial & ulnar arteries

Question 10

what branch does the ulnar artery give off, and into which arteries does it divide

Answer 10

common interosseus artery - divides into the anterior & posterior interosseus arteries (relative to the interosseus membrane)

Question 11

to what muscles does the ulnar artery run DEEP to? what arterial arch does it form?

Answer 11

along the medial forearm, DEEP to flexor carpi ulnaris & flexor digitorum profundus

forms the superficial palmar arch –> common and proper palmar digital arteries

Question 12

through which anatomical structure does the ulnar artery pass to enter the hand?

Answer 12

superficial to flexor retinaculum through Guyon’s canal

Question 13

what is the course of the radial artery in the forearm and hand?

Answer 13

• bifurcation from the brachial artery at the level of the radial neck
• superficial to the radius, deep to the brachioradialis
• passes laterally at the wrist (pulse point)
• wraps around to pass through the anatomical snuff box
• forms the deep palmar arch

Question 14

what palmar arch does the radial artery form?

Answer 14

deep palmar arch

Question 15

what is the clinical significance of the anastomosis between the superficial and deep palmar arches?

Answer 15

collateral blood flow between the ulnar & radial arteries - assessed during Allen’s test to ensure a complete palmar arch

Question 16

what arteries supply the fingers? how are they derived?

Answer 16

proper palmar digital arteries - derived from common palmar digital arteries of the superficial & palmar metacarpal arteries from the deep palmar arches anastomosing

Question 17

where is the radial pulse detected relative to the flexor carpi radialis?

Answer 17

lateral to the flexor carpi radialis tendon at the wrist

Question 18

what artery runs deep to the pronator teres?

Answer 18

ulnar artery

Question 19

what two muscles does the ulnar artery run deep to in the forearm?

Answer 19

flexor carpi ulnaris
flexor digitorum profundus

Question 20

what do the palmar metacarpal arteries arise from? how do they contribute to arterial supply in the hand?

Answer 20

arise from the deep palmar arch - anastomose with common palmar digital arteries to form proper palmar digital arteries that supply the fingers

Question 21

where does the radial artery go after passing the lateral aspect of the wrist?

Answer 21

through anatomical snuff box –> forms the deep palmar arch

Question 22

what is being assessed during an Allen’s test?

Answer 22

collateral blood flow between the radial and ulnar arteries by checking for a complete palmar arch

Question 23

nerve roots & cord origins of the radial nerve?

Answer 23

roots - C5-T1
cord - posterior

Question 24

at what anatomical structure does the radial nerve divide into its superficial and deep branches?

Answer 24

level of the cubital fossa

Question 25

what is the continuation of the deep branch of the radial nerve?

Answer 25

posterior interosseus nerve

Question 26

which areas of the hand are supplied by the superficial branch of the radial nerve?

Answer 26

skin of the lateral 3 1/2 fingers on the hand dorsum

Question 27

through which anatomical structure does the median nerve pass at the wrist?

Answer 27

through carpal tunnel - deep to flexor retinaculum

Question 28

of what nerve is the anterior interosseus nerve a branch of? function?

Answer 28

the median nerve - supplies deep muscles of the anterior forearm compartment (apart from the medial half of the flexor digitorum profundus & flexor carpi ulnaris)

Question 29

which muscles are innervated by the recurrent branch of the median nerve?

Answer 29

thenar eminence

Question 30

what muscle does the deep branch of the radial nerve pierce? what does it do from here?

Answer 30

supinator - passes into the posterior forearm compartment & continues as the posterior interosseus nerve

Question 31

how does the radial nerve pass relative to the lateral epicondyle? what does it do from here?

Answer 31

anterior - then divides into a superficial and deep branch at the level of the cubital fossa

Question 32

describe the course of the median nerve

Answer 32

arises from C5/6-T1 nerve roots & medial and lateral cords

lies medial to the brachial artery at the cubital fossa & deep to the bicipital aponeurosis - runs deep to the pronator teres between the two heads

gives off anterior interosseus branch - supplies most of the anterior forearm compartment muscles

continues in between flexor digitorum profundus and superficialis - passes deep to flexor retinaculum through carpal tunnel and gives off recurrent branch of the median nerve - supplies thenar eminence

continues as common palmar digital nerves - then as proper palmar digital arteries = supplies lateral 3 1/2 fingers & loops over to hand dorsum to supply areas the radial nerve doesn’t

Question 33

muscle tendons contained in the carpal tunnel?

Answer 33

flexor pollicis longus
flexor digitorum profundus
flexor digitorum superficialis

Question 34

nerve at risk of compression in the carpal tunnel?

Answer 34

median nerve

Question 35

floor/walls & roof of carpal tunnel?

Answer 35

floor & walls - carpal bones
roof - flexor retinaculum (tough fibrous ligament that spans the carpal arch)

Question 36

describe the course of the ulnar nerve

Answer 36

arises from C8-T roots & medial cord

passes posterior to the medial epicondyle & in between the heads of the flexor carpi ulnaris

goes in between the flexor carpi ulnaris and flexor digitorum profundus - branches supply medial 1/2 of FDP

continues down medial forearm, superior to flexor retinaculum - gives off superficial and deep branches

superficial branch continues as common & proper palmar digital nerves

deep branch supplies intrinsic hand muscles (not thenar eminence & 1st or 2nd lumbricals)

Question 37

where does the ulnar nerve pass at the elbow? what clinical condition can arise here?

Answer 37

passes POSTERIOR to medial epicondyle & between two heads of the flexor carpi ulnaris - before passing deep to FCU and FDP

condition: cubital tunnel syndrome - compression of the ulnar nerve

Question 38

which structures are supplied by the deep branch of the ulnar nerve in the hand?

Answer 38

intrinsic hand muscles - not the thenar eminence or 1st and 2nd lumbricals

Question 39

what nerve pierces the supinator? what does it continue as?

Answer 39

radial nerve - continues as the posterior interosseus nerve

Question 40

what nerve supplies the medial 1 and 1/2 fingers?

Answer 40

dorsal branch of the ulnar nerve

Question 41

what structure is not part of the carpal tunnel but passes within its own tunnel?

Answer 41

tendon of flexor carpi radialis

Question 42

roof, floor, medial and lateral boundaries of the cubital/ulnar tunnel?

Answer 42

roof - joint capsule & ulnar collateral ligament
floor - cubital tunnel retinaculum
medial wall - medial epicondyle of humerus
lateral - olecranon process of ulna

Question 43

which nerve passes through the cubital tunnel?

Answer 43

ulnar nerve

Question 44

symptoms of cubital tunnel syndrome?

Answer 44

numbness/weakness in medial 1 and 1/2 fingers & muscle wasting in intrinsic hand muscles supplied by the ulnar nerve

Question 45

where else can the ulnar nerve be compressed apart from the cubital tunnel?

Answer 45

at the wrist in Guyon’s canal - often due toa ganglion cyst

Question 46

what nerve passes through the carpal tunnel? what symptoms would arise if this nerve was compressed?

Answer 46

median nerve - compression causes carpal tunnel syndrome

sensory changes in lateral 3 1/2 fingers
thenar muscle wasting