Upper extremity Flashcards
Parts of axillary artery
- from 1st rib to pectoralis minor
- behind the pectoralis minor
- below pectoralis minor to teres major
branches of axillary artery
- superior thoracic artery
- thoracoacromial
- lateral thoracic
- subscapular
- anterior humeral circumflex
- posterior humeral circumflex
Branches of subclavian artery
- Vertebral
- internal mammary
- thyrocervical trunk
- costocervical trunk
- dorsal scapular
origin of deep palmar arch
radial artery
origin of superficial palmar arch
ulnar artery
most common upper arm anatomy variant
earl division of brachial artery (high origin of the radial , or accessory / duplicate brachial artery)
Parts of subclavian artery
- origin of the vessel to the medial border of scalene anterior
- behind the scalene anterior
- lateral border of scalenus anterior to the outer border of the first rib
Hypothenar hammer syndrome
repetitive trauma to the ulnar artery
artery gets injured at the hook of the hamate bone
ulnar artery aneurysm and digital arteries occlusive disease (embolization)
aberrant left subclavian
artery most common with right sided aortic arch
6 fold increase in congenital heart disease
most are asymptomatic however greater proportion has symptoms than with aberrant right subclavian artery
normal subclavian and axillary PSV
70-120cm/s
brachial artery PSV
50-100cm/s
radial / ulnar PSV
40-90cm/s
How do you diagnose subclavian steal
check for effects of reactive hyperemia. Inflate BP cuff on arm, keep inflated for 3-4 min. Increased flow to the arm after deflation will make reverse flow in vertebral arteries more pronounced
median nerve function
1) vascular branches to brachial artery –> sympathetic fibers
2) muscles: pronator teres
flexor carpi radialis
palmaris longus
flexor digitorum superficialis
flexor digitorum produnfus (lateral half)
pronator quadratus
oponens pollicis, abductor pollicis brevis, flexor policis brevis
3) motor to 1st and 2nd lumbrical muscle, thenar eminence
4) skin of palmar thumb, index, middle finger, 1/2 ring finger and neil beds of these fingers, lateral part of palm,
Forearm fasciotomy
3 anatomic compartments: dorsal (superficial muscles), volar (deep muscles) and “mobile wad” (innervated by radial nerve)
- lazy S incision - releases the volar and dorsal compartment. May add incision on the dorsal aspect
- full decompression requires carpal tunel release
Normal DBI
> 0.9
DBI indicating hemodynamically significant lesion that produces symptoms
<0.7
DBI for rest pain
<0.4
Most frequent cause of UE
Ischemia
60% embolus from the heart
Expose second part of axillary artery
Divide pectoralis minor muscle
Expose distal 3rd of axillary artery
Oblique incision along lateral margin of pectoralis major muscle with arm abducted 90 degrees
Mid to distal brachial artery exposure
Medial incision over bicipital groove
Avoid cutaneous branches of median nerve located within the subcutaneous tissue during dissection
In use brachial sheath longitudinally
Median nerve is located superficially
Divide crossing vein branches to minimize the risk of injury to ulnar nerve
Radical artery course
In oblique line from brachial artery pulse medial to biceps tendon to style is process
In midforearm artery is medial to brachioradialis and lateral to flexor Capri radialis
Distal radial artery approach
Vertical incision over anatomic snuff box on dorsum of hand
Deepen incision through subcutaneous tissue and expose radial artery on the floor of the snuffbox
Ulnar artery exposure
Course: from medial Eli condyle of humerus to pusiform bone.
In midforearm: beneath deep fascia between bellies of flexor digitorun laterally abd flexor carpin ulnaris medially
At wrist: artery is latera to flexor carpi ulnaris (most medial tendon palpable at the wrist)
What nerves to look out for when exposing ulnar artery
Ulnar nerve on the latera aspect of artery in the distal ⅔
Palmar cutaneous branches of the ulnar nerve are superficial to the artery and should be preserved
Interosseus artey course
Initial few milimitera of the common interosseus can be accessed by following ulnar artery down from brachial artery and then dividing some of the fibers of the superficial flexor digitorum - look for the large branch going latera and deep from ulnar artery
Common interosseus bifurcated into anterior and posterior interosseous proximal to forearm interosseus is membrane
Exposure of the interpsseous artery
Same incision used to expose midportion ulnar arterseparate flexor carpi ulnaris from superficial flexor digitorum
Elevate superficial flexor digitorum along the median nerve and dissect along the antrior surface of flexor digitorum profundus
Elevate flexor pollicis longus towards radius to expose anterior interosseous neurovascular bundle
Posterior interosseous artery is beat approached through dorsal forearm incision along medial aspect of radius
Duplex feature that favors subclsvian artery stenosis over occlusion
Early systolic deceleration in vertebral artery
What’s quadrilateral space
Bordered by teres minor superiority, numeral shaft laterally, teres major inferiorly and long head of the triceps muscle medially. 20% of arterial TOS, mainly in young athletes with overhead arm motions.
Posterior humeral circumflex artery is affected
Radical nerve
Originated from the posterior cord of the brachial plexus C5-8 and T1
- Cutaneous innervation: dorsum of the hand and 1,2,3 and lateral 4th finger; back of the arm
- Motor: triceps, brachioradialis, extensor carpi radialis longus and brevis, supinator, extensor digitorum, extensor carpi ulnaris, abductor policis longus, extensor pollicis longus and brevis
Injury to radial nerve at the axillary
Saturday night palsy
Loss of extension of forearm, weakness of supination, loss of extension of hand and finger
Wrist drop
Loss of sensation in latera arm, posterior forear , dorsal hand
Mid arm radial nerve injury
Mid shaft humerus fracture
Weakness of supination. And loss of extension of hand and fingers
Wrist drop
Loss of sensation in posterior arm, dosas hand
Radial nerve injury at the elbow
Radius neck fracture, elbow dislocation
Weakness in extension of hand and loss of extension of fingers
Finger droop and partial wrist drop
No sensory deficit
Median nerve injury above the elbow
Supracondylar humerus fracture
Loss of pronation of forearm, weakness in flex ion of the hand at the wrist
Loss of abduction and opposition of thumb
Ape hand deformity, benediction sign
Loss of sensation in 1,2,3 and half of 4 digits and thenar region
Ulnar nerve
Sensation to 5th digit and medial half of the 4th digit
Motor: flexor carpi ulnaris, flexor digitorum profundus, hypothenar muscles (opponens, abductor, flexor digiti minimis), 3,4 lumbeical muscles, adductor policis,
Musculocutaneous nerve
Coracobrachialis, biceps, brachialis,
Sensation to the latera side of the forearm from elbow to wrist
Brachial plexus
Upper - C5-6
Middle - C7
Lower - C8-T1
Each trunk then splits into two (anterior and posterior) division .
Then regroup to become three cords:
Posterior (c5-8, t1)
Lateral (c5-c7)
Medial (c8-t1)
What nerves come from the lateral cord of brachial plexus
Lateral pectoral
Musculocutaneous
Lateral root of median nerve
What nerves come from posterior cord
Upper scapular Thoracodorsal Lower subscapular Axillary nerve Radial nerve
What nerves come from medial does od brachial plexus
Medial pectoral nerve
Medial root of the medial nerve
Medial cutaneous nerve of the arm and forearm
Ulnar nerve
