Upper limb 1.7

Question 1

Where do cutaneous nerves of the shoulder arise from?

Answer 1

From supraclavicular nerves of the cervial plexus

Question 2

Where do cutaneous nerves of the arm arise from?

Answer 2

the axillary nerve, from the radial nerve, or directly from the brachial plexus

Question 3

What are the largest superficial veins of the arm?

Answer 3

• Cephalic vein

- Basilic vein

Question 4

How is the cephalic vein joined to the basilica vein?

Answer 4

By the median cubital vein which passes anteriorly across the cubital fodder (variation in this pattern is common)

Question 5

How do superficial veins communication with deep veins?

Answer 5

1. Via perforating veins, the superficial veins communicate with deep veins accompanying the brachial artery and its branches.
2. ## The superficial and deep veins of the upper limb possess valves to assist in returning blood to the heart.

Question 6

Where does the basilic cephalic vein drain?

Answer 6

• The cephalic vein drains proximally into the axillary vein

- The basilic vein drains proximally into, or becomes continuous with, the axillary vein.

Question 7

What is the median cubital veins often used for?

Answer 7

venipuncture to withdraw a blood sample

Question 8

Where do cutaneous nerves of the forearm arise from?

Answer 8

From:

• the musculocutaneous nerve
• the radial nerve
• the ulnar nerve
• or directly from the brachial plexus

Question 9

How does the cephalic and basilic vein communication in the cubital fossa?

Answer 9

Via cubital vien

Question 10

How do superficial veins communication with deeper veins in the forearm?

Answer 10

1. via perforating branches
2. The deeper veins accompany the radial and ulnar arteries and their major branches. 3. The superficial and deep veins of the upper limb possess valves to assist in returning blood to the heart.

Question 11

How are the veins organised with the hand?

Answer 11

• The cephalic and basilic veins begin on the dorsum of the hand; because the hand is largely used for grasping objects, the arterial blood from the palmar arches is squeezed from the palm and drains into the dorsal venous plexus and thence into the cephalic and basilic veins
• If the veins were on the palm, they would be squeezed shut every time we grasped something!

Question 12

What does a rich vascular anastomosis form from around the shoulder joint?

Answer 12

Branches of:

• thyrocervical trunk
• thoracoacromial artery
• subscapular artery
• posterior and anterior humeral circumflex arteries

Question 13

What do the anastomosis supply?

Answer 13

1. supplies the 17 muscles attaching to the scapula and some of the shoulder muscles
2. provides collateral circulation to the upper limb should the proximal part of the axillary artery become occluded.

Question 14

How does the dorsal scapular artery anastomose?

Answer 14

The dorsal scapular artery (from the thyrocervical trunk) anastomoses freely across the supraspinous and infraspinous fossae with branches from the suprascapular, posterior humeral circumflex, and circumflex scapular branches of the subscapular arteries

Question 15

What is blood supply like around joints?

Answer 15

1. Joints tend to have rich vascular anastomoses around them to supply the muscles working on each joint and to supply the joint itself.
2. Clinically, these anastomoses can be critical if a proximal artery is lacerated, because adjacent arteries can still supply distal tissues with blood.

Question 16

What is the brachial artery a continuation of?

Answer 16

the axillary artery; it begins at the lower margin of the teres major muscle

Question 17

What does the brachial artery provide?

Answer 17

provides a deep branch to the muscles of the posterior compartment of the arm

Question 18

What does the brachial artery do in the cubital fossa?

Answer 18

divides into the radial and ulnar arteries

Question 19

What is the elbow joint surrounded by?

Answer 19

• The elbow joint is surrounded by a rich anastomosis of radial and ulnar recurrent and collateral arteries
• Like the shoulder joint, the elbow joint possesses a rich vascular anastomosis, providing blood to the muscles acting on the elbow joint and supplying the joint itself.

Question 20

How does the radial nerve travel?

Answer 20

The radial nerve courses with the deep branch of the brachial artery in the arm

Question 21

How does the ulnar nerve travel?

Answer 21

The ulnar nerve courses with the superior ulnar collateral artery

Question 22

How does the median nerve travell?

Answer 22

The median nerve courses with the brachial artery

Question 23

What is the superficial palmar arch a continuation of?

Answer 23

• the ulnar artery
• It anastomoses with the superficial palmar branch of the radial artery
• From this superficial arch arise common palmar digital arteries, which divide into proper palmar digital arteries.

Question 24

What is the deep palmar arch?

Answer 24

1. A deep palmar arch exists deeper within the palm
2. It is the terminal part of the radial artery, and it anastomoses with the deep palmar branch of the ulnar artery
3. Perforating branches join the superficial and deep palmar arches

Question 25

What is Allen’s test?

Answer 25

1. Allen’s test is used to test the vascular perfusion distal to the wrist.
2. The examiner’s thumbs are placed lightly on the patient’s ulnar and radial arteries as the patient makes a tight fist to “blanch” the palmar skin.
3. Then, compressing the radial artery with the thumb, the examiner releases the pressure on the ulnar artery and asks the patient to open the clenched fist.
   - Normally, the skin should turn pink immediately, indicating normal ulnar artery blood flow through the anastomotic palmar arches.
   - Then, the test is repeated by occluding the ulnar artery to assess radial artery flow.

Question 26

What is the axillary artery?

Answer 26

-A direct continuation of the subclavian awry and the branches of these two arteries form
an important arterial anastomosis around the scapula and shoulder region

Question 27

Where else do major anastomoses occur?

Answer 27

Major anastomoses also occur around the elbow and wrist and in the palm (palmar arches)

Question 28

Where are the major pulse points of the upper limb?

Answer 28

1. Brachial pulse, at the medial aspect of the midarm
2. Cubital pulse (brachial artery), felt in the cubital fossa just medial to the biceps brachii muscle tendon
3. Radial pulse, at the wrist just lateral to the flexor carpi radialis muscle tendon
4. Ulnar pulse, at the wrist, just proximolateral to the pisiform bone