Upper Limb Flashcards
From arch of aorta to the lateral border of 1st rib
Subclavian artery
Branches of subclavian artery
Internal thoracic artery
Vertebral artery
Thyrocervical trunk
Continuous with superior epigastric artery which anastomoses with inferior epigastric artery (artery branch of external iliac artery
- provides collateral circulation if the abdominal aorta is blocked
Internal thoracic artery
3 branches of thyrocervical trunk
Suprascapular artery
Transverse cervical artery
Inferior thyroid artery
Collateral circulation around the shoulder
Surpascapular artery
Transverse cervical artery
Continuation of subclavian artery, extends from the lateral border of 1st rib to the inferior border of the TERES major muscle.
The tendon of Pectoralis minor muscles crosses the axillary artery anteriorly
Axillary artery
May be damaged by midshaft fracture of the humerus along with the radial nerve as they travel together in the posterior aspect of the humerus in the radial groove
Deep branchial artery (brachial artery)
Posterior to the tendons of flexor digitorum superficialis & profundus
Deep laceration at the metacarpal-carpal joint that cuts the deep palmar arch also compromises FLEXION of fingers
Deep palmar arch
Branches of Axillary artery
Thoracoacromial artery
Lateral thoracic artery
Anterior humeral circumflex artery
Posterior humeral circumflex artery
Subscapular artery
Branches of brachial artery
Deep brachial artery
Radial artery
Ulnar artery
Commencement: Arch of aorta
Termination: Lateral border of 1st rib
Subclavian artery
Commencement: Lateral border of 1st rib
Termination: Inferior border of teres major
Axillary artery
Commencement: lateral border of the teres major
Termination: cubical fossa
Branchial artery
COLLATERAL CIRCULATION
Around the shoulder
Transverse cervical artery
Suprascapular artery
Subscapular artery
Circumflex scapular artery
COLLATERAL CIRCULATION
Around the elbow
Superior ulnar collateral artery
- anastomoses with posterior ulnar recurrent artery
Inferior ulnar collateral artery
- anastomoses with anterior ulnar recurrent artery
Middle collateral artery
- anastomoses with interosseous recurrent artery
Radial collateral artery
- anastomoses with radial recurrent artery
COLLATERAL CIRCULATION
In the hand
Superficial palmar arch
Deep palmar arch
Most commonly used for access during long-term hemodialysis
Radial & Cephalic vein
Placement of ligatures
Subclavian or Axillary artery between the thyrocervical trunk & Subscapular artery
Brachial artery distal to the inferior ulnar collateral artery
Percutaneous arterial catheterization
Uses brachial artery if femoral artery approach is unavailable
Left brachial artery
- preferred because it allows access to the descending aorta without crossing the R Brachiocephalic trunk & L common carotid artery, thereby reducing risk of stroke
Brachial plexus
Ventral primary rami (C5-T1)
- between anterior & middle scalene muscles
Upper middle & lower trunks
- posterior triangle of the neck
3 anterior & 3 posterior divisions
- deep to the clavicle & are named according to their relation to the axillary artery
Lateral, medial & posterior cords
- axilla, deep to the Pectoralis minor muscle
5 terminal branches of BRACHIAL PLEXUS
MUSCULOCUTANEOUS nerve (C5,6,7)
AXILLARY nerve (C5,6)
RADIAL nerve (C5,6,7,8,T1)
MEDIAN nerve (C5,6,7,8,T1)
ULNAR nerve (C8,T1)
Arise from the brachial plexus proximal to the terminal nerves
Innervate the proximal limb muscles (shoulder girdle muscles)
Collateral nerves
COLLATERAL NERVE:
Dorsal scapular nerve
Structures innervated: RHOMBOIDS
COLLATERAL NERVE:
Long thoracic nerve
Structures innervated: SERRATUS ANTERIOR
COLLATERAL NERVE
Suprascapular nerve
Structures innervated: SUPRASPINATUS & INFRASPINATUS
COLLATERAL NERVE
Lateral pectoral nerve
Structures innervated: PECTORALIS MAJOR
COLLATERAL NERVE
Medial pectoral nerve
Structures innervated: PECTORALIS MAJOR & MINOR
COLLATERAL NERVE
Upper subscapular nerve
Structures innervated: SUBSCAPULARIS
COLLATERAL NERVE
Middle subscapular (thoracodorsal) nerve
Structure innervated: LATISSIMUS DORSI
COLLATERAL NERVE
Lower Subscapular nerve
Structures innervated: SUBSCAPULARIS & TERES MAJOR
COLLATERAL NERVE
Medial brachial cutaneous nerve
Structures innervated: SKIN OF MEDIAL ARM
COLLATERAL NERVE
Medial antebrachial cutaneous nerve
Structures innervated: SKIN OF MEDIAL FOREARM
Violent stretch between the head & shoulder (adduction traction of the arm & hyperextension of the neck)
Nerves damaged:
- Musculocutaneous
- Suprascapular
- Axillary
- Phrenic
Clinical sign:
- pronated & medially rotated arm (waiter’s tip hand)
- ipsilateral paralysis of diaphragm
ERB-Duchenne’s (C5 & C6, upper trunk)
Sudden upward pull of the arm (abduction injury)
Nerves damaged:
- Median
- Ulnar
- Sympathetic of T1
- spinal nerve
Clinical sign:
- loss of function of the wrist & hand
- Horner syndrome
KLUMPKE’s (C8 & T1, lower trunk)
Arterial supply
Subclavian artery
Axillary artery
Brachial artery
Superficial palmar arch
Deep palmar arch
