Upper Limb (Nerves and Vessels) Flashcards
OVERVIEW OF VEINS OF THE UPPER LIMB
- 2 types of veins =
- ____ venous network drains into lateral ____ and medial ____ veins
- ____ veins form communication between superifical and deep veins
OVERVIEW OF VEINS OF THE UPPER LIMB
- 2 types of veins = SUPERFICIAL VEINS + Deep venous comitants
- DORSAL venous network drains into lateral CEPHALIC and medial BASILIC veins
- PERFORATING veins form communication between superifical and deep veins
State the vein used in venipuncture
median cubital vein
State the boundaries of the axilla
Apex - clavicle, 1st rib, superior border of scapula
Base - fascia, skin
Anterior wall - pectoralis major
Posterior wall - subscapularis
Medial wall - serratus anterior, ribs 1-4
Lateral wall - humerus
State the contents of the axilla
- axillary V
- axillary A
- axillary LN
- brachial plexus
BRACHIAL PLEXUS
- State the root of the plexus
- State the branched nerves
- Draw the brachial plexus out
BRACHIAL PLEXUS
- C5-T1
- Branched nerves - musculocutaneous, medial, ulnar, axillary, radial
Label the anatomy of a peripheral nerve
State the myotomes of
1. BICEPS BRACHII TENDON REFLEX
2. TRICEPS TENDON REFLEX
biceps brachii tendon reflex - c5/6
triceps tendon reflex - c7/8 (supinator jerk)
State what occurs in ERB’S PALSY
ERB’S PALSY
- Injury to superior trunk of brachial plexus (c5-6)
- Paralysis of deltoids, biceps, brachialis, brachioradialis
- Recap: Musculocutaneous nerve - C5-7, Axillary nerve - C5-C6
- Result - Waiter’s tip position (upper limb with adducted shoulder, medially rotated arm, extended elbow)
- Due to fall on shoulder separating neck + stretch of brachial plexus
State what occurs in KLUMPKE’S PALSY
KLUMPKE’S PALSY
- Results from injuries to the inferior trunk of the brachial plexus (C8-T1)
- Paralysis of short muscles (lumbricals and interossei)
- Result - Claw hand (fingers hyperextended at MCPJ and flexed at IPJ)
- Due to breech birth
MUSCULOCUTANEOUS NERVE
- Nerve roots -
- Motor supply -
- Sensory supply -
- Result of lesion -
MUSCULOCUTANEOUS NERVE
- Nerve roots - C5-7
- Motor supply - coracobrachialis, biceps, brachialis
- Sensory supply - lateral aspect of forearm (lateral cutaneous nerve of forearm)
- Result of lesion - weakened elbow flexion, weakened supination
MEDIAN NERVE
- Nerve roots -
- Motor supply -
- Sensory supply -
MEDIAN NERVE
- Nerve roots - C6-T1
- Motor supply - all flexors of forearm (except fcu and medial fdp), 3/4 thenar muscles, lumbricals 3+4
- Sensory supply - palmar surface of lateral 3/5 digits + nail beds of dorsal side
Compare the effects of a median nerve lesion AT ELBOW and AT WRIST
MEDIAN NERVE LESION AT ELBOW
- Loss of pronation
- Weak wrist flexion
- Wrist deviation towards ulnar side
- Adducted thumb
- Wasting of thenar eminence (ape hand)
MEDIAN NERVE LESION AT WRIST
- Thenar muscles paralysed
- Loss of opposition
- Loss of abduction of thumb
CARPAL TUNNEL
- Floor = Formed by the concavity of ____ bones
- Roof =
- Spans between the hook of ____ and ____ (medially) to the ____ and ____ (laterally)
- Contains a total of ____ tendons (____ of fingers and thumbs)
- Contains ____ N
CARPAL TUNNEL
- Floor = Formed by the concavity of CARPAL bones
- Roof = FLEXOR RETINACULUM
- Spans between the hook of HAMATE and PISIFORM (medially) to the SCAPHOID and TRAPEZIUM (laterally)
- Contains a total of 9 tendons (FLEXORS of fingers and thumbs)
- Contains MEDIAN N
Label the carpal tunnel and its structures
State what occurs in CARPAL TUNNEL SYNDROME
CARPAL TUNNEL SYNDROME
- Positive tinel sign
- Positive phalen test
- Inflammation of tendons or the synovial sheath –> compression of the medial N
- Numbness or tingling over lateral 3.5 digits and dorsal nail beds
- Atrophy of thenar eminence (weak opposition, weak flexion and weak adduction of thumb)
ULNAR NERVE
- Nerve roots -
- Motor supply -
- Sensory supply -
ULNAR NERVE
- Nerve roots - C7-T1
- Motor supply - flexor carpi ulnaris, medial half of flexor digitorum profundus, hypothenar msucles, interossei, 3rd-4th lumbricals, adductor pollicis
- Sensory supply - dorsal and anterior aspects of medial 1.5 fingers and associated dorsal and palmar hand areas
State the commonest cause of ulnar nerve injury
medial epicondyle injury (golfer’s elbow) or fracture
Compare the effects of a ulnar nerve lesion AT ELBOW and AT WRIST
ULNAR NERVE LESION AT ELBOW
- Paralysis of medial half of flexor digitorum profundus and flexor carpi ulnaris
- Claw hand (less severe) - MCPJ of medial 2 fingers hyperextended, IPJ flexed (opposed actions)
- Sensory loss (numbness and tingling) over the medial 1.5 digits
ULNAR NERVE LESION AT WRIST
- Paralysis of intrinsic muscles of finges (except 1-2 lumbricals, thenar muscles except adductor pollicis)
- Claw hand (more severe) - MCPJ of medial 2 fingers hyperextended, IPJ normal (flexor digitorum profundus
- Sensory loss (numbness and tingling) over the medial 1.5 digits
State the result of CUBITAL TUNNEL SYNDROME
CUBITAL TUNNEL SYNDROME
- tingling and numbness over medial 1.5 digits
- chronic compression can led to muscle wasting –> claw hand
RADIAL NERVE
- Nerve roots -
- Motor supply -
- Sensory supply -
RADIAL NERVE
- Nerve roots - C5-T1
- Motor supply - extensor muscles of the arm and forearm
- Sensory supply - posterior aspect of arm and forearm (superifical branch is entirely sensory) + dorsum of thumb and lateral 1.5 digits
State the common RADIAL NERVE INJURIES
- radial nerve injury at axilla
- radial nerve injury at midshaft of humerus (radial groove)
- deep branch of radial nerve lesion at radial head
State the result of the 3 types of radial nerve injury
RADIAL NERVE INJURY AT AXILLA
- Paralysis of the triceps, brachioradialis, supinator and extensor muscles of the wrist and digits
RADIAL NERVE INJURY AT THE MIDSHAFT OF THE HUMERUS (RADIAL GROOVE)
- Weakened triceps
- Paralysis of brachioradialis, supinator and extensor msucles of wrist and digits
- Wrist drop
DEEP BRANCH OF RADIAL NERVE LESION AT RADIAL HEAD
- Inability to extend thumb and MCP joints of other digits
- No sensory loss since deep branch is entirely motor
State the 3 parts of the axillary A
1st PART:
- Superior thoracic A
2nd PART:
- Thoracoacromial A
- Inferior thoracic A
3rd PART:
- Subscapular A
- Anteiror circumflex humeral A
- Posterior circumflex humeral A
State which part of the axillary A should be compressed to control profuse bleeding due to stab wounds in the axilla
3rd part
- Subscapular A
- Anteiror circumflex humeral A
- Posterior circumflex humeral A
State the 2 artery anastomosis that occcurs around the scapula
dorsal scapular A + subscapular A
intercostal A + subscapular A
Radial A continues as ____ palmar arch
Ulnar A continues as ____ palmar arch
Radial A continues as DEEP palmar arch
Ulnar A continues as SUPERFICIAL palmar arch
RADIAL RECURRENT ARTERY anastomoses with ____ A from ____ A
ULNAR RECURRENT ARTERY anastomoses with ____ and ____ collateral A from ____ A
RADIAL RECURRENT ARTERY anastomoses with COLLATERAL A from DEEP A
ULNAR RECURRENT ARTERY anastomoses with SUPERIOR and INFERIOR collateral A from BRACHIAL A
