Upper Limbs Flashcards

Question

Veins

Answer 1

Veins going with arteries (subclavian vein, axillary vein, brachial vein = deep veins) Superficial are not paired with arteries and can been seen through skin Superficial and deep veins communicate • Vigorous muscular contraction compresses deep veins and shunts blood to superficial veins Superficial veins • Cephalic and basilic veins originate on dorsal venous network (cephalic on thumb side, basilic on pinky side) * Basilic v (along with brachial vv) becomes axillary v, and runs medially * Cephalic v drains into axillary v • Median cubital v connects basilic and cephalic v Cephalic vein passes over anatomical snuff box: site of access for replacement of blood or fluid *NOTE* that there is a cubital fossa in the superior part of the elbow joint and then there you will always have communication between the cephalic and basilic veins. This is a very common place for blood to be taken. The connection between cephalic and basilic veins is medial cubital vein aka intermediate vein.

Answer 2

Between extensor tendons of thumb Extend thumb to see it Radial artery crosses it. Pulse can be taken here.

Answer 3

Deltoid, Pectoralis major, clavicle Cephalic vein drains into axillary vein

Answer 4

Entire upper limb Lateral part of breast Thoracoabdominal wall above umbilicus In limbs, superficial lymphatics follow superficial veins, deeper lymphatics follow deep arteries and veins but superficial for both lymph and blood will drain into the deep. For example, the lymph following the cephalic vein will then go deep and drain into the lymph nodes around the axillary vein. So superficial drains into deep and not vice versa. All deep veins have lymph nodes accompanying them -- Axillary lymph nodes are important because the lymph from the entire upper limb drains here and even more important from the lateral part of the breast (important to understand the spread of breast cancer to the axillary region) and the whole thoracoabdominal wall above the umbilicus. So the lymph from this region goes into these deep lymph nodes. So superficial for both lymph and blood will drain into the deep. So here, for example, the lymph following the cephalic vein will then go deep and drain into the lymph nodes around the axillary vein. So superficial drains into deep and not vice versa.

Answer 5

* Ventral rami of spinal nerves C5-T1 * Motor and sensory to upper limb *********ROOTS********* the beginning of the brachial plexus. formed by the anterior divisions of spinal nerves C5, C6, C7, C8 and T1.(the posterior divisions go on to innervate the skin and musculature of the trunk). leave the spinal cord via the intervertebral foramina of the vertebral column then divides into anterior and posterior nerve fibres nerves pass between the anterior and medial scalene muscles to enter the base of the neck. Coming off the root C5 is also the DORSAL SCAPULAR n. (to the rhomboids and levator scapulae), as well as the LONG THORACIC N. to Serratus Anterior (C5, C6, C7) and the 1st intercostal n. from T1 ********TRUNKS******** base of the neck, the roots of the brachial plexus converge, forming three trunks. 1. Superior trunk: C5 and C6 (coming off superior is also the n. to subclavius and suprascular n. to supra/infraspinatus m.) 2. Middle trunk: C7 3. Inferior trunk: C8 and T1 The trunks begin to move laterally, crossing the posterior triangle of the neck. ********CORDS******** Once the anterior and posterior divisions have entered the axilla, they combine together to form three nerves. These nerves are named by their position relative to the second part of the axillary artery. The lateral cord is formed by: - The anterior division of the superior trunk -The anterior division of the middle trunk (Gives off lateral pectoral n. - pectoralis major) The posterior cord is formed by: - The posterior division of the superior trunk -The posterior division of the middle trunk - The posterior division of the inferior trunk (Gives off branches of upper/lower subscapular n. and thoracodorsal n.) The medial cord is formed by: - The anterior division of the inferior trunk. (Gives off medial pectoral and medial cutaneous n to arm and medial cutaneous n. to forearm) The cords give rise to the major branches of the brachial plexus. *****BRANCHES***** - Musculocutaneous (C5-C7) - Axillary (C5/C6) - Radial (C5-T1) - Median (C5-T1) - Ulnar (C8/T1

Answer 6

LATERAL CORD 1) Lateral Pectoral 2) Musculocutaneus - Motor to muscles of anterior compartment of arm – Pierces coracobrachialis – Sensory to skin of lateral forearm 3) Median ``` POSTERIOR CORD 1) Upper Subscapular 2) Lower Subscapular 3) Thoracodorsal 4) Radial - From posterior cord - Motor to muscles of posterior compartment of arm - Runs in radial groove between medial and lateral heads of triceps - also supplies the muscles of the posterior compartment of the forearm – including brachioradialis ``` 5) Axillary Motor to deltoid and teres minor ``` MEDIAL CORD Median Pectoral Ulnar Medial Cutaneous Arm Medial Cutaneous Forearm Median ```

Answer 7

Considered part of posterior comp because | innervated by RADIAL nerve, but FLEXOR of forearm

Answer 8

``` - From medial and lateral cords – Motor to most muscles of anterior compartment of forearm • Except 1 1⁄2 muscles: flexor carpi ulnaris, half of flexor digitorum profundus) ``` – Motor to the thenar muscles in hand, and thumb! Also note the cutaneous innervation if we look at the lateral 3 and half fingers of the hand and the palm ***everything that is not innervated by the radial nerve is innervated by the median nerve.*** Median nerve that loops around the tips and innervates the distal phalanges on the dorsal side.

Answer 9

– From medial cord – Motor to 1 1⁄2 muscles in forearm – Motor to most muscles in hand Note sensory innervation of hand: • Ulnar - skin of hand medial to line bisecting 4th digit • Median - skin of hand medial to line bisecting 4th digit

Answer 10

Axilla (armpit) -Contains the nerves and vessels that supply upper limb -Contains lymph nodes Pectoralis major and minor connecting anteriorly to the head of the humerus then you have your serratus anterior and the ribs and you have the muscles trees major and subscapularis on the ventral surface and all of these are the borders of the axilla. Within that you can have your brachial plexus and your axillary artery and vein. Cubital fossa Carpal Tunnel

Answer 11

• Excess pressure on structures passing between anterior and middle scalenes at the thoracic inlet (T1, 1st rib, manubrium) – Subclavian artery is compressed crossing 1st rib ! pallor, coldness, cyanosis – Inferior truck is compressed causing numbness and tingling of digits • From trauma, injury, tumor/growth, congenital abnormality (e.g. cervical rib), etc.

Answer 12

``` Transition between arm and forearm • Anterior to elbow joint • Borders – Imaginary line between medial and lateral epicondyles – Brachioradialis m – Pronator teres m – Floor: Brachialis m – Roof: Superficial fascia and skin ``` CONTENTS ``` • Tendon of biceps brachii • Brachial artery – Blood pressure is taken by placing stethoscope over brachial artery in cubital fossa ``` • Median nerve • Median cubital vein – Median cubital vein is often used for venipuncture

Answer 13

* Tunnel of carpal bones and ligament * Contains tendons and median nerve Carpal Tunnel Syndrome ``` Pressure on median nerve within carpal tunnel May be caused by swelling of tendons and tendon sheaths Tinel’s sign: Tapping on nerve produces pain and “pins and needles” ```