W1: Upper limb vasculature and nerves Flashcards
Discuss pulse points
Radial pulse: lateral of the wrist.
Ulnar pulse: medial of the wrist.
Brachial pulse: in the antecubital fossa.
Axillary pulse: inferiorly of the lateral wall of the axilla.
Allen test: measures arterial competency, digital compression of both ulnar and radial arteries at the level of the wrist. - see if whole hand goes white and goes pink when one released
Which artery do we use to measure blood pressure?
Brachial
What order does the blood supply come in
Subclavian artery
Axillary artery
Brachial artery
Radial artery+ Ulnar artery
Digital arteries
What veins used for venopuncture most commonly?
Superficial veins of the arm: basilic vein
cephalic vein
median cubital vein
(in the antecubital fossa).
These veins are recommended as they are well supported by muscle and connective tissue, visible and easily palpable.
Theoretically, any sufficiently large and palpable vein across the body can be used for venepuncture.
What comes off aortic arch?
Brachiocephalic
Left common carotid
Left subclavian
What does the brachiocephailc split into?
Right subclavian and right common carotid
What does axillary split into?
Subscapular
Posterior circumflex humeral artery
Anterior circumflex humeral artery
Brachial artery
Where can subclavian originate from?
Right = brachiocephalic trunk
Left = arch of the aorta
Discuss axillary artery
The axillary artery lies deep to the pectoralis minor and is enclosed in the axillary sheath (a fibrous layer that covers the artery and the three cords of the brachial plexus).
Discuss brachial artery
The brachial artery is a continuation of the axillary artery past the lower border of the teres major. It is the main supply of blood for the arm.
Immediately distal to the teres major, the brachial artery gives rise to the profunda brachii (deep artery), which travels with the radial nerve in the radial groove of the humerus and supplies structures in the posterior aspect of the upper arm (e.g. triceps brachii). The profunda brachii terminates by contributing to an anastomotic network around the elbow joint.
The brachial artery proper descends down the arm. As it moves through the cubital fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the radial and ulnar arteries.
What does the brachial split into? Discuss
Radial and ulnar
Radial artery – supplies the posterolateral aspect of the forearm. It contributes to anastomotic networks surrounding the elbow joint and carpal bones. The radial pulse can be palpated in the wrist
Ulnar artery – supplies the anteromedial aspect of the forearm. It contributes to an anastomotic network surrounding the elbow joint.
Also gives rise to the anterior and posterior interosseous arteries, which supply deeper structures in the forearm.
These two arteries anastomose in the hand by forming two arches – the superficial palmar arch, and the deep palmar arch.
Where does the radial artery enter the hand?
Floor of anatomical snuffbox
Discuss palmar arches
Superficial palmar arch – located anteriorly to the flexor tendons in the hand and deep to the palmar aponeurosis. It gives rise to the digital arteries, which supply the four fingers.
Deep palmar arch – located deep to the flexor tendons of the hand. It contributes to the blood supply to the digits and to the wrist joint.
Allen test: measures arterial competency, digital compression of both ulnar and radial arteries at the level of the wrist.
Discuss venous drainage
Digital veins -> dorsal venous arch of the hand - both basilic (ulnar aspect) and cephalic (radial aspect) veins of forearm -> median cubital vein at anterior elbow (join briefly) -> the basilic then joins deep veins (called venae comitantes) -> these form the axillary vein into which the cephalic eins drain inferior to the clavicle -> axillary then drains into subclavian
Discuss lymphatic drainage
Runs parallel to venous
Lateral nodes drain most of the lymph - then drain into central - then into apical
Axillary lymph nodes drain the lymph from lateral quadrants of the breast
Draw the brachial plexus
Discuss the cords
