Blood Supply Of The Upper Limbs Flashcards by Adrian Tiglao

SUBCLAVIAN ARTERY

RIGHT SUBLCAVIAN ARTER

LEFT SUBLCAVIAN ARTERY

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 Arises from 💡brachiocephalic artery, behind the sternoclavicular joint
 Arches upward and laterally over the pleura and between the scalene anterior and medius muscle
 Becomes the 💡axillary artery at the outer border of 💡1st rib

RIGHT SUBLCAVIAN ARTERY

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 Arises from 💡arch of aorta in the thorax
 Ascends to the root of the neck and arches
laterally (similar to the right subclavian artery)

LEFT SUBLCAVIAN ARTERY

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The __ passes anterior to this artery on each side and divides it to 3 parts

Anterior scalene muscles

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FIRST PART:

 Extends from the origin of the subclavian artery to the medial border of the scalenius anterior muscle
 BRANCHES:

o Vertebral Artery
o Thyrocervical trunk
o Internal Thoracic Artery

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SECOND PART:

 Lies behind the scalenius anterior muscle
 BRANCHES:

o Costocervical trunk
 Superior intercostal artery
 Deep cervical artery

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 Extends from lateral border of scalenius anterior muscle across the posterior triangle of the neck to the lateral border of 1st rib
 No branch (usually)
 Superficial cervical arteries, suprascapular
arteries or both (ocassionally)

THIRD PART:

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 Begins at lateral border of 💡1st rib
 Ends at lower border of 💡teres major
o Continues as the brachial artery  Closely related to the cords of brachial
plexus and its branches
 Enclosed by 💡axillary sheath (connective
tissue sheath)

AXILLARY ARTERY

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crosses in front and divides it into 3 parts

Pectoralis minor muscles

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FIRST PART:

Extends from lateral border of the 1st rib to the upper border of pectoralis minor.

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SECOND PART:

 Lies behind pectoralis minor
 RELATIONSHIPS:
o ANTERIORLY: pectoralis minor, major and skin
o POSTERIORLY: posterior cord of brachial plexus, subscapularis muscle and shoulder joint
o LATERALLY: lateral cord of brachial plexus
o MEDIALLY: medial cord of brachial plexus and axillary nerve
 BRANCHES
o Thoracoacromial artery
o Lateral thoracic artery

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THIRD PART:

 Extend from lower border of pectoralis minor to lower border of teres major
 RELATIONSHIPS:
o ANTERIORLY: pectoralis major,
median nerve
o POSTERIORLY: subscapularis,
latissimus dorsi & teres major.
Axillary and radial nerves
o LATERALLY: coracobrachialis,
biceps brachii, humerus. Lateral root
of median nerve
o MEDIALLY: ulnar nerve, axillary vein
and medial cutaneous nerve of the
arm
 BRANCHES
o Subscapular artery
o Anterior and posterior circumflex humeral artery

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 Between branches of subclavian and axillary artery
 BRANCHES FORM SUBCLAVIAN ARTERY
o Suprascapular artery
o Superficial cervical artery
 BRANCHES FROM AXILLARY ARTERY
o Subscapular artery
o Anterior and posterior circumflex
humeral artery

ANTERIAL ANASTOMOSIS AROUND ELBOW JOINT

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o The existence of anastomosis around shoulder joint is vital to preserving the upper limb necessary to ligate the axillary artery

ARTERIAL ANASTOMOSIS AND LIGATION OF THE AXILLARY ARTERY

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 Begins at 💡lower border of teres major
 Main arterial supply to the arm
 Terminates opposite of neck of the radius
by dividing into 💡radial and ulnar arteries

BRACHIAL ARTERY

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RELATIONS OF BRACHIAL ARTERY

o ANTERIORLY:
 Vessel is superficial and is
overlapped from lateral side by coracobrachialis and biceps
 Medial cutaneous nerve of the forearm lies in front of the upper part;

 Median nerve crosses its medial part
 Bicipital aponeurosis crosses its lower part
o POSTERIORLY:
 Artery lies on triceps, the
corabrachialis insertion and
the brachialis muscle o MEDIALLY:
 Ulnar nerve and basilic vein in the upper part; median nerve lies on its medial part of the lower arm
o LATERALLY:
 Median nerve and
coracobrachialis and biceps
above
 Tendon of the biceps lies
lateral to the artery in the
lowest part

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BRANCHES OF BRACHIAL ARTERY

o Muscular arteries
o Nutrient artery to the humerus o Profunda artery
 beginning
o Superior ulnar collateral artery
 middle
o Inferior ulnar collateral artery
 Termination

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 Larger of the two terminal branches of the brachial artery
 Begins in the cubital fossa at the level of the neck of the radius
 In the upper part of its course, it lies deep to the most flexor muscles
 Below, becomes superficial (lies between the tendons of FCU and FDS)
 In front of the flexor retinaculum, it lies lateral
to the pisiform bone.

ULNAR ARTERY

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ULNAR ARTERY ends by forming the __, often anastomosing with the superficial palmar branch of the radial artery

superficial palmar arch

Ulnar artery branches

Muscular branches Recurrent branches Branches that take part in the arterial anastomosis around the wrist joint Common interosseous artery  Anterior and posterior interosseous artery

 Smaller  Begins at the cubital fossa at the level of the neck of the radius  Passes downward and laterally, beneath the brachioradialis muscle and resting on the deep muscles of the forearm  In the middle third of its course, the superficial branch of radial nerve lies on its lateral side  In the distal part of the forearm, the radial artery lies on the anterior surface of the radius, 💡 Between the tendons of FCR and brachioradialis -> radial pulse  It leaves the forearm by winding around the lateral aspect of the wrist to reach the posterior surface of the hand

RADIAL ARTERY

Branches of radial artery

``` o Muscular branches o Recurrent branches o Superficial palmar branch  Arises just above the wrist  Joins the ulnar artery to form the superficial palmar arch ```

Used to determine the patency of the ulnar and radial arteries

Allen’s Test

Anastomosis between the radial and ulnar arteries, called __

deep and superficial palmar arches

arise to supply the structures in the hand and fingers

Palmar metacarpal and digital arteries

Ulnar Artery Enters the hand anterior to the flexor retinaculum on the lateral side of the ulnar nerve and the pisiform bone

Ulnar Artery Gives off deep branch and then continues into the palm as the superficial palmar arch

Direct continuation of the ulnar artery Curves laterally behind the palmar aponeurosis and in front of the long flexor tendons Arch is completed on the lateral side by one of the branches of the radial artery Curve of the arch lies across the palm, at the level of the distal border of the fully extended thumb

Superficial Palmar Arch

ARTERIES OF THE PALM

FOUR DIGITAL ARTERIES DEEP BRANCH OF THE ULNAR ARTERY RADIAL ARTERY PRINCEPS POLLICIS ARTERY RADIALIS INDICIS ARTERY

Arise from the convexity of the arch and | pass to the fingers

FOUR DIGITAL ARTERIES

 Arises in front of the flexor retinaculum  Passes between the abductor digiti minimi and flexor digiti minimi  Joins the radial artery to complete the deep palmar arch

DEEP BRANCH OF THE ULNAR ARTERY

 Leaves the dorsum of the hand by turning forward between the proximal ends of the 1st and 2nd metacarpal bones and the two heads of the first dorsal interosseous muscle  On entering the palm, it curves medially between the oblique and transverse heads of the adductor pollicis and continues as the deep palmar arch

RADIAL ARTERY

 Direct continuation of the radial artery  Curves medially beneath the long flexor tendons and in front of the metacarpal bones and the interosseous muscles  Completed on the medial side by the deep branch of the ulnar artery  Curve of the arch lies at the level with the proximal border of the extended thumb  Sends branches superiorly, which take part in the wrist joint anastomosis and inferiorly, to join the digital branches of the superficial palmar arch

DEEP PALMAR ARCH

 Supplies the lateral side of the index | finger

RADIALIS INDICIS ARTERY

Divides into two and supplies the lateral | and medial sides of the thumb

PRINCEPS POLLICIS ARTERY

 Can be palpated in the root of the posterior triangle.  Can be compressed here against the first rib to stop catastrophic hemorrhage

SUBCLAVIAN ARTERY

Can be palpated in the arm as it lies on | the brachialis and is overlapped from the lateral side by the biceps brachii

BRACHIAL ARTERY

DEEP VEINS

``` Palmar Metacarpal vein , Deep venous palmar arch , Radial veins ,Ulnar veins ,brachial vein , axillary vein , subclavian vein . ```

It drains the metacarpal region of the palm and then eventually draining into the deep veins of the arm

PALMAR METACARPAL VEIN

It drains the metacarpal region of the palm and then eventually draining into the deep veins of the arm . Deep veins arise from deep palmar venous arch in the hand . Drains the deep palmar venous arch in the hand

DEEP PALMAR VENOUS ARCH

Smaller than ulnar vein | Receives the dorsal metacarpal veins

RADIAL VEIN

Drains the superficial palmar venous arch in the hand | At the elbow, they receive further branches from the anterior and posterior interosseous veins

ULNAR VEIN

formed by the unification of the 💡ulnar and radial veins at the elbow. ▪ It accompanies the brachial artery in the region of the arm. Its perforating branches drain the anterior

Brachial Vein

It is formed at the lower border of the teres major muscle by the 💡union of the brachial vein and the basilic vein. ▪ Has three parts, analogous to the three parts of the axillary artery.  Runs upward on the medial side of the axillary artery and ends at the lateral border

Axillary Vein

Occurs occasionally after excessive and unaccustomed movements of the arm at the shoulder joint.

Spontaneous Thrombosis of the Axillary/ Subclavian Vein

- Branch of the cephalic vein in the cubital fossa - Runs upward and medially then joins the basilic vein -Crosses in front of the brachial artery and median nerve - Separated by the bicipital aponeurosis - Common site for venipuncture

MEDIAN CUBITAL VEIN

 Ascends in the superficial fascia on the lateral side of the biceps  On the infraclavicular fossa, it drains into the axillary vein  Arises from the lateral side of the dorsal venous arch on the back of the hand and winds around the lateral border of the forearm

CEPHALIC VEIN

 Arises from the medial side of the dorsal venous arch on the back of the hand and winds around the medial border of the forearm  Ascends in the superficial fascia on the medial side of the biceps  Halfway up, it pierces the deep fascia and at the lower border of the teres major joins the venae commitantes of the brachial vein to form axillary vein  It receives the median cubital vein

BASILIC VEIN

Superficial veins are clinically important and are used for venipuncture, transfusion and cardiac catherization

VENIPUNCTURE AND BLOOD TRANSFUSION

Veins of choice for central venous catherization

BASILIC AND CEPHALIC VEIN CATHERIZATION

```  20 to 30 in number  Drains lymph vessels from o Lateral quadrant of the breast o Superficial lymph vessels from the thoracoabdominal wall above the level of the umbilicus o Lymph vessels of the upper limb  Divided into 6 groups: o Anterior (Pectoral) groups o Posterior (Subscapular) groups o Lateral group o Central group o Infraclavicular (Deltopectoral) o Apical group ```

AXILLARY NODES

 Drains the superficial tissues of the upper arm o Passes upward to the axilla  Lateral Side o Follows the cephalic vein to the infraclavicular group  Medial Side o Follows the basilic vein to the lateral group of axillary nodes

SUPERFICIAL LYMPHATIC VESSELS

 Drains the muscles and deep structures of the arm |  Drains into the lateral group of axillary nodes

DEEP LYMPHATIC VESSELS

The lymph from the medial side of the hand ascends in vessels that accompany the basilica vein

The lymph from the medial side of the hand | drain into the __ and then ascend to drain into the __

supratrochlear nodes lateral axillary nodes

The lymph from the lateral side of the hand ascends in vessels that accompany the cephalic vein

The lymph from the lateral side of the hand drain into the __, and some drain into the __

infraclavicular nodes lateral axillary nodes

``` o Infection of the lymph vessels of the arm o Red streaks along the course of the lymph vessels are characteristics of the condition ```

Lymphangitis

o If the infection reaches the lymph nodes o Enlarge and tender

Lymphadenitis

Blood Supply Of The Upper Limbs Flashcards

(89 cards)