brachial plexus/ vascular anatomy/ nerve of uppere limb

Question 1

is a Big network of nerves supplying the (Skin& muscles) of the upper limb​

Answer 1

brachial plexus:

Question 2

brachial plexus: begins?

Answer 2

it begins in the neck and extends into the axilla. ​

Most of its branches arise in the axilla​

Question 3

The brachial plexus is formed by?

Answer 3

anterior primary rami of C5 C6,C7,C8, and T1 ​

Question 4

Stages of the formation of the Brachial Plexus:​

Answer 4

1- Roots​

2- Trunks​

3- Divisions​

4- Cords​

5- Branches​

Question 5

Roots of THE BRACHIAL PLEXUS​ are? Its Origin may shift up by one segment (C4-C8) and called? its may shift down by one segment (C6-T2)? roots pass betwee?

Answer 5

Are the anterior primary rami of C5 C6,C7,C8, and T1

Prefixed Plexus​

Postfixed Plexus​

these roots pass between the anterior and middle scalene muscles to enter the base of the neck.​

Question 6

Trunks of THE BRACHIAL PLEXUS​ are called? each formed by? where does the trunk lie?

Answer 6

The Brachial Plexus has 3 Trunks: ​

1- The upper trunk: is formed by the union of C5 and C6 roots​

2- The middle trunk: is a continuation of the C7 root​

3- The lower trunk: is formed by the union of the C8 and T1 roots.​

Trunks lies in the neck above the clavicle​

Question 7

Divisions of THE BRACHIAL PLEXUS​ are? and they generally supply?

Answer 7

Each of the three trunks of the brachial plexus divides into an anterior and a posterior division​

The anterior divisions usually supply flexor muscles ​

The posterior divisions usually supply extensor muscles​

Question 8

Cords of THE BRACHIAL PLEXUS​ are? and originate from?

Answer 8

The Brachial Plexus has 3 Cords: ​

1- The lateral cord originates from the union of the anterior divisions of the upper and middle trunks .​

2- The medial cord is the continuation of the anterior division of the lower trunk.​

3- The posterior cord originates from the union of the posterior divisions of the 3 trunks.​

Question 9

The cords are arranged around the Axillary artery as follow:​
1-2-3 part of the axillary artery

Answer 9

1ST Part of Axillary artery:​

Medial cord: behind the artery​

Lateral &Posterior cords: lateral to the artery​

2ND Part of Axillary artery :​

Medial cord: medial to the artery​

Lateral cord: lateral to the artery​

Posterior cord: behind the artery​

3RD Part of Axillary artery :​

• Has the same relationship with the terminal branches of the brachial plexus.​

​

Question 10

Branches from the Roots​? and supply?

Answer 10

1- Dorsal scapular nerve (C5)​

Supplies the following muscles: levator scapulae, rhomboids (MAJOR-MINOR)​

​

2- Long thoracic nerve (C5, 6, and 7): Supply Serratus anterior muscle​

Question 11

Branches from the Upper Trunk​

Answer 11

Nerve to Subclavius (C5 and 6): Supplies the Subclavius muscle​

2- Suprascapular nerve (C5 and 6): Supplies the Supraspinatus and Infraspinatus muscles​

Question 12

Branches from the Lateral Cord​

Answer 12

1- Lateral pectoral N.(C5-7): supplies Pectoralis major​

2- Musculocutaneous N. (C5-7): supplies All muscles in the anterior compartment of the arm (flexors), sensory to the Skin on lateral side of forearm ​

3- Lateral root of median N. (C5-7):

Question 13

Branches from the Medial Cord​

Answer 13

1- Medial pectoral nerve(C8,T1): Pectoralis major, pectoralis minor​

2- Medial cutaneous nerve of arm(C8,T1): to Skin on medial side of distal one-third of arm​

3- Medial cutaneous nerve of forearm(C8,T1)​

To Skin on medial side of forearm​

4- Medial root of median nerve (C8,T1): ​

Median N. gives All muscles in the anterior compartment of the forearm (flexors) except muscles supplied by Ulnar N (1& 1/2 ms.)​

• Also, some muscles in the hand​

5- Ulnar nerve(C7,8,T1)​

To flexor carpi ulnaris and the medial half of flexor digitorum profundus in the forearm, some muscles in the hand​

Question 14

Branches from the Posterior Cord​

Answer 14

1- Upper subscapular N (C5,6): Subscapularis muscle​

2- Lower subscapular N (C5,6) : Subscapularis& Teres major muscles​

3- N. to Lattisimus dorsi (Thoracodorsal N.) (C6-8) : Supplies Latissimus dorsi muscle​

4- Axillary N.(C5,6): ​

Deltoid& Teres minor muscles​

Sensory to Skin over upper lateral part of arm​

5- Radial N. (C5-8,T1): ​

All muscles in the posterior compartments of arm and forearm (Extensors)​

Sensory to Skin on the posterior aspects of the arm and forearm, the lower lateral surface of the arm, and the dorsal lateral surface of the hand​

Question 15

Damage to the whole plexus​? happens when? what results?

Answer 15

it is rare​

It can occur with : motorbike accidents ​

If all roots are damaged : the whole limb is immobile and anesthetic​

Question 16

It is the most common traction injury​
It includes Birth injury​
Person fall on shoulder with undue separation of head and shoulder​
Leads to paralysis of: ​
Abductors (deltoid& supraspinatus) and lateral rotators (teres minor& infraspinatus) of the shoulder and supinators are paralyzed​ ?

Answer 16

Traction injury to the upper roots (C5& C6) and trunk (Erb’s paralysis) (Erb-Duchenne paralysis)​

Question 17

result in sensory loss over lower part of deltoid (supplied by axillary)​
Deformity: (policeman’s tip hand) or Waiter taking tip?

Answer 17

Erb’s

Question 18

In which the arm hangs by the side(adducted) and is rotated medially. The forearm is extended and pronated at the elbow

Answer 18

(Erb’s paralysis) (Erb-Duchenne paralysis)​

Question 19

Can be caused by:​
1- A cervical rib​
2- birth injury​
3- excessive abduction of the arm with undue separation from trunk​
Small muscles of the hand are mainly affected ​
Deformity: (Claw hand)​
In which there is hyperextension of metacarpophalangeal joints & flexion of interphalangeal joints​

Answer 19

Injury to the Lowest roots (C8& T1) or lower trunk (Klumpke’s paralysis)​

Question 20

The serratus anterior is paralyzed due to injury of the?

Answer 20

long thoracic nerve .

Question 21

The long thoracic nerve may be injured as a result of: ​? deformity?

Answer 21

1- Direct trauma or stretch​

2- A blow to the ribs underneath outstretched arm. ​

3- During surgery of Breast Cancer (mastectomy)​

​

Deformity: (Winged Scapula)​

In which the medial border and inferior angle of the scapula pull away from the posterior thoracic wall (like a Wing) when the arm is raised and pushes against a wall​

Question 22

Axillary nerve origin?

Answer 22

branch of posterior cord of the brachial plexus. It is mixed

Question 23

Axillary nerve course ?

Answer 23

1. nerve leaves axilla by passing through the quadrangular space (
2. in company with posterior circumflex humeral vessels) close to the surgical neck of the humerus.
3. • It ends deep to deltoid by dividing into anterior and posterior branches.

Question 24

Axillary nerve (C5,6)
• Branches and distribution?

Answer 24

• Anterior branch supplies :
  1. anterior part of deltoid.
• Posterior branch supplies :
  1. posterior part of deltoid
  2. teres minor ms.
  3. upper lateral cutaneous N. of arm which supplies skin over upper lateral part of the arm (skin
  over the lower half of deltoid
  muscle)

Question 25

fractures of the humeral surgical neck or dislocations of shoulder. M,ay injure which nerve ?

Answer 25

axillary N. may be injured

Question 26

The axillary N. Is injured what happens?

Answer 26

``` The deltoid is paralyzed with loss of power of abduction at the shoulder and flattened shoulder.  There is sensory loss over upper lateral part of the arm (skin over the lower half of deltoid muscle). ```

Question 27

Median nerve course ?

Answer 27

1. In the upper part of the arm = lateral to the brachial A. 2. Midarm, it crosses the brachial artery to become medial to it down to the cubital fossa. 3. Pass between the two heads of pronator teres. 4. Descends behind flexor digitorum superficialis adherent to its fascia. 5. Appears lateral to the flexor digitorum In superficial position. 6. Pass deep to the flexor retinaculum .

Question 28

Which nerve Pass deep to the flexor retinaculum . | ?

Answer 28

Median nerve

Question 29

Branches of median nerve and what do they supply?

Answer 29

In the arm: • No branches in the arm. • Communication from its lateral root to the ulnar n (c7 fibres). • In the forearm: gives 1. Muscular branches: to superficial and intermediate flexors except flexor carpi ulnaris 2. anterior interosseus nerve supplies all the deep flexors except medial 1/2 of the flexor digitorum profundus. 3. Palmar cutaneous branch : arise above the flexor retinaculum and superficial to it, to supply the skin of the lateral 2/3 of the palm of the hand (This palmar branch is spared in carpal tunnel syndrome because it passes into the hand superficial to the flexor retinaculum of the wrist) • In the hand: 1. Recurrent branch: supplies thenar muscles. 2. Palmar digital nerves: supply • Two lateral lumbricals and • Skin of the lateral 3and ½ digits (palmar surface and nail beds)

Question 30

Injury of the median nerve at the elbow

Answer 30

1. Superficial and intermediate flexors of the forearm (except flexor carpi ulnaris) ( muscular branches ) 1. Pronator teres. 2. Flexor carpi radialis. 3. Palmaris longus. 4. Flexor digitorum superficialis. = Their paralysis leads to 1. Loss of pronation 2. Weakness of flexion at the wrist. 3. Loss of flexion at the proximal and middle phalanges (prominent in the 2 nd and 3rd fingers). (Hand of benediction). IN ADDITION TO ULNAR DEVIATION 2. II) Deep flexors of the forearm (except medial ½ of the flexor digi. profundus) ( Ant. interosseous ) . (1. Lateral half of flexor digitorum profundus. 2. Flexor pollicis longus. 3. Pronator quadratus.) = Their paralysis leads to. 1. Loss of flexion of the distal phalanges of the index and middle fingers. 2. Loss of the flexion of the thumb. 3. Loss of pronation 3. Thenar muscles and lateral two lumbrical ( Recurrent and palmar digital nerves) ( 1. Abductor pollicis brevis. 2. Flexor pollicis brevis. 3. Opponens pollicis. 4. Two lateral lumbricals) = Their paralysis leads 1. Weakness of abduction of the thumb. 2. Loss of flexion of the thumb. 3. Loss of opposition of the thumb. 4. loss of flexion of the index and middle at the MP. Atrophy of thenar eminence Action of the In addition to adduction of the thumb lumbricals 4. Injury of the median nerve at the elbow (sensory loss) (Palmar cutaneous and palmar digital) (Loss of sensation of 1. lateral 2 /3 of the palm. 2. Palmar surface of the lateral 3 and ½ fingers &nail bed.

Question 31

Injury of the median nerve at the wrist ?

Answer 31

1. Motor loss Recurrent and palmar digital nerves ( 1. Abductor pollicis brevis (APB) . 2. Flexor pollicis brevis. 3. Opponens pollicis. 4. Two lateral lumbricals) = Their paralysis leads to 1. Weakness of abduction of the thumb. 2. Weakness of flexion of the thumb. 3. Loss of opposition of the thumb. 4. Weakness of flexion of the index and middle at the MP joints. Atrophy of thenar eminence In addition to adduction of the Action of the lumbricals thumb () 2. sensory loss: Palmar digital nerves Palmar surface of the lateral 3 and ½ fingers &nail bed.

Question 32

This condition is often obscure, though in some instances it may be a direct effect of increased pressure on the median nerve caused by overuse, swelling of the tendons and tendons sheaths (e.g. rheumatoid arthritis), and cysts arising from the carpal joints. The median nerve is the most sensitive structure in the tunnel. ?

Answer 32

Carpal tunnel syndrome

Question 33

Pain and pins-and-needles in the distribution of the median nerve. • Gently tapping over the median nerve (in the region of the flexor retinaculum) readily produces the previous symptoms (Tinel's sign). • Weakness and loss of muscle bulk of the thenar muscles may also occur. • difficulty buttoning a shirt or blouse as well as gripping things such as a comb ( weakness of the APB and loss of function of opponens pollicis ). ?

Answer 33

Carpal tunnel syndrome

Question 34

difficulty buttoning a shirt or blouse as well as gripping things such as a comb ( weakness of the APB and loss of function of opponens pollicis ). ?

Answer 34

Carpal tunnel syndrome

Question 35

The ability to grasp an object between the pad of the thumb and the pad of one of the fingers (opposition) depends on normal functioning of the?

Answer 35

thenar muscles, which are innervated by the recurrent branch of the median nerve.

Question 36

Injury of the musculocutaneous nerve | uncommon in this protected position) is typically inflicted by a weapon such as a knife.

Answer 36

1- Weakness of flexion of the elbow joint and supination of the forearm. Flexion and supination are still possible, produced by the brachioradialis and supinator, respectively, both of which are supplied by the radial nerve. 2- Loss of sensation may occur on the lateral surface of the forearm supplied by the lateral cutaneous nerve of the forearm, the continuation of the musculocutaneous nerve

Question 37

Radial Nerve origin?

Answer 37

``` continuation of the posterior cord of brachial plexus and enters the arm by crossing the inferior margin of the teres major muscle ```

Question 38

Radial Nerve course?

Answer 38

1. In the axilla it lies behind 3rd part of axillary artery 2. runs in the spiral groove of humerus. 3. In the spiral groove, lies directly in contact with the shaft of the humerus (Dangerous Position). 4. After leaving the spiral groove 5. The nerve enters the anterior compartment on the lateral side of the arm 6. Enter arm 7. Give branch post. Inters 8. Pierces supinator muscles 9. Turns around neck of radius 10. Reach back of forearms 11. Superficial radial nerve in front of lateral side of forearms 12. Reach dorsum of hand

Question 39

Radial nerve and branches and muscles it supplies ?

Answer 39

1. Radial N: brachioradialis/ triceps / anconeus / ECRL 2. Posterior interosseous nerve : (extensor of forearm ) 3.superficial radial n : • skin of lateral 2/3 of back of hand. • Skin over the back of proximal phalanges of lateral 3 ½ fingers.

Question 40

Injuries of Radial Nerve

Answer 40

``` Motor; • Triceps, anconeus and long extensors of the wrist are paralyzed • Unable to extend the elbow joint, wrist joint and fingers • Wrist drop • Unable to flex the fingers firmly for gripping • sensory • Sensory loss on the lateral part of dorsum of the hand • Sensory loss on the dorsal surface of the roots of the lateral 3 & ½ fingers ```

Question 41

ULNAR NERVE Origin?

Answer 41

From the medial cord of | the brachial plexus.

Question 42

ULNAR NERVE | Course?

Answer 42

1. It runs downward on the medial side of the brachial artery middle of the arm. 2. enters the posterior compartment of the arm. 3. has no branches in the arm. 4. At the elbow, it passes behind the medial epicondyle. 5. Go to forearm 6. Enters between the heads of flexor carpi ulnaris 7. medial to ulnar artery 8. Branch in arm 9. Branch in forearm cutanous 10. Enters the palm superficial to the flexor retinaculum 11. Ends by dividing into: superficial deep branches

Question 43

Ulnar nerve and branch’s supply?

Answer 43

- Ulnar nerve: 1. Flexor Carpi ulnaris 2. Medial ½ Flexor Digitorum Profundus - palmar cutaneous branch ( sensory): 1. supply skin over hypothenar eminence - Superficial branch: 1. Cutaneous: Skin over the Palmar aspect of the medial 1+ ½ fingers (including nail beds). - Deep branch : ``` It supplies 13 muscles : 1. Three hypothenar muscles. 2. Adductor pollicis.(near thenar ) 3. All dorsal & palmar interossei. 4. Medial 2 lumbrical. ```

Question 44

LESION OF ULNAR NERVE ABOVE ELBOW | ?

Answer 44

``` Motor deficit: • loss of flexion of the 4th and 5th digits • Atrophy of hypothenar muscles. • Loss of adduction of hand & thumb • Sensory deficit: • Loss of sensation in ulnar half of the palm and dorsum of hand, and the medial 1½ digits on both palmar and dorsal aspects of the hand ```

Question 45

LESION OF ULNAR NERVE ABOVE WRIST | ?

Answer 45

``` • 1- Inability to adduct thumb • 2- Inability to put the hand in writing position • - Sensory loss to fingers only • - Partial claw hand deformity is more prominent ```

Question 46

Adducting the fingers to grasp an object placed between | them are innervated by th?

Answer 46

deep branch of the ulnar nerve

Question 47

The ability to grasp an object between the pad of the thumb and the pad of one of the fingers depends on normal functioning of the thenar muscles, which are innervated by the ?

Answer 47

recurrent branch of the median nerve

Question 48

The Subclavian Artery- Origin?

Answer 48

Origin: Right subclavian artery arises from the brachiocephalic trunk. Left subclavian branches directly off the arch of aorta.

Question 49

The Subclavian Artery- Course | ?

Answer 49

Both subclavian arteries are divided into 3 parts by the anterior scalene muscle: 1. 1st part: from origin of artery to anterior scalene muscle. 2. 2nd part: posterior to the muscle. 3. 3rd part: lateral to the muscle and before the artery reaches the lateral border of 1st rib.

Question 50

The Subclavian Artery- Branches?

Answer 50

Branches: 1. Vertebral artery 2. Thyrocervical trunk 3. Internal thoracic artery 4. Costocervical trunk

Question 51

The Subclavian Artery Termination?

Answer 51

Termination: When the subclavian arteries cross the lateral edge of the 1st rib, they enter the axilla, and are called axillary arteries.

Question 52

The Axillary Artery- Origin, Course Termination?

Answer 52

The subclavian artery in the neck becomes the axillary artery at the lateral margin of first rib, and passes through axilla, becoming the brachial artery at the inferior margin of the teres major muscle.  Is closely related to the cords of brachial plexus and their branches.  Is enclosed within the axillary sheath.

Question 53

Axillary Artery is separated into 3 parts by the | ??

Answer 53

PECTORALIS MINOR MUSCLE, which crosses anteriorly to the vessel: 1. First part is proximal to pectoralis minor. 2. Second part is posterior to pectoralis minor. 3. Third part is distal to pectoralis minor.

Question 54

The Axillary Artery- 1st part extends ? Related ant. And lat? Branches?

Answer 54

Extends from the lateral border of 1st rib to upper border of the pectoralis minor muscle.  Related: Anteriorly: to the pectoralis major muscle Laterally: to the cords of the brachial plexus.  Gives ONE branch: The superior thoracic artery (Highest thoracic artery).

Question 55

The Axillary Artery- 2nd part extends ? Related ant. , post. And lat? Branches?

Answer 55

Lies behind the pectoralis minor muscle.  It is related medially, laterally, and posteriorly to the corresponding cords of the brachial plexus.  Gives TWO branches: 1. The thoracoacromial artery → divides into 4 branches: Pectoral, deltoid, clavicular, and acromial branches. 2. The lateral thoracic artery.

Question 56

The Axillary Artery- 3rd part extends ? Related ant. , post. And lat? Branches?

Answer 56

Extends from the lower border of pectoralis minor muscle to the lower border teres major muscle.  Related medially, laterally, and posteriorly, to the branches of the cords of the brachial plexus.  Gives THREE branches: 1.The subscapular artery 2.The anterior circumflex humeral artery → passes anterior to the surgical neck of humerus. 3.The posterior circumflex humeral artery → passes posterior to the surgical neck of humerus.

Question 57

Anastomosis around shoulder joint?

Answer 57

Branches from Subclavian Artery: a. Suprascapular artery b. Superficial cervical artery  Branches from Axillary Artery: a. Subscapular artery b. Anterior circumflex humeral artery c. Posterior circumflex humeral artery And they form an interconnected vascular network around the scapula.

Question 58

Brachial Artery- Origin, Termination & Relations ant. Post, med. lat.

Answer 58

 Is a continuation of the axillary artery at the lower border of teres major muscle.  Provides main arterial supply for the arm.  Terminates opposite neck of radius by dividing into radial & ulnar arteries. Relations:  Anteriorly: median nerve, and bicipital aponeurosis.  Posteriorly: triceps, coracobrachialis and brachialis.  Medially: basilic vein, ulnar and median nerves.  Laterally: coracbrachialis and biceps muscles.

Question 59

The Brachial Artery- Branches | ?

Answer 59

Muscular.  Nutrient to humerus.  Profunda brachii → largest branch, supplies posterior compartment of arm.  Superior ulnar collateral → share in anastomosis around elbow joint.  Inferior ulnar collateral → share in anastomosis around elbow joint.

Question 60

The larger of the two terminal branches of the brachial | artery. ?

Answer 60

Ulnar Artery

Question 61

Ulnar Artery | Course?

Answer 61

Begins in the cubital fossa at the level of neck of radius.  Descends through the anterior compartment of the forearm.  Enters the palm, in front of the flexor retinaculum, with the ulnar nerve.  Ends by forming the superficial palmer arch, by anastomosing with superficial palmer branch of radial artery.

Question 62

The smaller of the two terminal branches of the brachial artery. ?

Answer 62

Radial Artery

Question 63

Radial Artery | Course?

Answer 63

Begins in the cubital fossa at the level of neck of radius.  Descends downward and laterally.  Leaves the forearm by winding around the lateral aspect of the wrist to reach the dorsum of the hand.

Question 64

Anastomosis around elbow joint?

Answer 64

between branches of Brachial, Radial and Ulnar arteries:  Branches from Brachial Artery: a. Profunda Brachii artery b. Superior ulnar collateral artery c. Inferior ulnar collateral artery  Branches from Ulnar and Radial Arteries: a. Radial & ulnar recurrent arteries b. Posterior interosseous recurrent artery

Question 65

➢ Enters the hand anterior to the flexor retinaculum, on the lateral side of the ulnar nerve and pisiform bone. ➢ Gives a deep branch. ➢ Continue as the superficial palmar arch. Which artery ?

Answer 65

Ulnar Artery:

Question 66

Leaves dorsum of the hand and on entering the palm, it continues as deep palmar arch. ➢ Gives a superficial branch. Which artery?

Answer 66

Radial Artery:

Question 67

Is the direct continuation of the ulnar artery  Is completed by branch from the radial artery.  Lies approximately at the level of the distal border of the extended thumb.  Gives: digital arteries from its convexity to supply the fingers. Which arch?

Answer 67

Superficial Palmar Arch

Question 68

a continuation of the radial artery.  Is completed by deep branch of ulnar artery.  Lies at a level of the proximal border of extended thumb.  It sends branches: superiorly to share in anastomosis around the wrist joint & inferiorly to join branches of the superficial palmar arch. Which arch?

Answer 68

Deep Palmar Arch

Question 69

accompany the arteries and constitute the vena comitantes of those vessels. Are? are placed immediately beneath the skin, in the superficial fascia. Are?

Answer 69

1. deep veins | 2. superficial veins

Question 70

``` lies on the dorsum of the hand, in the subcutanous tissue.  Drains into the cephalic vein laterally, and basilic vein medially Which vein? ```

Answer 70

1. Dorsal Venous Arch (network):

Question 71

Arises from the lateral end of the dorsal venous arch of hand.

Answer 71

Cephalic Vein

Question 72

``` Ascends on radial side of the forearm to the elbow and continues up the arm in the deltopectoral groove.  Pierces clavipectoral fascia to drain into the axillary vein. ? ```

Answer 72

Cephalic Vein

Question 73

Arises from the medial side of the dorsal venous arch of hand. ?

Answer 73

Basilic Vein

Question 74

``` Ascends on the ulnar side of forearm to the elbow o In the middle of the arm, it pierces the deep fascia and joins the brachial vein or axillary vein. ? ```

Answer 74

Basilic Vein

Question 75

Links cephalic vein and basilic vein in the cubital fossa. ❑ Is a frequent site for venipuncture. ?

Answer 75

Median Cubital Vein

Question 76

Accompany the arteries of the same region and | bear similar names.

Answer 76

Venae commitantes:

Question 77

placed one on either side of the brachial artery. | ?

Answer 77

Brachial veins:

Question 78

Begins at the lower border of the Teres major, as the continuation of the basilic vein. ➢ Ends at the outer border of the first rib as the subclavian vein. ➢ Receives the brachial veins and tributaries. ➢ close to its termination, the cephalic vein. ?>

Answer 78

Axillary vein:

Question 79

Is the continuation of the axillary vein.  Extends from the outer border of the first rib to the sternal end of the clavicle, where it unites with the internal jugular to form the brachiocephalic (innominate) vein. ?

Answer 79

Subclavian Vein