Cubital Fossa

Question 1

Subclavian artery

Answer 1

Origin: Right- from the brachiocephalic trunk
Left-arises directly from the aortic arch
-ends at the lateral border of the first rib by becoming the axillary artery

Question 2

Thyrocervical trunk

Answer 2

• short vessel arising from the first part of the subclavian artery supplies this region via two branches
  1. Transverse cervical artery
  2. Suprascapular artery

Question 3

Transverse cervical artery

Answer 3

• branch of thyrocervical trunk
• passes laterally through the root of the neck to the anterior border of the trapezius
• may bifurcate into a deep branch (dorsal scapular) and a superficial branch (superficial cervical)
• then passes deep to the trapezius in company with the spinal accessory nerve
• supplies trapezius and elevator scapulae

Question 4

Suprascapular artery

Answer 4

• branch of thyrocervical trunk
• -passes laterally through the root of the neck running deep to and parallel to the clavicle
• then deep to trapezius to follow the suprascapular nerve
• passes superior to the superior transverse scapular ligament and then lies directly on the scapula
• descends lateral along the spinoglenoid notch of the scapular neck. To arrive in the infraspinous fossa
• supplies supraspinous, infraspinous, and the acromioclavicular and glenohumeral joints.

Question 5

Dorsal scapular artery

Answer 5

• arises from the 2nd or 3rd part of the subclavian (75%) or from transverse cervical artery (25%)
• courses laterally and posteriorly in the root of the neck
• passes through the diverging fiber of the brachial plexus
• turns inferiorly and courses anterior to the elevator scapulae and then rhomboid muscles along the medial border of the scapula in company with the dorsal scapular nerve
• supplies rhomboid major and minor, lavator scapulae, and serratus anterior

Question 6

Axillary artery

Answer 6

• continuation of subclavian a.
• lateral border of rib 1 to the lower border of the Teres muscle.
• continues into the arm as the brachial artery.

Question 7

Pec minor subdivides the axillary artery into 3 parts:

Answer 7

1. Rib 1 to medial border of pec minor
   - superior thoracic artery
2. deep to pec minor.
   - lateral thoracic artery
   - Thoracoacromial artery
3. Lateral border of axillary artery, follows subscapularis
   - subscapular
   - anterior circumflex humeral a.
   - posterior circumflex humeral a.

Question 8

Superior thoracic artery

Answer 8

First part of axillary

-supplies the proximal regions of the medial and anterior axillary walls

Question 9

Lateral thoracic artery

Answer 9

2nd part of axillary a

• arises from anterior surface of the axillary
• follows pec minor and supplies the medial/anterior walls
• in females it contributes the blood supply to the breast

Question 10

Thoracoacromial artery

Answer 10

2nd part of axillary a.

• penetrates the clavipectoral fascia, then divides into 4 smaller branches to the anterior axilla.
  1. Pectoral branch- gives blood supply to the breast
  2. Deltoid branch- accompanies the cephalic vein
  3. Acromial branch
  4. Clavicular branch

Question 11

Subscapular artery

Answer 11

3rd part of axillary a.
-largest branch of the axillary artery, follows the subscapularis
I. Circumflex scapular- (through the triangular space) enters the infraspinous fossa, to anastomoses with the suprascapular artery, and the deep branch of the transverse cervical artery (dorsal scapular artery)
II. Thoracodorsal-to deep surface of latissimus dorsi

Question 12

Anterior circumflex humeral artery

Answer 12

-arises from the lateral side of the axillary, travels anterior to the surgical neck to anastomose with Posterior circumflex humeral artery

Question 13

Posterior circumflex humeral artery

Answer 13

• passes through the quadrangular space
• supplies the surrounding muscles and the glenohumeral joint
• anastomosis with branches from the profunda brachii.

Question 14

Deep branch of transverse cervical a.

Answer 14

-from the thyrocervical trunk from the subclavian artery (or dorsal scapular directly from subclavian)

Question 15

Suprascapular artery

Answer 15

-from the thyrocervical trunk

Question 16

Circumflex scapular branch

Answer 16

-along with Deep branch of transverse artery and suprascapular artery form an anastomotic network

Question 17

Quadrangular space

Boundaries and contents?

Answer 17

• Teres minor superiorly, Teres major inferiorly, long head of triceps brachii medially, and surgical neck of humerus laterally
  Contents- axillary nerve and the posterior circumflex humeral artery

Question 18

Triangular space

Boundaries and content?

Answer 18

• Teres minor, Teres major, and long head of triceps brachii

- circumflex scapular vessels

Question 19

Triangular interval

Boundaries and contents?

Answer 19

• long head of triceps brachii, shaft of humerus, and Teres minor
• radial nerve an profunda brachii artery

Question 20

Deltopectoral triangle

Boundaries and contents

Answer 20

• clavicle, deltoid, and pec major

- cephalic vein and deltoid branches of the Thoracoacromial artery; coracoid process pal patted deep within

Question 21

Brachial artery

Answer 21

• continuation of the axillary artery at the level of the inferior border of the teres major muscle.
• ends near neck, divides into radial and ulnar arteries.
• lies on the anterior surfaces of the coracobrachialis and the brachialis muscles
• closely associated with the median nerve

Question 22

Profunda brachii (deep brachial)

Answer 22

• largest branch of the brachial artery.
• gives off three branches
  1. Ascending branch
  2. Middle collateral artery
  3. Radial collateral artery

Question 23

Ascending branch

Answer 23

-runs superiorly between the long and lateral head of the triceps to anastomose with a descending branch of the posterior circumflex humeral artery.

Question 24

Middle collateral artery

Answer 24

-descends within the medial head of the triceps brachii toward the elbow to anastomose with the interosseus recurrent artery.

Question 25

Radial collateral artery

Answer 25

- continuation of the profunda brachii which perforates the lateral Intermuscular septum and runs anterior to the elbow to anastomose with the radial recurrent artery (branch of radial artery). - closely associated with the radial nerve

Question 26

Nutrient humeral artery

Answer 26

-arises from the brachial artery in the middle of the arm and passes into the nutrient foramen on the anteromedial aspect of humerus

Question 27

Superior ulnar collateral artery

Answer 27

- branches from brachial artery about the middle of the arm, descends with the ulnar nerve to the posterior aspect of the medial epicondyle. - passing posterior to the elbow joint, it anastomoses with the posterior ulnar recurrent artery.

Question 28

Inferior ulnar collateral artery

Answer 28

- originates immediately proximal to the elbow joint from the brachial artery - crosses anterior to the elbow to anastomose with the anterior ulnar recurrent artery.

Question 29

Cubital fossa | Boundaries?

Answer 29

-triangular space anterior to the elbow Roof-skins, deep fascia and bicipital aponeurosis Proximal boundary- line connecting the humeral spicondyles Lateral boundary- brachioradialis Medial boundary- pronator peres Floor- formed by the brachialis and supinator muscles

Question 30

Cubital fossa | Contents lateral--> medial

Answer 30

Lateral to medial 1. Deep branch of the radial nerve 2. Radial recurrent artery 3. Tendon of the biceps brachii 4. Brachial artery (perhaps its ulnar/radial derivatives; and related veins) 5. Median nerve 6. Anterior ulnar recurrent artery

Question 31

Superficial veins of arm

Answer 31

Cephalic and basilic - arise from the dorsal venous network of the hand, and interconnected by the median cubital vein and terminate in the axillary vein - connect to deep veins by perforating fascia to merge deeper

Question 32

Deep veins

Answer 32

- paired deep veins (venae comitantes) accompany/parallel the deep arteries, often forming a network of anastomosing vessels around the artery. - deep brachial veins merge with the basilic vein to form the axillary vein near the inferior border of the teres major.

Question 33

Cubital (supratrochlear) nodes

Answer 33

- in distal limb | - found along the basilica vein, just proximal to the elbow.

Question 34

6 groups of lymph nodes in the axilla

Answer 34

1. Humeral group-receives most of the lymph from the upper limb, drains to central group. 2. Subscapular group-drains the scapular and posterior thoracic regions, drains to central group. 3. Pectoral- drains the anterior thoracic wall, including the breast, drains to central and apical groups 4. Central group- receives drainage from the humeral, subscapular, and pectoral groups, drains into apical group 5. Infraclavicular- adjacent to the cephalic vein, receives drainage from area, including breast 6. Apical group- receives drainage from the central and infraclavicular groups, and form the subclavian lymphatic trunk Left side-subclavian lymphatic trunk drains into the thoracic duct Right side- may be joined by the jugular and bronchomediastinal trunks to form the righ lymphatic duct

Question 35

Forearm

Answer 35

-contains muscles that are the prime movers of the wrist and hand and the nerves and blood supply of these muscles as they also extend distally beyond the forearm

Question 36

Wrist region (carpus)

Answer 36

Contains the wrist joint and the proximal portion of the hand, the carpus.

Question 37

Wrist joint (radiocarpal joint)

Answer 37

- between distal surface of the radius and the two most lateral carpal bones of the proximal row (scaphoid, lunate) - carpal bones are shaped and arranged to form an anterior concavity with a taut retinaculum completing a tunnel (carpal tunnel) of which pass most tenons of anterior forearm muscles and neurovasculature to supply the hand

Question 38

Hand

Answer 38

-contains carpal bones, the metacarpals, and the fingers formed by phalanges

Question 39

Radioulnar Joints

Answer 39

1. Proximal radioulnar joint 2. Interosseus membrane 3. Distal radio-ulnar joint

Question 40

Interosseus membrane

Answer 40

-strong, fibrous interconnection between the radius and ulna not only binds the two bones together, but also helps to transmit distal forces from the radius to the ulna

Question 41

Distal radio-ulnar joint

Answer 41

- head of the ulna articulates with the ulnar notch of the radius - during pronation and supination, the radius rotates on the ulna. - held together by triangular fibrocartilage complex (TFCC)

Question 42

Radiocarpal (wrist) joint

Answer 42

- distal part of the radius and triangular fibrocartilage of the wrist articulate with the concave surface formed by three proximal-row carpal bones (scaphoid, lunate, and triquetrum) - head of ulna is NOT in wrist joint.

Question 43

Intercarpal joints

Answer 43

-held together by interosseus ligaments with help to delineate joint cavities.

Question 44

Carpometacarpal

Answer 44

-thumb has its own separte carpometacarpal joint between the trapezium and the first metacarpal.

Question 45

Interphalangeal joints

Answer 45

-function as pure hinge-joints (flexion-extension) due to restriction created by ulnar and radial collateral ligaments

Question 46

Elbow movements

Answer 46

- hinge joint | - can flex/extend in sagittal plane

Question 47

Forearm (radioulnar) movement

Answer 47

- 2 synovial and 1 syndesmotic joint | - can probate/supinate around long axis

Question 48

Wrist (radiocarpal) movements

Answer 48

- condyloid joint | - flex/extend (sagittal plane) and abduct/ adduct (frontal)

Question 49

Fingers 2-5 movement of Metacarpophalangeal joints and Proximal and Distal Interphalangeal joints

Answer 49

MP-can extend/flex (sagittal) and abduct/adduct (frontal plane) PIP and DIP- can flex/extend (sagittal plane)

Question 50

Thumb (finger 1) movements

Answer 50

CMC joint- flex/extend (oblique plane) and abduct/adduct (perpendicular to flex/extend plane) MP joint- can flex/extend (parallel CMC joint) Interphalangeal (IP)- can flex/extend (parallel CMC joint)