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Flashcards in Cubital Fossa Deck (50):
1

Subclavian artery

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

2

Thyrocervical trunk

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

3

Transverse cervical artery

-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

4

Suprascapular artery

-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.

5

Dorsal scapular artery

-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

6

Axillary artery

-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.

7

Pec minor subdivides the axillary artery into 3 parts:

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.

8

Superior thoracic artery

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

9

Lateral thoracic artery

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

10

Thoracoacromial artery

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

11

Subscapular artery

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

12

Anterior circumflex humeral artery

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

13

Posterior circumflex humeral artery

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

14

Deep branch of transverse cervical a.

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

15

Suprascapular artery

-from the thyrocervical trunk

16

Circumflex scapular branch

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

17

Quadrangular space
Boundaries and contents?

- 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

18

Triangular space
Boundaries and content?

- Teres minor, Teres major, and long head of triceps brachii
-circumflex scapular vessels

19

Triangular interval
Boundaries and contents?

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

20

Deltopectoral triangle
Boundaries and contents

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

21

Brachial artery

-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

22

Profunda brachii (deep brachial)

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

23

Ascending branch

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

24

Middle collateral artery

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

25

Radial collateral artery

-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

26

Nutrient humeral artery

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

27

Superior ulnar collateral artery

-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.

28

Inferior ulnar collateral artery

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

29

Cubital fossa
Boundaries?

-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

30

Cubital fossa
Contents lateral--> medial

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

31

Superficial veins of arm

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

32

Deep veins

-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.

33

Cubital (supratrochlear) nodes

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

34

6 groups of lymph nodes in the axilla

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

35

Forearm

-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

36

Wrist region (carpus)

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

37

Wrist joint (radiocarpal joint)

-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

38

Hand

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

39

Radioulnar Joints

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

40

Interosseus membrane

-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

41

Distal radio-ulnar joint

-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)

42

Radiocarpal (wrist) joint

-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.

43

Intercarpal joints

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

44

Carpometacarpal

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

45

Interphalangeal joints

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

46

Elbow movements

-hinge joint
-can flex/extend in sagittal plane

47

Forearm (radioulnar) movement

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

48

Wrist (radiocarpal) movements

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

49

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

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

50

Thumb (finger 1) movements

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)