Lecture 5: Nerves and Vasculature Upper Limb Flashcards Preview

Year 2 Term 1 Movement > Lecture 5: Nerves and Vasculature Upper Limb > Flashcards

Flashcards in Lecture 5: Nerves and Vasculature Upper Limb Deck (57):

When does the Subclavian artery become the axillary artery?

When it passes the lateral border of the first rib


What 3 important arteries come off the subclavian artery?

Vertebal artery, internal thoracic and thyrocervical trunk (Giving rise to the inferior thyroid)


Which important branches come off the axillary artery?

The anterior and posterior circumflex humeral


Which muscle divides the axillary artery into 3 parts?

Pec minor


Which important branches come off the brachial artery?

Profunda Brachii (Giving rise to the radial collateral) and superior and inferior ulna collateral


Which foramina does the vertebral artery pass through?



What is subclavian steal syndrome?

Occlusion of the subclavian artery, proximal to the vertebral artery origin, causing reverse flow in the ipsilateral vertebral artery


When does the axillary artery become the brachial artery?

At the inferior border of teres major


Where does the brachial artery divide?

In the cubital fossa


What does the profunda brachii artery supply?

Posterior compartment of the arm


What 2 vessels travel through the triangular interval and the spiral groove?

The profunda Brachii artery and the radial nerve


How are brachial vessels commonly injured?

Penetrating and blunt trauma, usually associated with humeral fractures


What is the difference in prognosis of a injury to the brachial artery proximal to the profunda brachii or distal to it?

Proximal = 50% loss of limb
Distal = 25% loss of limb


What are the peri-articular anastomosis and what do they do?

Network of anastomosis of the brachial and profunda brachii arteries in the arm, with the radial and ulna arteries in the fore-arm
They ensure bloodflow to the fore-arm even of the elbow is fully flexed


What does the radial artery supply?

The anterolateral aspect of the fore-arm, including flexors and extensors


What does the ulnar artery supply?

The medial side of the forearm, mainly flexors and pronators


Where does the anterior interosseous artery supply?

The middle of the flexor compartment


What does the posterior interosseous artery supply?

The middle of the extensor compartment


What important branches does the ulnar artery give off in the fore-arm?

Anterior and posterior ulnar recurrent arteries and the common interosseous artery (Giving rise to the anterior and posterior interosseous arteries)


How does the radial artery pass to the palmar side of the hand?

Pierces the first dorsal interosseous muscle and passes between the two heads of adductor pollicis


Where can the brachial pulse be palpated in the mid-arm?

In the cleft between biceps and triceps
N.B. At this point it's just inferior to the medial nerve


What is the arrangement of the 3 structures in the cubital fossa?

Tendon, most lateral. Artery, in the middle and median nerve, most medial


Where can the radial and ulnar arteries be palpated at the wrist?

Lateral to the tendons of flexor carpi radialis and ulnaris respectively


The cephalic and basilic drain which parts of the hand?

Cephalic = Lateral side of dorsal venus arch
Basilic = Medial side of dorsal venus arch


The ulnar artery supplies which part of the hand?

Mainly the medial 3.5 digits


The radial artery supplies which part of the hand?

Mainly the lateral 1.5 digits


After running through the deltopectoral triangle what does the cephalic vein do?

Pierces the clavipectoral fascia and drains into the axillary vein


What is a useful site for venepuncture?

Median cubital vein


What are venae comitantes?

2+ veins that accompany an artery so that pulsations aid return


Which arteries of the arm are accompanied by venue comitantes?

Deep and superficial palmar arches, radial and ulnar and brachial


How is the axillary vein formed?

When the venue comitantes of the brachial artery merge with the basilic vein


When does the axillary vein become the subclavian vein?

After it passes under the clavicle


How does the subclavian vein drain into the heart?

Joins the internal jugular to form the brachiocephalic veins which join to form the SVC


What is Erb's palsy?

It's common in newborn when there is stretching of the neck during delivery, causing damage to the C5, C6 nerve roots, leading to paralysis of the muscles of the shoulder and the arm supplied by C5, C6


What are the clinical features of Erb's palsy?

Arm hangs limply by side
"Waiter's tip" position
adducted shoulder- Due to loss of abductors
Medially rotated arm- Due to loss of lateral rotators
Extended elbow - Loss of flexion by brachialis and biceps
Pronated forearm - Loss of supination by biceps


How can Erb's palsy occur in adults, and what is the prognosis?

Violent falls on the side of the head and shoulder, forcing the two apart
The prognosis depends upon the degree of damage, function may return within months or may be permanent


What investigation would be carried out to confirm Erb's palsy in an adult?

An MRI shows nerve root damage


Can Erb's palsy be cured?

Yes, with a nerve transplant


What is Klumpke's Palsy?

Damage to the inferior trunk of the brachial plexus C8, T1 - Ulnar nerve


Is Klumpke's palsy more or less common than Erb's palsy?

Less common


How does Klumpke's palsy occur?

In newborns when the upper limb is pulled excessively and in adults when the upper limb is suddenly pulled superiorly


What are the clinical features of Klumpke's palsy?

Paralysis of the intrinsic muscles of the hand and ulnar flexes of the wrist and digits
Imbalance of the intrinsic and extrinsic muscles leads to claw hand


What does claw hand occur in?

Klumpke's palsy (Damage to the ulnar nerve)


What is claw hand?

Hyperextension at the metacarpophalangeal joints and flexion at the interphalangeal joints
Due to paralysed lumbricals of digits 4 and 5


What is the cubital tunnel?

a tendinous arch between the humeral and ulnar heads of flexor carpi ulnaris


What passes through the cubital tunnel?

The ulnar nerve


What is the second most common entrapment syndrome?

Cubital tunnel syndrome


What 3 things may cause cubital tunnel syndrome?

1. Constricting fascial bands
2. Direct compression
3. Occupational activities from repetitive flexion and extension


What are the symptoms of cubital tunnel syndrome?

Same as Klumpke's palsy


What is the treatment of cubital tunnel syndrome?

Initially, anti-inflammatories then surgery if unresolved


What other syndrome may also be associated with Klumpke's palsy? and why?

Horner's syndrome
Because sympathetic neuron's supplying the head originate from T1


What is radial nerve palsy?

Injury to the radial nerve in the spiral groove results in wrist drop as an inability to extend wrist and metacarpophalangeal joints due to paralysis of extensor muscles of the forearm


Why is triceps weakened rather than paralysis?

Because a branch to the long head is given off before the damage


How can the median nerve be injured at the elbow?

By supra condylar fractures or pronator teres syndrome


What does median nerve damage result in?

The hand of Benediction


What is the hand of benediction?

Inability to flex digits 1-3


Why is flexion of digits 4 and 5 weakened but still possible?

Because the median nerve supplies FDC and FDP but not the 2 medial lumbricals (They are supplied by the ulnar nerve)