Nerve and Blood Supply to the Upper Limb Flashcards
The surgical neck of the humerus is at risk of …, and if this happens, it can cause trauma to which arteries?
The surgical neck of the humerus is at risk of fracture, and if this happens, it can cause trauma to the anterior/posterior circumflex humeral arteries
Brachial artery
- The brachial artery is a continuation of the axillary artery past the lower border of the … major.
- It is the main supply of blood for the arm.
- Supplies … muscles (biceps brachii, coracobrachialis, brachialis muscle in … compartments)
- Immediately distal to the teres major, the brachial artery gives rise to the … brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the … aspect of the upper arm (…, e.g. triceps brachii).
- It terminates by contributing to an … network around the elbow joint.
- The brachial artery proper descends down the arm. As it moves through the … fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the … and … arteries.
- The brachial artery is a continuation of the axillary artery past the lower border of the teres major.
- It is the main supply of blood for the arm.
- Supplies flexor muscles (biceps brachii, coracobrachialis, brachialis muscle in anterior compartments)
- Immediately distal to the teres major, the brachial artery gives rise to the profunda brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the posterior aspect of the upper arm (extensors, e.g. triceps brachii).
- It terminates by contributing to an anastomotic network around the elbow joint.
- The brachial artery proper descends down the arm. As it moves through the cubital fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the radial and ulnar arteries.
Motor Functions of the Median Nerve
- Innervates the … and … muscles in the … compartment of the forearm (except the flexor carpi ulnaris and medial 2 bellies of the flexor digitorum profundus, innervated by the ulnar nerve). Also supplies innervation to the thenar muscles and lateral two lumbricals in the hand (lateral hand)
- Innervates the flexor and pronator muscles in the anterior compartment of the forearm (except the flexor carpi ulnaris and medial 2 bellies of the flexor digitorum profundus, innervated by the ulnar nerve). Also supplies innervation to the thenar muscles and lateral two lumbricals in the hand (lateral hand)
Motor innervation - (Brachial Plexus roots)
- Motor axons within each root innervate a different functional group of muscles (myotomes)
- C5 Motor root innervate Arm abductor (the …)
- C6 innervate Forearm flexors (the …)
- C7 innervate Forearm extensors (the …) and Wrist flexors/extensors
- C8 innervate … flexors/extensors
- T1 innervate … hand muscles
- Motor axons within each root innervate a different functional group of muscles (myotomes)
- C5 Motor root innervate Arm abductor (Deltoid)
- C6 innervate Forearm flexors (Biceps)
- C7 innervate Forearm extensors (Triceps) and Wrist flexors/extensors
- C8 innervate Digit flexors/extensors
- T1 innervate Intrinsic hand muscles
Lateral cord of the Brachial Plexus
- Terminates as … nerve and lateral part of … nerve
- Terminates as musculocutaneous nerve and lateral part of median nerve
Cutaneous innervation by terminal branches
- Map looks different to … map
- Terminal branches contain axons from … spinal nerve
- Map looks different to dermatome map
- Terminal branches contain axons from multiple spinal nerve
What artery supplies the upper limb?
Subclavian artery supplies the upper limb
The axillary artery ends at the lower border of … major
teres major
The map shows the cutaenous innervation by terminal branches - match the colour to a nerve
- Grey =
- Pink =
- Green =
- Purple = (from the … cord)
- Blue =
- Yellow =
- Grey = axillary
- Pink = radial
- Green = musculocutaneous
- Purple = medial cutaneous (from the medial cord)
- Blue = ulnar
- Yellow = median
Muculocutaenous nerve
- The musculocutaneous nerve is the terminal branch of the … cord of the brachial plexus and emerges at the inferior border of pectoralis minor muscle
- It pierces the … muscle near its point of insertion on the humerus. It gives a branch to this muscle.
- The musculocutaneous nerve then passes down the flexor compartment of the upper arm, superficial to … but deep to the … … muscle.
- It innervates both these muscles and gives articular branches to the humerus and the elbow.
- The nerve continues into the forearm as the lateral … nerve and provides sensory innervation to the lateral aspect of the forearm.
- The musculocutaneous nerve is the terminal branch of the lateral cord of the brachial plexus (C5, C6 and C7) and emerges at the inferior border of pectoralis minor muscle
- It pierces the coracobrachialis muscle near its point of insertion on the humerus. It gives a branch to this muscle.
- The musculocutaneous nerve then passes down the flexor compartment of the upper arm, superficial to brachialis but deep to the biceps brachii muscle.
- It innervates both these muscles and gives articular branches to the humerus and the elbow.
- The nerve continues into the forearm as the lateral cutaneous nerve and provides sensory innervation to the lateral aspect of the forearm.
Sensory Functions of the Axillary Nerve
- Gives rise to the upper lateral cutaneous nerve of arm, which innervates the skin over the lower deltoid (‘regimental … area’).
- Gives rise to the upper lateral cutaneous nerve of arm, which innervates the skin over the lower deltoid (‘regimental badge area’).
Cephalic and basilic veins drain into what vein?
Cephalic and basilic veins drain into axillary vein
C… Motor Axon innervates Arm abductor (Deltoid)
C5 Motor Axon innervate Arm abductor (Deltoid)
The brachial artery gives rise to the … brachii
The brachial artery gives rise to the profunda brachii
Medial Cord of the Brachial Plexus
- The medial cord is formed by:
- The anterior division of the … trunk.
- The medial cord is formed by:
- The anterior division of the inferior trunk.
The axillary artery can be divided into three parts based on its position relative to the … … muscle
The axillary artery can be divided into three parts based on its position relative to the pectoralis minor muscle
These are the 5 … branches
These are the 5 terminal branches
The median nerve is derived from the … and … … of the brachial plexus
The median nerve is derived from the medial and lateral cords of the brachial plexus
Axillary Nerve
- Axillary nerve goes through the … space (teres minor above, teres major below, long head of tricep, shaft of humerus)
- Also passing through this space with the axillary nerve is the posterior … humeral artery which weaves around surgical neck
- Supplies … muscle and the teres … muscle as it’s passing through
- Also supples region of skin on lateral aspect of arm - military … area of arm
- Axillary nerve goes through the quadrangular space (teres minor above, teres major below, long head of tricep, shaft of humerus)
- Also passing through this space with the axillary nerve is the posterior circumflex humeral artery - weaves around surgical neck
- Supplies deltoid muscle and the teres minor muscle as it’s passing through
- Also supples region of skin on lateral aspect of arm - military badge area of arm
Cephalic Vein
- Like the basilic vein, the cephalic vein also arises from the … venous network of the hand. It ascends the antero-… aspect of the upper limb, passing anteriorly at the elbow.
- At the shoulder, the cephalic vein travels between the deltoid and pectoralis major muscles (known as the deltopectoral groove), and enters the axilla region via the clavipectoral triangle. Within the axilla, the cephalic vein empties into … vein.
- The cephalic and basilic veins are connected at the elbow by the median cubital vein.
- The cephalic vein also arises from the dorsal venous network of the hand. It ascends the antero-lateral aspect of the upper limb, passing anteriorly at the elbow.
- At the shoulder, the cephalic vein travels between the deltoid and pectoralis major muscles (known as the deltopectoral groove), and enters the axilla region via the clavipectoral triangle. Within the axilla, the cephalic vein empties into axillary vein.
- The cephalic and basilic veins are connected at the elbow by the median cubital vein.
Median nerve
- Runs down the arm with the … artery
- Doesn’t innervate anything in the upper arm
- Passes into forearm through the … fossa
- Nerve roots: C6 – T1 (also contains fibres from C5 in some individuals).
- Motor functions: Innervates … forearm and lateral hand
- Sensory functions: Innervates … palm hand and what digits?
- Runs down the arm with the brachial artery
- Doesn’t innervate anything in the upper arm
- Passes into forearm through the cubital fossa ->
- Nerve roots: C6 – T1 (also contains fibres from C5 in some individuals).
- Motor functions: Innervates anterior forearm and lateral hand
- Sensory functions: Innervates lateral palm hand (near thumb), D1,D2,D3 and half of D4
The map shows the cutaenous innervation by terminal branches - match the colour to a nerve
- Grey =
- Pink =
- Green =
- Purple = (from the … cord)
- Blue =
- Yellow =
- Grey = axillary
- Pink = radial
- Green = musculocutaneous
- Purple = medial cutaneous (from the medial cord)
- Blue = ulnar
- Yellow = median
Medial Cord of the Brachial Plexus
- Terminates as … part of median nerve and the … nerve
- Terminates as medial part of median nerve and the ulnar nerve
Lymphatic drainage of the Upper Limb
- Relatively … lymph nodes in upper limb
- Some lymph nodes around elbow beside basilic vein - … nodes
- Some lymph nodes sit beside cephalic vein in the … groove - … node
- Lymph drains to … nodes
- Relatively few lymph nodes in upper limb
- Some lymph nodes around elbow beside basilic vein - cubital nodes
- Some lymph nodes sit beside cephalic vein in the deltopectoral groove - deltopectoral node
- Lymph drains to axillary nodes - sit around our axillary vein
Veins of the upper limb drain into what vein?
axillary vein (into subclavian vein)
Median nerve passes through … … - If this nerve is compressed it can cause what syndrome?
- Median nerve passes through carpal tunnel
- Can become compressed in the carpal tunnel - carpal tunnel syndrome
Dermatomes
- “An individual area of … innervated by a single … nerve”
- Established during development
- Lots of overlap/variation
- “An individual area of skin innervated by a single spinal nerve”
- Established during development
- Lots of overlap/variation
What plexus innervates the structures of the upper limb?
Brachial plexus
T… Motor Axon innervates Intrinsic hand muscles
T1 Motor Axon innervates Intrinsic hand muscles
Divisions - Brachial Plexus
- Each … divides into … and … divisions
- The … divisions forms the lateral and medial cords
- These divisions mainly contain axons that are going to innervate the … compartment of upper limb
- The … divisions forms the posterior cord
- These divisions mainly contain axons that are going to innervate the … compartment of upper limb
- The … divisions forms the lateral and medial cords
- Each trunk divides into anterior and posterior divisions
- The anterior divisions forms the lateral and medial cords
- These divisions mainly contain axons that are going to innervate the flexor compartment of upper limb
- The posterior divisions forms the posterior cord
- These divisions mainly contain axons that are going to innervate the extensor compartment of upper limb
- The anterior divisions forms the lateral and medial cords
Roots of Brachial Plexus - Nerves
- Coming off of the … cervical root is the dorsal scapular nerve which supplies the rhomboids and levator scapulae
- Coming off of C…,C…,C… is the long thoracic nerve which innervates serratus anterior
- Coming off of the 5th cervical root is the dorsal scapular nerve which supplies the rhomboids and levator scapulae
- Coming off of C5,C6,C7 is the long thoracic nerve which innervates serratus anterior
Cords of the Brachial Plexus
- Anterior and posterior … form cords
- They sit under our … … muscle (3rd,4th,5th rib - inserts into coracoid process)
- Cords are named lateral, posterior, medial (named in position to … artery - posterior cord sits behind it)
- Anterior and Posterior divisions form cords
- They sit under our pectoralis minor muscle (3rd,4th,5th rib - inserts into coracoid process)
- Cords are named lateral, posterior, medial (named in position to axillary artery - posterior cord sits behind it)
The Right Subclavian artery comes directly from where?
The Right Subclavian artery comes directly from the Brachiocephalic Trunk
The Median Nerve innervates all of the flexor and pronator muscles in the anterior compartment of the forearm - except for which two muscles?
Flexor carpi ulnaris & medial 2 bellies of the flexor digitorum profundus
The map shows the cutaenous innervation by terminal branches - match the colour to a nerve
- Grey =
- Pink =
- Green =
- Purple = (from the … cord)
- Blue =
- Yellow =
- Grey = axillary
- Pink = radial
- Green = musculocutaneous
- Purple = medial cutaneous (from the medial cord)
- Blue = ulnar
- Yellow = median
When the radial artery reaches the hand, it forms a deep … arch
When the radial artery reaches the hand, it forms a deep palmer arch
Ulnar artery
- … side of the forearm
- Covered by flexor … ulnaris muscle
- Deep branch - common … artery
- Forms … palmer arch
- Medial side of the forearm
- Covered by flexor carpi ulnaris muscle
- Gives off a deep branch - common interosseous artery
- Forms superficial palmer arch
Clinical: Altered sensation in the region of a … indicates damage to specific spinal nerve of spinal cord segment (i.e. proximal nerve injury)
Clinical: Altered sensation in the region of a dermatome indicates damage to specific spinal nerve of spinal cord segment (i.e. proximal nerve injury)
Axillary Artery
- Fill in the missing blanks
- Risk of fracture
- Anterior/posterior circumflex humeral
- Subscapular artery
Ulnar artery in the hand
- The ulnar artery passes into hand from … palmer arch
- Anastomoses with our radial artery on the lateral side
- Branches given off the supercial palmer arch - palmer … arteries
- The ulnar artery passes into hand from superficial palmer arch
- Anastomoses with our radial artery on the lateral side
- Branches given off the supercial palmer arch - palmer digital arteries
The map shows the cutaenous innervation by terminal branches - match the colour to a nerve
- Grey =
- Pink =
- Green =
- Purple = (from the … cord)
- Blue =
- Yellow =
- Grey = axillary
- Pink = radial
- Green = musculocutaneous
- Purple = medial cutaneous (from the medial cord)
- Blue = ulnar
- Yellow = median
The Subclavian artery ends as it crosses outer border of … … and becomes the axillary artery
The Subclavian artery ends as it crosses outer border of first rib and becomes the axillary artery
The yellow divisions are … and the green divisions are …
The yellow divisions are posterior and the green divisions are anterior
Subclavian Artery
- Passes through scalene … (over first rib)
- Divided into 3 parts by scalenus anterior:
- 1st is … to muscle
- 2nd is … muscle
- 3rd is … to muscle
- Passes through scalene triangle (over first rib)
- Divided into 3 parts by scalenus anterior:
- 1st is Medial to muscle
- 2nd is Behind muscle
- 3rd is Lateral to muscle
C… Motor Axon innervates Forearm flexors (Biceps)
C6 innervates Forearm flexors (Biceps)
The Subclavian artery ends as it crosses outer border of first rib and becomes what artery?
axillary artery
Radial nerve
- The radial nerve is the terminal continuation of the … cord of the brachial plexus.
- It Passes … in the arm
- Enters our … compartment and passes through our … groove (
- (lies between the humeral attachments of the lateral and medial heads of the … … muscle)
- Enters the forearm just under … muscle and then terminates by dividing into two branches:
- … branch (motor) – innervates the muscles in the posterior compartment of the forearm (innervates all of … muscles)
- … branch (sensory) – contributes to the cutaneous innervation of the dorsal hand and fingers.
- The radial nerve is the terminal continuation of the posterior cord of the brachial plexus.
- It Passes posterially in the arm
- Enters our extensor compartment and passes through our radial groove (lies between the humeral attachments of the lateral and medial heads of the triceps brachii)
- Enters the forearm just under brachioradialis muscle and then terminates by dividing into two branches:
- Deep branch (motor) – innervates the muscles in the posterior compartment of the forearm (innervates all of extensor muscles)
- Superficial branch (sensory) – contributes to the cutaneous innervation of the dorsal hand and fingers.
- Cutaneous innervation of the shoulder and upper limb comes from multiple peripheral nerves originating from cervical and thoracic nerve roots, with most of the nerves originating from the brachial plexus.
- Clinical: Altered sensation in one of the above areas indicates damage to a more … nerve segment
- Cutaneous innervation of the shoulder and upper limb comes from multiple peripheral nerves originating from cervical and thoracic nerve roots, with most of the nerves originating from the brachial plexus.
- Clinical: Altered sensation in one of the above areas indicates damage to a more distal nerve segment
Musculocutaneous nerve - overview
- Nerve roots – … - …
- Motor functions – muscles in the anterior compartment of the arm (…, … … and the …).
- Sensory functions – gives rise to the lateral … nerve of forearm, which innervates the lateral aspect of the forearm.
- Nerve roots – C5-C7.
- Motor functions – muscles in the anterior compartment of the arm (coracobrachialis, biceps brachii and the brachialis).
- Sensory functions – gives rise to the lateral cutaneous nerve of forearm, which innervates the lateral aspect of the forearm.
Subclavian artery can be split into … parts depending on the position of the vessel in relation to … …
Subclavian artery can be split into three parts (1st, 2nd, 3rd) depending on the position of the vessel in relation to scalenus anterior
Terminal branches of the bracial plexus
- The 5 terminal branches of the brachial plexus are the …, …, …, …, and … nerves
- The 5 terminal branches of the brachial plexus are the musculocutaneous, median, ulnar, axillary, and radial nerves
Quadrangular space
- Borders: Teres … above, Teres … below, long head of …, shaft of …
- What passes through it? (one nerve, one artery)
- Borders: Teres minor above, Teres major below, long head of tricep, shaft of humerus
- What passes through it? - axillary nerve and the posterior circumflex humeral artery
Radial artery
- … side of forearm
- … of the two terminal branches
- Covered by … muscle
- Forms … palmer arch
- Lateral side of forearm
- Smaller of the two terminal branches
- Covered by brachioradialis muscle
- Forms deeper palmer arch
What is circled in this image?
Cords of the brachial plexus
How do we find our deep palmer arch and superficial palmer arch?
- Extend thumb - line across = approx location of deep palmer arch
- one finger breadth distal = approx location of superficial palmer arch
C… Motor Axon innervates Forearm extensors (Triceps) and Wrist flexors/extensors
C7 Motor Axon innervates Forearm extensors (Triceps) and Wrist flexors/extensors
Radial Nerve branches
- The nerve terminates in the forearm by dividing into two branches:
- Deep branch (…) – innervates the muscles in the posterior compartment of the forearm.
- Superficial branch (…) – contributes to the cutaneous innervation of the dorsal hand and fingers.
- The nerve terminates in the forearm by dividing into two branches:
- Deep branch (motor) – innervates the muscles in the posterior compartment of the forearm.
- Superficial branch (sensory) – contributes to the cutaneous innervation of the dorsal hand and fingers.
Trunks - Brachial Plexus
- At the base of the neck, the … of the brachial plexus converge to form three trunks. These structures are named by their relative anatomical location:
- Superior trunk – a combination of … and … roots.
- Middle trunk – continuation of …
- Inferior trunk – combination of … and … roots.
- Trunks pass through the … triangle
- At the base of the neck, the roots of the brachial plexus converge to form three trunks. These structures are named by their relative anatomical location:
- Superior trunk – a combination of C5 and C6 roots.
- Middle trunk – continuation of C7.
- Inferior trunk – combination of C8 and T1 roots.
- Trunks pass through the scalene triangle
Profunda brachii artery
- The … artery gives rise to the profunda brachii (deep artery), which travels with the … nerve in the … groove of the humerus and supplies structures in the posterior aspect of the upper arm (e.g. triceps brachii).
- The profunda brachii terminates by contributing to an anastomotic network around the elbow joint.
- The brachial artery gives rise to the profunda brachii (deep artery), which travels with the radial nerve in the radial groove of the humerus and supplies structures in the posterior aspect of the upper arm (e.g. triceps brachii).
- The profunda brachii terminates by contributing to an anastomotic network around the elbow joint.
Label the diagram (Superficial veins of the upper limb)
Left = Cephalic vein, Right = Basilic vein
Basilic Vein
- The basilic vein originates from the … venous network of the hand and ascends the … aspect of the upper limb.
- At the border of the teres major, the vein moves deep into the arm. Here, it combines with the brachial veins from the deep venous system to form the … vein.
- The basilic vein originates from the dorsal venous network of the hand and ascends the medial aspect of the upper limb.
- At the border of the teres major, the vein moves deep into the arm. Here, it combines with the brachial veins from the deep venous system to form the axillary vein.
The cephalic and basilic veins are connected at the elbow by the … … vein.
The cephalic and basilic veins are connected at the elbow by the median cubital vein.
The … nerve is derived from the medial and lateral cords of the brachial plexus
The median nerve is derived from the medial and lateral cords of the brachial plexus
The brachial plexus is divided into five parts; …, …, …, … and … (a good mnemonic for this is Read That Damn Cadaver Book). There are no functional differences between these divisions – they are simply used to aid explanation of the brachial plexus.
The brachial plexus is divided into five parts; roots, trunks, divisions, cords and branches (a good mnemonic for this is Read That Damn Cadaver Book). There are no functional differences between these divisions – they are simply used to aid explanation of the brachial plexus.
What digits does the median nerve innervate? (sensory - skin innervation)
D1,D2,D3 and half D4
The anterior humeral … artery is a vessel arising from the axillary artery at the proximal part of the arm.
The anterior humeral circumflex artery is a vessel arising from the axillary artery at the proximal part of the arm.
Label the diagram
- Spinal/radial groove
- Posterior circumflex humeral artery
- Profunda brachii artery
- Radial nerve
Radial Nerve branches
- The nerve terminates in the forearm by dividing into two branches:
- Deep branch (motor) – innervates the muscles in the … compartment of the forearm.
- Superficial branch (sensory) – contributes to the cutaneous innervation of the … hand and fingers.
- The nerve terminates in the forearm by dividing into two branches:
- Deep branch (motor) – innervates the muscles in the posterior compartment of the forearm.
- Superficial branch (sensory) – contributes to the cutaneous innervation of the dorsal hand and fingers.
Posterior cord of the Brachial Plexus
- Sits directly behind our … artery
- Terminates as … nerve and the … nerve
- Sits directly behind our axillary artery
- Terminates as radial nerve and the axillary nerve
Label the arteries (upper arm)
- top left = profunda brachii
- top right = brachal artery
- bottom left = radial artery
- bottom right = ulnar artery
Ulnar nerve
- Passes down the medial side - behind brachial artery and median nerve
- Passes down the back of the elbow joint
- Passes through the cubital … -> formed between medial epicondyle and olecranon of ulnar
- Sits under flexor carpi ulnaris muscle with the ulnar artery
- In forearm, nerve innervators flexor carpi ulnaris muscle and the two bellies of flexor … … (anterior flexor compartments of forearm are mainly innerated by median nerve except for these two)
- Median nerve passes across the wrist and enters the hand on the medial side - innervates the medial intrinsic muscles and skin on medial side - what digits?
- Passes down the medial side - behind brachial artery and median nerve
- Passes down the back of the elbow joint
- Passes through the cubital tunnel -> formed between medial epicondyle and olecranon of ulnar
- Sits under flexor carpi ulnaris muscle with the ulnar artery
- In forearm, nerve innervators flexor carpi ulnaris muscle and the two bellies of flexor digitorum profundus (anterior flexor compartments of forearm are mainly innerated by median nerve except for these two)
- Median nerve passes across the wrist and enters the hand on the medial side - innervates most of the intrinsic muscles and skin on medial side (half of D4 and D5)
Brachial artery
- The brachial artery is a continuation of the axillary artery past the lower border of the … major.
- It is the main supply of blood for the arm.
- Supplies … muscles (biceps brachii, coracobrachialis, brachialis muscle in … compartments)
- Immediately distal to the teres major, the brachial artery gives rise to the … brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the … aspect of the upper arm (…, e.g. triceps brachii).
- It terminates by contributing to an … network around the elbow joint.
- The brachial artery proper descends down the arm. As it moves through the … fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the … and … arteries.
- The brachial artery is a continuation of the axillary artery past the lower border of the teres major.
- It is the main supply of blood for the arm.
- Supplies flexor muscles (biceps brachii, coracobrachialis, brachialis muscle in anterior compartments)
- Immediately distal to the teres major, the brachial artery gives rise to the profunda brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the posterior aspect of the upper arm (extensors, e.g. triceps brachii).
- It terminates by contributing to an anastomotic network around the elbow joint.
- The brachial artery proper descends down the arm. As it moves through the cubital fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the radial and ulnar arteries.
Brachial artery
- The brachial artery is a continuation of the axillary artery past the lower border of the … major.
- It is the main supply of blood for the arm.
- Supplies … muscles (biceps brachii, coracobrachialis, brachialis muscle in … compartments)
- Immediately distal to the teres major, the brachial artery gives rise to the … brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the … aspect of the upper arm (…, e.g. triceps brachii).
- It terminates by contributing to an … network around the elbow joint.
- The brachial artery proper descends down the arm. As it moves through the … fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the … and … arteries.
- The brachial artery is a continuation of the axillary artery past the lower border of the teres major.
- It is the main supply of blood for the arm.
- Supplies flexor muscles (biceps brachii, coracobrachialis, brachialis muscle in anterior compartments)
- Immediately distal to the teres major, the brachial artery gives rise to the profunda brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the posterior aspect of the upper arm (extensors, e.g. triceps brachii).
- It terminates by contributing to an anastomotic network around the elbow joint.
- The brachial artery proper descends down the arm. As it moves through the cubital fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the radial and ulnar arteries.
Radial artery in the hand
- The radial artery enters the hand dorsally, crossing the floor of the … …
- Pierces first dorsal … muscle (allows abduction of index finger)
- Reaches palmer aspect of hand - forms … palmer arch (below flexor tendons)
- The radial artery enters the hand dorsally, crossing the floor of the anatomical snuffbox.
- Pierces first dorsal interosseous muscle (abduct index finger)
- Reaches palmer aspect of hand - forms deep palmer arch (below flexor tendons)
What muscle is this?
Teres major
Subclavian Artery - Divisions
- 1st part is … to scalenus anterior - it has lots of branches - (Vertebral artery, internal thoracic artery) but the most important is the … trunk (supplies thyroid, cervical, scapular)
- 2nd part is … scalenus anterior - costocervical trunk (don’t need to remember)
- 3rd part is … to scalenus anterior - … … artery
- 1st part is medial to scalenus anterior - it has lots of branches - (Vertebral artery, internal thoracic artery) but the most important is the thyrocervical trunk (supplies thyroid, cervical, scapular) contributes to scapular anastomosis
- 2nd part is behind scalenus anterior - costocervical trunk (don’t need to remember)
- 3rd part is lateral to scalenus anterior - dorsal scapular artery - contributes to scapular anastomosis
The Left Subclavian artery comes directly from where?
The Left Subclavian artery comes directly from the arch of aorta
At the shoulder, the cephalic vein travels between the … and … major muscles (known as the … groove), and enters the axilla region via the clavipectoral triangle. Within the axilla, the cephalic vein empties into … vein.
At the shoulder, the cephalic vein travels between the deltoid and pectoralis major muscles (known as the deltopectoral groove), and enters the axilla region via the clavipectoral triangle. Within the axilla, the cephalic vein empties into axillary vein.
Roots of Brachial Plexus - Nerves
- Coming off of the 5th cervical root is the … … nerve which supplies the rhomboids and levator scapulae
- Coming off of C5,C6,C7 is the … … nerve which innervates serratus anterior
- Coming off of the 5th cervical root is the dorsal scapular nerve which supplies the rhomboids and levator scapulae
- Coming off of C5,C6,C7 is the long thoracic nerve which innervates serratus anterior
Altered sensation in the region of a dermatome indicates damage to … spinal nerve of spinal cord segment whereas altered sensation in one of the cutaneous innervation areas indicates damage to a more … nerve segment
Altered sensation in the region of a dermatome indicates damage to specific spinal nerve of spinal cord segment (i.e. proximal nerve injury) whereas altered sensation in one of the cutaneous innervation areas indicates damage to a more distal nerve segment (i.e. distal nerve injury)
Profunda brachii artery
- Accompanies … nerve in spiral groove
- The spiral/radial groove is formed between the … and … heads of the … muscle
- If we were to … the humerus at the shaft at this point we may damage this artery which would affect the blood supply to the triceps muscle
- Accompanies radial nerve in spiral groove
- The spiral/radial groove is formed between the lateral and medial heads of the triceps muscle
- If we were to fracture the humerus at the shaft at this point we may damage this artery which would affect the blood supply to the triceps muscle
Match the colours to a nerve
Brachial Plexus - Division Overview
- Divided into r…, t…, d…, c…, … branches (contain axons from multiple spinal nerves - … nerves)
- Divided into roots, trunks, divisions, cords, terminal branches (contain axons from multiple spinal nerves - mixed nerves)
Fill in the blanks
- anterior - axons to flexor compartments
- posterior - axons to extensor compartments
The arterial supply to the upper limb begins as the subclavian artery. On the right, the subclavian artery arises from the … trunk. On the left, it branches directly from the … of …
The arterial supply to the upper limb begins as the subclavian artery. On the right, the subclavian artery arises from the brachiocephalic trunk. On the left, it branches directly from the arch of aorta.
Superficial veins of Upper Limb
- Fill in the blanks
- Left = basilic vein, Middle = cephalic vein, Below = dorsal venous arch
- Right = basilic vein
Brachial artery
- The brachial artery is a continuation of the axillary artery past the lower border of the … major.
- It is the main supply of blood for the arm.
- Supplies … muscles (biceps brachii, coracobrachialis, brachialis muscle in … compartments)
- Immediately distal to the teres major, the brachial artery gives rise to the … brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the … aspect of the upper arm (…, e.g. triceps brachii).
- It terminates by contributing to an … network around the elbow joint.
- The brachial artery proper descends down the arm. As it moves through the … fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the … and … arteries.
- The brachial artery is a continuation of the axillary artery past the lower border of the teres major.
- It is the main supply of blood for the arm.
- Supplies flexor muscles (biceps brachii, coracobrachialis, brachialis muscle in anterior compartments)
- Immediately distal to the teres major, the brachial artery gives rise to the profunda brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the posterior aspect of the upper arm (extensors, e.g. triceps brachii).
- It terminates by contributing to an anastomotic network around the elbow joint.
- The brachial artery proper descends down the arm. As it moves through the cubital fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the radial and ulnar arteries.
Muculocutaenous nerve
- The musculocutaneous nerve is the terminal branch of the … cord of the brachial plexus and emerges at the inferior border of pectoralis minor muscle
- It pierces the … muscle near its point of insertion on the humerus. It gives a branch to this muscle.
- The musculocutaneous nerve then passes down the flexor compartment of the upper arm, superficial to … but deep to the … … muscle.
- It innervates both these muscles and gives articular branches to the humerus and the elbow.
- The nerve continues into the forearm as the lateral … nerve and provides sensory innervation to the lateral aspect of the forearm.
- The musculocutaneous nerve is the terminal branch of the lateral cord of the brachial plexus (C5, C6 and C7) and emerges at the inferior border of pectoralis minor muscle
- It pierces the coracobrachialis muscle near its point of insertion on the humerus. It gives a branch to this muscle.
- The musculocutaneous nerve then passes down the flexor compartment of the upper arm, superficial to brachialis but deep to the biceps brachii muscle.
- It innervates both these muscles and gives articular branches to the humerus and the elbow.
- The nerve continues into the forearm as the lateral cutaneous nerve and provides sensory innervation to the lateral aspect of the forearm.
C… Motor Axon innervates Digit flexors/extensors
C8 Motor Axon innervates Digit flexors/extensors
Axillary Artery
- Divided into three parts by … …:
- 1st … to muscle
- 2nd … muscle
- 3rd … to muscle
- First and second parts closely associated with the … plexus
- Ends at lower border of teres …
- Becomes … artery
- Divided into three parts by pectoralis minor:
- 1st Medial to muscle
- 2nd Behind muscle
- 3rd Lateral to muscle
- First and second parts closely associated with the brachial plexus
- Ends at lower border of teres major
- Becomes brachial artery
Radial nerve
- The radial nerve is the terminal continuation of the … cord of the brachial plexus.
- It Passes … in the arm
- Enters our … compartment and passes through our … groove (
- (lies between the humeral attachments of the lateral and medial heads of the … … muscle)
- Enters the forearm just under … muscle and then terminates by dividing into two branches:
- … branch (motor) – innervates the muscles in the posterior compartment of the forearm (innervates all of … muscles)
- … branch (sensory) – contributes to the cutaneous innervation of the dorsal hand and fingers.
- The radial nerve is the terminal continuation of the posterior cord of the brachial plexus.
- It Passes posterially in the arm
- Enters our extensor compartment and passes through our radial groove (lies between the humeral attachments of the lateral and medial heads of the triceps brachii)
- Enters the forearm just under brachioradialis muscle and then terminates by dividing into two branches:
- Deep branch (motor) – innervates the muscles in the posterior compartment of the forearm (innervates all of extensor muscles)
- Superficial branch (sensory) – contributes to the cutaneous innervation of the dorsal hand and fingers.
Superficial Lymphatic Vessels of the Upper Limb
- The vessels shadowing the basilic vein go on to enter the … lymph nodes. These are found medially to the vein, and proximally to the medial epicondyle of the humerus. Vessels carrying on from these nodes then continue up the arm, terminating in the lateral axillary lymph nodes.
- The vessels shadowing the cephalic vein generally cross the proximal part of the arm and shoulder to enter the apical axillary lymph nodes, though some exceptions instead enter the more superficial … lymph nodes.
- The vessels shadowing the basilic vein go on to enter the cubital lymph nodes. These are found medially to the vein, and proximally to the medial epicondyle of the humerus. Vessels carrying on from these nodes then continue up the arm, terminating in the lateral axillary lymph nodes.
- The vessels shadowing the cephalic vein generally cross the proximal part of the arm and shoulder to enter the apical axillary lymph nodes, though some exceptions instead enter the more superficial deltopectoral lymph nodes.
Motor Functions of the Axillary Nerve
- Innervates the teres … and … muscles
- Innervates the teres minor and deltoid muscles
Altered sensation in the region of a dermatome indicates damage to specific spinal nerve of spinal cord segment (i.e. … nerve injury) whereas altered sensation in one of the cutaneous innervation areas indicates damage to a more distal nerve segment (i.e. … nerve injury)
Altered sensation in the region of a dermatome indicates damage to specific spinal nerve of spinal cord segment (i.e. proximal nerve injury) whereas altered sensation in one of the cutaneous innervation areas indicates damage to a more distal nerve segment (i.e. distal nerve injury)
The brachial artery proper descends down the arm. As it moves through the … fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the … and … arteries
The brachial artery proper descends down the arm. As it moves through the cubital fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the radial and ulnar arteries
Brachial artery
- The brachial artery is a continuation of the axillary artery past the lower border of the … major.
- It is the main supply of blood for the arm.
- Supplies … muscles (biceps brachii, coracobrachialis, brachialis muscle in … compartments)
- Immediately distal to the teres major, the brachial artery gives rise to the … brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the … aspect of the upper arm (…, e.g. triceps brachii).
- It terminates by contributing to an … network around the elbow joint.
- The brachial artery proper descends down the arm. As it moves through the … fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the … and … arteries.
- The brachial artery is a continuation of the axillary artery past the lower border of the teres major.
- It is the main supply of blood for the arm.
- Supplies flexor muscles (biceps brachii, coracobrachialis, brachialis muscle in anterior compartments)
- Immediately distal to the teres major, the brachial artery gives rise to the profunda brachii (deep artery), which travels with the radial nerve in the spiral/radial groove of the humerus and supplies structures in the posterior aspect of the upper arm (extensors, e.g. triceps brachii).
- It terminates by contributing to an anastomotic network around the elbow joint.
- The brachial artery proper descends down the arm. As it moves through the cubital fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the radial and ulnar arteries.
The map shows the cutaenous innervation by terminal branches - match the colour to a nerve
- Grey =
- Pink =
- Green =
- Purple = (from the … cord)
- Blue =
- Yellow =
- Grey = axillary
- Pink = radial
- Green = musculocutaneous
- Purple = medial cutaneous (from the medial cord)
- Blue = ulnar
- Yellow = median
Roots of the Brachial Plexus
- Roots are … primary rami of C…-T…
- Roots are ventral primary rami of C5-T1
Motor Functions of the Ulnar Nerve
- Two muscles of the anterior forearm – flexor … … and medial half of flexor .. …
- Intrinsic muscles of the hand (apart from the thenar muscles and two lateral lumbricals - innervated by median nerve)
- Two muscles of the anterior forearm – flexor carpi ulnaris and medial half of flexor digitorum profundus
- Intrinsic muscles of the hand (apart from the thenar muscles and two lateral lumbricals - innervated by median nerve)
Axillary artery - Underneath Pec minor
- Lots of branches given off of the axillary artery
- 1st part - branch to supply thorax
- 2nd part - branch to supply axillary region
-
3rd part: (need to know)
- … artery - contributes to scapular …
- anterior and posterior … h… arteries - form a circle around … neck of humerus (prone to … - so risk damaging these arteries)
- Lots of branches given off of the axillary artery
- 1st part - branch to supply thorax
- 2nd part - branch to supply axillary region
- 3rd part:
- subscapular artery - contributes to scapular anastomosis
- anterior and posterior circumflex humeral arteries - form a circle around surgical neck of humerus (prone to fracture - so risk damaging these arteries)
Venous Return of Upper Limb - Deep and Superficial Veins
- Deep veins tend to follow arteries:
- … veins
- Venae comitantes
- Superficial veins:
- … - runs up the lateral forearm and lateral side of arm
- … - runs up the medial forearm and medial side of arm arm
- Both arise from … … arch
- Deep veins tend to follow arteries:
- Paired veins
- Venae comitantes
- Superficial veins:
- Cephalic - runs up the lateral forearm and lateral side of arm
-
Basilic - runs up the medial forearm and medial side of arm arm
- Both arise from dorsal venous arch
Roots of Brachial Plexus - Nerves
- Coming off of the 5th cervical root is the dorsal scapular nerve which supplies the … and … scapulae
- Coming off of C5,C6,C7 is the long thoracic nerve which innervates … …
- Coming off of the 5th cervical root is the dorsal scapular nerve which supplies the rhomboids and levator scapulae
- Coming off of C5,C6,C7 is the long thoracic nerve which innervates serratus anterior
Venous return of Upper limb
- Considerably variable
- Veins in upper limb all drain into … vein which drains into … vein
- Veins can be divided into … veins and … veins
- Considerably variable
- Veins in upper limb all drain into axillary vein into subclavian vein
- Veins can be divided into deep veins and superficial veins
Dermatomes of the upper limb
- C4: over the … joint.
- C5: the … aspect of the lower edge of the … muscle (known as the “regimental …”).
- C6: the palmar side of the ….
- C7: the palmar side of the … finger.
- C8: the palmar side of the … finger.
- T1: the … aspect of … and …
- C4: over the acromioclavicular joint.
- C5: the lateral aspect of the lower edge of the deltoid muscle (known as the “regimental badge”).
- C6: the palmar side of the thumb.
- C7: the palmar side of the middle finger.
- C8: the palmar side of the little finger.
- T1: T1: the medial aspect of forearm and arm
Lateral cord
- The lateral cord gives rise to the lateral … nerve, which supplies the … muscles. The terminal branches of the lateral cord are the lateral head of the median nerve and the … nerve.
- The lateral cord gives rise to the lateral pectoral nerve, which supplies the pectoral muscles. The terminal branches of the lateral cord are the lateral head of the median nerve and the musculocutaneous nerve. (The musculocutaneous nerve pierces coracobrachialis approximately 5cm distal to the conjoint tendon. Trace the musculocutaneous nerve as it pierces this muscle and follow the nerve deep to biceps until it emerges on its lateral aspect just above the elbow. Its terminal branch is the lateral cutaneous nerve of the forearm, which supplies the skin of the lateral forearm on both the dorsal and ventral aspects.)
The musculocutaneous nerve pierces … approximately 5cm distal to the conjoint tendon. Its terminal branch is the lateral … nerve of the forearm, which supplies the skin of the lateral forearm on both the dorsal and ventral aspects.
The musculocutaneous nerve pierces coracobrachialis approximately 5cm distal to the conjoint tendon. Its terminal branch is the lateral cutaneous nerve of the forearm, which supplies the skin of the lateral forearm on both the dorsal and ventral aspects.
Which structures does the musculocutaneous nerve supply?
The musculocutaneous nerve innervates the three muscles of the anterior compartment of the arm: the coracobrachialis, biceps brachii, and brachialis. It is also responsible for cutaneous innervation of the lateral forearm
Which area of skin in the hand does the ulnar nerve supply?
- The ulnar nerve provides sensory supply to the following areas of the hand:
- The skin of the palmar and dorsal aspects of the medial 1½ digits and adjacent palm.
- The skin on the medial side of the dorsum of hand.
Which area of skin in the hand does the median nerve supply?
- The sensory supply of the median nerve includes:
- The skin of the palmar and distal dorsal aspects of the lateral three-and-the-half digits and adjacent palm.
- The skin of the palmar and distal dorsal aspects of the thumb and radial half of 2nd digit.
- The skin of the palmar and distal dorsal aspects of the lateral three-and-the-half digits and adjacent palm.
The stem artery of the upper limb is the … artery
The stem artery of the upper limb is the subclavian artery
Arterial Supply to the Upper Limb
- The stem artery of the upper limb is the subclavian artery.
- The origin of this artery differs on the two sides of the body.
- On the right side, it is a branch of the … trunk.
- On the left hand side it normally arises directly off the ….
- As the subclavian artery passes over the first rib it changes its name to the … artery (see figure below).
- In the axilla, the … artery is accompanied by the cords of the brachial plexus. Once this artery crosses the lower border of teres major it changes its name again to become the … artery, which is the main artery within the arm. This artery gives off many small muscular branches and also the … (or deep) brachii artery, which accompanies the radial nerve in the spiral groove of the humerus to supply triceps and the elbow joint.
- The stem artery of the upper limb is the subclavian artery.
- The origin of this artery differs on the two sides of the body.
- On the right side, it is a branch of the brachiocephalic trunk.
- On the left hand side it normally arises directly off the aorta.
- As the subclavian artery passes over the first rib it changes its name to the axillary artery (see figure below). In the axilla, the axillary artery is accompanied by the cords of the brachial plexus. Once the axillary artery crosses the lower border of teres major it changes its name again to become the brachial artery, which is the main artery within the arm. The brachial artery gives off many small muscular branches and also the profunda (or deep) brachii artery, which accompanies the radial nerve in the spiral groove of the humerus to supply triceps and the elbow joint.
