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Flashcards in Superficial Structures Of Upper Limb Deck (49):
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Pectoral fascia

Invests the pectoralis major and is continuous inferiorly with the fascia of the anterior abdominal wall

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Axillary fascia

Pectoral fascia leaves lateral border of pectoralis major and becomes axillary fascia which forms the floor of the axilla

2

Clavipectoral fascia

Deep to pectoral fascia and pectoralis major
Descends from the clavicle enclosing the subclavius and then the pectoralis minor, becoming continuous inferiorly with the axillary fascia

3

Costocoracoid membrane

Part of Clavipectoral fascia between pectoralis minor and subclavius
Pierced by lateral pectoral nerve which primarily supplies pectoralis major

4

Suspensory ligament of axilla

Part of Clavipectoral fascia inferior to pectoralis minor
Supports axillary fascia and pulls it and the skin inferior to it upward during abduction of arm, forming axillary fossa

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Deltoid fascia

Invests the deltoid and is continuous with the pectoral fascia anteriorly and the dense infra spinous fascia posteriorly

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Brachial fascia

Sheath of deep fascia, encloses arm like a snug sleeve
Continuous superiorly with deltoid, pectoral, axillary and infra spinous fasciae
Attached inferiorly to the epicondyles of the humerus and the olecranon of the ulna and is continuous with the antebrachial fascia. The deep fascia of the forearm

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Inter muscular septa

Medial and lateral inter muscular septa
Extend from the deep surface of the brachial fascia and attach to the central shaft and medial and lateral supra epicondylar ridges of the humerus
Divide arm into anterior (flexor) and posterior (extensor) fasciae compartments
Each of which contains muscles serving similar functions and sharing common Innervation

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Antebrachial fascia

Fascial compartments in the forearm surrounded by antebrachial fascia
Separated by interosseus membrane, connecting radius and ulna

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Extensor retinaculum

Antebrachial fascia Thickens posteriorly over the distal ends of the radius and ulna to form a transverse band
Holds extensor tendons in position

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Flexor retinaculum

Antebrachial fascia continues distal but deeper than palmar carpal ligament
Transverse carpal ligament
Extends between the anterior prominences of the outer carpal bones and converts to carpal tunnel

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Palmar carpal ligament

Anterior thickening of antebrachial fascia
Continuous with extensor retinaculum

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Carpal tunnel

Converted by flexor retinaculum: anterior concavity of the carpus into the carpal tunnel through which flexor tendons and median nerve pass

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Palmar fascia

Deep fascia of the upper limb continues beyond the extensor and flexor retnacula

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Palmar aponeurosis

Central part of palmar fascia
Thick, tendinous and triangular
Forms four distinct thickenings that radiate to the bases of the fingers and become continuous with the fibrous tendon sheaths of the digits

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Superficial transverse metacarpal ligament

Bands transversed distally
Form the base of the palmar aponeurosis

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Brachial plexus

Anterior rami of c5 to t1 spinal nerves

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Cervical plexus

Series of nerve loops formed between adjacent anterior rami of the first four cervical nerves
Deep to SCM on lateral aspect of neck

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Supra clavicular nerves

C3 c4
Pass anterior to clavicle, immediately deep to platysma and supply skin over clavicle and superolaterally aspect of pectoralis major

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Posterior cutaneous nerve of the arm

C5-c8
Branch of radial nerve, supplies skin on the posterior surface of the arm

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Posterior cutaneous nerve of forearm

C5 to c8
Also a branch of radial nerve
Supplies skin on posterior surface of forearm

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Superior lateral cutaneous nerve of the arm

C5-c6
Terminal branch of axillary nerve, emerges from beneath posterior margin of the deltoid to supply the skin over the lower part of this muscle and on the lateral surface of the midarm

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Inferior lateral cutaneous nerve of the arm

C5c6
Branch of radial nerve
Supplies skin over infero lateral aspect of the arm
Frequently a branch of the posterior cutaneous nerve of the forearm

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Lateral cutaneous nerve of the forearm

C6c7
Terminal branch of musculocutaneous nerve
Supplies skin on lateral side of forearm

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Medial cutaneous nerve of arm

C8-t2
Arises from medial cord of brachial plexus, often uniting in the axillary with the lateral cutaneous branch of the 2nd intercostal nerve
Supplies skin on medial side of the arm

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Intercostobrachial nerve

T2
Lateral cutaneous branch of 2nd intercostal nerve
Also contributes to Innervation of skin on medial surface of the arm

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Medial cutaneous nerve of the forearm

C8, t1
Arises from medial cord of brachial plexus and supplies skin on the anterior and medial surfaces of the forearm

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Dorsal venous network

Dorsum of the hand
From which cephalon and basilic veins originate

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Perforating veins

Form communications between the superficial and deep veins

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Cephalic vein

Ascends on subcutaneous tissue from the lateral aspect of the dorsal venous network, proceeding along the lateral border of the wrist and the anterolateral surface of the forearm and arm

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Median cubital vein

Anterior to elbow, communicates with Cephalic vein
Passes obliquely across anterior aspect of the elbow and joins the basilic vein

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Cephalic vein superiorly

Cephalic vein passes between the deltoid and pectoralis muscles and enters Clavipectoral triangle, where it pierces Costocoracoid membrane, part of the Clavipectoral fascia, and joins terminal part of axillary vein

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Basilic vein

Ascends in subcutaneous tissue from the medial end of the dorsal venous network, along the medial end of the dorsal venous network along the medial side of the forearm and inferior part of the arm
Then passes deeply near junction of the middle and inferior thirds of the arm, piercing the brachial fascia, and running superiorly parallel to the brachial artery, where it merges with accompanying veins of brachial artery to form axillary vein

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Median antebrachial vein

Median vein of forearm
Ascends in the middle of anterior aspect of forearm

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Deep veins

Lie internal to deep fascia and usually occur as paired, continually interanastomosing, accompanying veins that travel with and bear the same name as the major arteries of the upper limb

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Superficial lymphatic vessels

Arise from lymphatic plexuses in the skin of the fingers, palm and dorsum of the hand and ascend mostly with superficial veins, such as the Cephalic and basilic veins

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Cubital lymph nodes

Some lymphatic vessels accompanying basilic vein enter
Located proximal to medial epicondyle

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Humeral (lateral) axillary lymph nodes

Efferent vessels from cubital lymph nodes ascend in the arm and terminate here

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Apical axillary lymph nodes

Most lymphatic vessels accompanying Cephalic vein cross proximal part of the arm and anterior aspect of shoulder to enter here

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Deltopectoral lymph nodes

Some vessels enter
More superficial

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Deep lymphatic vessels

Less numerous than superficial
accompany major deep veins and terminate in Humeral (lateral) axillary lymph nodes

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Injury to axillary nerve

Atrophy of the deltoid occurs when the axillary nerve is damaged
Rounded contour of shoulder disappears
Slight hollow inferior to acromion
To test deltoid, abduct against resistance starting at 15 degrees

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C3 c4 dermatome

Supply region at the base of the neck, extending laterally over the shoulder

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C5 dermatome

Supplies arm laterally (ie superior aspect of abducted limb

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C6 nerve dermatome

Supplies forearm laterally and the thumb

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C7 dermatome

Supplies middle and ring fingers (or middle three fingers) and the middle of the posterior surface if the limb

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C8 dermatome

Little finger, medial side of the hand and the forearm (ie the inferior aspect of the abducted limb)

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T1 dermatome

Middle of the forearm to the axilla

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T2 dermatome

Supplies a small part of the arm and the skin of the axilla