. SgMgIt: loss of skin sensations over lateralT"of deltoid. . Deformitv: flat shoulder. It is a mixed nerve from the lateral cord COURSE & RemTIONS: o Lateral to the 3'd part of Axillary artery. o Leaves the axilla by piercing the coracobrachialis m.ilr o Then descends downwards between biceps & brachialis. LEtcrd.o,o BneNcHrr'{*

 

. Superior & inferior ulnar collateral arteries.

around the

around the

UPPER LIMB I

PnoruruDA BRAcHU ARTERY:

- A large vessel that arises from the medial and posterior part of the brachial

artery, just below the lower border of the teres major.

- lt enters the spiral groove together with the radial nerye, where it gives off

the following branches:

a. Ascending branch: ascends on the back of the humerus to

anastomose with the post circumflex humeral artery.

b. 2 descending branches (anterior & posterior) that descend with the

radial nerve towards the lateral epicondyle.

SunTaCE ANAToMY oF AxILLARY & BRAcHIAL ARTERIES:

' The arm should be abducted & the forearm should be supinated.

. Draw 3 points:

a. At the midclavicular point.

b. At the level of posterior fold of axilla.

c. At midpoint of the cubital fossa.

. A line from a to b = Axillaray A.

, Alinefrom bto c= BrachialA.

BeCtnSl in the cubital fossa as the larger of the 2 terminal branches of the

brachial artery.

Gounsel in the forearm:

- Begins a little below the bend of elbow, and passes obliquely downward.

- Reaches the ulnar side of the forearm at a point about midway between the

elbow and the wrist.

- lt then runs along the ulnar border to the wrist.

- lt crosses the transverse carpal ligament lateral to the pisiform bone, and

immediately beyond this bone divides into two branches, which enter into

the formation of the superficial and deep volar arches.

ENOS I in ttre palm by becoming the superficial palmar arch.

Bnarucnes:

Anterior Recurrent

Posterior Recurrent

Common lnterosseous

Muscular

Anterior & posterior carpal

Volar

DorsalCarpal Superficial Volar Arch

Surface anatomy of ulnar & radial arteries:

a. At midcubitalfossa.

b. At styloid process of the radius.

c. At medial epicondyle of the humerus.

d. At the pisiform bone.

e. At the junction of the upper & lower of a line between c & d.

I UPPER LIMB

BgClruS I in tne cubital fossa as the smaller of the 2 terminal branches of the

brachial artery. lts origin lies at the level of the neck of the radius.

Gounse l

ln the forearm:

- The artery leaves the cubital fossa at its apex, under cover of the

brachioradialis muscle.

- lt descends along the lateral side of forearm down to the wrist.

- lt then winds backward, around the lateral side of the wrist.

ln the dorsum of the hand:

- lt passes in the floor of anatomical snuff -box.

- lt passes fonrvard between the two heads of the first lnterosseous dorsalis,

to reach the palm of the hand.

ln the palm of hand:

It passes between the two heads of adductor pollicis.

EttOS ] in tne palm by becoming the deep palmar arch.

Bnencnes I

Radial Recurrent.

Muscular.

Volar Carpal.

Superficial Volar.

DorsalCarpal.

First Dorsal Metacarpal.

Lateraldorsal digital

Princeps Pollicis.

Volaris lndicis Radialis.

Volar Metacarpal.

Perforating.

Recurrent.

UPPER LIMB I

ATaSTOMOSIS AROUND THE SCAPULA

1"t part of the Subclavian arterv

"n

2. Deep branches of transverse cervical artery.

1. Sub-scapular artery.

2. Circumflex scapular artery (branch from sub-scapular artery).

SuncrcAL IMPoRTANcE:

o If there is obstruction of the subclavian artery, this anastomosis will be

on duty (if the obstruction is between the 1't part of subclavian & 3'd part

of axillary).

o lf the obstruction is proximal to thyro-cervical trunk, with effort of the UL,

vasodilatation occurs & blood shifts from vertebral artery to the UL

through the anastomosis around the scapula or through the artery itself

which will lead to syncopal attacks. This is called (STEAL

PHENOMENON).

AruesroMosrs

H UTUERUS

AROUND SURGICAL NECK OF

Axillarv arterv

o Anterior circumflex humeral artery.

o Posterior circumflex humeral artery

Brachial arterv

o Ascending branches of Profunda brachii.

SuncrcAL IMPoRTANcE:

Used as collaterals in chronic ischemia.

AruasroMosrs ARoUND THE Eleow

o Around medial epicondvle:

branches of I superior ulnu sollaterall a----a> Iposterior ulnu ncutentl branshe$ 0f

braclial a. I interior ulnar sollaterd

, <**'**n> [anterior ntnu recunent I dnu a

o Around lateral epicondvle:

branctres of lant des, br. of profunda I { , } lndial recurert a ton ndial a. I

brachial a. [lost. Ues. br. of profrnda, <*'**'** > [rust. interos$ers nflrrent afron ulnu af

UPPER LIMB I

Anlerior

ATISToMOSIS AROUND THE WRIST

- Anterior carpal arch:

Formed by anastomosis of the anterior carpal branches of radial & ulnar

arteries in front of the wrist.

- Posterior carpal arch:

Formed by anastomosis of the posterior carpal branches of radial & ulnar

arteries behind the wrist.

ATISToMOSIS IN THE HAND

- Deep palmar arch: formed mainly by

radial artery & completed by a branch of

ulnar artery.

- Superficial palmar arch: formed mainly

by ulnar artery & completed by a branch of

radial artery.

- Anastomosis in the diqits between

diqital arteries.

I UPPER LIMB

Dorsal venous arch

- lt lies acrbss the lower part of the dorsum of the hand.

- lt gives origin to both the cephalic & basilica veins from the lateral &medial ends

of the venous arch respectively.

Gephalic vein

- lt begins from the lateral ends of the dorsal venous arch & ascends on the lateral

side of forearm.

- lt reaches the front of the elbow joint where it communicates with the basilica

vein through the median cubital vein.

- lt ascends on the lateral margin of biceps & continues in delto-pectoral groove.

- lt then pierces clavi-pectoral fascia to end in the axillary vein.

Basilic vein

- lt begins from the medial ends of the dorsal venous arch & ascends on the

medial side of forearm.

- As it passes in front of medial epicondyle it is joined by median cubital vein.

- lt ascends along the medial margin of biceps brachii where it pierces the deep

fascia opposite the insertion of coracobrachialis.

- lt enters the axilla at the lower border of teres major to become the axillary vein.

Median cubital vein

- lt lies obliquely in front of elbow where it joins the cephalic vein 1 inch below

lateral epicondyle & joins the basilic vein 1 inch above the medial epicondyle.

Axillarv vein

Course:

- lt begins at the lower border of teres major as a continuation of basilica vein.

- lt ascends on the medial side of the axillary artery.

- lt ends at the outer border of the 1"t rib by becoming the subclavian vein.

Tributaries:

1. 2 vena comitants which accompany the brachial artery.

2. Cephalic vein.

3. Veins which accompany the branches of the axillary artery.

UPPER LIMB I

Roors=*

o C5, 6, 7,8 &T1.

o Posterior to scalenus anterior.

TnuNKSl 1in tne neck) {*

. Upper trunk ) union of C5 & C6.

. Medial trunk ) ct alone.

. Lower trunk ) union of C8 & T1.

DrvrsroNS:

o Each trunk gives anterior & posterior divisions (behind middle Ts of the

clavicle).

o Anterior division innervates the entire flexor compartment of ,a{$

Gonos: {F

ln the axilla in relation to the axillary artery (named according to relations to

2nd part of axillary artery)

.@Formedbyunionofanteriordivisionofupper&middle

trunks (C5, 6, 7).

. @{jgl1i1}$li Anterior division of lower trunk (C8, T1).

. Posterior cord:

contribution from anterior divisions.

Branches of the Roots:

. Nerve to Rhomboids (C5).

. Nerve to Serratus anterior (Long thoracic N. of Bell) (CS, 6, 7).

. Root to phrenic nerve (C5).

. AII roots ) to scalene muscle & longus coli.

Branches of the Upper Trunk:

. Supra-scapular Nerve. (C5, 6).

Lateral pectoral

nerve(C5,6,7)

Lateral root of

median nerve

(c5,6,7)

Musculocutaneous nerve

(c5,6,7)

Medial pectoral n.

(c8, T1)

Medial root of

median n. (C8, T1)

Med. cutaneous n. of

the forearm (C8, T1)

Ulnar n. (C7,8, Tl)

ffi: Upper sub-scapular n (C5, 6)

$: Lower sub-scapular n (C5,6)

t' N.to latissimus dorsi

(c6,7,8)

f: Axillary (circumflex ) n.

(c5,6)

S: Radial n. (C5,6, 7, 8, T1)

. Nerve to subclavius (C5, 6).

!.E C7 receives a gray ramus from the inferior cervical (or stellate)

sympathetic ganglion

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UPPER LIMB I

SuncrcAL luponrANcE (BnecHtAL Plexus lruuunv):

Gomplete brachial plexus iniuries ) damage of ail roots.

1. Motor changes ) Affecting all muscles of the upper limb.

2. Sensory changes ) Anesthesia of whole upper limb except:

a) Medial side of arm (supplied by intercosto-brachial nerve).

b) Skin over upper part of deltoid muscle (supplied by supraclavicular nerve).

3. Horner's syndrome ) dug to sympathetic paralysis.

Upper trunk iniurv: (C5 - C 6) Erb-Duchenne paralysis

7- Motor changes: ) policeman's tip deformity.

2- Sensory changes ) anesthesia over the deltoid muscle.

Lower trunk iniurv (C8 - T1) Klumpke's paralysis

1. Motor changes: ) complete claw hand.

2. Sensory changes ) anesthesia along the medial aspect of the forearm

& the medial 3Tzfingers.

3. Horner's syndrome ) due to sympathetic paralysis,

Medial cord iniurv leads to

. Paralysis of the long flexors of the fingers

. Paralysis of all the intrinsic muscles of the hand

, Loss of cutaneous sensation over anterior surface of palm & fingers

Thoracic outlet svndrome; involves c8-r1lfrt

I UPPER LIMB

It is a mixed nerve.

Counse & RemnoNS:

o Arises from the posterior cord of

brachial plexus (C5, 6) behind the

3'd part of the axillary artery.

. Passes backwards through the

quadrangular space then around

the surgical neck of the humerus.

SuncrcAL IMpoRTANcE: (AxrLLARv Nenve lnlunv):

. Ugtgl: paralysis of deltoid & teres minor.

. SgMgIt: loss of skin sensations over lateralT"of deltoid.

. Deformitv: flat shoulder.

It is a mixed nerve from the lateral cord

COURSE & RemTIONS:

o Lateral to the 3'd part of Axillary artery.

o Leaves the axilla by piercing the coracobrachialis m.ilr

o Then descends downwards between biceps & brachialis. LEtcrd.o,o

BneNcHrr'{*

o lt supplies all muscles of the anterior

compartment of the arm (coracobrachialis,

biceps & brachialis).

o Lateral cutaneous nerve of the forearm (the

continuation the musculo-cutaneous nerve) ) sensory to the lateral Tz of forearm.

]llad$Irlla

;-- lJltilfEtra

-Medial

inlEflnus

RadqlnsvB,

UPPER LIMB I

*.

Counse & ReunoNS:

ln the Axilla :

o Arises as the terminal branch of posterior cord (C5, 6, 7, 8 & T1).

. Behind the 3'd part of the axillary artery.

ln the Arm:

. Lies behind upper part of brachial artery, between it & the long head of triceps.

Passes between medial & lateral heads of triceps.

lnside the spiral qroove: is accompanied by

profunda brachii artery.

After leaving the spiral groove: it pierces the

lateral inter-muscular septum to enter the

anterior compartment on the lateral side of the

arm.

Here, the nerve lies deeply in the groove

between the brachialis & brachioradialis.

ln the Forearm & Hand:

ln front of the lateral epicondyle it gives the

posterior interosseous & continues downwards as

the superficial radial nerve.

It passes deep to brachioradialis.