Blood supply (Upper Limb) / Transitions and sections (Upper Limb) (page 40-48)

Where does the lymphatic drainage of the upper limb pass? (usikker, lag flere spørsmål)

- fingers: Lymph vessels of the fingers pass into the dorsum of the hand and are joined by the lymph vessels on the palm (may ascend along the anterior forearm). - lymph medial side of hand/forearm/arm: Lymph from the medial side of the hand, forearm & arm ascends in vessels accompanying the basilic vein & drains into the supratrochlear nodes (drains into the lateral axillary nodes) in the superficial fascia of the cubital fossa or passes directly to the lateral axillary nodes. - lymph lateral side of the hand, forearm,arm: Lymph from lateral side of the hand, forearm & arm ascends in vessels accompanying the cephalic vein and drains into the infraclavicular & lateral axillary nodes

What are the base of the axilla formed by?

. It's base is formed by the deep fascia of serratus anterior and the arm that attach to the axillary folds formed by the pectoralis major muscle (anteriorly) and latissimus dorsi and teres major muscles (posteriorly).

Where can the peripheral artery pulses be felt in the upper limb?

1. Axillary pulse 2. Brachial pulse in mid-arm 3. Brachial pulse in the cubital fossa 4. Radial pulse in distal forearm 5. Ulnar pulse in distal forearm 6. Radial pulse in the anatomical snuffbox

What does superficial & deep palmar arterial arches receive?

Accompany superficial & deep palmar arterial arches. Receive corresponding tributaries.

What passes through the neurovascular bundle?

All the nerves (brachial plexus), artery and vein are going through the neurovascular bundle.

From what does radial and ulnar veins arise from and where does it emerge?

Arise from the venous arches of the hand and ascend through the forearm with the radial and ulnar arteries. Merge into the brachial veins at the elbow.

Where does the axillary artery arises from? where does axilla artery extends from and to?

Arises as the continuation of the subclavian artery. Extends from the first rib to the inferior border of the teres major muscle. (Lies within the axilla with the brachial plexus and axillary vein, surrounded by the axillary sheath.)

At which level does the brachial artery splits into radial artery and ulnar artery?

At the level of neck/head of radius brachial artery splits into radial artery and ulnar artery.

What do you know about the radial artery?

Direct continuation of the brachial artery at its bifurcation at the neck of the radius. - Crosses the pronator teres muscle and descends in the forearm adjacent (vedsidenav) to the superficial branch of the radial nerve. - Ends by completing the deep palmar arch in the hand.

Where does the basillic vein passes?

Drains the dorsal venous network of the hand and ascends in the medial aspect of the forearm. Joined by the median cubital vein in the cubital fossa. Ascends superficially along the medial aspect of the arm to join the axillary vein

How does the ulnar artery enters the hand?

Enters the hand with the ulnar nerve through the canal of Guyon. Terminates by forming the superficial palmar arch.

Where does brachial artery extend from and too?

Extends from the inferior border of the teres major muscle to its bifurcation at the neck of the radius. (elbow joint)

What is superficial palmar arterial arch mainly formed by? Where is it located? what does it give rise to?

Formed mainly by the ulnar artery with a contribution from the radial artery (superficial palmar branch). Located deep to the palmar aponeurosis. Gives rise to the palmar digital arteries.

Where does the cephalic vein passes?

Formed over the anatomical snuff-box and drains superficial veins of the hand. Passes along the anterolateral aspect of the forearm. Communicates with the basilic vein and the deep veins at the cubital fossa via the median cubital vein. Ascends in the lateral aspect of the arm and joins the axillary vein.

What is deep palmar arterial arch mainly formed by? Where is it located? what does it give rise to?

Formed predominantly by the radial artery with a contribution from the ulnar artery (deep branch). Located deep to the long flexor tendons on the bases of the metacarpals. Gives rise to the palmar metacarpal arteries.

Where does the ulnar artery extend from?

From its origin at the neck of the radius it passes deep to pronator teres and is crossed by the median nerve. It then lies deep to the flexor carpi ulnaris muscle and at the wrist passes over the flexor retinaculum and enters the hand with the ulnar nerve through the canal of Guyon. Terminates by forming the superficial palmar arch.

Where do you find the axilla? What does this space enables?

Inferomedial to the shoulder joint lies the pyramidal axilla located between the arm and thorax. This space enables vessels and nerves to pass between the neck and the upper limb.

In which muscle does the ulnar artery lies deep to and which muscle does it crosses?

It then lies deep to the flexor carpi ulnaris muscle It then lies deep to the flexor carpi ulnaris muscle and at the wrist passes over the flexor retinaculum.

does the ulnar nerve pass through the cubital fossa?

NO, The ulnar nerve does not pass through the cubital fossa. It lies behind the medial epicondyle of the humerus, posteromedial to the elbow joint.

What is interosseous veins?

One of two deep veins (anterior or posterior) that run parallel to their corresponding artery in the forearm to drain the wrist and hand.

Name the venous drainage from the upper limb on this picture.

Page 17 in the notes. · Pink line and the blue inside on the picture is the palmar side - they are deep.

How does brachial artery travels in the arm and what structures (vein,nerve) lies close to it?

Passes through the arm with the brachial veins on either side and the median nerve lying lateral to it through the superior half of the arm and then crossing to the medial side of the brachial artery to the cubital fossa.

What structures are passing superficial to the flexor retinaculum?

Passing superficial to the flexor retinaculum is the tendon of palmaris longus (blends with the flexor retinaculum), ulnar nerve, ulnar artery, palmar cutaneous branches of the median and ulnar nerves, superficial palmar branch of the radial artery.

Does cephalic vein pass over the anatomical snuffbox?

Radial artery and cephalic vein passes over the tendon of extensor pollicis longus tendon. over the snuffbox

What does the axillary vein receives venous blood from? what are the surroundings? When does the axillary artery become subclavian artery?

Receives the brachial veins and the superficial veins (cephalic and basilic veins). basilic veins empty into axillary. Lies medial to the axillary artery in the axilla, surrounded by the axillary sheath. At the border of the 1st rib it becomes the subclavian vein

Where are the superficial veins of the upper limb located?

Subcutaneous and located in the superficial fascia.

What are the anterior wall of the axilla formed by?

The anterior wall of the axilla is formed by the clavicle, subclavius muscle and pectoralis major and minor muscles.

What are the apex of axilla formed by?

The apex of the axilla is formed by the clavicle anteriorly, scapula posteriorly and the first rib medially.

What does the axillary sheath encloses?

The axillary sheath (derived from the prevertebral layer of deep cervical fascia) encloses the axillary artery, axillary vein and cords of the brachial plexus.

Where does the biceps branchii tendon passes through the cubital fossa?

The biceps brachii tendon passes lateral to the brachial artery and median nerve and twists as is passes to attach to the radial tuberosity.

Where does the brachial artery passes through the cubital fossa?

The brachial artery passes laterally to the median nerve and bifurcates at the neck of the radius into the ulnar and radial arteries. The brachial artery is used here for measuring blood pressure. The ulnar artery passes inferomedially, deep to pronator teres and the radial artery passes inferolaterally on the biceps brachii tendon deep to brachioradialis.

What does the deep vein communicate with?

The deep veins communicate with the superficial veins of the upper limb.

How are the deep veins of the upper limb usual lined?

The deep veins of the upper limb are usual double and lie on either side of their accompanying artery thus they can be named "venae comitantes" of the artery or by the name of the artery.

Where does the extensor tendons pass into the hand?

The extensor tendons pass into the hand underneath the extensor retinaculum on the posterior aspect of the wrist and are separated into 6 longitudinal compartments. From lateral to medial these structures include the: · Abductor pollicis longus and extensor pollicis brevis tendons · Tendons of extensor carpi radialis longus and brevis (common synovial sheath) · Tendon of extensor pollicis longus · Extensor digitorum and extensor indicis tendons (common synovial sheath) · Tendon of extensor digiti minimi · Tendon of extensor carpi ulnaris Superficially crossing the extensor retinaculum to enter the hand is the dorsal branch of the ulnar nerve, superficial branch of the radial nerve and the radial artery

What are the floor/roof of cubital fossa?

The floor is predominantly formed by the brachialis muscle with supinator inferolaterally. The roof is composed of the deep fascia of the forearm reinforced by the bicipital aponeurosis.

What are the medial/lateral wall of axilla formed by?

The medial wall is formed by the upper 5 ribs and intercostal muscles covered by the serratus anterior muscle. lateral wall by the bicipital groove containing the long head of biceps tendon.

Where does the median nerve passes through the cubital fossa?

The median nerve passes medially through the cubital fossa and enters the forearm through the 2 heads of pronator teres, giving off the anterior interossesous nerve.

What are the posterior wall of axilla formed by?

The posterior wall of axilla: by the scapula and subscapularis and teres major muscles with the tendon of latissimus dorsi.

Where does the radial nerve passes thourgh the cubital fossa?

The radial nerve lies most lateral and passes between brachialis and brachioradialis before dividing into the superficial radial nerve (continues into the forearm deep to brahioradialis) and posterior interosseous (deep radial) nerve (passes posteriorly to enter the forearm between the 2 heads of supinator).

What are the "imaginary line" cubital fossa?

The triangular cubital fossa is bound by an imaginary line between the medial and lateral epicondyles, brachioradialis muscle (laterally) and pronator teres muscle (medially).

what does the brachial vein drain into? and what are the brachial vein formed by?

Two brachial veins associated with the brachial artery ascend in the arm to drain into the axillary vein. Formed from the venae comitantes of the radial and ulnar arteries.

Where does dorsal venous arch and digital vein drain into?

Veins of the hand that drain into the basilic and cephalic veins.

what do you have to do if there is a huge bleeding in the upper limb? is it difficult to control the bleeding when the palmar arches are lacerated?

compress the brachial artery to control haemorrhage. · When there is a huge bleeding in the upper limb, you can control the bleeding by compressing the medial side of the arm - compressing the brachial artery. yes.

if there is a fracture to clavicle, what could happen to subclavian artery? What can happen with subclavian artery with compression between the first rib and clavicle?

it Could damage the subclavian vessels, subclavian artery and vein causing a hematoma and loss of blood supply. · Could also get compression between the first rib and clavicle which also will cause loss of blood supply to the entire upper limb and cause pain.

What are the structures located deep to the deep fascia?

median nerve, brachial artery, biceps branchii tendon, radial nerve and ulnar nerve.

is the right and left blood artery circulation the same?

no, different. Because Left subclavian artery coming out alone but on the right side the right subclavian artery is actually a branch of brachiocephalic trunk.

Where does the flxor retinaculum attaches?

o medially to the pisiform and the hook of the hamate and o laterally to the scaphoid tubercle and trapezium forming the fibro-osseous carpal tunnel with the carpal bones.

name the features of the arteries in hand - posterior view.

page 16 in notes. · You can see radial artery passing over the snuff box. · Radial and ulnar artery is forming anastomosis with anterior- posterior interosseous artery at the back of the hand. Remember that this also are suppling blood to the digital branches of the arteries.

Which veins can you see in this picture?

page 17 in quizlet notes.

Where does the deep palmar arch ends?

· And the deep palmar arch is close to the wrist bones.

Where does brachial artery divides?

· As brachial artery passes through cubital fossa - to the point of where radial head is located - the artery is divided into right radial artery and right ulnar artery.

Which vein do you find in the middle of L. cephalic and L. basillic vein in the cubital fossa? what does this vein take venous drainage from?

· As cephalic vein and basillic vein pass trough the elbow joint, there is a interfering network there. In the middle of those two vein there is a median cubital vein (venipuncture) in the cubital fossa. This vein takes the venous drainage from the interosseous veins.

At which level does ulnar artery gives of the posterior and anterior interosseous artery?

· At the place where the interosseous membrane begins ulnar nerve gives off posterior interosseous- and anterior interosseous artery (deeper artery)

Where is the blood samples often taken in the clinic?

· Blood samples in the clinic: cubital fossa - median cubital vein.

Which muscles are medial to brachial artery? Which muscle does brachial artery lies on?

· Brachial artery is medial to biceps branchii and corocobrachialis. lie on brachialis muscles

Which artery does brachiocephalic trunk gives off? where does right subclavian artery passes?

· Brachiocephalic trunk gives off the right subclavian artery which passes under the clavicle between the first rib and the clavicle.

Where does the superficial palmar arch ends?

· If you completely extend the thumb you can see somewhere at the metacarpophalangeal joint of the thumb you can take an imaginary line right over the metacarpophalangeal joint and there is where the superficial palmar arch ends.

Which nerves are the brachial artery accompanied by?

· Its accompanied by both median and ulnar nerve.

Where does L. cephalic vein drain into?

· L cephalic vein drains into L subclavian vein between the deltoid and pectoralis major muscles it pierces through a small hole and it enters subclavian vein. · L subclavian vein drains into left brachiocephalic vein and superior vena cava and finally it goes to the heart.

Which artery are most superficial of radial artery/ulnar artery and interosseous artery?

· Radial artery and ulnar artery more superficial then interosseous artery.

What does right (left) ulnar artery divide into?

· Right ulnar artery divides again: anterior interosseous artery and posterior interosseous artery. Remember that it is interosseous membrane between radial artery and ulnar artery.

Where does the venous drainage start from in the upper limb?

· Start from the peripheral tissue.

What are the superficial veins and where does they travell?

· Start of back off your hand you will see a large network of veins and they are quite superficial. Referred as dorsal venous arch - network of veins. · Some of the veins are going back of your thumb - L cephalic vein (radial side) and passes OVER the anatomical snuff box. And also towards the ulnar side called - L basillic vein. · L basillic ( L axillary vein) and L. cephalic veins (L subclavian vein) drains into the venous drainage.

Which one of the superficial palmar arch and deep palmar arch is more distal?

· Superficial palmar arch: is more distal (in line with the distal margin of the extended thumb) · Deep palmar arch: is more proximal

What are the structures that are passing through the carpal tunnel and entering and leaving the hand?

· Tendon of flexor carpi radialis (enclosed within its own synovial sheath in a lateral compartment of the tunnel) · Tendon of flexor pollicis longus · Four tendons of flexor digitorum profundus and the four tendons of flexor digitorum superficialis (enclosed within the same synovial sheath) · Median nerve

When does the axillary artery become brachial artery? And where does it travel in the arm?

· The axillary artery becomes brachial artery in the arm. The brachial artery is at the medial side of the arm and passes anterior to medial epicondyle passing in the middle of the cubital fossa.

Where does the basillic vein passes in the arm and emptying?

· The basillic vein passes along the arm and drains into axillary artery.

What are the superficial structures lying superficial to the deep fascia?

· The cephalic vein (lateral) and basilic vein (medial) are most typically united by the median cubital vein, although anatomical variations do exist. These large superficial veins are commonly used for venipuncture. · The lateral cutaneous nerve of the forearm lies lateral to the cephalic vein and the branches of the medial cutaneous nerve of the forearm run with the basilic vein and its tributaries.

Where does the cephalic vein passes in the arm? and emptying?

· The cephalic vein in the arm is passing between the pectoralis major and the deltoid muscle pass under the clavicle and drains into subclavian vein.

Where is the posterior & anterior interosseous veins located and where does they drain into?

· The posterior & anterior interosseous veins is two of them on either side of the interosseous membrane in the forearm. Both of them are draining into ulnar vein. · The posterior & anterior interosseous veins are coming from the deep palmar/superficial palmar venous arches.

Where does radial and ulnar artery continuous too?

· Then it passes to the palm and they are formed together (radial artery and ulnar artery) and forming arches. - superficial & deep palmar arches.

Where does ulnar artery and radial artery passes along?

· Ulnar artery - passes along the ulnar nerve · Radial artery - passes along the radial nerve under brachioradialis.

Which of radial artery and ulnar artery are most superficial?

· Ulnar artery by the ulnar nerve - just under the skin - more superficial

Where does the ulnar artery passes?

· Ulnar artery exits over the "flexor retinaculum" and then passes through canal of guyon between the hookup of hamate and pisiform. · The ulnar artery is passing through the canal of Guyon and becomes a superficial palmar arch and deep palmar arch.

where does the radial artery enters the hand? does radial artery only form superficial palmar arch? true or false?

· radial artery passes on the back off the thumb over the anatomical snuff box. Therefor you can say that radial nerve does not go straight into palm. · The radial artery goes back off the thumb over the anatomical snuff box. The tiny branch of radial artery is forming superficial palmar arch and the main/major part of radial artery is forming deep palmar arch.

What are the contents that axilla include?

• Brachial plexus and it's branches • Axillary artery and it's branches • Axillary vein and it's tributaries • Axillary lymph vessels • Axillary lymph nodes