Gross Anatomy: Nerve, Blood Vessels and Lymphatic Sys.

1. Axillary A

2. Anterior and Posteroir Circumflex humeral artery

3. Brachial artery

4. Profunda artery

5. Radial artery

6. ulnar artery

7. Common Interosseus artery

8. Deep palmar Arch

9. superficial palmar arch

10. Digital arteries

Arteries of the Upper Limb

Brachiocephalic trunk, L. Common carotid artery, L. subclavian artery

3 Branches emerging from the aortic arch

Brachiocephalic trunk

Artery which divides into the right subclavian artery and right common artery

Left common carotid

It is main blood supply of the head and neck, including the brain
It also reflects the pressure of the heart—has direct contact with the aorta

Left Subclavian artery

• Main blood vessels that supply the upper limb, and parts of the chest/thorax and neck

• Reflects aortic pressure—has more direct branching from aorta

• Exits the thoracic cage by hooking/ passing through the 1st rib

• ANATOMICAL LANDMARK

  • The 2st rib is the 1st anatomical landmark

  • Marks end of the _____ artery

Axillary Artery

Continuation of the subclavian artery after it cross the lateral border of the first rib

Passes posteriorly to the pectoralis Minor

Split into 3 parts

ANATOMICAL LANDMARK

• 1st Part = Proximal to Pectoralis Minor

  • From 1st rib to medial border of hte pectoralis minor

• 2nd Part = Posterior to Pectoralis Minor

  • Lies directly behind the pectoralis minor muscle

• 3rd part = Distal to Pectoralis minor

  • From the lateral border of the pectoralis minor to the inferior border of the teres major

• End of Axillary Artery is @ inferior border of teres major which transitions into brachial artery

Superior/Supreme Thoracic Artery

Refers to the 1st part of the axillary artery and Supplies blood to the upper pole of the chest wall

Thoracoacromial artery

first branch of the 2nd part of the axillary artery

• It supplies the deltoid, clavicular, acromial and pectoral

Lateral Thoracic artery

Second branch of the 2nd part of the axillary artery

Descends on the lateral side of the chest wall together with the long thoracic nerve

• Supplies blood to the lateral chest wall

Thoracic artery and subclavian artery

The breast is supplied by 2 arteries

the first artery mentioned supplies the lateral side

the second one supplies the media area

subscapular artery

first branch of the axillary artery which goes posteriorly to supply blood to the subscapular area

Circumflex arteries

Has both anterior and posterior arteries

It is located on the second and third branch of the 3rd part of the axillary artery
It anastomoses with one another, forming a loop around the surgical neck of the humerus

Brachial artery

The main artery of the arm(brachium) and the continuation of the axillary artery

It begins after the inferior border of the teres major and ends at the cubital fossa

LOCATION:

It runs along the medial side of the brachium
It lies deep to the biceps brachii and along the brachialis muscle

Supplies the anterior fascial compartment of the arm

Profunda Brachii or Deep Humeral Artery

• The posterior branch which passes along the shaft of the humerus and supplies the posterior fascial compartment

  • Course:

    • Passess posterirly behind the shaft of the humerus, within the spiral groove

    • Curves around the posterior surface of the humerus together with the radial nerve

Supplies blood to the triceps brachii muscle

Brachial artery

A superficial artery which makes it palpable and commonly used for measuring blood pressure with a sphygmomanometer

antecubital fossa

Location where the brachial artery will split into 2

Radial Artery

Located on the lateral side of the forearm and is more superficial than the ulnar artery
It supplies the lateral aspect of the forearm and hand

Palpable near the wrist

Radial artery

It curves posteriorly at the wrist and passes through the anatomical snuffbox, then continues to form the deep palmar arch

• Anatomical Snuffbox

  • A triangular depression on the lateral wrist

  • The radial artery passes here, where its pulse can be palpated

Ulnar Artery

• Best seen near the wrist but mostly deep beneath the forearm muscles

  • Passes under the flexor digitorum superfacialis(FDS) and between FDS and flexor digitorum profundus(FDP)

  • Supplies the 2nd and 3rd muscle layers of the anterior forearm

  • Can be palpated near the wrist/hand

Common Interosseus artery

Branch of the ulnar artery in the proximal anterior forearm
Divides into two branches

• Anterior ____ Artery

• Posterior ______ Artery

Anterior Interosseus artery

Lies on the interosseous membrane

Supplies the deep(4th) layer of the anterior forearm

Passes under the pronator quadratus
Ends on the anterior surface of the carpals

Deepest artery of the anterior fascial compartment

Posterior Interosseus Artery

Pierces the interosseus membrane

Runs under the supinator muscle

Supplies the posterior fascial compartment of the forearm

Superficial palmar arch

Formed mainly by the ulnar artery after entering the palmar region

Anastomoses with the radial artery to form a complete arch

Ensures collateral blood supply to the hand

• If one artery is blocked, the other can still supply the palm

Superficial Palmar Arch

Its branches give rise to the digital arteries of the fingers

It lies deep to the palmar aponeurosis but superficial to the long flexor tendons

Anatomical Snuffbox

A triangular depression located on the lateral aspect of the wrist

Veins

Vessels that transport the deoxygenated blood from the peripheral regions back to the heart

Dorsal Venous Network

Located beneath the skin(superficial)
This is the most accessed vein for blood extraction

Prominent veins of the dorsum of the hand

Cephalic vein

The dorsal venous network drains blood toward the lateral side which enters the___ vein

Basilic vein

The dorsal venous network drains blood toward the medial side which enters the___ vein

median antecubital vein

In the antecubital region, the ___ connects the cephalic and basilic vein

Cephalic Vein Pathway

Where blood may flow from the lateral side of the dorsal venous netwrok into the cephalic vein

Ascends along the lateral arm

Occupies the deltopectoral groove, which separates the deltoid and pectoral muscle

Passes under the clavicle, where it will disappear

Empties into axillary vein which then becomes the subclavian vein

Basilic vein pathway

Blood flows from the medial side of the dorsal venous network into the basilic vein
Ascends along the medial forearm and arm, eventually joining the deep veins

Becomes continuous with or drains into the axillary vein

May disappear mid-forearm before joining the deeper veins

Median cubital vein

Located medially in the cubital fossa
Most accessed blood vessel/ vein for venipuncture

Acts as bridge connecting the cephalic and basilic veins

Superficial and Deep Palmar arch

Collects blood from the hand and eventually drains into larger veins of the forearm, radial and ulnar vein

Veins in this region usually come in pairs

Radial Vein

Drains the lateral forearm and some deep structure of the thumb side

Ulnar vein

Drains the medial forearm and the pinky finger

Radial ulnar veins

Both unite to form the brachial veins

Brachial Vein

Near the cubital fossa but as it ascends, it drains the deep structures of the arm

Axillary vein

Runs through the axilla and is formed by the union of the brahcial vein and the basilic vein

Subclavian vein

Continuation of the axillary vein beyond the lateral border of the first rib

Passes beneath the clavicle
Joins with their respective internal jugular veins—> for the brachiocephalic vein—>drains into the superior vena cava, returning blood to the heart

Musculocutaneous Nerve

Originates from the lateral cord

It supplies muscles of the anterior arm compartment

Runs beneath the biceps brachii

• Biceps brachii

• Brachialis

• Coracobrachialis

May be injured if the biceps brachii is cut

A. It is not a musculocutaneous nerve injury
Rationale: The nerve is located deep under the biceps brachii

A patient with a superficial lacerated wound on the anterior arm. What are your findings?

B. It is a deep hacking would that you can view the humerus and can affect the elbow & shoulder flexion, weak forearm suppination and loss of sensation on the lateral side of the forearm

Gunshot wound that transversed the arm and went through the posterior compartment. What are your findings?

Axillary nerve

Originates from the posterior cord

It passes posterior to the surgical neck of the humerus, under the axilla

Median Nerve

Origin: Half of the lateral + Half of the medial cord
Travels with the brachial artery along the medial arm but gives no branches there

Innervates: Thenar Muscles, Anterior Forearm Muscles, Lumbricals & Palmar surface of thumb, index middle and half of ring finger

Radial Nerve

Origin: Posterior cord(Largest branch)

Innervates: All the skin of the posterior arm, forearm and the lateral half ot the dorsum of the hand

All muscles of posterior fascial compartment of the arm and forearm

Deep branch of Radial Nerve

Supplies the muscles of the posterior fascial compartment—specifically the posterior interosseous nerve

Passes thorough the arcade of Frohse and exits at the supinator, where it continues as the posterior interosseous nerve

Superficial branch of the Radial Nerve

It is the sensory nerve that supplies the posterior forearm and hand and accompanies the radial artery

Ulnar Nerve

Innervates: Flexor Carpi Ulnaris, Medial half of Flexor digitorum profundus and most intrinsic muscles of the hand and wrist

• Except: Thenar eminence and Lumbrical 1 and 2

Lateral Pectoral Nerve

From the lateral cord of the brachial plexus

Provides innervation to the pectoralis minor only

Medial Pectoral Nerve

From the medial cord of the brachial plexus

Provides innervation to the pectoralis minor and pectoralis major

Long Thoracic Nerve

Innervates the serratus anterior

Arises from C5,C6,C7 roots of the cervical section of the spinal cord

Cranial Nerve

Innervates the Trapezius

Also known as the spinal accessory nerve which comes directly form the brainstem

Suprascapular Nerve

Innervates the supraspinatus and infraspinatus

Forms the upper trunk(C5-C6)

Passes through the suprascapular notch

Upper subscapular nerve

Supplies subscapularis

Lower subscapular nerve

Supplies subscapularis and teres major