Nerve And Blood Supply Of The Upper Limb

Nerve and Blood Supply of the Upper Extremities Enrico C. Aguila, OTRP August 7, 2009 OTPT 102: Applied Anatomy and Kinesiology College of Allied Medical Professions University of the Philippines Manila Page This material was developed

This material was developed for use by students

Learning Objectives: § At the end of the SGD and didactics, the student should be able to: § Describe brachial plexus in terms of: – Roots, trunks, divisions, cords and branches – Pathway – Motor distribution – Sensory distribution § Describe the arterial and venous circulation of the upper extremity in terms of: – Vessels – Pathway – Distribution – Function § Describe the lymphatic circulation of the upper extremity. Page This material was developed

This material was developed for use by students

Brachial Plexus - Collection of nerves that enter the upper extremities

Page This material was developed

This material was developed for use by students

Lies partly in the neck and partly in the axilla

Page This material was developed

This material was developed for use by students

Gives rise to the nerves that innervate the UE

Page This material was developed

This material was developed for use by students

Functions §Sensory innervation of skin and deep structures such as joints §Motor innervation of the muscles of the UE §Influence over the diameters of the blood vessels by the sympathetic vasomotor nerves §Sympathetic secretomotor supply to the Page This material was developed

This material was developed for use by students

Parts

§Really Tired? Drink Coffee Buddy! §R = ROOTS (ventral rami) (5) §T = TRUNKS (3) §D = DIVISIONS (2) §C = CORDS (3) §B = BRANCHES (Many!!) Page This material was developed

This material was developed for use by students

Nerve roots C5 C6 C7 C8 T1

Page This material was developed

This material was developed for use by students

Trunks (formed by the roots in the neck) C5 C6 C7 Upper

Middle

C8 T1

Lower

Page This material was developed

This material was developed for use by students

Divisions (neck)

TRUNKS

Page

U ppe Midd le L owe

This material was developed

DIVISIONS Anteri

or Posteri Anteri or or Posteri Anteri or or Posteri or

This material was developed for use by students

Cords – formed by the joining of the divisions in the axilla

T U M L

D A P A

CORDS Lateral Medial

P A P

Page This material was developed

Posterior This material was developed for use by students

Cords – give off branches (axilla) Lateral

Musculocutaneous Median

Medial

Ulnar Thoracodorsal

Axillary

Posterior Radial Upper and lower Subscapular Page This material was developed

This material was developed for use by students

Page This material was developed

This material was developed for use by students

SupS N

C7

A nt rio e r

C6

P e t os r rio

Up pe

A nte

M iddl

C8

T1

Lo we LT N

P oste

P os rio te r

C5

DS N

Brachial Plexus LPN L ate

MC

R

P oste U S S N

A nte

M

L S S N

T D N

Ax

Me dia M P

M B C

M A B C

U

Nerves of the Brachial Plexus

Page This material was developed

This material was developed for use by students

Dorsal scapular (C5) §Rhomboids minor §Rhomboids major

Page This material was developed

This material was developed for use by students

Long thoracic C5, C6, C7 §Serratus anterior

Page This material was developed

This material was developed for use by students

Nerve to subclavius C5, C6 §Subclavius §May give branch to the phrenic nerve (accessory phrenic nerve)

Page This material was developed

This material was developed for use by students

Suprascapular C5, C6 §Supraspinatus §infraspinatus

Page This material was developed

This material was developed for use by students

Lateral pectoral C5, C6, C7 §Pectoralis major

Page This material was developed

This material was developed for use by students

Medial pectoral §Pectoralis major §Pectoralis minor

Page This material was developed

This material was developed for use by students

Musculocutaneous C5, C6, C7 §Coracobrachialis §Brachialis §Biceps

Page This material was developed

This material was developed for use by students

Upper subscapular C5, C6 §Subscapularis

Page This material was developed

This material was developed for use by students

Lower subscapular C5, C6 §Subscapularis §Teres major

Page This material was developed

This material was developed for use by students

Thoracodorsal C6, C7, C8 §Latissimus dorsi

Page This material was developed

This material was developed for use by students

Medial cutaneous nerve of arm §Skin on medial side of distal one third of arm

Page This material was developed

This material was developed for use by students

Medial cutaneous nerve of forearm §Skin on medial side of forearm

Page This material was developed

This material was developed for use by students

Axillary C5, C6 §Motor – Teres minor – Deltoid §Sensory – Skin over lateral part of upper arm

Page This material was developed

This material was developed for use by students

Radial C5, C6, C7, C8, T1

Page This material was developed

This material was developed for use by students

Page This material was developed

This material was developed for use by students

Median nerve C5, C6, C7, C8, T1

Page This material was developed

This material was developed for use by students

Page This material was developed

This material was developed for use by students

Ulnar C8, T1

Page This material was developed

This material was developed for use by students

Page This material was developed

This material was developed for use by students

Innervation of Joints

Page This material was developed

This material was developed for use by students

Sensorty innervation of the UE

Page This material was developed

This material was developed for use by students

Sensory innervation of the hand

Page This material was developed

This material was developed for use by students

Arterial supply of the UE

Page This material was developed

This material was developed for use by students

Page This material was developed

This material was developed for use by students

Page This material was developed

This material was developed for use by students

Subclavian artery

§ Passes laterally deep to the clavicle. § Becomes the axillary artery as it passes into the axillary region.

Page This material was developed

This material was developed for use by students

Axillary artery

§ Starts at the lateral border of the first rib, as a continuation of the subclavian, and ends at the lower border of the axilla (i.e. the lower border of teres major) to become the brachial artery Page This material was developed

This material was developed for use by students

Branches of the axillary

Page This material was developed

This material was developed for use by students

First Part of the Axillary Artery § between the lateral border of the first rib and the superior border of the pectoralis minor muscle § enclosed in the axillary sheath along with the axillary vein. § has only one branch, the supreme thoracic artery. § This artery helps to supply the first two intercostal spaces and the superior part of the serratus anterior muscle.

Page This material was developed

This material was developed for use by students

Second Part of the Axillary Artery § This part of the artery lies deep to the pectoralis minor muscle. § The lateral, medial and posterior cords of the brachial plexus are so named respective to this part of the axillary artery. § This part of the axillary artery has two branches, the thoracoacromial and lateral thoracic arteries.

Page This material was developed

This material was developed for use by students

The Thoracoacromial Artery § This is a short, wide trunk that arises from the axillary artery deep to the pectoralis minor muscle. § It pierces the costocoracoid membrane, which is part of the clavipectoral fascia. § It then divides into 4 branches (acromial, deltoid, pectoral, and clavicular) deep to the clavicular head of the pectoralis major muscle.

Page This material was developed

This material was developed for use by students

The Lateral Thoracic Artery § This nerve descends along the axillary border of the pectoralis minor muscle. § It supplies the pectoral muscles and the axillary lymph nodes. § The lateral thoracic artery is large in women, and is an important source of blood to the lower part of the mammary glands.

Page This material was developed

This material was developed for use by students

Third Part of the Axillary Artery § This part extends from the inferior border of the pectoralis minor muscle to the inferior border of the teres major muscle. § It has three branches, the anterior and posterior circumflex humeral arteries and the subscapular artery.

Page This material was developed

This material was developed for use by students

Circumflex Humeral Arteries § These arteries pass around the surgical neck of the humerus and anastomose with each other. § The anterior circumflex humeral artery passes laterally, deep to the coracobrachialis and the biceps brachii muscles. § It gives off an ascending branch that supplies the shoulder, but the main artery winds around the surgical neck of the humerus. § The larger posterior circumflex humeral artery passes through the posterior wall of the axilla through the quadrangular space. § It is accompanied by the axillary nerve to supply the surrounding muscles.

Page This material was developed

This material was developed for use by students

The Subscapular Artery § This is the largest branch of the axillary artery. § It descends along the lateral border of the subscapularis muscle and divides into the circumflex scapular artery and the thoracodorsal artery. § The circumflex scapular artery passes around the lateral border of the scapula to supply muscles on the dorsum of the scapula. § The thoracodorsal artery continues the general course of the subscapular artery to supply adjacent muscles, principally, the latissimus dorsi muscle.

Page This material was developed

This material was developed for use by students

Axillary Artery Subclavian A.

Superior thoracic A. 1st Axillary A.

2nd Axillary A. Axillary A.

Thoracoacromial A. lateral thoracic A. Subscapular A.

anterior circumflex humeral A 3rd Axillary A.

posterior circumflex humeral A Page This material was developed

This material was developed for use by students

Brachial artery § This artery begins at the inferior border of the teres major muscle as the continuation of the axillary artery. § It runs inferiorly and slightly laterally on the medial side of the biceps brachii muscle to the cubital fossa, where it ends opposite the neck of the radius. § It is superficial and palpable throughout its whole length.

Page This material was developed

This material was developed for use by students

§ At first it lies medial to the humerus and then anterior to it. § It lies anterior to the triceps brachii and brachialis muscles, and is overlapped by the biceps brachii and coracobrachialis muscles. § It accompanies the median nerve, which crosses it anteriorly at the middle of the arm. § Under the cover of the bicipital aponeurosis, the brachial artery divides into the radial and ulnar arteries.

Page This material was developed

This material was developed for use by students

Branches of the brachial artery § The brachial artery gives rise to many unnamed muscular branches, mainly from its lateral side. § The named branches of the brachial artery are the profunda brachii artery, the nutrient humeral artery, and the ulnar collateral arteries (superior and inferior).

Page This material was developed

This material was developed for use by students

Profunda Brachii Artery § This is the largest branch of the brachial artery, and has the most superior origin. § It accompanies the radial nerve in its posterior course in the radial groove. § Posterior to the humerus, the profunda brachii artery (or deep brachial artery) divides into anterior and posterior ascending branches. § These help form the arterial anastomoses of the elbow region.

Page This material was developed

This material was developed for use by students

Ulnar collateraal arteries Inferior Ulnar Collateral Artery

Superior Ulnar Collateral Artery § This arises from the §  This arises from the brachial artery near the brachial artery about 5 middle of the arm. cm proximal to the § It accompanies the ulnar elbow crease. § It then passes nerve posterior to the medial epicondyle of the inferomedially, anterior humerus. to the medial epicondyle § Here, it anastomoses of the humerus. with the posterior ulnar § Here, it joins the recurrent branch of the anastomoses of the ulnar artery and the elbow region. inferior ulnar collateral

Page

This material was developed

This material was developed for use by students

Page This material was developed

This material was developed for use by students

Branches of the brachial artery § profunda (accompanying the radial nerve); § superior ulnar collateral (accompanying the ulnar nerve); § nutrient (to the humerus); § inferior ulnar collateral.

Page This material was developed

This material was developed for use by students

Radial and ulnar arteries § brachial artery bifurcates proximal to the cubital fossa into the radial and ulnar arteries. § supply the blood to the forearm and a portion of the hand and digits.

Page This material was developed

This material was developed for use by students

Radial artery § The radial artery courses down the lateral side of the arm where it sends many small branches to the forearm. § The radial recurrent artery is the first and largest major branch of the radial artery which serves the region of the elbow.

Page This material was developed

This material was developed for use by students

Ulnar artery § The ulnar artery extends down the ulnar side of the forearm and serves the medial side of the forearm through many small branches. § The first large branch of the ulnar nerve is the ulnar recurrent artery which arises from the proximal portion near the elbow.

Page This material was developed

This material was developed for use by students

§ Veins of the Upper extremity § Note: The veins of the upper extremity are classified as either deep or superficial veins. The superficial veins are highly variable and form an extensive network just below the skin. The deep veins accompany the arteries of the same region and bear similar names. A brief summary of the two types of veins follows. § Deep Veins of the Upper Extremity § The radial vein on the lateral side of the forearm and the ulnar vein on the medial side drain blood form the deep and superficial palmar arches of the hand. The radial and ulnar veins join in the cubital fossa to form the brachial vein which continues up the medial side Page This material was developed

This material was developed for use by students

§ Superficial Veins of the Upper Extremity § The main superficial vessels of the upper extremity are the basilic and cephalic veins. The basilic vein passes on the ulnar side of the forearm and the medial side of the arm. Near the head of the humerus, the basilic vein merges with the brachial vein and forms the axillary vein. The cephalic vein drains the superficial portion of the hand and forearm on the radial side and continues p the lateral side of the arm. In the shoulder region the cephalic vein pierces the fascia and joins the axillary vein. Another portion of the superficial vein is the median vein. It ascends from the cephalic vein on the lateral side to connect with the basilic vein on the medial side. Page This material was developed

This material was developed for use by students

Page This material was developed

This material was developed for use by students