Anatomy, School of Biomedical Sciences and Pharmacy

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NERVES & BLOOD VESSELS OF THE UPPER LIMB AND SURFACE ANATOMY
NERVES OF UPPER LIMB
BRACHIAL PLEXUS (L. brachial, arm; L. plexus, braid)
Supplies motor & sensory supply to upper limb structures (except tip of shoulder)
Formed from C5, C6, C7, C8, T1 spinal N. roots
Terminal branches off which arise the peripheral nerves. Aim to know what muscle compartments these nerves supply
and where they lie superficially as nerve damage may occur.

TERMINAL BRANCHES:
Axillary Nerve (C5, 6)
Supplies deltoid & teres minor, sensory to skin over upper triceps & lower deltoid.
Radial Nerve (C5, 6,7,8, T1)
Largest, supplies all mm. of posterior compartments of arm & forearm (are these flexors or extensors?)
Supplies skin to posterior arm, forearm, lateral part of dorsum of hand
Musculocutaneous (C5, 6,7)
Supplies muscles in flexor compartment of arm (which 3 muscles?)
Cutaneous to skin of anterior aspect of forearm
Median Nerve (C6, 7,8,T1)
Supplies anterior skin & mm. of forearm
Pronators, flexors (except on the medial side of the wrist and hand), thenar mm., lateral 2 lumbricals
Skin of palm of lateral 3 1/2 digits (over thenar eminence)
What structure does it travel under? What is the name of the syndrome that can occur in this area?
Ulnar Nerve (C7, 8,T1)
Supplies muscles on the medial side of the wrist and hand and deep hand muscles (the interossei).
Sensory to skin of palm & dorsum of medial 1 1/2 digits
Myotomes - A myotome consists of muscle.
A group of mm. supplied by a single spinal cord segment
Named from spinal segment that gives origin to motor neurones supplying its mm.
Dermatomes - consists of skin.
A region of skin which receives sensory innervation from a single spinal cord segment

NERVE LESIONS
Afferent Lesions
1. When sensory impulses cant reach spinal cord ! sensory defects, loss of some spinal reflexes
2. Damage/pressure ! impulses from site; tingling, itching, pain from area of distribution
e.g. ulnar N. behind funny bone
Efferent Lesions
1. If impulses cant reach mm. ! paralysis
2. Loss of spinal reflexes as well
e.g. disc lesions in neck or carpal tunnel syndrome

ARTERIES OF THE UPPER LIMB
1. Start at Arch of Aorta - Eventually becomes:
2. Subclavian: Under clavicle, across rib 1; becomes axillary A.
3. Axillary: Travels through axilla surrounded by nn. of brachial plexus & veins. Becomes:
4. Brachial: From medial part of humerus, through cubital fossa. Below elbow joint divides:
! 2 terminal branches: radial & ulnar arteries
5. Radial: Down lateral side of forearm. Enters palm deeply, forms deep palmar arch

Anatomy, School of Biomedical Sciences and Pharmacy
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6. Ulnar: Large terminal branch, down medial side of forearm. Enters palm as superficial palmar arch
Main pulse sites: axilla, along medial humerus, radial at wrist (and in snuff box), and ulna at wrist.

VEINS OF THE UPPER LIMB
Blood from each upper limb is returned to the heart by deep & superficial vv.
Veins described according to direction of blood flow: origin = distally & terminate proximally
Valves
Permit flow only towards the heart, prevent reverse flow of blood
Superficial veins. - Just below skin, connect extensively with each other & deep vv.
Deep veins. - Usually accompany aa. & usually have same names
e.g. Radial vv., ulnar vv., brachial vv., axillary vv.,
Superficial Veins - Large & variable
Begin as Dorsal Venous Arch at the back of hand
Cephalic Vein - lateral, up anterolateral forearm, arm often noticeable on anterior aspect of the deltoid muscle.
Empties into Axillary Vein.
Median cubital vein - runs upwards & medially across cubital fossa. Important to view where this lies relative to other
important structures.
Basilic Vein - from medial side of dorsal venous arch, up medial forearm. At elbow joins with median cubital V. and
joins with brachial vv in arm.
Axillary Vein - becomes Subclavian Vein continuing venous return back to heart.
Cubital fossa triangle at elbow that contains the brachial artery and vein, median nerve

III. SURFACE ANATOMY OF THE WRIST AND HAND REGIONS
Carpal bones pisiform, scaphoid
Joints position of radiocarpal midcarpal, metacarpophalangeal, interphalangeal
Other features palmar aponeurosis, extensor tendons, anatomical snuffbox, carpal tunnel region
Muscles identify position of thenar and hypothenar compartments
Movements define and demonstrate movements of wrist, digits and pollex

Learning Tasks:



On the images on the left:
Label the cephalic, basilica and median cubital veins.

Label the subclavian, axillary, brachial, radial and ulnar arteries and the
palmar arches deep and superficial.




















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On the image below consider matching a nerve with a number:
9 =
10 =
11 =
12 =
13 =






















What muscle groups will be affected if
the median nerve is damaged at the
wrist?



What muscle groups will be affected if
the ulna nerve is damaged at the
elbow?



What muscle groups will be affected if
the radial nerve is damaged as it
passes around the humerus?







References: Moore and Dalley (2014). Clinically Orientated Anatomy Chapter 6. Lippincott Williams Wilkins
Tweitmeyer A and McCracken T. (1988). Regional Guide to Human Anatomy. Lea and Febiger, Philadelphia.