Escolar Documentos
Profissional Documentos
Cultura Documentos
1.Describetheskin,superficialfascia,anddeepfasciaoftheupperlimb.
SuperficialSensoryNerves
(discussedfurtherlater)
a)Supraclavicularnerves(C3C4)
b)Upperlateralcutaneousnerveofthearm
Branchoftheaxillarynerve(C5C6)
c)Lowerlateralcutaneousnerveofthearm
d)medialcutaneousnerveofthearm(T1)andtheintercostobrachialnerves(T2)
e)posteriorcutaneousnerveofthearm
SuperficialVeins
(discussedfurtherlater)
Theveinsoftheupperlimbcanbedividedintotwogroups:superficialanddeep.
Thedeepveinscomprisethevenaecomitantes,whichaccompanyallthelargearteries,
usuallyinpairs,andtheaxillaryvein.
Ex:Cephalicvein,basilicvein
Halfwayupthearm,itpiercesthedeepfasciaandatthelowerborderoftheteresmajor
joinsthevenaecomitantesofthebrachialarterytoformtheaxillaryvein.
NerveSupplyoftheVeins
Smoothmuscleinthewalloftheveins
Innervation:sympatheticpostganglionicnervefibers(providevasomotortone)
SuperficialLymphNodes
Drain:superficialtissuesoftheupperarmpassupwardtotheaxilla
Lateralside:followthecephalicveintotheinfraclaviculargroupofnodes
Medialside:followthebasilicveintothelateralgroupofaxillarynodes
DeepLymphVessels
Drain:deepstructuresofthearmdrainintothelateralgroupofaxillarynodes.
FascialCompartments
Upperarmisenclosedinasheathofdeepfascia
Compiledby:AMSAUST
Creditstotheowner
Fasciasepta(medialandlateral)divideupperarmintoanteriorandposteriorfascial
compartment.
Theseseptaareattachedtothemedialsupracondylarridgeandlateralsupracondylar
ridgeofthehumerus
Thinneranteriorcoveringofthearmandbecomesthickerasitgoesposteriorly
Contentsofthedeepfascialcompartment:
Bicepsbrachiimuscle
Coracobrachialismuscle
Brachialismuscle
Musculocateneousnerve
Mediannerve
Ulnarnerve
Radialnerve
Brachialarteryandbranches
Tricepsbrachiimuscle
Anconeousmuscle
Cubitalfossa
2.Illustratetheareasofdistributionofthemajorcutaneousnervesoftheupper
limb.
Compiledby:AMSAUST
Creditstotheowner
#2continuation
Compiledby:AMSAUST
Creditstotheowner
Supraclavicularnerves
Formation:C4&C5
Areasupplied:skinovershoulder
Upperlateralcutaneousnerveofarm(superficialnerve)
Formation:branchoftheaxillarynerveC5&C6
Areaofdistribution:skinoverthelowerhalfofthedeltoid
Lowerlateralcutaneousnerveofarm(superficialnerve)
Formation:branchofradialnerveC5&C6
Areaofdistribution:skinoverthelateralsurfaceofthearmbelowdeltoid
Intercostobrachialnerve
Formation:lateralcutaneousbranchofthe2ndintercostalnerve
Course:joinswiththemedialcutaneousnerveofarm
Areaofdistribution:skinofarmpitandmedialsideofthearm
Medialcutaneousnerveofarm
Formation:(T1)arisefromthemedialcordofthebrachialplexus
Course:goesdownwardandjoinswiththeintercostobrachialnerve
Areaofdistribution:skinofarmpitandmedialsideofthearm
Lateralcutaneousnerveofforearm
Formation:abranchofthemusculocutaneousnerve
Course:
passesbehindthecephalicvein,anddivides,oppositethe
elbowjoint,intoa
volar
anda
dorsal
branch
Branches:
Volarbranch
Course:descendsalongtheradialborderofforearmtothe
wrist
Areasupplied:lateralhalfofvolarsurfacecommunicates
withsuperficialbranchoftheradialnerve,andpalmar
cutaneousbranchofthemediannerve
Dorsalbranch
Course:dorsalsurfaceofradialsideofforearmtothewrist
Areasupplied:skinoflowertwothirdsofthedorsolateral
surfaceoftheforearm,communicatingwiththesuperficial
branchoftheradialnerveanddorsalantebrachialcutaneous
branchoftheradial
Compiledby:AMSAUST
Creditstotheowner
Medialcutaneousnerveofforearm
Formation:arisesfrommedialcordofthebrachialplexus,descendsin
frontoftheaxillaryartery
Course:piercesthefasciaandsuppliesintegumentcoveringthebiceps
brachii,thenrunsdowntheulnarsideofthearmmedialtothebrachial
artery,piercesthedeepfasciawiththebasilicvein.dividesintothevolar
andulnarbranch
Branches:
Volarbranch
Course:passesinfront,occasionallybehindmedianbasilic
veindescendsonthefrontoftheulnarsideoftheforearm
Areasupplied:communicateswithpalmarcutaneousbranch
ofulnarnerve
Ulnarbranch
Course:passesobliquelydownwardtothemedialsideof
basilicvein,infrontofmedialepicondyleofhumerus,backof
theforearm,descendsonitsulnarsideasfaraswrist
Areasupplied:communicateswithmedialbrachial
cutaneous,dorsalantebrachialcutaneousbranchofthe
radial,dorsalbranchoftheulnar
Posteriorcutaneousbranchofulnarnerve
Formation:branchofradialnerveC8
Areaofdistribution:skinofthebackofthearm
Superficialbranchofradialnerve
Location:Slightlylateraltotheradialartery,concealedbehind
brachioradialis.sensorynerve
Areasofdistribution
Lateralbranch:radialsideofthumb,skinofradialsideandballof
thumb,joiningwithvolarbranchoflateralantebrachialcutaneous
nerve
Medialbranch:communicates,abovethewrist,withthedorsal
branchofthelateralantebrachialcutaneous,onthebackofthe
hand,withthedorsalbranchoftheulnarnerve
Palmarcutaneousbranchofmediannerve
Formation:branchofmediannerve
Compiledby:AMSAUST
Creditstotheowner
Course:piercesthepalmarcarpalligament,dividesintolateralbranchand
medialbranch
Areasofdistribution
Lateralbranch:suppliesskinovertheballofthumb,communicates
withvolarbranchoflateralantebrachialcutaneous
Medialbranch:suppliesskinofpalm,andcommunicateswith
palmarbranchoftheulnar
Ulnarnerve
Formation:frommedialcordofbrachialplexusintheaxilla
Course:
runsdownwardonthemedialsideofthebrachialarteryasfaras
middleofthearm
attheinsertionofthecoracobrachialis,thenervepiercesmedial
fascialseptumwiththesuperiorulnarcollateralartery
enterstheposteriorcompartmentofthearm,thenpassesbehind
themedial
Areaofdistribution:
flexorcarpiulnaris,medialhalfofFDP,hypothenar
muscles,thirdandfourthlumbricals,allinterosseimuscles,skinoverthe
medialhandand1digits
(Netter)
flexorcarpiulnaris&medialhalfofflexordigitorumprofundus,
flexordigitiminimi,opponensdigitiminimi,abductordigitiminimi,
adductorpollicis,thirdandfourthlumbricals,interossei,palmaris
brevis,skinofmedialhalfofdorsumofhandandpalm,skinof
palmaranddorsalsurfacesofmedialoneandahalffingers(Snell)
Mediannerve
Formation:medialbranchofthelateralcord,lateralbranchofthemedial
cord
Course:runsdownwardonthelateralsideofthebrachialarteryhalfway
downtheupperarm,itcrossthebrachialarteryandcontinuesdownward
onitsmedialside
Areaofdistribution:
forearmflexors,thenarmuslcesand1st&2nd
lumbricals,skinoverthelateralhandand3digits
(Netter)
pronatorteres,flexorcarpiradialis,palmarislongus,flexor
digitorumsuperficialis,abductorpollicisbrevis,opponenspollicis
longus,flexordigitorumprofundus(lateralhalf),pronatorquadratus
palmarcutaneousbranchtolateralhalfofpalmanddigital
Compiledby:AMSAUST
Creditstotheowner
branchestopalmarsurfaceoflateralthreeandahalffingers
articularbranchestoelbow,wrist,andcarpaljoints(Snell)
Compiledby:AMSAUST
Creditstotheowner
3.Illustratetheformationofthemajorsuperficialveinsoftheupperlimb.
Superficialveins
CephalicVein
Origin:unionofdigitalveinsfromthethumbandlateralendofthedorsalvenousarch
Commencement:lateralaspectofthedorsum(back)ofthehand
Course:Itwouldascendalongthelateralborderoftheforearmandassumesan
anterolateralpositionatthecubitalfossauptothearmuntilitlodgesinthegroove
betweendeltoidandpectoralismajor.Itwilldrainintotheaxillaryvein
Termination:Deltopectoralgroove
BasilicVein
Origin:medialendofthedorsalvenousarch
Commencement:medialborderofthewrist
Course:Itascendsattheposteromedialborderoftheforearm,twistingtoamore
medialpositioninfrontofthemedialepicondyle.Atthelowerborderoftheteresmajor,
theveinmovesdeepintothearmandcombineswithbrachialveinstoformtheaxillary
vein.
Termination:lowerborderoftheteresmajormuscle
Communicatingveins
Linksthecephalicandbasilicveins
Itislocatedanteriorly
1.Mediancubitalveincrossinginfrontofthecubitalfossafromthecephalicvein
atalowerleveltothebasilicanearsthemedialepicondyle
2.Medianveinoftheforearmifpresent,itfrequentlydividesintotwostems,
whichcommunicateswiththecephalicandbasilicveinsoneachsideofthe
cubitalfossa.
3.Deepmuscularveinssituatedunderneaththedeepfascia
a.Radialvein
b.Ulnarvein
c.Brachialvein
Compiledby:AMSAUST
Creditstotheowner
4.Discussthemusclesoftheanteriorcompartmentofthearm
The
anteriorcompartmentofthearm
isoneofthetwocompartmentsofthearm.
Asheathofdeepfasciasurroundsthearm,thebrachialfascia.Twointermuscular
septae(medialandlateral)extendfromittoattachtothe
humerus
atthemedal
condylarridgeandlateralsupracondylarridge,respectively.Theseseptaedividethe
armintoitsanteriorand
posteriorcompartments
.
Bloodsupply
brachialartery
Nervesupply
Primarilybythe
musculocutaneousnerve
(C5,6),althoughthe
radialnerve
(C7)does
supplyasmalllateralpartofbrachialis.
Muscles
Threeflexors:
1.
bicepsbrachii
(alsoknownsimplyas
biceps
)isatwoheadedmuscleintheanteriorcompartmentof
thearmthatflexesattheelbowandsupinatestheforearm.
origin
shorthead:coracoidprocess
longhead:supraglenoidtubercleofthe
scapula
insertion
:radialtuberosityoftheproximal
radius
innervation
:
musculocutaneousnerve
action
:flexionattheelbowandsupinationoftheforearm
2.
brachialis
Compiledby:AMSAUST
Creditstotheowner
oneofthethreemusclesoftheanteriorcompartmentofthearm.Itisonlyinvolvedin
flexionattheelbowandthereforethestrongestflexorattheelbow,c.f.bicepsbrachii
whichisalsoinvolvedinsupinationbecauseofitsinsertionontheradius.
origin
:lowerportionofthemedialsurfaceofthe
humerus
insertion
:ulnatuberosityandcoronoidprocessofthe
ulna
innervation
:
musculocutaneousnerve
and
radialnerve
(proprioceptive
branch)
action
:flexionattheelbow
3.
coracobrachialis
(ormoresimply
coracobrachialis
)isoneofthethreemusclesoftheanterior
compartmentofthearmthatactstoperformflexionattheelbow.Itsitbeneathbiceps
brachii.
origin
:coracoidprocessof
scapula
insertion
:viaaflattendonontothemidportionofthemedialsurfaceof
humerus
innervation
:
musculocutaneousnerve
action
:
shoulderflexion
and
shoulderadduction
Compiledby:AMSAUST
Creditstotheowner
5.Discussthemusclesofposteriorcompartmentofthearm.
Posteriorcompartmentofthearm
Generalities:
Allofthemusclesoftheposteriorcompartmentofthearmareinnervatedbythe
radialnerve
Allofthemusclesintheposteriorcompartmentofthearmaresuppliedbythe
profundabrachiiartery,whichisabranchofthebrachialartery
Muscles:
Tricepsbrachii
o3headslong,lateral,andmedial
oVerticalfibersofthelongheadofthetricepsbrachiiinterposebetweentheteres
musclestobecomeacommonboundaryforthetriangularandquadrangularspaces
oTheneurovascularstructurespassingalongtheposteriorcompartmentofthearm
separatesthemedialandlateralheadsofthetricepsbrachii
oStrongextensoroftheelbowjoint
Anconeusmuscle
oSmall,insignificanttriangularshapedmuscle
oHelpsstabilizeelbowjoint
Origin
Compiledby:AMSAUST
Creditstotheowner
Insertion
Action
Innervations
Triceps
brachii
LONGHEAD
Infraglenoid
tubercleofthe
scapula
Olecranon
processofthe
ulna
Main
extensorof
theelbow
joint
Radialnerve
Triceps
brachii
LATERAL
HEAD
Upperhalfof
theposterior
surfaceofthe
humeralshaft
Triceps
brachii
MEDIAL
HEAD
Lowerhalfof
theposterior
surfaceofthe
humeralshaft
Lateral
epicondyleof
thehumerus
Helpstabilize
theelbow
joint
Anconeus
muscle
Structurescrossingtheposteriorcompartment:
UlnarandRadialnerves
Superiorandinferiorulnarcollateralarteries
Profundabrachiiartery
Profundabrachiiartery
Commencement:atthemedialsideofthelowerborderoftheteresmajor
oSimilarcommencementwiththebrachialartery
Origin:brachialartery
Course:alongtheradialnerve,itwindsalongtheradialgrooveofthehumerus,
reachingthelateralepicondyle
Termination:infrontandbehindtheepicondyle
Branches:
oAnteriordescendingbranch
oPosteriordescendingbranch
Theanteriorandposteriordescendingbranchesanastomosewiththeradialand
ulnararteries
Compiledby:AMSAUST
Creditstotheowner
6.Describethecourseoftheradialandmusculocutaneousnerves
Radialnerve:
Intheproximalthirdofthearm,itliesbehindthebrachialarteryfromwhereitwinds
aroundthehumeralshaftaccompaniedbytheprofundabrachiiartery.Atthelateral
supracondylararea,itemergesbetweenthelateralbordersofthebrachialisand
brachioradialismusclewhereitdividesintoasuperficialbranchtotheforearmanda
deepbranchwhichproceedstotheposteriorcompartmentoftheforearm
Musculocutaneousnerve:
Itpiercesthecoracobrachialismuscleandcoursesdeeptothebiceps,downtothe
antecubitalareawhereitsurfacesatthelateralborderofthebicepstendonfromwhere
itcoursessuperficiallyontheanterolateralsurfaceoftheforearmtodistributeits
terminalcutaneousbranches.
Compiledby:AMSAUST
Creditstotheowner
7.Describethebrachialartery.
BrachialArtery
Continuationoftheaxillaryartery
mainarterialsupplyofthearm
Commencement:lowerborderoftheteresmajormuscle
Course:emergingfromthelowerborderoftheteresmajormuscle,Brachialarteryis
rathersuperficialinitscourse.Itisoverlappedfromthelateralsidebybicepsbrachii
muscle.Itliesuponthetricepsandthecoracobrachialismuscles.Intheproximalregion
thearteryliesmedialtothehumeruswhereitispalpable.Inthelowerpartofitscourse
thearterygainsananteriorpositionrelativetothehumerus.Thebrachialartery
accompaniesthemediannervewhichcrossesitfromlateraltomedialsideinthemiddle
ofthearm.
Termination:Neckoftheradiusasitdividesintoradialandulnararteries
Branches:
Brachialarteryhasfollowingimportantbranches
1.Muscularbranches:Itsuppliesallthemusclesofarmdirectlyorthroughitsbranches.
2.Nutrientarterytothehumerus:
3.Deepbrachialarteryofthearm(Profundabrachiiartery):Profundabrachiiartery
arisesfrommedialandposteriorpartofbrachialarteryasalargebranchjustbelowthe
lowerborderofteresmajormuscle.Itcloselyfollowstheradialnerveandpasses
betweenthelateralandmedialheadsoftricepsmuscle.Afterpassingthroughtheradial
groveofhumerusalongtheradialnerve,itpiercesthelateralintermuscularseptumand
reachesthefrontoflateralepicondyleofhumerus.Itendsbyanastomosingwiththe
radialrecurrentartery.
Profundabrachiiarterysuppliesthedeltoidmuscle(whichisprimarilysuppliedbythe
posteriorcircumflexhumeralartery)andoccasionallyalsogivesanunusualnutrient
arterytothehumerus.Atitsend,ittakespartintheformationofanastomosesaround
elbowjoint.
4.Superiorulnarcollateralartery:Itisasmallsizedarteryarisingfromthebrachial
arteryjustbelowthemiddleofthearm.Itpiercesthemedialintermuscularseptumof
thearmandreachesbehindthemedialepicondyleofhumerus.Itendsbytakingpartin
anastomosesaroundtheelbowjoint.
5.Inferiorulnarcollateralartery:Itarisesfrombrachialarteryabouttwoandhalfinches
abovetheelbowjoint.Nearitsoriginitpiercesthemedialintermuscularseptumand
reachesbehindthemedialepicondyleofhumerus.Itendsbytakingpartin
anastomosesaroundtheelbowjoint.
6.RadialarteryTerminalBranch
7.UlnararteryTerminalBranch
Compiledby:AMSAUST
Creditstotheowner
8.Illustratethecubitalfossashowingtheboundaries,contentsandthespatial
relationshipsoftheassociatedmuscularandneurovascularstructures]
Compiledby:AMSAUST
Creditstotheowner
Compiledby:AMSAUST
Creditstotheowner