VASCULATURE OF THE UPPER LIMB THE NATURAL DESIRE OF GOOD MEN IS KNOWLEDGE. LEONARDO DA VINCI Lecture...
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VASCULATURE OF THE UPPER LIMB THE NATURAL DESIRE OF GOOD MEN IS KNOWLEDGE. LEONARDO DA VINCI Lecture Idara C. Eshiet WINDSOR UNIVERSITY SCHOOL OF MEDICINE
VASCULATURE OF THE UPPER LIMB THE NATURAL DESIRE OF GOOD MEN IS
KNOWLEDGE. LEONARDO DA VINCI Lecture Idara C. Eshiet WINDSOR
UNIVERSITY SCHOOL OF MEDICINE
Slide 2
Relationship of the upper limb to the neck Right posterior
scapula region Arteries associated with gateways in the posterior
scapular region Arterial anastomoses around the shoulder Posterior
wall of the axilla Axillary artery Branches of the axillary artery
Brachial artery & branches Vasculature of the arm
Slide 3
Relationship of the upper limb to the neck
Slide 4
Spaces in posterior scapula region Quadrangular space Superior:
teres minor inferior: teres major Medial: long head of triceps
Lateral: humerus Quadrangular space Triangular space
Slide 5
Triangular Space Superiorly: teres minor, subscapularis
Inferior : teres major Lateral : long head of triceps
Slide 6
Triangular Interval Medially long head of the triceps brachii
Laterally shaft of the humerus Superiorly teres major
Slide 7
Contents Quadrangular space The axillary nerve & posterior
circumflex humeral artery. Triangular space Circumflex scapular
branch of subscapular artery 1 2 3
Slide 8
Slide 9
Posterior wall of the axilla Triangular interval Radial nerve
Profunda brachii artery Triangular space Circumflex scapular
artery
Slide 10
Arteries and nerves associated with gateways in the posterior
scapular region
Slide 11
Axillary artery The subclavian artery in the neck becomes the
axillary artery at the lateral margin of rib1 Becomes the brachial
artery at the inferior margin of the teres major muscle. The
axillary artery is separated into 3 parts by the pectoralis minor
muscle. Pectoralis minor m. 1 2 3
Slide 12
Branches of the axillary artery The axillary artery is
separated into three parts by the pectoralis minor muscle, which
crosses anteriorly to the vessel. First part is proximal to
pectoralis minor Second part is posterior to pectoralis minor Third
part is distal to pectoralis min.
Slide 13
Branches of the axillary artery 1st part gives 1branch :
superior thoracic artery 2 nd part gives 2 branches:
thoraco-acromial artery & lateral thoracic artery 3 rd part
gives 3 branches : subscapular artery, anterior circumflex humeral
artery, and posterior circumflex humeral artery 12a 2b 3b.c 3a
Slide 14
Slide 15
Arterial Anastomoses around the Scapula Collateral circulation:
Subclavian artery-----Suprascapular artery--------circumflex
scapular artery----subscapular artery----axillary artery
Slide 16
Axillary vein The axillary vein begins at the lower margin of
the teres major muscle and is the continuation of the basilic vein.
The axillary vein passes through the axilla medial and anterior to
the axillary artery and becomes the subclavian vein. Tributaries of
the axillary vein generally follow the branches of the axillary
artery. Other tributaries include brachial veins that follow the
brachial artery, and the cephalic vein.
Slide 17
Brachial Artery This is a continuation of Axillary artery
beyond lower border of Teres major. It is Superficial and palpable
throughout its course. It ends opposite the neck of the radius in
the cubital fossa under cover the bicipital aponeurosis. It
terminally divides into Radial & Ulnar Arteries
Slide 18
Branches: 1-Muscular : muscles of flexor compartment
2-Nutrient: to the humerus 3-the Deep Brachial Artery (profunda
brachii artery) -arises near the beginning of brachial artery
-follows the Radial Nerve into the spiral groove 4- Superior&
inferior Ulnar collateral Arteries -Arises from the middle of the
B.A and follows the Ulnar Nerve
Slide 19
Slide 20
Collateral and Recurrent arteries make very efficient
anastomoses around the ELBOW
Slide 21
Veins of the arm 1. Deep veins: Paired brachial veins pass
along the medial & lateral sides of the brachial a. 2.
Subcutaneous veins: Basilic vein Cephalic vein Axillary v. Basilic
v. Cephalic v. deep v.
Slide 22
Cubital fossa Radial artery Ulnar artery Deep veins Vasculature
of the forearm
Slide 23
Cubital fossa The brachial artery normally bifurcates into
radial & ulnar a. in the apex of the fossa. The ulnar n. does
not pass through the cubital fossa Median c.v. Radial a. Ulnar
a.
Slide 24
Slide 25
Radial Artery Begins in the cubital fossa as a smaller terminal
branch of the brachial artery at the level of the neck of the
radius. It passes downwards & laterally, beneath
brachioradialis muscle In the distal part of the forearm, it lies
b/w brachioradialis tendon laterally & FCR tendon medially. It
is covered only by the skin and fascia(site for taking the radial
pulse). It leaves the forearm by winding around the lateral aspect
of the wrist
Slide 26
Slide 27
Branches of the Radial Artery 1. Muscular branches 2. Recurrent
Branch 3. Superficial palmar branch this arises just above the
wrist and joins the Ulna a. to form the superficial palmar
arch
Slide 28
Ulnar artery Begins in the cubital fossa at the level of the
neck of the radius. It is larger than the radial artery. Descends
deep to the flexor muscles Becomes superficial in lower part of
forearm and lies b/w FCU and FDS tendons Ulnar a.
Slide 29
In the Palm It enters the palm Superficial to the flexor
retinaculum in company with ulnar nerve. It ends by forming the
Superficial Palmar arch anastomosing with the superficial palmar
branch of the radial artery
Slide 30
ULNAR ARTERY RADIAL ARTERY Superficial palmer arch Deep palmer
arch Deep branch Of UA Superfical branch of RA IMP
Slide 31
Branches of the ulnar artery 1. Muscular branches 2. Ulnar
recurrent a. with anterior & posterior branches 3. Common
interroseous a. branches are anterior & posterior interosseous
arteries). 4. 2 small carpal a. ( dorsal carpal branch & palmar
carpal branch).
Slide 32
Collateral and Recurrent arteries make very efficient
anastomoses around the ELBOW
Slide 33
IMP
Slide 34
veins Deep veins of the anterior compartment generally
accompany the arteries & ultimately drain into brachial veins
associated with the brachial artery in the cubital fossa.
Slide 35
Ulnar artery & Superficial Palmar arch Radial artery &
Deep Palmar arch Dorsal Venous arch Blood supply to the hand
Slide 36
Arteries & Veins The blood supply to the hand is by the
radial & ulnar arteries, which form 2 interconnected vascular
arches (superficial & deep) in the palm. Vessels to the digits,
muscles, & joints originate from the 2 arches & the parents
arteries: The radial artery contributes substantially to the supply
of the thumb & the lateral side of the index finger; The
remaining digits & the medial side of the index finger are
supplied mainly by the ulnar artery.
Slide 37
Radial artery VS. Ulnar artery in the Hand The radial artery
contributes substantially to the supply of the thumb & the
lateral side of the index finger ; The remaining digits & the
medial side of the index finger are supplied mainly by the ulnar
artery.
Slide 38
Ulnar artery & superficial palmar arch A palmar digital
artery to medial side of little finger 3 large, common palmar
digital arteries, which are joined by the palmar metacarpal
arteries from the deep palmar arch before bifurcating into the
proper palmar digital arteries, which enter the fingers.
Slide 39
Radial artery & Deep Palmar arch 2 vessels, the princeps
pollicis artery & the radialis indicis artery, arise from the
radial artery. The princeps pollicis artery is the major blood
supply to the thumb. The radialis indicis artery supplies the
lateral side of the index finger.
Slide 40
Deep Palmar arch The deep palmar arch gives rise to : 3 palmar
metacarpal arteries, which join the common palmar digital arteries
from the superficial palmar arch; 3 perforating branches, which
anastomose with the dorsal metacarpal arteries from the dorsal
carpal arch.
Slide 41
Dorsal venous arch of the hand The deep veins follow the
arteries; the superficial veins drain into a dorsal venous network
on the back of the hand over the metacarpal bones.
Slide 42
Dorsal venous arch The cephalic vein originates from the
lateral side of the dorsal venous network & passes over the
anatomical snuffbox into the forearm. The basilic vein originates
from the medial side of the dorsal venous network & passes into
the dorsomedial aspect of the forearm.
Slide 43
Snuffbox The base of the triangle is at the wrist & the
apex is directed into the thumb The lateral border is formed by the
tendons of the abductor pollicis longus & extensor pollicis
brevis The medial border is formed by the tendon of the extensor
pollicis longus The floor is formed by the scaphoid &
trapezium, & distal ends of the tendons of the extensor carpi
radialis longus & extensor carpi radialis brevis.
Slide 44
Slide 45
Anatomical snuffbox The radial artery passes obliquely through
the anatomical snuffbox, deep to the extensor tendons of the thumb
& lies adjacent to the scaphoid & trapezium
Slide 46
Surface Anatomy
Slide 47
Surface Anatomy.2
Slide 48
Surface Anatomy.3 Axillary pulse Radial pulse Radial p. in
anatomical snuff box Brachial p. cf. brachial p. Ulnar pulse
Slide 49
POWER REVIEW1. 1. What are the borders of the triangular
spaces? Superior: teres minor m. / Inferior: Teres major m.
Lateral: Long head of triceps. 2. what are the borders of the
quadrangular space? Superior : teres minor / Inferior: Teres major
Medial: Long head of triceps/ Lateral: Humerus 3. which nerve &
vessel run in the spiral groove on the posterior humerus, & are
therefore susceptible to damage following fracture of the humeral
shaft? The radial nerve & the deep brachial artery
Slide 50
POWER REVIEW2. 4. Which nerve passes posterior to the medial
humeral epicondyle (funny bone)? The ulnar nerve 5. Which
structures pass through the carpal tunnel? The median nerve, the
flexor pollicis longus tendon, the 4 flexor digitorum profundus
tendons, and the 4 flexor digitorum superficialis tendons.
Slide 51
POWER REVIEW3. 6. What structures pass through the quadrangular
space? The axillary nerve & posterior circumflex humeral artery
7. what structure passes through the triangular space? Circumflex
scapular artery
Slide 52
POWER REVIEW 4. 8. which nerve innervates the flexors of the
upper limb? The musculocutaneous nerve 9. which nerve innervate the
extensors of the upper limb? The radial nerve 10. the median nerve
lies in close proximity to which artery? The brachial artery (the
median nerve is located just anterior to it)
Slide 53
POWER REVIEW 5. 11. In the hand, which nerve innervates the
thenar muscles? Median nerve 12. In the hand, which nerve
innervates the hypothenar muscles? Ulnar nerve 13.The ulnar artery
lies btwn which 2 muscles? The flexor digitorum superficialis &
the flexor digitorum profundus
Slide 54
POWER REVIEW QUESTIONS1. 14. The common interosseous artery (a
branch of the ulnar artery) divides into which 2 arteries? The
anterior interosseous artery & the posterior interosseous
artery 15. Which artery runs with the superficial branch of the
radial nerve under the brachioradialis muscle? Radial artery
Slide 55
REVIEW QUESTIONS1 The deep artery of the arm accompanies which
of the following before passing around the body of the humerus?
Which of the following is true regarding the quadrangular space?
Which of the following is derived from the radial artery?
Slide 56
Quality is never an accident. It is always the result of high
intention, sincere effort and skillful execution. It represents the
wise choice of many alternatives. References.. Grays Anatomy for
students, 2 nd edition Anatomy Recall, 2 nd edition unknown