i want 30 multpile choice questions with their model answer that covers different aspects of all of the following information: 1. arterial supply (subclavian,axillary,brachial,ulnar,ul nar, hand arches) 2. venous drainage (superficial & deep). 3. nerve supply(musculocut., axillary, median, ulnar &radial). 4. Common Nerve injuries.Arterial Supply of the Upper Limb
Any artery 1. Origin 2. Course 3. branches• The arterial supply to the upper
limb is delivered via five main vessels
(proximal to distal):
• Subclavian artery
• Axillary artery
• Brachial artery
• Radial artery
• Ulnar arterySubclavian Artery
• The arterial supply to the upper limb
begins as the subclavian artery.
• On the right, the subclavian artery
arises from the brachiocephalic trunk.
On the left, it branches directly from
the arch of aorta.
• The subclavian artery travels laterally
towards the axilla.• It can be divided into three parts based on its position relative to the anterior scalene muscle:
• First part – origin of the subclavian artery to the medial border of the anterior scalene.
• Second part – posterior to the anterior scalene. • Third part – lateral border of anterior scalene to the lateral border of the first rib.
• At the lateral border of the first rib, the subclavian artery enters the axilla – and is renamed the axillary artery.Axillary Artery
• The axillary artery lies deep to
the
pectoralis minor and
is enclosed in the axillary sheath
(a
fibrous
layer
that covers the artery and the
three cords of the brachial
plexus).• Importantly, the artery can be divided
into three parts based on its position
relative
to
minor muscle:
• First part : proximal to pectoralis minor
• Second part: posterior to pectoralis
minor
• Third part: distal to pectoralis minor
the
pectoralisThe main branches of the axillary
artery include: SAL thoracic+ 3 اتجاهات
First Part
Second Part
• Superior
thoracic
artery
• Thoracoacro
mial
(acromiothor
acic) artery
• Lateral
thoracic
artery
Third Part
• Subscapular
artery
• Anterior and
posterior
circumflex
humeral
arteries• The anterior and posterior circumflex humeral arteries form an anastomotic network around the surgical neck of the humerus and can be damaged in cases of fracture.
• Termination: At the lower border of the teres major muscle, the axillary artery is renamed the brachial artery.Brachial Artery
• Beginning: The brachial artery is a continuation
of the axillary artery below the lower border of
the teres major.
• It is the main supply of blood for the arm.
• Course: As a continuation of the axillary artery,
the
brachial
artery
runs medial
to
the humerus proximally, before moving more
anteriorly to lie between the epicondyles of the
humerus.• Branches: The brachial artery supplies the content of the arm via its four branches:
1. profunda brachii artery. 2. nutrient artery to humerus. 3. Muscular branches. 4. superior ulnar collateral artery. 5. inferior ulnar collateral artery.• Termination: it ends at the level of
the neck of the radius about 1cm
distal to the elbow joint.
• At this point,
it
divides into
the ulnar and radial arteries.• Immediately distal to the teres major, the brachial
artery gives rise to the profunda brachii (deep
artery), which travels with the radial nerve in the
radial groove of the humerus and supplies
structures in the posterior aspect of the upper arm
(e.g. triceps brachii).
• It gives three branches: one ascending and 2
descending (posterior descending branch and
anterior descending branch).
• The profunda brachii terminates by contributing
to an anastomotic network around the elbow joint.Profunda
brachiiRadial and Ulnar Arteries
• The radial and ulnar arteries are formed by the
bifurcation of the brachial artery within the cubital fossa
(at the level of the neck of the radius):
• Radial artery : supplies the posterolateral aspect of the
forearm.
It contributes to anastomotic networks
surrounding the elbow joint and carpal bones.
– The radial pulse can be palpated in the distal forearm,
immediately lateral to the prominent tendon of the flexor carpi
radialis muscle.
• Ulnar artery : supplies the anteromedial aspect of the
forearm. It contributes to an anastomotic network
surrounding the elbow joint.
– Also gives rise to the anterior and posterior interosseous
arteries, which supply deeper structures in the forearm.Branches
 radial artery: • radial recurrent artery. • Muscular arteries. • palmar carpal branch. • superficial palmar branch. `ulnar artery: • Ant. & post. ulnar recurrent arteries. • muscular arteries . • common interosseous artery. • dorsal and palmar carpal arteries.• These two
arteries anastomose in the hand by forming two arches:
1. the superficial palmar arch. 2. the deep palmar arch.Hand: Superficial and Deep Palmar Arches
• The hand has a rich arterial supply with many anastomoses between vessels. This allows the hand to be perfused even when under high resistance to flow (such as when grasping or applying pressure).
• The ulnar artery enters the hand 1. anterior to the flexor retinaculum and 2. lateral to the ulnar nerve.• It gives rise to the deep
palmar branch
• continues laterally across
the palm as the superficial
palmar arch.• The radial artery enters the hand
dorsally, crossing the floor of
the anatomical snuffbox.
• It then turns medially and travels
between the heads of the adductor
pollicis muscle.The radial artery branches in the
hand:
1. Dorsal carpal br (at the wrist).
2. to the thumb (princips policis art.),
3. the index finger(radialis indicis art.)
• then continues as the deep palmar
arch.• As a result, two arterial arches are formed:Venous Drainage of the Upper
Limb
• The venous system of the upper
limb drains deoxygenated blood
from the arm, forearm and hand.
• It can be subdivided into
1. the superficial system and
2. the deep system.Any vein
1.Beginning
2.Course
3.tributaries
4.termination• Superficial Veins • The major superficial veins of the upper limb are the cephalic and basilic veins.
• They are located within the subcutaneous tissue of the upper limb.
1. Basilic Vein • The basilic vein originates from the dorsal venous network of the hand and ascends on the medial side of the upper limb.
• At the middle of the arm, pierce the deep fascia. • At the lower border of the teres major, continues as the axillary vein.2. Cephalic Vein • The cephalic vein also arises from the dorsal venous network of the hand.
• It ascends the antero-lateral aspect of the upper limb.
• At the shoulder, the cephalic vein travels between the deltoid and pectoralis major muscles (known as the deltopectoral groove), and enters the axilla region by piercing the clavipectoral fascia.
• Within the axilla, the cephalic vein empties into axillary vein.
• The cephalic and basilic veins are connected at the elbow by the median cubital vein.Deep Veins
• The deep venous system of the upper limb is situated underneath the deep fascia.
• It is formed by paired veins (vena comitantes), which accompany and lie either side of an artery.
• The deep veins share the name of the artery they accompany.
• The brachial veins are the largest in size, and are situated either side of the brachial artery.
• The pulsations of the brachial artery assist thePerforating veins
• run between the deep and superficial veins of the upper limb, connecting the two systems.