Blood Supply of Upper Limb (Viva)

Blood Supply of Upper Limb (Viva)

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Blood Supply of Upper Limb (Viva)

ARTERIES OF UPPER LIMB

Q.1 What is the extent of the axillary artery?

It extends from the outer border of the first rib to the lower border of teres major muscle. It is a continuation of the subclavian artery and it continues as a brachial artery.

 

Q.2 What are the parts of the axillary artery?

Pectoralis minor muscle crosses it and divides it into three parts:

  • First Part: Proximal to muscle.
  • Second Part: Posterior to muscle.
  • Third Part: Distal to muscle.

 

Q.3 What are the relations of various nerves with the axillary artery?

First part:

  • Anterior: – Supraclavicular nerves – Lateral pectoral nerve – Loop of communication between lateral and medial pectoral nerve.
  • Posterior: – Nerve to serratus anterior – medial cord of brachial plexus
  • Lateral: Lateral and posterior cords of brachial plexus. Second part:
  • Posterior: Posterior cord of brachial plexus
  • Medial: – medial cord of brachial plexus – Medial pectoral nerve Lateral: Lateral cord of brachial plexus

Third part:

  • Anterior: Medial root of median nerve
  • Posterior: Axillary nerve
  • Lateral: – Musculocutaneous nerve and lateral root of the median nerve in the upper part – Trunk of the median nerve in the lower part.
  • Medial: – Medial cutaneous nerve of the forearm – Ulnar nerve – Medial cutaneous nerve of arm

 

Q.4 What is the relation of various muscles with the axillary artery?

Anteriorly:

  • Pectoralis major to whole artery except lowermost part
  • Pectoralis minor to second part
  • Clavipectoral fascia to first part.

Posteriorly:

  • Intercostal muscles of first space and serratus anterior to first part
  • Subscapularis to the second and upper portion of the third part.
    Teres major and tendon of latissimus dorsi to lower portion of the third part.

Laterally:

  • Coracobrachialis to second and third part

 

Q.5 Which veins cross the axillary artery?

Cephalic vein and thoracoacromial vein, the tributaries of axillary vein cross the first part.

 

Q.6 Name the branches of the axillary artery.

From first part:

  • Superior thoracic artery

From second part:

  • Thoracoacromial artery
  • Lateral thoracic artery.

From third part:

  • Subscapular artery
  • Anterior circumflex humeral artery
  • Posterior circumflex humeral artery

 

 Q.7 What is the extent of the brachial artery?

It extends from the lower border of teres major muscle to elbow at the level of the neck of radius just medial to the tendon of biceps.

 

Q.8 What are the nerves related to the brachial artery in its course?

  1. In the upper part of the arm:
  • Anteriorly to medial cutaneous nerve of forearm
  • Medially, to ulnar nerve
  • Laterally, to the median nerve.
  1. In the middle of the arm:
    Crossed by median nerve from lateral to medial side.

  2. In the lower part of the arm: 
    Medially, median nerve.
    Posteriorly, it is related to Radial nerve, only in the uppermost part.
  1. In elbow:
  • Laterally: Radial nerve
  • Medially: Median nerve

 

Q.9 Name the branches of the brachial artery.

  • Muscular branches
  • Profunda brachii artery
  • Superior ulnar collateral
  • Inferior ulnar collateral
  • Nutrient artery to humerus
  • Terminal branches: Radial and ulnar

 

Q.10 What is the clinical importance of the brachial artery?

Brachial pulsations are auscultated in front of elbow just medial to the tendon of biceps while recording the blood pressure.

 

Q.11 Name the branches of profunda brachii artery.

  • Anterior descending
  • Posterior descending
  • Ascending branch

 

Q.12 Name the branches of the radial artery.

  • Muscular branches
  • Radial recurrent branch
  • Palmar carpal branch
  • Superficial palmar branch
  • Dorsal carpal branch
  • First dorsal metacarpal artery
  • Princeps pollicis artery
  • Radialis indicis artery

 

Q.13 Where the pulsations of the radial artery are felt?

At the wrist against the anterior surface of the lower end of radius.

 

Q.14 Name the branches of the ulnar artery.

  • Muscular branches
  • Anterior and posterior ulnar recurrent branches
  • Palmar and dorsal carpal branches
  • Common interosseous artery
  • Superficial and deep palmar branch.

 

 Q.15 Anterior interosseous artery lies between which muscles?

Flexor digitorum profundus and flexor pollicis longus.

 

Q.16 Name the structure separating the ulnar artery from the median nerve at the elbow.

Ulnar head of pronator teres.

 

Q.17 What are the relations of the radial artery in the forearm.

Radial artery lies between flexor carpi radialis and brachioradialis.

 

Q.18 What is the clinical importance of Allen’s test?

This test is performed to test the patency of the radial or ulnar artery.

 

Q.19 Name the arteries forming an anastomosis around the scapula.

  • Suprascapular artery branch of cervical artery
  • Deep branch of transverse thyrocervical joint
  • Circumflex scapular artery, branch of subscapular artery.

 

Q.20 How the circulation is carried out when axillary artery is ligated.

By the collateral channels around the scapula, which connect the first part of the subclavian artery with the third part of the axillary artery.

 

 

VENOUS DRAINAGE OF UPPER LIMB

Q.1 What are the main superficial veins of the upper limb?

Cephalic (Preaxial) vein: Begins from the lateral end of the dorsal venous arch and drains into the axillary vein

Basilic (Postaxial) veins: Begins from the medial end of the dorsal venous arch and above the lower border of teres major continues as the axillary vein

  • Median cubital vein: Large communicating vein which shunts blood from cephalic to basilic in 70%.

  • Median vein of the forearm: Drains the palmar venous arch and ends in basilic or median cubital veins.

 

Q.12 Name the structures lying between the axillary artery and vein.

The vein lies anteromedial to the artery.

The two are separated by:

  • Medial cord of brachial plexus
  • Medial pectoral nerve
  • Ulnar nerve
  • Medial cutaneous nerve of forearm

 

Q.3 How the venous drainage of the upper limb is maintained in axillary vein obstruction?

By communication between the upper part of the cephalic vein with the external jugular vein in the neck.

 

Q.4 What is the clinical importance of the median cubital vein?

It is connected to the deep veins of the upper limb through a perforator which pierces the bicipital aponeurosis, which fixes it. So it does not slip away when intravenous injections are given.

 

LYMPHATIC DRAINAGE OF UPPER LIMB

Q.1 Which is the main lymph node of the upper limb?

Lateral group of axillary nodes.

 

Q.2 What is the area of lymphatic drainage of axillary lymph nodes?

  • Anterior group: Drains skin and muscles of anterior and lateral walls of the trunk up to the level of the umbilicus and part of the breast.
  • Posterior group: Drains skin and muscles of the back of trunk from the iliac crest to lower part of the neck.
  • Lateral group: Upper limb.

 

Q.3 How the axillary lymph nodes drain?

Anterior, posterior and lateral group drain into the central group which in turn drains into the apical group. Subclavian lymphatic trunk from apical group drains into thoracic duct on the left side and to the right lymphatic duct on the right side.

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