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Overview_of_upper_extremity

Overview_of_upper_extremity - Overview of the Upper...

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Overview of the Upper Extremity Superficial Veins There are three clinically significant superficial veins that are common sites for phlebotomy: cephalic; basilic and median cubital veins. The cephalic vein drains the dorsum of the hand and ascends along the lateral forearm. (The lateral forearm is considered to be cephalic because the upper extremity develops as a lateral projection from the body, thus making the lateral forearm closer to the head.) The cephalic vein passes through the deltopectoral groove to join with the axillary vein. The basilic vein also drains the dorsum of the hand, and ascends the medial forearm. It unites with the paired brachial veins in the arm to form the axillary vein. The median cubital vein interconnects the basilic and cephalic veins in the cubital fossa. The cubital fossa is the triangular space between the brachioradialis muscle (laterally) and the pronator teres muscle (medially). The contents of the cubital fossa include (from lateral to medial), the tendon of biceps brachii, brachial artery, and median nerve. Brachial plexus The brachial plexus is an interlacing network of nerves that innervates the pectoral girdle and upper limb. It is divided into roots, trunks, divisions, cords and branches. The mnemonic for this is: Randy Travis Drinks Cold Beer. The roots are derived from the ventral primary rami of C5 – T1. The cutaneous innervation derived from these roots produce dermatomes that are segmentally arranged from cranial (C5) to caudal (C8, T1). The muscle innervation from these roots produces myotomes that have a segmental distribution from proximal (C5-Deltoid) to distal (C8, T1- Interossei). The three trunks (superior, middle and inferior) are derived from roots C5-C6, C7 and C8-T1 respectively. Each trunk divides into an anterior and posterior division. The nerve fibers from the anterior division innervate the muscles in the anterior compartment of the arm and forearm which are the flexors and pronators of the arm, forearm and digits. The nerve fibers from the posterior division innervate the extensor and supinator muscles of the posterior compartment of the arm and forearm. The posterior divisions from all three trunks combine to form the posterior cord. The anterior divisions of the superior
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and middle trunks combine to form the lateral cord. The anterior division of the inferior trunk forms the medial cord. The cords are named for their position relative to the axillary artery (i.e the lateral cord is “lateral” to the axillary artery, etc). The cords terminate in branches (nerves). The major termnial branches of the brachial plexus in the upper extremity are the: radial and axillary nerves (from the posterior cord), ulnar nerve (from the medial cord), musculocutaneous nerve (from the lateral cord), and median nerve (from lateral and medial cords).
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