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266496434 hubs1105l8 blood vessels and nerves of the upper limb

266496434 hubs1105l8 blood vessels and nerves of the upper limb

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26/03/07 HUBS1105L8

Blood Vessels and Nerves of the Upper Limb

Learning Objectives:

1. Understand the formation & distribution of the brachial plexus

• Identify roots, trunks and cords of brachial plexus

• Identify named nerves: axillary, radial, musculocutaneous, median & ulnar

• Illustrate the structure of the brachial plexus diagrammatically

• Describe the distribution of axillary, radial, musculocutaneous, median & ulnar nn.

• Describe the major courses & relations of these nerves

• Describe segmental innervation of upper limb - dermatomes & myotomes

• State major effects of damage to:axillary, radial, musculocutaneous, median & ulnar

nn.

• Describe the motor & sensory nerve supply to the hand

• Describe methods of testing nerve integrity

2. Understand the structure of blood vessels to the upper limb

• Identify arteries: subclavian, axillary, brachial, radial, ulnar, superficial & deep

palmar arches

• Identify superficial veins: cephalic. basilic, median cubital

• Identify deep veins: brachial, venae comitantes

• Identify main features of arteriograms or venograms

• Describe the course & relations of major arteries & veins

• Describe the pattern of superficial & deep venous return (including valves)

• Describe the surface markings of major vessels

• Describe & explain the function of collateral arterial anastomoses

• Explain the hazard of injection in the cubital fossa

• Demonstrate & describe the palpation of pulses of the subclavian, axillar, brachial,

radial & ulnar arteries

The Nervous System

• The nervous system is organized into the central nervous system (brain and spinal

chord) and the peripheral nervous system (nerve fibres that carry information

between the CNS and the rest of the body).

• The spinal chord only goes as far as the lumbar region of the spine. After this

point the spinal nerves dangle downwards in a large lead.

NERVES OF THE UPPER LIMB

The Peripheral Nervous System

• The link between the neurons of the central nervous system and the rest of the

body.

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• Nerve cell bodies are clustered into groups called ganglia

• Nerve cell axons are bundled together and wrapped in connective tissue to for the

peripheral nerves. These axons carry sensory and motor commands.

Afferent Nerves: These come from the dorsal roots of the spinal chord. They send

information about the internal and external environment to the CNS. Visceral afferents

carry subconscious input, whereas sensory afferents carry conscious input. Sensory

information is categorised as either somatic (arising from the body’s surface) or special

(including vision, hearing, taste and smell) sensation.

Efferent Nerves: These come from the ventral roots of the spinal chord and are the

communication link by which the CNS controls the activities of muscles and glands, the

effector organs that carry out actions. The CNS regulates these organs by initiating action

potentials in the cell bodies of efferent neurons, whose axons terminate on these organs.

The autonomic nervous system innervates the involuntary branch of the peripheral

efferent division (smooth and cardiac muscle and glands) and the somatic nervous system

innervates voluntary control (skeletal muscle). The autonomic nervous system is further

divided into the sympathetic and parasympathetic nervous systems.

• Nerves can either arise from the brain stem (12 cranial nerves – mainly control the

structures of the head) or the spinal chord (31 pairs of spinal nerve come off the

spinal chord through openings between vertebrae)

• The spinal chord has two functions. It is the neuronal link between the brain and

the peripheral nervous system, being organised into ascending and descending

tracts for communication in both directions. It is also the integrating center for

spinal reflexes including the basic protective and postural reflexes.

• Afferent and efferent fibres are bundled together into spinal nerves, which supply

specific body regions and are attached to the spinal chord in a paired fashion

throughout its length.

• After the spinal nerves emerge from the spinal chord they progressively branch to

form a network of peripheral nerves that supply the tissues. The posterior branch*

supplies the deep muscles of the back and skin, whilst the ventral branch is larger

and forms plexuses (nerve networks) and supplies the superficial back,

extremities and the lateral and ventral trunk, except in the thoracic region where it

forms the intercostal nerve. => * Must remember posterior branch for exam.

Root Value: The spinal nerve from which a nerve is derived (may be more than one). The

spinal chord segments to which sensory and motor neurons attach.

Motor Distribution: The efferent distribution from the CNS to the muscle (The

information going from the brain to the muscles). The list of muscles supplied by a nerve.

Sensory Distribution: The afferent distributions, from the body to the CNS. The

peripheral nerve. Afferent information is received from the muscle, connective tissue and

joints

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26/03/07 HUBS1105L8 Blood Vessels and Nerves of the Upper Limb Learning Objectives: 1. Understand the formation & distribution of the brachial plexus • Identify roots, trunks and cords of brachial plexus • Identify named nerves: axillary, radial, musculocutaneous, median & ulnar • Illustrate the structure of the brachial plexus diagrammatically • Describe the distribution of axillary, radial, musculocutaneous, median & ulnar nn. • Describe the major courses & relations of these nerves • Describe segmental innervation of upper limb - dermatomes & myotomes • State major effects of damage to:axillary, radial, musculocutaneous, median & ulnar nn. • Describe the motor & sensory nerve supply to the hand • Describe methods of testing nerve integrity 2. Understand the structure of blood vessels to the upper limb • Identify arteries: subclavian, axillary, brachial, radial, ulnar, superficial & deep palmar arches • Identify superficial veins: cephalic. basilic, median cubital • Identify deep veins: brachial, venae comitantes • Identify main features of arteriograms or venograms • Describe the course & relations of major arteries & veins • Describe the pattern of superficial & deep venous return (including valves) • Describe the surface markings of major vessels • Describe & explain the function of collateral arterial anastomoses • Explain the hazard of injection in the cubital fossa • Demonstrate & describe the palpation of pulses of the subclavi ...
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