this lecture covered some basics in the structure of veins and arteries in upper limbs, as well as an extra slide about breast tissue. first it describes the major vein structure: the subclavian artery passes through the scalenes and becomes the axillary artery, which turns into the brachial artery below the teres major, until it bifurcates into the radial and ulnar artery in the forearm. on the backside, the major arteries in the scapular region which branch off of the axillary artery: the dorsal scapular artery is near the medial border of the scapula, the suprascapular artery is near the supra and infraspinous fossa, and the circumflex artery is near the medial triangular space. some possibilities for blockage or compression are looked at-- if the axillary artery is blocked, then flow can be shunted downstream via "reverse flow through the circumflex". thoracic outlet syndrome, or neurovascular compression syndrome, is a compression of the brachial plexus nerves and blood vessels that can occur either at the space between the scalenes, the costoclavicular space, or the pectoralis minor. cervical rib disorder is an extra rib growing off of C7 which can cause a similar sort of compression.
we then look at some of the major veins in the arms: the cephalic vein runs up the anterolateral forearm, up the bicep, between the deltoid and the pectoralis major, and drains into the subclavian vein. the basilic vein runs on the anteromedial side of the forearm and up the medial side of the arm, converging into the deep veins into the axillary vein. the medial cubital vein interconnects these two veins in the cubital fossa, which is a space in the upper forearm made from the borders of the pronator teres, brachioradialis, and the line between the two epicondyles. the cubital fossa also contains the median and radial nerves, superficial veins, brachial artery, and the tendon of the biceps. venae comitantes are veins that surround and hug major arteries and provide an alternate pathway for venous blood to return to the heart. being closer to the center of the body, they play a pivotal role in the regulation of body temperature, where blood is shunted to them in order to converse body heat (and shunted to the superficial veins to lower body temperature).
finally, some completely random facts about mammary glands. they are organized in 15-20 lobes, and are basically modified sweat glands embedded in adipose tissue. lactiferous ducts collect milk into lactiferous sinuses and cooper's ligaments anchor the breast to deep fascia. lymph channels from the breast carry lymph to four different locations: the opposite breast, the axilla, parasternal nodes, abdominal nodes.
questions
1. describe the arteries of the upper limb, going from the subclavian down to the radial and ulnar.
2. what are the arteries that circulate around the scapula and where are they?
3. if the axillary artery is occluded...
4. what is neurovascular compression syndrome?
5. what is a cervical rib?
6. what is the deep palmar arch?
7. describe the path of the ulnar artery in the hand.
8. palmar and dorsal arches branch into...
9. nerves and blood vessels run...
10. what are the veins that venipuncture can be performed in?
11. where does the cephalic vein run? where does it drain into?
12. where does the basilic vein run? where does it converge?
13. where does the medial cubital vein run?
14. what are venae comitantes?
15. how is body temperature regulated with superficial vs. deep veins?
16. what is the cubital fossa made of and what are the structures within it?
17. describe mammary glands.
18. lactiferous ducts...
19. suspensory (Cooper's) ligaments...
20. where do lymph channels carry lymph from the breast to?
answers
1. the subclavian artery runs between the middle and anterior scalene muscles and turns into the axillary artery, from the scalenes until the lower part of the teres major muscle. from there it turns into the brachial artery, up to the point of bifurcation into the radial and ulnar artery.
2. the dorsal scapular artery (vertebral border of scapula), suprascapular artery (supra, infraspinous fossa), and circumflex scapular artery (medial triangular space).
3. blood is shunted to the distal axillary artery by reverse flow through the circumflex artery.
4. compression of the brachial plexus and blood vessels, possible in three places: between scalenes, costoclavicular, and pectoralis minor.
5. an extra rib from the 7th vertebrae, can cause compression of the brachial plexus or arteries as well.
6. the portion of the radial artery that passes through the anatomical snuffbox and around the first metacarpal to enter the palm.
7. the ulnar artery goes through the tunnel of guyon (the space between the pisiform and hook of hamate), then forms the "superficial palmar arch".
8. metacarpal, common, and proper digital arteries paralleling the cutaneous nerves.
9. along the sides of digits.
10. cephalic, basilic, medial cubital
11. anterolateral forearm, over biceps, between deltoid and pectoralis major. drains into subclavian vein in clavipectoral triangle.
12. anteromedial forearm, penetrates medial side of arm. converges into deep veins to form axillary vein.
13. between the cephalic and basilic veins.in the cubital fossa.
14. veins that run accompany major arteries and provide an alternate means of venous return to the heart and aid in thermoregulation.
15. to lower body temperature, blood is shunted to superficial veins. to raise body temperature, blood is shunted to venae comitantes.
16. made of space between pronator teres, brachioradialis, line between two epicondyles. contains: superficial veins, median and radial nervees, brachial artery, biceps tendon.
17. 15-20 lobes, modified sweat glands embedded in adipose tissue.
18. drain milk into lactiferous sinuses.
19. support breast from deep fascia.
20. pectoral nodes in axilla, opposite breast, parasternal nodes, abdominal nodes.
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