Download Superficial Cutaneous Nerves of the Arm and Axilla

Superficial Cutaneous Nerves of the Arm and Axilla
Superficial Veins
Cephalic Vein
1. Drains the radial side of the arm
2. Connects to the Basilic Vein by the Median Cubital Vein
3. The Cephalic may be reduced because of predominant drainage through this vein
into the Basilic Vein
4. Ascends in the lateral bicipital groove to the interval between the Deltoid and
Pectoralis Muscles where it pierces the brachial fascia
5. Deep in the Deltopectoral triangle perforates a costocoracoid membrane and
empties into the Axillary Vein
Basilic Vein
1. Drains the ulnar side of the arm
2. Continues up the Medial bicipital groove and pierces the brachial fascia just
below the middle of the arm
3. Under the Brachial Fascia it enters the neurovascular compartment formed in the
medial intermuscular septum and
4. is found superficial to the Brachial Artery
5. eventually joining the Brachial Vein and then empties into the Axillary Vein
Deep Veins accompany the major arteries of the arm
Brachial Veins
1. These are paired accompanying veins called Venae Comitantes of the Brachial
Artery
2. At the lower border of the Teres Major they join
3. The Basilic Veins to form the Axillary Vein
4. The Axillary Vein becomes Subclavian Vein as it passes over the first rib
5. The subclavian joins the internal jugular vein behind the sternoclavicular joint to
form the Brachiocephalic Vein
6. The Left and Right Brachiocephalic Veins unite to form the superior Vena Cava
Cutaneous Nerves of the Upper Limb
1. Shoulder
a. Cervical Plexus from Ventral Rami of C1 to C4 and provide sensation to
the scalp, face, neck and shoulder
b. The Supraclavicular Nerves supply the area of the upper chest and
shoulder
2. Arm
a. Superior Lateral Brachial cutaneous Nerve (Axillary Nerve)
i. Emerges the
b. Posterior Brachial Cutaneous nerv (Radial Nerv)
c. Medial Brachial Cutaneous Nerv (Brachial Plexus)
d. Intercostobrachial Nerve (Lateral Cutaneous branch of T2)
i. Emerges from the 2nd intercostal space in between rib T2 and T3
ii. Pierces the Serratus Anterior to enter the Axilla
iii. Anastomoses with a branch from the Medial Brachial Cutaneous
Nerve
iv. From the the 2nd Intercostal space it descends posteriorly crossing
the Axilla to cross the tendon of the Latisimus Dorsi and pierces
the Brachial Fascia
v. The size of the Intercostobrachial Nerve varies inversely with the
size of the Medial Brachial Cutaneous Nerve
3. Forearm
a. Lateral Antebrachial Cutaneous Nerve
i. Cutaneous terminal of the Musculocutaneous Nerve
ii. Pierces the brachial fascia lateral to the biceps tendon
iii. Passes behind the cubital veins
iv. Usually divides into an anterior and posterior branch
1. Anterior Branch
a. The larger anterior branch follows the cephalic vein
and distributes to the radial half
b. Can communicate with the Superficial Radial Nerve
near the wrist
2. Posterior Branch is smaller
b. Posterior Antebrachial Cutaneous Nerve
i. Arises from the Radial nerve in its groove on the humerus
ii. Descends behind the lateral epicondyle
iii. Distributes to the dorsum of the forearm up to the wrist
c. Medial Antebrachial Cutaneous Nerve
i. Arises from the Medial Cord of the brachial plexus
ii. A small branch arises in the axilla and supplies the anteromedial
biceps area
iii. The main branch descends through the arm anterior and medial to
the brachial artery, in the neurovascular compartment formed in
the medial intermuscular septum
iv. At the junction of the middle and lower third of the arm it is in
company with the basilica vein and pierces the brachial fascia and
divides into an anterior and ulnar branch
v. The larger anterior branch can be superficial or deep to the cubital
veins
d. Wrist and Hand
i. Superficial Radial Nerve (from Radial C6 to C8)
1. The Superficial Radial Nerve is entirely cutaneous and runs
through the arm uner the brachioradialis muscle and with
the radial artery
2. It perforates the antebrachial fascia in the distal third of the
arm
ii.
iii.
iv.
v.
vi.
vii.
a. The medial branch divides into four dorsal digital
branches
b. The lateral branch supplies the skin over the radial
side f the thumb
Dorsal Branch of the Ulnar Nerve (C8, T1)
1. Arises 5cm above the wrist and passes dorsalward beneath
the flexor carpi ulnaris and pierces the forearm fascia at the
level of the stylid process of the ulna
2. At the ulnar border of the wrist the nerve divides into
dorsal digital nerves to supply the dorsal side of the lateral
or ulnar half of the 3rd digit and the 4th and 5th digits
Palmar branch of the Ulnar Nerve (C8, T1)
1. Arises in the middle of the forearm and descends under the
antebrachial fascia in front of the ulnar artery
2. It perforates the fascia just above the wrist and supplies the
hypothenar eminence and the medial part of the palm of the
hand
Palmar Branch of the Median Nerve (C6 to C8)
1. Arises just above the wrist and perforates the palmar carpal
ligament between the tendons of the palmaris longus and
flexor carpi radialis muscles
2. It supplies the medial side of the thenar eminence (of the
thumb) and the central depressed area of the palm
Digital Branches of the Median Nerve (C6 to C8)
Digital Branches of the Ulnar Nerve (C8, T1)
With the variability of the distribution of these nerves one should
use the following
1. Radial Dorsal side of the hand between the base of the
thumb and the index finger
2. Median The palmar side of the index finger
3. Ulnar The palmar side of the tip of the little ginger
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Woodburne
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