Download superficial veins, lymphatics and lymph nodes

SUPERFICIAL VEINS, LYMPHATICS AND LYMPH
NODES OF UPPER LIMB
LEARNING OBJECTIVES
• Normal Anatomy of veins of upper limb.
• Difference between superficial and deep veins.
• Features of individual superficial veins of upper
limb
• Applied anatomy of superficial veins of upper
limb.
• What is a lymph node.
• Identify the groups of lymph nodes.
• Describe groups and area of drainage of each
group of lymph nodes.
• Discuss the commencement, course and
termination of superficial lymphatic vessels.
• Discuss the clinical conditions related to lymphatic
channels of upper limb.
VEINS OF THE UPPER LIMB
•The veins of the upper
extremity are divided
into two sets,
superficial and deep;
•the two sets
anastomose frequently
with each other.
•The superficial veins
are placed immediately
beneath the
integument between
the two layers of
superficial fascia.
VEINS OF UPPER LIMB
SUPERFICIAL VEINS
- DORSAL VENOUS NETWORK
- CEPHALIC VEIN
- BASILIC VEIN
- AXILLARY VEIN( BASILIC+ BRACHIAL
VEIN)
- MEDIAN CUBITAL VEIN
- MEDIAN VEIN OF FOREARM
DEEP VEINS
NAMED ACCORDING TO COMPANIAN ARTERIES
- RADIAL VEIN
- ULNAR VEIN
- BRACHIAL VEIN
- AXILLARY VEIN
VEINS OF UPPER LIMB
SUPERFICIAL VEINS OF THE UPPER LIMB
Important
superficial veins of
upper limb
include;
•digital,
• metacarpal,
• cephalic,
• basilic,
• median.
SUPERFICIAL VEINS OF THE UPPER LIMB
CEPHALIC VEIN
• Arises from lateral side of the dorsal venous
network.
• Runs on the lateral side of the forearm and the
front of the elbow.
• Often connected with the basilic vein by the median
cubital vein in front of the elbow.
• Winds around the lateral border of the forearm.
Ascends into the cubital fossa and up the front of
the arm on the lateral side of the biceps.
• Continues up in the deltopectoral groove.
• Pierces clavipectoral fascia in the floor of the
groove to drain into axillary vein.
SUPERFICIAL VEINS OF THE UPPER LIMB
BASILIC VEIN
• Arises from the medial side of the dorsal venous
network of hand.
• Winds around the medial border of the forearm.
• Then ascends into the cubital fossa and up the
front of the arm on the medial side of the biceps to
middle of the arm where it pierces the deep fascia
and joins the brachial vein or axillary vein.
SUPERFICIAL VEINS OF THE UPPER LIMB
Median cubital vein:
•
•
Links cephalic vein and basilic vein in
the cubital fossa.
It is a frequent site for venepuncture
to remove a sample of blood or add
fluid to the blood.
PECTORAL REGION
• Deep fascia
– Superficial layer
– Deep layer.
CLAVIPECTORAL FASCIA
• The deep fascia which extends
between subclavius, coracoid
process and pectoralis minor
muscles
– The structures pass through
the clavipectoral fascia
» Cephalic v.
» Thoracoacromial a.
» Lateral pectoral n.
MEDIAN ANTEBRACHIAL VEIN
• Arises in the palmar venous
network.
• Ascends on the front of the
forearm.
• Terminates in the median cubital or
the basilic vein.
Veins of the Forearm
• 1. Cephalic vein
2. Median Cubital vein
3. Accessory Cephalic vein
4. Basilic vein
5. Cephalic vein
6. Median antebrachial vein
DORSAL VENOUS NETWORK
• Receives dorsal digital veins
by means of dorsal
metacarpal veins.
• Also receives palmar digital
veins by means of
intercapitular and palmar
metacarpal veins.
• Radial part is continued
proximally as the cephalic
vein.
• Ulnar part is continued
proximally as the basilic vein.
AXILLARY VEIN
• Formed at the lower
border of the teres major
by the union the brachial
vein and the basilic vein
• Runs upward on the
medial side of the axillary
artery
• Ends at the lateral border
of the first rib by
becoming the subclavian
vein
• Diagram of some
common patterns of
the superficial veins of
the upper limb. Only
the larger channels at
the elbow are shown:
these are the ones
most likely to be visible
through the skin
APPLIED ANATOMY
• The superficial veins are also used for intravenous injections in
clinical settings.
• They are also abused by drug users. After many injections, the
venous walls collapse and become fibrosed and unusable. These
fibrotic vessels can be easily spotted.
• Superficial veins form many interconnections and can be removed
without worrying about loss of blood blow back to the heart.
APPLIED IMPORTANCE OF SUPERFICIAL VEINS
These are used for vene puncture.
(a) Diagram of veins in
a forearm showing the
antecubital fossa area
where blood samples
are taken,
(b) Venous blood
sample being taken
from a vein in the
antecubital fossa using a
venepuncture vacuum
system
LYMPHOID SYSTEM
• consists of all of the
tissue aggregates and
organs composed of
lymphoid tissue which
function together to
produce our specific
resistance to disease
(immunity).
•
An oval structure, 1 to 25mm
in diameter.
• Enclosed by a capsule with an
internal framework of
trabeculae consisting of
collagenous and reticular
fibers.
THE LYMPH NODE
• Found primarily in the
proximal area of the limbs, i.e.,
axilla, inguinal and cervical
nodes, as well as, the
retroperitoneal area of the
pelvis and abdomen and the
surface of thoracic and
abdominal organs.
LYMPH NODES
LYMPHOID SYSTEM
•
The lymphatic vessels are arranged into a superficial and a
deep set.
• On the surface of the body the superficial lymphatic vessels
are placed immediately beneath the integument,
accompanying the superficial veins; they join the deep
lymphatic vessels in certain situations by perforating the
deep fascia.
• In the interior of the body they lie in the submucous areolar
tissue, throughout the whole length of the digestive,
respiratory, and genito-urinary tracts; and in the subserous
tissue of the thoracic and abdominal walls
LYMPHOID SYSTEM
THE LYMPH GLANDS OF THE UPPER
EXTREMITY
The lymph glands of the upper extremity are divided
into two sets.
1)superficial 2)deep.
• superficial lymph glands
• Are few and of small size.
• One or two supratrochlear glands are placed
above the medial epicondyle of the humerus,
medial to the basilic vein.
• Their afferents drain the middle, ring, and little
fingers, the medial portion of the hand, and the
superficial area over the ulnar side of the forearm.
SUPERFICIAL LYMPH GLANDS
• These vessels are in free
communication with the other
lymphatic vessels of the forearm.
• Their efferents accompany the basilic
vein and join the deeper vessels.
• One or two deltoideopectoral glands
are found beside the cephalic vein,
between the Pectoralis major and
Deltoideus, immediately below the
clavicle.
• They are situated in the course of the
external collecting trunks of the arm.
DEEP LYMPH GLANDS
• Are chiefly grouped in
the axilla, although a
few may be found in the
forearm, in the course
of the radial, ulnar, and
interosseous vessels,
and in the arm along
the medial side of the
brachial artery.
• Tubular vessels
transport back lymph
to the blood ultimately
replacing the volume
lost from the blood
during the formation of
the interstitial fluid.
• These channels are the
lymphatic channels or
simply called
lymphatics
LYMPHATIC
CHANNELS
AXILLARY GROUP OF LYMPH NODES
CLASSIFICATION ON BASIS OF LOCATION:
• Humeral (Lateral) Node:
– Posteromedial to the axillary vein.
– Receive most of the lymphatic drainage from
the upper limb.
• Pectoral (anterior) nodes
– occur along inferior margin of pectoralis
minor muscle along the course of lateral
thoracic vessels.
– Receive drainage from the abdominal wall, the
chest, and the mammary gland.
• Subscapular (Posterior) Nodes
– on the posterior axillary wall in association
with the subscapular vessels drain the
posterior axillary wall.
– Receive lymphatics from the back, the
shoulder, and the neck.
• Central Nodes:
– are embedded in axillary fat
– receive tributaries from humeral,
subscapular, and pectoral groups of nodes.
– Apical Nodes :
– are the most superior group of nodes in the
axilla
– drain all other groups of nodes in the region.
In addition, they receive lymphatic vessels that
accompany the cephalic vein as well as vessels
that drain the superior region of the
mammary gland.
AXILLARY LYMPH NODES
LYMPHATICS OF UPPER LIMB
SUPERFICIAL LYMPHATICS
• Lymphatics of the finger
Drain into the plexus on the dorsum and palm of
the hand.
• Medial group of lymphatic vessels
Accompanies the basilic vein; passes through the
cubital or supratrochlear nodes; and ascends to
enter the lateral axillary nodes , which drain first
into the central axillary nodes and then into the
apical axillary nodes.
• Lateral group of lymphatic vessels
Accompanies the cephalic vein and drains into the
lateral axillary nodes and also into the
deltopectoral (infraclavicular) node, which then
drain into the apical nodes.
THE LYMPHATIC VESSELS OF THE UPPER
EXTREMITY
• The lymphatic vessels of the upper extremity are
divided into two sets, superficial and deep.
SUPERFICIAL LYMPHATICS
• Lymphatics of the finger
Drain into the plexus on the dorsum and palm of
the hand.
• Medial group of lymphatic vessels
Accompanies the basilic vein; passes through the
cubital or supratrochlear nodes; and ascends to
enter the lateral axillary nodes , which drain first
into the central axillary nodes and then into the
apical axillary nodes.
• Lateral group of lymphatic vessels
Accompanies the cephalic vein and drains into the
lateral axillary nodes and also into the
deltopectoral (infraclavicular) node, which then
drain into the apical nodes.
THE LYMPHATIC VESSELS OF THE UPPER
EXTREMITY
• The lymphatic vessels of the upper extremity are
divided into two sets, superficial and deep.
superficial lymphatic vessels
• commence in the lymphatic plexus which
everywhere pervades the skin;
• the meshes of the plexus are much finer in the palm
and on the flexor aspect of the digits than
elsewhere.
• The digital plexuses are drained by a pair of
vessels which run on the sides of each digit, and
incline backward to reach the dorsum of the hand.
• From the dense plexus of the palm, vessels pass in
different directions, viz., upward toward the wrist,
downward to join the digital vessels, medialward to
join the vessels on the ulnar border of the hand,
and lateralward to those on the thumb.
• Several vessels from the central part of the plexus
unite to form a trunk, which passes around the
metacarpal bone of the index finger to join the
vessels on the back of that digit and on the back of
the thumb.
• Running upward in front of and behind the wrist,
the lymphatic vessels are collected into radial,
median, and ulnar groups, which accompany
respectively the cephalic, median, and basilic veins
in the forearm.
• A few of the ulnar lymphatics end in the
supratrochlear glands, but the majority pass
directly to the lateral group of axillary glands.
• Some of the radial vessels are collected into a
trunk which ascends with the cephalic vein to the
deltoideopectoral glands; the efferents from this
group pass either to the subclavicular axillary
glands or to the inferior cervical glands.
DEEP LYMPHATIC VESSELS
• Accompany the deep bloodvessels.
• In the forearm, they consist of four sets,
corresponding with the radial, ulnar, volar, and
dorsal interosseous arteries.
• They communicate at intervals with the superficial
lymphatics, and some of them end in the glands
which are occasionally found beside the arteries.
• In their course upward, a few end in the glands
which lie upon the brachial artery; but most of
them pass to the lateral group of axillary glands.
THANK YOU