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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