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It consequently passes over the scaphoid and trapezium • Third part (lateral to pectoralis minor)agives off the subscapular in the snuffbox and exits by passing between the two heads of artery which follows the lateral border of the scapula and gives off adductor pollicis to enter the palm and forms the deep palmar arch the circumflex scapular artery discount tadapox 80mg with visa erectile dysfunction natural remedy. It gives off the princeps pollicis to the thumb and the radialis indicis The brachial artery to the index finger cheap 80mg tadapox diabetic with erectile dysfunction icd 9 code. The brachial artery is crossed superficially by the median nerve in the mid- The ulnar artery arm from lateral to medial and hence lies between the median nerve • Course: the ulnar artery commences as the terminal bifurcation of (medial relation) and biceps tendon (lateral relation) in the cubital fossa the brachial artery at the level of the neck of the radius. At the wrist both the ulnar artery and nerve lie lateral (radial) to • Other branchesainclude a nutrient artery to the humerus and flexor carpi ulnaris and pass over the flexor retinaculum giving carpal superior and inferior ulnar collateral branches which ultimately branches which contribute to the dorsal and palmar carpal arches. The reduced arterial flow results in ischaemic necro- is completed by the superficial palmar branch of the radial artery. The common interosseous artery is the first ulnar branch to arise and it subdivides into the: The radial artery • Anterior interosseous artery: descends with the interosseous branch • Course: the radial artery arises at the level of the neck of the radius of the median nerve on the anterior surface of the interosseous from the bifurcation of the brachial artery. It predominantly supplies the flexor compartment of the don to lie firstly on supinator then descends on the radial side of the forearm. The radial artery passes sequentially runs with the deep branch of the radial nerve supplying the extensor over supinator, pronator teres, the radial head of flexor digitorum muscles of the forearm, eventually anastomosing with the anterior superficialis, flexor pollicis longus and pronator quadratus. They drain lymph from the ulnar side of the forearm As in the lower limb the venous drainage comprises interconnected and hand. From lateral, then anterolateral, aspects of the forearm and arm and this point the efferent vessels pass through the clavipectoral fascia to finally courses in the deltopectoral groove to pierce the clavipec- drain into the apical group of axillary nodes and thence centrally. If a patient • The basilic vein commences from the medial end of the dorsal presents with an infected insect bite of the thumb, the infraclavicular venous network. If, however, infection occurred on the aspects of the forearm and arm to pierce the deep fascia (in the patient’s little finger, lymphadenopathy of the supratrochlear nodes region of the mid-arm) to join with the venae comitantes of the would result. The breasts are present in both sexes and have similar characteristics • The deep veins: consist of venae comitantes (veins which accom- until puberty when, in the female, they enlarge and develop the capac- pany arteries). The breasts are essentially specialized skin The superficial veins of the upper limb are of extreme clinical import- glands comprising fat, glandular and connective tissue. It extends monly used sites are the median cubital vein in the antecubital fossa and from the 2nd to 6th ribs anteriorly and from the lateral edge of the ster- the cephalic vein in the forearm. A part of the breast, the axillary tail, extends laterally through the deep fascia beneath pectoralis to enter Lymphatic drainage of the chest wall and the axilla. The lobes are separated by fibrous Lymph from the chest wall and upper limb drains centrally via axillary, septa (suspensory ligaments) which pass from the deep fascia to the supratrochlear and infraclavicular lymph nodes. In its terminal por- Axillary lymph node groups tion the duct is dilated (lactiferous sinus) and thence continues to the There are approximately 30–50 lymph nodes in the axilla. Its surface is usually irregular due to • Anterior (pectoral) group: these lie along the anterior part of the multiple small tuberclesaMontgomery’s glands. They receive lymph from the upper anterior • Blood supply: is from the perforating branches of the internal part of the trunk wall and breast. From here lymph is passed to The axillary lymph nodes represent an early site of metastasis from prim- the thoracic duct (on the left) or right lymphatic trunks (see Fig. Damage to axillary lymphatics during surgical clearance of axillary nodes or resulting from radio- Lymph node groups in the arm therapy to the axilla increases the likelihood of subsequent upper limb • The supratrochlear group of nodes lie subcutaneously above the lymphoedema. The venous and lymphatic drainage of the upper limb and the breast 69 30 Nerves of the upper limb I Fig. Here it supplies the skin of the lateral forearm as far as the • Course: it passes through the quadrangular space with the posterior wrist. It provides: a motor supply to deltoid and teres minor; a sensory supply to the skin overlying deltoid; and an articu- The median nerve (C6,7,8,T1) (Fig. A short between the long and medial heads of triceps into the posterior com- distance above the wrist it emerges from the lateral side of flexor partment and down between the medial and lateral heads of triceps. It ter- eminence (but not adductor pollicis); the branches to the 1st and 2nd minates by dividing into two major nerves: lumbricals; and the cutaneous supply to the palmar skin of the thumb, • The posterior interosseous nerveapasses between the two heads index, middle and lateral half of the ring fingers. It winds under the medial epicondyle and passes between the two heads of Infraclavicular branches flexor carpi ulnaris to enter the forearm and supplies flexor cari ulnaris • Medial and lateral pectoral nerves: supply pectoralis major and and half of flexor digitorum profundus. Erb–Duchenne paralysis • The deep terminal branchasupplies the hypothenar muscles as Excessive downward traction on the upper limb during birth can result well as two lumbricals, the interossei and adductor pollicis.

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