Ulnar Nerve and Palmar Nerves
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Questions and Answers

The ulnar nerve descends along the triceps to lie on the shaft of the humerus between the medial epicondyle and the coronoid process.

False (B)

The ulnar nerve supplies the flexor carpi ulnaris via nerve root C7 and the ulnar half of flexor digitorum profundus via C8 and T1.

True (A)

The palmar branch of the median nerve innervates the skin towards the center of the palm after perforating the flexor retinaculum distally.

False (B)

The palmar cutaneous branch of the ulnar nerve supplies skin over the thenar muscles.

<p>False (B)</p> Signup and view all the answers

The ulnar nerve's digital branches supply the ulnar one and a half fingers on their palmar surfaces, tips, and their ventral surfaces over the distal one and a half phalanges.

<p>False (B)</p> Signup and view all the answers

The dorsal cutaneous branch of the ulnar nerve provides sensory innervation to the dorsal skin of two and a half fingers, including the nail beds.

<p>False (B)</p> Signup and view all the answers

Grey rami communicantes transmit sensory information from the skin arterioles, sweat glands, and arrectores pilorum muscles to the central nervous system for processing.

<p>False (B)</p> Signup and view all the answers

The superficial branch of the ulnar nerve supplies the palmaris longus muscle and provides sensory innervation to the ulnar one and a half fingers, including their nail beds.

<p>False (B)</p> Signup and view all the answers

Periarterial sympathectomy is a surgical procedure that denervates an extended segment of the artery to treat distal vascular conditions.

<p>False (B)</p> Signup and view all the answers

The deep branch of the ulnar nerve passes between abductor and flexor digiti minimi, then between opponens digiti minimi, and supplies all three hypothenar muscles.

<p>True (A)</p> Signup and view all the answers

Preganglionic sympathetic fibers destined for the upper limb originate primarily from cell bodies located in the upper 6 thoracic segments of the spinal cord.

<p>True (A)</p> Signup and view all the answers

The flexor carpi ulnaris and the flexor digitorum superficialis are innervated by the ulnar nerve.

<p>False (B)</p> Signup and view all the answers

The lower subscapular nerve (C5, 6) innervates teres major.

<p>False (B)</p> Signup and view all the answers

Sympathetic fibers run along the digital arteries to reach an arteriole in a fingertip.

<p>False (B)</p> Signup and view all the answers

The thoracodorsal nerve is vulnerable during operations on the axillary lymph nodes.

<p>False (B)</p> Signup and view all the answers

The roots of the brachial plexus are situated in the posterior triangle of the neck.

<p>False (B)</p> Signup and view all the answers

The anterior branch of the axillary nerve supplies teres minor and winds around the posterior border of deltoid.

<p>False (B)</p> Signup and view all the answers

The posterior cutaneous nerve of the arm (C8, T1) passes back medial to the long head of biceps brachii and supplies a strip of skin along the extensor surface of the arm down to the elbow.

<p>False (B)</p> Signup and view all the answers

In a post-fixed brachial plexus, the plexus originates from the spinal nerve roots C6-T2.

<p>True (A)</p> Signup and view all the answers

The long thoracic nerve, which innervates the serratus anterior muscle, originates from nerve roots C5, C6, C7 and runs posterior to the midaxillary line.

<p>True (A)</p> Signup and view all the answers

The midcarpal joint, located within the carpus, is characterized by a Z-shaped synovial space that separates the proximal and distal rows of carpal bones.

<p>False (B)</p> Signup and view all the answers

The skin covering the shoulder region receives its nerve supply from the supraclavicular nerves, which originate from the cervical plexus.

<p>True (A)</p> Signup and view all the answers

The intercostobrachial nerve, originating from the lateral branch of the second intercostal nerve, consistently innervates the skin of the axillary floor and the medial surface of the arm extensively.

<p>False (B)</p> Signup and view all the answers

The lateral surface of the arm is innervated by the upper lateral cutaneous nerve, a branch of the radial nerve, and the lower lateral cutaneous nerve, a branch of the axillary nerve.

<p>False (B)</p> Signup and view all the answers

The posterior cutaneous nerve of the arm, a branch of the radial nerve, provides sensory innervation to a strip of skin located posteriorly over the biceps brachii muscle.

<p>False (B)</p> Signup and view all the answers

The medial cutaneous nerve of the forearm exclusively supplies the skin of the forearm and does not contribute to the innervation of the arm above the cubital fossa.

<p>False (B)</p> Signup and view all the answers

The medial and lateral cutaneous nerves of the forearm both originate from the medial cord of the brachial plexus and innervate the medial and lateral aspects of the forearm, respectively.

<p>False (B)</p> Signup and view all the answers

The posterior cutaneous nerve of the forearm, a branch of the radial nerve, provides sensory innervation to the posterior aspect of the forearm.

<p>True (A)</p> Signup and view all the answers

The lateral pectoral nerve, originating from the lateral cord, exclusively innervates the upper fibers of the pectoralis major muscle.

<p>False (B)</p> Signup and view all the answers

The musculocutaneous nerve transitions into the lateral cutaneous nerve of the forearm after emerging at the medial border of the biceps tendon.

<p>False (B)</p> Signup and view all the answers

Both the lateral and medial roots of the median nerve contain nerve fibers originating from spinal nerve roots C5, C6, and C7.

<p>False (B)</p> Signup and view all the answers

The medial pectoral nerve, arising from the medial cord, directly supplies the sternocostal fibers of pectoralis major before innervating pectoralis minor.

<p>False (B)</p> Signup and view all the answers

The median nerve in the forearm supplies flexor carpi ulnaris and flexor digitorum profundus muscles.

<p>False (B)</p> Signup and view all the answers

The palmar cutaneous branch of the median nerve passes through the carpal tunnel to supply sensation to the palm.

<p>False (B)</p> Signup and view all the answers

The recurrent branch of the median nerve, originating from the medial branch in the hand, innervates the thenar muscles.

<p>False (B)</p> Signup and view all the answers

The medial cutaneous nerve of the arm is a large and consistently present nerve that extends to the elbow.

<p>False (B)</p> Signup and view all the answers

The medial cutaneous nerve of the forearm and the lateral cutaneous nerve of the forearm have overlapping territories of sensory innervation.

<p>False (B)</p> Signup and view all the answers

The ulnar nerve consistently picks up C7 fibers from the medial cord to innervate flexor carpi ulnaris.

<p>False (B)</p> Signup and view all the answers

The second branch to the medial head of the triceps brachii muscle, also known as the ulnar collateral nerve, innervates the anconeus muscle after passing deep to the triceps.

<p>False (B)</p> Signup and view all the answers

The lower lateral cutaneous nerve of the arm (C5) emerges from the radial nerve prior to the radial nerve's passage through the lateral intermuscular septum, and it provides sensory innervation to the skin of the lateral arm extending inferiorly to the wrist.

<p>False (B)</p> Signup and view all the answers

In the flexor compartment of the forearm, the radial nerve's main trunk, situated between the brachialis and brachioradialis muscles, gives off a primary motor branch to the brachialis muscle.

<p>False (B)</p> Signup and view all the answers

The posterior interosseous nerve, after branching off at the elbow, initially provides motor innervation to the extensor carpi radialis longus and supinator muscles within the cubital fossa.

<p>False (B)</p> Signup and view all the answers

Within the extensor compartment of the forearm, the posterior interosseous nerve provides motor innervation to a total of ten muscles, including the extensor digitorum, extensor carpi ulnaris, and all three thenar muscles.

<p>False (B)</p> Signup and view all the answers

Flashcards

Midcarpal Joint

An S-shaped joint that creates a continuous synovial space between rows of carpal bones.

Supraclavicular Nerves

Supplies skin over the shoulder.

Intercostobrachial Nerve

Supplies the floor of the axilla and part of the medial arm.

Upper and Lower Lateral Cutaneous Nerves

Supplies the lateral surface of the arm.

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Posterior Cutaneous Nerve of Arm

Supplies skin on the posterior arm.

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Medial Cutaneous Nerve of Arm & Intercostobrachial Nerve

Supply the medial & anterior surfaces of the arm.

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Posterior Cutaneous Nerve of Forearm

Supplies skin on the posterior forearm.

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Medial and Lateral Cutaneous Nerves of Forearm

Supply the medial and lateral sides of the forearm.

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Lower lateral cutaneous nerve

A branch of the radial nerve that supplies skin over the lateral surface of the arm down to the elbow.

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Posterior cutaneous nerve of the forearm

A branch of the radial nerve that supplies a strip of skin over the extensor surface of the forearm as far as the wrist.

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Main trunk of the radial nerve (in forearm)

Supplies brachioradialis & extensor carpi radialis longus; gives off the posterior interosseous branch; continues as the terminal cutaneous branch.

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Posterior interosseous nerve

Supplies extensor carpi radialis brevis and supinator in the cubital fossa, then enters the extensor compartment of the forearm. Supplies seven more muscles in the extensor compartment

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Muscles supplied by posterior interosseous nerve

Extensor digitorum, Extensor digiti minimi, extensor carpi ulnaris, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus and extensor indicis.

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Musculocutaneous nerve

Supplies the flexor compartment of the upper arm.

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Radial nerve

Innervates the extensor compartment of the upper arm.

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Median nerve (forearm)

Primarily innervates the flexor compartment of the forearm.

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Ulnar nerve (forearm)

Innervates the flexor carpi ulnaris and half of the flexor digitorum profundus.

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Ulnar nerve (hand)

Primarily innervates the intrinsic muscles of the hand.

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Median nerve (hand)

Innervates the three muscles of the thenar eminence and the radial two lumbricals.

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Grey ramus communicans

Each root of the brachial plexus joins these, carrying sympathetic fibers.

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Roots of brachial plexus

Anterior rami of C5-T1 nerves.

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Dorsal scapular nerve

Runs deep to levator scapulae and rhomboids, supplying all three muscles.

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Lateral Pectoral Nerve Function

Supplies the upper fibers of the pectoralis major muscle.

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Musculocutaneous Nerve Function

Innervates flexor muscles in the arm (coracobrachialis, biceps brachii, brachialis) and provides cutaneous sensation to the lateral forearm.

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Lateral Root of Median Nerve

Combines with the medial root to form the median nerve, contributing fibers from C5, C6, and C7.

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Medial Pectoral Nerve function

Sends a branch to pectoralis minor and supplies the lower fibers of pectoralis major.

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Medial Root of Median Nerve

Joins the lateral root to form the median nerve, carrying fibers from C8 and T1.

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Median Nerve Function

Innervates most forearm flexors, thenar muscles, the radial 3.5 digits (flexor side and nail beds), and the corresponding palm area.

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Anterior Interosseous Nerve

Arises from the median nerve in the cubital fossa and innervates the deep flexor compartment of the forearm.

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Palmar Cutaneous Branch of Median Nerve

Branches off the median nerve and supplies the thumb side of the palm.

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Recurrent Branch of Median Nerve

Arises from the lateral branch of the median nerve in the hand and supplies the three thenar muscles.

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Medial Cutaneous Nerve of Forearm Function

Supplies skin along the ulnar border of the forearm down to the wrist.

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Ulnar Nerve Forearm Supply

The ulnar nerve supplies flexor carpi ulnaris and the ulnar half of flexor digitorum profundus in the forearm.

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Ulnar Nerve Palmar Cutaneous Branch

The palmar cutaneous branch of the ulnar nerve supplies sensation to the skin over the hypothenar muscles.

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Ulnar Nerve Dorsal Cutaneous Branch

The dorsal cutaneous branch supplies the dorsal skin of one and a half fingers (sometimes two and a half) on the ulnar side, falling short of the nail beds.

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Ulnar Nerve Superficial Branch

The superficial branch supplies palmaris brevis and the ulnar one and a half fingers, including their nail beds.

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Ulnar Nerve Deep Branch

The deep branch supplies the hypothenar muscles, the two ulnar lumbricals, all interossei, and adductor pollicis.

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Subscapular Nerves

The upper and lower subscapular nerves (C5, 6) supply the subscapularis, with the lower also innervating teres major.

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Thoracodorsal Nerve

The thoracodorsal nerve (C6, 7, 8) supplies the latissimus dorsi.

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Axillary Nerve

The axillary nerve (C5, 6) supplies the deltoid, teres minor, the shoulder joint, and skin over the joint.

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Radial Nerve Function

The radial nerve (C5-T1) is the nerve of the extensor compartments of the arm and forearm, supplying skin over them and on the dorsum of the hand.

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Posterior Cutaneous Nerve of the Arm

The posterior cutaneous nerve of the arm (C8, T1) supplies a strip of skin along the extensor surface of the arm down to the elbow.

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Study Notes

Summary of Upper Limb Innervation

Cutaneous Innervation

  • The skin over the shoulder is supplied by the supraclavicular nerves (C4) from the cervical plexus.
  • The floor of the axilla and a variable area of the medial surface of the arm are supplied by the lateral branch of the second intercostal nerve, the intercostobrachial nerve.
  • The lateral surface of the arm is supplied by the upper lateral cutaneous and the lower lateral cutaneous nerves, branches of the axillary and radial nerves respectively.
  • A strip of skin posteriorly over the triceps is supplied by the posterior cutaneous nerve of the arm, a branch of the radial nerve.
  • The intercostobrachial nerve and the medial cutaneous nerve of the arm supply the medial and anterior surfaces of the arm.
  • The medial cutaneous nerve of the forearm supplies some skin of the arm just above the cubital fossa.
  • A strip of skin posteriorly in the forearm is supplied by the posterior cutaneous nerve of the forearm, a branch of the radial nerve.
  • The medial and lateral sides of the forearm are supplied by the medial and lateral cutaneous nerves of the forearm (from medial cord of the brachial plexus and musculocutaneous nerves respectively).
  • The palm of the hand is supplied on the ulnar side by the superficial branches of the ulnar nerve.
  • The skin towards the centre of the palm is innervated by the palmar branch of the median nerve.
  • The palmar surfaces of the fingers and thumb are supplied by digital branches of the ulnar and median nerves.
  • The ulnar digital branches supply the ulnar one and a half fingers on their palmar surfaces, tips, and dorsal surfaces over the distal one and a half phalanges.
  • The median nerve supplies the radial three and a half digits on their palmar surfaces, tips, and dorsal surfaces over the distal one and a half phalanges via its digital branches.
  • The dorsal surface of the hand is supplied on the ulnar side (one and a half fingers) by the dorsal branch of the ulnar nerve.
  • The radial three and a half digits and the web of the thumb are supplied by the terminal cutaneous branches of the radial nerve.

Sympathetic Innervation

  • Each dermatome of the upper limb is supplied via the cutaneous nerves by hitch-hiking grey fibres from cell bodies in the appropriate sympathetic ganglion.
  • Dermatomes C5 and 6 receive fibres from cell bodies in the middle cervical ganglion.
  • Dermatomes C7 and 8 receive fibres from the inferior cervical ganglion and Tl from the first thoracic, or stellate, ganglion.
  • In the skin, the grey rami innervate arterioles, sweat glands, and the arrectores pilorum muscles.
  • The deep sympathetic supply to the limb is by a series of grey fibers that join the main artery from adjacent nerves, forming a periarterial plexus.
  • The preganglionic fibres for the upper limb come mostly from cell bodies in the upper six thoracic segments of the spinal cord.

Muscular Innervation

  • In the upper arm, the flexor compartment is supplied by the musculocutaneous nerve and the extensor compartment by the radial nerve.
  • The flexor compartment of the forearm is supplied chiefly by the median nerve, except for the flexor carpi ulnaris and half of flexor digitorum profundus, which are supplied by the ulnar nerve.
  • The extensor compartment of the forearm is supplied by the radial nerve or its motor branch, the posterior interosseous nerve.
  • The intrinsic muscles of the hand are supplied chiefly by the ulnar nerve, with the median nerve supplying only the three muscles of the thenar eminence and the radial two lumbricals.

Brachial Plexus

  • The roots of the plexus (anterior rami of C5-T1 nerves) lie between the scalene muscles.
  • The trunks are in the posterior triangle.
  • The divisions are behind the clavicle.
  • The cords are arranged around the second part of the axillary artery.
  • About 10% of plexuses are pre-fixed (from C4-C8), and 10% post-fixed (C6-T2).

Branches of the Roots

  • C5: Dorsal scapular nerve.
  • C5, 6: Nerve to subclavius.
  • C5, 6, 7: Long thoracic nerve.
  • The dorsal scapular nerve (C5) runs deep to levator scapulae and the two rhomboids, supplying all three muscles.
  • The nerve to subclavius (C5, 6) passes over the trunks of the plexus and in front of the subclavian vein.
  • The long thoracic nerve (C5, 6, 7) forms on the first digitation of the serratus anterior muscle and runs vertically downwards just behind the midaxillary line.

Branch of the Upper Trunk

  • The suprascapular nerve (C5, 6) passes beneath the transverse scapular ligament and supplies supraspinatus, infraspinatus, and the posterior part of the capsule of the shoulder joint.

Branches of the Lateral Cord

  • C5, 6, 7: Lateral pectoral nerve.
  • C5, 6, 7: Musculocutaneous nerve.
  • C5, 6, 7: Lateral root of median nerve.
  • The lateral pectoral nerve (C5, 6, 7) passes through the clavipectoral fascia and supplies the upper fibres of pectoralis major.
  • The musculocutaneous nerve (C5, 6, 7) supplies coracobrachialis, biceps, and brachialis.
  • The lateral root of the median nerve (C5, 6, 7) joins the medial root to form the median nerve.

Branches of the Medial Cord

  • C8, T1: Medial pectoral nerve.
  • C8, T1: Medial root of median nerve.
  • C8, T1: Medial cutaneous nerve of arm.
  • C8, T1: Medial cutaneous nerve of forearm.
  • C7, 8, T1: Ulnar nerve.
  • The medial pectoral nerve (C8, T1) gives a branch to pectoralis minor and then pierces it to supply the lower fibres of pectoralis major.
  • The medial root of the median nerve (C8, T1) crosses the axillary artery to join the lateral root and form the median nerve (C5-T1).
  • The median nerve (C5, 6, 7, 8, T1) supplies most of the flexor muscles of the forearm, the three thenar muscles, and two lumbricals in the hand.
  • The medial cutaneous nerve of the arm (C8, T1) supplies skin medial to the anterior axial line but fails to reach the elbow.
  • The medial cutaneous nerve of the forearm (C8, T1) supplies the lower part of the arm above the elbow and then divides into anterior and posterior branches to supply the skin along the ulnar border of the forearm down to the wrist.
  • The ulnar nerve (C7, 8, T1) supplies some flexor muscles on the ulnar side of the forearm and the skin of the ulnar one and a half digits.

Branches of the Posterior Cord

  • C5, 6: Upper subscapular nerve.
  • C6, 7, 8: Thoracodorsal nerve.
  • C5, 6: Lower subscapular nerve.
  • C5, 6: Axillary nerve.
  • C5, 6, 7, 8, T1: Radial nerve.
  • The upper and lower subscapular nerves (C5, 6) supply subscapularis, with the lower nerve also innervating teres minor.
  • The thoracodorsal nerve (C6, 7, 8) supplies latissimus dorsi.
  • The axillary nerve (C5, 6) supplies deltoid, teres minor, the shoulder joint, and skin over the joint.
  • The radial nerve (C5, 6, 7, 8, T1) supplies the extensor compartments of the arm and forearm, and skin over them and on the dorsum of the hand.

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Description

The ulnar nerve descends along the triceps to lie on the humerus. The palmar branch of the median nerve innervates the skin of the palm. The ulnar nerve's digital branches supply the ulnar fingers on their palmar and ventral surfaces.

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