Venous &lymphatic drainage of upper limb Dr.N.Mugunthan
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This document summarizes the anatomy of the veins and lymphatics of the upper limb. It describes the superficial and deep veins, including the cephalic, basilic, median cubital and median veins. It also outlines the superficial and deep lymphatic vessels that drain to axillary lymph nodes. Key applications are discussed, such as using the median cubital vein for IV access due to its protection by surrounding structures. Inflammations of veins and lymph vessels along with lymphadenitis are also mentioned.
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Venous &lymphatic drainage of upper limb Dr.N.Mugunthan
- 2. LEARNING OBJECTIVES Veins of upper limb 1. Superficial veins 2. Deep veins Lymphatic's of upper limb 1. Superficial Lymphatic's 2. Deep lymphatic's Applied anatomy ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 3. VEINS OF UPPER LIMB 1. Superficial veins 2. Deep veins Superficial veins: • Run away from pressure points • Absent in palm, ulnar border of forearm , back of arm & over trapezius • Utilized for intravenous injections ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 4. SUPERFICIAL VEINS a) Dorsal venous arch b) Cephalic vein (preaxial) c) Basilic vein (postaxial) d) Median cubital vein e) Median vein of forearm ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 5. DORSAL VENOUS ARCH • Lies on the dorsum of hand • Tributaries: • 3 dorsal metacarpal veins • 1 Dorsal digital vein – medial side of little finger • 1Dorsal digital vein –radial side of index finger • 2Dorsal digital vein – from thumb • Veins from palm – around the margins of hand & perforating through interosseous space. 1. Basilic vein (begin) 2. Cephalic vein (begin) 3. Dorsal venous arch ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 6. • From its medial end – gives origin to basil vein • From its lateral end – gives origin to cephalic vein DORSAL VENOUS ARCH cont… ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 7. CEPHALIC VEIN (PRE AXIAL VEIN) • Begins at lateral end of dorsal venous arch Course: • Roof of anatomical snuff box • Crosses lat.border of forearm • Front of elbow (lat.border of biceps) • Pierces deep fascia (lower border of pect.major) • Deltopectoral groove • Pierces clavipectoral fascia • Termination -Joins the axillary vein ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 8. • Accompanied by lateral cutaneous nerve of forearm • Terminal part of radial nerve • At elbow connected with basilic vein through median cubital vein CEPHALIC VEIN cont…. ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 9. BASILIC VEIN (POSTAXIAL) • Begins at the medial end of dorsal venous arch • Course: • Back of forearm (ulnar border) • Crosses the ulnar border at elbow • Front of elbow (medial to biceps) • Middle of arm –pierces deep fascia • Runs along medial side of brachial artery • (Termination)Continuous as axiallry vein at lower border of teres major ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 10. • Accompanied by medial cutaneous nerve of forearm (post.branch) • Terminal part of dorsal branch of ulnar nerve • At front of elbow joined by median cubital vein BASILIC VEIN cont…. ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 11. MEDIAN CUBITAL VEIN • Large communicating vein • Connecting cephalic vein with basilic vein • Shunts blood from cephalic vein to basilic vein • Situation: • Front of elbow ( roof of cubital fossa) ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 12. • Begins –from cephalic vein 2.5 cm below the elbow • Course: runs obliquely upward & medially • Ends in basilic vein 2.5cm above the medial epicondyle • Separated from brachial artery by bicipital aponeurosis (Lacertus fibrosis – God’s Grace) MEDIAN CUBITAL VEIN cont… ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 13. • Tributaries: • Median vein of forearm • Connected to deep through perforator vein which pierces bicipital aponeurosis • Perforator vein fixes the median cubital vein – (ideal site for IV injections) MEDIAN CUBITAL VEIN cont… ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 14. MEDIAN VEIN OF FOREARM • Begins – palmar venous network • Ends – in median cubital vein or basilic or cephalic vein • It may divide into median cephalic & median basilic vein (absence of median cubital vein) • Median cephalic vein joins with cephalic vein & median basilic vein joins with basilic vein ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 15. DEEP VEINS • Radial & ulnar veins (venae comitantes) • Brachial vein • Axillary vein ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 16. • Radial & ulnar veins (venae comitantes) • Accompanying the radial & ulnar artery • At elbow unite to form brachial vein • Brachial vein • Accompanying brachial artery DEEP VEINS cont… ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 17. • Brachial vein joins with basilic vein at lower border of teres major to form axillary vein • Axillary vein • Accompanying axillary artery • Receives cephalic vein (tributaries) DEEP VEINS cont… ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 18. LYMPHATIC DRAINAGE OF UPPER LIMB 1. Lymphatic vessels 2. Lymph nodes ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 19. LYMPHATIC VESSELS 1. Superficial lymphatics 2. Deep lymphatics ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 20. SUPERFICIAL LYMPHATICS • Collect lymph from skin & subcutaneous tissues • Mostly drain into axillary nodes • Few drain into • Supratrochlear nodes (from medial side of forearm) • Deltopectoral or infraclavicular nodes (from lateral side of forearm) • Vertical area of lymphshed in middle of back of forearm & arm ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 21. DEEP LYMPHATICS • Drain structures lying deep to deep fascia • Less numerous • Run along the ulnar,radial , brachial & axillary vessels • Drain into axillary nodes ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 22. LYMPH NODES • Present along the course of lymph vessels • Arranged in groups • Small bean like structure • Normally not palpable • Enlarged & painful in infection (lymphadinitis) or malignancy ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 23. AXILLARY LYMPH NODES Arranged in 5 groups: 1. Anterior or pectoral group 2. Posterior or scapular group 3. Lateral group 4. Central group 5. Apical group ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 24. • Anterior or pectoral group: • Lies along lateral thoracic vessels • Direct contact with axillary tail of breast • Receives lymph from major part of breast & upper half of ant.wall of trunk AXILLARY LYMPH NODES cont…. ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 25. • Posterior or scapular group: • Lies along subscapular vessels • Receives lymph from post.wall of upper half of trunk & • Axillary tail of breast AXILLARY LYMPH NODES cont…. ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 26. Lateral group: • Lies along axillary vein (lower part) • Receives lymph from upper limb AXILLARY LYMPH NODES cont…. ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 27. Central group: • Lies in the upper axilla • Receives lymph from anterior,posterior & lateral group of nodes • Drains into apical group AXILLARY LYMPH NODES cont…. ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 28. Apical group: • Lies along axillary vessel (upper part) & deep to clavipectoral fascia • Receives lymph from central group, upper part of breast & from thumb AXILLARY LYMPH NODES cont…. ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 29. APPLIED ANATOMY • Median cubital vein: • Ideal site for IV access – for withdrawal of blood, injecting drugs & cardiac catheterization ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 30. • Median cubital vein -Ideal site for IV access Reason: 1. Bicipital aponeurosis separating it from brachial artery 2. Not accompanied by cutaneous nerves 3. Perforating veins piercing bicipital aponeurosis fixes the vein and prevent from slip away during piercing APPLIED ANATOMY cont… ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 31. • Thrombophlebitis: inflammation of vein • Venography : contrast x-ray (angiography) of upper limb vein APPLIED ANATOMY cont… ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 32. • Lymphangitis: • Inflammation of lymph vessels • Lymphadenitis: • Inflammation of lymph node • Enlarged node is painful & • Firm in consistency APPLIED ANATOMY cont… ©Dr.N.Mugunthan ©Dr.N.Mugunthan
- 33. SUMMARY Veins of upper limb 1. Superficial veins 2. Deep veins Lymphatic's of upper limb 1. Superficial Lymphatic's 2. Deep lymphatic's Applied anatomy ©Dr.N.Mugunthan ©Dr.N.Mugunthan
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