Venous drainage and Lymphatics of the upper limb

Venous drainage and Lymphatics of the upper limb Dr. Qudusia sultana

What is this?

The veins of upper limb n They are divided into two sets, n superficial and n deep n which anastomose freely with each other.

n The superficial veins of upper limb n placed immediately under the skin, in the superficial fascia. n They are the cephalic, basilic and median cubital veins, and their tributaries.

Dorsal venous arch n It is seen on the back of the hand. n Formed by the union of three dorsal metacarpal veins. Which inreturn formed by the union of dorsal digital veins.

Cephalic vein n The cephalic vein begins in the radial part of the dorsal venous arch of hand n winds upwards round the radial border of the forearm to its anterior surface; n it then ascends subcutaneously along the lateral side of the forearm and arm to the upper one -third of the arm

n It lies in the groove between the pectoralis major and deltoid n It pierces the deep fascia to end in the axillary vein or subclavian vein.

Applied anatomy n Internal arterio- venous fistulas for haemodialysis in chronic renal failure between cephalic vein and Radial artery.

Basilic vein n The basilic vein begins in the ulnar part of the dorsal venous arch of the hand. n It runs up for some distance on the posterior surface of the ulnar side of the forearm. n Inclines forwards to the anterior surface below the elbow

Basilic vein n It then ascends medial to biceps n perforates the deep fascia a little below the middle of the arm to end in the brachial vein.

n The basilic vein is used for cardiac catheterization.

Median cubital vein n The median cubital vein is given off from the cephalic vein about 2. 5 cms below and front of the elbow , and passes medially to join the basilic vein about 2. 5 cms above the elbow. n Receives tributaries from forearm.

n Significance: n Blood sampling n Blood transfusion n Intravenous injection in general, are often performed at the bend of the elbow( the median cubital vein). n Cardiac catheterization

Deep veins of the upper limb n Follow the course of arteries. n Arranged in pairs on either side of the artery and are called as venae commitants

Lymph nodes of upper limb

Introduction n Lymphatics n Lymph nodes n Applied anatomy

General n Lymphatic Vessels n Lymph nodes. n Bean Shaped. n Not palpable normally n Palpable in case of infection.

Lymphatics n Superficial Lymphatics: Collect lymph from skin and subcutaneous tissue. n Drain into axillary nodes n Medial three fingers, medial side of the arm and forearm –along the basilic veinsupratrohlear lymphnodes n Index and thumb finger, Lateral side of the arm and forearm – along the cephalic vein-deltopectoral or infraclavicular nodes. n

Lymphatics n Deep Lymphatics n Follow the arteries n Less numerous. n Drains structures deeper to deep fascia. n End in the axillary nodes.

Lymph nodes n Axillary Lymph Node (Pectoralis group). n Scattered in the fibro-fatty tissue of the axilla.

Lymph nodes Five groups: n Anterior Group: n Along the lateral thoracic vessels. (lower border of the pectoralis minor). n Recieves lymph from the upper half of the anterior wall of the trunk and from the major part of the

Lymph nodes n Posterior Group (Scapular group). n Along the subscapular vessels, on the posterior fold of the axilla. n Receive lymph from the posterior wall of the trunk upto the iliac crest.

Lymph nodes n Lateral Group: Along the upper part of the humerus, medial to the axillary vein. n Receive lymph from the upper limb. n

Lymph nodes n Central group: Fat of the base of axilla. n Recieves lymph from other groups and drains into the apical group. n

n Intercosto brachial nerve passes through the central nodes. n If enlarged due to ca breast –compresses the nerve –referred pain along the medial side of arm.

Lymph nodes n Apical group / Infraclavicular: n Lie deep to the clavipectoral fascia along the axillary vessels. n Receive lymph from the central group, n Lmphatics along the cephalic vein, n upper part of the breast, thumb and its web. n Drains into subclavian

Lymph nodes n Deltopectoral nodes: n Lies in the deltopectoral groove along the cephalic vein. n Superficial cubital / supratrochlear nodes. n Lie above the medial epicondyle. n Drains the ulnar side of the hand forearm.

Lymph nodes n Deep lymph nodes: 1. 2. 3. Medial side of the brachial artery. At the bifurcation of the brachial artery. Occasionally along the artery of the forearm.

Applied Anatomy n Lymphangitis. n Lymphadenitis. n Lymphedema. n Supratrochlear lymphnodes are enlarged in Syphilis.

Grouping according to the location of Pectoralis minor

Rotter’s nodes