Radial nerve
Axilla: Saturday night palsy or using crutches- Loss of extension at elbow, wrist, and MP joints- Weakened supination- Sensory loss on posterior arm, forearm, and dorsum of thumb- "Wrist drop" Mid-shaft of humerus at radial groove or lateral elbow (lateral epicondyle or radial head dislocation:- Loss of forearm extensors of the wrist and MP joints- Weakened supination- Sensory loss on the posterior forearm and dorsum of thumb- "Wrist drop"Lesions of radial nerve distal to axilla, elbow extension is spared. Wrist: laceration- No motor loss- Sensory loss only on dorsal aspect of thumb (first dorsal web space)
Median nerve
Elbow: Supracondylar fracture of humerus- Weakened wrist flexion (with ulnar deviation)- Loss of pronation- Loss of digital flexion of lateral 3 digits resulting in the inability to make a complete fist, "hand of benediction"- Loss of thumb opposition (opponens pollicis muscle); sign is ape hand- Loss of first 2 lumbricals- Thenar atrophy- Sensory loss of palmar surface of the lateral hand and the palmar surfaces of the lateral 31/2 digitsA lesion of median nerve at elbow results in the "hand of benediction" and "ape hand." Wrist: carpal tunnel or laceration- Loss of thumb opposition (opponens pollicis muscle); sign is ape hand- Loss of first 2 lumbricals- Thenar atrophy- Sensory loss of the palmar surfaces of lateral 31/2 digits. Note sensory loss on lateral palm may be spared.Lesions of median nerve at the wrist present without benediction hand and with normal wrist flexion, digital flexion, and pronation.
Ulnar nerve
Elbow (medial epicondyle), wrist (lacerations), or fracture of hook of hamate- Loss of hypothenar muscles, 3rd and 4th lumbricals, all interossei and adductor pollicis- With elbow lesion there is a minimal weakening of wrist flexion with radial deviation- Loss of abduction and adduction of digits 2-5 (interossei muscles)- Weakened interphalangeal (IP) extension of digits 2-5- Loss of thumb adduction- Atrophy of hypothenar eminence- "Claw hand": note that clawing is greater with a wrist lesion- Sensory loss on medial 11/2 digits
Musculocutaneous nerve
- Loss of elbow flexion and weakness in supination - Loss of sensation on lateral aspect of the forearm
Axillary artery
- From the first rib to the posterior edge of the teres major muscle Branches:- Lateral thoracic artery – supplies mammary gland, runs with long thoracic nerve- Subscapular artery – collateral to shoulder with suprascapular branch of suclavian artery- Posterior humeral circumflex artery – at surgical neck with axillary nerve
Sensory innervation of the lower leg and foot
- The lateral leg and dorsum of the foot are supplied mainly by the superficial fibular nerve, with the exception of the first dorsal web space, which is supplied by the deep fibular nerve. - The sole of the foot is upplied by the lateral and medial plantar branches of the tibial nerve. - The sural nerve (a combination of both peroneal and tibial branches) supplies the posterior leg and lateral side of the foot. - The saphenous nerve (a branch of the femoral nerve) supplies the medial leg and medial foot.
Arterial supply of the leg
Femoral artery- Profunda femoris artery→ Medial circumflex femoral artery – supplies head of femur (avascular necrosis)→ Lateral circumflex femoral artery→ Perforating arteries - Popliteal artery→ Anterior tibial artery: courses with deep fibular nerve in anterior compartment of leg → Dorsalis pedis artery→ Posterior tibial artery: courses with tibial nerve in posterior compartment of leg and passes posterior to the medial malleolus
