Effects of X-Rays

X-Rays produce high energy, high speed electrons when interacting with matter

1. Heat, Excitation and Ionization
1. Since the kinetic energy of the atom is the manifestation of its temperature, the slowing down of the photo-electron is associated with the generation of heat.
2. Excited atoms radiate light, or ultraviolet light
3. Chemical changes induced by ejecting electrons
4. Recombination of positive electron and electron - and the emission of characteristic radiation
5. Materials of high atomic numbers - Bremsstrahling production - 
2. 
   

Pregnancy and Medical Radiation

MR Angiography

       
MR Angiography

1. diagnosis of stenosis of carotid bifurcations and intra-cranial aneurysms.
2. suspected venous thrombosis of the chest, abdomen and pelvis
3. pre-surgical workup of carotid endarterectomy or liver transplantation

Problems

1. exaggerated artefacts
2. inferior spacial resolution

Lymphatic System, Radiological Anatomy Notes

Lymphatic System, Radiological Anatomy Notes

CT:

• Advantage
• non-invasive
• minimal expertise
• easily reproducible for follow up
• can image all intra-abdominal lymph nodes and extranodal disease
•  
• Disadvantage
• Expensive
• cant detect disease in normal sized vessels
• cant detect vessel abnormalities or internal structure of lymph nodes
• not seen retroperitonial fat 

US

• Advantage
• non-invasive
• can image extranodal disease
• Disadvantage
• Operator dependent
• bowel gas
• Internal structure of lymph node not seen
• Lymph node must be greater than 1,5cm to be seen

MRI

• Advantage
• Not specifically used to study the lymphatic system
• Lymph nodes are well seen on MRI if pathological and enlarged
• Tumour invasion and inflammatory changes - High T2 signal
• Multiplanar - ability allows for accurate anatomical localisation
• useful to characterise extent of tumour

CONSENSUS: PERFORM CT AT OUTSET - REVERSE LYPHOGRAPHY IS A SECOND LINE WHERE CT IS EQUIVOCAL OR NON-DIAGNOSTIC QUALITY


Imaging:

• Plain films
• Lymphangiography 
• 
• Indications 
• Suspect lymph vessel disease (lymphoedema) usually technically very difficult
• Diseases effecting lymph nodes
• Lymphomas and cancer that metastasis to retroperitoneum - ie cancer of the bladder and gonads
• occult lymphoma associated with skin disorders
• Mycosis fungoides, exfoliative dermatitis
• Miscellaneous
• Chyluria, chylothorax, lymphoceel, filiarisis
• Contraindications
• Pulmonary disease and poor lung function. 
• pulmonary reaction to oily contrast media, risk of pulmonary emboli
• Cardiovascular disease - IHD, CCF, and Right to Left Shunt
• Radiotherapy to the lungs within 2 weeks 
• dilatation of pulmonary capillaries and risk of paradox Pulmonary Emboli
• Proposed GA
• risk of GA is increased post lymphangiogram
• Known hypersensitivity 
• Sepsis and gross edema 
• Contrast Media:
• Oily
• is the best contrast media - opacifies the nodes and vessels. Stays in Lymph nodes for months or years
• H2O Soluble
• opacifies only vessels - diffuse quickly into blood at 1st lymph node - only used for proximal afferent vessels.
• Patient preperation
• Sedation especially for children
• if legs - elevate for 24 hours preprocedure
• fasting patient and empty bladder
• preliminary films - 
• PA chest evaluation
• Heart disorders - control abdominal xray
• Technique for Bipedal Lymphography
• Principle: a diffusible dye is injected subcutaneously so that it can be taken up by Lymph Vessels and colour them - and able to cannulate
•  method used where there is a lymphatic drainage system, but vast majority - 
• feet
• hands - to a lesser extent

1. Outlining of Lymphatics: Patient supine on Xray table, skin prep with hibitane. Patent blue dye mixed with local anaesthetic is injected interdigitally. Patient walks for 20 to 30 minutes and dye layden lymph vessels will be recognised as green vessels through the skin.
2. Cannulation: small incision.
1.  Lymphatic vessel is prepared and cannulated with a 26G needle borded to a polyethene cannula which is connected to a syringe and filled with saline. The best test for proper positioning is however, injection of contrast. Patient feels pain in the limb, usually mild, and eventual leaking of contrast can be demonstrated. 
2.  
3. Injection of contrast:
1. usual dose of Lipoidol is 7 to 8 ml / foot
4. Close incision
5. Take Radiographs:
1. Lymphatic phase
1. AP pelvis
2. Abdominal AP lat and oblique
3. PA chest
1. wait gently for 10 minutes them penetrate view to show thoracic duct
2. nodal phase
1. after 24 hours
2. some people do IV Pat same time
3. delayed phase - can asses response to treatment
1. Supine abdominal
2. AP pelvis
6. Complications:
1. D/T patent blue - 
1. allergy is rare
2. patient urine will be blue green for 24 hours
2. D/T oily contrast media
1. allergic reaction is rare
2. pain during injection
3. pulmonary air embolism
1. minute high density opacities can be detected
2. usually asymptomatic but fever and cough
4. lymphangitis
5. paradoxal embolus
6. hepatic emboli
1. lymph obstruction
3. D/T technique
1. extravasation 
2. lymphatic rapture
3. wound sepsis
7. Findings
1. Normal Lymphatic Vessels
1. delicate linear channels < 1mm with beaded appearance above small valves that prevent retrograde flow
2. ascend in straight lines without tortuousity
3. tend to divide and rejoin
4. efferent vessels leave via hilium of node - larger and fewer then afferent and more beaded
2. Normal Lymph Nodes
1. typically ovoid and 1,5 cm to 2 cm 
2. each node is outlined by its marginal sinus
3. closely packed punctate pattern of contrast and contain defects d/t lymphoid follicles in the node(characterized by dots or points)
3. The Thoracic duct
1. Extends from the Cisterna Chyli and runs through the aortic hiatus and in thorax lies between aorta and azygos vein
2.  http://radiographics.rsna.org/content/24/3/809/F1.expansion
3. Joins junction of Left subclavian and Left jugular veins
4. The Duct is beaded by its velves and has variable width upto 8 mm in some cases
5. Often slightly dilated just before its venous junction 
6.  
8. Advantages of Lymphangiography
1. only direct radiological approach to visualise lymph nodes and vessels
2. only method to study lymphatic vessels and its disorders
3. May detect disease in normal sized lymph nodes
4. can asses internal structure of lymph nodes
9. Disadvantages
1. Technically difficult 
2. Time consuming
3. Maybe medically contraindicated
4. Does not image liver and spleen
1. Lymph nodes: internal iliac, mesenteric, retrocrural, hilar

Guermazi A, Brice P, Hennequin C, Sarfati E (2003). "Lymphography: an old technique retains its usefulness". Radiographics 23 (6): 1541–58; discussion 1559–60. doi:10.1148/rg.236035704.PMID 14615563. Full text

1. paradoxal embolus
1. A paradoxical embolism is a kind of stroke or other form of arterial thrombosis caused by embolism of a thrombus (blood clot) of venous origin through a lateral opening in the heart, such as a patent foramen ovale.^[1]
   The opening is typically an atrial septal defect, but can also be a ventricular septal defect.
   Paradoxical embolisms represent two percent of arterial emboli.^[2]

   Pathophysiology

   Passage of a clot (thrombus) from a vein to an artery. When clots in veins break off (embolize) , they travel first to the right side of the heart and, normally, then to the lungs where they lodge, causingpulmonary embolism. On the other hand, when there is a hole in the wall between the two upper chambers of the heart (an atrial septal defect), a clot can cross from the right to the left side of the heart, then pass into the arteries as a paradoxical embolism. Once in the arterial circulation, a clot can travel to the brain, block a vessel there, and cause a stroke (cerebrovascular accident). Also called crossed embolism.

Tomogram of lungs, AP Projection, L87, Thorax, Atlas of Radiologic Anatomy, Lothar Wicke

Thorax PA projection - How to read a CXR

• general review – is the film well penetrated and symmetrical. Are breast shadows (if present) equal? Are nipple shadows (if present) equal? Are there artefacts such as wire sutures after cardiac surgery?
• The film is well penetrated and symmetrical
• No breast shadows are present
• No Nipple Shadows
• No artifacts present
• is the image centred? – inner clavicles should be the same distance from the midline
• The Image is centered
• is the trachea central?
• The trachea is central
• Carina - Bifurcation of trachea
• follow the mediastinal outline downwards. Are their any bumps that shouldn’t be there? What might they be?
• Left
• Aortic arch
• Pulmonary Vein
• Left Auricle
• Left Ventricle
• Right
• Superior Vena Cava - T3
• Right Atrium
• Inferior Vena Cava
• does the lowest part of the heart shadow meet the diaphragm at a sharply defined angle? If not why not?
• Yes
• does the dome of the diaphragm have a normal sweep? Why not?
• Yes
• is the heart width less than twice the chest width (cardiothoracic ratio over 50% is abnormal e.g. in heart failure)
• Yes
• does the outer edge of the diaphragm meet the pleura at a sharp acute angle? If not why not?
• Cannot see if the Costodiaphragmatic recess is sharp
• is the sweep from the cardiophrenic angle to the lung apex symmetrical and equal? If not, why not?
• Cannot see
• do the lung markings go from the mediastinum to all areas of the lung normally?
• Yes
• Left Primary Bronchus
• Pulmonary Vein
• check the skeleton. Fractured ribs are difficult to see but there may be signs of old fractures. They may be at different stages or places suggesting previous trauma. Bony metastases or osteoporotic signs may be seen.
• No fractures
• Medial Margin of the Scapula
• Superior Angle of the Scapula
• Clavicles
• 1st Rib

Other

• Fundus of Stomach

10. Al-Jabbar The Overpowering Lord Whoever recites Ya Jabbaru will not be subjected to coercion, and will not be exposed to violence, severity or harshness.

Thorax Lateral Projection, L83, Thorax, Atlas of Radiologic Anatomy, Lothar Wicke

• Trachea
• Left Primary Bronchus
• Right Primary Bronchus
• Inferior Lobar Bronchus
• Pulmonary Veins
• Humerus
• Clavicle
• Manubrium of the Sternum
• Angle of the Sternum (Louis)
• Body of the Sternum
• Heart

lat chest LLL consolidation

10. Al-Jabbar The Overpowering Lord Whoever recites Ya Jabbaru will not be subjected to coercion, and will not be exposed to violence, severity or harshness.

Thorax PA projection, L83, Thorax, Atlas of Radiologic Anatomy, Lothar Wicke

Thorax PA projection - How to read a CXR

• general review – is the film well penetrated and symmetrical. Are breast shadows (if present) equal? Are nipple shadows (if present) equal? Are there artefacts such as wire sutures after cardiac surgery?
• The film is well penetrated and symmetrical
• The breast shadows are present and equal
• No Nipple Shadows
• No artifacts present
• is the image centred? – inner clavicles should be the same distance from the midline
• The Image is centered
• is the trachea central?
• The trachea is central
• Carina - Bifurcation of trachea
• follow the mediastinal outline downwards. Are their any bumps that shouldn’t be there? What might they be?
• Left
• Aortic arch
• Pulmonary Vein
• Left Auricle
• Left Ventricle
• Right
• Superior Vena Cava - T3
• Right Atrium
• Inferior Vena Cava
• does the lowest part of the heart shadow meet the diaphragm at a sharply defined angle? If not why not?
• Yes
• does the dome of the diaphragm have a normal sweep? Why not?
• Yes
• is the heart width less than twice the chest width (cardiothoracic ratio over 50% is abnormal e.g. in heart failure)
• Yes
• does the outer edge of the diaphragm meet the pleura at a sharp acute angle? If not why not?
• Yes
• Costodiaphragmatic recess sharp
• is the sweep from the cardiophrenic angle to the lung apex symmetrical and equal? If not, why not?
• Yes
• do the lung markings go from the mediastinum to all areas of the lung normally?
• Yes
• Left Primary Bronchus
• Pulmonary Vein
• check the skeleton. Fractured ribs are difficult to see but there may be signs of old fractures. They may be at different stages or places suggesting previous trauma. Bony metastases or osteoporotic signs may be seen.
• No fractures
• Medial Margin of the Scapula
• Superior Angle of the Scapula
• Clavicles
• 1st Rib

Other

• Fundus of Stomach

The main regions where a chest X-ray may identify problems may be summarized as ABCDEF by their first letters:^[3]

• Airways, including hilar adenopathy or enlargement
• Breast shadows
• Bones, e.g. rib fractures and lytic bone lesions
• Cardiac silhoutte, detecting cardiac enlargement
• Costophrenic angles, including pleural effusions
• Diaphragm, e.g. evidence of free air
• Edges, e.g. apices for fibrosis, pneumothorax, pleural thickening or plaques
• Extrathoracic tissues
• Fields (lung parenchyma), being evidence of alveolar filling
• Failure, e.g. alveolar air space disease with prominent vascularity with or without pleural effusions

Systemic Review of a CXR, CXR, PA Projection

Systemic Review of a CXR

• general review – is the film well penetrated and symmetrical. Are breast shadows (if present) equal? Are nipple shadows (if present) equal? Are there artefacts such as wire sutures after cardiac surgery?
• is the image centred? – inner clavicles should be the same distance from the midline
• is the trachea central?
• follow the mediastinal outline downwards. Are their any bumps that shouldn’t be there? What might they be?
• does the lowest part of the heart shadow meet the diaphragm at a sharply defined angle? If not why not?
• does the dome of the diaphragm have a normal sweep? Why not?
• is the heart width less than twice the chest width (cardiothoracic ratio over 50% is abnormal e.g. in heart failure)
• does the outer edge of the diaphragm meet the pleura at a sharp acute angle? If not why not?
• is the sweep from the cardiophrenic angle to the lung apex symmetrical and equal? If not, why not?
• do the lung markings go from the mediastinum to all areas of the lung normally?
• check the skeleton. Fractured ribs are difficult to see but there may be signs of old fractures. They may be at different stages or places suggesting previous trauma. Bony metastases or osteoporotic signs may be seen.

10. Al-Jabbar: The Overpowering Lord Whoever recites Ya Jabbaru will not be subjected to coercion, and will not be exposed to violence, severity or harshness.

Hip (Coxal) Bone, N474 Notes, Anatomy, Lower Limb, Hip and Thigh

Hip (Coxal) Bone, N474 Notes, Anatomy, Lower Limb, Hip and Thigh

Lateral View

• Ilium
• Iliac Crest
• Intermediate Zone
• Tuberculum
• Outer Lip
• Wing - Gluteal Surface
• Anterior Superior Iliac Spine
• Anterior Inferior Iliac Spine
• Superior Acetabulum
• Gluteal Lines
• Posterior
• Anterior
• Inferior
• Posterior Superior Iliac Spines
• Posterior Inferior Iliac Spines
• Greater Sciatic Notch
• Ischium
• Ischial Spine
• Lesser Sciatic Notch
• Body of the Ischium
• Ischial Tuberosity
• Ramus of the Ischium
• (Obturator foramen posterior half)
• Pubis
• Superior Pubic Ramus
• Obturator Crest
• Inferior Pubic Ramus

Medial View

• Ilium
• Iliac Crest
• Intermediate Zone
• Inner Lip
• Iliac Tuberorsity
• Posterior Superior Iliac Spine
• Posterior Inferior Iliac Spine
• Articular Surface for Sacrum
• Anterior Superior Iliac Spine
•  Anterior Inferior Iliac Spine
• Wing of the Ilium - Iliac Fossa Surface
• Arcuate line
• Iliopubic Eminence
• Ischium
• 
  
• Pubis

10. Al-Jabbar
The Overpowering Lord
Whoever recites Ya Jabbaru will not be subjected to coercion, and will not be exposed to violence, severity or harshness.

Lymph Vessels and Nodes of Lower Limb, N473 Notes, Anatomy, Lower Limb, Cutaneous Anatomy

Lymph Vessels and Nodes of Lower Limb, N473 Notes, Anatomy, Lower Limb, Cutaneous Anatomy

What is the relationship between Fascia and Lymph Drainage?

Fascia

• Cribiform fascia with Saphenous Opening
• Fascia Lata
• Deep Fascia of the Leg - Crural Fascia

Lymph Nodes (always around the vein)

• Superficial Inguinal Lymph Nodes
• Horizontal Group
• Superolateral nodes
• Superomedial Nodes
• Vertical Group
• Inferior Nodes
• Popliteal Lymph Nodes
• Deep Inguinal Lymph Nodes
• External Iliac Lymph Nodes  

Superficial Nerves and Veins of the Lower Limb: Posterior View, N472 Notes, Anatomy, Lower Limb, Cutaneous Anatomy

Superficial Nerves and Veins of the Lower Limb: Posterior View, N472 Notes, Anatomy, Lower Limb, Cutaneous Anatomy

• Nerves
• Clunial Nerves
• Medial Clunial Nerves - S1, S2, S3
• Lateral Clunial Nerves - L1, L2, L3
• Inferior Clunial Nerves - from posterior femoral cutaneous nerve
• Femoral Nerve
• Branches from the lateral femoral cutaneous nerve
• Branches from the Posterior Femoral Cutaneous Nerve
• Branches from the Femoral Cutaneous Nerve (Medially)
• Sapheneous Nerve
• Branches (Medial)
• Sural Cutaneous Nerve
• Lateral Sural Cutaneous Nerve - Common Fibular Nerve (Peroneal Nerve)
• Medial Sural Cutaneous Nerve - from Tibial Nerve
• Sural Nerve
• Lateral Calcaneal branches of Sural nerve 
• Lateral Dorsal Cutaneous Nerve
• Tibial Nerve
• Medial Calcaneal Branches of Tibial Nerve
• Plantar Cutaneous branches of
• Medial Plantar Nerve
• Lateral Plantar Nerve
• Veins
• Accessory Saphenous Vein
• Greater Saphenous Vein
• Small Saphenous Vein

Superficial Nerves and Veins of the Lower Limb: Anterior View, N471 Notes, Anatomy, Lower Limb, Cutaneous Anatomy

Superficial Nerves and Veins of the Lower Limb: Anterior View, N471 Notes, Anatomy, Lower Limb, Cutaneous Anatomy

• Nerves
• Subcostal Nerve
• Lateral cutaneous branch of the Subcostal Nerve
• Femoral Nerve
• Lateral femoral cutaneous nerve
• Anterior Cutaneous Nerve
• Saphenous nerve
• Infrapatellar branch
• terminal branch with Saphenous vein
• Genitofemoral nerve to 
• femoral triangel
• Genital Branch
• Ilioinguinal nerve -  passes superficial to the inguinal ring
• Obturator Nerve
• Cutaneous branches (medial)
• Dorsal Digital nerves
• Lateral Sural Cutaneous Nerve
• Superficial fibular nerve (Peroneal Nerve)
• Medial dorsal cutaneous branch
• Intermediate dorsal cutaneous branch
• Lateral dorsal cutaneous branch
• Veins
• Femoral Vein
• Lateral femoral cutaneous vein
• Superficial Epigastric vein
• Superficial external pudendal vein
• Great Saphenous Vein
• Dorsal digital 
• Venous Arch
• Vein of the medial side of the great toe
• Small Sapheous Vein

• 

The vein is medial to the arterial pulse, for taking blood. The nerve is lateral to the artery, for femoral nerve blockade. The space in which the nerve runs extends up to the psoas and the lumbar plexus, and therefore particularly with hand pressure below the point of injection and larger volumes a considerable spread of block can be produced.

ELECTRICITY AND MAGNETISM, Physics, Pre-exam Course Lecture 1

ELECTRICITY AND MAGNETISM

System of Units

• Systeme International (SI)
• 7 base units: kilogram, meter, second, ampere, kelvin, candela, mole
• Derived units

  Electrical Forces and Fields

•          Charge measured in Coulomb  (C)

•            F = kq₁q₂/r²

•            with q₁ and q₂ charges, r the distance between

•            charges, and k a constant

•            E = F/q

•            Electrical Forces on Charge, F = Eq

Electrical Current

•          SI unit   ampere

•                          I = q/t


Electrical Potential Difference

•          Voltage:   V = E / q  measured in volt (V)
with E the electrical potential energy in joule (J)

•            1 volt  =  1 joule per coulomb

•            Electron-volt (eV):  Kinetic energy obtained by an electron accelerated across potential difference of one volt

•            1 eV  =  1.602 Í 10^-19 J

Electrical Power

•          SI unit – watt (W)

•         1W  =  1 joule per second

•          P = VI

Direct and Alternating Current

•          Normal household use single phase 220 V AC

Conductors

•             Resistance

•            R = V/I or V = IR

•            Ohm’s Law

•            SI unit   ohm (W)

Magnetic Forces and Fields

•          Magnetic fields caused by moving electrical charges

•         Two poles: North and South

•         Magnetic dipole

Magnetic Forces and Fields

•          SI unit, magnetic field strength, tesla (T)

Electromagnetic Induction

•           Michael Faraday

•            Changing magnetic field induces PD

•            Lenz’s Law:   magnetic field opposes the inducing field


Electromagnetic Induction

•          Self Induction

•          Mutual Induction

Magnetic Properties of Matter

•          Diamagnetic Materials

•            Individual electrons orbiting nucleus give rise to magnetic fields too small to measure

•            Paramagnetic Materials

•            Ferromagnetic Materials

•            Iron, nickel and cobalt

•            Magnetic Domains

Lower Limb, N469 Notes, Anatomy, Lower Limb, Topographic Anatomy. Lower Limb, N470 Notes, Anatomy, Lower Limb, Cutaneous Anatomy

Lower Limb, N469 Notes, Anatomy, Lower Limb, Topographic Anatomy

Lower Limb, N470 Notes, Anatomy, Lower Limb, Cutaneous Anatomy

• Whats the difference between a Dermatome and an Autonomous Sensory zone
• With few exceptions, there is complete overlap between adjacent dermatomes. This means that the loss of a single nerve root rarely produces significant loss of skin sensitivity. The exception to this rule is found in small patches in the distal extremities, which have been termed "autonomous zones." In these regions single nerve roots supply distinct and non-overlapping areas of skin. By their nature the "autonomous zones" represent only a small portion of any dermatome and only a few nerve roots have such autonomous zones. For example, the C5 nerve root may be the sole supply to an area of the lateral arm and proximal part of the lateral forearm. The C6 nerve root may distinctly supply some skin of the thumb and index finger. Injuries to the C7 nerve root may decrease sensation over the middle and sometimes the index finger along with a restricted area on the dorsum of the hand. C8 nerve root lesions can produce similar symptoms over the small digit occasionally extending into the hypothenar area of the hand. In the lower limb, L4 nerve root damage may decrease sensation over the medial part of the leg, while L5 lesions affect sensation over part of the dorsum of the foot and great toe. S1 nerve root lesions typically decrease sensation on the lateral side of the foot.

Nerves of the Upper Limb, N467 Notes, Anatomy, Upper Limb, Neurovasculature

Nothing noteworthy here

Nerves of the Upper Limb, N467 Notes, Anatomy, Upper Limb, Neurovasculature

Radial Nerve in Arm and Nerves of Posterior Shoulder, N465 Notes, Anatomy, Upper Limb, Neurovasculature

1. Dorsal scapular Nerve (Root C5)
1. Levator Scapulae
2. Rhomboid Minor Muscle
3. Rhomboid Major Muscle
2. Suprascapular Nerve (Root C5, C6)
1. Supraspinatus Muscle
2. Infraspinatus muscle
3. ? Articular Innervation of Glenoheumaral Joint
3. Lower Subscapular nerve
1. Subscapularis Muscle
2. Teres Major Muscle 
4. Axillary Nerve (Root C5, C6) - (middle trunk, posterior division, posterior cord)
1. Muscle
1. Deltoid Muscle
2. Teres Minor Muscle
3. Long Head of the Triceps Brachii
2. Sensory
1. Shoulder Joint
2. Superior Lateral Cutaneous Nerve
5. Radial Nerve (Roots C5,C6, C7, C8, T1) - Terminal Branch of the Posterior Cord of the Brachial Plexus
1. Course
1. Through the Triangular Space of the axilla
2. Triceps Brachii
1. After giving off branches to the long and medial heads of the triceps brachii, it enters a groove on the humerus, the radial sulcus, where it innervates the lateral head of the triceps.
3. Pierces the Lateral Intermuscular Septum and enters the anterior compartment of the arm
2. Motor
1. Muscular Branches
1. Triceps Brachii
2. Aconeous
3. Brachioradialis
4. Extensor Carpi Radialis Longus
2. Deep Branch of radial nerve
1. Extensor Carpi Radialis Brevis
2. Supinator
3. Posterior Interosseous Nerve
1. Extensor digitorum
2. Extensor digiti minimi
3. Extensor Carpi Ulnaris
4. Abductor Pollicis Longus
5. Extensor pollicis Brevis
6. Extensor Pollicis longus
7. Extensor Indicis
3. Cutaneous Nerves
1. Inferior Lateral Brachial Cutaneous Nerve
2. Posterior Brachial Cutaneous Nerve
3. Posterior Antebrachial Cutaneous Nerve
4. Superficial Branch Radial Nerve

Radial Nerve in Arm and Nerves of Posterior Shoulder, N465 Notes, Anatomy, Upper Limb, Neurovasculature

Ulnar Nerve, N464 Notes, Anatomy, Upper Limb, Neurovasculature

Innervates	flexor carpi ulnaris flexor digitorum profundis lumbrical muscles opponens digiti minimi flexor digiti minimi abductor digiti minimi interossei adductor pollicis
From	C8, T1 (branches off from Medial cord)

1. Roots of Ulnar Nerve (C8 to T1) of the Median Cord of the Brachial Plexus
2. Forearm - 
1. Flexor Carpi Ulnaris and medial half of Flexor Digitorum Profundus
2. Branches
1. Muscular branches of the Ulnar Nerve
2. Palmar Branches of the Ulnar Nerve
3. Dorsal Branch of the Ulnar Nerve
3. Hand -
1. The Ulnar Nerve and Artery pass superficial to the flexor retinaculum, via the Ulnar Canal
2. Branches of the Ulnar Nerve in the Hand
1. Superficial branch
1. Palmaris Brevis
2. Deep branch
1. Hypothenar Muscles
1. Opponens Digiti Minimi
2. Abductor Digiti Minimi
3. ?Flexor Digiti Minimi Brevis of the hand
2. The 3rd and 4th Lumbrical muscles
3. Dorsal Interossei
4. Palmar Interossei

Hypothenar Muscles:

1. Palmaris Brevis
2. Abductor Digiti Minimi
3. Flexor Digiti Minimi
4. Opponens Digiti Minimi

Ulnar Nerve, N464 Notes, Anatomy, Upper Limb, Neurovasculature

Median Nerve, N463 Notes, Anatomy, Upper Limb, Neurovasculature

Branches from the medial and lateral cords: median nerve (Roots C5, C6, C7, C8, & T1)

1. Is formed by heads from both the medial and lateral cords.
2. Runs down the anteromedial aspect of the arm but does not branch in the brachium. Continues down the arm to enter the forearm with the brachial artery.
3. The median nerve is the only nerve that passes through the carpal tunnel, where it may be compressed to cause carpal tunnel syndrome. 
4. Articular branch to the Elbow
5. Two branches in the forearm:
   • anterior interosseous branch 
   • courses with the anterior interosseous artery and 
   • innervates all the muscles of the anterior compartment of the forearm except the flexor carpi ulnaris and the medial (ulnar) half of flexor digitorum profundus. 
   • It ends with its innervation of pronator quadratus.
   • palmar cutaneous branch of the median nerve arises at the distal part of the forearm. 
   • It supplies sensory innervation to the lateral aspect of the skin of the palm (but not the digits).

Arm - vascular sympathetic branches to the wall of the Brachial artery.

Forearm

• It innervates all of the flexors in the forearm except flexor carpi ulnaris and that part of flexor digitorum profundus that supplies the medial two digits. The latter two muscles are supplied by the ulnar nerve (specifically the Muscular branches of ulnar nerve).
• The main portion of the median nerve supplies the following muscles:

1. Superficial group:

1. Pronator teres
2. Flexor carpi radialis
3. Palmaris longus

1. Intermediate group:

• Flexor digitorum superficialis muscle

1. The anterior interosseus branch of the median nerve supplies the following muscles:

Deep group:

• Flexor digitorum profundus (only the lateral half)
• Flexor pollicis longus
• Pronator quadratus

[edit]Hand

1. motor innervation to the 1st and 2nd lumbrical muscles. 
2. muscles of the thenar eminence by a recurrent thenar branch. The rest of the intrinsic muscles of the hand are supplied by the ulnar nerve.

The median nerve innervates the skin of the palmar side of the thumb, the index and middle finger, half the ring finger, and the nail bed of these fingers. The lateral part of the palm is supplied by the palmar cutaneous branch of the median nerve, which leaves the nerve proximal to the wrist creases. This palmar cutaneous branch travels in a separate fascial groove adjacent to the flexor carpi radialis and then superficial to the flexor retinaculum. It is therefore spared in carpal tunnel syndrome.

The muscles of the hand supplied by the median nerve can be remembered using the mnemonic, "LOAF" for 

1. Lumbricals 1 & 2, 
2. Opponens pollicis, 
3. Abductor pollicis brevis and 
4. Flexor pollicis brevis. Superficial Head only - Deep Head supplied by the Ulnar Nerve

Median Nerve, N463 Notes, Anatomy, Upper Limb, Neurovasculature