Topic Overview

Cutaneous Nerves, Superficial Veins & Lymphatic Drainage

Introduction

• Cutaneous nerves → supply skin of upper limb (carry sensory + sympathetic fibers).

• Superficial veins → important for venous return and venipuncture.

• Lymphatic drainage → clinically important for spread of infection and carcinoma.

Cutaneous Nerves of Upper Limb

Arm

• Medial side → medial cutaneous nerve of arm (C8, T1).

• Posterior side → posterior cutaneous nerve of arm (radial nerve).

• Upper lateral side → upper lateral cutaneous nerve of arm (axillary nerve).

• Lower lateral side → lower lateral cutaneous nerve of arm (radial nerve).

Forearm

• Medial side → medial cutaneous nerve of forearm (C8, T1).

• Lateral side → lateral cutaneous nerve of forearm (continuation of musculocutaneous nerve).

• Posterior side → posterior cutaneous nerve of forearm (radial nerve).

Hand

• Palmar aspect:

  • Lateral 3½ digits + palm → median nerve.

  • Medial 1½ digits + palm → ulnar nerve.

• Dorsal aspect:

  • Lateral 3½ fingers (proximal phalanges) → radial nerve.

  • Medial 1½ fingers → ulnar nerve.

  • Tips of lateral 3½ fingers → median nerve.

Superficial Veins of Upper Limb

• Dorsal venous arch → source of major superficial veins.

• Cephalic vein

  • Origin: lateral side of dorsal venous arch.

  • Course: ascends along lateral forearm and arm, passes in deltopectoral groove.

  • Drainage: into axillary vein.

  • Clinical: used for cardiac catheterization.

• Basilic vein

  • Origin: medial side of dorsal venous arch.

  • Course: ascends medial forearm and arm, joins brachial veins to form axillary vein.

• Median cubital vein

  • Communication between cephalic and basilic veins in cubital fossa.

  • Clinical: common site for venipuncture.

Lymphatic Drainage of Upper Limb

• Superficial lymphatics → follow superficial veins.

  • Lateral group (along cephalic vein) → apical axillary nodes.

  • Medial group (along basilic vein) → lateral (humeral) axillary nodes.

• Deep lymphatics → accompany deep veins, drain into humeral axillary nodes.

• Final drainage → all axillary nodes → apical group → subclavian lymph trunk → thoracic duct (left) or right lymphatic duct (right).

Dissection

1. Make midline incisions along arm and forearm.

2. Reflect skin and superficial fascia.

3. Identify superficial veins (cephalic, basilic, median cubital).

4. Trace accompanying cutaneous nerves.

5. Follow superficial lymphatic vessels along veins towards axilla.

Clinical Anatomy

• Venipuncture → median cubital vein most commonly used.

• Thrombophlebitis → inflammation of superficial veins (seen in IV drug users, infections).

• Cephalic vein → used for cardiac catheterization (entry into right atrium).

• Basilic vein → preferred for long-term IV cannulation.

• Infections of hand → spread along lymphatics → axillary lymphadenitis.

• Lymphedema → swelling of limb after axillary node dissection (breast carcinoma surgery).

• Nerve lesions with sensory loss:

  • Axillary nerve → regimental badge anesthesia.

  • Radial nerve → dorsum of hand.

  • Median nerve → lateral 3½ fingers (palmar).

  • Ulnar nerve → medial 1½ fingers.