For foreign first-year students for autumn term Module Methodical elaboration for practice class on human anatomy for foreign first-year students for autumn term

3. The internal mammary artery (a. mammaria interna) arises from the under surface of the first portion of the subclavian, opposite the thyrocervical trunk. It descends behind the cartilages of the upper six ribs at a distance of about 1.25 cm. from the margin of the sternum, and at the level of the sixth intercostal space divides into the musculophrenic and superior epigastric arteries.

Pericardiacophrenic.

Intercostal.

Anterior Mediastinal.

Perforating.

Pericardial.

Musculophrenic.

Sternal.

The Pericardiacophrenic Artery (a. pericardiacophrenica; a. comes nervi phrenici) is a long slender branch, which accompanies the phrenic nerve, between the pleura and pericardium, to the diaphragm, to which it is distributed; it anastomoses with the musculophrenic and inferior phrenic arteries.

The Anterior Mediastinal Arteries (aa. mediastinales anteriores; mediastinal arteries) are small vessels, distributed to the areolar tissue and lymph glands in the anterior mediastinal cavity, and to the remains of the thymus.

The Pericardial Branches supply the upper part of the anterior surface of the pericardium; the lower part receives branches from the musculophrenic artery.

The Sternal Branches (rami sternales) are distributed to the Transversus thoracis, and to the posterior surface of the sternum.

The anterior mediastinal, pericardial, and sternal branches, together with some twigs from the pericardiacophrenic, anastomose with branches from the intercostal and bronchial arteries, and form a subpleural mediastinal plexus.

The Intercoastal Branches (rami intercostales; anterior intercostal arteries) supply the upper five or six intercostal spaces. Two in number in each space, these small vessels pass lateralward, one lying near the lower margin of the rib above, and the other near the upper margin of the rib below, and anastomose with the intercostal arteries from the aorta. They are at first situated between the pleura and the Intercostales interni, and then between the Intercostales interni and externi. They supply the Intercostales and, by branches which perforate the Intercostales externi, the Pectorales and the mamma.

The Perforating Branches (rami perforantes) correspond to the five or six intercostal spaces. They pass forward through the intercostal spaces, and, curving lateralward, supply the Pectoralis major and the integument. Those which correspond to the second, third, and fourth spaces give branches to the mamma, and during lactation are of large size.

The Musculophrenic Artery (a. musculophrenica) is directed obliquely downward and lateralward, behind the cartilages of the false ribs; it perforates the diaphragm at the eighth or ninth costal cartilage, and ends, considerably reduced in size, opposite the last intercostal space. It gives off intercostal branches to the seventh, eighth, and ninth intercostal spaces; these diminish in size as the spaces decrease in length, and are distributed in a manner precisely similar to the intercostals from the internal mammary. The musculophrenic also gives branches to the lower part of the pericardium, and others which run backward to the diaphragm, and downward to the abdominal muscles.

The Superior Epigastric Artery (a. epigastrica superior) continues in the original direction of the internal mammary; it descends through the interval between the costal and sternal attachments of the diaphragm, and enters the sheath of the Rectus abdominis, at first lying behind the muscle, and then perforating and supplying it, and anastomosing with the inferior epigastric artery from the external iliac. Branches perforate the anterior wall of the sheath of the Rectus, and supply the muscles of the abdomen and the integument, and a small branch passes in front of the xiphoid process and anastomoses with the artery of the opposite side. It also gives some twigs to the diaphragm, while from the artery of the right side small branches extend into the falciform ligament of the liver and anastomose with the hepatic artery.

4. The costocervical trunk (truncus costocervicalis; superior intercostal artery) arises from the upper and back part of the subclavian artery, behind the Scalenus anterior on the right side, and medial to that muscle on the left side. Passing backward, it gives off the profunda cervicalis, and, continuing as the highest intercostal artery, descends behind the pleura in front of the necks of the first and second ribs, and anastomoses with the first aortic intercostal. As it crosses the neck of the first rib it lies medial to the anterior division of the first thoracic nerve, and lateral to the first thoracic ganglion of the sympathetic trunk.

In the first intercostal space, it gives off a branch which is distributed in a manner similar to the distribution of the aortic intercostals. The branch for the second intercostal space usually joins with one from the highest aortic intercostal artery. This branch is not constant, but is more commonly found on the right side; when absent, its place is supplied by an intercostal branch from the aorta. Each intercostal gives off a posterior branch which goes to the posterior vertebral muscles, and sends a small spinal branch through the corresponding intervertebral foramen to the medulla spinalis and its membranes.

The Profunda Cervicalis (a. cervicalis profunda; deep cervical branch) arises, in most cases, from the costocervical trunk, and is analogous to the posterior branch of an aortic intercostal artery: occasionally it is a separate branch from the subclavian artery. Passing backward, above the eighth cervical nerve and between the transverse process of the seventh cervical vertebra and the neck of the first rib, it runs up the back of the neck, between the Semispinales capitis and colli, as high as the axis vertebra, supplying these and adjacent muscles, and anastomosing with the deep division of the descending branch of the occipital, and with branches of the vertebral. It gives off a spinal twig which enters the canal through the intervertebral foramen between the seventh cervical and first thoracic vertebræ.

Note. The vertebral artery sometimes enters the foramen in the transverse process of the fifth vertebra, and has been seen entering that of the seventh vertebra.

a) interrogation of the students on the home task;

b) study of samples (topic according to the plan);

c) fill in the protocol of current lesson;

d) checking and signing the protocols by teacher.
8. Forms and methods of the self-checking.

Questions:

10. Sources of the information: Human anatomy

11. The program of self-preparation of students:

1. To learn the appropriate sections under the textbook

2. To consider preparations and to study them according to the plan of practical class.

3. To fill in the report of practical class.

4. To be able to show on a preparation of the Arteries of the Upper Extremity. a. te Subclavian Artery.

.

Methodical elaboration for practice class on human anatomy

1. The topic: The Brachial Artery, the Axillary Artery

2. The place: classroom of the department of human anatomy.

3. The aim: to know the structure of the Brachial Artery, the Axillary Artery.

4. The professional orientation of students: The knowledge of this topic are necessary for doctors of all specialities, it represents special interest for therapists.

5. The basic of knowledge:

6. The plan of the practice class:

A. Checking of the home task: interrogation or the test control – 30 min

B. Summary lecture on the topic by teacher – 20 min

а) The Brachial Artery;

b) The Anticubital Fossa;

c) The branches of the brachial artery;

4. 
   The Axillary Artery;
   
5. 
   The branches of the axillary artery;
   

Working plan:

The brachial artery commences at the lower margin of the tendon of the Teres major, and, passing down the arm, ends about 1 cm. below the bend of the elbow, where it divides into the radial and ulnar arteries. At first the brachial artery lies medial to the humerus; but as it runs down the arm it gradually gets in front of the bone, and at the bend of the elbow it lies midway between its two epicondyles.

Sometimes, long slender vessels, vasa aberrantia, connect the brachial or the axillary artery with one of the arteries of the forearm, or branches from them. These vessels usually join the radial.

Profunda Brachii.

Superior Ulnar Collateral.

Nutrient.

Inferior Ulnar Collateral.

Muscular.

1. The arteria profunda brachii (superior profunda artery) is a large vessel which arises from the medial and back part of the brachial, just below the lower border of the Teres major. It follows closely the radial nerve, running at first backward between the medial and lateral heads of the Triceps brachii, then along the groove for the radial nerve, where it is covered by the lateral head of the Triceps brachii, to the lateral side of the arm; there it pierces the lateral intermuscular septum, and, descending between the Brachioradialis and the Brachialis to the front of the lateral epicondyle of the humerus, ends by anastomosing with the radial recurrent artery. It gives branches to the Deltoideus and to the muscles between which it lies; it supplies an occasional nutrient artery which enters the humerus behind the deltoid tuberosity. A branch ascends between the long and lateral heads of the Triceps brachii to anastomose with the posterior humeral circumflex artery; a middle collateral branch descends in the middle head of the Triceps brachii and assists in forming the anastomosis above the olecranon; and, lastly, a radial collateral branch runs down behind the lateral intermuscular septum to the back of the lateral epicondyle of the humerus, where it anastomoses with the interosseous recurrent and the inferior ulnar collateral arteries.

2. The nutrient artery (a. nutricia humeri) of the body of the humerus arises about the middle of the arm and enters the nutrient canal near the insertion of the Coracobrachialis.

3. The superior ulnar collateral artery (a. collateralis ulnaris superior; inferior profunda artery), of small size, arises from the brachial a little below the middle of the arm; it frequently springs from the upper part of the a. profunda brachii. It pierces the medial intermuscular septum, and descends on the surface of the medial head of the Triceps brachii to the space between the medial epicondyle and olecranon, accompanied by the ulnar nerve, and ends under the Flexor carpi ulnaris by anastomosing with the posterior ulnar recurrent, and inferior ulnar collateral. It sometimes sends a branch in front of the medial epicondyle, to anastomose with the anterior ulnar recurrent.

4. The inferior ulnar collateral artery (a. collateralis ulnaris inferior; anastomotica magna artery) arises about 5 cm. above the elbow. It passes medialward upon the Brachialis, and piercing the medial intermuscular septum, winds around the back of the humerus between the Triceps brachii and the bone, forming, by its junction with the profunda brachii, an arch above the olecranon fossa. As the vessel lies on the Brachialis, it gives off branches which ascend to join the superior ulnar collateral: others descend in front of the medial epicondyle, to anastomose with the anterior ulnar recurrent. Behind the medial epicondyle a branch anastomoses with the superior ulnar collateral and posterior ulnar recurrent arteries.

5. The muscular branches (rami musculares) three or four in number, are distributed to the Coracobrachialis, Biceps brachii, and Brachialis.

The Anastomosis Around the Elbow-joint.—The vessels engaged in this anastomosis may be conveniently divided into those situated in front of and those behind the medial and lateral epicondyles of the humerus. The branches anastomosing in front of the medial epicondyle are: the anterior branch of the inferior ulnar collateral, the anterior ulnar recurrent, and the anterior branch of the superior ulnar collateral. Those behind the medial epicondyle are: the inferior ulnar collateral, the posterior ulnar recurrent, and the posterior branch of the superior ulnar collateral. The branches anastomosing in front of the lateral epicondyle are: the radial recurrent and the terminal part of the profunda brachii. Those behind the lateral epicondyle (perhaps more properly described as being situated between the lateral epicondyle and the olecranon) are: the inferior ulnar collateral, the interosseous recurrent, and the radial collateral branch of the profunda brachii. There is also an arch of anastomosis above the olecranon, formed by the interosseous recurrent joining with the inferior ulnar collateral and posterior ulnar recurrent.
The Axilla

The axilla is a pyramidal space, situated between the upper lateral part of the chest and the medial side of the arm.

The axillary artery, the continuation of the subclavian, commences at the outer border of the first rib, and ends at the lower border of the tendon of the Teres major, where it takes the name of brachial. Its direction varies with the position of the limb; thus the vessel is nearly straight when the arm is directed at right angles with the trunk, concave upward when the arm is elevated above this, and convex upward and lateralward when the arm lies by the side. At its origin the artery is very deeply situated, but near its termination is superficial, being covered only by the skin and fascia. To facilitate the description of the vessel it is divided into three portions; the first part lies above, the second behind, and the third below the Pectoralis minor.

The second portion of the axillary artery is covered, anteriorly, by the Pectorales major and minor; posterior to it are the posterior cord of the brachial plexus, and some areolar tissue which intervenes between it and the Subscapularis; on the medial side is the axillary vein, separated from the artery by the medial cord of the brachial plexus and the medial anterior thoracic nerve; on the lateral side is the lateral cord of the brachial plexus. The brachial plexus thus surrounds the artery on three sides, and separates it from direct contact with the vein and adjacent muscles.

The third portion of the axillary artery extends from the lower border of the Pectoralis minor to the lower border of the tendon of the Teres major. In front, it is covered by the lower part of the Pectoralis major above, but only by the integument and fascia below; behind, it is in relation with the lower part of the Subscapularis, and the tendons of the Latissimus dorsi and Teres major; on its lateral side is the Coracobrachialis, and on its medial or thoracic side, the axillary vein. The nerves of the brachial plexus bear the following relations to this part of the artery: on the lateral side are the lateral head and the trunk of the median, and the musculocutaneous for a short distance; on the medial side the ulnar (between the vein and artery) and medial brachial cutaneous (to the medial side of the vein); in front are the medial head of the median and the medial antibrachial cutaneous, and behind, the radial and axillary, the latter only as far as the lower border of the Subscapularis.