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Long Thoracic Nerve DysfunctionPics Clinical Consideration
First rib

Figure 18-1. Arteriograms of the shoulder region (A) and forearm (B). (C) Arterial supply of the upper limb. (D) Collateral circulation around the shoulder. The lines from proximal to distal indicate the lateral border of the first rib, the inferior border of the teres major muscle, and the cubital fossa. It is important to be able to identify an artery on an arteriogram and to know which nerve runs with that artery. A = anterior circumflex humeral artery; AX= axillary artery; BR- brachial artery; CF = circumflex scapular artery; D = deep palmar arch; DB = deep brachial artery (runs with the radial nerve); IF= inferior thyroid artery; IT= internal thoracic artery; IU= inferior ulnar collateral artery; LC = left common carotid artery; LS = left subclavian artery; LT = lateral thoracic artery (runs with the long thoracic nerve); P = posterior circumflex humeral artery (runs with the axillary nerve); R = radial artery; RC = right common carotid artery; RS = right subclavian artery; S = superficial palmar arch; SB = subscapular artery; SS = suprascapular artery; TA = thoracoacromial artery; TC = transverse cervical artery; TY = thyrocervical trunk; U = ulnar artery (runs with the ulnar nerve); V= vertebral artery. (A and B reprinted with permission from Fleck-enstein P, Tranum-Jensen J: Anatomy in Diagnostic Imaging. Philadelphia, WB Saunders, 1993, PP 76, 77.)

E. Deep palmar arch is located posterior to the tendons of the flexor digitorum superfi-cialis and profundus muscles. Consequently, a deep laceration at the metacarpal—carpal joint that cuts the deep palmar arch also compromises flexion of the fingers.

II. COLLATERAL CIRCULATION is found in the following regions:

A. Around the shoulder (see Figure 18-1). Circulation in this area involves the following arteries:

1. Transverse cervical artery

2. Suprascapular artery

3. Subscapular artery

4. Circumflex scapular artery

B. Around the elbow. Circulation in this area involves the following arteries:

1. Superior ulnar collateral artery, which anastomoses with the posterior ulnar recurrent artery

2. Inferior ulnar collateral artery, which anastomoses with the anterior ulnar recurrent artery

3. Middle collateral artery, which anastomoses with the interosseous recurrent artery

4. Radial collateral artery, which anastomoses with the radial recurrent artery

C. In the hand. Circulation in this area involves the:

1. Superficial palmar arch

2. Deep palmar arch

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