Anatomy
Upper Limb
Question 13 of 180
A 82 year old woman is brought to the ED by her son. She complains of numbness in her fingers, her son was concerned this may have been a stroke. On examination you note loss of sensation to the skin over the palmar surface of the medial one and a half fingers. This area is supplied by which of the following nerves:
Answer:
The superficial branch of the ulnar nerve supplies the skin over the palmar surface of the medial one and a half fingers.Cutaneous Innervation of Upper Limb
Anatomy / Upper Limb / Innervation of Upper Limb
Last Updated: 1st November 2022
Table: Cutaneous Innervation of the Upper Limb
| Cutaneous Nerve | Origin | Skin Supplied |
|---|---|---|
| Lateral supraclavicular nerve | Cervical plexus (C3, C4) | Upper half of deltoid muscle |
| Superior lateral cutaneous nerve of the arm | Axillary nerve | Lower half of deltoid muscle |
| Inferior lateral cutaneous nerve of the arm | Radial nerve | Lateral arm below deltoid muscle |
| Medial cutaneous nerve of the arm | Brachial plexus (C8, T1) | Medial arm |
| Intercostobrachial nerve | Second intercostal nerve (T2) | Axilla |
| Posterior cutaneous nerve of the arm | Radial nerve | Posterior arm |
| Medial cutaneous nerve of the forearm | Brachial plexus (C8, T1) | Medial forearm |
| Posterior cutaneous nerve of the forearm | Radial nerve | Posterior forearm |
| Lateral cutaneous nerve of the forearm | Musculocutaneous nerve | Lateral forearm |
| Superficial branch of radial nerve | Radial nerve | Lateral dorsum of hand and lateral three and a half digits |
| Palmar cutaneous branch of ulnar nerve | Ulnar nerve | Medial half of palm |
| Dorsal cutaneous branch of ulnar nerve | Ulnar nerve | Medial dorsum of hand and medial one and a half fingers |
| Superficial branch of ulnar nerve | Ulnar nerve | Palmar surface of medial one and a half digits |
| Palmar cutaneous branch of median nerve | Median nerve | Lateral half of palm |
| Palmar digital branch of median nerve | Median nerve | Palmar surface and fingertips of lateral three and a half digits |
![Modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons](https://mrcemsuccess.com/wp-content/uploads/2016/12/Cutaneous-Innervation-1.png)
Cutaneous Innervation of Upper Limb. (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
Cutaneous Innervation of Arm
- The lateral supraclavicular nerve, branch of the cervical plexus, supplies the skin over the upper half of the deltoid muscle.
- The superior lateral cutaneous nerve of the arm, branch of the axillary nerve, supplies the skin over the lower half of the deltoid muscle (regimental badge area).
- The inferior lateral cutaneous nerve of the arm, branch of the radial nerve, supplies the skin over the lateral side of the arm below the deltoid muscle.
- The medial cutaneous nerve of the arm, branch of the brachial plexus, supplies the skin over the medial arm.
- The intercostobrachial nerve, branch of the second intercostal nerve, supplies the skin of the axilla.
- The posterior cutaneous nerve of the arm, branch of the radial nerve, supplies the skin over the posterior arm.
Cutaneous Innervation of Forearm
- The medial cutaneous nerve of the forearm, branch of the brachial plexus, supplies the skin over the medial aspect of the forearm.
- The posterior cutaneous nerve of the forearm, branch of the radial nerve, supplies the skin over the posterior forearm.
- The lateral cutaneous nerve of the forearm, branch of the musculocutaneous nerve, supplies the skin over the lateral aspect of the forearm.
Cutaneous Innervation of Hand
- The superficial branch of the radial nerve supplies the skin over the lateral dorsum of the hand and the dorsum of the lateral three and a half digits (except for the fingertips).
- The palmar cutaneous branch of the ulnar nerve supplies the skin over the medial half of the palm.
- The dorsal cutaneous branch of the ulnar nerve supplies the skin over the medial dorsum of the hand and the dorsum of the medial one and a half fingers.
- The superficial branch of the ulnar nerve supplies the skin over the palmar surface of the medial one and a half fingers.
- The palmar cutaneous branch of the median nerve supplies the skin over the lateral half of the palm.
- The palmar digital branch of the median nerve supplies the skin over the palmar surface and the fingertips of the lateral three and a half digits.
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
