68 



THE SUPERIOR EXTREMITY 



The siiperficial lymph glands are the superficial cubital glands which lie 

 in the fat of the front of the medial side of the arm immediately proximal 

 to the medial epicondyle (see p. 63). 



The lymph from the skin and subcutaneous tissues of the superior 

 extremity forms two main streams, (i) From the palm, the ulnar border 

 and the ulnar part of the dorsal surface of the hand, the greater part of the 

 front, the ulnar border, and the ulnar part of the dorsal surface of the fore- 

 arm, it flows through a series of superficial lymph vessels which accompany 

 the tributaries and the distal part of the trunk of the basilic vein to the 

 superficial cubital glands. The efferent vessels from the superficial cubital 

 glands, reinforced by lymph vessels from the medial part of the arm, 

 accompany the proximal part of the basilic vein through the deep fascia ; 

 some of them end in the brachial glands, but the majority pass to the 

 lateral axillary glands. (2) The second stream flows from the radial part 

 of the dorsal aspect of the hand, the radial border, and the radial part of 

 the posterior surface of the forearm and the lateral part of the arm, through 

 a series of lymph vessels which accompany the cephalic vein. They end 

 in the delto- pectoral glands, which receive lymph also from the region 

 of the shoulder. The lymph from the lateral axillary glands and the 

 delto-pectoral glands passes to the infraclavicular glands, and thence on the 

 right side to the right lymph duct, and on the left side to the thoracic duct. 



The lymph from the deep and superficial parts of the scapular region 

 flows mainly to the posterior axillary glands, and through them to the infra- 

 clavicular glands. The superficial and deep lymph vessels of the anterior 

 axillary region have already been traced. They carry lymph partly to the 

 anterior axillary and interpectoral glands, whence it passes to the infra- 

 clavicular glands, and partly directly to the infraclavicular glands, but they 

 also convey it to the sternal lymph glands, and they communicate with the 

 lymph vessels of the upper and anterior part of the abdomen (see p. 17 

 and Fig. 14). 



When the superficial veins and their connections have 

 been cleaned and studied, the cutaneous nerves of the 

 superior extremity must be found and cleaned; they are: 



1. The posterior supraclavicular nerves. 



2. The intercosto-brachial nerve. 



3. The medial cutaneous nerve of the arm. 



4. The lateral brachial cutaneous nerve. 



5. The posterior cutaneous nerve of the 



arm. 



cutaneous nerve of the 



The medial 

 forearm. 



The dorsal 

 forearm. 



The lateral 

 forearm. 



To the skin of the arm. 



cutaneous nerve of the 



To the skin of the arm and 

 the forearm. 



cutaneous nerve of the \ To the forearm and ball of 

 the thumb. 



the skin of the pato. 



9. The palmar cutaneous branch of the'i 



10. ThrpltLTcutaneous branch of the 



ulnar nerve. 

 1 1 . The digital branches of the median nerve. 



12. The digital branches of the ulnar nerve. 



13. The superficial branch of the radial nerve and its dorsal digital 



branches. 



14. The dorsal branch of the ulnar nerve and its dorsal digital branches. 



