Elbow joint, its structure, axis of rotation, ligaments. Muscles acting on the joint, their innervation. Arterial network of the joint

10.11.2020

Arthrosis of the elbow joint is a dangerous disease that, if not diagnosed and treated in a timely manner, can lead to disability. It consists of a dystrophic change in the existing cartilage and bone tissue, their structure and density.

As the disease progresses, the patient may experience sharp, increasing degenerative disorders of cartilage tissue. In other words, it collapses and loses its integrity. This process can spread to nearby tissues, bones, muscles and joints. This disease carries the risk of premature disability.

In the early stages, the patient may not even notice the deterioration of the condition of his own joints. The insidiousness of this disease lies in the fact that for a long time it does not manifest itself in any way, remains unnoticed, hidden. A person begins to notice an increased level of discomfort when bending the arm at the elbow joint only during strong and prolonged loads. Later, this situation is repeated in a state of rest and rest.

Gradually, the arm stops raising, and the full range of movement is reduced. Pain does not go away day or night, so finding a comfortable position that relieves discomfort is quite difficult. The joint tissue continues to actively grow, damaging the elbow and deforming it beyond recognition.

Arthrosis of the elbow joint is most often encountered by athletes, as well as representatives of professions in which the arms are constantly used and are under 24-hour tension. These are, for example, drivers, pianists, editors, mechanism assemblers in factories and many others.

Constant overwork occurs, joints and ligaments spasm, and the normal blood flow of not only the tissues of the hands, but also the elbow joints is disrupted. In this case, the patient gradually experiences a decrease in the amount of synovial fluid in the joint, which leads to a sharp deterioration in the quality of cartilage lubrication and a decrease in its quantity. Despite the fact that this disease is considered age-related and previously affected people over 45 years of age, at the moment statistics show that arthrosis has become “younger”.

Main signs and symptoms of acute arthrosis of the elbow joint

To recognize the first signs of such a dangerous disease, a person needs to pay attention to the following factors:

• increased body and joint temperature;
• redness of the skin under the elbow joint;
• swelling of soft tissues located near the elbow;
• disruption of normal hand functions due to constant pain and swelling.

It is also worth taking into account that not all symptoms may be pronounced. Some do not make themselves felt for a long time, gradually destroying the structure of the joint.

Anatomy of the Human Ulnar Artery - information:

Ulnar artery, a. ulnaris , represents one of the two terminal branches (the larger one) of the brachial artery. From its origin in the ulnar fossa (opposite the neck of the radius), it fits under m. pronator teres, goes obliquely to the middle third of the forearm, deviating to the ulnar side.

In the lower two-thirds it runs parallel to the ulna, first in the space between m. flexor digitorum superficialis and m. flexor carpi ulnaris, in the lower third, due to the transition of muscles into tendons, its position becomes more superficial (sulcus ulnaris). At the radial side of the pisiform bone, the ulnar artery passes into the canalis carpi ulnaris (spatium interaponeuroticum) and, passing to the palm, is part of the arcus palmaris superficialis.

Branches of the ulnar artery:

1. A. recurrens ulnaris, the recurrent ulnar artery, gives off two branches - rami anterior et posterior, which pass in front and behind the medial epicondyle, anastomosing with the aa. collaterales ulnares superior et inferior. Thanks to these anastomoses, as well as the above anastomoses between the branches of a. profunda brachii and a. radialis in the circumference of the elbow joint, an arterial network is obtained - rete articulare cubiti.
2. A. interossea communis, the common interosseous artery, goes to the interosseous membrane, at the proximal edge, which is divided into two branches: a. interossea anterior along the anterior surface of the interosseous membrane reaches m. pronator quadratus, pierces the membrane and goes to the rear, where it ends in the rete carpi dorsale. At the beginning of your journey a. interossea anterior gives a. mediana (directed to the palm together with n. medianus), aa. diaphyseos radii et ulnae - to the bones of the forearm and rami musculares - to the surrounding muscles;
3. a. interossea posterior passes through the upper opening of the interosseous membrane to the back side, gives off a. interossea recurrens, lies between the superficial and deep layers of the extensor muscles and in the wrist area anastomoses with a. interossea anterior.

Causes of the disease

Experts identify the following list of main factors that can cause progressive arthrosis of the elbow joint:

• elbow injuries of varying severity;
• rheumatoid arthritis;
• hereditary predispositions;
• metabolic disorders and lack of vitamins in the body;
• hypothermia, which is periodic or systematic;
• inflammation inside the joint and joint capsule;
• respiratory diseases and complications after them;
• foci (both hidden and obvious) of chronic infection in the body.

Therefore, if a person notices a sharp decrease in arm mobility, accompanied by pain, it is necessary to urgently contact the appropriate specialists. They will carry out a full range of diagnostic procedures. Surgical intervention may be necessary to stabilize the patient's condition.

Types and degrees of arthrosis of the elbow joint

Depending on the symptoms and degree of damage to the joints, the following degrees of arthrosis are distinguished:

1. First degree. Has mild symptoms. It is mainly characterized by pain in the joints after performing prolonged, monotonous movements or after exertion. In this case, as soon as the joints return to a state of rest and relax, pain and discomfort disappear. Such symptoms can be repeated repeatedly without arousing suspicion in the patient.
2. Second degree. At this stage, the pain does not disappear after the load is removed, the discomfort increases as gradual destruction and deformation of the joint, as well as the tissues and bones of the elbow, occur. A characteristic crunch and swelling occurs, which does not disappear over time. The patient begins to monitor his movements, refraining from those that provoke painful spasms.
3. Third degree. It is considered the most severe, since at this stage the destruction of the integrity of the joint progresses, which leads to significant limitation in the movements of the arm. Bone tissue grows, causing muscle tone to decrease. The pain continues day and night, so it is no longer possible to cope without constant use of painkillers.

The peculiarity of this disease is that for a fairly long period of time it does not show itself in any way. An exacerbation can be caused by a series of circumstances or previous inflammatory processes.

Branches of the ulnar artery

1. The recurrent ulnar artery (a. recurrens ulnaris) begins in the upper third, participates in the formation of the network of the elbow joint, connecting the anterior and posterior branches with the collateral ulnar arteries - the upper and lower of the brachial arteries.

2. Common interosseous artery (a. interosseus communis) - large and short with anterior and posterior branches supplying blood to the median nerve, elbow joint, deep muscles of the forearm, wrist and wrist joint.

3. The posterior interosseous artery (a. interosseus posterior) supplies all the posterior muscles of the forearm: the supinator, extensors of the wrist and fingers, and the abductor pollicis longus muscle.

4. The interosseous arteries anastomose with the branches of the radial and ulnar arteries with their terminal branches, forming a carpal arterial network with the dorsal metacarpal arteries extending from it.

5. The pre-terminal branches of the ulnar artery - the palmar carpal and deep palmar (r. carpeus palmais et r. palmaris profundus) form, when connected to the branches of the radial artery, the palmar carpal network, sometimes the deep palmar arch. They supply blood to the intermetacarpal muscles and the muscles of the eminence of the little finger.

6. From the deep palmar arch, the common digital arteries begin, turning into the proper digital ones, located on adjacent sides of the fingers.

An arterial network arises around the elbow joint due to the collateral branches of the brachial artery and the recurrent collaterals of the ulnar, radial and interosseous arteries. At the wrist, the carpal and palmar branches of the radial, ulnar and anterior interosseous arteries anastomose with each other in the palmar network; in the dorsal network - the carpal dorsal branches of the ulnar, radial, anterior and posterior interosseous arteries.

18(IV) Arteries of the hand
Arteries of the hand are represented by the terminal branches of the radial and ulnar arteries. In the wrist they are connected in the form of network anastomoses, and in the palm of the arcuate connections, from which the metacarpal and digital arteries arise. On the wrist there are palmar and dorsal arterial networks with dorsal carpal and digital arteries, and in the metacarpal region of the palm there are palmar arches with common and proper digital arteries.

The palmar and carpal branches of the radial artery, connecting with the branches of the same name of the ulnar and interosseous arteries, form the palmar and dorsal arterial networks in the wrist (rete carpi palmare et rete carpi dorsale). Both networks supply blood to the capsules and ligaments of the joints: radiocarpal, midcarpal, intercarpal and carpometacarpal and the muscle tendons passing in the canals of the flexor and extensor retinaculum.

The following arteries depart from the dorsal network of the wrist.

1. 3-4 dorsal metacarpal arteries (aa.metacarpeae dorsales) - for blood supply to the dorsal interosseous muscles, skin and subcutaneous tissue of the metacarpus. From each dorsal artery, two posterior (dorsal) digital arteries for the II-V fingers begin. In the absence of dorsal arteries, the blood supply is provided by the perforated branches of the deep palmar arch.

2. The blood supply to the thumb is carried out by branches not only of the first dorsal carpal artery from the arterial network, but also from its own artery (a. princeps pollicis). It originates from the radial artery and in turn divides into two palmar branches for the thumb and a radial branch for the index finger.

The superficial palmar arch (arcus palmaris superficialis) is formed by the terminal section of the ulnar artery (main part), connecting with the superficial palmar branch of the radial artery. The arch is located under the palmar aponeurosis, but above the flexor tendons of the fingers and is projected in the region of the middle of the bodies of the metacarpal bones. From the semicircle of the arch, the common palmar digital arteries (short) begin, turning into the long proper digital ones. From the components of the superficial arch - the ulnar artery and the palmar branch of the radius - muscle branches extend to the muscles of the eminences of the thumb and little finger.

The deep palmar arch (arcus palmaris profundus) arises from the terminal section of the radial artery (main part) and the thin, deep palmar branch of the ulnar artery. The arc lies under the flexor tendons of the fingers and is projected at the level of the bases of the metacarpal bones. Short muscle branches extend from it to the eminence of the little finger, palmar interosseous muscles; common and proper digital arteries.

The palmar arches and carpal networks, digital and intermetacarpal arteries form many inter- and intrasystemic anastomoses, and around the joints - collateral networks, which ensures uninterrupted and rich blood supply to the hand. It is necessary to ensure the grasping function of the hand and the opposition of the thumb.

19 (IV) Femoral artery
The femoral artery (a. femoralis), being a continuation of the external iliac, passes to the thigh in the vascular lacuna, and the femoral nerve in the muscular lacuna. Both lacunae are located under the inguinal ligament and are separated by the iliopectineal arch. The artery, upon exiting the lacuna, lies in the iliopectineal groove between the muscles of the thigh of the same name, located lateral to the femoral vein. Having left the short groove, the artery descends into the femoral triangle and enters the adductor canal, which it leaves in the popliteal fossa at the upper border. In the fossa, the artery is called the popliteal and its branches form the arterial network of the knee joint.

The femoral artery, vein and nerve of the same name constitute a neurovascular bundle, in which the artery along the thigh is accompanied only by a hidden branch of the femoral nerve. The beam is projected along a line from the middle of the inguinal ligament to the medial epicondyle of the femur.

Branches of the femoral artery

· Deep femoral artery (a. profunda femoris) - departs 3-4 cm below the inguinal ligament, the large and main branch supplying the thigh muscles is divided into branches that bend around the femur: medial, lateral and perforating (3-4) (a circumflexa medialis, aa circumflexa lateralis, aa perforantes) - for the hip joint, muscles of the lower girdle and posterior thigh muscles.

· The circumflex branches form an arterial network around the hip joint and enter into connection with the branches of the obturator artery, gluteal arteries, due to which they supply blood not only to the hip joint, but also to the muscles: iliopsoas, pectineus, external obturator, piriformis, quadratus, gluteal, the beginning of the sartorius and quadriceps and tensor fasciae lata. The acetabular branch departs from the medial artery to the joint. The arterial network of the joint provides roundabout (collateral) blood flow, but only when the deep artery of the femur is patent.

· Under the inguinal ligament, small branches begin from the femoral artery, emerging through a hidden gap into the subcutaneous tissue: superficial epigastric artery (a. epigastrica superficialis), superficial circumflex ilium artery (a. circumflexa ilium superficialis), 2-3 external genital arteries (aa . pudendae externae), which anastomose in the skin and subcutaneous tissue, muscles of the pubic and inguinal regions with the superior epigastric artery, with the terminal branches of the lumbar arteries. The superficial circumflex iliac artery has muscle and articular anastomoses with the same, but deep artery, a branch of the external iliac artery, as well as with the lateral circumflex femoral artery.

· Through the anterior opening of the adductor canal, another branch of the femoral artery emerges - the descending knee artery (a. genus descendens), which is involved in the formation of the network of the knee joint; together with it, the hidden nerve leaves the canal and the femoral artery.

· Numerous small branches extend to the surrounding muscles along the entire length of the femoral artery.

20(IV) Popliteal artery
The popliteal artery (a. poplitea), being a continuation of the femoral one, is located in the popliteal fossa along with the vein of the same name and the sciatic or tibial nerves. The popliteal fossa is bounded at the top on the lateral side by the biceps muscle, on the medial side by the semimembranosus, and below by the two heads (medial and lateral) of the gastrocnemius muscle. The bottom of the fossa is formed by the popliteal surface of the femur, the capsule of the knee joint and the popliteal muscle.

Under the own fascia in the fossa, occupying a median position, in the direction from top to bottom lie the above-mentioned nerve, vein, artery - a memorable word for the syntopy of the neurovascular bundle "Neva" - according to the first letters of the components of the neurovascular bundle. The popliteal artery is located close to the bone, capsule and muscle (take into account the possibility of damage due to injury!). Its average length is 16 cm, diameter is 13 mm. At the level of the lower edge of the popliteus muscle, the artery divides into terminal branches - the anterior and posterior tibial.

Lateral branches of the popliteal artery

1. Lateral superior knee artery (a. genus superior lateralis) – begins above the lateral femoral condyle, supplies blood to the vastus lateralis and biceps muscles, and the knee joint.

2. Medial superior knee artery (a. genus superior mtdialis) - begins at the level of the medial femoral epicondyle - for the vastus medialis muscle and capsule of the knee joint.

3. Middle knee artery (a. genus media) - to the posterior wall of the joint capsule, its meniscus, cruciate ligaments, synovial folds.

4. The medial inferior knee artery (a. genus inferior medialis) departs at the level of the medial condyle of the tibia - for the medial head of the gastrocnemius muscle, the capsule of the knee joint.

5. Lateral inferior knee artery (a. genus inferior lateralis) – for the lateral head of the gastrocnemius and long plantar muscles.

All branches, connecting with each other, form an arterial network around the knee joint. In addition, the descending knee branch of the femoral artery (a. genus descendens), the recurrent branches of the posterior and anterior tibial arteries (r. recurrens tibialis posterior, r. recurrens tibialis anterior) also participate in the blood supply to the knee joint and the formation of its network. With maximum bending of the knees, compression of the popliteal arteries occurs, but the blood flow is not disturbed due to the presence of a well-developed arterial network of the knee joints.

21(IV) Arteries of the lower leg
The tibial arteries belong to the lower leg: anterior and posterior (a. tibialis anterior et a. tibialis posterior). They are the final branches of the popliteal artery and begin from it at the level of the lower edge of the popliteal muscle. Together with the veins of the same name, the tibial and peroneal nerves, they form three neurovascular bundles of the lower leg. The posterior bundle includes the posterior tibial artery, 2-3 accompanying deep veins and the tibial nerve. The anterior bundle consists of the anterior tibial artery, 2-3 accompanying deep veins and the deep branch of the peroneal nerve, the lateral bundle consists of the peroneal artery, 2-3 accompanying deep veins and the superficial branch of the peroneal nerve.

The posterior bundle runs in the superior tibial-popliteal canal between the tibialis posterior and flexor pollicis longus anteriorly and the soleus muscle posteriorly. Upon exiting it at the border of the middle and lower third of the leg, the bundle lies relatively superficially, under the medial edge of the soleus muscle and the fascia proper of the leg. At the level of the medial malleolus, the posterior neurovascular bundle enters under the flexor retinaculum (medial malleolar fibrous canal) and exits through the calcaneal canal to the sole.

The posterior tibial artery (a. tibialis posterior) is a direct continuation of the popliteal and at the level of the upper third of the leg it gives off the largest branch - the peroneal artery (a. fibularis seu a. peronea), which, together with 2 deep veins of the same name, passes under the long flexor muscle finger and enters the lower musculofibular canal (between the fibula and the above-mentioned muscle). Behind the lateral malleolus, it is divided into terminal branches: lateral malleolar and calcaneal (rr. malleolares laterales, rr. calcanei) - for the collateral network of the ankles and heel.

The peroneal artery supplies the peroneus longus and brevis muscles and the lateral border of the triceps muscle. Below, its perforating branch connects with the lateral anterior malleolar artery from the anterior tibial. Its connecting branch anastomoses with the posterior tibial artery in the lower third of the leg.

Small branches of the posterior tibial artery:

1. The branch that goes around the head of the fibula is involved in the formation of the network of the knee joint and the blood supply to the peroneal muscles.

2. Muscle branches are directed to the posterior muscles of the leg: triceps, tibialis posterior, flexor pollicis longus, flexor digitorum longus.

The terminal branches of the posterior tibial artery - the medial and lateral plantar arteries (a. plantaris medialis et a. plantaris lateralis) supply blood to the foot. The medial plantar artery divides into deep and superficial branches. The larger and longer lateral plantar artery forms a plantar arch at the level of the bases of the metatarsal bones, which at the first metatarsal bone anastomoses with the deep branch of the dorsal artery of the foot. From the plantar arch begin 4 metatarsal arteries with piercing branches and common digital arteries.

The anterior tibial artery (a. tibialis anterior) starts from the popliteal at the lower edge of the popliteal muscle, passes slightly in the tibial-popliteal canal, at the level of the upper third leaves it through the upper anterior opening of the interosseous membrane and descends downwards along it, gradually approaching the skin, passes on the foot as the dorsal artery.

Branches:

1. recurrent: anterior and posterior (a. recurrens tibialis anterior, a. recurrens tibialis posterior) - for the knee arterial network and blood supply to the knee and tibiofibular joints, tibialis anterior muscle and extensor digitorum longus;

2. ankle anterior: medial and lateral (a. malleolaris anterior medialis, a. malleolaris anterior lateralis) - for the formation of ankle networks, supplying the ankle joint, tarsal bones and its joints;

3. terminal branch - dorsal artery of the foot (a. dorsalis pedis) with the first metatarsal, deep plantar, tarsal (lateral and medial), arcuate branches and I - IV digital branches.

Blood supply to the ankle joint is carried out by the ankle branches of the tibial and peroneal arteries, which form the medial and lateral malleolar and calcaneal networks, continuing anteriorly and posteriorly to the joint capsule. The medial malleolar network (rete malleolare mediale) arises from the connection of the medial anterior malleolar artery from the anterior tibial with the medial malleolar branch of the posterior tibial artery and with the medial tarsal branches of the dorsalis pedis artery. In the lateral malleolar network (rete malleolare laterale), the lateral anterior malleolar artery is anastomosed from the anterior tibial artery, the lateral malleolar and perforating branches from the peroneal artery. The calcaneal network (rete calcaneum) is formed by the fusion of the calcaneal branches of the posterior tibial and peroneal arteries.

22(IV) Arteries of the foot Arteries of
the foot are the terminal branches of the tibial arteries: plantar medial and lateral (a. plantaris medialis et a. plantaris lateralis) - from the posterior tibial, dorsal (a. dorsalis pedis) - from the anterior tibial. Together with the deep veins of the same name, as well as with the terminal branches of the tibial and deep peroneal nerves, they form neurovascular bundles located in the medial and lateral plantar grooves, and on the dorsum of the foot - in the first intermetatarsal space.

The lateral plantar artery (a. plantaris lateralis), larger and longer than the medial one, at the base of the fifth metatarsal bone it bends in the medial direction, forming a plantar arterial arch. The arch is projected at the level of the bases of the metatarsal bones and ends with a connection with the deep branch of the dorsal artery of the foot, passing in the first intermetatarsal space. Four metatarsal arteries (aa. metatarseae plantares) with perforating and common digital branches begin from the arch. The perforating arteries connect through the interosseous spaces with the dorsal metatarsal arteries. Proprietary digital arteries arise from the common digital ones. The first digital artery gives off two branches to the big toe and one to the medial surface of the second. The rest give off two branches, which pass along the lateral surfaces of the fingers facing each other.

The medial plantar artery (a. plantaris medialis) passes under the abductor pollicis muscle into the medial groove and is divided into superficial and deep branches that supply the muscles of the eminence of the big toe. It anastomoses with the first dorsal metatarsal artery.

The dorsal artery of the foot (a. dorsalis pedis) passes in the fibrous canal of the extensor retinaculum between the tendons of the long extensor pollicis and extensor digitorum longus and further along the first intermetatarsal space above the dorsal interosseous muscles, where its pulsation is clearly palpable.

Terminal and lateral branches extend from it:

the first dorsal metatarsal artery (a. metatarsea dorsalis I) with three digital branches: two to the big toe, one to the medial surface of the second;

deep plantar artery, anastomosing through the first interosseous space with the plantar arch;

arcuate artery;

lateral and medial tarsal arteries (aa. tarseae lateralis et medialis) - to the same edges of the foot for blood supply to the skin.

The arcuate artery (a. arcuata), as the terminal branch of the dorsal artery of the foot, passes at the level of the metatarsophalangeal joints and connects with the lateral tarsal branch, completing the intrasystemic anastomosis. From the dorsal arch or otherwise arcuate artery, the I-IV dorsal metatarsal arteries begin, passing into the dorsal digital arteries.

23(IV) Superior vena cava The superior vena
cava system unites the veins of the head and neck, upper extremities, chest and abdominal walls, chest cavity and mediastinum. The superior vena cava itself (v. cava superior) has a length of 5-8 cm, a diameter of 2-2.5 cm and is formed by the fusion of the short right and long left brachiocephalic veins (vv. brachiocephalicae dextra et sinistra) at the level of the synchondrosis of the right first costal cartilage with the sternum. Its flow into the right atrium is projected to the level of the third right sternocostal joint. The brachiocephalic veins and the superior vena cava do not have valves; they are surrounded by tissue that fixes their outer walls; therefore, if damaged, they do not collapse and, due to the suction effect of the thoracic cavity, are capable of embolism.

Anterior to the superior vena cava is the thymus and the medial surface of the upper lobe of the right lung. Along the right surface, the mediastinal pleura and the right phrenic nerve grow to the vein; the root of the right lung is located behind and below. The tributaries of the vein are on the right - the azygos vein (v. azygos), on the left - small mediastinal and pericardial veins.

The azygos vein (v. azygos) of the thoracic cavity arises from the right ascending lumbar vein (v. lumbalis ascendens dextra) anastomosing with the right lumbar veins from the inferior vena cava system (cava-caval intersystem anastomosis). The right ascending lumbar vein is located in the retroperitoneal space of the abdomen behind the psoas major muscle, passes between the muscle bundles of the right diaphragmatic leg into the posterior mediastinum, where it is called the azygos vein. It lies to the right and along the lateral surface of the thoracic spine. At the level of the IV-V thoracic vertebrae, it bends around the back of the lung root and, going anteriorly and slightly downward, flows into the superior vena cava. At the mouth of the azygos vein there are two semilunar valves.

The hemizygos vein (v. hemiazygos) continues into the mediastinum the left ascending lumbar vein, which passes through the left leg of the diaphragm and further along the left lateral surface of the thoracic vertebrae, but at the level of the VII-X vertebrae it crosses the vertebral column in front and flows into the azygos vein. The accessory hemizygos vein (v. hemiazygos accessoria) runs from above along the upper thoracic vertebrae to meet the hemigyzygos and connects with it.

The posterior intercostal veins flow into the azygos and semi-gypsy veins, and through them the veins of the vertebral plexuses, esophageal, bronchial, pericardial and mediastinal veins. The posterior intercostal veins anastomose with the anterior intercostal veins from the internal thoracic vein, forming intrasystemic superior caval anastomoses in the chest wall.

The vertebral plexuses - external and internal (plexus venosi vertebrales externi et interni) - each has an anterior and posterior part, located along the entire spinal column from the foramen magnum to the apex of the sacrum. The external plexus surrounds the vertebral bodies and arches with processes, the internal one is located in the epidural space of the spinal canal. Blood from the plexuses enters the intervertebral veins (vv. intervertebrales), which pass through the openings of the same name and flow into the posterior intercostal, lumbar and sacral veins. From the upper cervical spine and its plexuses, blood enters the vertebral and occipital veins.

Due to the vertebral plexuses, a cava-caval intersystem anastomosis occurs. The same anastomosis exists between the phrenic, posterior intercostal and lumbar veins.

The tributaries of the brachiocephalic veins, forming the superior vena cava, participate in the formation of porto-caval anastomoses through the epigastric and periumbilical veins. The esophageal veins, connecting with the gastric veins, form an organ porto-caval anastomosis.

Anomalies of the superior vena cava without hemodynamic disturbances:

Ø accessory, left superior vena cava;

Ø atresia of the main vein while maintaining the accessory vein.

Malformations of the superior vena cava, accompanied by circulatory disorders:

Ø accessory vein, infusing blood into the left atrium (doubling and dystopia);

Ø atresia of the right vein while the left one is preserved with its flow into the left atrium.

24 (IV) Brachiocephalic veins
Both brachiocephalic veins: right and left (vv. brachiocephlicae dextra et sinistra) begin at the confluence of the subclavian and internal jugular veins of the right and left side at the level and behind the sternoclavicular joints, and end with the formation of the superior vena cava at the level attachment to the sternum of the first right costal cartilage. The brachiocephalic veins do not have valves, their outer wall is fixed with tissue; when damaged, the veins gape, bleed fatally and capture emboli. The left vein, 5-6 cm long, runs obliquely down and to the right behind the manubrium of the sternum, having behind it the arterial brachiocephalic trunk, the common carotid and left subclavian arteries. The right vein, 3 cm long, has a vertical position and passes behind the right edge of the manubrium of the sternum, adjacent to the right dome of the pleura.

Since the formation of the brachiocephalic veins occurs at an angle, the confluence of the internal jugular and subclavian veins is called the jugular venous angle (angulus venosus juguli). The thoracic lymphatic duct (ductus thoracicus) flows into it or into one of the veins of its components on the left, and the right lymphatic duct (ductus lymphaticus dexter) on the right. This is how the circulatory and lymphatic vascular systems connect.

Tributaries of the brachiocephalic veins

Ø The vertebral vein (v. vertebralis) passes through the openings of the transverse processes of the cervical vertebrae; blood from the internal vertebral plexuses flows into it through the intervertebral veins.

Ø The deep cervical vein (v. cervicalis profunda) collects blood from the external vertebral plexuses and the posterior deep muscles of the neck and occiput.

Ø The internal thoracic vein (v. thoracica interna) runs parallel to the edge of the sternum in the anterior mediastinum, starts from the epigastric and musculophrenic veins, receives blood from the anterior intercostal veins.

Ø Thyroid inferior veins (1-3) (vv. thyroideae inferiores), their branch - the lower laryngeal vein (v. laryngea inferior) anastomoses with the middle and superior thyroid veins from the system of jugular veins of the neck, forming an intersystem anastomosis in the form of an unpaired thyroid plexus.

Ø The highest intercostal vein (v. intercostalis suprema) collects blood from the upper 3-4 intercostal spaces, has connections with the branches of the subclavian and axillary veins.

Ø Small veins of the internal thoracic organs: thymic, pericardial, bronchial, pericardial, mediastinal, esophageal.

Venous blood flows from the head through four interconnected systems, which differ in their multi-tier (multi-story) arrangement:

Ø along valveless veins of the soft tissues of the head, face and emissary veins;

Ø along valveless diploic and emissary veins of the skull bones;

Ø along the sinuses of the dura mater and emissary veins;

Ø along the superficial and deep veins (valveless) and venous plexuses of the brain and skull.

Emissary veins (vv. emissariae) connect the first three systems: the veins of the soft integument of the head with the diploic and sinuses of the dura mater, into which the veins of the brain also flow. Therefore, the outlet (emissary) veins act as a kind of redistributors of venous blood on the head (a kind of valve function), for example, when the pressure in one of the systems increases.

Almost all venous blood from the brain from the superficial and deep veins, ventricular plexuses and internal veins flows into the sinuses of the dura mater, and from them into the internal jugular vein, which begins from the sigmoid sinus in the jugular foramen of the skull. Only a small part of the cerebral venous blood enters the vertebral plexuses through the basilar vein.

Blood flows from the skin, organs, muscles of the head and face through superficial veins (facial, transverse vein of the face, frontal, temporal, parietal, occipital, posterior auricular), flowing into the external and anterior jugular veins, less often into the internal jugular vein. The veins of the outer integument of the neck, its muscles and organs, and vertebrae flow into the external, anterior and internal jugular veins, as well as into the subclavian and brachiocephalic veins.

The veins of the head are valveless, and in the neck the superficial veins have rare semilunar valves, which may be absent. The superficial veins of the neck are saved from compression by the subcutaneous muscle (platysma), and the deep veins by the surrounding tissue. The veins of the neck, together with the arteries, nerves and organs, are mobile and easily change their topography when the head posture changes, which is necessarily taken into account when performing medical manipulations on them. Due to their fixation to the first rib, the subclavian veins have the least mobility, which in medical practice are often punctured to ensure rapid delivery of medicinal fluids to the heart. All veins of the soft integument of the head and face form many anastomoses among themselves in the form of large looped plexuses.

In the canals and openings, fossae of the outer base of the skull there are finely looped venous plexuses - oval, carotid, hypoglossal canal, pterygoid plexus. The vertebral plexuses begin in the area of ​​the foramen magnum.

From the upper limb, blood flows through the superficial valvular, saphenous veins into the deep brachial and axillary veins. Blood moves through the dorsal venous network of the hand (rete venosum dorsale manus), lateral (cephalic - v. cephalica), medial (basilic - v. basilica) and intermediate veins of the elbow and forearm (v. intermedia cubiti, v. intermtdia antebrachii).

Deep veins (valvular) accompany the arteries of the same name, starting with the digital and metacarpal palmar, and then successively the blood enters the superficial and deep venous palmar arches, ulnar, interosseous, and radial veins. They have many transverse anastomoses among themselves and, merging together, give rise to the brachial veins. In the distal parts of the limb (hand, forearm), one artery is accompanied by 2-4 deep veins, and in the proximal parts (upper third of the shoulder and in the armpit) - one vein each, but the caliber of these veins increases significantly.

There are many anastomoses between the superficial and deep veins, especially under the skin in the distal parts of the limb, where a large-loop venous plexus is formed on the dorsum of the hand. Of great importance are perforating anastomoses that connect veins located at different depth levels. Circumferential venous drainage occurs due to venous anastomoses in the area of ​​the scapula, medial chest wall and lower neck, around large joints - shoulder, elbow, wrist.

25 (IV) Inferior vena cava
The inferior vena cava (v. cava inferior) - valveless, long - is formed by the fusion of the common iliac veins at the level between the IV-V lumbar vertebrae. It follows upward to the tendinous center of the diaphragm along the lumbar spine, gradually deviating anteriorly and passing in front of the right psoas major muscle, but behind the root of the mesentery and pancreatic head. Relative to the spine, it is always located to the right and in front of the lumbar vertebral bodies. Behind the horizontal part of the duodenum, it goes somewhat anteriorly and to the right, passing through the posterior edge of the liver in the groove of the same name. Through the tendon center of the diaphragm and its pericardial field it enters the chest cavity and the lower mediastinum, flowing into the right atrium from below.

The vein lies in the abdomen behind the peritoneum, having the aorta to its left, the right sympathetic trunk behind it, the parietal peritoneum in front, covering the head of the pancreas and the horizontal part of the duodenum, the root of the mesentery. Throughout its entire length, the vein is surrounded by fiber, which fuses with the outer membrane of the vein with fibrous fibers and attaches it to the vertebrae. In the diaphragm, the outer shell of the vein adheres to the tendon center and the extraperitoneal field of the liver. The tributary veins have few semilunar valves, but many inter- and intrasystemic anastomoses.

Timely diagnosis of the disease

To quickly recognize arthrosis of the elbow joint, it is necessary to undergo a set of diagnostic tests:

• appointment and examination by an orthopedist, questioning for the presence of discomfort in certain areas of the body;
• palpation of the disturbing part of the body;
• X-ray of the joint in several projections, depending on the preliminary and clinical diagnosis;
• general blood tests;
• detailed consultation with other specialists to form a more complete picture;
• CT, MRI or ultrasound of the damaged joint.

This will help determine the presence of this disease, its stage and the degree of damage to the joints.

Branches of the radial artery:

1. A. recurrens radialis, recurrent radial artery , begins in the ulnar fossa, goes proximally to the anterior surface of the lateral epicondyle, where it anastomoses with the above a. collateralis radialis from a. prodúnda brachii.

2. Rami musculáres - to the surrounding muscles.

3. Ramus carpeus palmaris, palmar carpal branch , begins in the lower part of the forearm and goes to the ulnar side towards a similar branch from a. ulnaris. From anastomosis with rámus carpeus palmaris a. ulnaris on the palmar surface of the wrist is formed réte carpi palmare.

4. Rámus palmaris superficialis, superficial palmar branch , passes over the thénar or pierces its superficial layers and, connecting with the end of the ulnar artery, enters the arcus palmaris superficialis.

5. Rámus carpeus dorsalis, dorsal carpal branch , departs in the “snuffbox” area and with the branch of the same name a. The ulnaris forms a network on the back of the wrist, réte carpi dorsale, which also receives branches from the interosseous arteries (aa. interosseae anterior et postérior).

6. A. metacárpea dorsalis prima, the first dorsal metacarpal artery , goes on the back of the hand to the radial side of the index finger and to both sides of the thumb.

7. A. prínceps pollicis, the first artery of the thumb , departs from the radius as soon as the latter penetrates through the first interosseous space into the palm, runs along the palmar surface of the first metacarpal bone and divides into branches, aa. digitalis palmares

, to both sides of the thumb and to the radial side of the index finger.

Ulnar artery

Ulnar artery, a. ulnaris

, represents one of the two terminal branches (the larger one) of the brachial artery. From its origin in the ulnar fossa (opposite the neck of the radius), it fits under m. pronator teres, up to the middle third of the forearm it goes obliquely, deviating to the ulnar side. In the lower two-thirds it runs parallel to the ulna, first in the space between m. flexor digitorum superficialis and m. fléxor carpi ulnaris, in the lower third, due to the transition of muscles into tendons, its position becomes more superficial (sulcus ulnaris). At the radial side of the pisiform bone, the ulnar artery passes into the canális carpi ulnáris (spátium interaponeuróticum) and, passing to the palm, is part of the arcus palmaris superficiális.

Branches of the ulnar artery:

1. A. recurrens ulnaris, recurrent ulnar artery , gives two branches - rami antérior et postérior, which pass in front and behind the medial epicondyle, anastomosing with aa. collateráles ulnáres supérior et inférior. Thanks to these anastomoses, as well as the above anastomoses between the branches of a. profúnda brachii and a. radial in the circumference of the elbow joint, an arterial network is obtained - réte articuláre cúbiti.

2. A. interossea communis, common interosseous artery , goes to the interosseous membrane, at the proximal edge of which it divides into two branches: a) a. interossea anterior

along the anterior surface of the interosseous membrane reaches m.
pronátor quadrátus, pierces the membrane and goes to the rear, where it ends in réte carpi dorsale. At the beginning of your journey a. interóssea antérior gives a. mediana (directed towards the palm together with n. medianus), aa. diaphýseos rádii et úlnae - to the bones of the forearm and rámi musculáres - to the surrounding muscles; b) a.
interossea posterior passes through the upper opening of the interosseous membrane to the back side, gives off a. interóssea recúrrens, lies between the superficial and deep layers of the extensor muscles and in the wrist area anastomoses with a. interóssea anterior.

3. Ramus carpeus palmaris, palmar carpal branch , goes towards the branch of the radial artery of the same name, with which it anastomoses.

Treatment methods for arthrosis

For each patient, the orthopedic doctor selects an individual treatment regimen, which depends on the complexity of the joint damage, the person’s condition, his age, as well as the presence of concomitant diseases that may affect the overall picture. Depending on which hand (left or right) was injured, treatment is also selected. It can be:

• exercises, therapeutic and preventive gymnastics;
• physiotherapy using modern technologies and drugs;
• drug treatment;
• proper nutrition as the main way to maintain a healthy lifestyle;
• chondroprotectors as constant assistants in the restoration of damaged cartilage tissue;
• taking medications, administering various injections to restore tissue.

In particularly severe and advanced situations, when the stage of joint destruction is catastrophic, it is necessary to resort to surgical intervention and prosthetics.

It is important to realize that the treatment of such a serious disease is permanent and must be carried out systematically, without skipping. There cannot be any rest or days off for patients when performing certain procedures. The recovery period is quite long and requires significant effort. The patient should perform gymnastics and develop hand mobility. Proper and balanced nutrition will also be beneficial.

Author of the article:
Vyacheslav Samoilov