Blood Vessel and Lymphatics of Upper Limb Dr Raj

Objectives At the end of the lecture, you should be able to : Identify the origin of the vascular supply for the upper limb. Describe the main arteries and their branches of the arm, forearm & hand. Describe the vascular arches for the hand. Describe the venous drainage of the upper limb Describe lymph nodes in the axilla

Arteries Of The Upper Limb Right subclavian artery Left subclavian artery Axillary artery Brachial artery Ulnar artery Radial artery Palmar arches

Begins at the lateral border of the 1st rib as continuation of the subclavian artery. Continues as brachial artery at lower border of teres major muscle. Is closely related to the cords of brachial plexus and their branches Is enclosed within the axillary sheath. Is crossed anteriorly by the pectoralis minor muscle, and is divided into three parts; 1st, 2nd & 3rd.

1 Branch from 1st Part Superior thoracic artery: Supplies posterior aspects of intercostal spaces 1 and 2 and part of serratus anterior

2 Branches from 2nd Part Thoracoacromial artery (trunk): Pectoral branch Deltoid branch Acromial branch Clavicular branch Lateral thoracic artery: Extends along lateral side of pectoralis minor. Supplies part of pectoral muscles, lymph nodes and breast (esp. important in women)

3 Branches from 3rd Part Posterior circumflex humeral: Passes around posterior aspect of surgical neck of humerus. Anastomoses with the anterior circumflex humeral Runs with axillary nerve. Supplies deltoid and triceps muscle Part of contents of quadrilateral space.

3 Branches from 3rd Part Posterior circumflex humeral: Passes around posterior aspect of surgical neck of humerus. Anastomoses with the anterior circumflex humeral Runs with axillary nerve. Supplies deltoid and triceps muscle Part of contents of quadrilateral space.

Anterior circumflex humeral: Subscapular: Thoracodorsal: Latissimus muscle Circumflex scapular:

Brachial Artery

Is a continuation of the axillary artery at the lower border of teres major muscle. Provides main arterial supply for the arm. Terminates opposite neck of radius by dividing into radial & ulnar arteries.

Brachial Artery: Branches Muscular. Nutrient to humerus. Profunda brachii Superior ulnar collateral. Inferior ulnar collateral.

Branches of Brachial Artery Deep brachial (profunda brachii): Anastomoses with radial recurrent.

Branches of Brachial Artery Nutrient humeral artery. Superior ulnar collateral: Runs with ulnar nerve. Passes posterior to medial epicondyle. Anastomoses with posterior ulnar recurrent artery.

Branches of Brachial Artery Nutrient humeral artery. Inferior ulnar collateral: Passes anterior to medial epicondyle. Anastomoses with anterior ulnar recurrent artery.

Brachial Artery Runs medial to median nerve in upper part of arm. Runs lateral to median nerve in lower part of arm. Passes deep to bicipital aponeurosis lateral to median nerve and medial to bicipital tendon.

Brachial Artery Branches into radial and ulnar arteries.

Radial Artery Gives off radial recurrent to radial collateral from deep brachial. Enters wrist and hand to form deep palmar arch.

Ulnar Artery Gives off common interosseous artery (trunk) near its origin. Runs through antebrachium with ulnar nerve. Enters wrist and hand to form superficial palmar arch.

Ulnar Artery Common interosseous artery gives off anterior and posterior interosseous arteries: Run on either side of the interosseous membrane in the antebrachium.

Ulnar Artery: Branches Muscular . Recurrent branch for anastomosis around the elbow joint. Common interosseous artery, which gives anterior and posterior interosseous arteries. Branch to anastomoses around the wrist joint.

The Radial Artery The smaller of the two terminal branches of the brachial artery. Begins in the cubital fossa at the level of neck of radius. Descends downward and laterally. Leaves the forearm by winding around the lateral aspect of the wrist to reach the dorsum of the hand. Radial artery

Radial Artery: Branches Muscular Recurrent branch for anastomosis around the elbow joint. Superficial palmar branch , joins the ulnar artery to form the superficial palmar arch.

Arteries of the Palm Ulnar artery: Enters the hand: anterior to the flexor retinaculum, on the lateral side of the ulnar nerve and pisiform bone. Gives a deep branch. Continue as the superficial palmar arch. Ulnar artery FR Superficial palmar arch

1st dorsal interosseous muscle Arteries of the Palm Radial artery; Leaves dorsum of the hand by turning forward between the proximal ends of the 1st and 2nd metacarpal bones and two heads of the 1st dorsal inerossous muscle. On entering the palm it continues as deep palmar arch. It gives; arteria radialis indecis and arteria princeps policis. Radial artery 1st dorsal interosseous muscle

The Superficial Palmar Arch Radialis indices a. Is the direct continuation of the ulnar artery, as it curves laterally behind the palmar aponeurosis. Is completed by branch from the radial artery. Lies approximately at the level of the distal border of the extended thumb. Gives: digital arteries from its convexity to supply the fingers. Princeps pollicis a. Digital arteries Ulnar a. Radial a.

The superficial palmar arch is more distal than the deep palmar arch.

Veins of the Upper Limb The veins of the upper limb are divided into two sets: Superficial and Deep The two sets anastomose frequently with each other. The superficial veins are placed immediately beneath the skin, in the superficial fascia. The deep veins accompany the arteries, and constitute the venæ comitantes of those vessels

Cephalic Vein Runs along lateral side of antebrachium in superficial fascia. Receives tributaries from median vein near the level of the elbow. Runs along lateral side of brachium in superficial fascia. Runs through deltopectoral triangle. Pierces clavipectoral fascia. Dumps into axillary vein.

Basilic Vein Runs along medial side of antebrachium. Receives median cubital vein drainage. Median cubital vein lies superficial to bicipital aponeurosis: Useful site for venipuncture. Runs in deep fascia along medial side of brachium. Joins with venae comitantes to form axillary vein.

Axillary Vein Formed by union of basilic vein and venae comitantes. Renamed subclavian vein after it passes under clavicle.

Lymphatics Lymphatic drainage is from palmar surface to dorsal surface of hand. Laterally: Lymphatics follow cephalic vein to: Chain of nodes in deltapectoral groove to: Axillary nodes. Medially: Lymphatics flow to epitrochlear nodes to:

Lymph Nodes Brachial: Pectoral: Lie medial to humerus near axillary artery and vein. Pectoral: Lie behind pectoralis minor with lateral thoracic artery. Drain mammary gland.

Lymph Nodes Subscapular: Central nodes: Apical nodes behind clavicle. Lie along lower border of scapula with subscapular artery. Drain back. Central nodes: In axillary fat. Receive lymph from all the above nodes. Drain to: Apical nodes behind clavicle.