Blood Supply of the Upper Limb Dr. Sama-ul-Haque

Objectives Describe axillary artery and its relations. Enlist the branches of axillary artery. Discuss the arterial anastomosis around the shoulder joint. Describe brachial artery, its relations and branches. Discuss the arterial anastomosis around the elbow joint.

Objectives Discuss the radial and ulnar arteries with their relations and branches. Describe the formation of superficial and deep palmar arches. Explain the formation of dorsal venous arch. Discuss the superficial veins of the upper limb. Describe the formation of axillary vein.  

Axillary Artery Begins at the lateral border of 1st rib as a continuation of subclavian artery. Ends at the lower border of teres major muscle by continuing as brachial artery. Pectoralis minor muscle crosses in front of the artery and divides it into 3 parts.

Axillary Artery

Axillary Artery 1st part of Axillary artery: Relations: Anteriorly: Pectoralis Major Posteriorly: Long thoracic nerve Laterally: Three cords of brachial plexus Medially: Axillary vein Branches: Highest thoracic artery

Axillary Artery 2nd part of Axillary artery: Relations: Anteriorly: Pectoralis Minor & Pectoralis Major Posteriorly: Posterior cord of Brachial Plexus (BP) Laterally: Lateral cord of Brachial Plexus Medially: Medial Lateral cord of BP & Axillary vein Branches: Thoracoacromial artery Lateral Thoracic artery

Axillary Artery 3rd part of Axillary artery: Relations: Anteriorly: Pectoralis Major Posteriorly: Subscapularis, Latissimus dorsi & Teres Major Laterally: Lateral cord of Brachial Plexus Medially: Medial Lateral cord of BP & Axillary vein Branches: Subscapular artery Anterior & Posterior circumflex humeral arteries

Branches of Axillary Artery

Anastomosis around shoulder joint Anastomosis occurs between branches of Subclavian and Axillary arteries: Branches from Subclavian Artery: Suprascapular artery Superficial cervical artery Branches from Axillary Artery: Subscapular artery Anterior circumflex humeral artery Posterior circumflex humeral artery

Anastomosis around shoulder joint

Brachial Artery Begins at the lower border of teres major muscle as a continuation of Axillary artery. Terminates opposite the neck of the radius by dividing into Radial and Ulnar arteries.

Relations of Brachial Artery Anteriorly: Coracobrachialis & Biceps Posteriorly: Brachialis & Triceps Laterally: Median nerve & Coracobrachialis Medially: Ulnar nerve & Basilic vein

Branches of Brachial Artery Muscular branches Nutrient artery Profunda Brachii artery Superior ulnar collateral artery Inferior ulnar collateral artery

Brachial Artery

Anastomosis around elbow joint Anastomosis occurs between branches of Brachial, Radial and Ulnar arteries: Branches from Brachial Artery: Profunda Brachii artery Superior ulnar collateral artery Inferior ulnar collateral artery Branches from Ulnar and Radial Arteries: Radial & ulnar recurrent arteries Posterior interosseous recurrent artery

Anastomosis around elbow joint

Radial Artery Smaller terminal branch of Brachial artery. Begins in the cubital fossa & passes below Brachioradialis muscle. Rest on deep muscles of forearm. In the distal part of forearm it lies on anterior surface of the Radius.

Radial Artery At wrist it winds backward and passes anteriorly into the palm between two heads of 1st dorsal interossei muscle. Then it joins deep branch of ulnar artery to form Deep Palmar Arch.

Radial Artery

Branches of Radial Artery Muscular branches Recurrent branch Superficial Palmar branch Joins ulnar artery to form Superficial Palmar Arch Radialis Indicis artery Princeps Pollicis

Ulnar Artery Larger terminal branch of Brachial artery. Begins in the cubital fossa & descends through anterior compartment of forearm. It enters the palm in front of flexor retinaculum. It ends by forming Superficial Palmar Arch with Superficial Palmar branch of Radial artery.

Branches of Ulnar Artery Muscular branches Recurrent branches Deep Palmar branch Joins radial artery to form Deep Palmar Arch Common Interosseous artery Anterior Interosseous artery Posterior Interosseous artery

Ulnar Artery

Ulnar Artery Branches

Areas of Ulnar & Radial Arteries Supply

Deep Palmar Arch Direct continuation of Radial artery. Deeply placed in palm in front of the metacarpal bones & Interosseous muscles. The Arch on medial side is completed by deep branch of the ulnar artery. Branches: Palmar, Metacarpal, Perforating & Recurrent

Deep Palmar Arch

Superficial Palmar Arch Direct continuation of Ulnar artery. Superficially placed in palm in front of the long flexor tendons. The Arch on lateral side is completed by superficial palmar branch of the radial artery. Branches: Four digital arteries

Superficial Palmar Arch

Areas of Upper Limb Arteries Pulsation

Veins of the Upper Limb Superficial veins Deep veins

Veins of the Upper Limb

Superficial Veins of the Upper Limb Dorsal venous arch Veins of the Palm Cephalic vein Basilic vein Median vein of the forearm

Dorsal venous arch Lies in the subcutaneous tissue proximal to Metacarpophalangeal joints Drains on the lateral side into the Cephalic vein Drains on the medial side into the Basilic vein Communicates with the deep veins of the palm freely

Dorsal Venous Arch

Dorsal venous arch

Veins of the Palm Superficial palmar venous Arch Deep palmar venous Arch

Cephalic Vein Arises from the lateral side of the dorsal venous arch on the back of hand. Winds round the lateral border of forearm Ascends in the superficial fascia into the cubital fossa and up the front of the arm on the lateral side of Biceps

Cephalic Vein On reaching the interval between deltoid & Pectoralis major muscles, it pierces deep fascia & joins the Axillary vein. Drains the lateral and posterior surfaces of the limb. Median Cubital Vein, a branch of cephalic vein, joins the Basilic vein in the cubital fossa.

Cephalic Vein

Cephalic Vein

Cephalic Vein

Basilic Vein Arises from the medial side of the dorsal venous arch on the back of hand Winds round the medial border of forearm Ascends in the superficial fascia on the posterior surface of the forearm Below elbow it inclines to reach the cubital fossa

Basilic Vein Ascends on the medial side of Biceps It pierces deep fascia at the middle of the arm It joins the vena comitantes of the brachial artery to form the Axillary vein. Drains the medial and posterior surfaces of the limb. Receives Median Cubital Vein at cubital fossa.

Basilic Vein

Median Cubital Vein

Median Vein of the Forearm Arises in the palm Ascends on the front of forearm Drains into Basilic vein or Median cubital vein or divides into two branches: Median Basilic vein: (Drain into basilic vein) Median cephalic vein: (Drain into cephalic vein)

Median Vein of the Forearm

Deep Veins of the Upper Limb Venae Comitantes Axillary vein

Vena Comitantes Deep veins accompany the respective arteries as vena comitantes Two vena comitantes of brachial artery join the basilic vein at the lower border of teres major to form Axillary vein

Axillary Vein Formed by the union of the vena comitantes of brachial artery with basilic vein It becomes Subclavian Vein at the outer border of 1st rib Tributaries correspond to the branches of the axillary artery and also receive Cephalic Vein

Axillary Vein

Superficial and Deep veins of the Limb

Varicose veins

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