Blood Supply of the Upper Limb

Dr. Sama-ul-Dr. Sama-ul-HaqueHaque

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 ArteryAxillary 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 ArteryAxillary 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 ArteryAxillary 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 ArteryAxillary 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 ArteryBranches of Axillary Artery

Anastomosis around shoulder jointAnastomosis 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 jointAnastomosis around shoulder joint

Brachial ArteryBrachial 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 ArteryRelations of Brachial Artery

Relations:

Anteriorly: Coracobrachialis & Biceps

Posteriorly: Brachialis & Triceps

Laterally: Median nerve & Coracobrachialis

Medially: Ulnar nerve & Basilic vein

Branches of Brachial ArteryBranches of Brachial Artery

Muscular branches

Nutrient artery

Profunda Brachii artery

Superior ulnar collateral artery

Inferior ulnar collateral artery

Brachial Artery

Anastomosis around elbow jointAnastomosis 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 jointAnastomosis around elbow joint

Radial ArteryRadial 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 ArteryRadial 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 ArteryBranches of Radial Artery

Muscular branches

Recurrent branch

Superficial Palmar branch

Joins ulnar artery to form Superficial

Palmar Arch

Radialis Indicis artery

Princeps Pollicis

Ulnar ArteryUlnar 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 ArteryBranches 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 ArchDeep 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 ArchSuperficial 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 LimbVeins of the Upper Limb

Superficial veins

Deep veins

Veins of the Upper

Limb

Superficial Veins of the Upper LimbSuperficial Veins of the Upper Limb Dorsal venous arch

Veins of the Palm

Cephalic vein

Basilic vein

Median vein of the forearm

Dorsal venous archDorsal 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 Dorsal

Venous Venous

ArchArch

Dorsal venous archDorsal venous arch

Veins of the PalmVeins of the Palm

Superficial palmar venous Arch

Deep palmar venous Arch

Cephalic VeinCephalic 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 VeinCephalic 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 VeinCephalic Vein

Cephalic VeinCephalic Vein

CephalicCephalic

VeinVein

Basilic VeinBasilic 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 VeinBasilic 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 Basilic

VeinVein

Median Cubital Vein

Median Vein of the ForearmMedian 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 ForearmMedian Vein of the Forearm

Deep Veins of the Upper LimbDeep Veins of the Upper Limb

Venae Comitantes

Axillary vein

Vena ComitantesVena 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 VeinAxillary 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 Axillary

VeinVein

Superficial and Deep veins of the LimbSuperficial and Deep veins of the Limb

Varicose veins

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