Vessels Of The Upper Limb Anatomy Notes

Arteries

Question 1. What is axis artery of upper limb? Enumerate the various arteries that represent the axis artery in the adult.
Answer.

• The axis artery is formed by the 7th cervical intersegmental artery.
• In the adult, it persists in the form of the following arteries:
  • Axillary artery
  • Brachial artery
  • Anterior interosseous artery
  • Deep palmar arch

Question 2. Give a brief account of the axillary artery.
Answer.

Axillary Artery Origin

Axillary Artery is the artery of lateral side of the forearm. It arises in the cubital fossa, 1 cm below the bend of the elbow, as a smaller terminal branch of the brachial artery.

Axillary Artery Course and termination

Axillary Artery runs downwards along the lateral side of the front of forearm to reach the distal end of radius.

At the wrist, the radial artery winds dorsally passing deep to the tendons of abductor pollicis longus and extensor pollicis brevis to enter the anatomical snuffbox on dorsolateral part of the hand.

Axillary Artery enters the palm by passing between the two heads of 1st dorsal interosseous muscle and terminates by forming the deep palmar arch.

Axillary Artery Branches

• Radial recurrent artery
• Dorsal carpal branch
• Palmar carpal branch
• First dorsal metacarpal artery – on dorsum of hand
• Superficial palmar branch.
• Arteria princeps pollicis
• Arteria radialis indicis

Axillary Artery Applied anatomy

The pulsations of radial artery can be felt at two sites: (a) laterally in front of the distal one-third of radius (radial pulse) and (b) in the anatomical snuffbox.

Ulnar Artery

 Ulnar Artery Origin

• Ulnar artery is the larger terminal branch of the brachial artery.
•  Ulnar Artery arises in the cubital fossa at the level of neck of radius 1 cm below the bend of the elbow.
• In the upper one-third, it runs obliquely, downwards and medially while in the lower two-third, it runs vertically downwards along the medial side of the front of forearm to the lateral side of pisiform bone.
•  Ulnar Artery enters palm by passing superficial to flexor retinaculum. In the palm, it forms superficial palmar arch.

Branches of Ulnar Artery

• Anterior ulnar recurrent artery
• Posterior ulnar recurrent artery
• Common interosseous artery
• Posterior interosseous artery through common interosseous artery
• Palmar carpal branch
• Dorsal carpal branch

Read And Learn More: Selective Anatomy Notes And Question And Answers

Superficial Palmar Arch

The superficial palmar arch is an important anastomosis between ulnar and radial arteries in the palm of the hand.

Superficial Palmar Arch Formation

Superficial Palmar Arch is formed by the superficial palmar branch of the ulnar artery (the main continuation of ulnar artery). The arch is completed on the lateral side by one of the following arteries:

• Superficial palmar branch of the radial artery (most common)
• Princeps pollicis artery
• Radialis indices artery

Note: The princeps pollicis and radial indices arteries are not the branches of deep palmar arch.

Superficial Palmar Arch Location and branches

• The superficial palmar arch lies superficial to the long flexor tendons with convexity directed distally.
• Superficial Palmar Arch lies at the level of distal border of the fully extended thumb.
• Superficial Palmar Arch gives off four palmar digital arteries, which supply medial 3.5 digits.

Superficial Palmar Arch Applied anatomy

The superficial palmar arch is one of the important anastomotic arterial channels for efficient blood supply to the hand in case of blockage of the radial or ulnar artery.

Deep Palmar Arch

Deep Palmar Arch  Formation

Deep Palmar Arch  is formed by the continuation of radial artery in the palm. The arch is completed on the medial side by the deep branch of the ulnar artery.

Deep Palmar Arch  Location and branches

The arch lies deep to long flexor tendons with convexity directed distally. It lies about 1 cm proximal to the superficial palmar arch (at the level of proximal border of the fully extended thumb).

Deep Palmar Arch  gives off the following branches:

• Three palmar metacarpal arteries (to second, third and fourth interosseous spaces)
• Three perforating arteries
• Recurrent branches

Deep Palmar Arch  Applied anatomy

The deeper palmar arch is one of the important anastomotic arterial channels between the radial and ulnar arteries for efficient blood supply to the hand in the event of blockage of the radial or ulnar artery.

Arterial Anastomosis Around the Scapula

Arterial Anastomosis Around the Scapula is an arterial anastomosis around the elbow between the branches of brachial artery with the branches from upper ends of ulnar and radial arteries. The anastomoses take place in front and behind the two epicondyles of the humerus.

 

In front of lateral epicondyle:

Between the anterior descending branch (radial collateral artery) of the profunda brachii artery and the radial recurrent artery – a branch of the radial artery.

Behind the lateral epicondyle:

Between the posterior descending branch (middle collateral artery) of the profunda brachii artery and the interosseous recurrent branch of the posterior interosseous artery.

In front of medial epicondyle:

Between the inferior ulnar collateral branch of the brachial artery and the anterior ulnar recurrent branch of the ulnar artery.

Behind the medial epicondyle:

Between the superior ulnar collateral branch of the brachial artery and the posterior ulnar recurrent artery – a branch of the ulnar artery.

Upper Limb Where Arterial Pulsations

• Pulsations of axillary artery can be felt against the lateral wall of the axilla.
• Pulsations of brachial artery can be felt: (a) on the medial side of midarm where it lies on the tendon of insertion of coracobrachialis and (b) in the cubital fossa medial to the tendon of biceps brachii.
• Pulsations of radial artery can be felt:
  • At the wrist in front of lower end of radius lateral to the tendon of flexor carpi radialis
  • In the anatomical snuff box
• Pulsations of ulnar artery can be felt at the wrist just lateral to the pisiform bone.

Veins

Deep veins

• Venae comitantes of radial and ulnar arteries
• Venae comitantes of brachial artery
• Brachial vein
• Axillary vein

Superficial veins

• Cephalic vein
• Basilic vein
• Median vein of forearm

Axillary Vein Commencement

Axillary Vein  begins as the continuation of basilic vein at the lower border of teres major.

Axillary Vein Course

Axillary Vein  passes upwards to reach the axilla where it lies medial to axillary artery. At the outer border of 1st rib, it continues as the subclavian vein.

Axillary Vein Tributaries

• Brachial veins (at its commencement)
• Cephalic vein near its termination
• Veins corresponding to branches of the axillary artery, i.e. lateral thoracic vein, subscapular vein, etc.

Cephalic Vein

The cephalic vein is the superficial preaxial vein of the upper limb.

Cephalic Vein Commencement, course and termination

Begins from the lateral side of dorsal venous arch of hand.

Cephalic Vein passes upwards across the roof of anatomical snuffbox on the dorsum of hand; then it curves around the radius to reach the front of forearm.

Cephalic Vein ascends on the lateral part of the front of forearm. One inch below the elbow, it gives the median cubital vein which joins the basilic vein on the medial side.

Then it ascends lateral to biceps, and pierces deep fascia at the lower border of pectoralis major to enter the deltopectoral groove to reach the infraclavicular fossa. Here it takes a sharp turn backwards to pierce the clavipectoral fascia and ends in the axillary vein.

At elbow, the greater part of its blood is drained into basilic vein through median cubital vein.

Cephalic Vein Tributaries

• Unnamed veins from front and back of lateral side of forearm
• Median cephalic vein (if present)

Cephalic Vein Applied anatomy

Cephalic Vein is used for intravenous injection.

Basilic Vein

Basilic Vein  is the superficial postaxial vein of the upper limb.

Commencement, course and termination

• Begins from the medial side of the dorsal venous arch of hand.
• Ascends on the medial border of the forearm. Then it curves forwards a little below elbow, to ascend on the front of the elbow.
• One inch above the elbow, it is joined by the median cubital vein.
• Then, it ascends on the medial side of the biceps and pierces the deep fascia in the middle of the arm.
• Thereafter, it ascends medial to the brachial artery; and at the lower border of teres major it continues into the axilla as axillary vein.

Basilic Vein  Tributaries

• Unnamed veins from front and back of medial side of forearm
• Median cubital vein

Basilic Vein  Applied anatomy

Basilic Vein  is used for:

• Giving intravenous injections
• Performing cardiac catheterization

Median Cubital Vein

The median cubital vein is a large communicating venous channel on the front of the elbow joining the cephalic vein with the basilic vein. It begins from cephalic vein 2.5 cm below the bend of elbow and runs upward and medially to join the basilic vein 2.5 cm above the bend of elbow. It shunts the blood from cephalic vein to the basilic vein. It is the most superficial vein in the body.

Median Cubital Vein Applied anatomy

The median cubital vein is the most preferred site for intravenous injections because:

• Median Cubital Vein is easy to access, as the vein is superficial and prominent.
• Median Cubital Vein is well supported by the underlying bicipital aponeurosis when elbow is extended.
• Median Cubital Vein is anchored by a perforating vein to the deep veins so that it does not slip during the venepuncture.