1. Blood supply of the upper limb. Major arterial anastomoses of the upper extremity. 2. The veins of the upper limb. 3. Innervation of the upper limb. Schematic representation of the innervation of the skin of the upper limb. 4. Lymphatic vessels of the upper extremity.

1. The Department of Human anatomy
Blood supply and
innervation of
upper limb.
Lecture

2. Plan
 Blood supply of the upper limb. Major
arterial anastomoses of the upper
extremity.
 The veins of the upper limb.
 Innervation of the upper limb.
Schematic representation of the
innervation of the skin of the upper
limb.
 Lymphatic vessels of the upper
extremity.

3. The aortic arch gives off the
brachiocephlic trunk (right
subclavian) and the left
subclavian arteries, course
into the arm and change their
names to the axillary arteries
(axillar region), which then
continue into the arm as the
brachial arteries. The brachial
artery gives off a deep
brachial artery high in the
arm, which courses in the
posterior compartment. The
brachial artery divides into
the ulnar and radial arteries
of the forearm and hand.
Blood Supply:

4. Spatium interscalenum
•Content:
�The roots of
the brachial
plexus(C5-T1)
�Subclavian
artery(which
becomes the
axillary artery
as it crosses
the lateral
boarder of rib1)

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6. Figure 19.23b
Vertebral artery
Costocervical trunk
Thoracoacromial artery
Axillary artery
Subscapular artery
Radial artery
Ulnar artery
Brachial artery
Suprascapular artery
Thyrocervical trunk
Posterior circumflex
humeral artery
Anterior circumflex
humeral artery
Deep artery of arm
Common
interosseous
artery
Deep palmar arch
Superficial palmar arch
Digital arteries
Common carotid
arteries
Right subclavian artery
Left subclavian artery
Brachiocephalic trunk
Posterior intercostal
arteries
Anterior intercostal
artery
Internal thoracic artery
Lateral thoracic artery
Descending aorta

7. Arteries of the Upper Limb
 Subclavian passes
between clavicle &
1st rib
 Vessel changes
names as passes
to different regions
 subclavian to
axillary to brachial
to radial & ulnar
 brachial used and
radial artery for
pulse

8. Vascular supply
 Subclavian→axillary
→radial
 Collateral circulation
 Posterior/anterior
circumflex humeral
 Deep brachial a.
 Radial a. (with median
n.) →deep palmar
arch
 Ulnar a. (with ulnar n.)
→ superficial palmar
arch

9. 1. a . circumflexa scapulae ( a .
subscapularis ) and a .
suprascapular (from tr .
thyrocervicalis );
2. a . circumflexa scapulae (a .
subscapularis ) and a . transversa
colli (a . subclavia ) ;
3. a . thoracica superior , a.
thoracica lateralis , a.
thoracodorsalis (a . axillaris ) and
a. intercostalis suprema , rr .
intercostales anteriores (a .
subclavia ).
Important anastomosis
axillary and subclavian
arteries are:

10.  CUBITAL FOSSA
The brachial
artery divides
into the ulnar
and radial
arteries of
the forearm
and hand.

11. .

13.
1. Brachial artery (a. brachialis).
2. Deep shoulder artery (a. profunda brachii).
3. The upper collateral ulnar artery (a. collateralis ulnaris
superior).
4. Lower collateral ulnar artery (a. collateralis ulnaris inferior).
5. Anterior branch of the ulnar swivel artery (r. anterior a. recurrens
ulnaris).
6. Posterior branch of the ulnar swivel artery (r. posterior a.
recurrens ulnaris).
7. Ulnar swivel artery (a. recurrens ulnaris).
8. Ulnar artery (a. ulnaris).
9. Common interosseous artery (a. interossea communis).
10. Anterior interosseous artery (a. interossea anterior).
11. Posterior interosseous artery (a. interossea posterior).
12. Swivel interosseous artery (a. interossea recurrens).
13. Radial artery (a. radialis).
14. Radial swivel artery (a. recurrens radialis).
15. The middle collateral artery (a. collateralis media).
Schematic representation
of the arterial network of elbow joint

14. Rete carpi dorsale:
r.carpeus dorsales (from
a. radialis) r. carpeus
dorsales (from a. ulnaris ),
aa . interosseae anterior et
posterior (from a. ulnaris).
Aarcus palmaris
superficialis:
a. ulnaris and r .
palmaris superficialis
(from a. radialis )
Arcus palmaris
profundus :
а. radialis and r. palmaris
profundus (from a. ulnaris )

15. Anatomical Snuffbox
 Lateral = E.pollicis brevis
 Medial = E. pollicis longus
 Floor = scaphoid, styloid of radius
 Contains Radial Artery (pulse)

16. Determining the arterial pulse on the upper limbs
The Axillary pulse: palpated in the
lower part of the lateral wall of the
armpit (axillary artery).
The Brachial pulse: it is determined
by brachial artery within the upper
extremity, near the elbow.
The Radial pulse: palpated on the
lateral side of the wrist(radial
artery).
The Ulnar pulse: defined on the
medial part of the wrist (ulnar
artery).

17. Clinical note
- Any structure (such as a
cervical rib) which reduces the
size of the spacium
interscalenum can compromise
blood flow and innervation to
the upper limb reduced radial
pulse, paresthesia, and/or motor
weakness (venous return is not
impaired).

18. Veins of the upper limb
Veins of the upper limb
are divided into
superficial and deep
drainage. Deep drainage
follows the arteries
previously mentioned
and are named similarly
(i.e., brachial artery—
brachial vein).
The superficial drainage
is the cephalic and
basilic veins which drain
subcutaneous tissue and
eventually drain.

19. Veins of the upper limb
SUPERFICIAL VEINS
-DORSAL VENOUS NETWORK
-CEPHALIC VEIN
-BASILIC VEIN
-MEDIAN CUBITAL VEIN
-MEDIAN VEIN OF FOREARM
-RADIAL VEIN (2)
-ULNAR VEIN (2)
-BRACHIAL VEIN (2)
-AXILLARY VEIN (1)
-DEEP VEINS

20. Figure 19.28b
Right subclavian vein
Brachiocephalic veins
Axillary vein
Brachial vein
Cephalic vein
Basilic vein
Median cubital vein
Median antebrachial
vein
Basilic vein
Internal jugular vein
External jugular vein
Left subclavian vein
Superior vena cava
Azygos vein
Inferior vena cava
Ascending lumbar vein
Accessory hemiazygos
vein
Hemiazygos vein
Posterior intercostals
Ulnar vein
Deep palmar venous arch
Superficial palmar venous arch
Digital veins
Cephalic vein
Radial vein
Anterior view

21. Upper Limb

22. Spinal Nerves
 31 pairs – contain thousands
of nerve fibers
 Connect to the spinal cord
 8 pairs of cervical nerves
(C1-C8)
 12 pairs of thoracic nerves
(T1-T12)
 5 pairs of lumbar nerves (L1-
L5)
 5 pairs of sacral nerves (S1-
S5)
 1 pair of coccygeal nerves
(Co1)

23. The plexuses
Forms by ventral rami
 Cervical plexus
 Brachial plexus
 Lumbar plexus
 Sacral plexus
 Coccygeal plexus
 Thoracic ventral
rami do not form
nerve plexuses

24. Brachial Plexus
 The brachial plexus
is a network of nerve
fibers, running from
the spine, formed by
the ventral rami of
the lower four
cervical and first
thoracic nerve
roots (C5-C8, T1).

25. Brachial plexus components
•supraclavicular part
Trunks (3)
•supraclavicular part
•Upper (superior) trunk:formed by the
union of roots C5 & C6
•Middle trunk:the lateral extension of
the C7 root
•Lower (inferior) trunk: formed by the
union of roots C8 & T1

26. Brachial plexus components
Cords (3)
•Lateral cord: formed by the union of anterior
divisions of the superior & middle trunks (C5, C6, &
C7)
•Medial cord:formed by the anterior division of the
inferior trunk (C8 & T1)
•Posterior cord: formed by the union of the three
posterior divisions (C5 to T1)

27. • Posterior compartment—posterior
cord
• Anterior compartment—medial, lateral
cords
• Name of cord is relative to axillary
artery
Brachial Plexus
1. UPPER TRUNK
2. MIDDLE TRUNK
3. LOWER TRUNK
Supraclavicular part
Infraclavicular part

28. Brachial Plexus

30. Brachial PlexusFasciculus
lateralis
n. musculocutaneus
r.lateralis n.medianus
Fasciculus
medialis
n.cutaneus brachii
medialis
n.cutaneus antebrachii
medialis
n . ulnaris
r. medialis
n.medianus
Fasciculus
posterior
n . axillaris
n . radialis

31. INPORTANT NERVES AND
THEIR AREA OF SUPPLY
 MUSCULOCUTANEOUS NERVE
A) SUPPLIES THE BICEPS, CORACOBRACHIALIS AND
BRACHIALIS
AXILLARY NERVE
- SUPPLIES THE DELTOID AND TERES MINOR MUSCLE
- SUPPLIES THE SHOULDER JOINT
RADIAL NERVE
- SUPPLIES THE TRICEPS
- SUPPLIES THE BRACHIORADIALIS
- SUPPLIES MOST OF THE EXTENSORS OF THE FOREARM

32. Brachial plexusMain nerves:
Musculocutaneous –
to arm flexors
Median – anterior
forearm muscles and
lateral palm
Ulnar – anteromedial
muscles of forearm
and medial hand
Axillary – to deltoid
and teres minor
Radial – to posterior
part of limb

33. Brachial plexus
Major branches:
a. Axillary Nerve (shoulder
region—2 muscles)
b. Musculocutaneous
Nerve (anterior
compartment of arm)
c. Radial Nerve (posterior
compartment of arm and
forearm)
d. Median Nerve (anterior
compartment of forearm—
1½ exceptions)
e. Ulnar Nerve (intrinsic
hand muscles—except
thenar eminence)
Innervation

35. Brachial plexus

36. IMPORTANT NERVES AND AREA OF SUPPLY
 1. MEDIAN NERVE( formed from both medial and lateral cord)-
 a) supplies all the flexors of the forearm
 b) intrinsic muscles in the lateral palm including thenar eminence)
2. ULNAR NERVE
 a) supplies the flexor carpi ulnaris
 b) supplies most of the intrinsic muscles of the hand including the
hypothenar eminence, and skin on the medial side of the hand

37. CLINICAL APPLICATION
- injury to median nerve-” APE HAND”
- injury to ulnar nerve-” CLAW HAND”

38. 3.THE RADIAL NERVE
INJURY TO RADIAL NERVE- ”WRIST
DROP”
Motor Functions
As mentioned above, the triceps
brachii muscle is innervated by
the radial nerve, this muscle
extends the arm at the elbow. In
the forearm, it gives rise to the
deep branch of the radial nerve,
which innervates the muscles in
the posterior compartment of
the forearm.
Sensory Functions
The radial nerve gives rise to
cutaneous branches, that
supply sensory innervation to
the skin for most of the back of
the arm and hand.

39. CUTANEOUS INNERVATION

40. Sensory innervation of the hand

41. UMRU

42. Lymphatic System of the upper extremity

43. The lymph glands of the upper extremity
 The lymph glands of the upper
extremity are divided into two sets-
superficial and deep.
 The superficial lymph
glands (supratrochlear and
deltoideopectoral glands)
 The deep lymph
glands The Axillary Glands are
of large size, vary from twenty to
thirty in number, and may be
arranged in the following groups:
 lateral,
 anterior or pectoral,
 posterior or subscapular,
 central or intermediate,
 medial or subclavicular

44. Thank you for attention!