The document summarizes the major arteries and veins of the upper limb. The arterial supply includes the subclavian, axillary, brachial, radial, and ulnar arteries. The axillary artery can develop aneurysms, which are dilations that require surgical treatment. The brachial artery gives off the profunda brachii artery and then bifurcates into the radial and ulnar arteries. The venous drainage includes the superficial basilic and cephalic veins and the deep brachial veins that accompany the arteries. Subclavian steal syndrome is described as abnormal blood flow reversal in the subclavian artery causing neurological deficits. Treatments include carotid-subclavian bypass surgery and angioplasty.
The arterial supply to the upper limb is delivered via five main vessels (proximal to distal):
Subclavian artery
Axillary artery
Brachial artery
Radial artery
Ulnar artery
In this article, we shall look at the anatomy of the arteries of the upper limb – their anatomical course, branches and clinical correlations.
ARTERIAL SUPPLY OF UPPER LIMBThe arterial supply to the .docxrossskuddershamus
ARTERIAL SUPPLY
OF UPPER LIMB
The arterial supply to the upper limb begins in the chest as the subclavian artery. The right subclavian artery arises from the brachiocephalic trunk, while the left subclavian branches directly off the arch of aorta.
When the subclavian arteries cross the lateral edge of the 1st rib, they enter the axilla, and are called axillary arteries.
IN THE AXILLA
The axillary artery passes through the axilla, just underneath the pectoralis minor muscle, enclosed in the axillary sheath.
At the level of the humeral surgical neck, the posterior and anterior circumflex humeral arteries arise. They circle posteriorly around the humerus to supply the shoulder region. The largest branch of the axillary artery also arises here – the subscapular artery.
The axillary artery becomes the brachial artery at the level of the teres major muscle.
Anteriorly
(i) Skin.
(ii) Superficial fascia
(iii) Deep fascia.
(iv) Clavicular part of the pectoralis major.
(v) Clavipectoral fascia with cephalic vein, lateral pectoral nerve, and thoracoacromial vessels.
Posteriorly
(i) First intercostal space with the external intercostal muscle.
(ii) First and second digitations of the serratus anterior with the nerve to serratus anterior.
(iii) Medial cord of brachial plexus with its medial pectoral
branch
laterally
Lateral and posterior cords of the brachial plexus.
Medially
Axillary vein
The first part of the axillary artery is enclosed (together with the brachial plexus) in the axillary sheath, derived from the prevertebral layer of deep cervical fascia.
Anteriorly
(i) Skin.
(ii) Superficial fascia.
(iii) Deep fascia.
(iv) Pectoralis major.
(v) Pectoralis minor
Posteriorly
(i) Posterior cord of brachial plexus.
(ii) subscapularis
Medially
(i) Medial cord of brachial plexus,
(ii) Medial pectoral nerve,
(iii) Axillary vein.
Laterally
Lateral cord of brachial plexus.
Anteriorly
(i) Skin.
(ii) Superficial fascia,
(iii) Deep fascia.
(iv) In the upper part there are the pectoralis major and medial root of the median nerve.
Posteriorly
(i) Radial nerve.
(ii) Axillary nerve in the upper part,
(iii) Subscapularis in the upper part,
(iv) Tendons of the latissimus dorsi and the teres major in the lower part.
Laterally
Coracobrachialis.
Musculocutaneous nerve in the upper part,
Lateral root of median nerve in the upper part,
Trunk of median nerve in the lower part.
Medially
(i) Axillary vein,
(ii) Medial cutaneous nerve of the forearm and ulnar nerve
(iii) Medial cutaneous nerve of arm
1st part:
Superior Thoracic artery
2nd part:
Acromiothoracic artery
Lateral Thoracic artery
3rd part:
Subscapular artery
Ant circumflex humeral artery
Post circumflex humeral artery
CLINICAL RELEVANCE: AXILLARY ARTERY ANEURYSM
An aneurysm is dilation of a blood vessel to more than twice its original size. Although rare, axillary artery aneurysms can occur as a result of atherosclerosis, thoracic out.
The arterial supply to the upper limb is delivered via five main vessels (proximal to distal):
Subclavian artery
Axillary artery
Brachial artery
Radial artery
Ulnar artery
In this article, we shall look at the anatomy of the arteries of the upper limb – their anatomical course, branches and clinical correlations.
ARTERIAL SUPPLY OF UPPER LIMBThe arterial supply to the .docxrossskuddershamus
ARTERIAL SUPPLY
OF UPPER LIMB
The arterial supply to the upper limb begins in the chest as the subclavian artery. The right subclavian artery arises from the brachiocephalic trunk, while the left subclavian branches directly off the arch of aorta.
When the subclavian arteries cross the lateral edge of the 1st rib, they enter the axilla, and are called axillary arteries.
IN THE AXILLA
The axillary artery passes through the axilla, just underneath the pectoralis minor muscle, enclosed in the axillary sheath.
At the level of the humeral surgical neck, the posterior and anterior circumflex humeral arteries arise. They circle posteriorly around the humerus to supply the shoulder region. The largest branch of the axillary artery also arises here – the subscapular artery.
The axillary artery becomes the brachial artery at the level of the teres major muscle.
Anteriorly
(i) Skin.
(ii) Superficial fascia
(iii) Deep fascia.
(iv) Clavicular part of the pectoralis major.
(v) Clavipectoral fascia with cephalic vein, lateral pectoral nerve, and thoracoacromial vessels.
Posteriorly
(i) First intercostal space with the external intercostal muscle.
(ii) First and second digitations of the serratus anterior with the nerve to serratus anterior.
(iii) Medial cord of brachial plexus with its medial pectoral
branch
laterally
Lateral and posterior cords of the brachial plexus.
Medially
Axillary vein
The first part of the axillary artery is enclosed (together with the brachial plexus) in the axillary sheath, derived from the prevertebral layer of deep cervical fascia.
Anteriorly
(i) Skin.
(ii) Superficial fascia.
(iii) Deep fascia.
(iv) Pectoralis major.
(v) Pectoralis minor
Posteriorly
(i) Posterior cord of brachial plexus.
(ii) subscapularis
Medially
(i) Medial cord of brachial plexus,
(ii) Medial pectoral nerve,
(iii) Axillary vein.
Laterally
Lateral cord of brachial plexus.
Anteriorly
(i) Skin.
(ii) Superficial fascia,
(iii) Deep fascia.
(iv) In the upper part there are the pectoralis major and medial root of the median nerve.
Posteriorly
(i) Radial nerve.
(ii) Axillary nerve in the upper part,
(iii) Subscapularis in the upper part,
(iv) Tendons of the latissimus dorsi and the teres major in the lower part.
Laterally
Coracobrachialis.
Musculocutaneous nerve in the upper part,
Lateral root of median nerve in the upper part,
Trunk of median nerve in the lower part.
Medially
(i) Axillary vein,
(ii) Medial cutaneous nerve of the forearm and ulnar nerve
(iii) Medial cutaneous nerve of arm
1st part:
Superior Thoracic artery
2nd part:
Acromiothoracic artery
Lateral Thoracic artery
3rd part:
Subscapular artery
Ant circumflex humeral artery
Post circumflex humeral artery
CLINICAL RELEVANCE: AXILLARY ARTERY ANEURYSM
An aneurysm is dilation of a blood vessel to more than twice its original size. Although rare, axillary artery aneurysms can occur as a result of atherosclerosis, thoracic out.
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.
venous drainage of the upper limb, median vein of forearm, deep veins, basilic vein, cephalic vein, median cubital vein, superficial vein, dorsal venous arch,
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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.
venous drainage of the upper limb, median vein of forearm, deep veins, basilic vein, cephalic vein, median cubital vein, superficial vein, dorsal venous arch,
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2. Arteries of Upper Limb
The arterial supply to the
upper limb is delivered via
five main vessels proximal to
distal)
• Subclavian artery
• Axillary artery
• Brachial artery
• Radial artery
• Ulnar artery
3. Subclavian Artery
On the right: the subclavian artery arises from the brachiocephalic trunk.
On the left: directly from the arch of aorta. The subclavian artery travels laterally towards the
axilla.
It can be divided into three parts based on its position relative to the anterior scalene muscle:
● First part - origin of the subclavian artery to the medial border of the anterior scalene.
● Second part - posterior to the anterior scalene
● Third part - lateral border of anterior scalene to the lateral border of the first rib.
4. Axillary Artery
• The axillary artery lies deep to the pectoralis minor and is enclosed in the axillary sheath (a
fibrous layer that covers the artery and the three cords of the brachial plexus).
• The artery can be divided into three parts based on its position relative to the pectoralis minor
muscle:
• First part (proximal to pectoralis minor)
• Second part (posterior to pectoralis minor)
• Third part (distal to pectoralis minor)
5. Axillary Artery Aneurysm
An axillary artery aneurysm is a dilation of the vessel to more than twice its original size. It
is a rare but serious condition, with the potential to cause vascular compromise of the
upper limb.
The dilated portion of the axillary artery can compress the brachial plexus, producing
neurological symptoms such as paraesthesia and muscle weakness.
The definitive treatment of an axillary artery aneurysm is surgical. It involves excising the
aneurysm and reconstructing the vessel wall using a vascular graft.
6. Brachial Artery
The brachial artery is a continuation of the axillary artery past the lower border of the teres
major.
It is the main supply of blood for the arm.
Immediately distal to the teres major, the brachial artery gives rise to the profunda brachii
(deep artery), which travels with the radial nerve in the radial groove of the humerus and
supplies structures in the posterior aspect of the upper arm (e.g. triceps brachii).
The brachial artery proper descends down the arm.
As it moves through the cubital fossa, underneath the bicipital aponeurosis, the brachial
artery terminates by bifurcating into the radial and ulnar arteries
7. Veins of Upper Limb
The venous system of the upper limb drains
deoxygenated blood from the arm, forearm and
hand.
• It can be subdivided into the superficial system
and the deep system.
8. Superficial Veins Deep Veins
Basilic Vein:
● The basilic vein originates from the dorsal venous network of the
hand and ascends the medial aspect of the upper limb.
● At the border of the teres major, the vein moves deep into the arm.
Here, it combines with the brachial veins from the deep venous system
to form the axillary vein.
Cephalic Vein:
● The cephalic vein also arises from the dorsal venous network of
the hand. It ascends the antero-lateral aspect of the upper limb,
passing anteriorly at the elbow.
● At the shoulder, the cephalic vein travels between the deltoid and
pectoralis major muscles (known as the deltopectoral groove), and
enters the axilla region via the clavipectoral triangle. Within the axilla,
the cephalic vein empties inte axillary vein.
The deep venous system of the upper limb is situated
underneath the deep fascia. It is formed by paired
veins, which accompany and lie either side of an artery.
In the upper extremity, the deep veins share the name
of the artery they accompany.
The brachial veins are the largest in size, and are
situated either side of the brachial artery. The
pulsations of the brachial artery assist the venous
return.
Veins that are structured in this way are known as vena
comitantes.
Perforating veins run between the deep and superficial
veins of the upper limb, connecting the two systems
9. SUBCLAVIAN STEAL SYNDROME
Subclavian steal syndrome is characterized by abnormal
blood flow in the arteries.
This affects the artery that supplies blood to the neck and
head or the arteries that supply blood to the arms In this
syndrome , there is reversal of blood flow in the vertebral
artery to the internal thoracic artery due to proximal
stenosis (narrowing) or occlusion of subclavian artery.
Signs and symptoms include:
●Syncope
●Neurologic deficits
●Severe memory problems
●Blood circulation problem in hands
● Blood pressure differential between arms
10. Its treatment include:
● Carotid subclavian bypass: Surgical procedure where a doctor connects the carotid artery to the
subclavian artery.
●Stent with balloon angioplasty
● Endarterectomy: Surgery to remove plaque from narrowed or blocked arteries.