Blood Supply of the Upper Limb

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

2. Objectives

3. Objectives

4. 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.

5. Axillary Artery

6. 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

8. 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 cord of BP & Axillary vein • Branches: • Thoracoacromial artery • Lateral Thoracic artery

9. Axillary Artery • 3rd part of Axillary artery: • Relations: • Anteriorly: Pectoralis Major • Posteriorly: Subscapularis, Latissimusdorsi, Teres Major • Axillary & Radial nerves • Laterally: Lateral cord of Brachial Plexus, • Coracobrachialis, Biceps, & Humerus • Medially: Medial cord of BP & Axillary vein • Branches: Subscapular artery • Anterior & Posterior circumflex humeral arteries

11. Branches of Axillary Artery

12. Anastomosis Around the Shoulder Joint • The extreme mobility of the shoulder joint may result in kinking of the axillary artery and a temporary occlusion of its lumen. • To compensate for this, an important arterial anastomosis exists between the branches of • The subclavian artery • The axillary artery. • Ensuring that an adequate blood flow takes place into the upper limb.

13. 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

14. Anastomosis around shoulder joint

15. Anastomosis around shoulder joint

16. 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.

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

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

19. Brachial Artery

20. 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

21. Anastomosis around elbow joint

22. 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.

23. 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.

24. Radial Artery

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

26. 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.

27. 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

28. Ulnar Artery

29. Ulnar Artery Branches

30. Areas of Ulnar & Radial Arteries Supply

31. 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

32. Deep Palmar Arch

33. Superficial Palmar Arch • Direct continuation of Ulnarartery. • 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

34. Superficial Palmar Arch

37. Areas of Upper Limb Arteries Pulsation

38. Veins of the Upper Limb • Superficial veins • Deep veins

39. Veins of the Upper Limb

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

41. 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

42. Dorsal Venous Arch

43. Dorsal venous arch

44. Veins of the Palm • Superficial palmar venous Arch • Deep palmar venous Arch

45. 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

46. 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, abranch of cephalic vein, joins the Basilic vein in the cubital fossa.

47. Cephalic Vein

48. Cephalic Vein

49. CephalicVein

50. 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