2Objectives At the end of the lecture, you should be able to : Identify the origin of the vascular supply for the upper limb.Describe the main arteries and their branches of the arm, forearm & hand.Describe the vascular arches for the hand.Describe the venous drainage of the upper limbDescribe lymph nodes in the axilla
3 Arteries Of The Upper Limb Right subclavianarteryLeft subclavianarteryAxillary arteryBrachial arteryUlnararteryRadial arteryPalmar arches
5Begins at the lateral border of the 1st rib as continuation of the subclavian artery. Continues as brachial artery at lower border of teres major muscle.Is closely related to the cords of brachial plexus and their branchesIs enclosed within the axillary sheath.Is crossed anteriorly by the pectoralis minor muscle, and is divided into three parts; 1st, 2nd & 3rd.
61 Branch from 1st Part Superior thoracic artery: Supplies posterior aspects of intercostal spaces 1 and 2 and part of serratus anterior
72 Branches from 2nd Part Thoracoacromial artery (trunk): Pectoral branchDeltoid branchAcromial branchClavicular branchLateral thoracic artery:Extends along lateral side of pectoralis minor.Supplies part of pectoral muscles, lymph nodes and breast (esp. important in women)
83 Branches from 3rd Part Posterior circumflex humeral: Passes around posterior aspect of surgical neck of humerus.Anastomoses with the anterior circumflex humeralRuns with axillary nerve.Supplies deltoid and triceps musclePart of contents of quadrilateral space.
93 Branches from 3rd Part Posterior circumflex humeral: Passes around posterior aspect of surgical neck of humerus.Anastomoses with the anterior circumflex humeralRuns with axillary nerve.Supplies deltoid and triceps musclePart of contents of quadrilateral space.
12Is a continuation of the axillary artery at the lower border of teres major muscle. Provides main arterial supply for the arm.Terminates opposite neck of radius by dividing into radial & ulnar arteries.
14Branches of Brachial Artery Deep brachial (profunda brachii):Anastomoses with radial recurrent.
15Branches of Brachial Artery Nutrient humeral artery.Superior ulnar collateral:Runs with ulnar nerve.Passes posterior to medial epicondyle.Anastomoses with posterior ulnar recurrent artery.
16Branches of Brachial Artery Nutrient humeral artery.Inferior ulnar collateral:Passes anterior to medial epicondyle.Anastomoses with anterior ulnar recurrent artery.
17Brachial Artery Runs medial to median nerve in upper part of arm. Runs lateral to median nerve in lower part of arm.Passes deep to bicipital aponeurosis lateral to median nerve and medial to bicipital tendon.
18Brachial ArteryBranches into radial and ulnar arteries.
19Radial ArteryGives off radial recurrent to radial collateral from deep brachial.Enters wrist and hand to form deep palmar arch.
20Ulnar ArteryGives off common interosseous artery (trunk) near its origin.Runs through antebrachium with ulnar nerve.Enters wrist and hand to form superficial palmar arch.
21Ulnar ArteryCommon interosseous artery gives off anterior and posterior interosseous arteries:Run on either side of the interosseous membrane in the antebrachium.
22Ulnar Artery: Branches Muscular .Recurrent branch for anastomosis around the elbow joint.Common interosseous artery, which gives anterior and posterior interosseous arteries.Branch to anastomoses around the wrist joint.
23The Radial ArteryThe smaller of the two terminal branches of the brachial artery.Begins in the cubital fossa at the level of neck of radius.Descends downward and laterally.Leaves the forearm by winding around the lateral aspect of the wrist to reach the dorsum of the hand.Radial artery
24Radial Artery: Branches MuscularRecurrent branch for anastomosis around the elbow joint.Superficial palmar branch , joins the ulnar artery to form the superficial palmar arch.
25Arteries of the Palm Ulnar artery: Enters the hand: anterior to the flexor retinaculum,on the lateral side of the ulnar nerve and pisiform bone.Gives a deep branch.Continue as the superficial palmar arch.Ulnar arteryFRSuperficial palmar arch
261st dorsal interosseous muscle Arteries of the PalmRadial artery;Leaves dorsum of the hand by turning forward between the proximal ends of the 1st and 2nd metacarpal bones and two heads of the 1st dorsal inerossous muscle.On entering the palm it continues as deep palmar arch.It gives; arteria radialis indecis and arteria princeps policis.Radial artery1st dorsal interosseous muscle
27The Superficial Palmar Arch Radialis indices a.Is the direct continuation of the ulnar artery, as it curves laterally behind the palmar aponeurosis.Is completed by branch from the radial artery.Lies approximately at the level of the distal border of the extended thumb.Gives: digital arteries from its convexity to supply the fingers.Princeps pollicis a.Digital arteriesUlnar a.Radial a.
28The superficial palmar arch is more distal than the deep palmar arch.
29Veins of the Upper LimbThe veins of the upper limb are divided into two sets: Superficial and DeepThe two sets anastomose frequently with each other.The superficial veins are placed immediately beneath the skin, in the superficial fascia.The deep veins accompany the arteries, and constitute the venæ comitantes of those vessels
30Cephalic VeinRuns along lateral side of antebrachium in superficial fascia.Receives tributaries from median vein near the level of the elbow.Runs along lateral side of brachium in superficial fascia.Runs through deltopectoral triangle.Pierces clavipectoral fascia.Dumps into axillary vein.
31Basilic Vein Runs along medial side of antebrachium. Receives median cubital vein drainage.Median cubital vein lies superficial to bicipital aponeurosis:Useful site for venipuncture.Runs in deep fascia along medial side of brachium.Joins with venae comitantes to form axillary vein.
32Axillary Vein Formed by union of basilic vein and venae comitantes. Renamed subclavian vein after it passes under clavicle.
33LymphaticsLymphatic drainage is from palmar surface to dorsal surface of hand.Laterally:Lymphatics follow cephalic vein to:Chain of nodes in deltapectoral groove to:Axillary nodes.Medially:Lymphatics flow to epitrochlear nodes to:
34Lymph Nodes Brachial: Pectoral: Lie medial to humerus near axillary artery and vein.Pectoral:Lie behind pectoralis minor with lateral thoracic artery.Drain mammary gland.
35Lymph Nodes Subscapular: Central nodes: Apical nodes behind clavicle. Lie along lower border of scapula with subscapular artery.Drain back.Central nodes:In axillary fat.Receive lymph from all the above nodes.Drain to:Apical nodes behind clavicle.