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

2. Objectives Describe axillary artery and its relations.
Enlist the branches of axillary artery.
Discuss the arterial anastomosis around the shoulder joint.
Describe brachial artery, its relations and branches.
Discuss the arterial anastomosis around the elbow joint.

3. Objectives
Discuss the radial and ulnar arteries with their relations and branches.
Describe the formation of superficial and deep palmar arches.
Explain the formation of dorsal venous arch.
Discuss the superficial veins of the upper limb.
Describe the formation of axillary vein.

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

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

8. Axillary Artery 3rd part of Axillary artery: Relations:
Anteriorly: Pectoralis Major
Posteriorly: Subscapularis, Latissimus dorsi & Teres Major
Laterally: Lateral cord of Brachial Plexus
Medially: Medial Lateral cord of BP & Axillary vein
Branches:
Subscapular artery
Anterior & Posterior circumflex humeral arteries

9. Branches of Axillary Artery

10. 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

11. Anastomosis around shoulder joint

12. 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.

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

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

15. Brachial Artery

16. 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

17. Anastomosis around elbow joint

18. 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.

19. 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.

20. Radial Artery

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

22. 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.

23. 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

24. Ulnar Artery

25. Ulnar Artery Branches

26. Areas of Ulnar & Radial Arteries Supply

27. 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

28. Deep Palmar Arch

29. Superficial Palmar Arch
Direct continuation of Ulnar artery.
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

30. Superficial Palmar Arch

33. Areas of Upper Limb Arteries Pulsation

34. Veins of the Upper Limb
Superficial veins
Deep veins

35. Veins of the Upper Limb

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

37. 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

38. Dorsal Venous Arch

39. Dorsal venous arch

40. Veins of the Palm Superficial palmar venous Arch
Deep palmar venous Arch

41. 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

42. 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, a branch of cephalic vein, joins the Basilic vein in the cubital fossa.

43. Cephalic Vein

44. Cephalic Vein

45. Cephalic Vein

46. 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

47. Basilic Vein Ascends on the medial side of Biceps
It pierces deep fascia at the middle of the arm
It joins the vena comitantes of the brachial artery to form the Axillary vein.
Drains the medial and posterior surfaces of the limb.
Receives Median Cubital Vein at cubital fossa.

48. Basilic Vein

49. Median Cubital Vein

50. Median Vein of the Forearm
Arises in the palm
Ascends on the front of forearm
Drains into Basilic vein or Median cubital vein or divides into two branches:
Median Basilic vein: (Drain into basilic vein)
Median cephalic vein: (Drain into cephalic vein)

51. Median Vein of the Forearm

52. Deep Veins of the Upper Limb
Venae Comitantes
Axillary vein

53. Vena Comitantes
Deep veins accompany the respective arteries as vena comitantes
Two vena comitantes of brachial artery join the basilic vein at the lower border of teres major to form Axillary vein

54. Axillary Vein
Formed by the union of the vena comitantes of brachial artery with basilic vein
It becomes Subclavian Vein at the outer border of 1st rib
Tributaries correspond to the branches of the axillary artery and also receive Cephalic Vein

55. Axillary Vein

56. Superficial and Deep veins of the Limb

57. Varicose veins

58. Thank You