5. Arterial structure

**Arterial supply of the Upper Limb**

Receives the blood supply from the subclavian artery.

AXILLARY ARTERY (She Taste Like Sweet Apple Pie)

Main artery of the upper limb and continuation of subclavian artery at the outer border of the first rib. It lies with the brachial plexus and the axillary vein.

It is divided into into three parts by pectoralis minor and ends at at the lower border of the teres major.

**Branches for the upper limb**

Anterior Circumflex Humeral Artery

Posterior Circumflex Humeral Artery

BRACHIAL ARTERY

Begins at the lower border of teres major muscle and is the principal blood supply to the arm

**Course**

Runs on the medial aspect of the upper arm to the cubital fossa. Flanked on either side by the brachial veins. The median nerve is laterally proximally and crosses it, lying medially distally.

Divides into the radial and ulnar arteries at the level of the radial head

**Branches:**

1.  Deep Brachial Artery (Profunda Brachii)

* Arises at its initiation
* Accompanies the radial nerve in its diagonal course around the humerus in the radial groove
* Ends as the middle and radial collateral arteries which participate in elbow anatomosis.
* Supplies the triceps and other muscles, and an ascending (deltoid) branch

2.  Nutrient artery of the humerus

3.  Muscular Branches: supply the flexor

4.  Superior Ulnar Collateral Artery: pierces the intermuscular septum with the ulnar nerve and anastomose with the posterior ulnar recurrent artery.

5.  Inferior Ulnar collateral Artery above the medial epicondyle and divides into anterior and posterior branches which anastomose with anterior ulnar recurrent.

6.  Terminal Branches: Radial and Ulnar Arteries

BLOOD SUPPLY OF THE FOREARM: RADIAL AND ULNAR ARTERIES

Terminal branches of the brachial artery. The ulnar artery is the principal blood supply of the forearm. Radial artery is the principal blood supply of the hand

RADIAL ARTERY

Passes on the lateral side of the forearm to the wrist and ends between the first and second metacarpals as the deep palmar arch.

**Branches:**

Radial Recurrent Artery: ascends on the brachoradialis muscle and anastomosis with the radial collateral artery.

Muscular Branches: supply the muscles of the radial side of the forearm.

Superficial palmar branch: comes off the distal end of the radius. Descends through the muscles of the thumb and joins the superficial branch of the ulnar artery to form the superficial palmar arterial arch.

Palmar carpal branch: runs deep to the wrist flexor tendons and forms the deep palmar carpal arch with the carpal branch of the ulna.

ULNAR ARTERY

Passes on the medial aspect of the forearm, between FDS and FDP to the hand and ends as the superficial palmar arch over the hypothenar eminence.

**Branches:**

* Anterior Ulnar Recurrent Artery: runs superiorly and anastomose with the anterior ulnar collateral arteries.
* Posterior ulnar Recurrent Artery: anastomose with the posterior ulnar collateral arteries.
* Common Interosseus Artery into anterior and posterior interosseous
* Muscular Branches: supply muscles of the ulnar aspect.
* Palmar Carpal Branch: runs deep to the flexor tendons and anastomoses with the palmar carpal branch of the radial artery to form the deep arch
* Dorsal Carpal Branch: arises above the pisiform, winds around the wrist and helps form the dorsal carpal arterial arch.

PALMAR CARPAL ARCHES

**Dorsal Carpal Arch**

* Branches of the radial and ulna artery and the anterior interosseus artery.
* Anastomoses through the interosseus spaces with the deep palmar metacarpal branches.
* Gives off dorsal metacarpal arteries

**Superficial Palmar Arch**

* Superficial to the tendons.
* Termination of ulnar artery (predominant) anastomoses with the superficial branch of the radial artery
* Four palmar digital branches,

**Deep Palmar Arch**

* Terminal branch of the radial artery (predominant) with the deep palmar branch of ulnar.

BLOOD SUPPLY OF THE HAND

* Palmar Metacarpal Arteries come off the deep palmar arch
* Common Palmar Digital Arteries come off the superficial palmar arch
* These ascend over the interosseus fascia from the 2nd to the 4th MC intervals, and anastomose with each other to give off two proper digital arteries.
* Proper Digital Arteries: supply the radial and ulnar side of each finger

**VARIATIONS**

* High bifurcation of brachial artery
* Aberrant radial artery arises from the axillary
* Duplication of brachial artery
* Absent ulna/ radial artery