Blood Supply of the Upper Limb

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Blood Supply of the Upper Limb

• Dr. Sama-ul-Haque

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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.
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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.  
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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.

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Axillary Artery
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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

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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

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Axillary Artery

• 3rd part of Axillary artery
• Relations
• Anteriorly Pectoralis Major
• Posteriorly Subscapularis, Latissimus dorsi,
  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

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Branches of Axillary Artery
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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.

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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

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Anastomosis around shoulder joint
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Anastomosis around shoulder joint
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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.

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Relations of Brachial Artery
Relations Anteriorly Coracobrachialis
Biceps Posteriorly Brachialis
Triceps Laterally Median nerve
Coracobrachialis Medially Ulnar nerve
Basilic vein
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Branches of Brachial Artery

• Muscular branches
• Nutrient artery
• Profunda Brachii artery
• Superior ulnar collateral artery
• Inferior ulnar collateral artery

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Brachial Artery
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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

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Anastomosis around elbow joint
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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.

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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.

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Radial Artery
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Branches of Radial Artery

• Muscular branches
• Recurrent branch
• Superficial Palmar branch
• Joins ulnar artery to form Superficial Palmar
  Arch
• Radialis Indicis artery
• Princeps Pollicis

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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.

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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

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Ulnar Artery
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Ulnar Artery Branches
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Areas of Ulnar Radial Arteries Supply
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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

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Deep Palmar Arch
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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

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Superficial Palmar Arch
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Areas of Upper Limb Arteries Pulsation
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Veins of the Upper Limb

• Superficial veins
• Deep veins

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Veins of the Upper Limb
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Superficial Veins of the Upper Limb

• Dorsal venous arch
• Veins of the Palm
• Cephalic vein
• Basilic vein
• Median vein of the forearm

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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

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Dorsal Venous Arch
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Dorsal venous arch
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Veins of the Palm

• Superficial palmar venous Arch
• Deep palmar venous Arch

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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

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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.

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Cephalic Vein
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Cephalic Vein
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CephalicVein
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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

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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.

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Basilic Vein
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Median Cubital Vein
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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)

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Median Vein of the Forearm
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Deep Veins of the Upper Limb

• Venae Comitantes
• Axillary vein

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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

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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

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Axillary Vein
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Superficial and Deep veins of the Limb
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Varicose veins
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Thank You