BLood supply

ARTERIAL SUPPLY OF THE UPPER LIMBS

the blood for the right upper limb leaves the aortic arch through the brachiocephalic trunk which divides into a right common carotid artery and right subclavian artery on the left upper limb aortic arch left subclavian artery at the lateral border of the first rib, the main stem of the subclavian artery changes its name to axillary artery

 at the inferior border of the teres major muscle, the axillary artery changes its name to brachial artery ends in the cubital fossa by dividing into the radial artery and the ulnar artery superficial and deep palmar arterial arches metacarpal and digital arteries

A. Axillary Artery
Closed in the axillary sheath throughout its course pectoralis minor crosses it anteriorly divides it into 3 parts for descriptive purposes parts and branches

 first part - extends from the lateral border of the first rib to the medial border of the pectoralis minor 1.superior (highest) thoracic artery
arises just inferior to the subclavius supplies muscles in the 1st and 2nd intercostal spaces and the serratus anterior anastomoses with the intercostal arteries

 second part - lies posterior to the pectoralis minor 2.thoracoacromial artery

passes medial to pectoralis minor pierces costocoracoid membrane (part of clavipectoral fascia) and immediately divides into acromial, deltoid, pectoral, and clavicular branches

3.lateral thoracic artery may arise from thoracoacromial, suprascapular, or subscapular arteries descends along lateral border of pectoralis minor supplies pectoral muscles, axillary lymph nodes, and lateral part of breast

third part - extends from the lateral border of the pectoralis minor to the inferior border of the teres major 4.subscapular artery
largest branch of axillary artery descends along lateral border of subscapularis divides into circumflex scapular and thoracodorsal arteries supplies subscapularis, teres major, serratus anterior, and latissimus dorsi, and infraspinatus

 5.Anterior circumflex humeral artery passes laterally deep to coracobrachialis and biceps brachii gives off ascending branch that supplies shoulder 6.posterior circumflex humeral artery passes through posterior wall of axilla via the quadrangular space with axillary nerve supplies deltoid, teres major and minor, long head of triceps

Brachial Artery
1 main arterial supply to the arm 2. continuation of the axillary artery begins at the inferior border of the teres major ends in the cubital fossa opposite the neck of the radius 3. divides into radial and ulnar arteries under cover of the bicipital aponeurosis

 4. branches: a. muscular branches - to anterior compartment of the arm b. nutrient artery - arises around the middle of the arm; enters nutrient canal and runs distally in the canal toward the elbow c. deep brachial (profunda brachii) artery* arises near beginning of brachial artery; accompanies radial nerve through the radial (spiral) groove and passes around the shaft of the humerus to posterior compartment of arm; divides into anterior and posterior descending branches

 d. superior ulnar collateral artery* - arises near middle of arm and accompanies the ulnar nerve posterior to the medial epicondyle of the humerus where it anastomoses with the posterior branch of the ulnar recurrent artery and inferior ulnar collateral artery e. inferior ulnar collateral artery* - arises near termination of brachial artery; passes inferomedially anterior to the medial epicondyle of the humerus where it anastomoses with the anterior branch of the ulnar recurrent artery *c, d, and e take part in the elbow anastomosis

 Note: Midway along the medial aspect of the arm, the brachial artery lies deep to muscle against bone. Palpate your own arm carefully in this region to detect its pulse. FIRST AID POINTER: In arterial bleeding of forearm or hand, digital compression at this point gives effective temporary hemostasis. Check this by feeling your own radial pulse while a classmate gives digital pressure on the brachial artery in the arm. What happens to the radial pulse?

D.Cubital Fossa
1. triangular depression on the anterior aspect of the elbow 2. boundaries: a. lateral - brachioradialis b. medial - pronator teres c. superior - imaginary line drawn between 2 epicondyles of humerus d. floor - supinator laterally and brachialis medially e. roof skin, subcutaneous tissue and deep fascia reinforced by bicipital aponeurosis

 3. contents terminal part of the brachial artery, between biceps tendon and median nerve, and its bifurcation into ulnar and radial arteries venae comitantes of the arteries biceps brachii tendon median nerve

 4. superficially, in the subcutaneous tissue overlying the fossa: median cubital vein lies anterior to the brachial artery medial and lateral antebrachial cutaneous nerves related to the basilic and cephalic veins, respectively
5. within the floor of the fossa deep and superficial branches of the radial nerve

E.

Ulnar Artery

1. larger terminal branch of brachial artery 2. begins in the cubital fossa at level of neck of radius 3. descends through anterior compartment of forearm deep to the flexor muscles in most of its course but becomes superficial distally 4. enters palm anterior to flexor retinaculum together with ulnar nerve just lateral to pisiform site for taking ulnar pulse

 5. ends by forming superficial palmar arch which is completed by the superficial palmar branch of the radial artery 6. branches: a)muscular branches to neighboring muscles b)recurrent branches to elbow anastomosis c)branches to wrist joint anastomosis

d)common interosseous artery 1. anterior interosseous artery passes downward with anterior interosseous nerve pierces interosseous membrane at upper border of pronator quadratus, descends posterior to it and takes part in wrist anastomosis branches: muscular branches, nutrient branches, median artery (to median nerve)

2 posterior interosseous artery passes posteriorly over superior border of interosseous membrane to enter posterior compartment of the forearm ends by anastomosing with anterior interosseous artery to take part in wrist anastomosis branches: muscular branches to neighboring muscles, recurrent branch to elbow anastomosis

Radial Artery
1. smaller terminal branch of brachial artery 2. begins at cubital fossa at level of neck of humerus 3. descends in anterior compartment on deep flexor muscles 4. lies on anterior surface of radius on distal part of forearm covered only by skin and fascia site for taking radial pulse

 5. leaves forearm by winding around lateral aspect of wrist to reach posterior surface of hand 6. ends by forming the deep palmar arch which is completed by the deep palmar branch of the ulnar artery 7. branches: a)muscular branches - to neighboring muscles b)recurrent branch to elbow anastomosis c) superficial palmar branch - joins ulnar artery to form superficial palmar arch

Arteries of the Hand

1. from the superficial palmar arch four common digital arteries which pass to the fingers: most medial artery supplies the medial side of little finger; remaining three subdivide into two and supply contiguous sides of little, ring, middle, and index fingers, respectively

the deep palmar arch gives off three palmar metacarpal arteries which join the common palmar digital arteries 3)radial artery gives of 2 branches on entering palm: a)arteria radialis indicis - to lateral side of index finger b)arteria princeps pollicis - splits to supply lateral and medial sides of thumb

VENOUS DRAINAGE OF THE UPPER LIMBS

A. Superficial Veins 1. The digits are drained of venous blood through anastomosing palmar dorsal digital veins most of the venous blood goes to the dorsum dorsal venous network 2.The cephalic vein starts at the lateral end of venous network ascends to course in the deltopectoral groove before it pierces the clavipectoral fascia axillary vein

c)The basilic vein starts at the medial end of the venous network ascends to end by piercing the brachial fascia joins the brachial vein axillary vein
d)The cephalic and basilic veins interconnect at the cubital region to form the median cubital vein commonly used for venipuncture

 B. Deep Veins (venae comitantes or venae comites) - accompany the arteries and usually are named according to the arteries they accompany, e.g. brachial veins for the venae comitantes of the brachial artery

LYMPHATIC DRAINAGE
A. The lymphatic vessels, just like the veins, consist of superficial and deep sets and accompany the main superficial and deep veins. B. These vessels are interrupted along their course by lymph nodes. In the upper limbs, the more constant ones are the: 1. cubital nodes - above the medial epicondyle 2. infraclavicular nodes 3. deltopectoral nodes

 C. Axillary Lymph Nodes and Areas Drained: 1. anterior (pectoral) - anterolateral thoracic wall to level of umbilicus, including breast central and apical nodes 2. posterior (subscapular) - posterior thoracic wall to level of iliac crest central nodes 3. central group - other groups apical nodes 4. lateral (brachial) - most of upper limb central and apical nodes 5. apical - all other groups D. From the axillary lymph nodes subclavian lymph trunk thoracic duct or right lymphatic duct.

CLINICAL CORRELATIONS
1. Venipuncture cubital fossa common site for extracting peripheral blood samples, for blood transfusion, and for IV drug administration, and for introduction of cardiac catheters to obtain blood samples from the great vessels or heart chambers median cubital vein or basilic vein usually selected

 2. Superficial Ulnar Artery descends superficial to forearm flexor muscles (in ~3% of individuals) pulsations visible and palpable may be mistaken for a vein bleeding or disastrous effects if used for injecting irritating drug

 3. Ischemia of the Fingers characterized by intermittent attacks of pallor of the fingers accompanied by paresthesia and pain cause may be due to an underlying disease or an anatomic abnormality if cause is idiopathic (Raynauds disease) treatment: surgery (cervical sympathectomy to dilate the digital arteries)