Vascularity of the upper extremity

• Subclavian artery

  • Left subclavian artery arises directly from the aorta; right subclavian artery arises from the brachiocephalic trunk.

  • Emerges between anterior and middle scalene muscles and becomes the axillary artery at outer border of the first rib

• Axillary artery

  • Divided into three parts on the basis of its physical relationship to pectoralis minor muscle (first part is medial to it, second is under it, and third is lateral to it)

  • Each part of the artery has as many branches as the number of that part (e.g., the second part has two branches: thoracoacromial and lateral thoracic) (Table 2.20).

  • Third part, at the origin of the anterior and posterior humeral circumflex arteries, is the most vulnerable to traumatic vascular injury.

• Brachial artery

  • Originates at the lower border of the tendon of the teres major and runs with the median nerve in the medial arm anterior to the intermuscular septum

Deep muscular branch (also known as the profunda brachii) accompanies the radial nerve posteriorly in the triangular interval).

Radial collateral and superior/inferior ulnar collateral branches around the elbow

Supratrochlear branch is least flexible branch.

Enters antecubital fossa (bordered by the two epicondyles, the brachioradialis laterally, and the pronator teres medially), passing anterior to brachialis and supinator muscles

Divides at the level of the radial neck into the radial and ulnar arteries (Table 2.21)

Radial artery

• Initially runs on the pronator teres, deep to the brachioradialis

• Continues to the wrist between this muscle and the FCR

• Forearm branches include the recurrent radial (which anastomoses with radial collateral artery) and muscular branches.

• At the wrist, the radial artery reaches the dorsum of the carpus by passing between the FCR and the abductor pollicis longus (APL) and EPB tendons (snuffbox).

• Before that, it gives off a superficial palmar branch that communicates with the superficial arch (ulnar artery).

• It forms the deep palmar arch in the hand.

   

   

  FIG. 2.23 Arteries of the shoulder and arm.‌

  From Drake RL et al, editors: Gray’s atlas of anatomy, ed 2, Philadelphia, 2015, Churchill Livingstone.

   

   

  FIG. 2.24 Arteries of the forearm.

  From Drake RL et al, editors: Gray’s atlas of anatomy, ed 2, Philadelphia, 2015, Churchill Livingstone.

   

• The dorsal carpal branch of the radial artery enters the scaphoid dorsally and distally.

Ulnar artery: larger of the two branches

• Covered by the superficial flexors proximally (between FDS and FDP)

• Distally the artery lies on the FDP between the tendons of the FCU and FDS.

   

   

  Table 2.20

   

  Parts of the Axillary Artery

   

   

  Part Branch Course
  I	Supreme thoracic	Medial to serratus anterior and pectoral muscles
  II	Thoracoacromial	Four branches: deltoid, acromial, pectoralis, clavicular
  	Lateral thoracic	Descends to serratus anterior
  III	Subscapular	Two branches: thoracodorsal and circumflex scapular (triangular space)
  	Anterior humeral circumflex	Blood supply to humeral head: arcuate artery lateral to bicipital groove
  	Posterior humeral circumflex	Branch in the quadrangular space accompanying axillary nerve

   

   

   

  Table 2.21

   

  Vascular Relationships in Forearm

   

   

  Artery Relationship
  Radial	On pronator teres deep to brachioradialis Enters wrist between brachioradialis and flexor carpi radialis
  Ulnar	Proximally between FDS and FDP Distally on FDP between FCU and FDS

• Forearm branches include the anterior and posterior recurrent ulnar (which anastomose with inferior and superior ulnar collateral arteries, respectively), the common interosseous (with anterior and posterior branches), and several muscular and nutrient arteries.

• At the wrist, ulnar artery lies on the TCL.

• Gives off a deep palmar branch (which anastomoses with the deep arch) and then forms the superficial palmar arch

Digital arteries arise from superficial palmar arch and run dorsal to digital nerves.