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Blood Supply of the Upper
Limb
Dr. Sama-ul-Haque
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.
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.
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.
Axillary
Artery
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
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
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
Branches of Axillary Artery
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
Anastomosis around shoulder joint
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.
Relations of Brachial Artery
Relations:
Anteriorly: Coracobrachialis & Biceps
Posteriorly: Brachialis & Triceps
Laterally:
Median nerve & Coracobrachialis
Medially: Ulnar nerve & Basilic vein
Branches of Brachial Artery
 Muscular branches
 Nutrient artery
 Profunda Brachii artery
 Superior ulnar collateral artery
 Inferior ulnar collateral artery
Brachial
Artery
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
Anastomosis around elbow joint
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.
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.
Radial
Artery
Branches of Radial Artery
 Muscular branches
 Recurrent branch
 Superficial Palmar branch
 Joins ulnar artery to form Superficial
Palmar Arch
 Radialis Indicis artery
 Princeps Pollicis
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.
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
Ulnar
Artery
Ulnar
Artery
Branches
Areas of
Ulnar
&
Radial
Arteries
Supply
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
Deep
Palmar
Arch
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
Superficial
Palmar
Arch
Areas of Upper
Limb Arteries
Pulsation
Veins of the Upper Limb
 Superficial veins
 Deep veins
Veins of
the Upper
Limb
Superficial Veins of the Upper Limb
 Dorsal venous arch
 Veins of the Palm
 Cephalic vein
 Basilic vein
 Median vein of the forearm
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
Dorsal
Venous
Arch
Dorsal venous arch
Veins of the Palm
 Superficial palmar venous Arch
 Deep palmar venous Arch
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
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.
Cephalic Vein
Cephalic Vein
Cephalic
Vein
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
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.
Basilic
Vein
Median Cubital Vein
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)
Median Vein of the Forearm
Deep Veins of the Upper Limb
 Venae Comitantes
 Axillary vein
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
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
Axillary
Vein
Superficial and Deep veins of the Limb
Varicose
veins
Thank You