Neurovasculature of the upper limb
The upper limb is truly a complex part of the human body. In order to thoroughly understand its structure, the anatomy of the upper limb is broken into compartments, such as regions, bones, joints, muscles, nerves and blood vessels. This compartmentalization helps to focus on the necessary details.
In this page, we are going to discuss the arteries, veins and nerves of each upper limb region; the shoulder, arm, forearm and hand. All together these form the neurovascular compartment of the upper limb.
Shoulder: axillary artery and six branches (superior thoracic, thoracoacromial, lateral thoracic, anterior circumflex humeral, posterior circumflex humeral, subscapular arteries)
Mnemonic: 'Save The Lions And Protect Species'
Arm: brachial artery and four branches (profunda brachii artery, nutrient artery to humerus, superior ulnar collateral artery, inferior ulnar collateral artery)
Forearm: radial artery and its branches (radial recurrent artery, palmar carpal branch, superficial carpal branch) and ulnar artery and its branches (anterior ulnar recurrent artery, posterior ulnar recurrent, muscular arteries, common interosseous artery, dorsal carpal artery, deep palmar artery, palmar carpal arteries)
Hand: superficial palmar and deep palmar arches, formed by the anastomosis of the radial and ulnar arteries
Mnemonic: 'Anatomical Pictures Can Definitely Deeply Please'
Shoulder: axillary vein
Arm: brachial veins
Forearm: basilic, cephalic and median forearm veins
Hand: deep veins and superficial veins which form the dorsal venous network
The nerves of the upper limb originate from the brachial plexus and include the musculocutaneous, axillary, median, radial and ulnar nerves.
- Upper limb arteries
- Upper limb veins
- Nerves of the upper limb
Upper limb arteries
The main artery supplying blood to the upper limb is the subclavian artery. The trunk of the subclavian artery is continuous throughout the entire upper limb. During its pathway, the artery changes its name based on the region it supplies. Thus the major named arteries of the upper limb are: the subclavian artery, the axillary artery, the brachial artery, and the ulnar and radial arteries.
Arteries of the shoulder
The main artery of the shoulder is the axillary artery. It originates from the subclavian artery at the lateral margin of the first rib and enters the shoulder region. The axillary artery supplies the content of the shoulder and the arm via its six branches that each originate from the trunk of the artery in the following order:
- Superior thoracic artery
- Thoracoacromial, lateral thoracic arteries
- Subscapular, anterior circumflex humeral, posterior circumflex humeral arteries
Do you want an easy way to remember the branches of the axillary? It is a very common exam question, so start using mnemonics like the one below:
Save The Lions And Protect Species
- Superior thoracic artery
- Thoracoacromial artery
- Lateral thoracic artery
- Anterior circumflex humeral artery
- Posterior circumflex humeral artery
- Subscapular artery
Arteries of the arm
The major artery of the arm is the brachial artery, which continues from the axillary artery at the lower margin of the teres major muscle. The brachial artery ends at the apex of the cubital fossa by giving off the forearm branches; the ulnar and radial arteries.
Check out an interesting clinical case about brachial artery transection.
Arteries of the forearm
The forearm region is literally full of muscles, with twenty of them laying within two compartments, all requiring a rich blood supply. The forearm region is thus supplied by two major vessels, the radial artery and ulnar artery. These arteries originate from the brachial artery at the apex of the cubital fossa, with the radial artery descending through the lateral part of the forearm and the ulnar artery through the medial part.
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Both arteries give off their main branches within the forearm; with the radial artery giving the radial recurrent artery, palmar carpal branch and superficial carpal branch, and the ulnar artery giving the ulnar recurrent artery, muscular arteries, common interosseous artery, dorsal and palmar carpal arteries.
Use the mnemonic below to learn the branches of the ulnar artery very easily!
Anatomical Pictures Can Definitely Deeply Please
- Anterior ulnar recurrent
- Posterior ulnar recurrent
- Common interosseous
- Dorsal carpal branch
- Deep palmar branch
- Palmar carpal branch
Arteries of the hand
The radial and ulnar arteries both end in the hand, anastomosing with each other. The radial artery mainly supplies the thumb and the lateral side of the index finger, while the ulnar artery supplies the medial side of the index finger and the rest of the fingers. Seems weird how only two arteries supply such a complex structure like the hand is?
Well, these two arteries form two anastomotic arches in the palm, called the superficial palmar arch and deep palmar arch, from which minor arteries to the muscles, digits and joints of the hand originate.
Upper limb veins
Veins usually accompany main arteries, which is also the case here. Since the veins convey blood from periphery to the heart, we’ll discuss the main veins of the upper extremity starting from the hand to the shoulder.
The hand has two venous networks that drain it. There are deep veins which accompany the arteries, and superficial veins which anastomose into a dorsal venous network. This superficial network is located at the dorsum of the hand. The basilic vein originates from the medial side of the dorsal venous network, while the cephalic vein originates from the lateral side. The two mentioned veins, basilic and cephalic, are the main veins of the forearm. They are superficially located, with basilic traveling through the ulnar, and cephalic traveling through the radial, side of the forearm. Besides these two, the median forearm vein assists in draining the forearm. It travels through the middle of the forearm. All three veins of the forearm tribute to the brachial veins.
The veins that drain the arm are the paired brachial veins. The brachial veins are deep veins that are positioned like some kind of bodyguards around the brachial artery - one travels along its medial side and the other along the lateral. Their tributaries are the veins of the forearm and the veins that accompany the branches of the brachial artery. All of them together tribute to the axillary vein.
The main vein of the shoulder is the axillary vein, which conveys blood from the shoulder and arm. It begins at the lower margin of the teres major muscle formed from the basilic vein and later the cephalic vein, gathering tributaries within the shoulders. It ultimately becomes the subclavian vein at the lateral border of the first rib.
Nerves of the upper limb
The upper limb is supplied by a nervous network called the brachial plexus. This plexus is made by the merging of the anterior rami from the lower four cervical nerves and the first thoracic nerve (C5-T1). The plexus is anatomically divided into roots, trunks, divisions, cords and finally, the terminal branches.
Terminal branches of the brachial plexus are:
- The musculocutaneous nerve: innervates the anterior compartment of the arm, including the skin of the lateral side of the forearm.
- The axillary nerve: innervates the deltoid, long head of the triceps brachii and teres minor muscles. Provides sensory innervation for the shoulder joint and the skin covering region of the deltoid muscle.
- The median nerve: innervates the anterior compartment of the forearm (except for the flexor carpi ulnaris and medial half of the flexor digitorum profundus), the thenar eminence (opponens pollicis, abductor pollicis brevis, flexor pollicis brevis), lateral lumbricals, and the skin of the lateral hand.
- The radial nerve: innervates the posterior compartments of the arm and forearm, skin of posterior arm, forearm and the dorsolateral part of the hand.
- The ulnar nerve: innervates the flexor carpi ulnaris and medial half of the flexor digitorum profundus, the hypothenar eminence (opponens digiti minimi, abductor digiti minimi, flexor digiti minimi brevis, palmaris brevis), medial lumbricals, dorsal and palmar interossei, adductor pollicis, and the skin of the medial hand.
Now take a look at this cadaveric image to see how the brachial plexus looks like in the actual human body.
Find out more about brachial plexus and its branches and reinforce your knowledge about the upper limb neurovasculature with the following learning materials: