Hey everyone! This is Nicole from Kenhub, and in this tutorial we will be reviewing the arteries of the upper limb. So as we can see in this image of the upper body, the arteries in the upper limb all originate from the aortic arch. And these eight arteries and arterial regions which branch from the shoulder to the fingers are the subclavian artery, the axillary artery, the brachial artery, the arteries of the elbow, the radial artery, the ulnar artery, the arteries of the hand and wrist, and the scapular arteries which are found on the posterior aspect of the upper torso.
So as you can see, we have quite a few arteries that are located in the upper limb and because there are so many, we're not going to go into detail about what each artery supplies. Rather, we're just going to focus on describing their path and naming their branches of which there are quite a few. So if you get lost, feel free to come back to this image and re-orient yourself to where you are in the upper limb. But to kick things off, let's begin by looking at the subclavian artery.
So in our image on the right, you can see the left and right subclavian arteries highlighted in green. And our subclavian artery is the first major artery to supply the upper limb coming off almost directly from the aortic arch. And the right subclavian artery arises from the brachiocephalic artery while the left subclavian artery arises directly from the aortic arch.
And moving to a space on the left over here, we can see an image of the scapula, humerus and clavicle as well as the arteries that run along it. And I just wanted to show this to you because running along here of course is the extension of our subclavian artery which is highlighted in green up here almost like an extension of our image on the right over here. So you can see that when the subclavian artery passes the lateral border of the first rib, it enters the region called the axilla. And this artery is therefore known in this region as the axillary artery.
The axillary artery which is highlighted in green and which is surrounded by the brachial plexus within the axilla can be divided into three parts. The first part which is this first little part marked by the black lines here gives off one branch – the superior thoracic artery. The second part – this middle bit which is a little bit longer than the first – gives off two branches – the lateral thoracic artery and the thoracoacromial artery. And note that the thoracoacromial artery gives rise to four branches called the pectoral, acromial, deltoid and clavicular branches.
The third part of the axillary artery down here gives off three branches – the subscapular artery, the posterior circumflex humeral artery and the anterior circumflex humeral artery. And note that the posterior and anterior circumflex arteries anastomose around the surgical neck of the humerus which you can already see happening around the neck in this image. And of course at the inferior border of the teres major muscle, the third part of the axillary artery becomes the brachial artery.
The brachial artery travels with the median nerve along the anterior arm medial to the biceps brachii muscle which of course we can imagine running along down the humerus around about here. And as you can probably guess, this is the artery that is compressed by the inflatable cuff during blood pressure readings. Unlike the axillary artery, there are only three branches arising from the brachial artery.
The deep brachial artery also known as the profunda brachii artery or deep artery of the arm courses around the posterior surface of the humerus and accompanies the radial nerve within the radial groove where it bifurcates giving rise to the radial collateral artery and the middle collateral artery located posteriorly. The superior ulnar collateral artery descends posterior to the medial epicondyle of the humerus along the ulnar nerve and the inferior ulnar collateral artery descends anterior to the medial epicondyle of the humerus.
The brachial artery bifurcates at the cubital fossa or the anterior elbow and gives rise to the ulnar artery and the radial artery. But before we continue let's take a closer look at the arteries supplying the elbow. The four collateral arteries we just saw that arise either directly or indirectly from the brachial artery are each continues with their own recurrent artery inferiorly. And just to give you a bit of a reminder, a recurrent artery is an artery that turns or deviates sharply after originating to run in the opposite direction of the artery it arose from. So just to make this clearer, I'll point out these recurrent arteries as well as the parent artery as we go along.
The radial collateral artery anastomoses with the radial recurrent artery which arises from the radial artery which we can see over here. The middle collateral artery anastomoses with the interosseus recurrent artery which indirectly arises from the ulnar artery which is over here as a branch of the posterior interosseus artery and here we can see the posterior interosseus artery coming off the interosseus artery. So we know that the origin of the interosseus recurrent artery is somewhere behind the radial tuberosity just here.
The superior ulnar collateral artery anastomoses with the posterior ulnar recurrent artery which itself arises from the ulnar artery and the inferior ulnar collateral artery anastomoses with the anterior ulnar recurrent artery which is also from the ulnar artery. All together these arteries contribute to the anastomotic network around the elbow.
Let's just go back to the bifurcation of the brachial artery now and take a look at the radial artery. The radial artery arises from the bifurcation of the brachial artery in the distal cubital fossa. It gives off the radial recurrent artery and then courses inferiorly along the lateral aspect of the anterior forearm. At its distal end, the radial artery descends onto the dorsal aspect of the hand by crossing the floor of the anatomical snuffbox which is bounded laterally by the tendons of the abductor pollicis longus and extensor pollicis brevis muscles and medially by the tendon of the extensor pollicis longus muscle. Distally, the radial artery gives off branches but this will be discussed later when we look at the anastomotic network of the hand and wrist.
The ulnar artery is the larger of the two arteries that arise from the brachial bifurcation. From the proximal portion of the ulnar artery arises the anterior and posterior ulnar recurrent arteries as well as the common interosseus artery which bifurcates to become the anterior and posterior interosseus arteries that supply the interosseus membrane. The ulnar artery descends inferomedially on the anterior forearm and enters the hand by traveling through the ulnar tunnel alongside the ulnar nerve which is around about here at the level of the wrist.
The hand and wrist receive an arterial supply from an anastomotic network formed by branches of the radial artery and the ulnar artery. And just a head's up, unlike the other images of the arteries which have been ventral, this image is of the dorsal aspect of the hand and wrist. The vessels highlighted in green form the dorsal carpal network and contains the dorsal carpal arch. This is formed by the joining of the dorsal carpal branches of the ulnar and radial arteries. It also receives contributions from the interosseus arteries. Next on our list are the dorsal metacarpal arteries and these arteries are continuous with the dorsal digital arteries.
Now let's flip over to view the palmar aspect of the hand and wrist. And this image is of the superficial palmar arch which is formed by the joining of the superficial branches of the ulnar and radial arteries. And deep to this arch lies the deep palmar arch which is formed by the joining of the deep branch of the ulnar artery and the radial artery. The superficial palmar arch gives off the common palmar digital arteries which join with the palmar metacarpal arteries arising from the deep palmar arch. The common palmar digital arteries are continuous with the proper palmar digital arteries.
Now that we've seen the arteries of the arm from the shoulder to the fingers, let's finish up by going back to the proximal upper limb to have a look at the arterial supply of the scapular region.
So at the beginning of this tutorial, we talked about the subclavian artery and we mainly talked about how it turned into the axillary artery. Before the subclavian artery reaches the axilla, however, it gives rise to the short thyrocervical trunk from which the cervicodorsal trunk – seen here in green – arises. And the branches of the cervicodorsal trunk of course run posteriorly to supply the scapula. So, in this image, we've eliminated the cervicodorsal trunk which is floating around invisibly up here but we can see clearly the arteries that arise from it as well as the other arteries that form the anastomosis around the scapula. So starting with our cervicodorsal trunk, let's look at our suprascapular artery which arises posterolaterally. Another branch of the thyrocervical trunk – the transverse cervical artery – also courses posteriorly and gives rise to the dorsal scapular artery.
As we've mentioned, the scapula is supplied by an anastomotic network formed by the suprascapular artery and the dorsal scapular artery as well as the circumflex scapular artery and the thoracodorsal artery which both arise from the subscapular artery, a branch of the axillary artery. And if we just head back in at a couple of arrows, we can see the anastomosis happening from the arteries that supply the scapula.
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