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Veins of the upper limb

Overview of the different veins of the shoulder, upper arm, forearm and hand.

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Transcript

Hello everyone! It's Megan from Kenhub here, and in today's tutorial, we're going to be looking at the veins of the upper limb.

As you're probably already aware, the veins of the body form a complex network that transports deoxygenated blood from the tissues of the body back to the heart. This network is so complex and variable that it can be tricky to learn and recall the important veins and their anatomical locations within the body. In this tutorial, we'll be focusing specifically on the upper limb breaking it down to help you really understand the venous anatomy here.

Starting with the venous networks of the hand, I'll take you upwards through the forearm and upper arm showing you the various pathways the deoxygenated blood might take on its journey back towards the heart. Before we start though, I want to briefly cover a couple of concepts that will be useful for you in this tutorial and for when you're looking at the arrangement of the venous system in general. I'll use this diagram here to help illustrate these concepts. Think of it as a really simplified cross-section with the skin surface being the top layer.

The human body is a three-dimensional thing and so veins are not all located at the same depth. The veins of the upper limb can be subdivided into the superficial veins and the deep veins. The superficial veins are located just beneath the integument which is just another word for the skin and between the two layers of superficial fascia. Just as a reminder, the term "fascia" refers to the layers of connective tissue that serve to stabilize and compartmentalize the internal structures of the body.

The superficial veins drain into the perforating veins shown here which in turn drain into the deep veins. The deep veins of the body tend to run in parallel with their accompanying artery sometimes in pairs and sometimes more and these are known as the venae comitantes of that particular artery. Veins are often arranged in this way as the pulsation of the accompanying artery helps with the venous return. Vena comitans singular for venae comitantes comes from Latin and quite simply means "accompanying vein". To further aid venous return, veins also have valves incorporated within them at regular intervals like the one indicated here which prevent blood from moving in the wrong direction through the vein.

Now that we have an idea of the general arrangement of the veins, let's start then to look more specifically at the veins of the upper limb. But before we do this, I'll give you a quick overview of what we're going to cover in today's tutorial. So we're going to consider the upper limb in three sections starting with the hand where we'll consider the palmar and the dorsal views. Then moving up to the forearm where we'll look at the superficial and deep veins separately so as not to get them mixed up. And, finally, we'll look at the upper arm where again we'll consider the superficial and deep veins separately.

As promised, we'll start our journey in the hand and we'll look at the superficial and the deep veins that drain the tissues here.

When looking at the palmar view of the hand, we can see both the superficial and deep palmar venous arches highlighted in green. These are closely associated with the palmar arterial arches of the hand indicated here by this line. If we remove the arterial and muscular structures, this will help us to see the veins a little better. You can still see that the venous network appears a little messy and complex and its arrangement does tend to vary between individuals. So it's perhaps good to take the positions I indicate here as a guide rather than a solid rule.

The superficial palmar venous arch as generally indicated here by this line receives venous blood flow via tributaries from the common digital veins. The term "digital" in this case refers to the fingers. This then drains into the ulnar vein which we'll cover in more detail later on in the tutorial. And if you stretched out the palm of your hand, you might just be able to catch a glimpse of the superficial palmar arch.

The deep palmar venous arch as indicated by this line receives blood flow from tributaries of the palmar metacarpal veins and drains into the radial vein which we'll also come to later on. If we flip the hand around to look at the dorsal view, we can see the superficial veins that make up the dorsal venous network of the hand highlighted in green. These veins can normally be palpated quite easily on the back of your hand but because they're closely linked to the venous network of the rest of the hand, compressing these does little to affect the overall venous return from this area. As well as draining into the superficial and deep palmar venous arches that we just discussed, this network also drains into the cephalic vein and the basilic vein. The fact that this network can be so easily seen on the back of the hand makes it a good site for common medical procedures requiring easy access to the veins such as venipuncture and cannulation.

So now that we've covered the important deep and superficial venous networks of the hand, I'll take you on to the next stage of our journey which is the forearm. I've broken this up for you so that we can look at the deep and the superficial veins separately so we don't get mixed up and we'll be starting off with the deep veins.

The first of these veins I'm going to show you are the radial veins highlighted here in green. Let's zoom in so we can take a closer look. If it helps you remember, you can think of the radial veins as being on the outer side of the arm when viewed in the anatomical position. Just like the radius of a circle refers to its outer edge. The radial veins are the venae comitantes of the radial artery and they receive tributaries from the deep palmar venous arch and travel up the forearm to drain into the brachial veins which I'll talk about more in just a bit.

If I take you over to the inner side of the forearm, I can show you the second of the deep forearm veins which are the ulnar veins highlighted in green. These veins are larger than the radial veins and are the venae comitantes of the ulnar artery. The ulnar veins receive venous blood flow from various sources, one being via tributaries from the deep palmar venous arch as I mentioned earlier. They also receive branches from the veins that drain the anterior and posterior interosseus muscles close to the elbow and a large communicating branch from the median cubital vein which we'll also go over in more detail a little later on.

The ulnar veins go on to join with the radial veins at the anterior cubital fossa which is just another term for the pit of your elbow to form other veins called the brachial veins in the upper arm. But before we travel further up to see those, we're going to stay in the forearm for just a little bit longer as there are more veins here located closer to the skin surface. I'm, of course, talking about the superficial veins of the forearm.

The proximity of these veins to the surface of the skin means that they might be visible on your own arm. This makes them a great site for venipuncture just like the dorsal venous network of the hand that we talked about earlier. So, first, we have the basilic vein which runs up the ulnar side of the forearm – that is, the inner side from our view like so. If we strip away the surrounding anatomy here, we can get a better view. The basilic vein helps to drain the dorsal venous network of the hand. It travels further up the arm beyond what we can see here and terminates when it opens into the brachial vein which I've mentioned already. We'll see this in just a bit when I take you further up the arm.

Hopping over to the other side of the forearm, we have the cephalic vein. This one gets its name from the fact that it runs from the hand towards the head as cephalus is Greek for the word "head". It receives blood flow from the lateral aspect of the arm and forearm as well as the dorsal venous network of the hand and goes on to join with the axillary vein further up the arm in an area called the clavipectoral triangle to become the subclavian vein. Like other superficial veins, it tends to be seen as a good vein for drawing blood.

As both the basilic and cephalic veins travel upwards and beyond the forearm, we'll be meeting them again soon, but before then, I want to tell you about this small but important vein which is located here in the region of the anterior cubital fossa which, remember, is just another term for the pit of your elbow. If we look at this a little closer, I can show you that this almost horizontal vein is the median cubital vein and it serves to connect the basilic vein and the cephalic vein. This vein is the most common site for venipuncture and it's also a site for the introduction of cardiac catheters during a procedure aptly named cardiac catheterization.

We've now seen the most important deep and superficial veins of the hand and forearm and so next I'll take you on to the final leg of our journey which will be the upper arm. We're going to start with the superficial veins this time before we cover the deep veins as you actually know them already. I'm, of course, talking about our old friends, the basilic vein and the cephalic veins, which we encountered in the forearm. These continue up the arm as I'm showing you here and if we take a closer look at our anatomical Annie we can see the upper arm portion of the basilic vein highlighted in green. If we go further and isolate the venous structures a bit more, we can see that the upper arm portion of the basilic vein is shorter than that of the cephalic vein which is here and that it terminates when it meets the brachial vein where this circle is here.

Jumping over to the other side of the arm, we can see the upper arm portion of the cephalic vein highlighted in green. This vein travels right up the arm and drains into the axillary vein here in an area known as the clavipectoral triangle to become the subclavian vein.

Moving on to the deep veins of the upper arm now, we'll start with the vein that I've mentioned a few times already in which I'm sure you're just dying to know about which is the brachial vein. Zooming in here and again isolating the venous structures will help to show more clearly that the brachial veins are deep veins formed by the union of the radial and ulnar veins down here at the anterior cubital fossa. The brachial veins are the venae comitantes of the brachial artery and receive many perforating branches from the anterior and posterior compartments of the arm. The brachial veins unite around here and join with the basilic vein to form the axillary vein.

Speaking of which, the next vein we're going to look at today is the axillary vein which we can see here highlighted in green. If we were to dissect through the surrounding structures like so and take a look at this image here, we can get a clearer look at the axillary vein highlighted again in green with the muscles of the upper thorax transected to help you get a better idea of the this location. The axillary vein is an important vein that receives venous blood flow from several sources. Stripping away the surrounding structures even further allows us to see this more clearly. It's formed by the union of the basilic vein and brachial veins down here and also receives tributaries from the cephalic vein and from branches that correspond with the branches of the axillary artery. We can also see here that the axillary vein increases in size as it ascends and ends at the lateral margin of the clavicle here where it becomes the subclavian vein.

If we look again briefly at the previous image, we can see how the axillary vein carries on to travel behind the clavicle. This is the point at which it becomes the subclavian vein highlighted now in green here which is the last of the major veins of the upper limb that we're focusing on today. This vein as we've just seen is a continuation of the axillary vein. Like a lot of terms in anatomy, we used this vein's name to help determine its location. Subclavian can be simply translated to beneath the clavicle which we can see pretty clearly in this image here. Of course, the venous return doesn't just stop here. It continues on.

If we remove some more of the surrounding structures again, we can see that the subclavian vein joins with the internal jugular vein coming down from the head to form the brachiocephalic vein. It may be helpful to know that sometimes the brachiocephalic vein can also be called the innominate vein. Moving further on, we can see that the brachiocephalic vein goes on to drain into the superior vena cava returning the deoxygenated blood to the heart so that the cycle can start again.

Before finishing the tutorial, I'm going to give you a quick summary of what we've talked about today which will hopefully help you see how the veins of the upper limb connect to each other overall.

We first talked about the arrangement of the veins in general, so we have the superficial veins which are located beneath the integument or skin and between the two layers of superficial fascia. The superficial veins then drain into the perforating veins which go on to drain into the deep veins. The deep veins are often in pairs accompanying an artery so that the pulsation of the artery can aid the venous blood flow. These pairs are known as venae comitantes. In addition to this arterial assistance, veins also have valves distributed at regular intervals which prevent the blood from traveling in the wrong direction.

Next, I talked about the veins of the hand which from the palmar view included the superficial palmar venous arch which receives blood flow from the common digital veins and the deep palmar venous arch which receives blood flow from the palmar metacarpal veins. If we flip the hand over so that we have a dorsal view, we can see the dorsal venous network highlighted in green. Like a lot of the superficial veins in this tutorial, this is one example of a great site for venipuncture and cannulation due to its proximity to the surface of the skin.

Moving upwards to the forearm, we have the deep veins which consist of the radial vein and the ulnar vein. As for the superficial veins, we talked about the basilic vein and the cephalic vein which are joined by the median cubital vein in the region of the anterior cubital fossa or the pit of your elbow. This small vein tends to be another good site for venipuncture.

Next we reached the upper arm. Here we continued following the superficial veins that we had previously met in the forearm including the basilic vein and the cephalic vein. As for the deep veins, we covered the brachial vein which joins up with the axillary vein in the clavipectoral triangle and goes on to become the subclavian vein.

Finally, I showed you briefly how the venous blood flow carries on into the brachiocephalic vein and then into the superior vena cava. This is the point at which the blood reaches the end of its cycle through the body and is returned to the heart.

And that's it from me today. I hope this has helped you to improve your understanding of the veins of the upper limb and thank you for watching.

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