VESSELS OF THE FREE PART

OF THE UPPER LIMB

ANATOMY OF THE
NEUROVASCULAR BUNDLES
OF THE UPPER LIMB

Slide-lecture for students of the 6-7

Faculty of Medicine
Lector – associate professor
Zharova Nataliya
 THE BRACHIAL
ARTERY
• The brachial artery
• (a. brachialis) is continuation
of the axillary artery.
Beginning at the lower border
of m. teres major, it passes to
the medial bicipital groove
and on the level of the neck of
the radius, it divides into two
terminal branches:
• the radial and
• the ulnar arteries.
• The brachial artery gives off many small
branches to the bone and muscles of the
arm and three large branches:
• 1. The deep brachial artery (a. profunda
brachii) starts from brachial artery soon after
its origin. It passes into the spiral canal, and
gives off arteries that supply the humerus
(aa. nutriciae humeri) and deltoid muscle (r.
deltoideus) and then divides into two
branches:
• (a) posterior descending branch called (a.
collateralis media) which penetrates the
thickness of m. triceps and anastomoses with
a. interossea recurrens (branch of the ulnar
artery) on the posterior surface of the lateral
epicondyle;
• (b) anterior descending branch (a. collateralis
radialis) which emerge through the inferior
opening of the spiral canal, passes forward
from the lateral epicondyle and anastomoses
with a. recurrens radialis (branch of radial
artery).
• These branches carry blood to the elbow
joint and form the arterial network of the
elbow joint (rete articulare cubiti)
2. The ulnar collateral artery (a.
collateralis ulnaris superior),
starts from the brachial artery
in the middle of the arm and
settles into the sulcus ulnaris
on the posterior surface of
the medial epicondyle where
it anastomoses with a.
recurrens ulnaris posterior
(branch of the ulnar artery). It
supplies the elbow joint with
blood and drains into the rete
articulare cubiti.
3. The supratrochlear artery (a.
collateralis ulnaris inferior),
begins from the brachial
artery above medial
epicondyle of the humerus. It
anastomosis anteriorly from
the medial epicondyle with a.
recurrens ulnaris anterior
(branch of the ulnar artery),
supplies the elbow joint and
drains into the rete articulare
cubiti.
 The Ulnar Artery
• The ulnar artery (a. ulnaris)
is the larger of two terminal
branches of the brachial
artery. It runs under m.
pronator teres in the ulnar
groove between m. flexor
digitorum superficialis and
m. flexor carpi ulnaris, in
the lower one third of the
forearm its position
becomes more superficial
and it passes into the ulnar
canal and crossing over to
the palm, continues with
the superficial palmar arch.
 THE ULNAR ARTERY

The branches of the ulnar artery:

1. The recurrent ulnar
2. The common interosseus artery
At the proximal border of the
membrane it divides into two
branches:
(a) a. interossea anterior passes
(b) a. interossea posterior passes
A. interossea posterior gives of the
a. interossea reccurens which
passes upward under m.
anconeus and anastomoses with
a. collateralis media on the
posterior surface of the lateral
epicondyle.
3. The anterior carpal branch
4. The posterior carpal branch
5. The deep palmar branch
 THE RADIAL ARTERY

The branches of the

radial artery:
1. The recurrent radial
artery
2. The muscular
3. The superficial palmar
branch
4. The anterior carpal
branch
5. The posterior carpal
branch
6. The radial artery of the
index
7. The artery of the thumb
8. The artery of the radius
 THE ELBOW ARTERIAL
NETWORK

• The arterial supply to the

elbow joint is from
the cubital
anastomosis, which
includes recurrent and
collateral branches from
the brachial and deep
brachial arteries.

• Its nerve supply is

provided by the median,
• musculocutaneous and
• radial nerves anteriorly,
and the ulnar nerve
posteriorly.
 THE PERIARTICULAR ARTERIAL ANASTOMOSIS OF THE ELBOW
consists of several arteries that supply the elbow joint and its supporting
structures.
• The arteries that contribute
include:
from the brachial artery
1. superior ulnar collateral artery
2. inferior ulnar collateral artery
3. from the deep brachial artery
4. middle collateral artery
5. radial collateral artery
from the radial artery
1. radial recurrent artery
from the ulnar artery
1. common interosseous artery
2. anterior interosseous artery
3. posterior interosseous artery
4. interosseous recurrent artery
5. posterior ulnar recurrent artery
6. anterior ulnar recurrent artery
 THE ARTERIES OF THE HAND
On the palmar surface of the hand there are superficial and deep palmar arches

The Superficial palmar arch lies under

the palmar aponeurosis. It is a
continuation of the ulnar artery and is
composed with the superficial palmar
branch of the radial artery.
The deep palmar arch lies deeply on the
bases of the metacarpal bones,
proximally to the superficial arch.
Formed mainly by the radial artery, it
is composed with the deep palmar
branch of the ulnar artery.
On the dorsal surface of the hand in the
region of the retinaculum extensorum
there is a dorsal carpal network
which is formed by union of the
posterior carpal branches of the radial
and ulnar arteries and anterior and
posterior interosseus arteries.
 THE RADIOCARPAL ARTERIAL NETWORK
• The radiocarpal joint
receives its blood supply
from the branches of the
dorsal and palmar carpal
arches.
• The palmar carpal arch is
generally formed by palmar
carpal branches of the radial
and ulnar arteries, anterior
interosseous artery and
penetrating branches of the
deep palmar arch.
• The dorsal carpal arch arises
from dorsal carpal branches
of the radial ulnar, anterior
interosseous and posterior
interosseous arteries.

Innervation
The radiocarpal joint receives its innervation from articular branches of the following
nerves;
Anterior interosseous nerve arising from median nerve (C5-T1)
Posterior interosseous nerve arising from radial nerve (C7-C8)
Deep and dorsal branches of the ulnar nerve (C8-T1)
 VEINS OF THE
UPPER
EXTREMITIES
• Veins of the upper extremities are
grouped into deep veins which are
accompanying veins of arteries
from which they derive their names
(Latin: vena comitantes),
and superficial veins.
 The deep veins
The deep veins (vv. profundae membri superiores) collect blood from the
muscles, bones, joints.
• Deep veins attend arteries, usually two veins for the every artery. The
names off these veins are same as for the arteries. Thus there are two
brachial, two ulnar, two radial, and two (anterior and posterior)
interosseus veins.
• Vv. ulnares and vv. radiales continue superficial and deep venous arches
of the hand. They ascend along same arteries and unite in the region of
the elbow flection forming two vv. brachiales. Last ones collect blood from
the arm and form axillary vein on the level of the lower edge of the teres
major muscle.
• The axillary vein (v. axillaris) lies in the axillary fossa in front of the axillary
artery. It collects blood from the deep and superficial veins of the free
upper limb. V. thoracica lateralis, v. subscapularis, v. circumflexa humeri
anterior and posterior also drain into the axillary vein.
 The superficial veins
The superficial veins (vv. superficiales membri superiores) are located in the subcutaneus tissue and
collect blood from the skin, subcutaneus tissues and superficial venous networks.
• 1. The cephalic vein (v. cephalica) or lateral subcutaneus vein is continuation of the first v.
metacarpalis dorsalis. It ascends along the radial side of the forearm, and then passes to its anterior
surface, reaches the elbow joint and then ascends along the lateral bicipital groove and drains into
the axillary vein.
• 2. The basilica vein (v. basilica) or medial subcutaneus vein is continuation of the fourth v.
metacarpalis dorsalis. It ascends along the ulnar side on the dorsal and then on the anterior surface
of the forearm to the elbow flexion where it anastomoses with the cephalic vein by means of the
median cubital vein, then it passes into the medial bicipital groove and, perforating the fascia in the
middle of the arm, drains into one of the brachial veins.
• 3. The median cubital vein (v.mediana cubiti) is an obliquely positioned anastomosis connecting v.
basilica and v. cephalica in the region of the elbow flection. It receives blood from the median
forearm’s vein (v. mediana antebrachii) which collects blood from the palmar surface of the hand and
forearm. The median cubital vein is important in practice as the site of intravenous injections.
• Hand
• There are two prominent superficial veins of the
upper limb; they are the cephalic and basilic veins,
and these two extensive veins originate from the
venous networks of the dorsum of the hand.
• The hand is drained by superficial and deep veins.
In the palm, these veins form “arches” and they
are associated with the superficial and deep
palmar (arterial) arches, hence they are
called superficial and deep venous palmar arches.
• In the dorsum of the hand are digital (phalangeal)
and metarcarpal veins which anastomose with
each other to form networks. The dorsal digital
veins drain into three dorsal metarcarpal veins,
which unite to form a dorsal venous network.
Superficial to the metarcarpus, this network unites
to give rise to two extensive superficial veins, the
cephalic and basilic veins.
• On the lateral side of the carpus in a region called
the anatomical snuffbox, the dorsal venous
network is prolonged proximally as the cephalic
vein, while the basilica vein arises from the medial
side.
• Relatively, little amount of blood is drained from
the hand into the deep veins of the forearm. Most
of the blood from the palm of the hand passes The anatomical snuffbox (also known as the radial
through to the venous network on the dorsum. All
of the superficial veins of the hand drain into the fossa), is a triangular depression found on the lateral
cephalic and basilic veins. aspect of the dorsum of the hand. It is located at the
level of the carpal bones, and best seen when the
thumb is extended.
• The forearm is drained by
numerous deep veins which form
double venae comitantes with
arteries of the forearm. These deep
veins of the forearm anatomoses
freely with each other and return
blood from the forearm with little
contribution (little blood volume)
from the hand.
• The cephalic and basilic veins are
major superficial veins of the
forearm. From the radial side
(lateral side) of the forearm,
the cephalic vein runs up, from the
anatomical snuffbox, along the
preaxial border of the upper limb.
It runs in the arm lateral to the
biceps brachii, in the deltopectoral
groove, and perforates the
clavipectoral fascia to drain into
the axillary vein.
• From the ulnar side (medial side of
forearm) the basilic vein runs up
the postaxial border of the upper
limb, pierces the deep fascia
halfway between the elbow and
axilla, and joins the brachial
veins to form the axillary veins.
• A third important superficial
vein of the forearm is
the median forearm
vein (or median antebrachial
vein). It drains subcutaneous
tissue of the anterior part of the
wrist and forearm. It bifurcates
at the elbow (approximately
within the cubital fossa) into
the median cephalic and median
basilic veins (producing an “M”
formation of cubital veins). The
latter receives a deep vein of the
forearm. These two branches of
the median forearm vein open
into the cephalic and basilic
veins respectively. The deep vein
which communicates with the
median basilic vein makes it a
larger vessel than the median
cephalic. The median cephalic is
much less movable in the
subcutaneous tissue than the
median basilica, and is therefore
is often more convenient to use
in intravenous therapy in spite
of its smaller size, although
variations exist among
individuals.
• Arm
• Like in the forearm, the
arm is drained by
the brachial veins (deep
veins that accompany
the brachial artery) and
all its branches. In
addition, the basilic and
cephalic veins course
upwards through the
subcutaneous tissue and
drain the superficial
regions of the arm. The
basilic veins perforate
the deep fascia in the
middle of the arm, while
the cephalic lies in the
groove between the
deltoid and pectoralis
major muscles, and ends
by piercing the
clavipectoral fascia to
enter the axillary vein.
 Clinical notes
• Venipuncture and variation of veins in the cubital fossa
• The cubital fossa is the common site for sampling and transfusion of blood and intravenous injections
because of the prominence and accessibility of veins. Usually, the median cubital vein or the basilic
vein is selected. The median cubital vein lies directly on the deep fascia, crossing the bicipital
aponeurosis, which separates it from the underlying brachial artery and median vein, and provides
protection to the latter.
 The cubital fossa is bounded by the brachialis above;
below it is bounded by the brachioradialis (laterally) and
pronator teres (medially).
• Median cubital vein (anterior view)
Historically, during the days of
bloodletting, the bicipital aponeurosis
was known as the grace Deux (Fr. Grace
of God) tendon, by the grace of which
arterial haemorrhage was usually
avoided. A tourniquet is placed around
the mid-arm to distend the veins around
the cubital fossa. Once the vein is
punctured, the tourniquet is removed so
that when the needle is removed the
vein will not bleed extensively.
• The cubital veins are also a site for the
introduction of cardiac catheters to
secure blood samples from the great
vessels and chambers of the heart.
These veins may also be used for
cardioangiography. The pattern of veins
in the cubital fossa varies greatly. In
approximately 20% of people, the
median antebrachial vein (median vein
of the forearm) divides into a median
basilic vein, which joins the basilic vein,
and a median cephalic vein which joins
the cephalic vein. In these cases, a clear
M formation is produced by the cubital
veins.
• It is important to observe
and remember that
either the median cubital
vein or the median basilic
vein, which ever pattern
is present, crosses
superficial to the brachial
artery, from which it is
separated by the bicipital
aponeurosis. These veins
are good sites for
drawing blood but are
not ideal for injecting an
irritating drug because of
the danger of injecting it
into the brachial artery.
In obese people, a
considerable amount of
fatty tissue may overlie
the vein.
Injuries to the axillary vein
Wounds in the axilla often involve the axillary vein because of its large size and exposed
position. When the arm is fully abducted, the axillary vein overlaps the axillary artery
anteriorly. A wound in the proximal part of the axillary vein is particularly dangerous, not
only because of profuse bleeding but also because of the risk of air entering it and
producing air emboli (air bubbles) in the blood.
 LITERATURE
1. TEXTBOOK OF HUMAN ANATOMY. M.R.Sapin, L.L.Kolesnikov, D.B.Nikitjuk: Moscow, New Wave Publisher Ltd;
2005.
2. Anatomy, descriptive and surgical: Gray's anatomy. Gray, Henry. Philadelphia : Courage Books/Running Press, 1974
3. Clinically Oriented Anatomy. Moore, Keith L. Philadelphia : Wolters Kluwer Health/Lippincott Williams & Wilkins,
2010 (6th ed)
4. Drake RL, Vogl W, Mitchell AWM. 'Gray's Anatomy for Students'. New York: Elsevier; 2005:69-70.
5. https://teachmeanatomy.info/neuroanatomy/brainstem/medulla-oblongata/
6. www.anatomynext.com
 THE END

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