Blood supply of upper limb by Dr-Ismail Khan

ARTERIAL SUPPLY OF THE UPPER LIMB

PresentedTo:

SIR MALIK SHERAZ

GROUP MEMBERS

1) Ismail Khan (Physiotherapist-JPMC)2) Wasey Ali3) Muhammad Irfan4) Nisar Ali5) Ishtiaque Ahmed6) Syed Osama

OBJECTIVES Axillary artery Parts, Relations and Branches of Axillary artery The arterial anastomosis around the shoulder joint Brachial artery Relations and Branches of brachial artery The arterial anastomosis around the elbow joint. Radial and Ulnar arteries with their relations and branches. The formation of superficial and deep palmar arches. Pulsation areas of upper limb

ARTERIAL SUPPLY OFTHE UPPER LIMB

Axillary arteryAxillary artery

Right Right subclaviansubclavian

arteryartery

Brachial Brachial arteryartery

Radial artery

Ulnar Ulnar arterarteryy

Palmar Palmar archesarches

AXILLARY ARTERYOrigination:Begins at the lateral border of 1st rib as a continuation of

subclavian artery.

Termination:Ends at the lower border of teres major muscle by

continuing as brachial artery.

Axillary Artery

PARTS OF AXILLARY ARTERY

Pectoralis minor muscle crosses in front of the artery and divides it into 3 parts.

1) First part: Proximal to pectoralis minor (from lateral border of 1st rib to upper border of pectoralis minor).

2) Second part: Deep (behind) to pectoralis minor.

3) Third part: Distal to pectoralis minor (from lower border of pectoralis minor to lower border of teres major)

PARTS OF AXILLARY ARTERY

RELATIONS Relations of 1st part of Axillary Artery:

Anteriorly:1.Skin

2.superficial fascia

3.Platysma

4.Supraclavicular nerves

5.Deep fascia

6.Pectoralis Major (clavicular part)

7.Clavipectoral fascia + cephalic vein, lateral pectoral nerve and

thoracoacromial artery

Relations of 1st part of Axillary Artery:

Posteriorly:

1) 1st intercostal space

2) 1st and 2nd digitations of the serratus anterior + nerve

3) Long thoracic nerve

Relations of 1st part of Axillary Artery:

Laterally:

1) Lateral and posterior cords of brachial plexus

Medially:

1) Axillary vein

2) Medial pectoral nerve

Relation of 2nd part of Axillary Artery:

Anteriorly:1)Skin

2)Superficial fascia

3)Deep fascia

4)Pectoralis Major

5)Pectoralis Minor


Posteriorly:

1) Posterior cord of Brachial Plexus

2) subscapularis muscles


Laterally:

1) Lateral cord of Brachial Plexus

2) coracobrachialis

Medially:

1) Medial Lateral cord of Brachial Plexus

2) Medial pectoral nerve

3) axillary vein

Relation of 3rd part of Axillary Artery:

Anteriorly:1) Skin

2) Superficial fascia

3) Deep fascia

4) Pectoralis Major for a short distance

5) medial root of median nerve


Posteriorly:

1) Subscapularis

2) Latissimus dorsi

3) Teres Major

4) Axillary and radial nerve


Laterally:

1) lateral root of median nerve

2) Musculocutaneous nerve

3) Corachobrachialis

4) Biceps

5) Humerus


Medially:

1) Axillary vein

2) Medial cutaneous nerve of arm

3) Medial cutaneous nerve of forearm

4) Ulnar nerve (between axillary artery & vein)

BRANCHES OF AXILLARY ARTERY

Branches from 1st part:

1) Superior (highest) thoracic artery

Branches from 2nd part :

Thoraco-acromial artery

Lateral Thoracic artery

Branches from 3rd part :

1)Subscapular artery

2)Anterior circumflex humeral artery

3)Posterior circumflex humeral artery

BRANCHES OF AXILLARY ARTERY

(1) SUPERIOR THORACIC ARTERY

It is a very small branch arising from 1st part.

Near the subclavius.

It runs downwards, forwards and medially passes between the two pectoral muscles.

Ends by supplying the pectoral muscles and thoracic wall.

(2) THORACO-ACROMIAL ARTERY

Branch of 2nd part.

Emerges at the upper border of pectoralis minor.

Pierces clavipectoral fascia.

Divides into following 4 branches;(a) Pectoral branch(b) Deltoid branch(c) Acromial branch(d) Clavicular branch

BRANCHES OF THORACO-ACROMIAL ARTERY:

(a) Pectoral Branch:

Passes between the pectoral muscles.

Supplies the pectoral muscles and the breast.

(b) Deltoid Branch:

Runs in the deltopectoral groove along with the cephalic vein.

(c) Acromial Branch:

Crosses the coracoid process and ends by joining the anastomoses over the acromion.

(d) Clavicular Branch:

Runs supermedially deep to the pectoralis major.

Supplies the sternoclavicular joint & subclavius.

(3) LATERAL THORACIC ARTERY:

Branch of 2nd part.

It emerges at, and runs along the lower border of pectoralis minor.

In females, the artery is large and gives off the lateral mammary branches to the breast.

(4) ANTERIOR CIRCUMFLEX HUMERAL ARTERY:

A small branch arising from the 3rd part of axillary artery.

It passes laterlly in front of the intertubercular sulcus of the humerus.

Anastomoses with the posterior circumflex humeral artery around the surgical neck of the humerus.

(5) POSTERIOR CIRCUMFLEX HUMERAL ARTERY:

Branch of 3rd part.

Much larger than anterior artery.

It runs backwards.

Passes through the quadrangular intermuscular space.

Ends by anastomosing with the anterior circumflex humeral artery around the surgical neck of the humerus.

(6) SUBSCAPULAR ARTERY:

It is the largest branch of the axillary artery, arising from 3rd part.

It runs along the lower border of the subscapularis.

Ends near the inferior angle of the scapula.

It supplies the latissimus dorsi and the serratus anterior.

ANASTOMOSIS AROUND

SHOULDER JOINT

Anastomosis occurs between branches of first part of Subclavian and third part of Axillary arteries;

Branches from Subclavian Artery:

1) Suprascapular artery

2) Superficial cervical artery

Branches from Axillary Artery:1) Subscapular artery

2) Anterior circumflex humeral artery

3) Posterior circumflex humeral artery

BRANCH OF SUBSCAPULAR ARTERY:

Circumflex Scapular Artery:

Larger than the continuation of the main artery.Passes through the triangular intermuscular space.Winds round the lateral border of scapula.

Further 2 Branches:

One branch to the subscapular fossa.Another branch to the infraspinous fossa.Both take part in the anastomoses around the scapula.

ANASTOMOSIS AROUND

SHOULDER JOINT

BRACHIAL ARTERYOrigination:Begins at the lower border of teres major muscle as a

continuation of Axillary artery.

Termination:Terminates opposite the neck of the radius in the cubital

fossa by dividing into Radial and Ulnar arteries.

RELATIONS OF BRACHIAL ARTERY

Anteriorly: 1)Coracobrachialis

2)Biceps brachi

It is crossed by;

•In upper part: Medial cutaneous nerve of arm

•In middle part: Median nerve

•In lower part: Bicipital aponeurosis


Posteriorly: 1)Triceps brachii

2)Brachialis

3)coracobrachialis (insertion)

4)Radial nerve

5)Profunda brachii artery


Laterally: (2 parts)In upper part: Median nerve, Coracobrachialis & biceps brachi

In lower part: Tendon of biceps

Medially: (2 parts)In upper part: Ulnar nerve & Basilic vein

In lower part: Median nerve


At the elbow, the structures from medial to the lateral side are;

(1) median nerve(2) Brachial artery(3) Biceps brachii tendon(4) Radial nerve on a deeper plane (MBBR)

BRANCHES OF BRACHIAL

ARTERY

1) Muscular branches

2) Nutrient artery to humerus

3) Profunda Brachii artery (accompanies the radial nerve)

4) Superior ulnar collateral branch (accompanies the ulnar nerve)

5) Inferior ulnar collateral (or supratrochlear) branch

6) Terminal branches (ends by)

(i) Radial artery

(ii) Ulnar artery

BRANCHESOF

BRACHIAL

ARTERY

PROFUNDA BRANCHII ARTERY

Deep branchial artery Large branch of brachial artery

Origination:Just below the teres major

Termination:Divide into terminal branches as it pierces lateral intermuscular septum in arm and accompany radial nerve.

BRANCHES OF PROFUNDA BRACHII ARTERY:

(1) Ascending (deltoid) branch

(2) Anterior descending (radial collateral)

(3) Posterior descending (middle collateral)

(4) Nutrient artery to humerus

ANASTOMOSIS AROUND

ELBOW JOINT

Anastomosis occurs between branches of Brachial, Radial and

Ulnar arteries:

Branches from Brachial Artery:1) Profunda Brachii artery

2) Superior ulnar collateral artery

3) Inferior ulnar collateral artery

Branches from Ulnar and Radial Arteries:1) Radial & ulnar recurrent arteries

2) Posterior interosseous recurrent artery

ANASTOMOSIS AROUND ELBOW

JOINT

SUBDIVISION OF ANASTOMOSES

The anastomoses can be subdivided into following parts;

(1) In front of the lateral epicondyle of the humerus(2) Behind the lateral epicondyle of the humerus(3) In front of the medial epicondyle of the humerus(4) Behind the medial epicondyle of the humerus

ANASTOMOSIS AROUND ELBOW JOINT

RADIAL ARTERY Smaller terminal branch of Brachial artery.

Origination: Begins in the cubital fossa & passes below

Brachioradialis muscle.

Termination: Continues in hand as deep palmar arch

RELATIONS IN FOREARM It lies deep to brachioradialis but in lower part it becomes

superficial between brachioradialis tendon (laterally) and flexor

carpi radialis tendon (medially).

Its bed is formed by biceps, supinator, pronator, F.D.S, F.P.L,

pronator quadratus & styloid process of radius.

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.

RELATIONS IN HAND

Enters the dorsum of hand deep to extensor retinaculum.

Leaves the dorsum of hand by turning forward between proximal ends of 1st and 2nd metacarpal bones.

In palm curves medially between two heads of adductor pollicis and continues as deep palmar arch.

BRANCHES IN FOREARM


2) Radial recurrent branch

3) Palmar carpal branch

4) Superficial Palmar branch (Joins ulnar artery to form

Superficial Palmar Arch)

5) Dorsal carpal branch

RADIAL ARTERY

BRANCHES IN HAND

In The Dorsum Of Hand:(1) First dorsum metacarpal artery (thumb & index finger)(2) Communicating branch (anastomose around wrist joint)

In The Palm:(1) Radialis indicis(2) Princeps pollicis artery(3) Deep palmar branch

ULNAR ARTERYLarger terminal branch of Brachial artery.

Origination:Begins in the cubital fossa & descends through anterior

compartment of forearm.

Termination:It ends by forming Superficial Palmar Arch with

Superficial Palmar branch of Radial artery.

RELATIONS IN FOREARM:

It goes down & medially deep to P.T, F.C.R, P.L, F.C.U, F.D.S.

Its bed is formed by brachialis (in upper part only) & F.D.P. (in lower part).

In lower part it becomes superficial by coming in between tendons of F.C.U. and F.D.S.

RELATIONS IN HAND:

It enters the palm in front of flexor retinaculum. lateral to ulnar nerve and pisiform bone.

BRANCHES IN FOREARM:


2) Anterior & posterior ulnar recurrent arteries

3) Palmar & dorsal carpal branches

4) Common Interosseous artery (largest branch)

a) Anterior Interosseous artery

b) Posterior Interosseous artery

BRANCHES IN HAND:

1) Superficial palmar branch

2) Deep Palmar branch

(arise in front of flexor retinaculum and passes

between abductor digiti minimi & flexor

digiti minimi then, Joins radial artery to

form Deep Palmar Arch)

ULNAR ARTERY

ULNAR ARTERY BRANCH

ES

AREAS OF ULNAR

& RADIAL

ARTERIES SUPPLY

DEEP PALMAR ARCH

Formation:From lateral side:By direct continuation of Radial artery.

From medial side:The Arch on medial side is completed by deep branch of

the ulnar artery.

RELATIONS:

1) Deep to long flexor tendons.

2) Superficial to metacarpal bones & interossel.

3) Deep branch of ulnar nerve lies with in its

concavity.

BRANCHES:

1) Three palmar metacarpal arteries2) Three Perforating branches3) Recurrent branches

DEEP PALMA

R ARCH

SUPERFICIAL PALMAR ARCH

Formation:From medial side:Direct continuation of Ulnar artery.

From lateral side:

The Arch is completed by superficial palmar branch of the

radial artery.

RELATIONS:Superficially:

1)Palmaris brevis

2)Palmar aponeurosis

Inferiorly:

1)long flexor tendons of finger

2)lumbricals

BRANCHES: Four digital arteries

SUPERFICIAL

PALMAR ARCH

AREAS OF UPPER LIMB

ARTERIES PULSATION

ANY QUESTIONS. . . ???

THANK YOU

Blood supply of upper limb by Dr-Ismail Khan

Education

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