Blood supply of upper limb

Superior thoracic Thoracoacromial Subscapular

aa aa aa

Brachiocephalic Subclavian Axillary aa Axillary aa Axillary aa

trunk aa (1st part) ( 2nd part) (3rd part)

Lateral Ant. Circ. Post. Circ.

thoracic Humeral Humeral
Radial aa aa aa
recurrent aa

Sup. Ulnar
Deep palmar Collateral aa
arch Radial aa
Superficial
branch
Deep branch Brachial aa
Superficial
Ulnar aa
palmar arch

Post. Inf. Ulnar

interosseous Anterior & Collateral Profunda
Common Posterior Ulnar aa brachii aa
Ant. interosseous recurrent
interosseous aa arteries
 Axillary Artery
Begins at the lateral border
of 1st rib as the continuation
of subclavian artery
Ends at inferior border of
teres major, becomes
brachial artery
It passes posterior to the
pectoralis minor & divided
into three parts in relative
to pectoralis minor
This muscle used as the land
mark for dividing the axillary
artery
 Branches of axillary Artery
A. 1st part = between medial border of pectoralis minor
& lateral border of 1st rib
has one branch:
superior thoracic artery (Supreme thoracic artery)
B. 2nd part= lies posterior to pectoralis minor
has two branches:
thoracoacromial artery and
lateral thoracic artery
C. 3rd part = between lateral border of pectoralis minor
inferior border of teres major
has three branches:
Subscapular artery,
Anterior circumflex humeral artery
Posterior circumflex humeral artery
Cont
 Cont
1.Superior thoracic artery
it supplies upper part of the pectoral region.
It forms anastomosis with the intercostal and the internal
thoracic arteries.
2. Thoracoacromial artery gives rise -4-branches.
Clavicular branch,
Acromial branch
Deltoid branch
Pectoral branch
3. Lateral thoracic artery
descends to the lateral thoracic wall along the lateral
border of the pectoralis minor muscle.
Branches from Thoracoacromial artery
 C. Branches from the third part
1. Subscapular artery - descends along the lateral border of
the scapula and divides in to;
thoracodorsal aa runs with the thoracodorsal nerve to
the latissimus dorsi muscle and
circumflex scapular arteries(the larger terminal branch
of the subscapular artery) It participates in the
anastomoses around the scapula..
2. Anterior circumflex humeral artery - a small branch runs
anterior to the surgical neck of the humerus.
3. Posterior circumflex humeral artery - it runs posteriorly
to the surgical neck of the humerus with the axillary
nerve and passes through quadrangular space.
Cont
 Arterial anastomoses around scapula
Several arteries join to form networks on anterior and
posterior surfaces of the scapula

1. Suprascapular artery

2. Dorsal scapular artery

3. Subscapular artery (via the circumflex scapular and

thoracodorsal artery branches).
NB: this anastomosis connects 1st part of subclavian and
3rd part of axillary arteries collateral channels in case of
obstruction or ligation of a lacerated between these parts
is necessary
 cont
For example, the axillary artery may have to be ligated
between the 1st rib and subscapular aa; the direction of
blood flow to the subscapular artery is reversed, enabling
blood to reach the third part of the axillary artery.

N.B, the Subscapular artery receives blood through

several anastomoses with the

suprascapular and

intercostal arteries
Anterior view of arterial anastomoses around scapula
Posterior view of arterial anastomoses around scapula
 Axillary vein
is the continuation of the
basilic vein begins at the
lower margin of the teres
major muscle and
passes through the axilla
medial and anterior to the
axillary artery and
becomes the subclavian
vein as it crosses the lateral
border of 1st rib.
Tributaries of the axillary
vein generally follow the
branches of the axillary
artery
 Axillary lymph nodes
There are 5 principal groups
of axillary lymph nodes:
1. Pectoral(anterior axillary
nodes)
2. subscapular, posterior
axillary nodes
3. Humeral (lateral),
4. central, and
5. Apical
 Axillary lymph
nodes
humeral (Lateral
Axillary)

Subscapular
(Posterior axillary)

Pectoral
(Anterior axillary)

Central Axillary

Apical Axillary
 Enlargement of axillary lymph nodes
An infection in the UL or pectoral region and breast,
including the superior part of the abdomen can cause the
axillary nodes to enlarge and inflamed, a condition called
lymphangitis

These nodes are also the most common site of

metastases (spread) of cancer of the breast

Upper lateral quadrant of breast most common site of

spread of cancer
 Brachial artery
The continuation of axillary art. that begins at the lower
border of teres major m.
Lies medially in the upper arm but turn anteriorly as it
approaches the elbows.
Enters elbow by passing under the biceptal
aponeurosis where it divides in to radial and ulnar
arteries.
In its course brachial veins and median nerve .
accompany the brachial art.
In the proximal part the median n. lies lateral to the
artery, but in the distal part medial to it.
Cont
 Cont
Branches of the brachial artery
1. Profunda brachii artery (deep brachial artery)
2. humeral nutrient artery that enters the bone
through its nutrient foramen
3. Superior ulnar collateral artery
4. Inferior ulnar collateral artery
5. unnamed muscular branches to flexors mm of the
arm
 Profunda brachii artery
Run to the dorsal side of humerus with the radial nerve
where they lie in a canal formed by the radial sulcus of
humerus and lateral and medial heads of triceps
Branches of profunda brachii artery
1. Ascending (deltoid) branch anastomose with the
posterior circumflex humeral artery.
2. middle collateral or Posterior descending - descends
behind lateral epicondyle anastomose with recurrent
interosseous artery
3. Radial collateral or Anterior descending anastomose
with the radial recurrent artery
 Peri-articular arterial anastomoses surround the elbow
1. superior ulnar collateral aa with posterior ulnar
recurrent artery

2. inferior ulnar collateral aa with anterior ulnar recurrent

artery

3. Radial collateral aa ( Anterior descending) anastomose

with the radial recurrent artery

4. middle collateral aa ( Posterior descending) with

recurrent interosseous artery
Peri-articular arterial anastomoses surround the elbow
 Arteries of Forearm
The main arteries are the
ulnar and radial arteries,

They arise opposite the neck

of the radius in the inferior
part of the cubital fossa as
terminal branches of the
brachial artery
 Branches of ulnar artery
1. Anterior ulnar recurrent artery and

2. Posterior ulnar recurrent artery

3. Common interosseous artery

4. Unnamed muscular branches

5. palmar carpal branch and

6. dorsal carpal branch, which supply the wrist

 Branches of the radial artery
1. Radial recurrent Artery
arises from the lateral side
of the radial artery
It ascends between the
brachioradialis and the
brachialis muscles and
anastomoses with the
radial collateral artery, a
branch of the profunda
brachii artery.
 Cont
2.The dorsal carpal and palmar branches of the
radial aa
They participate the arterial anastomosis around
the wrist by anastomosing with the branches of the
ulnar artery and terminal branches of the anterior
and posterior interosseous arteries, forming the
palmar and dorsal carpal arches

3. The unnamed muscular branches of the

radial artery supply muscles in anterolateral
forearm
Palmar carpal arches dorsal carpal arches
Blood supply to the hand.
 cont
At the hypothenar eminence the ulnar artery divides in to:
1. Superficial palmar branch (larger)- forms anastomosis
with the smaller superficial palmar branch of radial
artery to form the superficial palmar arch.
This arch gives one palmar digital artery to the medial
side of the little finger; and three large, common palmar
digital arteries.
each common palmar digital arteries re-branch to two
proper palmar digital arteries to supply the fingers.
 Cont
2. Deep palmar branch (smaller) - that forms
anastomosis with larger deep palmar branch of radial
artery to complete the deep palmar arch. And this
arch gives rise to three palmar metacarpal arteries
and the princeps pollicis artery.
The radialis indicis artery passes along the lateral side
of the index finger.
It usually arises from the radial artery, but it may
originate from the princeps pollicis
 Thank you

Monday, December 4, 2017