Arterial Supply of Upper Limb

I. Axillary Artery
The axillary artery is the principal arterial trunk of the upper limb.
• It is a continuation of the subclavian artery at the outer border of the 1st rib.
• It ends at the inferior border of the teres major muscle, where it becomes the brachial artery.
• Pectoralis minor muscle crosses it and so divides it into three parts (1st, 2nd and 3rd) which
are proximal, posterior and distal to the muscle.
Branches
• Branch of the rst part - Superior thoracic artery
• Branches of the second part - Acromio-thoracic and lateral thoracic artery
• Branches of the third part - Subscapular, anterior circum ex humeral and posterior circum ex
humeral artery
Surface anatomy
It is drawn by a straight line joining the mid-point of the clavicle to the junction of arm with the
lower border of posterior wall of axilla, with arm abducted at a right angle and palm facing
upward.
Applied Anatomy
• The axillary artery may be compressed against the humerus in the lateral wall of the axilla in
case of haemorrhage.

II. Brachial Artery

• It begins at the lower border of the teres major as the continuation of the axillary artery.
• It lies in the center of the cubital fossa, medial to the biceps tendon, lateral to the median
nerve, and deep to the bicipital aponeurosis.
• It terminates at the level of the neck of the radius by dividing into the radial and ulnar arteries.
Branches
• Profunda brachii (deep brachial) artery
• Superior ulnar collateral artery
• Inferior ulnar collateral artery
• Humeral nutrient artery.
• Muscular branches supply the coracobrachialis, biceps brachii and brachialis muscles.

III. Radial Artery

• It is the lateral branch of brachial artery opposite the neck of the radius in the inferior part of
the cubital fossa
• It ends in the palm by forming the deep palmar arch.
Branches
• Radial recurrent artery
• Muscular branches
• Palmar carpal branch
• Dorsal carpal branch
• Super cial palmar branch
• Princeps pollicis artery
• Radialis indicis artery

IV. Ulnar Artery

• It is the larger medial branch of the brachial artery in the cubital fossa.
• It ends in the palm by continuing as the super cial palmar arch.
Branches
• Anterior ulnar recurrent artery
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 • Posterior ulnar recurrent artery
• Common interosseous artery
• Palmar carpal branch
• Dorsal carpal branch
• Deep palmar branch
Super cial Palmar Arch
• The super cial palmar arch is the main continuation of the ulnar artery.
• It is completed by the super cial branch of the radial artery.
• Surface anatomy of the super cial palmar arch: It is located in the central part of the palm. It
lies on a line drawn across the palm at the level of the distal border of the fully extended thumb.
Deep Palmar Arch
• The deep palmar arch is the main continuation of the radial artery.
• It is completed by the deep branch of the ulnar artery.
• Surface anatomy of the deep palmar arch: It is located in the central part of the palm. It lies on
a line drawn across the palm at the level of the proximal border of the fully extended thumb.

Pulse Points
Peripheral pulses can be felt at the following locations in the upper limb
• Axillary pulse in the axilla
Lateral to the apex of the dome of skin covering the oor of the axilla.
• Brachial pulse in midarm
On the medial side of the arm in the cleft between the biceps brachii and triceps brachii
muscles. This is the position where a blood pressure cu is placed.
• Brachial pulse in the cubital fossa
Medial to the tendon of the biceps brachii muscle in the cubital fossa.
• Radial pulse in the distal forearm
Immediately lateral to the tendon of the exor carpi radialis muscle opposite the lower end of
the radius.
• Radial pulse in the anatomical snu box
Between the tendon of the extensor pollicis longus muscle and the tendons of the extensor
pollicis brevis and abductor pollicis longus muscles.
• Ulnar pulse in the distal forearm
Immediately under the lateral margin of the exor carpi ulnaris tendon and proximal to the
pisiform.

Anastomosis around the Scapula

• An extensive arterial anastomosis is present around the scapula.
• Several vessels join to form networks on the anterior and posterior surfaces of the scapula: the
dorsal scapular, suprascapular, and (via the circum ex scapular) subscapular arteries.
• This anastomosis serves as a collateral pathway between branches of the 1* part of the
subclavian artery.
• The chief vessels concerned are
Subscapular artery
• It is the largest branch of the 3rd
part of the axillary artery.
• It descends along the lateral border of the subscapularis on the posterior axillary wall.
• It divides into its two terminal branches, the circum ex scapular artery and the thoracodorsal
artery.
• The circum ex scapular artery curves around the lateral border of the scapula.
• It anastomoses with the suprascapular artery and the deep branch (dorsal scapular artery) of
the transverse cervical artery.
Dorsal scapular artery
• It is a branch of the transverse cervical artery which runs down the ventral border of the
scapula to its medial edge and inferior angle.
• The dorsal scapular artery anastomoses with the subscapular artery.
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Suprascapular artery
• It is a branch of thyrocervical trunk of the subclavian artery.
• It is distributed near the upper margin of the scapula, and in supraspinous and infraspinous
fossae.
Small branches of intercostal arteries
• All these branches form an extensive network on both the costal and dorsal surfaces of the
scapula, thus connecting the rst part of the subclavian artery and with the 3"d part of the
axillary artery.
Applied Anatomy
• It provides a collateral circulation to become established after ligation of 3rd part of the axillary
artery or 1st part of the subclavian artery or when there is blockage between these 2 points.

Anastomosis around the Elbow Joint

• The arterial anastomosis around the elbow takes place between the branches of brachial artery
and those from the upper end of radial and ulnar arteries.
• The anastomosis is divided into the following parts;,
1. In the front of the medial epicondyle
• Inferior ulnar collateral artery (branch of the brachial artery) anastomoses with anterior ulnar
recurrent artery (branch of the ulnar artery).
2. Behind the medial epicondyle
• Superior ulnar collateral artery (branch of the brachial artery) anastomoses with posterior ulnar
recurrent artery (branch of the ulnar artery).
3. In front of lateral epicondyle
• Radial collateral artery (branch of the profunda brachii artery), anastomose with radial recurrent
artery (branch of radial artery).
4. Behind the lateral epicondyle
• Posterior descending artery (branch of the profunda brachii artery), anastomose with
interosseous recurrent artery (branch of the posterior interosseous artery); and a branch of
common interosseous artery (a branch of the ulnar artery).
8. Above the olecranon fossa
• Middle collateral artery (branch of the profunda brachii artery), anastomose with transverse
branch from the posterior division of the inferior ulnar collateral artery.
Applied Anatomy
• If brachial artery is tied o distal to the inferior ulnar collateral artery, su cient blood reaches the
ulnar and radial arteries via the existing anastomoses around the elbow.

Anastomosis around the Wrist Joint

• Both radial and ulnar arteries give o palmar and dorsal carpal branches.
• These anastomose with each other deep to the long tendons, forming the palmar and dorsal
carpal arches.
Palmar carpal arch
• The palmar carpal branch of radial artery joins the palmar carpal branch of ulnar artery.
• The palmar carpal arch lies transversely across the wrist joint; it supplies the carpal bones and
sends branches distally into the hand to anastomose with the deep palmar arch.
Dorsal carpal arch
• The dorsal carpal branch of radial artery joins the dorsal carpal branch of ulnar artery.
• The dorsal carpal arch lies transversely across the distal row of carpal bones.
• They anastomose through the interosseous spaces with the deep palmar arch and the digital
branches of the super cial palmar arch.
• The common interosseous artery arises from the upper part of the ulnar artery and, divides into
the anterior and posterior interosseous arteries and end by taking part in the anastomosis
around the wrist joint.
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• Thus, a free anastomosis is established between radial and ulnar arteries through the carpal
and palmar arches.
Applied Anatomy
• Since hand is placed and held in many di erent positions, it requires an abundance of highly
branched and anastomosing arteries so that oxygenated blood is available in all positions.

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