Upper Limb - Neurovasculature

Anatomy of the Upper Limb - Neurovasculature

• Topic: Anatomy of the upper limb, neurovasculature, cubital fossa
• Lecturer: Dr. Viktoriia Yerokhina, Lecturer in Medical Sciences
• Institution: University of Central Lancashire (UCLan)

Subclavian Artery

• Origin: Arises from the brachiocephalic trunk (right side) and directly from the aortic arch (left side)
• Branches: Supplies inferior part of the neck, posterior part of the brain, anterior and lateral thoracic walls, anterior abdominal wall, and the upper extremity

Axillary Artery

• Continuity: Direct continuation of the subclavian artery in the axillary fossa
• Course: Gives off branches in the axillary fossa and then continues as the brachial artery
• Supply: Supplies muscles of the shoulder joint, muscles bordering the axillary fossa, deltoid, lateral thoracic wall (including its muscles and the mammary gland)

Axillary Artery Divisions

• Based on relationship to pectoralis minor): Divided into three parts:
  • First part: proximal to pectoralis minor
  • Second part: posterior to pectoralis minor
  • Third part: distal to pectoralis minor

Branches and Areas Supplied (Axillary Artery)

• Superior thoracic artery: Supplies pectoral muscles and mammary gland
• Thoracoacromial artery: Runs through the clavipectoral triangle
• Lateral thoracic artery: Descends on the serratus anterior, supplying it
• Subscapular artery: Has branches (circumflex scapular artery) supplying the posterior scapular muscles, and (thoraco-dorsal artery) supplying the latissimus dorsi muscle
• Anterior circumflex humeral artery: Smaller artery on the anterior surface of the surgical neck of the humerus
• Posterior circumflex humeral artery: Larger artery supplying the deltoid muscle

Arterial Supply to the Upper Limb

• Overview: Diagram showing the main arteries supplying the upper limb, including the brachial artery, radial artery, and ulnar artery. Also shows collateral arteries, and branches off major vessels.

Brachial Artery

• Origin: Continuation of the axillary artery, passing the lower border of the teres major
• Supply: Supplies the whole arm and elbow joint
• Bifurcation: Terminates in the cubital fossa where it splits into the ulnar and radial arteries
• Anastomosis: Its collaterals terminate in the cubital articular anastomosis

Brachial Artery - Branches and Areas Supplied

• Profunda brachii artery: Deep artery of the arm that runs between the lateral and medial heads of the triceps brachii. Supplies humeral shaft, posterior compartment muscles (deltoid, triceps brachii, anconeus, brachioradialis), and intermuscular septum.
• Humeral nutrient artery: Supplies the humeral shaft.
• Superior ulnar collateral artery: Terminates in the cubital articular anastomosis
• Inferior ulnar collateral artery: Arise just above the cubital fossa; enters the cubital articular anastomosis.
• Cubital articular anastomosis: A vascular network at the elbow joint, formed by the brachial, radial, and ulnar arteries

Radial and Ulnar Arteries

• Formation: Formed by the bifurcation of the brachial artery in the cubital fossa
• Course: Continue to the palm, but do not pass through the carpal tunnel
• Radial Artery Supply: Supplies the posterolateral aspect of the forearm, contributing to anastomotic networks around the elbow and carpal bones. Has a palpable pulse in the distal forearm.
• Ulnar Artery Supply: Supplies the anteromedial aspect of the forearm. Contributes to anastomoses around the elbow joint, and gives rise to anterior and posterior interosseous arteries supplying deeper forearm structures. Also, forms two arches in the hand (superficial and deep palmar arches)

Branches of the Radial Artery

• Radial recurrent artery: Arterial branch
• Palmar carpal branch: Palmar branch of radial artery
• Superficial palmar branch: Superficial palmar branch of radial artery
• Dorsal carpal branch: Dorsal branch of radial artery
• First dorsal metacarpal artery: First dorsal metacarpal branch
• First palmar metacarpal artery: First palmar metacarpal artery

Branches of the Ulnar Artery

• Ulnar recurrent artery: Arterial branch
• Common interosseous artery: Branch that further divides into anterior and posterior interosseous arteries
• Palmar carpal branch: Carpal branch of ulnar artery
• Dorsal carpal branch: Dorsal branch of ulnar artery
• Deep palmar branch: Forms deep palmar arch
• Common, posterior, and anterior interosseous arteries: Branches supplying deeper forearm structures

Radial and Ulnar Arteries (Summary)

• Key branches of both arteries supplying structures in the forearm and forming arches in the hand.

Superficial and Deep Palmar Arches

• Superficial Palmar Arch: Formed by an anastomosis between the ulnar artery and a branch of the radial artery
• Deep Palmar Arch: Forned by an anastomosis between the radial and ulnar arteries

Veins of the Upper Limb

• Two Systems: Superficial and deep venous systems
• Superficial System: Located in the subcutaneous tissue, draining into the deeper system. Includes intercapitular veins, dorsal venous network. Major veins like the basilic and cephalic veins.
• Deep System: Located below the deep fascia, accompanying arteries. The deep veins are venae comitantes, communicating with perforating veins to the superficial system. Includes deep veins of the palm, radial, ulnar, and brachial veins

Common Venous Patterns at the Elbow

• Two common patterns: H-shaped and M-shaped patterns
• The veins in front of the elbow usually form these two shapes.

Brachial Plexus

• Formation: Forned by the anterior rami (roots) of spinal nerves C4 through T1
• Major Nerves:
  • Axillary nerve
  • Musculocutaneous nerve
  • Radial nerve
  • Median nerve
  • Ulnar nerve
• Function: Innervates the muscles and skin of the upper limb and neck

Cubital/Antecubital Fossa

• Structure: Triangular space on the anterior side of the elbow joint
• Boundaries:
  • Proximal - biceps brachii
  • Lateral - brachioradialis muscle
  • Medial - pronator teres muscle
  • Bottom - brachialis muscle
• Contents:
  • Brachial artery, radial nerve, biceps brachii tendon, median nerve, and other structures

Explore the intricate details of the neurovasculature of the upper limb, focusing on the subclavian and axillary arteries. This quiz covers their origin, branches, and the muscles they supply, providing an essential understanding for medical students. Test your knowledge about the anatomy of the upper limb as related to the cubital fossa.