. Superior & inferior ulnar collateral arteries.
- A large vessel that arises from the medial and posterior part of the brachial
artery, just below the lower border of the teres major.
- lt enters the spiral groove together with the radial nerye, where it gives off
a. Ascending branch: ascends on the back of the humerus to
anastomose with the post circumflex humeral artery.
b. 2 descending branches (anterior & posterior) that descend with the
radial nerve towards the lateral epicondyle.
SunTaCE ANAToMY oF AxILLARY & BRAcHIAL ARTERIES:
' The arm should be abducted & the forearm should be supinated.
a. At the midclavicular point.
b. At the level of posterior fold of axilla.
c. At midpoint of the cubital fossa.
. A line from a to b = Axillaray A.
BeCtnSl in the cubital fossa as the larger of the 2 terminal branches of the
- Begins a little below the bend of elbow, and passes obliquely downward.
- Reaches the ulnar side of the forearm at a point about midway between the
- lt then runs along the ulnar border to the wrist.
- lt crosses the transverse carpal ligament lateral to the pisiform bone, and
immediately beyond this bone divides into two branches, which enter into
the formation of the superficial and deep volar arches.
ENOS I in ttre palm by becoming the superficial palmar arch.
DorsalCarpal Superficial Volar Arch
Surface anatomy of ulnar & radial arteries:
b. At styloid process of the radius.
c. At medial epicondyle of the humerus.
e. At the junction of the upper & lower of a line between c & d.
BgClruS I in tne cubital fossa as the smaller of the 2 terminal branches of the
brachial artery. lts origin lies at the level of the neck of the radius.
- The artery leaves the cubital fossa at its apex, under cover of the
- lt descends along the lateral side of forearm down to the wrist.
- lt then winds backward, around the lateral side of the wrist.
- lt passes in the floor of anatomical snuff -box.
- lt passes fonrvard between the two heads of the first lnterosseous dorsalis,
to reach the palm of the hand.
It passes between the two heads of adductor pollicis.
EttOS ] in tne palm by becoming the deep palmar arch.
ATaSTOMOSIS AROUND THE SCAPULA
1"t part of the Subclavian arterv
2. Deep branches of transverse cervical artery.
2. Circumflex scapular artery (branch from sub-scapular artery).
o If there is obstruction of the subclavian artery, this anastomosis will be
on duty (if the obstruction is between the 1't part of subclavian & 3'd part
o lf the obstruction is proximal to thyro-cervical trunk, with effort of the UL,
vasodilatation occurs & blood shifts from vertebral artery to the UL
through the anastomosis around the scapula or through the artery itself
which will lead to syncopal attacks. This is called (STEAL
o Anterior circumflex humeral artery.
o Posterior circumflex humeral artery
o Ascending branches of Profunda brachii.
Used as collaterals in chronic ischemia.
branches of I superior ulnu sollaterall a----a> Iposterior ulnu ncutentl branshe$ 0f
braclial a. I interior ulnar sollaterd
, <**'**n> [anterior ntnu recunent I dnu a
branctres of lant des, br. of profunda I { , } lndial recurert a ton ndial a. I
brachial a. [lost. Ues. br. of profrnda, <*'**'** > [rust. interos$ers nflrrent afron ulnu af
Formed by anastomosis of the anterior carpal branches of radial & ulnar
arteries in front of the wrist.
Formed by anastomosis of the posterior carpal branches of radial & ulnar
- Deep palmar arch: formed mainly by
radial artery & completed by a branch of
- Superficial palmar arch: formed mainly
by ulnar artery & completed by a branch of
- Anastomosis in the diqits between
- lt lies acrbss the lower part of the dorsum of the hand.
- lt gives origin to both the cephalic & basilica veins from the lateral &medial ends
of the venous arch respectively.
- lt begins from the lateral ends of the dorsal venous arch & ascends on the lateral
- lt reaches the front of the elbow joint where it communicates with the basilica
vein through the median cubital vein.
- lt ascends on the lateral margin of biceps & continues in delto-pectoral groove.
- lt then pierces clavi-pectoral fascia to end in the axillary vein.
- lt begins from the medial ends of the dorsal venous arch & ascends on the
- As it passes in front of medial epicondyle it is joined by median cubital vein.
- lt ascends along the medial margin of biceps brachii where it pierces the deep
fascia opposite the insertion of coracobrachialis.
- lt enters the axilla at the lower border of teres major to become the axillary vein.
- lt lies obliquely in front of elbow where it joins the cephalic vein 1 inch below
lateral epicondyle & joins the basilic vein 1 inch above the medial epicondyle.
- lt begins at the lower border of teres major as a continuation of basilica vein.
- lt ascends on the medial side of the axillary artery.
- lt ends at the outer border of the 1"t rib by becoming the subclavian vein.
1. 2 vena comitants which accompany the brachial artery.
3. Veins which accompany the branches of the axillary artery.
o Posterior to scalenus anterior.
. Upper trunk ) union of C5 & C6.
. Lower trunk ) union of C8 & T1.
o Each trunk gives anterior & posterior divisions (behind middle Ts of the
o Anterior division innervates the entire flexor compartment of ,a{$
ln the axilla in relation to the axillary artery (named according to relations to
.@Formedbyunionofanteriordivisionofupper&middle
. @{jgl1i1}$li Anterior division of lower trunk (C8, T1).
contribution from anterior divisions.
. Nerve to Serratus anterior (Long thoracic N. of Bell) (CS, 6, 7).
. AII roots ) to scalene muscle & longus coli.
. Supra-scapular Nerve. (C5, 6).
ffi: Upper sub-scapular n (C5, 6)
$: Lower sub-scapular n (C5,6)
. Nerve to subclavius (C5, 6).
!.E C7 receives a gray ramus from the inferior cervical (or stellate)
I Urfmnx rmao] fr{ llsrffisl trtril0M {b 0xlffisor$}
Sfifl ll,lBdirlrodolmEdirnnsrve r,HHfldaruo$ ruved ltr&rm
SuncrcAL luponrANcE (BnecHtAL Plexus lruuunv):
Gomplete brachial plexus iniuries ) damage of ail roots.
1. Motor changes ) Affecting all muscles of the upper limb.
2. Sensory changes ) Anesthesia of whole upper limb except:
a) Medial side of arm (supplied by intercosto-brachial nerve).
b) Skin over upper part of deltoid muscle (supplied by supraclavicular nerve).
3. Horner's syndrome ) dug to sympathetic paralysis.
Upper trunk iniurv: (C5 - C 6) Erb-Duchenne paralysis
7- Motor changes: ) policeman's tip deformity.
2- Sensory changes ) anesthesia over the deltoid muscle.
Lower trunk iniurv (C8 - T1) Klumpke's paralysis
1. Motor changes: ) complete claw hand.
2. Sensory changes ) anesthesia along the medial aspect of the forearm
3. Horner's syndrome ) due to sympathetic paralysis,
. Paralysis of the long flexors of the fingers
. Paralysis of all the intrinsic muscles of the hand
, Loss of cutaneous sensation over anterior surface of palm & fingers
Thoracic outlet svndrome; involves c8-r1lfrt
o Arises from the posterior cord of
brachial plexus (C5, 6) behind the
3'd part of the axillary artery.
. Passes backwards through the
quadrangular space then around
the surgical neck of the humerus.
SuncrcAL IMpoRTANcE: (AxrLLARv Nenve lnlunv):
. Ugtgl: paralysis of deltoid & teres minor.
. SgMgIt: loss of skin sensations over lateralT"of deltoid.
It is a mixed nerve from the lateral cord
o Lateral to the 3'd part of Axillary artery.
o Leaves the axilla by piercing the coracobrachialis m.ilr
o Then descends downwards between biceps & brachialis. LEtcrd.o,o
o lt supplies all muscles of the anterior
compartment of the arm (coracobrachialis,
o Lateral cutaneous nerve of the forearm (the
continuation the musculo-cutaneous nerve) ) sensory to the lateral Tz of forearm.
o Arises as the terminal branch of posterior cord (C5, 6, 7, 8 & T1).
. Behind the 3'd part of the axillary artery.
. Lies behind upper part of brachial artery, between it & the long head of triceps.
Passes between medial & lateral heads of triceps.
lnside the spiral qroove: is accompanied by
After leaving the spiral groove: it pierces the
lateral inter-muscular septum to enter the
anterior compartment on the lateral side of the
Here, the nerve lies deeply in the groove
between the brachialis & brachioradialis.
ln front of the lateral epicondyle it gives the
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