Blood supply of Upper Limb

Axilla & arm

Dr M Idris Siddiqui
 Subclavian artery
• The arterial supply to the upper limb begins in
the chest as the subclavian artery.
• The right subclavian artery arises from
the brachiocephalic trunk, while the left
subclavian branches directly off the arch of
aorta.
• When the subclavian arteries cross the lateral
edge of the 1st rib, they enter the axilla, and
are called axillary arteries.
 In the Axilla
The axillary artery
• The axillary artery passes through the apex of axilla,
along its lateral wall, just underneath the pectoralis
minor muscle, enclosed in the axillary sheath.
• At the level of the humeral surgical neck, the
posterior and anterior circumflex humeral arteries
arise.
– They circle posterior around the humerus to supply the
shoulder region.
– The largest branch of the axillary artery also arises here
– the subscapular artery.
The axillary artery
 PARTS

• The axillary artery is split into the following 3

parts by the pectoralis minor:
• First part, superior (or proximal) to the
muscle.
• Second part, posterior (or deep) to the
muscle.
• Third part, inferior (or distal) to the muscle.
 First part
• Axillary vein on its medial side.
• The lateral & posterior cords lie above it & on its
lateral side.
• The first intercostal space & first digitation of
serratus anterior lie posterior to it but separated by
medial cord.
 Second part
• The 3 cords of brachial plexus lie according to
their names in relation to 2nd part.
• The axillary vein is still medial but now
separated by medial cord.
• Two branches.
 anterior

lateral

medial
posterior
 Third part
• With the arm by the side, third part is clasped
by two (medial & lateral) roots of median
nerve.
 anterior

Lateral

Posterior
Medial
 The Axillary Artery
• The axillary artery becomes the brachial artery at
the level of the teres major muscle.
• The axillary vein is medial to the artery and the
cords of brachial plexus are arranged around the
2nd part of the artery (i.e. part deep to the
pectoralis minor);
– Lateral cord being lateral,
– Medial cord medial,
– Posterior cord behind.
Axillary artery
 Axillary artery
branches
• The axillary artery comprises of 6
branches:
• 1 branch from first part,
• 2 branches from the next part, and
• 3 branches from the third part.
–Majority of these branches go towards the
walls of the axilla.
 FROM FIRST PART
• Superior thoracic artery, a very small
branch, originates near the
subclavius,
• Enters between the pectoralis major
and minor muscles, and then these
muscles go towards the medial wall
of the axilla.
 FROM SECOND PART
1. Thoraco-acromial artery (acromiothoracic artery) : emerges
at the upper border of pectoralis minor, pierces
clavipectoral fascia and soon breaks up into 4 branches:
– (a) pectoral branch,
– (b) deltoid branch,
– (c) acromial branch,
– (d) clavicular branch.
• These branches radiate at right angle to every other. The pectoral branch,
largest runs between pectoral muscles, deltoid branch, ends by joining
anastomosis over the acromion, clavicular branch supplies sternoclavicular
joint.
2. Lateral thoracic artery : emerges at and runs along the
inferior border of pectoralis minor, supplying the branches
to pectoralis major and minor and serratus anterior muscles.
In the females, the lateral thoracic artery is large and gives
significant supply to the breast.
 FROM THIRD PART
1. Subscapular artery, the largest branch of axillary artery, runs
along the lower border of the subscapularis and ends near the
inferior angle of the scapula. It supplies a large branch,
the circumflex scapular artery; which goes through upper
triangular intermuscular space, distal to that it changes its name
thora odorsal artery to lattis us dorsi.

2. Anterior circumflex humeral artery, a small branch, enters in

front of surgical neck of humerus and anastomoses with the
posterior circumflex humeral artery to create an arterial circle
around the surgical neck of humerus

3. Posterior circumflex humeral artery, larger in relation to the

anterior circumflex humeral artery, enters backwards, together
with axillary nerve via the quadrangular intermuscular space,
crosses the posterior aspect of surgical neck of humerus to
anastomose with the anterior circumflex humeral artery.
BRACHIAL ARTERY
 BRACHIAL ARTERY

• DEFINITION
• Brachial Artery is the direct continuation
of the axillary artery within the arm,
ends at the level of neck of radius where
divides into radial and ulnar arteries.
Brachial artery
 Brachial artery
• BEGINNING:
• It begins at the lower border of teres major muscle.
• END:
• It ends at the cubital fossa about 1 cm below the bend
of the elbow joint, in the level of the neck of the radius.
• COURSE:
• The artery at first is located on the medial side of the
arm, then the artery gradually comes forwards in front
of the elbow joint between the 2 epicondyles of
the humerus.
• The ra hial artery is superfi ial throughout it s ourse,
being covered only by the skin and fasciae, thus easily
accessible.
 Brachial artery
• Immediately distal to the teres major,
the brachial artery gives rise to
the profunda brachii – the deep
artery of the arm.
• The brachial artery descends down
the arm immediately posterior to
the median nerve.
 BRANCHES
• Muscular branches to the muscles of the anterior compartment
of the arm.
• Profunda brachii artery (largest and first branch). It originates
from the posteromedial aspect of the brachial artery just below
the lower border of the teres major. It accompanies the radial
nerve with which it immediately leaves the lower triangular
intermuscular space to goes into the spiral groove on the posterior
surface of the humerus.
• Nutrient artery to humerus enters the nutrient foramen of
humerus located near the insertion of coracobrachialis.
• Superior ulnar collateral artery originates near the middle of the
arm and accompanies the ulnar nerve.
• Inferior ulnar collateral (or supratrochlear artery) originates near
the lower end of humerus and divides into the anterior and
posterior branches, which take part in the formation of arterial
anastomosis around the elbow.
• Radial and ulnar arteries (terminal branches).
 RELATIONS
a)In the upper party it is related to
medial cutaneous nerve of the
forearm, which lies in front of it.
b)In the middle part, it is crossed by
Anteriorly the median nerve from lateral to
medial side.
c)In the lower part,in the cubital fossa,
it is crossed by the bicipital
aponeurosis.
 RELATIONS
From above downwards, the brachial artery
lies successively on long head of triceps,
Posteriorly
medial head of triceps, coracobrachialis, and
brachialis muscles.
The ulnar nerve and basilic vein in the upper
Medially part of the arm; and median nerve in the lower
part of the arm.

The median nerve, coracobrachialis, and biceps

Laterally in the upper part of arm and tendon of biceps
in the lower part.
 CLINICAL SIGNIFICANCE
• Brachial pulse: The brachial pulse is commonly felt in
the cubital fossa edial to the te do of i eps a d it s
pulsations are auscultated for recording the blood
pressure. The biceps tendon is easily palpable on flexing
the elbow.
• Compression of brachial artery: The brachial artery can
be effectively compressed against the shaft of humerus in
the level of insertion of coracobrachialis to stop the
hemorrhages in the upper limb occurring from any artery
distal to the brachial artery, example, bleeding wounds of
the palmar arterial arches.
• Rupture of the brachial artery in supracondylar fracture of
the hu erus ay result i Volk a s is he i
contracture.