VASCULAR SUPPLY TO VASCULAR SUPPLY TO UPPER EXTREMITYUPPER EXTREMITY

ARTERIESARTERIES

Subclavian ArteriesSubclavian Arteries

Left subclavian:Left subclavian: Direct branch from Direct branch from

aortic archaortic arch

Right subclavian:Right subclavian: Branch from Branch from

brachiocephalicbrachiocephalic

Subclavian BranchesSubclavian Branches

Vertebral arteryVertebral artery Passes through Passes through

transverse transverse foramina 6-1foramina 6-1

Passes through Passes through foramen magnumforamen magnum

Unites with Unites with opposite vertebral opposite vertebral artery to form artery to form basilar arterybasilar artery

Subclavian BranchesSubclavian Branches

Thyrocervical trunkThyrocervical trunk Suprascapular a.Suprascapular a.

Passes btw Passes btw sternomastoid and sternomastoid and ant. Scalene ant. Scalene musclesmuscles

Passes over Passes over suprascapular lig.suprascapular lig.

To supraspinous To supraspinous fossafossa

Through Through spinoglenoid notchspinoglenoid notch

To infraspinous To infraspinous fossafossa

Subclavian BranchesSubclavian Branches

Thyrocervical trunkThyrocervical trunk Transverse cervical Transverse cervical

artery:artery: Passes ant to Passes ant to

scalenus ant scalenus ant musclemuscle

Runs with CN IXRuns with CN IX Supplies rhomboidsSupplies rhomboids

Inferior thyroid Inferior thyroid artery:artery:

Variable Variable

Subclavian BranchesSubclavian Branches

Internal thoracic:Internal thoracic: Gives off ant. Gives off ant.

Intercostals in Intercostals in intercostal spacesintercostal spaces

Subclavian ArterySubclavian Artery

Passes between Passes between first rib and clavicle first rib and clavicle and is renamed the and is renamed the axillary artery.axillary artery.

Runs across Runs across subclavian groove subclavian groove behind anterior behind anterior scalene muscle.scalene muscle.

Axillary ArteryAxillary Artery

Begins at inferior Begins at inferior border of first rib.border of first rib.

Divided into thirds Divided into thirds by pectoralis minor by pectoralis minor muscle:muscle: First part superior First part superior

to muscle.to muscle. Second part deep Second part deep

to muscle.to muscle. Third part inferior Third part inferior

to muscle.to muscle.

First Part of Axillary ArteryFirst Part of Axillary Artery

Superior thoracic Superior thoracic artery:artery: Supplies posterior Supplies posterior

aspects of aspects of intercostal spaces intercostal spaces 1 and 2 and part of 1 and 2 and part of serratus anteriorserratus anterior

Second Part of Axillary ArterySecond Part of Axillary Artery

Thoracoacromial Thoracoacromial artery (trunk):artery (trunk): Pectoral branchPectoral branch Deltoid branchDeltoid branch Acromial branchAcromial branch Clavicular branchClavicular branch

Second Part of Axillary ArterySecond Part of Axillary Artery

Lateral thoracic Lateral thoracic artery:artery: Extends along Extends along

lateral side of lateral side of pectoralis minor.pectoralis minor.

Supplies part of Supplies part of pectoral muscles, pectoral muscles, lymph nodes and lymph nodes and breast (esp. breast (esp. important in important in women)women)

Third Part of Axillary ArteryThird Part of Axillary Artery

Posterior Posterior circumflex circumflex humeral:humeral: Passes around Passes around

posterior aspect of posterior aspect of surgical neck of surgical neck of humerus.humerus.

Anastomoses with Anastomoses with the anterior the anterior circumflex humeral.circumflex humeral.

Third Part of Axillary ArteryThird Part of Axillary Artery

Posterior Posterior circumflex circumflex humeral:humeral: Runs with axillary Runs with axillary

nerve.nerve. Supplies deltoid Supplies deltoid

and triceps and triceps musclesmuscles

Part of contents of Part of contents of quadrilateral space.quadrilateral space.

Third Part of Axillary ArteryThird Part of Axillary Artery

Anterior circumflex Anterior circumflex humeral:humeral:

Subscapular:Subscapular: Thoracodorsal:Thoracodorsal:

Latissimus muscleLatissimus muscle

Circumflex Circumflex scapular:scapular:

Brachial ArteryBrachial Artery

Continuation of Continuation of axillary artery at axillary artery at inferior border of inferior border of teres major teres major muscle.muscle.

Branches of Brachial ArteryBranches of Brachial Artery

Deep brachial Deep brachial (profunda brachii):(profunda brachii): Wraps around posterior Wraps around posterior

surface of humerus.surface of humerus. Runs in radial groove Runs in radial groove

with radial nerve.with radial nerve. Supplies posterior Supplies posterior

compartment of compartment of brachium.brachium.

Branches of Brachial ArteryBranches of Brachial Artery

Deep brachial Deep brachial (profunda brachii):(profunda brachii): Branches:Branches:

Ascending branch to Ascending branch to posterior circumflex posterior circumflex humeral artery.humeral artery.

Descending branch Descending branch becomes radial collateral.becomes radial collateral.

Anastomoses with radial Anastomoses with radial recurrent.recurrent.

Branches of Brachial ArteryBranches of Brachial Artery

Nutrient humeral artery.Nutrient humeral artery. Superior ulnar Superior ulnar

collateral:collateral: Runs with ulnar nerve.Runs with ulnar nerve. Passes posterior to Passes posterior to

medial epicondyle.medial epicondyle. Anastomoses with Anastomoses with

posterior ulnar recurrent posterior ulnar recurrent artery.artery.

Branches of Brachial ArteryBranches of Brachial Artery

Nutrient humeral artery.Nutrient humeral artery. Inferior ulnar collateral:Inferior ulnar collateral:

Passes anterior to Passes anterior to medial epicondyle.medial epicondyle.

Anastomoses with Anastomoses with anterior ulnar recurrent anterior ulnar recurrent artery.artery.

Brachial ArteryBrachial Artery

Runs medial to median Runs medial to median nerve in upper part of nerve in upper part of arm.arm.

Runs lateral to median Runs lateral to median nerve in lower part of nerve in lower part of arm.arm.

Passes deep to bicipital Passes deep to bicipital aponeurosis lateral to aponeurosis lateral to median nerve and median nerve and medial to bicipital medial to bicipital tendon.tendon.

Brachial ArteryBrachial Artery

Branches into radial Branches into radial and ulnar arteries.and ulnar arteries.

Radial ArteryRadial Artery

Gives off radial Gives off radial recurrent to radial recurrent to radial collateral from deep collateral from deep brachial.brachial.

Enters wrist and hand Enters wrist and hand to form deep palmar to form deep palmar arch.arch.

Ulnar ArteryUlnar Artery

Gives off common Gives off common interosseous artery interosseous artery (trunk) near its origin.(trunk) near its origin.

Runs through Runs through antebrachium with ulnar antebrachium with ulnar nerve.nerve.

Enters wrist and hand Enters wrist and hand to form superficial to form superficial palmar arch.palmar arch.

Ulnar ArteryUlnar Artery

Common interosseous Common interosseous artery gives off anterior artery gives off anterior and posterior and posterior interosseous arteries:interosseous arteries: Run on either side of the Run on either side of the

interosseous membrane interosseous membrane in the antebrachium.in the antebrachium.

VASCULAR SUPPLY TO VASCULAR SUPPLY TO UPPER EXTREMITYUPPER EXTREMITY

VEINSVEINS

Venous Drainage of UEVenous Drainage of UE

Trace veins back to heart.Trace veins back to heart.Venous drainage begins with dorsal Venous drainage begins with dorsal

venous arch which receives blood from venous arch which receives blood from digits.digits.

Cephalic vein drains lateral side of dorsal Cephalic vein drains lateral side of dorsal venous arch.venous arch.

Basilic vein drains medial side of dorsal Basilic vein drains medial side of dorsal venous arch.venous arch.

Cephalic VeinCephalic Vein

Runs along lateral side of antebrachium in Runs along lateral side of antebrachium in superficial fascia.superficial fascia.

Receives tributaries from median vein Receives tributaries from median vein near the level of the elbow.near the level of the elbow.

Runs along lateral side of brachium in Runs along lateral side of brachium in superficial fascia.superficial fascia.

Runs through deltopectoral triangle.Runs through deltopectoral triangle.Pierces clavipectoral fascia.Pierces clavipectoral fascia.Dumps into axillary vein.Dumps into axillary vein.

Basilic VeinBasilic Vein

Runs along medial side of antebrachium.Runs along medial side of antebrachium.Receives median cubital vein drainage.Receives median cubital vein drainage.

Median cubital vein lies superficial to bicipital Median cubital vein lies superficial to bicipital aponeurosis:aponeurosis:

Useful site for venipuncture.Useful site for venipuncture.

Runs in deep fascia along medial side of Runs in deep fascia along medial side of brachium.brachium.

Joins with venae comitantes to form Joins with venae comitantes to form axillary vein.axillary vein.

Axillary VeinAxillary Vein

Formed by union of basilic vein and venae Formed by union of basilic vein and venae comitantes.comitantes.

Renamed subclavian vein after it passes Renamed subclavian vein after it passes under clavicle.under clavicle.

Subclavian VeinSubclavian Vein

Forms brachiocephalic vein along with Forms brachiocephalic vein along with jugular veins.jugular veins.

Note: there are two brachiocephalic veins Note: there are two brachiocephalic veins but only one brachiocephalic artery.but only one brachiocephalic artery.

The two brachiocephalic veins come The two brachiocephalic veins come together to form the superior vena cava.together to form the superior vena cava.

LymphaticsLymphatics

Lymphatic drainage is from palmar surface Lymphatic drainage is from palmar surface to dorsal surface of hand.to dorsal surface of hand.

Laterally:Laterally:Lymphatics follow cephalic vein to:Lymphatics follow cephalic vein to:

Chain of nodes in deltapectoral groove to:Chain of nodes in deltapectoral groove to:

Axillary nodes.Axillary nodes.

Medially:Medially:Lymphatics flow to epitrochlear nodes to:Lymphatics flow to epitrochlear nodes to:

Axillary nodes.Axillary nodes.

Lymph NodesLymph Nodes

Brachial:Brachial:Lie medial to humerus near axillary artery Lie medial to humerus near axillary artery and vein.and vein.

Pectoral:Pectoral:Lie behind pectoralis minor with lateral Lie behind pectoralis minor with lateral

thoracic artery.thoracic artery.

Drain mammary gland.Drain mammary gland.

Lymph NodesLymph Nodes

Subscapular:Subscapular:Lie along lower border of scapula with Lie along lower border of scapula with

subscapular artery.subscapular artery.Drain back.Drain back.

Central nodes:Central nodes:In axillary fat.In axillary fat.Receive lymph from all the above nodes.Receive lymph from all the above nodes.Drain to:Drain to:

Apical nodes behind clavicle.Apical nodes behind clavicle.