Blood Supply of the Upper Limb

1. Blood Supply of the Upper Limb Dr: Yasser Seddeg

2. Arteries of Upper Limb Axillary Artery • Continuation of subclavian artery at lateral border of first rib • Becomes brachial artery at lower border of teres major • Divided into three parts by overlying pectoralis minor teres major pectoralis minor

3. thoracoacromial a Branches of Axillary Artery superior thoracic a • First part, above muscle－gives rise to Superior Thoracic Artery • Second part, behind muscle－gives rise to • lateral thoracic a. and thoracoacromial a. • Third part, below muscle－gives rise to : • subscapulara., • anteriorand posterior humeral circumflex a. the former then divides into throcodorsal a. and circumflex scapular a. lateral thoracic a anterior and posterior humeral circumflex a subscapular a

5. Anastomsisaround Scapula • Between: • first part of subclavian artery and third part of axillary artery and intercostal arteries.

7. Brachial artery • Continuation of axillary artery • Divides into radial and ulnararteries at level of neck of radius • Branches • Deep brachial a. (Profunda) • accompanies with radial nerve • Superior ulnarcollaeral a. －accompanies with ulnar nerve • Inferior ulnar collateral a. • Nutrient branches. ulnar artery Radial artery

8. Radial and Ulnar Arteries Radial artery and branches • Radial recurrent a. • Superfical palmar branch • Principal artery of thumb Ulnar artery and branches • Ulnar recurrent a. • Common interosseousartery • Anterior interossous a. • Posterior interosseous a. • Deep palmar branch.

9. Superficial palmar arch • Formed by ulnar artery and superficial palmar branch of radial artery • Curve of arch lies across the palm, level with the distal border of fully extended thumb • Gives rise to three common palmar digital arteries each then divides into two proper palmar digital arteries

10. Deep palmar arch • Formed by radial artery and deep palmar branch of ulnar artery • Curve of arch lies across upper part of palmar at level with proximal border of extended thumb • Gives rise to three palmar metacarpal arteries

11. Radial & Ulnar Arteries medial lateral Radial artery Ulnar artery Common interosseous • Anterior • Posterior Dorsal and palmer carpal branches Dorsal and palmer carpal branches Deep (superficial) palmar arches superficial (deep)palmar arches

12. Allen test

13. Veins of the upper limb Deep veins: accompany the arteries of the same region and bear similar names Superficial veins • Cephalic vein • Arises from the lateral side of the dorsal venous rete of hand • Ascends on radial side of the forearm to the elbow and then in the lateral side of biceps brachii furrow, continues up the arm in the deltopectoral groove and then to the infraclavicularfossa, where it pierces clavipectoral fascia to drain into axillary vein Cephalic vein

14. Median cubital vein • Basilicvein • Arises from the medial side of the dorsal venous rete of hand • Ascends on the ulnar side of forearm to the elbow and then in the medial bicepitalbrachii furrow to middle of the arm where it pierces the deep fascia and joins the brachial vein or axillary vein • Median cubitalvein links cephalic vein and basilic vein in the cubitalfossa. It is a frequent site for venipuncture to remove a sample of blood or add fluid to the blood Basilic vein

15. The lymphatic drainage of upper limb Lymphatic vessels • Superficial－follow the superficial veins, drain into supratrochlear and axillary lymph nodes • Deep－accompany main vessels, end in axillary lymph nodes lymph nodes • Cubital lymph node: lies above medial epicondyle of humerus • Axillary lymph node－arranged in five groups Supratrochlear LN

16. Axillary lymph nodes－ arranged in five groups • Lateral lymph nodes － lie around the distal end of axillary vein , receiving drainage from the arm, forearm, and hand • Pectoral lymph nodes －lie along lateral thoracic vessels, receive afferents from anterior thoracic wall including central and lateral portion of mamma • Subscapular lymph node －along subscapular vessels, receive lymph from nape and scapular region • Efferents above three groups pass to central lymph node

17. Central lymph node－lie in fat of axillaryfossa, receive drainage from all the above nodes, efferents pass to apical lymph node • Apical lymph node • Lie in the apex of the axilla, along the proximal end of axillary vessels • Receive drainage chiefly from central lymph node , upper portion of mamma • Efferents form subclavian trunk, the right subclavian trunk joints the right lymphatic duct; left usually drains directly into thoracic duct