The arterial supply to the upper limb is delivered via five main vessels, proximal to distal – the Subclavian Artery, Axillary Artery, Brachial Artery, Radial Artery, and Ulnar Artery. In this article, we shall take an in-depth look at the anatomy of the arteries of the upper limb, their anatomical course, branches and clinical correlations.
The arterial supply to the upper limb begins with the subclavian artery. On the right side, this artery arises from the brachiocephalic trunk. On the left, it branches directly from the aortic arch. The subclavian artery then travels laterally towards the axilla. It can be divided into three parts, each based on its position relative to the anterior scalene muscle: the first part originates from the subclavian artery to the medial border of the anterior scalene muscle, the second part passes posterior to the anterior scalene, and the third part passes from the lateral border of the anterior scalene to the lateral border of the first rib.
At the lateral border of the first rib, the subclavian artery enters the axilla and is renamed the axillary artery.
The brachial artery is a continuation of the axillary artery past the lower border of the teres major. It is the main supplier of blood for the arm. Immediately distal to the teres major, the brachial artery gives rise to the profunda brachii (deep artery), which travels with the radial nerve in the radial groove of the humerus and supplies structures in the posterior aspect of the upper arm. As the brachial artery moves through the cubital fossa, underneath the bicipital aponeurosis, it terminates by bifurcating into the radial and ulnar arteries.
The radial artery supplies the posterolateral aspect of the forearm. It contributes to anastomotic networks surrounding the elbow joint and carpal bones. The radial pulse can be palpated in the distal forearm, immediately lateral to the prominent tendon of the flexor carpi radialis muscle.
The ulnar artery supplies the anteromedial aspect of the forearm and contributes to an anastomotic network surrounding the elbow joint. It also gives rise to the anterior and posterior interosseous arteries, which supply deeper structures in the forearm. These two arteries anastomose in the hand by forming two arches – the superficial palmar arch, and the deep palmar arch.
The hand has a rich arterial supply with many anastomoses between vessels, allowing the hand to be perfused even when under high resistance to flow (such as when grasping or applying pressure). Arterial supply to the hand begins with the ulnar and radial arteries.
The ulnar artery enters the hand anteriorly to the flexor retinaculum and laterally to the ulnar nerve. It gives rise to the deep palmar branch and continues laterally across the palm as the superficial palmar arch.
The radial artery enters the hand dorsally, crossing the floor of the anatomical snuffbox. It then turns medially and travels between the heads of the adductor pollicis muscle. The radial artery supplies a branch to the thumb, the index finger, and to the superficial palmar arch before continuing as the deep palmar arch.
As a result, two arterial arches are formed: the superficial palmar arch located anteriorly to the flexor tendons in the hand and deep to the palmar aponeurosis, and the deep palmar arch located deep to the flexor tendons of the hand. The superficial palmar arch gives rise to digital arteries, which supply the four fingers, and the deep palmar arch contributes to the blood supply to the digits and to the wrist joint.
The axillary artery is a major artery of the upper limb, lying deep to the pectoralis minor and enclosed in the axillary sheath, a fibrous layer which covers the artery and the three cords of the brachial plexus. It is marked by three distinct parts, each determined by its position relative to the pectoralis minor muscle.
The axillary artery gives rise to several related branches, each with its own unique function:
At the lower border of the teres major muscle, the axillary artery is renamed the brachial artery. This is the main supply of blood for the arm. Immediately distal to the teres major, the brachial artery gives rise to the profunda brachii (deep artery), which travels with the radial nerve in the radial groove of the humerus and supplies the triceps brachii muscle and other structures in the posterior aspect of the upper arm. The profunda brachii terminates by contributing to an anastomotic network around the elbow joint.
The brachial artery then descends down the arm, passing through the cubital fossa and underneath the bicipital aponeurosis. Here, the brachial artery terminates by bifurcating into the radial and ulnar arteries. The radial artery supplies the posterolateral aspect of the forearm and contributes to anastomotic networks surrounding the elbow joint and carpal bones, while the ulnar artery supplies the anteromedial aspect of the forearm and gives rise to the anterior and posterior interosseus arteries, which supply deeper structures in the forearm. The radial and ulnar arteries then anastomose in the hand by forming two arches – the superficial palmar arch and the deep palmar arch.
The hand receives its arterial supply via the ulnar and radial arteries. The ulnar artery enters the hand anteriorly to the flexor retinaculum and laterally to the ulnar nerve. It gives rise to the deep palmar branch and continues laterally across the palm as the superficial palmar arch. The radial artery enters the hand dorsally, crossing the floor of the anatomical snuffbox before turning medially and travelling between the heads of the adductor pollicis muscle. It supplies a branch to the thumb, the index finger and to the superficial palmar arch – it then continues as the deep palmar arch. This creates two arterial arches – the superficial palmar arch, located anteriorly to the flexor tendons in the hand and deep to the palmar aponeurosis, and the deep palmar arch, located deep to the flexor tendons of the hand. Both of these arches contribute to the blood supply to the digits and to the wrist joint.
