Page 202 - Clinical Anatomy

ECA3 7/18/06 6:45 PM Page 187

The arteries of the upper limb 187

The branches of the axillary artery supply the chest wall and shoulder;
conveniently, the 1st, 2nd and 3rd parts give off one, two and three
branches respectively:
•◊◊1st part: 1, superior thoracic artery
•◊◊2nd part: 1, acromiothoracic trunk
2, lateral thoracic artery
•◊◊3rd part: 1, subscapular artery
2, anterior circumflex humeral artery
3, posterior circumflex humeral artery
All but the circumflex humeral vessels are encountered in the axillary
dissection of a radical mastectomy.

The brachial artery
The brachial artery continues on from the axillary and ends at the level of
the neck of the radius by dividing into the radial and ulnar arteries. It is
superficial (immediately below the deep fascia) along its whole course,
except where it is crossed, at the level of the middle of the humerus, by the
median nerve which passes superficially from its lateral to medial side;
occasionally the nerve crosses deep to the artery. Fairly frequently the
artery divides into its two terminal branches in the upper arm.
The named branches of the artery are:
•◊◊the profunda (accompanying the radial nerve);
•◊◊superior ulnar collateral (accompanying the ulnar nerve);
•◊◊nutrient (to the humerus);
•◊◊inferior ulnar collateral.

The radial artery
The radial artery (Fig. 137) commences at the level of the radial neck by
lying on the tendon of biceps. In its upper half it lies overlapped by brachio-
radialis, the surface marking of the artery being the groove which can be
seen on the medial side of this tensed muscle in the muscular subject. Dis-
tally in the forearm the artery lies superficially between brachioradialis and
flexor carpi radialis, and it is between these two tendons that it is palpated
at the wrist (Fig. 116).
In the middle third of the forearm the radial nerve lies along the lateral
side of the artery; the nerve may here be incorporated in a carelessly placed
ligature.
Distal to the radial pulse, the artery gives off a branch to assist in
forming the superficial palmar arch. It then passes deep to the tendons of
abductor pollicis longus and extensor pollicis brevis to enter the anatomical
snuff-box (in which it can be felt), pierces the first dorsal interosseous
muscle and adductor pollicis, between the 1st and 2nd metacarpals, and
goes on to form the deep palmar arch with the deep branch of the ulnar
artery.