Blood Supply to the Upper Limb

Question 1

State the major blood supply to the upper limbs

Answer 1

The subclavian arteries :

• Starts at the brachiocephalic trunk (right) and aortic arch (left)
• Finishes at the lateral border of the 1st rib
• Becomes the axillary artery

Question 2

Describe the extent of the axillary artery

Answer 2

Extends from the lateral border of the 1st Rib to the inferior border of Teres major, where it becomes the brachial artery

Question 3

Describe the parts of the axillary artery

Answer 3

Split into 3 parts

1st before pec. minor : 1 branch
2nd behind pec. minor : 2 branches
3rd after pec. minor : 3 branches

Question 4

Mnemonic to remember branches of the axillary artery

Answer 4

Screw The Lawyer
Save A Patient

Question 5

State the branches of the axillary artery

Answer 5

Superior Thoracic

Thoraco-acromial
Lateral thoracic

Subscapular
Anterior circumflex humeral
Posterior circumflex humeral

Question 6

Name the scapular anastomosis

Answer 6

Suprascapular artery
Subscapular artery
Dorsal scapular artery

Question 7

Describe the extent of the brachial artery

Answer 7

Starts at the lower border of the Teres Major

Ends at its bifurcation anterior to the elbow to give the ulnar and radial arteries.

Question 8

State the branches of the brachial artery

Answer 8

Profunda Brachii
Superior Ulnar collateral
Inferior Ulnar collateral

Question 9

Describe the ulnar and radial arteries

Answer 9

Variable bifurcation
Ulnar is larger and deeper than the radial

Both have recurrent branches –> Elbow anastomosis

Radial, anterior in the forearm
- dorsally in the wrist

Ulnar remains anterior into the hand

Question 10

What are the interosseous arteries ?

Answer 10

Ulnar artery quickly gives a branch
Common interosseous

• Anterior interosseous
• Posterior interosseous

Question 11

Describe arteries of the wrist

Answer 11

Radial artery on the lateral side
Ulnar nerve and artery on the medial side

Neither enters the carpal tunnel

Radial passes posteriorly to the carpal bones
Ulnar passes anterior (superficial) to the flexor retinaculum

Question 12

Describe branches of wrist arteries

Answer 12

Radial and Ulnar have palmar and dorsal carpal branches
Dorsal and Palmar carpal arches

Question 13

Describe scaphoid fractures

Answer 13

Blood supply from distal to proximal

Fracture can cause avascular necrosis

Question 14

Describe the superficial arteries of the hand

Answer 14

Ulnar enters hand and gives off the deep branch, continuing as superficial branch, which creates the superficial palmar arch.

The superficial palmar arch meets the superficial palmar branch of radial

Question 15

State the branches of the superficial palmar arch

Answer 15

The arch gives off 3 common palmar digital arteries, each of which divides into 2 proper palmar digital arteries.

Question 16

Describe the deep arteries of the hand

Answer 16

The radial artery passes posteriorly on the scaphoid and trapezium.

It re-enters the palmar surface through the 1st dorsal interosseous muscles.

It forms the deep palmar arch, anastomosing with deep branch of ulnar.

Question 17

State the branches of the deep palmar arch

Answer 17

The deep palmar arch gives palmar metacarpal arteries which anastomose with common palmar arteries.

Question 18

Describe the relevance of hand anastomoses

Answer 18

Good collateral supply around highly moveable joints

Hand arterioles are very important for thermal regulation

Question 19

Describe venous drainage of the upper limbs

Answer 19

Deeps veins follow arterial supply (mostly) - venae comitantes

The brachial veins ( joined by the basilic vein at the lower border of teres major.) coalesce into the axillary vein.

Question 20

Describe the superficial veins of the upper limb

Answer 20

Dorsal venus network gives cephalic and basilica veins

Question 21

Describe the central venus system in the axilla

Answer 21

Veins are more numerous and variable than arteries

Frequent anastomoses

Axillary vein also receives some body wall veins from the lower abdomen.

Question 22

What is the cubital fossa ?

Answer 22

The area where the cephalic and basilic veins are joined/ linked anterior to the elbow, by the median cubital vein.

Question 23

What vein is used in venupunture ?

Answer 23

The median cubital vein

Question 24

State some general rules of lymphatics of the upper limbs

Answer 24

Superficial lymphatic drainage runs alongside the veins.

Superficial lymphatics from the lateral limb go alongside the cephalic, and the medial side go alongside the basilic.

Deep drainage :

Deep veins –> Lateral –> Apical