Upper limb

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Bones

Pectoral (Shoulder) Girdle

This structure joins the upper limb with the vertebral column, the axis of the body. It is composed by two bones, the scapula (shoulder blade) and the clavicle.

Clavicle

This irregular, flat and S-shaped bone joins the trunk with the upper limb. These features can be distinguished:

  • Body. The medial surface is flat and the lateral round. The inferior surface has two rough surfaces for ligaments and muscles, the conoid tubercle and the trapezoid line.
  • Lateral end (acromial), it articulates with the acromion of the scapula
  • Medial end (sternal), it articulates with the sternum.
Scapula

The scapula is a large flat triangular bone with two surfaces, 3 margins and three angles.

  • Anterior surface (costal). Sligthly concave surface called subscapular fossa.
  • Posterior surface (dosrsal). with the following structures:
    • Spine of scapula. In the upper third of the posterior surface. It divides it into two fossae:
      • Supraspinous fossa
      • Infraspinous fossa
    • Acromion. The anterolateral projection of the spine, over the head of the humerus. It articulates with the clavicle.
  • Superior border. With the coracoid process and the suprascapular notch.
  • Lateral border (axilar)
  • Medial border (vertebral)
  • Superior angle.
  • Lateral angle. Here is tge glenoid cavity that houses the head of the humerus forming the glenohumeral joint. Over it there is the supraglenoid tubercle and under it the infraglenoid.
  • Inferior angle.
Humerus

This is the longest and widest of the bones of the upper limb being yhe skeleton of the arm.

  • Proximal end.
    • Head. Half-spherically shaped articulating with the glenoid cavity.
    • Anatomical neck
    • Greater tubercle
    • Lesser tubercle
    • Intertubercular groove) bicipital groove.
    • Surgical neck
  • Shaft
    • Two borders (medial and lateral) and three surfaces (anterior medial, anterior lateral and posterior).
    • Radial groove. For the radial nerve and the profunda brachii artery.
    • Deltoid tuberosity.
  • Distal end.
    • Condyle. The distal end of the humerus, comprising the following structures:
      • Capitulum. Lateral structure to articulate with the radius.
      • Trochlea. Medial structure to articulate with the ulna.
      • Epicondyles (lateral and medial). Over the medial there is a groove for the ulnar nerve.
    • Coronoid fossa, anterior depression for the coronoid process of the ulna.
    • Olecranon fossa. Posterior pit for the olecranon of the ulna.
    • Supraepicondylar ridges (medial and lateral). Projections of the lateral and medial borders of the humerus' shaft.

Forearm bones

Two long bones: Radius and ulna. They give name to the lateral and medial surfaces of the whole upper limb, radial and ulnar. The radius is the movable bone.

Radius
  • Proximal end
    • Head. Disc-shaped structure with a superior concave articular surface (fovea) that articulates with the capitulum of the humerus. On the head there is a rim-like surface that articulates with the radial notch of the ulna.
    • Neck. The thin section between the head and the tuberosity.
    • Radial tuberosity (bicipital). Medial rough srface under the neck where the biceps tendon is attached.
  • Shaft. Triangular in cross-section with three borders (anterior, posterior and medial or interosseus) and three surfaces (anterior, posterior and lateral).
  • Distal end.
    • Ulnar notch. Medial notch to articulate with the articular circumference of the head of ulna.
    • Articular carpal surface. To articulate with the proximal row of carpal bones.
    • Styloid process.
Ulna
  • Proximal end. This spanner-shaped boy end has two processes that trap between them the trochlea. The surface between them is the trochlear notch.
    • Olecranon. Posterior and superior. It constitues the bony part of the elbow and is the attachment of the extensor muscles of the elbow joint.
    • Coronoid process. Anterior and inferior. It is housed in the coronoid fossa when in flexion.
    • Radial notch. In the lateral surface. Here articulates the radial head.
  • Shaft. Triangular in cross-section with three borders (anterior, posterior and lateral or interosseus) and three surfaces (anterior, posterior and medial).
  • Distal end (head).
    • Ulnar styloid process
    • Articular srface for the radius.

Bones of the hand

There are divided in three groups

Carpus

The 8 carpal bones are the bones of the wrist and are arranged in two rows:

  • Proximal row (from lateral to medial). Scaphoid, lunate, Triquetrum and pisiform. The first three form a condyle to articulate with the carpal notch of the radium. The pisiform is a big sesamoid of the triquetrum.
  • Distal row (from lateral to medial). Trapezium, trapezoid, Capitate and hamate. The hook of the hamate is placed in the palmar surface.
Metacarpus.

Is the region between the fingers and the wrist,forming the palm. These 5 bones have a base, a shaft and a distal head that form the head, being the knuckles when fingers in flexion. The first metacarpal can have two sesamoid in the palmar surface.

Phalanges

They are the bones of the fingers. There are three (proximal, middle and thistal) except in the thumb, that has only two, proximal and distal.

JOINTS

Pectoral Gridle

Sternoclavicular joint

Saddle or sella joint

Ligaments
(Sternoclaviculars)

Anterior, posterior and interclavicular)

Acromioclavicular

Gliding or planar joint.

Ligaments
  • Acromioclavicular
  • Coracoclavicular (Two ligaments: conoid, medial; eta trapezoid, lateral)

Shoulder

Glenohumeral

This ball and socket joint houses in the glenoid cavity the head of the humerus. As the head is much smaller than the cavity, it is expanded bt the fibrocartilaginous gleoid labrum. This has the wodest range of movements of the whole body.

Ligaments
  • Glenohumerals (superior, middle, inferior). They thicken the articular capsule anteriorly.
  • Coracohumeral (from the coracoid process to the lesser tubercle).
  • Coracoacromial. Roofs the shoulder joint.

Elbow

Humeroulnar joint

Hinge between the trochlea and the trochlear notch of the ulna. The extension is limited by the olecranon and the fossa.

Humeroradial joint

Condyloid between the capitulum and the head of the radius.

Proximal radioulnar joint

Pivot joint formed by the radial articular circumference and the radial notch of the ulna. The radius is embraced by the annular ligament of the radius, allowing its rotation. It is attached to the anterior and posterior margins of the radial notch of the ulna.

Ligaments
  • Ulnar collateral ligament (medial). From the medial epycondile to the medial side of the ulna.
  • Radial collateral ligament (lateral). From the lateral epicondyle to the annular ligament of the radius.
  • Quadrate ligament. From the neck of the radius to the radial notch of the ulna.
  • Oblique cord. From the radial tuberosity to the ulna.
  • Thick joint capsule.
  • Interosseus membrane. Between the medial border of the radius and the lateral border of the ulna.

Wrist joint

Distal radioulnar joint

Pivot joint between the ulnar notch of the radius and the articular sirface of the head of the ulna.

Ligaments
  • Anterior and posterior (palmar and dorsal) radioulnar ligaments.
  • Articular disc. This triangular shaped fibrous disc is placed between the ulna and the carpus with triangular shape. It anchors the ulna and the radius.

Radiocarpal joint

This condyloid joint is formed between the proximal row of carpal bones (scaphoid, lunate and triquetrum), the cavity on the distal end of the radius and the articular disc.

Ligaments
  • Radiocarpals (dorsal and palmar)
  • Palmar ulnocarpal
  • Ulnar carpal collateral ligament. From the styloid process of the ulna and the triquetrum and psisiform bones.
  • Radial carpal collateral ligament. From the styloid process of the radius to the scaphoid bone.

Intercarpal joints

They share a common capsule. They just allow slight gliding movements. There are palmar, dorsal and interosseus ligaments.

Midcarpal joint

Double condyloid between the proximal and the distal rows of the carpus.

The fact that there are many joints in a limited space, and that in general the joints are not too well supplied by blood makes quite difficult to properly heal fractures. The fracture of scaphoid is quite common when falling backward onto a hard surface and breaking their fall with extended outstretched hands. Nevertheless, in this situation is more usual to have a fracture of the distal end of the radius (Colles fracture).

Ligaments
  • Dorsal and palmar intercarpal ligaments
  • The flexor retinaculum is a fiborus band that joins the scaphoid and the trapezium with the pisiform and the hook of the hamate. Under it there is the carpal canal or tunnel where the tendons of the flexor muscles and the median nerve pass. When there is a overuse, the nerve can be pressed causing damage of the nerve.

Carpometacarpal joints

Between the distal row of the carpus and the metacarpal bases. They are gliding joints except the thumb joint, which is a saddle.

Ligaments

Dorsal and palmar carpometacarpal ligaments

Metacarpophalangeal joints

Condyloid joints between the heads of the metacarpal bones and the bases of the phalanges. They form the knuckles. At both sides of the joints there are placed the collateral ligaments.

Interphalangeal joints

Middle and distal hinge joints between the phalanges. They have collateral lgaments.

MUSCLES

The muscles of the upper limb can be classified into six groups: 1. Muscles that join the upper limb with the vertebral column 2. Muscles that connect the upper limb to the thorax 3. Scapular muscles 4. Muscles of the arm 5. Muscles of the forearm 6. Muscles of the hand

Muscles that join the upper limb with the vertebral column

These muscles elevate the shoulder girdle. They are the extrinsic muscles of the back: trapezius, rhomboid, latissimus dorsi and levator scapulae.

Muscles that connect the upper limb to the thorax

These muscles are used in the hug, when we use the shoulder and the elbow. The muscles in this group move the scapula forward and laterally. They also take part in the breathing, elevating the thorax.

Serratus anterior.

From the 1-9 ribs to the medial border of the scapula.

Pectoralis major.

From the clavicle, the sternum and first 4-6 ribs to the lateral lip of the intertubercular sulcus of the humerus (under the greater tubercle). It covers the pectoralis minor and forms the anterior border of the axilla.

Pectoralis minor

From the 3-5 ribs to the coracoid process.

Subclavius.

from the clavicle to the first rib.

Innervation

Collateral branches of the brachial plexus

Scapular muscles

These muscles take part in the glenohumeral joint moving the humerus with the scapula as reference, as in hugging or climbing. They also play an important role as they reinforce the joint such avoinding luxations.

Deltoid muscle

Large and triangular in shape. It forms the shape of the shoulder. They attachments are the clavicle, the acromion and the deltoid tuberosity of the humerus (in the anterolateral half of the shaft). This muscle has anterior, lateral and posterior attachments to the joint, so, it plays different roles. Anterior fibers are medial rotators, laterals abductors and posterior lateral rotators. It is responsible of the swing of arm when walking.

  • Innervation

Axillary nerve (C5-C6)

Teres major

From the medial border of the scapula (next to the inferior angle) to the medial lip of the intertubercular sulcus of the humerus. It is adductor and medial rotator.

  • Innervation

Collateral branches of the brachial plexus.

Supraspinatus muscle

From above the spine to the greater tubercle of the humerus. It initiates the abduction of the arm (the first 15º).

  • Innervation

Collateral branches of the brachial plexus.

Inpraspinatus muscle

From below the spine to the greater tubercle of the humerus (under the supraspinatus). It is lateral rotator.

  • Innervation

Collateral branches of the brachial plexus.

Teres minor

From the lateral angle of the scapila to the lower side of the greater tubercle. This and the supraspinatus are hard to distinguish, both are lateral rotators.

  • Innervation

Axillary nerve

Subscapularis

From the subscapular fossa to the lesser tubercle. It is medial rotator, covers the anterior surface of the scapula and forms the posterior wall of the axilla.

  • Innervation

Collateral branches of the brachial plexus.

Muscles of the arm

They are located in the anterior or the posterior surfaces. In general, anteriors are flexors of the elbow and posteriors extensors. The anteriors belong to the nerve musculocutaneous neuromuscular system and take part in the hug movement.


Anterior muscles of the arm

Biceps brachii

Two headed muscle with a common distal attachment, the radial tuberosity.

  • Short head. It is attached in the coracoid process
  • Long head. It is attached in the supraglenoid tubercle, its tendon passes by the intertubercular groove to enter inside the capsule of the shoulder.

The main function is the flexion and supination of the elbow, but it is also a weak abductor of he shoulder.

  • Innervation

Musculocutaneous nerve

Brachialis muscle

It is located under the biceps. Goes from the distal half of the anterior side of the shaft of the humerus to the coronoid process of the ulna. It is pure flexor of the elbow.

  • Innervation

Musculocutaneous nerve

Coracobrachialis muscle

From the coracoid process to the medial third of the humerus shaft. It is flexor of the arm and weak adductor.

  • Innervation

Musculocutaneous nerve


Posterior muscles of the arm

These muscles belong to the Radial Nerve Neuromuscular System and are extensors of the elbow. As the extension is limited by the ulnar olecranon, the main function of the muscles are to undone the flexion of the anterior muscles and also to strength the upper limb to stand the body.

Triceps brachii muscle

It is the main extensor of the elbow. It has three heads with common attachment to the ulnar olecranon.

  • Long head. From the olecranon to the infraglenoid tubercle.
  • Lateral head. From the olecranon to the Posterior surface of humerus, lateral and proximal to the groove of the radial nerve.
  • Medial head. From the olecranon to the Posterior surface of humerus, medial and distal to the groove of the radial nerve.
  • Innervation

Radial nerve

Anconaeus muscle

From the lateral epicondyle to the olecranon and the posterior side of ulna. It is a triangular, short and small muscle extensor of the elbow joint. Trizepsaren atzeko aldeko alde lateralean kokatzen den muskulu triangeluarra, laburra eta txikia da. Epikondiloan eta olekranonean eta kubitoaren atzeko aldean lotzen da.

  • Innervation

Radial nerve

Muscles of the forearm

The flexors are locate in the anterior compartment and the extensors in the posterior.


Anterior muscles of the forearm

They are located in two layers, deep and superficial.

Muscles of the superficial layer
Pronator teres

It has two proximal heads:

  • Humeral head attached to the medial epicondyle.
  • Ulnar head attached to the coronoid process.

The distal attachment is the lateral surface of the mid-shaft of the radius. It is pronator of the forearm and the hand.

  • Innervation

Median nerve.

Flexor carpi radialis

It is located under the pronator teres. Its attachments are the medial epicondyle (common attachment of the flexor muscles) and the bases of the 2nd and 3rd metacarpal bones by a tendon that passes through the flexor retinaculum. It is a powerful flexor of the wrist. Its tendon is palpable at the wrist and is important to locate the radial artery.

  • Innervation

Median nerve

Palmaris longus

It is present in the 85% of the population and is a thin fusiform muscle medial to the flexor carpi radialis. It is attached to the palmar aponeurosis by a long tendon that passes above the flexor retinaculum. It is flexor of the wrist and tensor of the palmar aponeurosis.

  • Innervation

Median nerve

Flexor carpi ulnaris

It is the most medial of the superficial flexors. Its origins are the medial epicondyle and the olecranon from where it goes to the pisiform, hamate and base of 5th metacarpal. The ulnar nerve crosses the proximal insertions. It is palpable in the medial border of the wrist, with the ulnar artery and nerve passing laterally to its tendon. It is flexor and adductor of the wrist.

  • Innervation

Ulnar nerve

Flexor digitorum superficialis

Is the largest of the flexors. It is located under the previous muscles and has two proximal attachments.

  • Humero-ulnar medial epicondyle and coronoid process.
  • Radial The proximal half of the anterior border of the radius.

The distal attachment are the shafts of the middle phalanges of the last four fingers, by four tendons. These tendons are called perforated tendons, as they are crossed by the tendons of the flexor digitorum profundus. It flexes the proximal interphalangeal joint, the metacarpo-phalangeal and the wrist, specially in fast flexion. It passes under the flexor retinaculum.

  • Innervation

Median nerve

Muscles of the deep layer
Flexor digitorum profundus

It is the only flexor of the distal phalanges. Its origin is the proximal part of the ulna and the interosseus membrane from where it goes to the palmar surface of the distal phalanges of the last four fingers. It also helps woth the other flexions. It also passes under the flexor retinaculum.

  • Innervation

Median nerve (lateral half) and ulnar nerve (medial half).

Flexor pollicis longus

It is lateral to the Flexor digitorum profundus and goes from the radius, below the tuberosity, to the distal phalanx of the thumb. It flexes the phalanges being the only flexor of the interphalangeal joint.

  • Innervation

Median nerve.

Pronator quadratus

This small and square-shaped muscle is the deepest muscle of the forearm. It is attached to the lower quarter of the ulna and the radius. It maintains both bones joined and also pronates the forearm.

  • Innervation

Median nerve.


Posterior muscles of the forearm

They are mostly extensors of the wrist and fingers, thus they undo the functions of the flexors and pronators (extension and supination). They also help maintaining the strength of the arm when used as a stand. They are located in two layers, deep and superficial.

Muscles of the superficial layer
Brachioradialis

It is the most superficial of the muscles of the radial border. It is attached to the lateral border of the humerus and the styloid process of the radius. It is supinator and accesory flexor of the elbow. Besaurrearen ertze erradialaren muskulurik azalekoena da. Humeroaren ertze lateralean eta erradioaren apofisi estiloideoan lotzen da. Ukondoa flexionatzen du.

  • Innervation

Radial nerve.

Extensor carpi radialis longus

From the lateral epicondyle (common origin of extensor muscles) to the base of the 2nd metacarpal. It extends and abducts the wrist.

  • Innervation

Radial nerve.

Extensor carpi radialis brevis

It is covered by the longus going from the lateral epicondyle to the base of the 3rd metacarpal. Both act together to extend and abduct the wrist.

  • Innervation

Radial nerve.

Extensor digitorum

From the lateral epicondyle to the middle and distal phalanges of the last 4 fingers. It extends the fingers and also dorsiflexes the wrist.

  • Innervation

Radial nerve.

Extensor digiti minimi

From the lateral epicondyle to the dorsal aponeurosis of the 5th finger. It extends the little finger.

  • Innervation

Radial nerve.

Extensor carpi ulnaris

It forms the ulnar border of the forearm. It goes from the lateral epicondyle to the base of the 5th metacarpal. It extends and adducts the wrist.

  • Innervation

Radial nerve.

Deep layer
Supinator

Is the deepest muscle of the posterior compartment. It has two heads, one goes from the lateral epicondyle and the other from the lateral side of the proximal third of the radius, the distal attachment is the anterior surface of the radius. Its function is supination helped by the biceps.

  • Innervation

Radial nerve.

Abductor pollicis longus

From the radius, the ulna and the proximal half of the interosseus membrane to the lateral side of the base of the 1st metacarpal. It abducts and extends the thumb.

  • Innervation

Radial nerve.

Extensor pollicis brevis.

Below the abductor longus, it goes from the posterior side of the radius to the proximal phalanx of the thumb. It extends the proximal interphalangeal joint.

  • Innervation

Radial nerve.

Extensor pollicis longus

From the middle third of the ulna and the interosseus membrane to the distal phalanx of the thumb. Extends the metacarpophalangeal and the interphalangeal joints.

  • Innervation

Radial nerve.

Extensor indicis

From the interosseus membrane and dorsal surface of ulna to the head of the 2nd metacarpal, where it joins the tendon for the index finger of the extensor digitorum. It is located distal to the extensor pollicis.

  • Innervation

Radial nerve.

Muscles of the hand

The hand is very specialized organ, therefore, it has many small muscles, i.e., the thumb has 8 muscles, 8 in the hand and 4 in the forearm. The muscles are placed in three groups:

Muscles of the thumb

Thenar eminence

Abductor pollicis brevis

This superficial muscle goes from the scaphoid, trapezium and flexor retinaculum to the lateral side of the base of the proximal phalanx. Abducts the thumb to put it perpendicular to the palm.

  • Innervation

Median nerve

Opponens pollicis

It is situated below the abductor brevis going from the trapezius and the flexor retinaculum to the lateral half of the palmar surface of the 1st metacarpal. It brings the pad of the thumb to face the pads of the rest of the fingers.

  • Innervation

Median nerve

Flexor pollicis brevis

It is medial to the abductor brevis having two heads.

  • Superficial: From the distal border of the flexor retinaculum and the trapezium to the proximal phalanx.
  • Deep: From the trapezoid and the capitate to the base of the proximal phalanx.

It flexes the proximal phalanx at the metacarpophalangeal joint.

  • Innervation

Median nerve (superficial) and ulnar nerve (deep).

Adductor pollicis brevis

This muscle does not belong to the thenar eminence. It has two heads:

  • Oblique: From the capitate to the base of the proximal phalanx of the thumb.
  • Transverse: From the 3rd metacarpal to the base of the proximal phalanx of the thumb. This muscle adducts the thumb and opposes it to the rest of the fingers.
  • Innervation

Ulnar nerve

Muscles of the little finger

Hypothenar eminence

Abductor digiti minimi

It is the most superficial of the hypothenar muscles. It goes from the pisiform to the medial side of the base of the proximal phalanx of the little finger. Abducts the little finger separating it from the 4th finger.

  • Innervation

Ulnar nerve

Oponens digiti minimi

This is the deepest muscle of the hypothenar eminence. It goes from the hook of the hamate to the base of the 5th metacarpal. It rotates the little finger towards the palm.

  • Innervation

Ulnar nerve

Muscles of the palm

Palmaris brevis

It is subcutaneous located over the hypotenar muscles, going from the flexor retinaculum to the dermis of the skin. It pulls the skin forming a ridge.

  • Innervation

Median nerve

Lumbricals

4 worm-shaped muscles located between the tendons of the flexor digitoum profundus, from where they go to the proximal phalanges of the 2nd - 5th fingers. They flex the metacarpophalangeal joint and extend the interpalangeal being extremely important in actions such as writing.

  • Innervation

Median nerve (1st and 2nd), ulnar nerve (3rd and 4th)

Interossei muscles
  • Palmar Interossei:
    • 1. From the medial side of the palmar surface of the 1st metacarpal to the medial side of the base of the proximal phalanx tof the humb.
    • 2. From the medial side of the 2nd metacarpal to the medial side of the base of the proximal phalanx of the index.
    • 3. From the lateral surface of the 4th metacarpal to the lateral side of the proximal phalanx of the 4th finger
    • 4. From the lateral surface of the 5th metacarpal to the lateral side of the proximal phalanx of the little finger.
  • Dorsal interossei :
    • 1. From the opposite sides of the 1st and 2nd metacarpals to the lateral side of the base of the proximal phalanx of the index finger.
    • 2. From the opposite sides of the 2nd and 3rd metacarpals to the lateral side of the base of the proximal phalanx of the middle finger.
    • 3. From the opposite sides of the 3rd and 4th metacarpals to the medial side of the base of the proximal phalanx of the index finger.
    • 4. From the opposite sides of the 4th and 5th metacarpals to the lateral side of the base of the proximal phalanx of the ring finger.

There are a total number of 8 interossei whose function is the flexion of the metacarpophalangeal joint and the extension of the interphalangeal. Palmar muscles are also adductor of the fingers and dorsal ones flexors.

  • Innervation

Ulnar nerve

INNERVATION

BRACHIAL PLEXUS

The innervation of the upper limb comes from the brachial plexus (C5-T1). From all the branches there are three terminal branches and some collateral ones. Terminal branches:

Posterior

It gives the radial and axillary nerves. The radial nerve exits the plexus, passes through the arm close to the humerus, enters the forearm enterior to the lateral epicondyle, crosses the supinator and in the forearm passes between the two muscular layers, giving innervatio to all the posterior muscles.

Lateral.

Musculocutaneous nerve Exits the plexus, passes through the coracobrachialis and continues in the arm between the biceps and the brachialis.

Medial.

Ulnar nerve. This nerve enters the arm by he medial side, passes down the arm and enters the forear between the olecranon and the medial epicondyle. Here is very superficial and can be easily injured. In the forearm continues between the two proximal insertions of the flexor carpi ulnaris being medial in the forearm, where it inervates one muscle and a half (the flexor carpi ulnaris and the medial half of the flexor digitorum profundus). It passes the wrist by the tunnel and gives two branches in the hand:

  • Superficial For the palmaris brevis
  • Deep For the hypothenar muscles.

From the lateral and the medial branches, two branches form the median nerve. It goes down the arm and enters the forearm between the two heads of the pronator teres. In the forearm passes between the two flexors and enter the hand by the tunnel, where it gives the palmar branch fot thenar muscles.

BLOOD SUPPLY

Arteries

The Subclavian artery is the branch of the aorta artery that supplies the upper limb. At the lateral margin of the 1st rib, the subclavian artery becomes the axillary artery, that has three sections:

  • 1) Between the 1st rib and the proximal edge of the pectoralis minor. It gives the “superior thoracic artery”, to supply the serratus.
  • 2) Under the pectoralis minor
    • Thoraco-acromial artery
    • Lateral thoracic artery
  • 3) Between the distal edge of the pectoralis minor and the distal edge of the teres major.
    • Subscapular artery. To supply the posterior side of the scapular structures.
    • 'Thoracodorsal artery . To supply the latissimus
    • Anterior and psoterior circumflex humeral arteries. To supply the glenohumeral joint.

The axillary artery is palpable in the inferior part of the axilla, at the distal margin of the teres major it becomes the brachial artery

Brachial artery

It begins as a continuation of the axillary artery and follows the line between the centre of the clavicle and the centre of the elbow. It is quite superficial and thus easily touchable. Branches:

  • Profunda brachii artery. It goes with the radial nerve up to the elbow, where it divides into the middle and the radial collateral arteries, that take part into the elbow network.
  • Ulnar collateral arteries (Superior and inferior). They take part into the elbow network.

The brachial artery divides in the elbow joint here it divides into the ulnar and the radial arteries.

Radial artery

It begins at the level of the neck of the radius and follows the line between the elbow and the radial styloid process. At the proximal half it is under the brachioradialis and then it is superficial and passes the wrist lateral to the abductoris hallucis longus. At the distal end, it becomes the lateral half of the deep palmar arch. Branches:

  • Radial recurrent artery Contributor of the network of the elbow joint.
  • Superficial palmar artery. It forms the lateral half of the superficial palmar arch.
  • Dorsal carpal artery. Lateral side of the dorsal carpal arch.
Ulnar artery

It is the main artery of the forearm. It passes under the pronator teres woth the median nerve and moves medial ath the middle of the forearm, where it goes under the flexor carpi ulnaris with the ulnar nerve. At the wrist, it passes laterally to the tendon of the flexor ulnaris over the flexor retinaculum. At the distal end it gives a branch to anastomose with the radial artery at the deep palmar arch and it cecomes the medial half of the superficial palmar arch. Branches:

  • Ulnar recurrent arteries (anterior and posterior) Contributors of the network of the elbow joint.
  • Deep palmar artery . It forms the medial half of the deep arch.
  • Dorsal carpal artery. Medial side of the dorsal carpal arch.
  • Common interosseus artery. This short branch of the ulnar artery divides into:
    • Anterior interosseus artery. It passes over the interosseus membrane and crosses it under the pronator quadratus to be part of the dorsal carpal arch.
    • Posterior interosseus artery. It passes to the posterior compartment crosing the interosseus membrane proximally and passes between the two posterior muscular layers. At the end, in joins the dorsal arch.
Pulse points
  • Brachial: At the cubital fossa
  • Radial: Lateral to the tendon of the flexor carpi radialis
  • Ulnar. Lateral to the tendon of the flexor carpi ulnaris.

Veins

Deep.

Two veins pass along both sides of the arteries up to the axillary vein, that finishes at the subclavian vein.

Superficial.

They form a subcutaneous network, that is different for each person.

  • The palmar veins go to the deep veins.
  • From the dorsal carpal veins, two veins are formed.
    • Cephalic vein: Lateral vein, from the dorsus of the hand passes to the anterolateral side to enter the axillary vein between the deltoid, the pectoralis major and the clavicle.
    • Basilic vein: Medial vein. From the dorsus passes to the medial side and becomes anterior at the elbow. At the middle part of the arm it enters the axillary vein.
    • Median cubital vein. At the cubital fossa, it links the cephalic and the basilic veins.

The main points to make Venipuncture are:

  • Dorsal carpl veins, that can be painful as they are small veins and the area is plentifully inervated.
  • The cephalic can be painful, as the radial nerve passes nearby.
  • The median cubital vein is mostly used to extract blood.

Lymphatic system

There are superficial and deep vessels. Deep vessels go with deep arteries and veins. Superficials are anteriors and parallels to basilic vein. The main lymph nodes are located in he axilla.

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