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Vascular Anatomy of the Upper Limb Musculoskeletal Block - Lecture 8

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Vascular Anatomy of the Upper Limb Musculoskeletal Block - Lecture 8 Vascular anatomy of the upper limb Musculoskeletal Block - Lecture 8 Objective: .✓ Identity the origin of vascular supply for the upper limb ✓ Describe the main arteries and their branches of the arm , forearm & hand ✓ Describe the vascular arches for the hand . ✓ Describe the superficial and deep veins of the upper limb Color index: Important In male’s slides only In female’s slides only Extra information, explanation Editing file Contact us: [email protected] Arteries of the upper limb 1- the subclavian artery Left subclavian artery Right subclavian artery Subclavian artery Axillary artery Brachial artery The left subclavian The right subclavian artery originates from artery originates from the brachiocephalic the arch of the aorta. artery. Ulnar artery Radial artery both Continue as Axillary Palmar arches artery at the lateral (outer) border of the 1st rib 2- the axillary artery Axillary artery -Begins at the lateral border of the 1st rib as continuation of the subclavian artery. -Continues as brachial artery at lower border of teres major muscle. -It’s closely related: to the cords of brachial plexus and their branches - It’s enclosed within the axillary sheath. ( axillary sheath is a fibrous sheath that encloses the axillary artery and the three cords of the brachial plexus to form the neurovascular bundle ) -It’s crossed anteriorly by the pectoralis minor muscle, and is divided into three parts; 1st, 2nd & 3rd. The 1st part The 1st part The 2nd part The 3rd part Extends from the lateral Lies: behind the Extends from the lower border border of 1st rib to upper pectoralis minor of pectoralis minor muscle to border of the pectoralis muscle. the lower border of teres The 3rd part minor muscle. major muscle. It is related: medially, Related: medially, laterally, and Related: laterally, and posteriorly, to the branches of 1-Anteriorly: to the posteriorly to the the cords of the brachial The 2nd part pectoralis major muscle plexus 2-Laterally: to the cords of corresponding cord of the brachial plexus. the brachial plexus. It gives; THREE Branches: 1-Anterior circumflex humeral It gives; TWO branches 2-Posterior circumflex It gives; ONE branch: humeral. Highest thoracic 1-Thoracoacromial . 3-Subscapular artery 2-Lateral thoracic. Anastomosis around shoulder joint Anastomosis occurs between branches of Subclavian and Axillary arteries Branches from Subclavian Branches from axillary Anterior circumflex Posterior circumflex Suprascapular artery Transverse cervical artery Subscapular artery humeral artery humeral artery Axillary artery 3- the brachial artery Branches -Is a continuation of Relations the axillary artery at 1- Anteriorly:crossed from 1- Muscular. the lower border of 2- Nutrient to humerus. teres major muscle above downward by medial 3- Profunda brachii -Provides main arterial cutaneous nerve of the 4- Superior ulnar collateral supply to the arm. forearm, median nerve, - Terminates opposite and bicipital aponeurosis. 5- Inferior ulnar collateral. Neck of Radius by dividing into Radial & Ulnar arteries. 2- Posterioly: triceps, coracobrachialis and brachialis. 3-Medially: basilic vein, ulnar and median nerves. 4-Laterally: coracobrachialis and biceps muscles. 4- The ulnar artery Branches Ulnar artery ● Muscular . ● Recurrent branch (for anastomosis around the elbow joint). ● The larger of the two terminal branches of the brachial artery. ● Common Interosseous artery, which gives: ● Begins in the cubital fossa at the (Anterior and Posterior) level of neck of radius. Interosseous arteries. ● Descends through the anterior ● Branch to anastomoses compartment of the forearm. around the wrist joint. ● Enters the palm, in front of the flexor retinaculum, with the ulnar nerve. ● Ends by forming the superficial palmer arch, by anastomosing with superficial palmer branch of radial artery. Branches 5- The Radial artery ● Muscular Radial artery ● Recurrent branch (for anastomosis around the elbow joint). ● The smaller of the two ● Superficial palmar terminal branches of the branch , joins the ulnar artery to form the brachial artery. superficial palmar ● Begins in the cubital fossa arch. at the level of neck of radius. ● Descends downward and laterally. ● Leaves the forearm by winding around the lateral aspect of the wrist to reach the dorsum of the hand. Anastomosis around Elbow Joint Arteries of the palm Anastomosis occurs between branches of Brachial, Radial and Ulnar arteries Around the epicondyle of humerus (medial & lateral) Around the lateral epicondyle The Branches from Branches from profunda brachii branches anastomose with the radial recurrent artery and the Ulnar and Brachial artery: interosseous recurrent artery. Radial Arteries: Around the medial epicondyle, the superior ulnar collateral artery ● Radial & ulnar ● anastomoses with the posterior ulnar Profunda Brachii recurrent arteries artery recurrent. The inferior ulnar collateral ● Posterior ● artery anastomoses with the anterior Superior ulnar Interosseous ulnar recurrent collateral artery recurrent artery ● Inferior ulnar (from ulnar) collateral artery -Arteries of the palm Radial arteries Ulnar arteries -Leaves dorsum of the hand by Enters the hand: turning forward between the proximal ends of the 1st and 2nd - anterior to the flexor metacarpal bones, and between retinaculum two heads of the 1st dorsal interosseous muscle. This place - on the lateral side of the called anatomical snuff box ulnar nerve and pisiform bone . -On entering the palm it continues ● Gives a deep branch as deep palmar arch. Continue as the superficial -gives; arteria radialis indices and arteria princeps pollicis. palmar arch. The superficial The deep palmar palmar arch arch The superficial palmar arch is more distal than the deep palmar arch - Is the direct continuation of the -Is a continuation of the radial ulnar artery, as it curves laterally artery as it curves medially behind the palmar aponeurosis beneath long flexor tendons , in front of the metacarpal bones and -Is completed by branch from the interosseous muscles. radial artery -Is completed on the medial side -Lies approximately at the level of by deep branch of ulnar artery. the Distal Border of the Extended Thumb. -Lies at a level of the Proximal Border of Extended thumb. Gives: digital arteries from its convexity to supply the fingers. It sends branches: 1- superiorly to share in anastomosis around the wrist joint 2- inferiorly to join branches of the superficial palmar arch. -Arterial Innervation And Raynaud’s Disease ➔ Raynaud’s disease is a vasospastic disease involves digital arteries Vascular changes that occur during acute Raynaud’s . It may require disease Cervicodorsal preganglionic sympathectomy , to prevent necrosis of the fingers. -Veins Of The Upper Limb - The veins of the upper limb are divided into two sets: Superficial and Deep - The two sets anastomose frequently with each other The deep veins The superficial veins accompany the arteries, and placed immediately beneath the constitute the venae comitantes of skin, in the superficial fascia those vessels. Axillary Cephalic Subclavian Basilic Beachial veins Median cubital Note: we study the veins from distal to proximal because they return the blood back to the heart -Superficial Veins -The dorsal digital veins drain into dorsal metacarpal veins, which unite to form a dorsal venous arch or network. -Dorsal venous network lies on the dorsum of the hand, in the subcutaneous tissue, proximal to the metacarpophalangeal joints. -Drains into the cephalic vein laterally, and basilic vein medially. Median Cephalic Basilic cubital -Arises from the -Arises from the lateral end of the medial side of the dorsal venous dorsal venous arch of hand arch of hand -Ascends on radial -Ascends on the side of the ulnar side of -Links cephalic forearm to the forearm to the vein and basilic elbow and elbow. vein in the cubital continues up to fossa. the arm in the - In the middle of deltopectoral the arm it pierces -Is a frequent site groove. the deep fascia for venipuncture. and joins the brachial vein or axillary vein. -It pierces clavipectoral fascia to drain into the axillary vein. -Deep Veins :Accompany the arteries of the same region and bear similar names Vena brachial vein Axillary vein Subclavian vein comitantes -They are generally -Begins at the lower border arranged in pairs. of the Teres major, as the -Is the continuation of the continuation of the basilic axillary vein. situated one on either side vein. of the corresponding -Extends from the outer artery. connected at -Ends at the outer border border of the first rib to intervals by short of the first rib as the -placed one on either side the sternal end of the transverse branches. subclavian vein. of the brachial artery. clavicle, where it unites with the internal jugular to -The superficial and deep -Receives: form the Brachiocephalic palmar arterial arches are 1- The brachial veins. (Innominate) vein. each accompanied by a pair 2- The cephalic vein (close of venæ comitantes which: I to its termination). A- constitute the superficial and deep palmar venous arches. B- receive the veins corresponding to the branches of the arterial arches. -The deep veins of the forearm are the venæ comitantes of the radial and ulnar arteries. -Vein Catheterization -The Basilic vein is the vein of choice for (ﻗﺳطرة).central venous catheterization Because: From the cubital fossa until reaching the axillary vein it increases in diameter and lies in direct line with the axillary vein. Abduction of the arm will overcome the troublesome caused by the valves in the axillary vein, and permits the catheter to move past the obstruction -While The Cephalic vein: does not increase in size as it ascends in the arm, and frequently divides into small branches At it's termination it joins the axillary vein at right angle ,so it is difficult to maneuver the catheter around this angle MCQs Q1: where does the Q2: One of the branches Q3:the axillary artery is a axillary artery begin ? of the 3rd part in axillary continuation of artery is A.Medial border of the 1st rib A.Anterior circumflex humeral A.Axillary artery B.Lateral border of the 1st rib B.Thoracoacromial B.
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