Arteries & Veins of the Upper Limb

• Begins as the continuation of the Subclavian Artery at the first rib • Passes deep to the pectoralis minor muscle • Ends at the teres major, where it is renamed the Brachial Artery

• Begins as the continuation of Axillary artery at the teres major muscle • Runs medial to the humerus between the anterior & posterior muscle compartments (PULSE POINT) • Runs into the cubital fossa, located between median nerve and biceps tendon (blood pressure auscultation) • Terminates within cubital fossa, bifurcating into Radial and Ulnar arteries

• Large branch of the brachial artery in the arm • Runs through the lateral triangular space with radial nerve • Passes posterior to the humerus in the radial/spiral groove with the radial nerve • Supplies posterior compartment of arm

• The smaller, more lateral, terminal branch of the brachial artery in cubital fossa • Enters the forearm descending deep to brachioradialis • Lies on the anterior surface of the distal radius, lateral to the tendon of Flexor Carpi Radialis tendon at the wrist PULSE POINT • Winds laterally around wrist, passes through floor of the anatomical snuffbox • Pierces muscles between the 1st and 2nd metacarpals to enter the hand • Connectswith the ulnar artery, forming the superficial and deep palmar arches

-The larger, more medial, terminal branch of the brachial artery in the cubital fossa • Enters forearm deep to pronator teres • Found lateral to Flexor Carpi Ulnaris tendon at the wrist PULSE POINT • Enters the palm superficial to carpal tunnel (flexor retinaculum) • Passes through the ulnar canal (tunnel of Guyon) with the ulnar nerve • Connects with the radial artery, forming the superficial and deep palmar arches

Palmar arches (anterior of hand) • Superficial • Deep Dorsal carpal arch (posterior to the carpals) -From these, a collection of digital arteries arise to supply the fingers and thumb

• Superficial and deep palmar venous arches – form ulnar and radial veins • Ulnar & radial veins- unite in cubital fossa to form brachial veins • Brachial veins- from cubital fossa to teres major • Axillary vein- from teres major to 1st rib (within axilla) • Subclavian vein – proximal to 1st rib

Cephalic vein – ‘towards the head’, located on lateral aspect of forearm and arm, drains into axillary vein Basilic vein – ‘towards the base’, on medial aspect of forearm and arm, drains into axillary vein Median cubital vein – joins the cephalic and basilic vein’s anterior to the cubital fossa Perforating veins – drain blood from superficial veins into deep veins (for more efficient return of blood to the heart)

Subclavian Artery- ends at the 1st rib Axillary Artery- from 1st rib to the teres major muscle (within axilla) Brachial Artery- from teres major to its bifurcation within cubital fossa Ulnar & Radial Arteries- begin as brachial artery divides Superficial and Deep Palmar Arches & Dorsal Carpal Arch - branches of ulnar & radial arteries that supply the hand

Deep veins • Located alongside deep structures eg muscle, bone • Tend to follow the pattern of the arteries • Multiple ‘accompanying veins’ run alongside the arteries. More efficient blood return, compared to superficial veins, due to musculovenous pump Superficial veins • Located in subcutaneous tissue (superficial fascia) • Do not accompany arteries • Not as efficient blood return, as deep veins, due to absence of musculovenous pump Perforating Veins -Drain blood from superficial veins into deep veins to enhance venous return

• The lymphatic system returns excess tissue fluid & leaked plasma proteins back into the blood stream, as well as removal of cell debris and infection • Lymph nodes are found along the course of the vessels at junctional points such as joints and anatomical spaces eg cubital fossa and axilla

• Lymph from right upper quadrant of the body is returned to the circulation by the right lymphatic duct. • It drains into the right venous angle (the junction b/w right internal jugular vein and the subclavian vein)

• Lymph from the remainder of the body (left upper quadrant and bottom half of the body) is returned to the circulation via the thoracic duct • It drains into the left venous angle (junction b/w left internal jugular vein and the left subclavian vein)