Anatomy chapters
Arteries and veins of the upper limb
Trace blood from the subclavian artery to the digits and back through the superficial and deep veins.
- The main artery becomes axillary at the first rib and brachial at teres major.
- The superficial palmar arch is mainly ulnar; the deep arch is mainly radial.
- Cephalic is lateral, basilic medial, and deep veins accompany arteries.
On this page
Overview
The main artery changes its name at two landmarks. The subclavian becomes the axillary artery at the lateral border of the first rib. The axillary becomes the brachial artery at the lower border of teres major.
Near the elbow, the brachial divides into radial and ulnar arteries. Their connections in the hand provide alternative routes to the digits.
Venous return uses both deep veins accompanying arteries and a superficial network visible beneath the skin.
The arterial name changes at the lateral first rib and lower border of teres major.
Axillary artery
The axillary artery runs through the axilla within a sheath shared with the brachial plexus. The axillary vein runs medial to the artery.
Pectoralis minor divides the artery into three parts: proximal, behind and distal to the muscle.
The cords of the plexus are named in relation to the second part. This relationship explains why an expanding arterial lesion can cause a neurological deficit as well as reduced blood flow.
| Name | Origin/roots | Supply/action | Clinical note |
|---|---|---|---|
| Superior thoracic | First part of axillary | Upper thoracic wall | The usual single first-part branch |
| Thoracoacromial | Second part of axillary | Pectoral, deltoid, acromial and clavicular regions | Pierces clavipectoral fascia |
| Lateral thoracic | Second part of axillary | Lateral chest wall and breast | Accompanies the lateral border of pectoralis minor |
| Subscapular | Third part of axillary | Posterior axillary wall | Gives circumflex scapular and thoracodorsal branches |
| Anterior circumflex humeral | Third part of axillary | Proximal humerus and shoulder | Passes anterior to the surgical neck |
| Posterior circumflex humeral | Third part of axillary | Deltoid and shoulder region | Travels with the axillary nerve |
The usual branch pattern is one, two and three branches from the three parts. This is a memory aid; anatomical variations occur.
Scapular anastomosis
The suprascapular and dorsal scapular arteries connect with the circumflex scapular artery around the scapula.
The first two come from the subclavian system, while the circumflex scapular comes through the subscapular branch of the axillary artery.
These connections can carry blood around an obstruction lying between their origins. They do not guarantee an adequate circulation after a sudden major arterial injury.
The exact position of an obstruction matters because a collateral route must connect vessels both above and below it.
The suprascapular artery usually crosses above the superior transverse scapular ligament, while the suprascapular nerve passes beneath it.
Brachial artery and elbow connections
The brachial artery descends in the medial bicipital groove. The median nerve starts lateral to it, crosses in front and becomes medial.
The profunda brachii artery leaves proximally and accompanies the radial nerve behind the humerus.
At the cubital fossa the brachial artery lies medial to the biceps tendon and lateral to the median nerve. Brachialis forms the deep bed; the bicipital aponeurosis covers the artery anteriorly.
The usual bifurcation is opposite the neck of the radius. A high division is a recognised variation, so an unexpected superficial vessel near the elbow must not automatically be assumed to be a vein.
| Name | Origin/roots | Supply/action | Clinical note |
|---|---|---|---|
| Profunda brachii | Brachial artery | Posterior arm; radial and middle collateral branches | At risk with humeral shaft injury |
| Superior ulnar collateral | Brachial artery | Medial elbow network | Runs towards the posterior medial elbow |
| Inferior ulnar collateral | Brachial artery | Medial elbow network | Connects with ulnar recurrent branches |
| Radial recurrent | Radial artery | Lateral elbow network | Connects with radial collateral |
| Ulnar recurrent branches | Ulnar artery | Medial elbow network | Anterior and posterior routes around the medial epicondyle |
| Interosseous recurrent | Posterior interosseous artery | Posterior elbow network | Connects with middle collateral |
The elbow network allows flow during changes in joint position. A pulse beyond an injury does not exclude partial arterial damage.
Radial and ulnar arteries
The radial artery descends deep to brachioradialis. Distally it becomes superficial between the tendons of brachioradialis and flexor carpi radialis. This is the usual radial pulse site.
It turns around the lateral wrist through the anatomical snuffbox, crosses the floor over scaphoid and trapezium, and enters the palm between the heads of the first dorsal interosseous.
It passes deep to adductor pollicis to contribute mainly to the deep palmar arch.
The ulnar artery passes deep to the superficial flexor muscles and gives a common interosseous branch. This divides into anterior and posterior interosseous arteries serving the deep forearm compartments.
Distally the ulnar artery accompanies the ulnar nerve, lying lateral to it. Both enter the hand superficial to the flexor retinaculum. The artery contributes mainly to the superficial palmar arch.
The superficial arch is mainly ulnar and the deep arch mainly radial.
Palmar arches and digital supply
The superficial arch lies deep to the palmar aponeurosis but superficial to the long flexor tendons. It is chiefly ulnar and is commonly completed by a superficial palmar branch of the radial artery.
Common palmar digital arteries divide into proper digital arteries along adjacent sides of the fingers.
The deep arch lies closer to the metacarpal bases and interossei, deep to the flexor tendons. It is chiefly radial and is completed by a deep ulnar branch. Its metacarpal branches communicate with the superficial system.
The princeps pollicis and radialis indicis usually arise from the radial system and supply the thumb and radial side of the index finger. Arch completeness and branch origins vary.
A distal pulse may persist despite significant arterial injury.
Superficial and deep veins
| Name | Origin/roots | Supply/action | Clinical note |
|---|---|---|---|
| Cephalic vein | Lateral dorsal venous network | Ascends lateral forearm and arm to axillary vein | Runs in the deltopectoral groove and pierces clavipectoral fascia |
| Basilic vein | Medial dorsal venous network | Ascends medially and joins brachial veins | Pierces deep fascia in the arm |
| Median cubital vein | Variable link between cephalic and basilic | Crosses anterior elbow superficially | Common venepuncture site |
| Deep veins | Paired veins alongside major forearm and arm arteries | Return blood towards axillary vein | Venae comitantes communicate with superficial veins |
The median antebrachial vein ascends from the palm and ends variably in basilic or median cubital channels.
The axillary vein begins at the lower border of teres major and becomes subclavian at the first rib. Superficial patterns vary considerably between people.
Lymphatic routes
Medial hand and forearm lymph may pass through supratrochlear nodes to lateral axillary nodes. Lateral superficial vessels follow the cephalic vein to deltopectoral and apical nodes.
Pectoral, subscapular and lateral groups drain towards central and apical axillary nodes; apical efferents form the subclavian lymph trunk. Deep lymphatics accompany deep vessels.
Clinical relevance
Supracondylar fracture
How it happens: A displaced distal humeral fracture threatens the brachial artery and median nerve anterior to the elbow.
What you see: Perfusion may deteriorate and anterior interosseous weakness may impair pinch. Severe forearm ischaemia can later produce a flexion contracture.
Venepuncture at the elbow
How it happens: A needle crosses superficial tissues near the median cubital vein. The bicipital aponeurosis separates it from the artery and median nerve below.
What you see: Unexpected arterial bleeding or neurological symptoms indicate possible deeper injury. Variable veins and cutaneous nerves mean the aponeurosis reduces risk without eliminating it.
Assessing hand collateral flow
How it happens: The modified Allen test temporarily compresses radial and ulnar inflow before observing reperfusion.
What you see: Slow or absent colour return suggests inadequate collateral flow. The bedside test has limitations; Doppler may be needed for important procedural decisions.
Use the borders of the first rib and teres major to identify arterial name changes. Match axillary branches to the three parts and distinguish the depth and dominant artery of each palmar arch. At the elbow, place the brachial artery between the biceps tendon and median nerve.
Quick revision
- Axillary artery begins at the lateral first rib and ends at teres major.
- Pectoralis minor divides the axillary artery into three parts.
- Profunda brachii travels with the radial nerve.
- Brachial artery usually divides opposite the radial neck.
- Radial artery crosses the anatomical snuffbox.
- Superficial and deep arches are mainly ulnar and radial respectively; cephalic is lateral; basilic is medial; median cubital connects them variably.
Sources: Snell's Clinical Anatomy by Regions, supplied Upper Limb chapter; UHS PGET Paper I MBBS Table of Specifications. Supplementary clinical testing and developmental context follow standard examination conventions and Duke Embryology where relevant. Picture links are visual study resources. Text and tables written independently for The House Job.
FAQ
Which artery accompanies the axillary nerve?
The posterior circumflex humeral artery in the quadrangular space.
Where is the brachial pulse felt?
Medial to the biceps tendon at the elbow, with the elbow slightly flexed.
Which palmar arch is more distal?
The superficial palmar arch generally extends further distally than the deep arch.
Does a palpable pulse exclude an arterial injury?
No. Partial injury or collateral flow may preserve a distal pulse despite a significant lesion.