hi let's talk about the arteries of the upper limb our adventure will begin with the subclavian
artery which on the right side is a branch of the brachiocephalic trunk and on the left
side is a direct branch of the arch of the aorta the subclavian artery has three distinct parts
which can all be found relative to their position to the anterior scalene muscle the
anterior scalene muscle attaches from transverse processes of cervical vertebrae to the first rib
the first part of the subclavian artery is found medial to the anterior scalene
muscle and it has three branches there's the vertebral artery the internal thoracic artery
and the thyrocervical trunk the vertebral artery is going to ascend the neck through the transverse
foramina of cervical vertebrae 6 through 1 before entering the skull through foramen magnum
where it joins its counterpart vertebral artery to form the basilar artery this basilar artery
is going to supply the brain with blood and it will have potential anastomoses with the
internal carotid arteries which are the other major blood supply to the brain
the internal thoracic artery is going to supply the anterior and lateral aspects of the wall of
the thorax as well as the abdomen with blood and the thyrocervical trunk has four major branches
there's the inferior thyroid artery which serves the thyroid gland the parathyroid glands
and the larynx with blood the ascending cervical artery which supplies deep neck
muscles such as the anterior scalene muscle with blood there's the transverse cervical
artery which supplies trapezius with blood and then there's the suprascapular artery
which supplies some of the rotator cuff muscles namely supraspinatus and infraspinatus with blood
we can't see the second part of the subclavian artery because it is occluded or behind
the anterior scalene muscle but there is a small trunk there called the costocervical trunk which
has two major branches there's a deep cervical artery which supplies some of the deep neck
muscles with blood and then a supreme intercostal artery which supplies the first and second
intercostal spaces with blood the third part of the subclavian artery runs from that lateral
border of anterior scalene out to the lateral border of the first rib and there's typically
one branch from this called the dorsal scapular artery here we can see the dorsal scapular artery
moving between the middle and the superior trunks of the brachial plexus that dorsal scapular artery
can from time to time be a branch from the transverse cervical artery but it's typically
conceived of as a branch of the third part of the subclavian artery and this dorsal scapular artery
is going to serve some of the muscles that attach to the medial border of the scapula
things like levator scapulae and the rhomboids muscles rhomboid major and minor with blood
and it will be an important component of the scapular anastomoses beyond the lateral border of
rib 1 is the axillary artery which we can see next so the axillary artery is going to
traverse the axilla it's going to have a special relationship with the brachial plexus so it's
going to be intermingled with elements of the brachial plexus and you'll probably learn or have
already learned in the neuroblock how different parts of the brachial plexus get their name
owing to the relative position to the axillary artery well just as the subclavian artery had
three parts the axillary artery also has three parts and these parts are designated
by their relationship to the pectoralis minor muscle which we can see its attachment there
so the first part of the axillary artery is going to be medial to pec minor and there is
one branch known as the superior thoracic artery the superior thoracic artery is going to
supply blood to some of the intercostal spaces of the lateral wall of the thorax
the second part of the axillary artery is going to be behind pectoralis minor muscle and there are
two uh major um two major branches here there's the thoracoacromial artery this
thoracoacromial artery is going to supply quite a few structures with blood
subclavius pectoralis major pectoralis minor they're branches to the deltoid muscle
so it does quite a bit of blood supply to the the general axillary region the other muscle
is the lateral thoracic artery lateral thoracic artery is descending down the lateral aspect of
the thorax to supply serratus anterior with blood and then we move on to the third part
of the axillary artery which has three major branches so this third part will be lateral to
pectoralis minor and it will be
medial or superior to
terry's major muscle which we can see there
and there are the three major branches the first is the subscapular artery
subscapular artery has two branches there's the thoracoacromial artery thoracoacromial
artery is going to be the major blood supply to latissimus dorsi which we can see there
and then we have the circumflex scapular artery which is going to
come around the lateral border of the scapula this is going to serve
some of those rotator cuff muscles with blood and anastomose with dorsal scapular artery and
suprascapular artery so if we think about the scapula as sort of a triangle here
we have circumflex scapular coming around that side we have dorsal scapular writing down that
side and then suprascapular coming down that way and these three arteries can provide some rather
extensive anastomoses about the scapula well also coming off this third part of the axillary artery
are going to be the circumflex humeral arteries there's a posterior and an anterior
these are going to wrap around the neck of the humerus there is the anterior circumflex humeral
artery there is the posterior circumflex humeral artery the posterior circumflex humeral artery
is transmitted through the quadrangular space and is usually accompanied typically by the axillary
nerve which is a branch of the brachial plexus and these two circumflex humeral arteries are going to
supply the proximal tumors with blood but they're the predominant blood supply to the deltoid muscle
once we get beyond teres major here we're no longer in the axillary artery but we're in the
brachial artery and here we can see the first branch of the brachial artery which
is the deep brachial artery and then a continuation of the brachial artery down
the arm that deep brachial artery is going to be the dominant blood supply to the
posterior compartment of the arm so think triceps brachii whereas the brachial artery will be the
dominant blood supply to the anterior compartment of the arm so biceps brachii coracobrachialis etc
that brachial artery is going to ramify into the radial and the ulnar artery um so usually it's
just um proximal to the the antecubital fossa where we have this split and so there is the
radial artery and there is the ulnar artery the radial artery is going to travel down
the lateral aspect of the forearm the ulnar artery is going to travel deep but predominantly medial
down the forearm over here we've stripped away a lot of the muscles of the forearm to to better
visualize that and let me let me show you what's going on here so there's the brachial artery and
then there's the division for the radial and the ulnar arteries so that radial artery travels down
the forearm and about there in the wrist is where we would palpate the the radial pulse and it goes
deep into the hand where it gives rise to the deep palmar arch the ulnar artery is going down the
medial aspect of the forearm and it gives off a short branch called the common interosseous artery
that common interosseous artery divides into an anterior and a posterior interosseous artery
so there's the anterior and there's the posterior these are on opposite sides of the interosseous
membrane that connects the radius and the ulna of the forearm and they're going to supply well the
anterior will supply the deep flexor compartment of the forearm and the posterior is going to
supply the the deeper parts of the extensor compartment of the forearm now that ulnar artery
when it gets to the hand is going to give rise to the superficial palmar arterial arch
and the deep and the superficial palmar arterial arches will very frequently anastomose they don't
always sometimes there is distinct um patterns of vascularization to the hand where there are not
anastomoses but if there are good collateral blood flow to the hand through anastomosis
between these polymer arches that frees up the radial artery for harvesting for other purposes
or cannulation for various cardiac procedures if necessary one way that i remember that the ulnar
artery gives rise to the superficial palmar arch is that superficial has a u in it u is for ulnar
so that is the uh the overview of the arteries of the upper limb so starting with the subclavian
artery and its branches the axillary artery and its branches the brachial artery and
its branches and then finally ending with the radial and ulnar artery branches that typically
anastomose through the deep and superficial palmar arterial arches thank you very much for your time