UPPER LIMB ARTERY

Subclavian artery
On the right, the subclavian artery arises from the brachiocephalic trunk. On the left, it
branches directly from the arch of aorta.
Can be divided in 3 part depending on the position relative to the anterior scalene
muscle.
- rst part: medial border of the anterior scalene. This part gives o several branches,
including the vertebral artery, which supplies part of the medulla, cerebellum, and
brain. the internal thoracic artery, which supplies the anterior thoracic wall and breast
tissue; and the thyrocervical trunk, which supplies blood to the larynx, trachea,
esophagus, thyroid and parathyroid glands.
- Second part: posterior to the anterior scalene. gives o the costocervical trunk, which
supplies the upper thorax
- Third part: lateral border This part gives o the dorsal scapular artery, which travels to
the back to supply some muscles of the upper back and shoulder, such as the levator
scapulae, trapezius muscles, and rhomboids.

At the lateral border of the rst rib, the subclavian artery enters the axilla and is renamed
the axillary artery.
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Axillary artery

Lies deep to the pectoralis minor and is enclosed in the axillary sheath (a brous layer
that covers the artery and the three cords of the brachial plexus).
Can be divided in 3 parts based on its position relative to pectoralis minor:
- 1: proximal —> 1 branches = superior thoracic artery
- 2: posterior —> 2 branches = thoraco-acromial; lateral thoracic
- 3: distal —> 3 branches = subscapular; anterior and posterior circum ex

At the lower border of major muscle is renamed brachial artery

Brachial artery
is a continuation of the axillary artery past the lower border of the teres major. It is the
main supply of blood for the arm.
Runs down the arm at the level of the neck of radius, where it divides in radial and ulnar
arteries.

It follow a super cial course below the deep fascia and give raise to 4 branches:
- profonda brachii: supplies structures in the posterior upper arm (triceps). At the end
we found radial collateral artery and middle collateral artery, that contributing to an
anastomotic network around the elbow joint.
- Humeral nutrient
- Superior collateral
- Inferior collateral

As the brachial artery moves through the cubital fossa, terminates by bifurcating into the
radial and ulnar arteries.
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Radial and Ulnar Arteries
 - radial: supplies the posterolateral aspect of the forearm. It contributes to anastomotic
networks surrounding the elbow joint and carpal bones.
o The radial pulse can be palpated in the distal forearm, immediately lateral to the
prominent tendon of the exor carpi radialis muscle.
- Ulnar: supplies the anteromedial aspect of the forearm. It contributes to an
anastomotic network surrounding the elbow joint.
o Also gives rise to the anterior and posterior interosseous arteries, which
supply deeper structures in the forearm.

These two arteries anastomose in the hand by forming two arches – the super cial palmar
arch, and the deep palmar arch.

Hand artery.
Both radial and ulnar enter the hand by the wrist. The ulnar enters medially. The radial
enters laterally.

Ulnar: pass super cially to transverse carpal ligament ( exor retinaculum) and enters the
hand through a small tunnel called ulnar canal. Then divided in
- super cial palmar branche
- Deep palmar branche
The super cial in the lateral part of the hand anastomose with the super cial branche of
the radial artery.

Radial: enters laterally to the wrist and then curves through the back of the hand and
cross the anatomical snu box (at the base of the thumb). Then enters the palm where it
forms the deep palmar arch and then anastomose with the DPB of the ulnar artery.

- Super cial palmar arch: located anteriorly (above) to the exor tendons in the hand
and deep to the palmar aponeurosis. It gives rise to the digital arteries, which supply
the four ngers.
- Deep palmar arch: located deep to the exor tendons of the hand. It contributes to
the blood supply to the digits and to the wrist joint.
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 UPPER LIMB VEINS
The venous system of the upper limb drains deoxygenated blood from the arm, forearm
and hand. It can be subdivided into the super cial system and the deep system.

Super cial
The major super cial veins are the cephalic and basilic veins. That are located in the
subcutaneous tissue.

- the basilic vein originates from the dorsal venous network of the hand and ascends
medially. At the border of the teres major, the vein moves deep into the arm where it
forms the axillary vein.
- The cephalic vein also arises from the dorsal venous network of the hand. It ascends
the antero-lateral. At the shoulder the vein enters the axillary region via clavipectoral
triangle. and empties into axillary vein.
The cephalic and basilic veins are connected at the elbow by the median cubital vein.

The super cial vein are connected to the deep vein by the Perforating veins.

Deep veins
Are situated under the deep fascia. The deep veins share the name of the artery they
accompany.
The brachial veins are the largest in size, and are situated either side of the brachial
artery. The pulsations of the brachial artery assist the venous return. Veins that are
structured in this way are known as vena comitantes.
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LOWER LIMB ARTERY
At the level of L4-L5 there are the aortic bifurcation that divides in right common iliac
artery and left common iliac artery.
The common iliac artery divides in 2 artery: internal iliac and external iliac. The internal
iliac gives rise to the hypogastric artery, the external iliac gives rise to the femoral
artery.
The hypogastric gives rise to the gluteal artery.
At the level of triangle of scarpa (inguinal ligament, abduttor and sartorius muscle) it
divides in medial femoral, lateral femoral and the perforating branches.
The medial enters through the abduttor canal and once reached the knee, takes the name
of poplitean artery.
The politean divides under the knee in anterior tibial artery, and tibioperoneal trunk.
The tibioperoneal trunk divides in posterior tibial artery and peroneal artery.
The anterior tibial artery continues at the level of the feet with the dorsal pedis that
supplie the dorsal part of the foot.
Instead the posterior tibial artery continues and divides in medial and lateral plantar
artery and these supply the palmar part of the foot. The lateral plantar artery
anastomose with the dorsal pedis creating the deep palmar branches that supplied also
the toes.
 LOWER LIMB VEINS
drain deoxygenated blood and return it to the heart.
- Deep veins: under deep fascia
- Super cial veins: in subcutaneous tissue.

Deep veins
The deep veins accompany and share the name of the major arteries.
The dorsal venous arch mostly drains into the super cial vein but some veins penetrate
deep into the leg, forming the anterior tibial vein.

On the plantar medial and lateral plantar veins arise. These combine and form the
posterior tibial and bular veins.
At the level of the knee the anterior tibial, posterior tibial and bular veins unite to form the
popliteal vein. The popliteal vein enters the thigh via the adductor canal.
Once the popliteal vein has entered the thigh, it is known as the femoral vein, that is then
known as external iliac and internal iliac.
At the level of the internal iliac empties the inferior and superior gluteal veins.

Super cial veins

- The great saphenous vein is formed by the dorsal venous arch of the foot, and the
dorsal vein of the great toe. It ascends up the medial side passing anteriorly to the
medial malleolus. As the vein moves up the leg, it receives tributaries from other small
super cial veins. The great saphenous vein terminates by draining into the femoral vein
immediately inferior to the inguinal ligament.
- The small saphenous vein is formed by the dorsal venous arch of the foot, and the
dorsal vein of the little toe. It moves up the posterior side of the leg, passing
posteriorly to the lateral malleolus. It moves between the two heads of the
gastrocnemius muscle and empties into the popliteal vein in the popliteal fossa.

NECK ARTERY
The main artery in the neck is the common carotid artery. The left common carotid
artery branches directly o the aortic arch and extends into the neck. The right common
carotid artery is a branch of the brachiocephalic trunk.
Both common carotid arteries ascend in the neck medially.

Near the bifurcation of the common carotid arteries, there are two important receptors,
the carotid sinus and the carotid body. The carotid sinus which senses the pressure in
the carotid artery system and transmits information to the brain about the blood pressure
in order to maintain blood pressure homeostasis.
The carotid body monitor the levels of oxygen in the blood; In accordance with the
changes sensed by the carotid body, the brain responds by changing the rate of
breathing.

At the level of the bifurcation the carotid divides in external and internal carotid artery:
- The internal carotid artery does not give o any branches in the neck.
- The external supplies parts of the neck, face and scalp and gives rise to
- superior thyroid artery: supply thyroid gland
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 - superior laryngeal artery branches o the superior thyroid artery
- ascending pharyngeal artery

NECK VEINS

The largest vein in the neck is the internal jugular vein, which drains blood from the
brain, neck muscles, face and organs of the neck.
It starts at the jugular foramen and passes under the sternocleidomastoid muscle.
Then it unites with the subclavian vein to form the brachiocephalic vein. At the end we
found a valve that prevent the retrograde ow.
There are two region identi ed as bulbs, that are region where the vein are dilated.
- superior bulb: located jugular fossa
- Inferior bulb: supraclavicular fossa.

The internal jugular vein communicate with the external thanks to the oblique jugular
vein.

There are a broad anastomosis between the external and internal jugular veins at the
angle of the mandible, that provides venous drainage of the face, scalp and cranium.
The external jugular vein descends super cial to the sternocleidomastoid, and
posterior to the clavicle, it empties into the subclavian vein.
The external jugular is easily palpable at the base of the neck.
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 Cervical plexus
Consist in cutaneous and muscular bers from the ventral rami of spinal nerve C1-C4 and
some bers from C5.
This plexus is located anteromedial to the levator scapulae and middle scalene muscles
and deep to the sternocleidomastoid muscle.

The cervical plexus forms from the anterior rami of spinal nerves C1, C2, C3, and C4. It is
a mixed nerve plexus as it provides both sensory and motor nerve bers. The sensory
bers (posterior branches) provide sensation to the skin of the neck, upper chest, and
shoulder regions. While the motor bers (anterior branches)provide innervation to the
muscles in the neck, chest, and shoulder regions.

Talking about these branches more in detail we have:

The phrenic nerve:
originate from C3-C4-C5 and takes sensory information from the diaphragm and sand
motor innervation to the diaphragm.

Ansa cervicalis:
Originate from C1-C3 and travels with bers from the hypoglossal nerve. These bers
innervate the 5 of extrinsic muscle of laryngeal muscle.

Transverse Cervical Nerve

Originate from C3-C4 and receive information from the skin of anterior triangle of the neck

Greater Auricular Nerve

is formed by bres from C2 and C3 roots and at the level of parotid gland divides.
Receives sensory information from the skin over the gland, the ear and the skin of the
neck

Lesser Occipital Nerve

Originate from C2 and receives information from the skin of the neck, the posterior scalp
and the ear.

BRACHIAL PLEXUS
The brachial plexus is a group of nerves that control the muscles of the shoulder, arm,
forearm, and hand. These same nerves also provide sensations (feeling) of the whole
upper limb. There are ve components of the brachial plexus: roots, trunks, divisions,
cords, and branches.

Roots
Originate from the ventral rami of the spinal nerve C5 C6 C7 C8 T1

Trunks
C5-C6 superior trunk
C7 middle trunk
C8-T1 inferior trunk
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Divisions:
Each of these trunk divide in 3 anterior and 3 posterior

Cords:
The posterior division unit to form the posterior cords. The anterior division of the middle
and superior trunk forms the lateral cord. The anterior division of inferior trunk form the
medial cord.

Nerves:
Originate from one or more cords and are:
- axillary nerve
- Radial nerve
- Median nerve
- Ulnar nerve
- Muscolocutaneous nerve

Ulnar nerve:
The ulnar nerve is formed from the C8 and T1 nerve roots.
When you hit this you get numbness an a feeling of electrical pain because is very close
to the elbow.
Can lead to the cubital tunnel syndrome
Radial nerve:
Originate from C5 to T1. The nerve gives function to the triceps muscles on the back of
the arm to straighten the elbow. Because the radial nerve wraps around the humerus
bone, it can be stretched or torn when the humerus bone is broken.

Median nerve:
Formed from C5 to T1. The median nerve travels along the inside of the arm near the
brachial artery. The median nerve does not provide any function until after it crosses the
elbow.
Is the most known because it can be compressed as it crosses the wrist and cause carpal
tunnel syndrome.

Muscolocutaneous:
Form C5 to C7. Innervates brachial muscle (biceps, coracobrachiale)

Axillary:
C5-C6. Innervates the deltoid, the teres minor, and the long head of the triceps muscle.
The axillary nerve also provides sensation to the side of the shoulder and can be injured
during shoulder dislocations.

Lower limb innervation

Both the lumbar and sacral plexus supply innervation to the lower limbs.

The sacral plexus gives rise to the sciatic nerve (L4 through S3), posterior femoral
nerve (S1 through S3), superior gluteal nerve (L4 through S2), and inferior gluteal
nerve.

-The sciatic nerve innervates the semimembranosus, semitendinosus, and adductor

magnus. it then divides in:
- tibial nerve: innervates exors of the knee, extensors of the ankle, exors of the toes
- common peroneal nerve: innervates the short head of the biceps femoris, bularis,
tibialis anterior, extensors of the toes, the skin over the anterior surface of the leg,
and dorsal surface of the foot.

-Pudendal Nerve Innervates the perineum.

-Posterior femoral cutaneous nerve: perineum and surface of thigh and leg
-superior and inferior gluteal nerve: gluteus and and tensor fasciae latae.

The lumbar plexus supplies innervation to the femoral (L2 through L4), lateral femoral
cutaneous (L2, L3), obturator (L2 through L4), and saphenous nerves (L2 through L4).

- The femoral nerve supplies innervation (sensation and motor) to the anterior thigh.
- The obturator nerve provides sensory innervation to the medial thigh and motor
function to the adductors.
- The saphenous and lateral femoral cutaneous nerves are both strictly sensory,
innervating the medial aspect of the leg and lateral thigh, respectively
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