Gross Anatomy: Upper Extremity Arteries

Transcription

1 Gross Anatomy: Upper Extremity Arteries By: Trevor Lohman DPT Illustrated by: Dennis Breese

2 1 Subclavian and Axillary arteries Hardening of the heart ages people more quickly than hardening of the arteries -Anonymous

3 Subclavian and Axillary Artery Structure List: 1. Subclavian artery a. thyrocervical trunk i. inferior thyroid artery 1. ascending cervical artery ii. dorsal scapular artery iii. suprascapular artery c. lateral thoracic artery d. subscapular artery i. scapular circumflex artery ii. thoracodorsal artery e. posterior humeral circumflex artery f. anterior humeral circumflex artery b. internal thoracic artery c. costocervical trunk i. deep cervical artery ii. supreme intercostal artery 2. Axillary artery a. highest thoracic artery b. thoracoacromial trunk artery i. acromial branch ii. deltoid branch iii. clavicular branch iv. pectoral branch 2

4 Subclavian and Axillary Arteries The left and right subclavian arteries supply the left and right upper extremities with oxygenated blood, respectively. While there are several arterial structures that branch from this pair of large arteries, we will only be focusing on the location of the subclavian artery and its main branches in these notes. We will however be covering the axillary artery in depth. 1. Subclavian artery b. internal thoracic artery c. costocervical trunk artery 2. Axillary artery b. highest thoracic artery c. thoracoacromial trunk artery ii. acromial br. a. thyrocervical trunk 3

5 iii. deltoid br. iv. clavicular br. v. pectoral br. d. lateral thoracic artery e. subscapular artery ii. scapular circumflex artery iii. thoracodorsal artery f. posterior humeral circumflex artery g. anterior humeral circumflex artery The structures of the axillary artery may seem numerous, but there are some very helpful mnemonic devices to aide in your retention of the material. The main branches of the axillary artery can be committed to memory using the following phrase HoTeL SPA H= highest thoracic artery T= thoracoacromial trunk L= lateral thoracic artery S= subscapular artery P= posterior humeral circumflex artery A= anterior humeral circumflex artery Not only does this mnemonic device help you to memorize the axillary artery branches, it helps you to memorize the order in which these branches depart from the axillary artery. An additional mnemonic device exists for the branches of the thoracoacromial trunk artery. All Dogs Can Pee A= acromial br. D= deltoid br. C= clavicular br. P= pectoral br. Using these two study aides, you can memorize nearly all of the axillary artery branches. On the next page, we will examine the structure and location of the brachial artery and its branches. The brachial artery is a continuation of the axillary artery, and begins as the axillary artery crosses the teres major muscle. 4

6 2 Brachial Artery Faith is the vital artery of the soul. When we begin to believe, we begin to love. Richard Watson

7 Brachial Artery Structure List: 1. Brachial artery a. profunda brachii artery (deep brachial a.) i. ascending br. ii. radial collateral a. iii. middle collateral a. b. Superior ulnar collateral artery c. Inferior ulnar collateral artery 6

8 The Brachial Artery and Associated Branches The brachial artery is simply a continuation of the axillary artery. This change in name occurs as the axillary artery crosses the teres major muscle. You can rest assured that the transition has occurred once you locate the brachial artery s first branch, the profunda brachii artery. Please find the brachial artery structure list below: i. ascending br. ii. radial collateral br. iii. middle collateral br. b. superior ulnar collateral artery c. inferior ulnar collateral artery 1. Brachial artery a. profunda brachiii artery (deep brachial a.) The branches of the brachial artery are less in number than those of the axillary ar- 7

9 tery. There is however an acronym to help you memorize the branches of the profunda brachii a. A.R.M. A= ascending branch R= radial collateral branch M= middle collateral branch Each of these branches serves as one half of an anastomosis with another arterial structure. The ascending branch connects to the loop formed around the humeral head by the anterior and posterior humeral circumflex arteries. The remaining anastomoses will be discussed on the following pages. 8

10 3 Radial and Ulnar Arteries A man is as old as his arteries and his interests. Josephus Daniels

11 Radial and Ulnar Artery Structure List 1. Radial artery a. radial recurrent a. f. dorsal carpal branch g. deep palmar arch b. palmar carpal branch a. c. superficial palmar arch a. d. princeps pollicis a. i. radialis indicis e. deep palmar arch a. 3. Superficial palmar arch a. (continuation of ulnar a.) a. common palmar digital arteries b. palmar digital arteries i. palmar metacarpal arteries 2. Ulnar artery b. anterior ulnar recurrent a. c. posterior ulnar recurrent a. d. common interosseous a. ii. interosseous recurrent a. iii. posterior interosseous a. iv.anterior interosseous a. e. palmar carpal branch 10

12 Arteries of the Forearm The brachial artery bifurcates once it reaches the antebrachial region forming two arteries that travel distally towards the hand. This bifurcation results in the division of the brachial artery into the radial and ulnar arteries. The radial artery travels down the forearm anterior to the radius, while the ulnar artery travels down the forearm anterior to the ulna. Keep in mind that we will only be covering the branches of these arteries found in the forearm. We will cover the branches found in the wrist and hand in the following section. The forearm branches of these two arteries are found below. 1. Radial artery a. radial recurrent artery 2. Ulnar artery a. anterior ulnar recurrent artery 11

13 b. posterior ulnar recurrent artery c. common interosseous artery i. interosseous recurrent anterior ii. anterior interosseous artery iii. posterior interosseous artery Upon examination of the picture on the previous page, you may notice that many of these structure share similar descriptors in their names. Two such examples are the words collateral and recurrent. These terms refer to the nature and direction of the blood carried by these vessels. In this manual we will examine eight of such vessels and their relationships with one another. It is these eight vessels that supply blood around the distal humerus and proximal radius and ulna bones. These structures and associated musculature form the elbow complex which is capable of a considerable amount of motion, and therefore requires a specialized vascular structure to allow for uninterrupted blood blow. The relationship between these eight vascular structures is as follows. 2. The middle collateral artery anastomoses with the interosseous recurrent artery. 3. The superior ulnar collateral artery anastomoses with the posterior ulnar recurrent artery. 4. The inferior ulnar collateral artery anastomoses with the anterior ulnar collateral artery. This arrangement can be more easily retained by employing the following device pronounced Rimsy Rippa: RMSI RIPA Where RMSI is an acronym denoting the the collateral branches of the brachial artery, and RIPA is an acronym denoting the recurrent branches of the radial and ulnar arteries. The letters of this device are arranged in vertical pairs based on the pairs of structures comprising each anastomosis. In other words, R pairs with R, M with I, S with P, and I with A. 1. The radial collateral artery anastomoses with the radial recurrent artery. 12

14 Arteries of the Hand 1. Radial artery a. palmar carpal branch b. superficial palmar arch a. palmar carpal branch b. dorsal carpal branch c. deep palmar arch c. princeps pollicis artery i. radialis indicis artery d. deep palmar arch i. palmar metacarpal arteries 2. Ulnar artery 3. Superficial palmar arch (continuation of ulnar a.) a. common palmar digital arteries b. palmar digital arteries 13

15 The list of structures on the previous page may be confusing due to the repetition of certain terms. You will find that certain structures, the deep palmar arch for example, appear as both radial and ulnar artery structures. This is due to the fact that some arterial branches connect to both the ulnar and radial artery, and therefore are listed in duplicate based on their origin. That s it! You have now mastered the arteries of the upper extremity. The structures may be numerous, but by using mnemonic devices and lots and lots of repetition, you can become an expert! Be sure to assess your knowledge by studying on cadavers in lab. You will find that the form and location of these structures vary, and sometimes dramatic differences may be found. That said, these notes present the arteries of the upper extremity in their most common arrangement, and although slight variations may be found, these notes should prepare you quite well for lab. 14