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Neurovasculature of the upper limbs

Last updated: April 18, 2021

Summarytoggle arrow icon

The arteries of the upper limb arise from the subclavian artery, a branch of the aortic arch. At the outer border of the 1st rib, the subclavian artery continues as the axillary artery, which is the main artery of the axillary fossa. At the inferior border of the teres major, the axillary artery continues as the brachial artery, the main artery of the arm. The brachial artery divides at the cubital fossa into the radial and ulnar arteries, the main arteries of the forearm and hand. The venous system of the upper limbs can be divided into a superficial and deep venous system. The cephalic vein, basilic vein, and medial antebrachial vein comprise the superficial venous system, which drains into the deep venous system. The deep veins accompany the arteries of the upper limbs and drain into the axillary vein; this continues as the subclavian vein and drains into the superior vena cava. The upper limb is innervated by nerves of the brachial plexus, a somatic neural network formed by the anterior branches of the spinal nerves C5–T1. The musculocutaneous, axillary, radial, ulnar, and median nerves are the most important sensorimotor nerves of the upper limb.

The upper limb is supplied by the axillary artery, which receives blood from the thoracic aorta via the subclavian artery and its branches.

Axillary artery [1][2]

Branches of the axillary artery

Overview of branches of the axillary artery
Vessel Origin Course Area of supply
Superior thoracic artery
  • 1st part
Thoracoacromial artery (thoracoacromial trunk)
  • 2nd part (first branch)
  • Runs posterior to the pectoralis minor muscle before piercing the clavipectoral fascia
  • Divides into four branches:
    • Pectoral branch
    • Deltoid branch
    • Acromial branch
    • Clavicular branch
Lateral thoracic artery
  • 2nd part (second branch)
Anterior humeral circumflex artery
  • 3rd part
Posterior humeral circumflex artery
Subscapular artery

Scapular anastomosis [2]

Overview of scapular arteries
Artery Origin Location
Dorsal scapular artery
Suprascapular artery
Circumflex scapular artery
Subscapular artery
Intercostal arteries

Brachial artery [1][2]

Overview of branches of the brachial artery
Vessel Course Area of supply
Deep artery of arm (profunda brachii)
Superior ulnar collateral artery
Inferior ulnar collateral artery
Middle ulnar collateral artery
  • Arises between the superior and inferior ulnar collateral arteries
  • Ensures collateral circulation to the skin by giving off perforator arteries
Nutrient artery of the humerus

The brachial artery can be compressed proximally against the medial humerus to stop bleeding in the distal arm.

The deep artery of the arm ensures collateral circulation through the elbow anastomosis in case of proximal brachial artery injury. Disruption of the brachial artery distal to the origin of the deep artery of the arm is associated with a greater degree of ischemia of the upper limb.

Radial artery

Overview of branches of the radial artery
Vessel Course Area of supply
Radial recurrent artery
Palmar carpal branch
Dorsal carpal branch
Superficial palmar branch
Deep palmar branch
First dorsal metacarpal arteries
  • Originates at the palmar aspect of the first intermetacarpal space
  • Divides into three branches: radial, intermediate, and ulnar
  • Radial branch to the thumb
  • Intermediate branch to the first web space
  • Ulnar branch to the second digit
Radialis indicis artery (radial artery of the index finger)
  • Originate at the webspace between the thumb and index finger
  • Run across the dorsal aspect of the hand
  • Radial (lateral) aspect of the second digit
Princeps pollicis (principal artery of the thumb)
  • The thumb

The Allen test evaluates patency of the collateral circulation to the hand through the radial and ulnar arteries.

Ulnar artery

Overview of branches of the ulnar artery
Vessel Course Area of blood supply
Ulnar recurrent arteries Anterior
Posterior
Common interosseous artery
  • Originates at the forearm
  • Divides immediately into the anterior and posterior interosseous arteries
  • Runs through the interosseus membrane of the forearm
Palmar carpal branch
Dorsal carpal branch
Deep palmar branch
Superficial palmar branch
  • Ulnar aspect of the index finger and third and fourth digits

Anastomosis within the hand

Overview [1]

Overview of veins of the upper limb
Veins Origin Course Termination Main tributaries Drains
Superficial veins
Cephalic vein
  • Along the lateral aspect of the forearm and arm
Basilic vein
Median antebrachial vein
  • Palmar venous network of the hand
  • Along the central aspect of the ventral forearm
Median cubital vein
  • The hand, wrist, and forearm
Deep veins
Radial veins
  • The lateral aspect of the forearm and hand
Ulnar veins
  • The medial aspect of the forearm and hand
Brachial veins
  • The arm, forearm, and hand
Axillary vein

Overview

The nerves of the upper limb are derived from the brachial plexus.

Brachial plexus

  • Definition: a somatic neural network derived from C5–T1 spinal nerves, from which the peripheral nerves of the upper limb arise
  • Composition: The brachial plexus is composed of roots, trunks, divisions, cords, and branches (proximal to distal).

Rugby Teams Drink Cool Beer!”: Roots, Trunks, Divisions, Cords, Branches (order of the brachial plexus divisions)

Roots

Nerves that arise from the roots of brachial plexus
Nerve

Dorsal scapular nerve

Long thoracic nerve

Nerve root
  • C5
  • C5–C7
Function
  • Motor nerve
Course
Innervation

Trunks

Nerves that arise from the upper trunk of brachial plexus
Nerve

Subclavian nerve

Suprascapular nerve

Nerve root
  • C5–C6
  • C4–C6
Function
  • Motor nerve
Course
Innervation

Divisions

  • Each trunk divides into an anterior and posterior division that enters the axillary fossa.
  • All three posterior divisions innervate the extensor compartment of the arm and forearm (i.e., the posterior compartment).
  • All three anterior divisions innervate the flexor compartment of the arm and forearm (i.e., the anterior compartment).

Cords

Branches [2]

Branches are the peripheral nerves that arise from each of the cords of the brachial plexus. The five most clinically significant branches of the brachial plexus are the musculocutaneous, axillary, median, radial, and ulnar nerves.

Lateral cord of the brachial plexus

Lateral cord and branches of the brachial plexus
Branches of the brachial plexus Spinal roots Course Motor innervation Sensory innervation
Musculocutaneous nerve
  • C5–C7
Lateral pectoral nerve
  • None
Lateral root of median nerve
  • Radial ⅔ of the palm
  • Palmar aspect of the radial 3 ½ fingers (i.e., the thumb, index finger, middle finger, and radial side of the ring finger)
  • Dorsal aspect of the distal phalanges of the radial 3 ½ fingers
  • Autonomous sensory zone: tip of the index finger

Medial cord of the brachial plexus

Medial cord and branches of the brachial plexus
Branches of the brachial plexus Spinal roots Course Motor innervation Sensory innervation
Medial root of median nerve
  • C8–T1
Medial pectoral nerve
  • None
Medial brachial cutaneous nerve (medial cutaneous nerve of arm)
  • None
  • Inferomedial aspect of the arm

Medial antebrachial cutaneous nerve (medial cutaneous nerve of forearm)

  • None
Ulnar nerve
  • Ulnar ⅓ of the palm
  • Palmar and dorsal aspects of the ulnar 1 ½ fingers (i.e., the little finger and the ulnar side of the ring finger)
  • Autonomous sensory zone: tip of the little finger

Branches from the medial and lateral cords form the median nerve.

Posterior cord of the brachial plexus

Posterior cord and branches of the brachial plexus
Branches of the brachial plexus Spinal roots Course Motor innervation Sensory innervation
Upper subscapular nerve
  • C5
  • None
Radial nerve
  • C5–T1
Axillary nerve
  • C5-C6
Lower subscapular nerve
  • C6–C8
  • None
Thoracodorsal nerve
  • C6
  • None

Disorders

Procedures

  • Site for intravenous access or cannulation, especially the median cubital and cephalic veins
  • Brachial arterial pressure: site for measuring blood pressure
  • Pectoral nerve block
  • Brachial plexus block
  1. Standring S. Gray's Anatomy: The Anatomical Basis of Clinical Practice. Elsevier Health Sciences ; 2016
  2. Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. Lippincott Williams & Wilkins ; 2013