Nerve and Blood Supply of The Upper Limb

Nerve and Blood
Supply of the Upper

Extremities
Enrico C. Aguila, OTRP
August 7, 2009
OTPT 102: Applied Anatomy and

Kinesiology
College of Allied Medical Professions
University of the Philippines Manila
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This material was developed This material was developed for use by students
Learning Objectives:
§ At the end of the SGD and didactics, the
student should be able to:
§ Describe brachial plexus in terms of:
– Roots, trunks, divisions, cords and branches
– Pathway
– Motor distribution
– Sensory distribution
§ Describe the arterial and venous circulation of the
upper extremity in terms of:
– Vessels
– Pathway
– Distribution
– Function
§ Describe the lymphatic circulation of the upper
extremity.
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Brachial Plexus - Collection of nerves that enter
the upper extremities
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Lies partly in the neck and partly in
the axilla
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Gives rise to the nerves that
innervate the UE
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Functions
§Sensory innervation of skin and deep
structures such as joints
§Motor innervation of the muscles of the

UE
§Influence over the diameters of the

blood vessels by the sympathetic
vasomotor nerves
§Sympathetic secretomotor supply to the

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Parts
§Really Tired? Drink Coffee
Buddy!
§R = ROOTS (ventral rami) (5)

§T = TRUNKS (3)
§D = DIVISIONS (2)
§C = CORDS (3)
§B = BRANCHES (Many!!)
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Nerve roots
C5
C6
C7
C8
T1
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Trunks (formed by the roots in the
neck)
C5
C6
C7
Upper Middle
C8
T1
Lower
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Divisions (neck)
TRUNKS DIVISIONS
Anteri
U or
Posteri
ppe Anteri
or
Midd or
Posteri
le Anteri
or
L or
Posteri
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This material was developed
or
This material was developed for use by students
Cords – formed by the joining of the divisions
in the axilla
T D CORDS
A
Lateral
U P
A
M Medial
P
A
L P
Posterior
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Cords – give off branches (axilla)
Lateral Musculocutaneous
Median
Medial Ulnar
Thoracodorsal
Axillary
Posterior
Radial
Upper and lower
Subscapular
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Brachial MC
Plexus LPN
DS
C5 N SupS
N
A
Up nte L
pe ate
R
os r
P e
C6
rio
t
A
rio e
r
nt
P P M
C7 oste
M oste
iddl U L
T
rio te S S Ax
D
P
r S S
os
C8 N
N N
A Me
Lo nte dia
we M M
T1 M A
B
LT P B
C
N C U
Nerves of the Brachial Plexus
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Dorsal scapular (C5)
§Rhomboids minor
§Rhomboids major
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Long thoracic C5, C6, C7
§Serratus anterior
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Nerve to subclavius C5, C6
§Subclavius
§May give branch to the phrenic nerve
(accessory phrenic nerve)
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Suprascapular C5, C6
§Supraspinatus
§infraspinatus
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Lateral pectoral C5, C6, C7
§Pectoralis major
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Medial pectoral
§Pectoralis major
§Pectoralis minor
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Musculocutaneous C5, C6, C7
§Coracobrachialis
§Brachialis
§Biceps
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Upper subscapular C5, C6
§Subscapularis
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Lower subscapular C5, C6
§Subscapularis
§Teres major
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Thoracodorsal C6, C7, C8
§Latissimus dorsi
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Medial cutaneous nerve of arm
§Skin on medial side of distal one third of

arm
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Medial cutaneous nerve of
forearm
§Skin on medial side of forearm
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Axillary C5, C6
§Motor
– Teres minor
– Deltoid
§Sensory
– Skin over lateral part
of upper arm
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Radial C5, C6, C7, C8, T1
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Median nerve C5, C6, C7, C8, T1
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Ulnar C8, T1
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Innervation of Joints
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Sensorty innervation of the UE
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Sensory innervation of the hand
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Arterial supply of the UE
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Subclavian artery
§ Passes laterally deep

to the clavicle.
§ Becomes the axillary
artery as it passes
into the axillary
region.
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Axillary artery
§ Starts at the lateral

border of the first rib,
as a continuation of
the subclavian, and
ends at the lower
border of the axilla
(i.e. the lower border
of teres major) to
become the brachial
artery
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Branches of the axillary
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First Part of the Axillary Artery
§ between the lateral border of the first rib and the
superior border of the pectoralis minor muscle
§ enclosed in the axillary sheath along with the axillary

vein.
§ has only one branch, the supreme thoracic artery.
§ This artery helps to supply the first two intercostal

spaces and the superior part of the serratus anterior
muscle.
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Second Part of the Axillary Artery
§ This part of the artery lies deep to the pectoralis
minor muscle.
§ The lateral, medial and posterior cords of the brachial

plexus are so named respective to this part of the
axillary artery.
§ This part of the axillary artery has two branches, the

thoracoacromial and lateral thoracic arteries.
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The Thoracoacromial Artery
§ This is a short, wide trunk that arises from the axillary
artery deep to the pectoralis minor muscle.
§ It pierces the costocoracoid membrane, which is part

of the clavipectoral fascia.
§ It then divides into 4 branches (acromial, deltoid,

pectoral, and clavicular) deep to the clavicular head
of the pectoralis major muscle.
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The Lateral Thoracic Artery
§ This nerve descends along the axillary border of the
pectoralis minor muscle.
§ It supplies the pectoral muscles and the axillary

lymph nodes.
§ The lateral thoracic artery is large in women, and is

an important source of blood to the lower part of the
mammary glands.
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Third Part of the Axillary Artery
§ This part extends from the inferior border of the
pectoralis minor muscle to the inferior border of the
teres major muscle.
§ It has three branches, the anterior and posterior

circumflex humeral arteries and the subscapular
artery.
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Circumflex Humeral Arteries
§ These arteries pass around the surgical neck of the
humerus and anastomose with each other.
§ The anterior circumflex humeral artery passes
laterally, deep to the coracobrachialis and the biceps
brachii muscles.
§ It gives off an ascending branch that supplies the
shoulder, but the main artery winds around the
surgical neck of the humerus.
§ The larger posterior circumflex humeral artery passes
through the posterior wall of the axilla through the
quadrangular space.
§ It is accompanied by the axillary nerve to supply the
surrounding muscles.
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The Subscapular Artery
§ This is the largest branch of the axillary artery.
§ It descends along the lateral border of the
subscapularis muscle and divides into the circumflex
scapular artery and the thoracodorsal artery.
§ The circumflex scapular artery passes around the
lateral border of the scapula to supply muscles on the
dorsum of the scapula.
§ The thoracodorsal artery continues the general course
of the subscapular artery to supply adjacent muscles,
principally, the latissimus dorsi muscle.
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Axillary Artery
Subclavian A. Superior thoracic A.
1st Axillary A.
Thoracoacromial A.
lateral thoracic A.
2nd Axillary A.
Axillary A. Subscapular A.
anterior circumflex humeral A
3rd Axillary A.
posterior circumflex humeral A

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Brachial artery
§ This artery begins at the inferior border of the teres
major muscle as the continuation of the axillary
artery.
§ It runs inferiorly and slightly laterally on the medial
side of the biceps brachii muscle to the cubital fossa,
where it ends opposite the neck of the radius.
§ It is superficial and palpable throughout its whole
length.
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§ At first it lies medial to the humerus and then anterior
to it.
§ It lies anterior to the triceps brachii and brachialis
muscles, and is overlapped by the biceps brachii and
coracobrachialis muscles.
§ It accompanies the median nerve, which crosses it
anteriorly at the middle of the arm.
§ Under the cover of the bicipital aponeurosis, the
brachial artery divides into the radial and ulnar
arteries.
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Branches of the brachial artery
§ The brachial artery gives rise to many unnamed
muscular branches, mainly from its lateral side.
§ The named branches of the brachial artery are the
profunda brachii artery, the nutrient humeral artery,
and the ulnar collateral arteries (superior and
inferior).
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Profunda Brachii Artery
§ This is the largest branch of the brachial artery, and
has the most superior origin.
§ It accompanies the radial nerve in its posterior course
in the radial groove.
§ Posterior to the humerus, the profunda brachii artery
(or deep brachial artery) divides into anterior and
posterior ascending branches.
§ These help form the arterial anastomoses of the
elbow region.
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Ulnar collateraal arteries
Inferior Ulnar
Superior Ulnar Collateral Artery
Collateral Artery
§ This arises from the § This arises from the
brachial artery near the brachial artery about 5
middle of the arm. cm proximal to the
§ It accompanies the ulnar elbow crease.
nerve posterior to the § It then passes
medial epicondyle of the inferomedially, anterior
humerus. to the medial epicondyle
§ Here, it anastomoses of the humerus.
with the posterior ulnar § Here, it joins the
recurrent branch of the anastomoses of the
ulnar artery and the elbow region.
inferior ulnar collateral
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Branches of the brachial artery
§ profunda (accompanying the radial nerve);
§ superior ulnar collateral (accompanying the ulnar
nerve);
§ nutrient (to the humerus);
§ inferior ulnar collateral.
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Radial and ulnar arteries
§ brachial artery bifurcates proximal to the cubital fossa
into the radial and ulnar arteries.
§ supply the blood to the forearm and a portion of the
hand and digits.
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Radial artery
§ The radial artery courses down the lateral side of the
arm where it sends many small branches to the
forearm.
§ The radial recurrent artery is the first and largest
major branch of the radial artery which serves the
region of the elbow.
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Ulnar artery
§ The ulnar artery extends down the ulnar side of the
forearm and serves the medial side of the forearm
through many small branches.
§ The first large branch of the ulnar nerve is the ulnar
recurrent artery which arises from the proximal
portion near the elbow.
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§ Veins of the Upper extremity
§ Note: The veins of the upper extremity are classified
as either deep or superficial veins. The superficial
veins are highly variable and form an extensive
network just below the skin. The deep veins
accompany the arteries of the same region and bear
similar names. A brief summary of the two types of
veins follows.
§ Deep Veins of the Upper Extremity
§ The radial vein on the lateral side of the forearm and
the ulnar vein on the medial side drain blood form the
deep and superficial palmar arches of the hand. The
radial and ulnar veins join in the cubital fossa to form
the brachial vein which continues up the medial side
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§ Superficial Veins of the Upper Extremity
§ The main superficial vessels of the upper extremity
are the basilic and cephalic veins. The basilic vein
passes on the ulnar side of the forearm and the
medial side of the arm. Near the head of the
humerus, the basilic vein merges with the brachial
vein and forms the axillary vein. The cephalic vein
drains the superficial portion of the hand and forearm
on the radial side and continues p the lateral side of
the arm. In the shoulder region the cephalic vein
pierces the fascia and joins the axillary vein. Another
portion of the superficial vein is the median vein. It
ascends from the cephalic vein on the lateral side to
connect with the basilic vein on the medial side.
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Nerve and Blood

Supply of the Upper

OTPT 102: Applied Anatomy and

§Motor innervation of the muscles of the

§Influence over the diameters of the

§Sympathetic secretomotor supply to the

§R = ROOTS (ventral rami) (5)

§Skin on medial side of distal one third of

§ Passes laterally deep

§ Starts at the lateral

§ enclosed in the axillary sheath along with the axillary

§ has only one branch, the supreme thoracic artery.

§ This artery helps to supply the first two intercostal

§ The lateral, medial and posterior cords of the brachial

§ This part of the axillary artery has two branches, the

§ It pierces the costocoracoid membrane, which is part

§ It then divides into 4 branches (acromial, deltoid,

§ It supplies the pectoral muscles and the axillary

§ The lateral thoracic artery is large in women, and is

§ It has three branches, the anterior and posterior

Subclavian A. Superior thoracic A.

anterior circumflex humeral A

posterior circumflex humeral A

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