Brachial artery (a. brachialis)(see atl.) begins at the lower edge of the large pectoral muscle and lies superficially on the shoulder, medial to the biceps muscle. The pulsation of the artery can be felt along almost its entire length and is easy to find to stop the bleeding.

The brachial artery, within its upper third, gives off deep brachial artery which goes around the humerus and nourishes triceps muscle, and then gives branches to the muscles of the anterior group of the shoulder (coracobrachialis, brachialis, biceps, deltoid) and to humerus. In addition, the brachial artery gives off branches descending to elbow joint– superior and inferior ulnar collateral arteries.

Radial artery (a. radialis), continuing the direction of the shoulder, runs parallel radius. At the distal end it is located so superficially that its pulsation is easily palpable. Having passed the styloid process of the radius, the artery turns to the back of the hand (see Atl.), from where it returns through the first intermetacarpal space to the palm, where it passes into the deep palmar arch. The radial artery gives branches to the muscles of the forearm, to the palmar and dorsal networks of the wrist, to the superficial palmar arch, to the thumb, and also radial recurrent artery to the elbow joint, which takes part in the formation of its vascular network.

Ulnar artery (a. ulnaris)(see Atl.) larger in diameter than the radius, descends along the ulna to the wrist joint. It is located between the superficial and deep layers of the muscles of the forearm. Lateral to the pisiform bone, the artery gives off a branch to the deep palmar arch, and itself passes into the superficial palmar arch, connecting by anastomosis with the branches of the radial artery. The branches of the ulnar artery supply the muscles of the anterior and rear groups forearms, participate in the formation of the dorsal and palmar network of the wrist, feed the radius and ulna bones, called ulnar recurrent artery rise to the area of ​​the elbow joint.

Thus, a rich network of roundabout (collateral) blood circulation is formed in the area of ​​the elbow joint. The branches of all three arteries anastomosing with each other - brachial, ulnar and radial - take part in the formation of the network.

Radial artery, a. radialis, begins distal to the gap of the humeroradial joint. It lies between the pronator teres and the brachioradialis muscle. The terminal section of the radial artery forms deep palmar arch, areas palmaris profundus. From this arc they originate palmar metacarpal arteries, aa. metacarpales palmares, blood supply to interosseous muscles. These arteries flow into the common palmar digital arteries (branches of the superficial palmar arch) and give off perforating branches, rr. perfordntes.

Many branches arise from the radial artery. The most significant of them are the following: 1) radial recurrent artery, a. hecurrens radialis, originates from the initial section of the radial artery; 2) superficial palmar branch, g. palmaris superficidlis, participates in the formation of the superficial palmar arch; 3) palmar carpal branch, d. carpalis palmaris, starts from the radial artery in the distal part of the forearm and participates in the formation of the palmar network of the wrist; 4) dorsal carpal branch, g. carpalis dorsalis, starts from the radial artery on the back of the hand, forms together with the branches of the interosseous arteries dorsal network of the wrist, rete carpdle dorsale. They are moving away from this network dorsal metacarpal arteries, aa. metacarpales dorsales, and from each of them - two dorsal digital arteries, aa. di-gittles dorsales, supplying blood to the dorsum of fingers II-V. On the back of the hand it separates from the radial artery first dorsal metacarpal artery, aa. metacarpalis dorsalis I, which gives off branches to the radial side of the first finger and to the adjacent sides of the first and second fingers. Having penetrated the palm, the radial artery gives off artery thumb brushes, a. princeps pollicis, which splits into two palmar digital arteries to both sides of the thumb and gives off radial artery of the index finger, a. radialis indicis.

Ulnar artery,a. ulnaris, from the ulnar fossa goes under pronator teres, giving muscular branches to it. In the palm, the ulnar artery forms superficial palmar arch, arcus palmaris superficialis. Branches depart from the ulnar artery: 1) muscle branches, rr. musculares, to the muscles of the forearm; 2) ulnar recurrent artery, a. recurrens ulnaris, departs from the beginning of the ulnar artery and is divided into anterior and posterior branches; 3) common interosseous artery, a. interossea communis, divided into anterior and posterior interosseous arteries. Anterior interosseous artery, a. interossea anterior, gives off a branch to the palmar network of the wrist and takes part in the formation of the dorsal network of the wrist. On the forearm she gives artery accompanying the median nerve, a. cotnitans nervi mediani. Posterior interosseous artery, a. interossea posterior, gives away recurrent interosseous artery, a. interossea recurrents, and participates in the formation of the elbow joint network ; 4) palmar carpal branch, g. carpalis palmaris, departs from the ulnar artery at the level of the styloid process of the ulna and participates in the formation of the palmar network of the wrist, supplying blood to the joints of the latter; 5) deep palmar branch, g. palmaris profundus, It arises from the ulnar artery near the pisiform bone and supplies the muscles of the eminence of the little finger and the skin over the little finger. The terminal section of the ulnar artery forms superficial palmar arch, arcus palmaris superficialis. They depart from this arc common palmar digital arteries, aa. digitales palms communes, and from them - own digital arteries, aa. digitales palmares propriae, to adjacent sides of adjacent fingers

Brachial artery, a. brachialis, is a direct continuation of the axillary artery. Starting at the bottom edge of m. teres major, it stretches in the sulcus bicipitalis to the elbow bend, where at the level of the neck of the radial bone it divides into its final branches - the radial and ulnar arteries. On its way to the sulcus bicipitalis medialis it is accompanied by two brachial veins and nerves (n. medianus, n. ulnaris, n. cutaneus brachii medialis et n. cutaneus antebrachii medialis). In addition to small branches to bone and muscles, the brachial artery gives off the following branches:

1. A. profunda brachii, deep brachial artery, moving away from a. brachialis shortly after the start of the last one; is a large branch, which, together with p. radialis, passes into the canalis humeromuscularis, gives off on the way the artery that feeds the humerus (a. diaphyseos humeri), and breaks up into a. collateralis media, penetrating into the thickness of m. triceps and anastomosing with a. interossea recurrens (from a. interossea posterior), And a. collateralis radialis; the latter comes to the surface through the lower opening of the spiral canal, goes anterior to epicondylus lateralis and anastomoses with a. recurrens radialis (branch of a. radialis). The deep brachial artery often (50%) arises along with other branches of the brachial or axillary arteries or (30%) is absent.

2. A. collateralis ulnaris superior, superior ulnar collateral artery, moves away from brachial artery in the middle of the shoulder, descends into the groove behind the epicondylus medialis, where it anastomoses with a. recurrens ulnaris posterior (branch of a. ulnaris).

3. A. collateralis ulnaris inferior, inferior ulnar collateral artery, departs from the brachial artery approximately 5 cm above the end of the latter and anastomoses anteriorly from the epicondylus medialis with a. recurrens ulnaris anterior (branch of a. ulnaris).

17. Arteries of the forearm: topography, branches and areas of blood supply. Blood supply to the elbow joint. Radial artery, a. radialis, in direction it is a continuation of the brachial artery. It goes medially from m. brachioradialis, first covered by it, and then in the sulcus radialis; in the lower third of the forearm, where the muscles turn into tendons, radial artery It is covered on the surface only by fascia and skin, which is why it is easily accessible for studying the pulse. Having reached the apex of the styloid process of the radius, a. radialis goes to the back, going around the lateral edge of the wrist and lying in the so-called snuff box, from where it comes out onto the palm in the first interosseous space between the bases of the I and II metacarpal bones. On the palm is the radial artery along with the deep branch of a. ulnaris forms arcus palmaris profundus - a deep palmar arch.

Branches of the radial artery:

1. A. recurrens radialis, recurrent radial artery, begins in the cubital fossa, goes proximally to the anterior surface of the lateral epicondyle, where it anastomoses with the above a. collateralis radialis from a. produnda brachii.

2. Rami musculares- to the surrounding muscles.

It begins in the lower part of the forearm and goes to the ulnar side towards a similar branch from a. ulnaris. From anastomosis with ramus carpeus palmaris a. ulnaris on the palmar surface of the wrist is formed by rete carpi palmare.

4. Ramus palmaris superficialis, superficial palmar branch, passes over the thenar or pierces its superficial layers and, connecting with the end of the ulnar artery, enters the arcus palmaris superficialis.

5. Ramus carpeus dorsalis, dorsal carpal branch, departs in the area of ​​the “snuffbox” and with the branch of the same name a. ulnaris forms a network on the back of the wrist, rete carpi dorsale, which also receives branches from the interosseous arteries (aa. interosseae anterior et posterior).

6. A. metacarpea dorsalis prima, first dorsal metacarpal artery, goes on the back of the hand to the radial side of the index finger and to both sides of the thumb.

7. A. princeps pollicis, first artery of the thumb, departs from the radius as soon as the latter penetrates through the first interosseous space into the palm, runs along the palmar surface of the first metacarpal bone and is divided into branches, aa. digitalis palmares, to both sides of the thumb and to the radial side of the index finger.

Ulnar artery, a. ulnaris, represents one of the two terminal branches (larger) of the brachial artery. From the starting point to cubital fossa(against the neck of the radius) it fits under m. pronator teres, goes obliquely to the middle third of the forearm, deviating to the ulnar side. In the lower two-thirds it runs parallel to the ulna, first in the space between m. flexor digitorum superficialis, etc. flexor carpi ulnaris, in the lower third, due to the transition of muscles into tendons, its position becomes more superficial (sulcus ulnaris). At the radial side of the pisiform bone, the ulnar artery passes into the canalis carpi ulnaris (spatium interaponeuroticum) and, passing to the palm, is part of the arcus palmaris superficialis.

Branches of the ulnar artery:

1. A. recurrens ulnaris, recurrent ulnar artery, gives two branches - rami anterior et posterior, which pass in front and behind the medial epicondyle, anastomosing with ah. collaterals ulnares superior et inferior. Thanks to these anastomoses, as well as the above anastomoses between the branches of a. profunda brachii and a. radialis in the circumference of the elbow joint, an arterial network is obtained - rete articulare cubiti.

2. A. interossea communis, common interosseous artery, goes to the interosseous membrane, at the proximal edge of which is divided into two branches: a) a. interossea anterior along the anterior surface of the interosseous membrane reaches m. pronator quadratus, pierces the membrane and goes to the rear, where it ends in rete carpi dorsale. At the beginning of my journey a. interossea anterior gives a. mediana (directed to the palm together with p. medianus), ah. diaphyseos radii et ulnae- to the bones of the forearm and rami musculares - to the surrounding muscles; b) a. interossea posterior passes through the upper opening of the interosseous membrane to the back side, gives off a. interossea recurrences, lies between the superficial and deep layers of the extensors and in the wrist area anastomoses with a. interossea anterior.

3. Ramus carpeus palmaris, palmar carpal branch, goes towards the branch of the same name of the radial artery, with which it anastomoses.

4. Ramus carpeus dorsalis, dorsal carpal branch, departs near the pisiform bone, goes under m. flexor carpi ulnaris on the back side towards the branch of the same name a. radialis.

5. Ramus palmaris profundus, deep palmar branch, penetrates under the tendons and nerves of the palm and together with a. radialis (see above) is involved in the formation of a deep palmar arch.

Blood supply to the elbow joint carried out through the rete articulare cubiti, formed by the branches of a. brachialis, a. radialis and a. ulnaris. Venous outflow goes through the veins of the same name.

18. Arteries of the hand. Arterial palmar arches and their branches. Arches and arteries of the hand. Superficial palmar arch. Deep palmar arch.

In the wrist area there are two networks: one palmar, rete carpi palmare, the other dorsal, rete carpi dorsale.

Rete carpi palmare formed from the connection of the palmar carpal branches of the radial and ulnar arteries (see above) and branches from the anterior interosseous. The palmar carpal network is located on the ligamentous apparatus of the wrist under the flexor tendons; its branches nourish the ligaments and articulationes mediocarpea et radiocarpea.

Rete carpi dorsale formed from the connection of the dorsal carpal branches of the radial and ulnar arteries and branches from the interosseous; located under the extensor tendons and gives branches: a) to the nearest joints (gg. ag-ticuldres), b) in the second, third and fourth interosseous spaces (aa. te-tacarpeae dor sales); at the base of the fingers, each of them is divided into branches to the fingers (aa. digitales dorsdles).

axillary artery,a. axllldris (Fig. 50), is a continuation of the subclavian artery (from the level of the 1st rib), located in the depths of the axillary fossa and surrounded by the trunks of the brachial plexus. At the lower edge of the tendon latissimus muscle of the back, the axillary artery passes into the brachial artery. According to the topography of the anterior wall of the axillary fossa, the axillary artery is conventionally divided into three sections. In the first section, at the level of the clavipectoral triangle, the following arteries depart from the axillary artery: 1) subscapular branches, rr. sub scapulares, branch in the muscle of the same name; 2) superior thoracic artery, a. thoracica superior, breaks up into branches that go to the first and second intercostal spaces, where they supply blood to the intercostal muscles, and also gives off thin branches to the pectoral muscles; 3) thoracocromial artery, thoraco- acromidlis, departs from the axillary artery above the upper edge of the pectoralis minor muscle and splits into 4 branches: acromial branch, g.acromidlis, takes part in the formation of the acromial network, from which the acromioclavicular joint, as well as partially the capsule, is supplied with blood shoulder joint; clavicular branch, g.claviculdris, non-permanent, nourishes the clavicle and subclavian muscle; deltoid branch, g.deltoideus, supplies blood to the deltoid and pectoralis major muscles and the corresponding areas of the skin of the chest; thoracic branches,rr. pectordles, directed to the pectoralis major and minor muscles.

In the second section, at the level of the thoracic triangle, the lateral thoracic artery, a. Thordcica laterlis. It descends down the outer surface of the serratus anterior muscle, where it branches. This artery also gives off lateral branches of the mammary gland,rr. mammdrii laterdles.

In the inframammary triangle (third section), three arteries depart from the axillary artery: 1) subscapular artery, a. subscapuldris, - the largest; divided by thoracodorsal arterya. thoracodorsdlis, which follows along the lateral edge of the scapula. It supplies the serratus anterior and teres major muscles, as well as the latissimus dorsi; And circumflex scapula arterya. circumflexa scapulae, which passes through a three-way hole on back surface scapula to the infraspinatus muscle and to other neighboring muscles, as well as to the skin of the scapular region; 2) the anterior circumflex artery of the humerus, a. circumflexa anterior humeri, passes in front of the surgical neck of the shoulder to the shoulder joint and to the deltoid muscle; 3) posterior circumflex humeral arterya. circumflexa posterior humeri, larger than the previous one, together with the axillary nerve, it is directed through the quadrilateral foramen to the deltoid muscle, anastomoses with the branches of the anterior artery, which bends around the humerus, and supplies blood to the shoulder joint and adjacent muscles.

Brachial arterya. brachidlis (Fig. 51), is a continuation of the axillary artery. It begins at the level of the lower edge of the pectoralis major muscle, where the brachial artery lies in front of the coracoid brachialis muscle. The artery is then located on the anterior surface of the brachialis muscle, in a groove passing medial to the biceps brachii muscle.

In the cubital fossa, at the level of the neck of the radius, the brachial artery divides into its terminal branches, the radial and ulnar arteries. A number of branches depart from the brachial artery: 1) muscle branches, rr. muscles, to the shoulder muscles; 2) deep brachial artery, a. profunda brdchii, starts from the brachial artery in the upper third of the shoulder, goes along with the radial nerve in the brachiomuscular canal between the posterior surface of the humerus and the triceps brachii muscle, where it gives off several branches: arteries supplying the humerus, aa.nutriciae hiimeri, deltoid branch, g.deltoideus, to the muscles of the same name and brachialis, middle collateral arterya. collateralis media, which gives branches to the triceps brachii muscle, passes in the posterior lateral ulnar groove and anastomoses with the recurrent interosseous artery, and radial collateral artery,a. colla­ teralis radidlis, which goes to the anterior lateral ulnar groove, where it anastomoses with the radial recurrent artery; 3) superior ulnar collateral artery, a. collateralis ulnaris superior, starts from the brachial artery below the deep artery of the shoulder. It accompanies the ulnar nerve, lies in the medial posterior ulnar groove, anastomoses with the posterior branch of the ulnar recurrent artery; 4) inferior ulnar collateral artery, a. collateralis ulnaris inferior, starts from the brachial artery just above the medial epicondyle of the humerus, runs medially along the anterior surface of the brachialis muscle and anastomoses with the anterior branch of the ulnar recurrent artery. All collateral arteries participate in the formation of the ulnar joint network, from which the elbow joint, adjacent muscles and skin in the area of ​​this joint are supplied.

16. Arteries shoulder girdle and free upper limb, branches, topography, areas of blood supply, anastomoses

Brachial artery is a continuation of the axillary, runs along the internal groove of the shoulder, supplies blood to the muscles and skin of the shoulder, the elbow joint, going down, gives the largest branch - the deep artery of the shoulder, which forms the upper and lower ulnar collateral arteries. In the cubital fossa, the brachial artery divides into the radial and ulnar arteries, which pass into the superficial and deep palmar arches. The brachial artery supplies blood to the muscles and skin of the shoulder, elbow joint, and skin in the area of ​​this joint.

Radial artery located on the front surface of the forearm, then moves to the back of the hand and palm, where it participates in the formation of a deep palmar arch. In the lower third of the forearm, the artery lies superficially, subcutaneously and can be easily palpated between the styloid process of the radius and the tendon radial muscle to determine the pulse. The branches of the artery extend to the elbow joint, muscles of the forearm and hand.

Ulnar artery passes between the anterior muscles. mi forearm, then to the palm, where it connects with the branch of the radial artery, forms the superficial palmar arch.

Table of contents of the topic "Shoulder joint (articulatio humeri). Anterior region of the shoulder.":
1. Shoulder joint (articulatio humeri). External landmarks of the shoulder joint. Projection of the joint space of the shoulder joint.
2. Anatomical neck of the humerus. Surgical neck of the humerus. Articular capsule of the shoulder joint.
3. Fibrous layer of the joint capsule. Ligaments of the shoulder joint. Muscles that strengthen the shoulder joint.
4. Synovial bursae of the shoulder joint. Topography of the synovial bursae of the shoulder joint. Ways of spread of purulent processes in the shoulder joint.
5. Collateral circulation in the area of ​​the shoulder girdle. Scapular arterial collateral circle. Occlusion of the axillary artery. Impaired blood flow in the axillary artery.
6. Anterior shoulder area. External landmarks of the anterior shoulder area. Boundaries of the anterior region of the shoulder. Projection onto the skin of the main neurovascular formations of the anterior region of the shoulder.
7. Layers of the anterior region of the shoulder. Anterior fascial bed of the shoulder. Muscle Casserib. Posterior fascial bed of the shoulder. Walls of the fascial bed of the shoulder.

9. Connection of the fiber of the anterior region of the shoulder with neighboring areas. Holes in the anterior region of the shoulder. Messages from the anterior shoulder area.

In the upper third of the shoulder n. medianus located next to the artery lateral to it. Medial to the artery lies n. ulnaris and even more medially - n. cutaneus antebrachu medialis. Inward from the main bundle, v is the most medial and superficial. basilica, which joins the bundle at the border of the upper and middle thirds, immediately after exiting Pirogov channel. In the upper third of the shoulder, this vein flows either into one of the brachial veins, or passes into the axillary region and flows into the axillary vein (Fig. 3.17).

N. musculocutaneus exits from the lateral side of the coracobrachialis muscle, which it pierces on the way from the axillary fossa to the anterior surface of the shoulder, and goes under long head biceps brachii muscle, and at the border with the middle third lies on the deep fascia covering the brachialis muscle. On its way, it gives off branches to all the muscles of the anterior fascial bed.

At the border of the anterior region of the shoulder and the axillary region, immediately below the lower edge of the tendon of the latissimus dorsi muscle behind the artery, a large trunk n. radialis. Almost immediately it is directed to the posterior fascial bed between the long and lateral heads of the triceps brachii muscle.

Rice. 3.17. Anterior surface of the shoulder. 1 - v. brachialis; 2, 5 - a. brachialis; 3 - v. cephalica; 4 - n. musculocutaneus; 6 - a. profunda brachii; 7 - n. radialis; 8 - Pirogov channel; 9 - n. ulnaris; 10-n. medianus; 11 - v. basilica; 12 - n. cutaneus antebrachii medialis.

Brachial artery in the upper third of the shoulder it gives off a large branch - deep brachial artery, a. profunda brachii, which almost immediately goes along with the radial nerve into the posterior fascial bed. At the border of the upper and middle third of the shoulder, another branch departs from the brachial artery: superior ulnar collateral artery, a. collateralis ulnaris superior, which further accompanies the ulnar nerve.

In the middle third of the shoulder n. medianus located in front of the brachial artery (crossing it).

N. ulnaris moves even more medially from the artery and, at the border with the upper third, pierces the medial intermuscular septum, passing into the posterior bed of the shoulder. Along with him comes a. collateralis ulnaris superior.

N. cutaneus antebrachii medialis also leaves the anterior fascial bed, entering the splitting of its own fascia (Pirogov channel), from where v emerges into the subfascial space. basilica

N. musculocutaneus is directed obliquely from top to bottom and from the inside to the outside between the biceps and brachialis muscles.

In the lower third of the shoulder n. medianus is already located medial to the artery, but next to it. Another branch departs from the artery here: a. collateralis ulnaris inferior. It goes obliquely down the surface of the brachial muscle to the ulnar region (the name of the artery is not associated with the ulnar nerve, which no longer exists in the anterior bed, but designates only the ulnar side of the limb), where it takes part in the formation of the ulnar collateral network.

On the lateral side of the lower third of the shoulder in the anterior bed, n. radialis. which pierces the lateral intermuscular septum and passes from the posterior to the anterior bed. It is located deep between the muscles: the brachialis and the lateral head of the triceps. At the border with the ulnar region, it lies just as deep, but already between the brachialis and brachioradialis muscles. In these intermuscular spaces the nerve travels accompanied by the radial collateral artery, a. collateralis radialis, - terminal branch of a. profunda brachii.

Here, at the border of the lower third of the shoulder with the anterior ulnar region, the terminal muscle emerges from under the biceps brachii muscle. branch of the musculocutaneous nerve, which here is called “lateral cutaneous nerve forearms", n. cutaneus antebrachii lateralis. It emerges from under its own fascia into the subcutaneous tissue distally, within the anterior ulnar region.

Thus, in within the anterior fascial bed of the shoulder along the entire length there are only the brachial artery with veins (closest to the bone), the median nerve and the musculocutaneous nerve. The median nerve does not give off branches on the shoulder. The remaining neurovascular formations pass either into the posterior bed ( radial nerve with the deep brachial artery in the upper third, the ulnar nerve with the superior ulnar collateral artery in the lower third), or into the subcutaneous tissue of the shoulder.

Educational video of the anatomy of the axillary, brachial arteries and their branches