Blood supply, venous
and lymphatic drainage,
Brachial plexus
Ruqayyah Ibiyeye (PhD)
Arterial blood supply to the Upper
limb Arch of aorta
Axillary artery Brachiocephalic trunk
Left common carorid
Part 1: Superior thoracic Left subclavian artery
artery
Part 2: Acromiothoracic trunk
& lateral thoracic artery Left subclavian artery
Part 3: anterior circumflex Axillary artery (lateral border of Brachial artery
humeral artery, posterior the 1st rib) • Profunda brachii
circumflex humeral artery & (Radial & middle
Brachial artery ( lower border of Teres
the subscapular artery collateral)
Major muscle) • Humeral nutrient
Radial artery artery
N.B: Subscapular artery is the Ulnar artery • Superior ulnar
largest branch with 2 brs. collateral artery
• Circumflex scapular artery N.B. Ends at the neck of the radius • Inferior ulnar
• Thoracodorsal artery collateral artery
Ulnar artery
Radial artery Ulnar recurrent artery
Radial recurrent artery Anterior interosseous artery
Posterior interosseous artery
Dorsal carpal arch Dorsal Dorsal digital
metacarpal
Deep ulnar arch
Superficial palmar arch Palmar
metacarpal
Common
Proper palmer
palmar digital
digital
Venous drainage of the Upper limb
• Superficial veins: it found in subcutaneous. It drains the superficial fascia
• Deep veins: IT accompanies tge arteries as the vena comitantes. It drains
tissues beneath the deep fascia.
• The deep and superficial veins are connected by perforating veins
• Superficial veins: Dorsal venous network—Cephalic vein(t)—Basilic Vein(L):
Both are connected by median cubital vein. The terminate into the axillary
vein
• Palmar venous network—median antebrachial vein; they drain into the
basilic vein
• Deep veins: Radial vein—dorsal metacarpal vein
Ulnar vein-palmar venous arch
Brachial vein—joins basilic vein to form axillary vein, empties into subclavian
vein
Brachial Plexus
• Introduction: It is a network of nerves that innervates the upper
limb. It consists of the roots, trunks, divisions, cords and branches,
from medial laterally It has five roots commonly formed by ventral
rami of C5, C6, C7, C8 and T1. (C4,T2).
• It is defined as having a superomedial supraclavicular part, which
lies above the clavicle, in the posterior triangle of the neck; and an
inferolateral infraclavicular part, which lies below the clavicle, in the
axilla
• Supraclavicular part: It comprises the roots and trunks of the
brachial plexus
• Infraclavicular part: It consists of cords of the brachial plexus and
the branches that arise from these cords (in the axilla)
Roots of the Brachial Plexus: The roots of the brachial plexus. They are
usually formed by the ventral rami of C5, C6, C8 and T1 spinal nerves. It pass
laterally, between scalene medius (behind) and scalene anterior (anteriorly), to
enter the posterior triangle of the neck. In the latter, they lie above the 3 rd part
of the subclavian artery
Branches from the root of the brachial plexus
• Dorsal scapular nerve (C5) -- Levator scapulae, rhomboid major and
rhomboid minor
• Long thoracic nerve (C5, C6, C7) –Serratus Anterior
• Nerves to scalene anterior, scalene medius, scalene posterior and longus colli
muscles (C5, C6, C7 and C8)
• A ramus to phrenic nerve (C5)—Scalene Anterior
Trunks of the Brachial Plexus: There are 3 trunks formed by the brachial plexus namely
the Superior, middle and the inferior trunk. They all lie in the lower part of the posterior
triangle of the neck, above the 3rd part of the subclavian artery, although the inferior trunk,
lies behind the subclavian artery
• Superior trunk is formed by unity of C5 and C6 spinal nerves
• Middle trunk is formed by C7 spinal nerve
• Inferior trunk is formed by the unity of C8 and T1
Branches of the trunks of the brachial plexus include:
Suprascapular nerve (C5, C6); and
Nerve to subclavius (C5, C6)
Divisions of the Brachial Plexus: It is usually at the medial 2/3rd of the clavicle. Each
trunk of the brachial plexus divides into anterior and posterior division. The anterior
divisions innervate flexor muscles of the upper limb; while the posterior divisions
innervate extensor muscles
Cords of the Brachial Plexus: There are three cords of the brachial plexus.
They arise from the union of the divisions of the brachial plexus. They are
designated as medial, lateral and posterior cords. They are all located in the
axilla, in close relation to the axillary vessels. The nomenclature of the
cords is in relationship with the axilla artery
• Lateral cord: It is formed by the union of the anterior divisions of the
upper and middle trunks of brachial plexus.
• Medial cord: It is the direct continuation of the anterior division of the
lower trunk of brachial plexus
• Posterior cord: It is formed by the union of the three posterior divisions
of the trunks of brachial plexus
Branches of the Lateral cord of the Brachial Plexus (C5, C6, C7)
• Lateral pectoral nerve: pectoralis major, minor and shoulder joint
• Musculocutaneous nerves: coracobrachialis, bicep brachii, brachialis and elbow joint
• Lateral root of median nerve
Branches of the Medial cord of the Brachial Plexus (C8, T1)
• Medial root of median nerve
• Medal pectoral nerve: pectoralis major and pectoralis minor
• Medial cutaneous nerves of the arm: skin of the distal half of the medial aspect of the
arm
Medial cutaneous nerves of the forearm: skin of the distal part of the anterior aspect of
the arm (via its anterior branch), and that of the medial and adjoining anterior and
posterior surfaces of the forearm, down to the wrist, via both branches
• Ulnar nerve:
Branches of the posterior cord of the brachial plexus
· Upper subscapular nerves (C5, C6): Subscapularis and Shoulder joint
· Lower subscapular nerves (C5, C6): inferolateral part of subscapularis
and teres major
Thoracodorsal nerve (C5, C7, C8): Latissimus dorsi
Axillary (C5, C6): deltoid muscle, skin over the lower part of deltoid and
lateral head of triceps, down to the middle of the arm
· Radial nerves (C5-T1):
Applied anatomy of the Brachial
Plexus
• Brachial block: This is the anaesthesia of the larger part of the upper limb. It can be effected
by injecting an anaesthetic into the angle between the clavicle and the posterior border of
sternocleidomastoid
• Erb-Duchenne palsy: It involves injury to the upper trunk of the plexus. The arm hangs
loosely at the side, with the forearm pronated, while the elbow is extended (‘waiter’s tip
position’). This is due to paralysis of deltoid, biceps brachii, brachialis and brachioradialis;
anaesthesia of lateral aspect of the limb also occurs
• Klumpke’s palsy: It is injury to the lower trunk of the brachial plexus. This produces paralysis
of the muscles of the forearm and hand, resulting in clawhand. Cervical sympathetic nerves are
also involved, resulting in pupillary disturbances. Erb-Duchenne palsy has a higher frequency
than Klumpke’s palsy
• Hyperabduction syndrome of the upper limb: the brachial plexus and axillary vessels are
compressed between the coracoid process and pectoralis minor; this produces pain in the limb
• Crutch palsy: it involves damage to the radial nerve in the axilla. This results from repeated
pressure of the crutch on the radial nerve, and is characterised by paralysis of extensor muscles
of the wrist, fingers and thumb.
