Brachial artery topography. Brachial artery, topography, branches, areas of blood supply
Brachial artery, a. brachialis, is a direct continuation of the axillary artery. It begins at the level of the lower edge of the pectoralis major muscle, lies in front of the coracobrachialis muscle, then in the medial ulnar groove, on the surface of the brachialis muscle. Following the muscle down, the brachial artery reaches the cubital fossa. Here it lies in the groove between the round pronator and the brachioradialis muscle under the aponeurosis of the biceps of the shoulder and is divided into two branches: the radial artery a. radialis, and ulnar artery, a. ulnaris. Sometimes, as a branching option, a. brachialis is divided into terminal branches above the anterior ulnar region, lying subcutaneously, and is called the superficial brachial artery, a. brachiatis superficialis.
The brachial artery is accompanied by two brachial veins, vv. brachiales, and median nerve, n. medianus. The latter in the upper third of the shoulder lies outward from the artery, in the middle third of the shoulder - in front, and in the lower third of the shoulder it is located along the medial surface of the artery.
The brachial artery, together with the brachial veins and the median nerve, forms the neurovascular bundle of the shoulder. 
The following branches depart from the brachial arteries.
1. The deep artery of the shoulder, a profunda brachii, begins in the upper third of the shoulder from the posterior surface of the brachial artery. Heading back, she, along with the radial nerve, n. radialis, spiral around rear surface humerus. Then the deep artery of the shoulder continues into the radial collateral artery, a. collateralis radialis, which goes first behind the lateral intermuscular septum of the shoulder and, having given branches to form the articular network of the elbow, rete articulare cubiti, anastomoses with the recurrent artery, a. recurrens radialis. 
The deep artery of the shoulder gives a number of branches:
a) deltoid branch, r. deltoideus, departs from the initial section of the deep artery of the shoulder, passes under the coracobrachial muscle and the biceps of the shoulder, gives them branches and reaches the deltoid muscle along the anterior surface of the humerus;
b) arteries supplying humerus, aa. nutriciae humeri, are sent to the nutrient holes of the humerus. May depart directly from the brachial artery;
c) middle collateral artery, a. collateralis media, follows down between the lateral and medial heads of the triceps muscle of the shoulder. Then it enters the thickness of the lateral head and, having reached elbow joint, anastomoses with a. interossea recurrens, taking part in the formation of the ulnar articular network.
2. Superior ulnar collateral artery, a. collateralis ulnaris superior, begins slightly below the deep artery of the shoulder from the medial surface of the brachial artery, and sometimes a common trunk with it. Heading down, the artery approaches the ulnar nerve, n. ulnaris, accompanies it to the medial condyle, where it takes part in the formation of the ulnar articular network. Blood supply to the shoulder muscle medial head the triceps muscle of the shoulder and the skin of this area; anastomoses at the medial condyle with the posterior branch of the recurrent ulnar artery, r. posterior a. recurrentis ulnaris.
3. Inferior ulnar collateral artery, a. collateralis ulnaris inferior, begins in the lower third of the shoulder from the medial surface of the brachial artery, just above the medial condyle. Heading downward along the anterior surface of the brachialis muscle, it anastomoses with the anterior branch of the recurrent ulnar artery, r. anterior a. recurrentis ulnaris. With its branches it reaches the region of the medial condyle, perforates the medial intermuscular septum of the shoulder and takes part in the formation of the ulnar articular network.
TO upper limb the axillary artery is sent, which begins at the level of the lateral edge of the 1st rib and ends at the level of the lower edge of the pectoralis major muscle, where it passes into brachial artery.
axillary artery or axillary artery (a. axillaris) is a direct continuation subclavian artery, lies in the armpit (cavity), where it is surrounded by nerves brachial plexus. The vessel is covered only by fascia, skin and lymph nodes. Its superficial location can be used for clamping to stop bleeding. Branches supplying the clavicle, scapula, muscles depart from the axillary artery shoulder girdle, intercostal and dentate muscles, shoulder and clavicular-acromial joints, as well as axillary lymph nodes and the mammary gland.
Rice. Axillary artery and its branches:
1 –axillary artery; 2–deltoid branch; 3–acromial branch; 4–thoracoacromial artery; 5–thoracic branch; 6–lateral thoracic artery; 7–thoracic artery; 8–artery around the scapula; 9–subscapular artery; 10–posterior circumflex artery of the humerus; eleven–anterior artery, envelope of the humerus; 12–deep artery of the shoulder; 13–superior ulnar collateral artery; 14–brachial artery.
Brachial artery (a. brachialis) begins at the lower edge of the pectoralis major muscle and lies in the medial groove of the shoulder next to the two brachial veins and the median nerve, medial to the biceps muscle. The pulsation of the artery can be felt for almost its entire length, and it is easy to find it to stop the bleeding.
The brachial artery within its upper third gives deep artery of the shoulder which wraps around the humerus and nourishes triceps muscle, blood supply to the skin, and then gives branches to the muscles of the anterior group of the shoulder (beak-shoulder, shoulder, biceps, deltoid) and to the humerus, as well as the shoulder joint. In addition, the brachial artery gives off branches descending to the elbow joint - the superior and inferior ulnar circumferential arteries.
In the cubital fossa, it divides into two independent arteries: ulnar And radiation.
Rice. arteries armpit:
1 - thoracoacromial artery; 2 - upper thoracic artery; 3 - axillary artery;
4 - subscapular artery; 5 - lateral thoracic artery; 6 - brachial artery.
Rice. Scheme of the axillary artery and its branches, front view: 1 - acromial branch; 2 - thoracoacromial artery; 3 - axillary artery; 4 - upper thoracic artery; 5 - thoracic branch; 6 - small pectoral muscle; 7 - pectoralis major muscle (cut off); 8 - lateral thoracic artery; 9 - thoracic artery; 10 - subscapular artery; 11 - artery, enveloping the scapula; 12 - brachial vein; 13 - brachial artery; 14 - axillary vein; 15 - deltoid branch
radial artery (a. radialis), continuing the direction of the humerus, runs parallel to the radius. At the distal end, it is located so superficially that its pulsation is easily felt. Having passed the styloid process of the radius, the artery turns to the back of the hand, from where it returns through the first intermetacarpal space to the palm, where it passes into the deep palmar arch. radial artery gives branches to the muscles of the forearm, to the palmar and dorsal networks of the wrist, to 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) larger diameter than the radius, descends along the ulna to wrist joint. It lies between the surface and deep layers forearm muscles. 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 anastomoses with the branches of the radial artery. The branches of the ulnar artery supply the muscles of the anterior and posterior groups of the forearm, participate in the formation rear And palmar network of the wrist, nourish the radius and ulna, called ulnar recurrent artery rise to the area of the elbow joint.
Thus, in the area of the elbow joint, a rich network roundabout (collateral) circulation. In the formation of the network, the branches of all three arteries anastomosing with each other - the brachial, ulnar and radial arteries - anastomose with each other.
There are two arterial arches on the palm.
Superficial palmar arch formed mainly by the end of the ulnar artery and a small superficial palmar branch of the radial artery. This branch is very thin and only when the movement of blood through the ulnar artery is disturbed does it participate in the formation of the superficial palmar arch. The arc lies approximately in the middle of the palm, under its superficial aponeurosis. The common palmar arteries of the fingers depart from the convex side of the arc; each of them is divided into two branches, which form numerous anastomoses at the ends of the fingers.
Rice. Palmar surface.
1 - superior ulnar collateral artery; 2 - lower ulnar collateral artery; 3 - brachial artery; 4 - ulnar recurrent artery; 5 - radial recurrent artery; 6 - ulnar artery; 7 - common interosseous artery; 8 - posterior interosseous artery; 9 - anterior interosseous artery; 10 - radial artery; 11 - palmar carpal branch; 12 - deep palmar branch; 13 - superficial palmar branch; 14 - deep palmar arch; 15 - superficial palmar arch; 16 - common palmar digital arteries; 17 - own palmar digital arteries.
Deep palmar arch thinner than the superficial palmar arch and is formed mainly by the end of the radial artery, and only a small branch enters it from the ulnar artery. The deep palmar arch lies on the palmar interosseous muscles and gives off its arteries, which flow into the common palmar arteries of the fingers.
Rice. Deep arteries of the hand, right. Front view. 1 - ulnar artery; 2 - palmar carpal branch of the ulnar artery; 3 - deep palmar branch; 4 - deep palmar arch; 5 - palmar metacarpal arteries; 6 - own palmar digital arteries; 7 - common palmar digital arteries; 8 - radial artery of the index finger; 9-beam artery thumb brushes; 10 - ulnar artery of the thumb; 11 - artery of the thumb; 12 - radial artery; 13 - palmar carpal branch of the radial artery; 14 - anterior interosseous artery.
In addition to the arcs, on the brush are formed palmar and dorsal carpal networks. From the latter, the dorsal metacarpal arteries depart into the interosseous spaces. Each of them is divided into two thin finger arteries.
Rice. Arteries of the hand, right. Back view. 1 - radial artery; 2 - dorsal carpal branch of the radial artery; 3 - ulnar palmar artery of the thumb; 4 - dorsal metacarpal arteries; 5 - dorsal carpal branch of the ulnar artery; 6 - dorsal network of the wrist; 7 - dorsal interosseous artery; 8 - dorsal branch of the anterior interosseous artery.
So, the hand as a whole and the fingers in particular are abundantly supplied with blood from many sources, which, due to the presence of arcs and networks, anastomose well with each other. This, as well as the location of the finger arteries on their protected surfaces facing each other, can be considered an adaptation of the hand to complex manipulations.
Rice. Scheme of the arteries of the upper limb (shoulder and forearm), right, front view:
1 - axillary artery; 2 - deep artery of the shoulder; 3 - brachial artery; 4 - superior ulnar collateral artery; 5 - humerus; 6 - lower ulnar collateral artery; 7 - common interosseous artery; 8 - anterior interosseous artery; 9 - ulnar artery; 10 - ulna; 11 - deep palmar arch; 12 - superficial palmar arch; 13 - common palmar digital arteries; 14 - own palmar digital arteries; 15 - bones of the wrist; 16 - wrist joint; 17 - radius; 18 - radial artery; 19 - elbow joint; 20 - anterior artery, envelope of the humerus; 21 - posterior artery, envelope of the humerus; 22 - head of the humerus; 23 - scapula.
Brachial artery (a. brachialis)(see Atl.) begins at the lower edge of the pectoralis major muscle and lies superficially on the shoulder, medial to the biceps muscle. The pulsation of the artery can be felt for almost its entire length, and it is easy to find it to stop the bleeding.
The brachial artery within its upper third gives deep artery of the shoulder which bends around the humerus and feeds the triceps muscle, and then gives branches to the muscles of the anterior group of the shoulder (beak-humeral, humerus, biceps, deltoid) and to the humerus. In addition, the brachial artery gives off branches descending to the elbow joint - the superior and inferior ulnar circumferential arteries.
Radial artery (a. radialis), continuing the direction of the humerus, runs parallel to the radius. At the distal end, it is located so superficially that its pulsation is easily felt. 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 off 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.) of a larger 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 anastomoses with the branches of the radial artery. The branches of the ulnar artery supply the muscles of the anterior and posterior groups of the forearm, participate in the formation of the dorsal and palmar network of the wrist, nourish the radius and ulna, 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. In the formation of the network, the branches of all three arteries anastomosing with each other - the brachial, ulnar and radial arteries - anastomose with each other.
radial artery, a. radialis, begins distal to the slit of the humeroradial joint. It lies between the round pronator and the brachioradialis muscle. The terminal section of the radial artery forms deep palmar arch, areas palmaris profundus. From this arc originate palmar metacarpal arteries, aa. metacarpales palmares, blood supply to the interosseous muscles. These arteries empty into the common palmar digital arteries (branches of the superficial palmar arch) and give off perforating branches, rr. perfordntes.
Many branches depart from the radial artery. The most significant of them are the following: 1) radial recurrent artery, a. gecurrens radialis, departs from the initial section of the radial artery; 2) superficial palmar branch, d. 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, d. 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. depart from this network dorsal metacarpal arteries, aa. metacarpales dorsales, and from each of them - two dorsal digital arteries, aa. di-gitdles dorsales, blood supply to the back surface of II-V fingers. On the back of the hand, it separates from the radial artery first dorsal metacarpal artery, aa. metacarpalis dorsalis I, which gives branches to the radial side of the I finger and to the adjacent sides of the I and II fingers. Penetrating into the palm, the radial artery gives artery of the thumb, a. princeps pollicis, which splits into two palmar digital arteries to both sides of the thumb and gives radial artery of the index finger, a. radialis indicis.
ulnar artery,a. ulnaris, from the cubital fossa goes under the round pronator, giving muscle branches to it. In the palm of the hand, the ulnar artery forms superficial palmar arch, arcus palmaris superficialis. Branches depart from the ulnar artery: 1) muscular 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, divides into anterior and posterior interosseous arteries. Anterior interosseous artery, a. interossea anterior, gives a branch to the palmar network of the wrist and takes part in the formation of the back 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 back recurrent interosseous artery, a. interossea recurrences, and participates in the formation of the ulnar articular network ; 4) palmar carpal branch, d. 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, supplies blood to the joints of the latter; 5) deep palmar branch, d. palmaris profundus, arises from the ulnar artery near the pisiform bone and supplies the muscles of the eminence of the little finger and the skin above the little finger. The terminal section of the ulnar artery forms superficial palmar arch, arcus palmaris superficialis. From this arc depart common palmar digital arteries, aa. digitales palmdres communes, and from them own digital arteries, aa. digitales palmares propriae, to adjacent sides of adjacent fingers
30.1. If the doors do not close (do not open) in the tail section of the train, the driver must report to the train dispatcher about the need to disembark passengers and close (open) the doors using the backup circuit.
30.2. If the doors do not close (do not open) via the backup circuit, the driver transmits information to the passengers about getting off the train via a train radio notification and directs the assistant driver to the tail car to close (open) the doors from the tail car control cabin via the main or backup circuit.
30.3. After disembarking passengers and closing the doors in the tail section of the train from the control cabin of the tail car, the assistant driver brings the control cabin to a non-working position and returns to the control cabin of the head car through the car interiors through the end doors.
Teacher: D.V. Belov
Engineer for OT e / d "Warsaw: N.Yu. Manerova
Topographic anatomy of the upper limb
The following areas are distinguished on the upper limb: 1) deltoid, 2) axillary, 3) shoulder, 4) elbow, 5) forearm, 6) wrist, 7) hand. In addition, common to the upper limb and chest are the anteroposterior and posterior superior regions of the chest, which make up the anterior and posterior walls of the armpit. The posterior superior region includes the scapular region.
Topography, projection of the arteries of the upper limb
Armpit arteries
1 - thoracoacromial artery;
2 - upper thoracic artery;
3 - axillary artery;
4 - subscapular artery;
5 - lateral thoracic artery;
6 - brachial artery
1) superior thoracic artery (a. thoracica superema) (Fig. 218), which supplies blood to the pectoralis major and minor, intercostal muscles and mammary gland;
2) thoracoacromial artery (a. thoracoacromialis) (Fig. 218, 220), it goes to the shoulder joint, muscles of the shoulder and chest;
3) lateral thoracic artery (a. thoracica lateralis) (Fig. 218), which supplies blood to the tissue of the axillary fossa, chest muscles, mammary gland and lymph nodes;
4) subscapular artery (a. subscapularis) (Fig. 218), nourishes the skin and muscles of the shoulder girdle, shoulder, shoulder joint and back.
Brachial artery (a. brachialis) (Fig. 218, 220, 221) continues the axillary artery and branches into vessels that feed the skin and muscles of the shoulder, shoulder and elbow joints. This:
1) deep artery of the shoulder (a. profunda brachii) (Fig. 219, 220), which is the largest branch of the brachial artery, enveloping the humerus behind and supplying blood rear group muscles of the shoulder and the humerus itself. The deep artery of the shoulder continues into the radial collateral artery (a. collateralis radialis), which anastomoses with the recurrent artery (a. recurrens) from the radial artery;
2) superior ulnar collateral artery (a. collateralis ulnaris superior) (Fig. 219, 220, 221), it provides blood elbow muscle, the medial head of the triceps muscle of the shoulder and the skin of this area;
3) the lower ulnar collateral artery (a. collateralis ulnaris inferior) (Fig. 220, 221), feeding the elbow joint, shoulder muscles and partially forearm.
The axillary artery (axillary, axillary, a. axillaris) departs from the subclavian at the level of the lower edge of the 1st rib, and passes into the brachial at the level of the lower edges of the pectoralis major and latissimus dorsi, that is, at the level of the anterior and posterior axillary walls. The artery lies deep and laterally in the axillary cavity. Surrounded in the form of a horseshoe by the medial, posterior, lateral nerve bundles of the brachial plexus, together with which the axillary vein forms the axillary neurovascular bundle.The axillary artery is conditionally divided into three sections:
The first is at the level of the claviculo-pectoral triangle (between the clavicle and the pectoralis minor muscle). It begins branches: subscapular, upper chest To pectoral muscles and the first two intercostal spaces; thoracoacromial artery - to the sternoacromial and shoulder joints, subclavian and deltoid muscles, pectoralis major and minor muscles.
The second is at the level of the pectoral triangle (pectoralis minor muscle). It departs the lateral thoracic artery with branches to the anterior serratus muscle and the mammary gland.
The third is at the level of the subpectoral triangle (between the lower edges of the large and small pectoral muscles). It branches off the largest artery - the subscapular (a. subscapularis), which supplies the thoracic-dorsal branch with the anterior dentate, large round and part latissimus dorsi, and the branch that surrounds the scapula is the infraspinatus and other muscles of the scapular region, to which it passes through the tripartite opening with the terminal branch (a. circumflexa scapulae).
In addition, in the third section, the anterior and posterior arteries begin, enveloping the humerus. The larger posterior artery and axillary nerve pass through a quadrilateral foramen into the posterior region of the shoulder girdle. Both arteries supply blood to the shoulder joint, deltoid, beak-brachial and other muscles adjacent to the joint.
The brachial artery (a. brachialis), accompanied by two deep veins and the adjacent median nerve, are located in the medial bicepital groove, forming the neurovascular bundle of the shoulder. In it, the median nerve crosses the vessels in the middle third of the shoulder. Medially from the bundle are the ulnar nerve, cutaneous nerves of the shoulder and forearm. In the cubital fossa, the brachial artery divides in the projection of the neck of the radius into the ulnar and radial arteries. In its course, it gives off small muscle and skin branches on the shoulder. The larger branches are the collateral ulnar arteries - superior and inferior.
The largest branch is the deep brachial artery (a. profunda brachii), which departs in the upper third of the shoulder and, together with the radial nerve, occupies the brachio-muscular canal, in which at the level of the middle third they are adjacent to the humerus (the possibility of damage in case of fractures). The deep artery may be absent in 30% or originate from the axillary artery (50%) The deep artery supplies the humerus, deltoid, triceps, shoulder muscle; gives off collateral branches: middle and radial.
All collateral branches participate in the formation of the arterial network of the elbow joint. The middle collateral artery passes through the triceps and joins with the recurrent interosseous. The collateral radial anastomoses with the recurrent radial, the upper and lower collateral ulnar anastomoses with the recurrent ulnar: anterior and posterior.
