To the arteries of the upper limb ( aa. membrane superioris) These include the branches of the subclavian and axillary arteries, going to the girdle of the upper limb, and the branches of the brachial artery, vascularizing the free upper limb (Fig. 171).
Axillary artery(a. axillaris) is a continuation of the subclavian artery below the 1st rib, passes into axillary cavity above and behind the vein of the same name. It is surrounded by trunks and branches of the brachial nerve plexus. There are 3 sections of the artery: above top edge pectoralis minor muscle, behind it and below its lower edge. The following branches sequentially depart from the axillary artery.
1. Superior thoracic artery(a. thoracica superior) goes to the anterior sections of the first two intercostal spaces.
2. Thoracromial artery(a. thoracoacromialis) supplies blood to the muscles of the shoulder girdle and shoulder joint.
3. Lateral thoracic artery(a. thoracica lateralis) goes to the serratus anterior muscle and mammary gland.
4. Subscapular artery(a. subscapularis)- branch of the lower section of the axillary artery; supplies blood to the muscles starting on the shoulder blade and the latissimus dorsi muscle (Fig. 172).
5. Anterior circumflex artery humerus (a. circumflexa humeri anterior), And posterior circumflex humeral artery(A. circumflexa humeri posterior), go around surgical neck humerus and supply blood to the shoulder joint.
All of the listed branches of the axillary artery anastomose with each other and with the branches of the subclavian artery, forming the arterial network of the shoulder girdle.
Brachial artery(a.brachialis) is a continuation of the axillary artery from the lower edge of the pectoralis major muscle, located in the medial groove of the shoulder to the ulnar fossa, where it divides into the radial and ulnar arteries.
Branches of the brachial artery:
1. Deep brachial artery(a. profunda brachii) passes in the brachiomuscular canal. Supplies blood to the shoulder muscles and humerus. Gives off the radial collateral artery (a. collaterales radialis).
2. Superior ulnar collateral artery(a. collateralis ulnaris superior) arises from the brachial artery below the deep brachial artery and accompanies the ulnar nerve to the medial epicondyle.
3. Inferior ulnar collateral artery(a. collateralis ulnaris inferior) starts from the lower third of the brachial artery.
4. Radial artery(a. radialis), continuing the direction of the brachial artery, it penetrates between the brachioradialis muscle and the pronator teres muscle on the forearm. It extends in its radial groove to the styloid process of the radius, at the level of which it turns to the back of the hand. Sequentially gives branches:
1) radial recurrent artery (a. recurrens radialis) to the elbow joint;
2) branches to the muscles of the forearm;
3) superficial palmar branch (r. palmaris superficialis);
4) palmar And dorsal carpal branches.
Then the radial artery penetrates the palmar surface through the first intermetacarpal space and gives off the artery thumb brushes and forms deep palmar arch (arcus palmaris profundus).
5. Ulnar artery(a. ulnaris) larger in diameter than the radial one, goes to the forearm from the ulnar fossa under the pronator teres, goes
Rice. 171. Arteries of the upper limb: 1 - axillary artery; 2 - superior thoracic artery; 3 - thoracoacromial artery; 4 - lateral thoracic artery; 5 - subscapular artery; 6 and 7 - anterior and posterior arteries that bend around the humerus; 8 - brachial artery; 9 - deep artery of the shoulder; 10 - superior ulnar collateral artery; 11 - radial collateral artery; 12 - inferior ulnar collateral artery; 13 - ulnar artery; 14 - radial artery; 15 - recurrent ulnar artery; 16 - recurrent radial artery; 17 - common interosseous artery; 18 - anterior interosseous artery; 19 - posterior interosseous artery
Rice. 172. Scheme of the axillary artery and its branches, front view: 1 - acromial branch; 2 - thoracoacromial artery; 3 - axillary artery; 4 - superior thoracic artery; 5 - thoracic branch; 6 - pectoralis minor muscle; 7 - pectoralis major muscle (cut off); 8 - lateral thoracic artery; 9 - thoracodorsal artery; 10 - subscapular artery; 11 - artery circumflexing the scapula; 12 - brachial vein; 13 - brachial artery; 14 - muscular vein; 15 - deltoid branch
in the ulnar groove and reaches the wrist joint. At the level of the pisiform bone, the artery deviates laterally into the palm. From the ulnar artery depart:
2) common interosseous artery (a. interossea communis), dividing into the anterior and posterior interosseous arteries, located in front and behind the interosseous membrane of the forearm and passing into the palmar and dorsal carpal branches; the recurrent interosseous artery departs from the posterior interosseous artery to the elbow joint;
3) dorsal and palmar carpal branches;
4) deep palmar branch.
The branches of the ulnar artery anastomose with the radial artery and supply blood to the muscles of the forearm, radius and ulna.
In the area of the elbow joint, the collateral and recurrent branches of the brachial, radial and ulnar arteries form an arterial network.
The blood supply to the hand is provided by arteries arising from the carpal arterial networks and palmar arches.
Palmar and dorsal carpal networks located in the area of the wrist joint and carpal bones. They are formed by the palmar and dorsal carpal branches of the radial, ulnar and interosseous arteries.
Superficial palmar arch(arcus palmaris superficialis) formed by the ulnar artery, which connects with the superficial palmar branch of the radial artery. Move away from the arc common palmar digital arteries, which are divided into own digital arteries. All digital arteries at the level of the nail phalanges form numerous nastomoses.
Deep palmar arch(arcus palmaris profundus) formed by the radial artery, connecting with the deep palmar branch of the ulnar artery. Its branches pass into the common palmar digital arteries
Arteries lower limb (aa. membri inferioris)
The lower limb is supplied with blood by branches internal And external iliac arteries(girdle of the lower limb) and branches femoral artery(free lower limb). All named
Rice. 173. Diagram of the location of the arteries of the hand:
1 - ulnar artery; 2 - deep palmar branch of the ulnar artery; 3 - deep palmar arch; 4 - superficial palmar arch; 5 - common palmar fingers; 6 - own palmar fingers; 7 - palmar metacarpals; 8 - artery of the thumb; 9 - superficial palmar branch of the radial artery; 10 - radial artery
the arteries widely anastomose with each other, forming the arterial networks of the pelvic girdle and hip joint.
Femoral artery(a. femoralis)(Fig. 174) - continuation of the external iliac artery below the inguinal ligament. Goes through vascular lacuna outward from the vein of the same name between the superficial and deep plates of the fascia lata to the adductor canal, from which it exits through its lower opening into the popliteal fossa. Here it is called the popliteal artery; on the thigh it gives off many branches.
Rice. 174. Arteries of the thigh:
1 - external iliac artery;
2 - deep artery, circumflex ilium; 3 - superficial epigastric artery; 4 - superficial artery, circumflex ilium; 5 - femoral artery; 6 - external genital arteries; 7 - medial artery, circumflex femur; 8 - lateral artery, circumflex femur; 9 - deep femoral artery; 10 - perforating arteries;
11 - descending genicular artery;
12 - posterior tibial artery;
13 - anterior tibial artery
Branches of the femoral artery:
1. Superficial epigastric artery(a. epigastrica superficialis) ascends to the subcutaneous tissue of the anterior abdominal wall.
2. Superficial artery circumflex ilium(a. circumflexa iliaca superficialis), begins in the femoral triangle, runs laterally parallel inguinal ligament to the anterior superior iliac spine; supplies blood to the skin and the tensor fascia lata.
3. External genital arteries(aa. pudendae externae) originate in the femoral triangle and go to the skin of the scrotum, penis and labia majora in women.
4. Deep femoral artery(a. profunda femoris)- the largest branch of the femoral artery. Goes deep. Supplies blood to all thigh muscles hip joint, femur and knee joint. Large branches extend from it:
1) medial and lateral arteries, circumflex femoral bone (aa. circumflexa femoris medialis et lateralis);
2) perforating arteries (aa. perforates), number 3, which extend to the back of the thigh.
5. Descending genicular artery(a. genus descendens) leaves the adductor canal through its anterior opening along with the saphenous nerve.
Popliteal artery(a. poplitea)(Fig. 175) is a direct continuation of the femoral artery. Located in the popliteal fossa. The popliteal artery lies deeper than the accompanying vein and tibial nerve. Branches extend from it to calf muscle, as well as to the knee joint:
1) lateral and medial superior genicular arteries (aa. genus superiores lateralis et medialis);
2) lateral and medial inferior genicular arteries (aa. genus inferiores lateralis et medialis);
3) middle genicular artery (a. genus media). These branches, anastomosing with each other and with the descending genicular artery, form the knee articular network, supplying blood to the knee joint and surrounding tissues. At the inferior border of the popliteus muscle, the popliteal artery divides into the posterior and anterior tibial arteries.
Posterior tibial artery(a. tibialis posterior)- the terminal branch of the popliteal artery, is its continuation, passes
Rice. 175. Diagram of the arteries of the lower limb, front view:
1 - abdominal aorta; 2 - common iliac; 3 - median sacral; 4 - internal iliac; 5 - lateral sacral; 6 - obturator; 7 - medial artery, circumflex femoral bone; 8 - deep artery of the femur; 9 - femoral; 10 - descending knee; 11 - medial upper knee; 12 - popliteal; 13 - medial lower knee; 14 - posterior tibial; 15 - fibular; 16 - anterior tibial; 17 - anterior tibial return; 18 - lateral lower knee; 19 - knee joint (arterial) network; 20 - lateral upper knee; 21 - lateral artery, circumflex femur; 22 - lower gluteal; 23 - deep artery, circumflex ilium; 24 - lower epigastric; 25 - upper gluteal; 26 - external iliac; 27 - iliopsoas
in the ankle-popliteal canal. It comes out from under the medial edge of the calcaneal tendon, goes around the medial malleolus from below and behind (here you can feel its pulsation). It supplies blood to the bones and muscles of the posterior and lateral groups of the leg and is divided into the medial and lateral plantar arteries (Fig. 176).
Medial plantar artery(a. plantaris medialis)- terminal branch of the posterior tibial artery. It passes along the medial groove of the sole, divides into superficial and deep branches, gives off branches to the muscles and its own plantar digital arteries: the first finger and the medial surface of the second finger; anastomoses with the first dorsal metatarsal artery.
Lateral plantar artery(a. plantaris lateralis), like the medial one, it is the terminal branch of the posterior tibial artery. It runs along the lateral groove of the sole and forms a plantar arch at the level of the proximal metatarsal bones. (arcus plantaris). The plantar metatarsal arteries, arising from the plantar arch, connect with the dorsal metatarsal arteries. All digital arteries of the foot - dorsal and plantar, with which the corresponding metatarsal arteries end, form numerous anastomoses and arterial networks.
Anterior tibial artery(a. tibialis anterior), having separated from the popliteal artery, it passes between the muscles that make up the anterior group of muscles of the leg. Gives off branches that supply blood to nearby bones and muscles.
Dorsal artery of the foot(a. dorsalis pedis) is a continuation of the anterior tibial artery below the retinaculum of the extensor tendons. The artery passes on the back of the foot, in the first intermetatarsal space, where it is accessible for determining the pulse. At the level of the metatarsal bones it gives off branches:
1) dorsal metatarsal artery, from which the 3 dorsal digital arteries arise;
2) arcuate artery, giving off the dorsal metatarsal arteries (II-V), passing into the dorsal digital arteries;
3) deep plantar branch, connecting to the plantar arterial arch.
Peroneal artery(a. fibularis) follows from the posterior tibial artery to fibula into the musculofibular canal. Supplies blood to the muscles of the lower leg (triceps, longus and
Rice. 176. Medial and lateral plantar arteries, inferior view. Part of the muscles of the plantar side of the foot was removed: 1 - common plantar digital arteries; 2 - medial plantar artery ( superficial branch); 3 - medial plantar artery (deep branch); 4 - medial plantar artery; 5 - retinaculum of flexor muscles; 6 - medial plantar nerve; 7 - posterior tibial artery; 8 - lateral plantar nerve; 9 - heel net; 10 - plantar aponeurosis; 11 - flexor digitorum brevis; 12 - muscle that abducts the little finger; 13 - lateral plantar artery; 14 - perforating branches; 15 - plantar arch; 16 - plantar metatarsal arteries; 17 - flexor digitorum longus tendon; 18 - flexor digitorum brevis tendon; 19 - adductor pollicis muscle; 20 - common plantar digital arteries; 21 - own plantar digital arteries
short fibula). Participates in the formation of the lateral malleolar network - rete malleolare laterale.
Questions for self-control
1. What branches arise from the axillary artery?
2. What branches arise from the brachial artery?
3. Which arteries supply blood elbow joint?
4. What arteries form the superficial and deep palmar arches?
5. Which arteries arise from the femoral artery?
6. What arteries supply the knee joint?
7. Where does the posterior tibial artery pass? What does it supply blood to?
8. What arteries supply blood to the foot?
The forearm is the middle segment of the upper limb. the forearm is formed by the ulna and radius bones (Fig. 1). Both bones are connected along their entire length by an interosseous membrane, their proximal ends take part in the formation; distally, the radius participates in the formation.
The muscles of the forearm (Fig. 2) are divided into two groups: the front - flexors and pronators (muscles that turn the palm down) and the back - extensors and supinators (muscles that turn the palm up). The anterior muscle group of the forearm consists of superficial and deep layers. The muscles of this group begin from the internal epicondyle of the humerus. The superficial layer consists of the flexor carpi ulnaris, flexor digitorum superficialis, palmaris longus, flexor carpi radialis, pronator teres, and brachioradialis muscles. The deep layer consists of the flexor digitorum profundus, flexor pollicis longus and pronator quadratus muscles. The posterior muscle group of the forearm also consists of superficial and deep layers. The muscles of the superficial layer begin from the external epicondyle and from the proximal part of the forearm. This layer consists of the short and long extensor carpi radialis, extensor digitorum, extensor digitorum minimus, and extensor carpi ulnaris. The deep layer contains the abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor index finger.
The blood supply to the forearm is carried out by the radial and ulnar arteries (terminal branches of the brachial artery).
Venous drainage occurs through the subcutaneous and deep veins.
The muscles of the forearm are innervated by branches of the ulnar, median and radial nerves. The ulnar nerve innervates the ulnar flexor of the hand and the ulnar part of the deep flexor of the digitorum, the median - all other flexors of the hand and fingers and pronators, the radial nerve - the brachioradialis muscle and all extensors.
I - radius; II - ulna. 1 - olecranon; 2 - block cutting; 3 - coronoid process; 4 - head of the radius; 5-neck of the radius; 6 - tuberosity ulna; 7 - tuberosity of the radius; 8 - interosseous membrane; 9 - styloid process of the ulna; 10 - styloid process of the radius.
Rice. 2. Places of origin and attachment of muscles on the bones of the right forearm, in front (a) and behind (b): 1 and 10 - superficial flexor digitorum (1 - ulnar part, 10 - radial part); d and c - flexor pollicis longus (2 - ulnar part, 8 - radial part); 3 and 9 - pronator teres; 4 - brachialis muscle; 5 - deep flexor of the fingers; 6 - pronator quadratus; 7 - brachioradialis muscle; 11 - muscle supinating the forearm; 12 - biceps brachii; 13 - elbow muscle; 14 - abductor pollicis longus muscle; 15 - short extensor pollicis; 16 - extensor of the index finger; 17 - long extensor pollicis; 18 - flexor carpi ulnaris.
Forearm (antebrachium) - the middle segment of the upper limb.
Anatomy. The proximal border of the forearm is formed by a circular line drawn 6 cm distal to the internal epicondyle of the humerus. The distal border of the forearm runs along a circular line drawn 3 cm above the skin fold of the wrist. The anterior and posterior regions of the forearm (regio antebrachii ant. et post.) are demarcated by lines drawn one from the medial epicondyle of the humerus to the styloid process of the ulna, the other from the lateral epicondyle to the styloid process of the radius.
The forearm has the shape of a flattened front to back and truncated cone, with its base facing upward and tapering downwards. Two convexities are visible in front, located respectively on the inner and outer halves of the forearm. They are formed by muscle groups - flexors and extensors of the forearm, hand and fingers. In the lower half of the anterior surface of the forearm, two depressions are visible, corresponding to the radial and ulnar grooves of the forearm, as well as the contours of the flexor tendons. When muscles contract in muscular people, the muscle landmarks of the forearm become more prominent (Fig. 1). On the posterior surface of the forearm, the radius and ulna, their styloid processes and the head of the ulna can be easily felt; on the anterior surface are the tendons of the flexor carpi radialis (m. flexor carpi radialis), the long palmar muscle (m. palmaris longus), the superficial flexor of the fingers (m. flexor digitorum superficialis) and the ulnar flexor of the hand (m. flexor carpi ulnaris).
Rice. 1. External landmarks of the forearm: a - anterior surface, b - posterior surface. 1 - v. basilica brachii; 2 - tendo m. bicipitis brachii; 3 - v. mediana antebrachii; 4 - m. flexor carpi ulnaris; s - m. palmaris longus; 6 - m. flexor digitorum superficialis; 7 - proximal skin fold of the wrist; 8 - distal skin fold of the wrist; 9 - processus styloideus radii; 10 - m. brachioradialis; 11 - m. flexor carpi radialis; 12 - m. brachioradialis; 13 - epicondylus lat.; 14 - m. extensor carpi radialis longus; 15 - m. extensor digitorum; 16 - m. extensor carpi ulnaris; 17 - m. extensor carpi radialis brevis; 18 - m. extensor digiti minimi; 19 - m. abductor pollicis longus; 20 - m. extensor pollicis brevis; 21 - m. abductor digiti minimi; 22 - processus styloideus ulnae; 23 - margo post, ulnae; 24 - v. basilica antebrachii; 25 - m. anconeus; 26 - olecranon; 27 - tendo m. tricipitis brachii.
Rice. 2. Bones of the forearm:
1 - capsula articularis;
2 - trochlea humeri;
3 - cavum articulare;
4 - ulna;
5 - membrana interossea antebrachii;
6 - articulatio distalis;
7 - radius;
8 - chorda obliqua;
9 - tendo m. bicipitis brachii (segment);
10 - lig. anulare radii;
11 - caput radii;
12 - capitulum humeri;
13 - humerus.
The skeleton of the forearm is formed by the ulna (ulna) and radius (radius) bones, which are articulated by the proximal and distal radioulnar joints (art. radioulnares proximalis et distalis). An interosseous membrane (membrana interossea) is stretched between the bones (Fig. 2). The forearm articulates with the humerus at the elbow joint (see). The distal end of the radius is connected to the hand by the wrist joint (see).
The skin of the anterior surface of the forearm is thin, mobile, and easily folded. Subcutaneous tissue poorly developed, has a single-layer structure. In the deep layer of fiber there are saphenous veins, closely connected with the superficial fascia. The cephalic vein and the external cutaneous nerve of the forearm (v. cephalica et n. cutaneus antebrachii lateralis) are located in front, the ulnar saphenous vein and the medial cutaneous nerve of the forearm (v. basilica et n. cutaneus antebrachii medialis) are located laterally. Between them in the middle passes the median vein of the forearm (v. mediana antebrachii). Located posteriorly in the subcutaneous layer superficial vessels and posterior cutaneous nerve of the forearm (n. cutaneus antebrachii post.). The superficial fascia is thinner, and the proper fascia of the forearm (fascia antebrachii) is denser, especially on the radial side. The processes of the fascia form a bed of muscles and the neurovascular bundle.
Muscles The forearms are divided into two groups: the anterior one, containing the flexors and pronators, and the posterior one, represented by the extensors and supinators. The anterior muscle group consists of superficial and deep layers. All muscles of this group, with the exception of the pronator teres and flexor pollicis longus (mm. pronator quadratus et flexor pollicis longus), begin from the internal epicondyle of the humerus (epicondylus medialis humeri). The superficial layer contains the flexor carpi ulnaris (m. flexor carpi ulnaris), which is attached to the pisiform bone (os pisiforme) and forms the ulnar edge of the forearm. Knowledge of the topography of this muscle has great importance when accessing the ulna, ulnar nerve and ulnar artery. The superficial flexor of the fingers (m. flexor digitorum superficialis) begins with two heads and occupies almost the entire anterior surface of the forearm. Its four tendons enter the carpal tunnel. The long palmar muscle (m. palmaris longus) occupies a mid-position and is woven into the palmar aponeurosis with a long tendon. The superficial layer includes the flexor carpi radialis (m. flexor carpi radialis), the tendon of which is attached to the base of the second metacarpal bone, as well as the pronator teres. The brachioradialis muscle (m. brachioradialis) lies laterally. It starts from the outer edge of the humerus and the intermuscular septum. Knowledge of the topography of this muscle is of great practical importance due to the close location of the superficial branch to it radial nerve and radial artery. The deep layer contains the deep flexor digitorum profundus, the long flexor pollicis longus and the pronator quadratus.
The posterior muscle group consists of superficial and deep layers. All muscles of the superficial layer begin from the external epicondyle of the shoulder and from the proximal part of the fascia of the forearm. They are located in the following order: closer to the radial edge - the short and long radial extensors of the hand (mm. extensores carpi radiales longus et brevis), the extensor of the fingers (m. extensor digitorum), somewhat further - the extensor of the small finger (m. extensor digiti minimi) , even further - the extensor carpi ulnaris (m. extensor carpi ulnaris). Among the muscles of the deep layer, closer to the radial side, there is a long muscle that abducts the pollicis (m. abductor pollicis longus), next to it is the short extensor pollicis brevis (m. extensor pollicis brevis), and then the long extensor pollicis (m. extensor pollicis longus) and the extensor of the index finger (m. extensor indicis). The radial extensors of the hand are attached to the base of the II (long) and III (short) metacarpal bones.
The spaces (grooves) between the muscles of the anterior group are filled with loose fiber. The vessels and nerves of the forearm pass through them. The radial groove (sulcus radialis) lies between the brachioradialis muscle and the flexor carpi radialis, where the radial artery (a. radialis) and the superficial branch of the radial nerve (ramus superficialis nervi radialis) pass; in the lower third of the forearm the artery is easily vulnerable. The median groove (sulcus medianus) runs between the flexor carpi radialis and the flexor digitorum superficialis: this groove is located in the lower quarter of the forearm and contains distal end median nerve (n. medianus), which lies under the fascia of the forearm and can be easily damaged. The ulnar groove (sulcus ulnaris) runs between the superficial flexor digitorum and flexor carpi ulnaris and contains the ulnar artery (a. ulnaris) and the ulnar nerve (n. ulnaris). The nerve is located on the ulnar side of the artery and accompanies it all the way to the hand. The proximity of an artery and a nerve often leads to their simultaneous damage, for example, when ligating an artery to stop bleeding. In case of isolated damage to the artery, it is necessary to carefully isolate the ends of the damaged vessel before ligation and maximize sparing of the uninjured nerve. Simultaneous damage to the ulnar nerve requires epineural sutures.
Rice. 1-4. Vessels and nerves of the anterior forearm. Rice. 1. Superficial veins and cutaneous nerves. Rice. 2. Superficially located muscles, vessels and nerves (the fascia of the forearm is partially removed and turned away). Rice. 3. Deep muscles, vessels and nerves (superficial muscles are partially removed). Rice. 4. Division of the brachial artery, origin of the common interosseous artery, median nerve (along its entire length), deep muscles, vessels and nerves (superficial muscles are removed; m. pronator teres is cut and turned away). 1 - v. basilica; 2 - ramus ant. n. cutanei antebrachii med.; 3 - v. cephalica; 4 - n. cutaneus antebrachii lat.; 5 - skin with subcutaneous fatty tissue; 6 - fascia antebrachii; 7 - v. mediana cubiti; 8 - m. pronator teres; 9 - m. flexor carpi radialis; 10 - m. palmaris longus; 11 - m. flexor carpi ulnaris; 12 - n. ulnaris; 13 - a. et vv. ulnares; 14 - m. flexor digitorum superficialis; 15 - n. medianus; 16 - a. et vv. radiales; 17 - ramus superficialis n. radialis; 18 - m. brachioradialis; 19 - m. pronator quadratus; 20 - m. flexor pollicis longus; 21 - m. flexor digitorum profundus; 22 - a. et vv. interosseae ant.; 23 - n. interosseus ant.; 24 - a. interossea communis; 25 - ramus profundus n. radialis; 26 - a. brachialis. 
Rice. 1-4. Vessels and nerves of the forearm. Rice. 1. Superficial veins and nerves. Rice. 2. Deep vessels and nerves. Rice. 3. Arteries of the forearm (semi-schematically). Rice. 4. Transverse cuts of the right forearm at the level of the proximal, middle and distal thirds. 1 - n. cutaneus antebrachii post.; 2 - n. cutaneus antebrachii lat.; 3 - v. cephalica; 4 - skin with subcutaneous fatty tissue; 5 - ramus ulnaris n. cutanei antebrachii med.; 6 - fascia antebrachii; 7 - m. supinator; 8 - m. extensor carpi radialis brevis; 9 - m. extensor carpi radialis longus; 10 - m. abductor pollicis longus; 11 - m. extensor pollicis brevis; 12 -radius; 13- a. inlerossea ant. (et v. interossea ant.); 14 - m. extensor pollicis longus (circumcised); 15 - n. interosseus post.; 16 - m. extensor digitorum; 17 - rami musculares; 18 - a. Interossea post, (et v. interossea post.); 19 - m. extensor carpi ulnaris; 20 - ulna; 21 - ramus superficialis n. radialis; 22 - a. brachialis; 23 - a. recurrens ulnaris; 24 - a. ulnaris (et w. ulnares on cuts); 25 - a. Interossea communis; 26 - membrane Interossea; 27 - a. radialis (et vv. radiales on cuts); 28 - tendo musculi bicipitis brachii (turned away); 29 - a. recurrent radialis; 30 - m. pronator teres; 31 - m. flexor carpi radialis; 32 - m. palmaris longus; 33 - m. flexor digitorum superficialis; 34 - m. flexor carpi ulnaris; 35 - n. ulnaris; 36 - m. flexor digitorum prof.; 37 - n. medianus; 38 - m. brachioradialis; 39 - ramus dorsalis manus n. ulnaris; 40 - m. pronator quadratus; 41 - m. flexor pollicis longus. 
Radial artery(arteria radialis) – located in the radial groove, in the distal part it is accessible to palpation. Below the styloid process of the radius it goes to the back of the hand, following through the “anatomical snuffbox” and participates in the formation of the deep palmar arterial arch. Branches: radial recurrent artery, muscular branches, palmar carpal branch, dorsal carpal branch, superficial palmar branch, thumb artery. Supplies flexor pollicis longus, flexor digitorum superficialis, abductor pollicis longus, pronator teres, flexor carpi radialis, supinator, extensor pollicis brevis and longus, extensors carpi brevis and longus, brachioradialis, palmaris longus, adductor pollicis, adductor pollicis longus , flexor pollicis brevis, short muscle, abductor pollicis, interosseous muscles, elbow joint, radius, skin of the forearm and hand.
ulnar artery ( arteria ulnaris) - - located in the ulnar groove with the nerve of the same name. The main source of formation of the superficial palmar arch. Branches: ulnar recurrent artery (divided into anterior and posterior branches), common interosseous artery (divided into recurrent, anterior and posterior interosseous), deep palmar branch, muscular branches, dorsal carpal branch, palmar carpal branch. Supplies blood to the muscles of the forearm and elbow joint.
ARTERIAL NETWORK OF THE ELBOW JOINT – formed by anastomoses between the collateral radial and recurrent radial, between the middle collateral and recurrent interosseous, between the anterior branch of the recurrent ulnar and inferior ulnar collateral, between posterior branch recurrent ulnar and superior ulnar collateral arteries.
ARTERIAL NETWORK OF THE RADIAL JOINT – formed by the dorsal and palmar carpal branches of the radial and ulnar arteries, as well as the anterior and posterior interosseous arteries. The network of the wrist joint is more pronounced on the back. From this part of the network depart four dorsal metacarpal arteries, which at the base of the fingers are divided into dorsal digital arteries.
superficial palmar arch ( arcus palmaris superficialis) - formed by the terminal segment of the ulnar artery and the superficial palmar branch of the radius. A branch extends from the arch to the ulnar side of the little finger and three common digital palmar arteries, which in the area of the interdigital folds are divided into their own palmar digital arteries.
deep palmar arch ( arcus palmaris profundus) - anastomosis of the terminal part of the radial artery with the deep palmar branch of the ulnar artery. The palmar metacarpal arteries depart from the arch, which flow into the fork of the common palmar digital arteries and give first branches to the dorsum of the hand.
3. Arteries of the forearm and hand: topography, branches, areas of blood supply.
radial artery, a . radidlis , comes medially from m. brachioradialis, first covered by it, and then in the sulcus radialis, the radial artery is covered on the surface only by fascia and skin. 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:
A. recurrencesradialis, recurrent radial artery, begins in the ulnar fossa, goes proximally to the anterior surface of the lateral epicondyle, where it anastomoses with the above a. collateralis radialis from a. Produnda brachii.
Ramimusculares- to the surrounding muscles..
Ramuscarpeuspalmaris, The palmar carpal branch 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. Ramuspalmdrissuperficialis, The 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.
Ramuscarpeusdorsalis, 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 A.
metacarpeadorsalisprima, the 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.. A. princeps pollicis, the first artery of the thumb, departs from the radial one, as soon as the latter penetrates through the first interosseous space into the palm, goes along the palmar surface of the first metacarpal bone and is divided into branches, ah.digitalis palmares, to both sides of the thumb and to the radial side of the index finger.
Ulnar artery, a . ulnaris one of the two terminal branches of the brachial artery. From the point of origin in the ulnar fossa, it fits under m. pronator teres, goes obliquely to the middle third of the forearm, deviating to the ulnar side. 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.
A. recurrencesulnaris, the recurrent ulnar artery gives two branches - rami anterior et posterior, which pass in front and behind the medial epicondyle, anastomosing with aa. 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.
A. interosseacommunis, common interosseous artery, goes to the interosseous membrane, at the proximal edge, 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 the rete carpi dorsale. At the beginning of your journey a. interossea anterior gives a. mediana (directed to the palm together with p. medianus), aa. 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 recurrens, lies between the superficial and deep layers of the extensor muscles and in the wrist area anastomoses with a. interossea anterior.
Ramuscarpeuspalmaris, The palmar carpal branch goes towards the branch of the same name of the radial artery, with which it anastomoses.
Ramuscarpeusdorsalis, 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.
Ramuspalmarisprofundus, deep palmar branch, penetrates under the tendons and nerves of the palm and together with a. radialis is involved in the formation of the deep palmar arch. Arteries of the hand. There are two networks in the wrist area: one palmar and one dorsal. Palmar formed from the connection of the palmar carpal branches of the radial and ulnar arteries and branches from the anterior interosseous .. Rear 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 b) in the second, third and fourth interosseous spaces at the base of the fingers, each of them is divided into branches to the fingers { aa. digitales dorsdles).
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Arterial vessels upper limbs supply blood to soft tissues and bones. The main arteries branch to form many smaller vessels that form anastomoses at the elbow and wrist.
The blood supply to the upper extremities is provided mainly by the brachial artery, which is a continuation of the axillary artery, which runs in a descending direction from inside shoulder This artery gives off many smaller vessels that supply blood to the adjacent muscles and humerus. The largest branch is the deep brachial artery, which supplies blood to the muscles that extend the elbow joint.
The deep brachial artery and other smaller arteries, which are branches of the brachial artery in its lower part, pass around the elbow joint. There they form a system of anastomoses (connections) before rejoining the main arteries of the forearm.
Forearm and hand
The brachial artery divides below the elbow joint into the radial and ulnar arteries. The radial artery runs from the cubital fossa along the entire length of the radius (forearm bone). At the lower end of the radius it is located close to the skin and soft tissues- here you can feel your pulse. The ulnar artery goes to the base of the ulna (the second bone of the forearm).The hand has a rich blood supply, which is provided by the terminal branches of the radial and ulnar arteries. The branches of the two arteries connect on the palm, forming the deep and superficial palmar arches, from which small branches branch off, providing blood supply to the fingers.
Veins of the upper extremities
The veins of the upper extremities are divided into deep and superficial. Superficial veins are located close to the skin, so they can often be easily seen.The outflow of venous blood from the upper extremities is ensured by two interconnected systems veins - deep and superficial. Deep veins are located next to the arteries, while superficial veins are located in subcutaneous fat layer. The arrangement of the veins can vary greatly, but they usually form the systems described below.
Deep veins
In most cases, the deep veins are paired and are located on both sides of the accompanying arteries. They often form anastomoses and plexuses surrounding the artery. The pulsation of blood inside the artery alternately compresses and unclenches the surrounding veins, thereby promoting the movement of blood towards the heart.The radial and ulnar veins arise from the palmar venous arches of the hand and, rising to the forearm, unite at the elbow joint, forming the brachial vein. The brachial vein, in turn, connects with the medial saphenous vein of the arm, resulting in the formation of the great axillary vein.
Superficial veins
There are two main superficial veins upper limb - lateral saphenous vein and medial saphenous vein of the arm. These veins begin from the dorsal venous arch of the hand. The lateral saphenous vein runs under the skin along the radial side of the forearm.The medial saphenous vein ascends along the ulnar side of the forearm, crossing the elbow joint to run along the border of the biceps muscle. Approximately in the middle of the shoulder, it goes deep into the soft tissue and becomes a deep vein.
Venipuncture
The location of the main median vein of the elbow in the cubital fossa allows venous blood to be collected from it for laboratory tests. Usually this large vein easy to see or feel, however, if the patient is overweight, it can be quite difficult to find.However, taking blood from the median vein of the elbow is associated with certain risks. The biceps tendon and brachial artery are located next to this vein, so you should avoid puncturing too deeply.
In some cases on top part the hand is required to apply a tourniquet to compress the veins of the forearm and make them more protruding above the surface of the skin.
The human body. Outside and inside. №47 2009
