Neurovasculature of the upper limbs
Last updated: March 22, 2022
Summary
The arteries of the upper limb arise from the subclavian artery, a branch of the aortic arch. At the outer border of the 1st rib, the subclavian artery continues as the axillary artery, which is the main artery of the axillary fossa. At the inferior border of the teres major, the axillary artery continues as the brachial artery, the main artery of the arm. The brachial artery divides at the cubital fossa into the radial and ulnar arteries, the main arteries of the forearm and hand. The venous system of the upper limbs can be divided into a superficial and deep venous system. The cephalic vein, basilic vein, and medial antebrachial vein comprise the superficial venous system, which drains into the deep venous system. The deep veins accompany the arteries of the upper limbs and drain into the axillary vein; this continues as the subclavian vein and drains into the superior vena cava. The upper limb is innervated by nerves of the brachial plexus, a somatic neural network formed by the anterior branches of the spinal nerves C5–T1. The musculocutaneous, axillary, radial, ulnar, and median nerves are the most important sensorimotor nerves of the upper limb.
Overview
Arteries
The upper limb is supplied by the axillary artery, which receives blood from the thoracic aorta via the subclavian artery and its branches.

Axillary artery [1][2]
Overview of branches of the axillary artery |
Vessel |
Origin |
Course |
Area of supply |
Superior thoracic artery |
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Thoracoacromial artery (thoracoacromial trunk) |
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- Runs posterior to the pectoralis minor muscle before piercing the clavipectoral fascia
- Divides into four branches:
- Pectoral branch
- Deltoid branch
- Acromial branch
- Clavicular branch
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Lateral thoracic artery
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Anterior humeral circumflex artery |
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Posterior humeral circumflex artery |
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Subscapular artery |
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Scapular anastomosis [2]
Brachial artery [1][2]
Overview of branches of the brachial artery
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Vessel |
Course |
Area of supply |
Deep artery of arm (profunda brachii) |
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Superior ulnar collateral artery |
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Inferior ulnar collateral artery |
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Middle ulnar collateral artery |
- Arises between the superior and inferior ulnar collateral arteries
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- Ensures collateral circulation to the skin by giving off perforator arteries
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Nutrient artery of the humerus |
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The brachial artery can be compressed proximally against the medial humerus to stop bleeding in the distal arm.
The deep artery of the arm ensures collateral circulation through the elbow anastomosis in case of proximal brachial artery injury. Disruption of the brachial artery distal to the origin of the deep artery of the arm is associated with a greater degree of ischemia of the upper limb.
Radial artery
- Origin: terminal branch of the brachial artery
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Course
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Anatomical relations
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Area of supply: supplies the elbow, wrist, hand, and the posterolateral aspect of the forearm
Overview of branches of the radial artery |
Vessel |
Course |
Area of supply |
Radial recurrent artery |
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Palmar carpal branch |
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Dorsal carpal branch |
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Superficial palmar branch |
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Deep palmar branch |
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First dorsal metacarpal arteries |
- Originates at the palmar aspect of the first intermetacarpal space
- Divides into three branches: radial, intermediate, and ulnar
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- Radial branch to the thumb
- Intermediate branch to the first web space
- Ulnar branch to the second digit
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Radialis indicis artery (radial artery of the index finger) |
- Originate at the webspace between the thumb and index finger
- Run across the dorsal aspect of the hand
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- Radial (lateral) aspect of the second digit
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Princeps pollicis (principal artery of the thumb) |
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The Allen test evaluates patency of the collateral circulation to the hand through the radial and ulnar arteries.
Ulnar artery
- Origin: terminal branch of the brachial artery
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Course
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Anatomical relations
- Area of supply: supplies the medial forearm, wrist and hand
Veins
Overview [1]

Overview of veins of the upper limb
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Veins |
Origin |
Course |
Termination |
Main tributaries |
Drains |
Superficial veins |
Cephalic vein |
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- Along the lateral aspect of the forearm and arm
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Basilic vein |
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Median antebrachial vein |
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Palmar venous network of the hand
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- Along the central aspect of the ventral forearm
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Median cubital vein |
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- The hand, wrist, and forearm
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Deep veins |
Radial veins |
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- The lateral aspect of the forearm and hand
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Ulnar veins |
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- The medial aspect of the forearm and hand
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Brachial veins
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- The arm, forearm, and hand
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Axillary vein |
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Nerves
Overview


The nerves of the upper limb are derived from the brachial plexus.

Brachial plexus
“Rugby Teams Drink Cool Beer!”: Roots, Trunks, Divisions, Cords, Branches (order of the brachial plexus divisions)

Roots
Nerves that arise from the roots of brachial plexus |
Nerve |
Dorsal scapular nerve |
Long thoracic nerve |
Nerve root |
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Function |
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Course |
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Innervation |
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Trunks
Nerves that arise from the upper trunk of brachial plexus |
Nerve |
Subclavian nerve |
Suprascapular nerve |
Nerve root |
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Function |
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Course |
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Innervation |
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Divisions
- Each trunk divides into an anterior and posterior division that enters the axillary fossa.
- All three posterior divisions innervate the extensor compartment of the arm and forearm (i.e., the posterior compartment).
- All three anterior divisions innervate the flexor compartment of the arm and forearm (i.e., the anterior compartment).
Cords
Branches [2]
Branches are the peripheral nerves that arise from each of the cords of the brachial plexus. The five most clinically significant branches of the brachial plexus are the musculocutaneous, axillary, median, radial, and ulnar nerves.
Lateral cord of the brachial plexus
Lateral cord and branches of the brachial plexus |
Branches of the brachial plexus |
Spinal roots |
Course |
Motor innervation |
Sensory innervation
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Musculocutaneous nerve
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Lateral aspect of the forearm (via the lateral antebrachial cutaneous nerve of the forearm)
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Lateral pectoral nerve |
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Lateral root of median nerve |
- The largest terminal branch of the lateral cord
- Passes medially to join a similar branch from the medial cord to form the median nerve
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- Radial ⅔ of the palm
- Palmar aspect of the radial 3 ½ fingers (i.e., the thumb, index finger, middle finger, and radial side of the ring finger)
- Dorsal aspect of the distal phalanges of the radial 3 ½ fingers
- Autonomous sensory zone: tip of the index finger
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Medial cord of the brachial plexus
Branches from the medial and lateral cords form the median nerve.


Posterior cord of the brachial plexus
Posterior cord and branches of the brachial plexus |
Branches of the brachial plexus |
Spinal roots |
Course |
Motor innervation |
Sensory innervation |
Upper subscapular nerve |
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Radial nerve
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Axillary nerve |
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Lower subscapular nerve |
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Thoracodorsal nerve |
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Clinical significance