The boundaries defining the beginning of the brachial artery are arbitrary. Most often, the border of the transition of the axillary artery into the brachial artery is considered to be the lower edge of the tendon latissimus muscle back or bottom edge large pectoral muscle.
The brachial artery is one of the most variable, both in terms of the level of branching from it and the topography of the main trunk, and in the location of abnormal branches, especially in cases of its high division. The bifurcation of the brachial artery (the place of division into the radial and ulnar arteries) also varies in location. The brachial artery is usually divided in the lower corner of the cubital fossa below the upper edge of the internal epicondyle of the shoulder by 3 - 5 cm. The division of the brachial artery into the ulnar and radial arteries is usually located 1 - 2 cm below the level of the elbow joint line.
On average, the length of the brachial artery is 15 cm in men, and 2 - 2.5 cm shorter in women, not counting cases of high origin of the brachial artery from the axillary above the loop of the median nerve.
The projection of the brachial artery depends on the position of the limb, its length, gender, age, and also, in particular, on the options for its origin and the level of its division into branches. The position of the hand is especially noticeable on the projection, since the ulnar fossa (the lowest point of the projection) due to the rotation of the head of the radial bone from the median position shifts inward. With the arm abducted to a right angle and rotated outward, the projection of the brachial artery passes along a line drawn along the inner edge of the coracula. brachialis muscle to a point lying 0.5 cm outward from the middle of the interepicondylar distance connecting the external and internal epicondyles humerus. With significant pronation of the forearm, the lower point of the projection of the brachial artery is located on the border between the inner and middle third, and with supination - on the border between the outer and middle third of the distance between the epicondyles.
It is important to know the projection of the brachial artery in relation to the humerus: in the upper third of the shoulder it is located 1.5 - 2.5 cm inward from the bone; in the middle third, the artery and median nerve are projected 1 - 1.5 cm outward from the inner edge of the bone, and the ulnar nerve is behind the median; in the lower third, the brachial artery and median nerve cross the bone from the inside outward and are projected onto its inner half, and the ulnar nerve - 0.5 - 1 cm inward from the inner edge of the humerus.
Along the course of the brachial artery, its syntopy also changes. In the upper third of the shoulder, it lies along the inner edge of the coracobrachialis muscle, the sheath of which forms the fascial sheath of the brachial artery and the median nerve, which is often located in front. At the posterior-inner edge of the artery is the ulnar nerve, often covered by v. basilica The ulnar nerve here often lies in the split of the internal intermuscular fascial septum of the shoulder. Outward from the neurovascular bundle, the musculocutaneous nerve runs, piercing the coracobrachial muscle, and posterior to it is the deep brachial artery along with the radial nerve.
In the middle third of the shoulder, the neurovascular bundle lies along the inner edge of the biceps brachii muscle, often covered by it. In this area, the median nerve is adjacent to the brachial artery in front, and the medial cutaneous nerve of the forearm and v. basilica - inside. Posteriorly 0.5 - 1 cm from the last formations, but already in the fascial bed of the triceps muscle, there is the ulnar nerve with the superior collateral ulnar artery.
In the lower third of the shoulder, the brachial artery with the veins of the same name remains in the fascia covering the brachialis muscle, and the medial cutaneous nerve of the forearm and v. basilica are located 1.5 cm posteriorly, separated from the brachial vessels by the fascia of the shoulder and a layer of subcutaneous tissue.
BRANCHES OF THE BRACHIAL ARTERY
Deep brachial artery(a. profunda brachii) most often departs from the posterior semicircle of the brachial artery, less often - from the internal or anterior semicircle, but always at an acute angle, most often at the level of the lower edge of the latissimus dorsi tendon, 1 - 2 cm below it. Deep artery the shoulder in the upper third of the shoulder is projected on the abducted and pronated limb to the lower edge of the deltoid muscle; in the middle third - on the gap between the brachialis muscle and the outer head of the triceps muscle and in the lower third - on the brachialis muscle and the long extensor carpi radialis.
In the deep artery of the shoulder, two sections can be distinguished: 1) intermuscular and 2) musculoskeletal. The first section in the upper third of the shoulder has a length on the abducted arm of 3–4 cm, the second – 4–6 cm. The musculoskeletal section of the deep brachial artery is located in the groove of the humerus, between the initial parts of the outer and inner heads of the triceps brachii muscle. The intermuscular section passes between the long and internal heads of this muscle. The projection of the deep brachial artery in the upper third crosses the humerus from front to back, in the middle third it corresponds to its posterior edge, and in the lower third it crosses the bone from top to bottom and from back to front, heading to the external epicondyle of the humerus.
The terminal branches of the deep brachial artery form anastomoses with the recurrent arteries arising from the vessels of the forearm.
Radial collateral artery(a. ccollateralis radialis) arises from the deep brachial artery in 89% of cases. In the radial collateral artery, three sections are conventionally distinguished: 1) in the canalis humeromuscularis; 2) in the thickness of the external intercondylar fascial septum of the shoulder; 3) in the lateral intermuscular groove of the ulnar fossa. From the first section branches extend to the muscles of the shoulder. The first section passes into the second at a height of 8–9 cm from the external epicondyle of the humerus. The length of the second section is 1 - 1.5 cm. The third section of the artery is located at the outer edge of the brachialis muscle, on the anterior surface of the external epicondyle and the elbow (humeroradial) joint. Here the radial collateral artery forms a direct anastomosis with the age branch from the radial artery.
Middle collateral artery(a. collateralis media) arises independently from the deep brachial artery more often than the radial collateral artery. It usually starts from the second section in the middle third of the posterior shoulder bed, located between the inner and outer heads of the triceps brachii muscle. It pierces the latter 1–2 cm above the external epicondyle of the humerus and is directed into the posterior external ulnar groove. Here the middle collateral artery anastomoses with the recurrent interosseous branch arising from the posterior interosseous artery. The branches of the middle collateral artery are involved in the formation of rete olecrani et rete cubiti.
Muscular branches(r. muscularis) originate mainly from the first section of the deep brachial artery and supply blood to the deltoid, coracobrachialis and biceps brachii muscles. Collateral arteries supply blood to the heads of the triceps brachii muscle. Thus, all the muscles of the posterior surface of the shoulder are supplied with blood from the deep brachial artery system. Therefore, if these muscles are damaged in the middle and lower third of the shoulder, it is advisable to ligate the deep artery of the shoulder to stop bleeding.
Branches supplying the humerus(rr. nutriciae humeri), depart from the second section of the deep artery of the shoulder and enter the corresponding openings located in the middle third on the posterior-inner surface of the humerus.
Superior ulnar collateral artery(a. collateralis ulnaris superior) departs from the internal semicircle of the brachial artery, most often at the level of the lower edge of the tendon of the latissimus dorsi muscle. In a third of cases it begins in the middle third of the shoulder.
The superior ulnar collateral artery and ulnar nerve are projected in the upper third of the shoulder (with the arm abducted to a right angle) to the inner edge of the coracobrachial muscle along with the brachial artery and the deep artery of the shoulder. Further down, the projection of the superior collateral artery and ulnar nerve shifts posteriorly in the middle third of the shoulder and corresponds to the inner head of the triceps brachii muscle. In the lower third of the shoulder, the artery and nerve project to the inner edge of the triceps brachii tendon and the edge of the inner epicondyle of the humerus.
In the superior ulnar collateral artery, four sections can be distinguished: 1) the upper one, located in the fascial sheath formed by the internal intermuscular septum of the shoulder and the fascia proper of the shoulder, where it lies together with the brachial vessels and the median nerve; 2) middle, located posterior to the internal intermuscular fascial septum in the fascial sheath formed by the sheath of the triceps brachii muscle, where the superior ulnar collateral vessels lie together with the ulnar nerve; 3) an area in the lower third of the shoulder, where the artery deepens into the thickness of the inner head of the triceps brachii muscle and can be separated from the ulnar nerve by its muscle bundles; 4) the final section of the artery passes from the internal head of the triceps brachii muscle to the posterior surface of the internal epicondyle of the humerus. Here, under the superficial fascia, the superior ulnar collateral artery forms an anastomosis with the posterior recurrent ulnar artery, which appears above the fascia proper between the heads of the flexor carpi ulnaris. From this area branches extend to the rete olecrani.
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 pronator teres and brachioradialis muscle under the aponeurosis of the biceps brachii muscle 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 median nerve, forms the neurovascular bundle of the shoulder. 
The following branches arise from the brachial arteries.
1. The deep artery of the shoulder, a profunda brachii, begins in the upper third of the shoulder from the posterointernal surface of the brachial artery. Heading back, it, together with the radial nerve, n. radialis, spirals around the posterior surface of the humerus. Then the deep brachial artery continues into the radial collateral artery, a. collateralis radialis, which first goes behind the lateral intermuscular septum of the shoulder and, having given off branches to form the articular network of the elbow, rete articulare cubiti, anastomoses with the recurrent artery, a. recurrent radialis. 
The deep brachial artery gives off a number of branches:
a) deltoid branch, r. deltoideus, departs from the initial section of the deep artery of the shoulder, passes under the coracobrachialis muscle and biceps brachii muscle, gives them branches and reaches the deltoid muscle along the anterior surface of the humerus;
b) arteries supplying the humerus, aa. nutriciae humeri, are directed into the nutrient openings of the humerus. May arise directly from the brachial artery;
c) middle collateral artery, a. collateralis media, follows down between the lateral and medial heads of the triceps brachii muscle. Then it enters the thickness of the lateral head and, reaching the elbow joint, anastomoses with a. interossea recurrens, taking part in education elbow joint no network.
2. Superior ulnar collateral artery, a. collateralis ulnaris superior, begins slightly below the deep brachial artery from the medial surface of the brachial artery, and sometimes shares a common trunk with it. Heading downwards, 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. Supplies blood to the brachialis muscle, the medial head of the triceps brachii muscle 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. Directing downwards 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 area of the medial condyle, pierces the medial intermuscular septum of the shoulder and takes part in the formation of the elbow articular network.
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 artery at the level of the lower edges of the pectoralis major and latissimus muscles, that is, at the level of the anterior and posterior axillary walls. The artery lies deep and laterally in the axillary cavity. Surrounded in a horseshoe shape by the medial, posterior, and lateral nerve bundles brachial plexus, together with which the axillary vein forms the axillary neurovascular bundle.The axillary artery is conventionally divided into three sections:
The first is at the level of the claviculopectoral triangle (between the collarbone and the pectoralis minor muscle). It begins branches: subscapular, upper thoracic to the 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 gives off the lateral thoracic artery with branches to the serratus anterior muscle and mammary gland.
The third is at the level of the subpectoral triangle (between the lower edges of the pectoralis major and minor muscles). The largest artery branches off in it - the subscapularis (a. subscapularis), which supplies the thoraco-dorsal branch with the serratus anterior, teres major and part of the latissimus muscle, and with the branch that goes around the scapula - the infraspinatus and other muscles of the scapular region, to which it passes through the trilateral foramen terminal branch (a. circumflexa scapulae).
In addition, the anterior and posterior arteries that encircle the humerus begin in the third section. The larger posterior artery and axillary nerve pass through the quadrilateral foramen into the posterior region of the shoulder girdle. Both arteries supply blood to the shoulder joint, deltoid, coracobrachialis 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 bicipital groove, forming the neurovascular bundle of the shoulder. In it, the median nerve crosses the vessels in the middle third of the shoulder. Medial to the bundle are the ulnar nerve, cutaneous nerves of the shoulder and forearm. In the ulnar fossa, the brachial artery is divided in the projection of the neck of the radial bone into the ulnar and radial arteries. As it moves, it produces small muscle and skin branches on the shoulder. The larger branches are the collateral ulnar arteries - superior and inferior.
The largest branch is considered to be the deep brachial artery (a. profunda brachii), which arises in the upper third of the shoulder and, together with the radial nerve, occupies the brachial-muscular canal, in which at the level of the middle third they are adjacent to the humerus (possible damage due to fractures). The deep artery may be absent in 30% or originate from the axillary artery (50%) The deep artery supplies the humerus, deltoid, triceps, brachialis muscles; 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 connects with the recurrent interosseous. The radial collateral anastomoses with the recurrent radial, the upper and lower ulnar collaterals anastomose with the recurrent ulnar: anterior and posterior.
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.
Brachial arterya. brachidlis(Fig. 51), is a continuation of the axillary artery. It begins at the level of the inferior border of the pectoralis major muscle, where the brachial artery lies anterior to the coracobrachialis 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 brachial canal between back surface humerus and 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 artery, a. 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. collateralis radilis, 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.
156. Radial artery, topography, branches, areas of blood supply.
radial artery,a. radidlis(Fig. 52), begins 1-3 cm distal to the gap of the brachioradial joint and continues the direction of the brachial artery. It lies between the pronator teres and the brachioradialis muscle, and in the lower third of the forearm it is covered only by fascia and skin, so it is easy to feel its pulsation here. In the distal forearm, the radial artery, going around the styloid process of the radius, passes to the back of the hand, and then through the first interosseous space penetrates the palm. The terminal section of the radial artery anastomoses with the deep palmar branch of the ulnar artery, forming deep palmar arch, arcus palmaris profundus. From this arc they originate palmar metacarpal arteries, aa. metacarpales palmares, blood supply interosseous muscles. These arteries flow into the common palmar digital arteries (branches of the superficial palmar arch) and give off perforating branches, rr. perfordntes, anastomosing with the dorsal metacarpal arteries arising from the dorsal network of the wrist.
From the radial artery along its length there are 9 to 11 branches, including muscular ones. The most significant of them are the following: 1) radial recurrent artery, a. ge-currens radidlis(Fig. 53), departs from the initial section of the radial artery, goes laterally and upward, lies in the anterior lateral ulnar groove, where it anastomoses with the radial collateral artery; 2) superficial palmar branch, g. palmaris superficial, directed to the palm, where in the thickness of the muscles of the eminence thumb or medially from its flexor brevis participates in the formation of the superficial palmar arch; 3) palmar carpal branch, l. carpdlis palmaris, starts from the radial artery in the distal part of the forearm, follows medially, anastomoses with the branch of the same name of the ulnar artery and participates in the formation of the palmar network of the wrist; 4) dorsal carpal branch, g. carpdlis dorsdlis, starts from the radial artery on the back of the hand, goes medially, anastomoses with the same branch of the ulnar artery, forming together with the branches of the interosseous arteries dorsal network of the wrist, rete carpdle dorsdle. 3-4 branches depart from this network dorsal metacarpal arteries, aa. metacarpales dorsdles, and from each of them - two dorsal digital arteries, aa. di~ gitdles dorsdles, supplying blood to the dorsum of II-V fingers. On the back of the hand it separates from the radial artery first dorsal metacarpal artery, aa. metacarpdlis dorsdlis I, which gives branches to the radial side of the I finger and to the adjacent sides of the I and II fingers. Having penetrated the palm, the radial artery gives off artery of the thumb, a. princeps pollicis, which splits into two palmar digital arteries to both sides of the thumb and gives off radial artery index finger, a. radilis indicis.
