The boundaries that define the beginning of the brachial artery are conditional. Most often, the border of the transition of the axillary artery to the brachial is considered to be the lower edge of the tendon latissimus dorsi back or lower edge large chest 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 usually divides 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 1–2 cm below the level of the elbow joint line.
On average, the length of the brachial artery in men is 15 cm, and in women it is 2–2.5 cm shorter, not counting cases of high discharge 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, on its length, on gender, age, and also, in particular, on the variants of the 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 lower point of the projection) is displaced inwards due to the rotation of the head of the radius from the median position. With the arm retracted to a right angle and rotated outward, the projection of the brachial artery passes along a line drawn along the inner edge of the beak shoulder muscle to a point lying 0.5 cm outward from the middle of the intercondylar distance connecting the outer and inner epicondyles humerus. With a 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 thirds, and with supination, on the border between the outer and middle thirds 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 1.5–2.5 cm medially 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 the median nerve cross the bone from the inside outward and project onto its inner half, and the ulnar nerve - 0.5 - 1 cm medially 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 coracobrachial muscle, the sheath of which forms the fascial sheath of the brachial artery and the median nerve, which is more often 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 splitting of the internal intermuscular fascial septum of the shoulder. Outward from the neurovascular bundle goes, perforating the coracobrachial muscle, the musculocutaneous nerve, and behind it is the deep artery of the shoulder along with the radial nerve.
In the middle third of the shoulder, the neurovascular bundle lies along the inner edge of the biceps of the shoulder, 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. Behind 0.5 - 1 cm from the last formations, but already in the fascial bed of the triceps muscle, there is an ulnar nerve with an upper 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 shoulder muscle, and the medial cutaneous nerve of the forearm and v. basilica are located 1.5 cm posteriorly, separated from the brachial vessels by their own fascia of the shoulder and a layer of subcutaneous tissue.
BRANCHES OF THE BRACHERIC ARTERY
Deep artery of the shoulder(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 tendon of the latissimus dorsi muscle, 1–2 cm below it. Deep artery 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 shoulder muscle and the outer head of the triceps muscle and in the lower third - on the shoulder muscle and the long radial extensor of the hand.
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 of 3-4 cm on the abducted arm, the second is 4-6 cm. The musculoskeletal section of the deep artery of the shoulder is located in the groove of the humerus, between the initial parts of the outer and inner heads of the triceps muscle of the shoulder. The intermuscular section runs between the long and inner heads of this muscle. The projection of the deep artery of the shoulder 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 towards the external epicondyle of the humerus.
The terminal branches of the deep artery of the shoulder form anastomoses with the recurrent arteries extending from the vessels of the forearm.
radial collateral artery(a. ccollateralis radialis) departs from the deep artery of the shoulder in 89% of cases. Three sections are conventionally distinguished in the radial collateral artery: 1) in canalis humeromuscularis; 2) in the thickness of the outer intercondylar fascial septum of the shoulder; 3) in the lateral intermuscular groove of the cubital fossa. Branches extend from the first section 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 brachial muscle, on the anterior surface of the external epicondyle and the ulnar (shoulder) joint. Here the radial collateral artery forms a direct fistula with an age branch from radial artery.
Middle collateral artery(a. collateralis media) departs independently from the deep artery of the shoulder more often than the radial collateral artery. Usually it starts from the second section in the middle third of the posterior shoulder bed, located between the inner and outer heads of the triceps muscle of the shoulder. It perforates the latter 1–2 cm above the external epicondyle of the humerus and goes to the posterior external ulnar groove. Here, the middle collateral artery anastomoses with the recurrent interosseous branch that originates 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) depart mainly from the first section of the deep artery of the shoulder and supply blood to the deltoid, beak-brachial and biceps muscles of the shoulder. The collateral arteries supply the heads of the triceps brachii. Thus, all the muscles of the back surface of the shoulder are supplied with blood from the system of the deep artery of the shoulder. Therefore, if these muscles are damaged in the middle and lower third of the shoulder, it is advisable to tie up the deep artery of the shoulder to stop bleeding.
Branches that feed the humerus(rr. nutriciae humeri), depart from the second section of the deep artery of the shoulder and enter the corresponding holes 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) on the inner edge of the coracobrachial muscle, together 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 internal head of the triceps muscle of the shoulder. In the lower third of the shoulder, the artery and nerve project onto the inner edge of the tendon of the triceps muscle of the shoulder and the edge of the inner epicondyle of the humerus.
Four sections can be distinguished in the superior ulnar collateral artery: 1) the upper one, located in the fascial sheath, formed by the internal intermuscular septum of the shoulder and the own fascia of the shoulder, where it lies along 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 case of the triceps muscle of the shoulder, where the upper ulnar collateral vessels lie together with the ulnar nerve; 3) a section in the lower third of the shoulder, where the artery deepens into the thickness of the internal head of the triceps muscle of the shoulder and can be separated from the ulnar nerve by its muscle bundles; 4) the end section of the artery passes from the internal head of the triceps muscle of the shoulder 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 its own fascia between the heads of the flexor ulnar ulnaris. From this area branch off 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 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, spirally wraps around the posterior surface of the 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 the 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 the elbow joint, anastomoses with a. interossea recurrens by taking part in education elbow joint 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, the medial head of 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.
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 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 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 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 pectoralis major and minor muscles). It branches off the largest artery - the subscapularis (a. subscapularis), which supplies the thoracic-dorsal branch with the anterior serratus, teres major and part of the latissimus dorsi, and with the branch that surrounds the scapula - the infraspinatus and other muscles of the scapular region, to which it passes through a tripartite opening 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, 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 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.
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 inner groove of the shoulder, provides blood to the muscles and skin of the shoulder, the elbow joint, descending 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, the elbow joint, and the skin in the area of this joint.
radial artery located on the front surface of the forearm, then goes 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 is well palpable between the styloid process of the radius and the tendon radial muscle to determine the pulse. The branches of the artery depart to the elbow joint, muscles of the forearm and hand.
Ulnar artery passes between the anterior muscle-. mi forearms, then on the palm, where it connects with the branch of the radial artery, forms a superficial palmar arch.
brachial artery,a. brachidlis(Fig. 51), is a continuation of the axillary artery. It begins at the level of the lower edge of the pectoralis major muscle, where the brachial artery lies in front of the coracobrachialis muscle. Then the artery is located on the anterior surface of the brachialis muscle, in the groove passing medially to the biceps brachii.
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 muscles of the shoulder; 2) deep artery of the shoulder, 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 rear surface humerus and the triceps muscle of the shoulder, where it gives off several branches: arteries supplying the humerus, aa. nutriciae hiimeri, deltoid branch, g. deltoideus, to the same and shoulder muscles, middle collateral artery, a. collateralis media, which gives branches to the triceps muscle of the shoulder, passes in the posterior lateral ulnar groove and anastomoses with the recurrent interosseous artery, and radial collateral artery, a. collateralis radidlis, 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, originates 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) lower ulnar collateral artery, a. collateralis ulnaris inferior, starts from the brachial artery just above the medial epicondyle of the humerus, goes medially along the anterior surface of the brachialis muscle and anastomoses with the anterior branch of the ulnar recurrent artery. All collateral arteries are involved in the formation of the ulnar articular network, from which the elbow joint, adjacent muscles and skin in the region of this joint are supplied with blood.
156. Radial artery, topography, branches, areas of blood supply.
radial artery,a. Radidlis(Fig. 52), begins 1-3 cm distal to the fissure of the brachioradial joint and continues the direction of the brachial artery. It lies between the round pronator and the brachioradialis muscle, and in the lower third of the forearm it is covered only by the fascia and skin, so it is easy to feel its pulsation here. In the distal forearm, the radial artery, having rounded the styloid process of the radius, passes to the rear of the hand, and then through the first interosseous gap penetrates into 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 originate palmar metacarpal arteries, aa. metacarpales palmares, blood supply interosseous muscles. These arteries empty 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 extending from the dorsal network of the wrist.
From the radial artery along its length, from 9 to 11 branches depart, 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 upwards, lies in the anterior lateral ulnar groove, where it anastomoses with the radial collateral artery; 2) superficial palmar branch, d. palmaris superficial, goes to the palm, where in the thickness of the muscles of the elevation thumb or medially from its short flexor participates in the formation of a 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 ulnar artery of the same name and participates in the formation of the palmar network of the wrist; 4) dorsal carpal branch, d. carpdlis dorsdlis, starts from the radial artery at the back of the hand, goes medially, anastomoses with the branch of the ulnar artery of the same name, forming together with the branches of the interosseous arteries dorsal network of the wrist, rete carpdle dorsdle. 3-4 depart from this network dorsal metacarpal arteries, aa. metacarpales dorsdles, and from each of them - two dorsal digital arteries, aa. di~ gitdles dorsdles, 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. metacarpdlis dorsdlis I, which gives branches to the radial side of the I finger and to the adjacent sides of the II 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 index finger, a. Radidlis indicis.
