The Brachial Artery is the extension of the axillary artery starting at the lower margin of the teres major muscle and is the major artery of the upper extremity. The brachial artery courses along the ventral surface of the arm and gives rise to multiple smaller branching arteries before reaching the cubital fossa. These branching arteries include the deep brachial artery, the superior ulnar collateral artery, and the inferior ulnar collateral artery. Once the brachial artery reaches the cubital fossa, it divides into its terminal branches: the radial and ulnar arteries of the forearm. 

The brachial artery and its branches supply the biceps brachii muscle, triceps brachii muscle, and coracobrachialis muscle. The median nerve, a division of the brachial plexus, initially lies lateral to the brachial artery at its proximal segment. At its distal segment, the median nerve crosses the medial side of the brachial artery and lies in the ventral cubital fossa.

Structure of the Brachial Artery

The following are the branches of the brachial artery in order of origin, proximal to distal.

Profunda Brachii/Deep Brachial Artery

The first branch of the brachial artery, this branch of the brachial artery arises below the inferior border of the teres major muscle. Paralleling this branch of the brachial artery is the radial nerve. Initially, the profunda brachii artery gives off an ascending deltoid branch aiding the posterior circumflex humeral artery in supplying the deltoid muscle. The profunda brachii artery then courses between the long and medial heads of the triceps brachii muscle and runs along the radial sulcus of the humerus. Once it reaches the lateral aspect of the upper extremity, the profunda brachii artery pierces the lateral intermuscular septum and supinator muscle before dividing into the middle and radial collateral arteries — the radial collateral artery anastomoses with the radial recurrent artery at the anterior cubital fossa. The middle collateral artery runs posterior to the cubital fossa and anastomoses with the interosseous recurrent artery superior to the olecranon of the ulna.

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Superior Ulnar Collateral Artery

The second branch of the brachial artery. Occasionally, this artery may arise from the profunda brachii artery. After its origin, it penetrates the medial intermuscular septum and courses along the medial head of the triceps brachii. Once it reaches the elbow, the superior ulnar collateral artery parallels the ulnar nerve along the space between the olecranon of the ulna and medial epicondyle of the humerus. The superior ulnar collateral artery ends via anastomosing with the posterior ulnar recurrent artery and inferior ulnar collateral artery deep to the flexor carpi ulnaris muscle.

Inferior Ulnar Collateral Artery

The third branch of the brachial artery, this vessel originates anterior to the lower segment of the humerus. It runs medially along the brachialis muscle before piercing the medial intermuscular septum. It anastomoses with the anterior ulnar recurrent artery and the superior ulnar collateral artery.

Ulnar Artery

There are two terminal branches of the brachial artery. The ulnar artery originates in the cubital fossa and courses distally between the second and third layers of the forearm flexor muscles. It provides vascular supply to the ulnar aspect of the flexor compartment. The ulnar artery then runs superior to the flexor retinaculum at the wrist and continues as the superficial palmar branch, a major vascular component of the hand. In addition, before continuing as the superficial palmar branch, the ulnar artery gives off a deep palmar branch that joins the deep palmar arch of the hand.

Radial Artery

The other of the two-terminal artery is the radial artery. The radial artery originates in the cubital fossa along with the ulnar artery at the bifurcation of the brachial artery. It courses under the brachioradialis muscle, running laterally to the flexor carpi radialis muscle. This course serves as the linear boundary between the flexor and extensor compartments of the forearm. The radial artery provides the vascular supply to the radial component of both compartments.

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Muscles and Brachial Artery

In discussing the vascular supply provided by the brachial artery and its branches, one must note that in the case of the upper extremity; each respective muscle often receives vascular supply from more than one artery. The following is a listing of the branches of the brachial artery along with the structures to which they provide vascular supply:

  • Brachial artery: biceps brachii muscle, triceps brachii muscle, coracobrachialis muscle
  • Profunda brachii artery: deltoid muscle, triceps brachii muscle, anconeus muscle
  • Superior ulnar collateral artery: supplies the periarticular arterial anastomoses of the elbow and elbow joint
  • Inferior ulnar collateral artery: brachialis muscle, biceps brachii muscle, coracobrachialis muscle
  • Ulnar artery: elbow joint, central and medial forearm muscles, common flexor sheath
  • Radial artery: elbow joint, lateral forearm muscles, carpal bones and joints, thumb and lateral index finger

References

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