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The brachial artery is the main arterial trunk of the arm, the direct continuation of the axillary artery beyond the lower border of teres major.
It supplies the arm muscles, gives off important collateral branches around the elbow, and ends by dividing into the radial and ulnar arteries.
Begins → at the lower border of teres major.
Ends → in the cubital fossa at the level of the neck of the radius by dividing into radial and ulnar arteries.
Runs down the medial side of the arm, initially lateral, then medial to the median nerve.
In the lower half, it lies medial to the biceps tendon and anterior to the brachialis muscle.
At the elbow, it lies under the bicipital aponeurosis, and superficial to the brachialis.
Covered by skin, superficial fascia, and deep fascia.
Crossed by median cubital vein (important for venipuncture).
Bicipital aponeurosis separates it from the median cubital vein.
Lies on triceps (upper part) and brachialis (lower part).
Accompanied by median nerve (medially) and basilic vein (superficially).
Median nerve (upper arm) initially lies lateral, then crosses to medial side.
Biceps brachii and coracobrachialis laterally.
Ulnar nerve and basilic vein.
To biceps brachii, coracobrachialis, and brachialis.
To humerus (enters through nutrient foramen near middle of bone).
Largest branch.
Arises near upper part of brachial artery.
Accompanies radial nerve in the spiral groove.
Ends by dividing into radial collateral and middle collateral arteries, which participate in elbow anastomosis.
Arises in middle of arm.
Accompanies ulnar nerve behind medial epicondyle.
Joins posterior ulnar recurrent artery in elbow anastomosis.
Arises 5 cm above elbow.
Passes anterior to medial epicondyle.
Joins anterior ulnar recurrent artery.
Radial artery (lateral).
Ulnar artery (medial).
Expose the anterior compartment of the arm as before.
Identify the biceps brachii and bicipital aponeurosis.
Deep to the aponeurosis, locate the brachial artery and median nerve.
Observe:
In upper part → median nerve is lateral to artery.
Mid-arm → median nerve crosses anteriorly.
Lower arm → median nerve becomes medial to artery.
Identify profunda brachii artery arising near teres major.
Trace superior and inferior ulnar collateral arteries descending toward elbow.
Note accompanying brachial veins (venae comitantes) on either side of artery.
Brachial pulse is felt in the cubital fossa, medial to biceps tendon.
Used for measuring blood pressure (by sphygmomanometer).
Can be compressed against the humerus in the mid-arm to control bleeding in distal limb injuries.
Brachial artery aneurysm may present as pulsatile swelling in the arm, causing median nerve compression (pain or paresthesia).
Blockage → ischemia of forearm and hand → pain, pallor, and pulselessness.
Immediate emergency revascularization needed.
Injection into brachial artery instead of vein → gangrene of forearm muscles due to spasm and ischemia.
Median cubital vein overlies brachial artery in cubital fossa, separated by bicipital aponeurosis → prevents accidental arterial puncture during blood sampling.
Important in ligation or obstruction of brachial artery.
Maintained via:
Superior & inferior ulnar collateral arteries.
Radial & middle collateral arteries (from profunda brachii).
Ulnar recurrent and radial recurrent arteries (below elbow).
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