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Brachial Artery - Anatomy & Clinical Note

Overview

The brachial artery is the major arterial supply to the arm. It is the direct continuation of the axillary artery, beginning at the inferior border of the teres major muscle, and terminates in the cubital fossa (antecubital fossa) by dividing into the radial and ulnar arteries at the level of the neck of the radius.

Imaging Anatomy - Bones, Joints, Vessels & Nerves, p. 159
Gray's Anatomy for Students, p. 875

Course

Segment	Relations
Origin	Inferior border of teres major - continuation of axillary artery
Proximal arm	Lies on the medial side of the humerus, in the medial bicipital groove; related to the ulnar and median nerves
Distal arm	Courses anteriorly, moving to a position midway between the medial and lateral epicondyles
Cubital fossa	Lies between the biceps brachii tendon (lateral) and the median nerve (medial), covered by the bicipital aponeurosis
Termination	Divides into radial and ulnar arteries at the level of the neck of the radius

Important landmark: The pulse of the brachial artery is palpable all along the ulnar border of the biceps brachii muscle throughout its course.

In the proximal arm, the artery can be compressed against the medial side of the humerus - useful for haemostasis.

Fischer's Mastery of Surgery, 8th ed.
THIEME General Anatomy & Musculoskeletal System, p. 408

Nerve Relations

Proximally: Median nerve is lateral and the ulnar nerve is medial to the artery
Distally: The median nerve crosses the brachial artery (from lateral to medial), so in the antecubital fossa it lies medial and deep to the artery
The ulnar nerve runs alongside the superior ulnar collateral artery

Branches

Branch	Notes
Profunda brachii (deep brachial artery)	Largest branch; courses with the radial nerve through the triangular interval and along the radial groove on the posterior surface of the humerus; divides into the radial collateral and middle collateral arteries - contributes to arterial anastomosis around the elbow
Superior ulnar collateral artery	Runs with the ulnar nerve; anastomoses with the posterior ulnar recurrent artery at the elbow
Inferior ulnar collateral artery	Contributes to elbow anastomosis
Nutrient arteries	Pass through the anteromedial surface of the humeral shaft
Muscular branches	Supply adjacent muscles

Branches of the brachial artery (listed):

Deep artery of the arm (profunda brachii)
Radial collateral artery
Medial collateral artery
Superior ulnar collateral artery
Inferior ulnar collateral artery
THIEME General Anatomy & Musculoskeletal System
Gray's Anatomy for Students, p. 876

Anastomosis Around the Elbow

The brachial artery and its branches form an important arterial anastomosis around the elbow joint through:

Radial and middle collateral arteries (from profunda brachii) + radial recurrent artery
Superior and inferior ulnar collateral arteries + ulnar recurrent arteries

Clinical implication: The brachial artery can be ligated safely distal to the origin of the profunda brachii (e.g., to control post-traumatic haemorrhage) because the elbow anastomosis can establish adequate collateral circulation.

Variations

Superficial brachial artery (4-12%): Courses superficial to (instead of deep to) the median nerve. More vulnerable to injury due to its superficial location.
High division (~20-25%): The artery bifurcates early in the arm, before the cubital fossa:
- High-branching radial artery (~10%)
- High-branching ulnar artery (~3%)
- Both radial and ulnar arise from brachial, with brachial continuing as common interosseous (~7%)
Duplicated brachial artery (rare): The axillary artery bifurcates into superficial and deep branches

High division pattern of the brachial artery, showing the superficial brachial artery, its relationship to the median nerve, and division into radial and ulnar arteries

Imaging Anatomy - Bones, Joints, Vessels & Nerves, p. 159
Fischer's Mastery of Surgery, 8th ed.

Clinical Significance

1. Blood Pressure Measurement

The brachial artery is the standard site for BP measurement. A sphygmomanometer cuff compresses the brachial artery against the humerus. A stethoscope placed over the artery in the cubital fossa detects Korotkoff sounds - the thumping becomes audible as cuff pressure falls below systolic (>120 mmHg) and disappears at diastolic pressure. Normal range: 90-120 / 60-80 mmHg.

Gray's Anatomy for Students, p. 876

2. Arterial Puncture / Cannulation

The brachial artery in or just proximal to the antecubital fossa is used when radial or axillary access is unavailable. However:

Lacks the collateral circulation advantage of the wrist (radial + ulnar dual supply)
Higher risk of ischaemic complications compared to radial artery
Requires arm maintained in extension
Needs a longer catheter (10 cm) to span the elbow joint
Safe cannulation has been demonstrated; one study of >3,000 catheterisations over 3 years found only one minor thrombotic complication
Roberts and Hedges' Clinical Procedures in Emergency Medicine

3. Brachial Artery Injury

Accounts for 14-30% of all arterial injuries and up to 60% of upper extremity arterial injuries
Proximal control: Manual compression of the artery against the humerus
Surgical approach: Longitudinal incision in the palpable groove on the medial side of the upper arm between biceps and triceps
The bicipital aponeurosis must be divided distally to expose the artery
Injuries distal to the profunda brachii origin may or may not cause critical ischaemia depending on the degree of collateral circulation damage
Low-velocity injuries: primary repair possible
High-velocity / blunt injuries: require more extensive reconstruction; spatulated anastomosis required to prevent narrowing
Fischer's Mastery of Surgery, 8th ed.

4. Supracondylar Fracture of the Humerus

The brachial artery is at risk of injury with supracondylar fractures in children, as it lies immediately anterior to the distal humerus in the cubital fossa. This is a surgical emergency requiring urgent assessment of distal pulses, capillary refill, and hand perfusion.

Summary Diagram (Cross-section, arm)

Lateral	Medial
Musculocutaneous nerve	Ulnar nerve
Biceps brachii	Triceps brachii
Brachioradialis (distally)	Medial head of triceps
Radial nerve (posterior)	Brachial artery
	Median nerve (crosses distally)
	Basilic vein

Sources: Gray's Anatomy for Students; Imaging Anatomy Vol. 3 - Bones, Joints, Vessels & Nerves; THIEME General Anatomy & Musculoskeletal System; Fischer's Mastery of Surgery, 8th ed.; Roberts and Hedges' Clinical Procedures in Emergency Medicine

Systemic anatomy book

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Here are the anatomy books available in the library:

Anatomy Books in the Library

General / Systemic Anatomy

#	Title	ISBN
1	Gray's Anatomy for Students	9780323934237
2	General Anatomy and Musculoskeletal System (THIEME Atlas of Anatomy)	9781626237186
3	Netter's Atlas of Human Anatomy	9780323547048

Color Atlases (THIEME - Sobotta series)

#	Title	ISBN
4	Color Atlas of Human Anatomy Vol. 1 (Locomotor System)	9783132424432
5	Color Atlas of Human Anatomy Vol. 2 (Internal Organs)	9783132424487
6	Color Atlas of Human Anatomy Vol. 3 (Nervous System & Sensory Organs)	9783132424517

Imaging & Ultrasound Anatomy

#	Title	ISBN
7	Color Atlas of Ultrasound Anatomy, 3e	9783132422049
8	Imaging Anatomy Vol. 3 - Bones, Joints, Vessels & Nerves	9781626239845

Neuroanatomy

#	Title	ISBN
9	Neuroanatomy through Clinical Cases, 3rd Edition	9781605359625

The most widely used for systemic/regional anatomy are Gray's Anatomy for Students and the THIEME Atlas series. For visual learners, Netter's Atlas and the Color Atlas (Sobotta) volumes are excellent references. Just let me know which book or topic you'd like to explore and I'll pull the relevant sections for you.

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