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Brachial artery and anastomosis around elbow

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I now have comprehensive information from multiple authoritative textbooks. Here is a full, well-organized answer:

Brachial Artery and Anastomosis Around the Elbow

Brachial Artery - 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 teres major (or lower border of pectoralis major, depending on the reference). It runs down the arm and terminates in the cubital fossa (antecubital fossa), where it bifurcates into the radial and ulnar arteries, usually at the apex of the fossa. - Gray's Anatomy for Students

Course in the Arm

  • Proximal arm: Lies on the medial side of the humerus, in the medial bicipital groove, where its pulse is palpable and it can be compressed against the humerus in an emergency.
  • Distal arm: Moves laterally to a position midway between the medial and lateral epicondyles.
  • Cubital fossa: Crosses anteriorly to the elbow joint, lying just medial to the biceps brachii tendon, covered by the bicipital aponeurosis (which protects it).
  • The median nerve runs immediately medial to it throughout its course; in the arm it crosses the brachial artery from lateral to medial. - Imaging Anatomy: Bones, Joints, Vessels and Nerves

Relationship to Median Nerve

The median nerve is formed lateral to the axillary artery, crosses superficial to the brachial artery from lateral to medial in the arm, and enters the cubital fossa medial to both the biceps tendon and brachial artery. It then passes between the heads of pronator teres. - Rockwood & Green's Fractures in Adults

Branches of the Brachial Artery

BranchNotes
Profunda brachii (deep brachial artery)Largest branch; arises at lower border of teres major. Passes with radial nerve through triangular interval and along radial groove. Divides into radial collateral and middle collateral arteries
Superior ulnar collateral arteryArises distal to profunda brachii; runs alongside the ulnar nerve; anastomoses posteriorly
Inferior ulnar collateral arteryArises more distally, just above the medial epicondyle near the olecranon fossa
Nutrient arteries to humerusPass through foramen in anteromedial humeral shaft
Muscular branchesNumerous, to arm muscles
  • General Anatomy and Musculoskeletal System (THIEME Atlas) | Color Atlas of Human Anatomy Vol. 2
The profunda brachii arises as a single trunk in 55-70% of cases. It may also arise from the axillary artery (22%), as a common trunk with the superior ulnar collateral artery (22%), or rarely from the circumflex humeral arteries.

Cubital Fossa

The cubital fossa is a triangular depression anterior to the elbow, bounded by:
  • Laterally: brachioradialis
  • Medially: pronator teres
  • Base: imaginary line between medial and lateral epicondyles
  • Floor: brachialis muscle
  • Roof: skin and superficial fascia (+ bicipital aponeurosis anteriorly)
Contents (lateral to medial): biceps tendon → brachial artery → median nerve
The radial nerve runs just under the brachioradialis lip (lateral margin) and divides into its superficial and deep branches here. The ulnar nerve does NOT pass through the cubital fossa - it passes posterior to the medial epicondyle. - Gray's Anatomy for Students

Anastomosis Around the Elbow (Cubital Anastomosis)

This is a periarticular vascular network encircling the elbow joint, formed by descending branches from above (brachial artery and profunda brachii) meeting ascending recurrent branches from below (radial and ulnar arteries).
Collateral vessels and anastomosis around the elbow - Rockwood & Green's
Anastomosis around the elbow showing collateral and recurrent vessels (Rockwood & Green's Fractures in Adults)

Three Vascular Arcades (from Rockwood & Green's)

ArcadeFormed bySupplies
LateralInterosseous recurrent + radial recurrent + radial collateral arteriesCapitellum, radial head, lateral epicondyle, lateral trochlea
MedialSuperior ulnar collateral + inferior ulnar collateral + anterior & posterior ulnar recurrent arteriesMedial epicondyle, medial trochlea
PosteriorMedial collateral artery + contributions from medial & lateral arcadesOlecranon fossa, supracondylar area

Detailed Components (THIEME Atlas)

Descending (from above):
  • Radial collateral artery (from profunda brachii) - communicates via radial recurrent artery
  • Middle collateral artery (from profunda brachii) - communicates via interosseous recurrent artery
  • Superior ulnar collateral artery (from brachial artery) - communicates via posterior ulnar recurrent artery
  • Inferior ulnar collateral artery (from brachial artery) - communicates via anterior ulnar recurrent artery
Ascending recurrent (from below):
  • Radial recurrent artery (1st branch of radial artery)
  • Anterior ulnar recurrent artery (from ulnar artery)
  • Posterior ulnar recurrent artery (from ulnar artery)
  • Recurrent interosseous artery (from posterior interosseous artery)

Clinical Significance

  1. Ligation of brachial artery: Because of the cubital anastomosis, the brachial artery can be safely ligated distal to the origin of the profunda brachii without compromising blood supply to the elbow region - collateral flow is maintained through the anastomotic network. - THIEME Atlas; Color Atlas of Human Anatomy Vol. 2
  2. Radial artery harvest for grafts: The patent cubital anastomosis permits removal of the radial artery as a graft (e.g., for coronary bypass), as collateral circulation is provided by recurrent vessels via the ulnar artery. - Color Atlas Vol. 2
  3. Supracondylar process and Struthers' ligament: In ~0.7% of people, a bony outgrowth (supracondylar process) above the medial epicondyle connects to the medial epicondyle via Struthers' ligament, forming a fibro-osseous supracondylar canal that can trap and compress both the brachial artery and the median nerve. - THIEME Atlas
  4. Superficial brachial artery variant (4-12%): Courses superficial to the median nerve instead of deep to it - more vulnerable to injury. It is an important fetal vessel and normally regresses postnatally. - Imaging Anatomy Vol. 3
  5. Supracondylar fractures in children: The brachial artery is at risk of injury (kinking, entrapment, or laceration) from the proximal fragment, particularly in extension-type supracondylar fractures. The robust anastomotic network may maintain some distal perfusion even with brachial artery injury, which can give a falsely reassuring pink hand.
Course of the axillary and brachial artery with cubital anastomosis
Course of the axillary and brachial arteries with cubital anastomosis - Color Atlas of Human Anatomy Vol. 2
Upper limb arteries overview showing collateral branches
Upper limb arterial overview showing collateral and recurrent branches - THIEME Atlas of General Anatomy
Sources:
  • Gray's Anatomy for Students, 4th Ed
  • General Anatomy and Musculoskeletal System (THIEME Atlas)
  • Color Atlas of Human Anatomy Vol. 2 - Internal Organs
  • Imaging Anatomy: Bones, Joints, Vessels and Nerves Vol. 3
  • Rockwood and Green's Fractures in Adults, 10th Ed (2025)
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