Show me branches and blood supply of brachial artery around the elbow.

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Brachial Artery: Branches and Blood Supply Around the Elbow

Overview and Course

The brachial artery is the continuation of the axillary artery, starting at the lower border of the teres major muscle. It descends in the medial bicipital groove, crossing anteriorly to the elbow joint where it lies immediately medial to the biceps brachii tendon, roughly midway between the medial and lateral epicondyles. It terminates in the cubital fossa at the level of the neck of the radius by dividing into the radial and ulnar arteries.

Brachial artery course - anterior view (Gray's Anatomy for Students)

Branches of the Brachial Artery

Branch	Origin	Course and Supply
Profunda brachii (deep brachial) artery	Largest branch; arises proximally	Enters posterior compartment with the radial nerve through the triangular interval; runs in the radial groove deep to the lateral head of triceps; supplies posterior arm muscles and anastomoses with the posterior circumflex humeral artery
Middle collateral artery	Terminal branch of profunda brachii	Descends to lateral/posterior elbow; anastomoses with the interosseous recurrent artery
Radial collateral artery	Terminal branch of profunda brachii	Accompanies radial nerve anteriorly to the lateral epicondyle; anastomoses with the radial recurrent artery
Superior ulnar collateral artery	Brachial artery, mid-arm	Follows ulnar nerve around medial epicondyle to posterior elbow; anastomoses with posterior ulnar recurrent artery
Inferior ulnar collateral artery	Brachial artery, distal arm	Passes anterior to medial epicondyle; anastomoses with anterior ulnar recurrent artery
Muscular branches	Along the course	Supply the biceps brachii, brachialis, and coracobrachialis
Humeral nutrient artery	Variable	Enters nutrient foramen on anteromedial surface of humeral shaft

Gray's Anatomy - Brachial artery branches (B)

The Arterial Network (Anastomosis) Around the Elbow

This periarticular anastomotic network is formed by descending branches from above meeting ascending recurrent branches from below:

THIEME Atlas - Arterial anastomoses around the elbow

Contributions to the network:

From the brachial artery / profunda brachii (above):

Radial collateral artery (lateral side)
Middle collateral artery (posterior side)
Superior ulnar collateral artery (medial/posterior)
Inferior ulnar collateral artery (medial/anterior)

From the radial and ulnar arteries (below):

Radial recurrent artery (from radial a.) - anastomoses with radial collateral
Interosseous recurrent artery (from posterior interosseous a.) - anastomoses with middle collateral
Anterior ulnar recurrent artery (from ulnar a.) - anastomoses with inferior ulnar collateral
Posterior ulnar recurrent artery (from ulnar a.) - anastomoses with superior ulnar collateral

Cubital Fossa Relationships

THIEME - Cubital fossa anatomy, anterior view

In the cubital fossa, from lateral to medial: biceps tendon → brachial artery → median nerve (mnemonic: TAN - Tendon, Artery, Nerve). The bicipital aponeurosis covers all these structures superficially.

Clinical Significance

Ligation safety: The brachial artery can be safely ligated distal to the origin of the profunda brachii because the periarticular anastomotic network provides adequate collateral circulation to the forearm. - THIEME Atlas of Anatomy, p. 394
Blood pressure measurement: The brachial artery is compressed against the humerus in the mid-arm when using a sphygmomanometer; the pulse is auscultated in the cubital fossa. - Gray's Anatomy for Students, p. 876
Variant anatomy: In ~20% of individuals, the brachial artery gives off a superficial brachial artery that courses superficial to the median nerve. This can present as a high-origin radial artery (10%), high-origin ulnar artery (3%), or early bifurcation (7%). - Fischer's Mastery of Surgery, p. 6991
Supracondylar process: A rare anomaly (0.7%) - a bony outgrowth above the medial epicondyle connected by Struthers' ligament can create a fibro-osseous canal that traps both the brachial artery and median nerve.
Elbow dislocation/fracture: Despite complete brachial artery disruption, the hand may remain well perfused due to the rich collateral network. - Campbell's Operative Orthopaedics, 15th Ed 2026

Sources: Gray's Anatomy for Students (9780323934237); THIEME Atlas of Anatomy - General Anatomy & Musculoskeletal System (9781626237186); Fischer's Mastery of Surgery 8th Ed (9781975176433); Campbell's Operative Orthopaedics 15th Ed (9780443117633)

Just draw me a table for management of pink pulseless supracondylar humerus fracture.

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Management of Pink Pulseless Hand in Supracondylar Humerus Fracture

Definition: The hand is pink and warm (adequate perfusion via collaterals) but the radial pulse is absent. This distinguishes it from the white/pale pulseless hand, which is a true vascular emergency with absent perfusion.

Step	Action	Detail
1. Initial assessment	Confirm hand is pink and warm	Check capillary refill, skin colour, temperature - perfusion present despite absent pulse
2. First-line treatment	Urgent CRPP (Closed Reduction + Percutaneous Pinning)	Reduction often relieves arterial kinking or spasm; pulse returns in the majority of cases after reduction
3. Post-reduction: pulse returns	Inpatient observation + splinting	Monitor hourly neurovascular checks; no further vascular intervention needed
4. Post-reduction: pulse still absent but hand remains pink	Inpatient observation + splinting	Continue close monitoring; collateral flow is maintaining perfusion
5. Hand becomes poorly perfused at any point	Vascular surgery consultation	Proceed to surgical exploration of brachial artery (arteriotomy / repair)
6. Arteriography	Generally not warranted	Location of injury (brachial artery at fracture site) is almost always known

Key Points

Feature	Pink Pulseless	White/Pale Pulseless
Hand perfusion	Maintained (collaterals intact)	Absent
Urgency	Urgent (not emergent)	Emergent
First step	CRPP	Emergent CRPP
Vascular exploration	Only if hand becomes poorly perfused	If perfusion not restored after CRPP
Prognosis	Pulse returns in most after reduction	Higher risk of ischaemia / arterial repair needed

Sources: Miller's Review of Orthopaedics 9th Ed, p. 950; Campbell's Operative Orthopaedics 15th Ed 2026

Create a quick-reference PDF on supracondylar fracture complications

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Supracondylar Fracture Complications

PDF Document · PDF

What's inside (single-page A4):

Section	Content
1. Overview	Epidemiology, mechanism, Gartland classification (I–IV)
2. Complications at a Glance	14-row colour-coded table - vascular injury, compartment syndrome, Volkmann contracture, all 4 nerve injuries, cubitus varus/valgus, recurvatum, pin complications, stiffness, AVN, growth disturbance
3. Vascular Injury Algorithm	Pink pulseless vs white pulseless - urgency, first step, post-reduction management
4. Nerve Injury Summary	AIN, radial, median, ulnar - clinical test, prognosis (AIN/radial excellent → ulnar only 25%)
5. Angular Deformity	Cubitus varus, valgus, recurvatum - cause, features, treatment
6. Clinical Pearls	8 high-yield points including the 3 As of compartment syndrome, pin configuration, arteriography rule, and cubitus varus ≠ growth arrest

Sources: Campbell's Operative Orthopaedics 15th Ed 2026, Miller's Review of Orthopaedics 9th Ed, Bailey & Love's 28th Ed, Rosen's Emergency Medicine.

Detailed anatomy of posterolateral corner of knee joint.

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I now have thorough content and all the key images. Here is the detailed anatomy of the posterolateral corner:

Posterolateral Corner (PLC) of the Knee - Detailed Anatomy

The posterolateral corner (PLC) is a complex region bounded by the lateral femoral condyle, the fibular head, and the posterior aspect of the lateral tibial plateau. It is the primary stabiliser against external tibial rotation, and also resists varus stress and posterior tibial translation, especially in the mid-ranges of flexion.

Anatomical Overview

Anterior view - fibular collateral ligament, popliteus tendon, and their relationship to the lateral meniscus:

Anterior view of knee - fibular collateral ligament and popliteus tendon

Posterior view - popliteus muscle, popliteofibular ligament, and fibular collateral ligament:

Posterior view - popliteofibular ligament and popliteus muscle

Primary Structures of the PLC

There are three structures universally recognised as the primary stabilisers:

1. Fibular (Lateral) Collateral Ligament (FCL / LCL)

Femoral origin: Proximal and posterior to the lateral femoral epicondyle; posterior, superficial, and proximal to the insertion of the popliteus tendon
Distal insertion: Anterior to the midpoint of the lateral fibular head (8 mm posterior to the anterior margin of the fibular head, 28 mm distal to the tip of the fibular styloid) - it is the most anterior structure inserting on the proximal fibula
Length: 63-71 mm
Mechanics: Tight in extension, lax in flexion (lies posterior to the axis of knee rotation). Primary restraint to varus stress in all degrees of knee flexion
Relation to biceps: The FCL cleaves the distal biceps femoris tendon immediately proximal to the fibular head - the direct and anterior arms of biceps long head become lateral to it, while the short head arms sit medial to it

2. Popliteus Tendon

Femoral attachment: Anterior aspect of the femoral popliteal sulcus, on the lateral femoral condyle - distal, anterior, and deep to the LCL (mnemonic: "DAD")
Course: The tendon is intracapsular but extra-articular and extrasynovial. It passes from the popliteal sulcus inferolaterally, then curves inferomedially toward the posterior proximal tibia
Hiatus: Traverses the coronary ligament via the popliteal hiatus (bounded by popliteomeniscal fascicles) to become intraarticular
Muscle belly: Originates on the posterior tibia above the soleal line; the myotendinous junction lies at the lateral third of the popliteal fossa
Function: Internally rotates the tibia; acts as a retractor of the lateral meniscus preventing impingement

MRI sagittal - popliteal sulcus, popliteus tendon (PT), fabella, and lateral gastrocnemius (GC-L)

3. Popliteofibular Ligament (PFL)

Origin: Inferolateral aspect of the popliteus myotendinous junction
Insertion: Apex of the fibular styloid process, and slightly medial to this apex - posteromedial to both the FCL and biceps femoris fibular attachments
Fibular attachment order (anterior to posterior): LCL → PFL → Biceps femoris
Structure: Two divisions (anterior and posterior) described; the posterior is more substantive
Significance: A fairly constant structure; biomechanical studies show the FCL, popliteus tendon, and PFL together are the most important stabilisers of the PLC

MRI - popliteofibular ligament (dark blue arrows) anchored at fibular styloid apex (yellow arrows) extending to popliteus myotendinous junction (purple arrows):

Secondary / Accessory Structures

Structure	Description	Status
Iliotibial band (ITB)	Runs from Gerdy's tubercle to the lateral femoral epicondyle; contributes to anterolateral stability	Constant
Biceps femoris tendon	Long and short heads converge and insert on the fibular head; reinforces the PLC laterally	Constant
Anterolateral ligament (ALL)	Origin: immediately anterior to popliteus tendon insertion on femur. Insertion: midway between Gerdy's tubercle and fibular head with firm attachments to lateral meniscus. Stabilises against internal tibial rotation	Constant
Fabellofibular ligament	Runs from the fabella (or lateral gastrocnemius tendon if fabella absent) to the fibular styloid; reinforces the posterolateral capsule	Variable (~20-35%)
Arcuate ligament	Y-shaped thickening of the posterolateral capsule; lateral limb to posterolateral capsule and oblique popliteal ligament, base to fibular styloid apex. Some recommend retiring this term as it is inconsistent	Variable; often absent
Lateral gastrocnemius tendon	Arises from the fabella/posterolateral femur; contributes to posterolateral capsule reinforcement	Constant
Mid-third lateral capsular ligament	Thickening of the mid-lateral capsule	Variable
Coronary ligament of lateral meniscus	Meniscotibial attachment; contributes to lateral meniscal stabilisation	Constant
Popliteomeniscal fascicles	Three fascicles (posteroinferior, posterosuperior, anteroinferior) from popliteus to posterior horn of lateral meniscus; form the popliteal hiatus	Posterosuperior + anteroinferior constant on MRI
Oblique popliteal ligament (Winslow's)	Extension of semimembranosus tendon; crosses the posterior capsule obliquely; reinforces the posterocentral capsule	Constant

3D CT showing ITB (green), FCL (blue), and biceps femoris (pink) at the lateral knee - with Gerdy's tubercle and fibular head:

3D CT - ITB, FCL, and biceps femoris insertions

Layers of the Lateral Knee (Seebacher Classification)

The lateral knee is organised into three layers (deep to superficial):

Layer	Contents
Layer I (superficial)	Iliotibial band anteriorly; biceps femoris and its expansion posteriorly
Layer II (middle)	Quadriceps retinaculum anteriorly; two patellofemoral ligaments
Layer III (deep / capsular)	Joint capsule; FCL (superficial lamina); popliteus tendon; fabellofibular + arcuate ligaments (deep lamina)

Biomechanics and Functional Anatomy

Motion Resisted	Primary Restraint	Secondary Restraint
External tibial rotation	Popliteus tendon + PFL	FCL, biceps femoris, ALL
Varus stress	FCL	Popliteus, IT band
Posterior tibial translation	PCL (primary)	PLC structures (secondary)
Internal tibial rotation	ACL (primary)	ALL, IT band
Genu recurvatum	PLC + PCL	Posterior capsule

The PLC provides its greatest contribution to posterolateral stability between 30° and 60° of knee flexion
The FCL is tight in extension and lax in flexion, while the popliteus tendon shows increasing tension with internal tibial rotation at all degrees of flexion
Isolated PLC injury rarely occurs; it is most commonly associated with PCL tears and/or ACL tears
Brachial artery can be safely ligated: the common peroneal (fibular) nerve is the critical neural structure at risk in the PLC region, passing posterior to the biceps femoris tendon and around the neck of the fibula

Vascular Relations

The inferior lateral genicular artery (branch of the popliteal artery) runs along the lateral meniscus, superficial to the popliteus tendon and PFL, and deep to the FCL. It is relevant surgically when performing posterolateral corner reconstruction or lateral meniscus surgery.

Nerve at Risk

The common peroneal nerve runs along the posterior border of the biceps femoris tendon, passes around the fibular neck just medial to the biceps insertion, and is at risk in:

PLC injuries (direct trauma / traction)
Surgical approaches to the posterolateral knee
Varus corrective osteotomies

Clinical Assessment Points

Varus stress test: 0° and 30° flexion - isolates FCL (LCL) at 30°
Dial test (external rotation): Asymmetric external rotation >10-15° at 30° only = isolated PLC; at 30° and 90° = combined PLC + PCL injury
Posterolateral drawer test: External tibial rotation at 80-90° flexion
Reverse pivot shift: Reduction of externally rotated/posterolaterally subluxed tibia during knee extension

Sources: Miller's Review of Orthopaedics 9th Ed (9780443112140, p. 338-339); Imaging Anatomy Vol 3 - Bones, Joints, Vessels & Nerves (9781626239845, pp. 288-299, 804-806); Campbell's Operative Orthopaedics 15th Ed 2026 (9780443117633); Grainger & Allison's Diagnostic Radiology (9780323760751, p. 996)

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