Proper Notes of all upper limbs bones, arteries,veins with tricks and proper explanation

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Complete Notes: Upper Limb Bones, Arteries & Veins

Source: THIEME Atlas of Anatomy - General Anatomy and Musculoskeletal System; Gray's Anatomy for Students

PART 1: BONES OF THE UPPER LIMB

The upper limb skeleton has 4 main segments: shoulder girdle, arm (brachium), forearm (antebrachium), and hand.

1. SHOULDER GIRDLE

Two bones connect the upper limb to the axial skeleton:

Bone	Key Features	Clinical Note
Clavicle	S-shaped; medial 2/3 convex forward, lateral 1/3 concave forward	Most commonly fractured bone; fractures at junction of medial 2/3 and lateral 1/3
Scapula	Flat triangular bone; has spine, acromion, coracoid process, glenoid cavity	Winged scapula = long thoracic nerve injury

Memory Trick - Clavicle "S" shape: "Starts Medially Convex (like a C-shape turned in), ends Laterally Concave" - think "S for Shoulder"

2. HUMERUS (Arm Bone)

The right humerus - anterior and posterior views showing all key landmarks

Proximal end features:

Head - articulates with glenoid cavity of scapula (glenohumeral joint)
Anatomic neck - narrow constriction at margin of head (articular cartilage boundary)
Surgical neck - below tubercles; most commonly fractured part (axillary nerve at risk)
Greater tubercle (lateral) - insertion of supraspinatus, infraspinatus, teres minor
Lesser tubercle (anterior/medial) - insertion of subscapularis
Intertubercular (bicipital) groove - between tubercles; long head of biceps tendon runs here

Shaft features:

Deltoid tuberosity - lateral surface, mid-shaft; deltoid muscle insertion
Radial (spiral) groove - winds around posterior shaft; radial nerve + profunda brachii artery run here

Distal end features:

Capitulum - lateral; articulates with head of radius
Trochlea - medial; articulates with trochlear notch of ulna
Medial epicondyle - ulnar nerve passes behind it ("funny bone")
Lateral epicondyle - extensor muscle origin
Olecranon fossa (posterior) - receives olecranon during extension
Coronoid fossa (anterior) - receives coronoid process during flexion
Radial fossa (anterior, lateral) - receives radial head during flexion

Memory Trick for humerus distal features: "My Caddy Takes Long Rounds"

Medial epicondyle, Capitulum, Trochlea, Lateral epicondyle, Radial fossa + olecranon fossa

Clinical Trick - Which nerve is injured?

Surgical neck fracture → Axillary nerve (deltoid paralysis, loss of shoulder abduction)

Midshaft fracture → Radial nerve (wrist drop)

Medial epicondyle fracture → Ulnar nerve (claw hand - ring + little finger)

Supracondylar fracture (kids) → Median nerve or anterior interosseous nerve (can't make "OK" sign)

3. RADIUS & ULNA (Forearm Bones)

Feature	Radius	Ulna
Position	Lateral (thumb side)	Medial (little finger side)
Proximal end	Head (disc-shaped), neck, radial tuberosity	Olecranon, coronoid process, trochlear notch, radial notch
Shaft	Wider distally	Wider proximally
Distal end	Wider; articular surface for wrist joint, styloid process	Head (small), styloid process
Key surface	Radial tuberosity = biceps brachii insertion	Olecranon = triceps insertion

Interosseous membrane connects radius and ulna, transmitting forces between them.

Radioulnar joints:

Proximal radioulnar joint - head of radius rotates in radial notch of ulna
Distal radioulnar joint - head of ulna rotates on ulnar notch of radius
Together they allow pronation and supination

Memory Trick - Radius vs Ulna: "RULE: Radius is Lateral, Ulna is Medial" (when anatomical position) Or: "The THUMB side = Radius" (both start with the same position - lateral)

Trick for forearm fractures:

Colles' fracture - distal radius fracture, dinner fork deformity (fall on outstretched hand, elderly)

Smith's fracture - reverse Colles (fall on back of hand, garden spade deformity)

Monteggia = proximal ulna fracture + radial head dislocation → "MR" = Monteggia-Radial

Galeazzi = distal radius fracture + distal radioulnar dislocation → "GU" = Galeazzi-Ulnar

4. HAND BONES

Bones of the right hand - palmar view showing carpals, metacarpals, and phalanges

The hand skeleton has three groups:

A. Carpal Bones (8 bones, 2 rows)

Proximal row (lateral to medial): Scaphoid - Lunate - Triquetrum - Pisiform

Distal row (lateral to medial): Trapezium - Trapezoid - Capitate - Hamate

Classic Memory Trick: "Some Lovers Try Positions That They Can't Handle"

Scaphoid, Lunate, Triquetrum, Pisiform | Trapezium, Trapezoid, Capitate, Hamate

Alternative (more fun): "She Looks Too Pretty, Try To Catch Her"

Key carpal facts:

Bone	Clinical Importance
Scaphoid	Most commonly fractured carpal; in anatomical snuffbox; avascular necrosis risk (blood supply enters distally)
Lunate	Most commonly dislocated carpal; can compress median nerve
Pisiform	Sesamoid bone in flexor carpi ulnaris tendon
Hamate	Hook of hamate fracture in golfers/cyclists; ulnar nerve at risk
Trapezium	At base of thumb; CMC joint of thumb formed here
Capitate	Largest carpal bone

Trick - Scaphoid fracture: Tender in anatomical snuffbox (between APL/EPB and EPL tendons). X-ray may be normal initially - treat as fracture if tender. Blood supply enters from distal end, so proximal pole avascular necrosis is a complication of proximal scaphoid fractures.

B. Metacarpal Bones (5 bones)

Numbered 1-5 (thumb to little finger)
Each has a base (proximal), shaft, and head (distal - forms the "knuckle")
1st metacarpal (thumb) is shortest and most mobile

Trick: "Boxer's fracture" = fracture of neck of 5th metacarpal (from punching with a closed fist)

C. Phalanges (14 bones)

Thumb has 2 phalanges: proximal + distal
Fingers 2-5 have 3 each: proximal + middle + distal
Total: 2 + (3 × 4) = 14 phalanges

Memory Trick: "The thumb has 2, rest have 3 - total 14 is the key"

PART 2: ARTERIES OF THE UPPER LIMB

Complete arterial supply of the upper limb from subclavian artery to digital arteries

The main arterial trunk flows: Subclavian → Axillary → Brachial → Radial + Ulnar → Palmar arches → Digital arteries

1. SUBCLAVIAN ARTERY

Becomes axillary artery as it crosses the lateral border of the 1st rib.

Key branches (divided into 3 parts by scalenus anterior):

Branch	Origin	Supply
Vertebral artery	Part 1	Brain via foramen magnum
Internal thoracic artery	Part 1	Anterior chest wall, breast
Thyrocervical trunk	Part 1	Thyroid, scapular region, neck
- Suprascapular artery	from thyrocervical trunk	Scapular muscles
- Transverse cervical artery	from thyrocervical trunk	Trapezius, neck muscles
Costocervical trunk	Part 2	Deep neck, upper intercostals

Memory Trick for subclavian branches: "VITamins Come From Scot's Country"

Vertebral, Internal thoracic, Thyrocervical trunk (with Suprascapular + Transverse cervical), Costocervical trunk

2. AXILLARY ARTERY

Runs from lateral border of 1st rib to lower border of teres major (where it becomes brachial). Divided into 3 parts by pectoralis minor muscle.

Branches by part:

Part	# of Branches	Branches
Part 1 (medial to pec minor)	1	Superior thoracic artery
Part 2 (behind pec minor)	2	Thoracoacromial artery, Lateral thoracic artery
Part 3 (lateral to pec minor)	3	Subscapular artery, Anterior circumflex humeral artery, Posterior circumflex humeral artery

Memory Trick: "1 branch, 2 branches, 3 branches" (Parts 1, 2, 3 give 1, 2, 3 branches)

Trick for thoracoacromial branches: "CAMP"

Clavicular, Acromial, M (deltoid), Pectoral

Clinically important: Posterior circumflex humeral artery travels with the axillary nerve through the quadrangular space.

Axillary artery relations:

Medially: axillary vein
Surrounded by cords of brachial plexus
Enclosed in axillary sheath (fascial investment)

3. BRACHIAL ARTERY

Runs from lower border of teres major to the cubital fossa (where it bifurcates at the neck of the radius). Lies medial to biceps tendon in cubital fossa.

Key branches:

Branch	Supply
Deep artery of arm (profunda brachii)	Runs in radial groove with radial nerve; gives radial + middle collateral arteries
Superior ulnar collateral artery	Elbow collateral network (medial side)
Inferior ulnar collateral artery	Elbow collateral network (medial side)

Bifurcation: In cubital fossa → Radial artery (lateral) + Ulnar artery (medial)

Clinical Trick:

Blood pressure is measured using the brachial artery in the cubital fossa

Brachial artery is the only artery in the arm - no major branches until it bifurcates

Brachial artery pulse palpated medial to biceps tendon

4. RADIAL ARTERY

Continues from brachial artery along the lateral (radial) side of the forearm. Passes deep to abductor pollicis longus and extensor pollicis brevis at the wrist → enters the anatomical snuffbox → passes between the 1st and 2nd metacarpals into the palm.

Key branches:

Branch	Location	Supply
Radial recurrent artery	Immediately after origin	Anastomoses with radial collateral (elbow network)
Palmar carpal branch	Wrist	Palmar carpal network
Superficial palmar branch	Wrist	Superficial palmar arch (minor contribution)
Dorsal carpal branch	Wrist	Dorsal carpal network → dorsal metacarpal arteries
Princeps pollicis artery	Palm	Thumb (both sides)
Radialis indicis	Palm	Lateral side of index finger
Deep palmar arch	Palm	Main contribution (anastomoses with deep branch of ulnar)
Palmar metacarpal arteries	From deep arch	Deep finger supply

Trick: Radial artery pulse felt at the radial side of wrist, between FCR tendon and radial styloid - used for pulse, Allen test, arterial blood gas sampling

5. ULNAR ARTERY

Larger of the two terminal branches. Runs along the medial (ulnar) side of the forearm. Enters hand superficial to flexor retinaculum via Guyon's canal (ulnar tunnel).

Key branches:

Branch	Supply
Ulnar recurrent artery (anterior + posterior)	Elbow network
Common interosseous artery	Bifurcates into anterior and posterior interosseous arteries
- Anterior interosseous	Runs on anterior interosseous membrane
- Posterior interosseous	Runs on posterior aspect; also gives recurrent interosseous
Palmar carpal branch	Palmar carpal network
Deep palmar branch	Deep palmar arch (minor contribution)
Superficial palmar arch	Main contribution to superficial arch
Common/proper palmar digital arteries	Fingers

6. PALMAR ARCHES

Arch	Formed mainly by	Location	Gives
Superficial palmar arch	Ulnar artery (+ superficial branch of radial)	Superficial to flexor tendons; at level of fully extended thumb	Common palmar digital arteries → proper palmar digital arteries
Deep palmar arch	Radial artery (+ deep branch of ulnar)	Deep to flexor tendons; 1 cm proximal to superficial arch	Palmar metacarpal arteries + perforating branches

Memory Trick: "SUDA" = Superficial = Ulnar; Deep = rAdial Or: "SU-DR" - Superficial-Ulnar, Deep-Radial

Allen's Test: Compress both radial and ulnar arteries at wrist. Release one. If hand flushes pink, that artery is patent and contributes to palmar arch. Used before radial artery cannulation.

PART 3: VEINS OF THE UPPER LIMB

Cubital fossa veins and variable patterns of superficial veins at the elbow

Veins of the upper limb are divided into superficial (subcutaneous, clinically accessible) and deep (accompanying arteries as venae comitantes).

DEEP VEINS (Venae Comitantes)

These travel alongside their corresponding arteries (usually paired):

Deep palmar venous arch
        ↓
Palmar metacarpal veins
        ↓
Radial veins + Ulnar veins  ←  (from superficial + deep palmar arch drainage)
        ↓
Brachial veins (2, paired around brachial artery)
        ↓
Axillary vein
        ↓
Subclavian vein

Deep Vein	Accompanies
Radial veins	Radial artery
Ulnar veins	Ulnar artery
Anterior/posterior interosseous veins	Interosseous arteries
Brachial veins	Brachial artery
Axillary vein	Axillary artery
Subclavian vein	Subclavian artery

Note: The axillary vein lies medial to the axillary artery in the axilla.

SUPERFICIAL VEINS (Clinically Most Important)

These travel in the subcutaneous tissue, independent of arteries.

A. Cephalic Vein

Origin: Dorsal venous network of hand (radial/lateral side)
Course: Ascends along lateral forearm → lateral aspect of biceps brachii → deltopectoral groove between deltoid and pectoralis major → pierces clavipectoral fascia → drains into axillary vein in clavipectoral triangle
Clinical use: IV access, peripherally inserted central catheter (PICC), venous cutdown site

Trick: "Cephalic = Clateral (lateral side) = Clavipectoral (drains there)"

B. Basilic Vein

Origin: Dorsal venous network of hand (ulnar/medial side)
Course: Ascends along medial forearm → medial bicipital groove → at mid-arm level pierces the basilic hiatus (deep fascia) → runs subfascially → joins brachial vein to form axillary vein
Lies close to medial antebrachial cutaneous nerve at elbow (injection risk)

Trick: "Basilic = Big, Basement (deep fascia), and Brachial (joins it to form axillary)"

C. Median Antebrachial Vein

Runs up the anterior (flexor) surface of the forearm
Drains mainly from dorsum of hand cutaneous veins, not from palmar surface
Divides at elbow into median cephalic (joins cephalic) and median basilic (joins basilic)

D. Median Cubital Vein

Connects cephalic and basilic veins across the cubital fossa
Most common site for venipuncture and blood collection
Bicipital aponeurosis separates it from the brachial artery beneath

Trick: "Median Cubital = Most Common for cannulation"

Summary Table: Superficial Veins

Vein	Side	Drains into
Cephalic	Lateral (radial)	Axillary vein (via deltopectoral groove)
Basilic	Medial (ulnar)	Axillary vein (via basilic hiatus at mid-arm)
Median antebrachial	Anterior forearm	Median cephalic + median basilic
Median cubital	Cubital fossa	Connects cephalic to basilic
Accessory cephalic	Extensor forearm	Cephalic vein
Dorsal venous network	Dorsum of hand	Source of cephalic and basilic

PERFORATOR VEINS

Connect superficial to deep veins through the deep fascia
Contain valves that direct blood from superficial → deep systems
The deep median cubital vein is an important perforator at the elbow

MASTER TRICK SUMMARY

Topic	Trick
Carpal bones	"Some Lovers Try Positions That They Can't Handle"
Axillary artery branches	Parts 1,2,3 give 1,2,3 branches
Thoracoacromial branches	"CAMP" (Clavicular, Acromial, deltoid, Pectoral)
Palmar arches	"SUDR" - Superficial=Ulnar, Deep=Radial
Nerve injured at surgical neck	Axillary nerve
Nerve injured at midshaft	Radial nerve (wrist drop)
Nerve injured at medial epicondyle	Ulnar nerve (claw hand)
Cephalic vein drainage	Axillary vein via deltopectoral groove
Basilic vein drainage	Axillary vein via basilic hiatus
Best IV access site	Median cubital vein
Most commonly fractured carpal	Scaphoid
Most commonly dislocated carpal	Lunate
Monteggia vs Galeazzi	MR (Monteggia-Radius head dislocated), GU (Galeazzi-Ulna DRUJ dislocated)

CLINICAL PEARLS

Allen's Test - before radial artery cannulation; tests patency of palmar arch collateral supply via ulnar
IV cannulation - median cubital vein is safest; watch for superficial ulnar artery variant (~3% of people) that may mimic a vein
Anatomical snuffbox - bounded by APL/EPB (radial) and EPL (ulnar); floor = scaphoid + trapezium; radial artery passes through; tender in scaphoid fracture
Cephalic vein PICC - sometimes difficult to advance past deltopectoral groove due to angle; basilic vein route preferred for central access
Quadrangular space - bounded by teres minor, teres major, long head of triceps, humerus; contains axillary nerve + posterior circumflex humeral artery - damaged in shoulder dislocation or humerus fracture

Sources: THIEME Atlas of Anatomy - General Anatomy and Musculoskeletal System, Gray's Anatomy for Students

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