Anatomy
In the fore-arm and on the wrist, the ulnar artery gives off several branches, which have received particular names. The branches in the fore-arm are the anterior and posterior recurrent, the interosseous, and several muscular branches. Those given at the wrist are named carpal branches (anterior and posterior).
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The brachial artery gives some unnamed branches, which are directed outwards and backwards to the muscles in its immediate neighbourhood, viz., to the coraco-brachialis, biceps, and brachialis anticus; the following, which incline inwards, have received names, and require description.
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Most of these peculiarities have reference to the place of origin of the artery, a subject already alluded to in the descriptions of the variations observed in the branches of the axillary and in the place of bifurcation of the brachial artery. In a considerable number of observations, the ulnar artery was found to deviate, in regard to its origin, in nearly the proportion of 1 in 13. In all cases but one, (in which it arose between two and three inches below the elbow-joint, in consequence of a late bifurcation of the brachial artery,) the place of origin of the ulnar artery was higher than usual. Moreover the brachial was, more frequently than the axillary, the source from which it sprang : indeed, the examples of its origin from the trunk at different parts appeared to decrease in number upwards.
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The axillary artery, gives off several branches, which supply the neighbouring structures. They consist of the branches furnished to the muscles on the chest (external thoracic) ; a large branch to the shoulder (subscapular) ; and two to the upper part of the arm (anterior circumflex and posterior circumflex). The branches are not constant in their number, Size, or mode of origin.
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The ulnar artery, [a. ulnaris], extends from the point of bifurcation of the brachial just indicated, along the inner side of the fore-arm, into the palm of the hand, where, joining a branch of the radial, opposite the muscles of the thumb, it forms the superficial palmar arch. In this course it inclines first downwards and inwards, describing a slight curve, the convexity of which is directed inwards, and passes under cover of the superficial muscles arising from the inner condyle of the humerus, viz., the pronator teres, flexor carpi radialis, palmaris longus, and flexor sublimis, until it reaches the flexor carpi ulnaris, about the junction of the upper with the middle third of the fore-arm ; at this point the artery comes into contact with the ulnar nerve, (previously separated from it by a considerable interval,) and, changing its direction, descends vertically with the nerve towards the inner border of the palm of the hand. Guided as it descends by the tendon of the flexor ulnaris muscle, along the radial border of which it is now placed, the ulnar artery reaches the outer or radial side of the pisiform bone, where, still accompanied by the nerve, it passes over the cutaneous surface of the anterior annular ligament of the wrist into the palm of the hand. Its disposition in the hand will be separately described.
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The axillary artery [a. axillaris], that part of the artery of the upper limb which intervenes between the subclavian and the brachial portions, lies obliquely upon the upper and lateral part of the thorax, extending from the outer border of the first rib to the lower margin of the tendons of the latissimus dorsi and teres major muscles. In this course it passes through the axilla or axillary space, and its direction varies with the position of the limb : when the arm hangs freely by the side, the vessel describes a curve having its concavity towards the chest; when the arm is at right angles with the trunk, the vessel is nearly straight, and if the limb be still more elevated, the concavity of the curve described by the vessel is directed upwards.
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The brachial or humeral artery, [a. brachialis], the continuation of the axillary, is placed along the inner and anterior aspect of the arm, extending from the lower border of the axilla, that is, of the tendons of the latissimus and teres major, to about a finger's breadth below the bend of the elbow, or opposite the neck of the radius, where it divides into the radial and ulnar arteries.
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The three large branches which arise from the first part of the subclavian artery spring from the parent trunk very close to each other, and are deeply seated at their origin under cover of the internal jugular vein. They proceed, however, from different sides of the parent vessel, pursue different directions, and are distributed to remotely separate parts.
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From their comparative frequency and surgical interest, the peculiarities of this artery, especially such as affect its trunk, deserve particular attention.
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The subclavian artery is so deeply placed, its connexions with important parts are so intimate and varied, and the branches are so large in proportion to the length of the trunk, that operations on this vessel present, in most cases, considerable difficulties to the surgeon. But the difficulties, it will be found, vary in different cases.
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In the operation for tying the brachial artery, the known direction of the vessel, and the inner margin of the biceps muscle chiefly aid in determining its position. In consequence of the thinness of the parts which cover the artery, and the position of the basilic and median basilic veins, with respect to it. even the integuments must be divided with care.
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In the neck the internal carotid artery usually gives no branch ; whilst within the carotid canal it sends a small offset to the tympanum, which anastomoses with the tympanic and stylo-mastoid arteries; within the cavernous sinus, some small branches, named arteries receptaculi, proceed from it to supply the walls of the sinus and the adjacent dura mater. One of these, distributed to the dura mater, is the anterior meningeal.
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The spleen is a large blood-vascular