Branches of the arch of the aorta
The arteries of the hand frequently vary from their usual mode of distribution.
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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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Of these branches the radial recurrent is sometimes very large, or it may be represented by several separate branches. When the radial itself arises high up, the recurrent artery usually comes from the residual brachial trunk or from the ulnar artery, or more rarely from the interosseous. When given from the brachial trunk, the radial recurrent has been found crossing beneath the tendon of the biceps.
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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 branches of the radial artery may be arranged according as they are given off in the fore-arm, on the wrist, and in the hand. The branches which arise from the radial in the fore-arm, are the radial recurrent, the muscular branches, the anterior carpal, and the superficial volar.
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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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From the usual place of origin the radial was found, in 429 observations, to deviate in the proportion of nearly 1 case in 8. In all it arose higher than usual, with the exception of one case of low division of the brachial artery, and in this the radial artery was joined by a vas aberrans. The brachial artery (most commonly near its upper end) was the source from which the radial proceeded in case of high origin much more frequently than the axillary.
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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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In most parts of the body the description of the artery of one side serves for that of the other likewise ; but this is not the case as regards the subclavian arteries (French : artère sous-clavière), for, as the right subclavian artery commences at the division of the innominate artery, whilst the left subclavian arises at once from the arch of the aorta, it follows that the two vessels must, in the first part of their course, differ materially in their length, direction, and connexions with contiguous 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 radial artery, (latin : a. radialis, french : artère radiale) in direction, though not in size, appears to be the continuation of the brachial. It extends from the bifurcation of the latter, obliquely along the front of the fore-arm as far as the lower end of the radius, below which it turns round the outer border of the wrist, and then descending to the back of the space between the metacarpal bones of the thumb and fore-finger, passes forwards to the palm of the hand, which it crosses towards the inner side, so as to form the deep palmar arch. From the change in its course at the lower end, the directions and connections of the radial artery may be separately described in the fore-arm, on the wrist, and in the hand.
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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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