Anatomy
Upper Limb
You are demonstrating a vascular examination on a patient to a group of medical students. Where is the radial artery pulsation best palpated:
Answer:
In the distal forearm, the radial artery lies immediately lateral to the large tendon of the flexor carpi radialis muscle and directly anterior to the pronator quadratus and the distal end of the radius; the pulse can be located by using the flexor carpi radialis muscle as a landmark.Anterior Forearm Arteries
Anatomy / Upper Limb / Anterior Forearm
Last Updated: 10th April 2019
Radial Artery
The radial artery, branch of the brachial artery, passes along the lateral aspect of the forearm, lying deep to the brachioradialis muscle proximally, and distally being covered only by skin and fascia, making this an ideal location to palpate the pulse or to gain arterial access (palpated just lateral to the flexor carpi radialis tendon, while compressing the artery against the radius bone). The radial artery enters the hand by curving around the lateral side of the wrist, passing over the floor of the anatomical snuffbox and penetrating the dorsolateral aspect of the hand between the bases of the first and second metacarpal bones.
Ulnar Artery
The larger ulnar artery, also a branch of the brachial artery, enters the forearm by passing deep to the pronator teres muscle and passes down the medial side of the forearm between the flexor carpi ulnaris and the flexor digitorum profundus muscles. The ulnar artery enters the hand, passing lateral to the pisiform bone and superficial to the flexor retinaculum. The ulnar artery gives rise to the common interosseous artery.
Carpal Arches
The palmar and dorsal carpal arches are formed from anastomosis between the carpal branches of the radial and ulnar arteries, and supply the wrist and carpal bones.
Venae Comitantes
Deep veins of the anterior compartment generally accompany the arteries and ultimately drain into brachial veins associated with the brachial artery in the cubital fossa.
![By Henry Vandyke Carter [Public domain], via Wikimedia Commons](https://mrcemsuccess.com/wp-content/uploads/2016/12/RadialUlnar-artery.png)
Arteries of the Anterior Forearm. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
