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Questions Answered: 238

Final Score 84%

200
38

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Anatomy

Upper Limb

Question 150 of 239

A patient presents to ED having sustained a laceration to the antecubital fossa with transection of the main vessel. Which of the following vessels is most likely spared:

Answer:

Immediately distal to the teres major, the brachial artery gives rise to the profunda brachii (deep artery), which travels with the radial nerve in the radial groove of the humerus and supplies structures in the posterior aspect of the upper arm (e.g. triceps brachii). The profunda brachii terminates by contributing to an anastomotic network around the elbow joint. The brachial artery proper descends down the arm. As it moves through the cubital fossa, underneath the bicipital aponeurosis, the brachial artery terminates by bifurcating into the radial and ulnar arteries. The radial recurrent artery arises from the radial artery immediately below the elbow. The common interosseous artery is the third main branch of the ulnar artery. It runs in the distal portion of the cubital fossa, posterior to the upper border of the interosseous membrane.

Brachial Artery

Anatomical Course

The brachial artery is a continuation of the axillary artery, beginning at the lower border of the teres major muscle and ending just distal to the elbow joint where it bifurcates into the radial and ulnar arteries. In the proximal arm, the brachial artery lies on the medial side. In the distal arm, it moves laterally to assume a position midway between the lateral and medial epicondyle of the humerus, before crossing anteriorly to the elbow joint.

By Henry Vandyke Carter [Public domain], via Wikimedia Commons

Brachial Artery. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

Palpation

The brachial artery is palpable along its length; in the proximal arm it can be compressed against the medial humerus and in the antecubital fossa it may be palpated immediately medial to the tendon of the biceps brachii muscle.

Branches

The brachial artery gives rise to numerous branches including:

  • the profunda brachii (deep brachial) artery
  • muscular branches
  • nutrient branches
  • ulnar collateral branches
  • terminal branches (radial and ulnar arteries)

The brachial artery is accompanied by venae comitantes.

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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

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