Anatomy
Upper Limb
A 32 year old construction worker presents to ED after an accident on the job. The tendon of the biceps brachii at the elbow has been severed by a laceration that extends 2 cm medially from the tendon. Which of the following structures is most likely to have also been injured:
Answer:
The brachial artery lies immediately medial to the tendon of the biceps brachii at the elbow. The musculocutaneous nerve does not cross the elbow (its terminal branch passes the elbow lateral to the tendon of the biceps). The profunda brachii artery arises from the brachial artery in the proximal part of the arm. The radial nerve passes the elbow lateral to the tendon of the biceps. The ulnar nerve crosses the elbow posterior to the medial epicondyle of the humerus.Brachial Artery
Anatomy / Upper Limb / Anterior Arm
Last Updated: 8th April 2019
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](https://mrcemsuccess.com/wp-content/uploads/2016/12/Brachial-Artery2.png)
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 |
