Main artery of the arm. Continuation of axillary artery. Runs superficially through anterior compartment. Ends in cubital fossa dividing into radial and ulnar arteries.

Origin

Continuation of axillary artery at lower border of teres major.

Course

• Descends through anterior compartment of arm — medial side → gradually inclines laterally to front of elbow
• Accompanied by two venae comitantes
• Closely related to median nerve (crosses sides during descent)
• Relatively superficial throughout — covered by skin, superficial and deep fascia
• Crosses elbow anteriorly → enters cubital fossa

Superficial course → important for pulse palpation, BP measurement, compression to control bleeding, injury in fractures around elbow.

Termination

Ends in cubital fossa at level of neck of radius, just medial to biceps tendon.

Surface Anatomy and Palpation

• Brachial pulse: cubital fossa, medial to biceps tendon
• Method: slightly flex elbow → palpate biceps tendon → feel medial to it
• Site for Korotkoff sounds during BP measurement
• Compression against humerus shaft (near coracobrachialis insertion) → controls distal bleeding

Relations of the Brachial Artery

Relation to the Median Nerve

Anterior Relations

• Skin, superficial fascia, deep fascia
• Medial cutaneous nerve of forearm (upper)
• Median nerve crossing in front (middle)
• Cubital fossa: bicipital aponeurosis and median cubital vein anteriorly
• Bicipital aponeurosis separates median cubital vein from artery and median nerve during venepuncture

Posterior Relations

1. Long head of triceps
2. Medial head of triceps
3. Insertion of coracobrachialis
4. Brachialis

• Upper part: radial nerve + profunda brachii artery (before passing through triangular interval)

Medial Relations

• Upper: ulnar nerve, basilic vein, medial cutaneous nerves
• Lower: median nerve
• Ulnar nerve pierces medial intermuscular septum → posterior compartment

Lateral Relations

• Upper: median nerve, coracobrachialis, biceps brachii
• Lower / cubital fossa: biceps tendon

Cubital Fossa Arrangement

Medial → Lateral:

MBBR — Median nerve, Brachial artery, Biceps tendon, Radial nerve TAN (lateral → medial, central contents) — biceps Tendon, brachial Artery, median Nerve

Branches of the Brachial Artery

Profunda Brachii Artery

• Largest branch of brachial artery
• Arises posterolateral, near beginning
• Accompanies radial nerve → triangular interval → radial groove

Arterial Anastomosis Around the Elbow Joint

Links descending collateral branches (brachial + profunda brachii) with ascending recurrent branches (radial, ulnar, interosseous arteries).

Four Main Sites

Medial side = ulnar: superior + inferior ulnar collateral ↔ anterior + posterior ulnar recurrent Lateral side = radial/interosseous: profunda branches ↔ radial recurrent + interosseous recurrent

Functional significance: Supplies bones, ligaments, capsule around elbow; maintains distal perfusion; provides collateral if brachial artery compromised (especially in supracondylar fracture).

Applied Anatomy of the Brachial Artery

Compression of the Brachial Artery

• Compressed against humerus; best site near coracobrachialis insertion (mid-arm)
• Uses: control bleeding from forearm/hand wounds

Brachial Pulse and Blood Pressure Measurement

• Palpated in cubital fossa, medial to biceps tendon
• Used for: pulse palpation, Korotkoff sounds (BP), assessment of distal flow after fractures

Injury in Supracondylar Fracture of Humerus

• Artery may be compressed, stretched, or torn by displaced fragment
• Consequences: ↓/absent radial pulse; forearm muscle ischaemia; compartment syndrome; Volkmann’s ischaemic contracture

Early danger signs (5 Ps):

• Pain (especially passive finger extension)
• Pallor
• Paraesthesia
• Pulselessness
• Paralysis (late sign)

Volkmann’s ischaemic contracture: Ischaemic necrosis + fibrosis of forearm flexors (especially FDP and FPL) → claw-like flexion deformity of hand and fingers

Venepuncture in the Cubital Fossa

• Median cubital vein used; bicipital aponeurosis protects brachial artery and median nerve
• Deep/misdirected puncture may injure artery or nerve

Ligation and Collateral Circulation

• Collateral circulation around elbow can maintain distal flow if brachial artery ligated near elbow
• Proximal injury or severe swelling/compartment pressure may still compromise perfusion
• Always check radial pulse and ischaemia signs after fractures around elbow

Rapid Revision Table

The brachial artery is the main artery of the arm. It is the direct continuation of the axillary artery, runs superficially through the anterior compartment of the arm, and ends in the cubital fossa by dividing into the radial and ulnar arteries. For exam recall, learn it as a continuous story: origin → course → relations → branches → elbow anastomosis → applied anatomy.

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Origin

The brachial artery begins as the continuation of the axillary artery at the lower border of teres major.

This point marks the transition from the axilla to the arm:

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Course

The artery runs downwards through the anterior compartment of the arm. It begins on the medial side of the arm and gradually inclines laterally to reach the front of the elbow.

Key points:

• It descends along the medial side of biceps brachii in the upper and middle arm.
• It is accompanied by two venae comitantes.
• It is closely related to the median nerve, which changes side as it descends.
• It is relatively superficial throughout the arm, being covered mainly by skin, superficial fascia, and deep fascia.
• It crosses the elbow anteriorly and enters the cubital fossa.

This superficial course is why the artery is important for pulse palpation, blood pressure measurement, compression to control bleeding, and injury in fractures around the elbow.

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Termination

The brachial artery ends in the cubital fossa at the level of the neck of the radius, just medial to the tendon of biceps brachii.

It divides into two terminal branches:

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Surface Anatomy and Palpation

The brachial pulse is best felt in the cubital fossa, just medial to the tendon of biceps brachii.

How to find it:

1. Slightly flex the elbow.
2. Palpate the biceps tendon in the cubital fossa.
3. Feel immediately medial to the tendon for the brachial artery.

This is the site where the stethoscope is placed to hear Korotkoff sounds during blood pressure measurement.

The brachial artery can also be compressed against the shaft of the humerus in the arm, especially near the insertion of coracobrachialis, to control bleeding from distal arteries.

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Relations of the Brachial Artery

The brachial artery is part of the main neurovascular bundle of the arm. The most important relation to remember is the changing position of the median nerve.

Relation to the Median Nerve

This crossing relation is a common exam point and helps orient the entire neurovascular bundle.

Anterior Relations

• Skin
• Superficial fascia
• Deep fascia
• Medial cutaneous nerve of forearm in the upper part
• Median nerve crossing in front of the artery in the middle of the arm
• In the cubital fossa: bicipital aponeurosis and median cubital vein lie anterior to the artery

The bicipital aponeurosis is clinically important because it separates the median cubital vein from the brachial artery and median nerve during venepuncture.

Posterior Relations

From above downwards, the artery lies on:

1. Long head of triceps
2. Medial head of triceps
3. Insertion of coracobrachialis
4. Brachialis

In the upper part, the radial nerve and profunda brachii artery are related posteriorly before they pass through the triangular interval to the radial groove.

Medial Relations

• Upper part: ulnar nerve, basilic vein, and medial cutaneous nerves
• Lower part: median nerve

The ulnar nerve initially lies medial to the artery, then pierces the medial intermuscular septum and enters the posterior compartment.

Lateral Relations

• Upper part: median nerve, coracobrachialis, and biceps brachii
• Lower part and cubital fossa: tendon of biceps brachii

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Cubital Fossa Arrangement

At the elbow, the important structures are arranged from medial to lateral as:

Memory aid: MBBR — Median nerve, Brachial artery, Biceps tendon, Radial nerve.

For the central cubital fossa contents alone, the classic lateral-to-medial relation is:

TAN — biceps Tendon, brachial Artery, median Nerve.

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Branches of the Brachial Artery

The branches of the brachial artery are best learned from proximal to distal.

Muscular Branches

The muscular branches supply the anterior compartment muscles of the arm:

• Biceps brachii
• Brachialis
• Coracobrachialis

Profunda Brachii Artery

The profunda brachii artery is the largest branch of the brachial artery.

Key features:

• Arises from the posteromedial aspect of the brachial artery near its beginning
• Accompanies the radial nerve
• Passes through the triangular interval
• Runs in the radial groove on the posterior surface of the humerus
• Gives important collateral branches to the elbow anastomosis

Important branches:

Nutrient Artery to Humerus

The nutrient artery enters the nutrient foramen of the humerus near the insertion of coracobrachialis and supplies the shaft of the humerus.

Superior Ulnar Collateral Artery

The superior ulnar collateral artery arises near the middle of the arm.

It accompanies the ulnar nerve, pierces the medial intermuscular septum, and contributes to the anastomosis behind the medial epicondyle.

Inferior Ulnar Collateral Artery

The inferior ulnar collateral artery arises from the lower part of the brachial artery, a little above the elbow.

It divides into:

• Anterior branch, which contributes in front of the medial epicondyle
• Posterior branch, which contributes behind the medial epicondyle

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Arterial Anastomosis Around the Elbow Joint

The arterial anastomosis around the elbow links:

• Descending collateral branches from the brachial artery and profunda brachii artery
• Ascending recurrent branches from the radial, ulnar, and interosseous arteries

Its purpose is to maintain blood supply to the forearm and hand when flow through the main brachial artery is temporarily reduced during elbow flexion or compromised by trauma.

The Four Main Anastomotic Sites

Memory Pattern

Think of the elbow anastomosis as two sides:

• Medial side = ulnar side: superior and inferior ulnar collateral arteries meet anterior and posterior ulnar recurrent arteries.
• Lateral side = radial/interosseous side: profunda brachii branches meet radial recurrent and interosseous recurrent arteries.

Functional Significance

• Supplies the bones, ligaments, and joint capsule around the elbow.
• Maintains distal perfusion during elbow movement.
• Provides collateral circulation if the brachial artery is narrowed or compressed near the elbow.
• Becomes clinically important in supracondylar fracture of the humerus, where the brachial artery may be stretched, compressed, or torn.

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Applied Anatomy of the Brachial Artery

Compression of the Brachial Artery

The brachial artery can be compressed against the humerus because it is superficial and closely related to the shaft of the bone.

The best site for compression is near the insertion of coracobrachialis in the mid-arm.

Uses:

• Control of bleeding from forearm or hand wounds
• Temporary control of haemorrhage from distal arterial injuries

Brachial Pulse and Blood Pressure Measurement

The brachial artery is palpated in the cubital fossa just medial to the biceps tendon.

This site is used for:

• Palpation of brachial pulse
• Auscultation of Korotkoff sounds during blood pressure recording
• Assessment of distal arterial flow after fractures around the elbow

Injury in Supracondylar Fracture of Humerus

In a supracondylar fracture of the humerus, the brachial artery may be compressed, stretched, or torn by the displaced fracture fragment.

Important consequences:

• Reduced or absent radial pulse
• Ischaemia of forearm muscles
• Compartment syndrome
• Volkmann’s ischaemic contracture if ischaemia is not relieved

Early danger signs include:

• Severe pain, especially pain on passive extension of fingers
• Pallor
• Paraesthesia
• Pulselessness
• Paralysis as a late sign

Volkmann’s ischaemic contracture occurs due to ischaemic necrosis and later fibrosis of forearm flexor muscles, especially flexor digitorum profundus and flexor pollicis longus, leading to a claw-like flexion deformity of the hand and fingers.

Venepuncture in the Cubital Fossa

The median cubital vein is commonly used for venepuncture. Deep to it lies the bicipital aponeurosis, which protects the brachial artery and median nerve.

Clinical point:

• Correct venepuncture is relatively safe because the bicipital aponeurosis separates the vein from deeper vital structures.
• Deep or misdirected puncture may injure the brachial artery or median nerve.

Median Nerve Vasomotor Branches

The median nerve gives vasomotor branches to the brachial artery during its course in the arm. This explains the close functional as well as anatomical relationship between the nerve and artery.

Ligation and Collateral Circulation

Collateral circulation around the elbow can help maintain distal blood flow if the brachial artery is blocked or ligated near the elbow.

However, injury proximal to important collateral branches, or severe trauma with swelling and compartment pressure, can still compromise forearm perfusion. Therefore, the radial pulse and signs of ischaemia must always be checked after fractures around the elbow.

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Rapid Revision Table

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