4b. 3. The Radial Artery

(A. Radialis)

The radial artery (Fig. 527) appears, from its direction, to be the continuation of the brachial, but it is smaller in caliber than the ulnar. It commences at the bifurcation of the brachial, just below the bend of the elbow, and passes along the radial side of the forearm to the wrist. It then winds backward, around the lateral side of the carpus, beneath the tendons of the Abductor pollicis longus and Extensores pollicis longus and brevis to the upper end of the space between the metacarpal bones of the thumb and index finger. Finally it passes forward between the two heads of the first Interosseous dorsalis, into the palm of the hand, where it crosses the metacarpal bones and at the ulnar side of the hand unites with the deep volar branch of the ulnar artery to form the deep volar arch. The radial artery therefore consists of three portions, one in the forearm, a second at the back of the wrist, and a third in the hand. 1 Relations.—(a) In the forearm the artery extends from the neck of the radius to the forepart of the styloid process, being placed to the medial side of the body of the bone above, and in front of it below. Its upper part is overlapped by the fleshy belly of the Brachioradialis; the rest of the artery is superficial, being covered by the integument and the superficial and deep fasciæ. In its course downward, it lies upon the tendon of the Biceps brachii, the Supinator, the Pronator teres, the radial origin of the Flexor digitorum sublimis, the Flexor pollicis longus, the Pronator quadratus, and the lower end of the radius. In the upper third of its course it lies between the Brachioradialis and the Pronator teres; in the lower two-thirds, between the tendons of the Brachioradialis and Flexor carpi radialis. The superficial branch of the radial nerve is close to the lateral side of the artery in the middle third of its course; and some filaments of the lateral antibrachial cutaneous nerve run along the lower part of the artery as it winds around the wrist. The vessel is accompanied by a pair of venæ comitantes throughout its whole course. 2

FIG. 527– The radial and ulnar arteries. (See enlarged image)

FIG. 528– Ulnar and radial arteries. Deep view. (See enlarged image) (b) At the wrist the artery reaches the back of the carpus by passing between the radial collateral ligament of the wrist and the tendons of the Abductor pollicis longus and Extensor pollicis brevis. It then descends on the navicular and greater multangular bones, and before disappearing between the heads of the first Interosseus dorsalis is crossed by the tendon of the Extensor pollicis longus. In the interval between the two Extensores pollicis it is crossed by the digital rami of the superficial branch of the radial nerve which go to the thumb and index finger. 3 (c) In the hand, it passes from the upper end of the first interosseous space, between the heads of the first Interosseus dorsalis, transversely across the palm between the Adductor pollicis obliquus and Adductor pollicis transversus, but sometimes piercing the latter muscle, to the base of the metacarpal bone of the little finger, where it anastomoses with the deep volar branch from the ulnar artery, completing the deep volar arch (Fig. 528). 4 Peculiarities.—The origin of the radial artery is, in nearly one case in eight, higher than usual; more often it arises from the axillary or upper part of the brachial than from the lower part of the latter vessel. In the forearm it deviates less frequently from its normal position than the ulnar. It has been found lying on the deep fascia instead of beneath it. It has also been observed on the surface of the Brachioradialis, instead of under its medial border; and in turning around the wrist, it has been seen lying on, instead of beneath, the Extensor tendons of the thumb. 5 Branches.—The branches of the radial artery may be divided into three groups, corresponding with the three regions in which the vessel is situated. 6

In the Forearm.	At the Wrist.	In the Hand.
Radial Recurrent.	Dorsal Carpal.	Princeps Pollicis.
Muscular.	First Dorsal Metacarpal.	Volaris Indicis Radialis.
Volar Carpal.		Volar Metacarpal.
Superficial Volar.		Perforating.
		Recurrent.

The radial recurrent artery (a. recurrens radialis) arises immediately below the elbow. It ascends between the branches of the radial nerve, lying on the Supinator and then between the Brachioradialis and Brachialis, supplying these muscles and the elbow-joint, and anastomosing with the terminal part of the profunda brachii. 7 The muscular branches (rami musculares) are distributed to the muscles on the radial side of the forearm. 8 The volar carpal branch (ramus carpeus volaris; anterior radial carpal artery) is a small vessel which arises near the lower border of the Pronator quadratus, and, running across the front of the carpus, anastomoses with the volar carpal branch of the ulnar artery. This anastomosis is joined by a branch from the volar interosseous above, and by recurrent branches from the deep volar arch below, thus forming a volar carpal net-work which supplies the articulations of the wrist and carpus. 9 The superficial volar branch (ramus volaris superficialis; superficialis volœ artery) arises from the radial artery, just where this vessel is about to wind around the lateral side of the wrist. Running forward, it passes through, occasionally over, the muscles of the ball of the thumb, which it supplies, and sometimes anastomoses with the terminal portion of the ulnar artery, completing the superficial volar arch. This vessel varies considerably in size: usually it is very small, and ends in the muscles of the thumb; sometimes it is as large as the continuation of the radial 10

The dorsal carpal branch (ramus carpeus dorsalis; posterior radial carpal artery) is a small vessel which arises beneath the Extensor tendons of the thumb; crossing the carpus transversely toward the medial border of the hand, it anastomoses with the dorsal carpal branch of the ulnar and with the volar and dorsal interosseous arteries to form a dorsal carpal network. From this network are given off three slender dorsal metacarpal arteries, which run downward on the second, third, and fourth Interossei dorsales and bifurcate into the dorsal digital branches for the supply of the adjacent sides of the middle, ring, and little fingers respectively, communicating with the proper volar digital branches of the superficial volar arch. Near their origins they anastomose with the deep volar arch by the superior perforating arteries, and near their points of bifurcation with the common volar digital vessels of the superficial volar arch by the inferior perforating arteries. 11 The first dorsal metacarpal arises just before the radial artery passes between the two heads of the first Interosseous dorsalis and divides almost immediately into two branches which supply the adjacent sides of the thumb and index finger; the radial side of the thumb receives a branch directly from the radial artery. 12 The arteria princeps pollicis arises from the radial just as it turns medialward to the deep part of the hand; it descends between the first Interosseous dorsalis and Adductor pollicis obliquus, along the ulnar side of the metacarpal bone of the thumb to the base of the first phalanx, where it lies beneath the tendon of the Flexor pollicis longus and divides into two branches. These make their appearance between the medial and lateral insertions of the Adductor pollicis obliquus, and run along the sides of the thumb, forming on the volar surface of the last phalanx an arch, from which branches are distributed to the integument and subcutaneous tissue of the thumb. 13 The arteria volaris indicis radialis (radialis indicis artery) arises close to the preceding, descends between the first Interosseus dorsalis and Adductor pollicis transversus, and runs along the radial side of the index finger to its extremity, where it anastomoses with the proper digital artery, supplying the ulnar side of the finger. At the lower border of the Adductor pollicis transversus this vessel anastomoses with the princeps pollicis, and gives a communicating branch to the superficial volar arch. The a. princeps pollicis and a. volaris indicis radialis may spring from a common trunk termed the first volar metacarpal artery. 14 The deep volar arch (arcus volaris profundus; deep palmar arch) (Fig. 528) is formed by the anastomosis of the terminal part of the radial artery with the deep volar branch of the ulnar. It lies upon the carpal extremities of the metacarpal bones and on the Interossei, being covered by the Adductor pollicis obliquus, the Flexor tendons of the fingers, and the Lumbricales. Alongside of it, but running in the opposite direction—that is to say, toward the radial side of the hand—is the deep branch of the ulnar nerve. 15 The volar metacarpal arteries (aa. metacarpeæ volares; palmar interosseous arteries), three or four in number, arise from the convexity of the deep volar arch; they run distally upon the Interossei, and anastomose at the clefts of the fingers with the common digital branches of the superficial volar arch. 16 The perforating branches (rami perforantes), three in number, pass backward from the deep volar arch, through the second, third, and fourth interosseous spaces and between the heads of the corresponding Interossei dorsalis, to anastomose with the dorsal metacarpal arteries. 17 The recurrent branches arise from the concavity of the deep volar arch. They ascend in front of the wrist, supply the intercarpal articulations, and end in the volar carpal network. 18

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