Indmedica Home | About Indmedica | Medical Jobs | Advertise On Indmedica
Search Indmedica Web
Indmedica - India's premier medical portal

Journal of the Anatomical Society of India

Ulnar Artery: A Case Report of Unusual Origin and Course

Author(s): Panicker, J.B., Thilakan, A. and Chandi, G.

Vol. 52, No. 2 (2003-07 - 2003-12)

Department of Anatomy, Cooperative Medical College, Kochi, INDIA

Abstract

In a routine dissection of the right upper limb of an adult male cadaver, an unusual branch of the brachial artery was found. The brachial artery terminated in the cubital fossa into radial and ulnar or interosseous arteries. The radial artery had normal course and branches. The other artery was deeper and gave the common interosseous artery, anterior and posterior ulnar recurrent arteries, and muscular branches to brachioradialis and flexor pollicis longus and ended in the median nerve in the distal part of the forearm. The unusual large branch from the brachial artery was a variant of ulnar artery, arose from the lateral side of the brachial artery, descended on the lateral side upto the cubital fossa and crossed the fossa from lateral to medial, superficial to median nerve. It then descended superficial to the muscles arising from medial epicondyle of the humerus and was covered by the deep fascia of the forearm, pierced the deep fascia proximal to the wrist, crossed the flexor retinaculum, and formed the superficial palmar arch. Throughout its course, this artery gave no branch. The embryological basis of the variation is presented.

Key words: Brachial artery, superficial antebrachial artery, superficial brachial artery, superficial ulnar artery, ulnar artery.

Introduction:

The brachial artery ends in the cubital fossa by dividing into radial and ulnar arteries. At the elbow, the ulnar artery sinks deeply into the cubital fossa and reaches the medial side of the forearm midway between elbow and wrist. The common interosseous artery is a short branch of the ulnar, passes back to the proximal border of the interosseous membrane and divides into anterior and posterior interosseous arteries. Anterior interosseous artery descends on the anterior aspect of the interosseous membrane with the median nerve's anterior interosseous branch. Median artery, a slender branch from anterior interosseous artery, accompanies and supplies the median nerve. (Williams et al, 1995)

Meterial and Methods:

In a routine dissection of the right upper limb of an adult male cadaver by the medical students in the Department of Anatomy, an unusual branch of the brachial artery was found. The branches of the brachial, ulnar, and radial arteries were carefully traced.

Observations:

The brachial artery had the named branches as usual. It terminated into radial and ulnar or interosseous arteries in the cubital fossa at the level of the neck of the radius. Radial artery had normal course and branches. The other artery was deeper and gave the common interosseous artery, anterior and posterior ulnar recurrent arteries, and muscular branches to brachioradialis and flexor pollicis longus and ended in the distal part of the forearm in the median nerve (Fig. 1).

The unusual large branch from the brachial artery arose from its lateral side at the level of the insertion of the coracobrachialis muscle (Fig.2). It descended on the lateral side up to the cubital fossa and crossed the fossa from lateral to medial, superficial to the median nerve. It then descended over the muscles arising from the medial epicondyle of the humerus and was covered by the deep fascia of the forearm, pierced the deep fascia proximal to the wrist, crossed the flexor retinaculum, entered the palm, and formed the superficial palmar arch, which was completed by the superficial palmar branch of the radial artery. Throughout its course, this artery gave no branch. In the left upper limb. the arterial pattern was normal.

Discussion:

Variations of the arterial pattern of the upper limb are common and have been reported earlier. (Thane, 1892; Schwyzer and De Garis, 1935; Mc Cormack et al, 1953; Coleman and Anson, 1961; Lippert and Pabst, 1985; Poteat, 1986; Rodriguez- Beaza et al, 1995; Aharinejad et al, 1997; Patnaik et al, 2000 a,b; Patnaik, et al, 2001 a,b; Celik et al 2001; Clerve, et al 2001; Suganthy et al, 2002). Supernumerary assessory branches may arise from the brachial artery (Huber 1930).

Ulnar artery was found to deviate from its usual mode of origin in one in thirteen cases; frequently it sprang from the lower part of the brachial artery; the position of the ulnar artery in the forearm was more frequently altered; in cases of high origin, it invariably descended over the muscles arising from the medial epicondyle of the humerus and was covered by the deep fascia of the forearm (Thane, 1892). The present case of ulnar artery is somewhat similar to the variations presented in Quain's Anatomy (Thane, 1892).

Ontogeny:

If the brachial artery is taken to terminate into radial and ulnar arteries, the embryological basis of the existing ulnar artery and the origin and course of the unusual branch of the brachial artery, replacing the ulnar artery in the present case, is as follows. Primitive axis artery and superficial brachial artery are implicated in the morphogenesis of the arteries of the upper limb (Singer 1933; Schwyzer and De Garis, 1935). The seventh cervical intersegmental artery forms the axis artery of the upper limb (Fig. 3a) and persists in the adult to form the axillary, brachial, and interosseous arteries (Fig. 3b). Transiently, the median artery arises as a branch of the interosseous artery, begins to regress and remains as a residual artery (Fig. 3b) accompanying the median nerve (Singer 1933). Radial and ulnar arteries are later additions to the axis artery. An ulnar artery and a median artery are branches (Fig. 3c) of the axis artery (Rodriguez. Baeza et al, 1995). A superficial brachial artery is a consistent embryonic vessel, coexisting or not with the brachial artery (Tountas and Bergman, 1993). It has two terminal branches (Fig. 3d): a lateral that continues as a part of the definitive radial artery (Vancov, 1961) and a medial, superficial antebrachial artery, which divides into median and ulnar artery branches, which are the trunks of origin of the median and ulnar arteries (Fig. 3d). These trunks of deep origin predominate and the superficial arteries regress (Rodriguez- Baeza et al. 1995). In the present case, the axis artery had formed the interosseous artery and given the trunks of the median and ulnar arteries. The ulnar branch of the superficial antebrachial artery (Fig. 3e) persists independently, without its usual anastomosis to the branch of the axis atery, as the large lateral branch of the brachial artery and the superficial ulnar atery, which is found in the distal part of the forearm and joins the superficial palmar arch.

If the brachial artery is taken to terminate into radial and interosseous arteries, the simpler embryological basis of the interosseous artery and the origin and course of the unusual branch of the brachial artery, replacing the ulnar artery, is the following. It appears probable that the abnormal arrangement results from early obstruction of the ulnar artery below the origin of the interosseous, and the development of a superficial vas aberrans, which replaces the portion of vessel below the obstrution and unites with the brachial. The interosseous artery in such cases of abnormality thus comprises not only the interosseous artery but also the portion of ulnar artery above the obstruction. and, in accordance with this view, the recurrent branches are derived from it (Thane 1892).

The present anomaly is very rare and does not seem to have been reported. This case is of significance. Such an artery may present a superficial pulse and a hazard to venipuncture (Hazlett, 1949) and lead to intra-arterial injections or ligature instead of the vein in the cubital fossa (Pabst and Lippert 1968; Thoma and Young, 1992) Variation in the branching pattern of the brachial artery is of significance in cardiac catheterization for angioplasty, pedicle flaps, arterial grafting or brachial pulse.

References:

  1. Aharinejad S., Nourani F. and Hollensteiner H. (1997) : Rare case of high origin of ulnar artery from the brachial artery. Clinical Anatomy 10: 253-258.
  2. Celik, H.H., Germus, G., Aldur, M.M. and Ozcelik, M. (2001): Origin of the radial and ulnar arteries : variation in 81 arteriograms. Morphologie 85 : 25-27.
  3. Clerve, A., Kahn M., Pangilinan, A.J. and Dardik, H. (2001) : Absence of the brachial artery : report of a rare human variation and review of upper extremity arterial anomalies. Journal of Vascular Surgery 33 : 191-194.
  4. Coleman S.S. and Anson, B.J. (1961) : Arterial patterns in the hand based upon a study of 650 specimens Surgery Gynecology and Obstetrics 113 : 409-424.
  5. Hazlett J.W. (1949) : Superficial ulnar artery with reference to accidental intra-arterial injection. Canadian Medical Association Journal 61 : 289-293.
  6. Huber G.C.: Piersol's Human Anatomy. In : The vascular system 9th Edn. Vol 1, J. B. Lippincott Co. Philadelphia. pp. 767-791. (1930).
  7. Lippert, H. and Pabst, R: Arterial variations in Man. Bergmann, Munich; pp. 66-73. (1985)
  8. Mc Cormack, L.J. Caldwell, M.D. and Anson, B.J. (1953): Brachial antebrachial arterial patterns. Surgery Gynecology and Obstetrics 96 : 43-54.
  9. Pabst R. and Lippert H. (1968) : Belderseitiges Vorkommen von A. brachialis superficiialis, ulnaris superficialis and A. mediana. Anatomischer Anzieger 123 : 223-226.
  10. Patnaik, V.V.G., Kalsey, G. and Singla, R.K. (2000a) : Anomalous course of radial artery and a variant of deep palmar arch: A case report. Journal of the Anatomical Society of India 49(1) : 54-57.
  11. Patnaik, V.V.G., Kalsey, G. and Singla, R.K. (2000b) : Superficial palmar arch duplication : A case report. Journal of the Anatomical Society of India 49(1) : 63-66.
  12. Patnaik, V.V.G., Kalsey, G. and Singla, R.K. (2001a) : Trifurcation of brachial artery-A case reportt. Journal of the Anatomical Society of India 50(2) : 163-165.
  13. Patnaik V.V.G. Kalsey G. and Singla R.K. (2001b): Bifurcation of axillary artery in its 3rd part-A case report. Journal of the Anatomical Society of India 50(2) : 166-169.
  14. Poteat, W.L. (1986) : Report of a rare human variation : Absence of the radial artery. Anatomical Record 214 : 89-95.
  15. Rodriguez-Baeza, A. Nebot, J., Ferreira, B., Reina, F, Perez, J., Sanudo, J.R. and Rolg, M. (1995) : An anatomical study and ontogenic explanation of 23 cases with variations in the main pattern of the human brachio-antebrachial arteries. Journal of Anatomy 187 : 473-479.
  16. Schwyzer, A.G. and DeGaris, C.F. (1935): Three diverse patterns of the arteria brachialis superficialis in man. Anatomical Record 63 : 405- 416.
  17. Singer E. (1933) : Embryological pattern persisting in the arteries of the arm. Anatomical Record 55 : 403-409.
  18. Suganthy J., Koshy S., Indrasingh I. and Vettivel S. (2002) : A very rare absence of radial artery : A case report. Journal of the Anatomical society of India 51(1) : 61-64.
  19. Thane, G. D. Quain's elements of Anatomy. In : Arthrology- Myology-Angiology. 10th Edn; Longman, Green, and Co. London : 445. (1892).
  20. Thoma, A. and Young, J.E.M. (1992) : The superficial ulnar artery "trap" and the free forearm flap. Annals of Plastic Surgery 28 : 370-372.
  21. Tountas, CH.P. and Bergman, R.A. : Anatomic Variations of the upper extremity. Churchill Livingstone, New York. pp. 196210 (1993).
  22. Vancov V. (1961) : Une variete extremement complexe des arteres du member superiur chez un foetus humain. Anatomischer anzeiger 109 : 400- 405.
  23. Williams, P.L.; Bannister, L.H. Berry M.M; Collins, P., Dyson, M. Dussek, J.E., Ferguson, M.W.J.: Gray's Anatomy, In : Cardiovasular system. Gabella, G. Edr. 38th Edn, Churchill Livingstone, London, Edinburgh pp: 1537-40 (1995). J. Anat. Soc. India 52(2) 177-179 (2003)

 

Missing Image

Fig.1

Division of brachial artery in the cubital fossa and termination of ulnar artery in the median nerve. A2- Unusual ulnar artery, B-bifurcation of brachial artery, C- anterior interosseous artery, B1- Continuation and termination of ulnar artery in median nerve, M- median nerve

 

Missing Image

Fig.2

Origin of unusual ulnar artery from brachial artery A- brachial artery, A1-unusual ulnar artery, A2-continuation of unusual ulnar artery, B-bifurcation of brachial artery.

 

Missing Image

Fig.3

Development of the unusual branch of the brachial artery. AA-axis artery; A-axillary artery; B-brachial artery; I - interosseous artery; M-median artery; U-ulnar artery; SB-superficial brachial artery; R- radial artery; SAB superficial antebrachial artery; SU- superficial ulnar artery; SPA-superficial palmar arch.

Access free medical resources from Wiley-Blackwell now!

About Indmedica - Conditions of Usage - Advertise On Indmedica - Contact Us

Copyright © 2005 Indmedica