Anatomy of the Upper Limb's Vascular and Lymphatic Systems

Clinical Tip: Pulse Palpation In a physical examination, clinicians locate specific pulses to assess arterial integrity. Common sites include the axillary pulse (in the axilla), the brachial pulse (in the bicipital groove), the radial pulse (at the wrist or the anatomical snuff box), and the ulnar pulse (at the wrist).

Venous Drainage: Superficial and Deep Systems

The venous system of the upper limb is divided into two distinct networks: the superficial veins located in the subcutaneous tissue and the deep veins located internal to the deep fascia.

Superficial Venous Drainage

The superficial veins arise from the dorsal venous network located on the back (dorsum) of the hand. From this network, two major veins emerge:

• Cephalic Vein: This vein runs along the lateral aspect of the wrist and the anterolateral surface of the forearm and arm. It eventually courses between the deltoid and pectoralis major muscles to enter the axillary vein.
• Basilic Vein: Located on the medial side of the forearm and the inferior part of the arm, the basilic vein eventually pierces the brachial fascia to merge with the deep veins and form the axillary vein.
• Median Cubital Vein: This is a crucial communicating vessel that passes obliquely across the anterior aspect of the elbow in the cubital fossa, connecting the cephalic and basilic veins.

Deep Venous Drainage

The deep veins lie internal to the deep fascia and typically travel alongside the major arteries. A key characteristic of these vessels is that they usually occur as paired veins (venae comitantes) that bear the same name as the arteries they accompany, such as the radial, ulnar, and brachial veins.

Lymphatic Drainage

The lymphatic system is responsible for draining interstitial fluid and transporting immune cells. In the upper limb, drainage is categorized into superficial and deep pathways.

Superficial Lymphatic Vessels

These vessels originate from the digital lymphatic vessels of the fingers and the lymphatic plexus of the palm. They travel alongside the cephalic vein, crossing the proximal arm and the anterior shoulder to drain into the apical axillary lymph nodes.

Deep Lymphatic Vessels

The deep lymphatic vessels follow a different route, accompanying the major deep veins (radial, ulnar, and brachial). These vessels ultimately drain into the humeral axillary (or lateral) lymph nodes.

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Summary Table: Vascular Transitions