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Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Upper Limb: Radial Recurrent Artery

Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Upper Limb

Radial Artery

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD

Peer Review Status: Internally Peer Reviewed


The radial artery may arise from the brachial more proximal than usual (approx. 1inch (2.54 cm) in every 8 cases studied), from the axillary artery, or from the brachial lower than the bend of the elbow although a low division of the brachial is rare. Tiedemann found a case where the radial arose below the upper third of the forearm.

It may run superficial to the fascia of the forearm.

In some cases it crosses over, instead of under, the extensors of the thumb.

The radial may terminate in the forearm or be absent, with its place in the forearm and hand being supplied by the ulnar, common interosseous, or an enlarged median artery.

It may be joined by a vas aberrans from the brachial or axillary artery.

The radial artery may be doubled or even tripled, with the three divisions arising from the axillary, median, and anterior interosseous arteries.

The princeps pollicis artery may arise from the radial artery in the palm of the hand.

Richard Quain found the radial artery to arise higher than usual in nearly one case in eight (~12.5%). Its origin was much more frequent from the axillary, or from the upper part of the brachial, which was more frequent than from the more distal part of the brachial. Low origin of the radial is much less frequent. In one case in 481 examples (~0.2%), (and that complicated by another variation, viz., the existence of a vas aberrans proceeding from the axillary to the radial) the place of division was between 2 to 3 inches (~6.35 cm) below the elbow-joint (Quain). Tiedemann reported it as "rarely occuring below the upper-third of the forearm."

Richard Quain provides the following discussion of the radial artery:
The radial artery more rarely deviates from its usual position in the forearm than does the ulnar. It has been found lying upon the semilunar fascia of the biceps, and over the aponeurosis of the forearm, instead of beneath those structures. It occasionally turns backwards over, instead of beneath, the tendons of the extensor muscles of the thumb; and in rarer cases it has been seen passing backwards over the supinator longus ( modern terminology, nomina: brachioradialis), above the middle of the forearm, and descending across the thumb-muscles to the wrist. In cases of low origin the radial artery passes beneath pronator teres and the radial origin of the flexor sublimis digitorum (flexor digitorum superficialis), to its usual position between the tendons of supinator longus (brachioradialis) and flexor carpi radialis. In two or three of these cases, it has been seen joined by a vas aberrantia occasionally derived from the brachial or axillary artery commonly ended by joining the radial artery or one of its branches.

The radial artery is sometimes much smaller than usual, and it has been seen terminating in the carpal and superficial volar offsets, or in muscular offsets at a variable level in the forearm. A few instances of absence of the radial artery are also recorded, the brachial artery being continued directly into the ulnar-interosseous trunk, and giving off only a radial recurrent branch at the usual place of division. In these cases the deficiency is generally supplied by the ulnar artery in the hand, or by a large median artery; more rarely by a branch of the anterior interosseous, directed outwards in front of the wrist, or joining the diminished radial trunk at the back of the hand.

The radial artery may run a superficial course, it may pass to the back of the wrist across the supinator longus and may lie upon, instead of beneath, the extensor tendons of the thumb (from Cunningham's Anatomy, 1902 edition). Charles (1903) reported a "very superficial radial" whose course was superficial to supinator longus, extensor ossis metacarpi pollicis, and ext. brevis pollicis successively, and at its termination close to the lateral border of the tendon of the extensor longus pollicis (for help with the terminology, see the Old and Modern Terminology comparison pages at the end of this cardiovascular review). The course and position of the (superficial) radial artery, in the forearm, is itself variable.

Branches of the radial artery are also variable. The radial recurrent is sometimes very large (relatively) or it may be replaced by several branches. One considerable branch occasionally passes backwards on the surface of the supinator brevis (modern nomina; supinator) muscle, and turns upwards behind the outer (lateral) condyle of the humerus, replacing the posterior interosseous recurrent artery. When the radial itself arises high up, the recurrent artery usually comes from the residual brachial trunk, or sometimes from the ulnar artery, or more rarely from the interosseous. When given from the brachial trunk, the radial recurrent has been found crossing beneath the tendon of the biceps.

The superficial volar branch is sometimes enlarged, and furnishes one or two digital branches (generally to the thumb and index finger), and along with this the communication with the superficial arch may be absent. This branch occasionally arises much higher than usual; and in a few cases the radial artery has been found dividing in the upper part of the forearm into two branches of nearly equal size, the one which descends into the palm of the hand as the superficial volar artery, giving off also the carpal and dorsal digital branches, while the other passes backwards at a variable level over the extensor tendons, in a manner described above.

The posterior carpal and dorsal interosseous branches of the radial are sometimes very small, their place being supplied by the perforating offset of the anterior interosseous, apparently by an enlargement of the ordinary anastomosis between them.

The first dorsal interosseous branch is frequently much enlarged, and furnishes the collateral digital arteries to the index and middle fingers. The dorsal artery of the index finger may similarly, though more rarely, supply one or both of the collateral arteries of the adjacent sides of the thumb and index finger.

High Origin (HO) of the Arteries of the Forearm
Radial Artery

Number of Observations

HO
Total

Origin

1) 380 240

Axillary

-?

Brachial

Upper third

-?

Middle third

-?

Lower third

-?
2) 270 148

Axillary

43

Brachial

Upper third

39

Middle third

36

Lower third

30
3) 136 72

Axillary

19

Brachial

Upper third

22

Middle third

15

Lower third

15

HO= High Origin

1) Statistics by Giacomini.
2) Statistics by authors cited by Giacomini.
3) Statistics by Dubreuil-Chambardel.

Precocious or high origin of the radial artery is reported by Dubreuil-Chambardel to be very frequent, ~58%.

High Origin (HO) of the Arteries of the Forearm
Radio-Ulnar Trunk

Number of Observations

HO
Total

Origin

1) 380 22
2) 270 25

Axillary

12

Brachial

13
3) 136 5

Axillary

2

Brachial

3

1) Statistics by Giacomini.
2) Statistics by authors cited by Giacomini.
3) Statistics by Dubreuil-Chambardel.

High Origin of the Arteries of the Forearm
Radio-Ulnar-Interosseous Trunk

Number of Observations

Total Origin:

1.

0

2.

270

24 ?

3.

136

19 ?

1) Statistics by Giacomini.
2) Statistics by authors cited by Giacomini.
3) Statistics by Dubreuil-Chambardel.

Image 34, Image 35, Image 36, Image 38 , Image 56, Image 60, Image 134Image 141, Image 186, Image 238, Image 239, Image 248, Image 249A, Image 330, Image 495, Image 496, Image 497,

Image 498Image 501Image 514, Image 528, Image 529

Deep

Image 252A, Image 252B, Image 252C, Image 252D, Image 252E, Image 252F, Image 252G, Image 252H, Image 252I, Image 252J

Double

Image 65

High Origin

See Image 186, Image 249D, Image 250

Recurrent

See Radial Recurrent Artery

Rudimentary

See Image 35, See Image 56, See Image 134, Image 140, Image 184, Image 185, Image 504

Superficial

Image 139, Image 249A, Image 249B, Image 249C, See Image 249D, See Image 250 Image 483

Princeps Pollicis

See Image 250

Reference
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