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

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

Ulnar Artery

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

Peer Review Status: Internally Peer Reviewed


The ulnar artery may arise from the brachial above the usual point of division or from the axillary, in which case it usually passes over the flexor muscles, but beneath the fascia, to reach its usual position in the forearm. In circumstances such as this, the artery may terminate in the proximal forearm with a persistent median artery supplying the superficial arch

The recurrent arteries and the common interosseous are usually derived from the trunk vessel from which the ulnar arises.

It may run beneath the muscles or merely beneath the skin, where it becomes vulnerable to iatrogenic or self-inflicted problems.

In cases of high division of the brachial, the ulnar may run in a superficial, subcutaneous position or beneath the fascia throughout its extent in the forearm.

In some cases of high origin and superficial course, it gives rise to the subscapular and profunda brachii but not the common interosseous.

It may also provide an accessory ulnar recurrent, radial recurrent, or accessory interosseous branch, which may enter the palm and provide any of the branches of the superficial palmar arch.

In some cases in which the origin of the brachial is normal, the ulnar takes a superficial course, covered by fascia in the forearm, and the recurrent branches and the common interosseous arise from the radial.

The ulnar may be a branch of profunda brachii.

The ulnar is sometimes doubled; in some cases one of the two arteries may take a superficial course in the forearm.

At the wrist, the ulnar artery lies on the flexor retinaculum accompanied by the ulnar nerve at the ulnar side of the artery. It then lies to the radial side of the pisiform bone and to the ulnar side of the hook of the hamate, the two bones form a protective channel (of Guyon) for artery and nerve that is converted into a canal by the flexor retinaculum. The artery and nerve may be compromised if a variation of the abductor digiti minimi also occupies the canal.

The ulnar artery is more variable in its position than the radial artery.

R. Quain describes the variations in the Ulnar artery as follows: In the whole of the cases observed, the ulnar artery was found to deviate from its usual mode of origin nearly in proportion of one in 13 (~7.7%). The brachial artery was, more frequently than the axillary the source from which it sprang; and the lower part of the brachial than the upper. In one case of high origin of the ulnar artery, the vessel was connected with the brachial opposite the elbow-joint by means of a transverse branch (read also remarks on the variations of the axillary and brachial arteries). The course and position of the ulnar artery in the forearm is more frequently variable than that of the radial.

In cases of high origin it almost invariably descends over the muscles arising from the inner (medial) condyle of the humerus, only one exception was found by R. Quain. In one instance the ulnar artery taking this course divided just below the elbow into a superficial and deep branch.

Most commonly in such cases it is covered by the fascia of the forearm; but instances also occur in which the artery rests on the fascia, and either continues in that position or again sinks below the fascia distally, while the vessel thus disposed is distributed distally after the manner of the usual ulnar artery. The vessel from which the high ulnar separates is afterwards divided into the radial and the interosseous; it appears therefore probable the this unusual arrangement results from the early obstruction of the ulnar artery below the origin of the interosseous artery, and the development of a superficial vas aberrans, which unites that portion of the vessel below the obstruction with the axillary or brachial trunk. The interosseous artery in such cases of variability thus comprises not only the ordinary interosseous branch, but also the portion of the ulnar artery above the obstruction; and, in accordance with this view (Quain's), one finds that the recurrent branches are derived from it.

The ulnar artery has been found taking a superficial course when arising in the usual situation, and in these cases also the reccurent and interosseous arteries may be given off by the radial trunk.

Heuston reported an ulnar artery, arising from the brachial at its usual place of origin, passed superficial to the flexor muscles of the forearm, giving off no important branch. The radial artery, while in the antecubital fossa, gave off a large branch, from which the following vessels had their origin- viz., anterior and posterior ulnar recurrent, radial recurrent, comes nervi mediani, and anterior and posterior interosseous, all of which had a normal distribution.

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

Number of Observations

HO
Total

Origin

1) 380 112

Axillary

-

Brachial

Upper third

-

Middle third

-

Lower third

-
2) 270 60

Axillary

21

Brachial

Upper third

15

Middle third

16

Lower third

8
3) 136 26

Axillary

7

Brahcial

Upper third

7

Middle third

6

Lower third

9

HO= High Origin

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

Precocious or high origin of the ulnar artery is reported by Dubreuil-Chambardel to be very frequent, ~24%.

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 32, Image 35, Image 36, Image 56, Image 60, Image 138, Image 186, Image 240, Image 246, Image 248, Image 252A, Image 252B, Image 252C, Image 252D, Image 252E, Image 252F, Image 252G, Image 252H, Image 252I,

Image 252J, Image 497, Image 498Image 501

Deep

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

Recurrent

Image 248

Superficial

Image 139, Image 249A, Image 249B, Image 249C, Image 250

Posterior Interosseus

See Image 250

Median, superficial

Image 65


References

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Beaumanoir (de Brest), -. (1882) Présentations de pièces anatomiques: l'artère cubitale. Bull. de la Soc. Anatomique de Paris 57:319.

Bergman, R.A., Thompson, S.A., Afifi, A.K. and F.A. Saadeh. (1988) Compendium of Human Anatomic Variation: Catalog, Atlas and World Literature. Urban & Schwarzenberg., Baltimore and Munich.

Bianchi, L. (1943) Considerazioni sopra un caso di arteria brachio-ulnare superficiale. Anat. Anz. 94:73-88.

Brême, G. (1899) Casuitischer Beitrage zur Kenntniss der Anomalien der Armarterien. Zeitschr. für Morphology und Anthropology 1:494.

Chassaignac, -. (1834) Anomalie de l'artère cubitale. Bull. et Mém. de la Soc. Anatomique de Paris 1834:2.

Cocchi, A. (1891) Contribuzione allo studio dell'anastomosi tra radiale e cubitale alla piegatura del cubito nella divisione prematura dell'arteria brachiale. Atti dell Accademia dei Fisiocritici in Siena. Ser. 4, 3:247-261.

Dean, M.H. (1880) Arterial anomalies. The Medical Record, N.Y. 17:384.

Demeaux, -. (1843) Anomalie des artères de l'avant-bras. Bull. et Mém. de la Soc. Anatomique de Paris 1843:72.

Demeaux, -. (1843) (Superficial cubital and radial arteries) Bulletins et Mem. de la Société Anatomique de Paris XVIII(2):72.

Gruber, W. (1867) über die Arteria mediana antibrachii superficialis, Arteria ulnaris antibrachii superficialis und Duplicität der arteria ulnaris. Arch. Anat. Physiol. Wissen. Med. 1867:668-687

Gruber, W. (1871) Duplicität der Arteria ulnaris - neuer Fall. Arch. Anat. Physiol. Wissen. Med. 1871:286-296.

Guerra, P. (1887) Anomalie rinvenute in cadaveri di delinquenti e di normali. Ateneo Medico Parmense 1:278-272.

Guerrier, Y. and R. Paleirac. (1951) Le tronc artèriel antibrachial. Assoc. Anatomistes Comptes Rendus 38:566-575.

Guyon, F. (1861) Note sur une disposition anatomique propre a la face antérieure de la région du poignet et non encore décrite. Bulletins et Mémoires. Société Anatorniques de Paris. 6:184-186.

Hazlett, J.W. (1949) The superficial ulnar artey with reference to accidental intra-arterial injection. Canad. Med. Assoc. J. 61:289-293.

Heuston, F.T. (1885) Notes on some anatomical anomalies. Trans. - Royal Academy of Medicine in Ireland 3:453-456.

Maruyama, K. (1944) Seltene Varietät der Arterien der oberen Extremität bei einem Japaner (A. brachialis superficialis lateralis inferior, A. antebrachialis superficialis mediano-ulnaris, Arcus volaris superficialis vom Typus mediano-ulnaris). Folia Anat. Jpn. 22:551-567.

Pabst, R. and H. Lippert. (1968) Beiderseitiges Vorkommen von A. brachialis superficialis, A. ulnaris superficialis, und A. mediana. Anat. Anz. 123:223-226.

Poynter, C.W.M. (1922) Congenital anomalies of the arteries and veins of the human body with bibliography. The University Studies of the University of Nebraska 22:1-106.

Radzikowski, A. and P. Szulczyk. (1972) The radial recurrent and ulnar recurrent arteries. Folia Morphol. 31:109-116.

Ramsay, A. (1813) Account of unusual conformation of some muscles and vessels. Edinburgh Medical and Surgical Journal 8:281-283.

Schwalbe, E. (1889) Beitrag zur Kenntniss der Arterienvarietäten des menschlichen Arms. Morphologichen Arbeiten 8:1-47. Schwalbe, E. (1898) Beitrag zur Kenntniss der Arterienvarietäten des menschlichen Arms. Morphologische Arbeiten 8:1-47.

Souligoux, Ch. (1895) Anomalie de l'artère cubitale. Bull. et Mém. de la Soc. Anatomique de Paris 1895:657.

Stocquart, A. (1887) Les anomalies de l'artère cubitale. Archives de Médecine et de Chirurgie Pratiques 2:85-86.

Tedeschi, -., Torraca, -. and -. Pavone. (1907) Anomalia delle arterie dell'antibraccio e del nervo mediano. Giorn. Internaz. delle Scienze Mediche 29:315-317.

Weathersby, H.T. (1956) Unusual variation of the ulnar artery. Anat. Rec. 124:245-248.

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