Where is ulnar pulse

In the three patients who underwent a concurrent restoration of the two arteries two with venous graft and one with primary end to end anastomosis , one restoration suffered thrombosis, while in the other, restoration continued to be functional.

One patient died in the immediate postoperative period because of multiple organ failure caused by polytraumatism. At hospital discharge, all patients presented good per-fusion in the damaged extremity, however three patients Penetrating trauma by splinters, through impact against glass panes as well as through cutting instruments knife and dagger is, in literature, the main cause of traumatism to the forearm arteries, while trauma to the forearm arteries associated to bone fracture are less frequent 1.

Most traumatisms reported in this paper were due to trauma by penetrating instruments. Arterial trauma in the forearm is diagnosed at clinical examination. Because of the superficiality of these arteries, absence of pulses, ischemia, local bleeding and heart murmurs in arterial passages are much more evident.

It is noteworthy that given the profuse collateral circulation of the forearm, injury to one of the arteries seldom brings about ischemia of the hand. That is why, application of the Allen test 7 is important, in which, should there be incomplete arcus palmaris, compression of one of the arteries at level of the radial face of the pulse, is associated to ischemia of the corresponding fingers.

Reports of the II World War experience, when arterial traumatisms were treated solely by arterial ligature, relate a 5. Should only one of the forearm arteries be injured, with no evidence of ischemia, it might be ligated with little risk of sequelae 9.

In presence of ischemia or concurrent injury of the radial and ulnar arteries, arterial restoration must be per-formed. In three of the 11 cases with isolated arterial in-jury radial, ulnar or interosseous perfusion of the hand suffered alteration, therefore a graft with inverted saphena was performed in two of them and a lateral suture in the other. Of the 13 cases with injury to both arteries of the forearm, for ten of the cases restoration of only one of the arteries was undertaken.

In the remaining three, restoration of both was carried out, as ischemia of the fingers persisted after repair of the first one. The only surrogate used for arterial grafts was autogenous vena saphena magna, notwithstanding the usage of synthetic prosthesis 6.

According to McCready, patients with injuries to the forearm arteries, seldom require fasciotomy, done by an extensive longitudinal incision in the flexor compartment, which can be extended through the carpal ligament until inside the hand 8. Lower rates of neurological injury than in other series were observed in the current casuistry.

As such, these structures tend to be visible by the naked eye, especially in individuals with thin skin or larger arteries. There are anatomical variations of the ulnar artery that are sometimes found in certain individuals.

Second part of the ulnar artery : One variation sometimes seen includes the possession of a second part of the brachial artery, which later combines to form a second part of the ulnar artery. These variations within the ulnar artery are relatively common; however, variations beginning at the level of the brachial artery are less common in the general population.

Some medical practitioners have difficulty distinguishing the ulnar artery from the superficial brachial artery in individuals where the ulnar artery begins earlier than in other individuals. Due to the confusion between the ulnar artery and other vascular structures, these variations can cause difficulties placing intravenous ports, administering medications intravenously, drawing blood from the ulnar artery, and other issues related to venipuncture.

Anatomical variations in these individuals may be the result of remaining embryological arteries or slight underdevelopment of arterial structures in the forearm. Superficial ulnar artery : In some individuals, both the radial and ulnar arteries appear more superficial than is typical. This is due to an underdevelopment of structures in the forearm and generally leads to a larger radial artery. Again, some diagnostic tests may mistake a more superficial ulnar artery for extraneous structures, venous inflammation, or other inflammatory conditions.

This makes identification and awareness of anatomical structures and potential variations important to diagnosis and appropriate treatment. Ulnar artery joined with radial artery : In very rare instances, and in cases where both arteries are more superficial than usual, the ulnar artery may be joined with the radial artery.

This leads to an abnormal branching pattern in the forearm, causing additional difficulty with interpreting imaging results, completing diagnostic tests, and mistakenly identifying impaired arterial structures in the forearm.

The ulnar artery serves the main function of transporting oxygenated blood to the muscles of the forearm and the hand. The ulnar artery should not be confused with the ulnar vein or the ulnar nerve , all of which have differing functions.

Besides feeding the forearm muscles, the ulnar artery also provides oxygenated blood to the smaller arteries within the hand and forearm. These smaller arteries include the digital arteries, which provide blood to each individual finger and the thumb.

There is an additional blood supply sent to the index finger. The ulnar artery provides blood supply to one side of the index finger, while the radial artery provides blood supply to the other side of the same finger. The index finger is one of the most integral of the digits in terms of stabilization and manipulation, making its blood supply of crucial importance.

The ulnar artery is used as a source to record a pulse. A normal reading of the ulnar pulse is typically between 60 and beats per minute bpm. This can be used as a simple way to record vital signs, monitor basic heart functioning, and check for cursory irregularities in the cardiovascular system.

The ulnar pulse can be taken by using the index and middle fingers to feel the artery and count the number of pulses present. Due to its location amidst other structures within the forearm, it may sometimes be difficult to locate and record the ulnar pulse.

However, this can be made easier by having the individual relax their arm, particularly at the wrist, to prevent tense muscles from obstructing the presence of the pulse. Irregularities noted in pulse at the level of the ulnar artery should be further investigated through more thorough diagnostic evaluations. One of the major conditions impacting the ulnar artery is ulnar artery thrombosis, also called hypothenar hammer syndrome or post-traumatic digital ischemia.

Put the tip of your index and long finger in the groove of your neck along your windpipe to feel the pulse in your carotid artery.

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Mayo Clinic does not endorse any of the third party products and services advertised. A single copy of these materials may be reprinted for noncommercial personal use only. This content does not have an English version. The superficial radial artery consists of a radial artery coursing above the tendons limiting the snuffbox. The absence of either the radial or ulnar arteries is considered very rare, as is the true duplication of the radial artery [ 3 ]. This variant corresponds to a brachial artery originating a superficial ulnar artery high up in the arm, whereas the radial artery is a continuation of the brachial artery [ 3 ].

The origin of the interosseous arteries from the radial artery, as recorded in the present case, is considered common in cases of ulnar arteries arising in the arm [ 3 ]. In addition, in the work conducted by Rodriguez-Niedenfuhr et al.

As far as the authors could determine, a SuBUA variant similar to the one we observed, with a path deep to the palmaris longus muscle, has just been reported twice in the literature. Quain found it in 2 cases while dissecting upper limbs [ 7 ], and Hazlet once in limbs [ 10 ].

Upper limb vascular variations are presently thought to result from a stochastic process of persistence, enlargement and differentiation of parts of the initial capillary network which would normally remain as capillaries or even regress [ 5 , 11 ].

The precise mechanisms that lead to the higher frequency of certain variants over others, remain to be elucidated [ 5 , 11 ]. Interestingly, Rodriguez-Niedenfuhr et al. The clinical importance of the superficial variations of the arteries of the upper limb are increasingly being recognized [ 1 ].

For example, by being superficial, they can be easily mistaken for subcutaneous veins, leading to inadvertent artery cannulation, with the potential risk of distal limb ischemia [ 1 , 12 , 13 ]. In addition, the superficial position of the radial or ulnar arteries makes them more vulnerable to trauma [ 1 ].

Moreover, the possibility of a SBUR variant should always be born in mind when using the arm or forearm as a source or as a recipient of microvascular flaps, or when using the radial artery as vascular graft [ 14 - 16 ]. Clinically, the presence of superficial forearm arteries can be suspected in the absence of palpable ulnar or radial pulses in their usual location, when superficial pulsatile vessels are found, or when patients complain of intermittent forearm or hand pain [ 1 ].

The ulnar artery can present several anatomical variations. In this paper we describe a bilateral superficial brachioulnar artery that, instead of travelling over the anterior aspect of the forearm muscles, as is usually the case in this variant of the ulnar artery, coursed under the palmaris longus muscle, before reaching the lateral aspect of the flexor carpi ulnaris muscle and becoming part of the ulnar neurovascular bundle.

This rare variant of the ulnar artery should always be born in mind when addressing the vessels of this region clinically. Written informed consent was obtained from the person who donated the cadaver dissected, prior to her death, for all teaching and academic purposes, namely for publication of relevant findings in scientific reports, including images.

A copy of the written consent is available for review by the Editor-in-Chief of this journal. All authors have read and approved the final manuscript. National Center for Biotechnology Information , U. BMC Res Notes. Published online Nov Author information Article notes Copyright and License information Disclaimer.

Corresponding author. Diogo Casal: ku. Received Jul 12; Accepted Nov This article has been cited by other articles in PMC. Abstract Background Variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people, and may have significant clinical implications.