Brachial Artery Pulse

The brachial artery pulse is an important palpable arterial pulse of the upper limb. It is most commonly assessed near the elbow, where the brachial artery enters the cubital fossa and lies medial to the tendon of the biceps brachii.

The brachial artery is the principal artery of the arm. It begins as the continuation of the axillary artery at the inferior border of the teres major muscle and descends along the medial aspect of the arm before entering the cubital fossa. It usually terminates by dividing into the radial and ulnar arteries.

Because the artery becomes relatively accessible near the elbow, this region is used for palpating the brachial pulse and for auscultating arterial sounds during routine blood pressure measurement.

Location of the Pulse

The brachial pulse is most readily palpated in the cubital fossa on the anterior aspect of the elbow.

The artery is located just medial to the biceps brachii tendon and can be compressed against deeper structures to appreciate its pulsation.

Surface Landmark

The biceps brachii tendon is the key surface landmark for locating the brachial artery at the elbow.

With the elbow slightly flexed, the tendon can be identified centrally in the cubital fossa. The artery lies immediately medial to it.

Palpation Technique

1. Position the upper limb comfortably with the elbow slightly flexed.
2. Identify the cubital fossa on the anterior aspect of the elbow.
3. Palpate the biceps brachii tendon near the center of the fossa.
4. Move the fingertips slightly medial to the tendon.
5. Apply gentle pressure until the arterial pulsation is felt.

Cubital Fossa

The cubital fossa is a triangular depression on the anterior aspect of the elbow.

It contains several important structures passing between the arm and forearm, including the distal brachial artery.

Boundaries of the Cubital Fossa

Boundary	Structure
Superior	Imaginary line between medial and lateral epicondyles
Medial	Pronator teres
Lateral	Brachioradialis
Floor	Brachialis and supinator
Roof	Skin, superficial fascia, deep fascia and bicipital aponeurosis

Contents of the Cubital Fossa

Several major structures lie within the cubital fossa. From lateral to medial, the principal deep structures are commonly remembered as the biceps tendon, brachial artery, and median nerve.

Structure	Relative Position
Biceps tendon	Lateral to brachial artery
Brachial artery	Between biceps tendon and median nerve
Median nerve	Medial to brachial artery

Biceps Brachii Tendon

The distal biceps tendon is easily identified when the elbow is flexed against resistance.

Because the brachial artery lies immediately medial to this tendon, it provides a reliable guide to pulse palpation.

Bicipital Aponeurosis

The bicipital aponeurosis extends medially from the distal biceps tendon into the deep fascia of the forearm.

It lies superficial to the brachial artery and median nerve and helps separate these deeper structures from superficial veins in the cubital region.

Median Nerve Relationship

The median nerve lies medial to the brachial artery in the cubital fossa.

This close relationship is important during examination, vascular procedures, and interpretation of injuries around the elbow.

Course of the Brachial Artery

The brachial artery begins at the inferior border of the teres major as the continuation of the axillary artery.

It descends through the arm, initially accompanying the median nerve, and approaches the anterior elbow along the medial side of the biceps brachii.

Surface Projection in the Arm

The course of the brachial artery can be approximated by a line extending from the medial aspect of the proximal arm toward the cubital fossa just medial to the biceps tendon.

Its pulsation may sometimes be appreciated at other points along this course, particularly where the vessel can be compressed against the humerus.

Termination

The brachial artery usually terminates in the cubital fossa by dividing into the radial and ulnar arteries.

The precise level of bifurcation can vary among individuals.

Radial Artery

The radial artery continues along the lateral side of the forearm and produces the commonly assessed radial pulse at the wrist.

It is one of the two major terminal branches of the brachial artery.

Ulnar Artery

The ulnar artery passes toward the medial side of the forearm and contributes substantially to the arterial supply of the hand.

It is usually the larger of the two terminal branches near their origin.

Major Branches in the Arm

The brachial artery gives rise to several branches before reaching the cubital fossa, including the profunda brachii artery and collateral branches participating in the arterial network around the elbow.

Relationship to the Humerus

In parts of the arm, the brachial artery can be compressed against the humerus.

This relationship contributes to the ability to control arterial flow temporarily by applying pressure at appropriate points.

Relationship to the Medial Bicipital Groove

The brachial artery descends along the medial side of the biceps brachii in the groove between the anterior and posterior muscular compartments of the arm.

The medial border of the biceps therefore helps indicate the vessel's surface course.

Brachial Pulse and Blood Pressure

The brachial artery is the standard artery used during routine upper-arm sphygmomanometry.

The blood pressure cuff compresses the artery in the arm, while arterial sounds are typically assessed over the brachial artery near the cubital fossa.

Stethoscope Position

During manual blood pressure measurement, the stethoscope is placed over the brachial artery in or just proximal to the cubital fossa.

The artery is first localized by palpation to improve positioning.

Korotkoff Sounds

As cuff pressure is gradually released, turbulent blood flow through the partially compressed brachial artery produces Korotkoff sounds.

These sounds are used to determine systolic and diastolic blood pressure during manual measurement.

Pulse Assessment

The brachial pulse can be assessed for presence, rate, rhythm, and relative strength.

Comparison with the opposite limb may help identify asymmetry in upper limb arterial perfusion.

Brachial Pulse in Infants

The brachial artery is an especially important pulse site in infants because the vessel is accessible along the medial aspect of the upper arm.

Its surface position makes it useful when assessing central circulation in this age group.

Relationship to Superficial Veins

Several superficial veins cross the cubital region, including the median cubital vein, cephalic vein, and basilic vein.

These veins lie superficial to the deep fascia, while the brachial artery lies deeper and is partly protected by the bicipital aponeurosis.

Median Cubital Vein

The median cubital vein commonly crosses the cubital fossa superficially and is frequently used for venipuncture.

The bicipital aponeurosis helps separate it from the underlying brachial artery and median nerve.

Brachial Artery Versus Median Cubital Vein

Feature	Brachial Artery	Median Cubital Vein
Depth	Deep to deep fascia and bicipital aponeurosis	Superficial fascia
Pulsation	Palpable pulse	No arterial pulsation
Main clinical use	Pulse and blood pressure assessment	Common venipuncture site

Clinical Significance

Blood Pressure Measurement

The brachial artery is the principal vessel used for conventional upper-arm blood pressure measurement.

Correct localization of the artery improves placement of the stethoscope and interpretation of Korotkoff sounds.

Upper Limb Circulation

Palpation of the brachial pulse can help assess arterial flow to the upper limb.

Findings are interpreted together with distal pulses, limb temperature, capillary refill, skin appearance, symptoms, and other clinical information.

Trauma

Injury to the arm or elbow can damage the brachial artery.

Because the vessel supplies the radial and ulnar arteries distally, significant injury can threaten perfusion of the forearm and hand.

Supracondylar Fracture

The brachial artery lies close to the distal humerus and can be affected by displaced supracondylar fractures, particularly in children.

Assessment of distal circulation is therefore important in injuries around the distal humerus.

Vascular Compression

The brachial artery can be compressed against the humerus to reduce distal arterial flow temporarily.

This surface relationship is relevant to hemorrhage control and to the mechanism of blood pressure cuffs.

Arterial Cannulation

The brachial artery can be accessed for selected vascular procedures, although its deep location and close relationship to important nerves require careful anatomical localization.

Venipuncture Safety

Knowledge of the deeper position of the brachial artery is important during procedures involving superficial veins of the cubital fossa.

The bicipital aponeurosis provides some separation between superficial venous structures and the artery.

Pulse Comparison

Pulse	Typical Surface Location
Brachial	Medial to biceps tendon in cubital fossa
Radial	Anterior-lateral distal forearm near wrist
Ulnar	Anterior-medial wrist, lateral to flexor carpi ulnaris tendon

Anatomical Variation

The level at which the brachial artery divides into radial and ulnar arteries varies.

Some individuals have a relatively high bifurcation, which can alter the expected vascular arrangement of the arm and cubital fossa.

Key Surface Anatomy Features

Feature	Key Point
Pulse site	Cubital fossa
Key landmark	Medial to biceps brachii tendon
Artery origin	Continuation of axillary artery
Usual termination	Radial and ulnar arteries
Nearby nerve	Median nerve lies medially
Protective structure	Bicipital aponeurosis
Superficial venous landmark	Median cubital vein
Main examination use	Pulse assessment
Major procedural use	Blood pressure measurement
Clinical importance	Upper limb perfusion and vascular assessment

Anatomical Importance

The brachial artery pulse is an important landmark of upper limb surface anatomy. At the elbow, the artery can be located in the cubital fossa immediately medial to the biceps brachii tendon, providing a reliable site for pulse assessment.

The artery's position also explains its central role in routine blood pressure measurement. The biceps tendon, bicipital aponeurosis, median nerve, and superficial veins of the cubital region provide important anatomical relationships for examination and procedures.

Because the brachial artery is the principal arterial pathway to the forearm and hand before dividing into the radial and ulnar arteries, assessment of its pulse is also important when evaluating upper limb circulation, elbow trauma, and injuries involving the distal humerus.