Common Interosseous Artery

The common interosseous artery is a short but vital arterial branch arising from the ulnar artery in the proximal forearm. It quickly bifurcates into two terminal branches - the anterior interosseous artery and the posterior interosseous artery - which descend on either side of the interosseous membrane. These branches supply deep structures of the forearm, wrist, and hand and play an important role in collateral circulation around the elbow.

Location

The common interosseous artery arises in the proximal part of the forearm, typically just distal to the origin of the ulnar artery in the cubital fossa. It is a short trunk - about 1 cm in length * that arises from the lateral side of the ulnar artery and runs toward the proximal edge of the interosseous membrane before dividing into its two branches.

Origin Ulnar artery (in the proximal forearm) Length Approximately 1 cm Branches Anterior interosseous artery, Posterior interosseous artery Region Supplied (via branches) Deep flexor and extensor muscles of forearm, interosseous membrane, elbow, wrist, and distal radioulnar joint

Branches

1. Anterior Interosseous Artery

• Descends on the anterior surface of the interosseous membrane, between the flexor digitorum profundus and flexor pollicis longus.

• Supplies deep anterior compartment muscles of the forearm and the radius and ulna via nutrient branches.

• Travels alongside the anterior interosseous nerve (branch of the median nerve).

• Pierces the interosseous membrane near the wrist to anastomose with the posterior interosseous artery and participate in dorsal carpal anastomosis.

2. Posterior Interosseous Artery

• Passes posteriorly above the interosseous membrane through an opening proximal to the membrane.

• Enters the posterior compartment of the forearm and supplies extensor muscles and surrounding structures.

• Gives off the interosseous recurrent artery, which participates in elbow anastomosis (posterior to the lateral epicondyle).

• Joins the dorsal carpal arch distally.

Function

• Deep muscular perfusion: Through its branches, it supplies oxygenated blood to deep muscles of both anterior and posterior compartments of the forearm.

• Joint circulation: Contributes to periarticular arterial networks of the elbow, wrist, and distal radioulnar joints.

• Bone supply: Nutrient branches from the anterior interosseous artery enter the shafts of the radius and ulna to nourish medullary bone.

Physiological Role(s)

• Maintains vascular integrity of deep structures during high-resistance and prolonged activity in the forearm.

• Supports collateral flow around the elbow and wrist in case of arterial compression or occlusion.

• Works with radial and ulnar arteries to support dual-plane perfusion across the interosseous membrane.

Relations

• Anterior interosseous artery: Lies between deep flexor muscles; travels alongside the anterior interosseous nerve.

• Posterior interosseous artery: Lies among extensor muscles; superficial to the interosseous membrane but deep to extensor digitorum.

• Both arteries approach the dorsal aspect of the wrist and contribute to the dorsal carpal arch.

Development

The common interosseous artery originates from the remodeling of the embryonic axial artery of the upper limb. As the forearm vasculature differentiates, this short vessel trunk arises from the early ulnar artery and provides two major interosseous branches, which expand alongside the forming interosseous membrane. Proper development is essential for forming the deep vascular plexus that supplies developing musculature and bone.

Clinical Significance

• Anterior interosseous syndrome: Ischemia or entrapment of the anterior interosseous nerve (not artery) may cause weakness in the flexor pollicis longus and pronator quadratus. However, compromised arterial flow can worsen nerve compression.

• Radial or ulnar artery occlusion: In such cases, the common interosseous and its branches may play a compensatory role in perfusing distal forearm and hand structures.

• Compartment syndrome: Damage to either interosseous branch within tight fascial compartments may contribute to ischemic muscle necrosis in the deep flexors or extensors.

• Trauma or fractures: Proximal forearm fractures may disrupt the origin of the common interosseous artery or compress its branches, especially near the interosseous membrane.

Imaging

• Doppler ultrasound: Can evaluate flow within anterior or posterior interosseous arteries and identify ischemic regions.

• MR angiography (MRA): Helps visualize the branching pattern and relationship with forearm musculature.

• Conventional angiography: Used in endovascular procedures or trauma assessments to localize bleeding sources.

Surface Anatomy

• The common interosseous artery itself is not palpable due to its short length and deep location.

• The anterior interosseous artery travels in the midline of the anterior forearm, often marked by the course of the anterior interosseous nerve (motor-only branch).

• The posterior interosseous artery can be localized indirectly by identifying its passage through the opening above the interosseous membrane in the proximal posterior forearm.

Anatomical Variations

• The common interosseous artery may arise more proximally or distally along the ulnar artery or may occasionally share a trunk with other branches.

• In rare cases, the common interosseous artery may arise from the brachial or radial artery as part of a high bifurcation variant.

• The anterior interosseous artery may be duplicated or form accessory branches that reach the flexor sheath or median nerve.

• There may be communication between anterior and posterior interosseous arteries beyond their standard connection near the wrist.

Elbow and Wrist Anastomosis Participation

The interosseous arteries participate in key anastomoses:

• Interosseous recurrent artery: Branch of the posterior interosseous artery; anastomoses with the middle collateral artery posterior to the lateral epicondyle.

• Anterior interosseous artery: Pierces the interosseous membrane distally and joins the dorsal carpal arch of the wrist.

• These connections support collateral flow during elbow flexion and contribute to wrist vascular arches (dorsal and palmar).