Download MBBS Anatomy PPT 9 Arm Cubital Fossa Output Notes

Learning Objectives

? At end of this session, students should be able to:

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? DESCRIBE

? Attachments, actions & innervations of - biceps

brachii, coracobrachialis, brachialis, triceps

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brachii

? Contents of ant & post compartment of arm ,

their anatomical Relations and clinical

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importance

? Boundaries of cubital fossa and its contents.

Medial Intermuscular Septum

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?From subcutaneous sheath to humerus.

?Separates muscles of anterior arm from medial

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side of triceps complex.

?Lateral Intermuscular Septum

?From subcutaneous sheath to humerus.

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?Separates muscles of anterior arm from lateral

side of triceps complex.

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Anterior Brachial

Compartment

BBC ? Musculocutaneous nerve

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Muscles

?Components:

Biceps brachii

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Coracobrachialis
Brachialis

?Function:

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Forearm flexors
Biceps also supinates forearm

Innervation
?Musculocutaneous nerve C5-6

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?Nerves passing through compartment - But

not innervating anterior compartment
structures are : Median & Ulnar nerve

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Through proximal part of anterior
compartment.

?Blood supply ?

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?Brachial artery

?Basilic vein and venae comitantes

Posterior compartment

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Triceps & anconeus ?
Radial Nerve

Muscles

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?Components:

?Triceps brachii.

?Anconeus.

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?Function:

?Forearm extensors.

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?Long head of triceps can extend shoulder

(arm).

?Synergists in forearm supination.

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?Innervation/Vascularization

?Radial nerve C7

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?Deep brachial artery
Nerves and Vessels in Arm

Median Nerve

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?Supplies flexor muscles on radial side of

forearm.

?Travels with brachial artery:

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?upper half - Lateral to brachial artery.

?lower half - Medial to brachial artery .

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?Crosses cubital fossa superficially:

?With brachial artery &

?Deep to bicipital aponeurosis

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Ulnar Nerve

?Supplies flexor muscles on ulnar side of forearm.

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?Starts in anterior brachial compartment - MC

?Medial to brachial artery
?Runs with superior ulnar collateral artery.

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?Pierces medial intermuscular septum:

?Enters posterior compartment of arm.

?Passes around (superficial) posterior to medial

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epicondyle.

?Passes into forearm between two heads of flexor

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carpi ulnaris muscle.

Radial Nerve - PC

?Supplies extensor muscles in posterior

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compartment of brachium as well as extensor
muscles of wrist and hand.

?Also supplies brachioradialis muscle- Propioceptive

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?Descends posterior to axillary artery:

?Spirals around the posterior surface of humerus in

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spiral (radial) groove.

?Accompanied with Profunda brachial artery.

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Radial Nerve

?Pierces lateral intermuscular septum distal to

deltoid insertion ? enters into anterior

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compartment.

?Passes into forearm:

?Between the brachialis medially and

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brachioradialis laterally.

?Divides into superficial and deep branches

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near lateral epicondyle.

Radial Nerve

?Branches in the axilla and upper third of arm:

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Muscular branch to long head of triceps.
Muscular branch to medial head of

triceps.

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Posterior cutaneous nerve of arm.

Radial Nerve

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?Branches in radial groove in middle third

of arm:

?Branch to lateral head , medial head of

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triceps and anconeus.

?Lower lateral cutaneous nerve of arm.

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?Posterior cutaneous nerve of forearm.

Arm

Bone of Arm Humerus

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Shoulder

M

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R

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A

Anterior

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Posterior

view

view

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Elbow

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lateral & medial intermuscular septa divide distal part

of arm into:

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? Anterior &
? Posterior compartments

Anterior Compartment: Contents

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Anterior Compartment: Contents

?Muscles: Biceps brachii,

Coracobrachialis, Brachialis

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?Blood Vessels: Brachial artery, Basilic

vein

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?Nerves : Musculocutaneous, Median,

Ulner & Radial

Muscles of the Anterior Compartment

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Coracobrachialis

Biceps brachii

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Brachialis

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Biceps Brachii

?Origin: Two heads:

Coracoid

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? Long head from

process

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supraglenoid
tubercle of
scapula
(intracapsular)

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? Short head from

the tip of
coronoid process
of scapula

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? Two heads join in

the middle of the
arm

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? Insertion:

Biceps brachii

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? posterior part of radial

Tendon

tuberosity, &

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inserted

?

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to radial

deep fascia of medial

tuberosity

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aspect of forearm
through - bicipital
aponeurosis

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? N/S : Musculocutaneous
? Action:

Bicipital

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?

aponeurosis

Strong supinator of the

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forearm (used in
screwing)

? Powerful flexor of elbow

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? Weak flexor of shoulder

Coracobrachialis

?Origin: Tip of coracoid

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process

?Insertion: Middle of

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medial side of shaft of
humerus

?Nerve supply:

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Musculocutaneous

?Action: Flexor & a weak

adductor of the arm

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Brachialis
?Origin: front of

lower half of

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humerus

?Insertion: anterior

surface of coronoid

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process of ulna

?Nerve supply:

Musculocutaneous

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& Radial

?Action: Strong

flexor of the

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forearm

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Posterior Compartment: Contents

?Muscles:

Triceps

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?Vessels:

Profunda
brachii &

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Ulnar
collateral
arteries

?Nerves:

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?Radial & Ulnar

Muscle of Posterior Compartment

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?Triceps brachii

Triceps

?Origin:

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?Three heads

Long head - infrglenoid

tubercle of scapula

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Lateral head from upper

half of posterior surface
of shaft of humerus

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above spiral groove

Medial head from lower

half of posterior surface

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of shaft of humerus
below spiral groove

?Insertion: Common

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tendon inserted into the
upper surface of the
olecranon process of
ulna

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?Nerve supply: Radial

nerve

?Action: Strong extensor

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of the elbow joint
Radial Nerve

?Branches in distal third of arm:

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? brachioradialis.

? extensor carpi radialis longus &

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brevis?

? Articular branches to elbow joint.

Musculocutaneous Nerve

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?Pierces coracobrachialis in upper half or third of

brachium.

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?Innervates muscles of anterior brachial

compartment.

?Pierces fascia lateral to biceps tendon:

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?Continues as lateral cutaneous nerve of

forearm.

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?Supplies skin on lateral forearm as far as wrist.

Nerves in arm

?Medial cutaneous nerve of arm :

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Direct branch from medial cord.

?Medial cutaneous nerve of forearm:

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Direct branch from medial cord.

Cephalic Vein

?Lateral continuation of dorsal venous

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arch.

?Ascends in superficial fascia along lateral

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aspect of forearm and arm.

?Passes through deltopectoral triangle.

?Empties into axillary vein.

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Basilic Vein

?Medial continuation of dorsal venous arch.

?Ascends in superficial fascia along lateral

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aspect of forearm and arm to middle of arm.

?Pierces deep fascia and ascends in upper

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aspect of arm in deep fascia.

?Joins venae comitantes to form axillary vein:

?Usually near inferior border of teres major.

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Median Cubital Vein

?Connects cephalic and basilic vein.

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?Extends diagonally across bicipital

aponeurosis.

?Receives blood from median

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antebrachial vein.

?Drains blood from palmar hand.

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Venae Comitantes

?Veins that parallel arteries:

?Usually two per artery.

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?Countercurrent heat exchange.

Brachial Artery

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?Direct continuation of axillary artery.

?Begins at inferior border of teres major.

?Main branch is deep brachial artery.

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?Other branches:

Superior ulnar collateral:

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To posterior ulnar recurrent.

Inferior ulnar collateral:

To anterior ulnar collateral.

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Relationships

?Radial nerve to deep brachial artery in

radial (spiral groove).

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?Brachial artery to median nerve.

?Brachial artery to bicipital aponeurosis.

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?Superior ulnar collateral artery to medial

epicondyle.

Relationships

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?Ulnar nerve to medial epicondyle.

?Musculocutaneous nerve to

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coracobrachialis muscle.

?Musculocutaneous nerve to biceps and

brachialis muscles.

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?Lateral cutaneous nerve of the forearm

to the bicipital tendon.

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CUBITAL FOSSA

Cubital fossa

A triangular space in front of elbow joint.

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Boundaries:
?Base: an imaginary line between 2

epicondyles of humerus

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?Laterally: medial border of brachioradialis

?Medially: lateral border of pronator teres

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?Apex: brachioradialis overlaps pronator teres


Cubital Fossa Boundaries

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? Lateral:

Brachioradialis muscle

? Medial:

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Pronator teres muscle

? Superior base:

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Line between two humeral epicondyles

? Floor:

Supinator and brachialis muscles

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Cubital fossa (boundaries)

Cubital fossa

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Roof:
?Skin

?Superficial fascia containing: cephalic vein, lateral

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cutaneous nerve of forearm, basilic vein, medial
cutaneous nerve of forearm & medial cubital vein

?Deep fascia

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?Bicipital aponeurosis
Floor:
1.

Brachialis (medially)

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2.

Supinator (laterally)

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Cubital fossa (roof)

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Cubital fossa

? CONTENTS:
From lateral to medial:
?Radial nerve & its deep branch

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?Tendon of biceps brachii
?Termination of brachial artery & beginning of radial

& ulnar arteries

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?Median nerve

Cubital fossa (contents)

Cubital Fossa Contents

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? Lateral to medial:

Biceps

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Tendon

Brachial Artery

Median Nerve

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Cubital Fossa

is a triangular depression on

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anterior aspect of the

elbow

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Boundaries

?Base: line drawn through two

epicondyles of humerus

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?Laterally: brachioradialis
?Medially: pronator teres
?Roof: skin, superficial, deep

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fascia and bicipital

aponeurosis

?Floor: brachialis medially and

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supinator laterally.

Contents of the Cubital Fossa

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(From medial to lateral side)