Arm and Cubital Fossa PDF

Arm and Cubital Fossa David L. McWhorter, Ph.D. Learning Objectives (LOs) provide structured learning (clear, logical progression of what is expected, helping to concentrate on crucial knowledge areas and reduce being overwhelmed by the topic's breadth), motivation (knowing the lecture's purpo...

Arm and Cubital Fossa David L. McWhorter, Ph.D. Learning Objectives (LOs) provide structured learning (clear, logical progression of what is expected, helping to concentrate on crucial knowledge areas and reduce being overwhelmed by the topic's breadth), motivation (knowing the lecture's purposes, providing milestones to work towards, providing real-world applications), active learning (encourage engagement with the material, understanding the significance of what is being learned), exam question preparation (manage expectations of what will be assessed on block exams), and improve academic performance (studies show students who are aware of LOs tend to perform better academically). 1. Define the arm and cubital fossa, including compartments and functions. 2. List the three anterior (flexor) and two posterior (extensor) compartment arm muscles, including their attachments, functions, and neurovasculature. 3. Recall the major deep and superficial arteries and veins, including their origin, distribution, and termination. 4. State the four major nerves traversing the arm, including the segmental origin and sensory/motor distribution. 5. Explain the boundaries and contents of the cubital fossa. 6. Summarize the clinical correlates associated with anatomical structures in the arm and cubital fossa. Road Map is a strategic plan outlining the content segments needed to achieve the learning objectives, ensuring the necessary steps are taken in a systematic and organized manner. Introduction Conclusion Muscles of the Arm: Anterior (flexor) compartment: 3 muscles Cubital Fossa Posterior (extensor) compartment: 2 muscles Blood vessels of the arm Nerves of the arm  The arm extends from the shoulder to the elbow (LO #1) Two types of movement occur between the arm and forearm at the elbow joint: 1. Flexion–extension 2. Pronation–supination Arm muscles are divided into anterior and posterior groups: Separated by the humerus and medial and lateral intermuscular septae (Fig. 3.49) Chief action of both groups is at the elbow joint: But some muscles also act at the glenohumeral joint  Cubital fossa is a superficial depression on the anterior aspect of the elbow (LO #1) Three triangular cubital fossa boundaries: 1. Superiorly, an imaginary line connecting the medial and lateral epicondyles 2. Medially, forearm flexor muscles arising from the common flexor attachment of the medial epicondyle; most specifically, the pronator teres 3. Laterally, forearm extensor muscles arising from the lateral epicondyle and supracondylar ridge; most specifically, the brachioradialis Floor is formed by: Brachialis and supinator muscles of the arm and forearm, respectively Roof is formed by: Continuity of brachial and antebrachial (deep) fascia reinforced by the bicipital aponeurosis, subcutaneous tissue, and skin Road Map is a strategic plan outlining the content segments needed to achieve the learning objectives, ensuring the necessary steps are taken in a systematic and organized manner. Introduction Conclusion Muscles of the Arm: Anterior (flexor) compartment: 3 muscles Cubital Fossa Posterior (extensor) compartment: 2 muscles Blood vessels of the arm Nerves of the arm  canshy menturances press (LO #2) sit 0 a in (LO #2)  Bicipital Myotatic Reflex (stretch reflex) is one of several n deep tendon reflexes routinely tested during physical mu examinations to evaluate the spinal cord, motor nerve, afferent nerves, and descending motor pathways (LO #6) Relaxed limb is partially extended at the elbow with the examiner’s thumb firmly placed on the bicep's tendon Reflex hammer briskly taps the base of the nail bed of the examiner’s thumb Normal (positive) response is an involuntary biceps contraction, felt as a brief jerk-like flexion of the elbow: Confirms the integrity of the musculocutaneous nerve (C5 and C6 spinal cord segments) Excessive, diminished, or prolonged (hung) responses may indicate: Central or peripheral nervous system disease or metabolic disorders (e.g., thyroid disease)  Biceps tendinitis and tendinosis are inflammation and degeneration of the bicep's long tendon, respectively (LO #6) Usually, the result of repetitive microtrauma (wear and tear) of the tendon of the biceps long head enclosed by a synovial sheath as it moves back and forth in the intertubercular groove of the humerus Common in sports involving throwing (e.g., baseball and cricket) and use of a racquet (e.g., tennis), overuse, or aging Both conditions are commonly accompanied by rotator cuff tears or SLAP (superior labrum anterior to posterior) lesions Both conditions usually cause a deep, throbbing ache in the anterior shoulder Most common clinical finding in biceps tendinitis is bicipital groove point tenderness with the arm in 10 degrees of internal rotation Local anesthetic injections into the bicep's tendon sheath may be therapeutic and diagnostic Ultrasonography is preferred for visualizing the overall tendon Magnetic resonance imaging or computed tomography arthrography is preferred for visualizing the intraarticular tendon and related pathology Conservative management of biceps tendinitis consists of rest, ice, oral analgesics, physical therapy, or corticosteroid injections into the bicep’s tendon sheath Surgery should be considered if conservative measures fail after three months or if there is severe damage to the biceps tendon A rupture of the long head of the biceps (LHB) tendon near its attachment to the supraglenoid tubercle is a common injury, especially as people age (LO #6) Risk factors include: Age, smoking, obesity, corticosteroid use, overuse, and rotator cuff disease Symptoms include: Months of increasing pain around the shoulder, sudden onset of more pain, bruising, swelling, and more prominent biceps that appear further down the arm Rupture is commonly associated with a snap or pop and the detached muscle belly forms a ball near the center of the distal anterior aspect of the arm (Popeye deformity) Most common treatment is conservative (non-surgical) and includes: Avoid heavy lifting and overhead activities to reduce pain and swelling Ice packs and NSAIDs to reduce pain and inflammation Physical therapy to strengthen the surrounding muscles and improve range of motion Most heal in about 6 weeks, but symptoms can last up to 3 months Short head of the biceps tendon provides ~90% of biceps function, losing the LHB doesn't significantly impact arm or biceps function Road Map is a strategic plan outlining the content segments needed to achieve the learning objectives, ensuring the necessary steps are taken in a systematic and organized manner. Introduction Conclusion Muscles of the Arm: Anterior (flexor) compartment: 3 muscles Cubital Fossa Posterior (extensor) compartment: 2 muscles Blood vessels of the arm Nerves of the arm  artie that travel in samedirection Brachial artery provides the main arterial asParents it hascollateral in name supply to the arm and is a continuation of opposite Recurrent the axillary artery (LO #3) Begins at the inferior border of the ____ ____ you mais muscle Gives rise to many unnamed muscular branches and the humeral nutrient artery during its O course through the arm Charentes Main named branches that arise from its medial aspect are: A. Protude brainoiartery (deep artery of the arm) ______ ______ I B. spent ________ and infer arteries: ________ Inr c _____ collateral Collateral arteries help form the periarticular arterial anastomoses of the elbow region Ends in the cubital fossa under cover of the bicipital aponeurosis and divides into: 1. Mda _______ artery thumb 2. otherartery _______ shows anastomoses  The brachial artery has several clinical uses (LO #6) Blood pressure by placing an inflatable cuff just above the cubital fossa and listening to blood flow Pulse on the inside of the arm, which can also be used to feel a baby's pulse Trauma from vascular injuries (e.g., arm fractures): Most commonly injured upper limb artery because it’s close to the skin surface Complications can include brachial artery occlusion, limb claudication, and the potential risk of limb loss Other procedures: May be used for controlling blood loss in trauma patients Dialysis access procedures Endovascular procedures for aneurysms or peripheral arterial disease  Coronary angiography requires arterial access and is typically gained via the radial artery or the femoral artery (LO #6) Blood vessels of your heart are visualized using X-rays: Catheter is advanced, a special “dye” (contrast media) is injected into the blood vessels supplying the heart, and digital images and videos are recorded Uses include the diagnosis of coronary artery disease, congenital heart disease, aneurysms, etc.  There are two sets of arm veins that anastomose with each other (LO #3) Pert V superficial deep Superficial veins are in the subcutaneous tissue: Two main superficial 20 veins are the cephalic and basilic veins Deep veins accompany the arteries Both sets of veins have valves, but they are more numerous in deep veins Mediancubital Road Map is a strategic plan outlining the content segments needed to achieve the learning objectives, ensuring the necessary steps are taken in a systematic and organized manner. Introduction Conclusion Muscles of the Arm: Anterior (flexor) compartment: 3 muscles Cubital Fossa Posterior (extensor) compartment: 2 muscles Blood vessels of the arm Nerves of the arm  There are four main nerves that pass through the arm (LO #4) fiber YEid.am Sc 10 taneasnene 1. _____________ Radial here 2. _____________ median here 3. _____________ here Umar 4. _____________ hand Muscles Median nerve runs distally in the arm on the lateral side of the brachial artery, crosses to the medial side, and contacts the brachialis (LO #4) Lies deep to the bicipital aponeurosis and median cubital vein in the cubital fossa No branches in the axilla or the arm: Supplies articular branches to the elbow joint Lateral root (C6-C7) of the median nerve Later Cod is a terminal branch of which structure? Medial root (C8-T1) of the median nerve is a terminal branch of which structure? media cos  Ulnar nerve passes anterior to the teres major and long head of the triceps, medial to the brachial artery (LO #4) Pierces the medial intermuscular septum with the superior ulnar collateral artery 4 Mm Mos Passes posterior to the medial epicondyle and medial to the olecranon: Referred to in lay terms as the “crazy bone” Superficial, easily palpable, and vulnerable to injury No branches in the arm: Supplies articular branches to the elbow 0 joint The ulnar nerve (C8-T1) is a terminal branch from which structure? What forms the answer to the above question? PAR At axin Radia MUM  The radial nerve enters the arm posterior to the brachial artery, medial to the humerus, and anterior to the long head of the triceps, giving branches to the triceps long and medial heads (LO #4) Supplies all posterior arm and forearm muscles Descends inferolaterally with the profunda brachii artery passing around the humerus in the radial groove: Branch to the lateral triceps head arises within the radial groove Continues inferiorly in the anterior compartment of the arm between the brachialis and brachioradialis muscles at the level of the lateral humeral epicondyle Musculocutaneous nerve begins opposite the inferior border of the pectoralis minor, pierces coracobrachialis, and continues distally between the biceps and brachialis (LO #4) Supplies all three anterior arm muscles Emerges lateral to the biceps as the lateral cutaneous nerve of the forearm: After crossing the anterior aspect of the elbow, it continues to supply the skin of the lateral aspect of the forearm The musculocutaneous nerve (C5-C7) is derived from which structure? LC Which structures form the answer to the above question? What are the origins of the answer to the above question? Road Map is a strategic plan outlining the content segments needed to achieve the learning objectives, ensuring the necessary steps are taken in a systematic and organized manner. Introduction Conclusion Muscles of the Arm: Anterior (flexor) compartment: 3 muscles Cubital Fossa Posterior (extensor) compartment: 2 muscles Blood vessels of the arm Nerves of the arm  Contents of the Cubital Fossa (LO #5) Distal part of the brachial artery and the beginning of its terminal branches, the radial and ulnar arteries: Brachial artery lies between the biceps tendon and the median nerve (Deep) accompanying veins of the arteries Biceps brachii tendon Median nerve Radial nerve, deep between the brachioradialis and the brachialis muscles: Divides into Its superficial and deep branches Superficially, in the subcutaneous tissue overlying the fossa are: The median cubital vein, lying anterior to the brachial artery The medial and lateral antebrachial cutaneous nerves, related to the basilic and cephalic veins  Name the numbered arteries of the elbow anastomoses (LO #5) Sup Uller Coll artery 1. _________________________ inf other call artery 2. _________________________ Radial call artery 3. _________________________ Middle Coll 4. _________________________ artery Radial Recurrent artery 5. _________________________ IRA 6. _________________________ A Unw Rec 7. _________________________ P une Ree 8. _________________________  The cubital fossa is the common site for sampling and transfusion of blood and intravenous injections because of the prominence and accessibility of veins (LO #6) Tourniquet is placed proximal to the cubital fossa to block venous return, causing the veins to engorge Median cubital vein is selected when the most common pattern of superficial veins is present: Lies on the deep fascia, running diagonally from the cephalic vein to the basilic vein, crossing superficial to the bicipital aponeurosis Be aware that the pattern of cubital fossa veins varies greatly: For example, ~20% of people have a median antebrachial vein (median vein of the forearm) that divides into a median basilic vein and a median cephalic vein Tourniquet is removed before infusing fluids or before taking the needle out of the vein following the drawing of blood to avoid excessive bleeding and bruising  Median cubital vein is also a site for the introduction of cardiac catheters to secure blood samples from the great vessels and chambers of the heart (LO #6) Right heart catheterization (RHC) is the gold standard for the invasive assessment of patients with cardiopulmonary hemodynamic disorders: Suspected pulmonary vascular disease, increased left heart filling pressure, or unexplained dyspnea Have you learned the material? 1. High-yield questions target core concepts most relevant to the subject matter, maximizing study efficiency without getting bogged down in the minutia and ensuring a broad understanding of a subject’s most critical aspects. 2. Clinical vignette questions are common clinically relevant topics framed as clinical scenarios that mimic the format and context of medical board exam items, providing an opportunity for clinical problem-solving directly applicable to patient care.  High-Yield Questions What divides the distal two-thirds of the humerus into anterior (flexor) and posterior (extensor) compartments? later medial into moon septa Which nerve supplies the three anterior compartment muscles? Muchretures Which anterior arm muscle is the primary supinator of the forearm? Bicep Which anterior arm muscle is the primary flexor of the forearm? Borkali underbis Which nerve supplies the posterior compartment three-headed extensor muscle? Radial Which head of the triceps acts at the shoulder? longhead Which artery supplies both compartments of the arm? Brachig artery Where is the primary neurovascular bundle located?medial Which structures form the boundaries of the cubital fossa?aspetofe enisTEIY.tn Which muscle tendon descends into the triangle to insert on the radial tuberosity? Bicep Which vein is most commonly found In the subcutaneous tissue of the cubital fossa? Median cubital vein In the clinical skills course, you are taught how to test the peripheral nervous system via deep tendon reflexes. The lead instructor asked you to perform a biceps tendon reflex and asked the following question—based on what you learned in anatomy, which spinal cord levels are being assessed during this clinical procedure? A. C4-C5 B. C5-C6 C. C6-C7 D. C7-C8 E. C8-T1  Several Resources for Clinical Vignette Questions Board Review Series: Gross Anatomy https://brs.lwwhealthlibrary.com/book.aspx?bookid=3238 Gray’s Anatomy Review E-Book https://web.p.ebscohost.com/ehost/detail/detail?vid=0&sid=329becc0-76e3-4280-900a- 9d6f11cab8cc%40redis&bdata=JkF1dGhUeXBlPWlwLHNoaWImc2l0ZT1laG9zdC1saXZl#AN=1167423&db=nlebk The Big Picture: Gross Anatomy, Medical Course & Step 1 Review https://accessmedicine.mhmedical.com/Book.aspx?bookid=2478#202020010 First Aid for the USMLE Step 1 2024 https://mhebooklibrary.com/doi/epdf/10.1036/9781266077395 Netter’s Clinical Anatomy https://mhebooklibrary.com/doi/epdf/10.1036/9781266077395 Netter’s Essential Systems-Based Anatomy https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323694971000035?scrollTo=%23hl0003094 University of Michigan Medical School – Practice Questions https://sites.google.com/a/umich.edu/bluelink/resources/practice-questions Texas Tech Medical Gross Anatomy https://anatomy.elpaso.ttuhsc.edu/quizzes/quiz_index.html Lippincott Illustrated Reviews: Anatomy https://premiumbasicsciences.lwwhealthlibrary.com/content.aspx?sectionid=234869049&bookid=2793  Reading Assignment Gray’s Anatomy for Students, 4th ed., Chapter 6, Arm and Cubital Fossa