Cubital Fossa Anatomy PDF

Anatomy of Upper Limb Supracondylar Fracture (Cubital Fossa) By Dr. Hassan Mohammed Rizk (Ph.D.) Associate Professor of Human Anatomy and Embryology  Case Study UPPER LIMB Supracondylar Fracture Volkmann’s Ischemic...

Anatomy of Upper Limb Supracondylar Fracture (Cubital Fossa) By Dr. Hassan Mohammed Rizk (Ph.D.) Associate Professor of Human Anatomy and Embryology  Case Study UPPER LIMB Supracondylar Fracture Volkmann’s Ischemic Contracture Cubital Fossa By Dr. Hassan Rezk August 29, 2024 2  Three Important Regions in Upper Limb UPPER LIMB Cubital Fossa By Dr. Hassan Rezk August 29, 2024 3  Objectives: by the end of this lecture the student must understand the following knowledge: ▪ Identify and demonstrate the Cubital Fossa regarding: UPPER LIMB 1) Definition. 2) Apex. 3) Base. 4) Borders. 5) Floor. 6) Roof. 7) Contents Cubital Fossa By Dr. Hassan Rezk August 29, 2024 4  Objective # ( 1 ) Definition of Cubital Fossa UPPER LIMB Cubitus (Elbow). Cubital fossa is an important area of transition between the arm and the forearm. It is located anterior to the elbow joint. Triangular depression formed between two compartments of forearm muscles. Cubital Fossa By Dr. Hassan Rezk August 29, 2024 5  Objective # ( 2 ) Roof of Cubital Fossa ❑ The following structures lie superficial to the cubital fossa UPPER LIMB in the following sequence: 1. Skin. 2. Superficial Fascia, which contains: a) Cephalic vein. Superficial Skin fascia b) Basilic vein. c) Median cubital vein. d) Lateral cutaneous nerve of forearm. e) Medial cutaneous nerve of forearm. Bicipital aponeurosis 3. Deep Fascia 4. Bicipital aponeurosis. Cubital Fossa By Dr. Hassan Rezk August 29, 2024 6  Apex, Base & Floor of Cubital Objective # ( 3 ) Fossa ❑ The apex of the cubital fossa: UPPER LIMB ▪ Is directed downwards. ▪ Is the formed by overlapping of the two borders. ❑ The base of the cubital fossa: ▪ Is directed upwards. ▪ Is an imaginary horizontal line between the medial and lateral epicondyles. ❑ The floor of the cubital fossa: ▪ Is formed mainly by the brachialis muscle. Cubital Fossa By Dr. Hassan Rezk August 29, 2024 7  Objective # ( 4 ) Borders of Cubital Fossa UPPER LIMB ❑ Lateral border of cubital fossa: is formed by the medial border of the brachioradialis muscle (1st muscle in the extensor compartment of forearm). ❑ Medial border of cubital fossa: is formed by the lateral border of the pronator teres muscle (1st muscle in the flexor compartment of forearm). Cubital Fossa By Dr. Hassan Rezk August 29, 2024 8  Objective # ( 5 ) Contents of Cubital Fossa Lateral to medial Really Need Book To Be At My Nicest ❑ The contents of the cubital fossa, from medial to UPPER LIMB Humerus lateral, are: 1) Median Nerve (most medial) Lateral to medial Medial to lateral 2) Brachial Artery. 3) Biceps brachii Tendon. 4) Radial Nerve (most lateral) Ulnar nerve is not a content of cubital fossa Cubital Fossa By Dr. Hassan Rezk August 29, 2024 9  Objective # ( 6 ) Arrangement of the Contents in Cubital Fossa ▪ Median nerve (which is the most medial content): ✓ Lies immediately medial to the brachial artery. ✓ Leaves the fossa between the two heads of pronator teres. ▪ Brachial artery: UPPER LIMB ✓ Lies medial to the tendon of biceps brachii. ✓ It divides into two terminal branches: ulnar artery & radial artery. ▪ Brachial artery and the median nerve: are covered and protected anteriorly by the bicipital aponeurosis. ▪ Bicipital aponeurosis passes between medial side of tendon of the biceps brachii muscle and deep fascia of the forearm. ▪ Radial nerve (which is the most lateral content): : ✓ Lies just under the lip of the brachioradialis muscle, which forms the lateral margin of the fossa. ✓ In this position, the radial nerve divides into superficial and deep branches. ▪ Ulnar nerve: ✓ Does not pass through the cubital fossa. ✓ Instead, it passes posterior to the medial epicondyle. ▪ Median cubital vein (vein of injection): ✓ Passes obliquely across the roof. ✓ Superficial to bicipital aponeurosis. ✓ Connects the cephalic vein on the lateral side of the upper limb with the basilic vein on the medial side. Cubital Fossa By Dr. Hassan Rezk August 29, 2024 10  Humerus UPPER LIMB Cubital Fossa By Dr. Hassan Rezk August 29, 2024 11 UPPER LIMB Anterior view of the right cubital fossa Showed the anatomical position of ulnar, median & radial nerves in cubital fossa Cubital Fossa By Dr. Hassan Rezk August 29, 2024 12 UPPER LIMB Cubital Fossa By Dr. Hassan Rezk August 29, 2024 13 UPPER LIMB Cubital Fossa By Dr. Hassan Rezk August 29, 2024 14  Supracondylar fracture of the Clinical Correlation humerus Transverse fracture of the distal end of the humerus, above the level of the UPPER LIMB epicondyles. The distal fragment and its soft tissues are pulled posteriorly by the triceps muscle. This posterior displacement effectively “bowstrings” the brachial artery over the irregular proximal fracture fragment. The muscles of the anterior compartment of the forearm are rendered ischemic and form severe contractions, significantly reducing the function of the anterior compartment and flexor muscles (Volkmann’s ischemic contracture). Cubital Fossa By Dr. Hassan Rezk August 29, 2024 15 UPPER LIMB Cubital Fossa By Dr. Hassan Rezk August 29, 2024 16  Brachial Artery Pulsations & Clinical Correlation Measurement Blood Pressure ▪ Brachial artery lies medial to the UPPER LIMB tendon of the biceps brachii muscle. ▪ This is the position where a stethoscope is placed to hear the pulse of the vessel when taking a blood pressure reading. Cubital Fossa By Dr. Hassan Rezk August 29, 2024 17  Clinical Correlation Median Cubital Vein Injection UPPER LIMB ▪ Median cubital veins runs superficial to bicipital aponeurosis with the following benefits: 1) Protects the underlying brachial artery and median nerve. 2) Support the median cubital vein during injection. Cubital Fossa By Dr. Hassan Rezk August 29, 2024 18  Case Scenario A 6-year-old girl is brought to the emergency department because of right elbow UPPER LIMB swelling and pain 30 minutes after falling onto her outstretched right arm. She has been unable to move her right elbow since the fall. Physical examination shows bruising, swelling, and tenderness of the right elbow; range of motion is limited by pain. An x-ray of the right arm shows a supracondylar fracture of the humerus with anterior displacement of the proximal fragment. Further evaluation is most likely to show which of the following findings? A. Absent distal radial pulse B. Radial deviation of the wrist C. Atrophy of the thenar eminence D. Inability to abduct shoulder E. Absent pulse of the proximal brachial artery F. Inability to flex the elbow Cubital Fossa By Dr. Hassan Rezk August 29, 2024 19  Reference UPPER LIMB Gray's anatomy for students, 3rd edition. ISBN: 978-0-7020-5131-9 Copyright© 2015, 2010, 2005 by Churchill Livingstone, an imprint of Elsevier Inc. Chapter 1, pages 18 - 24 Cubital Fossa By Dr. Hassan Rezk August 29, 2024 20 UPPER LIMB Cubital Fossa By Dr. Hassan Rezk August 29, 2024 21