UL Anatomy of the Arm and Cubital Fossa PDF

Anatomy of the arm and cubital fossa Ms AA Efuntayo [email protected] OFFICE: 0017 DH Mankweng Hospital  Lecture objectives By the end of this lecture, you should be able to: Describe the anatomy of the arm (brachium) Describe the fascial distributon of the arm Describe the fexor...

Anatomy of the arm and cubital fossa Ms AA Efuntayo [email protected] OFFICE: 0017 DH Mankweng Hospital  Lecture objectives By the end of this lecture, you should be able to: Describe the anatomy of the arm (brachium) Describe the fascial distributon of the arm Describe the fexor and extensor compartments of the arm Describe the neurovasculature of the arm Nerves: Musculocutaneous & radial Vasculature: Brachial artery & vein Clinical anatomy Describe the anatomy of the cubital fossa Describe boundaries and contents of the cubital fossa Superfcial & deep Clinical anatomy  Lecture objectives By the end of this lecture, you should be able to: Describe the anatomy of the arm (brachium) Describe the fascial distributon of the arm Describe the fexor and extensor compartments of the arm Describe the neurovasculature of the arm Nerves: Musculocutaneous & radial Vasculature: Brachial artery & vein Clinical anatomy Describe the anatomy of the cubital fossa Describe boundaries and contents of the cubital fossa Superfcial & deep Clinical anatomy Recap: Bones of the arm  Lecture objectives By the end of this lecture, you should be able to: Describe the anatomy of the arm (brachium) Describe the fascial distributon of the arm Describe the fexor and extensor compartments of the arm Describe the neurovasculature of the arm Nerves: Musculocutaneous & radial Vasculature: Brachial artery & vein Clinical anatomy Describe the anatomy of the cubital fossa Describe boundaries and contents of the cubital fossa Superfcial & deep Clinical anatomy Brachial fascia Sleeve of deep fascia around arm Contnuous with antebrachial fascia of forearm Medial and lateral intermuscular septa Extend from deep surface of brachial fascia to humerus Divide arm into anterior (fexor) and posterior (extensor) compartments Medial septum extends from medial lip of intertubercular sulcus (superiorly) → medial epicondyle Lateral septum extends from lateral lip of intertubercular sulcus (superiorly) → lateral epicondyle  Lecture objectives By the end of this lecture, you should be able to: Describe the anatomy of the arm (brachium) Describe the fascial distributon of the arm Describe the fexor and extensor compartments of the arm Describe the neurovasculature of the arm Nerves: Musculocutaneous & radial Vasculature: Brachial artery & vein Clinical anatomy Describe the anatomy of the cubital fossa Describe boundaries and contents of the cubital fossa Superfcial & deep Overview of Anterior (Flexor) compartment Flexors of the forearm and arm 3 Muscles: Biceps brachii Brachialis Coracobrachialis Blood supply & venous drainage: Brachial artery & vein additonal supply to Brachialis from recurrent radial artery* Innervaton: Musculocutaneous nerve additonal innervaton to Brachialis by the radial nerve* Biceps Brachii 2 heads of origin: Short head Origin: coracoid process Long head Origin: supraglenoid tubercle Inserton Biceps tendon >> Radial tuberosity Bicipital aponeurosis ataches to the deep fascia of forearm Biceps Brachii Innervaton Musculocutaneous nerve Functon Flex forearm at elbow joint Supinate forearm Weak arm fexor Bicipital aponeurosis reinforces wall of cubital fossa* Brachialis Origin Distal half of anterior surface of humerus Inserton Coronoid process of ulna & ulnar tuberosity Innervaton Musculocutaneous and Radial nerve 75% of populaton Functon Flexes forearm at elbow joint Coracobrachialis Origin Tip of coracoid process of scapula Inserton Middle third of shaf of humerus Innervaton Musculocutaneous nerve Functon Flexes arm at glenohumeral joint Adduct the arm  FLASH QUIZ The muscles of the anterior arm are only innervated by the musculocutaneous nerve a. True yellow green b. False  Lecture objectives By the end of this lecture, you should be able to: Describe the anatomy of the arm (brachium) Describe the fascial distributon of the arm Describe the fexor and extensor compartments of the arm Describe the neurovasculature of the arm Nerves: Musculocutaneous & radial Vasculature: Brachial artery & vein Clinical anatomy Describe the anatomy of the cubital fossa Describe boundaries and contents of the cubital fossa Superfcial & deep Overview of Posterior (Extensor) compartment Extensors of the forearm 2 Muscles: Triceps brachii Anconeus Blood supply Profunda brachii Innervaton: Radial nerve Triceps brachii 3 heads of Origin Long head: infraglenoid tubercle of scapula medial Lateral head: posterior shaf of humerus superior to radial groove Medial head: posterior shaf of humerus inferior to radial groove Inserton Common tendon at the olecranon process of ulna  Triceps brachii Functon: Main/ chief extensor of forearm Assist adducton of arm Stabilizes head of abducted humerus in glenohumeral joint (long head) Innervaton: Radial nerve Anconeus (triangular in shape) Origin Lateral epicondyle of humerus Inserton fbers diverge medially to atach on lateral aspect of olecranon process posterosuperior surface of ulna Anconeus (triangular in shape) Functon: Assist triceps in extending the forearm at elbow joint Stabilises elbow joint Innervaton: Radial nerve  Flash quiz Identfy this muscle a) Short head of biceps yellow b) Long head of biceps green  Flash quiz Identfy this muscle a) Short head of biceps yellow b) Long head of biceps green  Flash quiz Identfy this muscle a) Short head of biceps yellow b) Brachialis green c) Medial head of triceps orange d) Lateral head of triceps pink  Flash quiz Identfy this muscle a) Long head of biceps yellow b) Lateral head of Triceps green c) Brachioradialis orange d) Medial head of triceps pink  Lecture objectives By the end of this lecture, you should be able to: Describe the anatomy of the arm (brachium) Describe the fascial distributon of the arm Describe the fexor and extensor compartments of the arm Describe the neurovasculature of the arm Nerves: Musculocutaneous & radial Vasculature: Brachial artery & vein Clinical anatomy Describe the anatomy of the cubital fossa Describe boundaries and contents of the cubital fossa Superfcial & deep Clinical anatomy Nerves of the upper limb Musculocutaneous nerve Radial nerve Median nerve Ulnar nerve Musculocutaneous nerve Terminal branch of the lateral cord of the brachial plexus Pierces the coracobrachialis muscle Supplies all the muscles in the anterior compartment of arm Pierces the deep fascia to become cutaneous (superfcial)* Branches Muscular branches Lateral cutaneous nerve of forearm* Radial nerve Terminal contnuaton of the posterior cord of brachial plexus Lies posterior to the axillary artery Exits the axilla via the triangular interval* Lies in the radial groove accompanied by the profunda brachii artery Supplies triceps and anconeus Radial nerve Enters the cubital fossa by running ant. to lateral epicondyle before giving rise to 2 branches: Deep Motor innervates muscles in the post. compartment of the forearm Superfcial Sensory contributes to the cutaneous innervaton of the dorsal hand and fngers content of cubital fossa* Branches of the radial nerve 3 Branches in the axilla: 1 Cutaneous branch Posterior brachial cutaneous nerve 2 Muscular branches Long and medial heads of triceps Branches of the radial nerve 4 Branches in the spiral groove: 2 Cutaneous branches Lower lateral brachial cutaneous nerve Posterior antebrachial cutaneous nerve 2 Muscular branches Lateral head of the triceps Anconeus Branches of the radial nerve 4 Branches in the arm 1 Artcular branch Elbow joint 3 Muscular branches Brachialis Brachioradialis Extensor carpi radialis longus FLASH QUIZ Identfy the nerve responsible for detectng the noxious stmulus a) Radial nerve yellow b) Superfcial branch of radial nerve green c) Posterior brachial cutaneous nerve orange d) Musculocutaneous nerve pink THINK-PAIR-SHARE The nerve detectng the stmulus originates from the ___ a) Spiral part of radial nerve yellow b) Axillary part of radial nerve green orange c) Brachial part of radial nerve pink d) essure is  Clinical anatomy: Radial nerve Palsy Causes: fracture of midshaf of humerus Incorrect intramuscular injecton Saturday night palsy Results: loss of functon in the extensors of forearm, hand, metacarpals and phalanges loss of wrist extension leading to Wrist Drop producing a weakness of adducton and abducton of hand htps://www.youtube.com/watchwv=ccaFCjkOO5uw FLASH QUIZ Can these actons result in radial nerve palsyw  Lecture objectives By the end of this lecture, you should be able to: Describe the anatomy of the arm (brachium) Describe the fascial distributon of the arm Describe the fexor and extensor compartments of the arm Describe the neurovasculature of the arm Nerves: Musculocutaneous & radial Vasculature: Brachial artery & vein Clinical anatomy Describe the anatomy of the cubital fossa Describe boundaries and contents of the cubital fossa Superfcial & deep Clinical anatomy Brachial artery Origin Direct contnuaton of axillary artery lower border of teres major muscle Terminaton Neck of radius medial to biceps tendon Divides into terminal branches: Radial & Ulnar arteries Branches of the brachial artery Deep artery of arm (profunda brachii) Spiral (radial) groove with radial nerve to triceps Muscular branches Humeral nutrient Superior & inferior ulnar collateral Superior: runs with ulnar nerve Both anastomose around elbow Branches of the brachial artery Radial & middle collateral Originate from the descending branch of deep brachii artery Anastomosis around elbow Radial Ulnar Clinical anatomy: Brachial artery pulsation Auscultaton for manually recording blood pressure is carried out in front of elbow from the brachial artery FLASH QUIZ What is an obvious complicaton with a humeral fracture of this naturew  Veins of the arm 2 Deep veins: Brachial veins (paired) Accompany brachial artery Receives tributaries that accompany the branches of the brachial artery 2 large superfcial veins: Basilic vein lies distal half of the arm penetrates deep fascia to lie medial to the brachial artery Becomes axillary vein at lower border of teres major paired brachial veins >>> join the basilic (or axillary) vein Cephalic vein Veins of the arm Cephalic vein passes superiorly on the anterolateral aspect Passes through the anterior wall of the axilla to reach the axillary vein  Lecture objectives By the end of this lecture, you should be able to: Describe the anatomy of the arm (brachium) Describe the fascial distributon of the arm Describe the fexor and extensor compartments of the arm Describe the neurovasculature of the arm Nerves: Musculocutaneous & radial Vasculature: Brachial artery & vein Clinical anatomy Describe the anatomy of the cubital fossa Describe boundaries and contents of the cubital fossa Superfcial & deep Clinical anatomy  Cubital fossa Triangular with apex pointng distally Gateway/transiton point between the arm and forearm  Lecture objectives By the end of this lecture, you should be able to: Describe the anatomy of the arm (brachium) Describe the fascial distributon of the arm Describe the fexor and extensor compartments of the arm Describe the neurovasculature of the arm Nerves: Musculocutaneous & radial Vasculature: Brachial artery & vein Clinical anatomy Describe the anatomy of the cubital fossa Describe boundaries and contents of the cubital fossa Superfcial & deep Clinical anatomy Boundaries Medial: lateral boarder of Pronator teres* Lateral: medial boarder of Brachioradialis* Base: Imaginary line between medial & lateral epicondyles of humerus Floor: Brachialis & Supinator* Roof: Skin, superfcial & deep fasciae Reinforced by bicipital aponeurosis  Contents Superfcial & deep  Lecture objectives By the end of this lecture, you should be able to: Describe the anatomy of the arm (brachium) Describe the fascial distributon of the arm Describe the fexor and extensor compartments of the arm Describe the neurovasculature of the arm Nerves: Musculocutaneous & radial Vasculature: Brachial artery & vein Clinical anatomy Describe the anatomy of the cubital fossa Describe boundaries and contents of the cubital fossa Superfcial & deep Clinical anatomy Superfcial contents Located in roof Median cubital vein join cephalic and basilic veins Upper lateral cutaneous nerve of forearm Medial cutaneous nerve of forearm Clinical anatomy: Median cubital vein Vein of choice for venepuncture & intravenous injectons  Lecture objectives By the end of this lecture, you should be able to: Describe the anatomy of the arm (brachium) Describe the fascial distributon of the arm Describe the fexor and extensor compartments of the arm Describe the neurovasculature of the arm Nerves: Musculocutaneous & radial Vasculature: Brachial artery & vein Clinical anatomy Describe the anatomy of the cubital fossa Describe boundaries and contents of the cubital fossa Superfcial >> bicipital aponeurosis >> deep Clinical anatomy  Bicipital aponeurosis Broad aponeurosis of the biceps brachii located in the cubital fossa Separates superfcial from deep structures in the fossa Origin Distal inserton of the biceps brachii and runs across the brachial artery Inserton Antebrachial fascia of the forearm Functon Protects the brachial artery and the median nerve running deep to it  THINK-PAIR-SHARE The bicipital aponeurosis is clinically signifcant… WHYw What clinical procedure would require the protecton of the brachial artery & median nervew Deep contents Located in fossa (M>>L) Median nerve Brachial artery Biceps brachii tendon Radial nerve deep to brachioradialis Superfcial branch THINK-PAIR-SHARE All muscles of the anterior component of the arm are innervated by the musculocutaneous nerve with the brachialis also receiving innervaton from the radial nerve… Which trunks & divisions of the brachial plexus innervate fexor muscles END