ANATOMY OF THE ARM AGBAJE ADEDOYIN MOJEED

COMPARTMENTS OF THE ARM

The arm is divided into anterior and
posterior compartments by extension of
deep fascia which are called the medial
and lateral intermuscular septa.
– These septa provide additional surface for
the attachment of muscles.
– They also form planes along which nerves
and blood vessels
travel.
• The septa are well defined only in the I
lower half of the arm and are attached
to the medial and lateral borders and
supracondylar ridges of the humerus.
• The medial septum is pierced by the ulnar
nerve and the superior ulnar collateral
artery;the lateral septum is pierced by
the radial nerve and the anterior
descendingbranch of the profunda
brachii artery.
 COMPARTMENTS OF THE ARM
• Two additional septa are present in the anterior
compartment of the arm.
• The transverse septum separates the biceps from
the brachialis and encloses the musculocutaneous
nerve.
• The anteroposterior septum separates the brachialis
from the muscles attached to the lateral
supracondylar ridge; it encloses the radial nerves
and the anterior descending branch of the
profunda brachii artery.
 THE ANTERIOR COMPARTMENT
• There are three muscles located in the anterior compartment of the
upper arm.
• A good memory aid for this is BBC –
– Biceps ,
– Brachialis ,
– Coracobrachialis .
• Arterial supply to the anterior compartment of the upper arm is
via muscular branches of the Brachial artery.
• They are all innervated by the Musculocutaneous
nerve.
 THE POSTERIOR COMPARTMENT
• The posterior compartment of the upper arm contains the

triceps brachii muscle, which has three heads. The medial

head lies deeper than the other two, which cover it.

• Arterial supply to the posterior compartment of the upper

arm is via the profunda brachii artery.

 BICEPS BRACHII
Origin
Short head: tip of coracoid process of scapula;
Long head: supraglenoid tubercle of scapula,
passes through the shoulder joint and emerges from
the joint through the intertubercular groove.
Insertion Tuberosity of radius and fascia of
forearm via bicipital aponeurosis
Action
Supinates forearm and, when it is supine, flexes
forearm
Weak flexion of arm
Innervation Musculocutaneous nerve (C5, C6)
 CLINICAL RELEVANCE
• Biceps reflex: It is tested during physical examination by
tapping the tendon of biceps brachii by reflex hammer with
forearm pronated and partially extended at elbow. The normal
reflex is brief jerk-like flexion of the elbow. The normal reflex
confirms the integrity of musculocutaneous nerve and C5 and
C6 spinal segments.
THE BICIPITAL APONEUROSIS
• It is a broad aponeurosis of the biceps
brachii located in the cubital fossa .
• It separates superficial from deep
structures in the fossa.
• It originates from the distal insertion of the
biceps brachii and runs across the brachial
artery.
• It is inserted into the antebrachial fascia
of the forearm.
• It helps to protect the brachial artery and
the median nerve running underneath(
during venipuncture ) from the median
cubital vein.
Brachialis
Origin Distal half of anterior surface of
humerus

Insertion Coronoid process and

tuberosity of ulna

Action Major flexor of forearm -

flexes forearm in all positions

Innervation Musculocutaneous nerve (C5,

C6)

Arterial Supply Muscular branches of

brachial artery, recurrent radial artery
 CORACOBRACHIALIS
Origin
Tip of coracoid process of scapula
Insertion Middle third of medial surface of humerus
Action Helps to flex and adduct arm
Innervation Musculocutaneous nerve (C5, C6, C7)
Arterial Supply
•
Muscular branches of brachial artery
Note: Pierced by musculocutaneous nerve.
Ligament of• Struthers
It is a fibrous band which connects medial epicondyle
of humerus and supratrochlear spur (an occasional
downward projection from anterior surface of lower
part of humerus). This represents the remains of the
third head of coracobrachialis.
 ANATOMICAL EVENTS AT THE INSERTION OF
CORACOBRACHIALIS

1. Circular shaft of the humerus becomes triangular below this level.

2. Brachial artery passes from medial side of arm to its anterior
aspect.
3. Basilic vein pierces the deep fascia.
4. Median nerve crosses in front of the brachial artery from
the lateral to medial side.
5. Radial nerve pierces lateral intermuscular septum to pass from the posterior
compartment to the anterior compartment.
6. Ulnar nerve pierces medial intermuscular septum to go into the posterior
compartment.
7. Medial cutaneous nerve of the arm and forearm pierces the deep fascia.
8. Nutrient artery pierces the humerus.
 MUSCULOCUTANEOUS NERVE(C,5&6)
It arises from lateral cord of brachial
plexus
It pierces the coracobrachialis and
supplies
Biceps brachii Brachialis Coracobrachialis
It continues as lateral cutaneous nerve of
forearm.
 BRANCHES
• Muscular branches to the biceps,
coracobrachialis, and brachialis

• Cutaneous branches; the lateral cutaneous nerve of

the forearm supplies the skin of the front and
lateral aspects of the forearm down as far as the
root of the thumb.

• Articular branches to the elbow joint

 Begins at the lower margin of the tendon
of the Teres major as continuation of
BRACHIAL ARTERY Axillary.

It terminates just below the elbow by

dividing into the radial and ulnar
arteries.
Branches Profunda Brachii.

Superior Ulnar Collateral.

Nutrient artery of Humerus

Inferior Ulnar Collateral. Muscular.
TRICEPS BRACHII
Origin
Long head: infraglenoid tubercle of
scapula;
Lateral head: posterior surface of
humerus, superior to radial groove;
Medial head: posterior surface of
humerus, inferior to radial groove
Insertion
Proximal end of olecranon process of
ulna and fascia of forearm
Action
Chief extensor of forearm; long head
steadies head of abducted humerus
Innervation Radial nerve (C6, C7, C8)
Arterial Supply
Branches of deep brachial artery
Radial nerve
IN THE•
POSTERIOR COMPARTMENT
WINDS IN THE SPIRAL GROOVE OF THE
HUMERUS WITH THE PROFUNDA BRACHII
VESSELS.
Just above the elbow, it pierces the lateral
intermuscular septum and continues downward
into the cubital fossa
At the level of the elbow (lateral epicondyle), it
divides into superficial and deep branches.
Superficial branch , a sensory nerve of the hand
is a content of cubital fossa.
The deep branch of the radial nerve enters the
posterior compartment of the forearm.
 BRANCHES
• In the axilla, branches are given to the long
and medial heads of the triceps.

• In the spiral groove, branches are given to the

lateral and medial heads of the triceps.
Branches of radial
nerve Branches in the axilla
–Cutaneous branch - Posterior brachial cutaneous
nerve
–Muscular branches - Long and medial heads of
triceps
Branches in the spiral groove
–Cutaneous branches - Lower lateral brachial
cutaneous nerve, posterior antebrachial cutaneous
nerve
–Muscular branches - Lateral and medial heads of
the triceps, anconeus
•
Branches in the arm
–Articular branch - Elbow joint

–Muscular branches - Brachialis, brachioradialis,

extensor carpi radialis longus
 RADIAL NERVE PALSY
➢Causes:
• fracture of midshaft of humerus Intramuscular
• injection
• Saturday night palsy
• Crutch paralysis
• Fractures of shaft of humerus
➢Results in a loss of function in the extensors of
forearm, hand, metacarpals and phalanges.
➢Results in loss of wrist extension leading to
Wrist Drop and producing a weakness of
adduction and abduction of hand.
 ANCONEUS

•Anconeus connects the medial

aspect of the ulna to the lateral
aspect of the humerus and is a
short triangular elbow muscle.

•It is occasionally classified as a

branch of the triceps brachii muscle,
due to its location and functionality.
 ANCONEUS
• ORIGIN
– It arises from the lateral epicondyle of the
humerus and has a wide attachment within
the posterolateral surface of the olecranon
as well as associated posterior surface of
the ulna, by its own different tendon.
• Insertion
– Inserts at the olecranon of the ulna.
• Functions
– Mainly to allow a person to extend his
elbow and rotate the forearm. This action
is used to carry something, as a food
server would.
CUBITAL FOSSA
The cubital (anticubital) fossa is
a triangular-shaped depression over the
anterior aspect of the elbow joint.
It represents an area of transition
between the anatomical arm and
the forearm, and conveys several
important structures between these two
areas.
THE CUBITAL FOSSA Boundaries
The cubital fossa is triangular in shape and consists of
three borders, •a roof, and a floor:
•Lateral border• – medial border of the brachioradialis
muscle.
•Medial border• – lateral border of the pronator teres
muscle.
•Superior border – horizontal line drawn between the
epicondyles of •the humerus.
•Roof – bicipital aponeurosis, fascia, subcutaneous fat
and skin.
•Floor – brachialis (proximally) and supinator
(distally).
Arrangement of nerve in the
cubital fossa
 STRUCTURES IN ROOF
OF CUBITAL FOSSA
• • Skin
• Superficial fascia
• Deep fascia with bicipital
aponeurosis
• Cephalic vein Basilic vein
•
Median cubital vein connecting the
• cephalic and basilic veins
Lateral and medial cutaneous
• nerves of forearm
CONTENTS OF CUBITAL FOSSA
• Median nerve
• Brachial artery dividing into radial
and ulnar arteries
• Tendon of biceps brachii
• Radial nerve and its two terminal
branches (superficial and deep)
• Applied Aspect
• The median cubital vein is often
the vein of choice for intravenous
injections.
 CLINICAL RELEVANCE: SUPRACONDYLAR
FRACTURE
• A supracondylar fracture is a fracture of the distal humerus. The fracture is
typically transverse or oblique, and the most common mechanism of injury is
falling on an outstretched hand. It is more common in children than adults.
• In this type of injury, the contents of the cubital fossa can be damaged – either
directly, or by soft tissue swelling following the trauma.
• Damage to the brachial artery, if not repaired, can cause Volkmann’s
ischaemic contracture (uncontrolled flexion of the hand) as the forearm flexor
muscles become fibrotic and short.
• There also can be damage to the anterior interosseous nerve (branch of the
median nerve), ulnar nerve or radial nerve.