ARM and CUBITAL FOSSA

By: Neil Dolendo Marian Dale Escalona Ma. Andrea Indadao Monnel Loise Ordinario

Arm
 is the part of the upper limb between the shoulder and the elbow joints.  It is adapted for precise positioning of the hand and thus assist in the hand's manipulative tasks.

Brachial Fascia
o Deep fascia of the arm

o It is a sleeve of connective tissue that continuous at proximal end with the pectoral fascia, the axillary fascia and the deep fascia that covers the deltoid and latissimus dorsi muscles.

o It is connected to the medial and lateral sides of the humerus by the intermuscular septa, creating an anterior compartment and a posterior compartment for the muscles of the arm.

Brachial Fascia

Brachial Fascia

Anterior (flexor) Compartment of Arm

Muscles: Biceps Brachii, coracobrachialis, and brachialis.

Anterior (flexor) Compartment of Arm

Blood Supply: Brachial artery

Anterior (flexor) Compartment of Arm

Nerve Supply of the Muscles: Musculocutaneous nerve

Musculocutaneous Nerve

Musculocutaneous Nerve

Anterior (flexor) Compartment of Arm

Structures passing through the compartments: Musculocutaneous, median and ulnar nerves; brachial artery and basilic vein.

Musculocutaneous Nerve

Basilic Vein

Brachial Artery Median Nerve Ulnar Nerve

Anterior (flexor) Compartment of Arm

Muscles of the Anterior Compartment Biceps Brachii

 a two-headed muscle located on the upper arm.  Both of its heads arise on the scapula and join to form a single muscle belly which is attached to the upper forearm.  While the biceps crosses both the shoulder and elbow joints, its main function is at the latter where it flexes the elbow and supinates the forearm.  Both these movements are used when opening a bottle with a corkscrew: first biceps unscrews the cork (supination), then it pulls the cork out (flexion).

Muscles of the Anterior Compartment Biceps Brachii

Origin: long head: supraglenoid tubercle short head: coracoid process (apex)

long head: supraglenoid tubercle short head: coracoid process (apex)

Muscles of the Anterior Compartment Biceps Brachii

Insertion: radial tuberosity

Radial Tuberosity

Muscles of the Anterior Compartment Biceps Brachii

Innervation: musculocutaneous nerve

Muscles of the Anterior Compartment Biceps Brachii

Function: powerful flexor of forearm accessory flexor of arm supinator of forearm

Muscles of the Anterior Compartment Biceps Brachii

Short head Lond head

Muscles of the Anterior Compartment Coracobrachialis

Origin: coracoid process (apex)

Origin

Muscles of the Anterior Compartment Coracobrachialis

Insertion: mid-shaft of humerus (medial side)

Insertion

mid-shaft of humerus (medial side)

Muscles of the Anterior Compartment Coracobrachialis

Innervation: musculocutaneous nerve

Muscles of the Anterior Compartment Coracobrachialis

Function: helps flex and adduct arm stabilize glenohumeral joint

Muscles of the Anterior Compartment Coracobrachialis

Muscles of the Anterior Compartment Brachialis

 The brachialis (brachialis anticus) is a muscle in the upper arm that flexes the elbow joint.  It lies deeper than the biceps brachii, and is a synergist that assists the biceps brachii in flexing at the elbow. It makes up part of the floor of the region known as the cubital fossa.

Muscles of the Anterior Compartment Brachialis

Origin: distal half of humerus (anterior)

distal half of humerus (anterior)

Muscles of the Anterior Compartment Brachialis

Insertion: tuberosity of ulna

tuberosity of ulna

Muscles of the Anterior Compartment Brachialis

Innervation: musculocutaneous nerve

Muscles of the Anterior Compartment Brachialis

Function: pure flexor of forearm, in all directions

Muscles of the Anterior Compartment Brachialis

Muscles of the Anterior Compartment

Structures Passing through the Anterior Compartment Brachial Artery

o It begins at the lower border of the teres major muscle as a continuation of the axillary artery. o It provides the arterial supply of the arm.

o It terminates opposite neck of the radius by dividng into the radial and ulnar arteries.

Structures Passing through the Anterior Compartment

Structures Passing through the Anterior Compartment

Brachial Artery

Structures Passing through the Anterior Compartment Brachial Artery

Branches:
 Muscular branches to the anterior compartment of the upper arm.  Nutrient Artery to the humerus.  Profunda Artery arises near the beginning of the brachial artery and follows the radial nerve into the spiral nerve of the humerus.  Superior Ulnar Collateral Artery arises near the middle of the middle arm and follows the ulnar nerve.  Inferior Ulnar Collateral Artery arises near the termination of the artery and takes part in the anastomosis around the elbow joint.

Structures Passing through the Anterior Compartment

or Profunda Artery

Structures Passing through the Anterior Compartment Musculocutaneous Nerve

 From C5, C6, C7, is the main supplier of muscles of the anterior compartment. It originates from the lateral cord of the brachial plexus of nerves.  It arises from the lateral cord of the brachial plexus.  It runs downward and laterally, pierces the coracobrachialis muscle and then passes downward between biceps and brachialis muscles.

 Supplies the coracobrachialis muscle.  It appears at the lateral margin of the biceps tendon and pierces the deep fascia just above the elbow.  It runs down the lateral aspect of the forearm as the lateral cuteneous nerve of the forearm.

Structures Passing through the Anterior Compartment

Structures Passing through the Anterior Compartment

Musculocutaneous Nerve

Structures Passing through the Anterior Compartment Musculocutaneous Nerve

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.

Structures Passing through the Anterior Compartment Median Nerve

 Nerve origin C5-T1, which is a branch of the lateral and medial cords of the brachial plexus.  It runs downward on the lateral side of the brachial artery Halfway down the upper arm, it brachial artery and continuous downward on its medial side.

 It has no branches in the upper arm, except for a small vasomotor nerve to the brachial artery.

Structures Passing through the Anterior Compartment

Structures Passing through the Anterior Compartment

Median Nerve

Structures Passing through the Anterior Compartment Ulnar Nerve

 Its origin C8-T1, is a continuation of the medial cord of the brachial plexus.  It runs downward on the medial side of the brachial artery as far as the middle of the arm.  At the insertion of the coracobrachialis, the nerve pierces the medial fascial septum, accompanied by the superior ulnar collateral artery and enters posterior compartment of the arm.

 It has no branches in the anterior compartment of the upper arm.

Structures Passing through the Anterior Compartment

Structures Passing through the Anterior Compartment

Ulnar Nerve

Structures Passing through the Anterior Compartment Radial Nerve

 The radial nerve is a nerve in the human body that supplies the upper limb.  It supplies the medial and lateral head triceps brachii muscle of the arm, as well as all 12 muscles in the posterior osteofascial compartment of the forearm, as well as the associated joints and overlying skin.  It originates from the posterior cord of the brachial plexus with roots from C5, C6, C7, C8 & T1.  It supplies the dorsal muscles, such as triceps brachii, the extrinsic extensors of the wrist and hands, and the cutaneous nerve supply to most of the back of the hand.

Structures Passing through the Anterior Compartment

Structures Passing through the Anterior Compartment

Radial Nerve

Posterior (Extensor) Compartment of Arm

Posterior Compartment of Arm

Muscles: the three heads of the triceps muscle.

Lateral Head of Triceps Long Head of Triceps Median Head of Triceps

Posterior Compartment of Arm

Blood Supply: Profunda brachii and ulnar collateral arteries. Profunda brachii artery

Anterior ulnar collateral artery Posterior ulnar collateral artery

Posterior Compartment of Arm

Nerve Supply of the Muscles: Radial nerve

Posterior Compartment of Arm

Structures passing through the compartments: Radial nerve and ulnar nerve.

Muscles of the Posterior Compartment Triceps

Origin: long head: infraglenoid tubercle lateral head: humerus (posterior, superior to radial groove) medial head: humerus (posterior)

Muscles of the Posterior Compartment Triceps

Insertion: Olecranon

Muscles of the Posterior Compartment Triceps

Innervation: radial nerve

Radial nerve

Muscles of the Posterior Compartment Triceps

Function: extensor of forearm long head: extend and adduct arm, shunt muscle

Muscles of the Posterior Compartment Triceps

Structures Passing through the Posterior Compartment Radial Nerve

 Its origin is from the posterior cord of the brachial plexus in the axilla.  The nerve winds around the back of the arm, first between the long and medial heads of the triceps, then the spiral groove on the back of the humerus, between the lateral and medial heads of the triceps.  It pierces the lateral fascial septum above the elbow and continuous downward into the cubital fossa in front of the elbow, between the brachialis and brachioradialis muscles.  In the spiral groove, the nerve is accompanied by the profunda vessels, and lies directly in the contact with the shaft of the humerus.

Structures Passing through the Posterior Compartment

Radial Nerve

Structures Passing through the Posterior Compartment Radial Nerve

Branches:
 In the axilla: Branches are given to the long and medial heads of the triceps, and the posterior cutaneous nerve of the arm is given off.  In the spiral groove: Branches are given to the lateral and medial heads of the triceps and to the anconeus.  The lower lateral nerve of the arm supplies the skin over the lateral and the anterior aspects of the lower parts of the arm.  The posterior cutaneous nerve of the forearm runs down the middle of the back of the forearm as far as the wrist.  In the anterior compartment of the arm: After the nerve has piearced the lateral fascial septum, it gives branches to the brachialis, brachioradialis, and the extensor carpi radialis longus muscle. It also gives articular branches.

Structures Passing through the Posterior Compartment Ulnar Nerve

 Having pierced the medial fascial septum halfway down the upper arm, the ulnar nerve descends behind the septum, covered posteriorly by the medial head of the triceps.  The nerve is accompanied by the superior ulnar collateral vessels.  At the elbow, it lies behind the medial epicondyle of the humerus on the medial ligamentof the elbow joint.  It continuous downward to enter the forearm between the two heads of the origin of the flexor carpi ulnaris.

 It has an articular branch to the elbow joint.

Structures Passing through the Posterior Compartment

Ulnar Nerve

Structures Passing through the Posterior Compartment Profunda Brachii Artery

 Arises from the brachial artery near its origin.

 It accompanies the radial nerve through the spiral groove.

 Supplies the triceps muscle.

 Takes part in the anastomosis around the elbow joint.

Structures Passing through the Posterior Compartment

Profunda Brachii Artery

Structures Passing through the Posterior Compartment Superior and Inferior Ulnar Collateral Arteries
 Arise from the brachial artery.

Takes part in the anastomosis around the elbow joint

Structures Passing through the Posterior Compartment

Superior Collateral Artery

Inferior Collateral Artery

Cubital Fossa
 Is a depression in the anterior part of the elbow.  Clinically important because it contains superficial veins that are used foe venipuncture.  Large nerves and vessels pass through this region to enter the forearm.

Bounderies of the Cubital Fossa

Lateral boundary- brachioradialis

Bounderies of the Cubital Fossa

Medial boundary- pronator tere muscle

Bounderies of the Cubital Fossa

Superior boundary- an imaginary line connecting the medial and lateral epicondyles of the humerus.

Lateral Epicodyle

Medial Epicodyle

Bounderies of the Cubital Fossa

Superficial boundary (roof of the cubital fossa) - antebrachial fascia reinforced by the bicipital aponeurosis.

Bounderies of the Cubital Fossa

Deep boundary (floor of the cubital fossa) brachialis and supinator muscles.

Contents
The cubital fossa contains four main vertical structures (from lateral to medial):

 The radial nerve is in the vicinity of the cubital fossa, located between brachioradialis and brachialis muscles. It is often but not always considered part of the cubital fossa.

Radial nerve

Contents
 The biceps brachii tendon

Contents
 The brachial artery. The artery usually bifurcates near the apex (inferior part) of the cubital fossa into the radial artery (superficial) and ulnar artery (deeper).

Brachial artery

Contents
 The median nerve

Median nerve

Skeleton of the Arm and Cubital Region Humerus

 It is the bone of the arm that joins with the scapula above in the shoulder at the glenohumeral joint and with the ulna and radius below at the elbow.  The elbow joint is the hinge joint between the distal end of the humerus and the proximal ends of the radius and ulna.

It cannot be broken easily. Its strength allows it to handle loading up to 300 pounds (140 kg.).

Skeleton of the Arm and Cubital Region Humerus

 Medial Epicondyle - Is larger and more prominent than the lateral epicondyle, is directed a little backward.

Medial Epicondyle

Skeleton of the Arm and Cubital Region Humerus

 Lateral Epicondyle  is a small, tuberculated eminence, curved a little forward, and giving attachment to the radial collateral ligament of the elbow-joint, and to a tendon common to the origin of the Supinator and some of the Extensor muscles.

Lateral Epicondyle

Skeleton of the Arm and Cubital Region Humerus

 Olecranon Fossa - Above the back part of the trochlea of the humerus is a deep triangular depression, the olecranon fossa, in which the summit of the olecranon is received in extension of the forearm.

Olecranon Fossa

Skeleton of the Arm and Cubital Region

Radius
 is the bone of the forearm that extends from the lateral side of the elbow to the thumb side of the wrist. The radius is situated on the lateral side of the ulna, which exceeds it in length and size. It is a long bone, prism-shaped and slightly curved longitudinally. Head

Skeleton of the Arm and Cubital Region

Radius
Neck

Skeleton of the Arm and Cubital Region

Radius

Radial Tuberosity

Skeleton of the Arm and Cubital Region Ulna Olecranon Olecranon

- the inner and longer of the two bones of the human forearm which is fused to the radius

Olecranon