SGD5:ArmandCubitalFossa

1.Describetheskin,superficialfascia,anddeepfasciaoftheupperlimb.

SuperficialSensoryNerves
(discussedfurtherlater)
a)Supraclavicularnerves(C3C4)
b)Upperlateralcutaneousnerveofthearm
Branchoftheaxillarynerve(C5C6)
c)Lowerlateralcutaneousnerveofthearm
d)medialcutaneousnerveofthearm(T1)andtheintercostobrachialnerves(T2)
e)posteriorcutaneousnerveofthearm

SuperficialVeins
(discussedfurtherlater)
Theveinsoftheupperlimbcanbedividedintotwogroups:superficialanddeep.

Thedeepveinscomprisethevenaecomitantes,whichaccompanyallthelargearteries,
usuallyinpairs,andtheaxillaryvein.

Ex:Cephalicvein,basilicvein

Halfwayupthearm,itpiercesthedeepfasciaandatthelowerborderoftheteresmajor
joinsthevenaecomitantesofthebrachialarterytoformtheaxillaryvein.

NerveSupplyoftheVeins
Smoothmuscleinthewalloftheveins
Innervation:sympatheticpostganglionicnervefibers(providevasomotortone)

SuperficialLymphNodes
Drain:superficialtissuesoftheupperarmpassupwardtotheaxilla

Lateralside:followthecephalicveintotheinfraclaviculargroupofnodes
Medialside:followthebasilicveintothelateralgroupofaxillarynodes

DeepLymphVessels
Drain:deepstructuresofthearmdrainintothelateralgroupofaxillarynodes.

FascialCompartments
Upperarmisenclosedinasheathofdeepfascia

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Fasciasepta(medialandlateral)divideupperarmintoanteriorandposteriorfascial
compartment.
Theseseptaareattachedtothemedialsupracondylarridgeandlateralsupracondylar
ridgeofthehumerus
Thinneranteriorcoveringofthearmandbecomesthickerasitgoesposteriorly

Contentsofthedeepfascialcompartment:
Bicepsbrachiimuscle
Coracobrachialismuscle
Brachialismuscle
Musculocateneousnerve
Mediannerve
Ulnarnerve
Radialnerve
Brachialarteryandbranches
Tricepsbrachiimuscle
Anconeousmuscle
Cubitalfossa
2.Illustratetheareasofdistributionofthemajorcutaneousnervesoftheupper
limb.

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#2continuation

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Supraclavicularnerves
Formation:C4&C5
Areasupplied:skinovershoulder

Upperlateralcutaneousnerveofarm(superficialnerve)
Formation:branchoftheaxillarynerveC5&C6
Areaofdistribution:skinoverthelowerhalfofthedeltoid

Lowerlateralcutaneousnerveofarm(superficialnerve)
Formation:branchofradialnerveC5&C6
Areaofdistribution:skinoverthelateralsurfaceofthearmbelowdeltoid

Intercostobrachialnerve
Formation:lateralcutaneousbranchofthe2ndintercostalnerve
Course:joinswiththemedialcutaneousnerveofarm
Areaofdistribution:skinofarmpitandmedialsideofthearm

Medialcutaneousnerveofarm
Formation:(T1)arisefromthemedialcordofthebrachialplexus
Course:goesdownwardandjoinswiththeintercostobrachialnerve
Areaofdistribution:skinofarmpitandmedialsideofthearm

Lateralcutaneousnerveofforearm
Formation:abranchofthemusculocutaneousnerve
Course:
passesbehindthecephalicvein,anddivides,oppositethe
elbowjoint,intoa
volar
anda
dorsal
branch
Branches:
Volarbranch
Course:descendsalongtheradialborderofforearmtothe
wrist
Areasupplied:lateralhalfofvolarsurfacecommunicates
withsuperficialbranchoftheradialnerve,andpalmar
cutaneousbranchofthemediannerve
Dorsalbranch
Course:dorsalsurfaceofradialsideofforearmtothewrist
Areasupplied:skinoflowertwothirdsofthedorsolateral
surfaceoftheforearm,communicatingwiththesuperficial
branchoftheradialnerveanddorsalantebrachialcutaneous
branchoftheradial

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Medialcutaneousnerveofforearm
Formation:arisesfrommedialcordofthebrachialplexus,descendsin
frontoftheaxillaryartery
Course:piercesthefasciaandsuppliesintegumentcoveringthebiceps
brachii,thenrunsdowntheulnarsideofthearmmedialtothebrachial
artery,piercesthedeepfasciawiththebasilicvein.dividesintothevolar
andulnarbranch
Branches:
Volarbranch
Course:passesinfront,occasionallybehindmedianbasilic
veindescendsonthefrontoftheulnarsideoftheforearm
Areasupplied:communicateswithpalmarcutaneousbranch
ofulnarnerve
Ulnarbranch
Course:passesobliquelydownwardtothemedialsideof
basilicvein,infrontofmedialepicondyleofhumerus,backof
theforearm,descendsonitsulnarsideasfaraswrist
Areasupplied:communicateswithmedialbrachial
cutaneous,dorsalantebrachialcutaneousbranchofthe
radial,dorsalbranchoftheulnar

Posteriorcutaneousbranchofulnarnerve
Formation:branchofradialnerveC8
Areaofdistribution:skinofthebackofthearm

Superficialbranchofradialnerve
Location:Slightlylateraltotheradialartery,concealedbehind
brachioradialis.sensorynerve
Areasofdistribution
Lateralbranch:radialsideofthumb,skinofradialsideandballof
thumb,joiningwithvolarbranchoflateralantebrachialcutaneous
nerve
Medialbranch:communicates,abovethewrist,withthedorsal
branchofthelateralantebrachialcutaneous,onthebackofthe
hand,withthedorsalbranchoftheulnarnerve

Palmarcutaneousbranchofmediannerve
Formation:branchofmediannerve

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 Course:piercesthepalmarcarpalligament,dividesintolateralbranchand
medialbranch
Areasofdistribution
Lateralbranch:suppliesskinovertheballofthumb,communicates
withvolarbranchoflateralantebrachialcutaneous
Medialbranch:suppliesskinofpalm,andcommunicateswith
palmarbranchoftheulnar

Ulnarnerve
Formation:frommedialcordofbrachialplexusintheaxilla
Course:
runsdownwardonthemedialsideofthebrachialarteryasfaras
middleofthearm
attheinsertionofthecoracobrachialis,thenervepiercesmedial
fascialseptumwiththesuperiorulnarcollateralartery
enterstheposteriorcompartmentofthearm,thenpassesbehind
themedial
Areaofdistribution:
flexorcarpiulnaris,medialhalfofFDP,hypothenar
muscles,thirdandfourthlumbricals,allinterosseimuscles,skinoverthe
medialhandand1digits
(Netter)
flexorcarpiulnaris&medialhalfofflexordigitorumprofundus,
flexordigitiminimi,opponensdigitiminimi,abductordigitiminimi,
adductorpollicis,thirdandfourthlumbricals,interossei,palmaris
brevis,skinofmedialhalfofdorsumofhandandpalm,skinof
palmaranddorsalsurfacesofmedialoneandahalffingers(Snell)

Mediannerve
Formation:medialbranchofthelateralcord,lateralbranchofthemedial
cord
Course:runsdownwardonthelateralsideofthebrachialarteryhalfway
downtheupperarm,itcrossthebrachialarteryandcontinuesdownward
onitsmedialside
Areaofdistribution:
forearmflexors,thenarmuslcesand1st&2nd
lumbricals,skinoverthelateralhandand3digits
(Netter)
pronatorteres,flexorcarpiradialis,palmarislongus,flexor
digitorumsuperficialis,abductorpollicisbrevis,opponenspollicis
longus,flexordigitorumprofundus(lateralhalf),pronatorquadratus
palmarcutaneousbranchtolateralhalfofpalmanddigital

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branchestopalmarsurfaceoflateralthreeandahalffingers
articularbranchestoelbow,wrist,andcarpaljoints(Snell)

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3.Illustratetheformationofthemajorsuperficialveinsoftheupperlimb.

Superficialveins

CephalicVein
Origin:unionofdigitalveinsfromthethumbandlateralendofthedorsalvenousarch
Commencement:lateralaspectofthedorsum(back)ofthehand
Course:Itwouldascendalongthelateralborderoftheforearmandassumesan
anterolateralpositionatthecubitalfossauptothearmuntilitlodgesinthegroove
betweendeltoidandpectoralismajor.Itwilldrainintotheaxillaryvein
Termination:Deltopectoralgroove

BasilicVein
Origin:medialendofthedorsalvenousarch
Commencement:medialborderofthewrist
Course:Itascendsattheposteromedialborderoftheforearm,twistingtoamore
medialpositioninfrontofthemedialepicondyle.Atthelowerborderoftheteresmajor,
theveinmovesdeepintothearmandcombineswithbrachialveinstoformtheaxillary
vein.
Termination:lowerborderoftheteresmajormuscle

Communicatingveins
Linksthecephalicandbasilicveins
Itislocatedanteriorly

1.Mediancubitalveincrossinginfrontofthecubitalfossafromthecephalicvein
atalowerleveltothebasilicanearsthemedialepicondyle
2.Medianveinoftheforearmifpresent,itfrequentlydividesintotwostems,
whichcommunicateswiththecephalicandbasilicveinsoneachsideofthe
cubitalfossa.
3.Deepmuscularveinssituatedunderneaththedeepfascia
a.Radialvein
b.Ulnarvein
c.Brachialvein

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4.Discussthemusclesoftheanteriorcompartmentofthearm

The
anteriorcompartmentofthearm
isoneofthetwocompartmentsofthearm.
Asheathofdeepfasciasurroundsthearm,thebrachialfascia.Twointermuscular
septae(medialandlateral)extendfromittoattachtothe
humerus
atthemedal
condylarridgeandlateralsupracondylarridge,respectively.Theseseptaedividethe
armintoitsanteriorand
posteriorcompartments
.
Bloodsupply

brachialartery
Nervesupply

Primarilybythe
musculocutaneousnerve
(C5,6),althoughthe
radialnerve
(C7)does
supplyasmalllateralpartofbrachialis.
Muscles

Threeflexors:
1.
bicepsbrachii

(alsoknownsimplyas
biceps
)isatwoheadedmuscleintheanteriorcompartmentof
thearmthatflexesattheelbowandsupinatestheforearm.
origin
shorthead:coracoidprocess
longhead:supraglenoidtubercleofthe
scapula
insertion
:radialtuberosityoftheproximal
radius
innervation
:
musculocutaneousnerve
action
:flexionattheelbowandsupinationoftheforearm
2.
brachialis

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oneofthethreemusclesoftheanteriorcompartmentofthearm.Itisonlyinvolvedin
flexionattheelbowandthereforethestrongestflexorattheelbow,c.f.bicepsbrachii
whichisalsoinvolvedinsupinationbecauseofitsinsertionontheradius.
origin
:lowerportionofthemedialsurfaceofthe
humerus
insertion
:ulnatuberosityandcoronoidprocessofthe
ulna
innervation
:
musculocutaneousnerve
and
radialnerve
(proprioceptive
branch)
action
:flexionattheelbow

3.
coracobrachialis

(ormoresimply
coracobrachialis
)isoneofthethreemusclesoftheanterior
compartmentofthearmthatactstoperformflexionattheelbow.Itsitbeneathbiceps
brachii.
origin
:coracoidprocessof
scapula
insertion
:viaaflattendonontothemidportionofthemedialsurfaceof
humerus
innervation
:
musculocutaneousnerve
action
:
shoulderflexion
and
shoulderadduction

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5.Discussthemusclesofposteriorcompartmentofthearm.

Posteriorcompartmentofthearm
Generalities:
Allofthemusclesoftheposteriorcompartmentofthearmareinnervatedbythe
radialnerve
Allofthemusclesintheposteriorcompartmentofthearmaresuppliedbythe
profundabrachiiartery,whichisabranchofthebrachialartery
Muscles:
Tricepsbrachii
o3headslong,lateral,andmedial
oVerticalfibersofthelongheadofthetricepsbrachiiinterposebetweentheteres
musclestobecomeacommonboundaryforthetriangularandquadrangularspaces
oTheneurovascularstructurespassingalongtheposteriorcompartmentofthearm
separatesthemedialandlateralheadsofthetricepsbrachii
oStrongextensoroftheelbowjoint
Anconeusmuscle
oSmall,insignificanttriangularshapedmuscle
oHelpsstabilizeelbowjoint

Origin

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Insertion

Action

Innervations

Triceps
brachii
LONGHEAD

Infraglenoid
tubercleofthe
scapula

Olecranon
processofthe
ulna

Main
extensorof
theelbow
joint

Radialnerve

Triceps
brachii
LATERAL
HEAD

Upperhalfof
theposterior
surfaceofthe
humeralshaft

Triceps
brachii
MEDIAL
HEAD

Lowerhalfof
theposterior
surfaceofthe
humeralshaft

Lateral
epicondyleof
thehumerus

Helpstabilize
theelbow
joint

Anconeus
muscle

Structurescrossingtheposteriorcompartment:
UlnarandRadialnerves
Superiorandinferiorulnarcollateralarteries
Profundabrachiiartery
Profundabrachiiartery
Commencement:atthemedialsideofthelowerborderoftheteresmajor
oSimilarcommencementwiththebrachialartery
Origin:brachialartery
Course:alongtheradialnerve,itwindsalongtheradialgrooveofthehumerus,
reachingthelateralepicondyle
Termination:infrontandbehindtheepicondyle
Branches:
oAnteriordescendingbranch
oPosteriordescendingbranch
Theanteriorandposteriordescendingbranchesanastomosewiththeradialand
ulnararteries

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6.Describethecourseoftheradialandmusculocutaneousnerves

Radialnerve:
Intheproximalthirdofthearm,itliesbehindthebrachialarteryfromwhereitwinds
aroundthehumeralshaftaccompaniedbytheprofundabrachiiartery.Atthelateral
supracondylararea,itemergesbetweenthelateralbordersofthebrachialisand
brachioradialismusclewhereitdividesintoasuperficialbranchtotheforearmanda
deepbranchwhichproceedstotheposteriorcompartmentoftheforearm

Musculocutaneousnerve:
Itpiercesthecoracobrachialismuscleandcoursesdeeptothebiceps,downtothe
antecubitalareawhereitsurfacesatthelateralborderofthebicepstendonfromwhere
itcoursessuperficiallyontheanterolateralsurfaceoftheforearmtodistributeits
terminalcutaneousbranches.

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7.Describethebrachialartery.

BrachialArtery
Continuationoftheaxillaryartery
mainarterialsupplyofthearm
Commencement:lowerborderoftheteresmajormuscle
Course:emergingfromthelowerborderoftheteresmajormuscle,Brachialarteryis
rathersuperficialinitscourse.Itisoverlappedfromthelateralsidebybicepsbrachii
muscle.Itliesuponthetricepsandthecoracobrachialismuscles.Intheproximalregion
thearteryliesmedialtothehumeruswhereitispalpable.Inthelowerpartofitscourse
thearterygainsananteriorpositionrelativetothehumerus.Thebrachialartery
accompaniesthemediannervewhichcrossesitfromlateraltomedialsideinthemiddle
ofthearm.
Termination:Neckoftheradiusasitdividesintoradialandulnararteries
Branches:
Brachialarteryhasfollowingimportantbranches
1.Muscularbranches:Itsuppliesallthemusclesofarmdirectlyorthroughitsbranches.
2.Nutrientarterytothehumerus:
3.Deepbrachialarteryofthearm(Profundabrachiiartery):Profundabrachiiartery
arisesfrommedialandposteriorpartofbrachialarteryasalargebranchjustbelowthe
lowerborderofteresmajormuscle.Itcloselyfollowstheradialnerveandpasses
betweenthelateralandmedialheadsoftricepsmuscle.Afterpassingthroughtheradial
groveofhumerusalongtheradialnerve,itpiercesthelateralintermuscularseptumand
reachesthefrontoflateralepicondyleofhumerus.Itendsbyanastomosingwiththe
radialrecurrentartery.
Profundabrachiiarterysuppliesthedeltoidmuscle(whichisprimarilysuppliedbythe
posteriorcircumflexhumeralartery)andoccasionallyalsogivesanunusualnutrient
arterytothehumerus.Atitsend,ittakespartintheformationofanastomosesaround
elbowjoint.
4.Superiorulnarcollateralartery:Itisasmallsizedarteryarisingfromthebrachial
arteryjustbelowthemiddleofthearm.Itpiercesthemedialintermuscularseptumof
thearmandreachesbehindthemedialepicondyleofhumerus.Itendsbytakingpartin
anastomosesaroundtheelbowjoint.
5.Inferiorulnarcollateralartery:Itarisesfrombrachialarteryabouttwoandhalfinches
abovetheelbowjoint.Nearitsoriginitpiercesthemedialintermuscularseptumand
reachesbehindthemedialepicondyleofhumerus.Itendsbytakingpartin
anastomosesaroundtheelbowjoint.
6.RadialarteryTerminalBranch
7.UlnararteryTerminalBranch

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8.Illustratethecubitalfossashowingtheboundaries,contentsandthespatial
relationshipsoftheassociatedmuscularandneurovascularstructures]

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