Arm and Cubital Fossa Flashcards
What are the superficial structures of the upper limb?
- cutaneous nerves - located in superficial fascia; not visible through skin; branches of brachial plexus deep to deep fascia
- superficial veins - located in superficial fascia; generally visible through skin; tributaries to deep veins beneath deep fascia
What are the superficial veins of the upper limb?
- dorsal venous arch
- cephalic vein
- basilic vein
- median cubital vein
Describe the venous arch of the hand.
- drains superficial dorsal veins of hand
- arches across dorsal surface of hand
- tributary to both cephalic and basilic veins
Which vein near the hand is often used for venipuncture for an IV or drawing blood?
dorsal venous arch of hand
Describe the course of the cephalic vein.
- drains poterior/lateral aspect of upper limb
- runs in deltopectoral groove and pierces deep fascia
- tributary to axillary vein
Describe the course of the basilic vein.
- drains anterior/medial aspect of upper limb
- pierces deep fascia of arm
- tributary to brachial vein
Describe the course of the median cubital vein.
- connects cephalic and basilic veins
- located in the cubital fossa
Which vein near the elbow is often used for venipuncture for an IV or drawing blood?
median cubital vein
What is the deep fascia of the arm called?
brachial fascia
How does the brachial fascia connect to the humerus and how does it divide the arm?
- connected to the humerus by 2 fascial septa
- divided the arm into anterior and posterior compartments
How is the brachial fascia clinically relevant?
compartmental syndromes - increase in pressure of one of the compartments can affect circulation
What are the contents of the anterior compartment of the arm?
- biceps brachii, coracobrachialis, and brachialis muscles
- brachial vessels
- 5 brachial plexus nerves
- 3 motor nerves: musculocutaneous, median, and ulnar nerves
- 2 cutaneous nerves: medial brachial and medial antibrachial cutaneous nerves
What is the origin and insertion of the biceps brachii muscle?
- origin (long head) - supraglenoid tubercle of scapula
- origin (short head) - coracoid process of scapula
- insertion - radial (bicipital) tuberosity of radius
What is the action of the biceps brachii muscle?
flexes and supinates forearm (slight arm flexion)
What is the nerve and vascular supply of the biceps brachii muscle?
musculocutaneous nerve and brachial vessels
What is the origin and insertion of the coracobrachialis muscle?
- origin - coracoid process of scapula
- insertion - medial surface of middle of humerus
What is the action of the coracobrachialis muscle?
flexes and adducts arm
What is the nerve and vascular supply of the coracobrachialis muscle?
musculocutaneous nerve and brachial vessels
What is the origin and insertion of the brachialis muscle?
- origin - lower 1/2 of anterior humerus
- insertion - ulnar tuberosity of ulna
What is the action of the brachialis muscle?
flexes arm
What is the nerve and vascular supply of the brachialis muscle?
radial and musculocutaneous nerves and brachial vessels
What are the contents of the posterior compartment of the arm?
- triceps brachii muscle
- radial nerve
- deep brachial artery
What is the origin and insertion of the triceps brachii muscle?
- origin (long head) - infraglenoid tubercle of scapula
- origin (lateral head) - posterior shaft of humerus
- origin (medial head) - posterior shaft of humerus
- insertion - olecranon process of ulna
What is the action of the triceps brachii muscle?
extends forearm
What is the nerve and vascular supply of the triceps brachii muscle?
radial nerve and deep brachial vessels
What is the cubital fossa?
depressed area anterior to elbow
What are the contents of the cubital fossa?
- biceps brachii tendon
- brachial artery
- median nerve
- NOTE: superficial veins lie above this area (median cubital vein)
What surrounds the brachial artery and the median nerve?
bicipital aponeurosis
What are the boundaries of the cubital fossa?
- lateral border - brachioradialis muscle
- medial border - pronator teres muscle
- superior border - imaginary line between humeral epicondyles
- floor - supinator and brachialis muscles
After supplying the muscles of the arm, what does the musculocutaneous nerve continue as? What does it then supply?
- lateral antibrachial cutaneous nerve
- supplies skin of lateral forearm
What is the course of the median nerve once it enters the cubital fossa?
- crosses to the medial side of the brachial artery and enters cubital fossa
- runs between superficial and deep anterior forearm muscles
- supplies most muscles in anterior forearm
- continues under carpal tunnel to supply lateral hand
Describe the course of the ulnar nerve.
- travels posteriorly down medial aspect of arm
- runs in cubital tunnel between medial epicondyle and olecranon
- dives deep into medial forearm with ulnar artery to supply it
- continues over carpal tunnel to supply medial hand and deepest muscles of hand
Which nerve is known as the “funny bone” nerve?
ulnar nerve
Describe the course of the radial nerve.
- runs with deep brachial artery in radial groove of humerus (between lateral and medial heads of triceps)
- continues between brachialis and brachioradialis muscles
- supplies all of triceps brachii and lateral part of brachialis muscles
- divides into superficial and deep branches
- superficial branch - continues to supply skin on back of hand
- deep branch - dives to supply muscles of posterior forearm
Describe the course of the brachial artery.
- direct continuation of axillary artery
- runs from inferior border of teres major muscle to its bifurcation
- splits to radial and ulnar arteries in cubital fossa
- also sends off deep brachial artery (while in upper arm) and several muscular branches
- sends off superior and inferior ulnar collateral arteries
Name the 4 collateral arteries of the elbow region and their recurrent arteries.
- superior ulnar collateral artery - posterior ulnar recurrent artery
- inferior ulnar collateral artery - anterior ulnar recurrent artery
- radial collateral artery - interosseous recurrent artery
- middle collateral artery - interosseous recurrent artery
Where do the radial and middle collateral arteries branch from?
deep brachial artery
What region of the brachial artery can be ligated so that the blood supply will be covered via collateral circulation?
between the inferior ulnar collateral artery and the bifurcation of the brachial artery
Describe the course of the basilic vein.
- drains anterior/medial aspect of upper limb
- pierces deep fascia of arm
- tributary to brachial vein
