Sem 1 - T - Arm & Cubital Fossa - Anterior/posterior arm, Brachial artery/elbow joint anastamoses, cubital fossa, bones of upper limb

Question 1

Where is the arm? Which compartment of the arm has the flexors and which has the extensors of the arm?

Answer 1

The arm, anatomically, is located from the shoulder joint to the elbow joint The flexors of the arm is in the anterior compartment The extensors of the arm is in the posterior compartment

Question 2

What are the muscles of the anterior compartment of the arm? What is the nerve supply to these muscles? What cord of the brachial plexus does this nerve come from and what are its nerve roots?

Answer 2

The muslces of the anteiror compartment of the arm are: Biceps brachii Brachialis Coracobrachialis

The muscles are supplied by the musculocutaneous nerve (C5,6,7) and this is a terminal branch of the lateral cord

Question 3

WHat are the two different biceps brachii? Where do both heads arise from?

Answer 3

Long head of biceps - arises from the supraglenoid tubercle of the scapula Short head of biceps - arises from the coracoid process of the scapula

Question 4

What is the insertion point of the biceps brachii? What is the main function of the biceps brachii?

Answer 4

The biceps brachii forms the biceps tendon distally which inserts into the radial tuberosity Small amount of fibres also form the bicipital aponeurosis which is a fascial sheet joining the deep fascia of the forearm Function - Supination of the forearm and weakly flexes the arm

Question 5

What is the deep fascia of the forearm where the bicipital aponeurosis blends with known as? How does the biceps allow for supination of the forearm? When is the biceps brachii able to flex the arm? What is supination of the forearm?

Answer 5

Deep fascia of the forearm is known as the antebrachial fascia Supination of the forearm refers to the rotation of the radius - supine is when the palms face the sky - allowed by the biceps tendon insertion at the radial tuberosity Flexion of the arm by the biceps brachii only occurs when the arm is supine

Question 6

Where does the long head of the biceps run? What do the long and short heads of the biceps prevent? What is the nerve supply to the biceps brachii? (state which root valeus specifically of this nerve go to biceps brachii)

Answer 6

Long head of the biceps runs in the bicipital groove to attach to the supraglenoid tubercle of the scapula Long head of the biceps prevents the head of the humerus moving superiorly whilst the short head of the biceps prevents anterior dislocation of the shoulder joint Nerve supply - musculocutaneous nerve via only its C5,6 roots

Question 7

What are the attachments of the coracobrachialis? What is its function?

Answer 7

Coracobrachialis attaches from the coracoid process of the scapula to the medial shaft of the humerus Its main function is to flex the arm but it also adduct the arm

Question 8

What is the nerve supply of the coracobrachialis? Biceps brachii had the same nerve supply nut only had the C5,6 roots of the nerve used. Does coracobrachialis differ?

Answer 8

The coracobrachialis is pierced and supplied by the musculocoutaneous nerve (C5-7)

Question 9

What is the attachments of the brachialis muscles and what muscle does it lie?

Answer 9

The brachialis muscles originates at the distal half of the anterior surface of the humerus and inserts on the ulnar tuberosity and coronoid process of the ulna

Question 10

What is the nerve supply to the brachialis? Why can it sometimes recieve some fibres from the C7 root of the radial nerve?

Answer 10

The nerve supply to the brachialis is via the musculocutenous nerve (C5,6 roots) As it is a big muscle, it can wrap around the humerus and therefore a small component of lateral fibres from the radial nerve (C7) may also supply this muscle

Question 11

The arm has 4 muscles 3 anterior * Biceps brachii - Musculocutaneous nerve * Coracobrachialis - Musculocutaneous nerve * Brachialis - Musculocutaneous nerve, lateral fibres of radial nerve State each of the roots of the nerve fibres going to these muscles? What is the muscle in the posterior compartment known as?

Answer 11

Biceps brachii - Musculocutaneous nerve (C5,6) Coracobrachialis - Musculocutaneous nerve (C5-7) Brachialis - Musculocutaneous nerve (C5,6), lateral fibres supplied by radial nerve (C7) Trcieps brachii is the muscle of the posterior compartment of the arm

Question 12

The triceps brachii has three heads; a long head, a lateral head and a medial head. What is the common distal insertion of the triceps brachii?

Answer 12

Common distal insertion of the triceps brachii is into the olecranon of the ulna Biceps tendon inserts at the radial tuberosity Brachialis inserts at the ulna tuberosity and the coronoid process of the ulna

Question 13

What is the origin of the three heads of the triceps brachii?

Answer 13

The long head originates form the infraglenoid tubercle of the scapula The lateral head is from the posterior shaft of the humerus superior to the radial groove The medial head sits inferior to the lateral head and inserts on the posterior shaft of humerus inferior to the radial groove

Question 14

What form the radial groove in the humerus? What is the function of the triceps brachii? What does the long head of the triceps brachii resist?

Answer 14

The radial groove is formed by the radial nerve wrapping around the shaft of the humerus Triceps brachii acts to extend the elbow joint Long head of the triceps prevents dislocation of the shoulder joint

Question 15

State the attachments of the triceps brachii State the muscles function and its nerve supply

Answer 15

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Question 16

When is the brachial artery formed?

Answer 16

The brachial artery is formed once the axillary artery crosses the inferior border of the teres major

Question 17

The brachial artery gives off a branch known as the profunda brachii What is this also known as? What hiatus does this pass through and with what?

Answer 17

The profunda brachii is also known as the deep artery of the arm It passes through the triangular hiatus with the radial nerve to enter the posterior compartment of the arm Brachial artery - main supplier to anterior compartment Profunda brachii - main supplier to posterior compartment

Question 18

The peri-articular arterial anastomosis of the elbow consists of several arteries that supply the elbow joint and its supporting structures. It functions to allow blood to flow around the elbow joint no mater which position the joint is in. Have the brachial artery and the profunda femoris each giving off different branches (some of which also branch to provide more anastoamsoes) mainly known as recurrent collateral arteries What is the difference between collateral & recurrent arteries?

Answer 18

Collateral arteries branch off and flow in the same direction as the parent artery Recurrent arteries are arteries which branch off and then turn around to participate in an anastamoses so that they run in the opposite direction of the parent artery

Question 19

Are collateral and recurrent arteries formed below or above the elbow?

Answer 19

Collateral arteries form above the elbow and flow donwards Recurrent arteries form blow the elbow and turn around to flow backwards to participate in the anastomoses

Question 20

What are the collateral arteries and what to they branch from?

Answer 20

The radial and middle collateral arteries are the two terminal branches from the profunda brachii The superior and inferior ulnar collateral arteries branch from the brachial artery

Question 21

What are the reccurrent arteries branches of? Which artery branches to give the radial and ulnar arteries? We have the * Radial recurrent * Anterior ulnar recurrent * Posterior ulnar recurrent * Interosseus recurrent

Answer 21

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Question 22

State which of the collateral and recurrent arteries therefore anastamose (there are 4 recurrent and 4 collateral arteries) * Radial and middle collateral (profunda brachii) * Superior and inferior ulnar collateral (brachial) * Radial and interosseus recurrent * Anterior and posterior ulnar recurrent

Answer 22

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Question 23

What is the cubital fossa?

Answer 23

This is a depression an the anterior surface of the elbow joint

Question 24

What are the boundaries of the cubital fossa?

Answer 24

Laterally - brachioradialis Medially - pronator teres Roof - skin, fascia and bicipital aponeuroiss Floor - brachialis

Question 25

What forms the superior imaginary border of the cubital fossa?

Answer 25

A line drawn betweeen the medial and lateral epicondyles

Question 26

The deep veins of the arm run accompanying the arteries. What are they known as? The superficial veins run in the superficial fascia. At the cubital fossa they are in the superficial fascia above the bicipital aponeurosis. What are these two veins? (state medial or lateral)

Answer 26

Deep veins are known as venae commitantes (latin for accompanying vein) Examples: \* Radial artery and radial veins \* Ulnar artery and ulnar veins \* Brachial artery and brachial veins The superficial veins are the cephalic vein (located laterraly) and the basilic vein (located medially)

Question 27

What connects the cephalic and basilic vein? Which part of the cubital fossa are these found in?

Answer 27

Cephalic and basilic vein connect via the median cubital vein Found in the superficial fascia in the roof of the cubital fossa above the bicipital aponeurosis

Question 28

What is the anterior vein of the forearm known as? What nerve runs beside the cephalic and basilic veins?

Answer 28

Anterior median vein of the forearm (aka median antebrachial vein) - variation as to what it branches from Medial cutaneous nerve of the forearm runs beside the basilic vein Lateral cutaneous nerve of the forearm runs beside the cephalic vein

Question 29

Where do the medial and lateral cutaneous nerves of the forearm branch from?

Answer 29

Medial cutaneous nerve of the foreaerm - branch of the medial cord of the brachial plexus Lateral cutaneous nerve of the forearm comes from the musculocutaneous nerve

Question 30

So the cephalic, basilic and median cubital veins are found in the roof of the cubital fossa along with the lateral and medial cutaneous nerves of the forearm Again What are the boundaries of the cubital fossa?

Answer 30

Superiorly - imaginary line between medial and lateral epicondyles Medially - pronator teres Laterally - brachioradialis Roof - skin, fascia, bicipital aponeuroiss Floor - Brachialis

Question 31

The cubital fossa contains four main vertical structures with one being debated as to its inclusion in the cubital fossa What are the structures and which is not always considered part of the cubital fossa? Which veins accompanying the arteries are also present?

Answer 31

Medially to laterally \* Median nerve Brachial artery - which bifurcates into ulnar and radial artery \* Biceps tendon \* Radial nerve Radial nerve runs between the brachiordialis and brachialis and is not always considered part of the cubital fossa Venae commitantes accompanying the arteries are also present

Question 32

Name the arteries State what their main anastomaoses is with

Answer 32

Red - inferior ulnar collateral artery - given off shortly before the division of the brachial artery (anastamoses with anterior ulnar recurrent artery) Yellow - brachial artery Blue - radial recurrent artery - anastomoses with the radial colllateral artery

Question 33

The compartments of the arm are the anterior compartment of the arm and the posterior compartment of the arm, divided by the lateral and the medial intermuscular septa. Which structures perforate each septum?

Answer 33

The lateral intermuscular septum is perforated by the radial nerve and the profunda brachii The medial intermuscular septum is perforated by the ulnar nerve

Question 34

Does the musculocutaneous nerve run in either of the intermuscular septum?

Answer 34

The musculocutaneous nerve pierces the coracobrachialis muscle and therefore runs anterior to the humerus but not in either of the septum

Question 35

State what each box is covering Where are the common extensor and common flexor tendon of the forearm origins?

Answer 35

Pink box - lateral supracondylar ridge Maroon box - lateral epicondyle Black box - capitullum Green box - trochlea Blue box - medial epicondyle Common extensor oigin - lateral epicondyle Common flexor origin - medial epicondyle

Question 36

The coronoid process of the ulna inserts into the cornoid fossa which is on the anterior surface of the humerus What is the fossa on the posterior aspect of the humerus and what inserts here?

Answer 36

Posterior aspect- olecranon fossa for the olecranon of the ulna

Question 37

What does the head of the radius articulate with?

Answer 37

The head of the radius articulates with the captiulum of the humerus

Question 38

What type of joint is the elbow joint? Which ligaments prevent abudction and adduction of the elbow joint? What ligament allows for supination and pronation of the forearm?

Answer 38

The elbow joint is a synovial hinge joint The medial (ulnar) collateral ligament prevents abduction of the forearm The lateral (radial) collateral ligament prevents adduction of the forearm The annular ligament allows for supination and ponation of the forearm

Question 39

What does the annular ligament wrap around? What is the superior articulation between radius and ulna?

Answer 39

Radial head to radial notch of ulna The annular ligament attaches to the anterior and posterior aspect of the radial notches of the ulna wrapping around the radial head/neck and therefore maintaining the articulation between radial head and ulna

Question 40

What is the difference betweent he lateral collateral and medial collateral ligaments of the elbow joint?

Answer 40

Radial (Lateral) collateral ligament is one band preventing adduction of the elbow joint Ulna (Medial) collateral ligament is made up of 3 bands, anterior, posterior and oblique preventing abduction of the elbow joint

Question 41

Where does the ulnar nerve pass at the elbow joint?

Answer 41

The ulnar nerve pierces the medial intermuscular septum to pass behind the medial epicondyle of the humerus

Question 42

Label this Go down left hand side of anterior view, then right hand side

Answer 42

Radial notch of ulna, radial head, neck of radius, radial tuberosity, radius, styloid process of radius Olecranon, trochlear fossa, coronoid process of ulna, proximal RU joint, interosseus membrane, ulna, ulnar notch, head of ulna, distal RU joint