SGD5:ARM&CUBITALFOSSA

1D
CUBICLE6

1. Discusstheskin,superficialfasciaanddeepfasciaoftheupperlimb.

SuperficialFascia
Superficiallayercoveringthearm
Contents:
Superficialsensorynervessuppliestheskinofthearm
Cutaneousnervesonthelateralsurfaceofthearm
Supraclavicularnerves
Upperlateralcutaneousnerveofthearm
Lowerlateralcutaneousnerveofthearm
Cutaneousnervesonthemedialsurface
Medialcutaneousnerveofthearm
Intercostobrachialnerveofthearm
Posteriorcutaneousnerveofthearm
SuperficialVeins
Cephalicvein
BasilicVein
SuperficialLymphVessels

DeepFascia
Coversthemusclesoftheupperarm
Two dense intermuscular septa attached to the supracondylar ridges of the humerus
servetoseparatethemusclesoftheanteriorandposteriorcompartmentsofthearm.
Contents:

AnteriorFascialCompartment

BicepsBrachii
Coracobrachialis
Brachialis
BrachialArtery
MusculocutaneousNerve
MedianNerve
Ulnarnerve
BasilicVein
RadialNerve(Lowercompartment
abovelateralepicondyle)

PosteriorFascialCompartment

Triceps
Profundabrachii
Radialnerve
Ulnarnerve

2. Illustratetheareasofdistributionofthemajorcutaneousnervesoftheupperlimb.

CUTANEOUSNERVEONTHELATERALSURFACE:

Supraclavicularnerves

(C3,C4)

nervesupplytotheskinover
thepointoftheshoulder
halfwaydownthedeltoid

Upperlateralcutaneous
nerveofthearm

(branchofaxillaryC5,C6)

nervesupplytotheskinof
thelowerhalfofthedeltoid

Lowerlateralcutaneous
nerveofthearm

(branchofradialnerveC5,6) nervesupplytoskinover
lateralsurfaceofarmbelow
thedeltoid

CUTANEOUSNERVESONTHEMEDIALSURFACE:

PosteriorCutaneousNerve
totheArm

(C8)

Nervesupplyofskinofthe
backofthearm

Medialcutaneousnerveto
thearm

(T1)

Nervesupplytothearmpit
andmediansidethearm

Intercostalbrachialnerve

(T2)

Nervesupplytotheproximal
andmedialsurfacesofthe
arm

3. Discussthemajorsuperficialanddeepveinsoftheupperlimbastoitsformation,
commencement/terminationandcourse.

SUPERFICIALVEINS


1. CephalicVein:
Commencement:Subcutaneoustissuefromthelateraldorsumofthehand
(lateralaspectofthewrist).

Course:Startsatthebackofthehandbytheunionofthedigitalveinsfromthe
thumbandlateralendofthedorsalvenousarch.Afterascendingalongthe
lateralborderofthearm,theveingraduallyassumestheanterolateralpositionat
thecubitalregion.Itlodgesinthegroovebetweenthedeltoidmuscleandthe
pectoralismuscle(deltopectoralgroove).Itdrainsintotheaxillaryvein.

Termination:Deltopectoralgroove

Tributaries:Digitalveinsfromthethumb
Lateralendofthedorsalvenousarch

2.BasilicVein:
Formation:Medialendofthedorsalvenousarch

Commencement:Medialborderoftherisk

Course:Itascendsattheposteromedialborderoftheforearm,twistingtoamore
medialpositioninfrontofthemedialcondyle.Halfwayupthearm,itdipsintothe
deepfascia.Atthelowerborderoftheteresmajormuscle,itisjoinedbythe
venaecomitantesofthebrachialarterytoformtheaxillaryvein.

Termination:Lowerborderofteresmajormuscle

Communicatingveins(linkthecephalicveinandbasilicveins):
Mediancubitalveins
Medianveinoftheforearm

DEEPVEINS
Venaecomitantesofthebrachialartery
Formation:Unionofradialveinsandulnarveins
Termination:Lowerborderofteresmajormuscle

Axillaryvein
Commencement:Lowerborderofteresmajormuscle
Termination:Lateralborderofthe1strib
Drainsintosubclavianvein


4. Discussthemusclesoftheanteriorcompartmentofthearmastoitsattachments,
innervationandactionwithdemonstration.

AnteriorCompartmentoftheArm
Muscle

OIA

1.BicepsBrachii
1.1ShortHead
1.2LongHead

O(ShortHead):Coracoid
processofthescapula

O(LongHead):Supraglenoid
tubercleofscapula

I:Tuberosityofradiusand
bicipitalaponeurosisintodeep
fasciaofforearm

A:Supinatorofforearmand
flexorofelbowjointweakflexor
ofshoulderjoint

2.Brachialis

O:Frontoflowerhalfofhumerus

I:Coronoidprocessoftheulna

A:Flexorofelbowjoint

3.Coracobrachialis

O:Coracoidprocessofthe
scapula

I:Medialaspectofshaftof
humerus

A:Flexesarmandalsoweak
adductor

Innervation

MusculocutaneousNerve

5. Discusswithillustrationthemusclesoftheposteriorcompartmentofthearmastoits
attachments,innervationandactionwithdemonstration.

MusclesofthePosterior
CompartmentoftheArm

MUSCLE

ORIGIN

TRICEPS

LONGHEAD

LATERAL
HEAD

MEDIAL
HEAD

Infraglenoid
tubercleof
scapula

Upperhalfof
posterior
surfaceof
shaftof
humerus

Lowerhalfof
posterior
surfaceof
shaftof
humerus

INSERTION

OlecranonprocessofUlna

NERVE
SUPPLY

Radialnerve

NERVE
ROOTS

C6,7,&8

ACTION

Extensorofelbowjoint

6. Drawthecourseoftheradialandmusculocutaneousnervesincludingtheareas
innervated.


MUSCULOCUTANEOUSNERVE
Fromthelateralcordofthebrachialplexus(C5,6,7)intheaxilla
Runsdownward&laterally,piercesthecorachobrachialismuscle
Passesdownwardbetweenthebiceps&brachialismuscles

Appearsatthelateralmarginofbicepstendon&piercesthedeepfasciajustabovethe
elbow
Runsdownthelateralaspectoftheforearmasthelateralcutaneousnerveofthe
forearm

BRANCHES:
Muscularbranchestothebiceps,corachobrachialis,brachialis
Cutaneousbrancheslateralcutaneousnerveoftheforearmsuppliesthe
skinofthefrontandlateralaspectsoftheforearmdownasfarastherootofthe
thumb
Articularbranchestotheelbowjoint

RADIALNERVE
Largestbranchofthebrachialplexusliesbehindtheaxillaryartery
Fromtheposteriorcordofthebrachialplexusintheaxilla
Windsaroundthebackofthearminthespiralgrooveonthebackofthehumerus
betweentheheadsofthetriceps
Piercesthelateralfascialseptumabovetheelbow&continuesdownwardintothecubital
fossainfrontoftheelbow,betweenthebrachialisandbrachioradialismuscles
Inthespiralgroove,itisaccompaniedbytheprofundavesselsanditliesdirectlyin
contactwiththeshaftofthehumerus

BRANCHES
Intheaxilla,branchesaregiventothelongandmedialheadsofthetriceps&
posteriorcutaneousnerveofthearmisgivenoff
Inthespiralgroove,branchesaregiventothelateralandmedialheadsofthe
tricepsandtotheaconeus.Thelowerlateralcutaneousnerveofthearm
suppliestheskinoverthelateralandanterioraspectsofthelowerpartofthe
arm.Theposteriorcutaneousmerveoftheforearmrunsdownthemiddleof
thebackoftheforearmasfarasthewrist.
Intheanteriorcompartmentofthearm,afterthenervehaspiercedthelateral
fascialseptum,itgivesbranchestothebrachialis,brachioradialis,extensorcarpi
radialislongusmuscles.Italsogivesarticularbranchestotheelbowjoint.

7. Discussthebrachialarteryastoitsorigin,commencement/termination,course,
branchesandspatialrelationships.

Supply:mainarterialsupplytothearm
Origin:axillaryartery

Commencement:lowerborderoftheteresmajor
Termination:oppositetheneckoftheradiusdividingintoradialandulnararteries

Branches
1. Muscularbranchestotheanteriorcompartmentoftheupperarm
2. Nutrientarterytothehumerus
3. Profundaarteryarisesnearbeginningofthebrachialarteryfollowsradialnerveinto
thespiralgrooveofthehumerus
4. Superiorulnarcollateralarteryarisesnearthemiddleoftheupperarmfollowsthe
ulnarnerve
5. Inferiorulnarcollateralarteryarisesneartheterminationofthearterytakespartin
theanastomosisaroundtheelbowjoint


Spatialrelations

Anteriorlyitissuperficialoverlappedlaterallybycoracobrachialisandbicepsupper
part:posteriortomedialcutaneousnervemiddlepart:crossedbymediannervelower
part:crossedbybicipitalaponeurosis
Posteriorlyliesontriceps,coracobrachialisinsertion,andbrachialis
Mediallyupperpartofarm:ulnarnerveandbasilicveinlowerpart:mediannerveon
itsmedialside
Laterallyabove:mediannerve,coracobrachialis,andbicepsmuscleslowerpartof
course:medialtotendonofbiceps

8. Discusswithillustrationthecubitalfossaastoitsboundaries,contentswithitsspatial
relationship.

Cubitalfossatriangulardepressionthatliesinfrontoftheelbow

Boundaries:
Roof:skinandfasciareinforcedbythebicipitalaponeurosis
Floor:Brachialis
Baseofthetriangle:Imaginarylinebetweenthetwoepicondylesofthehumerus
Lateral:Brachioradialis
Medial:PronatorTeresmuscle

Contents:
Mediannerve
Bifurcationofthebrachialartery
Tendonofthebiceps
Radialnerveanditsdeepbranch

9. Discusstheshoulder&elbowjointsastoitscomponents,typeandrangeofmotionwith
demonstration.

ELBOWJOINT

Components/Articulations:
BetweenTrochleaandCapitulumoftheHumerus
andTrochlearnotchoftheUlnaandHeadoftheRadius
Coveredwithhyalinecartilage

Type:SynovialHingeJoint

Ligaments:


1. LateralLigamentorRadialCollateralLigament(triangular,attachedbytheapexto
lateralepicondyleofthehumerus)
2. MedialLigamentorUlnarCollateralLigament(triangular,with3bandsanterior,
posteriorandobliqueortransversebands)

3. AnnularLigament(encirclesradiuskeepingitconnectedtothehumerus)

NerveSupply:
branchesfrom
MedianNerves
UlnarNerves
MusculocutaneousNerves
RadialNerves

Movements:
Flexion(performedbythebrachialis,bicepsbrachii,brachioradialis,pronatorteres
muscle)
Extension(performedbythetricepsandanconeusmuscles)
Supination(performedbysupinatormuscleandbicepsbrachii)
Pronation(performedbypronatorteresandpronatorquadratus)