Upper limb Muscles of Arm, cubital fossa, and elbow joint Dr.Nivin Sharaf MD M.B.BCH

Objectives -Identify the following structures: humerus (medial & lateral epicondyles, lateral condyle (capitulum), medial condyle (trochlea), radius (head, styloid process, tuborosity), ulna (olecranon, coronoid process, styloid process) -Describe the movements of flexion and extension of the elbow joint. -Describe the articulation of the elbow joint with the radius and ulna. -Explain where you would aspirate a joint effusion. -Describe the course of neurovascular structures in the arm (brachial artery and vein, nerves - medial, ulnar and radial), and their relation in the cubital fossa -Name and identify the anatomical region of the cubital fossa (location, boundaries)

Surface Anatomy

Surface anatomy

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Bony Skeleton

Humerus and Scapula (Ant)

Humerus and Scapula (Post) Humeral Head Supra scapular Fossa Humeral Neck Anatomical Humeral Neck Surgical Infra scapular Fossa Radial groove Inferior Angle Medial epicondyle

Humerus and Scapula (Post) Humeral Head Supra scapular Fossa Humeral Neck Anatomical Humeral Neck Surgical Infra scapular Fossa Radial groove Inferior Angle Medial epicondyle

Elbow joint http://www.joint-pain-expert.net/images/elbow_joint_anatomy001.jpg http://www.joint-pain-expert.net/images/elbow_joint_anatomy001.jpg

Ligaments of Elbow

ELBOW= hinge jt. Humerus: medial & lateral epicondyles, lateral condyle (capitulum), medial condyle (trochlea) -coronoid fossa -olecranon fossa Radius: -head, -tuborosity (biceps insertion) Ulna: -olecranon, -coronoid process - tuborosity (brachialis insertion) Fibrous capsule of the elbow joint. Strong collateral ligaments on each side. - Annular ligament encircles radial head

Triceps tendon Cubital tunnel syndrome

Muscles

Anterior arm Mainly Flexors BBC Brachialis Biceps Coraco brachialis Nerve Supply! Musculo Cutaneous Nerve

Posterior arm

Arm muscles http://www.highfive.me.uk/Resources/Anatomy/UpperArm/All.JPG

Cubital Fossa Surface Anatomy

Cubital fossa. Roof of cubital fossa. – anterior to the elbow -superficial veins: Median Cubital v. Cephalic v. Basilic v. Floor of cubital fossa. - Brachialis m - Supinator m - Radial nerve: deep branch (muscular, articular) superficial branch (cutaneous) Cubital fossa. – anterior to the elbow Boundaries: Epicondyles * (medial & lateral) - Pronator Teres Brachioradialis Contents: - Brachial a (radial / ulnar aa) - Biceps tendon & aponeurosis - Median n

Cubital Fossa Identify the borders of the cubital fossa: Brachioradialis m. laterally, Pronator teres medially and Brachialis which forms the floor of the fossa.

Cubital Fossa Contents Lateral to medial, the Bicipital tendon, the Brachial artery, and the Median nerve. The Brachial veins may be removed. You should look for the branching of the Brachial a. into Radial and Ulnar aa. and the Superficial branch of the Radial nerve running underside Brachioradialis muscle http://virtualhumanembryo.lsuhsc.edu/hs2412/laboratory/New_Lab_Guide/UpperLimb/Anterior%20forearm%201.html

Course of nerves in anterior and posterior arm.

Brachial Plexus Randy Travis Drinks Cold Tea

Axilallry N and Radial N Axillary nerve supplies Deltoid muscle Teres Minor Skin over deltoid Axillary nerve Radial Nerve Radial Nerve Supplies all the extensors + Brachio Radialis Posterior View

Median Nerve Supplies all the flexors of the arm except Flexor Carpi Radialis (Radial N) Flexor Carpi Ulnaris (Ulnar N) Medial ½ of FDP

Radial Nerve

Brachial Plexus

Links http://www.bing.com/images/search?q=posterior+forarm&form=QBIR&qs=n#focal=703fca7fd9d811d3076749b41e801de4&furl=http%3A%2F%2Fwww.anatomyfacts.com%2FMuscle%2FMuscleBone_files%2Fimage019.gif http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/musculoskeletal_system/forearm_questions.html www.getbodysmart.com http://www.becomehealthynow.com/body/muscles/atlas/anconeus.shtml

References Google images Netter Anatomy Atlas University of Washington website Bing Images Yahoo Images http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/images/wrist_ant.jpg http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/musculoskeletal_system/forearm_questions.html http://iris3.med.tufts.edu/dentgross/labguide/SupHand2R.jpg http://www.dasd.k12.pa.us/57592111818543/lib/57592111818543/Muscles_of_the_Posterior_Trunk,_Shoulder_and_Arm_Numbered.jpg http://www.yamli.com/#t=image&q=axillary%20nerve&s=120&safe=1&isz=all&sm=ltr

1. Deltoid: scapula/clavicle to humerus- abducts arm 2. Levator scapulae: C-vertebrae to scapula- elevates scapula 3. Infraspinatus: lower scapular spine to humeral head- lateral rotation of humerus 4. Teres major: scapula to anterior humerus- medial rotation of humerus' 5. Teres Minor: scapula to posterior humerus- lateral rotaion of humerus 6. Supraspinatus: upper scapular spine to humeral head- abducts humerus 7. Trapeziues: Vertebrae/Occipital to scapula/clavicle- abduct arm, rotate, abduct scapula 8. Rhomboidius: T-vertebrae to scapula- raise/adduct scapula 9. Latissimus Dorsi: T-, L-, S- vertebrae to humerus- extend/adduct arm 10. Biceps: scapula to radius- flex elbow 11. Triceps: scapula/humerus to ulna- extend elbow 12. Pronator: Medial humerus to radius- medial rotation of forearm (pronation) 13. Flexor carpi radialis: medial humerus to 2nd/3rd metacarpal- flex/abduct hand 14. Flexor Digitorum: medial humerus/ulna to phalanges- flex fingers 15. Extensor carpi ulnaris: lateral humerus to 5th metacarpal- extend/adduct hand 16. Extensor digitorum: lateral humerus to phalanges- extend fingers 17. Extensor carpi radialis: lateral humerus to 2nd/3rd metacarpal- extend/adduct hand