Brachium, Cubital Fossa and um

8/8/2019 Brachium, Cubital Fossa and um

1/24

Brachium, Cubital Fossa and

Antebrachium

(The Upper Extremity)

H. Keith Brown

GA PCOM

Joints and hand are covered in another lecture.


2/24

UE Objectives Understand / describe the rotator cuff. Identify major features of UE bones and their

articulations at glenohumeral, radioulnar, carpaljoints.

Identify muscles, demonstrate their actions, citeinnervation and attachments.

Describe vessels and nerves pathway (routes) andpoints of vulnerabilities and their surface

anatomy landmarks. Correlate specific nerve lesions with upper

extremity paresis and / or paresthesias(dermatomes).


3/24

Readings

Moores 4th pp. 405- 459

Gilroys Atlas pp. 252-352

Netters 5th plates 400-468


4/24

Actions at joints are what really count

so for organization, lets start with:

Shoulder (Humerus)

Humeral Abduction

Adduction

Internal rotation

External rotation

Flexion Extension

Circumduction


5/24


6/24


7/24

For each action, be able to cite muscle group,

major nerve(s) and cord level(s).

Humeral abduction- (deltoid, axillaryC5); (supraspinatus,suprascapularC5).

Humeral adduction- (teres major- lower subscapularC6);(subscapularis- upper and lower subscapularC6);

( pectoralis major- lateral pectoralC6); (latissimus-thoracodorsal C7).

Internal /medial rotation- (teres major, subscapularis).

External / lateral rotation- (teres minor lowersubscapularC6); (infraspinatus- suprascapularC5.

Extension- (

Flexion- (choriocobrachialis,musculocutaneous C6); (ant.deltoid axillaryC5); (pectoralis major- lateral pectoralC6).

Circumduction- All the above.


8/24

Elbow (ulna)

Flexion- (brachialismusculocutaneous C6);

( bicepsmusculocutaneous C6); (brachioradialis

radialC5,6). Extension- (triceps radialC5,6)

Supination- (biceps ); (supinator radialC7).

Pronation- ( Pronator teresmedian C6,7);(pronator quadratusmedian C7,8)


9/24


10/24

Wrist (Carpus)

Flexion- (flexor carpi radialismedian C 6,7);

( flexor carpi ulnaris ulnarC 7,8).

Extension- (extensor carpi radialis radialC6,7);(extensor carpi ulnaris radialC6,7)

Adduction

Abduction

CircumductionNote: Flexors are from medial epicondyle,

Extensors are from lateral epicondyle


11/24

Digits ( from antibrachial muscles)

Flexion- (flexor digiti superficialismedian

C 6,7,8); (flexor digiti profundusmedian

C6,7,8). (FDP medial by ulnar) Extension- ( extensor digiti radialC 6,7,8).

Abduction of pollis- (abductor pollicis radial

C 7,8).Palmaris muscle is superficial, inserts in palmar

aponeurosis. Median nerve.


12/24

Arterial Blood Supply

Axillary

Brachial

Radial

Ulnar

Interosseous


13/24

Nerve Pathways

Be able to narrate the paths of the five major

nerves from brachial plexus to their targets

including points where they are vulnerable to

injury or compression.

Cite common signs and symptoms of UE nerve

injuries.

On surface anatomy, identify dermatomes and

cutaneous nerve distributions.


14/24

Musculocutaneous Nerve C5-7

Flexion of arm and forearm, supination.

Sensation of lateral forearm, joint capsule of

elbow. From lateral cord of brachial plexus -> thru the

coracobrachialis-> between biceps and

brachialis to lateral forearm skin and joint

capsule of elbow (sensory).


15/24

Axillary Nerve C5,6

Abduction ( deltoid) and external rotation (

teres minor) of arm.

Cutaneous sensation over lateral deltoid. From posterior cord of brachial plexus ->

posterior to the upper humerus and into the

quadrangular space.


16/24

Radial nerve C5-T1

Extension of the forearm, extension of carpus anddigits, supination, abduction of pollis.

Sensation for elbow joint capsule; interosseus

membrane, wrist, MP joints; posterio-lateral arm,forearm and dorsum of hand.

From posterior cord between long head of tricepsand humerus, posterior to humerus in radialgroove to radial tunnel and anterior to lateralepicondyle, deep to brachioradialis, deep branchpenetrates supinator, superficial continues tohand and becomes cutaneous.


17/24


18/24

The Cubital Fossa

Region anterior to humero-ulnar and humero-

radial joints.

Contents include: cubital vein, brachial artery,bicipital tendon, bicipital aponeurosis (Le

grace-a-dieu tendon) brachialis tendon,

median nerve and radial nerve.

Know this region well ! Be able to draw it,

describe it and explain it.


19/24

Median Nerve C6-T1

Flexion of fingers and lateral /radial flexion ofwrist; pronation, thenar muscles and first twolumbricals.

Sensation to lateral 2/3rds of the palm and first 3 fingers.

From medial and lateral cords through axilla to liebetween the brachialis and biceps then pass intothe cubital fossa penetrating the pronator teresand contiuing between the superficial and deepflexors digitorum to the carpal tunnel to thehand.


20/24


21/24

Ulnar Nerve C7-T1

Flexion of ulnar / 5th finger / pinkie; most intrinsicmuscles of the hand.

Sensation from the medial 1/3rd of the hand

( palmar and dorsal aspects); joint capsules.

Medial cord of brachial plexus following the brachialartery, then passing posterior to the medial epicondyle

and passing deep to the FCU to the wrist where itenters the palmer aspect via Guyons canal.


22/24

Venous Drainage

Basilar tributaries on medial / volar forearm

(over flexor compartment) joins deep veins

just above medial epicondyle to form brachial

vein.

Cephalic tributaries on lateral / dorsal forearm

continues over biceps and deltoid to join the

subclavian vein.


23/24

Lymphatics

Cubital and Axillary nodes.

Right vs left ?


24/24

Documents

Brachium, Cubital Fossa and um