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Arm and Cubital Fossa

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Arm and Cubital Fossa Two Minute History M1 - Anatomy Dissection: • 300 B.C Arm and Cubital Alexandrian Egypt: King Ptolemy I, its ok Fossa to dissect cadavers of executed, mummies etc… •Herophilus “Father of Anatomy” accused by a rival of DG Simpson, Ph.D. dissecting 600 criminals…..live criminals VCU Department of Anatomy •1300 AD Europe Pope Boniface VIII edict to stop dissection to reduce the flow of bodies “parted out and boiled” from the crusades. Unclear if this is broad ban or very narrow. 1 2 Dissection: Dissection: •1540 parliament passes “The United Company of Barbers and •1700’s with the expansion of medical Surgeons, dissect 4-6 executed schools cadavers are used as tuition criminals/yr (not enough even then) •Competition is very high and medical •1600’s Britain. The executed are schools actively advertise that training includes dissections etc.. dissected in public as punishment • 1628 William Harvey •1828 London had 10 full time (cardiovascular fame). Autopsy & 200 part time body snatchers (“seasonal work” at 312 bodies/yr) of live and dead…. Medicine expands and shortages develop •Inventions to foil grave robbers Harvey dissects father and sister •1828 Robert Knox….and the rest • 1740’s Lots of private medical is amazing history. schools competing for students, William Hogarth The Reward of Cruelty 3 4 market forces develop 1750-1751 Dissection: •Burke was hanged: 25,000 watched. Hare was granted immunity as crowd called “Burke Hare” •1828, knock on the •Burke dissected: 30,000 came to see the open lab door, Knox’s assistant purchases a cadaver •Knox hung in effigy: •William Hare and wife had a death in their boarding house Parliament asks the question can and used the body to pay debt owed on the room we teach from models/drawings ? •William Burke and William Hare realize the financial potential Burke’s death mask •Drunk is smothered in the house and sold + 13 others (too lazy or too dumb to dig the already newly dead instead of killing? ) •Mary Patterson…… 5 6 Upper Stiff: The curious lives of human cadavers Extremity by Mary Roach, 2003 7 8 Upper Extremity Osteology:Humerus Anterior Surface Arm Head •Anterior Compartment Anatomical neck •Posterior Compartment Greater & Lessor tubercle Cubital Fossa Intertubercular goove Forearm Surgical neck •Anterior Compartment Trochlea & Capitulm •Posterior Compartment Coronoid & radial fossa 9 Medial & Lateral epicondyles 10 Osteology:Humerus Anterior Posterior Surface Posterior Head Anatomical neck Greater tubercle Surgical neck Spiral groove Olecranon fossa Lateral & Medial Epicondyle 11 12 Osteology:Ulna Forearm Osteology: Major weight bearing bone Radius at the elbow joint. Major weight bearing bone of the wrist •Proximal the radial notch articulates with head of radius, allows supination and pronation •Proximal head articulates with •Trochlear notch articulates with the capitulum (“little head”) of trochlea of humerus, mediates the humerus. extension •Proximal head also articulates •At extension, olecranon fits into laterally with radial notch of ulna olecranon fossa of humerus •Head and neck are distal 13 14 Interosseous membrane Transmits forces from ulna (proximal) to radius (distal). Very tough connective tissue. Colles’ fracture, a Landmark for several fracture of the other structures, stay distal radius tuned. with forearm in extension http://www.eatonhand.com/hw/hw020.htm http://www.physioroom.com/injuries/arm/colles_fracture_full.shtml http://orthoinfo.aaos.org/fact/thr_report.cfm?thread_id=150&topcategory=Arm 15 16 Elbow •Humeroulnar articulation Weight bearing joint •Radial head Articulation Articulation articulates with of ulna and of radius and trochlea capitulum capitulum & ulna •Allows supination & pronation 17 18 Articular Capsule Radial Head Subluxation: Nurse Maid’s Syndrome Dislocation of the head of the radius from the annular ligament Radial, ulnar & annular ligaments. 19 http://www.tcusportsmedicine.com/elbow.htm20 C5 Upper Extremity Superior Trunk Lateral Cord Musculocutaneous Arm C6 •Anterior Compartment Terminal Nerves Median Nerve •Posterior Compartment C7 Middle Trunk of the Anterior Division Cubital Fossa C8 Forearm Inferior Trunk Medial Cord Ulnar Nerve •Anterior Compartment T1 •Posterior Compartment Robert Taylor.. Drinks... Cold.... Beer 21 22 Anterior Compartment Anterior Compartment Superficial •Bicep Long Head •Bicep Long Head Origin: Supraglenoid Tubercle •Bicep Short Head Actions • Flex elbow •Supinator of forearm • Flex, adduct & medially rotate shoulder 23 24 Anterior Compartment •Bicep Long Head Insertion: Radial Tuberosity & Aponeurosis 25 26 Anterior Compartment Anterior Compartment •Bicep Short Head •Bicep Short Head Origin: Insertion: Coracoid Process Radial Tuberosity & Aponeurosis 27 28 Coracobrachialis DeepSuperficial Anterior Anterior Compartment Compartment Origin: Coracoid process Insertion: Medial humerus •Coracobrachialis Adducts & Flexes shoulder •Brachialis Flexes elbow 29 Adducts & Flexes shoulder30 Brachialis Coracobrachialis Origin: Shaft of humerus Insertion: Ulnar tuberosity Brachialis Flexes elbow 31 32 C5 Upper Extremity Superior Trunk Terminal Nerves of the Posterior Division Arm C6 Axillary Nerve •Anterior Compartment Posterior division •Posterior Compartment C7 Middle Trunk Posterior Cord Radial Nerve Cubital Fossa C8 Forearm Inferior Trunk •Anterior Compartment T1 •Posterior Compartment Robert Taylor. Drinks... Cold….. Beer 33 34 Posterior Compartment Posterior Compartment •Triceps-3 Heads •Triceps-Long Head Long, Medial, & Lateral Origin: Infraglenoid tubercle Insertion: Olecranon process • (Anconeus) 35 36 Posterior Compartment Posterior Compartment •Triceps-Lateral Head •Triceps-Medial Head Origin: posterior humerus Origin: posterior humerus lateral to spiral groove below the spiral groove Insertion: Olecranon process Insertion: Olecranon process 37 38 Angiology Axillary Artery Tricepts Actions •Supreme Thoracic •Thoracoacromial Pectoral •Long head extends Deltoid Clavicular and adducts shoulder Acromial •As a group it is the •Lateral Thoracic extensor of elbow •Anterior Humeral •Posterior Humeral •Subscapular Circumflex scapular Thoracodorsal 39 40 Angiology Neurovascular Relationships Axillary Brachial Profunda Brachia Anterior Posterior Compartment Compartment 41 42 Surgical Neck Fracture Mid Shaft Fracture Potential damage to the Potential profunda artery & radial damage to the nerve anterior and posterior circumflex arteries 43 44 Upper Extremity Cubital Fossa Brachioradialis Arm Borders: •Anterior Compartment •Line connecting •Posterior Compartment medial & lateral epicondyles of humerus Cubital Fossa Pronator teres •Medial: Pronator Forearm teres •Anterior Compartment •Lateral: Brachioradialis •Posterior Compartment 45 46 Cubital Fossa: BAN Clinical Considerations •Cephalic & Basilic Vein Drain dorsum of hand & used for venipuncture B=Biceps tendon A=Brachial Artery N=Median Nerve •Brachial Artery Anomalous superficial ulnar or radial branch 47 48 Name 18 Muscle Attachments 10 Minute Break 49 50.
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