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Home , Infraglenoid tubercle, Radial fossa, Supraglenoid tubercle

Arm and

Musculoskeletal block- Anatomy-lecture 7

Editing file Color guide : Objectives Only in boys slides in Blue Only in girls slides in Purple ✓ Describe the attachments, actions and innervations of: important in Red a. brachii Doctor note in Green b. Coracobrachialis Extra information in Grey c. Brachialis d. brachii ✓ Define the boundaries of the cubital and enumerate its contents. ✓ Demonstrate the following features of the elbow joint: a. Articulating b. Capsule c. Lateral & medial collateral ligaments d. Synovial membrane ✓ Demonstrate the movements; flexion and extension of the elbow. ✓ List the main muscles producing the above movements. ✓ Define the boundaries of the cubital fossa and enumerate its contents. Shoulder THE : Posterior

An aponeurotic sheet separating various Anterior muscles of the upper limbs, including lateral view A R M and medial humeral septa. view Elbow

- The lateral and medial intermuscular septa Arm divide the distal part of the arm into two compartments Lateral Medial intermuscular intermuscular septum septum

Neurovascular skin Anterior Posterior bundle (flexor compartment) (extensor compartment) Fascia

Humerus 1-Anterior Fascial Compartment:

Note: the radial and ulnar nerves begin in the anterior compartment then pierce the intermuscular septum and enter the posterior compartment

Radial

Brachialis Ulnar Median Biceps Basilic vein brachii

Brachial Musculocutaneous artery Coracobrachialis 2. Blood 3. Nerves 1. muscles vessels Muscles Of Anterior Compartment Muscles Biceps Brachii Coracobrachialis Brachialis

-Long Head (lateral head) from of Tip of the coracoid Origin (intracapsular) process of scapula (with Front of the lower half -Short Head from the tip of of scapula short head of biceps of humerus -The two heads join in the middle of the arm brachii)

-Into the posterior part of the . Middle of the medial Anterior surface of Insertion -Into the deep fascia of the medial aspect of the side of the shaft of the coronoid process of through bicipital aponeurosis humerus

Nerve -Musculocutaneous Musculocutaneous (medial part) Supply -Radial (lateral part)

-Strong supinator of the forearm -Flexor Strong flexor of the used in screwing Powerful -Weak adductor of the Action -flexor of elbow forearm -Weak flexor of shoulder arm

Pictures 2-Posterior Fascial Compartment:

1. Muscles : Triceps brachii. 2. Vessels : - Profunda brachii(a branch from brachial artery). -Ulnar collateral arteries. 3. Nerves : -Ulnar nerve. -Radial nerve. Triceps brachii: ● Long head: from of the scapula.(remember the origin of the long head of the bicep head is supraglenoid tubercle)

● Origin lateral head: from the upper half of the posterior surface of the shaft of the humerus above the spiral groove.

● Medial head: from the lower half of the posterior surface of the shaft of the humerus below the spiral groove.

● Insertion Common tendon inserted into the upper surface of the process of ulna . Nerve ● Radial nerve. Supply

Action ● Strong extensor of the elbow joint. Cubital fossa: is a an area of transition between the anatomical arm and the forearm, located as triangular depression on the anterior surface of the elbow joint. It is a triangular depression that lies in front of the elbow.

● Base: Line drawn through the two epicondyles of humerus.

● Laterally: Brachioradialis.

Boundaries ● Medially: Pronator teres.

● Roof: Skin, superficial & deep fascia and bicipital aponeurosis.

● Floor: Brachialis Medially and supinator Laterally.

Contents 1. Median nerve. From the) 2. Brachial artery divides into radial & ulnar arteries. Medial to the 3. Biceps brachii tendon. (Lateral side 4. Deep branch of radial nerve. Only found in boys slide Cubital fossa:

Clinical relevance:

● The brachial pulse can be felt by palpating immediately medial to the biceps tendon in the cubital fossa.

● The median cubital vein is located superficially within the roof of the cubital fossa.

● It connects the basilic and cephalic veins. And ce be accessed easily-this makes it a common site for venipuncture. ELBOW JOINT:

It is the joint connecting the upper arm to the forearm, and is classed as an Uniaxial, Synovial Hinge Joint.

Consists of two separate Articulations:

Above: Trochlea and the capitulum of the Below: of the ulna and humerus. the head of the .

The articular surfaces are covered with articular (hyaline) cartilage CAPSULE:

● The elbow joint has a Capsule Above Below Picture capsule enclosing the joint. This in itself is strong and To the humerus To the margin of the along the upper coronoid process of fibrous, strengthening the margins of the the ulna and to the joint. coronoid and annular ligament, Anteriorly and to which surrounds the Attached the front of the head of the radius. medial and lateral ● The is epicondyles thickened medially and laterally to form collateral ligaments, which stabilize To the margins of To the upper margin the flexing and extending the olecranon and sides of the fossa of the olecranon process of motion of the arm. Posteriorly humerus the ulna and to the attached annular ligament. Ligaments of Elbow Joint:

Lateral ligament (radial collateral ligament) Medial ligament (ulnar collateral ligament)

Anterior Between Medial epicondyle and the Shape Triangular strong cord-like band coronoid process of ulna.

attached to the Lateral epicondyle of Apex Posterior Between Medial epicondyle and the humerus. weaker fan-like band olecranon process of ulna.

attached to the upper part of the Transverse Passes between the anterior and Base annular ligament. band posterior bands.

Coronoid process Synovial Membrane:

- This lines the inner surface of the capsule and covers fatty pads in the floors of the coronoid, radial, and .

- Is continuous below with synovial membrane of the superior radioulnar joint “Contains the synovial fluid” Relation:

Anterior Posterior Lateral Medial ● Brachialis ● Triceps muscle ● Common extensor ● Ulnar nerve ● Tendon of biceps ● Small bursa tendon (attached to “ Considered the largest ● Median nerve intervening Lateral epicondyle of unprotected nerve by ● Brachial artery the humerus) muscle or ”.

● Supinator Bursa: sac filled with synovial fluid countering friction at a joint

Bursae around the elbow joint: ● Subcutaneous olecranon bursa ● Subtendinous olecranon bursa BURSA: Only found in boys slide

● A bursa is a membranous sac filled with synovial fluid.

● It acts as a cushion to reduce friction between the moving parts

of a joint, limiting degenerative damage.

● There are many bursae in the elbow, but only a few have clinical

importance :

Subtendinous bursa Subcutaneous (olecranon) between the olecranon and the bursa tendon of the triceps brachii, between the olecranon and the reducing friction between the two overlying connective tissue structures during extension and (implicated in olecranon bursitis). flexion of the arm. Movement:

Extension Flexion

Is limited by the tension of the Is limited by the anterior surfaces of anterior ligament (medially) and the the forearm and arm coming into brachialis muscle. contact.

Nerves innervation by branches from the:

Median Nerve Radial Nerves Musculocutaneous Nerve Ulnar Nerve

Blood supply:

The arterial supply to the elbow joint is from the cubital anastomosis, which includes recurrent & collateral branches from the deep brachial arteries. Carrying Angle:

- And is important when carrying objects Articulations and applied anatomy:

The elbow joint is stable because of the: 1. Wrench-shaped articular surface of the olecranon and the pulley-shaped . 2. Strong medial and lateral ligaments.

Caused by Illustration

Dislocation

● Elbow dislocations are common & most are posterior. ● Posterior dislocation usually follows falling on the outstretched . ● Posterior dislocations of the joint are common in children because the parts of the bones that stabilize the joint are incompletely developed.

Avulsion of the epiphysis

● of the medial epicondyle is also common in childhood because the medial ligament is much stronger than the bond of union between the epiphysis and the diaphysis. ● They are usually a result from an avulsion (pull off) injury caused by : a valgus stress at the elbow and contraction of the flexor muscles as in : 1. fall on an outstretched hand with the elbow in full extension 2. posterior elbow dislocation 3. direct blow

*The radius/ulna is dislocated posteriorly NOT the humerus *valgus : a deformity involving oblique displacement of part of a limb away from the midline. Summary Team 435 MCQs

Question 1: Which of the following is not a part of the flexor compartment ? Question 5: What nerve supplies the triceps brachii ? A. Biceps A. Median B. median nerve B. Ulnar C. brachial artery C. Axillary D. triceps D. Radial Question 2: What is the muscle that is responsible in “screwing” ? Question 6: Brachialis origin is in front of the ………. half of humerus ? A.coracobrachialis A.middle B.biceps brachii B.lower C.brachialis C.upper D.triceps Question 7: What is the origin of coracobrachialis ? Question 3:What is the origin of the short head of the biceps brachii? A. supraglenoid tubercle of scapula A. Coracoid process B. Tip of the coracoid process of scapula B. Supraglenoid tubercle C. Anterior surface of coronoid process of ulna C. Infraglenoid tubercle D.Middle of the medial side of the shaft of the humerus D.Medial border of scapula Question 8: Which of the following is bi-innervated? Question 4:The lateral epicondyle of the humerus is attached to which part of the A.Biceps brachii elbow ligaments? B. Brachialis A. apex C. Coracobrachialis B. Base D.triceps

Answers: Q1.D- Q2.B -Q3.A -Q4.A- Q5.D- Q6.B-Q7.B- Q8.B Girls team : Team members ● Ajeed Al Rashoud ● Taif Alotaibi Boys team: ● Noura Al Turki ● Amirah Al-Zahrani ● Khalid AL-Dossari ● Alhanouf Al-haluli ● Naif Al-Dossari ● Sara Al-Abdulkarem ● Faisal Alqifari ● Rawan Al Zayed Special thank for ● Salman Alagla ● Razan Al Zohaifi Anatomy team 436 ● Ziyad Al-jofan ● Renad Al Haqbani ● Suhail Basuhail ● Nouf Al Humaidhi ● Ali Aldawood ● Fay Al Buqami ● Khalid Nagshabandi ● Jude Al Khalifah ● Mohammed Al-huqbani ● Nouf Al Hussaini ● Jehad Alorainy ● Alwateen Al Balawi ● Khalid AlKhani ● Rahaf Al Shabri ● Omar Alammari ● Danah Al Halees ● Haifa Al Waily ● Rema Al Mutawa Good luck Team leaders ● Amirah Al Dakhilallah ● Maha Al Nahdi ● Abdulrahman Shadid Give us your feedback: ● Renad Al Mutawa ● Ateen Almutairi ● Ghaida Al Braithen =This lecture done by ● Reham Yousef