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Tell You Heart That the Fear of Suffering Is Worse Than Suffering Itself. and No “Tell you heart that the fear of suffering is worse than suffering itself. And no heart has ever suffered when it goes in search of its dream.” Objectives: At the end of the lecture, students should: Describe the attachments, actions and innervations of: o Biceps brachii o Coracobrachialis o Brachialis o Triceps brachii Demonstrate the following features of the elbow joint: o Articulating bones o Capsule o Lateral & medial collateral ligaments o Synovial membrane o Demonstrate the movements : flexion and extension of the elbow. o List the main muscles producing the above movements. o Define the boundaries of the cubital fossa and enumerate its contents. An aponeurotic sheet separating various muscles of the upper limbs, The Arm including lateral and medial humeral septa. The lateral and medial intermuscular septa divide the distal part of the arm into two compartments: Anterior (Also known as flexor Posterior (Also known as extensor compartment) compartment) shoulder Lateral Medial intermuscular intermuscular septum septum arm Neurovascular skin bundle elbow Fascia Humerus Posterior Anterior Anterior Fascial compartment Contents Radial and ulnar pass through the anterior compartment before they enter the posterior compartment • Muscles: Biceps brachii, Coracobrachialis &Brachialis. • Blood Vessels: Brachial artery & Basilic vein. Near the • Nerves : Musculocutaneous, Median, *Radial &* Ulnar. biceps muscle Medial side Lateral side Extra Muscles of the Anterior Compartment Name of Muscle Biceps brachii *Coracobrachialis **Bracialis Has Two Heads: - Tip of the coracoid - Front of the lower half of Long Head (lateral head): From process of the scapula the Humerus. the Supraglenoid Tubercle of (with short head of the the scapula (Intracapsular) biceps brachii) inside the capsule of shoulder joint Short Head: The Tip of the Coracoid Process of the scapula. -The 2 heads join in the middle of the arm *Coracobrachiali s is a small muscle **Brachialis lies on humerus )نايمة عليها ) Name of Muscle Biceps brachii Coracobrachialis Bracialis - Into the posterior part of - Middle of the Medial side of - Anterior surface of Coronoid the Radial Tuberosity (by a the shaft of the humerus Process of the Ulna common tendon). - Into the deep fascia of the medial aspect of the foreman throuhg Bicipital Aponeurosis. - Musculocuteneous - Musculocuteneous - Musculocuteneous - Radial - Strong supinator of the - Flexor and weak adductor - Strong flexor of the forearm forearm. of the arm (or shoulder joint). (elbow). ( used in screwing) - Doesn’t act on the forearm because it doesn’t pass to the - Powerful flexor of Elbow. elbow “insertion in humerus” - Weak flexor of Shoulder. Note: • It is called Biceps because it has 2 heads. • It is called brachii because it is in the arm. • Brachialis is under the Biceps Posterior Fascial Compartment Contents Branch from brachial artery Nerves: Radial & Ulnar Vessels : Nerves: Muscles : Profunda brachii & Radial & Ulnar Triceps brachii Ulnar collateral arteries Origin: Three heads: Insertion: Long Head from infrglenoid tubercle of the scapula Common tendon inserted Action: Nerve Strong Lateral Head from the upper half of the posterior into the upper supply : Extensor of the surface of the shaft of humerus above the spiral groove surface of the Radial nerve olecranon elbow joint Medial Head from the lower half of the posterior process of ulna surface of the shaft of humerus below the spiral groove Cubital Fossa Cubital fossa: is a triangular depression that lies in the front of the elbow. (2) Boundaries of cubital fossa 1/Base: (1) line drawn 4/Roof: skin,superficial & through the two deep fascia and (4) bicipital (5) (1) epicondyles of humerus aponeurosis. (4) By cross section, the arrangement of (2) the layers will be “anterior to (3) posterior”: skin —>superficial fascia —> deep fascia —> bicipital aponeurosis . (1) (6) (5)Brachialis 2/Laterally: (2) 5/Floor: medially and (6) supinator Brachioradialis muscle (3) laterally 3/Medially: (3) pronator teres muscle Content of Cubital fossa 1- Median Nerve 2- Brachial Artery Cubital fossa content from lateral to medial: 3-Biceps brachii -1Deep branch of Radial Nerve. -2Biceps brachii Tendon. tendon. -3Brachial Artery. -4Median Nerve. For memorizing: 4-Deep branch of Really Need Beverage To Be At My Nicest. medial to lateral: radial nerve. Brachial artery passes through cubital fossa ( that’s why we can measure Piercing the blood pressure at cubital fossa). Cubital fossa contents from supinator muscle ELBOW Joint Elbow joint is Uniaxial, Synovial Hinge joint Articulation Trochlea and capitulum Capitulum of the humerus above with Trochlear notch Trochlea of ulna and the head of radius below The articular surfaces are covered with articular (hyaline) cartilage. Capsule Anteriorly: attached Posteriorly: attached Above Below Above Below To the humerus To the margin of To the margins of To the upper along the upper the coronoid the olecranon fossa margin and sides of margins of the process of the ulna of the humerus. the olecranon coronoid and radial and to the *anular process of the ulna fossa and to the ligament, which and to the anular front of the medial surrounds the head ligament. and lateral of the radius. epicondyles. *Surrounds the head of radius then attaches to ulna Anterior Posterior Synovial membrane *Remember from joint lecture: Synovial membrane produce synovial fluid to minimize the friction of the joint Lines the inner surface of the 1 capsule *للتذكير: Fossa هي جزء منخفض من العظم يستقبل جزء بارز من عظم آخر. covers fatty pads in the floors In humerus: 2 of the coronoid fossa, radial Anterior: fossa, and olecranon fossa. Coronoid fossa , radial fossa Posterior: Olecranon fossa. Is continuous below with 3 synovial membrane of the *superior and inferior Very important! radioulnar joints *superior radioulnar joint cause supination and pronation of forearm Ligaments Lateral ligament Medial ligament Radial collateral Ulnar collateral Triangular in shape stronger Cord-like weaker Fan-like Base Apex Anterior band Transverse band Posterior band Attached to the upper Attached to the between medial Passes between between medial Epicondyle of the Epicondyle of the margin of the annular lateral Epicondyle the Anterior humerus and and the posterior humerus and ligament of the radius of the humerus coronoid process of olecranon process of band ulna ulna Relation Relation يعني نوصف المفصل ايش الي قريب منه من 4 جهات مثل الجدول الي تحت Anterior Posterior medial lateral - Brachialis - Triceps muscle - Ulna nerve - Common (Under the medial extensor - Tendon of - Small bursa epicondyle, directly tendon. biceps intervening related to the skin (Originating from “subcutaneous” ) lateral epicondyle) - Brachialis artery - Supinator - Median nerve Bursea around elbow joint: Considered as the largest nerve that is - Subtendinous olecranon bursa. unprotected by muscles or bones. - Subcotanous olecranon bursa. لهذا السبب عند حدوث ضربة عند الكوع نشعر Bursa: Sac filled with synovial fluid بألمها وكأنها كهرباء countering friction at a joint Movement Flexion Extension is limited by the anterior surfaces of is limited by the tension of the the forearm and arm coming into anterior ligament and brachialis contact. muscle. The joint is supplied by branches from : Median Ulnar Musculocutaneous Radial nerves Carrying Angle • Carrying angle is the angle between the long axis of the extended forearm and the long axis of the arm. • It opens laterally. 1650-1700 • It is 170 degrees in male and 167 degrees in females. • It disappears when the elbow joint is flexed. • It allows The forearms to clear the hips in swinging movements during walking and is important when carrying objects. Articulation and applied anatomy of elbow joint The elbow joint is stable because of Wrench-shaped articular surface of the olecranon and Strong medial and lateral ligament pulley-shaped trochlea of humerus Elbow dislocation are common & most are posterior. Posterior dislocation Posterior dislocations of the usually follows falling joint are common in children on the outstretched because the parts of the bones hand. that stabilize the joint are incompletely developed. Articulation and applied anatomy of elbow joint The elbow joint is stable because of Wrench-shaped articular surface of the olecranon and Strong medial and lateral ligament pulley-shaped trochlea of humerus 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 1/contraction of the 2/ valgus stress at flexor muscles as in the elbow fall on an outstretched posterior elbow direct blow hand with the elbow in full dislocation extension Muscle: Compartment: Origin: Insertion: Nerve supply: Action: Anterior compartment Two heads: - In the Posterior part of the Musculocutaneous - Strong flexor of the Biceps brachii - Long head: From (flexor compartment) radial tuberosity. elbow. supraglenoid tubercle of - Into the deep fascia of the scapula the medial aspect of the - Weak flexor of the - Short head: from the tip of the coracoid process forarm through bicipital shoulder. of the scapula aponeurosis - Supinator of the The two heads are joined in the middle of the arm forearm . Coracobrachialis Anterior compartment from the tip of the Middle of the medial Musculocutaneous - flexor. (flexor compartment coracoid process of the side of the shaft of the - Weak adductor
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