Topic: Antecubital fossa

The cubital fossa, chelidon, or elbow pit is the triangular area on the anterior side of the upper
limb between the arm and forearm of a human or other hominid animals. It lies anteriorly to
the elbow (Latin cubitus) when in standard anatomical position.

Boundaries
superior (proximal) boundary – an imaginary horizontal line connecting the medial
epicondyle of the humerus to the lateral epicondyle of the humerus

medial (ulnar) boundary – lateral border of pronator teres muscle originating from the medial
epicondyle of the humerus.

lateral (radial) boundary – medial border of brachioradialis muscle originating from the
lateral supraepicondylar ridge of the humerus.

apex – it is directed inferiorly, and is formed by the meeting point of the lateral and medial
boundaries

superficial boundary (roof) – skin, superficial fascia containing the median cubital vein, the
lateral cutaneous nerve of the forearm and the medial cutaneous nerve of the forearm, deep
fascia reinforced by the bicipital aponeurosis (a sheet of tendon-like material that arises from
the tendon of the biceps brachii)

deep boundary (floor) – brachialis and supinator muscles

Contents
The cubital fossa contains four main vertical structures (from lateral to medial):

The radial nerve is in the vicinity of the cubital fossa, located between brachioradialis and
brachialis muscles. It is often but not always considered part of the cubital fossa.

The biceps brachii tendon

The brachial artery. The artery usually bifurcates near the apex (inferior part) of the cubital
fossa into the radial artery (superficial) and ulnar artery (deeper)

The median nerveThe ulnar nerve is also in the area, but is not in the cubital fossa; it occupies
a groove on the posterior aspect of the medial epicondyle of the humerus.

Several veins are also in the area (for example, the median cubital vein, cephalic vein, and
basilic vein) but these are usually considered superficial to the cubital fossa, and not part of
its contents.

From lateral to medial, the order of the contents within the cubital fossa can be described by
the acronym TAN: tendon, artery, nerve
Clinical aspects
Like other flexion surfaces of large joints (groin, popliteal fossa, armpit and essentially the
anterior part of the neck), it is an area where blood vessels and nerves pass relatively
superficially, and with an increased amount of lymph nodes.

During blood pressure measurements, the stethoscope is placed over the brachial artery in the
cubital fossa. The artery runs medial to the biceps tendon. The brachial pulse may be palpated
in the cubital fossa just medial to the tendon.

The area just superficial to the cubital fossa is often used for venous access (phlebotomy) in
procedures such as injections and obtaining samples for blood tests. A number of superficial
veins can cross this region. It may also be used for the insertion of a peripherally inserted
central catheter.

Historically, when (venous) blood-letting was practiced, the bicipital aponeurosis (the ceiling
of the cubital fossa) was known as the "grace of God" tendon because it protected the more
important contents of the fossa (i.e. the brachial artery and the median nerve).

Statistically, the antecubital fossa is the least tender region for peripheral intravenous access,
although it provides a greater risk for venous thrombosis.

Additional images
See also
Cubital tunnel

Median cubital vein

Peripherally inserted central catheter

References
External links
Diagrams at frca.co.uk

Animated Venous access tutorials