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The Upper Limb 1
The Upper Limb 1
The shoulder girdle consists of the clavicle and the scapula, which articulate
with one another at the acromioclavicular joint.
Clavicle
The clavicle is a long, slender bone that lies horizontally across the root of
the neck just beneath the skin. It articulates with the sternum and first costal
cartilage medially and with the acromion process of the scapula laterally.
The clavicle acts as a strut that holds the arm away from the trunk. It also
transmits forces from the upper limb to the axial skeleton and provides
attachment for muscles.
The medial two thirds of the clavicle is convex forward and its lateral third
is concave forward
Scapula
The scapula is a flat triangular bone that lies on the posterior chest wall
between the second and the seventh ribs. On its posterior surface, the spine
of the scapula projects backward. The lateral end of the spine is free and
forms the acromion, which articulates with the clavicle. The superolateral
angle of the scapula forms the pear-shaped glenoid cavity, or fossa, which
articulates with the head of the humerus at the shoulder joint. The coracoid
process projects upward and forward above the glenoid cavity and provides
attachment for muscles and ligaments. Medial to the base of the coracoid
process is the suprascapular notch.
The anterior surface of the scapula is concave and forms the shallow
subscapular fossa. The posterior surface of the scapula is divided by the
spine into the supraspinous fossa above and an infraspinous fossa below.
The inferior angle of the scapula can be palpated easily in the living subject
and marks the level of the seventh rib and the spine of the seventh thoracic
vertebra.
Humerus
The humerus articulates with the scapula at the shoulder joint and with the
radius and ulna at the elbow joint. The upper end of the humerus has a head,
which forms about one third of a sphere and articulates with the glenoid
cavity of the scapula. Immediately below the head is the anatomic neck.
Below the neck are the greater and lesser tuberosities, separated from each
other by the bicipital groove. Where the upper end of the humerus joins the
shaft is a narrow surgical neck. About halfway down the lateral aspect of the
shaft is a roughened elevation called the deltoid tuberosity. Behind and
below the tuberosity is a spiral groove, which accommodates the radial
nerve.
The lower end of the humerus possesses the medial and lateral epicondyles
for the attachment of muscles and ligaments, the rounded capitulum for
articulation with the head of the radius, and the pulley-shaped trochlea for
articulation with the trochlear notch of the ulna. Above the capitulum is the
radial fossa, which receives the head of the radius when the elbow is flexed.
Above the trochlea anteriorly is the coronoid fossa, which during the same
movement receives the coronoid process of the ulna. Above the trochlea
posteriorly is the olecranon fossa, which receives the olecranon process of
the ulna when the elbow joint is extended
5. Glenoid cavity
It is deepened by the glenoid labrum for the head of the humerus.
C. Humerus
1. Head
It has a smooth, rounded, articular surface and articulates with the scapula at
the
glenohumeral joint.
2. Anatomic neck
It is an indentation distal to the head of the humerus and provides for the
attachment of the
fibrous joint capsule.
3. Greater tubercle
It lies just lateral to the anatomic neck and provides attachments for the
supraspinatus,
infraspinatus, and teres minor muscles.
4. Lesser tubercle
It lies on the anterior medial side of the humerus, just distal to the anatomic
neck, and provides
an insertion for the subscapularis muscle.
5. Intertubercular (bicipital) groove
It lies between the greater and lesser tubercles, lodges the tendon of the long
head of the
biceps brachii muscle, and is bridged by the transverse humeral ligament ,
which restrains
the tendon of the biceps brachii long head.
Provides insertions for the pectoralis major on its lateral lip , the teres major
on its medial lip , and the latissimus dorsi on its floor.
6. Surgical neck
It is a narrow area distal to the tubercles that is a common site of fracture
and is in contact with the axillary nerve and the posterior humeral
circumflex artery.
7. Deltoid tuberosity
It is a V-shaped roughened area on the lateral aspect of the midshaft that
marks the insertion of
the deltoid muscle.
8. Spiral groove
It contains the radial nerve, separating the origin of the lateral head of the
triceps above and
the origin of the medial head below.
9. Trochlea
It is the medial articular surface, shaped like a spool, and articulates with the
trochlear notch
of the ulna .
10. Capitulum
It is the lateral articular surface, globular in shape, and articulates with the
head of the radius.
P.21
11. Olecranon fossa
It is a posterior depression above the trochlea of the humerus that houses the
olecranon of the
ulna on full extension of the forearm.
12. Coronoid fossa
It is an anterior depression above the trochlea of the humerus that
accommodates the coronoid process of the ulna on flexion of the elbow.
13. Radial fossa
It is an anterior depression above the capitulum that is occupied by the head
of the radius
during full flexion of the elbow joint.
14. Lateral epicondyle
It projects from the capitulum and provides the origin of the supinator and
extensor muscles of
the forearm.
15. Medial epicondyle
It projects from the trochlea and has a groove on the back for the ulnar nerve
and superior ulnar
collateral artery.It provides attachment sites for the ulnar collateral ligament,
the pronator teres, and the common tendon of the forearm flexor muscles.
The Axilla
The axilla, or armpit, is a pyramid-shaped space between the upper part of
the arm and the side of the chest. It forms an important passage for nerves,
blood, and lymph vessels as they travel from the root of the neck to the
upper limb. The upper end of the axilla, or apex, is directed into the root of
the neck and is bounded in front by the clavicle, behind by the upper border
of the scapula, and medially by the outer border of the first rib. The lower
end, or base, is bounded in front by the anterior axillary fold (formed by the
lower border of the pectoralis major muscle), behind by the posterior
axillary fold (formed by the tendon of latissimus dorsi and the teres major
muscle), and medially by the chest wall.
Walls of the Axilla
The walls of the axilla are made up as follows:
The base is formed by the skin stretching between the anterior and posterior
walls The axilla contains the principal vessels and nerves to the upper limb
and many lymph nodes.
Anteriorly: The pectoralis major and the skin. The cephalic vein
crosses the artery
Posteriorly: The long thoracic nerve (nerve to the serratus anterior)
Laterally: The three cords of the brachial plexus
Medially: The axillary vein
Anteriorly: The pectoralis minor, the pectoralis major, and the skin
Posteriorly: The posterior cord of the brachial plexus, the
subscapularis muscle, and the shoulder joint
Laterally: The lateral cord of the brachial plexus.
Medially: The medial cord of the brachial plexus and the axillary vein.
Relations
Anteriorly: The pectoralis major for a short distance; lower down the
artery it is crossed by the medial root of the median nerve.
Posteriorly: The subscapularis, the latissimus dorsi, and the teres
major. The axillary and radial nerves also lie behind the artery
Laterally: The coracobrachialis, the biceps, and the humerus. The
lateral root of the median and the musculocutaneous nerves also lie on
the lateral side.
Medially: The ulnar nerve, the axillary vein, and the medial cutaneous
nerve of the arm
The highest thoracic artery is small and runs along the upper border of
the pectoralis minor.
The Breasts
Location and Description
The breasts are specialized accessory glands of the skin that secrete milk.
They are present in both sexes. In males and immature females, they are
similar in structure. The nipples are small and surrounded by a colored area
of skin called the areola. The breast tissue consists of a system of ducts
embedded in connective tissue that does not extend beyond the margin of the
areola.
Puberty
At puberty in females, the breasts gradually enlarge and assume their
hemispherical shape under the influence of the ovarian hormones. The ducts
elongate, but the increased size of the glands is mainly from the deposition
of fat. The base of the breast extends from the second to the sixth rib and
from the lateral margin of the sternum to the midaxillary line. The greater
part of the gland lies in the superficial fascia. A small part, called the
axillary tail , extends upward and laterally, pierces the deep fascia at the
lower border of the pectoralis major muscle, and enters the axilla.
Each breast consists of 15 to 20 lobes, which radiate out from the nipple.
The main duct from each lobe opens separately on the summit of the nipple
and possesses a dilated ampulla just before its termination. The base of the
nipple is surrounded by the areola. Tiny tubercles on the areola are produced
by the underlying areolar glands.
The lobes of the gland are separated by fibrous septa that serve as
suspensory ligaments Behind the breasts is a space filled by loose
connective tissue called the retromammary space .
Young Women
In young women the breasts tend to protrude forward from a circular base.
Pregnancy
Early
In the early months of pregnancy, there is a rapid increase in length and
branching in the duct system .The secretory alveoli develop at the ends of
the smaller ducts and the connective tissue becomes filled with expanding
and budding secretory alveoli. The vascularity of the connective tissue also
increases to provide adequate nourishment for the developing gland. The
nipple enlarges, and the areola becomes darker and more extensive as a
result of increased deposits of melanin pigment in the epidermis. The areolar
glands enlarge and become more active.
Late
During the second half of pregnancy, the growth process slows. The breasts,
however, continue to enlarge, mostly because of the distention of the
secretory alveoli with the fluid secretion called colostrum.
Postweaning
Once the baby has been weaned, the breasts return to their inactive state. The
remaining milk is absorbed, the secretory alveoli shrink, and most of them
disappear. The interlobular connective tissue thickens. The breasts and the
nipples shrink and return nearly to their original size. The pigmentation of
the areola fades, but the area never lightens to its original color.
Postmenopause
After the menopause, the breast atrophies Most of the secretory alveoli
disappear, leaving behind the ducts. The amount of adipose tissue may
increase or decrease. The breasts tend to shrink in size and become more
pendulous. The atrophy after menopause is caused by an absence of ovarian
estrogens and progesterone.
Blood Supply
Arteries
The branches to the breasts include the perforating branches of the internal
thoracic artery and the intercostal arteries. The axillary artery also supplies
the gland via its lateral thoracic and thoracoacromial branches.
Veins
The veins correspond to the arteries.
Lymph Drainage
The lymph drainage of the mammary gland is of great clinical importance
because of the frequent development of cancer in the gland and the
subsequent dissemination of the malignant cells along the lymph vessels to
the lymph nodes.
The lateral quadrants of the breast drain into the anterior axillary or pectoral
group of nodes (situated just posterior to the lower border of the pectoralis
major muscle). The medial quadrants drain by means of vessels that pierce
the intercostal spaces and enter the internal thoracic group of nodes (situated
within the thoracic cavity along the course of the internal thoracic artery). A
few lymph vessels follow the posterior intercostal arteries and drain
posteriorly into the posterior intercostal nodes (situated along the course of
the posterior intercostal arteries); some vessels communicate with the lymph
vessels of the opposite breast and with those of the anterior abdominal wall.
Brachial Plexus
The brachial plexus is formed in the posterior triangle of the neck by the
union of the anterior rami of the fifth, sixth, seventh, and eighth cervical and
the first thoracic spinal nerves.
The plexus can be divided into roots, trunks, divisions, and cords. The roots
of C5 and 6 unite to form the upper trunk, the root of C7 continues as the
middle trunk, and the roots of C8 and TI unite to form the lower trunk. Each
trunk then divides into anterior and posterior divisions. The anterior
divisions of the upper and middle trunks unite to form the lateral cord, the
anterior division of the lower trunk continues as the medial cord, and the
posterior divisions of all three trunks join to form the posterior cord.
The roots, trunks, and divisions of the brachial plexus reside in the lower
part of the posterior triangle of the neck. The cords become arranged around
the axillary artery in the axilla. Here, the brachial plexus and the axillary
artery and vein are enclosed by a sheath of fascia called the axillary sheath.
Upper trunk
1. Nerve to subclavius (C5 and 6).
Lateral cord
1. Lateral pectoral nerve
2. Musculocutaneous nerve
3. Lateral root of median nerve
Medial cord
4. Ulnar nerve.
Branches of the Brachial Plexus Found in the Axilla: The nerve to the
subclavius (C5 and 6): supplies the subclavius muscle. It is important clinic
ally because it may give a contribution (C5) to the phrenic nerve; this
branch, when present, is referred to as the accessory phrenic nerve.
Arises from the roots of the brachial plexus in the neck and enters the axilla
by passing down over the lateral border of the first rib behind the axillary
vessels and brachial plexus. It descends over the lateral surface of the
serratus anterior muscle, which it supplies.
The lateral pectoral nerve: arises from the lateral cord of the brachial plexus
and supplies the pectoralis major muscle.
Arises from the lateral cord of the brachial plexus, supplies the
coracobrachialis muscle, and leaves the axilla by piercing that muscle.
The lateral root of the median nerve: is the direct continuation of the lateral
cord of the brachial plexus. It is joined by the medial root to form the
median nerve trunk, and this passes downward on the lateral side of the
axillary artery. The median nerve gives off no branches in the axilla.
Arises from the medial cord of the brachial plexus, supplies and pierces the
pectoralis minor muscle, and supplies the pectoralis major muscle.
The medial cutaneous nerve of the forearm: arises from the medial cord of
the brachial plexus and descends in front of the axillary artery.
The ulnar nerve (C8 and TI):
Arises from the medial cord of the brachial plexus and descends in the
interval between the axillary artery and vein. The ulnar nerve gives off no
branches in the axilla.
Arises from the medial cord of the brachial plexus and crosses in front of the
third part of the axillary artery to join the lateral root of the median nerve.
Arise from the posterior cord of the brachial plexus and supply the upper and
lower parts of the subscapularis muscle. In addition, the lower subscapular
nerve supplies the teres muscle.
The thoracodorsal nerve: arises from the posterior cord of the brachial
plexus and runs downward to supply the latissimus dorsi muscle.
Is one of the terminal branches of the Posterior cord of the brachial plexus. It
turns backward and passes through the quadrangular space. Having given off
a branch to the shoulder joint, it divides into anterior and posterior branches.
The radial nerve: is the largest branch of the brachial plexus and lies behind
the axillary artery. It gives off branches to the long and medial heads of the
triceps muscle and the posterior cutaneous nerve of the arm. The latter
branch is distributed to the skin on the middle of the back of the arm.
MUSCLES
Trapezius
The trapezius is a large, flat, triangular muscle that extends over the back of
the neck and thorax.
• Origin: From the medial third of the superior nuchal line of the occipital
bone, the external occipital protuberance, and the ligamentum nuchae: from
the spine of the seventh cervical vertebra and the spines and supraspinous
ligaments of all the thoracic vertebrae.
• Insertion: The upper fibers are directed downward and laterally into the
lateral third of the clavicle; the middle fibers are directed horizontally into
the acromion and the upper border of the spine of the scapula; the lowest
fibers are directed upward and laterally and are inserted on the medial end of
the spine of the scapula.
• Nerve supply: Motor fibers from the spinal part of the accessory nerve
(cranial nerve XI) and sensory fibers from the third and fourth cervical
nerves.
• Action: The trapezius muscle suspends the shoulder girdle from the skull
and the vertebral column. The upper fibers elevate the scapula. The middle
fibers pull the scapula medially. The lower fibers pull the medial border of
the scapula downward so that the glenoid cavity faces upward and forward.
Knowing that the scapula rotates around the point of attachment of the
coracoid process to the clavicle by the coracoclavicular ligament, it is easy
to understand that the superior and inferior fibers of the trapezius assist the
serratus anterior muscle in rotating the scapula when the arm is raised above
the head.
Subscapularis
• Origin: From the subscapular fossa on the anterior surface of the scapula.
• Insertion: Its fibers converge and are inserted on the lesser tuberosity of the
humerus.
• Nerve supply: The upper and lower subscapular nerves, branches of the
posterior cord of the brachial plexus.
• Action: Medially rotates the arm and acts with the other short muscles
around the shoulder joint in helping to stabilize this joint.
Latissimus Dorsi
The latissimus dorsi is a large, flat, triangular muscle that extends over the
lumbar region and the lower part of the thorax.
• Origin: From the posterior part of the iliac crest, the lumbar fascia, and the
spines of the lower six thoracic vertebrae (deep to the trapezius), from the
lower three or four ribs, and sometimes by a few fibers from the inferior
angle of the scapula.
• Insertion: Its tendon wraps around the lower border of the teres major
muscle and is inserted into the floor of the bicipital groove of the humerus.
• Nerve supply: The thoracodorsal nerve, a branch of the posterior cord of
the brachial plexus.
• Action: It extends, adducts, and medially rotates the arm.
Teres Major
• Origin: From the lower third of the lateral border of the scapula.
• Insertion: Into the medial lip of the bicipital groove of the humerus.
• Nerve supply: Lower subscapular nerve from the posterior cord of the
brachial plexus.
• Action: It medially rotates and adducts the arm.
Serratus Anterior
The serratus anterior is a large, thin muscle that covers the lateral chest
wall.
Levator Scapulae
• Origin: From the transverse processes of the upper four cervical vertebrae.
• Insertion: Into the medial border of the scapula opposite the supraspinous
fossa.
• Nerve supply: From the third and fourth cervical nerves and from the
dorsal scapular nerve (C5).
Rhomboid Minor
• Origin: From the lower part of the ligamentum nuchae and the spines of the
seventh cervical and first thoracic vertebrae.
• Insertion: Into the medial border of the scapula opposite the root of the
spine.
Rhomboid Major
• Origin: From the second to the fifth thoracic spines and the corresponding
supraspinous ligaments.
• Insertion: Into the medial border of the scapula opposite the infraspinous
fossa.
Supraspinatus
• Action: It assists the deltoid muscle in the abduction of the arm at the
shoulder joint by fixing the head of the humerus against the glenoid cavity.
Infraspinatus
• Action: It laterally rotates the arm and stabilizes the shoulder joint.
Teres Minor
• Origin: From the upper two-thirds of the lateral border of the scapula.
• Insertion: Into the lower facet of the greater tuberosity of the humerus and
into the capsule of the shoulder joint.
• Nerve supply: A branch of the axillary nerve.
• Action: It laterally rotates the arm and stabilizes the shoulder joint.
ROTATOR CUFF
Four muscles the supraspinatus, the Infraspinatus, the teres minor, and the
Subscapularis form what is termed the rotator cuff. The tone of these
muscles assists in holding the head of the humerus in the glenoid cavity of
the scapula during movements at the shoulder joint. Therefore, they assist in
stabilizing the shoulder joint. The cuff lies on the anterior, superior, and
posterior aspects of the joint. The cuff is deficient inferiorly, and this is a site
of potential weakness.
Quadrangular Space
Nerves
Spinal Part of the Accessory Nerve (Cranial Nerve Xl)
The spinal part of the accessory nerve runs downward in the posterior
triangle of the neck on the levator scapulae muscle. It is accompanied by
branches from the anterior rami of the third and fourth cervical nerves. The
accessory nerve runs beneath the anterior border of the trapezius muscle at
the junction of its middle and lower thirds and, together with the cervical
nerves, supplies the trapezius muscle.
Suprascapular Nerve
The suprascapular nerve arises from the upper trunk of the brachial plexus
(C5 and 6) in the posterior triangle in the neck. It runs downward and
laterally and passes beneath the suprascapular ligament, which bridges the
suprascapular notch, to reach the supraspinous fossa. It supplies the
supraspinatus and infraspinatus muscles and [he shoulder joint.
Axillary Nerve
The axillary nerve arises from the posterior cord of the brachial plexus (C5
and 6) in the axilla. It passes backward and enters the quadrangular space
with the posterior circumflex humeral artery. As the nerve passes through
the space, it comes into close relationship with the inferior aspect of the
capsule of the shoulder joint and with the medial side of the surgical neck of
the humerus. It terminates by dividing into anterior and posterior branches.
Branches
The axillary nerve has the following branches:
1. An articular branch to the shoulder joint.
2. An anterior terminal branch, which winds around the surgical neck of the
humerus beneath the deltoid muscle; it supplies the deltoid and the skin that
covers its lower part.
3. A posterior terminal branch, which gives off a branch to the teres minor
muscle and a few branches to the deltoid, then emerges from the posterior
border of the deltoid as the upper lateral cutaneous nerve of the arm.
It is thus seen that the axillary nerve supplies the shoulder joint, two
muscles, and the skin covering the lower half of the deltoid muscle.
The arm
Cutaneous nerves
The sensory nerve supply to the skin over the point of the shoulder to
halfway down the deltoid muscle is from the supraclavicular nerves (C3 and
4). The skin over the lower half of the deltoid is supplied by the upper lateral
cutaneous nerve of the arm, a branch of the axillary nerve (C5 and 6). The
skin over the lateral surface of the arm below the deltoid is supplied by the
lower lateral cutaneous nerve of the arm, a branch of the radial nerve (C5
and 6). The skin of the armpit and the medial side of the arm is supplied by
the medial cutaneous nerve of the arm (TI) and the intercostobrachial nerves
(T2). The skin of the back of the arm is supplied by the posterior cutaneous
nerve of the arm, a branch of the radial nerve (C8).
Superficial veins
The basilic vein ascends in the superficial fascia on the medial side of the
biceps. Halfway up the arm, it pierces the deep fascia and at the lower
border of the teres major joins the venae comitantes of the brachial artery to
form the axillary vein.
The arm is enclosed in a sheath of deep fascia. Two fascial septa, one on the
medial side and one on the lateral side, extend from this sheath and are
attached to the medial and lateral supracondylar ridges of the humerus,
respectively. By this means the arm is divided into an anterior and a
posterior fascial compartments.
• Origin: The long head from the supraglenoid tubercle of the scapula; the
short head from the tip of the coracoid process of the scapula.
The tendon of the long head crosses the humeral head within the capsule of
the shoulder joint and emerges from the joint surrounded by a synovial
sheath and lying in the bicipital groove of the humerus. It is joined in the
middle of the upper arm by the short head.
• Insertion: Into the posterior part of the tuberosity of the radius and, by the
bicipital aponeurosis, in to the deep fascia on the medial aspect of the
forearm.
• Action: The biceps is a strong supinator of the forearm. The biceps also is a
powerful flexor of the elbow joint and a weak flexor of the shoulder joint.
Coracobrachialis
• Origin: from the tip of the coracoid process.
• Insertion: Into the middle of the medial side of the shaft of the humerus.
Brachialis
• Origin: From the front of the lower half of the humerus.
• Insertion: into the anterior surface of the coronoid process of the ulna.
• Nerve supply: Musculocutaneous nerve. A small part of the muscle that
arises behind the deltoid tuberosity, and is therefore located in the posterior
compartment, is supplied by the radial nerve.
• Action: It is a strong flexor of the elbow joint.
Brachial Artery:
begins at the lower border of the teres major muscle as a continuation of the
axillary artery. It provides the main arterial supply to the arm. It terminates
opposite the neck of the radius by dividing into the radial and ulnar arteries.
Branches
1. The profunda artery arises near the beginning of the brachial artery and
follows the radial nerve into the spiral groove of the humerus.
2. The superior ulnar collateral artery arises near the middle of the upper arm
and follows the ulnar nerve.
5. The inferior ulnar collateral artery arises near the termination of the artery
and takes part in the anastomosis around the elbow joint.
Musculocutaneous Nerve:
Branches
1. Muscular branches to the biceps, coracobrachialis, and brachialis.
2. Cutaneous branches. The lateral cutaneous nerve of the forearm supplies
the skin of the front and lateral aspects of the forearm down as far as the root
of the thumb.
Median Nerve
It runs downward on the lateral side of the brachial artery. Halfway down
the upper arm, it crosses the brachial artery and continues downward on its
medial side.
The nerve, like the artery, is therefore superficial, but at the elbow it is
crossed by the bicipital aponeurosis.
The median nerve has no branches in the upper arm, except for a small
vasomotor nerve to the brachial artery.
Ulnar Nerve
It runs downward on the medial side of the brachial artery as far as the
middle of the arm. Here, at the insertion of the coracobrachialis, the nerve
pierces the medial fascial septum, accompanied by the superior ulnar
collateral artery, and enters the posterior compartment of the arm; the nerve
passes behind the medial epicondyle of the humerus. The ulnar nerve has no
branches in the anterior compartment of the arm.
Radial Nerve
On leaving the axilla, the radial nerve immediately enters the posterior
compartment of the arm and only enters the anterior compartment just above
the lateral epicondyle.
Triceps
• Origin: Long head from the infraglenoid tubercle of the scapula; lateral
head from the upper half of the posterior surface of the shaft of the humerus
above the spiral groove; medial head from the posterior surface of the lower
half of the shaft of the humerus below the spiral groove.
• Insertion: The common tendon is inserted into the upper surface of the
olecranon process of the ulna.
Radial nerve:
Winds around the back of the arm in the spiral groove on the back of the
humerus between the heads of the triceps. It pierces the lateral fascial
septum above the elbow and continues downward into the cubital fossa in
front of the elbow, between the brachialis and the brachioradialis muscles. In
the spiral groove the nerve is accompanied by the profunda vessels, and it
lies directly in contact with the shaft of the humerus.
Branches
1. in the axilla: Branches are given to the long and medial heads of the
triceps, and the posterior cutaneous nerve of the arm is given off.
2. in the spiral groove: Branches are given to the lateral and medial heads
of the triceps and to the anconeus. The lower lateral cutaneous nerve of
the arm supplies the skin over the lateral and anterior aspects of the lower
part of the arm. The posterior cutaneous nerve of the forearm runs down
the middle of the back of the forearm as far as the wrist.
Ulnar Nerve:
Having pierced the medial fascial septum halfway down the upper arm; the
ulnar nerve descends behind the septum, covered posteriorly by the medial
head of the triceps. The nerve is accompanied by the superior ulnar collateral
vessels. At the elbow, it lies behind the medial epicondyle of the humerus on
the medial ligament of the elbow joint. It continues downward to enter the
forearm between the two heads of origin of the flexor carpiulnaris.
Branches
The ulnar nerve has an articular branch to the elbow joint.
The profunda brachii artery arises from the brachial artery near its origin. It
accompanies the radial nerve through the spiral groove, supplies the triceps
muscle, and takes part in the anastomosis around the elbow joint.
Branches
Ulnar collateral arteries arise from the brachial artery and take part in the
anastomosis around the elbow joint.
Cubital fossa
Cubital fossa is the triangular area between pron. teres, brachiorad. And a
line joining the humeral epicond.
The roof is formed by the deep fascia of forearm, reinforced on the medial
side by the bicipital aponeurosis. Infront of the bicipital aponeurosis lies the
median cubital v. with the medial cut. N. of forearm; separating these
structures from the underlying med. N. and brachial a.
Is the triangular area between pron. teres, brachiorad. And a line joining the
humeral epicond.
The roof is formed by the deep fascia of forearm, reinforced on the medial
side by the bicipital aponeurosis. Infront of the bicipital aponeurosis lies the
median cubital v. with the medial cut. N. of forearm; separating these
structures from the underlying med. N. and brachial a.
The floor is formed in the main by brach. M. and below by the supin. As it
claps the neck of the radius.
Med. N., brach. A., tendon of biceps, and further lat. The radial N. and its
post. Inteross. Br. Which are only seen when brachioradialis is retracted
laterally.
The brachial art. is palpated med. To the tendon to define the position for
placing the stethoscope when taking the Blood Pressure.
The post. Inteross. N. gives branches to ext. carpi rad. Brevis & supinator
before disappearing from the fossa by passing between the two heads of
origin of Supinator M. in the ext. compartment.
The superficial branch of the radial N. passes down the forearm under cover
of brachioradialis.