Brachium, Cubital Fossa and Antebrachium

(The Upper Extremity)

Joints and hand are covered in another lecture.

H. Keith Brown
GA PCOM
 UE Objectives
• Understand / describe the rotator cuff.
• Identify major features of UE bones and their
articulations at glenohumeral, radioulnar, carpal
joints.
• Identify muscles, demonstrate their actions, cite
innervation and attachments.
• Describe vessels and nerves pathway (routes) and
points of vulnerabilities and their surface anatomy
landmarks.
• Correlate specific nerve lesions with upper extremity
paresis and / or paresthesias (dermatomes).
 Readings
• Moore’s 4th pp. 405- 459
• Gilroy’s Atlas pp. 252-352
• Netter’s 5th plates 400-468
Actions at joints are what really count so for organization, let’s start
with:
Shoulder (Humerus)

• Humeral Abduction
• Adduction
• Internal rotation
• External rotation
• Flexion
• Extension
• Circumduction
For each action, be able to cite muscle group,
major nerve(s) and cord level(s).
• Humeral abduction- (deltoid, axillary C5); (supraspinatus,
suprascapular C5).
• Humeral adduction- (teres major- lower subscapular C6);
(subscapularis- upper and lower subscapular C6);
( pectoralis major- lateral pectoral C6); (latissimus- thoracodorsal
C7).
• Internal /medial rotation- (teres major, subscapularis).
• External / lateral rotation- (teres minor – lower subscapular C6);
(infraspinatus- suprascapular C5.
• Extension- (
• Flexion- (choriocobrachialis, musculocutaneous C6); (ant. deltoid
axillary C5); (pectoralis major- lateral pectoral C6).
• Circumduction- All the above.
 Elbow (ulna)
• Flexion- (brachialis musculocutaneous C6);
( biceps musculocutaneous C6); (brachioradialis
radial C5,6).
• Extension- (triceps radial C5,6)
• Supination- (biceps ); (supinator radial C7).
• Pronation- ( Pronator teres median C6,7);
(pronator quadratus median C7,8)
 Wrist (Carpus)
• Flexion- (flexor carpi radialis median C 6,7);
( flexor carpi ulnaris ulnar C 7,8).
• Extension- (extensor carpi radialis radial C6,7);
(extensor carpi ulnaris radial C6,7)
• Adduction
• Abduction
• Circumduction
Note: Flexors are from medial epicondyle,
Extensors are from lateral epicondyle
 Digits ( from antibrachial muscles)
• Flexion- (flexor digiti superficialis median
C 6,7,8); (flexor digiti profundus median
C6,7,8). (FDP medial by ulnar)
• Extension- ( extensor digiti radial C 6,7,8).
• Abduction of pollis- (abductor pollicis radial
C 7,8).
Palmaris muscle is superficial, inserts in palmar
aponeurosis. Median nerve.
 Arterial Blood Supply
• Axillary
• Brachial
• Radial
• Ulnar
• Interosseous
 Nerve Pathways
• Be able to narrate the paths of the five major
nerves from brachial plexus to their targets
including points where they are vulnerable to
injury or compression.
• Cite common signs and symptoms of UE nerve
injuries.
• On surface anatomy, identify dermatomes and
cutaneous nerve distributions.
 Musculocutaneous Nerve C5-7
• Flexion of arm and forearm, supination.
• Sensation of lateral forearm, joint capsule of
elbow.
• From lateral cord of brachial plexus -> thru the
coracobrachialis-> between biceps and
brachialis to lateral forearm skin and joint
capsule of elbow (sensory).
 Axillary Nerve C5,6
• Abduction ( deltoid) and external rotation
( teres minor) of arm.
• Cutaneous sensation over lateral deltoid.
• From posterior cord of brachial plexus ->
posterior to the upper humerus and into the
quadrangular space.
 Radial nerve C5-T1
• Extension of the forearm, extension of carpus and
digits, supination, abduction of pollis.
• Sensation for elbow joint capsule; interosseus
membrane, wrist, MP joints; posterio-lateral arm,
forearm and dorsum of hand.
• From posterior cord between long head of triceps and
humerus, posterior to humerus in radial groove to
radial tunnel and anterior to lateral epicondyle, deep
to brachioradialis, deep branch penetrates supinator,
superficial continues to hand and becomes cutaneous.
 The Cubital Fossa
• Region anterior to humero-ulnar and humero-
radial joints.
• Contents include: cubital vein, brachial artery,
bicipital tendon, bicipital aponeurosis (Le
grace-a-dieu tendon) brachialis tendon,
median nerve and radial nerve.
• Know this region well ! Be able to draw it,
describe it and explain it.
 Median Nerve C6-T1
• Flexion of fingers and lateral /radial flexion of wrist;
pronation, thenar muscles and first two lumbricals.
• Sensation to lateral 2/3rds of the palm and first 3 ½
fingers.
• From medial and lateral cords through axilla to lie
between the brachialis and biceps then pass into
the cubital fossa penetrating the pronator teres and
contiuing between the superficial and deep flexors
digitorum to the carpal tunnel to the hand.
 Ulnar Nerve C7-T1
• Flexion of ulnar / 5th finger / “pinkie”; most intrinsic
muscles of the hand.
• Sensation from the medial 1/3rd of the hand
( palmar and dorsal aspects); joint capsules.

Medial cord of brachial plexus following the brachial

artery, then passing posterior to the medial epicondyle
and passing deep to the FCU to the wrist where it enters
the palmer aspect via Guyon’s canal.
 Venous Drainage
• Basilar tributaries on medial / volar forearm
(over flexor compartment) joins deep veins
just above medial epicondyle to form brachial
vein.
• Cephalic tributaries on lateral / dorsal forearm
continues over biceps and deltoid to join the
subclavian vein.
 Lymphatics
• Cubital and Axillary nodes.
• Right vs left ?