brachium, cubital fossa and um
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Brachium, Cubital Fossa and
Antebrachium
(The Upper Extremity)
H. Keith Brown
GA PCOM
Joints and hand are covered in another lecture.
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UE Objectives Understand / describe the rotator cuff. Identify major features of UE bones and their
articulations at glenohumeral, radioulnar, carpaljoints.
Identify muscles, demonstrate their actions, citeinnervation and attachments.
Describe vessels and nerves pathway (routes) andpoints of vulnerabilities and their surface
anatomy landmarks. Correlate specific nerve lesions with upper
extremity paresis and / or paresthesias(dermatomes).
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Readings
Moores 4th pp. 405- 459
Gilroys Atlas pp. 252-352
Netters 5th plates 400-468
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Actions at joints are what really count
so for organization, lets start with:
Shoulder (Humerus)
Humeral Abduction
Adduction
Internal rotation
External rotation
Flexion Extension
Circumduction
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For each action, be able to cite muscle group,
major nerve(s) and cord level(s).
Humeral abduction- (deltoid, axillaryC5); (supraspinatus,suprascapularC5).
Humeral adduction- (teres major- lower subscapularC6);(subscapularis- upper and lower subscapularC6);
( pectoralis major- lateral pectoralC6); (latissimus-thoracodorsal C7).
Internal /medial rotation- (teres major, subscapularis).
External / lateral rotation- (teres minor lowersubscapularC6); (infraspinatus- suprascapularC5.
Extension- (
Flexion- (choriocobrachialis,musculocutaneous C6); (ant.deltoid axillaryC5); (pectoralis major- lateral pectoralC6).
Circumduction- All the above.
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Elbow (ulna)
Flexion- (brachialismusculocutaneous C6);
( bicepsmusculocutaneous C6); (brachioradialis
radialC5,6). Extension- (triceps radialC5,6)
Supination- (biceps ); (supinator radialC7).
Pronation- ( Pronator teresmedian C6,7);(pronator quadratusmedian C7,8)
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Wrist (Carpus)
Flexion- (flexor carpi radialismedian C 6,7);
( flexor carpi ulnaris ulnarC 7,8).
Extension- (extensor carpi radialis radialC6,7);(extensor carpi ulnaris radialC6,7)
Adduction
Abduction
CircumductionNote: Flexors are from medial epicondyle,
Extensors are from lateral epicondyle
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Digits ( from antibrachial muscles)
Flexion- (flexor digiti superficialismedian
C 6,7,8); (flexor digiti profundusmedian
C6,7,8). (FDP medial by ulnar) Extension- ( extensor digiti radialC 6,7,8).
Abduction of pollis- (abductor pollicis radial
C 7,8).Palmaris muscle is superficial, inserts in palmar
aponeurosis. Median nerve.
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Arterial Blood Supply
Axillary
Brachial
Radial
Ulnar
Interosseous
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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.
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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).
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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.
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Radial nerve C5-T1
Extension of the forearm, extension of carpus anddigits, 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 tricepsand humerus, posterior to humerus in radialgroove to radial tunnel and anterior to lateralepicondyle, deep to brachioradialis, deep branchpenetrates supinator, superficial continues tohand and becomes cutaneous.
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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.
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Median Nerve C6-T1
Flexion of fingers and lateral /radial flexion ofwrist; pronation, thenar muscles and first twolumbricals.
Sensation to lateral 2/3rds of the palm and first 3 fingers.
From medial and lateral cords through axilla to liebetween the brachialis and biceps then pass intothe cubital fossa penetrating the pronator teresand contiuing between the superficial and deepflexors digitorum to the carpal tunnel to thehand.
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Ulnar Nerve C7-T1
Flexion of ulnar / 5th finger / pinkie; most intrinsicmuscles 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 brachialartery, then passing posterior to the medial epicondyle
and passing deep to the FCU to the wrist where itenters the palmer aspect via Guyons canal.
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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.
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Lymphatics
Cubital and Axillary nodes.
Right vs left ?
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