Upper limb Muscles of Arm, cubital fossa, and elbow joint

1. Dr.NivinSharaf MD M.B.BCH Upper limbMuscles of Arm, cubital fossa, and elbow joint

2. Objectives • -Identify the following structures: humerus(medial & lateral epicondyles, lateral condyle (capitulum), medial condyle (trochlea), radius (head, styloid process, tuborosity), ulna (olecranon, coronoid process, styloid process) • -Describe the movements of flexion and extension of the elbow joint. • -Describe the articulation of the elbow joint with the radius and ulna. • -Explain where you would aspirate a joint effusion. • -Describe the course of neurovascular structures in the arm (brachial artery and vein, nerves - medial, ulnar and radial), and their relation in the cubital fossa • -Name and identify the anatomical region of the cubital fossa (location, boundaries)

3. Surface Anatomy

4. Surface anatomy

5. .

6. Bony Skeleton

7. Humerus and Scapula (Ant)

8. Humerus and Scapula (Post) Humeral Head Supra scapular Fossa Humeral Neck Anatomical Humeral Neck Surgical Infra scapular Fossa Radial groove Inferior Angle Medial epicondyle

9. Humerus and Scapula (Post) Humeral Head Supra scapular Fossa Humeral Neck Anatomical Humeral Neck Surgical Infra scapular Fossa Radial groove Inferior Angle Medial epicondyle

10. Elbow joint http://www.joint-pain-expert.net/images/elbow_joint_anatomy001.jpg

11. Ligaments of Elbow

12. ELBOW= hinge jt. • Humerus: • medial & lateral epicondyles, • lateral condyle (capitulum), • medial condyle (trochlea) • -coronoid fossa • -olecranon fossa • Radius: • -head, • -tuborosity (biceps insertion) • Ulna: • -olecranon, • -coronoid process • - tuborosity (brachialis insertion) • Fibrous capsule of the elbow joint. • Strong collateral ligaments on • each side. • - Annular ligament encircles radial • head

13. Triceps tendon Cubital tunnel syndrome

14. Muscles

15. Anterior arm Mainly Flexors BBC Brachialis Biceps Coraco brachialis Nerve Supply! Musculo Cutaneous Nerve

16. Posterior arm

17. Arm muscles http://www.highfive.me.uk/Resources/Anatomy/UpperArm/All.JPG

18. Cubital Fossa Surface Anatomy

19. Roof of cubital fossa. -superficial veins: Median Cubital v. Cephalic v. Basilic v. Floor of cubital fossa. - Brachialis m - Supinator m - Radial nerve: deep branch (muscular, articular) superficial branch (cutaneous) • Cubital fossa. • – anterior to the elbow • Boundaries: • Epicondyles * • (medial & lateral) • - Pronator Teres • Brachioradialis • Contents: • - Brachial a • (radial / ulnar aa) • - Biceps tendon • & aponeurosis • - Median n

20. Cubital Fossa Identify the borders of the cubital fossa: Brachioradialis m. laterally, Pronator teres medially and Brachialis which forms the floor of the fossa.

21. Cubital Fossa Contents Lateral to medial, the Bicipital tendon, the Brachial artery, and the Median nerve. The Brachial veinsmay be removed. You should look for the branching of the Brachial a. into Radial and Ulnar aa. and the Superficial branch of the Radial nerve running underside Brachioradialismuscle

22. Course of nerves in anterior and posterior arm.

23. Brachial Plexus Randy Travis Drinks Cold Tea

24. Axilallry N and Radial N Axillary nerve supplies Deltoid muscle Teres Minor Skin over deltoid Axillary nerve Radial Nerve Radial Nerve Supplies all the extensors + BrachioRadialis Posterior View

25. Supplies all the flexors of the arm except Flexor Carpi Radialis (Radial N) Flexor Carpi Ulnaris (Ulnar N) Medial ½ of FDP Median Nerve

26. Radial Nerve

27. Brachial Plexus

29. Links • http://www.bing.com/images/search?q=posterior+forarm&form=QBIR&qs=n#focal=703fca7fd9d811d3076749b41e801de4&furl=http%3A%2F%2Fwww.anatomyfacts.com%2FMuscle%2FMuscleBone_files%2Fimage019.gif • http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/musculoskeletal_system/forearm_questions.html • www.getbodysmart.com • http://www.becomehealthynow.com/body/muscles/atlas/anconeus.shtml

30. References • Google images • Netter Anatomy Atlas • University of Washington website • Bing Images • Yahoo Images • http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/images/wrist_ant.jpg • http://www.med.umich.edu/lrc/coursepages/M1/anatomy/html/musculoskeletal_system/forearm_questions.html • http://iris3.med.tufts.edu/dentgross/labguide/SupHand2R.jpg • http://www.dasd.k12.pa.us/57592111818543/lib/57592111818543/Muscles_of_the_Posterior_Trunk,_Shoulder_and_Arm_Numbered.jpg • http://www.yamli.com/#t=image&q=axillary%20nerve&s=120&safe=1&isz=all&sm=ltr

31. 1. Deltoid: scapula/clavicle to humerus- abducts arm • 2. Levator scapulae: C-vertebrae to scapula- elevates scapula • 3. Infraspinatus: lower scapular spine to humeral head- lateral rotation of humerus • 4. Teres major: scapula to anterior humerus- medial rotation of humerus' • 5. Teres Minor: scapula to posterior humerus- lateral rotaion of humerus • 6. Supraspinatus: upper scapular spine to humeral head- abducts humerus • 7. Trapeziues: Vertebrae/Occipital to scapula/clavicle- abduct arm, rotate, abduct scapula • 8. Rhomboidius: T-vertebrae to scapula- raise/adduct scapula • 9. LatissimusDorsi: T-, L-, S- vertebrae to humerus- extend/adduct arm • 10. Biceps: scapula to radius- flex elbow • 11. Triceps: scapula/humerus to ulna- extend elbow • 12. Pronator: Medial humerus to radius- medial rotation of forearm (pronation) • 13. Flexor carpiradialis: medial humerus to 2nd/3rd metacarpal- flex/abduct hand • 14. Flexor Digitorum: medial humerus/ulna to phalanges- flex fingers • 15. Extensor carpiulnaris: lateral humerus to 5th metacarpal- extend/adduct hand • 16. Extensor digitorum: lateral humerus to phalanges- extend fingers • 17. Extensor carpiradialis: lateral humerus to 2nd/3rd metacarpal- extend/adduct hand