THE ARM
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THE ARM
The arm is the part of the upper
limb that extends from the
shoulder joint to the elbow joint.
The arm is divided by the medial
and lateral intermuscular septa
(fibrous septas) into :
Anterior compartment
posterior compartment
This gives each compartment
its individuality and freedom of
action.
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INTERMUSCULAR SEPTA
These fibrous septa are well
defined only in the lower half of
the arm
They are attached to the medial
and lateral borders and the
supracondylar ridges of the
humerus.
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INTERMUSCULAR SEPTA
Medial intermuscular
septum gives origin to the
most medial fibres of
brachialis and the medial
head of triceps
Brachioradialis and
extensor carpi radialis
longus extend out from the
humerus to gain
attachment to the lateral
septum in front.
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INTERMUSCULAR SEPTA
Two additional septa are present
in the anterior compartment of the
arm.
The transverse septum which
separates the biceps from the
brachialis and encloses the
musculocutaneous nerve.
The anteroposterior septum which
separates the brachialis from the
muscles attached to the lateral
supracondylar ridge; it encloses
the radial nerves and the anterior
descending branch of the profunda
brachii artery.
ANTERIOR COMPARTMENT OF ARM
Three muscles out of the four major arm muscles are in the anterior
(flexor) compartment.
These muscles are:
Coracobrachialis
Biceps brachii
Brachialis
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ANTERIOR COMPARTMENT OF ARM
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ANTERIOR COMPARTMENT OF ARM
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ANTERIOR COMPARTMENT OF ARM cont’d
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CORACOBRACHIALIS
Coracobrachialis is an
elongated muscle in the
supero-medial aspect of
the arm.
Morphologically, it may
represents the medial
compartment of the arm.
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CORACOBRACHIALIS
Origin: Apex of the coracoid
process of scapula.
Insertion: Midway along the
medial border of the humeral
shaft.
Nerve supply:
Musculocutaneous nerve
(C5,6).
Action: Weak flexor and
adductor of the arm at the
11 shoulder joint.
CORACOBRACHIALIS
The insertion of this
muscle is an important
anatomical/surgical
landmark; many transitions
0occur at this level.
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TRANSITIONS AT THE INSERTION OF
CORACOBRACHIALIS
Bone: The circular shaft becomes
triangular below this level.
Fascial septa: The medial and
lateral intermuscular septa
becomes better defined from this
level downwards.
Muscles
(i) Deltoid is inserted at this level
(ii) origin of brachialis. (iii) origin
of the medial head of triceps.
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CHANGES AT THE INSERTION OF
CORACOBRACHIALIS
Arteries
(i) The brachial artery passes from the medial side of the arm to its anterior
aspect.
(ii) The profunda brachii artery runs in the spiral groove and divides into its
anterior and posterior descending branches.
(iii) The superior ulnar collateral artery originates from the brachial artery, and
pierces the medial intermuscular septum with the ulnar nerve.
(iv) The nutrient artery of the humerus enters the bone.
Veins
(ii) The basilic vein pierces the deep fascia.
(ii) Two venae commitantes of the brachial
14 artery may unite to form one
brachial vein.
CHANGES AT THE INSERTION OF
CORACOBRACHIALIS
Nerves
(i) The median nerve crosses the brachial artery from the lateral to the
medial side.
(ii) The ulnar nerve pierces the medial intermuscular septum with the
superior ulnar collateral artery and goes to the posterior compartment.
(iii) The radial nerve pierces the lateral intermuscular septum with the
anterior descending (radial collateral) branch of the profunda brachii artery
and passes from the posterior to the anterior compartment of arm
(iv) The medial cutaneous nerve of the arm pierces the deep fascia.
(v) The medial cutaneous nerve of the forearm pierces the deep
fascia.
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BICEPS BRACHII Biceps is a ‘’two-joint muscle’’ that has
no attachment to the humerus.
Origin:
i) Long head from the of supraglenoid
tubercle and adjoining part of the
glenoid labrum of the scapula.
ii) Short head from the apex of the
coracoid process, lying on the lateral
side of the coracobrachialis.
Its two bellies lie side by side and are
connected loosely by areolar tissue,
but do not merge into a single tendon
until just above the elbow joint
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BICEPS cont’d
The tendon passes antero-
laterally through the cubital fossa
to its insertion
Bicep brachii tendon has a broad
medial expansion called the
bicipital aponeurosis (grace a’
dieu fascia)
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BICEPS cont’d
Insertion:
Posterior rough part of the radial
tuberosity. The tendon is
separated from the anterior part
of the tuberosity by a bursa
Nerve supply: Musculocutaneous
nerve (C5,6) with one branch to
each belly.
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BICEPS cont’d
Action:
It is strong supinator when
the forearm is flexed. All
screwing movements are
done with it.
Powerful flexor of the elbow
The long head prevents
upwards displacement of the
head of the humerus
The short head is a flexor of
the arm.
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BICEPS BRACHI TEST
Test: The forearm is
supinated and the elbow is
flexed against resistance.
The contracted muscle
which forms a prominent
bulge, and the tendon and
aponeurosis at the elbow
are easily palpable
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BICEPS cont’d
Diag: clin Anatomy (Snell,2012)
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BRACHIALIS
The brachialis is a flattened
fusiform muscle that lies posterior
(deep) to the biceps.
It covers the anterior part of the
elbow joint
It is the main flexor of the
forearm. It is regarded as the
workhorse of the elbow flexors
because of its almost constant
role and importance.
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BRACHIALIS
The muscle always contracts when
the elbow is flexed and is primarily
responsible for sustaining the
flexed position.
Origin:
Front of the lower aspect of the
humeral shaft and the medial
intermuscular septum.
Some fibres may arise from the
lower part of the radial groove
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BRACHIALIS Insertion: It is inserted into the
Coronoid process and rough ant.
Surface of the ulna tuberosity
Nerve supply: Musculocutaneous nerve
(motor), with small lateral part of the
muscle innervated by a branch of the
radial nerve (proprioceptive)
Acton: Flexor of the elbow joint.
Test: The forearm is semipronated and
flexed against resistance, and the
contracted muscle can be seen and
palpated if acting normally.
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POSTERIOR COMPARTMENT OF THE ARM
• The Posterior (extensor)
compartment of the arm is
occupied by the Triceps
brachii muscle and
Anconeus.
• The radial nerve and
profunda artery run through
it
• The ulnar nerve passes
through the lower part of
this compartment
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TRICEPS Origin:
The long head from the infraglenoid
tubercle of the scapula.
The long head of triceps crosses the
glenohumeral joint, and helps to stabilize
the adducted glenohumeral joint
The lateral head arises from the upper
aspect of the posterior surface of the
humeral shaft. The medial head arises
from the greater surface of the humeral
shaft
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TRICEPS
Insertion/attachment: Attached to the
proximal (upper) end of olecranon of
ulna and fascia of forearm.
A few fibres are inserted into the
posterior part of the capsule of the
elbow joint
Nerve supply: Radial nerve (C6,7 and 8).
Action: Chief extensor of forearm,
extensor of the elbow joint.
Test: The muscle is seen and felt when
27 the flexed forearm is extended against
TRICEPS cont’d
Clinical Anat by region, 9th ed., (Snells, 2012)
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TRICEPS TEST
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CUBITALCCUBITAL FOSSA FOSSA
INTRODUCTION
o Anatomical Position: It is
located anterior to the elbow
joint.
o Anatomical Shape: The fossa is
a triangular hollow/depression
o The cubital fossa marks the
anatomical transition between
the brachium and the
antebrachium.
CUBITAL FOSSA BORDERS
Laterally: medial border of brachioradialis
muscle
Medially: lateral border of pronator teres
muscle
Base: An imaginary horizontal line
connecting the medial epicondyle of the
humerus to the lateral epicondyle of the
humerus. It is directed upwards.
Apex: It is formed by the intersection of
the medial and lateral borders. Here the
brachioradialis overlaps the pronator teres.
The apex is directed downwards
CUBITAL FOSSA BORDERS CONT’D
Roof: formed by the;
1. skin
2. superficial fascia
3. Deep fascia, reinforced
by the bicipital aponeurosis
Floor: formed by;
- Brachialis muscle
proximally
- Supinator muscle distally
Structures in the roof Floor of the cubital
of the cubital fossa fossa
CONTENTS IN THE CUBITAL FOSSA
From lateral to medial, they include:
Radial nerve
Biceps tendon
Brachial artery
Median nerve
APPLIED ANATOMY
BRACHIAL PULSE AND BLOOD PRESSURE
Using a sphygmomanometer and placing the stethoscope over the cubital
fossa allows the blood pressure measurement due to pulsations of the
brachial may be palpated in the cubital fossa just medial to the bicep tendon.
Blood pressure being taken
SUPRACONDYLAR FRACTURE
A transverse fracture that spans between the
two epicondyle is a common fracture,
especially in the young and usually occurs
by falling onto a hyper-extended elbow. It
can also occur by falling onto a flexed
elbow.
The displaced fracture fragments may
impinge and cause damage to the contents of
the cubital fossa.
Direct damage or post-fracture swelling can
cause interference to the blood supply of the
forearm from the brachial artery. This can
result to Volkmann’s ischaemic
contracture
Post-fracture Volkmann’s
swelling ischaemic contracture
VENIPUNCTURE
• The area just superficial to the
cubital fossa is often used for
venous access (phlebotomy).
• The superficial veins in the
superficial fascia covering of the
cubital fossa are the common
sites for venipuncture.
• Median cubital vein connects the
basilic vein to the cephalic vein
and can be accessed for
venipuncture.
THE END
