Transcript Anterior aspect of the forearm & Cubital fossa-2012

Kaan Yücel M.D., Ph.D.
26.December.2012
Wednesday
2
Elbow joint
FOREARM
Wrist joint
Most major structures (nerves,veins,arteries)
via cubital fossa, anterior to elbow joint
Exception ulnar nerve
posterior to the medial epicondyle of humerus
Lateral intermuscular
septum
from the anterior border of
the radius to deep fascia
surrounding the limb
Interosseous membrane
links borders of the radius
and ulna
Attachment of deep
fascia
along the posterior border of
the ulna
Muscles in the anterior compartment
Flex the wrist & digits
Pronate the hand
Muscles in the posterior compartment
Extend the wrist & digits
Supinate the hand
Muscles of the anterior compartment
Mainly by median nerve
The one and a half exceptions by ulnar nerve
Muscles of the posterior compartment
All by radial nerve
(directly or by its deep branch)
7
8
Superficial
4 muscles
Intermediate
Deep
3 muscles
1. flexor carpi radialis
2. flexor carpi ulnaris
3. palmaris longus
4. pronator teres
two heads
Ulnar head
Humeral head
Medial epicondyle
1. flexor carpi radialis
Medial epicondyle of humerus
Base of metacarpals II & III
2. flexor carpi ulnaris
Humeral head: Medial epicondyle of humerus
Ulnar head: Olecranon & Posterior border of ulna
•Pisiform & hamate
•5th metacarpal
3. palmaris longus
Medial epicondyle of humerus
Flexor retinaculum &palmar aponeurosis
4. pronator teres
Humeral head: Medialepicondyle& adjacentsupraepicondylarridge
Ulnar head: Coronoid process
Lateral surface of radius
flexor digitorum superficialis
Humeroulnar head
• Medial epicondyle of humerus
• Adjacent margin of coronoid process
Radial head
Superior half of anterior border
Shafts of middle phalanges of
medial four digits
12
flexor
digitorum
profundus
flexor
pollicis
longus
•Proximal¾ of medial& anteriorsurfaces
of ulna
•Interosseousmembrane
• Anteriorsurfaceof radius
• Adjacentinterosseous
membrane
Bases of distal phalanges of 4th &5th digits
Bases of distal phalanges of 2nd &3rd digits
Base of distal
phalanx of thumb
pronator
quadratus
Distal ¼ of anterior
surface of ulna
Distal ¼ of
anterior surface
of radius
Flexion of forearm @ the elbow joint
Pronator teres
Flexion of hand @ the wrist joint
Flexor carpi radialis et ulnaris- Palmaris longus
Abduction (radial deviation) of hand @ the wrist joint
Flexor carpi radialis
Adduction (ulnar deviation) of hand @ the wrist joint
Flexor carpi ulnaris
Pronation of forearm
Pronator teres – Pronator quadratus
Flexor digitorum superficialis
 Flexes proximal interphalangeal joints of the index, middle, ring, & little fingers
 Flexes metacarpophalangeal joints of the same fingers and the wrist joint
Flexor digitorum profundus
 Flexes distal phalanges 4 & 5 at distal interphalangeal joints
 Flexes distal phalanges 2 and 3 at distal interphalangeal joints
Flexor pollicis longus
Flexes phalanges of thumb
All the muscles
by median nerve
Except 1.5
muscles by ulnar
nerve
Flexor carpi
ulnaris full
Flexor digitorum
profundus medial
half
part associated
w/ring & little
fingers
Brachial artery
deep venous
palmar arch in
the hand
principal nerve
no branches in the arm
other than small twigs to
the brachial artery.
Its major branch in the
forearm anterior
interosseous nerve
Leaves cubital fossa by passing
between
2 heads of pronator teres
&
humero-ulnar &radial heads of
flexor digitorum superficialis
Enters the anterior compartment
by passing posteriorly
around
medial epicondyle of humerus
&
between humeral & ulnar heads of
flexor carpi ulnaris muscle
Two small cutaneous
branches
palmar branch & dorsal branch
motor and sensory
functions in both
arm & forearm
but onlysensoryfunctionsin thehand
Superficial
(sensory)
deep to
brachioradialis
Deep (motor)
between two heads
of supinator
Continuation of
musculocutaneous nerve
Branch of medial cord of
brachial plexus
Branch of radial nerve
23
An important area of
transition between the
arm and the forearm.
seen superficially as
a depression on the
anterior aspect of the
elbow.
Deeply, it is a space
filled with a variable
amount of fat anterior
to the most distal
part of the humerus
and the elbow joint.
24
Superiorly imaginary line connecting medial
&lateral epicondyles.
Medially pronator teres.
Laterally brachioradialis.
25
1) Terminal part of
the brachial
artery,radial and
ulnar arteries
2) Biceps brachii
tendon
3) Median nerve
4) Radial nerve
5) (Deep)
accompanying veins
of the arteries
26
Superficially, in
the subcutaneous
tissue overlying
the fossa
median cubital
vein,
medial and lateral
antebrachial
cutaneous nerves
basilic and
cephalic veins.
27
median nerve lies immediately
medial to the brachial artery
and leaves the fossa by passing
between the ulnar and humeral
heads of the pronator teres
radial nerve lies under
brachioradialis
(lateral margin of the fossa)
gives off deep branch of the
radial nerve and continues as
superficial radial nerve.
28