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SGD 5: ARM AND CUBITAL FOSSA

1. Discuss the skin, superficial fascia and deep fascia of the upper limb

The skin over the point of the shoulder and halfway down the lateral surface of the
deltoid muscle is supplied by the supraclavicular nerves (C3 and 4).
Subcutaneous tissue or the superficial fascia is found deep to the skin and it contains fat
Deep fascia is found compartmentalizing and investing the muscles. If no structure
intervenes between the skin and the bone, the deep fascia is usually attached to bone.
The deep fascia of the upper limb continues beyond the extensor and flexor retinacula
as the palmar fascia

2. Illustrate the areas of distribution of the major cutaneous nerves of the upper
limb.

1. Supraclavicular nerves- pass over the clavicle, the cords of the brachial plexus against
the humeral head
2. Median nerve in the mid-upper arm, crossing over the brachial artery
3. Ulnar nerve in the groove of the medial epicondyle
4. Superficial radial nerve fibres as it passes over the tendon of extensor pollicis longus at
the wrist.
5. Axillary nerve is related closely to the surgical neck of the humerus 2 in (5 cm) below the
acromion process.
6. Radial nerve crosses the posterior aspect of the humeral shaft at its mid-point.
3. Discuss the major superficial and deep veins of the upper limb as to its formation,
commencement/termination and course.

SUPERFICIAL VEINS OF THE UPPER LIMB- lies at the superficial fascia


CEPHALIC VEIN
Arises from lateral side of the dorsal venous network.
Runs on the lateral side of the forearm and the front of the elbow.
Often connected with the 2asilica vein by the median cubital vein in front of the elbow.
Winds around the lateral border of the forearm. Ascends into the cubital fossa and up the front
of the arm on the lateral side of the biceps.
Continues up in the deltopectoral groove.
Pierces clavipectoral fascia in the floor of the groove to drain into axillary vein.
BASILIC VEIN
Arises from the medial side of the dorsal venous network of hand.
Winds around the medial border of the forearm.

Then ascends into the cubital fossa and up the front of the arm on the medial side of the
biceps to middle of the arm where it pierces the deep fascia and joins the brachial vein or
axillary vein.
Median cubital vein:
Links cephalic vein and 2asilica vein in the cubital fossa.
It is a frequent site for venepuncture to remove a sample of blood or add fluid to the blood.
DEEP VEINS OF THE UPPER LIMB
- Comprises the venae comitantes accompany large arteries and the axillary vein
Axillary Vein
Formed at the lower border of the teres major by the union the brachial vein and the 2asilica
vein
Runs upward on the medial side of the axillary artery
Ends at the lateral border of the first rib by becoming the subclavian vein
4. Discuss the muscles of the anterior compartment of the arm as to its attachments,
innervation and action

5. Discuss with illustration the muscles of the posterior compartment of the arm as
to its attachments, innervation and action
6. Draw

the

course of the radial and musculocutaneous nerves including the areas innervated

7. Discuss the brachial artery as to its origin, commencement/termination, course,


branches and spatial relationship.
The brachial artery begins at the lower border of the teres major muscle as a continuation of the
axillary artery. It provides the main arterial supply to the arm. It terminates opposite the neck of
the radius by dividing into the radial and ulnar arteries.
Relations

Anteriorly: The vessel is superficial and is overlapped from the lateral side by the
coracobrachialis and biceps. The medial cutaneous nerve of the forearm lies in front of
the upper part; the median nerve crosses its middle part; and the bicipital aponeurosis
crosses its lower part.

Posteriorly: The artery lies on the triceps, the coracobrachialis insertion, and the
brachialis.

Medially: The ulnar nerve and the basilic vein in the upper part of the arm; in the lower
part of the arm, the median nerve lies on its medial side.

Laterally: The median nerve and the coracobrachialis and biceps muscles above; the
tendon of the biceps lies lateral to the artery in the lower part of its course.

8. Discuss with illustration the cubital fossa as to its boundaries, contents with its
spatial relationship.
The cubital fossa is a triangular depression that lies in front of the elbow.
Boundaries

Laterally: The brachioradialis muscle

Medially: The pronator teres muscle

The base of the triangle is formed by an imaginary line drawn between the two epicondyles of
the humerus. The floor of the fossa is formed by the supinator muscle laterally and the
brachialis muscle medially. The roof is formed by skin and fascia and is reinforced by the
bicipital aponeurosis.
Contents

The cubital fossa contains the following structures, enumerated from the medial to the lateral
side: the median nerve, the bifurcation of the brachial artery into the ulnar and radial arteries,
the tendon of the biceps muscle, and the radial nerve and its deep branch.
The supratrochlear lymph node lies in the superficial fascia over the upper part of the fossa,
above the trochlea. It receives afferent lymph vessels from the third, fourth, and fifth fingers; the
medial part of the hand; and the medial side of the forearm. The efferent lymph vessels pass up
to the axilla and enter the lateral axillary group of nodes

9. Discuss the shoulder and elbow joints as to its components, type and range of
motion with demonstration.
Articulation: between trochlea and capitulum of the humerus and the trochlear notch of the ulna
and head of the radius its articular surfaces covered with hyaline cartilage.
Type: Synovial hinge joint
Capsule: Anterior: attached above to the humerus along upper margins of coronoid and radial
fossae to the front of the medial and lateral epicondyles and below to the margin of the coronoid
process of the ulna and to the annular ligament
Posterior: attached above to margins of olecranon fossa of the humerus and below to
the upper margin and sides of the olecranon process

Ligaments: Lateral ligament triangular; attached by its apex to lateral epicondyle of humerus
Medial ligament triangile; with 3 strong bands: anterior band, posterior band,
transverse band
Synovial membrane: lines the capsule and covers fatty pads in the floors of the coronoid,
radial, and olecranon fossae
Nerve supply: Branches from median, ulnar, musculocutaneous, and radial nerves