Brachium, Cubital Fossa, Elbow

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Brachium, Cubital Fossa, Elbow
2012-04-11 07:36:50
Brachium Cubital Fossa Elbow

Brachium, Cubital Fossa, Elbow
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  1. Biceps Brachii
    • Proximal Attachment: Short head: tip of coracoid process of scapula; Long head: supraglenoid tubercle of scapula and superior glenoid labrum
    • Distal Attachment: Radial tuberosity and fascia and skin of forearm via bicipital aponeurosis
    • Innervation: Musculocutaneous n. (C5–C7)
    • Main Actions: supinates forearm and, when it is supinated, flexes forearm/elbow; short head resists dislocation of shoulder; long head stabilises GH joint
  2. Coracobrachialis
    • Proximal Attachment: Tip of coracoid process of scapula
    • Distal Attachment: middle third of medial surface of humerus
    • Innervation: Musculocutaneous n. (C5–C7) (pierces)
    • Main Actions: helps flex and ADduct humerus; resists dislocation of shoulder
  3. Brachialis
    • Proximal Attachment: Distal half of anterior surface of humerus
    • Distal Attachment: Coronoid process and tuberosity of ulna
    • Innervation: Musculocutaneous n. (C5–C6)
    • Main Actions: Flexes forearm in all positions; uses trochlea as a pulley
  4. Triceps
    • Proximal Attachment: Long head: infraglenoid tubercle of scapula; medial head: posterior surface of humerus inferior to radial groove; lateral head: posterior surface of humerus superior to radial groove
    • Distal Attachment: Proximal end of olecranon of ulna and fascia of forearm
    • Innervation: Radial n. (C6–C8)
    • Main Actions: Chief extensor of forearm; long head extends and resists dislocation of shoulder; especially important during adduction
  5. Anconeus
    • Proximal Attachment: Lateral epicondyle of humerus
    • Distal Attachment: Lateral surface of olecranon and superior part of posterior surface of ulna
    • Innervation: Radial n. (C7–T1)
    • Main Actions: Assists triceps in extending forearm at terminal extension; stabilises elbow joint; may ABduct ulna during pronation (valgus stress)
  6. Contents of Anterior Compartment of Brachium
    • Biceps Brachii
    • Brachialis
    • Coracobrachialis
    • Musculocutaneous n. (innervates)
    • Brachial a.
    • Median n. (medial, does not innervate)
    • Ulnar n. (medial, does not innervate)
  7. Contents of Posterior Compartment of Brachium
    • Triceps Brachii
    • Radial n. (Innervates)
    • Radial a.
  8. Bicipital myotactic reflex
    hit biceps tendon to test C6 spinal root integrity
  9. Triceps Tendon Myotactic Reflex
    hit triceps tendon to test C7 spinal root integrity
  10. Musculocutaneous n.
    • Comes off lateral cord of brachial plexus
    • Pierces coracobrachialis
    • Goes between biceps and brachialis
    • Emerges lateral to biceps brachii and innervates skin of lateral forearm
  11. Radial n.
    • Branch of posterior cord of brachial plexus
    • Goes through triangular interval
    • Runs in radial groove of humerus deep to triceps lateral head and long bead; superior to medial
    • Divides in cupital fossa into superficial and deep
  12. Cubital Fossa
    • Triangular in shape
    • Borders: line between epicondyles; pronator teres (inferior medial); brachioradialis (inferior lateral)
    • Contents (lateral to medial): biceps tendon; brachial artery (splits in fossa); median nerve
    • Floor: brachialis
    • Deep muscle: supinator (wraps around neck, tuberosity, and shaft of radius)
  13. Elbow Joints
    • Humerus and Ulna (flexion and extension) — modified hinge: trochlea and trochlear notch
    • Humerus and Radius (flexion extension): capitulum and radial head
    • Radius and Ulna (pronation supination): radial head and radial notch of ulna
  14. Elbow Joint Stability
    • Joint Capsule (weak anteriorly and posteriorly)
    • MCL/UCL (ulnar collateral ligament)
    • LCL/RCL (radial collateral)
    • Bone articulations
    • Muscles crossing the joint
  15. Ulnar Collateral Ligament (UCL)
    • a.k.a. MCL
    • Anterior Bundle: medial epicondyle of humerus to coronoid process of ulna; taught especially in extension; strongest band
    • Posterior Bundle: medial epicondyle of humerus to olecranon process of ulna; taught especially in flexion
    • Transverse Bundle: coronoid process of ulna to olecranon process of ulna; helps deepen socket
    • Prevent valgus forces
  16. Radial Collateral Ligament (RCL)
    • a.k.a. LCL
    • RCL part: lateral epicondyle to annular ligament
    • LUCL part: lateral epicondyle to supinator crest of ulna
    • Prevents: radial head subluxation; varus stress
  17. Annular Ligament
    • Radial notch to radial notch on ulna
    • Prevents: separation of radial head and ulna
    • Lined with synovial membrane
    • Allows rotation of radius
  18. Oblique Cord
    • Lateral ulnar tuberosity to just below radial tuberosity
    • Prevents: inferior translation of radius
    • Stabilises proximal radioulnar joint during movement
  19. Bursas of Elbow Joint
    • 2 clnically important
    • Olecranon bursae: decreases friction between triceps tendon, olecranon, and skin
    • Bicipitoradial bursa: between biceps tendon and radial tuberosity
  20. Brachial Artery
    • Starts distal to teres major
    • Runs medial to biceps brachii
    • Divides into Radial a. and Ulnar a. in cubital fossa
  21. Arterial Anastomoses
    • Superior ulnar collateral <--> Posterior ulnar recurrent
    • Inferior ulnar collateral <--> Anterior ulnar recurrent
    • Radial recurrent <--> radial collateral
    • Interosseous recurrent <--> Middle collateral

    • Collaterals go with recurrents
    • Consonants together
    • Vowels together
    • Radials together