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THE ARM
• The arm extends from the shoulder to
the elbow.
• Two types of movement occur between
the arm and forearm at the elbow joint:
• flexion-extension and pronationsupination.
• The muscles performing these
movements are clearly divided into
anterior and posterior groups.
The skeletal support for the arm is the
humerus .
Most of the large muscles of the arm insert
into the proximal ends of the two bones of the
forearm, the radius and the ulna, and flex and
extend the forearm at the elbow joint.
In addition, the muscles predominantly
situated in the forearm that move the hand
originate at the distal end of the humerus.
Muscles of the Arm
• The anterior compartment of the arm
contains three muscles the coracobrachialis,
 brachialis,
 and biceps brachii muscles• The posterior compartment contains one
muscle-the triceps brachii muscle.
Anterior compartment muscle
MUSCLE

ORIGIN

INSERTION

INNERVATION

Coracob
rachialis

Tip of the
coracoid
process of the
scapular bone

Linear
roughening on
mid-shaft of
humerus on
medial side

Musculocutane Flexor of the
ous nerve
arm at the
[C5,C6,C7]
gleno-humeral
joint

Biceps
brachii

10/02/2014

Long headsupraglenoid
tubercle of
Radial
scapula;
tuberosity
short head-apex
of coracoid
process

ACTION

Powerful flexor
of the forearm
Musculocutane at the elbow
ous nerve
joint and
[C5,C6,C7]
supinator of the
forearm;
accessory flexor
of the arm at
the
glenohumeral
joint
5
The arm
Anterior compartment muscle
MUSCLE

Brachialis

10/02/2014

ORIGIN

INSERTION

Anterior aspect
of humerus
(medial and
Tuberosity of
lateral surfaces) the ulna
and adjacent
intermuscular
septae

INNERVATION
Musculocutane
ous nerve
[C5,C6, C7];
A small portion
of its lateral part
may be
innervated by
the radial nerve

ACTION
Powerful flexor
of the forearm
at the elbow
joint

7
The arm
Posterior compartment
MUSCLE

Triceps
brachii

ORIGIN
Long headinfraglenoid
tubercle of
scapula;
medial headposterior suface
of humerus;
lateral headposterior
surface of
humerus

INSERTION

INNERVATION

Superior surface Radial nerve
of the
[C6,C7,C8]
Olecranon of
the ulna bone

ACTION
Extension of the
forearm at the
elbow joint.
Long head can
also extend and
adduct the arm
at the shoulder
joint
The arm
Arteries and veins of the arm
• Brachial artery
• The major artery of the arm, is found in the
anterior compartment .
• It begins as a continuation of the axillary
artery at the lower border of the teres major
muscle, it terminates just distal to the elbow
joint where it divides into the radial and ulnar
arteries.
• In the proximal arm, the brachial artery lies on
the medial side.
• In the distal arm, it moves laterally to assume
a position midway between the lateral
epicondyle and the medial epicondyle of the
humerus.
• It crosses anteriorly to the elbow joint where
it lies immediately medial to the tendon of the
biceps brachii muscle.
• Branches of the brachial artery in the arm
include those to adjacent muscles and two
ulnar collateral vessels, which contribute to a
network of arteries around the elbow joint.
• Additional branches are the profunda brachii
artery and nutrient arteries to the humerus,
which passes through a foramen in the
anteromedial surface of the humeral shaft.
The arm
Profunda brachii artery
• The largest branch of the brachial artery, passes into
and supplies the posterior compartment of the arm.
• It enters the posterior compartment with the radial
nerve and together they pass through the triangular
interval, which is formed by the shaft of the humerus,
the inferior margin of the teres major muscle, and the
lateral margin of the long head of the triceps muscle.
• They then pass along the radial groove on the posterior
surface of the humerus deep to the lateral head of the
triceps brachii muscle.
Profunda brachii artery
Veins
• Paired brachial veins pass along the medial
and lateral sides of the brachial artery,
receiving tributaries that accompany branches
of the artery.
• In addition to these deep veins, two large
subcutaneous veins, the basilic vein and the
cephalic vein, are located in the arm.
• The basilic vein passes vertically in the distal
half of the arm, penetrates deep fascia to
assume a position medial to the brachial
artery, and then becomes the axillary vein at
the lower border of the teres major muscle.
The brachial veins join the basilic, or axillary,
vein.
• The cephalic vein passes superiorly on the
anterolateral aspect of the arm and through
the anterior wall of the axilla to reach the
axillary vein.
The arm
Nerves of the arm
• These four nerves are found within the
anterior and posterior compartments of the
arm;
• Musculocutaneous nerve
• Median nerve
• Ulnar nerve
• Radial nerve
Musculocutaneous nerve (C5-7)
• Is a large terminal branch of the lateral cord.
• Enters the arm by passing through the
coracobrachialis muscle.
• It passes diagonally down the arm in the plane
between the biceps brachii and brachialis
muscles.
• After giving rise to motor branches in the arm, it
emerges laterally to the tendon of the biceps
brachii muscle at the elbow, penetrates deep
fascia, and continues as the lateral cutaneous
nerve of forearm.
The arm
Median, ulnar nerve & radial nerve
• As discussed in brachial plexus- both the median
and ulnar nerve passes through the arm into the
forearm with no branches to the arm.
• The radial nerve originate from the posterior cord
of the brachial plexus, it enters the arm after
crossing the inferior margin of the teres major
muscle lying posterior to the brachial artery and
accompanied by the profundal brachial artery to
the posterior aspect of the arm.
The arm
The arm
The arm
THE ELBOW JOINT
• Definition;
• The elbow joint is a complex type of hinge
type of synovial joint involving three separate
articulations, which share a common synovial
cavity
• Articulation;
• It involves three separate articulations, which
share a common synovial cavity viz;
1. The humero-ulnar, between the trochea of
the humerus and the trochlear notch of the
ulna (a hinge joint)
2. The humero-radial, between the capitulum
and the upper concave surface of the radial
head (a ball and socket joint)
3. The the superior radio-ulnar, between the
head of the radius and the radial notch of the
ulna, the head beign held in place by the
tough annular ligament (a pivot joint)
The arm
• Capsule; the capsule is closely applied around
this complex articular arrangement.
• The non-articular medial and lateral
epicondyles are extracapsular
• It is thin and loose anteriorly and posteriorly
to allow flexion and extension, whereas it is
strongly thickened on either side to form the
medial andlateral collateral ligaments
• Ligaments; the collateral ligaments of the
elbow joint are strong triangular bands that
are medial and lateral thickenings of the
fibrous capsule.
• The fanlike radial collateral ligament extends
from the lateral epicondyle and attach distally
to the annular ligament around the radial
head.
• The medial, triangular ulnar collateral
ligament extends from the medial epicondyle
of the humerus to the coronoid process and
olecranon of the ulna.
• It consist of 3 bands;
• An anterior cordlike band which is the
strongest
• A posterior fanlike band, which is the weakest
• The slender oblique band, which deepens the
socket for the trochlea of the humerus.
The arm
The arm
• Innervation; nerve supply is by the ulnar,
radial and musculocutaneous nerves.
• May also have innervation from median nerve
as it passes through.
• Movements; two sets of movements take
place at the elbow:
• Flexion and extension at the humero-ulnar
and humero-radial joints;
• Pronation and supination at the proximal
radio-ulnar
The arm
•
•
•
•
•
•
•
•
•

MUSCLES INVOLVED IN THE MOVEMENTS;
FLEXION;
Biceps brachii
Brachialis
Brachoradialis
Pronator teres
EXTENSION;
Triceps brachii
aconeus
The arm
•
•
•
•
•
•
•
•
•
•

PRONATION;
Pronator teres
Pronator quadratus
Flexor carpi radialis
SUPINATOR;
Biceps brachii
Supinator
Extensor pollicis longus
Extensor policis bravis
Abductor policis longus
The arm
BURSAE
• Three olecranon bursae are clinically
important to the elbow joint. They include;
• Intratendinous olecranon bursa; which is sometimes
present in the tendon of triceps brachii.
• Subtendinous olecranon bursa; which is located
between the olecranon and the triceps tendon, just
proximal to its attachement to the olecranon.
• Subcutaneous olecranon bursa; which is located in
the subcutaneous connective tissue over the
olecranon
• BLOOD SUPPLY; the arteries supplying the
elbow joint are derived from the anastomosis
around the elbow.
APPLIED ANATOMY
• Bursatis of the elbow;
• The subcutaneous olecranon bursa is exposed to
injury during falls on the elbow and to infection
from abrasions of the skin covering the
olecranon.
• Repeated excessive pressure and frictions, as
occurs in wrestling, for example, may cause this
bursa to become inflamed, producing a friction
called subcutaneous olecranon bursitis.
(“student elbow”)
• Subtendinous olecranon bursitis; is much less
common.
• Results from excessive friction between the
triceps tendon and olecranon, e.g; resulting
from repeated flexion-extension of the
forearm as occurs during some assembly line
job.
The arm
• Dislocation of the elbow joint;
• Posterior dislocation of the elbow joint may
occur when children fall on their hands with
their elbows flexed.
• The distal end of the humerus is driven
through the weak anterior part of the fibrous
capsule as the radius and ulna dislocate
posteriorly.
ELBOW ANASTOMOSIS
• There is a rich arterial anastomosis around the
elbow joint, the arteries involved are branches
of brachial, radial and ulnar arteries.
• In front of the medial epicondyle;
• Anterior ulnar recurrent branch of ulnar artery
anastomoses with inferior ulnar collateral
branch of brachial artery.
• Behind the medial epicondyle;
• Posterior ulnar recurrent branch of ulnar
artery anastomoses with superior ulnar
collateral branch of brachial artery.
• In front of lateral epicondyle;
• Radial recurrent branch of radial artery
anastomoses with the anterior descending
branch of profunda brachii artery.
• Behind the lateral epicondyle;
• Interosseous recurrent artery from posterior
interosseous branch of common interosseous
of ulnar artery anastomoses with posterior
descending branch of profunda brachii artery.
Elbow anastomosis
The arm
GOODMORNING

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The arm

  • 2. • The arm extends from the shoulder to the elbow. • Two types of movement occur between the arm and forearm at the elbow joint: • flexion-extension and pronationsupination. • The muscles performing these movements are clearly divided into anterior and posterior groups.
  • 3. The skeletal support for the arm is the humerus . Most of the large muscles of the arm insert into the proximal ends of the two bones of the forearm, the radius and the ulna, and flex and extend the forearm at the elbow joint. In addition, the muscles predominantly situated in the forearm that move the hand originate at the distal end of the humerus.
  • 4. Muscles of the Arm • The anterior compartment of the arm contains three muscles the coracobrachialis,  brachialis,  and biceps brachii muscles• The posterior compartment contains one muscle-the triceps brachii muscle.
  • 5. Anterior compartment muscle MUSCLE ORIGIN INSERTION INNERVATION Coracob rachialis Tip of the coracoid process of the scapular bone Linear roughening on mid-shaft of humerus on medial side Musculocutane Flexor of the ous nerve arm at the [C5,C6,C7] gleno-humeral joint Biceps brachii 10/02/2014 Long headsupraglenoid tubercle of Radial scapula; tuberosity short head-apex of coracoid process ACTION Powerful flexor of the forearm Musculocutane at the elbow ous nerve joint and [C5,C6,C7] supinator of the forearm; accessory flexor of the arm at the glenohumeral joint 5
  • 7. Anterior compartment muscle MUSCLE Brachialis 10/02/2014 ORIGIN INSERTION Anterior aspect of humerus (medial and Tuberosity of lateral surfaces) the ulna and adjacent intermuscular septae INNERVATION Musculocutane ous nerve [C5,C6, C7]; A small portion of its lateral part may be innervated by the radial nerve ACTION Powerful flexor of the forearm at the elbow joint 7
  • 9. Posterior compartment MUSCLE Triceps brachii ORIGIN Long headinfraglenoid tubercle of scapula; medial headposterior suface of humerus; lateral headposterior surface of humerus INSERTION INNERVATION Superior surface Radial nerve of the [C6,C7,C8] Olecranon of the ulna bone ACTION Extension of the forearm at the elbow joint. Long head can also extend and adduct the arm at the shoulder joint
  • 11. Arteries and veins of the arm • Brachial artery • The major artery of the arm, is found in the anterior compartment . • It begins as a continuation of the axillary artery at the lower border of the teres major muscle, it terminates just distal to the elbow joint where it divides into the radial and ulnar arteries.
  • 12. • In the proximal arm, the brachial artery lies on the medial side. • In the distal arm, it moves laterally to assume a position midway between the lateral epicondyle and the medial epicondyle of the humerus. • It crosses anteriorly to the elbow joint where it lies immediately medial to the tendon of the biceps brachii muscle.
  • 13. • Branches of the brachial artery in the arm include those to adjacent muscles and two ulnar collateral vessels, which contribute to a network of arteries around the elbow joint. • Additional branches are the profunda brachii artery and nutrient arteries to the humerus, which passes through a foramen in the anteromedial surface of the humeral shaft.
  • 15. Profunda brachii artery • The largest branch of the brachial artery, passes into and supplies the posterior compartment of the arm. • It enters the posterior compartment with the radial nerve and together they pass through the triangular interval, which is formed by the shaft of the humerus, the inferior margin of the teres major muscle, and the lateral margin of the long head of the triceps muscle. • They then pass along the radial groove on the posterior surface of the humerus deep to the lateral head of the triceps brachii muscle.
  • 17. Veins • Paired brachial veins pass along the medial and lateral sides of the brachial artery, receiving tributaries that accompany branches of the artery. • In addition to these deep veins, two large subcutaneous veins, the basilic vein and the cephalic vein, are located in the arm.
  • 18. • The basilic vein passes vertically in the distal half of the arm, penetrates deep fascia to assume a position medial to the brachial artery, and then becomes the axillary vein at the lower border of the teres major muscle. The brachial veins join the basilic, or axillary, vein. • The cephalic vein passes superiorly on the anterolateral aspect of the arm and through the anterior wall of the axilla to reach the axillary vein.
  • 20. Nerves of the arm • These four nerves are found within the anterior and posterior compartments of the arm; • Musculocutaneous nerve • Median nerve • Ulnar nerve • Radial nerve
  • 21. Musculocutaneous nerve (C5-7) • Is a large terminal branch of the lateral cord. • Enters the arm by passing through the coracobrachialis muscle. • It passes diagonally down the arm in the plane between the biceps brachii and brachialis muscles. • After giving rise to motor branches in the arm, it emerges laterally to the tendon of the biceps brachii muscle at the elbow, penetrates deep fascia, and continues as the lateral cutaneous nerve of forearm.
  • 23. Median, ulnar nerve & radial nerve • As discussed in brachial plexus- both the median and ulnar nerve passes through the arm into the forearm with no branches to the arm. • The radial nerve originate from the posterior cord of the brachial plexus, it enters the arm after crossing the inferior margin of the teres major muscle lying posterior to the brachial artery and accompanied by the profundal brachial artery to the posterior aspect of the arm.
  • 28. • Definition; • The elbow joint is a complex type of hinge type of synovial joint involving three separate articulations, which share a common synovial cavity • Articulation; • It involves three separate articulations, which share a common synovial cavity viz;
  • 29. 1. The humero-ulnar, between the trochea of the humerus and the trochlear notch of the ulna (a hinge joint) 2. The humero-radial, between the capitulum and the upper concave surface of the radial head (a ball and socket joint) 3. The the superior radio-ulnar, between the head of the radius and the radial notch of the ulna, the head beign held in place by the tough annular ligament (a pivot joint)
  • 31. • Capsule; the capsule is closely applied around this complex articular arrangement. • The non-articular medial and lateral epicondyles are extracapsular • It is thin and loose anteriorly and posteriorly to allow flexion and extension, whereas it is strongly thickened on either side to form the medial andlateral collateral ligaments
  • 32. • Ligaments; the collateral ligaments of the elbow joint are strong triangular bands that are medial and lateral thickenings of the fibrous capsule. • The fanlike radial collateral ligament extends from the lateral epicondyle and attach distally to the annular ligament around the radial head.
  • 33. • The medial, triangular ulnar collateral ligament extends from the medial epicondyle of the humerus to the coronoid process and olecranon of the ulna. • It consist of 3 bands; • An anterior cordlike band which is the strongest • A posterior fanlike band, which is the weakest • The slender oblique band, which deepens the socket for the trochlea of the humerus.
  • 36. • Innervation; nerve supply is by the ulnar, radial and musculocutaneous nerves. • May also have innervation from median nerve as it passes through.
  • 37. • Movements; two sets of movements take place at the elbow: • Flexion and extension at the humero-ulnar and humero-radial joints; • Pronation and supination at the proximal radio-ulnar
  • 39. • • • • • • • • • MUSCLES INVOLVED IN THE MOVEMENTS; FLEXION; Biceps brachii Brachialis Brachoradialis Pronator teres EXTENSION; Triceps brachii aconeus
  • 41. • • • • • • • • • • PRONATION; Pronator teres Pronator quadratus Flexor carpi radialis SUPINATOR; Biceps brachii Supinator Extensor pollicis longus Extensor policis bravis Abductor policis longus
  • 43. BURSAE • Three olecranon bursae are clinically important to the elbow joint. They include; • Intratendinous olecranon bursa; which is sometimes present in the tendon of triceps brachii. • Subtendinous olecranon bursa; which is located between the olecranon and the triceps tendon, just proximal to its attachement to the olecranon. • Subcutaneous olecranon bursa; which is located in the subcutaneous connective tissue over the olecranon
  • 44. • BLOOD SUPPLY; the arteries supplying the elbow joint are derived from the anastomosis around the elbow.
  • 45. APPLIED ANATOMY • Bursatis of the elbow; • The subcutaneous olecranon bursa is exposed to injury during falls on the elbow and to infection from abrasions of the skin covering the olecranon. • Repeated excessive pressure and frictions, as occurs in wrestling, for example, may cause this bursa to become inflamed, producing a friction called subcutaneous olecranon bursitis. (“student elbow”)
  • 46. • Subtendinous olecranon bursitis; is much less common. • Results from excessive friction between the triceps tendon and olecranon, e.g; resulting from repeated flexion-extension of the forearm as occurs during some assembly line job.
  • 48. • Dislocation of the elbow joint; • Posterior dislocation of the elbow joint may occur when children fall on their hands with their elbows flexed. • The distal end of the humerus is driven through the weak anterior part of the fibrous capsule as the radius and ulna dislocate posteriorly.
  • 50. • There is a rich arterial anastomosis around the elbow joint, the arteries involved are branches of brachial, radial and ulnar arteries. • In front of the medial epicondyle; • Anterior ulnar recurrent branch of ulnar artery anastomoses with inferior ulnar collateral branch of brachial artery.
  • 51. • Behind the medial epicondyle; • Posterior ulnar recurrent branch of ulnar artery anastomoses with superior ulnar collateral branch of brachial artery. • In front of lateral epicondyle; • Radial recurrent branch of radial artery anastomoses with the anterior descending branch of profunda brachii artery.
  • 52. • Behind the lateral epicondyle; • Interosseous recurrent artery from posterior interosseous branch of common interosseous of ulnar artery anastomoses with posterior descending branch of profunda brachii artery.

Editor's Notes

  1. As the tendon enters the forearm, a flat sheet of connective tissue (the bicipitalaponeurosis) fans out from the medial side of the tendon to blend with deep fascia covering the anterior compartment of the forearm.
  2. The brachial artery is palpable along its length. In proximal regions, the brachial artery can be compressed against the medial side of the humerus.
  3. Branches of the profundabrachii artery supply adjacent muscles and anastomose with the posterior circumflex humeral artery. The artery terminates as two collateral vessels, which contribute to an anastomotic network of arteries around the elbow joint.
  4. The musculocutaneous nerve provides: motor innervation to all muscles in the anterior compartment of the arm; and sensory innervation to skin on the lateral surface of the forearm.