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ANATOMY
• GROSS ANATOMY
• UPPER LIMB
• THE BRACHIUM
• Dr. Chongo Shapi (BSc. HB, MBChB)
• Medical Doctor
16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 1
Bony landmarks
16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 2
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
3
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
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FASCIAL SEPTA
• Divides arm into anterior and posterior
compartments.
• Medial Intermuscular Septum: From
subcutaneous sheath to humerus.
Separates muscles of anterior arm from
medial side of triceps complex.
• Lateral Intermuscular Septum: From
subcutaneous sheath to humerus.
Separates muscles of anterior arm from
lateral side of triceps complex.
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
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16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
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MBChB
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MBChB
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ANTERIOR BRACHIAL
COMPARTMENT
• Components:
Biceps brachii
Coracobrachialis
Brachialis
• Function:
Forearm flexors
Biceps also
supinates forearm
• Vascularization:
Brachial artery, Basilic
vein and venae
comitantes
• Innervation and
functional neurological
level:
Musculocutaneous
nerve
C5-6
• Nerves passing through
compartment (not
innervating anterior
compartment
structures):
Median nerve.
Ulnar nerve:
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
9
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
10
POSTERIOR BRACHIAL
COMPARTMENT
• Components:
Triceps brachii.
Anconeus.
• Function:
Forearm
extensors.
Long head of
triceps can extend
shoulder (brachium).
Synergists in
forearm supination.
• Innervation and
functional
neurological level:
Radial nerve
C7
• Vascular supply to
compartment:
Deep brachial artery
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
11
Coracobrachialis
• ORIGIN
Apex of coracoid process of
scapula
• INSERTION
Medial surface of middle of
shaft of humerus, opposite
deltoid tuberosity
• ACTION
Flexes and adducts the
shoulder
• NERVE
Musculocutaneous - C6, 7
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
12
BICEPS BRACHII
• ORIGIN
Short head: apex of coracoid process of
scapula
long head: supraglenoid tubercle of scapula
(just above the fossa)
• INSERTION
Short, long heads: tuberosity of radius, and
aponeurosis of biceps brachii (laterous
fibrosus)
• ACTION
Flexes the shoulder joint, and the long head
may assist abduction if the humerus is
laterally rotated.
With the origin fixed: flexes the elbow,
moving forearm towards the humerus and
supinates forearm
With insertion fixed: flexes the elbow joint
moving the humerus toward the forearm as in
pull-up or chinning exercises
• NERVE
musculocutaneous nerve - C5, C6
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
13
BRACHIALIS
• ORIGIN
Humerus - distal 1/2, anterior
surface of humerus, and medial
and lateral intermuscular septa
• INSERTION
Ulna - coronoid process, ulnar
tuberosity
• ACTION
With origin fixed: flexes the elbow
joint moving the forearm toward the
humerus
With insertion fixed: flexes the
elbow joint moving the humerus
toward the forearm as in pull-up or
chinning exercises.
• NERVE
Musculocutaneous nerve + a small
branch of radial nerve - C5, C6
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
14
TRICEPS
• ORIGIN
– long head: scapula - infraglenoid
tubercle
– lateral head: humerus - lateral and
posterior surfaces of proximal 1/2 of
humerus; and lateral intermuscular
septum
– medial head: humerus - distal 2/3 of
medial and posterior surfaces of
humerus below the radial groove, and
from medial intermuscular septum
• INSERTION
Ulna - posterior surface olecranon
process; antebrachial fascia
• ACTION
Extends the elbow joint; long head
also assist in abduction and
extension of the shoulder joint
• NERVE
Radial nerve - C6, C7, C8, T1
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
15
ANCONEUS
• ORIGIN
Humerus - lateral epicondyle; on
posterior surface
• INSERTION
Ulna - olecranon process, on lateral
side; & proximal 1/4 of ulna, posterior
surface
• ACTION
Extends the elbow joint, and may
stabilize the ulna during pronation and
supination
• NERVE
Radial nerve - C7, C8, T1
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
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MBChB
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MBChB
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16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
19
CUTANEOUS NERVES AND
DERMATOMES
• Medial brachial cutaneous nerve: Middle of arm
- medial side - to skin over olecranon
• Medial antebrachial cutaneous nerve: Appears
just inferior to medial brachial nerve on medial
arm, splits:
a. Anterior branch - Skin of anteromedial
forearm.
b. Posterior branch - Skin of posteromedial
forearm.
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
20
CUTANEOUS NERVES AND
DERMATOMES
• Lateral antebrachial cutaneous nerve:
Continuation of musculocutaneous
- Appears just above inside of elbow, near
cephalic vein
- To skin of lateral & anterolateral forearm
- Also has anterior & posterior branches
• Superior lateral brachial cutaneous
nerve - A branch off the axillary nerve
- to skin over inferior half of deltoid
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
21
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
22
CUTANEOUS NERVES/DERMATOMES
• Posterior brachial cutaneous nerve -
Branches off the radial nerve up in the axilla
- to skin on dorsal arm inferior to deltoid
• Inferior lateral brachial cutaneous nerve =
Superior terminal branch - of radial nerve
- a small branch ~2 inches above lateral
epicondyle
- to skin of lower lateral & anterolateral arm
• Posterior antebrachial cutaneous nerve =
inferior terminal branch of radial nerve
- large - appears just below, posterior to lateral
epicondyle
- to skin on dorsal, lateral forearm
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
23
CUTANEOUS NERVES AND
DERMATOMES
• Superficial radial nerve
- lateral border, distal forearm, just proximal to
wrist
- from under lateral border of brachioradialis
- innervates skin on lateral dorsum of hand,
thumb, proximal 2/3 of 1st 2-3 fingers
(lateral side of middle or ring finger)
• Posterior cutaneous branch of the ulnar nerve:
- medial border, distal forearm, just proximal to
wrist
- innervates skin on medial dorsum of hand, last 2
fingers (medial side of ring finger)
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
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16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
25
ARTERIES
• Brachial artery: extension/continuation of axillary
artery, splits into two terminal branches (radial and
ulnar)
• Branches
– Profunda brachii artery ('deep'): largest, most
superior branch; follows radial nerve
- posterior descending branch (splits into radial
collateral artery and middle collateral artery)
– Two ulnar collateral arteries: branch off brachial
below profunda & above elbow
- superior ulnar collateral: mid-arm; follows ulnar
nerve post. to medial epicondyle
- inferior ulnar collateral: from ~2 in. proximal to
elbow, anterior to medial epicondyle
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
26
ARTERIES CONT’
• Radial artery: lateral, anterior to elbow, crosses
anterior to biceps tendon & supinator muscle;
overlapped by brachioradialis muscle
– radial recurrent: a branch toward lateral
epicondyle, anastomoses with profunda branch
• Ulnar artery: medial, anterior to elbow, goes deep to
pronator teres muscle
– anterior ulnar recurrent
– posterior ulnar recurrent
– common interosseous artery - divides into anterior
and posterior interosseous arteries (interosseous
recurrent artery -- branch off posterior
interosseous or common interosseous artery)
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
27
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
28
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
29
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
30
VEINS
• Cephalic vein: Lateral (radial side) - all the
way from wrist to deltopectoral groove, to
axillary vein
• Basilic vein: Medial (ulnar side) - goes
deep, joins venae comitantes (deep) &
brachial artery
• Median cubital vein: Crosses over,
connects cephalic with basilic - common site
for drawing blood
• Dorsal venous arch: Back of hand - often
used for an IV
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
31
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
32
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
33
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
34
ANASTOMOSES
• Collateral elbow circulation - Is created
by anastomoses between recurrents &
collaterals: including: radial recurrent;
ulnar recurrents (anterior & posterior)
ulnar collaterals (superior & inferior),
recurrent interosseous and descending
branch of profunda brachii
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
35
APPLIED ANATOMY
• Bicipital Myotatic Reflex
• Biceps Tendinitis (crepitus)
• Dislocation of the Tendon of
the Long Head of the Biceps
(Popeye deformity)
• Rupture of the Tendon of
the Long Head of the Biceps
• Interruption of Blood Flow in
the Brachial Artery
(haemostasis; Ischemic
compartment sydrome)
• Fracture of the Humeral
Shaft
• Injury to the
Musculocutaneous Nerve
• Injury to the Radial Nerve in
the Arm (wrist drop)
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
36
THANK YOU!
• If your journey had to be like theirs,
then God wouldn’t have had to go
through the process of creating
another replica. Your path is meant to
be unique to you and you only. So stop
comparing yourself!
16/11/2022 Dr. Chongo Shapi, BSc. HB,
MBChB
37

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The Brachium by Shapi.pdf

  • 1. ANATOMY • GROSS ANATOMY • UPPER LIMB • THE BRACHIUM • Dr. Chongo Shapi (BSc. HB, MBChB) • Medical Doctor 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 1
  • 2. Bony landmarks 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 2
  • 3. 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 3
  • 4. 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 4
  • 5. FASCIAL SEPTA • Divides arm into anterior and posterior compartments. • Medial Intermuscular Septum: From subcutaneous sheath to humerus. Separates muscles of anterior arm from medial side of triceps complex. • Lateral Intermuscular Septum: From subcutaneous sheath to humerus. Separates muscles of anterior arm from lateral side of triceps complex. 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 5
  • 6. 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 6
  • 7. 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 7
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  • 9. ANTERIOR BRACHIAL COMPARTMENT • Components: Biceps brachii Coracobrachialis Brachialis • Function: Forearm flexors Biceps also supinates forearm • Vascularization: Brachial artery, Basilic vein and venae comitantes • Innervation and functional neurological level: Musculocutaneous nerve C5-6 • Nerves passing through compartment (not innervating anterior compartment structures): Median nerve. Ulnar nerve: 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 9
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  • 11. POSTERIOR BRACHIAL COMPARTMENT • Components: Triceps brachii. Anconeus. • Function: Forearm extensors. Long head of triceps can extend shoulder (brachium). Synergists in forearm supination. • Innervation and functional neurological level: Radial nerve C7 • Vascular supply to compartment: Deep brachial artery 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 11
  • 12. Coracobrachialis • ORIGIN Apex of coracoid process of scapula • INSERTION Medial surface of middle of shaft of humerus, opposite deltoid tuberosity • ACTION Flexes and adducts the shoulder • NERVE Musculocutaneous - C6, 7 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 12
  • 13. BICEPS BRACHII • ORIGIN Short head: apex of coracoid process of scapula long head: supraglenoid tubercle of scapula (just above the fossa) • INSERTION Short, long heads: tuberosity of radius, and aponeurosis of biceps brachii (laterous fibrosus) • ACTION Flexes the shoulder joint, and the long head may assist abduction if the humerus is laterally rotated. With the origin fixed: flexes the elbow, moving forearm towards the humerus and supinates forearm With insertion fixed: flexes the elbow joint moving the humerus toward the forearm as in pull-up or chinning exercises • NERVE musculocutaneous nerve - C5, C6 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 13
  • 14. BRACHIALIS • ORIGIN Humerus - distal 1/2, anterior surface of humerus, and medial and lateral intermuscular septa • INSERTION Ulna - coronoid process, ulnar tuberosity • ACTION With origin fixed: flexes the elbow joint moving the forearm toward the humerus With insertion fixed: flexes the elbow joint moving the humerus toward the forearm as in pull-up or chinning exercises. • NERVE Musculocutaneous nerve + a small branch of radial nerve - C5, C6 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 14
  • 15. TRICEPS • ORIGIN – long head: scapula - infraglenoid tubercle – lateral head: humerus - lateral and posterior surfaces of proximal 1/2 of humerus; and lateral intermuscular septum – medial head: humerus - distal 2/3 of medial and posterior surfaces of humerus below the radial groove, and from medial intermuscular septum • INSERTION Ulna - posterior surface olecranon process; antebrachial fascia • ACTION Extends the elbow joint; long head also assist in abduction and extension of the shoulder joint • NERVE Radial nerve - C6, C7, C8, T1 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 15
  • 16. ANCONEUS • ORIGIN Humerus - lateral epicondyle; on posterior surface • INSERTION Ulna - olecranon process, on lateral side; & proximal 1/4 of ulna, posterior surface • ACTION Extends the elbow joint, and may stabilize the ulna during pronation and supination • NERVE Radial nerve - C7, C8, T1 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 16
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  • 20. CUTANEOUS NERVES AND DERMATOMES • Medial brachial cutaneous nerve: Middle of arm - medial side - to skin over olecranon • Medial antebrachial cutaneous nerve: Appears just inferior to medial brachial nerve on medial arm, splits: a. Anterior branch - Skin of anteromedial forearm. b. Posterior branch - Skin of posteromedial forearm. 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 20
  • 21. CUTANEOUS NERVES AND DERMATOMES • Lateral antebrachial cutaneous nerve: Continuation of musculocutaneous - Appears just above inside of elbow, near cephalic vein - To skin of lateral & anterolateral forearm - Also has anterior & posterior branches • Superior lateral brachial cutaneous nerve - A branch off the axillary nerve - to skin over inferior half of deltoid 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 21
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  • 23. CUTANEOUS NERVES/DERMATOMES • Posterior brachial cutaneous nerve - Branches off the radial nerve up in the axilla - to skin on dorsal arm inferior to deltoid • Inferior lateral brachial cutaneous nerve = Superior terminal branch - of radial nerve - a small branch ~2 inches above lateral epicondyle - to skin of lower lateral & anterolateral arm • Posterior antebrachial cutaneous nerve = inferior terminal branch of radial nerve - large - appears just below, posterior to lateral epicondyle - to skin on dorsal, lateral forearm 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 23
  • 24. CUTANEOUS NERVES AND DERMATOMES • Superficial radial nerve - lateral border, distal forearm, just proximal to wrist - from under lateral border of brachioradialis - innervates skin on lateral dorsum of hand, thumb, proximal 2/3 of 1st 2-3 fingers (lateral side of middle or ring finger) • Posterior cutaneous branch of the ulnar nerve: - medial border, distal forearm, just proximal to wrist - innervates skin on medial dorsum of hand, last 2 fingers (medial side of ring finger) 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 24
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  • 26. ARTERIES • Brachial artery: extension/continuation of axillary artery, splits into two terminal branches (radial and ulnar) • Branches – Profunda brachii artery ('deep'): largest, most superior branch; follows radial nerve - posterior descending branch (splits into radial collateral artery and middle collateral artery) – Two ulnar collateral arteries: branch off brachial below profunda & above elbow - superior ulnar collateral: mid-arm; follows ulnar nerve post. to medial epicondyle - inferior ulnar collateral: from ~2 in. proximal to elbow, anterior to medial epicondyle 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 26
  • 27. ARTERIES CONT’ • Radial artery: lateral, anterior to elbow, crosses anterior to biceps tendon & supinator muscle; overlapped by brachioradialis muscle – radial recurrent: a branch toward lateral epicondyle, anastomoses with profunda branch • Ulnar artery: medial, anterior to elbow, goes deep to pronator teres muscle – anterior ulnar recurrent – posterior ulnar recurrent – common interosseous artery - divides into anterior and posterior interosseous arteries (interosseous recurrent artery -- branch off posterior interosseous or common interosseous artery) 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 27
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  • 31. VEINS • Cephalic vein: Lateral (radial side) - all the way from wrist to deltopectoral groove, to axillary vein • Basilic vein: Medial (ulnar side) - goes deep, joins venae comitantes (deep) & brachial artery • Median cubital vein: Crosses over, connects cephalic with basilic - common site for drawing blood • Dorsal venous arch: Back of hand - often used for an IV 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 31
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  • 35. ANASTOMOSES • Collateral elbow circulation - Is created by anastomoses between recurrents & collaterals: including: radial recurrent; ulnar recurrents (anterior & posterior) ulnar collaterals (superior & inferior), recurrent interosseous and descending branch of profunda brachii 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 35
  • 36. APPLIED ANATOMY • Bicipital Myotatic Reflex • Biceps Tendinitis (crepitus) • Dislocation of the Tendon of the Long Head of the Biceps (Popeye deformity) • Rupture of the Tendon of the Long Head of the Biceps • Interruption of Blood Flow in the Brachial Artery (haemostasis; Ischemic compartment sydrome) • Fracture of the Humeral Shaft • Injury to the Musculocutaneous Nerve • Injury to the Radial Nerve in the Arm (wrist drop) 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 36
  • 37. THANK YOU! • If your journey had to be like theirs, then God wouldn’t have had to go through the process of creating another replica. Your path is meant to be unique to you and you only. So stop comparing yourself! 16/11/2022 Dr. Chongo Shapi, BSc. HB, MBChB 37