Clinical Anatomy of Upper Limb

1. UL: Arm and Elbow
Lecture 4
Maryna Kornieieva, PhD, MD
Asst. of Clinical Anatomy

2. Learning objectives
• Muscles
• Vessels
• Nerves
• Muscles
• Vessels
• Nerves
1. Arm and Elbow regions 2. Fasciae of the arm 3. Compartments of the arm and their contents
4. Bones of Elbow region 5. Anatomy of Elbow joint 6. Soft tissues around elbow 7. Contents of Cubital fossa

3. Skin and Subcutaneous tissues
Anterior aspect:
Elbow
region
Posterior aspect:
Arm
region
Arm
region
Elbow
region
Medial bicipital groove
Deltopectoral
groove
Supraclavicular
nerves
Upper lateral
cutaneous nerve of
the arm (Axilary)
Lower lateral
cutaneous
nerve of the
arm (Radial)
Medial
cutaneous
nerve of
the arm
Intercosto-
brachial
nerves
Posterior
cutaneous
nerve of the
arm (Radial)
Supraclavicular
nerves
Intercosto-
brachial
nerves

4. Veins of Upper Limb
Cephalic vein
Axillary vein
Basilic vein
Subclavian vein
Superficial:
Deep:
Venae comitantes

5. Deep Fascia of the Arm

6. Distal Humerus
Elbow joint
1. Radial fossa; 2. Lateral epicondyle;
3. Capitulum; 4. Trochlea; 5. Medial
epicondyle;6. Coronoid fossa; 7.
Olecranon fossa.
https://youtu.be/5CN_dXZsFdU
Articulation:
Head of
radius
Capitulum of
humerus
Trochlear
notch of
ulna
Trochlea of
humerus
Anterior
aspect
1. Radius: a) head, b) neck; c) radial tuberosity.
2. Ulna: a) trochlear notch; b) olecranon; c) coronoid
process; d) ulnar tuberosity; e) radial notch
1 2
a
c
a
b
b
e
d
c
Ligaments
- Ulnar collateral - - Radial collateral -
Annular lig. of radius (belongs
to the proxima raldio-ulnar j.)
Anterior
band
Posterior
band
Oblique
band
Joint capsule:
Anterior
aspect
Posterior
aspect

7. Contents of the Anterior Compartment (AC)
Muscles: Biceps brachii,
coracobrachialis, and
brachialis
Blood supply: Brachial
artery
Nerve supply to the
muscles: Musculocutaneous
nerve
Structures passing through
the compartment:
Median nerve;
Ulnar nerves (in the upper
half);
Radial nerve is present in the
Section at the junction of
distal third and proximal
two thirds of the humerus

8. Biceps Brachii
Function: flexion and supination of the forearm at the elbow joint.
+ flexion of the arm at shoulder joint.
Origin:
• short head:
coracoid process;
• long head:
supraglenoid
tubercle.
Insertion:
radial tuberosity
Short head
Long
head
Bicipital Aponeurosis
Transverse
humeral lig.

9. Tendon of Long Head of Biceps Brachii
Tendinitis Dislocation Rupture
Arthroscopic view of the long head of biceps
tendon as seen inside the shoulder joint
N Tear
Ultrasound
N
Axial MRI shows empty
bicipital groove

10. Brachialis and Coracobrachialis
Origin: the distal half of the
anterior aspect of the humerus;
Insertion: coronoid process and
tuberosity of ulna.
Function: flexes the forearm at
the elbow joint.
Brachialis Origin:
coracoid
process of
scapula
Insertion:
medial side of
midshaft of
the humerus.
Function:
flexes the arm
at shoulder
joint.
Coracobrachialis

11. 1. Muscular branches
2. Nutrient artery
3. Profunda brachii artery
4. Superior ulnar collateral a.
5. Inferior ulnar collateral a.
Branches:
Brachial Artery
Course:
3
4
5

12. Nerves of Anterior Compartment

13. Contents of the Posterior Compartment (PC)
Muscle: The three heads
of the triceps brachii
muscle
Nerve supply to the
muscle:
• Radial nerve
Blood supply:
• Profunda brachii
Structures passing
through the
compartment:
Ulnar nerve in the lower
half
Section at the junction of distal third and
proximal two thirds of the humerus

14. Triceps Brachii
Long head
Lateral head
Medial head
Insertion
Long
head
Lateral
head
Medial
head
Radial nerve
in spiral
groove
Olecranon bursae:
• Subtendinous;
• Subcutaneous.
“Student’s elbow” Anconeus

15. Neurovascular Bundle of PC
Brachial a.
1) Profunda Brachii a.
3) Middle
Collateral a.
Radial nerve Profunda Brahii a.
Posterior: Anterior:
1
2
3
1
3
2
Medial head
(faded)
Lateral head
of triceps
1) Radial n.
2) Superficial br.
(sensory)
3) Deep br. (motor)
2) Radial
Collateral a.
Brachioradialis
(faded)

16. Anterior Elbow Region
Superficial structures:
Cubital fossaDeep
structures:
Brachio-
radialis
Pronator
teres
Floor: supinator muscle laterally
and the brachialis muscle medially
Roof: bicipital aponeurosis, fascia
Contents: median nerve, brachial
artery, tendon of biceps, radial n.
M L
• Cephalic vein
• Basilic veins
• Median cubital vein
(anastomotic vessel b/w the first
two)

17. Traumas of Distal Humerus
Midhumeral fracture, X-ray, AP Distal humeral fracture, X-ray, AP
Radial n
Radial n
Ulnar n
Median n
Brachial a
Dislocation of elbow

18. Choose the Safest Approach to
Elbow/Distal Humerus:
Anterior
aspect:
Posterior
aspect:
Median n.
Ulnar n.
Radial n.
?

19. The Arm
Anterior
Compartment
Posterior
Compartment
• Triceps
• Radial n.
• Profunda brachii
• Biceps
• Brachialis
• Coracobrachialis
• Musculocutaneous n
• Brachial a.

20. Thank you for your attention!!!