arm & elbow · 2020. 12. 3. · itcontainsfour main muscles. an aponeurotic sheet separating...
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KHALEEL ALYAHYA, PHD, MED
www.kha lee la lyahya.net
ARM & ELBOW
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Objectives
▪ Describe the attachments, actions and innervations of:
• Biceps brachii• Coracobrachialis• Brachialis• Triceps brachii
▪ Demonstrate the following features of the elbow joint:
• Articulating bones• Capsule• Lateral & medial collateral ligaments• Synovial membrane
▪ Demonstrate the movements; flexion and extension of the elbow.
▪ List the main muscles producing the above movements.
▪ Define the boundaries of the cubital fossa and enumerate itscontents.
Khaleel Alyahya, PhD, MEd 2
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Resources
ESSENTIAL OF HUMAN
ANATOMY & PHYSIOLOGY
ATLAS OF HUMAN
ANATOMY
GRAY’S ANATOMY KENHUB
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THE ARM
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Introduction
▪ The arm is located between the shoulder joint and elbow joint.
▪ It contains four main muscles.
▪ An aponeurotic sheet separating those muscles, including lateraland medial humeral septa.
▪ The lateral and medial intermuscular septa divide the distal partof the arm into two compartments:
• Anterior compartments
o also known as the flexor compartment
• Posterior compartments
o also known as the extensor compartment
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Anterior Compartment
▪ Muscles: Biceps brachii, Coracobrachialis & Brachialis.
▪ Blood Vessels: Brachial artery and Basilic vein.
▪ Nerves: Musculocutaneous and Median.
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Muscles of Anterior Compartment
▪ Biceps brachii
▪ Coracobrachialis
▪ Brachialis
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Biceps Brachii
▪ Origin:• Long Head from supraglenoid tubercle of scapula (intracapsular)• Short Head from the tip of coracoid process of scapula• The two heads join in the middle of the arm
▪ Insertion:• In the posterior part of the radial tuberosity.• Into the deep fascia of the medial aspect of the forearm through
bicipital aponeurosis.
▪ Nerve supply:• Musculocutaneous
▪ Action:• Strong supinator of the forearm
o used in screwing.
• Powerful flexor of elbow• Weak flexor of shoulder
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Coracobrachialis
▪ Origin:• Tip of the coracoid process
▪ Insertion:• Middle of the medial side of the shaft of the humerus
▪ Nerve supply:• Musculocutaneous
▪ Action:• Flexor
• Weak adductor of the arm
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Brachialis
▪ Origin:• Front of the lower half of humerus
▪ Insertion:• Anterior surface of coronoid process of ulna
▪ Nerve supply:• Musculocutaneous and Radial
▪ Action:• Strong flexor of the forearm
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Posterior Compartment
▪ Muscles: Triceps brachii.
▪ Blood Vessels: Profunda brachii and Ulnar collateral arteries.
▪ Nerves: Radial and Ulnar.
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Muscles of Posterior Compartment
▪ Triceps brachii
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Triceps Brachii
▪ Origin:• Long Head from infrglenoid tubercle of the scapula.
• Lateral Head from the upper half of the posterior surface of theshaft of humerus above the spiral groove.
• Medial Head from the lower half of the posterior surface of theshaft of humerus below the spiral groove.
▪ Insertion:• Common tendon inserted into the upper surface of the
olecranon process of ulna.
▪ Nerve supply:• Radial
▪ Action:• Strong extensor of the elbow joint.
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Cubital Fossa
▪ It is an area of transition between theanatomical arm and the forearm.
▪ It is located as a triangular depression on theanterior surface of the elbow joint.
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Boundaries
▪ Base:
• Line drawn through the two epicondyles of humerus.
▪ Lateral:
• Brachioradialis.
▪ Medial:
• Pronator teres
▪ Roof:
• Skin, superficial & deep fascia and bicipital aponeurosis.
▪ Floor:
• Brachialis medially and supinator laterally.
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Content
▪ Biceps brachii tendon
▪ Brachial artery
• divides into radial & ulnar arteries.
▪ Median nerve
▪ Deep branch of radial nerve
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Clinical Significance
▪ The brachial pulse can be felt by palpating immediatelymedial to the biceps tendon in the cubital fossa.
▪ The median cubital vein is located superficially withinthe roof of the cubital fossa.
▪ It connects the basilic and cephalic veins and can beaccessed easily – this makes it a common site forvenipuncture.
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ELBOW JOINT
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Articulating Surfaces
▪ The elbow is the joint connecting the upper arm tothe forearm.
▪ It is classed as a hinge synovial joint.
▪ It consists of two separate articulations:• Trochlea and capitulum of the humerus above.
• Trochlear notch of ulna and the head of radiusbelow.
▪ The articular surfaces are covered with hyalinecartilage.
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Capsule
▪ The elbow joint has a capsule enclosing the joint.
▪ This is strong and fibrous, strengthening the joint.
▪ The joint capsule is thickened medially andlaterally to form collateral ligaments, whichstabilize the flexing and extending motion of thearm.
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Bursae
▪ A bursa is a membranous sac filled with synovial fluid.
▪ It acts as a cushion to reduce friction between the movingparts of a joint, limiting degenerative damage.
▪ There are many bursae in the elbow, but only a few haveclinical importance:
• Intratendinous located within the tendon of the tricepsbrachii.
• Subtendinous between the olecranon and the tendon of thetriceps brachii, reducing friction between the two structuresduring extension and flexion of the arm.
• Subcutaneous (olecranon) between the olecranon and theoverlying connective tissue (implicated in olecranon bursitis).
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Ligaments
▪ Lateral (Radial Collateral) Ligament• Triangular• Apex attached to the lateral epicondyle of humerus• Base attached to the upper margin of annular ligament.
▪ Medial (Ulnar Collateral) Ligament• Anterior strong cord-like band between medial epicondyle and
the coronoid process of ulna• Posterior weaker fan-like band between medial epicondyle and
the olecranon process of ulna• Transverse band passes between the anterior and posterior
bands
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Synovial Membrane
▪ This lines the capsule and covers fatty pads in the floors ofthe coronoid, radial, and olecranon fossae.
▪ Is continuous below with synovial membrane of the superiorradio-ulnar joint
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Movement
▪ The elbow joint is a hinge joint, movement is in only one plane.
▪ Flexion• It is limited by the anterior surfaces of the forearm and arm
coming into contact.
▪ Extension• It is limited by the tension of the anterior ligament and the
brachialis muscle.
▪ The joint is supplied by branches from the:
• Median
• Ulnar
• Musculocutaneous
• Radial nerves
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Carrying Angle
▪ Angle
• Between the long axis of the extended forearm and the longaxis of the arm.
▪ Open• Laterally
▪ Degree
• 170o in male and 167o in females
▪ Disappears• When the elbow joint is flexed
▪ Permits• The forearms to clear the hips in swinging movements during
walking and is important when carrying objects.
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Blood Supply & Innervation
▪ The arterial supply to the elbow joint is from the cubitalanastomosis, which includes recurrent and collateral branchesfrom the deep brachial arteries.
▪ The innervation of elbow joint is provided by themedian, musculocutaneous and radial nerves anteriorly, andthe ulnar nerve posteriorly.
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Bursitis
▪ Subcutaneous bursitis
• Repeated friction and pressure on the bursa can cause it to
become inflamed.
• Because this bursa lies relatively superficially, it can also
become infected (example, cut from a fall on the elbow)
▪ Subtendinous bursitis
• This is caused by repeated flexion and extension of the
forearm, commonly seen in assembly line workers.
• Usually flexion is more painful as more pressure is put on
the bursa.
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Dislocation
▪ An elbow dislocation usually occurs when a young child fallson a hand with the elbow flexed.
▪ The distal end of the humerus is driven through the weakestpart of the joint capsule, which is the anterior side.
▪ The ulnar collateral ligament is usually torn and there canalso be ulnar nerve involvement
▪ Most elbow dislocations are posterior, and it is important tonote that elbow dislocations are named by the position ofthe ulna and radius, not the humerus.
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Fractures
▪ Elbow fractures may result from a fall, a direct impact to theelbow, or a twisting injury to the arm.
▪ Sprains, strains or dislocations may occur at the same time asa fracture.
▪ X-rays are used to confirm if a fracture is present and if thebones are out of place.
▪ Sometimes, a CT scan might be needed to get furtherinvestigation.
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