Anatomy of the Upper Limb
Brachial
The Arm
Artery
Biceps
& Median
Brachialis
The Cubital Fossa Nerve
Apponeurosis
Bicepital
Pronator
Teres
Brachio-
By
Radialis
Dr. YOUSSEF SHOUKRY
ANATOMY OF THE UPPER LIMB … By: Dr. YOUSSEF SHOUKRY
FLEXORS OF THE ARM
Muscle Name Origin Insertion Action Nerve Supply
1. Biceps By 2 heads : By 2 ways : 2 main actions :
Short head: from the The two heads meet at Flexion of the elbow
tip of the coracoid the upper end of the joint
process in common humerus forming the Supination of the
origin with the bulk of the muscle flexed arm (1st
coracobrachialis which is inserted by 2 flexion then
Long head : from ways : supination)
the supraglenoid Biceps tendon in Protection mechanisms
tubercle the radial tuberosity The long head
All by the
Biceptal protects the shoulder
musculocutaneous
apponeurosis joint from
nerve (C5, C6 & C7),
turns medially in the dislocation
in addition the
deep fascia The apponeurosis brachialis is also
protects the brachial innervated by the
artery during radial nerve for its
intravenous lateral half
injection
2. Brachialis Lower half of the front In the coronoid The main flexor of the
of the shaft of the process of the ulna elbow joint
humerus & the 2
intermuscular septa
(Medial & lateral)
3. Coraco-Brachialis From tip of coracoid In the middle of shaft Flexion & medial
process of the humerus rotation of shoulder
joint
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ANATOMY OF THE UPPER LIMB … By: Dr. YOUSSEF SHOUKRY
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ANATOMY OF THE UPPER LIMB … By: Dr. YOUSSEF SHOUKRY
Notes to be remembered.
Biceps is the main supinator muscle.
To perform supination effectively, the biceps is inserted obliquely into the
radial tuberosity in its undersurface (Rough area) separated from the bone by
a bursa.
The appuneurosis helps to protect the obliquity of the tendon and hence
prevents over supination. With these two opposed forces of traction (The
tendon & the apponeurosis), the direction of movement is usually flexion
accompanied by supination.
Brachialis has 2-nerve supply: musculocutaneous nerve for the medial half &
radial nerve for the lateral half.
Coraco-brachialis is a small muscle that has its analogue in the lower limb
(Adductors of the thigh) but with no function in the upper limb, it plays a very
good role as an anatomical landmark at the level of its insertion.
Events at the level of insertion of the Coraco-Brachialis
N.B.: understanding the relation of the nerve and vessels of the arm is to
understand the events that occur at the levels of insertion of the Coraco-
Brachialis muscle.
1. Bones:
Nutrient artery enters the humerus.
The shaft of the humerus becomes triangular in the cut section.
2. Fascia:
The deep fascia sends two strong intermuscular septa (Medial &
lateral).
3. Muscles:
Insertion of the deltoid.
4. Arteries:
The brachial artery becomes anterior to the brachialis muscle.
5. Veins:
The basilar vein pierces the deep fascia and becomes deep.
6. Nerves:
The radial nerve: pierce the lateral intermuscular septum from
behind forward.
The median nerve: crosses over or behind the brachial artery from
lateral to medial.
The ulnar nerve: pierce the medial intermuscular septum from
before backwards.
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ANATOMY OF THE UPPER LIMB … By: Dr. YOUSSEF SHOUKRY
Events at the level of insertion of the coraco-brachialis muscle
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ANATOMY OF THE UPPER LIMB … By: Dr. YOUSSEF SHOUKRY
The Triceps Muscle
Origin : By 3 heads :
1. Long head: from the infraglenoid tubercle.
2. Lateral head: from the linear origin extending from the deltoid tuberosity
to the surgical neck of the humerus.
3. Medial head: from the lower half of the back of the shaft of the humerus
(The mirror image of the origin of the brachialis).
Insertion: at the posterior part of the upper surface of the olecranon process.
Action: 3 main actions :
1. The long head support the shoulder joint during abduction preventing its
dislocation.
2. The muscle is the main extensor of the elbow joint.
3. Some fibers from the medial head are inserted into the capsule of the
elbow joint, preventing its snipping during the extension of the elbow
joint. This special part is called Articularis Cubiti Muscle or Subancuneus.
Nerve supply: each head receives a branch of the radial nerve except for the
medial head which receives 2 branches at axilla and at the spiral groove.
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ANATOMY OF THE UPPER LIMB … By: Dr. YOUSSEF SHOUKRY
The Brachial artery
Beginning : at the lower border of the teres major muscle as the continuation
of the axillary artery.
End : at the cubital fossa (Neck of radius) by dividing into the radial and the
ulnar arteries.
Course and relations : it can be divided into 3 parts :
1. (1st part) In the upper part of the arm : the artery descends medial to the
humerus bone.
Relations to this part
First Part
Anteriorly : short head of the biceps muscle, and the coraco-brachialis muscle.
Posteriorly : long head of the triceps muscle and the radial nerve.
Medially : the ulnar nerve. Second Part
Laterally : the median nerve.
2. (2nd part) In the lower part of the arm : the artery becomes anterior to the
brachialis muscle, covered only by the biceps muscle. The median nerve
crosses over the artery from lateral to medial.
Third Part
3. (3rd part) At the cubital fossa : the artery is covered by the bicepital
apponeurosis and lies on the brachialis muscle and in between the tendon of
the biceps muscle and the median nerve.
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ANATOMY OF THE UPPER LIMB … By: Dr. YOUSSEF SHOUKRY
Branches : 5 main branches + 2 terminal branches (Radial & Ulnar arteries)
:
1. Nutrient artery to the humerus bone.
2. Muscular branches.
3. Superior ulnar collateral. Both form anastomosis around the
4. Inferior ulnar collateral. medial epicondyle.
5. The profunda brachii artery which enters the spiral groove with the radial
nerve and gives off 5 branches
- Nutrient. - Muscular.
- Anterior radial collateral. Both form anastomosis around the lateral
- Posterior radial collateral. epicondyle.
- Ascending branch (Which forms an anastomosis with the descending branch
of the posterior circumflex humeral artery.
Pulsation : At the cubital fossa, just medial to the tendon of the biceps.
Importance : blood pressure monitoring is done at this site, also the artery
may be used for cardiac catheterization.
Anastomosis : imagine what can happen if the distal end of the brachial
Anterior Radial
artery is occluded by a thrombus the result will be a gangrene of the Collateral
forearm if there is no anastomosis between the brachial artery and its
offsprings the radial and the ulnar arteries at the elbow joint. The Posterior Radial
Collateral
anastomosis of the artery are :
1. At the elbow joint :
- At the medial epicondyle superior and inferior ulnar
collaterals with the anterior and posterior ulnar recurrents.
- At the lateral epicondyle anterior and posterior radial
collaterals with the radial recurrent and the interosseus
recurrent.
2. By the ascending branch of the profunda brachii artery with the descending
branch of the posterior circumflex humeral artery.
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ANATOMY OF THE UPPER LIMB … By: Dr. YOUSSEF SHOUKRY
The Musculo-Cutaneous Nerve
Root value : C5, 6, 7.
Beginning : as a branch of the lateral cord of the brachial plexus.
Course and relations : the nerve begins lateral to the 3 rd part of the axillary
artery and then pierces the coraco-brachialis muscle supplying it. Then passes
between the biceps muscle and brachialis muscles. The nerve appears on the
lateral side of the biceps muscle as "The Lateral Cutaneous Nerve of the
Forearm".
Distribution :
1. Motor : biceps, brachialis (only the medial 1/2) & the coraco-brachialis
muscles.
2. Sensory : by the lateral cutaneous nerve of the forearm supplying the skin
of the lateral side of the forearm.
Effect of lesion :
Motor loss weak flexion & supination.
Sensory loss loss of sensations over the lateral side of the forearm.
Cubital Fossa
Definition : a triangular space in the front of the elbow joint for passage of
the vascular brachial artery and the median nerve from the arm to the forearm.
N.B.: the vessels cannot pass behind the elbow joint, as it is a site for
compression (Pressure site).
Boundaries : it has : an apex, a base, medial & lateral walls, roof and a floor.
- Medially : pronator teres muscle.
- Laterally : brachio-radialis muscle.
- Base : imaginary line between the 2 epicondyles of the humerus.
- Apex : crossing of brachio-radialis over the pronator teres muscle.
- Roof : skin, superficial fascia containing the median cubital vein, deep fascia
and the bicepital apponeurosis.
- Floor : brachialis muscle and the supinator muscle.
Contents : arranged from lateral to medial, they are :
- N Radial Nerve.
- T Biceps Tendon.
- A Brachial Artery giving its two terminal branches (Radial & Ulnar).
- N Median Nerve passing between the 2 heads of the pronator teres
muscle.
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ANATOMY OF THE UPPER LIMB … By: Dr. YOUSSEF SHOUKRY
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