2. ARM

3. SURFACE ANATOMY

4. Dr. L Tchakarov 3 deltoidThe borders of the deltoid are visible when the arm is abducted against resistance. distal attachmentThe distal attachment of the deltoid can be palpated on the lateral surface of the humerus.

5. Dr. L Tchakarov 4 long, lateral, and medial headsThe long, lateral, and medial heads of the triceps brachii form a bulge on the posterior aspect of the arm and are identifiable when the forearm is extended from the flexed position against resistance.

6. Dr. L Tchakarov 5 The olecranon, to which the triceps tendon attaches distally, is easily palpated. olecranon bursa,It is separated from the skin only by the olecranon bursa, which accounts for the mobility of the overlying skin. The triceps tendon is easily felt as it descends along the posterior aspect of the arm to the olecranon. The fingers can be pressed inwards on each side of the tendon, where the elbow joint is superficial. triceps bursasubtendinous olecranon bursaAn abnormal collection of fluid in the elbow joint or in the triceps bursa or subtendinous olecranon bursa is palpable at these sites; the bursa lies deep to the triceps tendon.

7. Dr. L Tchakarov 6 The biceps brachii forms a bulge on the anterior aspect of the arm; its belly becomes more prominent when the elbow is flexed and supinated against resistance. The biceps brachii tendon can be palpated in the cubital fossa, immediately lateral to the midline, especially when the elbow is flexed against resistance. The proximal part of the bicipital aponeurosis can be palpated where it passes obliquely over die brachial artery and median nerve. bicipital groovesMedial and lateral bicipital grooves separate the bulges formed by the biceps and triceps and indicate the location of the medial and lateral intermuscular septa.

8. Dr. L Tchakarov 7 lateralThe cephalic vein runs superiorly in the lateral bicipital groove, medialand the basilic vein ascends in the medial bicipital groove. Deep to the latter is the main neurovascular bundle of the limb.

9. Dr. L Tchakarov 8 it can be palpatedNo part of the shaft of the humerus is subcutaneous; however, it can be palpated with varying distinctness through the muscles surrounding it, especially in many elderly people. it can be palpatedThe head of the humerus is surrounded by muscles on all sides, except inferiorly; thus it can be palpated by pushing the fingers well up into the axilla. The arm should be close to the side so the axillary fascia is loose. by its movementsThe humeral head can be identified by its movements when the arm is moved and the inferior angle of the scapula is held so the scapula does not move. The medial epicondyle is more prominent.The medial and lateral epicondyles of the humerus are subcutaneous and can be easily palpated at the medial and lateral aspects of the elbow. The medial epicondyle is more prominent. deep to the medial borderThe brachial artery may be felt pulsating deep to the medial border of the biceps.

10. SUPERFICIAL SENSORY INNERVATION

11. Dr. L Tchakarov 10 The sensory nerve supply to the skin over the point of the shoulder to halfway down the deltoid muscle is from the supraclavicular nerves (C3 and 4). a branch of the axillary nerveThe skin over the lower half of the deltoid is supplied by the upper lateral cutaneous nerve of the arm, a branch of the axillary nerve (C5 and 6). a branch of the radial nerveThe skin over the lateral surface of the arm below the deltoid is supplied by the lower lateral cutaneous nerve of the arm, a branch of the radial nerve (C5 and 6). The skin of the armpit and the medial side of the arm is supplied by the medial cutaneous nerve of the arm (T1) and the intercostobrachial nerves (T2). a branch of the radial nerveThe skin of the back of the arm is supplied by the posterior cutaneous nerve of the arm, a branch of the radial nerve (C8).

12. SUPERFICIAL VEINS

13. Dr. L Tchakarov 12 The veins of the upper limb can be divided into two groups: 1.superficial and 2.deep. The deep veins comprise the venae comitantes, which accompany all the large arteries, usually in pairs, and the axillary vein. lie in the superficial fascia.The superficial veins of the arm lie in the superficial fascia.

14. Dr. L Tchakarov 13 drains into the axillary vein.The cephalic vein ascends in the superficial fascia on the lateral side of the biceps and, on reaching the infraclavicular fossa, drains into the axillary vein. The basilic vein ascends in the superficial fascia on the medial side of the biceps. it pierces the deep fasciaHalfway up the arm, it pierces the deep fascia and at the lower border of the teres major joins the venae comitantes of the brachial artery to form the axillary vein.

15. SUPERFICIAL LYMPH VESSELS

16. Dr. L Tchakarov 15 The superficial lymph vessels draining the superficial tissues of the upper arm pass upward to the axilla. infraclavicular group of nodes;Those from the lateral side of the arm follow the cephalic vein to the infraclavicular group of nodes; lateral group of axillary nodes.those from the medial side follow the basilic vein to the lateral group of axillary nodes. lateral group of axillary nodes.The deep lymphatic vessels draining the muscles and deep structures of the arm drain into the lateral group of axillary nodes.

17. FASCIAL COMPARTMENTS OF THE UPPER ARM

18. Dr. L Tchakarov 17 The upper arm is enclosed in a sheath of deep fascia. are attached to the medial and lateral supracondylar ridges of the humerus, respectively.Two fascial septa, one on the medial side and one on the lateral side, extend from this sheath and are attached to the medial and lateral supracondylar ridges of the humerus, respectively. By this means, the upper arm is divided into an anterior and a posterior fascial compartment, each having its muscles, nerves, and arteries.

19. ANTERIOR FASCIAL COMPARTMENT OF THE UPPER ARM

20. Dr. L Tchakarov 19 CONTENTS Muscles: 1.Biceps brachii, 2.Brachialis, and 3.Coracobrachialis. Why coracobrachialis is not seen in this cut? Blood supply: Brachial artery. Nerve supply to the muscles: Musculocutaneous nerve.

21. Dr. L Tchakarov 20 Structures passing through the compartment: 1.musculocutaneous, 2.median, and 3.ulnar nerves; 4.brachial artery and 5.basilic vein. in the lower partThe radial nerve is present in the lower part of the compartment. Why the cephalic vein is not listed?

22. MUSCLES OF THE ANTERIOR FASCIAL COMPARTMENT OF THE UPPER ARM

23. Dr. L Tchakarov 22 BICEPS BRACHII Origin: –The long head from the supraglenoid tubercle of the scapula; –the short head from the tip of the coracoid process of the scapula. –The tendon of the long head crosses the humeral head within the capsule of the shoulder joint and emerges from the joint surrounded by a synovial sheath and lying in the bicipital groove of the humerus. –It is joined in the middle of the upper arm by the short head. tuberosity of the radiusInsertion: Into the posterior part of the tuberosity of the radius and, by an aponeurotic band called the bicipital aponeurosis, into the deep fascia on the medial aspect of the forearm. The aponeurosis protects underlying structures present in the cubital fossa.

24. Dr. L Tchakarov 23 Nerve supply: Musculocutaneous nerve. Action: powerful flexorThe biceps is a powerful flexor of the elbow joint and a weak flexor of the shoulder joint. strong supinatorThe biceps is also a strong supinator of the forearm. Corkscrews and the threads of screws are designed to make use of this powerful supinator action in twisting the corkscrew into the cork or driving the screw into wood with a screwdriver.

25. Dr. L Tchakarov 24 CORACOBRACHIALIS Origin: From the tip of the coracoid process. Insertion: Into the middle of the medial side of the shaft of the humerus. Nerve supply: Musculocutaneous nerve. Action: It flexes the arm and is also a weak adductor.

26. Dr. L Tchakarov 25 BRACHIALIS Origin: From the front of the lower half of the humerus. Insertion: Into the anterior surface of the coronoid process of the ulna. Nerve supply: Musculocutaneous nerve. radial nerve. –A small part of the muscle that arises behind the deltoid tuberosity, and is therefore located in the posterior compartment, is supplied by the radial nerve. Action: It is a strong flexor of the elbow joint.

27. STRUCTURES PASSING THROUGH THE ANTERIOR FASCIAL COMPARTMENT OF THE UPPER ARM

28. Dr. L Tchakarov 27 BRACHIAL ARTERY at the lower border of the teres major muscleThe brachial artery begins at the lower border of the teres major muscle as a continuation of the axillary artery. It provides the main arterial supply to the arm. It terminates opposite the neck of the radius by dividing into the radial and ulnar arteries. Find the wrong label in this picture. Do not trust texbooks blindly.

29. Dr. L Tchakarov 28 RELATIONS Anteriorly: The vessel is superficial and is overlapped from the lateral side by the coracobrachialis and biceps. medial cutaneous nerve of the forearm –The medial cutaneous nerve of the forearm lies in front of the upper part; median nerve –the median nerve crosses its middle part; and bicipital aponeurosis –the bicipital aponeurosis crosses its lower part. Posteriorly: The artery lies on the triceps, the coracobrachialis insertion, and the brachialis.

30. Dr. L Tchakarov 29 Medially: ulnar nerveThe ulnar nerve and basilic veinthe basilic vein in the upper part of the arm; median nervein the lower part of the arm, the median nerve lies on its medial side. Laterally: median nerve coracobrachialis bicepsThe median nerve and the coracobrachialis and biceps muscles above; tendon of the bicepsthe tendon of the biceps lies lateral to the artery in the lower part of its course.

31. Dr. L Tchakarov 30 BRANCHES Muscular branches to the anterior compartment of the upper arm. The nutrient artery to the humerus. follows the radial nerveThe profunda artery arises near the beginning of the brachial artery and follows the radial nerve into the spiral groove of the humerus. follows the ulnar nerve.The superior ulnar collateral artery arises near the middle of the upper arm and follows the ulnar nerve. anastomosis around the elbow joint.The inferior ulnar collateral artery arises near the termination of the artery and takes part in the anastomosis around the elbow joint.

32. Dr. L Tchakarov 31 MUSCULOCUTANEOUS NERVE Origin: from the lateral cord of the brachial plexus (C5, 6, and 7) in the axilla. pierces the coracobrachialis muscle,It runs downward and laterally, pierces the coracobrachialis muscle, passes downward between the biceps and brachialis muscles.and then passes downward between the biceps and brachialis muscles. It appears at the lateral margin of the biceps tendonIt appears at the lateral margin of the biceps tendon and pierces the deep fascia just above the elbow. It runs down the lateral aspect of the forearm as the lateral cutaneous nerve of the forearm.

33. Dr. L Tchakarov 32 BRANCHES Muscular branches to the: 1.biceps, 2.coracobrachialis, and 3.brachialis. Cutaneous branches; the lateral cutaneous nerve of the forearm supplies the skin of the front and lateral aspects of the forearm down as far as the root of the thumb. Articular branches to the elbow joint.

34. Dr. L Tchakarov 33 MEDIAN NERVE Origin: from the medial and lateral cords of the brachial plexus in the axilla. lateral sideIt runs downward on the lateral side of the brachial artery. it crosses the brachial artery medial side.Halfway down the upper arm, it crosses the brachial artery and continues downward on its medial side. at the elbow, it is crossed by the bicipital aponeurosis.The nerve, like the artery, is therefore superficial; but at the elbow, it is crossed by the bicipital aponeurosis. small vasomotor nerve to the brachial artery.The median nerve has no branches in the upper arm, except for a small vasomotor nerve to the brachial artery.

35. Dr. L Tchakarov 34 ULNAR NERVE Origin: from the medial cord of the brachial plexus in the axilla. on the medial side of the brachial arteryIt runs downward on the medial side of the brachial artery as far as the middle of the arm. pierces the medial fascial septumHere, at the insertion of the coracobrachialis, the nerve pierces the medial fascial septum and, enters the posterior compartment of the arm;accompanied by the superior ulnar collateral artery, enters the posterior compartment of the arm; passes behind the medial epicondyle of the humerus.the nerve passes behind the medial epicondyle of the humerus. no branchesThe ulnar nerve has no branches in the anterior compartment of the upper arm.

36. Dr. L Tchakarov 35 RADIAL NERVE enters the posterior compartmentOn leaving the axilla, the radial nerve immediately enters the posterior compartment of the arm. re-enters the anterior compartmentIt re-enters the anterior compartment just above the lateral epicondyle.

37. POSTERIOR FASCIAL COMPARTMENT OF THE UPPER ARM

38. Dr. L Tchakarov 37 CONTENTS Muscles: The three heads of the triceps muscle. Nerve supply to the muscles: Radial nerve. Profunda brachii Ulnar collateral artery Blood supply:

39. Dr. L Tchakarov 38 Structures passing through the compartment: Radial nerve and ulnar nerve.

40. MUSCLE OF THE POSTERIOR FASCIAL COMPARTMENT OF THE UPPER ARM

41. Dr. L Tchakarov 40 TRICEPS The triceps is a large muscle that forms the greater part of the substance of the back of the arm. Origin: Long head from the infraglenoid tubercle of the scapula; above the spiral groove;lateral head from the upper half of the posterior surface of the shaft of the humerus above the spiral groove; below the spiral groove.medial head from the posterior surface of the lower half of the shaft of the humerus below the spiral groove. olecranonInsertion: The common tendon is inserted into the upper surface of the olecranon process of the ulna. Nerve supply: Radial nerve. strong extensorAction: This muscle is a strong extensor of the elbow joint.

42. STRUCTURES PASSING THROUGH THE POSTERIOR FASCIAL COMPARTMENT OF THE UPPER ARM

43. Dr. L Tchakarov 42 RADIAL NERVE Origin: from the posterior cord of the brachial plexus in the axilla. in the spiral grooveThe nerve winds around the back of the arm in the spiral groove on the back of the humerus between the heads of the triceps. profunda vessels,In the spiral groove, the nerve is accompanied by the profunda vessels, and it lies directly in contact with the shaft of the humerus. It pierces the lateral fascial septum between the brachialis and the brachioradialis muscles.It pierces the lateral fascial septum above the elbow and continues downward into the cubital fossa in front of the elbow, between the brachialis and the brachioradialis muscles.

44. Dr. L Tchakarov 43 BRANCHES long and medial heads of the triceps.In the axilla, branches are given to the long and medial heads of the triceps. lateral and medial heads of the triceps and to the anconeus.In the spiral groove, branches are given to the lateral and medial heads of the triceps and to the anconeus. brachialis, the brachioradialis, and the extensor carpi radialis longus muscles In the anterior compartment of the arm, after the nerve has pierced the lateral fascial septum, it gives branches to the brachialis, the brachioradialis, and the extensor carpi radialis longus muscles The radial nerve also gives articular branches to the elbow joint.

45. Dr. L Tchakarov 44 In the axilla, the radial nerve gives off the posterior cutaneous nerve of the arm. In the spiral groove, it gives off the lower lateral cutaneous nerve of the arm. This nerve supplies the skin over the lateral and anterior aspects of the lower part of the arm. The posterior cutaneous nerve of the forearm runs down the middle of the back of the forearm as far as the wrist.

46. ULNAR NERVE medial fascial septumHaving pierced the medial fascial septum halfway down the upper arm, the ulnar nerve descends behind the septum, covered posteriorly by the medial head of the triceps. superior ulnar collateral vessels.The nerve is accompanied by the superior ulnar collateral vessels. behind the medial epicondyle on the medial ligamentAt the elbow, it lies behind the medial epicondyle of the humerus on the medial ligament of the elbow joint. between the two heads of origin of the flexor carpi ulnaris.It continues downward to enter the forearm between the two heads of origin of the flexor carpi ulnaris. Branches articular branchThe ulnar nerve has an articular branch to the elbow joint.

47. Dr. L Tchakarov 46 PROFUNDA BRACHII ARTERY The profunda brachii artery arises from the brachial artery near its origin. accompanies the radial nerveIt accompanies the radial nerve through the spiral groove, supplies the triceps muscle,supplies the triceps muscle, and anastomosistakes part in the anastomosis around the elbow joint.

48. Dr. L Tchakarov 47 SUPERIOR AND INFERIOR ULNAR COLLATERAL ARTERIES The superior and inferior ulnar collateral arteries brachial arteryarise from the brachial artery and anastomosistake part in the anastomosis around the elbow joint.

49. WARNING USE THIS LECTURE ONLY ON COMPUTER PRINTOUTS DO NOT CONTAINT THE COMPLETE INFORMATION

50. THE END