CUBITAL FOSSA AND VESSELS OF FOREARM.pdf

Cubital fossa upper limb anatomy

3. LEARNING OBJECTIVES
•Know the location and boundaries of cubital fossa
•Enlist the contents of cubital fossa
•Discuss the clinical importance of cubital fossa
•Describe the origin, course, relations and branches of ulnar
artery
•Describe the origin, course, relations and branches of radial
artery and its along with its clinical importance

4. CUBITAL FOSSA
•DEFINITION: a triangular,
hollow space in front of the
elbow joint
•BOUNDARIES:
BASE: an imaginary line
between the two epicondyles
of humerus
LATERALLY: medial border of
brachioradialis
MEDIALLY: lateral border of
pronator teres
APEX: At the junction of
brachioradialis and pronator
teres

5. ROOF
1. SKIN
2. SUPERFICIAL FASCIA
Containing: lateral cutaneous
nerve of forearm, medial
cutaneous nerve of forearm &
medial cubital vein
3. DEEP FASCIA
4. BICIPITAL APONEUROSIS

6. FLOOR
1. Brachialis
(proximally)
2. Supinator (distally)

7. CONTENTS
•From medial to lateral:
(MBBS)
1. Median nerve, gives
branches for FCR, PL, FDS
and leaves the fossa by
passing between the heads
of pronator teres
2. Termination of Brachial
artery & beginning of radial
& ulnar arteries
3. Tendon of Biceps brachii
4. Superficial branch of Radial
nerve

8. APPLIED ANATOMY:
•MEDIAN CUBITAL
VEIN: IV injection, to
withdraw blood
•BLOOD PRESSURE
measurement: Brachial
artery in cubital fossa
•SUPRA CONDYLAR
FRACTURES

9. RADIAL ARTERY
•ORIGIN: begins in the inferior
portion of thecubital fossa, it
appears almost as a direct
continuationof the brachial
artery
•COURSE: The radial artery
travels down with lateral
convexity,then vertically
downwardson the radial side,
leaves the forearm by winding
posteriorly at wrist and enters
the anatomical snuff box

10. RELATIONS
ANTERIORLY:
Thebrachioradialis
musclewhile distally it is only
covered by fascia andskin
and fasciae
LATERALLY:
Brachioradialisthroughout
its extent, radial nerve in the
middle third
MEDIALLY:
upper1/3
rd
Pronator teres,
lower1/3
rd
flexor carpi
radialis

11. RELATIONS
POSTERIORLY:
tendon of thebiceps brachii,
supinator, pronator
teres,andflexor digitorum
superficialismuscles, flexor
pollicis longus, pronator
quadratus, lower end of radius

12. BRANCHES
•MUSCULAR BRANCHES
supply muscles on the radial
aspect of the forearm, in
particular the extensor muscles
of theposterior compartmentof
the forearm
•RADIAL RECURRENT ARTERY
This branch is just distal to
bifurcation from the brachial
artery, passes upwards, deep to
the brachioradialis. It anastomose
with the radial collateral artery
around elbow

13. BRANCHES
•PALMAR CARPAL BRANCH
arises near the distal border of
thepronator quadratus muscle and runs
along the anterior surface of thecarpal
bones, anastomosis with the palmar carpal
branch of the ulnar artery.
•DORSAL CARPAL BRANCH
Supply the carpal bones and their joints
The dorsal carpal branch branches off from
the radial artery at the proximal part of the
anatomical snuffbox and runs medially
across the wrist. It anastomoses with the
dorsal carpal branch of the ulnar artery and
posterior interosseous arteries to form
thedorsal carpal arch

14. BRANCHES
•SUPERFICIAL PALMAR
BRANCH
This branch completes the
lateral part of thesuperficial
palmar arch, which is mainly
formed by the direct
continuation of the ulnar
artery. Supply thenar muscles
•RADIAL PULSATION: Radial
artery is used to feel pulse at
wrist with flat radius behind it

15. ULNAR ARTERY
INTRODUCTION
ORIGIN: Brachial artery, larger
terminal branch
AREA OF BLOOD SUPPLY:
Medial aspect of the forearm,
medial aspect of the hand
The ulnar artery arises in
thecubital fossa

16. COURSE OF ULNAR ARTERY
•Passes obliquely
downward, reaches the
medial side of the forearm
about midway between
the elbow and the wrist
•It then runs vertically
along the medial(ulnar)
border to the wrist, enters
the hand by passing
superficial to flexor
retinaculum

17. RELATIONS
•ANTERIORLY:
•Upper half,covered by the
Pronator teres (the ulnar head of
pronator teres separates the ulnar
artery from themedian
nerve(which passes between the
two heads of pronator teres),
Flexor carpi radialis, Palmaris
longus, and Flexor digitorum
superficialis
•Lower half, covered by the skin ,
the superficial and deep fascia,
lies lateral to the flexor carpi
ulnaris

18. RELATIONS
POSTERIORLY: origin on
brachialis, in rest of its course on
flexor digitorum profundus
MEDIALLY: the ulnar nerve lies on
the medial side of the lower two-
thirds of the artery, and the
palmar cutaneous branch of the
nerve descends on the lower part
of the vessel to the palm of the
hand
LATERALLY: Flexor digitorum
superficialis
Accompanied with two venae
commitantes one on each side

19. BRANCHES
•ANTERIOR ULNAR RECURRENT
ARTERYarisesimmediately below the
elbow-joint, runs upward between the
Brachialis and Pronator teres,
participates in anastomosis around
elbow joint
•POSTERIOR ULNAR RECURRENT
ARTERYis much larger,
andarisessomewhat lower than the
anterior
•It passes backward and medially,
behind the Flexor digitorum
superficialis, participates in
anastomosis around elbow
•Both supply neighboring muscles

20. BRANCHES
•Gives off thecommon interosseus
artery just below the radial tuberosity
•which then divides at the upper border
of interosseous membrane to give
theanteriorandposterior
interosseous arteries
•These run down the forearm on either
side of the interosseus membrane
•Theposterior interosseoussupplies
the extensor muscles of the forearm
and in its upper part gives
interosseous recurrent branch
•Anterior one pierces interosseous
membrane, supplies posterior
compartment

21. BRANCHES
•The anterior interosseus
supplies the deep muscles of
the flexor compartment of the
forearm and extensor
compartment through its
terminal part, its branches are
1. Descending branch to the
palmar carpal arch
2. Muscular branches
3. Nutrient branches (radius and
ulna)
•Dorsal carpal branch
•Palmar carpal branch