Powerful forearm flexor
Posterior compartment muscle considered to be a distally placed continuation of the triceps brachii
The biceps brachii muscle has what type of fascicle arrangement?
The biceps is primarily responsible for what action?
Supination of the arm
A right handed person (a left handed person would be using diff. muscles to accomplish this action) insering a screw, pulling the cord from a wine bottle
Where do the two bellies of the bicecs meet?
Just distal to the middle of the arm
Which muscle crosses the head of the humerus within the glenohueral joint surrounded by synovial membrane & then descends in the intertubercular groove?
Long head of the humerus
Ligament passing from the grater to lesser tubercle converting the intertubercular groove into a canal
Transverse humeral ligament
Separates the biceps tendon from-and reduces abrasion against the anterior part of the radial tuberosity
Triangular membranous band that runs from the biceps tendon across the cubital fossa, merging with the antebrachial (deep) fascia, covering the flexor muscles in the medial side of the forearm attaching to the subcutaneos border of the ulna
Palpation of bicipital aponerosis
Can be easily felt obliquely over the brachial artery and median nerve
Bicipital aponerosis function
Protection for brachial artery and median nerve. Helps lessen the pressure of the triceps tendon on the radial tuberosity during pronation and supination of the forearm
Which head of biceps can also do shoulder flexion?
What percentage of people have a 3rd head of the biceps?
10% arisng at the superomedial part of the brachialis, in most the 3rd head lies posterior to the brachial artery
How to test for the biceps?
How is it palpated?
The elbow is flexed against resistance when the arm is supinated.
A prominent bulge is prominent on the anterior arm.
Which tendon of biceps in inclosed in a synovial sheath?
The long head. This tendon moves back and forth in the intertubercular groove. Wear of this mechanism is a common cause of shoulder pain.
Inflammation of the tendon (biceps tendonitis) usually results from what?
Usually the result of repetitive microtauma.
(common in sports such as baseball, crickets, tennis)
Irritaion and inflammation of tendon may produce tenderness and crepitus (crackling sound)
Painful condition that may occur in young persons during traumatic separation of the proximal epiphysis of the hummerus
-Can also occur in older athletes w/ a history of biceps tendonitis (signs)
Dislocation of the tendon of the long head of the biceps from the intertubercular groove of the humerus
During arm rotation a sensation of popping or catching is felt
What is "Popeye deformity?"
What causes it?
What age group is it common in?
Name given to the ball formed by the detached biceps muscle belly (long head) tendon torn from supraglenoid tubercle
-Usualy as a result of wear & tear of an inflammed tendon as it moves back and forth in the intertubercular groove
-Pop is heard
-Common in older than 33yrs
-baseball pitchers, swimmers (repetitive overhead motions)
-Also may result from forceful flexion against resistance (weight lifters)
The brachialis muscle has what type of fascicle arrangement?
What muscle is the main flexor of the forearm?
Workhorse of the elbow flexors
Able to flex it in all positions (pronated/ supinated) and during slow (use to pick up & and put down a tea cup) and quick movements?
Muscle that has the musculocutaneous nerve pierce through it and the distal part attachment indicates loaction of the nutrient foramen of the humerus?
Muscle that helps to stabalize the glenohumeral joint.
Along with the Deltoid and long head of the triceps it serves as what kind of muscle?
What important structures may run beep to it? Its importance
serves as a shunt muscle, resisting downward dislocation of the head of the humerus.
The median nerve and/ or brachial artery may run deep to it and may be compressed by it
What kind of injury may happen to a child or adolenscent as a result of a direct blow or direct injury of the shoulder?
May produce fracture-dislocation of the proximal epiphysis b/c the articular capsule of the shoulder joint is stronger than the epiphyseal plate
-In severe fractures humerus is displaced, humeral head remains in normal relationship w/ glenoid cavity
The triceps brachii muscle has what type of fascicle arrangement?
Test for the Triceps biceps or to determine function of it nerve
Arm abducted 90 degrees then the flexed forearm is extended against resistance
-need to compare w/ other side & take into consideration if pt right or left handed
Reduces friction b/w triceps tendon and olecranon
Subtendinous olecranon bursa
if distal means it is b/w tendon & skin
Brachial artery path
•Begins at inferior border of of the teres major
•Ends in the cubital fossa opposite the neck of the radius
-Divides into the radial and ulnar artery
Blood supply to elbow?
Branches of the medial artery arising from the medial aspect?
•Deep artery of the arm
•Superior ulnar collateral artery
•Inferior ulnar collateral artery
(collateral arteries help form arterial anastomes of the elbow)
Largest branch of the brachial artery what does it accompany?
Deep artery of the arm
accompanies the radial nerve through the radial groove
Divides into anterior and posterior branches & participates in anastomes around the elbow
Superior ulnar collateral artery
arises from middle aspect of brachial artery, near middle of arm
-Accompanies the ulnar nerve (posterior to middle epicondyle)
-Formes anastomes w/ posterior or posterior branch of:
•ulnar recurrent artery
•inferior ulnar collateral artery
•another brachial branch arising distally
Inferior Ulnar Collateral Artery
Arises from brachial artery
Approximately 5cm proximal to the elbow crease
Passes inferomedially to the medial epicondyle
Joins anastomes of the elbow region wih:
anterior or anterior branch of the ulnar recurrent artery
Blood pressure is measure using what instrument?
Where is the cuff placed what is it compressing?
Where is the stetoscope placed?
-Placed around the arm
-Inflated to compress the brachial artery
-stetoscope is placed over the artery in the cubital fossa
First sound in blood pressure is...
Palpation of the brachial artery
Belly of biceps has to be pushed laterally to detect pulsation. Light touch
Best place in arm to control hemorrhage/ bleeding
Compress near middle of arm
-can be compressed distal to deep artery of arm while still allowing enough blood to reach ulnar and radial arteries
Will a midhumeral fracture likely paralize the triceps?
Radial nerve lesion in this area should always be considered.
However, if the nerve is lesioned it is not likely to paralize the triceps because of high origin of two heads of this muscle
Midhumeral fractures are usually of what kind?
Transverse, somewhat commuted
In what direction may supracondylar fractures be displaced?
Actions of brachialis and triceps in supracondylar fractures?
These muscles tend to pull the distal fragment over the proximal fragment shortening the limb
-tend to pull any of the nerves or vessels of the brachial vessels
-an injury to the brachial arteries needs arterial repair
Which veins of the arm have more numerous valves?
Which veins anastome freely with each other ?
Superficial (in the subcutaneous tissue)
Deep veins (accompany the arteries )
Main superficial veins here:
Cephalic & Basilic
Cephalic and Basilc veins are deep or subcutaneous?
Subcutaneous, they are easily seen through the skin
Cepahalic: b/w deltoid & pec major-->deltopectoal groove-->deltopectoral triangle--> empties into axillary vein
Basilic: penetrates fascia in middle and inferior thirds of the arm-->runs superiorly into the axilla-->form axillary vein
Path of radial nerve as it enters the arm
Enters the arm posterior to the brachial artery, medial to humerus, anterior to the long head of the triceps, descends inferolaterally with the deep brachial artery--> when it reaches the lateral the lateral border of the humerus it pierces the lateral intermuscular septum, continues inferiorly in anterior compartment of arm b/w brachialis & brachioradialis-->divides to deep (muscular) and superficial (cutaneous) braches (dorsum of hand)
Path of median nerve
Initially lateral to brachial artery-->in middle of arm crosses to medial side --> contacts brachialis--> descends deep to bicipital aponerousis & median cubital vein--> supplies articular branches in the elbow joint
Ulnar nerve path
Passes distally anterior to triceps--> on medial side of brachial artery--pierces the middle intermuscular septum with w/ superior collateral artery--> descends b/w septum & medial head of triceps
Does injury to musculocutaneous nerve cause complete loss of arm flexion?
Great weakness however of flexion & supination of the elbow joint (paralysis of coracobrachialis, biceps, brachialis). Loss of sensation on lateral side of forearm
Some shoulder muscles can flex arm & some forearm muscles (median) and brachioradialis (radial) can still do some weak flexion of forearm
Injury to radial nerve superior to origin of its branches to triceps brachii
•Extensor muscles of wrist & digits
•Loss of sensation in skin of this area too
Injury in radial groove of radial nerve
Triceps not completely paralyzed, only weakened.
Only medial head is affected. Oher heads innervated higher up
-Muscles of posterior forearm paralyzed
Characteristic clinical sign of radial nerve injury
-Inability to extend the wrist, digits (at MCP)
-Wrist is flexed (due to unopposed tonus of flexor muscles, gravity)
Boundaries of Cubital Fossa
Triangular hollow area on anterior aspect of elbow
•Superiorly: imaginary line connecting medial & lateral
•Medially: pronator teres
•Floor: brachialis, supinator
•Roof: formed by deep fascia, reinforced by
Contents of the Cubital foss
•Terminal part of brachial artery
•Accompanying veins of the arteries
•Biceps brachii tendon
(barchial artery lies b/w biceps tendon & median nerve (medial))
What vein, overlying the cubital fossa lies anterior to brachial artery?
Median cubital vein
Veins usually used for venipucture.
- common site for blood transfusion & intravenous injections
Median cubital vein & Basilic vein
What tendon can be palpated in the cubital fossa?
The biceps brachii tendon
Lateral to the midline, especially when elbow is flexed against resistance
Where can the bicipital aponerosis be palpated?
As it passes obliquely over the brachial and median nerve in cubital fossa
Superficial muscles of flexor-pronator group of forearm
-Flexor Carpi Radialis
-Flexor Carpi Ulnaris
-Flexor Digitorum Superficialis
(These all cross the elbow joint)
Deep muscles of flexor-pronator group of forearm
-Flexor Digitorum Profundus
-Flexor Pollicis Longus
-Pronator Quadratus (deepest and most distal)
Which long flexor flexes the digits in slow action, such as needed in climbing?
-Reinforced by the FDS when speed against resistance are required?
Flexor Digitorum Profundus (FDP)
In conjunction with what muscle does the Flexor Carpi Radialis produce flexion of the wrist?
Flexor Carpi Ulnaris
Pure abduction of the wrist is produced when what muscles work together?
-flexor carpi radialis
-extensor carpi radialis brevis
-extensor carpi radialis longus
What motion is produced when the flexor carpi radialis acts alone?
-flexion & abduction at wrist (hand moves anterolaterally)
What structure lies just laterally to the tendon of flexor caroi radialis?
Which is the most medial of the superficial flexors?
Flexor carpi ulnaris
When acting alone what motion does the Flexor carpi ulnaris produce?
Simultaneous flexion and adduction at the hand at the wrist
What muscles work together together to produce pure adduction of wrist?
Flexor carpi ulnaris & extensor carpi ulnaris
What nerve passes b/w the two heads of the flexor carpi ulnaris?
Largest superficial muscle in forearm
Flexor Digitorum Superficialis (FDS)
What nerve & artery pass b/w the two heads of the Flexor Digitorum Superficialis (FDS)?
Median nerve & ulnar artery
What tendon lies lateral to the FDP?
Has its own synovial sheath
Flexor Pollicis Longus (FPL)
Only muscle that flexes the interphalangeal joint of thumb
Passes through Carpal tunnel (flexor retinaculum)
Flexor Pollicis Longus (FPL)
Travels down medial to humerus (no branches)
Enters forearm w/ brachial artery
cubital fossa (medial side)
Travels b/w heads of pronator teres
Down b/w FDS & FDP
B/w FDS & FCR becomes superficial palmar cutaneous just proximal to flexor retinaculum passes superficial to it
In wrist lies in the radial side of tendon of palmaris longus
Deep to palmaris longus tendon
**Gives articular elbow braches along w/ ulnar nerve