ACD 3, 4, 5, 6

By Jose Paolo A. Dio, I-B 2017-2018

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 ACD 4

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 1. Discuss the skin, superficial fascia, and
deep fascia of the upper limb & 2. Discuss the
areas of distribution of the major cutaneous
nerves of the upper limb &
3. Discuss the major superficial and deep
veins of the upper arm as to its formation,
commencement/termination, and course
pp. 367 - 370

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 Skin contains:
1. Superficial sensory nerves
2. Superficial & Deep veins
3. Superficial lymph vessels

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 1. Superficial sensory nerves
A. Nerves supplying the lateral surface of
the arm
1. Supraclavicular nerves (C3 & 4)
Sensory nerve supply to the skin over
the point of the shoulder to halfway
down the deltoid muscle
2. Upper lateral cutaneous nerve (C5
& 6 Axillary)
Supplies skin over the lower half of
the deltoid
3. Lower lateral cutaneous nerve (C5
& 6 Axillary)
Supplies akin over the lateral surface
of the arm below the deltoid
B. Nerves supplying the medial surface of
the arm
1. Medial cutaneous nerve (T1)
Supplies skin of armpit and medial
side of arm
2. Intercostobrachial nerves (T2)
Also supplies skin of armpit and
medial side of arm
3. Posterior cutaneous nerve (branch
of radial nerve C8)
Supplies skin at the back of the arm
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 2. Superficial Veins
1. Deep veins
Venae comitantes
Axillary vein
2. Superficial veins
Cephalic vein
Ascends in the superficial
fascia on the lateral side of the
biceps and, on reaching
infraclavicular fossa, drains
into axillary vein
Basilic vein
Ascends in the superficial
fascia on the medial side of
the biceps.
Halfway 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
Nerve supply of the veins
Sympathetic postganglionic
nerve fibers
Innervates the smooth muscle
17/09/2017 in the wall of the vein Jose Paolo A. Dio, I-B, 2017-2018 6
 Superficial Lymph Vessels
The vessels draining the
superficial tissues of the upper
arm pass upward to the axilla
Those from the lateral side of
the arm follow the cephalic
vein to the infraclavicular
group of nodes
Those from the medial side
follow the basilic vein to the
lateral group of axillary nodes

Deep lymphatic vessels

drains the muscles and deeps
structures of the arm; they
drain into lateral group of
axillary nodes

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 4. Discuss the muscles of the anterior
compartment of the arm as to its
attachments, innervation, and action &
7. Discuss the brachial artery as to its origin,
commencement/termination, course,
branches, and spatial relations &
anterior compartment of arm & includes
6. Musculocutaneous nerve
pp. 370-376

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 Fascial compartments of the Upper Arm

Upper arm is enclosed in a sheath of deep fascia

Two fascial septae
One on medial side
Attached to medial supracondylar ridge of humerus
One on lateral side
Attached to lateral supracondylar ridge of humerus
Upper arm divided into anterior and posterior
fascial compartment with their own muscles,
nerves, arteries

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 Contents of the anterior fascial
compartment of upepr arm
Muscles
Biceps brachii
Coracobrachialis
Brachialis
Blood supply:
Brachial artery
Nerve supply to muscles
Musculocutaneous nerve
Structures passing through
compartment
Musculocutaneous, median, ulnar
nerves
Brachial artery
Basilic vein
Radial nerve (only present in lower
part)

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 Muscles of the anterior fascial
compartment
Biceps brachii
Powerful supinator (turn
to make the hand face
outward)
The action is made use of
in twisting the corkscrew
into the cork or driving
the s crew into wood w a
screwdriver
A powerful flexor of the
elbow joint
Weak flexor of the
shoulder joint

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 Structures passing through the anterior fascial compartment
1. Brachial artery
Begins at lower border of teres
major as a continuation of the
axillary artery
Main arterial supply to arm
Terminates opposite the neck of
radius by dividing into radial and
ulnar arteries
Relations:
Anteriorly: Vessel is superficial but
overlapped laterally by
coracobrachialis and biceps; medial
cutaneous nerve of forearm is in
front of its upper part; median
nerve crosses its middle; bicipital
aponeurosis crosses lower part
Posteriorly: lies on triceps,
coracobrachialis insertion, and
brachialis
Medially: ulnar nerve and basilic
vein in the upper part of arm;
median nerve on lower part
Laterally: median nerve and
coracobrachialis and biceps muscle
above; tendon of biceps below
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1. Brachial artery
Branches
Muscular branches: to anterior
compartment of upper arm
Nutrient artery: to humerus
Profunda artery: arises near
beginning of the brachial
artery; follows radial nerve into
spiral groove of the humerus
Superior ulnar collateral
artery: arises near miffle of the
upper arm; follows ulnar nerve
Inferior ulnar collateral artery:
arises near termination of the
artery; takes part in the
anastomosis around elbow
joint

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2. Musculocutaneous Nerve
Origin from the lateral cord of
brachial plexus (C5,6,7)
Passes downward between biceps
and brachialis muscle
Appears at the lateral margin of the
biceps tendon and pierces the deep
fascia above elbow
Runs down lateral aspect of of
forearm as lateral cutaneous nerve of
forearm
Branches:
Muscular branches to biceps,
coracobrachialis, and brachialis
Cutaneous branches; the lateral
cutaneous nerve of the forearm
supplies skin o forearm down as far as
root of the thumb
Articular branches to elbow joint

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3. Median Nerve
Origin from medial and lateral
cords of the brachial plexus in the
axilla
Runs downward on lateral side of
brachial artery
Halfway down upper arm, crosses
brachial artery and continues
downward on medial side
Nerve is superficial (like the
artery) but at elbow, crosses by
bicipital aponeurosis
No branches except for a small
vasomotor nerve to the brachial
artery

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4. Ulnar Nerve
Origin from the medial cord of
the brachial plexus in the axilla
Runs downward on the medial
side of the brachial artery as far
as the middle of the arm; here, at
the insertion of the
coracobrachialis, the nerve
pierces the medial fascial septum,
along with superior ulnar
collateral artery
Enters posterior compartment of
the arm
Nerve passes behind medial
epicondyle of the humerus
No branches in anterior
compartment of upper arm
5. Radial Nerve
Once it leaves axilla, it
immediately enters the posterior
compartment of the arm
Enters anterior compartment just
above lateral epicondyle Jose Paolo A. Dio, I-B, 2017-2018
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 5. Discuss with illustration the
muscles of the posterior
compartment of the arm as to its
attachments, innervations, and
actions & includes
6. radial nerve
pp. 376-378

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 Contents of the posterior fascial
compartment of the upper arm
Muscles
Three heads of triceps
muscle
Nerve supply to muscle
Radial nerve
Blood supply
Profunda brachii & ulnar
collateral arteries
Structures passing
through compartment
Radial nerve and ulnar
nerve

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 Muscles of the posterior fascial
compartment

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 Structures passing through the
posterior fascial compartment
1. Radial nerve
Origin from posterior cord of
brachial plexus in axilla
Winds around the back of
the arm in the spiral groove
on the back of the humerus
between heads of triceps
Pierces the lateral fascial
septum above elbow and
continues downward into
cubital fossa in front of
elbow, between brachialis
and brachoradialis muscle
In spiral groove, nerve
accompanied by profunda
vessels
Lies directly in contact w Jose Paolo A. Dio, I-B, 2017-2018
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shaft of humerus leg
1. Radial nerve
Branches
In axilla:
Posterior cutaneous nerve of
arm
In spiral groove:
Lower lateral cutaneous
nerve of arm: supplies skin
over lateral and anterior
aspects of lower part of arm
Posterior cutaneous nerve of
forearm: runs down middle
of back of forearm as far as
wrist
In anterior compartment of
arm:
Gives branches to brachialis,
brachioradialis, and extensor
carpi radialis longus muscle
Gives articular branches to
elbow joint

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 2. Ulnar Nerve
Having pierced the medial
fascial septum halfway down
upper arm, ulnar nerve
descends behind septum,
covered posteriorly by medial
head of triceps
Nerve accompanied by
superior ulnar collateral vessels
At elbow, lies behind medial
epicondyle of humerus on
medial ligament of elbow joint
Continues downward to enter
forearm between 2 heads of
origin of flexor carpi ulnaris

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2. Ulnar nerve
Has an articular branch to
elbow joint
3. Profunda brachii artery
Arises from brachial artery near
origin
Accompanies radial nerve
through spiral groove, supplies
triceps muscles, and takes part
in anastomisis around elbow
joint
4. Superior and inferior ulnar
collateral arteries
Arise from brachial artery
Take part in anastomisis around
elbow joint

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 8. Discuss with illustration the
cubital fossa as to its boundaries,
contents with its spatial relations
p. 378

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 Cubital fossa
Depression that lies in front of elbow
Bounded laterally by brachoradialis
muscle
Bounded medially by pronator teres
muscle
Base: imaginary line between two
epicondyles of humerus
Floor: formed by supinator muscle
laterally and brachialis muscle
medially
Contents (medial to lateral):
Median nerve
Bifurcation of brachial artery
Tendon of biceps
Radial nerve
Mnemonic from lateral to medial: Be
Right There Always My PT

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 9. Discuss the shoulder joint as to its
component bones, type, and
movements
pp. 364-365

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 Component bones:
The articulation occurs
between rounded head of Shoulder joint
humerus and the shallow
pear-shaped glenoid cavity
of the
Articular surface covered
by hyaline cartilage
Glenoid cavity deepened
by the presence of
fibrocartilaginous rim
called glenoid labrum
Type: ball and socket joint
Movement: Flexion,
extension, abduction,
adduction, lateral
rotation, medial rotation,
circumduction
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 10. Discuss the elbow joints as to its
component bones, type, and
movements
pp. 406-408

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 Component bones:
Articulation occurs
between trochlea and
capitulum of the humerus
Elbow joint
and the trochlear notch of
the ulna and head of the
radius
Articular surfaces covered
with hyaline cartilage
Type: Synovial hinge joint
Movements:
Capable of flexion and
extension
Flexion performed by
brachialis, biceps brachii,
brachioradialis, and
pronator teres
Extension performed by
triceps and anconeus
muscles
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