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Lesson 4 Brachium Brachium - arm • A. Bony landmarks • 1. humerus – a. lateral epicondyle - radial side – b. medial epicondyle - ulnar side • 2. ulna – a. olecranon process – elbow – b. styloid process of ulna - dorsomedial point of wrist • 3. radius – a. styloid process of radius - lateral point of wrist • 4. Interosseous membrane: fibrous connective membrane, between radius and ulna Cutaneous nerves • (A)1. Medial brachial cutaneous nerve: middle of arm medial side - to skin over olecranon • (A) 2. Medial antebrachial cutaneous nerve: appears just inferior to medial brachial nerve on medial arm, splits: – a. anterior branch - skin of anteromedial forearm – b. posterior branch - skin of posteromedial forearm • (A) 3. Lateral antebrachial cutaneous nerve: continuation of musculocutaneous - appears just above inside of elbow, near cephalic vein - to skin of lateral & anterolateral forearm - also has anterior & posterior branches • (P) 4. Superior lateral brachial cutaneous nerve - a branch off the axillary nerve - to skin over inferior half of deltoid Cutaneous nerves • (P) 5. Posterior brachial cutaneous nerve - branches off the radial nerve up in the axilla - to skin on dorsal arm inferior to deltoid • (P) 6. Inferior lateral brachial cutaneous nerve = superior terminal branch - of radial nerve - a small branch ~2 inches above lateral epicondyle - to skin of lower lateral & anterolateral arm • (P) 7. Posterior antebrachial cutaneous nerve = inferior terminal branch of radial nerve - large - appears just below, posterior to lateral epicondyle - to skin on dorsal, lateral forearm • (P) 8. Superficial radial nerve - lateral border, distal forearm, just proximal to wrist - from under lateral border of brachioradialis - innervates skin on lateral dorsum of hand, thumb, proximal 2/3 of 1st 2-3 fingers (lateral side of middle or ring finger) • (A) 9. Posterior cutaneous branch of the ulnar nerve: - medial border, distal forearm, just proximal to wrist - innervates skin on medial dorsum of hand, last 2 fingers (medial side of ring finger) Veins • 1. cephalic vein: lateral (radial side) - all the way from wrist to deltopectoral groove, to axillary vein • 2. basilic vein: medial (ulnar side) - goes deep, joins venae comitantes (deep) & brachial artery • 3. median cubital vein: crosses over, connects cephalic with basilic - common site for drawing blood • 4. dorsal venous arch: back of hand - often used for an IV Arteries • Brachial artery: extension/continuation of axillary artery, splits into two terminal branches (radial and ulnar) • Branches – 1. profunda brachii artery ('deep'): largest, most superior branch; follows radial nerve - posterior descending branch (splits into radial collateral artery and middle collateral artery) – 2. two ulnar collateral arteries: branch off brachial below profunda & above elbow - superior ulnar collateral: mid-arm; follows ulnar nerve post. to medial epicondyle - inferior ulnar collateral: from ~2 in. proximal to elbow, anterior to medial epicondyle Artery • 3. radial artery: lateral, anterior to elbow, crosses anterior to biceps tendon & supinator muscle; overlapped by brachioradialis muscle – radial recurrent: a branch toward lateral epicondyle, anastomoses with profunda branch • 4. ulnar artery: medial, anterior to elbow, goes deep to pronator teres muscle – anterior ulnar recurrent – posterior ulnar recurrent – common interosseous artery - divides into anterior and posterior interosseous arteries (interosseous recurrent artery -- branch off posterior interosseous or common interosseous artery) Anastomeses • ** Collateral elbow circulation - is created by anastomoses between recurrents & collaterals: • including: radial recurrent; ulnar recurrents (anterior & posterior) ulnar collaterals (superior & inferior), recurrent interosseous and descending branch of profunda brachii Coracobrachialis • ORIGIN apex of coracoid process of scapula • INSERTION medial surface of middle of shaft of humerus, opposite deltoid tuberosity • ACTION flexes and adducts the shoulder • NERVE musculocutaneous - C6, 7 BICEPS BRACHII • ORIGIN short head: apex of coracoid process of scapula long head: supraglenoid tubercle of scapula (just above the fossa) • INSERTION short, long heads: tuberosity of radius, and aponeurosis of biceps brachii (laterous fibrosus) • ACTION Flexes the shoulder joint, and the long head may assist abduction if the humerus is laterally rotated. With the origin fixed: flexes the elbow, moving forearm towards the humerus and supinates forearm With insertion fixed: flexes the elbow joint moving the humerus toward the forearm as in pull-up or chinning exercises • NERVE musculocutaneous nerve - C5, C6 BRACHIALIS • ORIGIN humerus - distal 1/2, anterior surface of humerus, and medial and lateral intermuscular septa • INSERTION ulna - coronoid process, ulnar tuberosity • ACTION With origin fixed: flexes the elbow joint moving the forearm toward the humerus With insertion fixed: flexes the elbow joint moving the humerus toward the forearm as in pull-up or chinning exercises. • NERVE musculocutaneous nerve + a small branch of radial nerve - C5, C6 TRICEPS • ORIGIN – long head: scapula - infraglenoid tubercle – lateral head: humerus - lateral and posterior surfaces of proximal 1/2 of humerus; and lateral intermuscular septum – medial head: humerus - distal 2/3 of medial and posterior surfaces of humerus below the radial groove, and from medial intermuscular septum • INSERTION ulna - posterior surface olecranon process; antebrachial fascia • ACTION extends the elbow joint; long head also assist in abduction and extension of the shoulder joint • NERVE radial nerve - C6, C7, C8, T1 ANCONEUS • ORIGIN humerus - lateral epicondyle; on posterior surface • INSERTION ulna - olecranon process, on lateral side; & proximal 1/4 of ulna, posterior surface • ACTION extends the elbow joint, and may stabilize the ulna during pronation and supination • NERVE radial nerve - C7, C8, T1