UPPER AND LOWER LIMB
ANA 211
Anterior and Posterior compartment
of the Arm
Auza, M I (BSc, MSc)
Department of Human Anatomy
Faculty of Basic Medical Sciences
Bingham University, Karu
WISDOM QUOTE
“Every harvest depends
on what was planted.
Sow time in your
academics so you can
produce the right result”
COMPARTMENTS OF THE ARM
• The deep fascia encloses the arm
like a sleeve.
• The two fascial septa, one on the
medial side and one on the lateral
side extend inwards from the
fascial sleeve and get attached
to the medial and lateral
supracondylar ridges of the
humerus, respectively.
• These septa and fascial sleeve
divide the arm into anterior and
posterior compartments.
• Each compartment has its own
muscles, nerve, and artery
CONTENTS OF THE ANTERIOR
COMPARTMENT OF THE ARM
• Muscles: Biceps brachii, coracobrachialis, and brachialis.
• Nerve: Musculocutaneous nerve.
• Artery: Brachial artery.
• In addition to the above structures, the following large
nerves also pass through the anterior compartment of arm:
• Median nerve.
• Ulnar nerve.
• Radial nerve.
Muscle: Biceps Brachii
Origin
• Short head: from the tip of coracoid process of
scapula
• Long Head: from Supraglenoid tubercle of the
scapula
Insertion:
• Posterior rough part of the Radial tuberosity
Nerve Supply:
• Musculocutaneous Nerve (C5, C6, C7)
Action:
• Supination of the forearm when elbow is flexed
• Powerful Flexor of the forearm when elbow is
extended
• Weak flexor of the shoulder joint
Muscle: Brachialis
Origin
• Lower half of the anterior surface
of the humerus
Insertion:
• Anterior surface of the coronoid
process of the ulna including ulnar
tuberosity
Nerve Supply:
• Musculocutaneous Nerve Mainly
• Radial Nerve
Action:
• Flexion of the forearm in all
position
Muscle: Coracobrachialis
Origin
• Tip of the coracoid process of
the scapula along with short head
of biceps
Insertion:
• Middle one-third of medial
border of the humerus
Nerve Supply:
• Musculocutaneous Nerve (C5, C6,
C7)
Action:
• Helps in Flexion and adduction of
the arm
Anatomical events at the insertion of
the coracobrachialis
• Circular shaft of the humerus
becomes triangular below this
level
• Brachial artery passes from
medial side of arm to its
anterior aspect
• Basic vein pierces the deep
fascia
• Median nerve crosses in front
of the brachial artery from
the lateral to medial side
Anatomical events at the insertion of
the coracobrachialis
• Radial nerve pierces lateral
intermuscular septum to pass
from the posterior compartment
to the anterior compartment
• Ulnar nerve pierces medial
intermuscular septum to go into
the posterior compartment
• Medial cutaneous nerve of the
arm and forearm pierces the
deep fascia
• Nutrient artery pierces the
humerus.
Musculocutaneous Nerve: Origin and
Course
• It is the nerve of the front of
the arm
• It arises from the lateral cord
of the Brachial Plexus in the
axilla
• It runs downward and laterally,
pierces the coracobrachialis
which it supplies
• Then passes between the Biceps
and Brachialis muscles
• It appears at the lateral aspect
of the forearm as the lateral
cutaneous nerve of forearm
Musculocutaneous Nerve: Branches
and Distribution
• Muscular Branches to the
biceps brachii,
coracobrachialis and brachialis
• Cutaneous Branch (Lateral
cutaneous nerve of forearm)
supplies the skin on the front
and lateral aspect of the
forearm
• Articular Branch to the elbow
joint through its branches to
the brachialis muscle.
Clinical Correlation
Injury to the musculocutaneous nerve: It is rare but if it
occurs it leads to the following signs and symptoms:
• Loss of strong flexion and supination
• Loss of biceps tendon reflex
• Loss of sensation along the lateral aspect of the forearm.
Brachial Artery
• It is the main artery of the
arm
• It begins at the lower border
of the teres major muscle as
the continuation of the
axillary artery
• Terminates in front of the
elbow at the level of the neck
of radius by dividing into
• Radial artery
• Ulnar artery
Brachial Artery: Relations
Anteriorly
• In the upper part, it is
related to medial cutaneous
nerve of the forearm, which
lies in front of it.
• In the middle part, it is
crossed by the median nerve
from lateral to medial side.
• In the lower part, in the
cubital fossa, it is crossed
by the bicipital aponeurosis.
Brachial Artery: Relations
Posteriorly From above
downwards:
• The brachial artery lies
successively on
• Long head of triceps
• Medial head of triceps,
• Coracobrachialis, and
• Brachialis muscles
Brachial Artery: Relations
Medially
• The ulnar nerve and basilic
vein in the upper part of the
arm; and median nerve in the
lower part of the arm.
Laterally
• The median nerve,
coracobrachialis, and biceps in
the upper part of arm and
tendon of biceps in the lower
part.
Branches of Brachial Artery
• Muscular branch
• Profunda brachii artery
• Nutrient artery
• Superior ulnar collateral artery
• Inferior ulnar collateral (or supratrochlear artery)
• Radial and ulnar arteries (terminal branches)
Clinical correlation
Brachial pulse:
• The brachial pulse is
commonly felt in the cubital
fossa medial to the tendon
of biceps and its pulsations
are auscultated for
recording the blood
pressure.
• The biceps tendon is easily
palpable on flexing the
elbow.
Clinical correlation
Compression of brachial
artery:
• The brachial artery can be
effectively compressed
against the shaft of humerus
at the level of insertion of
coracobrachialis to stop the
hemorrhages in the upper limb
occurring from any artery
distal to the brachial artery,
e.g., bleeding wounds of the
palmar arterial arches .
Clinical correlation
Rupture of the brachial
artery in supracondylar
fracture of the humerus may
lead to Volkmann’s ischemic
contracture.
Arterial Anastomosis around the Elbow
• The arterial anastomosis
around the elbow takes
place between the branches
of brachial artery and
those from the upper ends
of radial and ulnar
arteries.
Arterial anastomosis around the elbow joint
(L lateral epicondyle, M medial epicondyle).
Arterial Anastomosis around the Elbow
In front of the medial
epicondyle:
(a) Inferior ulnar collateral
artery and branch from the
superior ulnar collateral
artery (branches of the
brachial artery), anastomose
with
(b) Anterior ulnar recurrent
artery (branch of the ulnar
artery).
Arterial anastomosis around the elbow joint
(L lateral epicondyle, M medial epicondyle).
Arterial Anastomosis around the Elbow
Behind the medial
epicondyle:
(a) Superior ulnar collateral
artery and a branch from the
inferior ulnar collateral artery
(branches of brachial artery),
anastomose with
(b) Posterior ulnar recurrent
artery (branch of the ulnar
artery).
Arterial anastomosis around the elbow joint
(L lateral epicondyle, M medial epicondyle).
Arterial Anastomosis around the Elbow
In front of lateral epicondyle:
(a) Radial collateral artery (branch
of the profunda
brachii artery), anastomose with
(b) Radial recurrent artery
(branch of the radial artery).
Arterial anastomosis around the elbow joint
(L lateral epicondyle, M medial epicondyle).
Arterial Anastomosis around the Elbow
Behind the lateral epicondyle:
(a) Posterior descending artery
(branch of the profunda
brachii artery), anastomose with
(b) Interosseous recurrent
artery (branch of the posterior
interosseous artery); and a branch
of common interosseous artery (a
branch of the ulnar artery).
Arterial anastomosis around the elbow joint
(L lateral epicondyle, M medial epicondyle).
Arterial Anastomosis around the Elbow
Above the olecranon fossa:
(a) Middle collateral artery
(branch of the profunda
brachii artery), anastomose with
(b) Transverse branch from the
posterior division of the
inferior ulnar collateral artery.
Arterial anastomosis around the elbow joint
(L lateral epicondyle, M medial epicondyle).
Large Nerves Passing
Through the Arm
• Median Nerve
• Ulnar Nerve
• Radial Nerve
Median Nerve
• The median nerve arises from
the lateral and medial cords of
the brachial plexus in axilla.
• It is closely related to the
brachial artery throughout its
course in the arm. Therefore,
it is like the brachial artery.
• It is superficially located
except at elbow where it is
crossed by the bicipital
aponeurosis.
Relationship of Median Nerve with
Brachial Artery in the Arm
• In the upper part, it is
lateral to the artery.
• In the middle part, it
crosses in front of the
artery from lateral to
medial side.
• In the lower part, it is
medial to the artery up to
elbow.
Branches of Median Nerve
• In the arm, the median nerve gives rise to the following
branches:
1. Nerve to pronator teres just above the elbow.
2. Vasomotor nerve to the brachial artery.
3. Articular branch to the elbow joint at or just below the elbow.
Ulnar Nerve
• The ulnar nerve arises from medial
cord of the brachial plexus in the axilla.
• It then runs downwards on the medial
side of the arm medial to the brachial
artery up to the insertion of
coracobrachialis.
• Here it pierces the medial
intermuscular septum along with the
superior ulnar collateral artery to
enter the posterior compartment of
the arm.
• At the elbow, the ulnar nerve passes
behind the medial epicondyle of
humerus where it can be easily
palpated.
• The ulnar nerve does not give any
branch in the arm.
Radial Nerve
Origin and course
• The radial nerve arises from the
posterior cord of the brachial plexus in
the axilla.
• In the arm the nerve first lies
posterior to the brachial artery.
• Then it winds around the back of the
arm to enter the radial/spiral groove
of humerus between the lateral and
medial heads of the triceps; where it is
accompanied by profunda brachii
artery.
• At the lower end of the spiral groove,
it pierces lateral intermuscular septum
and enters the anterior compartment of
the arm.
Radial Nerve
• At the lower end of the spiral groove,
it pierces lateral intermuscular septum
and enters the anterior compartment of
the arm. Here it continues downward in
front of the elbow in the cubital fossa,
between the brachialis and
brachioradialis muscles.
• Then at a variable point it divides into
two terminal branches:
• (a) a sensory branch, the superficial
radial nerve, and
• (b) a motor branch, the deep radial
nerve.
• The latter disappears into the
substance of supinator muscle just
below the elbow.
Branches Of Radial Nerve
In the axilla:
• (a) Nerves to long and medial heads of triceps.
• (b) Posterior cutaneous nerve of the arm.
In the spiral groove:
• (a) Nerves to lateral and medial heads of triceps.
• (b) Nerve to anconeus.
• (c) Lower lateral cutaneous nerve of the arm.
• (d) Posterior cutaneous nerve of forearm.
In the anterior compartment of the arm:
• (a) Nerves to brachialis, brachioradialis, and
extensor carpi radialis longus.
• (b) Articular branches to the elbow joint.
• (c) Deep radial nerve.
• (d) Superficial radial nerve
CUBITAL FOSSA
• The cubital fossa is a
triangular hollow in
front of the elbow.
• It corresponds (i.e.,
homologous) to the
popliteal fossa of the
lower limb.
Boundaries
• Lateral: Medial border of
brachioradialis muscle.
• Medial: Lateral border of pronator
teres muscle.
• Base: An imaginary horizontal line,
joining the front of two epicondyles
of the humerus.
• Apex: Meeting point of the lateral
and medial boundaries. Here
brachioradialis overlaps the
pronator teres.
• Floor: It is formed by two muscles,
brachialis in the upper part and
supinator in the lower part.
Boundaries
• Roof: It is formed from
superficial to deep by:
a. Skin
b. Superficial fascia containing
Median vein connecting
cephalic and Basilic vein,
and median and lateral
cutaneous nerves of the
forearm
c. Deep fascia strengthened
by Bicipital Aponeurosis
Contents
• Median Nerve
• Brachial artery
• Biceps tendon
• Radial nerve
Contents of the Posterior Arm
• Muscle: Triceps Brachii
• Nerve: Radial Nerve
• Artery: Profunda brachii artery
Triceps Brachii Muscle: Origin,
Insertion and Action
• It is a large muscle at the back of
the arm and It has three head
Origin
• Long head: Arises from the
infraglenoid tubercle of the scapula
• Lateral Head: Arises from the
Oblique ridge above the spiral
groove on the upper part of the
posterior surface of the shaft of the
humerus
• Medial Head: Arises from the
posterior surface of the lower half
of the shaft of humerus below the
spiral groove
Triceps Brachii Muscle: Origin,
Insertion and Action
Insertion
• The common tendon is inserted into the posterior part of the
superior surface of the olecranon process of ulna.
Nerve supply
• By radial nerve (C7, C8). Each head receives a separate branch
from radial nerve in the following manner:
• Nerve to long head arises from the radial nerve in axilla.
• Nerve to lateral head arises from the radial nerve in the radial
groove.
• Nerve to medial head arises from the radial nerve in the radial
groove.
Triceps Brachii Muscle: Origin,
Insertion and Action
Actions
• The triceps brachii is the powerful extensor of the elbow
joint.
• The long head supports the head of humerus during
hyperabduction of the arm.
Artery: Profunda brachii artery
• The profunda brachii artery is
the largest branch of the
brachial artery.
• It arises from the posterolateral
aspect of the brachial artery
just below the teres major.
• It accompanies the radial nerve
through the radial groove and
then terminates by dividing into
anterior and posterior
descending branches, which take
part in the arterial anastomosis
around the elbow joint.
Branches Profunda brachii artery
Deltoid (ascending) branch:
• It ascends between long and
lateral heads of triceps and
anastomoses with the
descending branch of the
posterior circumflex humeral
artery.
Nutrient artery to humerus:
• It enters the shaft of
humerus in the radial groove,
just behind the deltoid
tuberosity.
Branches Profunda brachii artery
Anterior descending (radial
collateral) artery:
• It is the smaller terminal branch,
which accompanies the radial nerve
and anastomoses with the radial
recurrent artery in front of the
lateral epicondyle of the humerus.
Posterior descending (middle
collateral) artery:
• It is the larger terminal branch of
the profunda brachii artery, which
descends behind the shaft of
humerus and anastomoses with the
interosseous recurrent artery
behind the lateral epicondyle of the
humerus.
