POSTERIOR

COMPARTMENT OF ARM

DR PASHMINA SHAIKH
ASSOCIATE PROFESSOR
ANATOMY, LUMHS
LEARNING OBJECTIVE
• AT THE END OF LECTURE STUDENTS SHOULD BE ABLE TO:
• DESCRIBE THE MUSCLES OF POSTERIOR COMPARTMENT OF ARM,
• DESCRIBE THE FUNCTION,NEUROVASCULAR BUNDLE OF POSTERIOR
COMPARTMENT OF ARM
• APPLIED ANATOMY OF PROFUNDA BRACHII ARTERY & RADIAL NERVE,
• DESCRIBE THE ARTICULATION OF ELBOW JOINT.
• ATTACHMENT OF SYNOVIAL MEMBRANE & FIBROUS CAPSULE OF
JOINT, LIGAMENTS OF JOINT.
• NEUROVASCULAR SUPPLY & MOVEMENT OF JOINT.
• DISLOCATION OF JOINT
• The muscle of the posterior
compartment of the arm is the
triceps brachii muscle
• The triceps brachii muscle has
three heads
• The long head originates from the
infraglenoid tubercle of the
scapula;
• The medial head originates from
the extensive area on the
posterior surface of the shaft of
the humerus inferior to the radial
groove;
• The lateral head originates from a
linear roughening superior to the
radial groove of the humerus.
• The three heads converge to
form a large tendon, which
inserts on the superior surface
of the olecranon of the ulna.
• The triceps brachii muscle
extends the forearm at the
elbow joint.
• Innervation of triceps brachii is
by branches of the radial
nerve.
• A tap on the tendon of triceps
brachii tests predominantly
spinal cord segment C7
• THE PROFUNDA BRACHII ARTERY
• the largest branch of the brachial artery,
passes into and supplies the posterior
compartment of the arm
• It enters the posterior compartment with
the radial nerve and together they pass
through the triangular interval, which is
formed by the shaft of the humerus, the
inferior margin of the teres major muscle,
and the lateral margin of the long head of
the triceps muscle.
• They then pass along the radial groove on
the posterior surface of the humerus deep
to the lateral head of the triceps brachii
muscle.
• Branches of the profunda brachii artery
supply adjacent muscles and anastomose
with the posterior circumflex humeral artery.
• The artery terminates as two collateral
vessels, which contribute to an anastomotic
network of arteries around the elbow joint.
• THE RADIAL NERVE
• originates from the posterior cord of the brachial
plexus and enters the arm by crossing the inferior
margin of the teres major muscle .
• it enters the arm, it lies posterior to the brachial
artery. Accompanied by the profunda brachii artery,
the radial nerve enters the posterior compartment
of the arm by passing through the triangular
interval.
• As the radial nerve passes diagonally, from medial
to lateral, through the posterior compartment, it lies
in the radial groove directly on bone.
• On the lateral side of the arm, it passes anteriorly
through the lateral intermuscular septum and enters
the anterior compartment where it lies between the
brachialis muscle and a muscle of the posterior
compartment of the forearm — the brachioradialis
muscle, which attaches to the lateral
supraepicondylar ridge of the humerus.
• The radial nerve enters the forearm anterior to the
lateral epicondyle of the humerus, just deep to the
brachioradialis muscle. In the arm, the radial nerve
ELBOW JOINT
 ELBOW JOINT
• The elbow joint is a complex joint
involving three separate articulations,
which share a common synovial cavity
• The joints between the trochlear
notch of the ulna and the trochlea of
the humerus and between the head
of the radius and the capitulum of the
humerus are primarily involved with
hinge-like flexion and extension of the
forearm
• The joint between the head of the
radius and the radial notch of the
ulna, the proximal radio-ulnar joint, is
involved with pronation and
supination of the forearm
• The articular surfaces of the bones are
covered with hyaline cartilage.
• The synovial membrane originates from the
edges of the articular cartilage and lines the
radial fossa, the coronoid fossa, the
olecranon fossa, the deep surface of the
joint capsule, and the medial surface of the
trochlea
• The synovial membrane is separated from
the fibrous membrane of the joint capsule
by pads of fat in regions overlying the
coronoid fossa, the olecranon fossa, and the
radial fossa.
• These fat pads accommodate the related
bony processes during extension and flexion
of the elbow processes during extension
and flexion of the elbow.
• Attachments of the brachialis and triceps
brachii muscles to the joint capsule
overlying these regions pull the attached fat
pads out of the way when the adjacent
bony processes are moved into the fossae.
• The fibrous membrane of the joint capsule
overlies the synovial membrane, encloses
the joint, and attaches to the medial
epicondyle and the margins of the olecranon,
coronoid, and radial fossae of the humerus.
• It also attaches to the coronoid process and
olecranon of the ulna.
• On the lateral side, the free inferior margin
of the joint capsule passes around the neck
of the radius from an anterior attachment to
the coronoid process of the ulna to a
posterior attachment to the base of the
olecranon.
• The fibrous membrane of the joint capsule is
thickened medially and laterally to form
collateral ligaments, which support the
flexion and extension movements of the
elbow joint
• The external surface of the joint
capsule is reinforced laterally where it
cuffs the head of the radius with a
strong anular ligament of radius .
• This ligament blends with the fibrous
membrane of the joint capsule in most
regions, they are separate posteriorly.
• The anular ligament of radius also
blends with the radial collateral
ligament
• The anular ligament of radius and
related joint capsule allow the radial
head to slide against the radial notch of
the ulna and pivot on the capitulum
during pronation and supination of the
forearm
• The deep surface of the fibrous
membrane of the joint capsule
and the related anular ligament
of radius that articulate with the
sides of the radial head are
lined by cartilage.
• A pocket of synovial membrane
(sacciform recess) protrudes
from the inferior free margin of
the joint capsule and facilitates
rotation of the radial head
during pronation and supination
• Vascular supply to the elbow
joint is through an
anastomotic network of
vessels derived from
collateral and recurrent
branches of the brachial,
profunda brachii, radial, and
ulnar arteries.
• The elbow joint is
innervated predominantly
by branches of the radial
and musculocutaneous
nerves, but there may be
some innervation by
branches of the ulnar and
median nerves.
PULLED ELBOW
• Pulled elbow is a disorder that typically occurs in children under 5
years of age.
• It is commonly caused by a sharp pull of the child ’ s hand, usually
when the child is pulled up a curb.
• The not-yet-developed head of the radius and the laxity of the anular
ligament of radius allow the head to sublux from this cuff of tissue.
• Pulled elbow is extremely painful, but can be treated easily by simple
supination and compression of the elbow joint by the clinician.
• When the radial head is relocated the pain subsides immediately and
the child can continue with normal activity.
ELBOW JOINT INJURY

• The elbow joint can be injured in many ways;

• the types of injuries are age dependent.
• When a fracture or soft tissue trauma is suspected, a plain lateral and an anterior – posterior radiograph are
obtained.
• As the elbow develops in children, numerous secondary ossification centers appear before and around
puberty.
• It is easy to mistakenly interpret these as fractures.
• it is also possible for the epiphyses and apophyses to be “ pulled off ” or disrupted.
• when interpreting a child ’ s radiograph of the elbow, the physician must know the child ’ s age
• Fusion occurs at around the time of puberty.
• An understanding of the normal epiphyses and apophyses and their normal relationship to the bones will
secure a correct diagnosis.
• The approximate ages of appearance of the secondary ossification centers around the elbow joint are:
• capitulum — 1 year;
• head (of radius) — 5 years;
• medial epicondyle — 5 years;
• trochlea — 11 years;
• olecranon — 12 years;
• lateral epicondyle — 13 years.