What makes up the cubital fossa

The roof consists of skin and fascia and is reinforced by the bicipital aponeurosis which is a sheet of tendon-like material that arises from the tendon of the biceps brachii. The bicipital aponeurosis forms a partial protective covering to the medial nerve, brachial artery and ulnar artery.

Within the roof runs the median cubital vein, which can be accessed for venipuncture see clinical significance below. The cubital fossa contains four main vertical structures from lateral to medial. Anatomically the superficial veins of the cubital fossa are classified into four types according to the presence of the median cubital vein MCV or median antebrachial vein.

Type II presenting the both cephalic and basilic vein connected by the median cubital vein is most common followed by type I. Although the most common type of male and female was different as type I and type II, respectively, there is no statistical difference between them. The frequency of the types between right and left upper limbs was also not different. Because of the wide variations of these superficial veins, it has been reported that adverse effects such as bruising, hematoma, and sensory change occurred by mispuncture in various health care systems.

Most medical practitioners are aware of two patterns of venous returns in the cubital fossa. This variation underlines the importance of using the intravenous illuminator for venipuncture. Brachial artery pseudoaneurysms are a pulsatile hematoma caused by hemorrhage on soft tissues.

They are more common after interventional procedures than after diagnostic procedures, although brachial artery pseudoaneurysms are rare.

Complications of pseudoaneurysms can cause a serious threat to the afflicted limb and the patient's life. During blood pressure measurements, the stethoscope is placed over the brachial artery in the cubital fossa. The artery runs medial to the biceps tendon. The brachial pulse may be palpated in the cubital fossa just medial to the tendon. Last's Anatomy. Elsevier Australia.

Read it at Google Books - Find it at Amazon 2. Robert H. Whitaker, Neil R. Instant Anatomy. ISBN: Related articles: Anatomy: Upper limb. Promoted articles advertising. Cases and figures. Figure 1: boundaries Figure 1: boundaries. Figure 2: contents Figure 2: contents. The biceps tendon passes centrally through the cubital fossa and attaches to the radial tuberosity of the radius. The biceps tendon is relatively easy to identify by palpation and can be used as a useful landmark for the other contents of the cubital fossa.

Medial to the biceps tendon is the brachial artery and median nerve. The brachial pulse is key to measuring blood pressure manually with a sphygmomanometer. The brachial artery is first palpated and then auscultated to listen for Korotkoff sounds which appear and disappear during inflation and deflation of the sphygmomanometer allowing systolic and diastolic blood pressure to be measured.

The brachial artery is a continuation of the axillary artery and sits just medial to the biceps tendon within the cubital fossa. The median nerve lies most medially within the cubital fossa, immediately medial to the brachial artery.

The median nerve exits the cubital fossa between the two heads of the ulnar and humeral heads of pronator teres. The median nerve has an important role in wrist flexion, forearm pronation and movements of the digits by innervating most of the muscles of the anterior compartment of the forearm.

As a side note; the ulnar nerve does not pass through the cubital fossa. The ulnar nerve passes down the medial side of the forearm through the cubital tunnel and passes posteriorly to the medial epicondyle to enter the anterior forearm.

The superficial veins of the cubital fossa lie superior to the roof of the fossa and are separated from the brachial artery and median nerve by the bicipital aponeurosis.

The superficial veins of the cubital fossa include the basilic vein located medially, the cephalic vein located laterally and the median cubital vein which connects these two veins together. The superficial veins located superior to the cubital fossa are often used in procedures such as venepuncture and intravenous cannulation.

The aponeurosis confers an element of protection to the brachial artery and median nerve in this instance. A supracondylar fracture of the humerus is a relatively common fracture in children.

As the elbow is hyper-extended in this instance, a fracture can occur between the medial and lateral epicondyles. Anatomical knowledge is essential for preventing iatrogenic injury during surgery. Patients in renal failure requiring dialysis undergo a procedure to create an arteriovenous fistula which is a connection between an artery and a vein. The brachial artery and cephalic vein are commonly used to create an arteriovenous fistula.

It originates from the shaft of the humerus and inserts into the ulna tuberosity of the ulna. The supinator forms the distal aspect of the floor. Its nerve supply is from the posterior interosseus branch of the radial nerve, and its function is the supination of the forearm.

It has two heads, with one from the lateral humeral epicondyle, and the other originating from the posterior ulna. They come together and insert into the posterior radius.

Due to the key structures lying within the cubital fossa, damage secondary to trauma can lead to significant long-term effects, most commonly occurring following supracondylar fractures. Supracondylar fractures can be described by the Modified Gartland classification [14] :. Gartland II, III, and IV fractures, in particular, are at risk of causing damage to the radial nerve, median nerve, or brachial artery. When considering venepuncture, one of the most commonly used sites is the median cubital vein.

It lies very superficially within the roof of the cubital fossa, making it an easily accessible vein. When assessing manual blood pressure, a stethoscope is placed over the cubital fossa to auscultate the brachial artery for Korotkoff sounds.

An important pathology to note is cubital tunnel syndrome. While not directly involving the cubital fossa itself, it is an ulnar neuropathy that occurs at the level of the cubital fossa.

The ulnar nerve runs posteriorly to the medial epicondyle of the humerus, within a structure named the cubital tunnel. The ulnar nerve can become compressed within this tunnel, either acutely or chronically. The syndrome typically presents with sensory paraesthesia in the ulnar distribution of the hand the medial aspect of the hand and medial one and a half digits and can present with motor symptoms, such as clumsiness with intrinsic hand movements.

Treatment of the condition can be conservative, including education and elbow splinting or surgical decompression.