Cubital Fossa

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Introduction

The Cubital Fossa is a triangular-shaped depression, located between the forearm and the arm on the anterior surface of the elbow, with the apex of the triangle pointing distally. It is also known as the “antecubital” because it lies anteriorly to the elbow. It is a space filled with different structures that makes up its content. It has three boundaries/borders, and it also has a floor and a roof

Structures/Borders

• Apex: Imaginary line connecting the medial and lateral epicondyles

• Medial border -  the pronator teres

• Lateral border - the brachioradialis

• The floor - formed by the brachialis and supinator muscles

• The roof - formed by the skin and fascia of the arm and forearm reinforced by 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 median nerve, brachial artery, ulnar artery, and radial artery.

Contents

The cubital fossa contains four structures which from medial to lateral are;

• The median nerve- The median nerve leaves the cubital between the two heads of the pronator teres. It supplies the majority of the flexor muscles in the forearm. It runs distally in the arm on the lateral side of the brachial artery until it reaches the middle of the arm, where it crosses to the medial side and contacts the brachialis. The median nerve the descends into the cubital fossa, where it lies deep to the bicipital aponeurosis and median cubital vein. The median nerve has no branches in the axilla or arm, but it does supply articular branches to the elbow joint.

• The brachial artery – The brachial artery provides the main arterial supply to the arm and is the continuation of the axillary artery.The brachial artery usually divides at the apex of the fossa into the radial and ulnar arteries which supplies the forearm, and it lies between the biceps tendon and the median nerve. The brachial artery may be felt pulsating deep to the medial border of the biceps. the medial and lateral epicondyles of the humerus are subcutaneous and can be easily palpated at the medial and lateral aspects of the elbow.

• The tendon of biceps brachii- It is a muscle of the anterior compartment of the arm. The biceps tendon runs through the cubital fossa, attaching  to the radial tuberousity, just distal to the neck of the raidus

• The radial nerve- The radial nerves enters the arm posterior to the brachial artery, medial to the with the profunda brachii artery .  Radial nerve It divides into superficial and deep branches. The radial nerve is in a deep groove also known as the radial groove between the brachioradialis and brachialis to the level lateral epicondyle of the humerus dividing into its superficial and deep branches . Anterior to the lateral epicondyle, the radial nerve divide into deep  and superficial branches.

• Superficially, in the subcutaneous tissue overlying the cubital  fossa are the median cubital vein, lying anterior to the brachial artery , the medial and lateral cutaneous nerves of the forearm, related to the basilic and cephalic veins.

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References

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