Vessels and nerves of the cubital fossa. Topography of the elbow region. Layered topography of the anterior ulnar region

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Three-sided and four-sided holes. Elbow hole. Medial, lateral, median sulcus of the forearm

On the back wall cavitas axillaris there is a triangular space formed by the surgical neck of the shoulder (laterally), m. teres major (bottom) and m. subscapularis (above), which is divided vertically by the long head m. triceps into two holes.

1. Lateral, quadrilateral, foramen quadrilaterum, formed by the named muscles and bone (a. circumflexa humeri posterior and n. axillaris pass through it).

2. Medial, tripartite, foramen trilaterum(a. circumflexa scapulae passes through it), limited only by the named muscles.

Between the muscles, fascia and bones of the upper limb there are spaces, channels and grooves, in which vessels and nerves lie. Knowing them is important for surgery.

Sulcus n. radialis of the humerus, being covered by the triceps muscle of the shoulder, turns into canal, canalis humeromuscularis(the named nerve passes through it, accompanied by a. and v. profundae brachii).

On the front surface of the shoulder, between m. brachialis and the edges of m. biceps brachii located two furrows: sulcus bicipitalis medialis et lateralis. Of these, the deeper medial, sulcus bicipitalis medialis, serves as a bed for the neurovascular bundle of the shoulder.

Anterior to the elbow joint, in the area of ​​the elbow bend, lies cubital fossa, fossa cubitalis, bounded by m. brachioradialis (laterally) and m. pronator teres (medially). The bottom of the fossa and its upper border forms m. brachialis.

Between the muscles of the forearm are three furrows:

1. Medial, ulnar, sulcus ulnaris: between m. flexor carpi ulnaris (medially) and m. flexor digitorum superficialis (laterally). It contains the ulnar nerve, artery and veins.

2. Lateral, radial, sulcus radialis: between m. brachioradialis (laterally) and m. flexor carpi radialis (medially). It contains the same nerve, artery and vein.

3. Median, sulcus medianus: between m. flexor carpi radialis (laterally) and m. flexor digitorum superficialis (medially). n passes through it. medianus.

In the region of the wrist joint there are three canals, which are obtained due to the presence of the retinaculum flexorum here. Throwing in the form of a bridge from eminentia carpi ulnaris to eminentia carpi radialis, it turns the gutter between the named hills, sulcus carpi, into a canal, canalis carpalis, and bifurcating into the radial and ulnar sides, it forms canalis carpi radialis and canalis carpi unlaris, respectively.

In the cubital canal are the ulnar nerve and vessels, which continue here from the sulcus ulnaris of the forearm. In the canalis carpi radialis lies the tendon m. flexor carpi radialis, surrounded by a synovial sheath.

Finally, in the canalis carpalis there are 2 separate synovial sheaths:
1) for tendons mm. flexores digitorum superficialis et profundus and
2) for tendon m. flexoris pollicis longus.

First vag. synovialis communis mm. flexorum represents a medially located voluminous sac covering 8 tendons of the deep and superficial flexors of the fingers. At the top, it protrudes 1–2 cm proximal to the retinaculum flexorum, and at the bottom it reaches the middle of the palm. Only on the side of the little finger does it continue along the tendons of the long muscles that flex it, surrounding them and reaching with them the base of the distal phalanx of the fifth finger.

Second vagina, vag. tendinis m. flexoris pollicis longi, located laterally, represents a long and narrow canal in which the tendon of the long flexor of the thumb is enclosed. At the top, the vagina also protrudes 1-2 cm proximal to the retinaculum flexorum, and below it continues along the tendon to the base of the distal phalanx of the first finger. The remaining 3 fingers have separate sheaths, vag. synoviales tendinum digitorum (manus), covering the flexor tendons of the corresponding finger.
These sheaths extend from the line of the metacarpophalangeal articulation to the base of the nail phalanges. Consequently, II-IV fingers on the palmar side have isolated sheaths for the tendons of their common flexors, and on the segment corresponding to the distal halves of the metacarpal bones, they are completely devoid of them.

Vagina synovialis communis mm. flexorum, covering the tendons of the fifth finger, at the same time it does not surround the tendons of the I-IV fingers on all sides; it is believed that it forms three protrusions, one of which is located in front of the tendons of the superficial flexors, the other is between them and the tendons of the deep flexor, and the third is behind these tendons. Thus, the ulnar synovial sheath is a true synovial sheath only for the tendons of the fifth finger.

The tendon sheaths on the palmar side of the fingers are covered with a dense fibrous plate, which, adhering to the scallops along the edges of the phalanges, forms a bone-fibrous canal on each finger, surrounding the tendons along with their sheath. The fibrous walls of the canal are very dense in the region of the bodies of the phalanx bones, where they form transverse thickenings, pars annularis vaginae fibrosae. In the area of ​​​​the joints, they are much weaker and are reinforced by obliquely crossing connective tissue bundles, pars cruciformis vaginae fibrosae.
The tendons inside the vagina are connected to their walls through thin mesentery, mesotendineum, which carry blood vessels and nerves.

The ulnar fossa (fossa cubitalis, PNA, BNA; fossa cubiti, JNA) is a depression in the anterior ulnar region, medially bounded by the round pronator, laterally by the brachioradialis, from above by the brachial muscle; contains fiber, brachial artery and veins, median nerve, lymphatic...

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(fossa cubitalis, PNA, BNA; fossa cubiti, JNA)
a depression in the anterior ulnar region, medially limited by the round pronator, laterally by the brachioradialis, from above by the brachial muscle; contains fiber, brachial artery and veins, median nerve, lymph nodes.

Watch value Ulnar fossa in other dictionaries

fossa- pits, 1. Reduce. to a hole in 1 meaning, a small hole. || Generally - a small deepening in something. on the cheeks when smiling. 2. The name of some organs in lower animals (zool.). Auditory fossa. Olfactory fossa.
Explanatory Dictionary of Ushakov

fossa- -and; pl. genus. pits, dates. pits; well. Decrease to Yama (1 sign); small hole. Chickens dug holes. I. for the seedling. I. from the stone. Jump over the hole. // A small indentation in smth., in smth.........
Explanatory Dictionary of Kuznetsov

Artery Collateral Ulnar Superior- (a. collateralis ulnaris superior, PNA, BNA) see the list of anat. terms.
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Artery Collateral Ulnar Inferior- (a. collateralis ulnaris inferior, PNA, BNA) see the list of anat. terms.
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Artery Ulnar- (a. ulnaris, PNA, BNA, JNA; a. cubitalis) see List of anat. terms 2) (a. cubitalis) - see the list of anat. terms.
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Artery ulnar recurrent- (a. recurrens ulnaris, PNA, JNA; a. recurrentes ulnares anterior et posterior, BNA) see the list of anat. terms.
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femoral fossa- (fovea femoralis) deepening of the parietal peritoneum below the lateral inguinal fossa, corresponding to the deep ring of the femoral canal.
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Vein Cutaneous Ulnar- (v. cutanea ulnaris) see the list of anat. terms.
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Vienna Regional Ulnar- (v. marginalis ulnaris) see the list of anat. terms.
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Vienna Ulnar Median- (v. mediana cubiti, PNA, BNA, JNA) see the list of anat. terms.
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temporal fossa- (fossa temporalis, PNA, BNA, JNA; synonym temple) a paired depression on the skull, formed by the scales of the temporal bone, part of the parietal bone, a large wing of the sphenoid and zygomatic process of the frontal bone.
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Taste fossa- (foveola gustatoria, LNH; syn. taste course) a canal formed by the apical sections of epithelial cells, connecting the taste bud with the taste pore.
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pituitary fossa- (fossa hypophysialis, PNA; fossa hypophyseos, BNA, JNA) a depression in the Turkish saddle in which the pituitary gland is placed.
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Elbow bone-, tubular bone of the inner side of the forearm. Its upper end articulates with the HUMERUS and with the RADIUM, a somewhat shorter bone on the outer side........
Scientific and technical encyclopedic dictionary

glandular fossa- (syn. glandular bag) the rudiment of the gland in the form of an invagination lined with glandulocytes on the surface of the integumentary epithelium.
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Poles Hyoid Fossa— (P. N. Gerdy) see Sleepy Triangle.
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Jobert Fossa- (A. J. Jobert de Lamballe, 1799-1867, French surgeon) a fossa on the medial surface of the knee joint area, bounded in front by the tendon of the large adductor muscle, behind by the tendons ........
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Carhartha Fossa— (R. Carhart) see Carhart recess.
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Fang Fossa- (fossa canina, PNA, BNA, JNA) see Dog hole.
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Clubhand Elbow- (manus vara) K. with a deviation of the hand to the ulnar side.
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Ulna bone- (ulna, PNA, BNA, JNA) see the list of anat. terms.
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Pterygopalatine Fossa- (fossa pterygopalatina, PNA, BNA, JNA) a slit-like space in the infratemporal region, bounded in front by the tubercle of the upper jaw, behind - by the pterygoid process of the sphenoid bone, ........
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Ulnar furrow- (sulcus ulnaris) a narrow gap between the ulnar flexor of the wrist and the superficial flexor of the fingers in the lower half of the forearm; contains the ulnar neurovascular bundle.
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Ulnar sulcus Posterior Lateral- (sulcus cubitalis posterior lateralis) deepening between the olecranon and the lateral epicondyle of the humerus; contains an anastomosis between the middle collateral and recurrent interosseous arteries.
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Ulnar sulcus Posterior medial- (sulcus cubitalis posterior medialis) deepening between the olecranon and the medial epicondyle of the humerus; contains the ulnar nerve and anastomosis between the superior ulnar collateral ........
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Ulnar furrow Anterior Lateral- (sulcus cubitalis anterior lateralis) a narrow gap between the brachial and brachioradial muscles; contains the radial nerve, its branches and anastomosis between the radial collateral and radial recurrent arteries.
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Ulnar sulcus Anterior Medial- (sulcus cubitalis anterior medialis) a narrow gap between the shoulder muscle and the round pronator; contains the brachial artery and its branches with their accompanying veins, anastomosis between ........
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Elbow Branch- (ramus ulnaris, PNA, BNA, JNA) see the list of anat. terms. 1471.
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Elbow Region- (regio cubiti, PNA; syn. elbow) area of ​​​​the upper limb, located between the shoulder and forearm; boundaries L. o. lie 2 cm above and below the line connecting the epicondyles of the humerus ........
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Ulnar fossa- (fossa cubitalis, PNA, BNA; fossa cubiti, JNA) depression in the anterior ulnar region, medially limited by the round pronator, laterally by the brachioradialis, from above by the brachial muscle; contains........
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Borders: horizontal lines passing through two transverse fingers ( 4 cm) above and below the condyles of the humerus;

Layers: The skin, especially in the elbow, is very thin. In the subcutaneous tissue and under the superficial fascia, the lean veins and nerves lie on top; outside - v. cephalica and n. cutaneus antebrachii lateralis (continuation of the musculocutaneous nerve), from the inside - v. basilica and n. Cutaneus antebrachii medialis. Both veins are connected by anastomoses, the structure of which often resembles the letter M or I. In the first case, the external anastomosis is called v. mcdiana cephalica, and the inner one is v. mediana basilica. In the second case, the oblique anastomosis is called v. mediana cubity. Usually these anastomoses are a continuation of the vein going to the forearm - v. mediana antebrachii, which in turn is connected with the deep veins of the ulnar region through v. mediana profunda.

Superficial formations also include lymphatic nodules (2-3), located 1-2 transverse fingers above the internal epicondyle (nodi lymphatici cubitales superficiales).

Own fascia of the elbow region has the peculiarity that it thickens due to the additional tendon of the biceps muscle - its aponeurosis (aponeurosis m. Bicipitis), formerly called lacertus fibrosus. The fibers of the latter stretch in the medial direction, while the main tendon of the biceps muscle is located laterally.

Muscles lie under their own fascia, and the lateral group is formed by mm. brachioraclialis and supinator (innervated by the radial nerve), medial, going from outside to inside, mm. pronator teres, flexor carpi radialis, palmaris lognus (innervated by the median first), flexor carpi ulnaris (innervated by the ulnar nerve) and m. flexor digitorum superficialis (innervated by the median nerve). Of all these muscles, two directly limit the cubital fossa: outside - m. brachioradialis, from the inside - m. pronator teres.

The bottom of the cubital fossa is made by the tendon of the biceps muscle and the wide lower end of the brachialis muscle. The biceps ends at tuberositas radii, the brachialis ends with a short tendon at tuberositas ulnae. Between the tendon of the biceps muscle and tuberositas radii is a permanent synovial bag (bursa bicipitoradialis).

SNP: Surface:

lateral: v.cephalica and lateral cutaneous nerve of the forearm (from the musculocutaneous nerve);

medial: v. basilica and the medial cutaneous nerve of the forearm (a branch from the system of the medial bundle of the brachial plexus; located medially from the vein).

Deep:

lateral: radial collateral vessels and radial nerve (vessels from the system of radial arteries and veins; nerve from the system of the posterior bundle of the brachial plexus, located laterally from the vessels on the joint capsule);

medial: brachial artery and veins, median nerve (nerve from the system of medial and lateral bundles of the brachial plexus; located medially from the vessels; vessels are located medially in relation to the tendon of the biceps muscle of the shoulder);

rear: ulnar nerve and superior collateral ulnar artery and veins (vessels from the system of the ulnar artery and vein; the nerve from the system of the medial bundle of the brachial plexus is located on the joint capsule);

Technique of venipuncture and venesection in the anterior elbow area:

Venepuncture: used for taking blood for diagnostic or therapeutic purposes and for administering drugs. Location - superficial veins of the elbow. Set: tourniquet, gloves, iodine tincture, 70% alcohol, needle with syringe, gauze.

Before proceeding with the puncture of the vein, a tourniquet is applied to the middle shoulder without squeezing the artery (the compression of the artery is determined by the disappearance or weakening of the pulse). The patient squeezes and unclenches his fingers several times, as a result of which the veins are more intensively filled with blood. The injection site of the needle is treated with iodine tincture, and then wiped with alcohol so as not to darken the projection of the vein on the skin surface. The puncture can be made only with a needle or a needle connected to a syringe. The needle is injected with the right hand, resting it on the patient's hand. With the left hand, the skin is slightly pulled and the needle is gradually passed through the skin and the wall of the vein.

As soon as the feeling that the needle is in the vein is received, and a drop of blood appears, the needle is slightly lowered down and advanced along the vessel. If the puncture is made for intravenous injection, then after the appearance of a drop of blood in the needle, the tourniquet is immediately removed; when taking blood from a vein, the tourniquet is left until the end of the manipulation.

In the process of taking blood from a vein, the needle is held all the time with the right hand, avoiding any movement.

If a vein is punctured for the purpose of infusing any medicated liquids, the correctness of the needle entering the vessel is checked by pulling the syringe plunger towards you. When the needle is correctly inserted, the blood stream will flow freely into the syringe. When the puncture is over, the needle is quickly removed, the injection site is pressed down with a sterile gauze and smeared with iodine. The patient bends his arm at the elbow, thus squeezing the left gauze napkin - the hole in the vein immediately closes.

Venesection:

Purpose: for intravenous infusion of fluids using a cannula (blood transfusion, infusion of saline, etc.), as well as in cases where vein puncture with a needle is difficult.

Set: tourniquet, needle with syringe for anesthesia, scalpel, two ligatures, scissors, cannula or Dufo needle, needle holder, skin needle, gauze, adhesive plaster.

For venesection, a tourniquet is also applied to the limbs, as well as for vein puncture. The skin is disinfected in the usual way, the incision site is anesthetized with 3-5 ml of 0.5% novocaine solution. A shallow incision 2-3 cm long is made in the transverse direction to the long axis of the vein (it is also possible along the vein). Having found the vein, the tourniquet is removed and two ligatures are brought under it, then the vein is cut with thin scissors to half its diameter. A cannula (or Dufo needle) is inserted into the opening of the vein and secured with a ligature.

Then the wound is narrowed with two interrupted sutures; a sterile gauze pad is placed under the needle or cannula. The needle, together with the rubber tube of the transfusion system, is fixed with two strips of adhesive tape. After removal of the cannula, the vein is bandaged.

Projection line of the brachial artery in the cubital fossa- from a point away from 2 cm above the inner condyle of the humerus, through the middle of the elbow bend to the outer edge of the forearm; access is direct.