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M01.03.005 The Cubital Fossa
The cubital fossa is a triangular-shaped depression located on the anterior aspect of the elbow joint. It serves as a transitional area between the anatomical arm and forearm, facilitating the passage of crucial neurovascular structures.
Overview
- Shape: Triangular depression over the anterior elbow.
- Function: Passageway for major structures transitioning between the arm and forearm.
- Clinical Relevance: Common site for venepuncture and prone to injury in supracondylar fractures.
Borders of the Cubital Fossa
The cubital fossa is defined by three borders, a roof, and a floor:
| Borders | Description |
|---|---|
| Lateral | Medial border of the brachioradialis muscle. |
| Medial | Lateral border of the pronator teres muscle. |
| Superior | A horizontal line drawn between the epicondyles of the humerus. |
| Roof | Formed by the bicipital aponeurosis, fascia, subcutaneous fat, and skin. |
| Floor | Proximally by the brachialis and distally by the supinator. |
Contents of the Cubital Fossa
The cubital fossa contains key structures arranged from lateral to medial.
| Structure | Details |
|---|---|
| Radial Nerve | – Located along the lateral border. |
| Biceps Tendon | Centrally located, attaches to the radial tuberosity.Contributes to the roof via the bicipital aponeurosis. |
| Brachial Artery | Bifurcates into the radial and ulnar arteries at the apex. – Pulse palpable medial to the biceps tendon. |
| Median Nerve | Travels medially, exits by passing between the two heads of the pronator teres. – Provides motor and sensory innervation to the anterior forearm and hand. |
| Median Cubital Vein: | Connects the basilic and cephalic veins. Common site for venepuncture due to its superficial location. |
Mnemonic
“Really Need Beer To Be At My Nicest“
- Radial Nerve
- Biceps Tendon
- Brachial Artery
- Median Nerve
Clinical Relevance
1. Supracondylar Fracture
- Definition: Fracture of the distal humerus, often from falling on an outstretched hand.
- Epidemiology: More common in children.
Potential Complications
- Brachial Artery Injury:
- May lead to Volkmann’s Ischaemic Contracture (fibrosis and shortening of forearm flexor muscles).
- Nerve Damage:
- Anterior interosseous nerve: Tested by asking the patient to make an “OK” sign (tests flexor pollicis longus).
- Ulnar or radial nerve injury.
Gartland Classification
| Type | Description | Management |
|---|---|---|
| I | Minimally displaced | Conservative (above-elbow cast). |
| II | Displaced with intact posterior cortex | Surgical fixation with crossed K-wires. |
| III | Completely off-ended | Surgical fixation with crossed K-wires. |
Points to Remember
- Anatomical Significance: The cubital fossa is a critical passageway for neurovascular structures.
- Clinical Importance: Commonly involved in venepuncture and injury due to fractures.
- Mnemonic for Contents: “Really Need Beer To Be At My Nicest.”
- Key Clinical Test: “OK sign” for anterior interosseous nerve integrity.
References
- Gray’s Anatomy for Students, 4th Edition
- Netter’s Clinical Anatomy, 3rd Edition
- Relevant online anatomy and clinical practice resources