00:01
In this lecture, we are going to look at the
superficial structures and cutaneous innervations
of the upper limb. So we are going to look at
the fascia of the upper limb. This connective
tissue layer. We'll look at the superficial and
deep fascia. We'll then look specifically
at an example we'll look at the brachial fascia.
We'll then look at the venous drainage. We will
look at the cephalic vein, the basilic vein
and how they run into the axillary vein and
we will also look at the communication between
the two known as the median cubital vein.
00:37
We'll then look at the cutaneous innervation of
the upper limb. We'll look at the dermatomal
distribution and then we'll move on to some specific
cutaneous nerves. So here we can see we have
got both an anterior and a posterior view of
the upper limb. And we can see that covering all
of these muscles which we are go in to detail,
is a white glistening layer and this is
the deep fascia. We have deep fascia and we
call it deep fascia. Because we also have
superficial fascia and the superficial fascia
which we can't see on these pictures because
that lies deep to the skin and the skin has
been removed. The deep fascia is what we can
see surrounding the muscles, on the superficial
fascia is this loose connective tissue and
fatty layer. So we can't see that because it
has been removed. But it is made up of loose
connective tissues and varying amounts of
fats. The superficial fascia lies deep to
the skin and it is therefore pierced by cutaneous
nerves that supply the skin and also superficial
veins. Lying between the superficial fascia
and the skeletal muscle, biceps brachii for
example we have the deep fascia. And the deep
fascia we can see on both this anterior and
this posterior view, this is white glistening
layer, this white glistening membrane.
02:11
And we can see that it is covering all of the muscles
we could see in the upper limb. It is made
up of dense, well organized connective tissue
and there is no fat. So this is just a membranous
layer that surrounds the muscle. We are going
to look at the example of the fascia.
02:32
Bearing in mind, we have the deep fascia lying over
all of the musculature of the upper limb.
02:37
Specifically we are going to look at what's
known as the brachial fascia. We can see
it here anteriorly it is covering the arm. We
can see it here anteriorly and we can see it
here posteriorly. So this brachial fascia
encloses the musculature of the arm.
02:54
So this tight cuff that is surrounding the musculature
within the arm. It is continuous with superior
structures of the upper limb. So it is continuous
superiorly with fascia covering the deltoid,
fascia covering the pectoral muscles and fascia
lining the axilla. So this deep fascia is
continuous across the entire upper limb. And we
are just looking at the brachial fascia here
anteriorly and we can see it here posteriorly.
Again the continuous layer with the deltoid
fascia, the axillary fascia and we can see
here anteriorly the pectoral fascia.
03:32
Inferiorly, the deep fascia is going to be continuous,
with what's known as the antebrachial fascia. Now antebrachial
indicates the fascia surrounding the forearm.
So here we have the anterior aspect
of forearm and we have the antebrachial fascia
covering it. And we can see we've got
this continuous layer. It is also the brachial
fascia attaching to the epicondyles of
the humerus. And this helps to anchor it down in
position. We will talk about that later on
when we mention the bicipital aponeurosis.
So here we can see this deep fascia running all
the way along the upper limb. Some important
features of it. It also extends between the
muscles, so whilst it is just covering the muscles
of the upper limb, it also extends deep into
the arm and it attaches to the humerus. And as
we'll see later on when we look at the arm
in more detail. There are, in fact, two
compartments in the arm and these compartment
are created by the deep fascia passing down
and attaching to the humerus. Therefore more
known as medial and lateral intermuscular
septae. So here we can see deep fascia and here
we can just see this medial intermuscular septum.
And this septum here is actually going to pass
deep into the arm and attaches to the humerus.
We also have a lateral line that is going
to be on this lateral side. Here we can see it,
this lateral intermuscular septum. So here we
can see we have got these two septa that
are passing deep attaching to the humerus.
05:14
Everything that are folded anterior to it is going
to be in the anterior compartment and everything
posterior to it is going to be in the posterior
compartment. And here we have the two compartments
of the arm. A similar arrangement occurs in most
regions of both the upper limb and the lower
limb. So for example in the forearm, we also have
an anterior and a posterior compartment.
05:38
And when we go and look in the leg region, we will
see that we have an anterior and posterior
and the lateral compartments that are similarly
formed via these pieces of fascia passing
deep into the limb. Have a note the fascia that
I have mentioned, I said the pectoral fascia
that is running over the pectoralis muscles,
we have got the deltoid fascia, we have got
the axillary fascia and we have got the brachial
fascia extending down deep into the antebrachial
fascia. And these are really important. We will come back
to them throughout the course when we talk about
various muscles.