Upper Limb

Cubital Fossa

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Overview


The cubital fossa is a triangular anatomical area over the anterior elbow. It represents an important area of transition between the arm and forearm, several important anatomical structures pass through this area.

Gross Anatomy


The cubital fossa is triangular in shape, and thus has three borders:

 

     Superior border An imaginary line between the epicondyles of the humerus.

 

     Lateral border  The medial border of the brachioradialis muscle

 

     Medial border  The lateral border of the pronator teres muscle

 

The floor is formed proximally by brachialis and distally by supinator, the roof is skin and fascia along with the bicipital aponeurosis 


Clinical Anatomy


Supracondylar fracture is a common fracture, occurring just above the humeral condyles.The causes a posterior displacement of the distal part in relation to the humerus, potentially damaging the contents of the fossa directly or through stretching of the structures. This may cause brachial artery occlusion or median or radial nerve injury. It is therefore vital that distal neurovascular status is assessed and documented when seeing these injuries.

 

Venepuncture is commonly performed at the cubital fossa. Whilst not strictly part of the contents, the median cubital vein traverses the roof to connect the cephalic and basillic veins and is reliably located just lateral to the biceps tendon. It is important to ensure the vessel is not pulsatile before puncture as the brachial artery is close by.

 

Brachial pulse and artery are palpable medial to the biceps tendon. It is here that the vessel is auscultated for Korotov sounds when measuring blood pressure, assessed with Doppler ultrasound for ABPI measurement and may even be used for arterial puncture.  


Quick Anatomy


Key Facts


Aide-Memoire

Contents lateral to medial are TAN: Tendon, Arterty, Nerve


To remember the contents of the cubital fossa,  you can use the mnemonic Really Need Beer To Be At My Nicest.


Summary


The cubital fossa is a triangular space containing several important structures. You will be familiar with it from early clinical practice, particularly in surgery as a common site of injury and anaesthetics as a common site of vascular and nerve access. Understanding the basic structure and its contents will make cross-sectional and surgical anatomy easier to understand. 

References


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