 Good day everybody. This is Dr. Sanjay Sanyal, professor of department chair. This is going to be a quick demonstration of the left quibital fossa It's boundaries contents and a few clinical correlations. This is a supine category left side The lateral boundary is the brachioridialis. The middle boundary is the prointerteris The superior the floor is the brachialis and inferiorly the floor is the supinator muscle Now let's take a quick look at the contents We have the median nerve Then the next structure is the brachial artery, which I'm picking up just now Then the further laterally we have the biceps tendon, which is going deep inside and getting inserted onto the radial tuberosity and Extending medially from the biceps tendon. We have this biceps aponeurosis, which bridges over and reinforces the roof and The lateral most structure which I've lifted up with my thumb is the radial nerve, which is under the cover of the brachioridialis muscle Therefore going from medium to lateral we have the median nerve Brachial artery, biceps tendon, radial nerve, in short Mbbr At this juncture we have an important clinical correlation If there's a supra condylar fracture of the humerus that is above the upper limit of the quibital fossa Then either the median nerve and or the brachial artery can be injured This is the next way of the elbow and a child showing anterior dislocation of the elbow This is the same series implications as supra condylar fracture Have you mentioned all these? Now we will shift our focus to another cadaver and show the right cable fossa and a few special aspects about that Now let's take a look at other vein on the medial side of the arm and I've picked it up here This is the basillic vein The basillic vein is formed in a similar way like the cephalic vein on the medial side of the arm And it runs on the medial side, receives a contribution from the cephalic vein And then it communicates with the venae Commitantes of the brachial artery and we can see the venae comitantes here We can see one vein here Accompanied the brachial artery and we can see another vein here accompanying the brachial artery These are the venae comitantes of the brachial artery. I picked up one here. I picked up one here So this is a feature of inner system of the lower limb and upper limb So these venae comitantes they unite with the basillic vein and then as it goes up It becomes bigger and bigger and forms an axillary vein. Having mentioned the basillic vein Let me give you a quick overview of the surgical landmarks that we use to perform a basillic venae section Because it's quite deep and it's covered by fat Therefore we need to have these landmarks in place. One landmark is the medial epicondyle where my finger is located The other landmark is the bicep tendon. We can feel that in every person We join them with a straight line We take the midpoint of that line and we go one inch above that We make an incision and when we do that we reach the basillic vein So therefore this landmark and these markings are used to do a venae section of the basillic vein And this communication between the cephalic vein and the basillic vein Which runs on the surface of the roof of the cubital fossa is called the median cubital vein This pattern that you can see here is referred to as the H shape pattern We can have a variant pattern. Some people have a median anti-brachial vein Which runs in the middle of the flexor aspect of the forearm and that divides into a median cephalic and a median basillic vein Point which I wanted to emphasize was this nerve We can see a nerve running with the basillic vein just like there was a nerve running with the cephalic vein This is the medial cutaneous nerve of the forearm higher up There is another corresponding nerve which is known as the medial cutaneous nerve of the arm These are both of these are branches from the medial or the brachial plexus and they run along with the basillic vein So when there is an injury to the basillic vein then these nerves can be irritated The next point I want to draw your attention to was this facial structure which we have cut and reflected This is the biceps poneurosis and how do we know if I trace this this is the tendon of the biceps And we can see that the main tendon is going into the radial tuberosity and it is simultaneously giving an expansion Which is running Inframedially this biceps aponeurosis expansion Merges with the deep fascia on the surface of the forearm and that is the pronated muscle This biceps aponeurosis serves several important functions Number one it protects the structures in the cubital fossa namely the median nerve and the brachial artery and we can see it is Protecting and as you can see this median cubital vein runs on the surface of the biceps aponeurosis This is quite often used by paramedics and nurses for many puncture And as you can see in this also they had done any puncture and there has been extravasation of blood So therefore this biceps aponeurosis protects the deeper structures from injury and we can see that here Another function of this biceps aponeurosis is by virtue of the fact that it merges with the fascia here It exerts traction and therefore it reduces the pressure of the biceps tendon itself on the radial tuberosity This biceps aponeurosis it forms the roof of the cubital fossa and it reinforces the roof of the cubital fossa and all the veins and the Nerves they run on the surface of the biceps aponeurosis So these are some of the roles performed by this biceps aponeurosis and we can see that here So these are some of the superficial structures, which I wanted to show you Thank you very much for watching Dr. Sanjay Sanyal signing out. 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