Location

·  Volar aspect of elbow joint

Borders

·  Superior: imaginary line between the epicondyles of the humerus

·  Inferior: angle formed by brachioradialis and pronator teres

·  Medial: pronator teres

·  Lateral: brachioradialis

·  Roof: deep fascia of the forearm and biceps aponeurosis

·  Floor: brachialis and supinator

Key structures: medial to lateral

·  Median nerve

·  Brachial artery

·  Biceps tendon and aponeurosis

·  Radial nerve

Arteries

·  Brachial artery: passes under biceps aponeurosis, bifurcates into radial and ulnar arteries

·  Multiple collateral branches: superior and inferior ulnar, radial, interosseous

·  Collaterals may be absent or ineffective, quasi end artery, cannulation preferred elsewhere

·  Note median nerve medial to it; risk of damage during cannulation

Veins

·  Cephalic: passes lateral to anterior cubital fossa (ACF); easily cannulated

·  Basilic: passes medial to ACF

·  Median antecubital vein: passes across ACF from cephalic to basilic; risk of arterial puncture during cannulation

·  Valves at junctions

Nerves

·  Radial: passes across ACF then under cover of brachioradialis

·  Median: passes between the two heads of pronator teres

Lymphatics

·  Deep lymphatics pass with arteries

·  Superficial lymphatics pass with venous structures

Borders

·   Superior: inferior border inguinal ligament

·   Inferior: angle between sartorius and adductor longus; continuous with adductor canal

·   Medial: medial border of adductor longus

·   Lateral: med border of sartorius

·   Floor: pectineus, iliopsoas

·   Roof: fascia lata

Contents

On their own:

1) Lateral cutaneous nerve of thigh

2) Femoral nerve (note deep to fascia iliaca)

3) Nerve to pectineus (note deep to fascia iliaca)

Femoral sheath (inferior projection of transversalis fascia anteriorly and iliac fascia posteriorly)

1) Lateral compartment: common femoral artery and genitofemoral nerve

2) Intermediate compartment: femoral vein

3) Medial compartment = femoral canal: lymph node and lymphatics

Landmarks

·   Femoral artery: mid-inguinal point; overlies psoas and hip joint capsule

·   Femoral vein: 1cm below and 1cm medial to femoral a pulsation

·   Femoral nerve: 1-2cm below and lat; pop through fascia lata then pop through fascia iliaca

·   Fascia iliaca block: 1cm below inguinal lig, between its lateral and middle thirds; pop through fascia lata and iliaca