Cubital Fossa

The cubital fossa is the region anterior to the elbow joint. The cubital fossa is seen as the triangular depression between the brachioradialis and pronator teres muscles. Except for the ulnar nerve, which runs posteriorly, most of the major neurovascular structures transition from the arm to the forearm via the cubital fossa. The 4 important structures of the cubital fossa (from lateral to medial) are the radial nerve, tendon of the biceps brachii muscle, brachial artery, and median nerve.

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Boundaries

The cubital fossa is the transitional area between the upper arm and the forearm anterior to the elbow joint. The cubital fossa is defined by the following anatomical boundaries:

BoundaryStructure
SuperiorHorizontal line joining medial and lateral epicondyles of the humerus
LateralMedial border of the brachioradialis muscle
MedialLateral border of the pronator teres muscle
ApexDirected inferiorly, the meeting point of the lateral and medial boundaries
FloorBrachialis muscle (proximally) and supinator muscle (distally)
RoofJoining of brachial and forearm fascia plus bicipital aponeurosis
Cubital fossa boundaries

Boundaries of the cubital fossa

Image by BioDigital, edited by Lecturio

Contents

The important structures of the cubital fossa can be organized from lateral to medial and include all the important neurovascular structures except for the ulnar nerve, which runs posterior to the medial epicondyle.

Cubital fossa contents

Contents of the cubital fossa:
Deep within the fossa (right box, lateral to medial): radial nerve, biceps tendon, bifurcation of the brachial artery into radial and ulnar arteries, and median nerve
Superficial to the biceps aponeurosis (left side): cephalic vein, median cubital vein, basilic vein, lateral cutaneous nerve, and medial cutaneous nerve of the forearm

Image by Lecturio.

Structures deep within the cubital fossa (lateral to medial)

  • Radial nerve: located below or posterior to the brachioradialis, and therefore not always included in the description of the cubital fossa 
  • Distal biceps tendon: attaches at the radial tuberosity
  • Brachial artery: bifurcates into the radial and ulnar arteries at the distal end of the cubital fossa or apex of the fossa
  • Median nerve: exits the cubital fossa beneath the pronator teres muscle
Cubital Fossa

Deep view of the cubital fossa

Image by BioDigital, edited by Lecturio

Structures within the superficial fascia of the cubital fossa

  • Median cubital, cephalic, and basilic veins
  • Lateral and medial cutaneous nerves of the forearm
  • Lymphatics: epitrochlear lymph nodes (cubital lymph nodes)
    • Within subcutaneous fat above the medial epicondyle of the humerus
    • Drains into the axillary lymph nodes
Superficial view of the cubital fossa

Superficial view of the cubital fossa

Image by BioDigital, edited by Lecturio

Clinical Relevance

The following are important clinical concepts related to the structures found within the cubital fossa:

  • Brachial pulse: The brachial pulse (brachial artery) can be palpated immediately medial to the biceps tendon in the cubital fossa.
  • Blood pressure: The cubital fossa is a site for placement of the diaphragm of the stethoscope during blood pressure measurement over the brachial artery.
  • Venipuncture: the process of obtaining intravenous access, most commonly performed to obtain venous blood for testing or to acquire intravenous access. The cubital fossa is a common site for venipuncture because of the prominence and accessibility of the veins, especially the median cubital vein located superficially within the roof of the cubital fossa.

References

  1. Drake, R.L., Vogl, A.W., & Mitchell, A.W.M. (2014). Gray’s Anatomy for Students (3rd ed.). Philadelphia, PA:  Churchill Livingstone

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