The Arm

Biceps Brachii

Patient Position:

Supine with the forearm supinated.

Needle Insertion:

Insert the needle just below the midpoint between the shoulder and elbow joint. If needle is inserted too deeply, it will be in the brachialis.

Activation:

Flex the elbow with forearm fully supinated and with external rotation of the arm.

Innervation:

C5,C6-upper trunk-lateral cord-musculocutaneous nerve.

Origin

Short Head: coracoid process of the scapula, lateral to the tendon of the coracobrachialis.

Long Head: Supraglenoid tubercle of the scapula.

Insertion:

Radial tuberosity and the lacertus fibrosis (forearm fascia) into the ulnar side of the forearm.

Figure 13-1. Biceps brachii.

Brachialis

Patient Position:

Supine with the arm at the side of the thorax, elbow slightly flexed, and the forearm pronated.

Needle Insertion:

Note the biceps and brachioradialis at the lower one-third of the arm. At the space between the biceps and brachioradialis of the lower one-third of the arm, the needle is inserted toward the front of humerus.

Activation:

Flex the elbow.

Clinical Notes:

Similar to biceps brachii. Some of the lateral portion of this muscle may be innervated by the radial nerve.

Innervation:

C5,C6-upper trunk-lateral cord-musculocutaneous nerve.

Figure 13-2. Brachialis.

Origin:

Distal half of the anterior humerus, at the insertion of deltoid.

Insertion:

Ulnar tuberosity and coronoid process of the ulna.

Coracobrachialis

Patient Position:

Supine.

Needle Insertion:

Insert the needle near the junction between the proximal end of the anterior axillary fold (anterior wall) and the anterior border of the deltoid muscle. If the needle is inserted too laterally, it will be in the biceps brachii.

Activation:

Flex, adduct, and externally rotate the arm with elbow flexed.

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