The next layer encountered is the investing layer of deep fascia, which is strongest posteriorly where it covers the triceps muscle. Below the insertion of the deltoid, it is thickened on each side by a strong intermuscular septum that stabilizes the fascia to the respective supracondylar ridge and epicondyle. The intermuscular septa separate the posterior triceps muscle from the muscles of the anterior compartment of the arm and provide attachment for both.
The radial nerve and the anterior descending branch of the profunda brachii artery perforate the lateral intermuscular septum (Fig. 1.3) 10 cm proximal to the lateral epicondyle. The ulnar nerve and the ulnar collateral artery perforate the medial intermuscular septum 8 cm above the medial epicondyle. Excision or division of this septum is recommended when performing anterior transposition of the ulnar nerve. The bicipital aponeurosis
(lacertus fibrosis) (Fig. 1.4) is a thickening of the deep fascia that extends from the biceps brachii tendon to the subcutaneous border of the ulna and can be palpated on the medial aspect of the taut biceps tendon.
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