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1、GROSS ANATOMY OF THE FOREARM,Chen yonghua,Main Menu,Bones of the forearm.Superficial muscles of the anterior compartment. Deep muscles of the anterior compartment.Arteries and nerves of the anterior compartment.Superficial muscles of the posterior compartment.Deep muscles of the posterior compartmen
2、t.Arteries and nerves of the posterior compartment.,Acknowledgements,Bones of the forearm,The radius proximally articulates with the humerus at the elbow joint. Distally it articulates with the scaphoid and lunate bones of the carpus, and with the ulna at the distal radioulnar joint.The ulna is the
3、more medial of the two bones. Its proximal end articulates with the humerus at the elbow joint. Distally it articulates with the radius. It is excluded from the wrist joint by the articular disc.The interosseous membrane bind the radius and the ulna together.,Head,Interosseous membrane,Radius,Humeru
4、s,Tuberosity of radius,Ulna,Head,Fig 1. Anterior view of bones of the forearm.,总体记忆,前臂共有18块肌肉分为屈肌与伸肌二部分屈肌8块分为浅层与深层浅层有5块深层有3块伸肌10块浅深各5块,前臂8块屈肌,浅层5块旋前圆肌桡侧屈腕肌掌长肌指浅屈肌尺侧屈腕肌,Superficial muscles of the anterior compartment. Title page.,1,2,3,4,The superficial muscles of the anterior compartment include pro
5、nator teres, flexor carpi radialis, palmaris longus, and flexor carpi ulnaris. Also included in this group is flexor digitorum superficialis. The superficial group of muscles all have the same origin, which is attached to the medial epicondyle of the humerus.,FOR FURTHER DETAILS CLICK ON EACH INDIVI
6、DUAL MUSCLE BELOW.,Pronator teresFlexor carpi radialisFlexor carpi ulnarisFlexor digitorum superficialisPalmaris longus (not included in the diagram).,Fig 2. Showing superficial muscles of the posterior compartment.,Brachio-radialis,Return to main menu,Pronator Teres,The pronator teres has two heads
7、, the humeral head and the ulnar head. The median nerve enters the forearm between the two heads.Origin :-Humeral head- Medial epicondyle of the humerus.Ulnar head- Medial border of the coronoid process of the ulna.Insertion :-Lateral aspect of the shaft of the radius.Nerve supply :- Median nerve, C
8、6 and C7.Action :- Pronation of the forearm. Flexion of the forearm.,Pronator teres,Radius,Fig 3. Pronator teres.,Return to title page,Flexor carpi radialis, palmaris longus, and flexor carpi ulnaris,Flexor carpi radialisOrigin:- Medial epicondyle of the humerus.Insertion:- Base of the second and th
9、ird metacarpal bones.Nerve supply:- Median nerve, C6 and C7.Action:- Flexes the hand at the wrist joint. Abducts the hand at the wrist joint.Palmaris longus Origin:- Medial epicondyle of the humerus. Insertion:- Flexor retinaculum and palmar aponeurosis. Nerve supply:- Median nerve, C7 and C8 Action
10、:- Flexes the hand at wrist joint.Flexor carpi ulnaris.Origin:- Humeral head- Medial epicondyle of the humerus.Ulnar head- Medial aspect of the olecranon process of the ulna and the posterior border of the ulna. Insertion:- Pisiform bone, hook of the hamate, and base of the fifth metacarpal bone. Ne
11、rve supply:- The ulnar nerve, C7, C8, and T1. Action:- Flexes the hand at wrist joint. Adducts the hand at wrist joint,Pronator teres,Flexor carpi radialis,Palmaris longus,Flexor carpi ulnaris,Fig 4. Flexor carpi radialis and ulnaris and palmaris longus,Return to title page,Flexor digitorum superfic
12、ialis.,Origin:-Humeroulnar head: Medial epicondyle of the humerus and the medial margin of the coronoid process of the ulna.Radial head: Rising from the oblique line on the anterior surface of the shaft of the radius.Insertion:- The muscle belly gives rise to four tendons distally. Each of the tendo
13、n attaches to the sides of the middle phalanx of the four medial finger.Nerve supply:- Median nerve, C8 and T1.Action:- Flexes the middle phalanx of fingers. Flexes the proximal phalanx of fingers (weak). Flexes the wrist.,Flexor digitorum superficialis.,Fig 5. Flexor digitorum superficialis.,Return
14、 to title page,前臂8块屈肌,深层3块指深屈肌挴长屈肌旋前方肌,Deep Muscles of the anterior compartment. Title page,The deep muscles of the forearm comprise of the flexor pollicis longus, flexor digitorum profundus and pronator quadratus.For further details click on each of the individual muscles.1. Flexor digitorum profun
15、dus.2. Flexor pollicis longus.Pronator quadratus not shown.,1,1,2,Brachio-radialis (cut),Tendon of carpi flexor radialis (cut),Fig 6. Deep muscles of the anterior compartment.,Return to main menu,Flexor digitorum profundus and flexor pollicis longus,Flexor pollicis longusOrigin:- Middle of the anter
16、ior surface of the shaft of the radius and from the adjoining part of the interosseous membrane.Insertion:- The tendon passes distally through the carpal tunnel and attaches to the distal phalanx of the thumb.Nerve supply:- The anterior interosseous branch of the median nerve.Action:- Flexes the pha
17、langes of the thumb.Flexor digitorum profundusOrigin:- Upper three-quarters of the anteriomedial shaft of the ulna.Insertion:- The muscle divides into four tendons just prior to traversing the carpal tunnel. They attach to the distal phalanx of the four fingers.Nerve supply:- The medial part is supp
18、lied by the ulnar nerve, the lateral portion is supplied by the anterior interosseous branch of the median nerve, C8 and T1.Action:- Flexes the finger. Exclusive flexor of the distal phalanx. Weak flexor of the wrist.,Flexor pollicis longus,Pronator quadratus,Flexor digitorum profundus,Fig 7. Flexor
19、 digitorum profundus and flexor pollicis longus.,Return to title page,Pronator Quadratus,Origin:- Lower quarter of the anterior surface of the shaft of the ulna.Insertion:- Lower quarter of the anterior surface of the shaft of the radius.Nerve supply:- The anterior interosseous branch of the median
20、nerve.Action:- Pronates the forearm.,Pronator quadratus,Flexor carpi radialis (cut),Flexor pollicis longus,Flexor digitorum profundus,Flexor carpi ulnaris (cut),Fig 8. Pronator quadratus.,Return to title page,Arteries and Nerves of the anterior compartment. Title page,Ulnar artery:- Larger than the
21、radial artery. It passes between the arch formed by the radial and ulnar attachment of the flexor digitorum superficialis and descends through the anterior compartment. It enters the palm of the hand in front of the flexor retinaculum, and promptly divides in superficial and deep palmer branches.Bra
22、nches- Muscular branches- to the muscles of the anterior compartment. Recurrent branches- to the anastomosis around the wrist jointBranches to the anastomosis around the wrist jointCommon interosseous artery- arises in the upper part of the ulnar artery and then divides in the anterior and posterior
23、 interosseous arteries.Anterior interosseous artery:- arises from the common interosseous artery and descends in the anterior compartment to eventually join the anastomosis around the wrist joint. It supplies the deep flexor muscles, and gives off nutrient branches to the the radius and ulna.,Brachi
24、al artery,Median nerve,Ulnar nerve,Radial nerve,Ulnar artery,Fig 9. Arteries and nerves of the anterior compartment.,Next,Return to nerves,Arteries and Nerves of the anterior compartment.,Posterior interosseous artery- arises from the common interosseous artery and and enters the posterior compartme
25、nt.Radial artery:- It begins in the cubital fossa when the brachial artery divides into the radial and ulna artery. It passes distally, travels under the brachioradialis, resting on the deep flexor muscles. The artery briefly travels on the lateral side of the radius, before travelling over the ante
26、rior surface of the radius. The artery then winds around the lateral aspect of the wrist, before entering the palm of the hand to form the deep palmer arch.Branches-Muscular branches: to the neighbouring muscles.Branches to the anastomosis around the wrist and elbow joint.Superficial palmer joint: a
27、rises just above the wrist, frequently joins the ulnar artery to give rise to the superficial palmer arch.,Radial nerve,Superficial radial nerve,Radial artery,Brachial artery,Median nerve,Ulnar nerve,Ulnar artery,Median nerve,Fig 10. Arteries and nerves of the anterior compartment.,Next,Return to ne
28、rves,Nerves of the anterior compartment,Median Nerve (fig 9, fig 10)The median nerve leaves the cubital fossa in between the two heads of the pronator teres. It descends between the superficial and deep flexor muscles. At the wrist it lies superficially, before entering the palm behind the flexor re
29、tinaculum.Branches:-Muscular branch:- all the superficial muscles of the anterior compartment except flexor carpi ulnaris.Articular branches: to the elbow jointAnterior interosseous nerve: arises from the median nerve as it emerges from the two heads of the pronator teres. (see below)Palmer cutaneou
30、s Branch: Distributed to the skin over the lateral part of the palm.Anterior interosseous nerve It arises from the median nerve (see above) and then descends down the anterior surface of the interosseous membrane. Branches-Muscular branches: all the muscles of deep flexion in the anterior compartmen
31、t except the medial part of digitorum profundus.Articular branches: to the wrist joint, the distal radioulnar joint, and the joints of the carpus.Ulnar Nerve(fig9, fig 10)The ulnar nerve passes behind the medial epicondyle and enters the forearm between the two heads of flexor carpi ulnaris. It desc
32、ends between the flexor carpi ulnaris and the flexor digitorum profundus. The ulnar nerve becomes superficial at the wrist, before entering the palm in front of the flexor retinaculum.Branches-Muscular branches: to the flexor carpi ulnaris and to the medial half of the flexor digitorum profundus.Art
33、icular branches: to the elbow joint.Palmar cutaneous branch: arises in the middle of the forearm, Supplies skin over the thenar eminence.Dorsal cutaneous branch: arises in the distal third of the of the forearm, and passes medially to the dorsum of the hand.,Return to main menu,前臂10块伸肌,浅层5块桡侧腕长伸肌桡侧腕
34、短伸肌指伸肌小指伸肌尺侧腕伸肌,Superficial muscles of the posterior compartment. Title page,The superficial muscles of the anterior compartment are mainly concerned with the extension at wrist joint and of the digit. The muscles in this group comprise of the Extensor carpi radialis brevis, extensor digitorum, exte
35、nsor digiti minimi, extensor carpi ulnaris, and the two more lateral lying brachioradialis and extensor carpi radialis longus.NB- The anconeus also lies in the posterior compartment but is functionally very different to the rest of the muscles in this group. Its action are to aid the triceps in exte
36、nsion at the elbow joint.Click below on each of the muscles for further detail about each of the individual muscles.1. Extensor carpi radialis longus2. Extensor digitorum3. Extensor carpi ulnaris4. Extensor digiti minimiBrachioradialis and extensor carpi brevis are not included in the figure.,2,4,An
37、coneus,2,3,1,Fig 11. Superficial muscles of the posterior compartment.,Return to main menu,Extensor carpi radialis longus and brevis, and extensor carpi ulnaris,Extensor carpi radialis longusOrigin:- From the lower third of the lateral supracondylar ridge of the humerus.Insertion:- Posterior surface
38、 of the base of the second metacarpal bone.Nerve supply:- Radial nerve, C6 and C7.Action:- Extends and abducts the hand at the wrist joint.Extensor carpi radialis brevisOrigin:- From the common tendon attached to the lateral epicondyle of the humerus.Insertion:- Posterior surface of the base of the
39、third metacarpal bone.Nerve supply:- Posterior interosseous nerve, C7 and C8.Action:- Extends and abducts the hand at the wrist joint.Extensor carpi ulnarisOrigin:- From the common tendon attached to the lateral epicondyle of the humerus.Insertion:- Posterior surface of the base of the fifth metacar
40、pal bone.Nerve supply:- Posterior interosseous nerve, C7 and C8Action:- Extends and adducts the hand at wrist joint.,Extensor carpi radialis longus,Extensor carpi radialis brevis,Extensor carpi ulnaris,Fig 12. Extensor carpi radialis brevis and longus and extensor carpi ulnaris.,Return to title page
41、,Extensor digitorum and extensor digiti minimi,Extensor digitorumOrigin:- From the common tendon attached to the lateral epicondyle of the humerus.Insertion:- The muscle divides into four tendons which pass to the fingers and form the dorsal expansion. On the dorsum of the hand these are interconnec
42、ted by fibrous tissue. Near the proximal interphalangeal joint of each finger the expansions divide into the central part, which inserts into base of the middle phalanx, and the two lateral parts, which insert into the base of the distal phalanx. Nerve supply:- Posterior interosseous nerve, C7 and C
43、8Action:- Mainly it extends the metacarpophalangeal joint, but it also assists in extending the proximal and distal interphalangeal joint and the arm. Extensor digiti minimi Origin:- From the common tendon attached to the lateral epicondyle of the humerus.Insertion:- Via two tendons to the dorsal ex
44、pansion for the little finger.Nerve supply:- Posterior interosseous nerve, C7 and C8Action:- Assists in the extension of the little finger.,Extensor digitorum,Extensor digiti minimi,Fig 13. Extensor digitorum and extensor digiti minimi.,Return to title page,Brachioradialis,Origin:- From the upper tw
45、p thirds of the lateral supracondylar ridge of the humerus.Insertion:- Base of the styloid process of the radius.Nerve supply:- Radial nerve, C5 and C6.Action:- It flexes the forearm (despite being being served by an extensor nerve), assists in rotating or restoring the arm into midprone position, d
46、epending on the initial position.,Brachio-radialis,Extensor carpi radialis longus,Extensor carpi radialis brevis,Flexor carpi radialis,Fig 15. Brachioradialis (anterior view).,Fig 14 Brachioradialis (lateral view).,Return to title page,Deep muscles in the posterior compartment. Title page,The deep m
47、uscles of the fore arm consist of three muscles that act on the thumb, the extensor indicis and supinator. Except for the supinator they all originate from only the forearm bones.For further details on each of the bones click on the individual muscles.1. Supinator.2. Abductor pollicis longus.3. Exte
48、nsor pollicis longus.4. Extensor indicis.5. Extensor pollicis brevis.,1,2,4,3,5,Fig 16. Deep muscles of the posterior compartment.,Return to main menu,Extensor pollicis longus and brevis, and abductor pollicis longus,Abductor pollicis longusOrigin:- Middle of the posterior surface of the shaft of th
49、e ulna and radius.Insertion:- Posterior surface of the base of the first metacarpal bone.Nerve supply:- The posterior interosseous nerve, C7 and C8.Action:- Abducts and extends the thumb.Extensor pollicis longusOrigin:- From the posterior surface of the ulna.Insertion:- Posterior surface of the base
50、 of the distal phalanx of the thumb.Nerve supply:- The posterior interosseous nerve, C7 and C8.Action:- Extends the thumb.Extensor pollicis brevisOrigin:- Posterior surface of the radius.Insertion:- Posterior surface of the proximal phalanx of the thumbNerve supply:- The posterior interosseous nerve
