Objectives

• Skeleton • structures in the

• anatomical land marks, region of wrist
• cutaneous nerves,
• carpal tunnel
• dermatomes
• superficial veins •Eg.s of clinical aspects.
• lymphatics
• compartments and
the structures in them
• Space of Parona.
Cubital fossa merges the arm to forearm.
Bounderies of cubital fossa:
Base - line joining the epicondyles
Medial - pronator teres.M
Lateral – brachioradialis.M
Roof -skin,
-fascia and
-bicipital aponeurosis
Floor - capsule of elbow joint,
brachialis.M
supinator.M
Contents in the cubital fossa-- medial to lateral
• Median nerve
• Brachial artery
(with terminal branches)
• Biceps brachii tendon
• Structures on the roof ;
• Basilic and cephalic veins
• Cutaneous nerves of forearm

(medial and lateral.)

• Median cubital vein and its communications.

•Note; radial.N and terminal branches- deep to lateral boundery.

 Skeleton- Radius ulna and interosseous membrane
 Anatomical/surface land marks
– Medial and lateral epicondyles
– Olecrenon
– Head of radius
– Subcutaneous border of ulna
– Lower ends of radius and ulna
– Styloid processes of radius and ulna
– Dorsal tubercle of radius
– Visible and palpable tendons.
Cutaneous nerves of forearm-- Medial, lateral &
posterior cutaneous nerves of forearm.
Posterior view Anterior view
Dermatomes of forearm

C5
 Superficial veins
Cephalic vein From dorsal venous arch
Basilic vein
Superficial forearm veins
Median cubital.v
Median cephalic.v
Median basilic.v

Peripheral intravenous access.

Superficial lymphatics follow the superficial veins;

- medial side- go to
supratrochlear / epitrochlear
nodes and then to the lateral
group of axillary nodes

- Lateral side - go to
infraclavicular nodes
 Compartments of the forearm:

• Flexor (anterior) compartment,

• Extensor (posterior) compartment

Flexor compartment;

Superficial Muscles:
1. Pronator teres, M.N
2. Flexor carpi radialis,M.N

3. Palmaris longus, M.N

4. Flexor digitorum-

superficialis, M.N
5. Flexor carpi ulnaris. U.N

1 and 2 = C6 7

3, 4 and 6 = C7 8
Superficial muscles arises from -

-Medial epicondyle of humerus=common flexor origin.

In addition three of them have additional origin,

-Fl. Dig.Suprficialis --med.Lig of elbow, radius & ulna.

-Pronator teres – humerus and ulna.

-Fl. Car. Ulnaris -- ulna.

Superficial muscles - origin and insertion
Flexor compartment-

Deep muscles.

Flexor digitorum
profundus-

Flexor pollicis longus,

Pronator quadratus,
 Origin and insertion of deep muscles:
Flexor digitorum profundus-
Flexor pollicis longus,
Pronator quadratus,
Anterior aspect
Deep muscles ; nerve supply

1.Flexor digitorum profundus,

medial part - ---- Ulnar.N

lateral part– anterior

interosseous .N

2. Flexor pollicis longus,

anterior interosseous.N

3. Pronator quadratus,
anterior interosseous.N.

1 = C7, 8 and T1
 Action of muscles of flexor compartment-
On joints from elbow to distal inter-phalangeal joints.

Superficial Muscles: Deep muscles


Pronator teres, - Flexor digitorum
profundus,

Flexor carpi radialis, - Flexor pollicis longus,
 Palmaris longus,
- Pronator quadratus,
 Flexor digitorum-

superficialis,
 Flexor carpi ulnaris,

Note thumb has only one interphalangeal joint.

 Nerves of flexor compartment of forearm.

Median nerve, C5,6,7,8,T1

Anterior interosseous .N.

= a branch of median nerve

Ulnar nerve, C7,8,T1.

Course and relations in this compartment.

Branches of median nerve
in the anterior compartment of forearm;
- branches to superficial muscles,

- anterior interosseous branch to

-deep muscles(except medial part of flex.dig.pro)
-inferior radio-ulnar joint

- articular branches to elbow, sup. radioulnar and

wrist joints,

- palmar cutaneous branch.

 Branches of ulnar nerve in the forearm.
- muscular branches to
flexor carpi ulnaris,
flexor digitorum profundus-medial part,

- articular branch to elbow and wrist joints,

At the wrist gives

- dorsal branch,
- Superficial and deep branches.
 Blood vessels in the anterior compartment
.-Radial.A
-Ulnar.A
-Anterior interosseus. A
-Median artery
(persistant part of axial
artery of fetal limb).

Venae comitantes of radial and

ulnar arteries join to form venae
comitantes of brachial artery.

Deep lymphatics travel along

the deep blood vessel and go
to lateral group of axillary
nodes.
Anterior interosseous atrery supplies
anterior compartment .
Space of Parona
superficial to the pronator quadratus,
deep to the long flexor tendons,

upper limit- oblique origin of

flexor digitorum superficialis.

flexor tendon sheaths protrude

into this space

flexor sheath infections can

extend into this space.
Extensor (Posterior) compartment of forearm :

Muscles:
Extensor carpi radialis longus,

Extensor carpi radialis brevis,

Extensor digitorum,

Extensor digiti minimi,

Extensor carpi ulnaris,

Anconeus.
Supinator,

Abductor pollicis longus,

Extensor pollicis longus,

Extensor pollicis brevis,

Extensor indicis.
Superficial extensors arise from;
- common
extensor origin on
lateral epicondyle of the humarus

- some muscles are also attached to

humerus, radius and ulna.

Extensor compartment muscles – origin and insertion
Tendons go to the hand under
the extensor retinaculum.
 Individual and combination actions
Brachioradialis, Anconeus,

Ext.carpi radialis longus, Supinator,

Ext.carpi radialis brevis, Abductor pollicis longus,

Extensor digitorum, Extensor pollicis longus,

Extensor digiti minimi, Extensor pollicis brevis,

Extensor carpi ulnaris, Extensor indicis.

Extensors are essential for power of grip.

Motor innervation:

- Radial nerve supplies (main nerve);

. Brachioradialis,
. Ext.carpi radialis longus.

- Nerve to medial head of triceps (given off in spiral

groove) supplies anconeus. –

Posterior interosseous .N (branch of radial nerve).

supplies rest of the muscles of the posterior compartment
of the forearm.
Radial .N and Branches
in the forearm;

- posterior interosseous .N
(deep branch)

- articular branches to
radio-ulnar joint

- radial nerve continues as

superficial branch to
the dorsum of the hand.
 Blood supply to extensor compartment
Posterior interosseous artery--- supplies
upper 2/3rds
Anterior interosseous artery--- supplies
lower 1/3rd.
 Region of the wrist
Between forearm and hand.

-Carpal tunnel;

anterior aspect

-Extensor tendons;

dorsal aspect

-Anatomical snuff box;

 Carpal tunnel
Space between flexor retinaculum & the carpal bones.
 Structures passing through the carpal tunnel;
-Median nerve,
-Tendons of:
. Flexor digitorum superficialis,
. Flexor digitorum profundus,
. Flexor pollicis longus.
Structures passing through the roof of carpal tunnel;
-The tendon of flexor carpi radialis
-The ulnar nerve through Guyons tunnel.

Carpal tunnel syndrome

Effects of compression
on median nerve
in the
carpal tunnel.
Structures passing on the roof of the carpal tunnel;
 Tendon of palmaris longus,
 Palmar cutaneous branch of median nerve,
 Superficial branch of radial artery.
 Ulnar artery,
 Superficial veins,
 Arterial blood supply in the region of the wrist
Anterior and posterior carpal arterial arches.

The carpal branches of radial, ulnar, and anterior interosseous arteries

The carpal arches communicate with dorsal metacarpal arteries.

Veins- mainly via deep veins.

Six compartments of ext. retinaculum, lateral to medial:
Abductor pollicis longus,
Extensor pollicis brevis. 1st

Ext.carpi radialis longus

Ext.carpi radialis brevis. 2nd

Ext.pollicis longus 3rd

Ext.digitorum
Ext.indicis 4th

Ext.digitiminimi 5th

Ext.carpi ulnaris. 6th

Anatomical snuff box- on the lateral aspect
Bounderies:
Lateral,
- abductor pollicis longus.
- extensor pollicis brevis,
Medial,
- extensor pollicis longus.
Floor
- base of 1st metacarpal
- scaphoid,
- trapezium
- styloid process of radius.
Radial artery passes on the floor of anatomical-
-snuff box.
Roof of anatomical snuff box: - fascia and skin.
Passing in the superficial fascia of the roof--
- cephalic vein
- cutaneous branch of radial nerve.
 Clinical aspects

Deformities at the wrist

- Manus varus = Wrist is fixed in adduction,
- Manus valgus = Wrist is fixed in abduction,
- Cystic swelling of synovial sheath-- ganglion
- Wrist drop = Damage to
- radial nerve
- posterior interosseous nerve.

- Injury to any structure.

- Extention of hand infections into Parona’s space Etc.
Dinner fork deformity = Displaced fracture at wrist.
End of topic

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