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ANTERIOR ASPECT OF THE FOREARM&
CUBITAL FOSSA
Kaan Yücel M.D., Ph.D. 26.December.2012 Wednesday
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2
THE ANATOMYOF FOREARM
IN
5 QUESTIONS
INTRODUCTION
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1. Wheres is the forearm?
between the elbow & wrist joints
Elbow joint
Wrist jointFOREARM
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2. Which structures pass between the arm & forearm?
Most major structures (nerves,veins,arteries)via cubital fossa, anterior to elbow joint Exception ulnar nerveposterior to the medial epicondyle of humerus
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3. How is forearm divided?Anterior compartmentPosterior compartmentLateral intermuscular septumfrom the anterior border of the radius to deep fascia surrounding the limb
Interosseous membranelinks borders of the radius and ulna
Attachment of deep fascia along the posterior border of the ulna
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4. Movements of the forearm muscles?
Muscles in the anterior compartment Flex the wrist & digits Pronate the handMuscles in the posterior compartment Extend the wrist & digitsSupinate the hand
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Muscles of the anterior compartment Mainly by median nerveThe one and a half exceptions by ulnar nerve Muscles of the posterior compartment All by radial nerve (directly or by its deep branch)
Watch out, Median nerve @median plane of the forearmUlnar nerve @ medial side
5. Innervation of the forearm muscles?
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THE ANATOMY
OF ANTERIOR ASPECT OF FOREARM
IN
12 QUESTIONS
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1. Layers of anterior compartment forearm muscles?Superficial Intermediate Deep
4 muscles 3 muscles
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2. Muscles of the superficial layer?
1. flexor carpi radialis2. flexor carpi ulnaris3. palmaris longus4. pronator teres
two headsUlnar headHumeral head
Medial epicondyle
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2. Muscles of the superficial layer?
1. flexor carpi radialis
Medial epicondyle of humerus Base of metacarpals II & III
2. flexor carpi ulnarisHumeral head: Medial epicondyle of humerusUlnar head: Olecranon & Posterior border of ulna•Pisiform & hamate •5th metacarpal3. palmaris longusMedial epicondyle of humerus Flexor retinaculum & palmar aponeurosis
4. pronator teresHumeral head: Medial epicondyle & adjacent supraepicondylar ridgeUlnar head: Coronoid processLateral surface of radius
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3. ..the muscles of the intermediate and deep layers?
flexor digitorum superficialis
3. Muscles of the intermediate layer?
Humeroulnar head• Medial epicondyle of humerus • Adjacent margin of coronoid processRadial headSuperior half of anterior border
Shafts of middle phalanges of
medial four digits
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3. ..the muscles of the intermediate and deep layers?flexor digitorum profundus
flexor pollicis longus
pronator quadratus
4. Muscles of the deep layer?
•Proximal ¾ of medial & anterior surfaces of ulna •Interosseous membrane
Bases of distal phalanges of 4th & 5th digitsBases of distal phalanges of 2nd & 3rd digits
• Anterior surface of radius• Adjacent interosseous
membrane
Base of distal phalanx of thumb
Distal ¼ of anterior surface of ulna
Distal ¼ of anterior surface of radius
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5. Fxns of the anterior compartment muscles
Flexion of forearm @ the elbow jointPronator teresFlexion of hand @ the wrist jointFlexor carpi radialis et ulnaris- Palmaris longus
Abduction (radial deviation) of hand @ the wrist jointFlexor carpi radialis
Adduction (ulnar deviation) of hand @ the wrist jointFlexor carpi ulnaris
Pronation of forearmPronator teres – Pronator quadratus
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5. Fxns of the anterior compartment muscles
Flexor digitorum superficialis
Flexor digitorum profundus Flexes distal phalanges 4 & 5 at distal interphalangeal joints
Flexes distal phalanges 2 and 3 at distal interphalangeal joints
Flexes proximal interphalangeal joints of the index, middle, ring, & little fingers Flexes metacarpophalangeal joints of the same fingers and the wrist joint
Flexor pollicis longusFlexes phalanges of thumb
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6. Innervation of the anterior compartment muscles
All the muscles by median nerve
Except 1.5 muscles by ulnar nerveFlexor carpi ulnaris full
Flexor digitorum profundus medial half part associated w/ring & little fingers
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7. Arteries in the anterior compartment of the forearm
Brachial artery
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8. Veins in the anterior compartment of the forearm
deep venous palmar arch in
the hand
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9. Median nerve
principal nerveno branches in the arm other than small twigs to the brachial artery. Its major branch in the forearm anterior interosseous nerve
Leaves cubital fossa by passing between 2 heads of pronator teres &humero-ulnar &radial heads of flexor digitorum superficialis
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10. Ulnar nerve
Enters the anterior compartment by passing posteriorlyaround medial epicondyle of humerus &between humeral & ulnar heads of flexor carpi ulnaris muscle
Two small cutaneous branches palmar branch & dorsal branch
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11. Radial nerve
motor and sensory functions in both arm & forearm but only sensory functions in the hand
Superficial (sensory)deep to brachioradialis
Deep (motor)between two heads of supinator
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12. Lateral & medial cutaneous nerves of forearm
Lateral cutaneous nerve of forearmContinuation of musculocutaneous nerve
Medial cutaneous nerve of forearmBranch of medial cord of brachial plexus
Posterior cutaneous nerve of forearmBranch of radial nerve
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THE ANATOMY
IN
4 QUESTIONS
OF CUBITAL FOSSA
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An important area of transition between the arm and the forearm. seen superficially as a depression on the anterior aspect of the elbow.
Deeply, it is a space filled with a variable amount of fat anterior to the most distal part of the humerus and the elbow joint.
1. What is the cubital fossa?
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Superiorly imaginary line connecting medial &lateral epicondyles.Medially pronator teres.Laterally brachioradialis.
2. What are the boundaries of the cubital fossa?
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1) Terminal part of the brachial artery,radial and ulnar arteries 2) Biceps brachii tendon
3) Median nerve
4) Radial nerve
5) (Deep) accompanying veins of the arteries
3. What are the contents of the cubital fossa?
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Superficially, in the subcutaneous tissue overlying the fossa median cubital vein, medial and lateral antebrachial cutaneous nervesbasilic and cephalic veins.
3. What are the contents of the cubital fossa?
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median nerve lies immediately medial to the brachial artery and leaves the fossa by passing between the ulnar and humeral heads of the pronator teres
radial nerve lies under brachioradialis (lateral margin of the fossa)
gives off deep branch of the radial nerve and continues as superficial radial nerve.
4. Which nerves are in the cubital fossa?