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07 Anterior/Posterior Forearm & Hand

September 6, 2018

TRANS Nocom, Nolasco, Nora, Nuñez, Onagan CORE Garces, Marcelo, Mauricio, Morales, Ocampo VPAA Natural 09175454982
 FOREARM

1.07 Anterior/Posterior Forearm & Hand LE 1 TRANS 7

Cubital Fossa
Location: Medial - Pronator Teres (15),
Lateral - Brachioradialis (5)
Contents: Brachial Artery (2), Median Nerve
(11), Radial nerve (not seen in photo), tendon
of biceps brachii (17)

Note: Site of venipuncture due to veins being

large
ANTERIOR FOREARM
A. Superficial
1. Pronator Teres
2. Flexor Carpi Radialis
3. Flexor Carpi Ulnaris
4. Palmaris Longus
B. Intermediate
1. Flexor Digitorum Superficialis
C. Deep
1. Flexor Digitorum Profundus
2. Flexor Pollicis Longus
3. Pronator Quadratus

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 ANTERIOR FOREARM
• SUPERFICIAL LAYER
• Attached proximally by common flexor tendon to medial epicondyle
of humerus

1. Pronator teres
2. Flexor carpi radialis
3. Palmaris longus
4. Flexor carpi ulnaris

1.07 Anterior/Posterior Forearm & Hand LE 1 TRANS 7

 Pronator teres
• Most lateral of the superficial
forearm flexors

Action: Pronates and flexes forearm

(at elbow)
Blood supply: Anterior ulnar recurrent
artery
Nerve supply: Median nerve (C6, C7)
Pronator teres

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 Flexor carpi radialis
• Medial to pronator teres

Action: Flexes and abducts hand (at

wrist)
Blood supply: Radial artery
Nerve supply: Median nerve (C6, C7)
Flexor carpi radialis

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 Palmaris longus
• Small fusiform muscle

Action: Flexes hand (at wrist) and

tenses palmar aponeurosis
Blood supply: Posterior ulnar
recurrent artery
Palmaris
Nerve supply: Median nerve (C7, longus

C8)

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 Flexor carpi ulnaris
• Most medial of the superficial flexor
muscles

Action: Flexes and adducts hand (at

wrist)
Blood supply: Posterior ulnar recurrent
artery
Flexor
Nerve supply: Ulnar nerve (C7, C8) carpi
ulnaris

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 ANTERIOR FOREARM
• INTERMEDIATE LAYER
• Consists of one muscle

1. Flexor digitorum superficialis

1.07 Anterior/Posterior Forearm & Hand LE 1 TRANS 7

 Flexor digitorum superficialis
• Gives rise to four tendons

Action: Flexes middle and proximal

phalanges of medial 4 digits and
flexes hand (at wrist) Flexor
digitorum
Blood supply: Ulnar and radial superficialis
muscle
arteries

Nerve supply: Median nerve

(C7, C8, T1)

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 ANTERIOR FOREARM
• DEEP LAYER
• Consists of 3 muscles

1. Flexor digitorum profundus

2. Flexor pollicis longus
3. Pronator quadratus

1.07 Anterior/Posterior Forearm & Hand LE 1 TRANS 7

Flexor digitorum profundus
• Only muscle that can flex the
distal interphalangeal joints of
the finger
Action: Flexes distal phalanges of
medial 4 digits, assist with flexion of
hand at wrist
Blood supply: Anterior interosseous
artery, muscular branches of Ulnar Flexor
artery digitorum
profundus
Nerve supply: Ulnar nerve (Medial);
Median nerve (Lateral)

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 Flexor pollicis longus
• Only muscle that flexes
interphalangeal joint of the
thumb
Flexor pollicis
longus

Action: Flex phalange of the 1st

digit (thumb)
Blood supply: Anterior interosseous
artery
Nerve supply: Median nerve (C8-T1)

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 Pronator quadratus
• Prime mover for pronation

Pronator
Action: Pronates forearm, deep quadratus

fibers bind radius and ulna

together
Blood supply: Anterior
interosseous artery
Nerve supply: Median nerve (C8-
T1)

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 A B
ANTERIOR LEFT FOREARM
A. Superficial and B. Deep muscles
intermediate muscles
1. Basillic vein 1. Abductor pollicis longus
2. Biceps tendon 2. Biceps
3. Bicipital aponeurosis 3. Brachialis
4. Brachial artery 4. Brachioradialis
5. Brachioradialis 5. Common flexor origin
6. Cephalic vein 6. Extensor carpi radialis
7. Common flexor origin brevis
8. Flexor carpi radialis 7. Extensor carpi radialis
9. Flexor carpi ulnaris longus
10. Flexor digitorum 8. Flexor carpi radialis
superficialis 9. Flexor carpi ulnaris
11. Flexor pollicis longus 10. Flexor digitorum
12. Medial epicondyle profundus
13. Median cubital vein 11. Flexor pollicis longus
14. Median forearm vein 12. Flexor retinaculum
15. Median nerve 13. Pronator quadratus
16. Palmar branch of median 14. Pronator teres
nerve 15. Supinator
17. Palmar branch of ulnar
nerve
18. Palmaris longus
19. Pronator quadratus
20. Pronator teres
21. Radial artery
22. Ulnar artery
23. Ulnar nerve

1.07 Anterior/Posterior Forearm & Hand LE 1 TRANS 7

POSTERIOR FOREARM
- Arises from common extensor tendon on the lateral epicondyle of the humerus
- Nerve Supply: Radial Nerve

A. Superficial (takes care of 3 other digits)

1. Brachioradialis
2. Extensor Carpi Radialis Longus
3. Extensor Carpi Radialis Brevis
4. Extensor Carpi Ulnaris
5. Extensor Digitorum
6. Extensor Digiti Minimi
B. Deep (takes care of pollicis and indicis)
1. Supinator
2. Abductor Pollicis Longus
3. Extensor Pollicis Brevis
4. Extensor Pollicis Longus
5. Extensor Indicis

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

POSTERIOR FOREARM
● SUPERFICIAL LAYER

1. Brachioradialis
2. Extensor Carpi Radialis Longus
3. Extensor Carpi Radialis Brevis
4. Extensor Carpi Ulnaris
5. Extensor Digitorum
6. Extensor Digiti Minimi

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

POSTERIOR FOREARM

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 Brachioradialis
-Fusiform muscle lying superficially on the
anterolateral surface of the forearm

Insertion: Lateral side of distal end of radius

Origin: Proximal 2/3 of lateral supracondylar
ridge of humerus

Action: Flexion of forearm at elbow joint

when forearm is midpronated

Note: brachioradialis is a flexor of the forearm, but it is located in the posterior

(posterolateral) or extensor compartment and is thus supplied by the radial nerve.

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 Extensor Carpi
Radialis Longus
-Fusiform muscle and is overlapped by the
brachioradialis

Insertion: Dorsal base of 2nd metacarpal

and slip to 3rd metacarpal
Origin: Distal third of lateral supracondylar
ridge of humerus

Action: Extends and abducts hand at wrist

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 Extensor Carpi
Radialis Brevis
-Shorter
-Acts as synergists to other muscles

Insertion: Dorsal base of 3rd metacarpal and

slip to 2nd metacarpal
Origin: Lateral epicondyle of humerus

Action: Extension and abduction of hand

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 Extensor Carpi
Ulnaris
-Long fusiform muscle

Insertion: Dorsal base of 5th metacarpal

Origin: Lateral epicondyle of humerus and
posterior border of ulna

Action: Extension and adduction of hand

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 Extensor Digitorum
-Principal extensor of the digits

Insertion: Extensor expansions of medial 4

digits
Origin: Lateral epicondyle of humerus

Action: Extension of medial 4 digits and

assists in wrist extension

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 Extensor Digiti
Minimi
-Fusiform slip of muscle

Insertion: Extensor expansion of 5th digit

Origin: Lateral epicondyle of humerus

Action: Extension of 5th digit

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 POSTERIOR FOREARM
● DEEP LAYER

Innervation: Radial Nerve

Blood Supply: Posterior Interosseous Artery

1. Supinator
2. Abductor Pollicis Longus
3. Extensor Pollicis Brevis
4. Extensor Pollicis Longus
5. Extensor Indicis

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 Supinator

Abductor Pollicis Longus Extensor Pollicis Longus

Extensor Pollicis Brevis

Extensor Indicis

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 Supinator
- Floor of cubtial fossa

Insertion: Lateral epicondyle of humerus

Origin: Lateral, posterior and anterior
surfaces of proximal third of radius

Action: Prime mover for slow,

unopposed supination of forearm

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 Abductor Pollicis Longus

-Wall of anatomical snuffbox

Insertion: Posterior surface of ulna, radius, and

interosseous membrane
Origin: Base of 1st metacarpal

Action: Abducts thumb

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 Extensor Pollicis Brevis
- Wall of anatomical snuffbox

Insertion: Posterior surface of radius and

interosseous membrane
Origin: Dorsal base of proximal phalanx of
thumb

Action: Extends proximal phalanx of thumb

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 Extensor Pollicis Longus
- Wall of anatomical snuffbox

Insertion: Posterior surface of middle third of

ulna and interosseous membrane
Origin: Dorsal base of distal phalanx of thumb

Action: Extends distal phalanx of thumb

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 Extensor Indicis

Insertion: Posterior surface of ulna and

interosseous membrane
Origin: Extensor/expansion of 2nd digit

Action: extends 2nd digit and helps extend

hand at wrist

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

 Applied Anatomy
- Injury to radial nerve in forearm leads to wrist drop
- aka Radial Nerve Palsy
Arteries of Forearm Brachial Artery

Median Nerve
- Main Arteries: Ulnar Artery
and Radial Artery Ulnar Artery
- Terminal branches of the
brachial artery

Radial Artery M
E
D
I
A
L

Landmark: Median Nerve

Arteries of Forearm Medial Epicondyle of Humerus

Brachial Artery

Posterior Ulnar Recurrent Artery

Radial Recurrent Artery
Anterior Ulnar Recurrent Artery

Common Interosseous Artery

Ulnar Artery

Radial Artery
 HAND

1.07 Anterior/Posterior Forearm & Arm LE 1 TRANS 7

PIP Joint and DIP Joint
- Proximal Interphalangeal Joint and Distal Interphalangeal Joint
- tendons of the flexor digitorum superficialis (FDS) branches into two
as it attaches to the sides of the middle phalanx passing the PIP joint.
The flexor digitorum profundus (FDP) attaches to the distal phalanx
crossing the DIP joint while going through the bellies of the FDS
Flexor Rentinaculum (cut)
- makes up the Carpal Tunnel.

Location: between Abductor Digiti Minimi (1)

and thenar muscle. Connects the forearm to
the middle compartment of the deep plane
of the palm
Function: Passage of Median Nerve and
flexors of the hand (FDS, FDP, FDL)

Note: In Carpal Tunnel Syndrome, pain,

tingling, and swelling are caused by pressure
on the median nerve. Relieved by surgically
releasing the flexor retinaculum.
Anatomical Snuff Box
Location: Medially - Extensor pollicis longus
(15), Laterally - Extensor pollicis brevis (14),
and Abductor pollicis longus (23)
Floor: Scaphoid and Trapezium
Nerve Supply: Radial Nerve
Blood Supply: Radial Artery and Cephalic
Vein (4)
Note: Radius and trapezium form the
common wrist joint which is prone to
fracture during a fall in an outstretched
hand position due to the focus of force in
these areas.
Cephalic vein (2)
 Palmar Aponeurosis
Location: Thenar and Hypothenar
eminences. The proximal end (the
triangular palmar aponeurosis)
continues to the flexor retinaculum
and the palmaris longus tendon.
From the apex, it forms 4
longitudinal bands towards the
base of the proximal phalanx.
Action / Function: Palmar Fascia
Notes: Covers soft tissues and
overlies the long flexor tendons
 Hypothenar Eminence
Action / Function: fine
movements of the little
finger
Nerve Supply: Ulnar Nerve
Notes: The hypothenar
muscles produce
hypothenar eminence - a
muscular protrusion on the
medial side of the palm, at
the base of the little finger.
Consists of:
1. Flexor digiti minimi
brevis
2. Abductor digiti minimi
3. Opponens digiti minimi

http://teachmeanatomy.info/upper-limb/muscles/hand/
 Thenar Eminence
Action / Function: fine
movements of the tumb
Nerve Supply: Median Nerve
Notes: The thenar muscles are
three short muscles located at
the base of the tumb. Consists
of:
1. Flexor pollicis brevis
2. Abductor Pollicis brevis
3. Opponens Pollicis

http://teachmeanatomy.info/upper-limb/muscles/hand/
 Abductor Pollicis Brevis
Action / Function: thumb abduction
Blood Supply: Superficial Palmar arch
Nerve Supply: Median Nerve
Notes: It originates from the flexor
retinaculum of the hand, the tubercle
of the scaphoid bone, and additionally
sometimes from the tubercle of the
trapezium.
It is inserted by a thin, flat tendon into
the lateral side of the base of the first
phalanx of the thumb and the capsule
of the metacarpophalangeal joint.
 Flexor Pollicis Brevis
Action / Function: flexes proximal
phalanx of thumb
Blood Supply: Superficial Palmar
arch
Nerve Supply: Median Nerve
Notes: It is one of the three thenar
muscles. It has both a superficial
part and a deep part.

http://www.eatonhand.com/jpg/1860409.jpg
 Opponens Pollicis
Action / Function: flexion and medial
rotation of 1st metacarpal at
carpometacarpal joint during
opposition
Blood Supply: Superficial palmar arch
Nerve Supply: Median Nerve
Notes: It originates from the flexor
retinaculum of the hand and the
tubercle of the trapezium. It passes
downward and laterally, and is inserted
into the whole length of the
metacarpal bone of the thumb on its
radial side.
 Abductor Digiti Minimi
Action / Function: Abducts little
finger (5th digit, pinky)
Blood Supply: Ulnar artery
Nerve Supply: Ulnar nerve
Notes: It arises from the
pisiform bone, the pisohamate
ligament, and the flexor
retinaculum. It is inserted in the
base of the proximal phalanx of
the 5th digit on the ulnar or
medial side.
 Flexor Digiti Minimi
Action / Function: flexes little finger (5th digit,
pinky)
Blood Supply: Deep palmar branch of ulnar
artery
Nerve Supply: Ulnar nerve
Notes: It is one of the three muscles in the
hypothenar group. These three muscles form
the fleshy mass at the base of the little finger,
and are solely concerned with the movement
of digit V. The other two muscles that make up
the hypothenar muscle group are the abductor
digiti minimi and the opponens digiti minimi.
From anatomical position medial to lateral is
the abductor digiti minimi, flexor digiti minimi,
and opponens digiti minimi.
 Opponens Digiti Minimi
Action / Function: Draws 5th
metacarpal anteriorly and
rotates it, bringing little finger
(5th digit) into opposition with
thumb
Blood Supply: Deep palmar
branch of ulnar artery
Nerve Supply: Ulnar nerve
Notes: Muscle of a triangular
form, and placed immediately
beneath the palmaris brevis,
abductor minimi digiti, and flexor
brevis minimi digiti. It is one of
the three hypothenar muscles
that controls the little finger.
 Adductor Pollicis
Action / Function: adducts
thumb at the carpometacarpal
joint
Blood Supply: Deep palmar arch
Nerve Supply: Ulnar nerve
Notes: The radial artery passes
between two heads, travelling
from the back of the hand into
the palm, where it forms the
deep palmar arch.
 Lumbricals
Action / Function: flex
metacarpophalangeal joints and
extend interphalangeal joints
Blood Supply: superficial and
deep palmar arches
Nerve Supply: Median nerve (1st
and 2nd) and Ulnar nerve (3rd
and 4th)
Notes:
1st and 2nd: Unipennate
3rd and 4th: Bipennate
 Palmar and Dorsal Interossei
Action / Function: abduction (dorsal) and adduction (palmar) of digits
Blood Supply: Deep palmar arch
Nerve Supply: Ulnar nerve
Notes: Originate along the shaft of the metacarpal bone of the digit on
which they act. They are inserted into the base of the proximal phalanx and
the extensor expansion of the extensor digitorum of the same digit.
The dorsal interosseous muscles are bipennate, with each muscle arising by
two heads from the adjacent sides of the metacarpal bones, but more
extensively from the metacarpal bone of the finger into which the muscle is
inserted. They are inserted into the bases of the proximal phalanges and into
the extensor expansion of the corresponding extensor digitorum tendon.
The middle digit has two dorsal interossei insert onto it while the first digit
(thumb) and the fifth digit (little finger) have none. Each finger is provided
with two interossei (palmar or dorsal), with the exception of the little finger,
in which the abductor digiti minimi muscle takes the place of one of the
dorsal interossei.
Palmar and Dorsal Interossei
References:
Abrahams, P. H., Boon, J. M., Spratt, J. D., Hutchings, R. T., & Abrahams, P. H.
(2008). McMinn's clinical atlas of human anatomy. St. Louis, Mo.: Elsevier/Mosby.

Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2010). Clinically Oriented Anatomy
(6th ed.). Philadelphia: Lippincott Williams & Wilkins.

Netter, F. H. (2006). Atlas of human anatomy. Philadelphia, PA: Saunders/Elsevier.