TRAUMATIC INJURY SECONDARY TO VEHICULAR ACCIDENT

GROSS ANATOMY

1. Identify the musculofascial compartments of the forearm

Forearm (lower arm; antebrachium) is the segment of the upper limb from the elbow down to the wrist.
It is enclosed in a sheath of deep fascia. The deep fascia together with a strong ligamentous band called
interosseous membrane and fibrous intermuscular septa, divides the forearm into three musculofascial
compartments: Anterior, lateral, and posterior compartments.

a. Give the muscles on each compartment

i. List the origin, insertion and action of each muscles

Anterior Compartment of the Forearm

Muscle Origin Insertion Action
Superficial group
Pronator Teres
- Humeral head Medial epicondyle of
the humerus
Lateral aspect of shaft Pronation and flexion
- Ulnar head Medial border of
of radius of forearm
coronoid process of
ulna
Flexor Carpi radialis Medial epicondyle of Bases of the 2nd and 3rd Flexes and abducts
the humerus metacarpal bones hand at wrist joint
Palmaris longus Flexor retinaculum and Flexes hands
palmar aponeurosis
Flexor carpi ulnaris
- Humeral head Medial epicondyle of - Pisiform bone Flexes and adducts
the humerus - Hook of the hamate hand at wrist joint
- Ulnar head - Medial aspect of - Base at 5th
olecranon process metacarpal bone
- Posterior border of
ulna
Intermediate group
Flexor Digitorum Superficialis
- Humeroulnar - Medial epicondyle of
head humerus
Flexes middle phalanx
- Medial border of
of fingers
coronoid process of Middle phalanx of
Assists in flexing
ulna medial 4 fingers
proximal phalanx and
- Radial head Oblique line on
hand
anterior surface of
shaft of radius
Deep group
Flexor pollicis longus Anterior surface of Distal phalanx of Flexes digital phalanx
radius shaft thumb of thumb
Flexor digitorum Anteromedial surface Distal phalanges of - Flexes digital phalanx
profundus of shaft of ulna medial 4 fingers of fingers
- Assists in flexion of
middle and proximal
phalanges and wrist
Pronator quadratus Anterios surface of Anterior surface of Pronates forearm
shaft of ulna shaft of radius

Lateral Compartment of the Forearm

Muscle Origin Insertion Action
Brachioradialis Lateral supracondylar Base of styloid process - Flexes forearm at
ridge of humerus of radius elbow joint
- Rotates forearm to
midprone position
Extensor carpi radialis Posterior surface of Extends and abducts
longus base of 2nd metacarpal hand at wrist joint
bone

Posterior Compartment of the Forearm

Muscle Origin Insertion Action
Superficial group
Extensor carpi radialis Posterior surface of Extends and abducts
brevis base of 3rd metacarpal hand at wrist joint
bone
Extensor digitorum Middle and distal Extends fingers and
phalanges of medial 4 hand
fingers
Extensor digiti minimi Lateral epicondyle of Extensor expansion of Extends metacarpal
humerus little finger phalangeal joint of little
finger
Extensor carpi ulnaris Base of 5th metacarpal Extends and adducts
bone hand at wrist joint
Anconeus Lateral surface of Extends elbow joints
olecranon process of
ulna
Deep group
Supinator - Lateral epicondyle of Neck and shaft of Supination of forearm
humerus radius
- Anular ligament of
proximal radioulnar
joint
- Ulna
Abductor pollicis Posterior surface of Base of 1st metacarpal Abducts and extends
longus radius and ulna shafts bone thumb
Extensor pollicis brevis Posterior surface of Base of proximal Extends
radius shaft phalanx of thumb metacarpophalangeal
joints of thumb
Extensor pollicis Posterior surface of Extends distal phalanx
longus ulna shaft of thumb
Extensor indicis Extensor expansion of Extends
index finger metacarpophalangeal
joint of index finger

b. Give the blood supply and venous drainage of each compartment

i. Trace the blood supply from their origin to termination in the hand

Blood supply of the Anterior Compartment of the Forearm

Radial artery
Smaller of the terminal branches of the brachial artery

Commencement: Cubital fossa at the level of the neck of the radius

Termination: leaves forearm by winding around the lateral aspect of the wrist to reach posterior hand
surface

Course:
1. Passes downward and laterally, beneath the brachioradialis muscle and rest on deep muscles
of the forearm
2. In middle 3rd of the course – superficial branch lies on its lateral side
3. In distal part of the forearm
- Lies on anterior surface of the radius (only covered by skin and fascia)
- Has the tendon of flexor carpi radialis on its medial side (site for taking radial pulse)

Branches in the Forearm:

 Muscular branches – to neighboring muscles
 Recurrent branch – takes part in arterial anastomosis around elbow joint
 Superficial palmar branch - arises above the wrist; enters palm of the hand and joins ulnar
artery – forms superficial palmar arch

Ulnar artery
Larger of the 2 terminal branches of the brachial artery
 Commencement: Cubital fossa at level of the neck of the radius
Termination: Palm in front of the flexor retinaculum in company with ulnar nerve

Course:
1. Descends through anterior compartment of the forearm
2. In upper part – lies deep in flexor muscles
3. Below its course – becomes superficial – lies between tendons of flexor carpi ulnaris and
flexor digitorum superficialis
4. Enters palm in front of the flexor retinaculum with the ulnar nerve – lies lateral to pisiform
bone (covered only by skin and fascia – site for taking ulnar pulse)
5. Forms superficial palmar arch – anastomoses with superficial palmar branch of the radial
artery

Branches
 Muscular branches – to neighboring muscles
 Recurrent branches – take part in arterial anastomosis around elbow joint
 Branches that take part in arterial anastomoses around wrist joint
 Common interosseous artery
 Arises from upper part of ulnar artery
 Divides into anterior and posterior – distributed to muscles in front and behind interosseous
membrane
 Provide nutrient arteries to radius and ulna

Blood supply of the Lateral Compartment of the Forearm

Derived from the branches of the radial and brachial arteries

Blood supply of the Posterior Compartment of the Forearm

Anterior and Posterior Interosseous arteries
- Arise from common interosseous artery – branch of the ulnar artery
- Pass downward on the anterior and posterior surface of the interosseous

ii. Trace the veins to their drainage

Superficial Veins

 Lies in the superficial fascia

 Cephalic vein, Median cubital vein, Basilic vein

Cephalic Vein

- Arises from the lateral side of the dorsal venous arch (back of the hand)
- Winds around the lateral border of the forearm
- Ascends into the cubital fossa and up the front of the arm - on lateral side of the biceps
- Terminates in axillary vein in deltopectoral triangle

Median Cubital vein

- Branch of the cephalic vein in the cubital fossa

 - Runs upward, medially joins the basilic vein
- In the cubital fossa – median cubital crosses in front of the brachial artery and median
nerve; separated from brachial artery and median nerve by the bicipital aponeurosis

Basilic vein

- Arises from medial side of the dorsal venous arch (back of the hand)
- Winds around the medial border of the forearm
- Ascends into cubital fossa and up the front of the arm – on medial side of the biceps
- Terminates – joins venae comitantes of the brachial artery – forms axillary vein

c. Give the nerve supply of each compartment

i. Trace the nerves from their origin distally to the forearm indicating the major landmarks
they traverse

Nerve supply of the Anterior Compartment of the Forearm

Median nerve

Course

1. Leaves cubital fossa – passes between 2 heads of the pronator teres

2. Continues downward behind the flexor digitorum superficialis Rest posteriorly on flexor
digitorum profundus
3. At wrist – emerges from lateral border of the flexor digitorum superficialis muscles; lies
behind tendon of palmaris longus
4. Enters palm – passes behind flexor retinaculum

Branches

 Muscular branches – in cubital fossa to the pronator teres, flexor carpi radialis, palmaris
longus, flexor digitorum superficialis
 Articular branches – to elbow joint
 Anterior Interosseous Nerve
 Arises from median nerve (emerge between 2 heads of the pronator teres)
 Passes downward on anterior surface of interosseous membrane (between
flexor pollicis longus and flexor digitorum profundus)
 Ends on anterior surface of the carpus

Branches:

 Muscular branches – to flexor pollicis longus, pronator quadratus, lateral

half of flexor digitorum profundus
 Articular branches – to wrist and distal radioulnar joints; also supply
hand joints
 Palmar cutaneous branch
 Arises in lower part of forearm
 Distributed to skin over lateral part of the palm
Ulnar nerve

Course

1. Passes behind the medial epicondyle of the humerus , crosses medial ligament of the elbow
joint
2. Enters front of the forearm – passes between 2 heads of the flexor carpi ulnaris
3. Runs downward the forearm between flexor carpi ulnaris and flexor digitorum profundus
4. In distal 2/3 – ulnar artery lies on lateral side of median nerve
5. At wrist – becomes superficial; lies between tendons of the flexor carpi ulnarus and flexor
digitorum superficialis
6. Enters palm – passes in front of flexor retinaculum and lateral the pisiform bone

Branches

 Muscular branches – to flexor carpi ulnaris and medial half of flexor digitorum profundus
 Articular branches – to elbow joint
 Palmar cutaneous branch
 Arises in middle of the forearm
 Supplies skin over hypothenar eminence
 Dorsal posterior cutaneous branch
 Large branch, arises in distal 3rd of the forearm
 Passes medially between tendon of flexor carpi ulnaris and ulna
 Distributed on posterior surface of hand and fingers

Nerve supply of the Lateral Compartment of the Forearm

Radial Nerve

Course

1. Pierces lateral intermuscular septum in lower part of the arm Passes forward into cubital
fossa
2. Passes downward in front of lateral epicondyle of the humerus – lies between brachialis
(medial side) and extensor carpi radialis (lateral)
3. At level of lateral epicondyle – divides into superficial and deep branches

Branches

 Muscular branches – to brachioradialis, extensor carpi radialis longus, small branch to

lateral part of brachialis
 Articular branches - to elbow joint
 Deep branch of the radial nerve
 Winds around neck of radius (within supinator muscle)
 Enters posterior compartment of the of the forearm
  Superficial branch of the radial nerve

Superficial Branch of the radial nerve

 Direct continuation of the nerve after main stem has given off its deep branch in front of lateral
epicondyle of the humerus

Course

1. Runs down under cover of brachioradialis muscle on lateral of the radial artery
2. In distal part of the forearm – leaves the artery and passes backward under the tendon of
the brachioradialis
3. Reaches posterior surface of the wrist – divides into terminal branches supplying:
o Skin on lateral 2/3 of the posterior surface of the hand
o Posterior surface over the proximal phalanges of the lateral 3 ½ fingers

Nerve supply of the Posterior Compartment of the Forearm

Deep branch of the Radial Nerve

Course

1. Arises from radial nerve in front of the lateral epicondyle of the humerus and cubital
fossa
2. Pierces supinator and winds around alteral aspect of the neck of the radius - reaches
posterior compartment of the forearm
3. Descends in interval between superficial and deep groups of muscles
4. Reaches posterior surface of wrist joints

Branches

 Muscular branches – superficial and deep group except extensor carpi ulnaris and
anconeus
 Articular branches – to wrist and carpal joints

2. Identify the bones of the forearm and hand

a. Give their major features and identify the major bony landmarks of the forearm, wrist, and hand.

MICRO ANATOMY

1. Identify the layers of the skin

2. Give the fundamental type of tissue and subtype of tissue of each layer
3. Describe the type of muscle that is involved in the patient
4. Give the 2 types of bone tissue
5. Describe each type of bone tissue
6. Discuss the two types of formation of bone
7. Describe in sequence the healing mechanism/process in this patient