ARM AND FOREARM

Arm (brachium) : region between  Anterior / Flexor

shoulder to joint
2 Compartments of Arm :
-Innervated by Musculocutaneous Nerve
-Blood supply by brachial artery
 Posterior / Extensor
-Innervated by Radial Nerve
-Blood supply by profunda brachii artery

In addition to this, the following also pass through :

-Ulnar nerve
-Ulnar collateral arteries

Muscles Nerve Supply Origin Insertion Function

Biceps Brachii Long Head : Supraglenoid Radial Tuberosity Supinates forearm
Tubercle (scapula) Deep fascia of forearm Flexes forearm

Musculocutan Short : Coracoid process scapula

Coracobrachialis eous Nerve Ccoracoid process Middle of medial Flexion and Adduction of the arm
(scapula) humerus
Brachialis Distal 1/2 of anterior surface of -Ulnar tuberosity Flexion of the forearm
humerus -Coronoid Process of (most powerful flexor)
Ulna
Triceps Brachii Radial Nerve Long : Infraglenoid Tubercle Olecranon process of Extension forearm at elbow joint
(posterior) ulna
Lateral : Superior to Radial Groove

Medial : Inferior to Radial Groove

Cubital Fossa
‘Triangular Hollow Depression infront of Elbow Joint’

Boundaries
Lateral : Brachioradialis
Medial : Pronator Teres
Superior Base : Line between 2 humeral epicondyles

Contents :
Median nerve
Brachial Artery
Biceps’ tendon
Superficial branch of radial nerve

Floor :
Brachialis
Supinator

Structures in Roof :
Median Cubital vein
Bicipital Aponeurosis, deep fascia of arm & forearm
Medial and Lateral Cutaneous Nerve of Forearm
Muscle Nerve Supply Origin Insertion Function
5 SUPERFICIAL FLEXOR GROUP
Pronator Teres -Humeral head : CFO
-Ulnar head : Coronoid Pronation of forearm at RU
process (ulna) Mid-radius joint

Flexor Carpi Median Nerve Bases of 2nd 3rd Flex & Abduct hand
Radialis metacarpals
Palmaris Longus Common Flexor Origin Flexor retinaculum and Flex hand
palmar aponeurosis

Flexor Digitorum Median Nerve -Humeroulnar : ME & Middle phalanges of Flexes :

Superficialis Coronoid process (ulna) medial 4 fingers -Medial 4 fingers at joints of
(Intermediate Medial part is fingers except DIPj.
Layer) supplied by Ulnar -Radial : Superior anterior -Hand at wrist joint
Nerve border (radius)
Flexor Carpi Ulnar Nerve Pisiform ,hamate, Base Flex & Adduct hand
Ulnaris Olecranon (ulna) of 5th metacarpal
3 DEEP FLEXOR GROUP
Flexor Digitorum Medial part : Ulnar -Anterior surface of Ulna Distal Phalanges of Flexes :
Profundus Nerve -Ant. Surface of medial 4 digits -Medial 4 fingers
Anterior Interosseous Interosseous Membrane -Hand at wrist joint
brach of Median
Nerve (lateral)

Flexor Pollicis Anterior Inter. -Anterior surface of Radius Distal phalanx of the Flexes thumb
Longus -Ant. Surface of Interosseous thumb
Membrane
Pronator Anterior Inter. Distal 1/4 Ulna Distal 1/4 Radius Pronates the forearm at RU
Quadratus joint
7 SUPERFICIAL EXTENSOR GROUP
Brachioradialis Radial Nerve, before it
divides into its Distal end of radius Flexes forearm at elbow
superficial & deep Lateral supracondylar ridge (lateral surface) joint
branches of humerus

Extensor Carpi Radial Nerve Base of 2nd metacarpal

Radialis Longus Extends & abducts hand
“ Brevis Radial nerve (deep Base of 3rd metacarpal (with FCR)
branch) bone

Extensor Lateral epicondyle of Extensor expansions of Extends fingers & hand :

Digitorum humerus (CEO) medial 4 digits medial 4 fingers

Extensor Digiti Radial nerve Extensor expansion of Extends fingers &hand :

Minimi (posterior 5th digit 5th digit
interosseous branch)
Extensor Carpi CEO & Posterior Ulna 5th Metacarpal (dorsal Extends & adducts the
Ulnaris aspect) (with FCU)

Anconeus “ and posterior surface of Lateral surface of Extends the elbow &
Radial Nerve joint capsule in some cases Olecranon of ulna tighten its joint capsule

5 DEEP EXTENSOR GROUP

Abductor Pollicis Radial nerve (posterior Proximal ulna & radius , IM Base of 1st metacarpal Abduct thumb
Longus interosseous branch)
Extensor Pollicis
Brevis
Extensor Pollicis Radial Nerve
Longus
Extensor Indicis
Supinator Radial Nerve (deep
branch)
Begins at lower border of
teres major, continuation of
axillary artery
Branches of Brachial Artery
-Profunda Brachii artery
-Superior Ulnar Collateral
-Inferior Ulnar Collateral
-Radial Artery
-Ulnar Artery
 Ulnar Artery
-larger branch of Brachial
Artery in Cubital Fossa
Branches
 Radial Artery
Periarticular Arterial
Anastomoses of Elbow
Distal Radius and IM Proximal phalanx of Extends thumb at MCP joint
thumb
Posterior surface of Ulna, IM Distal phalanx of Extends thumb
thumnb
Posterior of Ulna Extensor expansion of Extends all the joint of
the 2nd digit index finger
Lateral Epicondyle Proximal Radius Supinates forearm
Annular ligament
Supinator crest of Ulna
BRACHIAL ARTERY
Terminates opposite neck of radius, divide into Radial & Ulnar Artery.
Descends arm towards cubital fossa, medial to biceps brachii
-In middle of arm, it is crossed by Median Nerve.
-In Cubital Fossa, it is covered by Bicipital Aponeurosis
Profunda Brachii Artery : First and largest branch.
Accompanied by radial nerve, divide into Middle & Radial Collateral
Arteries.
Course : passes between arch formed by radial & ulnar attachment of
the flexor digitorum superficialis & descends through anterior
compartment.
Descends to reach medial side of forearm - lateral to Ulnar Nerve
Passes superficial to Flexor Retinaculum at wrist
i. Common Interosseous Artery
ii. Anterior Interosseous Artery
iii. Posterior Interosseous Artery
iv. Anterior & Posterior Ulnar Recurrent Arteries
After arising from Brachial Artery, RA gives off Radial Recurrent Artery
RA descends lateral side of forearm deep to brachioradialis
At distal end of forearm, RA lies lateral to Flexor Carpi Radialis Tendon
i. Radial Recurrent Artery (anastomosis)
-between branches of
brachial artery & branches
of radial & ulnar arteries

-Provides collateral
circulation if there is a
gradual & partial occlusion
of Brachial Artery.

Clinical Correlation Locate brachial artery pulse in cubital fossa

Manual Blood Pressure Place stethoscope lightly over brachial artery to auscultate the
Measurement Korotkoff sounds

Mostly common type of elbow injury in children

Supracondylar Humerus Commonly occurs after a fall on an outstretched hand
Fracture Vascular injury can occur
Brachial artery can be :
-stretchd or occluded over the displaced bone fragments
-partially lacerated / transected
Supracondylar Humerus Sudden and complete occlusion / laceration of brachial artery can
Fracture result in ischemia of muscles in forearm

-Collateral circulation can’t compensate for the sudden

occlusion/laceration of brachial artery

-Can lead to necrosis of muscles in forearm -> necrotic tissue

replaced by fibrous scar tissue -> affected muscles shorten
permanently (contracture) -> hand deformity