FOREARM & DORSUM OF HAND

LEARNING OBJECTIVES:

1.  Describe the Extent and Surface Anatomy of Forearm and Dorsum of Hand
2.  Describe the Major features of Bones: Humerus, Radius & Ulna
3.  Identify major Superficial veins of Forearm; for each describe the origin, areas of
drainage and clinical importance
4.  Describe the Attachments, Innervation and Actions of:
-Muscles of Anterior compartment (Flexor-Pronator) of Forearm
-Muscles of Posterior compartment (Extensor- Supinator) of Forearm
5.  Describe the Arterial Blood supply and Venous drainage of Forearm
6.  Describe distribution of Nerves in the Forearm---Sensory & Motor
7.  Read about Clinical correlations from Moore’s--- “BLUE BOXES”
BONES: RADIUS & ULNA
Olecranon process

Trochlear notch
Head

Coronoid
Neck
process
Radial Ulnar tuberosity
Tuberosity
(Biceps brachii)
Supinator crest
Oblique line
ULNA
Pronator tubercle
(Pronator teres)
Interosseous membrane Posterior border
RADIUS (Type of joint: Fibrous --
Syndesmosis)
Lateral surface

Posterior surface

Head
Dorsal turbecle
Styloid process
Styloid process of ulna Styloid process

Anterior view: Right radius and ulna in SUPINATION Anterior view: Right radius and ulna in PRONATION
BONY LANDMARKS:
Distal Humerus and Proximal Radius & Ulna
Olecranon
fossa

Medial supracondylar ridge

Lateral Olecranon
supracondylar ridge process

Coronoid fossa
Lateral
epicondyle
Radial
fossa

Lateral
Medial
epicondyle
epicondyle
Capitulum
Trochlea
Groove for
ulnar nerve
U
R
Coronoid L R
A
process
A N D
D U I
I L
Radial notch of ulna
A U
U N S
S A

Anterior view: in extension Posterior view: in extension

BONES: DISTAL RADIUS

The four surfaces (anterior, medial, posterior, and lateral) of the

distal radius are shown from left to right, along with the styloid One useful landmark for dorsal palpation is
process and dorsal tubercle. Lister's tubercle which lies in approximately
the middle of the distal radius, aligned with
the middle metacarpal (arrow). Between
these bony landmarks lie the lunate and
capitate.
SURFACE ANATOMY: Ø The Cubital fossa
lies on the anterior
surface of the elbow
Ø  Palpate the tendon
of Biceps in the
Cubital fossa and
feel for the
pulsations of
Brachial artery
medial to the tendon
of Biceps brachii
Ø On the living
appreciate the
superficial veins at
the cubital fossa
SURFACE ANATOMY: Ø Palpate the medial and lateral
epicondyles of the humerus.
Ø Palpate the head of the Radius
distal to the lateral epicondyle.
Ø Palpate the Olecranon of the
uUna.
Ø Palpate the head of the Ulna
felt as a rounded prominence
at the wrist when the hand is
pronated.
Ø Just distal to the head of the
Ulna is the Styloid process.
Ø The Radial styloid process is
palpable on the lateral side of
the wrist when the hand is
supinated. This is located
approximately 1 cm distal to
the Ulnar styloid process
SKIN INCISIONS:
Ø Place the forearm in
supine position and
make the incisions
shown in the figure---
(Refer to Grant’s
dissector)
Ø Reflect the skin. Be
careful not to cut the
superficial veins of
the hand and forearm
when reflecting the
skin
 VEINS, SENSORY NERVES, DEEP FASCIA:
SUPERFICIAL VEINS:
-CEPHALIC VEIN
-BASILIC VEIN
Basilic vein -MEDIAN CUBITAL VEIN
Cephalic vein of the arm Median cubital vein is commonly used for vein-punctures
DEEP VEINS: accompany arteries, drain into Brachial veins---Radial
Median cubital
vein
veins, Ulnar veins, posterior & anterior interosseous veins
Median
antebrachial
PERFORATING VEINS: connect superficial and deep veins
vein
SENSORY NERVES:
Perforating Basilic vein of
the forearm 1. Lateral cutaneous nerve of forearm----from Musculocutaneous
veins
2. Medial cutaneous nerve of forearm
3. Posterior cutaneous nerve of forearm
Basilic 4. Superficial branch of radial nerve
vein

ANTEBRACHIAL Cephalic vein

DEEP FASCIA OF FOREARM (ANTEBRACHIAL FASCIA)
FASCIA A “sleeve” of fascia that surrounds the forearm. Intermuscular septae
(2) extend from inner aspect of fascia and attach onto Radius and Ulna.
This specific arrangement connecting Lateral & Medial Intermuscular
septae, Interosseous membrane, Radius and Ulna, divides forearm into
Dorsal venous arch
two compartment;
-------Anterior (Flexor-pronator)
-------Posterior (Extensor-supinator)
ANTERIOR/ FLEXOR COMPARTMENT:
Ø Using scissors, carefully remove the Antebrachial fascia from
underlying muscles
Ø Identify Brachioradialis on the lateral side of the forearm.
This is the only flexor of the forearm that is innervated by the
Radial nerve
Ø Identify the muscles in the superficial layer: Pronator teres,
Flexor carpi radialis, Palmaris longus and Flexor carpi
ulnaris from lateral to medial side. The muscles of the
superficial layer take origin from the common flexor tendon
Ø Identify the Flexor digitorum superficialis, which lies in the
middle layer deep to the superficial layer of muscles. Reflect
the Pronator teres from its distal attachment to the pronator
tubercle on the Radius and identify the belly of the Flexor
digitorum superficialis
Ø Pronator teres, Flexor carpi radialis, Palmaris longus and
Flexor digitorum superficialis are innervated by Median nerve,
whereas Flexor carpi ulnaris is innervated by Ulnar nerve
ANTERIOR COMPARTMENT OF FOREARM: Superficial layer
I) PRONATOR TERES
FCR
II) FLEXOR CARPI RADIALIS
Pronator
Teres
PL III) PALMARIS LONGUS
FCU
IV) FLEXOR CARPI ULNARIS
Flexor Carpi
i) Pronator Teres:
Radialis Action: Pronates and flexes forearm
All muscles in superficial &
intermediate layers arise together from
ii) Flexor Carpi Radialis:
medial epicondyle of humerus Action: Flexes and abducts hand
(Common flexor origin)
iii) Palmaris Longus:
Action: Flexes hand
iv) Flexor Carpi Ulnaris:
Action: Flexes and adducts hand
Flexor Carpi
Ulnaris
NOTE: All these muscles attached proximally via a
Common tendon to Medial epicondyle of Humerus----
“Common Flexor Origin”

NOTE: BRACHIORADIALIS though it lies in

Palmaris
Longus anterior part of forearm and flexes the elbow, is not
considered part of anterior compartment, its
grouped with the Exensor compartment because its
innervated by Radial nerve (nerve of posterior
compartment)
 ANTERIOR COMPARTMENT OF FOREARM: Intermediate layer

FLEXOR DIGITORUM SUPERFICIALIS:

-Common Flexor Origin:
-Four tendons attach into middle phalanges of 4
Flexor
Flexor Digitorum
fingers
Digitorum Superficialis -Action: Flex proximal interphalangeal joints
Superficialis
Flexes wrist joint
Flex Metacarpophalangeal joints
(MCP)

NOTE:
All muscles of the Superficial and Intermediate
layers are innervated by the MEDIAN NERVE
except for the Flexor carpi ulnaris muscle
innervated by the ULNAR NERVE
ANTERIOR/ FLEXOR COMPARTMENT:
Ø Flexor digitorum superficialis
divides into four tendons. Each
tendon further divides into two
tendons which attach to the
middle phalanges of the medial
four digits. This step will be
seen when we dissect the hand
Ø The Flexor digitorum
superficialis is supplied by
Median nerve and is
responsible for flexion of wrist,
flexion of Metacarpophalangeal
joints and the proximal
Interphalangeal joints of medial
four fingers
 ANTERIOR COMPARTMENT OF FOREARM: Deep layer
Flexor I)  FLEXOR POLLICIS LONGUS (unipannete, round tendon)
Digitorum II)  FLEXOR DIGITORUM PROFUNDUS
Profundus
III)  PRONATOR QUADRATUS

i) Flexor digitorum profundus:

Action: Flex distal interphalangeal joints
Flexes wrist joint
Flexor Flex MCP
Pollicis
Longus Innervation: DOUBLE
Pronator
quadratus
ii) Flexor pollicis longus:
Action: Flexes the thumb

iii) Pronator quadratus:

Action: Pronates the forearm

NOTE: All muscles of the deep layer are innervated by

Cut ANTERIOR INTEROSSEOUS NERVE (a branch of Median
tendon of nerve) expect for the Medial part of Flexor Digitorum
FDS Profundus innervated by the ULNAR NERVE

tendon
of FDP
ANTERIOR/ FLEXOR COMPARTMENT:
Ø Lift the superficial and intermediate group of
muscles with help of forceps to identify the
Deep muscles of the Forearm
Ø There are three deep muscles of the Forearm:
- Flexor pollicis longus
- Flexor digitorum profundus
- Pronator quadratus
Ø Identify the round tendon of Flexor pollicis
longus on the lateral side of the forearm
Ø Identify the massive fleshy belly of Flexor
digitorum profundus on the medial side of the
forearm
Ø Identify the Pronator quadratus in the distal
1/3rd of forearm between the Radius and Ulna
Ø The Flexor pollicis longus, Pronator quadratus
and lateral half of Flexor digitorum profundus
are innervated by the Anterior Interosseous
nerve, which is a branch of Median nerve. The
medial half of Flexor digitorum profundus and
Flexor carpi Ulnaris are innervated by Ulnar
nerve
ANTERIOR/ FLEXOR COMPARTMENT:
Ø Cut the ulnar head of origin of Flexor
digitorum superficialis to expose the
deep muscles of forearm clearly. Be
careful not to cut the Median nerve
running deep to the Flexor digitorum
superficialis
Ø Identify the Flexor pollicis longus on the
lateral side of forearm (It is a unipennate
muscle)
Ø Identify the Flexor digitorum
profundus. Note that its four tendons
attach to the distal phalanges of the medial
four digits. The tendons of insertion of
Flexor digitorum profundus will be
exposed when we dissect the hand
ANTERIOR/ FLEXOR COMPARTMENT:
Ø Move the Flexor digitorum profundus
laterally to expose the Pronator
quadratus
Ø Identify the Anterior interosseous nerve,
a branch of Median nerve and see it giving
branches to the Flexor pollicis longus,
Pronator quadratus and lateral half of
Flexor digitorum profundus
Ø Trace the Brachial artery and see it
dividing into the Radial and Ulnar arteries
Ø  Follow the Ulnar artery as it gives off
the Common interosseous artery and
continues as the Ulnar artery
SKIN INCISIONS FOR EXTENSORS OF FOREARM AND HAND:

Ø Place the Forearm in the prone position. Make the incisions

shown in the figure and reflect the skin. Be careful not to damage
the superficial veins of the hand and Forearm while reflecting the
skin
Ø Remove the skin on the Dorsum of the hand and all the digits as
shown by the dotted lines in the figure.
EXTENSOR SURFACE OF FOREAMR & HAND:
Ø Remove the antebrachial
fascia on the posterior aspect
of the forearm. Be careful so as
not to sever the tendons of
muscles in this compartment
Ø  Identify the dorsal venous
arch in the superficial fascia of
dorsum of hand
Ø Identify the Cephalic vein
that ascends from the lateral
margin of the Dorsal venous
arch into the anterolateral
aspect of the proximal forearm
and arm
Ø  Identify the Basilic vein
arising from the medial aspect
of the dorsal venous arch and
running on the medial side of
the forearm
 Ø Identify the thick Extensor
POSTERIOR/ EXTENSOR COMPARTMENT: retinaculum between the Radius and
Ulna
Ø Identify the superficial branch of
Radial nerve, which becomes
cutaneous after passing underneath the
Brachioradialis and supplies skin of
dorsum of hand and the lateral three
and a half digits
Ø Identify the muscles seen in the
posterior compartment of the
Forearm. Identify the muscles in the
superficial layer and their proximal as
well as distal attachment
- Brachioradialis
- Extensor carpi radialis longus
- Extensor carpi radialis brevis
- Extensor digitorum
- Extensor digiti minimi
- Extensor carpi ulnaris
Ø Identify the muscles of the deep layer
which extend and abducts the thumb
- Abductor pollicis longus
- Extensor pollicis brevis
- Extensor pollicis longus
POSTERIOR COMPARMENT OF FOREARM: Superficial layer
Extensor i)  BRACHIORADIALIS
Carpi Radialis ii)  EXTENSOR CARPI RADIALIS LONGUS
Brachioradialis Longus iii)  EXTENSOR CARPI RADIALIS BREVIS
iv)  EXTENSOR DIGITORUM
v)  EXTENSOR DIGITI MINIMI
Extensor Carpi vi)  EXTENSOR CARPI ULNARIS
Radialis Brevis
BRACHIORADIALIS:
Action: Weak flexor of forearm

Extensor EXTENSOR CARPI RADIALIS LONGUS:

Digitorum Action: Extends, abducts hand at wrist joint
EXTENSOR CARPI RADIALIS BREVIS,
Extensor EXTENSOR DIGITORUM, EXTENSOR DIGITI MINIMI,
Digiti EXTENSOR CARPI ULNARIS: All these muscles arise by a
Minimi Common tendon from Lateral epicondyle of humerus--”Common
Extensor Origin”
Extensor
Carpi
Ulnaris
INNERVATION:
-Brachioradialis,
ECRL by RADIAL NERVE
sor
-ECRB by Deep branch of RADIAL NERVE
Exten culum
ret ina -ED, EDM, ECU by POSTERIOR INTEROSSEUS
NERVE (a continuation of the Deep branch of Radial
nerve)
 POSTERIOR COMPARTMENT OF FOREARM: Deep layer
ED (cut) A. Outcropping muscles of the Thumb:
1)  ABDUCTOR POLLICIS LONGUS
2)  EXTENSOR POLLICIS BREVIS
3)  EXTENSOR POLLICIS LONGUS
ABDUCTOR POLLICIS LONGUS:
Abductor pollicis longus
Action: Abducts thumb
Extensor pollicis longus EXTENSOR POLLICIS BREVIS:
Action: Extends MCP & Carpometacarpal joints of thumb
Supinator
EXTENSOR POLLICIS LONGUS:
Extensor Action: Extends interphalangeal, MCP & Carpometacarpal joints of thumb
pollicis
brevis
B. Other muscles in Deep layer:
Extensor 1)  EXTENSOR INDICIS
indicis 2)  SUPINATOR
EXTENSOR INDICIS:
Action: Extends index finger
SUPINATOR:
Action: Supinates forearm

INNERVATION:
All muscle of posterior compartment deep layer are innervated
by the POSTERIOR INTEROSSEOUS NERVE except for the
Supinator which receives from the Deep branch of Radial nerve
POSTERIOR/ EXTENSOR
COMPARTMENT:
Ø Review the muscles of posterior
compartment of forearm and its
innervation
Ø Remove the extensor retinaculum to follow
the tendons proximally and distally
Ø Identify distal attachments of all tendons:
Note that the Abductor pollicis longus and
Extensor pollicis brevis are the most lateral
Ø  Extensor carpi radialis longus can be seen
inserting to the base of second metacarpal,
whereas Extensor carpi radialis brevis gets
inserted to the base of third metacarpal
Ø Extensor indicis lies deep to extensor
digitorum. Follow it to the extensor
expansion of Index finger
 ARTERIES OF FOREARM: The main arteries are ULNAR and RADIAL arteries terminal
branches of Brachial artery in Cubital fossa
i) RADIAL ARTERY: Continues as Radial artery and gives off
Radial recurrent artery that contributes to anastomosis around
elbow joint. It leaves forearm by coiling around lateral aspect of
wrist
ii) ULNAR ARTERY: Continues as Ulnar artery and gives off:
Radial
recurrent -COMMON INTEROSSEOUS ARTERY which divides into
artery ŸANTERIOR INTEROSSEOUS &
ŸPOSTERIOR INTEROSSEOUS
Recurrent
interosseous Anterior interosseous artery runs distally on the anterior surface
artery of the interosseous membrane accompanied by the Anterior
interosseous nerve. Posterior interosseous artery passes
RADIAL posteriorly over proximal end of interosseous membrane to supply
ARTERY
posterior compartment of forearm, it runs with the Posterior
Radial
recurrent interosseous nerve
artery -Recurrent interosseous artery arise from the Post.
Interosseous art. It ascends to participate in the anastomosis around
the elbow joint
Common OTHER BRANCHES of ULNAR ARTERY
interosseous artery Radial - Anterior ulnar recurrent artery, Posterior ulnar recurrent artery,
artery
ULNAR
Ulnar Palmar carpal branch, Dorsal carpal branch & Unnamed muscular
artery
Posterior
ARTERY branches
interosseous
artery
Anterior interosseous Ulnar artery runs on medial side of forearm lateral to Ulnar nerve &
artery crosses the anterior surface of flexor retinaculum to reach the hand
ANTERIOR/ FLEXOR COMPARTMENT:
Ø Identify the Brachial artery in the cubital fossa
and follow it until it divides into Radial and
Ulnar arteries at the level of the neck of the
Radius
Ø  Follow the Radial artery as it runs distally on
the lateral side of forearm, where it lies between
Brachioradialis and Flexor carpi radialis. The
pulsations of Radial artery can be felt on the
anterior surface of the Forearm at the level of the
wrist between the Brachioradialis and Flexor
carpi radialis tendons
Ø Follow the Ulnar artery on the medial margin of
forearm, lateral to the tendon of Flexor carpi
ulnaris. The ulnar artery passes superficial to the
Flexor retinaculum with the ulnar nerve to enter
the hand
ANTERIOR/ FLEXOR
COMPARTMENT:
Ø Identify the Common
interosseous artery which divides
into two branches: Anterior and
Posterior interosseous arteries
Ø The Anterior interosseous BA

artery runs on the anterior surface

of Interosseous membrane with
the Anterior interosseous nerve UA

and vein, whereas the Posterior CIA

interosseous artery passes AIA

through a gap above the
interosseous membrane to run on
UA
the posterior aspect of the
Forearm
 NERVES OF FOREARM: MEDIAN NERVE:

Radial BRANCHES in FOREARM:
nerve Ulnar -ARTICULAR BRANCHES: To elbow joint
nerve
- MUSCULAR BRANCHES: To muscles in the superficial and intermediate
Median layers of anterior compartment except FCU
Superficial - ANTERIOR INTEROSSEOUS NERVE: Arises between two heads of Pronator
nerve
branch
of Median teres, runs deep with Anterior interosseous vessels, innervates muscles in deep
Radial
nerve layer of anterior compartment except the medial part of FDP. Ends as articular
nerve branch to wrist joint
- PALMAR CUTANEOUS BRANCH: To skin of lateral 2/3 palm
MEDIAN NERVE PASSES DEEP TO THE FLEXOR RETINACULUM INTO
THE CARPAL TUNELL TO REACH STRUCTURES IN THE HAND
Median ULNAR NERVE:
nerve
BRANCHES in FOREARM:
- MUSCULAR BRANCHES: To FCU and medial part of FDP
- ARTICULAR BRANCHES: To elbow joint
- PALMAR CUTANEOUS BRANCH
Ulnar
nerve
- DORSAL CUTANEOUS BRANCH
ULNAR NERVE PASSES SUPERFICIAL TO FLEXOR RETINACULUM TO
REACH STRUCTURES IN THE HAND
RADIAL NERVE:
BRANCHES in FOREARM:
As it runs along lateral wall of cubital fossa the Radial nerve gives off;
MUSCULAR BRANCHES to Brachioradialis and ECRL muscles. Then it
Ulnar divides into 2 terminal branches;
nerve 1. SUPERFICIAL 2. DEEP
SUPERFICIAL BRANCH of RADIAL NERVE:
Runs deep to Brachioradialis èroof of Anatomical snuff box. Its sensory to the
skin on the dorsum of hand
NERVES OF FOREARM: DEEP BRANCH of RADIAL NERVE: Passes laterally from its
point of origin and sends off branches to innervate: ECRB, it then
Radial nerve penetrates the Supinator to reach the Extensor compartment where
Deep branch of its name changes to POSTERIOR INTEROSSEOUS NERVE
Radial nerve which runs with Posterior interrosseous vessels. Posterior
interosseous nerve innervates the: ED, EDM, ECU and all muscles
Posterior
in the deep layer of posterior compartment: APL, EPB, EPL and
Interosseous EI. It terminates as ARTICULAR BRANCH to wrist joint
nerve

Superficial
branch Musculocutaneous
of Radial nerve nerve

Lateral cutaneous
nerve of forearm

MUSCULOCUTANEOUS NERVE
In the forearm, the Musculocutaneous nerve terminate as the LATERAL CUTANEOUS NERVE OF FOREARM
 RADIAL NERVE: Summary
i) The main branch of the Radial nerve supplies the:
• Triceps brachii
• Brachialis
• Brachioradialis
• Extensor carpi radialis longus
ii) The Deep branch of the Radial nerve supplies:
•  Extensor carpi radialis brevis
•  Supinator
iii) The Posterior interosseous nerve supplies:
•  Extensor digitorum
CLINICAL NOTE: •  Extensor digiti minimi
WRIST DROP
(RADIAL NERVE PALSY)
•  Extensor carpi ulnaris
Results from injury to Radial nerve as it •  Extensor Indicis
runs in the Spiral groove, this causes •  Extensor pollicis longus
paralysis of Extensors muscles of forearm
and therefore inability to extend the wrist •  Extensor pollicis brevis
or fingers. The wrist drops as a result of •  Abductor pollicis longus
unopposed action of Flexors
 DORSUM OF HAND:
Basilic vein
Cephalic vein

Extensor
pollicis longus

Superficial
Radial artery
Dorsal venous arch branch of
Radial nerve

Ulnar
nerve Extensor
pollicis brevis

Abductor
pollicis longus

Superficial branch of Radial nerve

ANATOMICAL SNUFFBOX: is an area whose floor is formed by Scaphoid and Trapezium. It lies between
the tendon of Extensor pollicis longus medially and tendons of Extensor pollicis brevis & Abductor pollicis
longus laterally. The Radial artery runs in the snuffbox, and its roof is innervated by Superficial Branch of
Radial nerve. Scaphoid fractures produce pain in this area.
POSTERIOR/ EXTENSOR COMPARTMENT:
Ø Identify the boundaries of
Anatomical snuff box
Ø Identify Abductor pollicis longus
and Extensor pollicis brevis,
which form the lateral boundary of
the Anatomical snuff box
Ø Identify Extensor pollicis longus,
which forms the medial boundary
of the Anatomical snuff box
Ø Identify the Radial artery in the
snuff box and follow it until it
pierces the First dorsal
interosseous muscle to enter the
hand and form the Deep palmar
arch
Ø Superficial branch of Radial
nerve runs in the roof of the
Anatomical snuff box
 Dorsal
interroseous
Extensor expansion: (Bipenate)

Extensor
digitorum
tendon

Lumbrical

Extensor

1st Dorsal
interrosseous
digiti
minimi
EXTENSOR EXPANSION:
On the dorsum of the hand, Extensor tendons flatten out to form
“Extensor expansions” ---which wrap around the dorsum & sides of
Extensor digitorum proximal phalanges and distal ends of Metacarpals. FUNCTIONS:
tendons
Extensor
indicis -Each extensor expansion forms a “hood” that holds the extensor
tendon in the middle of the digit
- Gives attachment to the tendons of Lumbricals and Interossei
muscles
DORSAL INTEROSSEI:
Abduction 2, 3, 4, & 5 digits
Extension of IP joints
INTEROSSEI are located between the Metacarpal bones. There are 4 bipennate, dorsal and 3
unipennate palmar interossei.
DORSAL INTEROSSEI Abduct digits 2, 3, 4 and 5 (DAB)
PALMAR INTEROSSEI Adduct digits 2, 4 and 5 (PAD)
(For the thumb, abduction is not performed by interossei, but rather by abductor pollicis longus
and brevis, and adduction by adductor pollicis. For the little finger, abduction is performed by
abductor digiti minimi.)
Both dorsal and palmar interossei attach to Extensor expansions, and therefore, these muscles
will Flex the MP (Metacarpal phalangeal joints) and Extend the IP (Interphalangeal) joints.
The Interossei are innervated by the Deep branch of the Ulnar nerve.
PALMAR INTEROSSEI:
(UNIPENNATE) Adduction 2, 4, &5 digits
Flexion of
MP joint
 Ø Lift the Extensor tendons of Forearm
DORSUM OF THE HAND: to Identify the Dorsal interosseous
muscles on the Dorsum of the Hand
Ø Dorsal interossei are bipennate
muscles, four in number and take
attachment from the adjacent
Metacarpal bones and get inserted
into the Dorsal digital expansion of
Fingers
Ø Dorsal interossei are numbered from
lateral to medial side
Ø  Identify first Dorsal interosseous
muscle between first and second
Metacarpal bones and see the Radial
artery piercing it
Ø Second Dorsal interosseous muscle
takes attachment from second and
third Metacarpal bones. In the same
way follow the third and fourth
Dorsal interossei muscles
DORSUM OF THE HAND:

Ø Review the four Dorsal

interossei muscles on the
Dorsum of the Hand
Ø  They are all innervated by
Deep branch of the Ulnar
nerve
Ø  They are Abductors of the
digits (DAB)
Ø They Flex the
Metacarpophalangeal (MP)
joints and extend the
Interphalangeal (IP) joints
 REFERENCES:

Ø Clinically Oriented Anatomy by Moore et al. 7th Edition: Pg. 744-77

Ø Essential Clinical Anatomy by Moore et al. 5th Edition: Pg. 438-451
Ø Internet

LAB CHECK LIST:
Bony Landmarks:
Radius:
- Head
- Neck of Radius
- Radial tuberosity
- Pronator tubercle
- Styloid process
- Interosseous border
- Dorsal (Leister’s) Tubercle
Ulna:
- Olecranon process
- Coronoid process
- Ulnar tuberosity
- Trochlear notch
- Radial notch
- Interosseous border
-Head
-Styloid process
Muscles:
Flexor Region:
- Brachioradialis
Superficial group:
- Pronator teres
- Flexor carpi radialis
- Palmaris longus
- Flexor digitorum superficialis
- Flexor carpi ulnaris
Deep group:
- Flexor pollicis longus
- Flexor digitorum profundus
- Pronator quadratus
Nerves:
- Median nerve:
- Anterior interosseous nerve
- Ulnar nerve
- Radial nerve:
- Superficial branch
- Deep branch
- Lateral cutaneous nerve of the forearm
(A continuation of the Musculocutaneous nerve
after it crosses the elbow joint)

LAB CHECK LIST:
Arteries:
-Radial artery
-Ulnar artery: continues as Ulnar
artery -gives Common interosseous
artery
-Common interosseous artery:
i)Anterior interosseous artery
ii)Posterior interosseous artery
Arteries/Nerves:
-Posterior interosseous nerve (A
continuation of the deep branch of
Radial nerve)
-Posterior interosseous artery
EXTENSOR REGION:
Muscles:
- Extensor carpi radialis longus
- Extensor carpi radialis brevis
- Supinator
- Extensor digitorum
- Extensor indicis
- Extensor pollicis longus
- Abductor pollicis longus
- Extensor pollicis brevis
- Extensor digiti minimi
- Extensor carpi ulnaris
- Anconeus
Other structures:
- Interosseous membrane
- Extensor retinaculum
TEST YOUR KNOWLEDGE:
The nerve that becomes Posterior interosseous nerve is the:
A.  Axillary nerve
B.  Median nerve
C.  Musculocutaneous nerve
D.  Radial nerve
E.  Ulnar nerve
TEST YOUR KNOWLEDGE:

If a muscle has the word “carpi” in its name, it typically

inserts on the:
A.  Base of the metacarpal
B.  Distal row of carpal bones
C.  Head of the metarcapal
D.  Proximal phalanx
E.  Proximal row of carpal bones
TEST YOUR KNOWLEDGE:

If your patient couldn’t pronate her forearm, you might

suspect damage to:
A.  Axillary nerve
B.  Median nerve
C.  Musculocutaneous nerve
D.  Radial nerve
E.  Ulnar nerve
TEST YOUR KNOWLEDGE:

Which muscle does not originate from common flexor

tendon?
A.  Flexor carpi radialis
B.  Flexor digitorum superficialis
C.  Flexor policis longus
D.  Palmaris longus
E.  Pronator teres
TEST YOUR KNOWLEDGE:

Superficial branch of radial nerve:

A.  Innervates the brachioradialis
B.  Innervates the supinator
C.  Supplies skin of the dorsal hand
D.  Supplies skin of the posterior forearm
E.  Travels deep to extensor digitorum muscle
 THANKS FOR YOUR
ATTENTION AND WISHING

I WILL ADDRESS ANY QUESTIONS THAT YOU MAY HAVE IN THE LAB!