To list sensory nerve supply of skin of forearm.

To list anterior forearm muscles in relation to layers.

To follow course & branches of neurovascular bundles
in the region.
To relate some clinical conditions to anatomical facts.
 Upper limb anatomy

It is derived from:
1. Ant. & post. branches of lat. cutaneous n.
Lat. Cut. N. Med.
of forearm which is the direct continuation Cut. N.

of musculocutaneous n.
2. Ant. & post. branches of med. cutaneous n.
of forearm (C8 & T1).
3. Post. cutaneous n. of forearm, a branch of
radial n., it supplies a narrow strip of skin Post.
Cut. N.
along middle of post. surface of forearm
down to the wrist.
 Upper limb anatomy

1. Cephalic vein arises from the lateral side of dorsal venous

arch & winds around the lateral border of forearm, to
ascends up into cubital & up to front of arm on lat. side of
biceps.
It gives median cubital vein which runs Median
upward & medially to join basilic vein Cephali
cubital v.

median cubital vein crosses in front of c vein

brachial a. & median n. being separated Cephalic v.

from them by bicipital aponeurosis.

 Upper limb anatomy

2. Basilic vein arises from the med. side

of dorsal venous arch on dorsum of
the hand and winds around med.
border of the forearm. It then ascends
into cubital fossa and up to the front
of the arm on med. side of biceps. Cephalic
vein

Basilic v.

Median
cubital v.
 Upper limb anatomy

Flexor retinaculum is a thickening of deep

fascia that holds long flexor tendons in
position. It converts the concave ant. surface
of carpus into an osteofascial tunnel called
carpal tunnel. It is attached to pisiform & FR

hook of hamate bones medially and to

tubercle of scaphoid & trapezium laterally.
 Upper limb anatomy

Extensor retinaculum is a thickening of

deep fascia that stretches across dorsum of
wrist & holds long extensor tendons in
ER
position. It converts the grooves on distal
end of radius & ulna into six separate
tunnels. It is attached to pisiform & hook
of hamate bones medially, & to distal end
of radius laterally.
 Upper limb anatomy

Interosseous membrane is a thin but strong

membrane uniting radius & ulna. It provides
attachment for neighboring muscles. Its lower
part is pierced by ant. interosseous vessels.
Anterior Interosseous
border border
Fascial Compartments of the Forearm:
The forearm is enclosed in a sheath of deep
Interosseous
fascia, which is attached to posterior border of the membrane
ulna. This fascial sheath, together with the
interosseous membrane divide the forearm into an
ant. & post. compartments, each having its own
muscles, nerves, and blood supply.
 Upper limb anatomy

It contains superficial & deep group of muscles.

Superficial group includes pronator teres,
flexor carpi radialis, palmaris longus, flexor Pronator
teres
carpi unlaris, & flexor digitorum superficialis. Flexor
carpi
All these muscles share the same origin radialis

which is the medial humeral epicondyle, since Palmaris

longus
they arise in a common tendon which is Flexor carpi
ulnaris
referred to as common flexor tendon. Flexor
digitorum
superficialis
 Upper limb anatomy

In addition pronator teres has an ulnar head pronator

(humeral)
which arises from med. side of coronoid F.C.R.,
process of ulna. Palmaris &
F.D.S.
Ulnar head of flexor carpi ulnaris arises pronator
from med. side of olecranon process & post. (ulnar)

border of ulna.
F.D.S.
Radial head of flexor digitorum (Radial
superficialis arises from oblique line on ant. head)
surface of shaft of radius.
 Upper limb anatomy

Humeral
Pronator teres is inserted into pronator tuberosity of head
radius. It is innervated by median n. It pronates &
flexes forearm at elbow joint.
Flexor carpi radialis passes beneath FR to be inserted Ulnar
head
into bases of 2nd & 3rd metacarpal bones. It is Pronator
innervated by median n. It flexes & abducts hand at teres

wrist joint.
Palmaris longus is often absent and when present it is
inserted into flexor retinaculum & palmar aponeurosis. Palmaris
It is innervated by median n. It flexes hand at wrist joint. longus
 Upper limb anatomy

Flexor carpi ulnaris is inserted into

pisiform bone & by mean of two
ligaments, pisohamate &
pisometacarpal, into hook of hamate & F.C.U.

base of 5th metacarpal bone

respectively. It is innervated by ulnar
pisohamate
nerve It flexes & adducts hand at wrist
Pisometa-
joint. carpal
 Upper limb anatomy

Flexor digitorum superficialis gives rise to four

tendons in lower part of forearm which enters the
hand by passing behind FR. On reaching proximal
phalanges each tendon divides into two slips which
then unite & the tendons again divide into two
slips which are inserted into sides of middle
phalanges. F.D.S.

Innervation median nerve. It flexes middle

phalanges & assists in flexing proximal phalanges
at metacarpophalangeal joints.
 Upper limb anatomy

Deep group of muscles includes flexor

pollicis longus, flexor digitorum profundus,
& pronator quadratus.

Flexor pollicis longus arises from middle

of ant. surface of shaft of radius & F.D.P.

adjoining interosseous membrane. It passes

under FR to be inserted into base of distal F.P.L.

phalanx of thumb. It is innervated by ant. P. Quadratus

interosseous nerve. It flexes distal phalanx
of thumb.
 Upper limb anatomy

Flexor digitorum profundus arises from

upper 3/4th of ant. & med. surfaces of
shaft of ulna & the adjoining part of
interosseous membrane.

It gives rise to four tendons in lower part of

forearm which enters the hand by passing
behind FR. beneath tendons of flexor
digitorum superficialis. The tendons are
inserted into bases of distal phalanges.
 Upper limb anatomy

The medial half of flexor digitorum profundus is

innervated by ulnar nerve. On the other hand the lateral
half is innervated by anterior interosseous branch of
median nerve.
It flexes the distal phalanges & assists in flexing middle
& proximal phalanges & flexion of the hand at wrist joint.
 Upper limb anatomy

Pronator quadratus arises from lower

1/4th of the anterior surface of shaft of ulna
to be inserted into lower quarter of
anterior surface of shaft of radius. It is
P. Quadratus
innervated by the anterior interosseous
nerve. It pronates forearm at the superior &
inferior radioulnar joints.
 Upper limb anatomy

Ulnar artery is the larger of two terminal

branches of brachial a. It begins in cubital
fossa at level of neck of radius & descends in C. I. A.
the ant. compartment of forearm under cover
Median n.
of superficial group of muscles.
Ulnar a.
In the lower part of the forearm, it becomes
Radial a.
superficial & lies between tendons of flexor
carpi ulnaris & flexor digitorum
superficialis.
Ulnar a.
 Upper limb anatomy

Then it enters palm in front of FR.

in company with ulnar nerve where
Sup. Palmar br.
it ends by forming superficial of radial

palmar arch by anastomosing with

superficial palmar branch of the Sup. Palmar
arch
radial artery. At wrist it lies just
lateral to pisiform & ulnar nerve.
 Upper limb anatomy

Branches: A.U.R.

1. Muscular branches. Common

2. Ant. & post. ulnar recurrent branches I.A.

A.I.A.
that share in the arterial anastomosis
around elbow joint.
3. Branches that takes part in the anastomosis
around the wrist.
4. Common interosseous artery which after
a brief course divides into ant. & post. P. Quadratus

interosseous arteries.
 Upper limb anatomy

Anterior interosseous artery is a small artery,

A.U.R.
which passes downward with anterior
interosseous nerve on the front of interosseous
membrane. At upper border of pronator A.I.A.
quadratus, it pierces interosseous membrane &
descends behind it to takes part in the
anastomosis around wrist joint. It gives off
muscular branches, nutrient branches to radius
& ulna & median artery to median nerve P. Quadratus
 Upper limb anatomy

Post. I.A. arises from common interosseous a. &

passes backward over upper border of
Recurrent
interosseous membrane to enter post. I.A.

compartment of forearm between supinator &

abductor pollicis longus & reach interval Supinator

between superficial & deep groups of muscles. It Abductor

ends by anastomosing with ant. Interosseous a. It pollicis
longus
gives off muscular branches & recurrent
Post. I. A.
interosseous artery which takes part in arterial
anastomosis around elbow joint.
 Upper limb anatomy

Radial artery is the smaller of the two Brachio-

radialis
terminal branches of brachial a. It begins
in cubital fossa & passes downward &
laterally beneath brachioradialis & C. I. A.

resting on deep muscles of forearm.

Median n.

In middle 1/3rd of its course, superficial

Ulnar a.
branch of radial nerve lies on its lateral
side. In lower part of forearm, it lies on Radial a.

anterior surface of radius & is covered

only by skin & fascia.
 Upper limb anatomy

At wrist tendon of brachioradialis lies lateral

to the artery while that of flexor carpi radialis
lies medial to it. The artery leaves forearm by
winding around the lateral aspect of wrist to Radial
reach dorsal surface of hand. recurrent
artery

Branches:
1. Muscular branches. Brachior
adialis
2. Radial recurrent branch.
3. Superficial palmar branch. Flexor
carpi
radialis
 Upper limb anatomy

Median nerve leaves cubital fossa by passing

between two heads of pronator teres. It runs
behind humeral head of that muscle and is
separated from ulnar artery by ulnar head of
same muscle.
It continues downward behind flexor digitorum
superficialis & rests posterior on profundus
muscle.
 Upper limb anatomy

At wrist it lies lat. to tendons of superficialis m. &

behind tendon of palmaris longus muscle. It enters
palm by passing behind FR.

Branches: Palmaris
longus
1. Muscular branches to pronator F.D.S.
teres, flexor carpi radialis, palmaris
longus & superficialis.
2. Articular branches to elbow.
3. Anterior interosseous nerve.
4. Palmar cutaneous branch.
 Upper limb anatomy

Ulnar nerve passes behind medial humeral

Ulnar
epicondyle and enters the anterior nerve
compartment of the forearm by passing
between the two heads of the flexor carpi
ulnaris. It then descends downward between
the flexor carpi ulnaris and the flexor
digitorum profundus.
 Upper limb anatomy

In lower 2/3rd of forearm, the ulnar artery

lies on the lateral side of the nerve. At the
wrist the nerve becomes superficial and lies
between tendons of flexor carpi ulnaris and
flexor digitorum superficialis. Ulnar nerve
enters the palm by passing in front of Ulnar nerve

Ulnar artery
flexor retinaculum. At the wrist also the
artery lies lateral to the nerve.
 Upper limb anatomy

Branches:
1. Muscular branches.
2. Articular branches to elbow joint.
3. Palmar cutaneous branch arises in middle of
forearm. It supplies skin over hypothenar muscles.
4. Dorsal cutaneous branch arises in distal 1/3rd of
forearm. It passes med. between tendon of flexor carpi
ulnaris & ulna reaching dorsum of hand where it is
distributed there.
 Upper limb anatomy

Compartment syndrome of forearm: as the forearm is

divided into several compartments by the interosseous
membrane & the fibrous inter-muscular septa, each
compartment has its own muscles, nerves, and blood
supply. Thus, there is very little space within each
compartment, & any edema can cause compression of
blood vessels.
 Upper limb anatomy

Early signs include altered skin sensation, pain, tenderness

of the skin over the compartment, and absence of capillary
refill in the nail beds.

Surgical intervention to decompress the affected

compartment by incising the skin & deep fascia over the
affected compartment.
Summary:
Flexor retinaculum hold long flexor tendons in position.
Extensor retinaculum holds long extensor tendon in
position.
Interosseous membrane joins the radius & ulna together.
Ant. compartment of forearm has two groups of muscles.
Median nerve supplies all muscles of ant. compartment
apart from med. half of profundus & flexor carpi ulnaris.
Arterial supply of ant. compartment achieved by ant.
interosseous artery.