GROSS: FOREARM Contents of the Anterior Fascial Compartment

Bones of the Forearm

- Radius
- Ulna Superficial
● Pronator Teres
● Flexor Carpi Radialis
● Palmaris Longus
● Flexor Carpi Ulnaris

Intermediate
Joints
● Flexor Digitorum Superficialis
Elbow:
● Humeroulnar Joint
● Humeroradial Joint

Forearm: Deep
● Proximal Radioulnar Joint ● Flexor Pollicis Longus
● Distal Radioulnar Joint ● Flexor Digitorum Profondus
● Pronator Quadratus
Blood Supply
● Radial Artery
● Ulnar Artery

Nerve Supply
● Median Nerve Nerve Supply
● Ulnar Nerve ● Deep Branch of Radial Nerve

All the muscles are supplied by the median nerve

and its branches, except the Flexor Carpi Ulnaris
and the medial part of the Flexor Digitorum
Profundus, which are supplied by the Ulnar nerve

Anatomical Spaces
Contents of the Posterior Fascial Compartment
of the Forearm
Superficial
● Extensor Carpi Radialis Brevis
● Extensor Digitorum Communis
● Extensor Digiti Minimi
● Extensor Carpi Ulnaris
● Anconeus*
Cubital Fossa
1. Medially - Pronator Teres
2. Laterally - Brachioradialis
3. Base - Imaginary Line drawn between the
two epicondyles of the humerus
4. Floor - Supinator muscle laterally, and
Brachialis muscle medially
5. Roof - Skiing and Fascia

Deep
● Supinator
● Abductor Pollicis Longus
● Extensor Pollicis Brevis
● Extensor Pollicis Longus
● Extensor Indicis Propius

Lateral
● Brachioradialis
● Extensor Carpi Radialis Long

Blood Supply
● Posterior and Anterior Interosseous Arteries
Contents of the Cubital Fossa (From Medial to ● Fracture on midshaft of humerus
Lateral) “Saturday Night Palsy” or
1. Median Nerve “Honeymoon palsy”
2. Bifurcation of Brachial Artery into Ulnar and ● “Wrist Drop”
Radial Arteries ● Sensory Loss Radial Nerve
3. Tendons of Biceps muscle distribution at the wrist and hand
4. Radial nerve and its deep branch ○ The lateral part of the
dorsum of the hand and on
the dorsal surface of the
roots of the lateral three and
a half fingers

3. At the level of the Elbow Joint

● Injured due to trauma as it passes
through the supinator muscle
● Iatrogenic, surgery on the raidal
head “Posterior Interosseus nerve
syndrome”
● Wrist Drop - No
● Sensory Loss - Yes
Sensory Innervation of the Upper Limb
4. At the level of the Wrist
● Injured due to handcuffs or
watchbands
● Pure sensory deficit of the wrist and
hand
● Radial nerve distribution
● NO Wrist Drop

Radial Nerve Injury

1. At the level of the Axilla

● Complete paralysis of all muscles
innervated by the Radial Nerve
● Sensory loss radial nerve distribution
from the arm going to the fingers
● Crutch palsy, and
fracture/dislocation of the upper end
of the humerus

Median Nerve Injury

1. At the Upper Arm

● Complete Paralysis of all muscles
innervated by the Median nerve
● “Ape Hand” or “Simian Hand”
deformity
● Loss of pronation and decrease
flexion of the hand at the wrist
● Sensory loss Median Nerve
distribution at the hand

2. At the Spiral Groove of the Humerus

● Most frequent site of injury of the
radial nerve
 2. At the level of the Elbow
● Paralysis of pronator muscles of the
forearm and the long flexor muscles
of the wrist and fingers EXCEPT: the
FCU, and the medial side of the FDP
muscles whose insertion is at the
ring and little fingers
● Ape/Simian hand deformity
● Sensory loss Median nerve
distribution at the hand
3. At the level of the wrist
● “Carpal Tunnel Syndrome”
● Ape/Simian Hand Deformity
● Palmar cutaneous branch of Median
Nerve - Intact
● Palmar DIgital Branch of Median
Nerve - Impaired
Musculocutaneous Nerve Injury
● Rarely Happens
○ Because it is protected position deep
to the biceps brachii muscles
● May Affect the coracobrachialis, Biceps,
and brachialis muscle
● Sensory loss at the lateral forearm
● Is there total loss of elbow flexion and
supination - NO
Tennis Elbow (Lateral Epicondylitis)
● Overuse of elbow and hand, through
activities that involved repeated forced
grasping and pronation-supination
● Partial Rupture of the extensor tendons
near their origin from the lateral epicondyle
prontation and supination of the forearm
with forceful elbow movement
● Pain on lateral aspect of the elbow radiating
down the forearm
● Tenderness over the lateral epicondyle
● Weak grip

Ulnar Nerve Injury

● Paralysis of the FCU, and the medial side of
the FDP muscle whose insertion is at the
ring and little fingers
● Partial “claw hand” deformity
● Sensory loss Ulnar nerve distribution at the
hand
● “Guttering” - Atrophy of the intrinsic hand
muscle

Golfer’s Elbow (Medial Epicondylitis)

● Tenderness at medial epicondyle
● Pain and loss of strength with gripping or
repetitive motion
Fracture/Dislocation
● Compression Injuries
● Distraction Injuries - Nursemaid’s
Elbow/Pulled Elbow

Osteonectrosis/Avascular Necrosis
● Panner’s Disease - Ostenoecrosis of the
capitulum
○ Decrease Blood Flow

De Quervain’s Tenosynovitis
● Commonly Involves
○ Abductor Pollicis Longs
○ Extensor Pollics Brevis
○ Extensor Pollics Longus
● Pain near the styloid process of the radius,
local swelling
● Pain upon thumb opposition with ulnar
deviation