St. Luke’s College of Medicine – William H.

Quasha Memorial
ANATOMY BLOCK 1

Lecture: 4 – Forearm and Hand Date: August 10, 2015

Lecturer: Marissa P. Roxas, MD., MHPEd. Trans Team: Matibag, Merino, Mijares, Miranda

Topic Outline  Has 4 tendons which insert to the middle phalanx of

nd th
I. Forearm the 4 medial fingers. (2 to 5 digits)
3. Deep Layer
A. Anterior Compartment
1. Superficial Layer  Flexor digitorum profundus
2. Intermediate Layer  Distal phalanx of 4 medial fingers.
3. Deep Layer  Tendon which flexes the index finger will detach from
B. Posterior Compartment the main muscle at the distal part of the forearm. This
allows independent movement of the index finger.
1. Muscles that extend and abduct / adduct the hand
 Flexor pollicis longus – flexor of the thumb
2. Muscles that extend the medial 4 digits  Pronator quadratus – quadrangular in shape.
3. Muscles that extend / abduct the first digit  Muscle which attaches to both the radius and ulna.
4. Brachioradialis
5. Supinator B. Posterior Compartment
C. Cubital Fossa
 These are divided according to their general function.
D. Arterial Supply 1. Extend and abduct/ adduct the hand
E. Venous drainage
 Extensor carpi radialis longus - extend and abduct hand
F. Nerve Supply
at the wrist joint, active during clenching of fist
II. Wrist and Hand
 Extensor carpi radialis brevis – extends and abducts
A. Function of the hand
hand at wrist
B. Fascia and other special structures of the wrist
 Extensor carpi ulnaris - extends and adducts hand at
C. Anatomical Snuffbox wrist joint (also active during fist clenching)
nd th
D. Intrinsic Muscles of the hand 2. Extend the medial 4 digits (2 to 5 digit)
E. Arteries and Nerves of the Hand  Extensor digitorum – also has 4 tendons which attach to
F. Clinical Application the 4 medial fingers (just like flexor digitorum muscles)
III. Reference  Extensor indicis – extensor of the index finger
IV. Review Questions  Extensor digiti minimi – part of the extensor digitorum
th
V. Quiz and extends the 5 digit.
3. Extend/ abduct the first digit
 Abductor pollicis longus
 Extensor pollicis longus
I. Forearm  Extensor pollicis brevis
 Distal unit of the upper limb 4. Brachioradialis – flexes the forearm, forms the lateral
 Extends from the elbow to the wrist and contains the two border of the cubital fossa, incapable of acting at the wrist,
bones, radius and ulna active during quick movements or in the presence of
 Assists the shoulder in the application of force and in resistance during flexion of the arm.
controlling the placement of the hand in space 5. Supinator – a deep muscle which puts the forearm at a
 Divided by a deep fascia called the antebrachial fascia supine position, rotates radius to turn palm anteriorly or
grouping it into posterior and anterior compartments with the superiorly (if the elbow is flexed)
interosseous membrane

Figure 2. Posterior Compartment of the Forearm

C. Cubital Fossa
 A space at the anterior face, between the arm and the
forearm that is quite triangular in shape.
 Boundaries:
 Lateral – brachioradialis
 Medial – pronator teres.
Figure 1. Anterior Compartment of the Forearm
 Superior – an imaginary line connecting the medial and
lateral epicondyles of the humerus.
A. Anterior Compartment
 Structures:
 Divided according to the muscular layers
 Median nerve
 Flexor – Pronator muscles
 Brachial artery – this is also where this branches off into
1. Superficial Layer
the ulnar and radial arteries.
 Flexor carpi ulnaris - most medial, flexes and adducts
 Tendon of the biceps brachii
the hand (at wrist area)  Radial nerve – this is where it splits into the superficial
 Flexor carpi radialis - flexes and abducts the hand (at (cutaneous) and deep (motor) branches.
wrist area) D. Arterial Supply:
 Palmaris longus - there is anatomic variation. There is a  Ulnar artery
percentage of the population which does not have this  Larger branch of the brachial artery
muscle. It has a short belly and a long tendon. The  Descends deep into the pronator teres
tendon is commonly mistaken for median nerve.  Ends by forming the superficial palmar arch.
 Radial artery
 Pronator Teres - puts the forearm at a prone position
 Smaller branch of the brachial artery
2. Intermediate Layer  Superficial on the distal part of the forearm – an optimal
 Flexor digitorum superficialis site for taking the radial pulse
 It is a very large muscle  Ends by forming the deep palmar arch

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 ANATOMY BLOCK 1

D. Intrinsic Muscles of the hand

E. Venous drainage:  They all originate in the hand
 Superficial veins of the forearm 1. Thenar muscles (thumb)
 Begin from the dorsal venous arch of the hand  Abductor pollicis brevis: short abductor of the thumb
 Cephalic  Flexor pollicis brevis: short flexor of the thumb, aids in
o More lateral major vein of the forearm the opposition of the thumb
o Communicate with the median cubital vein  Opponens pollicis: opposes the thumb (most important
o Drains to the axillary vein thumb movement)
 Basilic 2. Adductor compartment
o More dorsal major vein of the forearm  Adductor pollicis: moves the thumb towards the palm of
o Join veins which accompany the axillary artery (venae the hand, gives power to the grip
comitantes) 3. Hypothenar
 Abductor digiti minimi
F. Nerve Supply:  Flexor digiti minimi brevis
 originate from the nerves of the brachial plexus (except for  Opponens digiti minimi
the axillary and musculocutaneous nerves) 4. Lumbrical muscles (4)
 Median nerve  Worm-like form
o Does not supply any muscle in the arm  Flexes and extends the 2nd-5th digits
o Innervates all anterior compartments of the arm and 5. Dorsal interossei (4) – abduction of digits, (DAB)
forearm except for: 6. Palmar interossei (3) – adduction of digits, (PAD)
 Flexor carpi ulnaris
 Flexor digitorum profundus (Medial head)
o Supplies the:
 Pronator Teres
 Pronator quadratus
 Flexor digitorum superficialis
 Ulnar nerve
o Innervates the 2 muscles not innervated by the median
nerve
o Guyon canal
 Where ulnar nerve and artery passes
 Between pisiform and hook of hamate
 Radial nerve
o Splits into the superficial (cutaneous) and deep (motor)
branches
o Deep branch supplies:
 Posterior component of forearm

II. Wrist and Hand

 Wrist: located at the junction of the forearm and hand
 Hand: manual part of the upper limb distal to the forearm
A. Functions of the hand Figure 3. Intrinsic Muscles of the hand
 Power grip (palm grasp)
 Forcible motions of the digits acting against the palm E. Arterial Supply
 Involves long flexor muscle to the digits, intrinsic  Superficial palmar arch
muscles in the palm and extensors of the wrist  Deep palmar arch
 Hook grip  Digital arteries
 Posture used when carrying a briefcase F. Nerve supply
 Involves long flexors of the digits a. Median nerve
 Precision Handling grip  Enters the hand through the carpal tunnel
 Requires fine control of movements of the digits  Supplies two and a half thenar muscles and the 1st
 Involves the long flexor and extensor muscles and 2nd lumbricals
 Pinching b. Ulnar nerve
 Compression of something between the thumb and  Known as the "nerve of the fine movements" because
the index finger it innervates most of the intrinsic muscles concerned
with the intricate movement of hands
 Supplies hypothenar muscles, 3 and fourth
rd
B. Fascia and other special structures of the wrist
 Flexor retinaculum – anterior lumbricals, interossei muscles, adductor pollicis
 Carpal tunnel: c. Radial nerve
o Median nerve  No nerve supply in the hand
o Flexor tendons  Superficial branch of the radial nerve is entirely
o Radial artery sensory
o Ulnar artery and nerve
 Extensor retinaculum – posterior aspect of wrist G. Clinical Application
 Palmar aponeurosis – easy grip 1. Median nerve palsy – Carpal tunnel syndrome
 Fibrous digital sheaths – hold tendon and synovial flexor  Transverse Carpal Ligament constricts the median
sheaths nerve
 Synovial flexor sheaths – secrete synovial fluid  Thenar muscles may atrophy due to long standing
 Palmar fascial spaces compression
 Gradual numbness of fingers
C. Anatomical Snuffbox 2. Ulnar nerve palsy
 Boundaries: Tendons of the  Compression of nerve on hard surface (chair, table,
 Abductor pollicis longus etc.)
 Extensor pollicis brevis  Abduction and adduction by the interosseous muscles
diminished, then lost.
 Extensor pollicis longus
 Numbness and tingling in ulnar nerve distribution in
 Radial artery – pulse can also be felt here
hand. Interosseous muscle wasting between thumb
 The scaphoid and the hook of the trapezium forms the
and index finger.
floor.
 Numbness and tingling in little finger and medial half of
ring finger.
3. Radial nerve palsy – Saturday Night palsy
 Compression of nerve in axilla or upper arm in patient
sleeping with arm over chair back, edge of bed, etc.
 Wrist Drop

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III. References

th
Moore, 7 Ed.
 Doctor Roxas’ lecture and ppt

th
Netter, 6 Ed.

IV. QUIZ
1. What are the thick fascia surrounding the anterior and
posterior aspects of the wrist, respectively?
2. What are the two muscles not innervated by the median
nerve?
3. What is the space within which the ulnar artery and nerve
pass through at the wrist?
4. True or False: The whole dorsum of the hand is innervated
by the ulnar nerve.
5. What is the only muscle in the forearm which flexes the
forearm at the elbow?
a) Interossei ulnaris brevis c) Brachioradialis
b) Flexor antebrachius longus d) Biceps brachii

Answers:
1. Flexor and extensor retinaculum
2. Flexor carpi ulnaris and flexor digitorum profundus (medial
head)
3. Guyon canal
4. False, most is innervated by the radial nerve, particularly
th st
the lateral ½ of the 4 digit up to the 1 digit.
5. c.) Brachioradilais

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