Level 2

Semester 2
Module (locomotor)
Anterior forearm
& cubital fossa
INSTRUCTOR INFORMATION
• Name: prof. Mona Hassan
• Department: Anatomy
• Office hours: Saturday
 Learning Outcomes
By the end of the lecture, the students will be able to:
Define compartments of the forearm.
Describe muscles of the anterior compartment of the forearm.
Describe vessels of the anterior compartment of the forearm.
Forearm is divided into two
compartments:
-Anterior (flexor)
compartment.
-Posterior (Extensor)
compartment.
 Contents

Muscles – 8muscles:-arrranged in two groups

–Superficial (Five)
--Deep (Three)

Vessels :Radial and Ulnar

Common interosseous branch of ulnar artery dividing into

Ant. & post. interosseous branches

Nerves : Median and Ulnar nerves

- Anterior interosseous branch of median nerve

MUSCLES OF FRONT OF FOREARM
• SUPERFICIAL GROUP (5)
From lateral to medial:
1. Pronator teres (PT)
2. Flexor carpi radialis (FCR)
3. Palmaris longus (PL) (may be absent)
4. Flexor digitorum superficialis FDS)
5. Flexor carpi ulnaris (FCU)
• DEEP GROUP (3)
1. Flexor pollicis longus (FPL)
2. Flexor digitorum profundus (FDP
3. Pronator quadratus (PQ)
 Pronator Teres

Origin
by Humeral (Superficial) And Ulnar (deep) Heads
Humeral Head

Ulnar Head
Medial border of coronoid process of ulna

Insertion
By a flat tendon to the middle of the lateral surface of Radius

N. Supply

Median nerve , before it pass b/w two heads

Action : Pronation of Forearm , Weak Flexor of Elbow
Flexor Carpi Radialis

Origin
• Medial epicondyle
• from adjoining deep fascia

Insertion
Palmer surface of base of second and third
metacarpal bones

Nerve supply
Median nerve

Action
Flexor of wrist
Along with ECRL & ECRB – abduction of wrist
Palmaris longus

Origin
Medial epicondyle of humerus
Course
Long tendon Nerve Supply
Passes in front of flexor retinaculum Median Nerve
Insertion Action
Continues as central part of Palmer aponeurosis Weak flexor of wrist
 Flexor Carpi Ulnaris

Origin
Two heads
Humeral head

Ulnar head
Medial margin of olecranon process and 2/3rd of
the post border of ulna

Insertion
To pisiform bone
through pisohammate and pisometacarpal l hook of
hamate and base of fifth metacarp
igaments
Nerve supply al bone
Ulnar nerve

Action
Flexor of wrist,along with ECU – adduction of wrist
wrist
Flexor digitorum Superficialis

Origin
Two heads

Humero-ulnar
Medial epicondyle of humerus and medial margin
of coronoid process

Radial head
Whole length of ant. Oblique line of radius
Course
Form four tendons above wrist
arranged in superficial (mostly
radial) and deep group of two each
Passes below fl. Retinaculum and
diverge in palm
Superficial – for middle and ring
finger
Deep – for index and ring finger

Nerve supply
Median nerve
Insertion
At base of proximal phalanx each digit tendon splits into two
Allow the passage of tendon of F. digitorum porofundus Slips
reunite again, and split again to be attached to
side of the shaft of middle phalanx

Action
Flexion of middle phalanx at proximal interphalangeal joint
In prolonged contraction – Flexion of metacarpophalangeal joint and wrist
joint
DEEP GROUP
• ALL MUSCLES ARE ATTACHED TO ANTERIOR SURFACE
OF SHAFT OF RADIUS AND/OR ULNA
 Deep Flexors

►Flexor Pollicis Longus

►Flexor Digitorum Profundus

►Pronator Quadratus
Flexor Poliicis Longus

Origin
Ant. Surface of shaft of radius below anterior oblique line
and adjoining Interosseous membrane Passes below Fl.
Retinaculum

Insertion
Palmer surface of base of distal phalanx of thumb

Nerve supply
Ant. Interosseous branch Of Median Nerve

Action
Flexor of Thumb
Flexor Digitorum Profundus

Origin

Ant. and Medial surface of upper 3/4th of shaft of ulna

Including medial surface of coronoid and olecranon

process

Adjoining Interosseous memb

And upper3/4th of post. border of ulna

 Course
Form four tendons

Remain united except the tendon for index

finger

Passes deep to flexor retinaculum Diverge in

palm

Passes in b/w slips of superficialis Give origin

to four lumbricals
Insertion
Palmer surface of base of terminal (distal) phalanx of medial four fingers

Nerve Supply
Medial part- Ulnar nerve
Latreral part - Ant. Interosseous branch Of Median Nerve

Action - Flexes terminal phalanx

In anatomy, a vinculum (pl. vincula) is a
band of connective tissue, similar to a
ligament, that connect a flexor tendon to a
phalanx bone. They contain tiny vessels
which supply blood to the tendon.[1] In
vertebrate anatomy, they are referred to as
mesotendons.
These vincula are four folds in the synovial
membrane
 Pronator Quadratus
Origin
Bony ridge on antero-medial surface of
lower1/4th of ulna

Insertion
Superficial fibres
Ant. Surface of lower 1/4th of radius and
adjoining anterior border of radius

Deep Fibres
Tiangular area just above the ulnar notch

Nerve Supply
Anterior Interosseous branch of Median Nerve
Action

Superficial fibres
principal pronators

Deep fibres
prevent separation of two bones on
thurst
Functional Classification of Flexor Muscles

Flexors of Wrist
•Fl. Carpi Radialis
•Fl. Carpi Ulnaris

Flexors of Middle Phalanges

•Fl. Digitorum Superficialis

Flexors of Distal Phalanges

•Fl. Digitorum Profundus
•Fl. Pollicis Longus

Pronator of the Forearm

•Pronator Teres
•Pronator Quadratus
NERVE SUPPLY
• ALL MUSCLES OF FRONT OF FOREARM ARE SUPPLIED BY MEDIAN
NERVE EXCEPT:
1. FCU ULNAR
2. MEDIAL HALF OF FDP NERVE
 The Ulnar Artery
 The larger of the two terminal branches of the
brachial artery.
 Begins in the cubital fossa at the level of neck
of radius.
 Descends through the anterior compartment of
the forearm.
 Enters the palm, in front of the flexor Ulnar artery
retinaculum, with the ulnar nerve.
 Ends by forming the superficial palmer arch, by
anastomosing with superficial palmer branch of
radial artery.
Superficial palmar
arch
 Ulnar Artery: Branches
 Muscular .
 Recurrent branch for anastomosis
around the elbow joint.
 Common interosseous artery, which
gives anterior and posterior
interosseous arteries.
 Branch to anastomoses around the
wrist joint.
 The Radial Artery
 The smaller of the two terminal
branches of the brachial artery.
 Begins in the cubital fossa at the level
of neck of radius.
 Descends downward and laterally.
Radial artery
 Leaves the forearm by winding
around the lateral aspect of the wrist
to reach the dorsum of the hand.
 Radial Artery: Branches

 Muscular
Recurrent branch for
anastomosis around the elbow
joint.
 Superficial palmar branch ,
joins the ulnar artery to form
the superficial palmar arch.
MEDIAN NERVE
In the cubital fossa it lies deep to the
bicipital aponeurosis.
It leaves the fossa between the 2 heads
of the pronator teres.
Then it descends between the flexor
digitorum superficialis & the flexor
digitorum profundus.
It passes to the palm deep or through
the carpal tunnel lateral to the tendon
of flexor digitorum superficialis, and
deep to the tendon of palmaris longus.

39
BRANCHES OF THE MEDIAN NERVE IN • Muscular: To
THE FOREARM • Pronator teres,
• Flexor carpi radialis,
• Palmaris longus,
• Flexor digitorum superficialis.
• Palmar cutaneous branch:
• It arises at the distal part of forearm.. It
descends superficial to flexor retinaculum to
supply skin of the lateral 2/3 of the palm.
• Articular: To elbow joint.
• Anterior interosseous nerve:
• Descends between flexor pollicis longus and
flexor digitorum profundus, anterior to the
interosseous membrane.
• It supplies : FPL+PQ+ lateral half of FDP.
• It gives an articular branches to wrist & distal
radioulnar joint.
40
 Median Nerve in the Forearm
• Median nerve passes into the
forearm anterior to elbow joint,
where branches innervate most of
the muscles in the anterior
compartment of the forearm
(except for the flexor carpi ulnaris
muscle and the medial half of the
flexor digitorum profundus, which
are innervated by the ulnar nerve).
ULNAR NERVE
in the Forearm

• It continues downward to enter the

forearm between the two heads of the
flexor carpi ulnaris.
• It runs down the forearm between FCU
and FDP.
• In the lower half of the forearm it lies
medial to the ulnar artery.

42
ULNAR NERVE in the Forearm • Branches:
• Muscular: To 1 ½ muscles.
• Flexor carpi ulnaris.
• Medial ½ of FDP
• Articular: To elbow joint.
• Dorsal or posterior cutaneous branch:
• To the dorsal surface medial 1/3rd of
the hand and 1½ fingers.
• Palmar cutaneous branch : to supply
skin of palm of hand.

43
 Radial nerve In the Forearm

•It pierces the Lateral

Intermuscular septum
•Descends in front of the Lateral
Epicondyle
•runs forward into the Cubital
Fossa
•Divides into Superficial & Deep
branches.
 Branches: Arising Close to Lateral Epicondyle

Muscular to:
1. Brachioradialis.
2. Extensor carpi radialis longus.
3. Brachialis.
Articular to: Elbow joint
 Superficial Branch
SUPERFICIAL BRANCH OF RADIAL NERVE

•It descends under cover of

Brachioradialis
•Lies lateral to radial artery.
•Emerges beneath the brachioradialis
tendon.
•Reaches the posterior surface of the
wrist, where it divides into terminal
branches
Cubital Fossa

The cubital fossa is a

triangular depression
on the anterior aspect
of the
elbow
Boundaries
• Base: line drawn through the two
epicondyles of humerus
• Laterally: brachioradialis
• Medially: pronator teres
• Roof: skin, superficial & deep fascia and
bicipital aponeurosis
• Floor: brachialis medially and supinator
laterally.
Contents of the Cubital Fossa
(From medial to lateral side)
THANK YOU