FOREARM
FOREARM
• Deep stratum muscles: arise from forearm bones and interosseous membrane
• NOTE the pronator / supinator muscles always arise from a stable bone: ulna or humerus (not
radius)
Brachioradialis:
• Extra muscle which used to belong to the extensor muscle group, and ∆ has radial nerve
innervation.
• Has migrated around to front of forearm to become a flexor of elbow (doesn’t reach
wrist).
• Arises from lateral epicondyle of the humerus.
• Inserts into the disal radius – radial styloid process
Pronator teres:
• Prontates forearm
• Also a weak flexor of elbow joint
• Arises almost completely from medial epicondyle of humerus
• Small number of fibres arise from coronoid process of ulna.
• Inserts into lateral side of radius.
• Innervated by median nerve
• Forms medial border of cubital fossa.
Flexor carpi radialis
• Flexes radial side of wrist
• Abducts the wrist
• Supplied by the median nerve.
• Arises from medial epicondyle of humerus
• Body of muscle gives rise to tendon in lower forearm; tendon passes over front of wrist
to insert into index metacarpal.
• Tendon is held in place on index metacarpal by fibrous band – flexor retinaculum.
• Flexor retinaculum is attached to carpal bones on either side – converting concavity of
the carpus into osseofascial tunnel.
• Flexor retinaculum also maintains concavity or carpal arch.
• Flexor carpi radialis tendon travels through tunnel on groove in trapezium to reach index
metacarpal.
• Deep fibres of the retinaculum create a private tunnel for the tendon in this groove.
FDS + FDP share common synovial sheath under flexor retinaculum
Nature of tendons travelling through osseofascial tunnels:
• Tendon is surrounded by 2 layers of synovial membrane, which are continuous (as in
synovial joint).
• Reduces friction.
• Inner membrane is closely applied to tendon.
• Outer membrane applied to tunnel wall.
• Layers are continuous proximally and distally – space created between them contains
film of lubricating synovial fluid.
Palmaris longus:
• Delicate muscle, absent in 15% population
• Weak flexor of wrist
• Arises from medial epicondyle of humerus
• Inserts into dense fasica of palm of hand (palmar aponeurosis)
• Travels over surface of the flexor retinaculum – I.e. doesn’t pass through the
osseofascial tunnel. ∆ no synovial sheath.
• Supplied by median nerve
• As the tendons pass over palmar surface of fingers, held in place by fibrous flexor
sheaths.
• Fibrous sheath is attached to the margins of the phalanges, and fuses with the distal
phalange.
• Fibrous flexor sheath froms an osseofascial tunnel along each digit, through which the
tendon passes.
• ∆ each tendon is once more surrounded by SM sheath.
• In the case of the little finger, this sheath is continuous with the sheath surrounding the
tendons in the osseofascial tunnel of the wrist.
• Synovial infection can occur if there is penetrating injury to the sunvial membranes in
the fingers. This infection can spread more widely if the damage is to the little finger.
Synovial membrane of little finger is continuous with the membrane surrounding the
tendons under the flexor retinaculum
CUBITAL FOSSA:
• Brachioradialis and pronator teres converge on one another.
• Intermuscular space between brachioradialis and pronator teres, in front of the elbow, is
called the cubital fossa.
• Triangle, bounded by:
o Brachioradialis
o Pronator teres
o Line drawn between humerus epicondyles.
DDEEEEPP SSTTRRAATTUUM
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• 3 muscles
• Muscles of the superficial stratum – except flexor carpi ulnaris – are supplied by the median
nerve.
• All the muscles of the deep stratum are supplied by a branch of the median nerve – anterior
interosseous nerve (FDP gets a contribution from ulnar nerve)
• Ulnar side if flexor digitorum profundus, also recieves supply from the ulna nerve.
Pronator quadratus:
• Action: pronates the forearm
• Origin: lower ¼ of ulna
• Insertion: passes obliquely to radius
• Innervation: anterior interosseous nerve
• Gives rise to 4 tendons which pass through the osseofascial tunnel in wrist.
• Share a common synovial sheath with the tendons of flexor digitorum superficialis.
• Tendons of the flexor digitorum profundus lie deep to those of the superficialis.
• Enter the fibrous flexor sheaths of the fingers deep to the superficialis tendons.
• Slip through the split superficialis tendon to insert into the terminal phalanges of the digits.
Summary:
• Flexors of the fingers & thumb:
o Flexor digitorum superficialis
o Flexor digitorum profundus
o Flexor pollicis longus
• Pronators of the forearm:
o Pronator teres
o Pronator quadratus
• Flexors of the wrist:
o Flexor carpi radialis (+ abductor)
o Flexor carpi ulnaris (+ adductor)
o Palmaris longus
SSHHO
ORRTT M
MUUSSCCLLEESS O
OFF FFIINNGGEERRSS AANNDD TTHHUUM
MBB
• Long muscles: arise in forearm (described above)
o Flexor digitorum superficialis
o Flexor digitorum profundus
o Flexor pollicis longus
• Short muscles: arise in hand itself.
Movements of hand:
• Interphalangeal joints (IP): flexion & extension
• Metacarpalphalangeal joints (MCP): flexion, extension, abduction, adduction
• Abduction & adduction are relative to midline of the hand – defined as passing through the
middle finger.
• Power grip:
o Thumb & thenar eminence on one side
o Fingers and palm on other side of object.
SHORT MUSCLES:
• Arise in palm
• Interosseous muscles: deeply place between metacarpals
• Lumbrical muscles: connect flexor + extensor tendons
• Thenar muscles: fleshy mass on palmar surface of thumb metacarpal
• Hypothenar muscles: fleshy mass on palmar surface of little finger metacarpal
Interosseous muscles:
• Arise from metacarpal bones
• Two sets:
o 4 dorsal muscles
o 4 palmar muscles
• Both supplied by ulnar nerve
Dorsal interossei:
Arise between adjacent metacarpals
Give way to tendons which pass deep to ligaments uniting metacarpal heads of index, middle
and ring fingers.
Tendons then pass onto dorsum of middle 3 fingers and insert into the extensor tendon of the
finger.
Palmar interossei:
Arise from palmar aspect of metacarpals
NOTE the middle finger metacarpal does not have palmar interossei (it doesn’t need an
adductor)
As with the dorsal interossei, they pass deep to the metacarpal ligaments and insert into the
extensor tendons on the dorsum of the thumb, index, ring and little fingers.
The 1st palmar interoseous (on thumb) is small.
o The adductor pollicis is superficial to the first dorsal and palmar interosseous muscles.
o Adductor pollicis is supplied by the ulnar nerve.
Thenar muscles:
o Grouped on palmar surface of first metacarpal (thumb) – giving the thenal eminence
o Composed of 3 muscles:
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
o All supplied by the median nerve.
o All 3 muscles blend into the same origin:
Lateral aspect of flexor retinaculum
Scaphoid
Trapezium
Hypothenar muscles:
o 3 muscles on the palmar surface of the little finger:
Abductor digiti minimi
Flexor digiti minimi
Opponens digiti minimi
o All supplied by the ulnar nerve
o All 3 muscles arise from a common origin of:
Pisiform
Hook of hamate
Medial end of flexor retinaculum
o Palmaris brevis is an additional small muscle which overlies the hypothenar muscles.
o Arises from flexor retinaculum
o Inserts into skin above ulnar border of palm
o Puckers the skin to deepen cup of palm
o Supplied by ulnar nerve
MOVEMENTS OF THE HAND:
o Functional division of the hand when holding an object is not the midline, but:
Thenar eminence and thumb on one side
Fingers, palm and hypothenar eminence on the other side.
o Thus for functional movements the terms abduction and adduction of the fingers becomes
useless.
o Instead, movements of the MCP joints should be described in terms of:
Radial deviation
Ulnar deviation
1) In going to grip something (e.g. walking with hand out to shake someones hand):
Fingers are swung together towards ulnar side of limb, at MCP joint – the fingers are
ulnar deviated at the MCP joint:
Interosseous muscles
Abductor digiti minimi
Thumb is swung towards radial side, at MCP joint – the thumb is radially deviated at the
MCP joint:
Abductor pollicis brevis.
2) Palm is cupped:
Opponens pollicis and opponens digiti minimi rotate the 1st and 5th metacarpals so that
the thumb is opposed and the palmar surface of thumb faces the palmar surface of the
fingers.
Palm is cupped.
3) ‘Power grip’:
Long flexors (flexor digitorum superficialis & profundus) curl thumb and fingers around
the object power grip.
o The same ulnar deviation of the fingers and radial deviation of the thumb can be seen in a
‘precision grip’, when the pad of the thumb is opposed to the pad of a single finger.
o Precision grip is combination of:
o Abduction
o Opposition
o The fingers act together, and the thumb acts on its own.
LUMBRICAL MUSCLES:
o 4 delicate muscles
o Arise from radial side of flexor digitorum profundus tendons in the palm
o First and second lumbricals = unipennate
o Second and third lumbricals = bipennate
o Pass around to the dorsum of the corresponding finger and insert into the extensor tendon
(extensor expansion) alond with the interossei tendons.
o I.e. they pass from palm to dorsum, from flexor to extenson tendons.
Palmar aponeurosis:
o Triangular in shape
o Apex is fused with fibres of the flexor retinaculum
o Tendon of the palmaris longus (superficial stratum of forearm musculature) inserts into the apex
of the palmar aponeurosis.
o Base of the aponeurosis divides into 4 fascial processes which insert into the fibrous sheaths
which cover the flexor tendons.