FRONT OFFOREARM

Mrs vidya prashant

ANTERIOR (FLEXOR) COMPARTMENT

Superficial flexors

Five(5) in number

common origin -- medial epicondyle

Pronator Teres

Flexor Carpi Radialis

Palmaris Longus

Flexor Carpi UlnarisFlexor Digitorum Superficialis

Deep Flexors

3 in number

confined to radius and Ulna

Flexor Pollicis LongusFlexor Digitorum Profundus

Pronator Quadratus

Pronator Teres

Origin

Humeral Head :medial supracondylar ridgemedial epicondyle

Ulnar Head :medial border of coronoid process of ulna

Insertion : middle of lateral surface of radius

Nerve supply : median nerve

Action: pronation of forearmweak flexor of elbow joint

Action : Pronation of Forearm , Weak Flexor ofElbow

Origin : Medial epicondyle

Insertion : Palmer surface of base of 2nd & 3rd

metacarpal bones

Nerve supply :Median nerve

Action: Flexor of wristAlong with ECRL & ECRB – abduction of wrist

Flexor Carpi Radialis

Palmaris longus

Origin : medial epicondyle of humerus

insertion: continious as palmaraponeurosis in hand

Nerve supply : median nerve

Action: weak flexor of wrist

Flexor Carpi Ulnaris

OriginHumeral head :Medial epicondyle of humerus

Ulnar head: Medial margin of olecranon process

&2/3rd of the post border of ulna through

deep fascia

Insertion : Pisiform bone

Nerve supply: ulnar nerve

Action: flexor of wrist, along with ECU - adduction of wrist

Flexor Digitorum Superficialis(Sublimis)

OriginHumeral head :medial epicondyleUlnar head :medial margin of coronoid process of ulnaRadial head : anterior oblique line of radius

Insertion : gives 4 tendons for medial 4 fingers each tendon splits to enclose FDP ,inserted to the sides of shaft of middle phalanx of medial 4 fingers

Nerve supply : median nerve

Action: flexion of poximal interphalangeal joint

Flexor Digitorum Superficialis(Sublimis)

Flexor Digitorum Profundus

Origin :•Ant.& Medial surface of upper 3/4th of shaft of ulna,

• medial surface of coronoid & olecranon processes of ulna,

• posterior border of ulna through deep fascia,

• interosseous membrane.

Insertion: base of terminal phalanx of medial 4 fingers

Nerve supply:Medial part – ulnar nerveLateral part- anterior interosseous nerve branch of median

nerveAction: flexes distal interphalangeal joint

Pronator Quadratus

Origin : antero-medial surface of lower1/4th of ulna

Insertion: lower 1/4th of radius

Nerve supply: anterior interosseous branch of median nerve

Action: principal pronator of forearm

SPACE OF PARONAIt is a potential space deep to long flexor tendons of forearm, where the proximal part of synovial sheath of flexor tendon of hand extend

Infection may extend to space of parona fron the infected synovial sheaths of flexor tendons

Pus is drained by incision along border of forearm.

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

Flexor Retinaculum

Attachment

MediallyPisiformHook of Hamate

Laterally

Tubercle of ScaphoidCrest of Trapezium

STRUCTURES PASSING ABOVE THE FLEXOR RETINACULUM

Tendon of Palmaris longus

Palmer cutaneous branch of Median nerve

Palmer cutaneous branch of Ulnar nerve

Ulnar vessels

Ulnar nerve

STRUCTURES PASSING BELOW THE FLEXOR RETINACULUM

Median nerve

Tendon of flexor digitorum superficialis

Tendon of flexor digitoum profundus

• Tendon of flexor pollicis longus

•Radial bursa

•Ulnar bursa

RADIAL ARTERY

ORIGIN : at the level of neck of radius

COURSE : leaves the apex of cubital fossa

Overlapped by brachioradialis

Lies in between BR & FCR

extend to the styloid process of radius where the pulsation of artery is felt.

Branches : Radial Recurrent Artery –anastomosis wit radial collateral branch of profunda brachiPalmar & Dorsal Carpal branch – anastomosis wit corr. Carpal branch of ulnar artery

to form palmar & dorsal carpal arch Superficial Palmar branch – joins wit ulnar artery to form SUPERFICIAL PALMAR ARCHMuscular branches

ULNAR ARTERYOrigin: larger terminal branch of brachial artery ,arises abt 1cm below the bend of elbow

Course: lies deep to superficial flexor muscles

in lower 2/3rd of forearm , lies in bet. FCU & FDS runs along wit ulnar nerve medially

above the flexor retinaculum

In palm it lies on lateral side of pisiform bone ,

here it divides into SUPERFICIAL & DEEP BRANCH FORMS SUPERFICIAL & DEEP PALMAR ARCH

Branches:1.Anterior ulnar recurrent artery -anastomosis wit inferior ulnar collateral artery(brachial art.)

2.Posterior ulnar recurrent artery -with s.ulnar collateral & interosseous recurrent arteries

3.Common interosseous artery :

Anterior interosseous artery-descends in contact wit ant.surface of interosseousmembrane accompany by ant.interosseous nerve (median nerve),

anastomosis wit posterior interosseou artery &enters in the formation of dorsal carpal arch.

It gives descending branch before piercing interosseous memb. to join wit palmar carpal arch.

GIVES NUTRIENT BRANCH TO RADIUS & ULNA

Posterior interosseous artery: close to post. surface of interosseous membrane acc. by post.interosseousnerve( radial nerve). Joins wit AIA

Gives interosseous recurrent – anast. With middle collateral branch of profunda brachi

4.Palmar & dorsal carpal branch5.Muscular branch

Median nerve Course: pass inbet.heads of pronator teres

undersurface of FDS

Abt 5 cm above flexor retinaculum, it emerges from the lateral border of FDS

Lies bet. PL &FCR

Pass beneath the flexor retinaculum

Enters into the palmSupply: superficial group of flexor muscles (except FCU)BRANCHES: 1.Anterior interosseous nerve : deep group of flexor muscles (except medial half of FDP)2.Articular branch- elbow,sup.&inf.RU ,wrist joint3.Muscular branches4.Cutaneous branch –skin of thenar eminance5.Communicating branches- with ulnar nerve

ULNAR NERVE COURSE: enters forearm bet.2 heads of FCU

in upper half rest on FDP & covered by FCU

In lower half it runs lateral to FCU tendonAcc by ulnar artery laterally

Enters palm on lateral side of pisiform bone above the flexor retinaculum

Divides into SUPERFICIAL & DEEP TERMINAL BRANCH

Branches:1.Muscular branches- FCU & medial half of FDP2.Articular branch: elbow 3.Dorsal branch4.Palmar cutaneous branch

Thank u