8. anatomy of forearm and wrist.ppt1

8/20/2019 8. Anatomy of Forearm and Wrist.ppt1

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ObjectivesObjectives

• SkeletonSkeleton

• anatomical land marks,anatomical land marks,• cutaneous nerves,cutaneous nerves,

• dermatomesdermatomes

•superficial veinssuperficial veins

• lymphaticslymphatics

• compartments andcompartments and

the structures in themthe structures in them

• Space of Parona.Space of Parona.

• structures in thestructures in the

region of wrist region of wrist • carpal tunnelcarpal tunnel

•Eg.s of clinical aspects.Eg.s of clinical aspects.


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Bounderies of cubitalfossa:

Cubital fossa merges the arm toforearm.

Contents.


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Skeleton- adius ulna and interosseousadius ulna and interosseous

membranemembrane

!natomical"surface land marks!natomical"surface land marks# $edial and lateral epicond%les$edial and lateral epicond%les

# OlecrenonOlecrenon

# &ead of radius&ead of radius# Subcutaneous border of ulnaSubcutaneous border of ulna

# 'o(er ends of radius and ulna'o(er ends of radius and ulna

# St%loid processes of radius and ulnaSt%loid processes of radius and ulna

# )orsal tubercle of radius)orsal tubercle of radius

# *isible and palpable tendons.*isible and palpable tendons.


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$edial+ lateral ,$edial+ lateral ,

posterior cutaneous nerves of forearm.posterior cutaneous nerves of forearm.

!nterior vie(Posterior vie(

Cutaneous nervesCutaneous nerves of forearm--of forearm--


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)ermatomes of)ermatomes of

forearmforearm

C5


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SupercialSupercial

veinsveins

Cephalic veinCephalic vein

Basilic veinBasilic vein

Supercial forearm veinsSupercial forearm veins

$edian cubital.v$edian cubital.v

$edian cephalic.v$edian cephalic.v$edian basilic.v$edian basilic.v

Peripheral intravenousPeripheral intravenous

access.access.

rom dorsal venousarch


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Supercial l%mphatics follo( the supercialveins/

- medial side- go to

supratrochlear " epitrochlear

nodes and then to the lateralgroup of a0illar% nodes

- 'ateral side - go to

infraclavicular nodes


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Compartments of the forearm:Compartments of the forearm:

• le0or 1anterior2 compartment+le0or 1anterior2 compartment+

• 30tensor 1posterior2 compartment30tensor 1posterior2 compartment


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le0or compartment/

Superfcial Muscles:1. Pronator teres, M.N2. Flexor carpi radialis,M.N3. Palmaris longus, M.N4. Flexor digitorum-superficialis, M.N5. Flexor carpi ulnaris.U.N

4 and 5 6 C7 8

9+ and 7 6 C8 ;


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Supercial muscles arises from -Supercial muscles arises from -

-$edial epicond%le of humerus6common lnaris -- ulna.


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Supercial muscles - origin andSupercial muscles - origin and

insertioninsertion


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Deep musclesDeep muscles..

le0or digitorumle0or digitorum

profundus-profundus-

le0or pollicisle0or pollicis

longus+longus+

Pronator ?uadratus+Pronator ?uadratus+

Flexor compartment-


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le0or digitorum profundus-le0or digitorum profundus-

le0or pollicis longus+le0or pollicis longus+

Pronator ?uadratus+Pronator ?uadratus+

Origin and insertion of deepof deep

muscles:muscles:

! n t e r i o r a s p

e c t


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Deep muscles ; nerveDeep muscles ; nerve

supply supply

4.4.le0or digitorum profundus+le0or digitorum profundus+

medial part - ----medial part - ----

>lnar.@>lnar.@

lateral part# anteriorlateral part# anteriorinterosseous .@ interosseous .@

5. le0or pollicis longus+5. le0or pollicis longus+

anterior interosseous.@anterior interosseous.@

9. Pronator ?uadratus+9. Pronator ?uadratus+

anterior [email protected] interosseous.@.


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!ction of muscles of


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@erves of


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-- branches tobranches to supercial muscles+supercial muscles+

-- aanterior interosseous branch to

-deep muscles1e0cept medial part of


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Branches of ulnar nerve in the forearm.

- muscular branches toto


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Blood vessels in theBlood vessels in the anterioranterior

compartmentcompartment ..-adial.!->lnar.!-!nterior interosseus. !-$edian arter%1persistant part of a0ialarter% of fetal limb2.

*enae comitantes of radialand ulnar arteries join toform venae comitantes of

brachial arter%.)eep)eep l%mphatics travell%mphatics travel

along the deep blood vesselalong the deep blood vessel

and go to lateral group ofand go to lateral group of

a0illar% nodes.a0illar% nodes.


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!nterior interosseous atrer% supplies

anterior compartment .


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Space of ParonaSpace of Parona

supercial to the pronator ?uadratus+supercial to the pronator ?uadratus+

deep to the long


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uscles:uscles:

30tensor carpi radialis30tensor carpi radialislongus+longus+

30tensor carpi radialis brevis+ 30tensor carpi radialis brevis+

30tensor digitorum+ 30tensor digitorum+

30tensor digiti minimi+ 30tensor digiti minimi+

30tensor carpi ulnaris+ 30tensor carpi ulnaris+ !nconeus.!nconeus.

30tensor 1Posterior2 compartment of forear


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Supinator+Supinator+

!bductor pollicis!bductor pollicis

longus+longus+

30tensor pollicis30tensor pollicislongus+longus+

30tensor pollicis30tensor pollicis

brevis+brevis+

30tensor indicis.30tensor indicis.


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Supercial e0tensors arise from/Supercial e0tensors arise from/

--

common e0tensor origin oncommon e0tensor origin onlateral epicond%le of thelateral epicond%le of the

humarushumarus

- some muscles are also- some muscles are alsoattached toattached to

humerus! radius and ulna.humerus! radius and ulna.


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30tensor compartment muscles # origin and30tensor compartment muscles # origin and

insertioninsertion


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Aendons Aendons go to the handgo to the hand

under under

the extensorthe extensor retinaculum.retinaculum.


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=ndividual and combination actions=ndividual and combination actions

30tensors are essential for po(er of grip.30tensors are essential for po(er of grip.

Brachioradialis+Brachioradialis+

30t.carpi radialis30t.carpi radialis

longus+longus+

30t.carpi radialis30t.carpi radialisbrevis+brevis+

30tensor digitorum+ 30tensor digitorum+

30tensor digiti minimi+ 30tensor digiti minimi+

30tensor carpi ulnaris+ 30tensor carpi ulnaris+

!nconeus+!nconeus+

Supinator+Supinator+

!bductor pollicis!bductor pollicis

longus+longus+


longus+longus+


brevis+brevis+


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otor innervation:otor innervation:

-- adialadial nerve supplies 1main nerve2/nerve supplies 1main nerve2/ . Brachioradialis+. Brachioradialis+

. 30t.carpi radialis longus.. 30t.carpi radialis longus.

- @erve to medial head of triceps 1given o in- @erve to medial head of triceps 1given o in

spiralspiral

groove2groove2 supplies anconeus. #supplies anconeus. #

Posterior interosseous .@Posterior interosseous .@ "#ranch of radial"#ranch of radialnerve$nerve$. supplies rest of the muscles of the. supplies rest of the muscles of the

posterior compartment of the forearm.posterior compartment of the forearm.


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%adial .N%adial .N and Branchesand Branches

in the forearm/ in the forearm/

- posterior interosseous .@- posterior interosseous .@

1deep branch21deep branch2

- articular branches to- articular branches to

radio-ulnar jointradio-ulnar joint

- radial nerve continues asradial nerve continues assupercial branch tosupercial branch to

the dorsum of the hand.the dorsum of the hand.


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Blood suppl% to e0tensorBlood suppl% to e0tensor

compartmentcompartmentPosterior interosseous arter%---Posterior interosseous arter%---

suppliessuppliesupper 5"9upper 5"9rdsrds

!nterior interosseous arter%---!nterior interosseous arter%---

suppliessupplies

lo(er 4"9lo(er 4"9rdrd..


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%egion of the &rist%egion of the &rist

-Carpal tunnel/-Carpal tunnel/

anterior aspectanterior aspect

-30tensor tendons/-30tensor tendons/

dorsal aspectdorsal aspect

-!natomical snu-!natomical snu

bo0/bo0/

Between forearm and hand.


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Carpal tunnelCarpal tunnelSpace bet(eenSpace bet(een


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Structures passing through the carpal tunnel/the carpal tunnel/

-$edian nerve+-$edian nerve+

- Aendons of: Aendons of: . le0or digitorum supercialis+. le0or digitorum supercialis+

. le0or digitorum profundus+. le0or digitorum profundus+

. le0or pollicis longus.. le0or pollicis longus.


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Structures passing through the roof of carpal tunnel/Structures passing through the roof of carpal tunnel/

-Ahe tendon of


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Structures passing on the roof of the carpalStructures passing on the roof of the carpal

tunnel/tunnel/ Aendon of palmaris longus+ Aendon of palmaris longus+

Palmar cutaneous branch of median nerve+Palmar cutaneous branch of median nerve+

Supercial branch of radial arter%.Supercial branch of radial arter%.

>lnar arter%+>lnar arter%+

Supercial veins+Supercial veins+


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!rterial blood suppl% in the region of the (rist!rterial blood suppl% in the region of the (rist

!nterior and posterior!nterior and posterior carpal arterialcarpal arterial

arches.arches.

Ahe carpal branches of radial+ ulnar+ and anterior interosseous Ahe carpal branches of radial+ ulnar+ and anterior interosseous

arteriesarteries

Ahe carpal arches communicate (ith dorsal metacarpal Ahe carpal arches communicate (ith dorsal metacarpal

arteries.arteries.

*eins- mainl% via deep veins.*eins- mainl% via deep veins.


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Six compartments of ext. retinaculumSix compartments of ext. retinaculum+ lateral to+ lateral tomedial:medial:

!bductor pollicis longus+!bductor pollicis longus+

30tensor pollicis brevis. 430tensor pollicis brevis. 4stst

30t.carpi radialis longus30t.carpi radialis longus

30t.carpi radialis brevis. 530t.carpi radialis brevis. 5ndnd

30t.pollicis longus 930t.pollicis longus 9rdrd

30t.digitorum30t.digitorum

30t.indicis 30t.indicis thth

30t.digitiminimi 30t.digitiminimi thth

30t.carpi ulnaris. 730t.carpi ulnaris. 7thth

' i l ( #' t i l ( # h l lth l t l


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BBounderies:ounderies:

'ateral+'ateral+ - abductor pollicis- abductor pollicis

longus.longus.

- e0tensor pollicis- e0tensor pollicis

brevis+brevis+

$edial+$edial+

- e0tensor pollicis- e0tensor pollicis

longus.longus.

'natomical snu( #ox'natomical snu( #ox- on the lateral- on the lateral

aspectaspect

loorloor

- base of 4st metacarpal- base of 4st metacarpal- scaphoid+scaphoid+- trapeEiumtrapeEium

- st%loid process of- st%loid process of

radius.radius.


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adial arter% passes on the


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%oof %oof of anatomical snu bo0: - fascia and- fascia and

skin.skin.

Passing in the supercial fascia of the roof--

- cephalic vein

- cutaneous branch of radial nerve.


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Clinical aspectsClinical aspects

)eformities at the)eformities at the

(rist(rist

- $anus varus 6 Frist is 0ed in adduction+- $anus varus 6 Frist is 0ed in adduction+

- $anus valgus 6 Frist is 0ed in abduction+- $anus valgus 6 Frist is 0ed in abduction+

- C%stic s(elling of s%novial sheath--- C%stic s(elling of s%novial sheath--

ganglionganglion- Frist dropFrist drop )) )amage to)amage to

- radial nerve- radial nerve

- posterior interosseous nerve.- posterior interosseous nerve.

- =njur% to an% structure.- 30tention of hand infections into ParonaGsspace 3tc.


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)inner fork deformit% 6 )isplaced fracture at (rist.)inner fork deformit% 6 )isplaced fracture at (rist.


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8. anatomy of forearm and wrist.ppt1

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