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Kaan Ycel M.D., Ph.D10.January.2012 TuesdayANTERIOR ASPECT OF THE FOREARM & CUBITAL FOSSA1

IN 21 QUESTIONS

2THE ANATOMYOF FOREARMIN5 QUESTIONSINTRODUCTION31. What is the forearm?Part of the upper limb between the elbow joint and the wrist joint

Elbow jointWrist jointFOREARM42. ....passes between the arm & forearm ?Most major structures (nerves,veins,arteries)via cubital fossa, anterior to elbow joint

Exception ulnar nerveposterior to the medial epicondyle of humerus

5Anterior & posterior compartmentsSeparated by:

Lateral intermuscular septumfrom the anterior border of the radius to deep fascia surrounding the limb

Interosseous membranelinks borders of the radius and ulna

Attachment of deep fascia along the posterior border of the ulna3. What are the parts of the forearm ?

6Muscles in the anterior compartment Flex the wrist & digits Pronate the handMuscles in the posterior compartment Extend the wrist & digitsSupinate the hand

4. Which movements do the forearm muscles?

7The muscles of the anterior compartment Mainly by median nerveThe one and a half exceptions by ulnar nerve The muscles of the posterior compartment All by radial nerve (directly or by its deep branch)

5. ...the innervation of forearm muscles?

Watch out, Median nerve @median plane of the forearmUlnar nerve @ medial side 8THE ANATOMYOF ANTERIOR ASPECT OF FOREARMIN11 QUESTIONS91. How are the anterior compartment muscles established?In 3 layers

SuperficialDeep

Intermediate102. ...the muscles of the superficial layer?Superficial layerflexor carpi radialisflexor carpi ulnarispalmaris longuspronator teres

Medial epicondyleof humerus

Pisiform113. ..the muscles of the intermediate and deep layers?flexor digitorum superficialis

Intermediate layerDeep layer

flexor digitorum profundus

flexor pollicis longus

pronator quadratus

Distal phalanx-baseDistal phalanx-base

Middle phalanx- shaft124. ...functions of these muscles?Flexor digitorum superficialisFlex metacarpophalangeal & proximal interphalangeal joints Flexor digitorum profundusFlex the distal phalanges of medial 4 fingersFlexor pollicis longusFlex the thumbPronator teresRotate radius over ulna during pronationPronator quadratus Prime mover for pronationFlexor carpi ulnarisFlexes and adducts hand (at wrist)

Flexor carpi radialisFlexes and abducts hand (at wrist)Palmaris longusFlexes hand (at wrist) and tenses palmar aponeurosis FLEXION OF THE HANDPRONATION135. ...innervation of these muscles?All the muscles by median nerveExcept 1.5 muscles by ulnar nerveFlexor carpi ulnaris fullFlexor digitorum profundus medial half part associated w/ring & little fingers

146. How is the arterial supply of the anterior compartment?Inf. border of teres major

Axillary arteryTill where?

Brachial artery

Neck of the radiusBracihal artery divides intoUlnar artery (medial)Radial artery (lateral)

157. Which veins do you see in the anterior compartment?(Paired) Deep veins accompanying veins plentiful in the forearm.arise from the anastomosing deep venous palmar arch in the hand.

drain into brachial veins in the cubital fossa.

168. ...the median nerve in the anterior compartment?principal nerveno branches in the arm other than small twigs to the brachial artery. Its major branch in the forearm anterior interosseous nerve

Leaves the cubital fossa by passing between 2 heads of the pronator teres and humero-ulnar and radial heads of the flexor digitorum superficialis.

179. ...the ulnar nerve in the anterior compartment?

Enters the anterior compartment by passing posteriorly around medial epicondyle of humerus and between humeral and ulnar heads of flexor carpi ulnaris muscleTwo small cutaneous branches; palmar branch & dorsal branch 1810. ....the radial nerve in the anterior compartment?motor and sensory functions in both arm & forearm (but only sensory functions in the hand) in the forearm Superficial (sensory)deep to brachioradialis deep (motor)between two heads of supinator

1911. What are the lateral and medial cutaneous nerves of the forearm?Lateral cutaneous nerve of the forearmcontinuation of the musculocutaneous nerve

Medial cutaneous nerve of the forearmindependent branch of the medial cord -brachial plexus

Posterior cutanoues of the forearm (radial nerve)

20THE ANATOMYIN5 QUESTIONSOF CUBITAL FOSSA211. What is the cubital fossa?An important area of transition between the arm and the forearm. seen superficially as a depression on the anterior aspect of the elbow.

Deeply, it is a space filled with a variable amount of fat anterior to the most distal part of the humerus and the elbow joint.

222. What are the boundaries of the cubital fossa?Superiorly imaginary line connecting medial &lateral epicondyles.Medially pronator teres.Laterally brachioradialis.

233. ...the contents of the cubital fossa?

1) Terminal part of the brachial artery,radial and ulnar arteries

2) Biceps brachii tendon

3) Median nerve

4) Radial nerve

5) (Deep) accompanying veins of the arteries

244. ...the contents of the cubital fossa?Superficially, in the subcutaneous tissue overlying the fossa median cubital vein, medial and lateral antebrachial cutaneous nervesbasilic and cephalic veins.

255. ....nerves in the cubital fossa?median nerve lies immediately medial to the brachial artery and leaves the fossa by passing between the ulnar and humeral heads of the pronator teres muscle. radial nerve lies under brachioradialis (lateral margin of the fossa)

gives off deep branch of the radial nerve and continues as superficial radial nerve.

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