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ANTERIOR, POSTERIOR COMPARTMENTS & CUBITAL
FOSSA
Dr. Kumar K. V.
Associate Professor
26.10.2009
Biceps brachii• Origin: long head,
supraglenoid tubercle; short head, coracoid process
• Insertion: radial tuberosity• Action: supinator of forearm,
flexor of elbow joint, weak flexor of should joint
Pronator teres• Origin: medical epicondyle of
humerus and deep fascia of forearm
• Insertion: middle of lateral surface of radius
• Action: pronation of forearm and flexion of elbow
Muscles of arm• Antererior
group– Biceps brachii
Coracobrachialis
– Brachialis
• Posterior group – triceps brachii
Musculocutaneous n.
Median n.Medial brachial cutaneous n.
Medial antebrachial cutaneous n.
Superior ulnar coleteral a.
Deep brachial a.
Ulnar n.
Ulnar n.
Biceps
Median n.
Musculocutaneous n.
Median n.
Axillary a.
Brachial a.
Medial antebrachial cutaneous n.
Medial brachial cutaneous n.
Deep brachial a.
Superior ulnar coleteral a.& Ulnar n.
Inferior ulnar coleteral a.
• Musculocutaneous
Distribution: Biceps brachii, brachalis and coracobrachialis ‘BBC nerve’; skin on anterior aspect of forearm
Brachial artery• Continuation of axillary
artery• Divides into radial and
ulnar arteries at level of neck of radius
• Branches – Deep brachial a. -
accompanies with radial nerve
– Superior ulnar collaeral a.
– - accompanies with ulnar nerve
– Inferior ulnar collateral a.
Radial artery and branches • Radial recurrent a. • Superfical palmar branch• Principal artery of thumb
Ulnar artery and branches• Ulnar recurrent a. • Common interosseous artery
– Anterior interossous a. – Posterior interosseous a.
Deep palmar branch
Supraspinatus
Axillary nerve in the quadrangular space
Triceps muscles
Tendon of Triceps
Ulnar n.
Teres Major
Deltoid
Unconeus
POSTERIOR COMPARTMENT
OF ARM
Triceps brachii• Origin: long head,
infraglenoid tubercle; lateral head, above groove for radial n., medial head, below groove for radial n.
• Insertion: olecranon of ulna
• Action: extends elbow joint), long head can extend and adduct shoulder joint
• Radial Nerve in the Arm & Forearm– Distribution:
Extensor muscles of arm and forearm, brachioradialis; skin on back of arm, forearm, and radial side of dorsum of hand and radial two and one-half fingers
– Injury: Wristdrop
Joints of the Upper Extremity
• Elbow Joint– Synovial – hinge– Diarthrosis
• Articulations– Humerus & Ulna– Humerus & Radius
• Many Ligaments
Cubital fossaBoundaries • Base - line drawn
through epicondyles of humerus
• Apex - brachioradialis laterally and pronator teres medially
• Roof - skin, superficial fascia, deep fascia and aponeurosis of biceps
• Floor - brachialis, supinator and capsule of elbow joint
Contents from lateral to medial
• Biceps brachii tendon
• Brachial a.divides into radial and ulnar a.usually at apex of fossa
• Median n.
Lateral to the biceps brachii tendon,radial n. and lateral antebrachial cutaneous n.
• Basilic vein– Arises from the medial side
of the dorsal venous arch of hand
– Ascends on the ulnar side of forearm to the elbow and then in the medial bicepital brachii furrow to middle of the arm where it pierces the deep fascia and joins the brachial vein or axillary vein
• Median cubital vein links cephalic vein and basilic vein in the cubital fossa. It is a frequent site for venipuncture to remove a sample of blood or add fluid to the blood
Anterior Compartment Forearm
Flexor Carpi Radialis
Flexor Retinaculum
Medial Epicondyle
Flexor Digitorum Superficialis is deep to other flexors
Flexor Carpi Ulnaris
BrachioradialisPronator Teres
Anterior View
Muscles of forearm
• Superficial layer– Brachioradialis– Pronator teres– Flexor carpi radialis– Palmaris longus– Flexor carpi ulnaris
Muscolocutaneous n.
Brachial a.
Radial n.
Radial a.
Median n.
Common interosseous a.
Ulnar a., v. & n.
FOREARM VESSELS &NERVES
Radial recurrent a.
Radial a.
Radial n.
Median n.
Ulnar n.
Ulnar a.
Ulnar recurrent a.
Ulnar n.
Brachial a.
CUBITAL NERVES &ARTERIES
Superficial Layer:
(1) Pronator teres, (2) flexor carpi radialis, (3) palmaris longus, (4) flexor digitorum superficialis and (5) flexor carpi ulnaris.
Deep Layer:
(1) Flexor pollicis longus, (2) flexor digitorum profundus and (3) pronator quadratus.
Muscles of the Anterior Compartment of Muscles of the Anterior Compartment of the forearmthe forearm
Pronators of thePronators of theforearmforearm
Pronator teresOrigin:Origin:
Humeral head:Humeral head: from the medial epicondyle of the humerus from the medial epicondyle of the humerus (common flexor origin).(common flexor origin).Ulnar head:Ulnar head: from the medial border of the coronoid from the medial border of the coronoid process of the ulna.process of the ulna.
Insertion:Insertion:Into the pronator tuberosity on the lateral surface of the Into the pronator tuberosity on the lateral surface of the middle part of the shaft of the radius.middle part of the shaft of the radius.
Nerve Supply:Nerve Supply:From the median nerve.From the median nerve.
Action:Action:Pronation of the forearm at the radio-ulnar joints.Pronation of the forearm at the radio-ulnar joints.
Flexion of the forearm at the elbow jointFlexion of the forearm at the elbow joint..
Flexor carpi
radialis
Flexor digitorum superficialisFlexor digitorum superficialis Origin:Origin:
1.1. Humero-ulnar head:Humero-ulnar head: from the medial epicondyle of the from the medial epicondyle of the humerus (common flexor origin) and from the medial humerus (common flexor origin) and from the medial border of the coronoid process of the ulna.border of the coronoid process of the ulna.
2.2. Radial head:Radial head: from the oblique line on the anterior surface from the oblique line on the anterior surface of the shaft of the radius.of the shaft of the radius.
Insertion:Insertion:• Its tendon divides into 4 tendons which are inserted into Its tendon divides into 4 tendons which are inserted into
the sides of the middle phalanges of the medial 4 fingers.the sides of the middle phalanges of the medial 4 fingers. Nerve Supply:Nerve Supply:
• From the median nerve.From the median nerve. Action:Action:
1.1. Flexion of the proximal interphalageal joints and Flexion of the proximal interphalageal joints and metacarpophalangeal joints of the medial 4 fingers.metacarpophalangeal joints of the medial 4 fingers.
2.2. Helps of flexion of the hand at the wrist joint.Helps of flexion of the hand at the wrist joint.
Flexor digitorum profundusFlexor digitorum profundus Origin:Origin:
• From the upper ¾ of the anterior surface of the shaft of the ulna From the upper ¾ of the anterior surface of the shaft of the ulna and adjoining part of the interosseus membrane.and adjoining part of the interosseus membrane.
Insertion:Insertion:• The muscle divides into 4 tendons which pierce the tendons of The muscle divides into 4 tendons which pierce the tendons of
the flexor digitorum superficialis and are inserted into the bases the flexor digitorum superficialis and are inserted into the bases of the distal phalanges of the medial 4 fingers.of the distal phalanges of the medial 4 fingers.
Nerve Supply:Nerve Supply:• Its lateral half:Its lateral half: from the anterior interosseus nerve (branch of from the anterior interosseus nerve (branch of
the median nerve).the median nerve).• It medial half:It medial half: from the ulnar nerve. from the ulnar nerve.
Action:Action:1.1. Flexion of the distal interphalangeal joints of the medial 4 Flexion of the distal interphalangeal joints of the medial 4
fingers.fingers.2.2. Helps in flexion of the proximal interphalangeal joints and Helps in flexion of the proximal interphalangeal joints and
metacarpophalangeal joints of the medial 4 fingers.metacarpophalangeal joints of the medial 4 fingers.3.3. Helps of flexion of the hand at the wrist joint.Helps of flexion of the hand at the wrist joint.
BrachioradialisOrigin:
from the upper 2/3 of the lateral supracondylar ridge of the humerus.
Insertion:Into the base of the styloid process of the radius.
Nerve Supply:From the radial nerve.
Action:Flexion of the forearm (specially in midprone
position).Restoration of the forearm into the midprone
position.
Extensor Extensor CompartmentsCompartments
Of the Forearm &Of the Forearm &The HandThe Hand
Extensor digitorumOrigin:
from the lateral epicondyle of the humerus (common extensor origin).
Insertion:Into the extensor expansion of the medial 4
fingers.Nerve Supply:
From the deep branch of radial nerve.Action:
Extension of metacarpophalangeal and interphalangeal joints of the medial 4 fingers.
Extension of the hand at wrist joint.
SupinatorOrigin:Origin:
from (1) the lateral epicondyle of the humerus, (2) from (1) the lateral epicondyle of the humerus, (2) lateral collateral ligament of the elbow joint, (3) lateral collateral ligament of the elbow joint, (3) annular ligament of the superior radio-ulnar joint, annular ligament of the superior radio-ulnar joint, and (4) supinator fossa and crest of the ulna.and (4) supinator fossa and crest of the ulna.
Insertion:Insertion:
Into the upper 1/3 of the lateral surface of the shaft of Into the upper 1/3 of the lateral surface of the shaft of the radius.the radius.
Nerve Supply:Nerve Supply:
From the deep branch of the radial nerve.From the deep branch of the radial nerve.
Action:Action:
It helps the biceps in supination of the forearm at the It helps the biceps in supination of the forearm at the radio-ulnar joints.radio-ulnar joints.
Deep palmar fascia
Superficial layer• Thenar fascia• Hypothenar fascia• Palmar aponeurosis thick
triangular membrane
Deep layer palmar interosseous fascia
Palmar aponeurosis
Carpal TunnelFlexor retinaculum• Thickening of deep fascia in the
hand• Attached laterally to scaphoid and
trapeziun and medially to pisiform and hamate
Carpal tunnel Formed by flexor retinaculum and carpal groove
• Transmits– Median n.– Flexor digitorum superficialis and
flexor digitorum profundus enclosed by common flexor sheath
– Flexor pollicus longus enclosed by tendinous sheath of flexor pollicus longus
Flexar Retinaculum & related structures
Common flexor sheath
Tendinous sheath of flexor pollicis longus
Muscles of hand• Lateral group - thenar (4)
– Abductor pollicis brevis– Flexor pollicis brevis– Opponens pollicis– Adductor pollicis
• Action: flex, abduct, adduct and oppose thumb
• Medial group - hypothenar (3)– Abductor digiti minimi– Flexor digiti minimi
brevisOpponens digiti minimi– Action: flex, abduct , and
oppose little finger
Superficial palmar arch• Formed by ulnar artery
and superficial palmar branch of radial artery
• Curve of arch lies across the palm, level with the distal border of fully extended thumb
• Gives rise to three common palmar digital arteries each then divides into two proper palmar digital arteries
Superficial palmar a.
recurrent n.
Ulnar a.
Superficial Palmar Arterial Arch
Nerves, Vessels & Hand Muscles
Deep palmar arch• Formed by radial artery
and deep palmar branch of ulnar artery
• Curve of arch lies across upper part of palmar at level with proximal border of extended thumb
• Gives rise to three palmar metacarpal arteries
Intermedial group• Lumbricales (4) - flex
fingers at MP joints; extend fingers at IP joints
• Palmar interossei (3) - adduct fingers towards middle finger at MP joints
• Dorsal interossei (3) -abduct fingers away from middle finger at MP joints
Intrinsic Muscles of Hand
ABduction
Palmar Interossei
Lumbricals
ADDuction
1st
2nd
3rd
4th
Dorsal Interossei
Interossei help the lumbricals to extend IP joints and flex MC-P joints
Lumbricals & Nerves
Anatomical snuff box
• When the thumb is abducted and extended, a triangular hollow appears between the tendon of the extensor pollicis longs medially and the tendons of the extensor pollicis brevis and abductor pollicis longus laterally.
• The floor of the snuff box is the scaphoid and trapezium bones and crossed by the radial a..
Extensor Retinaculum & Dorsum of Hand
Dorsum of handExtensor retinaculum• Thickening of deep faxcia of
forearm a wrist
• Attached laterally to radius and medially to styloid process of ulna and triquetrum
• Forms six fibrous compartments for extensor tendons passing from forearm into hand:
• tendons of abductor pollicis longus and extensor pollicis brevis and their synovial sheaths;
• tendons of extensor carpi radialis longus and brevis and their synovial sheaths;
• tendon of pollicis longus and its synovial sheath;
• tendons of extensor digitorum, extensor indicis and their synovial sheaths;
• tendon of extensor digiti minimi and its synovial sheaths;
• tendon of extensor carpi ulnaris and its synovial sheaths
Fascia of the dorsal hand
• The superficial fascia• Deep fascia - the
dorsal fascia of hand– Superficial layer (dorsal
aponeurosis) – Deep layer (dorsal
interosseous fascia)
Two spaces• The dorsal subcutaneous space• The dorsal subaponeurotic space
Superficial fascia
Dorsal aponeurosis
Dorsal interosseous fascia
Dorsal subcutaneous space
Dorsal subaponeurotic space
Nerves of hand • Median n. - thenar except adductor pollicis, first two
lumbricals; skin of thenar, central part of palm, palmar aspect of radial three and one-half fingers, including middle and distal fingers on dorsum
• Ulnar n. - hypothenar muscles, interossei, 3rd and 4th lumbricals and adductor pollicis; skin of hypothenar, palmar surface of ulnar one and one-half fingers
• Radial n. skin of radial side of dorsum of hand and radial two and one-half fingers
Intrinsic Muscles of Hand
• Little finger– All digiti minimi Ulnar
(Flexor, Abductor, Opponens)
• Thumb– Abductor pollicis brevis Median– Flexor pollicis brevis Median– Opponens pollicis Median– Adductor pollicis Ulnar
• Other Intrinsic Muscles– Palmar + Dorsal Interossei Ulnar– Lumbricals Median, Ulnar
Muscle Nerve