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The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
The antebrachium
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The antebrachium

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  • 1. The Antebrachium Maribel G. Castro, M.D. CPU College of Medicine
  • 2.  
  • 3.  
  • 4.  
  • 5. The Cubital Fossa <ul><li>A triangular hollow area on the anterior surface of the elbow </li></ul><ul><li>Boundaries: </li></ul><ul><ul><li>superior – imaginary line connecting the epicondyles </li></ul></ul><ul><ul><li>medial – pronator teres </li></ul></ul><ul><ul><li>lateral – brachioradialis </li></ul></ul><ul><li>Floor: brachialis and supinator muscles </li></ul><ul><li>Roof: deep fascia and bicipital aponeurosis </li></ul><ul><li> - covered by superficial fascia and skin </li></ul>
  • 6. The Cubital Fossa <ul><li>Contents: </li></ul><ul><li>Biceps tendon </li></ul><ul><li>Brachial artery and its terminal branches ( radial and ulnar arteries) </li></ul><ul><li>Brachial veins </li></ul><ul><li>Parts on the median and radial nerves </li></ul>
  • 7. Muscles in the Cubital Region <ul><li>1. Pronator teres – medial border </li></ul><ul><li>- has 2 heads of proximal attachment </li></ul><ul><li>- origin: medial epicondyle of humerus and conoid process of ulna </li></ul><ul><li>- insertion: middle of lateral surface of radius </li></ul><ul><li>- action: pronates the forearm and flexes it </li></ul><ul><li> assists the pronator quadratus during pronation and is a weak flexor of the forearm </li></ul>
  • 8. Muscles in the Cubital Region <ul><li>2. Brachioradialis – lateral border </li></ul><ul><li>- most superficial muscle on the radial side of the forearm </li></ul><ul><li>- origin: proximal 2/3 of supracondylar ridge of humerus </li></ul><ul><li>- insertion: lateral surface of distal end of radius </li></ul><ul><li>- action: flexes forearm especially when quick movement is required or when a weight is lifted during slow flexion of the forearm </li></ul>
  • 9. Muscles in the Cubital Region <ul><li>3. Supinator – floor </li></ul><ul><li>- lies deep in the cubital fossa </li></ul><ul><li>- humeral and ulnar heads of attachment envelope the neck and proximal part of the body of the radius </li></ul><ul><li>- origin: lateral epicondyle of humerus, radial collateral and annular ligaments, supinator fossa and crest of ulna </li></ul><ul><li>- insertion: lateral, posterior and anterior surfaces of proximal third of radius </li></ul><ul><li>- action: prime mover in supination of the forearm and hand </li></ul><ul><li>4. Brachialis - floor </li></ul>
  • 10.  
  • 11. Muscles of the Forearm <ul><li>A. Flexor/Volar/Anterior Surface </li></ul><ul><li>1. Superficial Group </li></ul><ul><li>a. pronator teres – prominent when the forearm is strongly flexed and pronated </li></ul><ul><li>b. flexor carpi radialis </li></ul><ul><li>- medial to the pronator teres </li></ul><ul><li>- origin: medial epicondyle of humerus </li></ul><ul><li>- insertion: base of 2 nd metacarpal bone </li></ul><ul><li>- action: flexes hand and abducts it </li></ul><ul><li>- in the middle of the forearm, its fleshy belly is replaced by a long, flattened tendon that becomes cordlike as it appraches the wrist </li></ul><ul><li>- tendon is a good guide to the radial artery which lies lateral to it </li></ul>
  • 12. <ul><li>c. palmaris longus </li></ul><ul><li>- small, fusiform muscle; is absent on one or both sides (usually the left) in about 14% of people, but its actions are not missed </li></ul><ul><li>- origin: medial epicondyle of humerus </li></ul><ul><li>- insertion: distal half of flexor retinaculum and palmar aponeurosis </li></ul><ul><li>- action: flexes hand and tightens palmar aponeurosis </li></ul><ul><li>- its tendon is a useful guide to the median nerve which passes lateral to it </li></ul><ul><li>d. flexor carpi ulnaris </li></ul><ul><li>- most medial of the superficial of the flexors </li></ul><ul><li>- has two heads b/n which the ulnar nerve passes </li></ul><ul><li>- origin: humeral head – medial epicondyle </li></ul><ul><li> ulnar head – olecranon and posterior border of ulna </li></ul><ul><li>- insertion: pisiform bone, hook of hamate bone and 5 th metacarpal bone </li></ul><ul><li>- action: flexes and adducts the the hand </li></ul><ul><li>- tendon is a good guide to the ulnar nerve and artery which are on its lateral side </li></ul>
  • 13.  
  • 14.  
  • 15. <ul><li>2. Intermediate Group </li></ul><ul><li>a. flexor digitorum superficialis/sublimis </li></ul><ul><li>- largest superficial muscle in the forearm </li></ul><ul><li>- has 2 heads; forms an intermediate layer b/n the superficial and deep groups </li></ul><ul><li>- the ulnar and median nerves and the ulnar artery pass deeply between the heads </li></ul><ul><li>- near the wrist, gives rise to 4 tendons which pass deep to the flexor retinaculum where they are surrounded by a common flexor synovial sheath </li></ul><ul><li>- origin: humeroulnar head – medial epicondyle of humerus, ulnar collateral ligament, coronoid process of ulna </li></ul><ul><li> radial head – superior half of anterior border of radius </li></ul><ul><li>- insertion: bodies of the medial 4 digits </li></ul><ul><li>- action: flexes middle phalanges of medial 4 digits; acting more strongly, flexes proximal phalanges and hand </li></ul>
  • 16.  
  • 17.  
  • 18. <ul><li>3. Deep Group </li></ul><ul><li>a. flexor digitorum profundus </li></ul><ul><li>- the only one that can flex the distal interphalangeal joints </li></ul><ul><li>- origin: proximal ¾ of medial and anterior surfaces of ulna and interosseous membrane </li></ul><ul><li>- insertion: bases of distal phalanges of medial 4 digits </li></ul><ul><li>- tendons pass posterior to the tendons of the flexor digitorum superficialis and the flexor retinaculum </li></ul><ul><li>- action: flexes the distal phalanges of the 2 nd to 5 th digits after the sublimis has flexed the middle phalanges </li></ul>
  • 19. <ul><li>b. flexor pollicis longus </li></ul><ul><li>- lies lateral to the flexor digitorum profundus where it clothes the anterior aspect of the radius </li></ul><ul><li>- passes deep to the flexor retinaculum, enveloped in its own synovial sheath </li></ul><ul><li>- origin: anterior surface of radius and adajcent interosseous membrane </li></ul><ul><li>- insertion: base of distal phalanx of thumb </li></ul><ul><li>- action: flexes distal phalanx of thumb and secondarily the proximal phalanx and 1 st metacarpal bone </li></ul><ul><li>- only muscle that flexes the interphalangeal joint of the thumb </li></ul><ul><li>- also flexes the metacarpophalangeal joint and carpometacarpal joints of the thumb </li></ul><ul><li>- assists in wrist flexion </li></ul>
  • 20. <ul><li>c. pronator quadratus </li></ul><ul><li>- quadrangular muscle </li></ul><ul><li>- deepest muscle in the anterior aspect of the forearm </li></ul><ul><li>- clothes the distal 4 th of the radius and ulna </li></ul><ul><li>- origin: distal 4 th of anterior surface of ulna </li></ul><ul><li>- insertion: distal 4 th of anterior surface of radius </li></ul><ul><li>- action: pronates forearm at the superior and inferior radioulnar joints </li></ul><ul><li>- prime mover in the pronation of the forearm </li></ul><ul><li>- initiates pronation and assisted by the pronator teres when more speed and power are needed </li></ul><ul><li>- deep fibers bind ulna and radius together </li></ul>
  • 21.  
  • 22.  
  • 23. Muscles of the Forearm <ul><li>B. Extensor/Dorsal/Posterior </li></ul><ul><li>1. Superficial Group </li></ul><ul><li>a. brachioradialis </li></ul><ul><li>b. extensor carpi radialis longus </li></ul><ul><li>- partially overlapped by the brachioradialis with which it is often blended </li></ul><ul><li>- origin: lateral supracondylar ridge of humerus </li></ul><ul><li>- insertion: base of 2 nd metacarpal bone </li></ul><ul><li>- action: extend and abduct the hand at the wrist joint </li></ul>
  • 24. <ul><li>c. extensor carpi radialis brevis </li></ul><ul><li>- origin: lateral epicondyle of the humerus </li></ul><ul><li>- insertion: base of 3 rd metacarpal bone </li></ul><ul><li>- action: extend and abduct hand at wrist joint </li></ul><ul><li>- act together with the extensor carpi radialis longus to steady the wrist during flexion of the medial 4 digits </li></ul><ul><li>d. extensor digitorum </li></ul><ul><li>- principal extensor of the medial 4 digits </li></ul><ul><li>- occupies much of the posterior surface of the forearm </li></ul><ul><li>- divides into 4 tendons proximal to the wrist which pass through a common synovial sheath, deep to the extensor retinaculum </li></ul><ul><li>- origin: lateral epicondyle of humerus </li></ul><ul><li>- insertion: extensor expansion of medial 4 digits </li></ul><ul><li>- action: extends medial 4 digits at MCP joints; extends hand at wrist joint; through its collateral reinforcements, extends the middle and distal phalanges </li></ul>
  • 25. <ul><li>e. extensor digiti minimi </li></ul><ul><li>- a partially detached part of the extensor digitorum </li></ul><ul><li>- its tendon runs through a separate compartment in the extensor retinaculum and then divides into 2 slips; the lateral one is joined to the tendon of the extensor digitorum </li></ul><ul><li>- origin: lateral epicondyle of humerus </li></ul><ul><li>- insertion: extensor expansion of 5 th digit </li></ul><ul><li>- action: extends digit 5 at MCP and IP joints; </li></ul>
  • 26. <ul><li>f. extensor carpi ulnaris </li></ul><ul><li>- has 2 heads </li></ul><ul><li>- its tendon runs in a groove between the head and styloid process of the ulna within a special compartment of the extensor retinaculum </li></ul><ul><li>- origin: lateral epicondyle of humerus and posterior border of ulna </li></ul><ul><li>- insertion: base of 5 th metacarpal </li></ul><ul><li>- action: extends and adducts hand at wrist joint </li></ul><ul><li>g. aconeus </li></ul><ul><li>* part of the triceps and does not actually belong to the posterior fascial compartment of the forearm, but for convenience and as is the custom , it is listed with it </li></ul>
  • 27.  
  • 28.  
  • 29.  
  • 30. <ul><li>2. Deep Group </li></ul><ul><li>- consists of 3 muscles that act on the thumb ( abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus) and the extensor indicis which help to extend the 2 nd digit </li></ul><ul><li>- anatomical snuff box </li></ul><ul><li>Boundaries: </li></ul><ul><li>- anterior - abductor pollicis longus and extensor pollicis brevis </li></ul><ul><li>- posterior - tendon of extensor pollicis longus </li></ul><ul><li>- floor – scaphoid and trapezium </li></ul><ul><li> * scaphoid – most frequently fractured carpal bone </li></ul><ul><li> - injury to this results in localized tenderness in the snuff box </li></ul>
  • 31. <ul><li>a.abductor pollicis longus </li></ul><ul><li>- lies just distal to the supinator muscle and is closely related to the extensor pollicis brevis </li></ul><ul><li>- origin: posterior surface of ulna and radius, and interosseous membrane </li></ul><ul><li>- insertion: base of 1 st metacarpal bone </li></ul><ul><li>- action: abducts thumb and extends it at carpometacarpal joint </li></ul><ul><li>- acts with the abductor pollicis brevis during abduction of the thumb and with the extensor pollicis during extension of this digit </li></ul><ul><li>- its tendon passes deep to the extensor retinaculum in a common synovial sheath with the tendon of the extensor pollicis brevis </li></ul>
  • 32. <ul><li>b. extensor pollicis brevis </li></ul><ul><li>- lies distal to the long abductor of the thumb and is partly covered with it </li></ul><ul><li>- origin: posterior surface of radius and interosseous membrane </li></ul><ul><li>- insertion: base of proximal phalanx of thumb </li></ul><ul><li>- action: extends proximal phalanx of thumb at at carpometacarpal joint </li></ul><ul><li>- helps to extend distal phalanx </li></ul><ul><li>- in continued action, it helps to extend the metacarpal bone of the thumb </li></ul><ul><li>- helps to extend and abduct hand </li></ul>
  • 33. <ul><li>c. extensor pollicis longus </li></ul><ul><li>- origin: posterior surface of middle third of ulna and interosseous membrane </li></ul><ul><li>- insertion: base of distal phalanx of thumb </li></ul><ul><li>- action: extends distal phalanx of thumb at MCP and IP joints </li></ul><ul><li>- adducts the extended thumb and rotates it laterally; can also abduct hand </li></ul><ul><li>d. extensor indicis </li></ul><ul><li>- lies medial and alongside the extensor pollicis longus </li></ul><ul><li>- origin: posterior surface of ulna and interosseous membrane </li></ul><ul><li>- insertion: extensor expansion of second digit </li></ul><ul><li>- action: extends digit 2 and helps to extend hand </li></ul><ul><li>- acting with extensor digitorum , it extends the finger at the proximal IP joint </li></ul><ul><li>e. supinator </li></ul>
  • 34.  
  • 35.  
  • 36.  
  • 37. Arteries <ul><li>radial artery – smaller </li></ul><ul><li>Brachial artery branch </li></ul><ul><li>ulnar artery </li></ul><ul><li>1. Radial artery </li></ul><ul><li>- trunk is not crossed by any muscle but the brachioradialis is lateral and overlaps it; flexor carpi radialis is medial in its distal 2/3 </li></ul><ul><li>- muscular branches supply muscles on the lateral side of the forearm </li></ul><ul><li>- gives off the radial recurrent artery (supplies brachioradialis and brachialis m., and the elbow joint) which anastomoses with the radial collateral artery, a branch of the profunda brachii </li></ul><ul><li>- at the wrist, covered only by superficial and deep fasciae and skin thus its pulsation can easily be felt </li></ul><ul><li>- crosses the floor of the snuff box and ends by completing the deep palmar arterial arch in conjunction with the ulnar artery </li></ul>
  • 38. <ul><li>1. radial artery cont…. </li></ul><ul><li>Branches </li></ul><ul><li>a. muscular branches </li></ul><ul><li>b. radial recurrent artery </li></ul><ul><li>c. superficial palmar branch </li></ul><ul><li>- arises at the distal end of the radius just proximal to the wrist </li></ul><ul><li>- supplies muscles of the thenar eminence </li></ul><ul><li>- anastomoses with the terminal part of the ulnar artery to form the superficial palmar arterial arch </li></ul>
  • 39. <ul><li>d. palmar carpal branch </li></ul><ul><li>- arises near the distal border of the pronator quadratus </li></ul><ul><li>- runs across the wrist deep to the flexor tendons where it anastomoses with the carpal branch of the ulnar artery and recurrent branches of the deep palmar arch to form the palmar carpal arch </li></ul><ul><li>e. dorsal carpal branch </li></ul><ul><li>- runs medially across the dorsal surface of the wrist, deep to the extensor tendons </li></ul><ul><li>- anastomoses with the dorsal carpal branch of the ulnar artery and with terminations of the anterior and posterior interosseous arteries to form the dorsal carpal arch </li></ul>
  • 40. <ul><li>2. ulnar artery </li></ul><ul><li>- begins near the neck of the radius, just medial to the biceps tendon </li></ul><ul><li>- in the forearm, passes deep to the fibrous arch of the flexor digitorum superficialis and crosses posterior to the median nerve </li></ul><ul><li>- in the distal 2/3 of the forearm , the ulnar artery lies lateral to the ulnar nerve </li></ul><ul><li>- leaves the forearm by passing superficial to the flexor retinaculum on the lateral side of the pisiform bone </li></ul><ul><li>- at the wrist, the ulnar artery and nerve lie lateral to the tendon of the flexor carpi ulnaris </li></ul><ul><li>- its pulse is not readily felt at the wrist because it is bridged by deep fascia ( the volar carpal ligament ) </li></ul>
  • 41. <ul><li>2. ulnar artery cont… </li></ul><ul><li>- branches supply medial muscles in the forearm and hand, the common flexor synovial sheath and the ulnar nerve </li></ul><ul><li>a. anterior ulnar recurrent a. </li></ul><ul><li>- arises just inferior to the elbow runs superiorly between the brachialis and pronator teres which it supplies </li></ul><ul><li>- anastomoses with the inferior ulnar collateral a . </li></ul><ul><li>b. posterior ulnar recurrent a. </li></ul><ul><li>- arises distal to the anterior ulnar recurrent a. </li></ul><ul><li>- anastomoses with the superior ulnar collateral a. </li></ul><ul><li>- takes part in the arterial anastomoses around the elbow </li></ul>
  • 42. <ul><li>c. common interosseous a. </li></ul><ul><li>- arises in the distal part of the cubital fossa and divides into anterior and posterior branches </li></ul><ul><li>1.) anterior interosseous artery </li></ul><ul><li>- passes distally on the interosseous membrane to the proximal border of the pronator quadratus </li></ul><ul><li>- pierces the membrane at the level of the pronator quadratus and continues distally to join the dorsal carpal arch </li></ul><ul><li>2.) posterior interosseous artery </li></ul><ul><li>- passes posteriorly b/n the bones of the forearm </li></ul><ul><li>- supplies adjacent muscles </li></ul><ul><li>- gives off the posterior interosseous recurrent a. which passes superiorly, posterior to the lateral epicondyle, and participates in the arterial anastomoses around the elbow </li></ul>
  • 43. <ul><li>d. muscular branches </li></ul><ul><li>- supply muscles on the medial side of the forearm, mainly the flexor-pronator group </li></ul><ul><li>e. palmar carpal branch </li></ul><ul><li>- small branch running across the anterior aspect of the wrist, deep to the tendons of the flexor digitorum profundus </li></ul><ul><li>- anastomoses with the palmar carpal branch of the radial artery </li></ul><ul><li>e. dorsal carpal branch </li></ul><ul><li>- arises just proximal to the pisiform bone </li></ul><ul><li>- passes across the dorsal surface of the wrist deep to the extensor tendons </li></ul><ul><li>- anastomoses with the dorsal carpal branch of the radial a. </li></ul>
  • 44. <ul><li>f. superficial branch </li></ul><ul><li>- continues into the palm as the superficial palmar arch </li></ul><ul><li>g. deep palmar branch </li></ul><ul><li>- passes deeply in the hand </li></ul><ul><li>- anastomoses with the radial artery and completes the deep palmar arch </li></ul>
  • 45.  
  • 46.  
  • 47. Nerves <ul><li>Median – principal nerve of the anterior fascial compartment </li></ul><ul><li>Ulnar </li></ul><ul><li>Radial – enters the posterior compartment </li></ul><ul><li>- Nerves of the anterior aspect of the forearm are only 2 in number: the median and ulnar </li></ul>
  • 48. <ul><li>1. Median Nerve </li></ul><ul><li>- enters the forearm with the brachial artery </li></ul><ul><li>- brachialis b/n 2 heads of pronator teres flexor digitorum superficialis flexor digitorum profundus </li></ul><ul><li> near the wrist becomes superficial b/n tendons of flexor digitorum superficialis and flexor carpi radialis, deep to the palmaris longus tendon </li></ul><ul><li>- has no branches in the arm </li></ul><ul><li>Branches </li></ul><ul><li>a. articular branches – elbow joint </li></ul><ul><li>b. muscular branches – pronator teres, pronator quadratus, and all flexors except flexor carpi ulnaris and the medial half of the flexor digitorum profundus (ulnar nerve) </li></ul>
  • 49. <ul><li>c. anterior interosseous nerve </li></ul><ul><li>- passes inferiorly on the interosseous membrane with the anterior interosseous branch of the ulnar artery </li></ul><ul><li>- runs b/n the flexor digitorum profundus and flexor pollicis longus muscles to reach the pronator quadratus; supplies these 3 muscles </li></ul><ul><li>- ends by sending articular branches to the wrist joint </li></ul><ul><li>d. palmar cutaneous branch </li></ul><ul><li>- supply the skin of the lateral part of the palm </li></ul>
  • 50. <ul><li>2. Ulnar Nerve </li></ul><ul><li>- passes posterior to the medial epicondyle b/n the 2 heads of the flexor carpi ulnaris descends deep to the flexor digitorum profundus (accompanies ulnar artery near the middle of the arm) medial side of ulnar artery and lateral side of flexor carpi ulnaris tendon distal part of forearm becomes realt6ively superficial covered only by fascia and skin pierces deep fascia and passes superficial to the flexor retinaculum with the ulnar artery, lateral to the pisiform between pisiform and hook of hamate ( canal of Guyon – covered by a slip of flexor retinaculum) </li></ul>
  • 51. <ul><li>Branches </li></ul><ul><li>a. articular branches </li></ul><ul><li> – elbow joint </li></ul><ul><li> - passes in the groove b/n the olecranon and medial epicondyle </li></ul><ul><li> b. muscular branches </li></ul><ul><li> – supply flexor carpi ulnaris and medial half of flexor digitorum profundus </li></ul><ul><li>c. palmar cutaneous branch </li></ul><ul><li>- arises from the ulnar nerve near the middle of the forearm and pierces the deep fascia in is distal third to supply skin on the medial part of palm </li></ul><ul><li>d. dorsal cutaneous branch </li></ul><ul><li>- arises from ulnar nerve in distal half of forearm and passes inferiorly b/n the ulna and flexor carpi ulnaris </li></ul><ul><li>- supplies posterior surface of medial part of hand </li></ul>
  • 52. <ul><li>3. Radial Nerve </li></ul><ul><li>- descends between brachialis and brachioradialis crosses anterior aspect of lateral epicondyle of humerus </li></ul><ul><li> enters forearm divides into superficial and deep branches </li></ul><ul><li>Branches </li></ul><ul><li>a. superficial branch </li></ul><ul><li>- smaller of the 2 branches </li></ul><ul><li>- direct continuation of the radial nerve </li></ul><ul><li>- supplies skin on the dorsum of the wirst, hand, thumb and lateral 1 ½ digits </li></ul>
  • 53. <ul><li>b. deep branch </li></ul><ul><li>- larger of the 2 terminal branches </li></ul><ul><li>- entirely muscular and articular in its distribution </li></ul><ul><li>- supplies extensor carpi radialis brevis, supinator </li></ul><ul><li>- pierces the supinator muscle and curving around the lateral side of the radius to enter the posterior fascial compartment of the forearm </li></ul><ul><li>- supplies extensor muscles </li></ul><ul><li>- posterior interosseous n. – accompanies posterior interosseous artery and supplies deep extensors </li></ul>
  • 54. Gud PM 

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