1. By: Dr Anita Rani Anatomy Lecture 7th November 2016
Forearm and Hand
By: Dr Anita Rani
Anatomy Lecture 7th November 2016

2. Lesson Plan Identify skeleton and joints
Muscles : attachments and location
Action of Muscles on joints
Nerves: course and branches
Arteries : course and branches
Fascia
Applied
Revision
Questions

3. Skeleton and Joints

4. Muscles: Forearm 8 Superficial : cross elbow 1.Pronator teres
2. Flexor carpi radialis
3. Palmaris longus
4. Flexor carpi ulnaris
9. Supinator
10. Brachioradialis
Intermediate
5. Flexor digitorum superficialis
Deep:
6. Flexor Pollicis Longus
7. Flexor digitorum Profundus
8. Pronator Quadratus

5. Muscles : Hand 20 Thenar muscles: 4 Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
Adductor pollicis
Lumbricals: 4 with tendons of FDP
Interossei:
Palmar 4
Dorsal 4
Hypothenar muscles: 4 Abductor Digiti minimi
Flexor digiti minimi Opponens digiti minimi
Palmaris brevis

6. Supinator

7. Pronator Quadratus

8. Flexor pollicis longus

9. Flexor Digitorum Profundus

10. Flexor digitorum superficialis

11. Pronator teres

12. Palmaris longus

13. Flexor carpi ulnaris & radialis

14. Brachioradialis

16. Thenar & Hypothenar muscles

17. Thenar & Hypothenar Muscles

18. lumbricals

19. Interossei
dorsal
palmar

20. Actions Elbow: Flexion : muscle crossing front of elbow BR, PT
FCR, FCU, PL, FDS

21. Actions
Radio-ulnar joints
Pronation: PT, PQ
Supination: Supinator

22. Actions at wrist joint Flexion: all muscles except…. Abduction: FCR
Adduction: FCU

23. Actions at carpometacarpal joints: Ist: Abduction: APB
Adduction: Adductor pollicis
Flexion: Flexor pollicis longus, flexor pollicis brevis
Opposition: opponens pollicis

24. Actions Metacarpo-phalangeal joints:
Flexion: FDS, FDP, lumbricals, PI and DI
Abduction: Dorsal interossei [ DAB]
Adduction: Palmar interossei [PAD]

25. Actions Inter-phalangeal joints: Flexion: Proximal: FDS Distal: FDP
Extension: Lumbricals, Dorsal and Palmar interossei

26. Nerves: Ulnar, Median and Radial

27. Nerves: Ulnar Elbow : lies behind medial epicondyle
Enters forearm by passing b/w 2 heads of FCU
In forearm runs b/w FDP and FDS
Enters palm by passing superficial to flexor retinaculum b/w pisiform and ulnar vs
Divides in to superficial and deep terminal branches

28. Ulnar nerve Contd…
Superficial branch supply Palmaris brevis and skin of medial 1 &1/2 fingers.
Deep branch passes backwards b/w flexor and abductor digiti minimi.
Runs in the concavity of deep palmar arch.
Ends by supplying adductor pollicis.

29. Ulnar Nerve

30. Ulnar nerve in Hand

31. Ulnar Nerve: branches/ supply
FCU
medial half of FDP
Palmaris brevis
3 hypothenar muscles
3rd and 4th lumbricals
All interossei
Adductor pollicis
Skin over hypothenar eminence.
Skin of volar aspect of 1 & ½ fingers
Skin of dorsum of hand and proximal parts of medial 2 & ½ fingers

32. Cutaneous innervation of Ulnar nerve

33. Median Nerve Main nerve of forearm
In cubital fossa lies medial to brachial artery
Enters forearm by passing between 2 heads of pronator teres
Separated from ulnar artery by deep head of pronator teres
Runs on the surface of FDP deep to FDS
5 cm above flexor retinaculum lies b/w FCR & FDS
Overlapped by the tendon of Palmaris longus

34. Median nerve

35. Nerves: Median
Enters the palm by passing deep to flexor retinaculum in carpal tunnel
Breaks into medial and lateral branch
Lateral branch gives off recurrent branch that curve around distal border of FR to supply thenar muscles & 3 digital branches
Medial branch gives out 2 digital branches

36. Median Nerve : branches/supply
Muscles: PT, FCR, PL, & FDS
Via anterior interosseous nerve:
FPL, PQ & radial half of FDP
Palmar cutaneous branch:
skin over thenar eminence & central part of palm
In Hand:
5 muscles: 3 thenar muscles and 2 lumbricals
skin of lateral 3 & ½ digits

37. Cutaneous innervation :Median nerve

38. Arteries of forearm and hand
Nerves: Median
Nerves: Median

39. Superficial and Deep Palmar Arches

40. Carpal Tunnel

41. Flexor Retinaculum

42. Palmar Aponeurosis and synovial sheaths of tendons

43. Ulnar nerve injury Which muscles are paralysed?
What do you understand by deformity?

44. Median nerve injury

45. Which of the following muscle of forearm helps in flexion at elbow?
a. flexor digitorum profundus
b. flexor pollicis longus
C. pronator quadratus
D. pronator teres

46. Which of the following nerve supplies skin over terminal phalanx of index finger?
Median nerve
Ulnar nerve
Radial nerve
Musculocutaneous nerve