ANTERIOR ASPECT OF THE FOREARM & CUBITAL FOSSA

1. ANTERIOR ASPECT OF THE FOREARM & CUBITAL FOSSA • 26.December.2012 Wednesday Kaan Yücel M.D., Ph.D.

2. THE ANATOMY OF FOREARM IN 5 QUESTIONS INTRODUCTION

3. 1. Wheresis theforearm? between the elbow & wrist joints Elbowjoint • FOREARM Wristjoint

4. 2. Whichstructurespassbetweenthearm & forearm? • Most major structures(nerves,veins,arteries) • viacubital fossa,anterior to elbow joint • Exception ulnar nerve • posterior to the medial epicondyle of humerus

5. 3. How is forearmdivided? Anteriorcompartment Posteriorcompartment Lateralintermuscular septum from the anterior border of the radius to deep fascia surrounding the limb Interosseous membrane links borders of the radius and ulna Attachment of deep fascia along the posterior border of the ulna

6. 4. Movements of theforearmmuscles? • Muscles in theanteriorcompartment • Flexthewrist & digits • Pronatethehand • Muscles in theposteriorcompartment • Extendthewrist & digits • Supinatethehand

7. 5. Innervation of theforearmmuscles? Musclesof the anterior compartment Mainly by median nerve The one and a half exceptions by ulnar nerve Musclesof the posterior compartment All by radial nerve (directly or by its deep branch) Watch out, Median nerve @median plane of the forearm Ulnar nerve @ medial side

8. THE ANATOMY OF ANTERIOR ASPECT OF FOREARM IN 12 QUESTIONS

9. 1. Layers of anteriorcompartmentforearmmuscles? • SuperficialIntermediateDeep 3 muscles 4 muscles

10. 2. Muscles of thesuperficiallayer? flexorcarpiradialis flexorcarpiulnaris palmarislongus pronatorteres twoheads Ulnarhead Humeralhead Medialepicondyle

11. 2. Muscles of thesuperficiallayer? flexorcarpiradialis Medialepicondyle of humerus Base of metacarpals II & III • 2. flexorcarpiulnaris • Humeralhead: Medialepicondyle of humerus • Ulnarhead: Olecranon & Posterior border of ulna • •Pisiform& hamate • •5th metacarpal • 3. palmarislongus • Medialepicondyle of humerus • Flexor retinaculum &palmar aponeurosis • 4. pronatorteres • Humeralhead: Medialepicondyle& adjacentsupraepicondylarridge • Ulnarhead: Coronoidprocess • Lateral surface of radius

12. 3. Muscles of theintermediatelayer? 3. ..the muscles of the intermediate and deep layers? flexor digitorum superficialis Humeroulnarhead • Medial epicondyle of humerus • Adjacent margin of coronoid process Radialhead Superior half of anterior border Shafts of middle phalanges of medial four digits

13. 4. Muscles of thedeeplayer? 3. ..the muscles of the intermediate and deep layers? flexor pollicis longus flexor digitorum profundus pronator quadratus • Proximal¾ of medial& anteriorsurfaces of ulna • Interosseousmembrane • Anteriorsurface of radius • Adjacentinterosseousmembrane Distal ¼ of anterior surface of ulna Distal ¼ of anterior surface of radius Bases of distal phalanges of 4th &5th digits Bases of distal phalanges of 2nd &3rd digits Base of distal phalanx of thumb

14. 5. Fxns of theanteriorcompartmentmuscles Flexion of forearm @ theelbowjoint Pronator teres • Flexionof hand @ thewristjoint • Flexorcarpiradialis et ulnaris- Palmarislongus • Abduction (radialdeviation) of hand @ thewristjoint • Flexorcarpiradialis • Adduction (ulnardeviation) of hand @ thewristjoint • Flexorcarpiulnaris • Pronationof forearm • Pronator teres – Pronatorquadratus

15. 5. Fxns of theanteriorcompartmentmuscles Flexordigitorumsuperficialis • Flexesproximalinterphalangealjointsof theindex, middle, ring, & littlefingers • Flexesmetacarpophalangealjointsof thesamefingersandthewristjoint • Flexordigitorumprofundus • Flexesdistalphalanges4 & 5 at distalinterphalangealjoints • Flexes distal phalanges 2 and 3 at distal interphalangeal joints Flexorpollicislongus Flexesphalanges of thumb

16. 6. Innervation of theanteriorcompartmentmuscles • Allthemusclesbymediannerve • Except1.5 musclesbyulnarnerve • Flexorcarpiulnarisfull • Flexordigitorumprofundusmedialhalf • partassociated w/ring & littlefingers

17. 7. Arteries in theanteriorcompartment of theforearm Brachialartery

18. 8. Veins in theanteriorcompartment of theforearm deepvenouspalmararch in thehand

19. 9. Mediannerve • principalnerve • no branches in the arm other than small twigs to the brachial artery. • Its major branch in the forearm anterior interosseous nerve Leaves cubitalfossa by passing between 2 heads of pronator teres & humero-ulnar &radial heads of flexor digitorumsuperficialis

20. 10. Ulnarnerve Enterstheanteriorcompartmentbypassingposteriorly around medialepicondyle of humerus & betweenhumeral& ulnarheads of flexorcarpiulnarismuscle Two small cutaneous branches palmar branch & dorsal branch

21. 11. Radialnerve • motor andsensory • functionsin botharm & forearm • but onlysensoryfunctions in thehand • Superficial(sensory) • deep to brachioradialis • Deep(motor) • between two heads of supinator

22. 12. Lateral & medialcutaneousnerves of forearm Lateralcutaneousnerve of forearm Continuationof musculocutaneousnerve Medialcutaneousnerve of forearm Branch of medialcord of brachialplexus Posteriorcutaneousnerve of forearm Branch of radialnerve

23. THE ANATOMY OF CUBITAL FOSSA IN 4 QUESTIONS

24. 1. 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.

25. 2. What are the boundaries of the cubital fossa? • Superiorly imaginary line connecting medial &lateral epicondyles. • Mediallypronator teres. • Laterallybrachioradialis.

26. 3. Whatarethe 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

27. 3. Whatarethe contents of the cubital fossa? Superficially, in the subcutaneous tissue overlying the fossa median cubital vein, medial and lateral antebrachial cutaneous nerves basilic and cephalic veins.

28. 4. Whichnervesare in the cubital fossa? median nervelies immediately medial to the brachial artery and leaves the fossa by passing between the ulnar and humeral heads of the pronatorteres radial nervelies under brachioradialis (lateral margin of the fossa) gives off deep branch of the radial nerve and continues as superficial radial nerve.