Kaan Yücel M.D., Ph.D

1. ANTERIOR ASPECT OF THE FOREARM • & • CUBITAL FOSSA • IN 21 QUESTIONS • Kaan Yücel M.D., Ph.D • 10.January.2012 Tuesday

2. THE ANATOMY OF FOREARM IN 5 QUESTIONS INTRODUCTION

3. 1. What is the forearm? Part of the upper limb between the elbow joint and the wrist joint Elbow joint FOREARM Wrist joint

4. 2. ....passes between the arm & forearm ? Mostmajor structures(nerves,veins,arteries) via cubital fossa,anterior to elbow joint Exception ulnar nerve posterior to the medial epicondyle of humerus

5. 3. What are the parts of the forearm ? Anterior&posterior compartments Separated by: Lateralintermuscularseptum from the anterior border of the radius to deep fascia surrounding the limb Interosseous membrane links borders of the radius and ulna Attachmentof deep fascia along the posterior border of the ulna

6. 4. Which movements do the forearm muscles? Muscles in the anterior compartment Flex the wrist & digits Pronate the hand Muscles in the posterior compartment Extend the wrist & digits Supinate the hand

7. 5. ...the innervation of forearm muscles? The muscles of the anterior compartment Mainly by median nerve The one and a half exceptions by ulnar nerve The muscles of 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 11 QUESTIONS

9. 1. How are the anterior compartment muscles established? In3 layers Deep Intermediate Superficial

10. 2. ...the muscles of the superficial layer? Superficial layer flexor carpi radialis flexor carpi ulnaris palmaris longus pronator teres Medial epicondyle of humerus Pisiform

11. 3. ..the muscles of the intermediate and deep layers? Intermediate layer flexor digitorum superficialis Deep layer flexor digitorum profundus pronator quadratus flexor pollicis longus Middle phalanx - shaft Distal phalanx-base Distal phalanx -base

12. 4. ...functions of these muscles? Flexor digitorum superficialis Flexmetacarpophalangeal& proximal interphalangealjoints Flexor digitorum profundus Flex the distal phalanges of medial 4 fingers Flexor pollicis longus Flex the thumb Pronator teres Rotate radius over ulna during pronation Pronator quadratus Prime mover for pronation Flexor carpi ulnaris Flexes and adducts hand (at wrist) Flexor carpi radialis Flexes and abducts hand (at wrist) Palmaris longus Flexes hand (at wrist) and tenses palmar aponeurosis FLEXION OF THE HAND PRONATION

13. 5. ...innervation of these muscles? All the muscles by median nerve Except 1.5 muscles by ulnar nerve Flexor carpi ulnaris full Flexor digitorum profundus medial half part associated w/ring & little fingers

14. 6. How is the arterial supply of the anterior compartment? Inf. border of teres major Axillary artery Till where? Brachial artery Bracihal artery divides into Ulnar artery (medial) Radial artery (lateral) Neck of the radius

15. 7. 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.

16. 8. ...the median nerve in the anterior compartment? principal nerve no branches in the arm other than small twigs to the brachial artery. Its major branch in the forearm anterior interosseousnerve Leaves the cubital fossa by passing between 2 heads of the pronator teres and humero-ulnar and radial heads of the flexor digitorum superficialis.

17. 9. ...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 muscle Two small cutaneous branches; palmar branch & dorsal branch

18. 10. ....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

19. 11. What are the lateral and medial cutaneous nerves of the forearm? Lateral cutaneous nerve of the forearm continuation of the musculocutaneous nerve Medial cutaneous nerve of the forearm independent branch of the medial cord -brachial plexus Posterior cutanoues of the forearm (radial nerve)

20. THE ANATOMY OF CUBITAL FOSSA IN 5 QUESTIONS

21. 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.

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

23. 3. ...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

24. 4. ...the 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.

25. 5. ....nerves 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 pronator teres muscle. radial nervelies under brachioradialis (lateral margin of the fossa) gives off deep branch of the radial nerve and continues as superficial radial nerve.

26. Just can’t get enough by Deepeche Mode

27. PLEASE TEAM UP WITH YOUR Y-CAL TEAM MEMBERS DURING THE CLASS SIT WITH THEM YOU ARE WELCOMED TO SHOW THE TEAM SPIRIT SUCH AS BRINGING TEAM FLAGS/LOGOS WEARING THE SAME COLOUR! TO GAIN POINTS, THE TEAAM CAPTAIN SHOULD RAISE THE HAND AND SHOW THE ANSWER WRITTEN ON A PAPER!

28. CASE 3 5 PTS CASE 4 5 PTS