GROSSANA: FOREARM • Innervation: Median nerve.

• Action: Flexion and abducts hand at the wrist.

Bones of the Forearm
3. Palmaris Longus
• Humerus (Lateral & Medial Epicondyles). • Origin: Medial epicondyle of the humerus.
• Ulna • Insertion: Palmar aponeurosis.
• Radius • Innervation: Median nerve.
• Action: Flexion of the wrist.
Contents of the Anterior Fascial Compartment of the
Forearm *Note: Palmaris Longus is absent in some individuals.

Superficial Group 4. Flexor Carpi Ulnaris

• Origin:
• Pronator Teres
a. Humeral head – Medial epicondyle of
• Flexor Carpi Radialis
the humerus.
• Palmaris Longus
b. Ulnar head – Medial aspect of
• Flexor Carpi Ulnaris olecranon process and posterior border
*Note: Muscles in the Anterior compartment are flexors of ulna.
and pronators, muscles in the Posterior compartment • Insertion: Pisiform bone, hook of hamate, base
are extensors and supinators. If located medially, they of 5th metacarpal bone.
are ulnar deviators or adductors, if lateral, they are • Innervation: Ulnar nerve.
radial deviators or abductors. • Action: Flexes and adducts hand at the wrist.

Intermediate Group *Note: Pisiform is in the proximal row, hamate is in the

distal row. Only muscle in the Anterior compartment
• Flexor Digitorum Superficialis innervated by the ulnar nerve.
Deep Group Intermediate Group (Anterior Fascial Compartment)
• Flexor Pollicis Longus 1. Flexor Digitorum Superficialis
• Flexor Digitorum Profundus • Origin:
• Pronator Quadratus a. Humeroulnar head – Medial epicondyle of
Blood Supply to the Muscles humerus, coronoid process of ulna.
b. Radial head – Oblique line on anterior
• Ulnar and Radial artery surface of shaft of radius.
• Insertion: Middle phalanx of index, middle, ring
*Note: Both are continuations of the brachial artery.
and little fingers (2nd, 3rd, 4th & 5th respectively).
Also provide blood to the wrist and hand. If the proximal
area of the artery is affected, then the distal is also • Innervation: Median nerve.
affected. If the distal area is affected, it does not affect • Action: Flexes the proximal interphalangeal
the proximal area. joint (PIP) metacarpophalangeal joint (MCP) and
wrist joint.
Nerve Supply to the Muscles
Deep Group (Anterior Fascial Compartment)
• All are supplied by the Median nerve except for the
1. Flexor Pollicis Longus
Flexor Carpi Ulnaris and the medial part of the
Flexor Digitorum Profundus • Origin: Anterior surface of shaft of radius.
• Insertion: Distal phalanx of thumb.
*Note: Median nerve passes through cubital fossa with • Innervation: Anterior interosseus branch of
the brachial artery, ulnar nerve passes through cubital median nerve.
tunnel. Muscles that pronate insert into the radius. • Action: Flexes distal phalanx of thumb.
Superficial Group (Anterior Fascial Compartment) *Note: Pollicis = thumb.
1. Pronator Teres 2. Flexor Digitorum Profundus
• Origin: • Origin: Anteromedial surface of shaft of ulna.
a. Humeral head – Medial epicondyle of • Insertion: Distal phalanges of index, middle,
the humerus. ring, and little fingers (2nd, 3rd, 4th, and 5th digits
b. Ulnar head – Medial border of coronoid respectively).
process of ulna. • Innervation:
• Insertion: Lateral aspect of shaft of radius. a. FDP inserted at 2nd and 3rd phalanx –
• Innervation: Median nerve. median nerve.
• Action: Pronation and flexion of the forearm. b. FDP inserted at 4th and 5th phalanx – ulnar
*Note: Primary action is where the insertion is, nerve.
secondary action is where the origin is. • Action: Flexes the Distal Interphalangeal Joint
(DIP), PIP, MCP and wrist joints.
2. Flexor Carpi Radialis 3. Pronator Quadratus
• Origin: Medial epicondyle of humerus. • Origin: Anterior surface of shaft of ulna.
• Insertion: Base of 2nd and 3rd metacarpal bones. • Insertion: Anterior surface of shaft of radius.
 • Innervation: Anterior interosseus branch of Deep Group (Posterior Fascial Compartment)
median nerve.
1. Supinator
• Action: Pronates the forearm.
• Origin: Lateral epicondyle of humerus, anular
Contents of the Posterior Fascial Compartment of the ligament of proximal radioulnar joint, and ulna.
Forearm • Insertion: Neck and shaft of radius.
• Innervation: Deep branch of radial nerve.
Superficial Group
• Action: Supination of forearm.
• Extensor Carpi Radialis Brevis
*Note: Muscles that have multiple origins are thicker,
• Extensor Digitorum Communis
and connect to other structures.
• Extensor Digiti Minimi
• Extensor Carpi Ulnaris 2. Abductor Pollicis Longus
• Anconeus • Origin: Posterior surface of shafts of radius.
• Insertion: Base of 1st metacarpal bone.
Deep Group
• Innervation: Deep branch of radial nerve.
• Supinator • Action: Abducts and extends the thumb.
• Abductor Pollicis Longus 3. Extensor Pollicis Brevis
• Extensor Pollicis Brevis • Origin: Posterior surface of shaft of radius.
• Extensor Pollicis Longus • Insertion: Base of proximal phalanx of thumb.
• Extensor Indicis Propius • Innervation: Deep branch of radial nerve.
• Action: Extends the MCP joint of the thumb.
*Note: Indicis = index finger. Longus = longer tendons. 4. Extensor Pollicis Longus
Brevis = shorter tendons.
• Origin: Posterior surface of shaft of ulna.
Blood Supply to the Muscles • Insertion: Base of distal phalanx of thumb.
• Innervation: Deep branch of radial nerve.
• Posterior and anterior interosseus arteries. • Action: Extends distal phalanx of thumb.
*Note: Still a branch of the brachial artery. 5. Extensor Indicis Propius
• Origin: Posterior surface of shaft of ulna.
Nerve Supply to the Muscles • Insertion: Extensor expansion oof index finger.
• Deep branch of the radial nerve. • Innervation: Deep branch of radial nerve.
• Action: Extends the MCP joint of the index
Superficial Group (Posterior Fascial Compartment) finger.
1. Extensor Carpi Radialis Brevis
• Origin: Lateral epicondyle of the humerus.
• Insertion: Posterior surface of base of 3rd Lateral Group (Lateral Fascial Compartment)
metacarpal bone. 1. Brachioradialis
• Innervation: Deep branch of radial nerve. • Origin: Lateral supracondylar ridge of humerus.
• Action: Extends and abducts hand at the wrist joint. • Insertion: Base of styloid process of radius.
2. Extensor Digitorum Communis • Innervation: Radial nerve.
• Origin: Lateral epicondyle of the humerus. • Action:
• Insertion: Middle and distal phalanges od 2nd, a. Flexes forearm at elbow joint.
3rd, 4th, and 5th digits. b. Rotates forearm to the midprone position.
• Innervation: Deep branch of radial nerve. 2. Extensor Carpi Radialis Longus
• Action: Extends the fingers and hand. • Origin: Lateral supracondylar ridge of humerus.
3. Extensor Digiti Minimi • Insertion: Posterior surface of base of 2nd
• Origin: Lateral epicondyle of the humerus. metacarpal bone.
• Insertion: Extensor expansion of little finger. • Innervation: Radial nerve.
• Innervation: Deep branch of radial nerve. • Action: Extends abducts hand at wrist joint.
• Action: Extends the MCP of little finger.
4. Extensor Carpi Ulnaris
• Origin: Lateral epicondyle of the humerus. Anatomical Spaces
• Insertion: Base of the 5th metacarpal bone.
• Innervation: Deep branch of radial nerve. Cubital Fossa
• Action: Extends and adducts hand at the wrist 1. Medially – pronator teres muscle.
joint. 2. Laterally – brachioradialis muscle.
3. Base – imaginary line drawn between the two
5. Anconeus epicondyles of the humerus.
• Origin: Lateral epicondyle of the humerus. 4. Floor – supinator muscle laterally, and brachialis
• Insertion: Lateral surface of olecranon process muscle medially.
of ulna. 5. Roof – skin and fascia.
• Innervation: Radial nerve.
• Action: Extends the elbow joint.
Contents of the Cubital Fossa (from medial to lateral) Basilic Vein

1. Median nerve. • Arises from the medial side of the dorsal venous
2. Bifurcation of Brachial artery into ulnar and radial arch of the hand.
arteries. • Winds around the medial border of the forearm
3. Tendon of biceps muscle. ascending to the cubital fossa.
4. Radial nerve and its deep branch. • From the cubital fossa, it goes medially to the
biceps of the arm.
Arterial Supply of the Forearm
• It then terminates by joining the venae comitantes
Ulnar Artery of the brachial artery to form the Axillary vein.

• Larger of the two terminal branches of the brachial *Note: Medial drainage is basilic, lateral drainage is
artery. cephalic.
• Lies deep to most of the flexor muscles of the
Medial Cubital Vein
forearm and continues in front of the flexor
retinaculum, just lateral to the pisiform. • Lies superficial to the bicipital aponeurosis at the
• The artery gives off a deep branch and then cubital fossa.
continues into the palm as the superficial palmar • In the cubital fossa, it connects the cephalic vein to
arch. the basilic vein.
• Crosses in front of the brachial artery and median
Branches of the Ulnar Artery
nerve.
1. Muscular branches.
Sensory Innervation:
2. Recurrent branches – take part in the arterial
anastomosis around the elbow joint.
3. Branches that take part in the arterial anastomosis
around the wrist joint.
4. Common interosseus artery – branches into
anterior and posterior interosseus arteries.

Radial Artery

• Smaller of the two terminal branches of the brachial

artery.
• Passes downward and laterally beneath the
brachioradialis muscle.
• Leaves the forearm by winding around the lateral Specific Nerve Injuries
aspect of the wrist to reach the posterior surface of Radial Nerve Injury
the hand and then continues into the palm as the
deep palmar arch. *Note: Same concept w/ arteries, if the proximal area is
affected then the distal area is affected as well.
Branches of the Radial Artery
1. At the level of the Axilla
1. Muscular branches. • Complete paralysis of all muscles innervated by
2. Nutrient branches to radius and ulna bones. the radial nerve.
3. Median artery to the median nerve. • Sensory loss radial nerve distribution from the
arm going to the fingers.
• Crutch palsy, and fracture/dislocation of the
upper end of the humerus.
2. At the spiral groove of the humerus
• Most frequent site of injury of the radial nerve.
• Fracture on midshaft of humerus.
• “Saturday night palsy” or “Honeymoon palsy”.
• “Wrist drop”.
• Sensory loss radial nerve distribution at the
*Note: 3 key veins: Cephalic, Basilic and Median Cubital wrist and hand.
vein. Median cubital vein is located in cubital fossa, 3. At the level of the elbow joint
where blood is taken from. • Injured due to trauma as it passes through the
supinator muscle.
Cephalic Vein
• Iatrogenic, surgery on the radial head.
• Arises from the lateral side of the dorsal venous • “Posterior interosseus nerve syndrome”.
arch of the hand. • Wrist drop – no.
• Winds around the lateral border of the forearm • Sensory loss – yes.
ascending to the cubital fossa.
*Note: Interosseus = pure motor nerve, no sensory
• From the cubital fossa, it goes anterolateral to the
innervation. Cutaneous = pure sensory nerve.
biceps muscle of the arm.
• It then terminates into the Axillary vein.
4. At the level of the wrist • Pain and loss of strength with gripping or repetitive
motion.
• Injured due to handcuffs or watchbands.
• Pure sensory deficit of the wrist and hand radial Fractures/Dislocations
nerve distribution.
• Compression Injuries.
Median Nerve Injury • Distraction Injuries.
• Nursemaid’s elbow/Pulled elbow.
1. At the upper arm
• Complete paralysis of all muscles innervated by *Note: Pulled elbow is most common in children, still
the median nerve. considered a distraction injury.
• “Ape hand” or “Simian hand” deformity.
Osteonecrosis/Avascular Necrosis
• Loss of pronation and decrease in flexion of the
hand at the wrist. • Panner’s Disease – osteonecrosis of the capitulum.
• Sensory loss median nerve distribution at the
hand. De Quervain’s Tenosynovitis
2. At the level of the elbow *Note: Inflammation of Abductor Pollicis Longus,
• Paralysis of pronator muscles of the forearm Extensor Pollicis Brevis and Extensor Pollicis Longus.
and the long flexor muscles of the wrist and
fingers EXCEPT: the FCU, and the medial side of • Commonly involves Abductor Pollicis Longus,
the FDP muscle whose insertion is at the ring Extensor Pollicis Brevis and Extensor Pollicis Longus.
and little fingers. • Pain near the styloid process of the radius, local
• Ape/Simian hand deformity. swelling.
• Sensory loss median nerve distribution at the • Pain upon thumb opposition with ulnar deviation.
hand. Osteoarthritis and Rheumatoid arthritis (OA/RA)
3. At the level of the wrist
• “Carpal Tunnel Syndrome”.
• Ape/Simian hand deformity.
• Palmar cutaneous branch of median nerve –
intact.
• Palmar digital branch of median nerve –
impaired.

Ulnar Nerve Injury

• Paralysis of the FCU, and the medial side of the FDP

muscle whose insertion is at the ring and little
fingers.
• Partial “claw hand” deformity.
• Sensory loss ulnar nerve distribution at the hand.
• “Guttering” – atrophy of the intrinsic hand muscles.

Musculocutaneous Nerve Injury

• Rarely happens.
• May affect the coracobrachialis, biceps, and
brachialis muscle.
• Sensory loss at the lateral forearm.
• Is there total loss of elbow flexion and supination? –
no.

Tennis Elbow (Lateral Epicondylitis)

• Overuse of elbow and hand, through activities that

involved repeated forced grasping and pronation-
supination.
• Partial rupture of the extensor tendons near their
origin from the lateral epicondyle.
• Pronation and supination of the forearm with
forceful elbow movement.
• Pain on lateral aspect of the elbow radiating down
the forearm.
• Tenderness over the lateral epicondyle.
• Weak grip.

Golfer’s Elbow (Medial Epicondylitis)

• Tenderness at medial epicondyle.