FOREARM
AND
HAND
Dr.P.Praveen Kumar
BONES
Osteology cont…..
DEEP MUSCLES OF ANTERIOR
COMPARTMENT OF FOREARM
Muscles cont……
NERVE SUPPLY OF THE FOREARM
The nerves branch from the brachial plexus and travel through the arm to supply
the elbow and the forearm. Some of these nerves continue through the forearm to
supply the wrist and hand.
• Median nerve: This nerve starts from the brachial plexus and runs down
alongside the brachial artery. It descends into the cubital fossa. It gives off
branches that serve the elbow joint and continues down the anterior part of the
forearm and into the hand through the carpal tunnel.
• Ulnar nerve: This nerve starts from the brachial plexus, passes through the arm
medial to the brachial artery, continues posterior to the medial epicondyle of the
humerus, and enters the forearm. It travels along the medial part of the forearm
until it enters the hand at the wrist.
Nerves cont…..
• Radial nerve: This nerve starts from the brachial plexus and runs
posterior to the brachial artery and anterior to the long head of the
triceps. It curves around the shaft of the humerus and continues toward
the cubital fossa. From there it branches into the deep and superficial
branches and continues down the lateral part of the forearm to enter the
hand.
• Musculocutaneous nerve: This nerve runs from the brachial plexus
through the anterior part of the arm and becomes the lateral cutaneous
ULNAR NERVE
• Does not give rise to branches during passage through arm
• • Supplies one and a half muscles:
• flexor carpi ulnaris(FCU) and
• Ulnar part of FDP
• • Nerve and artery emerge from beneath FCU tendon and
become superficial to proximal wrist.
• • Pass superficial to flexor retinaculum
• • Enter hand through groove between pisiform and hook of
• hamate
• • Ulnar canal: formed by band of fibrous tissue from flexor
• retinaculum bridges the groove
BLOOD SUPPLY IN THE FOREARM
Arteries
• Arteries run from the shoulder down to the wrist with just a few branches
given off near the elbow. Superficial and deep veins return blood toward
the heart. Following is a brief overview:
• Brachial artery: This artery stems from the axillary artery. It runs along
the anterior part of the arm, enters the cubital fossa, and divides into the
radial and ulnar arteries
• Ulnar artery: This artery runs from the cubital fossa down the anterior
and medial portion of the forearm until it enters the wrist.
• Radial artery: This artery runs from the cubital fossa down the anterior
and lateral portion of the forearm until it enters the wrist.
Blood supply………
Veins
• Cephalic and basilic veins: These veins provide
superficial venous return.
• Brachial, radial, and ulnar veins: These veins are
deeper. They accompany the arteries of the same names.
Muscles cont…..
• Space of Parona.
This is a potential space between the pronator quadratus deep and the overlying flexor tendons of
the forearm that is continuous through the carpal tunnel with the medial central palmar space.
It is also known as the sub-tendinous space of the wrist
- Pus in tendinous sheath in the hand can ascend in the radial bursa and eventually rupture into this
space;
- pus in little finger sheath can ascend in ulnar bursae and rupture into this space of Parona;
- pus from thenar abscess or mid-palmar abscess may rupture into space of Parona.
-if pus from either the radial or ulnar bursae ruptures into Parona’s space, it can be drained by the
same incision used for releasing pus from the proximal end of the ulnar bursae.
Mucsle cont…..
3. Supracondylar Fractures
A supracondylar fracture of the humerus usually occurs by
falling on a flexed elbow. It is a transverse fracture, spanning
between the two epicondyles.
--The displaced fracture fragments may impinge and damage
the content of the cubital fossa.
--Direct damage, or post-fracture swelling can cause
interference to the blood supply of the forearm from
the brachial artery. The resulting ischaemia can
cause Volkmann’s ischaemic contracture – uncontrolled
flexion of the hand, as flexors muscles become fibrotic and
short.
--There also can be damage to the median or radial nerves.
MUSCLES OF HAND
TWO GROUPS
1.EXTRINSIC GROUP
.EXTRINSIC EXTENSORS
.EXTRINSIC FLEXORS
2.INTRINSIC GROUP
.THENAR MUSCLES
.HYPO THENAR MUSCLES
.LUMBRICALS
.INTEROSSEUS-PALMAR &DORSAL
Dorsal Extensor Expansion
It is formed by the union of the tendons of: Extensor digitorum,
Extensor indicis, extensor digiti minimi, palmar & dorsal interossei
and lumbricals muscles.
All these tendons unite to form one tendon which divides into 3 slips,
a median one attached to middle phalanges and 2 lateral attached to
the terminal phalanges.
