Gambayan, Angela Bianca A.
Section C2
ASSIGNMENT NO. 6
ANTERIOR FOREARM (Ulno-volar surface):
CUBITAL FOSSA and PALMAR SURFACE OF THE HAND
LABORATORY PROCEDURE
I. Study of models or pre-dissected forearm
A. Borrow model or pre-dissected forearm from the technician. Examine the
anterior forearm. Identify the superficial nerves and blood vessels over the
lateral and medial aspects of the forearm if still intact in the pre-dissected
forearm.
B. In models or pre-dissected forearm identify the following muscles: from lateral
to medial pronator teres, flexor carpi radialis, palmaris longus, and flexor carpi
ulnaris.
C. In models of the hand identify the palmar aponeurosis and muscles over the
thenar and hypothenar areas.
D. In pre-dissected forearm lift or reflect the superficial muscles and identify the
deeper muscles, the flexor digitorum supeficialis, and flexor digitorum
profundus and flexor pollicis longus and pronator quadratus.
II. Study of bones and wrist joint
A. Examine the wrist joint. Identify the articulating bones.
III. Dissection;
A. Examine the anterior forearm. Palpate the lateral and medial epicondyles
proximally and the styloid process and head of the ulna distally.
B. Make a circumferential skin incision about 1 cm above the epicondyles or if
the arm is already dissected continue the dissection by making a longitudinal
skin incision from the level of the lateral epicondyle down to the styloid
process of the radius. Draw a diagramatic illustration of the skin incision.
C. Then, reflect the skin medially by doing a blunt subcutaneous dissection until
the superficial fascia of the whole anterior forearm is exposed.
D. Examine the superficial fascia. Identify the cutaneous vessels and nerves, such
as the cephalic vein laterally and basilic vein medially, and the lateral
cutaneous of the forearm laterally.
E. Give the termination of the cephalic vein?
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Ascend in the lateral side of biceps branchii
Prices claripectoral fascia to chain into the axillary veins
F. Describe the termination of the basilic vein?
Ascend to the medial side of biceps branchii
Prices deep facial on the lower border
G. What is the trunk of origin of the lateral cutaneous nerve of the forearm?
Musculocutaneous nerve
H. Clear the anterior forearm of fasciae and fats but leave the blood vessels and
nerves intact. Expose the superficial muscles.
1. Identify the superficial muscles as identified in models. Identify the
boundaries of the cubital fossa and its contents. Name the contents.
Superior- imaginary line connecting the lateral medial epicondyle
Medially- pronator teres
Laterally- grahio radialis
I. Over the wrist, a transverse band of fascia holds or secures the tendons of most
muscles of anterior forearm. This fascia is the flexor retinaculum.
1. Identify the muscle tendons and neurovascular structures that pass
superficial to the retinaculum. List them down.
Tendons of flexor carpi ulnaris +palmaris longus, ulna nerve+ blood vessels
Palmar cutaneous branch +median nerve
J. Without cutting any muscle, identify the muscle in the 2nd layer, flexor
digitorum superficialis. This muscle has 4 tendons.
With these tendons find and isolate the median nerve. This nerve together
with the tendons passes under the flexor retinaculum.
1. State the significance of the median nerve passing under the flexor
retinaculum..
The median nerve may be compressed under the flexion retinaculum by the highly
flexed tendionosus.
K. Over the medial aspect of the forearm, the ulna is just subcutaneous hence it is
now exposed. Carefully lift the flexor carpi ulnares on this side. The muscle
underneath is the medial or the ulnar portion of the flexor digitorum profundus.
On the same level laterally over the radius is the flexor pollicis longus. Deep to
the tendons of these 2 muscles over the distal ends of radius and ulna is the
pronator quadratus.
1. Identify the structures that run just beneath the flexor carpi ulnares.
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What are these?
Ulna artery+ nerve
L. On the lateral side, trace the radial artery from the cubital fossa downward.
1. What is its trunk of origin?
Branchial artery
M. At about the middle of anterior forearm, the radial artery runs parallel with
what structure?
Ulna artery
N. After the exposure, isolation and identification of structures ask any laboratory
preceptor to confirm your identification. Then review every thing!
HAND
I. Continue the dissection over the palmar aspect of the hand.
II. Make a midline skin incision from the distal border of the flexor retinaculum to the
base of the middle finger.
III. Extend the incision medial ward towards the medial border of the base of the little
finger, then lateral ward towards the lateral border of the base of the index finger.
IV. Carefully do a blunt dissection under the skin. Reflect the skin medial ward and
lateral ward.
V. Identify the palmar aponeurosis. Cut across this aponeurosis and pull the cut edges
proximally and distally. This exposes the tendons of flexor digitorum superficialis.
Deep to it is the superficial palmar arterial arch on the tendon of the flexor digitorum
profundus. The deep palmar arch lies deep to this tendons on the surface of the
interossei muscles.
1. Name the vessels that form this arterial arch.
Superior palmar arch- ulnar artery
Deep palmar arch – radial artery
2. Identify the muscle tendons over the hand. Identify the hypothenar muscles.
Remove the skin over the thenar aspect of the palm. Identify the muscles.
Abduction digiti minimum
Opponeus digiti minimum
Flexor digiti minimum
VI. Locate the lumbricals on the tendons of the flexor digitorum profundus. Deep
to the profundus are the interossei muscles.
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Label the boundaries of cubital fossa and its contents
Median
Biceps nerve
branchii
Branchial
artery
Branchoradialis Branchialis
Pronation
teres
Ulnar
artery
Label the anterior forearm showing the superficial
muscles.
Biceps branchii
Pronator teres
Branchio
radialis
Flexor carpi
radialis
Flexor carpi
ulnar
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Label the anterior forearm showing the superficial and deep muscles and related
neurovascular structures.
Pronatos
teres Radial artery Median nerve
Flexor carpi Ulnar
radiali
Palmaris Flexor Flexor digitorum
longus pollicis
Flexor
carpi
ulnaris Ulnar artery
Flexor digitorum
Label the palm of hand showing the deep and superficial palmar arches.
Branchial artery
Ulnar artery
Common interosseous artery Deep palmar branch+ ulnar artery
Radia Superficial palmar arch
l
Identify now the flexor retinaculum. What are the attachments of this fibrous strand.
_scaphoid_ pisiform hamate what is the name of the
tunnel underneath. Carpal tunnel Enumerate the structures found
deep and superficial to the tunnel. Label above structures in the model below.
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Flexor digitorum
superficial
tendons
Flexor digitorum
profundus tendons
In the hand model above, label the intrinsic muscles of the palmar surface of the hand.
In the cross section in the wrist, label the structures identified in the previous model of
the palm.
Palmarix longus
Median nerve
Flexor carpi radialis tendon
Flexor digitorum superficialis
Flexor policies longus tendins
Radial artery
Flexor digitorum profondus tendons
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ASSIGNMENT NO. 6B
POSTERO-LATERAL FOREARM, DORSUM OF HAND AND FINGERS
ELBOW AND WRIST JOINTS
At the end of the course the students must be able to:
1. Discuss the cutaneous innervation of the posterolateral forearm.
2. Enumerate the muscles in the posterolateral forearm.
2.1 lateral group
2.2. superficial group
2.3. deep group
3. Tabulate the origin, insertion, nerve supply and action of the muscle in
posterolateral forearm.
4. Discuss the neurovascular structures of the posterolateral forearm.
5. Define extensor retinaculum. Give the attachments.
6. Enumerate the contents of the osteofascial compartments under the
extensor retinaculum.
7. Describe the anatomical snuffbox.
7.1 Boundaries
7.2 Significance
8. Describe the dorsum of the hand.
8.1 Skin
8.2 Blood vessels
8.3 Tendons of extensor muscles
Wrist (radio-carpal) Joint
1. Name the bones that form the wrist joint
2. Classify the wrist joint.
2.1. Morphological
2.2. Functional
3. State what specific variety of joint is the wrist.
4. Name the movements possible at the wrist.
Elbow Joint
1. Name the bone that articulate at the elbow.
2. Name the articulations at the elbow.
3. Give the movements possible at each articulation.
4. Give the blood supply and nerve supply of the elbow.
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ASSIGNMENT NO. 6
POSTERO-LATERAL FOREARM, DORSUM OF HAND AND FINGERS
ELBOW AND WRIST JOINTS
LABORATORY PROCEDURE
I. Study of Models/ preserved/pre-dissected cadaver
A. Borrow model of muscles of upper extremity or a pre-dissected preserved
specimen of upper extremity.
B. Using an atlas of Gross Anatomy guide identify the muscles on the posterior
and lateral aspects of the forearm starting laterally. Label these muscles.
Branchioradialis
Extensor
digitorum
Extensor
carpiradialis longus
Extensor
Abductor pollicis
digitiminimi
brevis
Extensor
pollicis brevis
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C. Distally, identify the muscles that emerge between the extensor digitorum and
extensor carpi radialis brevis. What are these muscles?
Abductor pollicis longus / extensor pollicis brevis
D. Take note of a transverse band across the posterior surface of the wrist. What
is this?
Extensor retinaculum
E. Distal to this band over the dorsum of the hand are the tendons of extensor
digitorum. Follow them to their insertion. Give their insertion.
Distal and middle phalanges
F. Take note of a depression on the lateral aspect of the wrist., the anatomical
snuffbox. Identify the boundaries. List them down.
Laterally – tendon of extensor pollicis brevis
Medially – tendon of abductor pollicis longus / extensor pollicis brevis
immediate trunk of origin of this nerve?
G. State the significance of the anatomical snuffbox.
The scaphoid bone is easily palpated in this area / radial artery crosses its
floor, artery can be palpable
II. Study of Bones and Joints of the upper extremity – elbow and wrist joints
A. Get an articulated skeleton and study the bones and joints of the upper
extremity.
B. Examine the elbow joint. Identify the parts of bone that articulate at the elbow.
Humerus, ulna, radius
C. Test the movements of the elbow in your own body. Name the movements
possible at the elbow.
Flexor, extensor, pronator, supinator
D. Examine the wrist joint. Identify the carpal bones. Identify the bones that
articulate at the wrist. List hem down.
Radius, lunate scaphoid and triquetral
E. Test the movement possible at your wrist joint. List them down.
Abductor, adduction, extensor, and flexion
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III Dissection
A. Continue the removal of the skin of forearm using the blunt edge of
the scalpel. Identify the superficial blood vessels and nerves. Review
the previously dissected anterior aspect of the forearm.
B. Clean the posterior aspect of forearm.
C. Clear off the fats taking care not to cut the vessels like the cephalic
vein laterally and basilic vein medially.
D. Preserve the lateral cutaneous nerve of the forearm. What is the
immediate trunk of origin of this nerve?
E. Expose the muscles.
F. Identify them as you did with the model.
G. Lift or retract the muscles when trying to look for the structures
underneath.
H. Identify the extensor retinaculum. Examine the fascial spaces
underneath the extensor retinaculum and their contents.
I. Remove the skin over the dorsum of hand. Identify the tendons of the
extensors
J. Flex the proximal interphalangeal joints in one of your hands and extend
the metacarpophalangeal joints of the same hand.
K. Take note of the tendons that become prominent. These are the tendons
of what muscle?
VI.
A. Label the frontal view of the elbow joint.
Radial collateral Joint capsule
ligament
Ulnar collateral
Anular ligament ligament
with radius
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B. Label the articulating bones in wrist joint.
Lunate
Triquetrum
Scaphoid
Hamate Trapezium
Capitate
Trapezoid
C. Label the posterior view of the forearm showing the superficial group of muscles.
Extensor
Digitorum
Extensor
digitiminimi
Abductor pollicis
longus
Flexor carpi
Extensor pollicis
ulnari
brevis
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D. Label a cross section of the wrist showing the spaces under the extensor retinaculum
and their contents.
Median nerve
Flexor
digitorum Flexor carpi
radialis
Flexor digitorum
profundus tendon Flexor pollicis
longus
Radial artery
E. In the dorsum of the hand model, label all the tendons and muscles seen.
Abductor pollicus
longus
Extensor
Extensor pollicis
retinaculum
brevis
Extensor indicis Anatomical
tendon snuff box
Extensor Extensor pollicis
digitorum tendon longus muscle
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