Forearm joints and
muscles
MEDI2106, Spring 2020
Objectives
•Describe the boundaries and contents of the cubital fossa.
•Describe the basic structure of the elbow joint and its
movements
•Describe the Radio-ulnar joints and their movements
•Describe the major muscle groups in the fascial
compartments of the forearm and be able to explain the
functional importance of those muscle groups.
•Highlight the relationship between the vessels and nerves in
the arm and forearm
Cubital fossa
• Triangular space in front of
elbow.
• Boundaries:
Pronator teres
Brachioradialis
• Medially- Pronater teres
• Laterally Brachioradialis
• Base Line between two
epicondyles
1.Skin, superficial fascia
Cubital fossa: Roof 2.Bicipital Aponeurosis
3. Median cubital vein
LATERAL
MEDIAL
4.Medial cutaneous nerve
1
of forearm
Cephalic vein
5.Lateral cutaneous nerve
of forearm
(lateral)
Venipuncture – median cubital vein
3
Preferred in:
• Blood donation
2
• Withdrawing blood for
investigations
4 • Intravenous infusions.
5
Basilic vein
(medial)
Cubital fossa: Role of bicipital aponeurosis
NOTE: The biceps brachii tendon is inserted deep on radius • Covers and protects
but sends a fibrous expansion to medial side- Bicipital brachial artery—
aponeurosis • Separates medial
cubital vein
(superficial) from
deeper brachial artery
• Prevents artery being
injured during
withdrawing blood
from median cubital
vein
Floor- Muscles
1. Brachialis
2. supinator
Cubital fossa: Contents
TAN: Lateral to medial
• Tendon of biceps
• Artery: Brachial
artery & its branches
– Radial artery
– Ulnar artery
Lateral Medial • Nerve: Median nerve
• Palpation of brachial artery can be done MEDIAL to tendon of biceps
• Useful for recording blood pressure
Elbow joint • Classification:
articular bones and surfaces – Synovial
– Uniaxial joint
– Compound hinge
• Humero-ulnar
• Humero-radial
• Continuous with
proximal radioulnar
joint cavity
1) Humerus -trochlea & capitulum
2) Ulna- trochlear notch Trochlear notch
3) Radius- head
Stability: Bones, ligaments and muscles
• Fibrous capsule
• Ligaments
– Medial (Ulnar) collateral
– Lateral (Radial) collateral
• Ligaments stabilize the joint from
lateral and medial aspects
Annular ligament stabilizes proximal radio-ulnar joint
Fibrous capsule, Ligaments and synovial membrane
• Radial and ulnar collateral ligaments
– Both are triangular.
• Annular ligament
Elbow joint: Movements
Uniaxial joint
– FLEXION:
– EXTENSION
Flexion of elbow joint
Muscles: (BBB)
• Brachialis: Prime flexor
• Biceps brachii: also supplement flexion
• Brachioradialis: flexion in midprone position
Extension of elbow joint
• Triceps
• Gravity
• Helped by extensors of forearm. Their common origin is the lateral
epicondyle of humerus.
Normal Alignment of elbow joint
R
U
In flexion: medial and lateral In extension: medial and lateral
epicondyles and olecranon form epicondyles and olecranon lie in a
the sides of an equilateral straight line
triangle
Applied anatomy
In Dislocation of
Elbow
Relationship of the three
bony points;
– Medial epicondyle
– lateral epicondyles
– Olecranon
is disturbed
Applied anatomy
Supracondylar #
• Supracondylar fracture of humerus
–fall on outstretched hand.
• Dislocation of elbow-usually
posterior-if fall on outstretched
hand (posterior force)
• Tennis elbow -injury to forearm
extensors tendons and lateral
epicondyle.
• Student elbow -subcutaneous
olecranon bursitis.
# of olecranon
Radioulnar joints
1. Proximal /Superior:
• Synovial, Uniaxial, Pivot
2. Middle: Fibrous-
syndesmosis: interrosseus
membrane between radius
and ulna
3. Distal/Inferior : Synovial,
Uniaxial, Pivot
Superior radioulnar joint
Between:
• Head of radius
• Radial notch( facet) on the
ulna
Shares a common synovial
cavity elbow joint
Stabilizing factors of RU
joints
• Bony factors
• Ligaments:
– Proximal: Annular
ligament around neck of
radius
– Middle: Interosseous
membrane
– Distal: Articular disc
• Carrying angle
Annular ligament
• The angle between the long axis of Carrying angle
extended forearm and the long axis
of the arm
• Because trochlea is more distal that
capitulum
• Normal: 5-15 degrees away from the
body
• Abnormal:
• Reduced: Cubitus varus
• Increased: Cubitus valgus
Movements at RU Joints
Lower end of radius
rotates over the ulna
Muscles producing movements
• Pronation :
– Pronator Quadratus
– Pronator Teres
– Nerve supply:
Median nerve
• Supination:
– Supinator
– Biceps brachii
– Against resistance-
more powerful
• Supination is more powerful. Why?
• Functional Significance?
Applied Anatomy- proximal RUJ
• Pulled elbow
during semi-
pronation in
child- subluxation
of head of radius.
• Subluxation &
dislocation
Subluxation: head of radius slides out of the annular ligament on
being pulled downwards
As head is small and annular ligament is cylindrical in a child (in
adults it becomes more cone shaped)
Applied Anatomy
FOREARM: 2 COMPARTMENTS
Muscles in each compartment are arranged in a superficial and a
deep group
Organization of Muscles in the forearm
How are they named?
According to their:
• ACTIONS: Flexor, extensor, pronator, supinator etc.
• ATTACHMENTS:
• Carpi=wrist. Those attached to carpal bones will act ONLY on wrist
joint.
• Digitorum= digits= fingers. Those attached to phalanges (bones of
fingers) will act on ALL the joints they cross
• SIDE OF FORAM:
Radial (Lateral) side: Radialis
Ulnar (Medial side): Ulnaris
How they are named? Cont…..
• DEPTH:
– Profundus= deep
– Superficialis= superficial
• SIDE OF FORAM:
– Radial (Lateral) side: Radialis
– Ulnar (Medial side): Ulnaris
• LENGHTH:
• Longus (long) = Attached to base of distal phalanges. Hence LONGUS will
act on distal interphalangeal joints also (besides other proximal joints)
• Braves (short) = attached to base of middle phalanx. Hence BREVIS will act
only on proximal interphalangeal joints ( besides other proximal joints)
• INSERTION TO SPECIFIC DIGITS:
– Thumb= pollicis
– Index= indicis
– Little finger= digiti minimi
Anterior/FLEXOR Compartment of forearm
Superficial flexors
Common flexor origin:
medial epicondyle of
humerus
1.Pronator Teres
2.Flexor Carpi Radialis
3. Palmaris Longus
4.Flexor Digitorum
Superficialis ( 4
tendons)
5. Flexor Carpi Ulnaris
Anterior/FLEXOR Compartment of forearm
Deep Flexors
Pollex=thumb- pollicis-going to
thumb
Digitorum= digits=fingers
Longus= going to distal phalanx
Profundus= deep
Pronator, flexor -explains their
actions
Anterior/FLEXOR Compartment of
forearm
Muscles that Only flex at
the wrist.
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
CARPUS= WRIST
Carpi---attached to
carpal bones
Innervation: Flexor compartment Muscles
Posterior/EXTENSOR Compartment
DEEP GROUP
SUPERFICIAL GROUP
Functional Organization:
Extend Wrist
Extend / Abduct Thumb
Extend Index Finger
Supinate
Extensor compartment
superficial group
Anconeus
Deep Posterior Compartment
Abductor Pollicis Longus
Extensor Pollicis Brevis
Extensor Pollicis Longus
Extensor Indicis
Supinator
Functional Organization:
Extend Hand At Wrist
Extend / Abduct Thumb
Extend Index Finger
Supinate
Nerve Supply: Radial Nerve
Neurovasculature of Anterior Compartment of forearm
NOTE: Relationship of
Ulnar nerve and ulnar
artery
Deep branch of median
nerve: Anterior
interrosseus nerve -
supplies deep flexors
Blood vessels of forearm
Note How
the arteries
terminate in
the hand by
forming
FCR Palmar
arches
Pulsations of RADIAL artery can be felt LATERAL to tendon of FLEXOR CARPI RADIALIS
Pulsations of ULNAR artery can be felt LATERAL to tendon of ? FLEXOR CARPI ULNARIS
Relationship of Arteries ,Tendons and nerves at Wrist
LATERAL TO MEDIAL
Brachioradialis
Which pulsations? Where?
4. Palmaris longus
5. Flexor digitorum superficialis
1 Radial Artery 6.Ulnar artery
2.Flexor Carpi Radialis 7.Ulnar nerve
3. Median Nerve 8.Flexor carpi ulnaris
Thumb
Neurovasculature of Posterior compartment of forearm
RADIAL NERVE and its branches supply ALL
muscles in posterior compartment, including
Brachioradialis.)!(
ARTERY?
Posterior interosseous artery (branch of ulnar
artery) supplies posterior compartment of
forearm
