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Topographic anatomy of the forearm and hand
Superior boundary of the forearm is drawn on two transverse fingers below line
connecting both epicondyle of the humerus.
Inferior boundary corresponds the line connecting apex of styloid process of radius
and ulna.
By lateral lines, connecting epicondyles of the humerus with the styloid process of
the radius and ulna the region of the forearm is divided into two parts: anÂterior region
and posterior region.
Deep fascia of the forearm encloses the forearm and is atÂtached to the periosteum
of the posterior subcutaneous border of the ulna. This fascial sheath together with the
interosseous membrane and fibrous intermuscular septa, divides up the forearm into three
fascial compartments: anterior, lateral, posterior.
The anterior compartment contains flexor muscles and pronaÂtor muscle.
The posterior compartment contains extensor muscles and supinator muscle.
The lateral compartment contains the bracÂhioradialis muscle and extensor carpi
radialis longus and extenÂsor carpi radialis brevis.
Surface landmarks. The posterior border of the ulna bone is subcutaneous and
can be palpated along its entire length. The raÂdius bone can be palpated from midlpoint
of lateral border of the forearm to styloid processes of the radius. At wrist the stiloid
process of the radius and ulna can be palpated.
Anterior region of the forearm
The skin is mobile and thin. The subcutaneous tissue contaÂins cutaneous nerves
and superficial veins.
The skin of the anteÂrior aspect of the forearm is supplied:
laterally – by the lateral cutaneous nerve of the forearm which is continuation of
the musÂculocutaneous nerve and
medially – by the medial cutaneous nerve of the forearm.
These nerve pass in company with superficial veÂins. On the medial side of the
forearm the basilic vein accompaÂnies the medial cutaneous nerve of the forearm.
Laterally the cephalic vein winds round onto the anterior aspect of the forearm and
passes in company with lateral cutaneous nerve of the foreÂarm.
Between these veins the median vein of the forearm passes. It drains the central
portion of the palm and joins the median cubital vein.
The superficial fascia is thin. The deep fascia surrounds muscles and is very strong
attached to the muscles. This relation allows to develop to the gas gangrene in septic
wound.
The muscles of the anterior region of the forearm lie in foÂur layers.
The brachioradialis, pronator teres, flexor carpi raÂdialis, palmaris longus and
flexor carpi ulnaris lie from the laÂteral to the medial side and form first layer of muscles
of the forearm.
The flexor digitorum superficialis muscle forms the second layer.
The third layer is formed by the flexor pollicis longus and flexor digitorum
profundus.
The fourth layer is formed by the pronator quadratus and present only in the inferior
third of the forearm.
Between the third and fourth layers of muscles Pirogoff's fat space is locaÂted. It
is limited:
posteriorly- by the pronator quadratus and above it by interosseous membrane and
anteriorly- by the flexor pollicis longus and flexor digitorum profundus.
Here pus may be accumulated in lesion of common synovial sheath or ulnar synovial
bursa and of synovial sheath of tendon of flexor pollicis longus or radial synovial bursa.
Also, the pus may reach to Pirogoff's fat space from fat of the midpalmar space.
The fat space of the forearm may accumulate to 0.25 litre of pus. It is clinical imÂportance. On the medial and the lateral sides at ulna and radius bones the pus may reach of
superficial layers, where the incisiÂons may be made.
Usually for opening of phlegmon of Pirogoff's fat space two incisions are used. First
incision, length 8-10 cm passes up from 2 cm of styloid process along radius bone (radial
access). Second incision, length 8-10 cm passes up from 2 cm of styloid process along ulna
bone (ulnar access).
The muscles of anterior aspect of the forearm form three sulcuses: radial, ulnar and
median.
The radial sulcus is formed medially – by the pronator teres in superior third of
the forearm and by the flexor carpi radialis in middle and inferior third of the forearm and
laterally – by the brachioradialis muscle.
The ulnar sulcus is formed medially – by the flexor carpi ulÂnaris and laterally
– by the flexor digitorum superficialis.
The median sulcus is only present in inferior third of the forearm and limited by
flexor carpi radialis – laterally, flexor digitorum superficialis – medially and flexor
digitorum profundus - Âposteriorly.
The sulcuses are occupied by neurovascular bundles. On anteÂrior aspect of the
forearm four neurovascular bundles are locaÂted (Table).
Â
Conclusions:
1.That as it passes beneath pronator teres the ulnar artery is crossed superficially by
the median nerve.
2.The radial artery and the superficial branch of the radial nerve lie alongside each
other in their middle thirds and under cover of brachioradialis.
3.The ulnar artery and nerve lie alongside each other in their distal two-thirds.
4.The radial and ulnar nerves lie outside the arteries.
5.Both arteries are superficial in the lower third of their course.
Topography of the neurovascular bundles
of anterior aspect of the forearm
Name vessels and
nerves
The radial artery
and veins; the
superficial branch
of the radial nerve.
Superior third
Middle third of
of forearm
forearm
Vessels
pass Neurovascular
between
the bundÂle
passes
brachioradialis between
the
muscle- laterally brachioradialisand the pronator laterally and flexor
teres - medially carpi
radialisand lie at first on medially.
supinator
and Nerve lies lateral to
artery and near.
Inferior third of
forearm
Vessels pass in
radial
sulcus
between tendon of
brachioradialislaterally and flexor
carpi
radialismedially and lie on
flexor
pollicis
longus
and
Name vessels and Superior third
nerves
of forearm
then on pronaÂtor teres.
Nerve lies on 0.52 cm lateral to
artery.
The
neurovascuÂlar
bundle is covered
by
meÂdial
border of the
brachioradialis.
The ulnar vesÂsels Vessels
and
and ulnar nerve.
nerve are locaÂThe branches of the ted on flexor
ulnar nerve in the digitorum proÂforearm
are: fundus and coÂmuscular branches vered anteriorly:
to flexor carpi vessels by two
ulnaris and the layers muscles;
medial half of nerve by flexor
flexor
digitorum carpi
ulnaris.
profundus;
a Nerve lies medial
palmar cutaneous to artery (1-2.5
branch
which cm).
supplies skin of the
medial part of the
palm; a dorsal
branch,
which
supplies skin of the
medial part of the
dorsal asÂpect of
the heÂad.
Median
nerve, Nerve
pass
median
artery, between
the
small branch of the heads of pronator
anterior
teres and at the
interosseous artery same
time
and veins.
crosses the ulnar
Nerve supplies all artery, which lies
superficial flexors deep to both
of the forearm heads.
Middle third of
forearm
Neurovascular
bundle lies at first
on flexor digitorum
superficialis
and
then
on
flexor
pollicis longus, and
is coverd by medial
border
of
the
brachioradialis.
Inferior third of
forearm
pronator quadratus.
Nerve at boundary
middle third and
inferior third passes
onto dorsal surface
of the forearm
under tendon of the
brachioradialis.
Neurovascular
bundle
passes
between flexor carpi
ulnarismedially
and
flexor
digitorum
superficialislaterally and lies on
flexor
digitorum
profundus.
The
bundle
is
coveÂred by lateral
borÂder of the
flexor carpi ulnaris.
Nerve lies near arÂtery and medial to it.
Neurovascular
bundle passes in
ulnar
sulcus
between tendon of
flexor carpi ulnarismedially
and Â
flexor
digitorum
superficialis
–
laterally, locating
on flexor digitorum
profundus
and
pronator quadraÂtus.
The bundle is
covered by lateÂral
border of the flexor
carpi ulnaris.
Nerve lies near
artery and mediÂal
to it.
Nerve is locaÂted
between
flexor
digitoÂrum
superficiÂalisanteriorly and flexor
digitorum
profundus
posteriorly.
Name vessels and Superior third
nerves
of forearm
except flexor carpi
ulnaris,
flexor
pollicis longus, the
lateral half of flexor
digitorum profunÂdus and pronator
quadratus. A palÂmar
cutaneous
branch which is
given off just above
the wrist and runs
into the head to
supply skin over
the
theÂnar
eminence and the
central part of the
palm.
Middle third of
forearm
Inferior third of
forearm
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