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Forearm and Hand By: Dr Anita Rani Anatomy Lecture 7th November 2016 Lesson Plan • • • • • • • • • Identify skeleton and joints Muscles : attachments and location Action of Muscles on joints Nerves: course and branches Arteries : course and branches Fascia Applied Revision Questions Skeleton and Joints Muscles: Forearm 8 •Superficial : cross elbow 1.Pronator teres 9. Supinator 2. Flexor carpi radialis 10. Brachioradialis 3. Palmaris longus 4. Flexor carpi ulnaris Intermediate 5. Flexor digitorum Deep: superficialis 6. Flexor Pollicis Longus 7. Flexor digitorum Profundus 8. Pronator Quadratus Muscles : Hand 20 Thenar muscles: 4 Abductor pollicis brevis Flexor pollicis brevis Opponens pollicis Adductor pollicis Hypothenar muscles: 4 Abductor Digiti minimi Flexor digiti minimi Opponens digiti minimi Palmaris brevis Lumbricals: 4 with tendons of FDP Interossei: Palmar 4 Dorsal 4 Supinator Pronator Quadratus Flexor pollicis longus Flexor Digitorum Profundus Flexor digitorum superficialis Pronator teres Palmaris longus Flexor carpi ulnaris & radialis Brachioradialis Thenar & Hypothenar muscles Thenar & Hypothenar Muscles lumbricals Interossei dorsal palmar Actions • Elbow: Flexion : muscle crossing front of elbow BR, PT FCR, FCU, PL, FDS Actions • Radio-ulnar joints Pronation: PT, PQ Supination: Supinator Actions • at wrist joint • Flexion: all muscles except…. • Abduction: FCR • Adduction: FCU Actions • at carpometacarpal joints: Ist: Abduction: APB Adduction: Adductor pollicis • Flexion: Flexor pollicis longus, flexor pollicis brevis • Opposition: opponens pollicis Actions Metacarpophalangeal joints: • Flexion: FDS, FDP, lumbricals, PI and DI • Abduction: Dorsal interossei [ DAB] • Adduction: Palmar interossei [PAD] Actions Inter-phalangeal joints: • Flexion: • Proximal: FDS • Distal: FDP • Extension: Lumbricals, Dorsal and Palmar interossei Nerves: Ulnar, Median and Radial Nerves: Ulnar • Elbow : lies behind medial epicondyle • Enters forearm by passing b/w 2 heads of FCU • In forearm runs b/w FDP and FDS • Enters palm by passing superficial to flexor retinaculum b/w pisiform and ulnar vs • Divides in to superficial and deep terminal branches Ulnar nerve Contd… • Superficial branch supply Palmaris brevis and skin of medial 1 &1/2 fingers. • Deep branch passes backwards b/w flexor and abductor digiti minimi. • Runs in the concavity of deep palmar arch. • Ends by supplying adductor pollicis. Ulnar Nerve Ulnar nerve in Hand Ulnar Nerve: branches/ supply 1. 2. 3. 4. 5. 6. 7. 8. FCU medial half of FDP Palmaris brevis 3 hypothenar muscles 3rd and 4th lumbricals All interossei Adductor pollicis Skin over hypothenar eminence. 9. Skin of volar aspect of 1 & ½ fingers 10. Skin of dorsum of hand and proximal parts of medial 2 & ½ fingers Cutaneous innervation of Ulnar nerve Median Nerve • Main nerve of forearm • In cubital fossa lies medial to brachial artery • Enters forearm by passing between 2 heads of pronator teres • Separated from ulnar artery by deep head of pronator teres • Runs on the surface of FDP deep to FDS • 5 cm above flexor retinaculum lies b/w FCR & FDS • Overlapped by the tendon of Palmaris longus Median nerve Nerves: Median • Enters the palm by passing deep to flexor retinaculum in carpal tunnel • Breaks into medial and lateral branch • Lateral branch gives off recurrent branch that curve around distal border of FR to supply thenar muscles & 3 digital branches • Medial branch gives out 2 digital branches Median Nerve : branches/supply • Muscles: PT, FCR, PL, & FDS • Via anterior interosseous nerve: FPL, PQ & radial half of FDP • Palmar cutaneous branch: skin over thenar eminence & central part of palm In Hand: 5 muscles: 3 thenar muscles and 2 lumbricals skin of lateral 3 & ½ digits Cutaneous innervation :Median nerve Arteries of forearm and hand Nerves: Median Superficial and Deep Palmar Arches Carpal Tunnel Flexor Retinaculum Palmar Aponeurosis and synovial sheaths of tendons Ulnar nerve injury • Which muscles are paralysed? • What do you understand by deformity? Median nerve injury Which of the following muscle of forearm helps in flexion at elbow? • • • • a. flexor digitorum profundus b. flexor pollicis longus C. pronator quadratus D. pronator teres Which of the following nerve supplies skin over terminal phalanx of index finger? a. b. c. d. Median nerve Ulnar nerve Radial nerve Musculocutaneous nerve
