FLEXOR COMPARTMENT of forearm (1).pptx

FLEXOR COMPARTMENT of forearm

1. FLEXOR COMPARTMENT OF FOREARM Dr N. Anuradha MAMS

2. Forearm Extent - elbow to the wrist Contains two bones the radius and ulna joined by an interosseous membrane

3. INTRODUCTION • Forearm extends between the elbow and the wrist. • Forearm contains two bones: radius laterally and ulna medially. • Radius and ulna articulate as follows: 1. Superior radioulnar joint 2. Middle interosseous membrane that connects radius and ulna 3. Inferior radioulnar joint • Forearm is also called antebrachium (region between brachium and wrist). 3

4. Fascial Compartments of Forearm • Superficial fascia – thin and has minimal fat • Antebrachial fascia (deep fascia) – does not form a thick sleeve as in the thigh – permits frequent movements of muscles of forearm without impeding the movements 4

5. Fascial Compartments of Forearm • A ntebrachial fascia (deep fascia) – A ttached to the posterior subcutaneous border of ulna • Thickened to form F lexor retinaculum Extensor retinaculum. • Lateral intermuscular septum – extends from deep fascia to the radius 5 Compartment of forearm Anterior and posterior

6. Contents MUSCLES – 8 - arranged in 2 groups Superficial - 5 Deep - 3 ARTERIES – 2 - radial & ulnar,( anterior interosseous) NERVES – 3 - median, ulnar &radial

7. Muscles Superficial -5

8. Pronator teres ORIGIN: Humeral-medial supracondylar ridge Ulnar-medial border of coronoid process INSERTION: Middle of lat.surface of radius NERVE SUPPLY: Median nerve ACTION: Pronation

9. ORIGIN NERVE SUPPLY

10. 2)Flexor carpi radialis ORIGIN: Medial epicondyle INSERTION Base of 2 nd &3 rd metecarpals NERVE SUPPLY: Median ACTION: Flexion

11. 3)Palmaris longus ORIGIN: Medial epicondyle INSERTION: Central part of palmar aponeurosis NERVE SUPPLY Median ACTION: Weak flexor

12. 4)Flexor carpi ulnaris ORIGIN: Humeral-medial epicondyle Ulnar-medial margin of olecranon INSERTION: Pisiform bone NERVE SUPPLY: Ulnar ACTION: Flexion

13. ORIGIN: Humero -ulnar head- Medial epicondyle Radial- ant.oblique line INSERTION: Sides of middle phalanx NERVE SUPPLY: Medain nerve ACTION: Flexion of middle phalanx Flexor digitorum superficialis: ( Sublimis )

14. Deep - 3

15. ORIGIN: Ant. Surface of radius Interosseous membrane INSERTION Base of distal phalanx of thumb NERVE SUPPLY anterior interosseous n. ACTION Flexor of thumb 1)Flexor pollicis longus

16. 2)Flexor digitorum profundus ORIGIN: Ant&medial surface of ulna Interosseous membrane INSERTION: Base of terminal phalanx of Little finger. NERVE SUPPLY: medial – ulnar Lateral - AIN ACTION: Flexes terminal phalanges

17. ORIGIN INSERTION NERVE SUPPLY ACTION 3)Pronator Quadratus

18. Pronator Quadratus Origin • Oblique ridge on the lower one-fourth of anterior surface of shaft of ulna and area medial to it. Direction of fibers • Fibers runs laterally (horizontal). Unique feature Insertion • Superficial fibers: Distal one-fourth of anterior surface and anterior border of radius . • Deep fibers: Triangular area above the ulnar notch of radius Human Anatomy/Yogesh Sontakke 22

19. Pronator Quadratus Innervation Neet • Anterior interosseous branch of median nerve Actions • Superficial fibers – pronation of forearm. Clinical testing • Ask to pronate the forearm against the resistance. • Pronator quadratus is chief pronator of forearm and its action is assisted by pronator teres muscle Human Anatomy/Yogesh Sontakke 23

20. Some Interesting Facts • Flexor digitorum profundus is composite or hybrid muscle as it is supplied by dual nerves (medial part – ulnar nerve) (lateral part – median nerve). Viva, MCQ • Tendons of FDP passes deep to flexor retinaculum in the synovial sheath called ulnar bursa . • FDP is a powerful gripping muscle of hand. Human Anatomy/Yogesh Sontakke 24

21. Space of parona : Fascial lined potential space deep to flexor tendons Boundaries: In front: FDP &FPL Behind: PQ & interosseous membrane Above: FDS On each side: borders of forearm

22. ARTERIES OF FRONT OF FOREARM 1. Ulnar artery 2. Anterior interosseous artery 3. Radial artery Human Anatomy/Yogesh Sontakke 26

23. Blood vessels of front of forearm: 1)Radial artery: Terminal branch of brachial artery Runs b/w BR&FCR Crosses anatomical snuff box Branches: Radial recurrent Muscular Palmar carpal Dorsal carpal Superficial palmar First dorsal metacarpal Princeps pollicis Radialis indicis

24. Radial artery course in forearm

25. Branches 1. Muscular branches 2. Radial recurrent carpal branch 3. Anterior (palmar) carpal branch 4. Posterior (dorsal) carpal branch 5. Superficial palmar branch – completes superficial palmar arch Human Anatomy/Yogesh Sontakke 30

26. Clinical Integration Radial pulse • In clinical examination, radial artery is commonly palpated to measure pulse rate • Site: in the lower part of forearm against the anterior surface of lower end of radius lateral to the tendon of flexor carpi radialis. Viva, Practical guide Human Anatomy/Yogesh Sontakke 31

27. Ulnar artery: Deeply placed Runs b/w FCU&FDS Crosses Flexor retinaculum Divides into superficial & deep Branches: Anterior ulnar recurrent Posterior ulnar recurrent Common interosseous Palmar & dorsal carpal branches Muscular

28. Ulnar artery course in the forearm

29. Human Anatomy/Yogesh Sontakke 34

30. Anterior Interosseous Artery • Terminal branch of common interosseous artery. Neet • Also called volar interosseous artery . • Descends on the anterior surface of interosseous membrane with anterior interosseous nerve. Identification feature, MCQ • At the upper border of pronator quadratus muscle, the artery pierces interosseous membrane to enter the posterior compartment of forearm. Neet Human Anatomy/Yogesh Sontakke 35

31. Anterior Interosseous Artery Branches 1. Muscular branches 2. Nutrient arteries to radius and ulna 3. Median artery (only 8% people) that runs with median nerve. MCQ Human Anatomy/Yogesh Sontakke 36

32. Nerves of flexor copm ,. forearm 1 radial artery 2 ulnar artery.

33. Nerves: Median nerve: Lies b/w 2 heads of pronator teres Branches: Muscular Anterior interosseous Articular Palmar cutaneous Communicating

34. Median nerve in forearm

35. Human Anatomy/Yogesh Sontakke 40

36. Ulnar nerve: Lies b/w FCU Accompanies ulnar artery Branches: Muscular Articular Dorsal branch Palmar cutaneous

37. Ulnar Nerve • Branch of medial cord of brachial plexus • Root value: C7, C8, and T1. Neet Human Anatomy/Yogesh Sontakke 42

38. Ulnar nerve in forearm

39. Ulnar nerve in forearm

40. Ulnar nerve

41. Radial nerve: Divides into superficial & deep Deep br. In post. Compartment Superficial br. Rest on supinator, pronator teres, FDS& FPL

42. Volkmann’s ischemic contracture Sudden complete occlusion of brachial artery Cause paralysis of flexor muscles of forearm due to ischemia Undergo necrosis and fibrous tissue replaces the necrotic tissue.

43. Muscles shorten permanently producing a Flexor deformity characterized by flexion of the wrist, extension of the MP joints Flexion of the IP joints, Leads to loss of hand power.

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