Anatomical Study: The Forearm.

The largest bone of the upper limb is the humerus and it articulates proximally with the scapula and distally with the two forearm bones: the radius and ulna. There are two condyles found at the distal end of the humerus . The trochleais found on the medial side and characteristically has a shape of a sideways hourglass and the capitulum, which is shaped more like a ball is found on the lateral side. Situated on each side of the two condyles are the medial and lateral epic ondyles, which are sites for muscle attachment. There are two main depressions found superior to the trochlea ,that enable free movement of the ulna bone allowing flexion and extension of the elbow joint. The radius and ulna form the forearm and are usual ly easy to palpate. Proximally the articulate at the elbow with the humerus and distally they form the wrist joint. The radius and ulna are connected to each other by the interosseous membrane and articulate with each other at radioulnar joints both prox imally and distally. In the motion of pronation, the radius crosses over the ulna. The ulna is the bone that forms the elbow joint with the humerus and the prominent olecranon process is the palpatable elbow. The olecranon process and coronoid process both form a grip around the trochlea of the humerus allowing a hinge movement allowing flexion and extention of the forearm. The olecranon process fits into the olecranonfossa preventing hyperextention of the forearm. At the elbow, the radius articulates with the ulna at the radial notch. At the wrist, the styloid process of the ulna is the attachment of ligaments from bones forming the wrist. The radius is wider than the ulna at the distal end of the forearm. The head of the radius at the proximal end has a characteristic button shape and its superior surface allows movement by articulating with the capitulum of the humerus. The head of the radius interacts with the ulna via the radial notch of the ulna. The radial tuberosity is an attachment site of the powerful biceps brachii muscle of the arm. At the distal end of the radius, the ulnar notch allows articulation with the ulna bone and a radial styloid process, which provides lateral attachment for ligaments of wrist bones. There are two mai n functional muscle groups in the forearm: those moving the fingers and those moving the wrist. Forearm muscles usually have the belly of the muscle in the upper part of the forearm and long tendons passing through strong connective tissue bands known as retinacula, which prevent the tendons form popping out. There are two main muscle compartments of the forearm are the anterior flexors and posterior extensors. These compartments are further divided into deep and superficial layers. Beginning with the superficial anterior compartment, the Flexor carpiradialis, Palmaris longus, flexor carpiulnaris and flexor digitorum all originate in the area of the medial epicondyle of the humerus and attach at slightly different points on the wrist/hand and all have co mmon function of flexion. Flexor carpiradialis inserts on the base of the second and third metacarpal bones and it provides flexion movement of the wrist and abduction of the hand. Palmaris longus inserts on the palmaraponeurosis and is a weaker flexor o f the wrist. Flexor carpiulnaris is a two headed muscle, which has insertions on pisiform, hamate and fifth metacarpal bones. It is a powerful wrist flexor and aid s stabilisation of the wrist when extending fingers. Flexor digitorumsuperficialis is another two-headed muscle, which inserts via 4 tendons on the middle phalanges of fingers 2 -5. It has function in flexion of the middle fingers and the wrist. The final muscle found in the superficial anterior

compartment is the pronatorteres muscle, which ha s an important function in pronation of the forearm. This muscle inserts on to the lateral radius. All anterior superficial muscles of the forearm are innervated by the median nerve with the exception of flexor carpiulnaris, which is innervated by the uln ar nerve. Deep muscles of the anterior compartment consist of flexor pollicislongus, flexor digitorumfundus and pronatorquadratus. Flexor pollicislongus originates on the anterior surface of radius and interosseousmembrance and inserts on the distal phalynx of the thumb. Its function is to flex the thumb. Flexor digitorumprofundus has quite a broad origin from the coronoid process to the interosseous membrane and it inserts onto distal phalanges of fingers 2 -5. It flexes the fingers and the wrist. Finally, the pronatorquadratus originates from the distal anterior ulna and inserts on the distal anterior radius. It interacts with pronatorteres and enables pronation movement of the forearm. All deep anterior muscles are innervated by the median nerve. The posterior compartment of the forearm consists mainly of muscles providing extension movements. Beginning superficially, the extensor carpiradialislongus follows along the brachioradialis muscle, originating from the lateral epicondyle of the humerus and inserting on the base of second metacarpal. It enables extension and abduction of the wrist. Extensor carpiradialisbrevis is a shorter muscle and originates from lateral epicondyle of humerus and inserts on the base of the third metacarpal. It functions to extend and abduct the wrist. Extensor digitorum originate from lateral epicondyle of humerus and insert on to distal phalanges of fingers 2 -5. The main function of this muscle is to extend wrist and abduct fingers. The final muscle found in the superficial layer of the posterior compartment is the extensor carpiulnaris, which originates on the lateral epicondyle of humerus and posterior ulna and inserts on the base of the fifth metacarpal. It enables extension and adduction of the wrist.

Deep muscles of the posterior compartment include abductor pollicislongus, extensor indicis, extensor pollicisbrevis and longus and supinator. Abductor pollicislongus originates on the posterior surface of the ulna and radius and inserts on to the first metacarpal and trapezium. It functions mainly in extension and abduction of the thumb. Extensor pollicisbrevis and longus are a muscle pair which both originate at the dorsal shaft of the radius and ulna and insert on the proximal and distal phalynx of the thumb. They both function to extend the thumb. Extensor indicis is a small muscle originating from the posterior surface of the distal ulna and inserts on the index finger. It extends the wrist and index finger. The final muscle of the deep posterior compartment is the supinator muscle, which originates from the lateral epicondyle of the humerus and inserts on the proximal end of the radius. It is important in the supination movementand works in partnership with biceps brachii. All posterior compartment musc les are innervated by branches of the radial nerve.

General references: Marieb Grays

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