SECTION III

UPPER LIMB III: THE ELBOW AND THE FOREARM

               The elbow joint is a complex hinge joint formed between the distal end of
the humerus and the proximal ends of the ulna and radius. The forearm is the
part of the upper limb between the elbow and the wrist.
 
Objectives:
1. Identify the muscles in the forearm. Determine which belong the different
fascial compartments of the arm, their action and their blood and nerve supply.
2. Determine the groups of muscles in the anterior fascial compartment.
 
THE FOREARM
 
Dissection Guide
 
1. Make a skin incision from the lateral epicondyle to the lateral aspect of wrist.
(A)
 
2. Make a skin incision from the medial epicondyle to the medial aspect of wrist.
(B)
 
3. Reflect the skin and remove the fascia carefully. (C is the previous incision
done during dissection of the arm)
 
4. Identify the distal portion of the biceps brachii muscle and trace it distally to
its attachments.
 
5. Cut through the bicipital aponeurosis located on the medial side of the tendon
of the biceps muscle. Reflect the distal portion of the biceps brachii muscle
inferiorly to identify its tendon that is attached to the tuberosity of the radius.
The median nerve and the brachial artery are on the medial side of the tendon.
 
6. At or near the cubital fossa, the 2 large terminal branches of the brachial artery
can be identified.
 
7. On the lateral side of the biceps brachii tendon lies the deep branch of the
radial nerve and the superficial branch of the radial nerve.
 
8. Identify the brachioradialis muscle and its attachments. Identify the tendon of
the palmaris longus muscle and flexor carpi radialis muscle. Cutting these 2
tendons and reflecting them superficially will enable you to identify the flexor
digitorum superficialis. Try to identify the pronator teres muscle by cutting the
flexor digitorum superficialis muscle obliquely and reflecting it medially. Cut the
pronator teres near its attachment to the radius and reflect it superiorly. Try to
identify the ulnar artery.
 
9. Try to identify the ulnar nerve on the deep surface of the flexor carpi ulnaris
muscle. At the elbow, the ulnar nerve lies in a groove between the olecranon and
the medial epicondyle of the humerus.
 
10. Identify the supinator muscle. It inserts into the lateral aspect of the radius.
 
11. Upon reflecting the flexor digitorum superficialis muscle, the muscles of the
deepest layer of the forearm can be identified: flexor digitorum profundus
muscle, flexor pollicis longus muscle and pronator quadratus muscle.
 
12. The extensor muscles of the forearm can be seen posteriorly. You may place
the cadaver in prone position or rotate the arm medially.
 
13. Identify the superficial extensor group of muscles in the forearm:
brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis,
extensor digitorum, extensor digitorum minimi and extensor carpi ulnaris.
 
14. Either retract or cut the extensor digitorum muscle to expose the muscles of
the deep extensor group of the forearm. Identify the abductor pollicis longus
muscle, extensor pollicis brevis muscle, extensor pollicis longus muscle,
supinator muscle and extensor indicis muscle.
 

GUIDE QUESTIONS:
1. Draw 4 joints of the elbow complex and label.
 

2. Draw the ligaments of the elbow joint and label.

Medial view

A. The medial collateral ligament complex:

Anterior bundle of the medial collateral ligament (A-MCL)
Posterior bundle of the medial collateral ligament (P-MCL)
Transverse ligament (T-MCL)
Lateral view

B. Lateral collateral ligament complex:

Lateral ulnar collateral ligament (LUCL)
Radial collateral ligament (RCL)
Annular ligament (AL)

3. Draw the cubital fossa and its boundaries (roof, floor, and contents); label.
4. Draw the bones of the forearm, label. 
5.In tabulated form, list the muscles of all compartments of the forearm (Origin,
Insertion, Action, and Nerve supply).