GROSS

THE FOREARM AND THE HAND ANATOMY

Arturo M. Decano, M.D. | September 9, 2020 BLOCK 1

TABLE OF CONTENTS
I. THE FOREARM’S AND HAND’S BONES .......................................1
A. BONES OF THE FOREARM ................................................. 1
II. FOREARMS MUSCLE...................................................................1
A. ANTERIOR COMPARTMENT ............................................... 1
B. POSTERIOR COMPARTMENT............................................. 1
III. CUBITAL FOSSA .........................................................................2
IV. FOREARM: BLOOD AND NERVE SUPPLY .................................2
A.BLOOD SUPPLY OF THE FOREARM ................................... 2
B.NERVE SUPPLY OF THE FOREARM ................................... 2
V. WRIST AND HAND .......................................................................2
A.BONES OF THE WRIST AND THE HAND ............................. 2
B.FASCIA AND COMPARTMENTS ........................................... 3
C. MUSCLES OF THE HAND .................................................... 4
D. BLOOD SUPPLY OF THE HAND.......................................... 5
E. NERVE SUPPLY OF THE HAND .......................................... 5
F. CLINICAL APPLICATIONS.................................................... 5 Figure 2. Anterior Superficial Muscle of the Forearm [TeachMeAnatomy]
III. REVIEW QUESTIONS..................................................................6
IV. MNENOMICS ...............................................................................6 INTERMEDIATE LAYER
V. REFERENCES..............................................................................6
● Flexor digitorum superficialis
VI. APPENDIX ...................................................................................7
VII. SUMMARY ..................................................................................7 o Gives rise to four tendons for the 2 nd to 5th digits
o Flexes proximal interphalangeal joint
I. THE FOREARM’S AND HAND’S BONES
DEEP LAYER
A. BONES OF THE FOREARM ● Flexor digitorum profundus
● Ulna o Gives rise to four tendons for the 2 nd to 5th digits
o Stabilizing bone of the forearm o Flexes distal interphalangeal joint
o Medial and longer of the two forearm bones o Inserts separately to index finger, easier flex
o For articulation with the humerus proximally o Innervation
▪ Olecranon ▪ Ulnar/medial half: ulnar nerve
- projects proximally from posterior aspect, short ▪ Radial/lateral half: median nerve
lever for extension of elbow ● Flexor pollicis longus
▪ Coronoid process o Lateral to flexor digitorum profundus
- projects anteriorly o Flexes thumb
▪ Trochlear notch ● Pronator quadratus
- jaws of crescent wrench, articulates with trochlea o Deepest muscle
o Laterally attaches to the radius o Only muscle attached at radius on one end then ulna on
o Other landmarks: the other
▪ Radial notch o Pronates forearm
- lateral side of coronoid process, receives radius
● Radius
o Head of radius
▪ Articulates with the capitulum
o Radial tuberosity
▪ Where biceps brachiii tendon attaches
o Ulnar notch
▪ Accommodates head of ulna
Figure 3. Deep Muscle Layer of the Forearm [TeachMeAnatomy]

B. POSTERIOR COMPARTMENT
● Extend, abduct, or adduct the hand
HANDS
● Extensor carpi radialis longus and brevis
o Extend and abducts hand
● Extensor carpi ulnaris
Figure 1. Bones of the Forearm [Dr. Roxas’ PPT]
o Extend and adducts hand
II. FOREARMS MUSCLE FOUR DIGITS
● Antebrachial fascia ● Extensor digitorum
o Divides the muscles into two compartments o Extends medial four fingers
● Extensor digiti minimi
A. ANTERIOR COMPARTMENT
o Extends 5th digit, helps in extension of four medial fingers
● Known as flexor pronator muscles
● Extensor indicis
SUPERFICIAL LAYER o Inserts in 2nd digit, extends independently (when you’re
● Pronator teres pointing)
o Most lateral of the superficial forearm flexor
o Pronates and flexes forearm
o Innervated by median nerve
● Flexor carpi ulnaris
o Most medial of the superficial forearm flexor
o Flexes and adducts hands
o Only muscle in anterior compartment that is fully innervated
by the ulnar nerve
● Flexor carpi radialis
o Medial to pronator teres
o Flexes and abducts hand
o Innervated by median nerve
● Palmaris longus
o May be absent
o Has unusually long tendon
o Flexes hand and tenses palmar aponeurosis Figure 4. Posterior Compartment of the Forearm [TeachMeAnatomy]

★ Note
1 of 7 Trans 1.04 v1 | TH Sarte, Chesca | TG # 05: Dy, Figueroa, Paler
✓ Important!
 GROSS ANATOMY THE FOREARM AND THE HAND

VENOUS DRAINAGE
FIRST DIGIT
● Abductor pollicis longus Superficial Veins of the Forearm
o Abducts and extends originate in the subcutaneous tissue on the dorsum of the hand
● Extensor pollicis brevis from the dorsal venous network
o Extends proximal phalanx • Cephalic Vein
● Extensor pollicis longus o Begins from the lateral border of the dorsal venous network,
o Extends distal phalanx ascend along the lateral border of the forearm, reaching the
cubital fossa
Communicate with basilica vein via median cubital
vein
Ascend to the arm, enters the delto-pectoral triangle
and drains into the axillary vein
• Basilic Vein
o Begins from the medial part of the dorsal venous network
o Ascend along the medial border of the forearm
Communicate with the cephalic vein via median
cubital vein
Ascend to deep fascia of the arm and merge with
veins accompanying the brachial artery and forms the
axillary vein

Figure 5. Muscles of the Forearm [Google, Sept. 9, 2019]

FOREARM
● Brachioradialis: flexes forearm
● Supinator: supinates forearm

III. CUBITAL FOSSA

● Boundaries
o Lateral boundary: brachioradialis
o Medial boundary: pronator teres
o Superior boundary: connects epicondyle of the humerus
● Other structures:
o Radial nerve
o Median nerve
o Brachial artery
o Tendon of biceps brachii
Figure 8. Venous Drainage of the Upper Limb [Moore]

Deep Veins of the Forearm

named after the artery they accompany (e.g. brachial veins) and
usually come in pairs
B. NERVE SUPPLY OF THE FOREARM
• Median Nerve
o Supplies all muscles in the anterior compartment of the
forearm except:
Flexor carpi ulnaris
Medial half of flexor digitorum profundus
• Ulnar Nerve
o Flexor carpi ulnaris
o Median half of flexor digitorum profundus
Figure 6. Structures in Cubital Fossa [Voin]
o Passes through the Guyon’s Canal (aka ulnar canal)
IV. FOREARM: BLOOD AND NERVE SUPPLY together with the ulnar artery [2024 Trans]
A. BLOOD SUPPLY OF THE FOREARM • Radial Nerve
o Has 2 branches:
ARTERIAL SUPPLY
Superficial branch – sensory
Ulnar Artery Deep branch/Posterior interosseous nerve – motor
• Descends in the forearm deep into the superficial and supplies all muscles in the posterior compartment of
intermediate layers of muscles [Roxas, 2020] the forearm
• Ends at the superficial palmar arch of the hand
V. WRIST AND HAND
Radial Artery A. BONES OF THE WRIST AND THE HAND
• Descends deep to the brachioradialis
WRIST
o Superficial at the distal part of the forearm (wrist)
• aka carpus, is composed of 8 carpal bones arranged in
o Good site for taking the radial pulse
proximal and distal rows of four [Moore]
• Ends at the deep palmar arch
o give flexibility to the wrist
• Proximal Row (lateral to medial)
o Scaphoid
o Lunate
o Triquetrum
o Pisiform
• Distal Row (lateral to medial)
o Trapezium
o Trapezoid
o Capitate
o Hamate

Figure 7. Arteries of the Forearm [Dr. Roxas’ PPT]

★ Note
2 of 7 SLMCCM-WHQM 2025 #BenteSingko
✓ Important!
 GROSS ANATOMY THE FOREARM AND THE HAND

B. FASCIA AND COMPARTMENTS

WRIST
• Extensor Retinaculum (dorsal) and Flexor Retinaculum
(ventral)
o Deep fascia that keeps tendons in place during wrist
movement
• Carpal Tunnel
o At the anterior surface of the wrist
o Flexor retinaculum – roof of the tunnel
o Structures that pass through the carpal tunnel:
Flexor tendons
Median nerve

Figure 9. Metacarpal Bones [Netter]

Wrist Joint
• A condyloid/ellipsoid joint [2024 Trans]
• Articulation of the distal end of the radius, articular disc of the
distal radio-ulnar joint, and the proximal carpal bones (except
Figure 12. Carpal Tunnel | also seen is the Flexor Retinaculum [Dr’ Roxas’ PPT
pisiform)
• Movements: Note: the ulnar artery, ulnar nerve, and radial artery do not pass
o Flexion through the carpal tunnel. The ulnar artery and nerve are located
o Extension superficial to the flexor retinaculum [2024]
o Abduction
HAND
o Adduction
o Rotation • Palmar Aponeurosis
Note: o Strong, well-defined part of the deep fascia of the palm
• Ulna doesn’t participate in the wrist joint [Roxas, 2020] [Moore,p.773]

• Pisiform is not part of the wrist joint [Roxas, 2020]
o Gives firm attachment to the overlying skin for grip
improvement
o Proximal end/apex of the triangular palmar aponeurosis is
continuous with the flexor retinaculum and the palmaris
longus tendon[Moore]
o Protects tendons passing underneath it [Roxas, 2020]

Figure 10. Cross-sectional view of the wrist joint [Dr’ Roxas’ PPT]

HAND
• The skeleton of the hand consists of carpals in the wrist,
metacarpals in the hand proper, and phalanges in the digits
[Moore]
• Metacarpals
o Composed of 5 bones
o Each metacarpal consists of a base, a shaft, and a head Figure 13. Palmar Aponeurosis [Moore, p.773]
Proximal bases of metacarpals articulate with carpal
bones • Synovial Tendon Sheaths
Knuckles – distal heads articulating with the proximal o Enclose flexor and extensor tendons
phalanges o Has serous membranes that secrete a small amount of fluid,
• Phalanges allowing easier facilitation of movement of structures they
o Proximal, Middle, and Distal Phalanges enclose
o Each of the digits has 3 phalanges, except for the thumb
which has only 2
1st digit (thumb) – proximal and distal phalanges
2nd-4th digits (4 medial digits) – proximal, middle, and
distal phalanges
Note: thumb – only has interphalangeal joint

Figure 14. Compartments of the Hand [Dr’ Roxas’ PPT]

• Fibrous Digital Sheaths

o Encloses the synovial tendon sheaths along with the
Figure 11. Bones of the Hand (palmar view) [Dr’ Roxas’ PPT]
tendons inside them
Joints of the Hand • Palmar Fascial Spaces
• Carpometacarpal joints – between carpal and metacarpal o Midpalmar Space
bones Continuous with the anterior compartment of the
• Metacarpal joints – between metacarpal and the phalanges forearm via carpal tunnel [Moore/2024 Trans]
• Interphalangeal joints Note: infection in the midpalmar space can spread to
o Proximal Interphalangeal (PIP) – between proximal and the forearm by passing through the carpal tunnel
middle phalanges o Thenar Space
o Distal Interphalangeal (DIP) – between middle and distal
phalanges

★ Note
3 of 7 SLMCCM-WHQM 2025 #BenteSingko
✓ Important!
 GROSS ANATOMY THE FOREARM AND THE HAND

C. MUSCLES OF THE HAND

EXTRINSIC MUSCLES
• Extrinsic muscles of the hand are the same muscles in the
forearm that insert into the digits
o Extrinsic due to their origin being outside of the hand itself.
INTRINSIC MUSCLES
• Located within the hand and separated into 5 compartments,
although they may be classified into 4 types of muscles.

Figure 15. Compartments of the Hand Dr’ Roxas’ PPT

Figure 18. Intrinsic Muscles of the Hand – Muscle Compartments. [Roxas,

2020]

Figure 16. Thenar Space Infection [Dr’ Roxas’ PPT] Thenar Muscles
COMPARTMENTS OF THE PALM • Opposition of the thumb or first digit
• Hypothenar Compartment [Moore] • Forms thenar eminence on lateral surface of palm
o Contains hypothenar muscles and is bounded anteriorly by
hypothenar fascia
o Medial to the medial fibrous septum
• Thenar Compartment [Moore]
o Contains the thenar muscles and is bounded anteriorly by
thenar fascia
o Lateral to the lateral fibrous septum
• Central Compartment [Moore] Figure 19. Thumb movements. [Moore, 2018]
o Between the hypothenar and the thenar compartments
o Contains the flexor tendons along with their sheaths, the Thenar Compartment
lumbricals, the superficial palmar arterial arch, and the digital • Abductor pollicis brevis – more lateral muscle
vessels and nerves; and is bounded anteriorly by the palmar o Action: abduction of the thumb; assistance in opposition of
aponeurosis the thumb
• Adductor Compartment [Moore] • Flexor pollicis brevis – medial to abductor pollicis brevis
o Deepest muscular plane of the palm o Action: flexion of the thumb at: carpometacarpal and
o Contains the adductor pollicis metacarpophalangeal joints
• Opponens pollicis – beneath the other two thenar muscles
ANATOMICAL SNUFF BOX o Action: opposition of the thumb
• Boundaries
o Anterior Boundaries Table 1. Summary of Movements of Thumb
Abductor Pollicis Longus Tendon Movement Muscles Involved
Extensor Pollicis Brevis Tendon Extensor pollicis longus
Scaphoid and Trapezium form parts of the floor Extension Extensor pollicis brevis
Abductor pollicis longus
• Things you can palpate in the area: Flexor pollicis longus
o Note: (fully extend your thumb to see it better) Flexion
Flexor pollicis brevis
o pulsation of the radial artery Abductor pollicis longus
the radial artery runs on the floor of the ASB Abduction
Abductor pollicis brevis
o scaphoid and trapezium
Adductor pollicis
found on the floor of the ASB Adduction
1st dorsal interosseous
Opposition Opponens pollicis
Note: Opposition of fingers other than the 5 th digit involves more movement
than can be produced by the opponens policis alone. [Moore, 2018]

Central and Short Muscles

Figure 17. Anatomical Snuffbox
Central compartment
• Lumbricals – long and slender, like a worm
o Arise from the tendons of the flexor digitorum profundus
o Action: flex the fingers at metacarpophalangeal joints;
extend interphalangeal joints
• 1st and 2nd lumbricals
• 3rd and 4th lumbricals
Interosseous Compartment
• Four (4) Dorsal Interossei – Between metacarpals
o Action: abduction of the digits
• Three (3) Palmar Interossei – On palmer surfaces of
metacarpals in interosseous compartment
o Action: adduction of the digits
[Dr’ Roxas’ PPT/Moore,p.757]

★ Note
4 of 7 SLMCCM-WHQM 2025 #BenteSingko
✓ Important!
 GROSS ANATOMY THE FOREARM AND THE HAND

Adductor Muscles o Thenar Muscules (2 ½)

o Lateral Lumbricals (1st and 2nd lumbricals)
Adductor compartment
• Sensory Distribution:
• Adductor pollicis o Skin on entire palmar surface
o Action: adduction of the thumb – allows gripping o Lateral and dorsum halves of the first 3 ½ digits
Hypothenar Muscles
Ulnar Nerve
• Responsible for movement of the little finger or 5 th digit
• Forms hypothenar eminence on the medial side of the palm • Also known as nerve of fine movements
• Motor Distribution: [Moore,2018]
Hypothenar Compartment o Muscles in the hand that are NOT supplied by the median
• Abductor digiti minimi – most superificial nerve
o Action: Abducts the 5th finger – helps flex its proximal • Sensory Distribution:
phalanx o Medial half of the dorsum of the hand
• Flexor digiti minimi brevis – lateral to abductor digiti minimi o 5th digit
o Action: Flexes the proximal phalanx of the 5th finger at the o Medial half of the 4th finger
metacarpophalangeal joint o Anterior surface of medial 1 ½ digits
• Opponens digiti minimi – deep to the abductor and flexor o Hypothenar muscles
muscles of the 5th finger o Medial two (2) lumbricals
o Action: draws the 5th metacarpal anteriorly, rotates 5th finger o Adductor pollicis
laterally; helps in bringing 5th finger into opposition with o Deep head of the flexor pollicis brevis
thumb o All interossei
D. BLOOD SUPPLY OF THE HAND Radial Nerve
ARTERIES OF THE HAND • Does not supply any hand muscles
• Superficial palmar arch[Moore, 2018] • Sensory Distribution only: [Moore,2018]
o Radial artery o Dorsum of the thumb
Will terminate in the hand by forming the deep palmar o Skin and fascia over the lateral 2⁄3 of the dorsum of the hand
arch, together with the deep branch of the ulnar artery o Dorsum of the thumb
o Ulnar artery o Proximal parts of lateral 1 ½ digits
Passes through Guyon’s canal F. CLINICAL APPLICATIONS
Ends in the hand as the superficial palmar arch
Completed on the lateral side by the superficial branch
of the radial artery forms an arch
Lies lateral to ulnar nerve
• Deep palmar arch
o Formed by the radial artery and the deep branch of the ulnar
artery

Figure 22. Carpal Tunnel [Roxas, 2020]

• Median Nerve Palsy or Carpal tunnel syndrome [Moore,2018]

o Numbness of fingers along distribution of the median nerve
o Cause:
Lesion that reduces the size of the carpal tunnel
Figure 20. Arteries of Wrist and Hand. [Moore, 2018]
Increase in size of the other nine structures or their
VEINS OF THE HAND coverings that pass through carpal tunnel
• Begins with the superficial and deep venous palmar arches o Symptoms:
drain into deep veins of the forearm Progressive loss of coordination and strength of the
• Dorsal Venous Network thumb
o Dorsal digital veins drains into three (3) dorsal metacarpal Inability to oppose thumbs
veins the dorsal metacarpal veins unite to form the dorsal Atrophy of thenar muscles
venous network o Treatment:
• Cephalic Vein Partial or complete surgical division of the flexor
o Prolongs the dorsal venous network proximally on the lateral retinaculum – carpal tunnel release
side o Doc Roxas’ sister had carpal tunnel in both hands
• Basilic Vein Pain became so severe she had to get surgery to
o Arises from medial side of dorsal venous network [Moore, 2018] attain relief from the pain surgery of both hands at
the same time and the hands needed to be in a splint
E. NERVE SUPPLY OF THE HAND

Figure 23. Ulnar Nerve Palsy [Roxas, 2020]

Figure 21. Sensory Innervation of Wrist and Hand. [Moore, 2018]
• Ulnar nerve palsy or Guyon Tunnel Syndrome
Median Nerve o Cause:
• Motor Distribution: [Moore,2018] Compression of the ulnar nerve
★ Note
5 of 7 SLMCCM-WHQM 2025 #BenteSingko
✓ Important!
 GROSS ANATOMY THE FOREARM AND THE HAND

o Symptoms: D. NOT A
Hypoesthesia or reduced sense of touch or sensation 10. Where does the tendon of the biceps brachii attach to?
in the medial 1 ½ fingers A. Tuberosity of the ulnar
Weakness of intrinsic muscles of the hand B. Trochlear notch
Adduction and abduction by the interossei are lost C. Radial tuberosity
o It’s like when you hit the medial part of your elbow on a hard D. NOT A
surface – funny bone Answers:
o Compression of the ulnar nerve which causes a numbness 1. Anterior (pronation, flexion, abduction & adduction of wrist)
and tingling in the areas along distribution of ulnar nerve to Posterior (supination, extension, abduction & adduction)
the medial 1 ½ digits 2. Brachial artery, Tendon of the biceps, Median nerve
o May also cause atrophy or wasting of the muscle supplied 3. A&C
by the ulnar nerve in the hand 4. B
5. C
6. B
7. D
8. B
9. B
10. C

IV. MNENOMICS
Cubital Fossa
• Boundaries:

Figure 24. Radial Nerve Palsy [Roxas, 2020]

• Radial nerve palsy or “Wrist Drop”

o Cause:
Compression of nerve in the axilla or upper arm
o Symptoms:
Inability to extend the wrist
Hand is flexed at the wrist and lies flaccid
Reduction in grip strength and functional lifting
o Real world example: your arm falling asleep because it was Figure 25. Boundaries of the Cubital Fossa [2024 Trans]

draped over the back of the chair • Contents: (medial to lateral) = Media AT Radio
o Not a permanent condition o Media – median nerve
o A – artery (brachial)
III. REVIEW QUESTIONS o T – tendon (biceps brachii)
1. What is the action of the muscles in the anterior o Radio – radial nerve
compartment of the forearm? Posterior forearm?
2. Name 2 structures that can be injured following a Contents of the Carpal Tunnel Song
penetrating wound to the cubital fossa. • Chant
3. The median nerve supplies the muscles in the anterior o 4 tendons of FDS (Flexor digitorum superficialis)
compartment of the forearm except the ___ &___? o 4 tendons of FDP (Flexor digitorum profundus
A. Flexor Carpi Ulnaris o FPL (Flexor pollicis longus)
B. Flexor Carpi Radialis o Median nerve
C. Medial half of the flexor digitorum profundus
D. Distal half of the flexor digitorum profundus
4. Injury to the radial nerve will result in the weakness of which Intrinsic Muscles of Hand: All for One And One For All
group of muscles?
• Abductor pollicis longus
A. Anterior forearm compartment muscles
• Flexor pollicis brevis
B. Posterior forearm compartment muscles
5. Which of the following muscles will lose its nerve supply if • Opponens pollicis
the median nerve is severed at the wrist? • Adductor pollicis
A. Adductor pollicis • Opponens digiti minimi
B. Flexor digiti minimi • Flexor digiti minimi brevis
C. Abductor pollicis brevis • Abductor digiti minimi
D. 1st dorsal interosseous
6. Injury to the ulnar nerve will result to diminished sensation CARPAL BONES – Some Lovers Try Positions That They
on this digit/part of the hand: Can’t Handle
A. Base of the thumb, palmar surface • Scaphoid
B. Dorsal surface of the 5th digit • Lunate
C. Dorsal surface of the proximal half of 2 nd and 3rd digits • Triquetrum
D. Lateral part of palm • Pisiform
7. The numbness in the fingers that is experienced by a • Trapezium
patient with carpal tunnel syndrome is the consequence of • Trapezoid
the compression of the:
• Capitate
A. Flexor tendons
• Hamate
B. Palmar arterial arches
C. Ulnar nerve
D. Median nerve Movements of the Interosseous Compartment Muscles
8. Which of the following are carpal bones in the distal row? • PAD and DAB
A. Triquetrum o Palmar ADduct
B. Trapoezoid o Dorsal Abduct
C. Both
D. NOT A V. REFERENCES
9. Which of the following is the joint that connects the proximal Moore, K.L., Dalley A.F., & Aguar A.M.R. (2018). Clinically
phalanges and the metacarpals? Oriented Anatomy. (8th ed.). Wolters Kluwer.
A. Carpometacarpal joint Roxas, M.P. (2020). The Forearm and the Hand. Lecture Slides
B. Metacarpophalangeal joint
C. Interphalangeal joint

★ Note
6 of 7 SLMCCM-WHQM 2025 #BenteSingko
✓ Important!
 GROSS ANATOMY THE FOREARM AND THE HAND

VI. APPENDIX

Figure 25. Superficial dissections of the right palm [Moore, 2018]

Figure 26. Attachments of intrinsic muscles of hand and actions of interossei. [Moore, 2018]
VII. SUMMARY
• The anterior compartment of the forearm FLEXES while the posterior compartment EXTENDS, ABDUCTS, ABDUCTS
• Boundary of the cubital fossa are the: ABDUCTOR POLLICIS LONGUS and EXTENSOR POLLICIS LONGUS
• Median Nerve
o Supplies all muscles in the anterior compartment of the forearm except:
Flexor carpi ulnaris
Medial half of flexor digitorum profundus
• Each of the digits has 3 phalanges, except for the thumb which has only 2
• Ulna doesn’t participate in the wrist joint [Roxas, 2020]
• Pisiform is not part of the wrist joint [Roxas, 2020]
• Thenar muscles in the hand control the thumb or 1st digit
• Hypothenar muscles in the hand control the pinky or 5th digit or little finger
• There are 4 lumbricals – flex the metacarpophalangeal joints
• Two arteries of the hand: ulnar artery and radial artery
o Ulnar artery will form superficial palmar arch with the radial artery [Moore, 2018]
o Deep branch of ulnar artery + radial artery = deep palmar arch [Moore, 2018]
• Median Nerve: Motor = Thenar Muscles and lateral 1 st and 2nd lumbricals
• Ulnar Nerve: Motor = Muscles not supplied by median nerve
• Radial Nerve: Motor = none

★ TG/TH Note
7 of 7 SLMCCM-WHQM 2025 #BenteSingko
✓ Important!