Anatomy Lecture 2:

Arm and forearm

Dr Choy Ker Woon

Senior Lecturer
Department of Anatomy
Faculty of Medicine, UiTM
 Specific Learning Outcomes
Content:

1. Arm region - bones, muscles and nerves

2. Forearm region- bones, muscles and nerves
3. Arterial Supply of arm and forearm
4. Venous Drainage of arm and forearm
5. Cubital Fossa
6. Applied anatomy
 Specific Learning Outcomes

Content:

1. Arm region - bones, muscles and nerves

2. Forearm region- bones, muscles and nerves
3. Arterial Supply of arm and forearm
4. Venous Drainage of arm and forearm
5. Cubital Fossa
6. Applied anatomy
Humerus

Type: Long Bone

Parts:
Ends: upper & lower
Shaft: intervene two ends.
 Humerus
Anterior View
Posterior View
Intertubercular
groove

Proximal end

Distal end

Distal end
Humerus
Humerus
Nerves in direct contact:

1. Axillary nerve- around surgical neck

2. Radial nerve- in deltoid groove
3. Ulnar nerve- behind medial
epicondyle
4. Median nerve- anterior to
the supracondylar humerus

7
Humerus important relations
General arrangement of layers of the arm

Intermuscular septum (medial and

lateral) → Anterior & posterior
compartment

a) Anterior compartment
(musculocutaneous nerve)

b) Posterior compartment (radial

nerve)

10
 Anterior compartment of arm- flexor compartment
Bicep brachii
All by Musculocutaneous
nerve

(**Pierced by (**2 nerves innvervation:

Musculocutaneous Musculocutaneous nerve,
nerve) radial nerve) Brachialis

(** main flexor) 11

Posterior compartment of arm- extensor
compartment

12
 Specific Learning Outcomes

Content:

1. Arm region - bones, muscles and nerves

2. Forearm region- bones, muscles and nerves
3. Arterial Supply of arm and forearm
4. Venous Drainage of arm and forearm
5. Cubital Fossa
6. Applied anatomy
Radius & Ulna
Type: Long Bone

❑ Radius is the lateral & ulna is

medial bone of forearm.

❑ Parts: Ends: upper & lower;

Shaft: intervene two ends.
 Ulnar

1. Olecranon Process
2. Trochlear Notch
3. Coronoid Process
4 Radial Notch
5. Head of Ulna
6. Styloid Process of ulnar

15
 Radius

1. Head of Radius
2. Neck of Radius
3. Radial Tuberosity
4. Radius (Shaft)
5. Styloid Process
6.
Ulnar Notch of
radius

16
17
 General Arrangement of layers in forearm
Intermuscular septum (medial
and lateral) Median nerve
(6 ½ ms)
Ulnar nerve
(1 ½ ms)
2 compartments

→Anterior (flexor –pronator

compartment)

→Posterior (extensor-
supinator compartment)
Radial
nerve
Ulnar nerve
(All 12 ms)
18
FOREARM: Anterior (flexor –pronator compartment)

Muscle
• > flexion of wrist jt
• < flexion of elbow jt
• Flexion of fingers & thumb
• pronation
3 layers
• Superficial (4 muscles)
• Intermediate (1 muscle)
• Deep (3 muscles)

19
 FOREARM: Anterior (flexor –pronator compartment)
Superficial layer

• Flexor carpi ulnaris

• Palmaris Longus
• Flexor carpi radialis
• Pronator Teres

Medial Lateral
 FOREARM: Anterior (flexor –pronator compartment)
Superficial layer-4 muscles

1) Flexor Carpi Ulnaris (FCU)

O 2 heads
• Humeral head-CFO
• Ulnar head- Olecranon & post
surface of ulna
I Pisiform, hamate, 5th metacarpal
N Ulnar nv (**passes between 2 heads)
A Flex & adduct wrist joint
Flex elbow jt (weak)

21
 FOREARM: Anterior (flexor –pronator compartment)
Superficial layer-4 muscles

2) Palmaris Longus
(Absent in 21% of people)

O CFO
I Palmar aponeurosis of hand
N Median nv

A Flex wrist jt
Flex elbow (weak)

22
 FOREARM: Anterior (flexor –pronator compartment)
Superficial layer-4 muscles

3) Flexor Carpi Radialis (FCR)

O CFO
I Base of metacarpals of digit 2&3
N Median nv
A Flex and abduction wrist jt
Flex elbow jt (weak)

23
 FOREARM: Anterior (flexor –pronator compartment)
Superficial layer-4 muscles

4) Pronator teres

O 2 heads
Humeral head- CFO
Ulnar head-coronoid process
I Midshalf of radius (lat surface)
N Median nv (**pass between 2 head)

A Pronate forearm
Flexion of elbow jt (weak)

24
 FOREARM: Anterior (flexor –pronator compartment)
Summary of Superficial
layer
(Median nv)
(Median nv)
• FPFP - Passes between the 2 heads*
• Origin: Common flexor
origin at medial
(Median nv)
epicondyle

(Ulnar nv)
- Passes between the 2 heads*

Medial Lateral

25
 FOREARM: Anterior (flexor –pronator compartment)
Intermediate layer-1 muscle

1) Flexor Digitorium
Superficialis (FDS)

O 2 heads
• Humeroulnar head- CFO & coronoid
process
(Median nv)
• Radial head- Sup ½ of anterior border
of radius (oblique line)
I 4 tendons (2 slips/tendon) to middle
phalanx of 2th -5th digits
N Flex wrist jt
Flex MCP jt & PIP jt (2th -5th digits)
A Median nv
26
FOREARM: Anterior (flexor –pronator compartment)
Deep layers- 3 muscles

(Median nv)

27
 FOREARM: Anterior (flexor –pronator compartment)
Deep layers- 3 muscles

1) Flexor Digitorium
Profundus (FDP)
O Ant & med surf of ulnar
Interosseous membrane
I 4 tendons (2 slips/tendon) to distal
phalanx of 2th -5th digits
N Flexion of wrist jt
Flexion of MCP jt , PIP jt, DIP jt (2th -5th
digits)
A Median nv (digit 2 & 3)
Ulnar nv (digit 4 & 5)
(the only muscle that can flex DIP jt)
 FOREARM: Anterior (flexor –pronator compartment)
Deep layers- 3 muscles
2) Flexor pollicis Longus (FPL)
O Ant surface of radius
Interosseous membrane
I Base of distral phalanx of thumb
N Median nv
A Flexion of wrist jt
Flexion of MCP jt & IP jt of thumb

3) Pronator Quadratus (PQ)

O Distal ¼ surf of ulna
I Distal ¼ surf of radius
N Median nv
A Pronates forearm
FOREARM: Anterior (flexor –pronator compartment)
Summary of Deep layers- 3 muscles

(Median nv) (Median nv)

(Median nv)

Digit 2,3→ median nv

Digit 4,5→ ulnar nv

30
FOREARM: Anterior (flexor –pronator compartment)

Superficial Intermediate Deep

Layer Layer Layer 31
32
FOREARM: Posterior (extensor -supinator compartment)

Muscle • Nerve: radial nv

• > wrist jt
• < elbow jt • Common extensor origin at
• extension of fingers & lateral epicondlyle
thumb
• Supination of forearm • 12 muscles (7 supf, 5 deep)

33
FOREARM: Posterior (extensor -supinator compartment)
• Superficial layer • Deep layer
Fascia of the arm and forearm
1)Brachial fascia
- Deep fascia of the arm
- Enclosed the muscles of the arm, and
sends septa between them.
- Continuous with deltoid and pectoral fascia
above

2) Antebrachial fascia
- Deep fascia of the forearm
- Enclosed the muscles of the forearm, and
sends septa between them.
- continuous above with the brachial fascia
 Specific Learning Outcomes

Content:

1. Arm region - bones, muscles and nerves

2. Forearm region- bones, muscles and nerves
3. Arterial Supply of arm and forearm
4. Venous Drainage of arm and forearm
5. Cubital Fossa
6. Applied anatomy
 Brachial artery

Course:

Origin - Continuation of
axillary artery.
Extent - Extends from lower
border of teres major to neck
of radius.
Termination -Terminates
into radial and ulnar arteries.
Branches of brachial artery:
1. Profunda brachii (deep
artery).
2. Radial.
3. Ulnar.
4. Superior ulnar collateral.
5. Middle ulnar collateral.
6. Inferior ulnar collateral.
7. Muscular.
8. Nutrient.

39
Radial artery & Ulnar artery

Neck of radius

(lateral to FCR)

40
 Radial artery
Origin & Course:
• Arises from the brachial
artery at the neck of the
radius.
• descends along the lateral
side of the ant
compartment of forearm
• lateral to the flexor carpi
radialis (FCR) tendon.
• descends to the carpal
region of the hand
• completing the deep
palmar arch.
Branches in the forearm :
1. Radial recurrent artery.
2. Cutaneous branches.
lateral
3. Muscular branches.
Ulnar artery
Origin & Course:
• Arises from the brachial
artery at the neck of the
radius.
• Descend along medial side
of ant compartment of
forearm Completing
the superficial palmar arch
Branches in the forearm:
1. Common interosseous artery
- divides into the anterior &
posterior interosseous
arteries.
2. Cutaneous branches.
3. Muscular branches.
medial
41
Clinical anatomy:
• Radial pulse from radial
artery
• It is easily palpated proximal
to the wrist crease
immediately lateral to the
tendon of the flexor carpi
radialis muscle.

42
 Specific Learning Outcomes

Content:

1. Arm region - bones, muscles and nerves

2. Forearm region- bones, muscles and nerves
3. Arterial Supply of arm and forearm
4. Venous Drainage of arm and forearm
5. Cubital Fossa
6. Applied anatomy
Venous drainage of upper limb

• Superficial vein Perforating veins:

• Deep vein connecting the two
systems.

44
Superficial Vein
1) Basilic vein
• dorsal venous network of the hand
→medial aspect of the upper limb.
• At the border of the teres major
→deep into the arm + brachial
veins from the deep venous system
→ form the axillary vein.

2) Cephalic vein connected

by median
• dorsal venous network of the hand
cubital vein
→ antero-lateral aspect of the
upper limb, passing anteriorly at
the elbow.
• At the shoulder → deltopectoral
groove→ axilla → axillary vein. 45
 Deep Vein
1) Radial vein, Ulnar vein
share the name of the artery they
accompany.

2) Brachial vein
• Accompanied by brachial artery.

46
Deep Vein
3) Axillary vein
• medial to axillary artery
• starts at inferior border of
teres major, ascend to
lateral border of the 1st
rib
• ends as subclavian vein
• Branches of axillary veins
follow axillary arteries

47
 Specific Learning Outcomes

Content:

1. Arm region - bones, muscles and nerves

2. Forearm region- bones, muscles and nerves
3. Arterial Supply of arm and forearm
4. Venous Drainage of arm and forearm
5. Cubital Fossa
6. Applied anatomy
 Cubital Fossa
Definition:
Triangular depression anterior to
elbow

Boundaries:
1) Lateral: Brachioradialis muscle
2) Medial: Pronator Teres muscle
3) Base: Imaginary line between
medial epicondyle and lateral
epicondyle of humerus
Cubital Fossa
Roof:

1) Skin

2) Superficial Fascia, containing

a. Cephalic vein
b. Basilic vein
c. Median Cubital Vein
d. Lateral Cutaneous nerve of forearm
e. Medial Cutaneous nerve of forearm

3) Deep Fascia

4) Bicipital Aponeurosis
 Cubital Fossa
Contents

1) Median Nerve
2) Brachial Artery
3) Bicep Brachii Tendon
4) Radial Nerve
Cubital Fossa

Floor:
1) Lateral: Supinator muscle
2) Medial: Brachialis muscle
Clinical anatomy of cubital fossa:
1) Venupuncture

53
Clinical anatomy of cubital fossa :
2) Blood pressure measurement

• Brachial pulse from brachial

artery
• palpable on the anterior
aspect of the elbow, medial
to the tendon of the biceps
• Blood pressure measurement
using Stethoscope &
sphygmomanometer (blood
pressure cuff).

54
 THANK YOU
What we had covered so far?
1. Arm region - bones, muscles and
Arm
nerves
2. Forearm region- bones, muscles and
nerves
3. Arterial Supply of arm and forearm Forearm
4. Venous Drainage of arm and
forearm
5. Cubital Fossa
6. Applied anatomy

55