INTRODUCTION TO FOREARM

Dr:Misbah Ghous
DPT, MSNMPT
 Learning Objectives
• To explain the compartments of forearm
• To explain the muscles attached of forearm
• To explain the nerves of forearm
• To explain the blood supply of forearm

Front of Forearm 2
 Front of Forearm

Components of Forearm

• Eight Muscle, 5 Sup and 3 Deep

• 2 Arteries, Radial and Ulnar

• 3 Nerves, Median, Ulnar and Radial

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• Anatomical Groups
• 1. Superficial (common Flexor origin)
• Pronator teres
• Flexor carpi radialis
• Palmaris longus
• Flexor carpi ulnaris
• Flexor digitorum superficialis
• 3. Deep
• Pronator quadratus
• Flexor digitorum profundus
• Flexor pollicis longus

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Front of Forearm 5
 Flexor Carpi Ulnaris
• Attachments: 
– Origin
• from the medial epicondyle with the other
superficial flexors.
• Medial margin of olecranon and from posterior
border of ulna by aponeurosis
– Insertion:
• It passes into the wrist, and attaches to the pisiform
carpal bone.
– Innervation:
• Ulnar nerve
– Actions:
• Flexion of the wrist
• adduction at the wrist
• Fixes the pisiform bone during contraction of
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hypothenar muscles
 Palmaris Longus
• Attachments: 
– Origin
• from the medial epicondyle,
– Insertion:
• attaches to the flexor retinaculum of the wrist
and apex of palmar aponeurosis
– Actions:
• Flexion at the wrist
• Make palmar aponeurosis tensed
– Innervation:
• Median nerve

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Front of Forearm 8
 Flexor Carpi Radialis
• Attachments:
• Origin
• from the medial epicondyle,
• Insertion:
• attaches to the base of metacarpals
II and III
• Actions:
• Flexion and abduction at the wrist
• Innervation:
• Median nerve

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Front of Forearm 10
 Pronator Teres
• Attachments:
• origin
• It has two origins, one from the medial
epicondyle (Humeral head)
• and the other from the coronoid process of the
ulna. (ulnar Head)
• Insertion:
• It attaches to the mid-shaft of the radius, on its
lateral side
• Actions: 
• Pronates the forearm
• Innveration: 
• Median nerve

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Front of Forearm 12
• Flexor Digitorum Superficialis
• Attachments:
• Origin:
• It has two heads – one originates from the medial
epicondyle of the humerus, the other from the radius.
• Insertion:
• The muscle splits into four tendons at the wrist,
which travel through the carpal tunnel, and attaches
to the middle phalanges of the four fingers.
• Actions:
• Flexes the metacarpophalangeal joints and proximal
interphalangeal joints at the 4 fingers, and flexes at
the wrist
• Innervation:
• Median nerve Front of Forearm 13
Front of Forearm 14
Deep Muscles

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 Flexor Digitorum Profundus
• Origin
• Upper 3/4th of anterior and medial surface of ulna
• Upper 3/4th of posterior surface of ulna
• Medial surface of olecranon and coronoid processes of ulna
• associated interosseous membrane.
• Insertion:
• At the wrist, it splits into four tendons, that pass through
the carpal tunnel and attach to the palmar surface of distal
phalanges of the four fingers
• Actions:
• It is the only muscle that can flex the distal interphalangeal
joints of the fingers.
• It also flexes at metacarpophalangeal joints and
• flex at the wrist joint
• Innervation:
• The medial half (acts on the little and ring fingers) is
innervated by the ulnar nerve.
• The lateral half (acts on the middle and index fingers) is
innervated by the median nerve Front of Forearm 16
Front of Forearm 17
 Flexor Pollicis Longus
• Origin:
• from the upper 3/4th of anterior surface of
the radius, and
• surrounding interosseous membrane.
• Insertion:
• Attaches to the base of the distal phalanx
of the thumb.
• Actions: 
• Flexes the interphalangeal joint
and metacarpophalangeal joint of the
thumb
• Innervation:
• Median Nerve
• (anterior interosseous nerve)
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Front of Forearm 19
 Pronator Quadratus
• Origin
• Oblique ridge on the lower
1/4th 0f the anterior surface
of the ulna,
• Insertion:
• attaches to the anterior
surface of the radius
• Actions:
• Pronates the forearm
• Innervation:
• Median Nerve
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Front of Forearm 21
 Synovial sheaths of
flexor tendons
• Common flexor synovial sheath
• Long flexor tendons are enclosed
in it while passing through carpal
tunnel
• Synovial sheath for flexor
pollicis longus
• It may be separate or may
communicate with common flexor
synovial sheath
• Digital synovial sheath
• This enclose the flexor tendons of
fingers
1. Anterior annular ligament. 3. Great palmar bursa.
2. Synovial sheath of thumb. 4. Synovial sheath of little finger.

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 Arteries on front of forearm
• Radial artery
• Ulnar artery

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Radial artery

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 Radial artery
• Course and relation
• It is smaller terminal branch of brachial ar.
• Runs toward wrist with lateral convexity
• Leave forearm and enter anatomical snuff box
• Course and relations
• Anteriorly
• Brachioradialis
• Posteriorly
• Biceps tendon
• Supinator
• Insetion of pronator teres
• Radial origin of flexor digitorum superficialis
• Radial origin of flexor pollicis longus
• Pronator quadratus
• Lower end of radius
– Medially
• Pronator teres
• Tendons of flexor carpi radialis
– Laterally
• Brachioradialis Front of Forearm 25
 branches
• Radial recurrent artery
– It ends by anastomosing with radial
collateral artery in front of lateral
epicondyle of humerus
• Muscular branches
– Lateral muscles of forearm
• Palmar carpal branch
– It ends by ansatomosing with palmar
carpal branches of ulnar artery
• Superficial palmar branches
– It joins the terminal part of ulnar artery
to complete superficial palmar arch
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Front of Forearm 27
 Ulnar artery
• Larger terminal branch of brachial artery
• Begins in cubital fossa
• Runs obliquely downwards and medially In
the upper 1/3rd of forearm
• In lower 2/3rd it is vertical
• It enters the palm by passing superficial to
flexor retinaculum

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 Relations
• Anteriorly
– Upper half
– Pronator teres
– Flexor digitorum superficialis
– Flexor carpi radialis
– Palmaris longus
– Flexor carpi ulnaris
– Lower half
– Covered by skin, superficial and deep fascia

• Posteriorly
– Brachialis
– Flexor digitorum profundus

• Medially
– Ulnar nerve, flexor carpi ulnaris

• Laterally
– Flexor digitorum superficialis
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 Branches
• Anterior/posterior ulnar recurrent arteries
• Anastomose around elbow
• It anastomose with 2 ulnar collateral arteries
• Common interosseous artery
• It end by dividing into anterior/posterior arteries
• Muscular branches
• Medial muscles of forearm
• Palmar/dorsal carpal branches
• Anastomosis with wrist joint

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Front of Forearm 31
 Nerves of front of the forearm
• Median nerve
• Radial nerve
• Ulnar nerve

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 Median nerve
• Main nerve of front of forearm
• Also supply to muscles of thenar eminence
• Course and relations
• In cubital fossa
• It lies medial to brachial artery
• In front of brachialis muscle
• Enter forearm by passing 2 heads of pronator teres
• Along with ulnar artery it passes beneath fibrous arch of flexor
digitorum superficialis
• It is also accompanied by median artery (a branch of anterior
interosseous artery)
• It enters palm by passing deep to flexor retinaculum through carpal
tunnel
Front of Forearm 33
 branches
• Muscular branches
– Flexor carpi radialis
– Palmaris longus
– Flexor digitorum superficialis

• Anterior interosseous branch

– Flexor pollicis longus
– Flexor digitorum profundus (lateral half)
– Pronator quadratus
– Distal radioulnar and wrist joint

• Palmar cutaneous branch

– Skin over thenar eminence
– Central part of palm

• Articular branches
– Elbow
– Proximal radioulnar joint

• Vascular
– Radial/ulnar artery

• Communication
– Ulnar nerve Front of Forearm 34
Front of Forearm 35
Front of Forearm 36
 Ulnar nerve
• Course and relations
• At elbow
• It lies behind medial epicondyle of the humerus
• Enters forearm by passing b/w flexor carpi ulnaris
• In the forearm
• It runs b/w flexor digitorum profundus and superficialis laterally.
• Enters palm by passing superficial to flexor retinaculum lateral to
pisiform bone
• At wrist
• Ulnar neurovascular bundle b/w flexor carpi ulnaris and flexor
digitorum superficialis.

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Front of Forearm 38
 Branches
• Muscular
– Flexor carpi ulnaris
– Medial half of flexor digitorum profundus

• Palmar and dorsal cutaneous branch

• Palmar branch arises in the middle of forearm and
supplies the skin over hypothenar eminence
• Dorsal branch supplies proximal part of ulnar 1 ½
fingers and adjoining area of dorsum of hand
• Articular branch
» Elbow joint

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Front of Forearm 40
 Radial nerve
• Course and relations
– It divides into its terminal branches in the cubital fossa at level of
lateral epicondyle of humerus
• The deep terminal branch (posterior interosseous)
• Superficial terminal branch
– This nerve is closely related to the radial artery only in middle 1/3 rd
of forearm
– In upper 1/3rd it is separated from artery
– In lower 1/3rd it passes backwards under tendon of brachioradialis
– It supplies to cutaneously to the lateral half of the dorsum of hand
and to proximal part of dorsal surfaces of the thumb, index fingerm
lateral half of middle finger.

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Front of Forearm 42
Front of Forearm 43
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