Transcript Antebrachium Flexors - WELCOME to the future website of

Antebrachium Flexors
Bony, soft landmarks
• 1. humerus
– a. lateral epicondyle - radial side
– b. medial epicondyle - ulnar side
• 2. radius - head, neck, tuberosity, styloid process (more
distal than ulnar's styloid)
– interosseous border (medial edge, attachment of interosseous
mb); distal tubercle
• 3. ulna - olecranon process, coronoid process &
tuberosity, styloid process, trochlear notch interosseous
border (lateral edge); head (distal end of ulna)
• 4. flexor retinaculum: thick section of deep fascia at wrist
-holds forearm tendons in place
Vessels
• Brachial artery: extension/continuation of axillary
artery (barely reaches into forearm)
• Radial artery: lateral, anterior to elbow; partially
overlapped by brachioradialis muscle
– a. radial recurrent (around elbow, anastomoses with
branch from deep brachial artery)
– b. superficial palmar branch to form the superficial
palmar arch (anastomoses with ulnar branch)
– c. palmar carpal branch arch (joins with palmar carpal
branch from ulnar artery to form the palmar carpal
arch)
– d. dorsal carpal branch (joins with dorsal carpal branch
from ulnar artery to form dorsal arch, more later)
Ulnar artery
• ulnar artery: medial, anterior to elbow, deep to pronator
teres muscle
– a. anterior ulnar recurrent anastomoses with inferior ulnar
collateral artery
– b. posterior ulnar recurrent anastomoses with superior ulnar
collaterals around elbow
– c. common interosseous artery. - in cubital fossa (branch into
anterior, posterior branches)
– d. palmar carpal branch arch (anastomoses with radial branch,
see above)
– e. dorsal carpal branch arch
– f. superficial branch to form the superficial palmar arch
– g. deep palmar branch arch (anastomoses with radial artery)
Forearm Nerves
• Median & Ulnar - both are on the anterior side,
supply essentially all the flexors with few
exceptions
• 1. Median - on anterior side
– a. articular branches: to elbow
– b. muscular branches: to all flexors
(except flexor carpi ulnaris & medial part of digitorum
profundus by ulnar nerve)
– c. anterior interosseous nerve: to flexor digitorum
profundus (lateral 1/2) pollicis longus & pronator
quadratus
– d. palmar cutaneous branch: - to skin of lateral palm
Ulnar
• a. articular branches: to elbow
• b. muscular branches: to flexor carpi
ulnaris & medial part of digitorum
profundus
• c. palmar cutaneous branch: - to skin of
posterior, medial part of hand
Radial Nerve
• Radial - to posterior (supplies only extensors +
brachioradialis, its one and only flexor)
– a. superficial branch = continuation of radial
- to skin on lateral dorsal wrist, hand, thumb, lateral
1+1/2 digits (index, middle)
– b. deep branch - is larger, exclusively muscular &
articular - to extensor muscles; supinator
– c. posterior interosseous - a branch of the deep radial
- to deep extensors
Muscles
• 3 functional groups:
• flex wrist at hand = flexor carpi radialis;
flexor carpi ulnaris; palmaris longus
• flex fingers = flexor digitorum superficialis;
flexor digitorum profundus; flexor pollicis
longus
• pronate hand = pronator teres; pronator
quadratus
layers
• Superficial layer
– pronator teres; flexor carpi radialis; flexor carpi ulnaris;
palmaris longus
– share a common tendon from humerus (medial
epicondyle)
– & deep fascia that covers proximal parts of the
muscles
– then separate from each other as they extend distal to
the humerus
• 2. intermediate layer = flexor digitorum
superficialis
• 3. deep layer = flexor digitorum profundus; flexor
pollicis longus; pronator quadratus
PRONATOR TERES
• ORIGIN
– Origin of humeral head: Immediately
above medial epicondyle of humerus,
common flexor tendon, and deep
antebrachial fascia
– Origin of ulnar head: medial side of
coronoid process of ulna
• INSERTION
medial of lateral surface of radius
• ACTION
pronates forearm
• NERVE
median nerve – C6, 7
FLEXOR CARPI RADIALIS
• ORIGIN
common flexor tendon from medial
epicondyle of humerus, and deep
antebrachial fascia
• INSERTION
base of second metacarpal bone and a slip
to base of third metacarpal bone
• ACTION
flexes, abducts the wrist and may assist in
pronation of the forearm and flexion of the
elbow
• NERVE
median nerve - C6, C7, C8
PALMARIS LONGUS
• ORIGIN
common flexor tendon from medial
epicondyle of humerus, and deep
antebrachial fascia
• INSERTION
flexor retinaculum, and palmar aponeurosis.
• ACTION
tenses the palmar fascia, flexes the wrist,
and may assist in flexion of the elbow
• NERVE
median nerve – C(6), C7, C8, T1
PALMARIS BREVIS
• ORIGIN
ulnar border of palmar
aponeurosis and palmar surface
of flexor retinaculum
• INSERTION
Skin on ulnar border of hand
• ACTION
Corrugates the skin on ulnar
side of hand
• NERVE
ulnar, C7, 8, T1
FLEXOR CARPI ULNARIS
• ORIGIN
– humeral head: common flexor tendon from medial
epicondyle of humerus
– ulnar head: by aponeurosis from the medial margin
of olecranon, proximal two thirds of posterior border
of ulna, and from the deep antebrachial fascia
• INSERTION
pisiform bone and by ligaments, to hamate
and fifth metacarpal bones
• ACTION
flexes and adducts the wrist and may assist in
flexion of the elbow
• NERVE
ulnar nerve - C7, C8, T1
FLEXOR DIGITORUM SUPERFICIALIS
• ORIGIN
– Origin from humeral head: common flexor tendon
from medial epicondyle of humrus, ulnar collateral
ligament of elbow joint, and deep antebrachial fascia
– Origin from ulnar head: medial side of coronoid
process
– Origin from radial head: obique line of radius
• INSERTION
by four tendons into sides of middle phalanges
of second through fifth digits
• ACTION
flexes the proximal interphalangeal joints of
second through fifth digits, assists in flexion of
the metacarpophalangeal joints and in flexion of
the wrist
• NERVE
median nerve - C7, C8, T1
FLEXOR DIGITORUM PROFUNDUS
• ORIGIN
Anterior and medial surfaces of proximal three
fourths of ulna, interosseus membrane, and deep
antebrachial fascia
• INSERTION
by four tendons into bases of distal phalanges,
anterior surface
• ACTION
flexes distal interphalangeal joints of index, middle,
ring, and little fingers, and assists in flexion of
proximal interphalangeal and metacarpophalangeal
joints, may assist in flexion of the wrist
• NERVE
Profundus I, II median nerve C7, C8, T1
Profundus III, IV: ulnar nerve C7, C8, T1
FLEXOR POLLICIS LONGUS
• ORIGIN
Anterior surface of body of radius below
tuberosity, interosseus membrane, medial
border of coronoid process of ulna, and/or
medial epicondyle of humrus
• INSERTION
Base of distal phalanx of thumb, palmar
surface
• ACTION
flexes the interphalangeal joint of the thumb,
assists in flexion of the metacarpophalangeal
and carpometacarpal joints, and may assist
in flexion of the wrist
• NERVE
median nerve, C(6),C7, C8, T1
PRONATOR QUADRATUS
• ORIGIN
Medial side, anterior surface of
distal one fourth of ulna
• INSERTION
Lateral side, anterior surface of
distal one fourth of radius
• ACTION
pronate the forearm
• NERVE
median nerve, C7, C8, T1