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GROSSANATOMYOFTHEFOREARM丁香园 MainMenuBonesoftheforearm.Superficialmusclesoftheanteriorcompartment.Deepmusclesoftheanteriorcompartment.Arteriesandnervesoftheanteriorcompartment.Superficialmusclesoftheposteriorcompartment.Deepmusclesoftheposteriorcompartment.Arteriesandnervesoftheposteriorcompartment.Acknowledgements BonesoftheforearmTheradiusproximallyarticulateswiththehumerusattheelbowjoint.Distallyitarticulateswiththescaphoidandlunatebonesofthecarpus,andwiththeulnaatthedistalradioulnarjoint.Theulnaisthemoremedialofthetwobones.Itsproximalendarticulateswiththehumerusattheelbowjoint.Distallyitarticulateswiththeradius.Itisexcludedfromthewristjointbythearticulardisc.Theinterosseousmembranebindtheradiusandtheulnatogether.HeadInterosseousmembraneRadiusHumerusTuberosityofradiusUlnaHeadFig1.Anteriorviewofbonesoftheforearm. 总体记忆前臂共有18块肌肉分为屈肌与伸肌二部分屈肌8块分为浅层与深层浅层有5块深层有3块伸肌10块浅深各5块 前臂8块屈肌浅层5块旋前圆肌桡侧屈腕肌掌长肌指浅屈肌尺侧屈腕肌 Superficialmusclesoftheanteriorcompartment.Titlepage.1234Thesuperficialmusclesoftheanteriorcompartmentincludepronatorteres旋前圆肌,flexorcarpiradialis桡侧腕屈肌,palmarislongus掌长肌,andflexorcarpiulnaris.Alsoincludedinthisgroupisflexordigitorumsuperficialis.Thesuperficialgroupofmusclesallhavethesameorigin,whichisattachedtothemedialepicondyleofthehumerus肱骨内上髁.FORFURTHERDETAILSCLICKONEACHINDIVIDUALMUSCLEBELOW.PronatorteresFlexorcarpiradialisFlexorcarpiulnarisFlexordigitorumsuperficialisPalmarislongus(notincludedinthediagram).Fig2.Showingsuperficialmusclesoftheposteriorcompartment.Brachio-radialisReturntomainmenu PronatorTeres[5te7ri:z]Thepronatortereshastwoheads,thehumeralheadandtheulnarhead.Themediannerve正中神经enterstheforearmbetweenthetwoheads.Origin:-Humeralhead-Medialepicondyleofthehumerus.Ulnarhead-Medialborderofthecoronoidprocess冠突,冠状突oftheulna.Insertion附着:-Lateralaspectoftheshaftoftheradius.Nervesupply:-Mediannerve,C6andC7.Action:-Pronationoftheforearm.Flexionoftheforearm.PronatorteresRadiusFig3.Pronatorteres.Returntotitlepage *Flexorcarpiradialis,palmarislongus,andflexorcarpiulnarisFlexorcarpiradialisOrigin:-Medialepicondyleofthehumerus.Insertion:-Baseofthesecondandthirdmetacarpalbones.Nervesupply:-Mediannerve,C6andC7.Action:-Flexesthehandatthewristjoint.Abductsthehandatthewristjoint.PalmarislongusOrigin:-Medialepicondyleofthehumerus.Insertion:-Flexorretinaculumandpalmaraponeurosis.Nervesupply:-Mediannerve,C7andC8Action:-Flexesthehandatwristjoint.Flexorcarpiulnaris.Origin:-Humeralhead-Medialepicondyleofthehumerus.Ulnarhead-Medialaspectoftheolecranon鹰嘴(processoftheulnaandtheposteriorborderoftheulna.Insertion:-Pisiformbone豌豆状的,hookofthehamate,andbaseofthefifthmetacarpalbone.Nervesupply:-Theulnarnerve,C7,C8,andT1.Action:-Flexesthehandatwristjoint.AdductsthehandatwristjointPronatorteresFlexorcarpiradialisPalmarislongusFlexorcarpiulnarisFig4.FlexorcarpiradialisandulnarisandpalmarislongusReturntotitlepage Flexordigitorumsuperficialis.Origin:-Humeroulnarhead:Medialepicondyleofthehumerusandthemedialmarginofthecoronoidprocessoftheulna.Radialhead:Risingfromtheobliquelineontheanteriorsurfaceoftheshaftoftheradius.Insertion:-Themusclebellygivesrisetofourtendonsdistally.Eachofthetendonattachestothesidesofthemiddlephalanx指骨,趾骨ofthefourmedialfinger.Nervesupply:-Mediannerve,C8andT1.Action:-Flexesthemiddlephalanxoffingers.Flexestheproximalphalanxoffingers(weak).Flexesthewrist.Flexordigitorumsuperficialis.Fig5.Flexordigitorumsuperficialis.Returntotitlepage 前臂8块屈肌深层3块指深屈肌拇长屈肌旋前方肌 DeepMusclesoftheanteriorcompartment.TitlepageThedeepmusclesoftheforearmcompriseoftheflexorpollicislongus,flexordigitorumprofundusandpronatorquadratus.Forfurtherdetailsclickoneachoftheindividualmuscles.1.Flexordigitorumprofundus.2.Flexorpollicislongus.Pronatorquadratusnotshown.112Brachio-radialis(cut)Tendonofcarpiflexorradialis(cut)Fig6.Deepmusclesoftheanteriorcompartment.Returntomainmenu FlexordigitorumprofundusandflexorpollicislongusFlexorpollicislongusOrigin:-Middleoftheanteriorsurfaceoftheshaftoftheradiusandfromtheadjoiningpartoftheinterosseousmembrane.Insertion:-Thetendonpassesdistallythroughthecarpaltunnelandattachestothedistalphalanxofthethumb.Nervesupply:-Theanteriorinterosseousbranchofthemediannerve.Action:-Flexesthephalangesofthethumb.Flexordigitorumprofundus深的Origin:-Upperthree-quartersoftheanteriomedialshaftoftheulna.Insertion:-Themuscledividesintofourtendonsjustpriortotraversingthecarpaltunnel.Theyattachtothedistalphalanxofthefourfingers.Nervesupply:-Themedialpartissuppliedbytheulnarnerve,thelateralportionissuppliedbytheanteriorinterosseousbranchofthemediannerve,C8andT1.Action:-Flexesthefinger.Exclusiveflexorofthedistalphalanx.Weakflexorofthewrist.FlexorpollicislongusPronatorquadratusFlexordigitorumprofundusFig7.Flexordigitorumprofundusandflexorpollicislongus.Returntotitlepage PronatorQuadratusOrigin:-Lowerquarteroftheanteriorsurfaceoftheshaftoftheulna.Insertion:-Lowerquarteroftheanteriorsurfaceoftheshaftoftheradius.Nervesupply:-Theanteriorinterosseousbranchofthemediannerve.Action:-Pronatestheforearm.PronatorquadratusFlexorcarpiradialis(cut)FlexorpollicislongusFlexordigitorumprofundusFlexorcarpiulnaris(cut)Fig8.Pronatorquadratus.Returntotitlepage ArteriesandNervesoftheanteriorcompartment.TitlepageUlnarartery:-Largerthantheradialartery.Itpassesbetweenthearchformedbytheradialandulnarattachmentoftheflexordigitorumsuperficialisanddescendsthroughtheanteriorcompartment.Itentersthepalmofthehandinfrontoftheflexorretinaculum,andpromptlydividesinsuperficialanddeeppalmerbranches.Branches-Muscularbranches-tothemusclesoftheanteriorcompartment.Recurrentbranches-totheanastomosisaroundthewristjointBranchestotheanastomosisaroundthewristjointCommoninterosseousartery-arisesintheupperpartoftheulnararteryandthendividesintheanteriorandposteriorinterosseousarteries.Anteriorinterosseousartery:-arisesfromthecommoninterosseousarteryanddescendsintheanteriorcompartmenttoeventuallyjointheanastomosisaroundthewristjoint.Itsuppliesthedeepflexormuscles,andgivesoffnutrientbranchestothetheradiusandulna.BrachialarteryMediannerveUlnarnerveRadialnerveUlnararteryFig9.Arteriesandnervesoftheanteriorcompartment.NextReturntonerves ArteriesandNervesoftheanteriorcompartment.Posteriorinterosseousartery-arisesfromthecommoninterosseousarteryandandenterstheposteriorcompartment.Radialartery:-Itbeginsinthecubitalfossa肘窝whenthebrachialarterydividesintotheradialandulnaartery.Itpassesdistally,travelsunderthebrachioradialis,restingonthedeepflexormuscles.Thearterybrieflytravelsonthelateralsideoftheradius,beforetravellingovertheanteriorsurfaceoftheradius.Thearterythenwindsaroundthelateralaspectofthewrist,beforeenteringthepalmofthehandtoformthedeeppalmerarch.Branches-Muscularbranches:totheneighbouringmuscles.Branchestotheanastomosisaroundthewristandelbowjoint.Superficialpalmerjoint:arisesjustabovethewrist,frequentlyjoinstheulnararterytogiverisetothesuperficialpalmerarch.RadialnerveSuperficialradialnerveRadialarteryBrachialarteryMediannerveUlnarnerveUlnararteryMediannerveFig10.Arteriesandnervesoftheanteriorcompartment.NextReturntonerves NervesoftheanteriorcompartmentMedianNerve(fig9,fig10)Themediannerveleavesthecubitalfossainbetweenthetwoheadsofthepronatorteres.Itdescendsbetweenthesuperficialanddeepflexormuscles.Atthewristitliessuperficially,beforeenteringthepalmbehindtheflexorretinaculum.Branches:-Muscularbranch:-allthesuperficialmusclesoftheanteriorcompartmentexceptflexorcarpiulnaris.Articularbranches:totheelbowjointAnteriorinterosseousnerve:arisesfromthemediannerveasitemergesfromthetwoheadsofthepronatorteres.(seebelow)PalmercutaneousBranch:Distributedtotheskinoverthelateralpartofthepalm.AnteriorinterosseousnerveItarisesfromthemediannerve(seeabove)andthendescendsdowntheanteriorsurfaceoftheinterosseousmembrane.Branches-Muscularbranches:allthemusclesofdeepflexionintheanteriorcompartmentexceptthemedialpartofdigitorumprofundus.Articularbranches:tothewristjoint,thedistalradioulnarjoint,andthejointsofthecarpus.UlnarNerve(fig9,fig10)Theulnarnervepassesbehindthemedialepicondyleandenterstheforearmbetweenthetwoheadsofflexorcarpiulnaris.Itdescendsbetweentheflexorcarpiulnarisandtheflexordigitorumprofundus.Theulnarnervebecomessuperficialatthewrist,beforeenteringthepalminfrontoftheflexorretinaculum.Branches-Muscularbranches:totheflexorcarpiulnarisandtothemedialhalfoftheflexordigitorumprofundus.Articularbranches:totheelbowjoint.Palmarcutaneousbranch:arisesinthemiddleoftheforearm,Suppliesskinoverthethenareminence鱼际.Dorsalcutaneousbranch:arisesinthedistalthirdoftheoftheforearm,andpassesmediallytothedorsumofthehand.Returntomainmenu 前臂10块伸肌浅层5块桡侧腕长伸肌桡侧腕短伸肌指伸肌小指伸肌尺侧腕伸肌 Superficialmusclesoftheposteriorcompartment.TitlepageThesuperficialmusclesoftheanteriorcompartmentaremainlyconcernedwiththeextensionatwristjointandofthedigit.ThemusclesinthisgroupcompriseoftheExtensorcarpiradialisbrevis,extensordigitorum,extensordigitiminimi,extensorcarpiulnaris,andthetwomorelaterallyingbrachioradialisandextensorcarpiradialislongus.NB-Theanconeusalsoliesintheposteriorcompartmentbutisfunctionallyverydifferenttotherestofthemusclesinthisgroup.Itsactionaretoaidthetricepsinextensionattheelbowjoint.Clickbelowoneachofthemusclesforfurtherdetailabouteachoftheindividualmuscles.1.Extensorcarpiradialislongus2.Extensordigitorum3.Extensorcarpiulnaris4.ExtensordigitiminimiBrachioradialisandextensorcarpibrevisarenotincludedinthefigure.24Anconeus231Fig11.Superficialmusclesoftheposteriorcompartment.Returntomainmenu Extensorcarpiradialislongusandbrevis,andextensorcarpiulnarisExtensorcarpiradialislongusOrigin:-Fromthelowerthirdofthelateralsupracondylarridgeofthehumerus.Insertion:-Posteriorsurfaceofthebaseofthesecondmetacarpalbone.Nervesupply:-Radialnerve,C6andC7.Action:-Extendsandabductsthehandatthewristjoint.ExtensorcarpiradialisbrevisOrigin:-Fromthecommontendonattachedtothelateralepicondyleofthehumerus.Insertion:-Posteriorsurfaceofthebaseofthethirdmetacarpalbone.Nervesupply:-Posteriorinterosseousnerve,C7andC8.Action:-Extendsandabductsthehandatthewristjoint.ExtensorcarpiulnarisOrigin:-Fromthecommontendonattachedtothelateralepicondyleofthehumerus.Insertion:-Posteriorsurfaceofthebaseofthefifthmetacarpalbone.Nervesupply:-Posteriorinterosseousnerve,C7andC8Action:-Extendsandadductsthehandatwristjoint.ExtensorcarpiradialislongusExtensorcarpiradialisbrevisExtensorcarpiulnarisFig12.Extensorcarpiradialisbrevisandlongusandextensorcarpiulnaris.Returntotitlepage ExtensordigitorumandextensordigitiminimiExtensordigitorumOrigin:-Fromthecommontendonattachedtothelateralepicondyleofthehumerus.Insertion:-Themuscledividesintofourtendonswhichpasstothefingersandformthedorsalexpansion.Onthedorsumofthehandtheseareinterconnectedbyfibroustissue.Neartheproximalinterphalangealjointofeachfingertheexpansionsdivideintothecentralpart,whichinsertsintobaseofthemiddlephalanx,andthetwolateralparts,whichinsertintothebaseofthedistalphalanx.Nervesupply:-Posteriorinterosseousnerve,C7andC8Action:-Mainlyitextendsthemetacarpophalangealjoint,butitalsoassistsinextendingtheproximalanddistalinterphalangealjointandthearm.ExtensordigitiminimiOrigin:-Fromthecommontendonattachedtothelateralepicondyleofthehumerus.Insertion:-Viatwotendonstothedorsalexpansionforthelittlefinger.Nervesupply:-Posteriorinterosseousnerve,C7andC8Action:-Assistsintheextensionofthelittlefinger.ExtensordigitorumExtensordigitiminimiFig13.Extensordigitorumandextensordigitiminimi.Returntotitlepage BrachioradialisOrigin:-Fromtheuppertwpthirdsofthelateralsupracondylarridgeofthehumerus.Insertion:-Baseofthestyloidprocessoftheradius.Nervesupply:-Radialnerve,C5andC6.Action:-Itflexestheforearm(despitebeingbeingservedbyan‘extensor’nerve),assistsinrotatingorrestoringthearmintomidproneposition,dependingontheinitialposition.Brachio-radialisExtensorcarpiradialislongusExtensorcarpiradialisbrevisFlexorcarpiradialisFig15.Brachioradialis(anteriorview).Fig14Brachioradialis(lateralview).Returntotitlepage Deepmusclesintheposteriorcompartment.TitlepageThedeepmusclesoftheforearmconsistofthreemusclesthatactonthethumb,theextensorindicisandsupinator.Exceptforthesupinatortheyalloriginatefromonlytheforearmbones.Forfurtherdetailsoneachofthebonesclickontheindividualmuscles.1.Supinator.2.Abductorpollicislongus.3.Extensorpollicislongus.4.Extensorindicis.5.Extensorpollicisbrevis.12435Fig16.Deepmusclesoftheposteriorcompartment.Returntomainmenu Extensorpollicislongusandbrevis,andabductorpollicislongusAbductorpollicislongusOrigin:-Middleoftheposteriorsurfaceoftheshaftoftheulnaandradius.Insertion:-Posteriorsurfaceofthebaseofthefirstmetacarpalbone.Nervesupply:-Theposteriorinterosseousnerve,C7andC8.Action:-Abductsandextendsthethumb.ExtensorpollicislongusOrigin:-Fromtheposteriorsurfaceoftheulna.Insertion:-Posteriorsurfaceofthebaseofthedistalphalanxofthethumb.Nervesupply:-Theposteriorinterosseousnerve,C7andC8.Action:-Extendsthethumb.ExtensorpollicisbrevisOrigin:-Posteriorsurfaceoftheradius.Insertion:-PosteriorsurfaceoftheproximalphalanxofthethumbNervesupply:-Theposteriorinterosseousnerve,C7andC8.Action:-Extendsthethumb.Anatomicalsnuffbox:medialboundaryisthethetendonoftheextensorpollicislongusandthelateralboundaryisthetendonoftheabductorpollicislongusandextensorpollicisbrevis.Abductorpollicislongus.ExtensorpollicislongusFig17.Abductorpollicislongus,extensorpollicislongusandbrevis.ExtensorpollicisbrevisReturntotitlepage SupinatorSupinatorThesupinatorconsistsofobliqueandatransversehead.Origin:-Obliquehead:Fromthelateralepicondyleofthehumerusandcollateralligamentoftheelbowjoint.Transversehead:Supinatorcrestoftheulna.Insertion:-Bothheadswindlaterallyaroundtheproximalpartoftheradius,attachingtotheanterioraspectoftheradius.Nervesupply:-Posteriorinterosseousnerve,C6andC7.Action:-Supinatestheforearm(mainlyassistsasthebicepsbrachiiismainsupinatoroftheforearm).TransverseheadObliqueheadFig18.Supinatormuscle(anteriorview).Returntotitlepage ExtensorindicisOrigin:-Posteriorsurfaceoftheulna.Insertion:-DorsalexpansionoftheindexfingerNervesupply:-Posteriorinterosseousnerve,C7andC8.Action:-Extendstheindexfinger.ReturntotitlepageExtensorindicisFig19.Extensorpollicis Arteriesandnervesintheposteriorcompartment.TitlepageArteriesPosteriorinterosseousartery:-Asdiscussedpreviously,inthecubitalfossa,thecommoninterosseousarterydividesintheanteriorandposteriorinterosseousmuscle.Theposteriorinterosseousarteryliesbetweenthesuperficialanddeepextensormuscles.Itterminatesbyanastomosingwiththeanteriorinterosseousmuscleandtakingpartintheanastomosisaroundthewristjoint.Branches:Muscularbranch-totheneighbouringmuscles.Recurrentbranch-takespartintheanastomosisaroundthewristjoint.Anteriorinterosseousartery(discussedearlier):-Enterstheposteriorcompartmentinthedistalthirdoftheforearm.Suppliesbranchestoneighbouringmuscles.Radialartery(discussedearlier)Hasbranchesthatsupplythemusclesinthelateralaspectofcompartment.NextObliqueheadofsupinator(cut)PosteriorinterosseousarteryExtensorcarpiulnarisPosteriorinterosseousnerveExtensorcarpiradialisbrevisFig19.Posteriorinterosseousarteryandnerve. ArteriesandnervesintheposteriorcompartmentNervesTheposteriorcompartmentofthearmissuppliedbybranchesoftheradialnerve.Posteriorinterosseousnerve(Deepbranch):Itarisesfromtheradialnervejustinfrontofthelateralepicondyleofthehumerus.Itenterstheposteriorcompartmentinbetweenthetwoheadsofthesupinator.Branches:Muscularbranches:Tomostofthemusclesoftheposteriorcompartment(seeindividualmusclesfordetail).Articularbranches:Totheelbow,wristandcarpaljoints.Radialnerve:Branches:Muscularbranches:supplythebrachioradialisandtheextensorcarpiradialislongus.Articularbranches:Totheelbowjoint.ReturntomainmenuPosterorinterosseousarteryPosterorinterosseousnerveFig20.Posterorinterosseousarteryandnerve
