前臂解剖图谱幻灯

1、GROSS ANATOMY OF THE FOREARM Chen yonghuaMain MenuBones of the forearm.Superficial muscles of the anterior compartment. Deep muscles of the anterior compartment.Arteries and nerves of the anterior compartment.Superficial muscles of the posterior compartment.Deep muscles of the posterior compartment.

2、Arteries and nerves of the posterior compartment.AcknowledgementsBones of the forearmThe radius proximally articulates with the humerus at the elbow joint. Distally it articulates with the scaphoid and lunate bones of the carpus, and with the ulna at the distal radioulnar joint.The ulna is the more

3、medial of the two bones. Its proximal end articulates with the humerus at the elbow joint. Distally it articulates with the radius. It is excluded from the wrist joint by the articular disc.The interosseous membrane bind the radius and the ulna together.HeadInterosseous membraneRadiusHumerusTuberosi

4、ty of radiusUlnaHeadFig 1. Anterior view of bones of the forearm.总体记忆总体记忆 前臂共有前臂共有1818块肌肉块肌肉 分为屈肌与伸肌二部分分为屈肌与伸肌二部分 屈肌屈肌8 8块块 分为浅层与深层分为浅层与深层 浅层有浅层有5 5块块 深层有深层有3 3块块 伸肌伸肌1010块块 浅深各浅深各5 5块块前臂屈肌屈肌8块伸肌10块浅5深3浅5深5旋前圆肌桡侧屈腕肌掌长肌指浅屈肌尺侧屈腕肌Superficial muscles of the anterior compartment. Title page. 1234The supe

5、rficial muscles of the anterior compartment include pronator teres, flexor carpi radialis, palmaris longus, and flexor carpi ulnaris. Also included in this group is flexor digitorum superficialis. The superficial group of muscles all have the same origin, which is attached to the medial epicondyle o

6、f the humerus. FOR FURTHER DETAILS CLICK ON EACH INDIVIDUAL MUSCLE BELOW.Pronator teresFlexor carpi radialisFlexor carpi ulnarisFlexor digitorum superficialisPalmaris longus (not included in the diagram).Fig 2. Showing superficial muscles of the posterior compartment.Brachio-radialisPronator TeresTh

7、e pronator teres has two heads, the humeral head and the ulnar head. The median nerve enters the forearm between the two heads.Origin :-Humeral head- Medial epicondyle of the humerus.Ulnar head- Medial border of the coronoid process of the ulna.Insertion :-Lateral aspect of the shaft of the radius.N

8、erve supply :- Median nerve, C6 and C7.Action :- Pronation of the forearm. Flexion of the forearm.Pronator teresRadiusFig 3. Pronator teres.Flexor carpi radialis, palmaris longus, and flexor carpi ulnarisFlexor carpi radialisOrigin:- Medial epicondyle of the humerus.Insertion:- Base of the second an

9、d third metacarpal bones.Nerve supply:- Median nerve, C6 and C7.Action:- Flexes the hand at the wrist joint. Abducts the hand at the wrist joint.Palmaris longus Origin:- Medial epicondyle of the humerus. Insertion:- Flexor retinaculum and palmar aponeurosis. Nerve supply:- Median nerve, C7 and C8 Ac

10、tion:- Flexes the hand at wrist joint.Flexor carpi ulnaris.Origin:- Humeral head- Medial epicondyle of the humerus.Ulnar head- Medial aspect of the olecranon process of the ulna and the posterior border of the ulna. Insertion:- Pisiform bone, hook of the hamate, and base of the fifth metacarpal bone

11、. Nerve supply:- The ulnar nerve, C7, C8, and T1. Action:- Flexes the hand at wrist joint. Adducts the hand at wrist jointPronator teresFlexor carpi radialisPalmaris longusFlexor carpi ulnarisFig 4. Flexor carpi radialis and ulnaris and palmaris longusFlexor digitorum superficialis.Origin:-Humerouln

12、ar head: Medial epicondyle of the humerus and the medial margin of the coronoid process of the ulna.Radial head: Rising from the oblique line on the anterior surface of the shaft of the radius.Insertion:- The muscle belly gives rise to four tendons distally. Each of the tendon attaches to the sides

13、of the middle phalanx of the four medial finger.Nerve supply:- Median nerve, C8 and T1.Action:- Flexes the middle phalanx of fingers. Flexes the proximal phalanx of fingers (weak). Flexes the wrist.Flexor digitorum superficialis.Fig 5. Flexor digitorum superficialis.指深屈肌挴长屈肌旋前方肌Deep Muscles of the a

14、nterior compartment. Title pageThe deep muscles of the forearm comprise of the flexor pollicis longus, flexor digitorum profundus and pronator quadratus.For further details click on each of the individual muscles.1. Flexor digitorum profundus.2. Flexor pollicis longus.Pronator quadratus not shown.11

15、2Brachio-radialis (cut)Tendon of carpi flexor radialis (cut)Fig 6. Deep muscles of the anterior compartment.Return to main menuFlexor digitorum profundus and flexor pollicis longusFlexor pollicis longusOrigin:- Middle of the anterior surface of the shaft of the radius and from the adjoining part of

16、the interosseous membrane.Insertion:- The tendon passes distally through the carpal tunnel and attaches to the distal phalanx of the thumb.Nerve supply:- The anterior interosseous branch of the median nerve.Action:- Flexes the phalanges of the thumb.Flexor digitorum profundusOrigin:- Upper three-qua

17、rters of the anteriomedial shaft of the ulna.Insertion:- The muscle divides into four tendons just prior to traversing the carpal tunnel. They attach to the distal phalanx of the four fingers.Nerve supply:- The medial part is supplied by the ulnar nerve, the lateral portion is supplied by the anteri

18、or interosseous branch of the median nerve, C8 and T1.Action:- Flexes the finger. Exclusive flexor of the distal phalanx. Weak flexor of the wrist. Flexor pollicis longusPronator quadratusFlexor digitorum profundusFig 7. Flexor digitorum profundus and flexor pollicis longus.Return to title pageProna

19、tor QuadratusOrigin:- Lower quarter of the anterior surface of the shaft of the ulna.Insertion:- Lower quarter of the anterior surface of the shaft of the radius.Nerve supply:- The anterior interosseous branch of the median nerve.Action:- Pronates the forearm.Pronator quadratusFlexor carpi radialis

20、(cut)Flexor pollicis longusFlexor digitorum profundusFlexor carpi ulnaris (cut)Fig 8. Pronator quadratus.Return to title pageArteries and Nerves of the anterior compartment. Title page Ulnar artery:- Larger than the radial artery. It passes between the arch formed by the radial and ulnar attachment

21、of the flexor digitorum superficialis and descends through the anterior compartment. It enters the palm of the hand in front of the flexor retinaculum, and promptly divides in superficial and deep palmer branches.Branches- Muscular branches- to the muscles of the anterior compartment. Recurrent bran

22、ches- to the anastomosis around the wrist jointBranches to the anastomosis around the wrist jointCommon interosseous artery- arises in the upper part of the ulnar artery and then divides in the anterior and posterior interosseous arteries.Anterior interosseous artery:- arises from the common interos

23、seous artery and descends in the anterior compartment to eventually join the anastomosis around the wrist joint. It supplies the deep flexor muscles, and gives off nutrient branches to the the radius and ulna. Brachial arteryMedian nerveUlnar nerveRadial nerveUlnar arteryFig 9. Arteries and nerves o

24、f the anterior compartment.NextReturn to nervesArteries and Nerves of the anterior compartment.Posterior interosseous artery- arises from the common interosseous artery and and enters the posterior compartment.Radial artery:- It begins in the cubital fossa when the brachial artery divides into the r

25、adial and ulna artery. It passes distally, travels under the brachioradialis, resting on the deep flexor muscles. The artery briefly travels on the lateral side of the radius, before travelling over the anterior surface of the radius. The artery then winds around the lateral aspect of the wrist, bef

26、ore entering the palm of the hand to form the deep palmer arch.Branches-Muscular branches: to the neighbouring muscles.Branches to the anastomosis around the wrist and elbow joint.Superficial palmer joint: arises just above the wrist, frequently joins the ulnar artery to give rise to the superficial

27、 palmer arch.Radial nerveSuperficial radial nerveRadial arteryBrachial arteryMedian nerveUlnar nerveUlnar arteryMedian nerveFig 10. Arteries and nerves of the anterior compartment.Return to nervesNerves of the anterior compartmentMedian Nerve (fig 9, fig 10)The median nerve leaves the cubital fossa

28、in between the two heads of the pronator teres. It descends between the superficial and deep flexor muscles. At the wrist it lies superficially, before entering the palm behind the flexor retinaculum.Branches:-Muscular branch:- all the superficial muscles of the anterior compartment except flexor ca

29、rpi ulnaris.Articular branches: to the elbow jointAnterior interosseous nerve: arises from the median nerve as it emerges from the two heads of the pronator teres. (see below)Palmer cutaneous Branch: Distributed to the skin over the lateral part of the palm.Anterior interosseous nerve It arises from

30、 the median nerve (see above) and then descends down the anterior surface of the interosseous membrane. Branches-Muscular branches: all the muscles of deep flexion in the anterior compartment except the medial part of digitorum profundus.Articular branches: to the wrist joint, the distal radioulnar

31、joint, and the joints of the carpus.Ulnar Nerve(fig9, fig 10)The ulnar nerve passes behind the medial epicondyle and enters the forearm between the two heads of flexor carpi ulnaris. It descends between the flexor carpi ulnaris and the flexor digitorum profundus. The ulnar nerve becomes superficial

32、at the wrist, before entering the palm in front of the flexor retinaculum.Branches-Muscular branches: to the flexor carpi ulnaris and to the medial half of the flexor digitorum profundus.Articular branches: to the elbow joint.Palmar cutaneous branch: arises in the middle of the forearm, Supplies ski

33、n over the thenar eminence.Dorsal cutaneous branch: arises in the distal third of the of the forearm, and passes medially to the dorsum of the hand. Return to main menu桡侧腕长伸肌桡侧腕短伸肌指伸肌小指伸肌尺侧腕伸肌Superficial muscles of the posterior compartment. Title pageThe superficial muscles of the anterior compartm

34、ent are mainly concerned with the extension at wrist joint and of the digit. The muscles in this group comprise of the Extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris, and the two more lateral lying brachioradialis and extensor carpi radialis longus

35、.NB- The anconeus also lies in the posterior compartment but is functionally very different to the rest of the muscles in this group. Its action are to aid the triceps in extension at the elbow joint.Click below on each of the muscles for further detail about each of the individual muscles.1. Extens

36、or carpi radialis longus2. Extensor digitorum3. Extensor carpi ulnaris4. Extensor digiti minimiBrachioradialis and extensor carpi brevis are not included in the figure.24Anconeus231Fig 11. Superficial muscles of the posterior compartment.Return to main menuExtensor carpi radialis longus and brevis,

37、and extensor carpi ulnarisExtensor carpi radialis longusOrigin:- From the lower third of the lateral supracondylar ridge of the humerus.Insertion:- Posterior surface of the base of the second metacarpal bone.Nerve supply:- Radial nerve, C6 and C7.Action:- Extends and abducts the hand at the wrist jo

38、int.Extensor carpi radialis brevisOrigin:- From the common tendon attached to the lateral epicondyle of the humerus.Insertion:- Posterior surface of the base of the third metacarpal bone.Nerve supply:- Posterior interosseous nerve, C7 and C8.Action:- Extends and abducts the hand at the wrist joint.E

39、xtensor carpi ulnarisOrigin:- From the common tendon attached to the lateral epicondyle of the humerus.Insertion:- Posterior surface of the base of the fifth metacarpal bone.Nerve supply:- Posterior interosseous nerve, C7 and C8Action:- Extends and adducts the hand at wrist joint.Extensor carpi radi

40、alis longusExtensor carpi radialis brevisExtensor carpi ulnarisFig 12. Extensor carpi radialis brevis and longus and extensor carpi ulnaris. Return to title pageExtensor digitorum and extensor digiti minimiExtensor digitorumOrigin:- From the common tendon attached to the lateral epicondyle of the hu

41、merus.Insertion:- The muscle divides into four tendons which pass to the fingers and form the dorsal expansion. On the dorsum of the hand these are interconnected by fibrous tissue. Near the proximal interphalangeal joint of each finger the expansions divide into the central part, which inserts into

42、 base of the middle phalanx, and the two lateral parts, which insert into the base of the distal phalanx. Nerve supply:- Posterior interosseous nerve, C7 and C8Action:- Mainly it extends the metacarpophalangeal joint, but it also assists in extending the proximal and distal interphalangeal joint and

43、 the arm. Extensor digiti minimi Origin:- From the common tendon attached to the lateral epicondyle of the humerus.Insertion:- Via two tendons to the dorsal expansion for the little finger.Nerve supply:- Posterior interosseous nerve, C7 and C8Action:- Assists in the extension of the little finger.Ex

44、tensor digitorumExtensor digiti minimiFig 13. Extensor digitorum and extensor digiti minimi.Return to title pageBrachioradialisOrigin:- From the upper twp thirds of the lateral supracondylar ridge of the humerus.Insertion:- Base of the styloid process of the radius.Nerve supply:- Radial nerve, C5 an

45、d C6.Action:- It flexes the forearm (despite being being served by an extensor nerve), assists in rotating or restoring the arm into midprone position, depending on the initial position. Brachio-radialisExtensor carpi radialis longusExtensor carpi radialis brevisFlexor carpi radialisFig 15. Brachior

46、adialis (anterior view).Fig 14 Brachioradialis (lateral view).Return to title pageDeep muscles in the posterior compartment. Title pageThe deep muscles of the fore arm consist of three muscles that act on the thumb, the extensor indicis and supinator. Except for the supinator they all originate from

47、 only the forearm bones.For further details on each of the bones click on the individual muscles.1. Supinator.2. Abductor pollicis longus.3. Extensor pollicis longus.4. Extensor indicis.5. Extensor pollicis brevis.12435Fig 16. Deep muscles of the posterior compartment.Return to main menuExtensor pol

48、licis longus and brevis, and abductor pollicis longusAbductor pollicis longusOrigin:- Middle of the posterior surface of the shaft of the ulna and radius.Insertion:- Posterior surface of the base of the first metacarpal bone.Nerve supply:- The posterior interosseous nerve, C7 and C8.Action:- Abducts

49、 and extends the thumb.Extensor pollicis longusOrigin:- From the posterior surface of the ulna.Insertion:- Posterior surface of the base of the distal phalanx of the thumb.Nerve supply:- The posterior interosseous nerve, C7 and C8.Action:- Extends the thumb.Extensor pollicis brevisOrigin:- Posterior

50、 surface of the radius.Insertion:- Posterior surface of the proximal phalanx of the thumbNerve supply:- The posterior interosseous nerve, C7 and C8.Action:- Extends the thumb.Anatomical snuff box: medial boundary is the the tendon of the extensor pollicis longus and the lateral boundary is the tendo

51、n of the abductor pollicis longus and extensor pollicis brevis.Abductor pollicis longus.Extensor pollicis longusFig 17. Abductor pollicis longus, extensor pollicis longus and brevis.Extensor pollicis brevisReturn to title pageSupinatorSupinatorSupinatorThe supinator consists of oblique and a transve

52、rse head.Origin:- Origin:- Oblique head: From the lateral epicondyle of the humerus and collateral ligament of the elbow joint.Transverse head: Supinator crest of the ulna.Insertion:- Insertion:- Both heads wind laterally around the proximal part of the radius, attaching to the anterior aspect of th

53、e radius.Nerve supply:- Nerve supply:- Posterior interosseous nerve, C6 and C7.Action:- Action:- Supinates the forearm (mainly assists as the biceps brachii is main supinator of the forearm).Transverse headOblique headFig 18. Supinator muscle (anterior view).Return to title pageExtensor indicisOrigi

54、n:- Origin:- Posterior surface of the ulna.Insertion:- Insertion:- Dorsal expansion of the index fingerNerve supply:- Nerve supply:- Posterior interosseous nerve, C7 and C8.Action:- Action:- Extends the index finger.Return to title pageExtensor indicisFig 19. Extensor pollicisArteries and nerves in the posterior compartment. Title pageArteriesArteriesPosterior interosseous