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1. Muscles in the anterior compartment of the forearm (attachments, NV supply

and action)
Muscles

Origin

Insertion

NV Supply

Action

Additional

Superficial Layer
Pronator Teres

Medial

Middle Shaft

Median Nerve

Pronator,

epicondyle of

of radius

Ulnar/Radial

and helps in

A.

flexing the

the humerus

forearm
Flexor Carpi

Base of 2

Radialis

and 3

nd

rd

Just ulnar

Flexor and

Antagonist:

artery

abductor of

Extensor

wrist

carpi radialis

metacarpal
bones

brevis muscle

Palmaris

Palmar

Just ulnar

Longus

aponeurosis

artery

Wrist flexor

Absent in
14% of the
pop.

Flexor Carpi

Pisiform bone

Ulnaris

Muscular

Adduction

Antagonist:

branches of

& flexion of

Extensor

ulnar n.

wrist

carpi ulnaris

And Ulnar
artery
Intermediate Layer
Flexor

Medial

Ant. Margins

Median n.

Flexor of

A.K.A flexor

Digitorum

epicondyle of

on the bases

Ulnar A.

fingers

digitorum

Superficialis

the humerus

of the middle

sublimis

phalanges of 4
fingers
Deep Layer of Muscles
Flexor

Upper 3/4 of

Base of

Median/ muscular

Flex hand,

Antag:

Digitorum

volar/medial

distal

branches of ulnar

interphalangeal

Extensor

Profundus

surface of

phalanges

Ant.interosseous

joints

digitorum

body of ulna

of fingers

artery

muscle

Interosseous
membrane
Flexor

Mid 2/4 volar

Base of

Ant interosseous

Pollicis

surface of

distal

Artery & nerve

Flexion of thumb

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Longus

radius,

phalange

interosseus

of thumb

membrane
Pronator

Medial, ant

Lateral ant

Ant interosseous

Pronates the

Quadratus

surface of the

surface of

Artery

forearm

ulna

the radius

Median Nerve

2. Trace the course of the radial and ulnar arteries in the forearm up to its
terminal branches in the hand.
Radial artery:
C: Neck of Radius
Bifurcation of the brachial artery
Distally on the anterior part of the
forearm. There, it serves as a landmark
for the division between the anterior and
posterior compartments of the forearm,
with the posterior compartment beginning
just lateral to the artery. The artery winds
laterally around the wrist, passing through
the anatomical snuff box and between the
heads of the first dorsal interosseous
muscle. It passes anteriorly between the
heads of the adductor pollicis, and
becomes the deep palmar arch, which
joins with the deep branch of the ulnar
artery
Accompanied by radial vein.
Ulnar artery:
Arises from the brachial artery
T: Superficial palmar arch. It is palpable
on the anterior and medial aspect of the wrist.
Accompanied by ulnar veins.

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3. Describe the median and ulnar nerves and their branches including the areas
supplied.
Median N. lateral 2/3 of the palm, and the muscles
of thenar eminence. Its terminal branches course the
lateral 3 fingers and the lateral side of the 4th.
Accompanied by digital branches from the superficial
and deep palmar arches and their vena comites.
Ulnar N.- hypothenar eminence and digital branches
to the medial side of the palm; both sides of the 5th
finger and medial side of the 4th.
4. Discuss the carpal tunnel and the structures that pass thru it
! Passageway on the palmar side of the wrist that connects the forearm to
the middle compartment of the deep plane of the palm.
! The carpus, bony elements of the wrist, form an arch which is convex on
the dorsal side of the hand and concave on the palmar side. The groove on
the palmar side, the sulcus carpi, is covered by the flexor retinaculum, a
sheath of tough connective tissue, thus forming the carpal tunnel.
! Flexor tendons: flexor digitorum profundus (four tendons), flexor digitorum
superficialis (four tendons), flexor pollicis longus (one tendon)
! Single N. MEDIAN NERVE
5. Describe the skin and deep fascia of the palm of the hand, position of tendons,
nerves and vessels beneath the palmar aponeurosis.
! The palmar skin is thick and glabrous and not as pliable as the dorsal skin.
It is strongly attached to the underlying fascia by numerous vertical fibers.
These features enhance skin stability for proper grasping function. Has
high concentration of sensory nerve organs essential to the hand's normal
function.
! Deep structures in the middle of the palm includes the tendons of the long
flexors from the forearm. Lumbrical muscles, adductor pollocis,
interosseous muscles that are innervated by the ulnar nerve.

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6. Thenar, hypothenar muscles as to their attachment, innervations and action.

Muscle

Origin

Insertion

NV Supply Action

THENAR EMIINENCE
Abductor
Pollicis
Brevis

Transverse
carpal
ligament
(SCAPHOID
&
TRAPEZIUM)

Radial base
of proximal
phalanx of
thumb

Superficial Abduction of thumb

palmar
arch
Recurrent
branch of
median n.

Flexor
Pollicis
Brevis

Trapezoid,
flexor
retinaculum

Thumb,
proximal
phalanx

Opponens
Pollicis

Trapezium
and
transverse
carpal
ligament

Metacarpal
bone of
thumb

Deep
branch of
ulnar
nerve
&
Superficial
Palmar
arch,
Recurrent
branch of
median n.

Flex thumb at first

metacarpophalangeal
joint
Flexion of thumb at
first carpometacarpal
joint

HYPOTHENAR EMINENCE
DIGITI
QUINTI
MINIMI
Abductor

Pisiform

Base of
proximal
phalanx of
5th digit

Ulnar A.
Ulnar N.

Abducts little finger

Flexor

Hamate

Flexes little finger

Opponens

And flexor
retinaculum

Ulnar side
of the base
of the
proximal
phalanx of
minimi
Medial
border of
5th
metacarpal

Draws 5th metacarpal

anteriorly and rotates
it

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7. Describe the different layers of the palm of the hand.

! Skin Palmar skin: Thick, stable, contains sweat glands but no hair or
sebaceous glands. It is vascular and sensate.
-Skin creases: Digital, palmar and wrist creases.
! Subcutaneous Tissue - Adipose (fatty) tissue contains minute fibrous septae
connecting skin to deeper structures.
! Palmar aponeurosis (palmar fascia) - triangular shape; invests the muscles of
the palm, and consists of central, lateral, and medial portions. DENSE CT
! Deep structures tendons
A. Intrinsic muscles of the hand (18 + palmaris brevis)
1. Thenar muscles (3)
2. Hypothenar muscles (3)
3. Interosseous muscles (3 palmar and 4 dorsal)
4. Lumbrical muscles (4)
5. Adductor pollices muscle (2 heads)
B. Extrinsic muscles of the hand
1. Extrinsic flexors: FDS, FDP, and FPL supplied by median nerve and
anterior interosseous