ASSIGNMENT NO.

6A
ANTERIOR FOREARM (Ulno-volar surface):
CUBITAL FOSSA and PALMAR SURFACE OF THE HAND

At the end of the course the students must be able to:

Anterior Forearm
1. Describe the cubital fossa.
1.1.Boundaries
1.2.Contents

2. Describe the cutaneous innervation of the anterior forearm (lateral and

medial).

3. Name the neurovascuar contents of the superficial fascia.

4. Enumerate the muscles in the anterior compartment of the forearm.

4.1 superficial group
4.2 intermediate group
4.3 deep group

5. Tabulate the origin, insertion, individual action and nerve supply of the
muscles in the anterior compartment

6. Describe the flexor retinaculum.

7. Name the structures of anterior forearm that pass superficial to the

flexor retinaculum.

8. Regarding the median nerve, give the implication of passing under/deep

to the flexor retinaculum.

9. Discuss the blood supply of the anterior forearm:

9.1. origin
9.2. course
9.3 branches

10 . Discuss the nerve supply of the anterior forearm.

Palmar surface of the hand

1. Describe the innervation.

2. Describe the palmar aponeurosis. State the clinical importance.

3. Discuss the palmar arterial arches.

3.1.superficial
3.2.deep

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 4. Describe the thenar and hypothenar eminences. State their significance.

5. Enumerate the thenar and hypothenar muscles.

6. Tabulate the origin, insertion, nerve supply and actions of the thenar
and hypothenar muscles.

7. Tabulate the origin, insertion, action and nerve supply of the lumbricals,
and interossei muscles.

Clinical aspects:

1. Discuss the carpal tunnel syndrome

2. Define medial epicondylitis (Golfer’s elbow).

3. Analyze how the ff. develop

3.1.Claw hand deformity.
3.2.Ape hand deformity

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 ASSIGNMENT NO. 6
ANTERIOR FOREARM (Ulno-volar surface):
CUBITAL FOSSA and PALMAR SURFACE OF THE HAND
LABORATORY PROCEDURE

I. Study of models or pre-dissected forearm

A. Borrow model or pre-dissected forearm from the technician. Examine the
anterior forearm. Identify the superficial nerves and blood vessels over the
lateral and medial aspects of the forearm if still intact in the pre-dissected
forearm.

B. In models or pre-dissected forearm identify the following muscles: from lateral

to medial pronator teres, flexor carpi radialis, palmaris longus, and flexor carpi
ulnaris.

C. In models of the hand identify the palmar aponeurosis and muscles over the
thenar and hypothenar areas.

D. In pre-dissected forearm lift or reflect the superficial muscles and identify the
deeper muscles, the flexor digitorum supeficialis, and flexor digitorum
profundus and flexor pollicis longus and pronator quadratus.

II. Study of bones and wrist joint

A. Examine the wrist joint. Identify the articulating bones.

- scaphoid, lunate & triquetral bones
III. Dissection;
A. Examine the anterior forearm. Palpate the lateral and medial epicondyles
proximally and the styloid process and head of the ulna distally.

B. Make a circumferential skin incision about 1 cm above the epicondyles or if

the arm is already dissected continue the dissection by making a longitudinal
skin incision from the level of the lateral epicondyle down to the styloid
process of the radius. Draw a diagrammatic illustration of the skin incision.

C. Then, reflect the skin medially by doing a blunt subcutaneous dissection until
the superficial fascia of the whole anterior forearm is exposed.

D. Examine the superficial fascia. Identify the cutaneous vessels and nerves, such
as the cephalic vein laterally and basilic vein medially, and the lateral
cutaneous of the forearm laterally.

E. Give the termination of the cephalic vein?

- terminates into the axillary vein

F. Describe the termination of the basilic vein?

- terminates the brachial near the elbow

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 G. What is the trunk of origin of the lateral cutaneous nerve of the forearm?
- musculocutaneous nerve

H. Clear the anterior forearm of fasciae and fats but leave the blood vessels and
nerves intact. Expose the superficial muscles.
1. Identify the superficial muscles as identified in models. Identify the
boundaries of the cubital fossa and its contents. Name the contents.
- Lateral: Brachioradialis
- Superior: Inter-Epicondyle Line
- Floor: Brachialis & Supinator
- Medial: Pronator teres
- Rood: Deep fascia with Bicipital aponeurosis

I. Over the wrist, a transverse band of fascia holds or secures the tendons of most
muscles of anterior forearm. This fascia is the flexor retinaculum.
1. Identify the muscle tendons and neurovascular structures that pass
superficial to the retinaculum. List them down.
- Tendon of floor carpi radialis
- Tendon of palmaris longus
- Ulnar nerve and vessels
- Palmar cutaneous branch of median nerve
- Palmar cutaneous branch of ulnar nerve

J. Without cutting any muscle, identify the muscle in the 2 nd layer, flexor
digitorum superficialis. This muscle has 4 tendons.
With these tendons find and isolate the median nerve. This nerve together
with the tendons passes under the flexor retinaculum.
1. State the significance of the median nerve passing under the flexor
retinaculum.
- The median nerve passes through the carpal tunnel, that if
this narrows or when tissues surrounding the flexor tendons
swell and put pressure on the median nerve, Carpal Tunnel
Syndrome occurs.

K. Over the medial aspect of the forearm, the ulna is just subcutaneous hence it is
now exposed. Carefully lift the flexor carpi ulnares on this side. The muscle
underneath is the medial or the ulnar portion of the flexor digitorum profundus.
On the same level laterally over the radius is the flexor pollicis longus. Deep to
the tendons of these 2 muscles over the distal ends of radius and ulna is the
pronator quadratus.
1. Identify the structures that run just beneath the flexor carpi ulnares. What are
these?
- ulnar artery & ulnar nerve

L. On the lateral side, trace the radial artery from the cubital fossa downward.
1. What is its trunk of origin?
- inferior aspect of the cubital fossa

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M. At about the middle of anterior forearm, the radial artery runs parallel with
what structure?
- It runs along the lateral aspect of the forearm between the brachioradialis
and flexor carpi radialis muscle

N. After the exposure, isolation and identification of structures ask any laboratory
preceptor to confirm your identification. Then review every thing!

HAND

I. Continue the dissection over the palmar aspect of the hand.

II. Make a midline skin incision from the distal border of the flexor retinaculum to the
base of the middle finger.
III. Extend the incision medial ward towards the medial border of the base of the little
finger, then lateral ward towards the lateral border of the base of the index finger.
IV. Carefully do a blunt dissection under the skin. Reflect the skin medial ward and
lateral ward.
V. Identify the palmar aponeurosis. Cut across this aponeurosis and pull the cut edges
proximally and distally. This exposes the tendons of flexor digitorum superficialis.
Deep to it is the superficial palmar arterial arch on the tendon of the flexor digitorum
profundus. The deep palmar arch lies deep to this tendons on the surface of the
interossei muscles.
1. Name the vessels that form this arterial arch.
- Superficial & Deep palmar arch: Ulnar artery; radial artery

2. Identify the muscle tendons over the hand. Identify the hypothenar muscles.
Remove the skin over the thenar aspect of the palm. Identify the muscles.
Hypothenar muscles:
- Opponens digiti minimi
- Flexor digiti minimi
- Abductor digiti minimi

VI. Locate the lumbricals on the tendons of the flexor digitorum profundus. Deep
to the profundus are the interossei muscles.

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 Label the boundaries of cubital fossa and its contents

Median
Superior: medial nerve
epicondyle Superior:
medial
epicondyle

Lateral:
Brachioradialis Brachial
artery

Medial:
Pronator teres
Medial: Pronator
teres Lateral:
Brachioradialis

Label the anterior forearm showing the superficial muscles.

Biceps brachii

Brachialis muscle

Brachioradialis
muscle Pronator teres muscle

Flexor carpi radialis

muscle

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 Label the anterior forearm showing the superficial and deep muscles and related
neurovascular structures.

Pronator teres
Brachioradialis

Flexor carpi
radialis muscle
Flexor digitorum
profundus

Flexor carpi
ulnaris muscle

Flexor pollicis
Pronator
longus
quadratus

Label the palm of hand showing the deep and superficial palmar arches.
Ulnar artery

Deep palmar
arch

Superficial
palmar arch
Radial artery

Common digital
artery

Identify now the flexor retinaculum. What are the attachments of this fibrous strand?
Pisiform bone & hook of the hamate bone. What is the name of the tunnel underneath?
Carpal Tunnel. Enumerate the structures found deep and superficial to the tunnel. Label
above structures in the model below.
- flexor digitorum superficialis tendon
- median nerve
- flexor pollicis longus tendon
- flexor digitorum profundus
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 Flexor pollicis Pronator
longus quadratus

Abductor pollicis Abductor digiti

brevis mini

Flexor pollicis
brevis

In the hand model above, label the intrinsic muscles of the palmar surface of the hand.

In the cross section in the wrist, label the structures identified in the previous model of
the palm.
Flexor retinaculum
Ulnar artery
Median nerve
Ulnar nerve
Flexor carpi
radialis tendon

Flexor digitorum Flexor pollicis

superficialis tendon longus tendon

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 ASSIGNMENT NO. 6B
POSTERO-LATERAL FOREARM, DORSUM OF HAND AND FINGERS
ELBOW AND WRIST JOINTS

At the end of the course the students must be able to:

1. Discuss the cutaneous innervation of the posterolateral forearm.

2. Enumerate the muscles in the posterolateral forearm.
2.1 lateral group
2.2. superficial group
2.3. deep group
3. Tabulate the origin, insertion, nerve supply and action of the muscle in
posterolateral forearm.
4. Discuss the neurovascular structures of the posterolateral forearm.
5. Define extensor retinaculum. Give the attachments.
6. Enumerate the contents of the osteofascial compartments under the
extensor retinaculum.
7. Describe the anatomical snuffbox.
7.1 Boundaries
7.2 Significance
8. Describe the dorsum of the hand.
8.1 Skin
8.2 Blood vessels
8.3 Tendons of extensor muscles

Wrist (radio-carpal) Joint

1. Name the bones that form the wrist joint
2. Classify the wrist joint.
2.1.Morphological
2.2.Functional
3. State what specific variety of joint is the wrist.
4. Name the movements possible at the wrist.

Elbow Joint
1. Name the bone that articulate at the elbow.
2. Name the articulations at the elbow.
3. Give the movements possible at each articulation.
4. Give the blood supply and nerve supply of the elbow.

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 ASSIGNMENT NO. 6
POSTERO-LATERAL FOREARM, DORSUM OF HAND AND FINGERS
ELBOW AND WRIST JOINTS
LABORATORY PROCEDURE

I. Study of Models/ preserved/pre-dissected cadaver

A. Borrow model of muscles of upper extremity or a pre-dissected preserved

specimen of upper extremity.

B. Using an atlas of Gross Anatomy guide identify the muscles on the posterior
and lateral aspects of the forearm starting laterally. Label these muscles.
Extensor digitorum

Brachioradialis

Extensor carpi
radialis longus
Extensor carpi
radialis longus

Extensor carpi
Extensor ulnaris
digitorum

Extensor digiti
minimi

Abductor pollicis
longus

Extensor carpi
radialis brevis

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 C. Distally, identify the muscles that emerge between the extensor digitorum and
extensor carpi radialis brevis. What are these muscles?
- Abductor pollicis longus
- Extensor pollicis brevis
- Extensor pollicis longus
- Extensor indicis
- Supinator
- these are forearm deep muscles
D. Take note of a transverse band across the posterior surface of the wrist. What
is this?
- Flexor retinaculum

E. Distal to this band over the dorsum of the hand are the tendons of extensor
digitorum. Follow them to their insertion. Give their insertion.
- middle & distal phalanges of medial 4 fingers

F. Take note of a depression on the lateral aspect of the wrist., the anatomical
snuffbox. Identify the boundaries. List them down.

Laterally – tendon of extensor pollicis longus

Medially – tendon of extensor pollicis brevis & abductor pollicis longus
Proximal – styloid process of the radius
Floor – carpal bones; scaphoid & trapezium

Immediate trunk of origin of this nerve?

- radial artery: crosses the floor border & turns medially between the
adductor pollicis muscle
- radial nerve: found in the skin & subcutaneous tissue of the anatomical
snuffbox
- cephalic vein: arises from the dorsal venous of the hand & crosses the
anatomical snuffbox

G. State the significance of the anatomical snuffbox.

- This is where the scaphoid bone is most easily palpated and that the
pulsations of the radial artery can be felt.

II. Study of Bones and Joints of the upper extremity – elbow and wrist joints

A. Get an articulated skeleton and study the bones and joints of the upper
extremity.

B. Examine the elbow joint. Identify the parts of bone that articulate at the elbow.
- capitellum of the humerus with radial head
- trochlea of the humerus with the trochlear notch of the ulna
- radial head with the radial notch of ulna

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 C. Test the movements of the elbow in your own body. Name the movements
possible at the elbow.
- flexion, extension, supination & pronation

D. Examine the wrist joint. Identify the carpal bones. Identify the bones that
articulate at the wrist. List them down.
Carpal bones: Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium,
Trapezoid, Capitate, Hamate
Articulate the wrist: Scaphoid, Lunate & Triquetrum

E. Test the movement possible at your wrist joint. List them down.
- flexion, extension, abduction & adduction

III Dissection
A. Continue the removal of the skin of forearm using the blunt edge of
the scalpel. Identify the superficial blood vessels and nerves. Review
the previously dissected anterior aspect of the forearm.

B. Clean the posterior aspect of forearm.

C. Clear off the fats taking care not to cut the vessels like the cephalic
vein laterally and basilic vein medially.

D. Preserve the lateral cutaneous nerve of the forearm. What is the

immediate trunk of origin of this nerve?
- musculocutaneous nerve

E. Expose the muscles.

F. Identify them as you did with the model.

G. Lift or retract the muscles when trying to look for the structures
underneath.

H. Identify the extensor retinaculum. Examine the fascial spaces

underneath the extensor retinaculum and their contents.

I. Remove the skin over the dorsum of hand. Identify the tendons of the
extensors

J. Flex the proximal interphalangeal joints in one of your hands and extend
the metacarpophalangeal joints of the same hand.

K. Take note of the tendons that become prominent. These are the tendons
of what muscle?

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 VI.
A. Label the frontal view of the elbow joint.

Joint capsule

Ulnar collateral
ligament
Radial collateral
ligament

Biceps brachii
tendon
Anular ligament
of radius

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 B. Label the articulating bones in wrist joint.
Lunate

Triquetrum Scaphoid

Trapezium
Hamate

Trapezoid
Capitate

C. Label the posterior view of the forearm showing the superficial group of muscles.

Extensor digitorum

Extensor digit
minimi
Extensor
carpi ulnaris
Abductor pollicis
longus

Extensor pollicis
brevis

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 D. Label a cross section of the wrist showing the spaces under the extensor retinaculum
and their contents.
Flexor retinaculum
Ulnar artery

Median nerve
Ulnar nerve

Flexor carpi
Flexor digitorum
radialis tendon
profundus tendons

Flexor pollicis
longus tendon

E. In the dorsum of the hand model, label all the tendons and muscles seen.
Extensor digitorum
Extensor digit minimi

Abductor pollicis
Extensor carpi ulnaris longus

Extensor digitorum
Extensor pollicis
tendon
brevis

Extensor retinaculum

Extensor pollicis
longus tendon

Extensor indicis
tendon

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