Surface Anatomy of Forearm & Wrist

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Questions and Answers

Which structure of the forearm is described as being subcutaneous and forming a longitudinal furrow on the posterior aspect?

  • Styloid process of the ulna
  • Shaft of the radius
  • Head of the radius
  • Posterior border of the ulna (correct)

What forms a surface elevation on the medial part of the wrist when the hand is pronated?

  • Tubercle of Lister
  • Pisiform bone
  • Styloid process of the radius
  • Head of the ulna (correct)

Which process lies at a higher level and more posteriorly than the styloid process of the radius?

  • Styloid process of the ulna (correct)
  • Styloid process of the radius
  • Tubercle of Lister
  • Head of the ulna

Which part of the radius can be palpated on the posterior aspect without difficulty?

<p>Expanded lower end of the radius (C)</p> Signup and view all the answers

What occurs to the styloid processes in a Colles' fracture?

<p>They lie in the same plane (A)</p> Signup and view all the answers

What can be felt on the palmar aspect of the wrist at the base of the hypothenar eminence?

<p>Pisiform bone (A)</p> Signup and view all the answers

Which tendon grooves the ulnar aspect of the tubercle of Lister?

<p>Extensor pollicis longus tendon (D)</p> Signup and view all the answers

In the context of the forearm, what does the term 'palpable' refer to?

<p>Able to be touched and felt (A)</p> Signup and view all the answers

What is the location of the hook of the hamate in relation to the pisiform?

<p>2.5 cm distal to the pisiform (D)</p> Signup and view all the answers

Where can the tubercle of the scaphoid bone typically be found?

<p>At the base of the thenar eminence (D)</p> Signup and view all the answers

What anatomical feature indicates the line of the wrist joint?

<p>Transverse anterior wrist skin creases (A)</p> Signup and view all the answers

What forms the medial border of the cubital fossa?

<p>Pronator teres (A)</p> Signup and view all the answers

How can the brachioradialis muscle be demonstrated?

<p>By flexing the elbow in the semi-prone position against resistance (A)</p> Signup and view all the answers

Which statement accurately describes the shafts of the radius and ulna?

<p>They are covered by the bellies of the flexor and extensor muscle groups. (A)</p> Signup and view all the answers

What feature helps to identify the posterior border of the ulna?

<p>The longitudinal furrow on the forearm (B)</p> Signup and view all the answers

Which border surrounds the cubital fossa laterally?

<p>Brachioradialis (D)</p> Signup and view all the answers

Where does the radial nerve give off its posterior interosseous branch?

<p>At the level of the lateral epicondyle (C)</p> Signup and view all the answers

What structure does the posterior interosseous nerve supply in the forearm?

<p>All extensor muscles except brachioradialis and extensor carpi radialis longus (B)</p> Signup and view all the answers

In relation to the radial artery, where does the radial nerve lie in the middle one-third of the forearm?

<p>Along the radial side of the radial artery (D)</p> Signup and view all the answers

What is the distal termination of the radial nerve near the wrist indicated as?

<p>A pseudoganglion (D)</p> Signup and view all the answers

What can be used as a surgical landmark for the posterior interosseous nerve?

<p>The head of the radius (C)</p> Signup and view all the answers

How is the position of the posterior interosseous nerve indicated during a surgical procedure?

<p>By placing the index finger on the dorsal aspect of the radius (B)</p> Signup and view all the answers

Which digit's supply does the radial nerve ensure along the dorsum of the hand?

<p>The radial three and a half digits (C)</p> Signup and view all the answers

Which muscles are NOT supplied by the posterior interosseous nerve?

<p>Biceps brachii (B), Extensor carpi radialis longus (D)</p> Signup and view all the answers

What indicates the line separating the muscle groups mentioned?

<p>Longitudinal furrow of the ulna (A)</p> Signup and view all the answers

Which tendon becomes prominent when the wrist is flexed against resistance?

<p>Flexor digitorum superficialis (C)</p> Signup and view all the answers

What structure can be palpated immediately distal to the radial styloid process when the thumb is fully extended?

<p>Anatomical snuff box (B)</p> Signup and view all the answers

Which tendon can be felt when a finger is run proximally along the tendon of the extensor pollicis longus?

<p>Superficial radial nerve (A)</p> Signup and view all the answers

When can the tendons of the extensors of the wrist be most easily identified?

<p>When the fist is clenched and relaxed alternately (D)</p> Signup and view all the answers

What is the function of Lister’s tubercle in relation to the tendons?

<p>Separates extensor compartments (A)</p> Signup and view all the answers

Which condition is associated with regional tenderness to palpation due to compartment involvement?

<p>De Quervain’s tenosynovitis (D)</p> Signup and view all the answers

Which tendon is located in the second compartment of the wrist?

<p>Extensor carpi radialis longus (B)</p> Signup and view all the answers

Which compartment contains the extensor digiti minimi?

<p>Compartment 5 (B)</p> Signup and view all the answers

Where does the median nerve run in relation to the palmaris longus tendon?

<p>On the radial side (B)</p> Signup and view all the answers

What does deep pressure at the medial epicondyle of the humerus potentially cause?

<p>Paresthesia (B)</p> Signup and view all the answers

In which part of the forearm does the ulnar artery lie along the radial side of the ulnar nerve?

<p>Throughout its entire course (B)</p> Signup and view all the answers

How can the radial artery's pulsation be felt at the wrist?

<p>In the interval between the flexor carpi radialis and the anterior border of the radius (A)</p> Signup and view all the answers

Where does the radial artery commence?

<p>Opposite the neck of the radius (D)</p> Signup and view all the answers

What muscle group is located deep to the radial artery in its course down the forearm?

<p>Abductor pollicis longus and extensor pollicis brevis (A)</p> Signup and view all the answers

What line represents the course of the ulnar artery in relation to the superficial flexor muscles?

<p>It passes along the medial aspect of their elevation (D)</p> Signup and view all the answers

What is the significance of the ring finger during an incision for the removal of a fractured head of the radius?

<p>It serves as a landmark for incision depth. (D)</p> Signup and view all the answers

Which structure is indicated by a line joining the crest of the trapezium to the hook of the hamate?

<p>The distal border of the flexor retinaculum (B)</p> Signup and view all the answers

Which metacarpal head is the most prominent when feeling the knuckles?

<p>Head of the middle finger (A)</p> Signup and view all the answers

What forms the hypothenar eminence in the palm of the hand?

<p>Muscles of the little finger (D)</p> Signup and view all the answers

What is the location of the carpometacarpal joint of the thumb during palpation?

<p>On the dorsal aspect of the thumb (B)</p> Signup and view all the answers

How can the interphalangeal joints be palpated?

<p>On the dorsal aspect of the flexed finger (C)</p> Signup and view all the answers

Which statement describes the skin of the palm of the hand?

<p>It contains a number of creases of little reference value. (A)</p> Signup and view all the answers

What distinguishes the medial border of the hand?

<p>The medial aspect of the hypothenar eminence (C)</p> Signup and view all the answers

Flashcards

Ulna

The prominent, easily palpable bony landmark on the posterior aspect of the forearm. It extends from the olecranon to the styloid process, forming a longitudinal furrow when the elbow is flexed.

Head of the Ulna

The bony landmark on the medial (inner) side of the wrist, easily felt when the hand is pronated.

Styloid Process of the Ulna

The bony projection on the posteromedial (back and inner) aspect of the ulna, near the wrist. Can be palpated and used to identify ulnar fractures.

Lower end of Radius

The lower expanded end of the radius, forming a slight surface elevation on the lateral (outer) side of the wrist. Can be traced down to the styloid process.

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Styloid Process of the Radius

The bony projection on the lateral (outer) side of the radius, close to the wrist. Palpable and used to identify radial fractures.

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Pisiform Bone

A small, palpable bony prominence on the palmar (front) aspect of the wrist, at the base of the little finger.

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Colles' Fracture

A fracture of the lower end of the radius with displacement, causing the styloid processes of the radius and ulna to align on the same plane.

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Tubercle of Lister

A bony projection on the posterior aspect of the lower end of the radius, palpable and grooved by the tendon of extensor pollicis longus.

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Where can you palpate the hook of the hamate?

The hook of the hamate is a bony landmark on the palmar side of the wrist. It can be palpated 2.5 cm distal to the pisiform bone, in line with the ulnar border of the ring finger. Deep pressure on this area may also reveal the superficial branch of the ulnar nerve.

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How to palpate the tubercle of the scaphoid?

The tubercle of the scaphoid bone can be found at the base of the thenar eminence. It often forms a small visible elevation on the thumb side of the wrist.

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How to palpate the crest of the trapezium?

The crest of the trapezium lies distal to the tubercle of the scaphoid, deep to the thenar eminence muscles. Deep pressure can help identify it.

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Another way to palpate the scaphoid and trapezium?

The scaphoid and trapezium can also be palpated in the anatomical snuffbox, which is a depression on the radial side of the wrist, formed by tendons.

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Where is the wrist joint located?

The wrist joint is located between the carpus and the distal ends of the radius and ulna. It can be identified by the movement of flexion and extension of the wrist, even though it is covered by tendons.

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Describe the line of the wrist joint.

The line of the wrist joint corresponds to a line connecting the styloid process of the radius to the styloid process of the ulna. It is delineated by the proximal of the two transverse anterior wrist skin creases.

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What anatomical structure is the cubital fossa?

The cubital fossa is a depression found on the anterior aspect of the elbow. It is bordered medially by the pronator teres muscle and laterally by the brachioradialis muscle. The superior border is formed by the humerus.

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How is the brachioradialis muscle identified?

The brachioradialis muscle is the most superficial muscle on the lateral side of the forearm. Its prominence can be observed by flexing the elbow against resistance in a semi-prone position, creating a ridge extending beyond the elbow joint on the lateral side of the arm.

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Median Nerve Course in Forearm

The median nerve enters the forearm on the medial side of the brachial artery and runs vertically downwards in the midline of the limb. At the wrist, it lies exactly in the midline and projects from under the palmaris longus tendon on its radial side.

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Ulnar Nerve Course in Forearm

The ulnar nerve in the forearm follows a line drawn from the base of the medial epicondyle of the humerus to the radial side of the pisiform bone. Deep pressure at both these bony landmarks produces paresthesia.

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Ulnar Artery Course in Forearm

The ulnar artery starts in the midline of the forearm opposite the neck of the radius. Its upper course can be represented by a line passing downwards and medially across the elevation of the superficial flexor muscles, reaching the radial side of the ulnar nerve in the lower two-thirds of the forearm. The rest of its course in the forearm lies along the radial side of the ulnar nerve.

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Radial Artery Course in Forearm

The radial artery begins opposite the neck of the radius on the medial side of the biceps tendon. It runs downwards and radially through the forearm to the wrist, where its pulsation can be felt between the flexor carpi radialis tendon and the anterior border of the radius. It continues distally across the lower end of the radius, passes posteriorly to the tendons of abductor pollicis longus and extensor pollicis brevis, and enters the 'snuffbox' where its pulsation is again palpable.

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Radial Artery Course in Upper Forearm

The upper part of the line representing the course of the radial artery passes deep to the medial part of the brachioradialis muscle on the anterior aspect of the forearm.

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Longitudinal Furrow of the Forearm

A prominent groove on the posterior surface of the forearm, located between the two muscle groups responsible for wrist flexion and extension. It is a landmark used to identify these muscle groups.

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Anatomical Snuff Box

A distinct depression on the lateral side of the wrist, visible when the thumb is fully extended. It is located immediately distal to the radial styloid process.

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Expanded Base of the First Metacarpal

A bony projection on the lateral aspect of the wrist, located near the base of the thumb. It can be palpated during thumb movements, specifically circumduction.

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Extensor Digitorum Tendons

A tendon that runs along the back of the hand, visible when fingers are fully extended. It helps straighten the fingers.

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Extensor Tendons of the Wrist

The collection of tendons located within the six extensor compartments of the wrist. These tendons are responsible for various wrist and finger movements.

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De Quervain’s Tenosynovitis

A condition characterized by inflammation of the tendons that control thumb movements, specifically abductor pollicis longus and extensor pollicis brevis. It causes pain and tenderness on the radial side of the wrist.

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Radial (Lister's) Tubercle

A prominent bony landmark located on the posterior aspect of the lower end of the radius. It is palpable and serves as a point of reference for the tendons of extensor pollicis longus.

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Extensor Carpi Ulnaris Tendon

A tendon that crosses the wrist, located on the ulnar side. It can be palpated when the wrist is extended and deviated to the ulnar side.

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Posterior Interosseous Nerve Origin

The posterior interosseous nerve originates near the lateral epicondyle, winds around the upper end of the radius, and supplies all extensor muscles of the forearm except brachioradialis and extensor carpi radialis longus.

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Posterior Interosseous Nerve Function

The posterior interosseous nerve passes downwards and posteriorly, supplying all the extensor muscles of the forearm except brachioradialis and extensor carpi radialis longus, which are supplied by the radial nerve before it divides.

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Posterior Interosseous Nerve Course

The posterior interosseous nerve runs along the radial side of the radial artery in the middle third of the forearm.

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Posterior Interosseous Nerve Winding

The posterior interosseous nerve winds around the lateral side of the radius between the two planes of fibers of the supinator muscle.

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Posterior Interosseous Nerve Termination

The posterior interosseous nerve ends as a flattened pseudoganglion on the dorsum of the wrist, distributing filaments to the ligaments and joints of the carpus.

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Posterior Interosseous Nerve Palpation

The posterior interosseous nerve can be palpated along the dorsal aspect of the head of the radius.

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Posterior Interosseous Nerve Winding Location

The posterior interosseous nerve winds around the radius approximately 2.5 cm distal to the radial head.

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Posterior Interosseous Nerve Injury

Injury to the posterior interosseous nerve can cause weakness or paralysis of the extensor muscles in the forearm, leading to difficulties with wrist and finger extension.

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Flexor Retinaculum

The thick, fibrous band that covers the carpal bones on the palmar (front) side of the wrist.

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Thenar Eminence

The fleshy elevation on the thumb side of the palm, formed by the abductor pollicis brevis and flexor pollicis brevis muscles.

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Hypothenar Eminence

The fleshy elevation on the little finger side of the palm, formed by the corresponding muscles of the little finger.

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Carpometacarpal Joint of the Thumb

The saddle-shaped joint between the trapezium bone and the base of the first metacarpal bone, allowing for the thumb's wide range of movement.

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Study Notes

Surface Anatomy of Forearm & Wrist

  • The ulna's posterior border is subcutaneous from the olecranon superiorly to the styloid process.
  • It corresponds to a furrow on the posterior aspect of the forearm when the elbow is flexed.
  • The radius's shaft is not easily felt due to muscle coverage.
  • The ulnar styloid process can be felt, and it's position corresponds to the medial side of the wrist's posterior region when the hand is pronated.

Skeletal Surface Landmarks

  • The rounded ulnar head forms a surface elevation the medial part of the wrist's posterior aspect when the hand is pronated.
  • The ulna's styloid process extends distally from the posterior-medial aspect of the head.

Skeletal Surface Landmarks of the Carpals

  • The pisiform bone is easily palpated on the palmar aspect of the wrist, near the base of the hypothenar eminence.
  • It can be moved over the triquetral bone during passive wrist flexion.
  • The scaphoid tubercle is at the base of the thenar eminence, forming a small elevation visible.
  • The crest of the trapezium is identifiable with deep pressure.
  • The scaphoid and trapezium are also palpable in the anatomical snuffbox.

Skeletal Surface Landmarks of the Wrist Joint

  • The wrist joint is easily identified between the carpus and the distal ends of the radius and ulna, even when covered by tendons.
  • A line joining the styloid processes of the radius and ulna corresponds to the wrist joint line, convex upwards.

Soft Tissues: Cubital Fossa

  • The cubital fossa is formed as a depression in the middle of the upper forearm's anterior aspect.
  • It's bounded medially by pronator teres, laterally by brachioradialis, and superiorly by a line joining the two.

Soft Tissues: Brachioradialis

  • The brachioradialis is the most superficial muscle within the forearm's lateral side.
  • It appears as a prominent ridge when the elbow is flexed against resistance, extending above the elbow joint.

Soft Tissues: Shafts of Radius and Ulna

  • The radius and ulna are covered by the forearm's flexor and extensor muscle groups respectively.
  • A longitudinal furrow, marking the ulnar border, distinguishes the two muscle groups.
  • Distally, several tendons of both muscle groups are individually identifiable.

Soft Tissues: Tendons of Extensors

  • Extensor tendons are clearly visible on the posterior aspect of the carpus when the hand is clenched; they are easily identified.
  • The extensor digitorum tendons are evident on the dorsum of the hand when the fingers are extended.
  • The extensor carpi ulnaris tendon can be identified distally and ulnarly on the styloid process.

Soft Tissues: Anatomical Snuffbox

  • On extending the thumb, a depression, called the anatomical snuffbox, is evident on the lateral aspect of the wrist, distal to the radial styloid process.
  • It contains the articular surface of the scaphoid as well as the radial aspects of the trapezium/trapezoid; they are identified on deep pressure.

Soft Tissues : Radial Nerve

  • The origin of the posterior interosseous nerve is identified anteriorly to the lateral epicondyle.
  • The nerve is found between the ulnar head and dorsal tubercle of the radius in the distal forearm.
  • Its final form is as a flattened pseudoganglion, distributed to carpal ligaments and joints.

Soft Tissues: Radial Nerve (Surgical Landmark)

  • A significant surgical landmark is the point where the posterior interosseous nerve wraps around the upper end of the radius.
  • It can be marked by positioning the index finger on the radius's dorsal aspect, with the middle and ring fingers placed below, and the ring finger lies directly over the nerve.
  • This specific localization of the nerve is important for surgeries, ensuring incisions are not too far from the nerve.

Soft Tissues: Flexor Retinaculum

  • The concave distal border of the flexor retinaculum is indicated by a curved line connecting the trapezium's crest to the hook of the hamate.
  • The proximal border of the flexor retinaculum is identified by another curved line from the scaphoid tubercle to the pisiform.

Soft Tissues: Radial Artery

  • The radial artery's upper course lies deep to the brachioradialis' medial aspect.
  • It passes downward and laterally through the forearm, reaching the wrist where it lies between the tendon of flexor carpi radialis on the ulnar side and the radius' anterior margin laterally.

Soft Tissues: Ulnar Nerve

  • The ulnar nerve's course in the forearm follows a line from the base of the medial epicondyle of the humerus to the radial side of the pisiform bone.
  • Deep pressure on both bony landmarks results in paresthesia.
  • In the forearm's lower section, the ulnar nerve is positioned along the radial surface of the flexor carpi ulnaris tendon.

Soft Tissues: Hand - Surface Anatomy

  • The hand's palm displays skin creases, but these don't serve as reliable reference points.
  • The thenar eminence, formed by flexor and abductor pollicis brevis muscles, is a fleshy prominence on the palm's radial side.
  • The hypothenar eminence, formed by the corresponding little finger muscles, is present on the palm's ulnar side, but also less prominent.
  • The medial and lateral borders of the hand are defined by the medial and lateral aspects of the hypothenar and thenar eminences.
  • The carpometacarpal joint of the thumb's dorsal aspect is partially visible.
  • The distal palmar creases are placed proximal to the distal interphalangeal joints, and intermediate creases are positioned opposite the proximal interphalangeal joints, while the most proximal creases are located at the junction of the palm and the fingers.

Soft Tissues: Dorsal Aspects of the Hand

  • The dorsal aspects of the metacarpal shafts and the trapezium are mostly covered by extensor tendons, making them less distinct to the touch.
  • Proximal and middle finger phalanges' heads create palpable prominences distinctly visible on the dorsum of the hand when the fingers are flexed.

Soft Tissues: The Dorsal Venous Arch

  • A network of veins, the dorsal venous arch, is present on the back of the hand, but its arrangement varies among individuals.
  • The cephalic vein arises from the radial extremity of the arch, travelling along the radial side of the distal forearm.
  • The basilic vein originates from the ulnar side of the arch and ascends along the ulnar portion of the distal forearm.
  • Both veins are palpable, with the vein traversing the top of the anatomical snuffbox serving as a common intravenous cannulation site.

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