POST COMPARTMENT OF FOREARM

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BY DR NEETA CHHABRA

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POSTERIOR COMPARTMENT OF FOREARM : 

POSTERIOR COMPARTMENT OF FOREARM Also known as EXTENSOR COMPARTMENT CONTENTS MUSCLES NERVES VESSELS

Slide 2: 

Two layers: Superficial Deep Are associated with Movement of the wrist joint Extension of the fingers and thumb Supination. All muscles in the posterior compartment of the forearm are innervated by the radial nerve MUSCLES OF THE POSTERIOR COMPARTMENT

Superficial layer : 

Superficial layer Seven muscles ANCONEUS BRACHIORADIALIS EXTENSOR CARPI RADIALIS LONGUS EXTENSOR CARPI RADIALIS BREVIS EXTENSOR DIGITORUM EXTENSOR DIGITI MINIMI EXTENSOR CARPI ULNARIS SUPERFICIAL LAYER

Slide 4: 

SUPERFICIAL LAYER Common Origin Lat epicondyle of humerus . Except for Brachioradialis and Anconeus. Extend as tendons into the hand.

BRACHIORADIALIS : 

O:upper 2/3 of the lat supracondylar ridge of humerus,I/MSepta I: lat side of the distal end of radius proximal to styloid process Forms lateral boundary of cubital fossa. A: ant to elbow joint, acts as an accessory flexor of this joint. N S: Radial nerve BRACHIORADIALIS

EXTENSOR CARPI RADIALIS LONGUS : 

O:lower1/3 of supracondylar ridge ,lateral I/M Septum, Common tendon from lat epicondyle I: Dorsal surface of base of 2nd metacarpal Deep to brachioradialis . A:Extends and abducts wrist. N S :Radial nerve before it divides into superficial and deep branches EXTENSOR CARPI RADIALIS LONGUS

Slide 7: 

O:Lateral epicondyle of humerus. Radial collaeral lig of elbow I: Dorsal surfaces of bases of 2nd and 3rd metacarpals . Lies deep to extensor carpi radialis longus. A:Extends and abducts wrist. NS: Posterior interosseous nerve. EXTENSOR CARPI RADIALIS BREVIS

EXTENSOR DIGITORUM : 

O: Lateral epicondyle of humerus Forms four tendons, each passes into a finger I: Base of dorsal surfaces of middle and distal phalanges. A:Extends all joints of hand NS: Posterior interosseous nerve. EXTENSOR DIGITORUM

Slide 9: 

An accessory extensor of little finger, medial to extensor digitorum . O: Lateral epicondyle of humerus I: Dorsal digital expansion of little finger along with the tendon of extensor digitorum. A:Extends MCP &IP joints of little finger NS: Posterior interosseous nerve EXTENSOR DIGITI MINIMI

Slide 10: 

Lies medial to the extensor digiti minimi O: Lateral epicondyle of the humerus Posterior border of ulna by an aponeurosis I: Medial side of the base of 5th metacarpal . A: Extends and adducts the wrist NS: Posterior interosseous nerve EXTENSOR CARPI ULNARIS

ANCONEUS : 

Small triangular muscle behind the cubital joint. O:Post surface of lat epicondyle of humerus. I: Lat aspect of Olecranon Proximal 1/4th of post surface of ulna. A: Weak extensor of elbow NS: Radial Nerve ANCONEUS

Deep layer : 

Deep layer Five Muscles: SUPINATOR ABDUCTOR POLLICIS LONGUS EXTENSOR POLLICIS BREVIS EXTENSOR POLLICIS LONGUS EXTENSOR INDICIS. DEEP MUSCLES

DEEP MUSCLES : 

O:Post surfaces of radius, ulna, Int Memb pass into thumb and Index finger except Supinator APL,EPB,EPL emerge between ED & ECRB NS: Posterior interosseous nerve. DEEP MUSCLES

SUPINATOR : 

Two heads O: Superficial head: lat epicondyle of humerus, radial collateral lig of elbow annular lig, Deep head : supinator crest of ulna,post part of triangular area in front of it I: Lat surface of prox 1/3 of radius A: Supinates the forearm and hand NS: Posterior interroseous nerve. SUPINATOR

ABDUCTOR POLLICIS LONGUS : 

O: Prox post surfaces of the radius and ulna, interosseous memb. I: Radial side of base of 1st metacarpal . Trapezium A: Abd and ext of thumb at carpometacarpal joint NS: Posterior interroseous nerve ABDUCTOR POLLICIS LONGUS

EXTENSOR POLLICIS BREVIS : 

O: Post surface of radius, interosseous memb. I:Dorsal surface of base of prox phalanx of thumb. A:Extends prox phalanx and metacarpal of thumb. NS: Posterior interroseous nerve. EXTENSOR POLLICIS BREVIS

Slide 17: 

O: Posterior surface of ulna interosseous memb. I:Dorsal surface of distal phalanx of the thumb A:Extends all joints of the thumb NS: Posterior interosseous nerve. EXTENSOR POLLICIS LONGUS

Slide 18: 

O: Posterior surface of ulna distal to extensor pollicis longus, interosseous memb . I:Ulnar side of tendon of extensor digitorum for index finger. A:Extension of Index finger. NS: Posterior interosseous nerve EXTENSOR INDICES

Blood supply is predominantly through branches of the Radial Posterior interosseous Anterior interosseous arteries ARTERIES AND VEINS

Posterior interosseous artery : 

Posterior interosseous artery Branch of Common interosseous artery Crosses over interosseous memb to reach post compartment. Gives recurrent interosseous artery, which takes part in anastomosis around elbow joint . Passes between supinator and abductor pollicis longus to supply superficial extensors. Terminates by joining dorsal carpal arch of wrist after receiving terminal end of anterior interosseous artery. POSTERIOR INTEROSSEOUS ARTERY

Slide 21: 

Branch of the common interosseous artery. Situated in the anterior compartment of the forearm on the interosseous membrane. Perforating branches, which pass through the interosseous membrane to supply deep muscles of the posterior compartment ANTERIOR INTEROSSEOUS ARTERY

Slide 22: 

Deep veins of the posterior compartment generally accompany the arteries. They ultimately drain into brachial veins associated with the brachial artery in the cubital fossa. VEINS

POSTERIOR INTEROSSEOUS NERVE : 

Branch of radial nerve Enters back between sup &deep fibres of supinator Runs on post surface of interrosseous memb upto wrist Pseudoganglion-supplies wrist & intercarpal jts. Branches: A: Muscular B: Articular C: Sensory POSTERIOR INTEROSSEOUS NERVE

MUSCULAR BRANCHES : 

Before piercing SUPINATOR- ECRB & SUPINATOR While passing through SUPINATOR- BRANCH TO SUPINATOR After Emerging from SUPINATOR- 3 SHORT BRANCHES ED,EDM,ECU 2 LONG BRANCHES LATERAL MEDIAL APL,EPB EPL,EI MUSCULAR BRANCHES

Slide 25: 

Aconeus Brachioradialis ECRL Radial nerve Posterior interosseous nerve ECRB ED EDM ECU S APL EPB EPL EI Anconeus Brachioradialis Extensor carpi radialis longus Extensor carpi radialis brevis Extensor digitorum Extensor digiti minimi Supinator Abductor pollicis longus Extensor pollicis longus Extensor pollicis brevis Extensor indicis Extensor carpi ulnaris EXTENSOR COMPARTMENT :NERVE SUPPLY

ANATOMICAL SNUFFBOX : 

Anatomical snuffbox lies between extensor pollicis longus tendon on ulnar side and tendons of extensor pollicis brevis and abductor pollicis longus on radial side. ANATOMICAL SNUFFBOX

EXTENSOR RETINACULUM : 

A band like thickening in the deep fascia of forearm. About 2.5 cm wide. Passes obliquely across the extensor surface of wrist. Laterally to lower part of ant border of radius. Medially attached to styloid process of ulna. Triquetral & pisiform bones. EXTENSOR RETINACULUM

EXTENSOR RETINACULUM : 

EXTENSOR RETINACULUM Extensor carpal tunnel is divided in to six compartments by fibrous septa passing to bones of forearm.

EXTENSOR RETINACULUM : 

Starting from lateral side. COMPARTMENT STRUCTURES I Abductor pollicis longus Extensor pollicis brevis II Extensor carpi radialis longus Extensor carpi radialis brevis III Extensor pollicis longus. IV Extensor digitorium Extensor indicis Post interrosseous nerve Ant interrosseous artery  V Extensor digiti minimi.  VI Extensor carpi ulnaris EXTENSOR RETINACULUM

APPLIED ANATOMY : 

WRIST DROP: INJURY TO RADIAL NERVE ABOVE THE ORIGIN OF POST INTEROSSEOUS NERVE PARALYSIS OF EXTENSOR MUSCLES OF FOREARM IF DEEP BRANCH OF RADIAL NERVE IS DAMAGED EXT CARPI RADIALIS LONGUS AND BREVIS ARE SPARED WRIST DROP IS ABSENT APPLIED ANATOMY