INTRODUCTION TO BACK OF FOREARM AND HAND

Dr. Misbah Ghous

DPT, MSNMPT
 Learning objectives
• To explain the compartments of forearm
• To explain the muscles attached of forearm
• To explain the nerves of forearm
• To explain the blood supply of forearm

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 Back of forearm and hand
• Surface land marking
• Olecranon process
• Head of radius
• Posterior border of ulna
• Head of ulna
• Styloid process of the radius and ulna
• Dorsal tubercle of radius
• Anatomical snuff box
Palmar Side of Hand 3
Back of Forearm and Hand 4
 Extensor Compartments
There are a lot of wrist/finger extensors trying to fit in the wrist and anatomically these are
divided into 6 compartments.
• First compartment – it’s this that is affected in de Quervain tenosynovitis
– APL (abductor pollicis longus): attaches to 1st MC

– EPB (extensor pollicis brevis): attaches to base of proximal phalanx

• Second compartment
– ECRB (extensor carpi radialis brevis): attaches to 3rd MC

– ECRL (extensor carpis radialis longus): attaches to 2nd MC

• Third compartment
– EPL (extensor pollicis longus): passes around Lister’s tubercle of radius and inserts
on distal phalanx of thumb (extends thumb IPJ)

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 Continue…..
• Fourth compartment – the posterior interosseus nerve lies on the floor of this

compartment

– ED (extensor digitorum): no direct attachment to phalanx, attaches to the extensor

expansions

– EI (extensor indicis ) lies ulnar to 1st EDC tendon)

• Fifth compartment

– EDM (extensor digiti minimi): attaches to extensor expansion of little finger

• Sixth compartment

– ECU (extensor carpi ulnaris): attaches to base of 5th MC

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Back of Forearm and Hand 7
 Extensor retinaculum
• Deep fascia on the back of wrist is thickened to
form extensor retinaculum which hold extensor
tendon in place
• Attachments
– Laterally
» Lower part of anterior border of radius
– Medially
» Styloid process of ulna
» Triquetral
» Pisiform bone
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Palmar Side of Hand 9
Back of Forearm and Hand 10
 Superficial muscle of back of forearm

• Anconeus
• Brachioradialis
• Extensor carpi radialis longus

• Extensor carpi radialis brevis

• Extensor digitorum
• Extensor digiti minimi
• Extensor carpi ulnaris
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 Deep muscle of back of the forearm
• Supinator
• Abductor pollicis longus
• Extensor pollicis brevis
• Extensor pollicis longus
• Extensor indicis

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 Brachioradialis
• Origin:
• lateral supracondylar ridge of
humerus
• Insertion:
• styloid process of radius
• Nerve supply:
• Radial nerve
• Action:
• flexes forearm and supinates hand

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Back of Forearm and Hand 14
 extensor carpi radialis longus
• Origin:
• lateral supracondylar ridge of
humerus
• Insertion:
• base of 2nd metacarpal
• Nerve supply:
• Radial nerve
• Action:
• extends and abducts the wrist

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 extensor carpi radialis brevis
• Origin:
• lateral epicondyle of humerus
• Insertion:
• base of 3rd metacarpal
• Nerve supply
• Radial nerve
• Action:
• extends and abducts the wrist

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 extensor carpi ulnaris
• Origin:
• lateral epicondyle of humerus
posterior border of ulna
• Insertion:
• base of 5th metacarpal
• Nerve supply:
• Radial nerve
• Action:
• extends and adducts the hand

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 extensor digitorum
• Origin:
• lateral epicondyle of humerus
• Insertion:
• extensor expansion over fingers
• Nerve supply:
• Radial nerve
• Action:
• extends fingers, hand and
forearm

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Back of Forearm and Hand 19
 extensor digiti minimi
• Origin:
• lateral epicondyle of humerus
• Insertion:
• extensor expansion of little finger
• Nerve supply:
• Radial nerve
• Action:
• extends little finger

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Back of Forearm and Hand 21
 anconeus
• Origin:
• back of lateral epicondyle of
humerus
• Insertion:
• olecranon process
poster surface of ulna
• Nerve supply
• Radial nerve
• Action:
• extends forearm
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Back of Forearm and Hand 23
 supinator
• Origin:
• lateral epicondyle of humerus
crest of ulna
• Insertion:
• upper third of radius
• Nerve supply
• Radial nerve
• Action:
• supinates the forearm

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 abductor pollicis longus
• Origin:
• posterior surface of ulna
middle aspect of radius
• Insertion:
• base of 1st metacarpal
• Nerve supply
• Radial nerve
• Action:
• abducts thumb

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Back of Forearm and Hand 26
 extensor pollicis brevis
• Origin:
• middle 1/3rd of radius
• Insertion:
• base of proximal phalanx of
thumb
• Nerve supply:
• Radial nerve
• Action:
• extends thumb

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 Extensor Pollicis Longus
• Origin:
• middle 1/3rd ulna &
interosseous membrane
• Insertion:
• base of distal phalanx of thumb
• Nerve supply:
• Radial nerve
• Action:
• extends thumb

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 Extensor Indicis
• origin
• Posterior surface of ulna
• Insertion
• Extensor expansion of
index finger
• Nerve supply
• Radial nerve
• Action:
• Extends index finger

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 Deep terminal branches of radial nerve
(posterior interosseous nerve)
• Branches and distribution
• Muscular branch
» Extensor carpi radialis brevis
» Supinator
» Extensor digitorum
» Extensor digiti minimi
» Extensor carpi ulnaris
» Abductor pollicis longus
» Extensor pollicis brevis
» Extensor pollicis longus
» Extensor indicis
• Articular
» Wrist joint
» Distal radioulnar joint
» Intercarpal and interphalangeal joint
• Sensory branches
» Interosseous membrane
» Radius
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» ulna
 De Quervain tenosynovitis

• De Quervain's tenosynovitis is a painful condition affecting the

tendons on the thumb side of your wrist.

• If you have de Quervain's tenosynovitis, it will probably hurt when

you turn your wrist, grasp anything or make a fist

– APL 
– EPB
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de Quervain tenosynovitis

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