CVR-UL 50.

Posterior Compartment of Forearm, Dorsum of

Hand, Extensor

Presented by
Ranganath Vallabhajosyula

Learning Outcomes
Revise the osteology and joints of the forearm and wrist
Describe the structure and function of muscles in the posterior
compartment of the forearm
Discuss the long extensor tendons and intrinsic muscles of the
dorsum of the hand.
Discuss the anatomical snuff box, including boundaries and
contents.
Discuss the radial nerve, including its course and distribution.
Recognize common injuries in the forearm and wrist and discuss
their causes and complications.

Posterior (extensor
compartment)
This compartment is Floored by posterior surfaces of the radius and ulna
with intervening interosseous membrane
Limited medially the subcutaneous posterior border
of the ulna
Covered by the deep fascia, which is thickened and
form extensor retinaculum at the back of the wrist

Bones palpable at the back of the forearm are Posterior surface of the olecranon process, posterior
border, head and styloid process of the ulna
Head, dorsal tubercle and styloid process of the
radius

Osteology and joints of

forearm & wrist

Bones of the forearm

Hand bones

Elbow joint

Movement at elbow joint

Hinge variety of synovial joint
Flexion: brachialis (chief flexor),
biceps brachii (when the forearm
is supinated), brachioradialis
(when the forearm in mid-prone
position)
Extension: triceps brachii,
anconeus assisted by gravity

Radio ulnar joints

Synovial-Pivot joints
Articulations between ulna and
radius
Proximal and distal
Movements pronation and
supination
Interosseous membrane: Thin layer
of tissue running between ulna and
radius

Superior radio-ulnar joint

Movement at radio ulnar joints

Pronation: pronator quadratus assisted by pronator teres, flexor

carpi radialis and gravity
Supination: biceps brachii (in flexion), supinator (in extension)

Wrist joint

Flexor carpi radialis

Flexor carpi ulnaris
Palmaris longus

Flexor carpi radialis

Extensor carpi radialis longus
and brevis
Abductor pollicis longus and
extensor pollicis brevis

Extensor carpi
radialis longus and
brevis, extensor
carpi ulnaris

Flexor carpi ulnaris

Extensor carpi ulnaris

Metacarpophalangeal &
interphalangeal joints

Movement of the fingers

Abduction

Adduction

Movement of the fingers (except

thumb)

At metacarpophalangeal joints
Flexion: lumbricals, interossei
Extenson: extensor of the fingers
Abduction: dorsal interossei
Adduction: palmar interossei

At interphalangeal joints
Flexion: flexor digitorum profundus (at distal IP joints),
flexor digitorum superficialis (at proximal IP joints)
Extenson: extensor digitorum along with the lumbricals
and interossei

Movement of the thumb

Abduction

Adduction

Opposition

Extension

Reposition

Flexion

Movement of the thumb

At first metacarpophalangeal joints
Flexion: flexor pollicis brevis, opponens pollicis assisted by
flexor pollicis longus
Extenson: abductor pollicis longus, extensor pollicis bravis
assisted by extensor pollicis longus
Abduction: abductor pollicis longus and brevis
Adduction: adductor policis
Opposition: initiated by abductor pollicis longus and brevis,
maintained by flexor pollicis brevis and opponens pollicis

At interphalangeal joints
Flexion: flexor pollicis longus
Extenson: extensor pollicis longus and brevis

Muscles of
the posterior compartment of
the forearm

Muscles of the Forearm

Two functional groups: those that cause wrist movement, and
those that move the fingers and the thumb
These muscles insert via strong ligaments called flexor and
extensor retinacula
Most anterior muscles are flexors, and posterior muscles are
extensors
The pronator teres and pronator quadratus are not flexors,
but pronate the forearm
The supinator muscle is a synergist with the biceps brachii in
supinating the forearm

Forearm Compartments
Anterior compartment
Flexors & pronators
Medial epicondyle common flexor origin

Posterior compartment
Extensors & supinators
Lateral epicondyle common extensor origin

(Tennis Elbow)

Forearm Muscles : Posterior

Compartment
These muscles are
primarily extensors of
the wrist and fingers
All extensor muscles
of the forearm are
supplied by the radial
nerve (posterior
interosseous nerve)

Forearm Muscles
: Posterior
Compartment

Forearm Muscles : Posterior

Compartment (superficial Layer)
Lateral group:
Brachioradialis, extensor
carpi radialis longus,
extensor carpi radialis brevis
Posterior group: Extensor
digitorum, extensor digiti
minimi, extensor carpi
ulnaris, anconeus

Note: ECRL from

lat. supracondylar
ridge of humerus
- 2nd metacarpal

into ulna

Forearm Muscles : Posterior

Compartment (Deep Layer)
These muscles are primarily
extensors of the wrist and
fingers (exception- supinator)
Supinator, abductor policis
longus, extensor policis brevis,
extensor policis longus and
extensor indicis (from above
downwards and from lateral to
medial side)

from CEO & ulna into

neck & shaft of radius

Extensor Expansion
The four tendons of the extensor
digitorum fan out and form dorsal digital
expansion over the proximal phalanges of
the medial four fingers
When the extensor digitorum muscle
contracts, it pulls on the extensor
expansion and this, in turn extends the
interphalangeal joints.

Anatomical Snuffbox

Boundaries:
EPL
EPB
APL

1. extensor pollicis longus; 2. extensor pollicis brevis;

3. abductor pollicis longus; 4. scaphoid; 5. trapezium;
6. first metacarpal;
arrow = radial artery

Intrinsic Muscles of the Hand

These small muscles:
Lie in the palm of the hand (none on the dorsal side)
Move the metacarpals and fingers
Control precise movements (e.g., threading a needle)
Are the main abductors and adductors of the fingers
Produce opposition move the thumb toward the little
finger

Intrinsic Muscles of the

Hand: Groups
There are three groups of intrinsic hand muscles
The thenar eminence (ball of the thumb) and
hypothenar eminence (ball of the little finger) each
have a flexor, an abductor, and an opponens muscle
The midpalm muscles, the lumbricals and interossei,
extend the fingers
The interossei also abduct and adduct the fingers

Intrinsic Muscles of the

Hand: Groups

Figure 10.18c and d

PAD

ulnar nerve
(deep branch)
T1

DAB

ulnar nerve
(deep branch)
T1

Intrinsic Muscles of the Hand:

Lumbrical muscles

Insert into extensor expansion on dorsal surface

Lumbrical muscles

Lumbrical Muscles (same innervation as FDP)

Radial nerve

Superficial branch

Radial Nerve
in Forearm
Damage results in
inability to extend fingers
and wrist drop
-Mid shaft humerus
fracture - difficulty
flexing elbow in
midpronation, why

Dislocation at superior
radioulnar joint

Wrist drop/ Saturday night palsy

Colles fracture showing dinner fork deformity

Scaphoid

Colles

Smiths

Smiths fracture

Thank you