黃敏銓 [email protected] 1 Anterior and posterior compartments

Lateral intermuscular septum

Anterior compartment 前

Cubital fossa 外 內 Radius Ulna Posterior compartment

後

Interosseous membrane

Ulna

Carpal tunnel Radius 2 Anterior (8) Posterior (12)

Tendons

3 Anterior compartment

Three layers: • superficial (4) • intermediate (1) • deep (3)

Function: • Wrist movements • Flexion of fingers • Pronation

4 Superficial layer: Medial epicondyle Ulnar nerve Common flexor Median nerve Golfer's Flexor carpi radialis (Medial epicondylitis) Palmaris longus Pronator teres Flexor carpi ulnaris

Palmar aponeurosis

5 Ulnar nerve Flexor carpi ulnaris Humeral head Medial epicondyle Ulnar head Olecranon Posterior border of ulna Function: flexes and adducts wrist joint Flexor carpi ulnaris

Innervation: ulnar nerve

Pisohamate ligament Pisiform Pisometacarpal ligament

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SHAWN W. O’DRISCOLL et al., 1991

7 Palmaris longus 1. Tendon: 中偏內側 2. Function: flexes wrist joint, anchors skin 3. Innervation: median nerve Flexor carpi radialis Palmaris longus Pronator teres Flexor carpi ulnaris

Flexor carpi radialis 1. Tendon:中偏外側 2. Function: flexes and abducts wrist 3. Innervation: median nerve II

※Tendon是重要的Landmark

8 Pronator teres Origin: humeral head, ulnar head Insertion: mid-shaft of radius Median nerve Function: pronation / flexion of forearm Innervation: median nerve Pronator teres (humeral head)

Pronator teres (ulnar head)

Ulnar artery Median nerve

Anterior interosseous nerve

9 Intermediate layer: Humero-ulnar Flexor digitorum superficialis head Median nerve flex each finger independently Ulnar artery 一般原則：flex跨越的joints Radial head Flexor digitorum superficialis

四條tendons不在同一平面

Innervation: median nerve

Middle phalanges

10 Ulnar nerve: innervates medial half of flexor Deep layer digitorum profundus Intermediate/deep layer: Radius Ulna neurovascular plane Interosseous membrane Flexor digitorum profundus

Flexor pollicis longus

Pronator quadratus Flexor retinaculum Innervation: anterior interosseous nerve Ulnar nerve

Median nerve 11 Brachial artery

Anterior ulnar recurrent artery Radial recurrent artery Recurrent interosseous artery

Anterior and posterior Posterior ulnar recurrent artery interosseous arteries Ulnar artery

Common interosseous artery Radial artery

Palmar carpal branches

Superficial palmar branch Deep palmar branch Deep palmar arch 12 Superficial palmar arch ※神經損傷位置和症狀 Median nerve 的關連性 Radial nerve Ulnar nerve

注意神經可能受到壓迫的位置 造成的症狀 Deep branch Flexor carpi ulnaris

Supinator Superficial branch

Pronator teres

Anterior interosseous nerve

Dorsal branch Pronator quadratus

Palmar branch Palmar branch

13 Posterior compartment Superficial layer

Two layers: Lateral epicondyle • superficial (7) Extensor carpi • deep (5) Anconeus radialis longus Extensor carpi radialis brevis Function: Extensor carpi ulnaris

• wrist movements Extensor digiti minimi • extension of fingers Extensor digitorum • supination

* * *

Anterior view Posterior view

14 Superficial layer Proximal 2/3 of supraepicondylar ridge Brachioradialis

Function: Flexion of mid-pronated forearm

Innervation: radial nerve

Lateral surface of distal end of radius

15 Extensor carpi radialis longus / brevis

Function: extend and abduct Innervation: ECRL: radial nerve, ECRB: deep branch of radial nerve (或radial nerve) 握拳 Extensor carpi Extensor carpi radialis longus radialis brevis

Supraepicondylar ridge Base of 2nd metacarpal Lateral epicondyle Base of 3rd metacarpal

16 Extensor digitorum / Extensor digiti minimi

Function: extend metacarpophalangeal joint, interphalangeal joint Innervation: deep branch of radial nerve

Extensor carpi Extensor carpi radialis longus radialis brevis

Base of 2-5th Lateral epicondyle Base of 5th extensor expansion

17 Extensor carpi ulnaris

Function: extend and adduct hand 握拳 Innervation: deep branch of radial nerve

Extensor carpi Extensor carpi radialis longus radialis brevis

Base of 5th metacarpal Lateral epicondyle

18 Lateral epicondylitis

Common extensor tendon

Extensor carpi radialis longus Extensor carpi radialis brevis

Lateral epicondyle Extensor Extensor digitorum carpi ulnaris Extensor digiti minimi

19 Deep layer

Supinator Supinator (superficial head) (deep head) ulna

radius Abductor pollicis longus Extensor pollicis longus

Extensor indicis Extensor pollicis brevis

Dorsal tubercle of radius * * * *

20 Deep layer Supinator Innervation: deep branch of radial nerve

superficial head deep head Supinator

Radial tunnel

Deep branch Supinator

21 Deep layer ulna Innervation: radius Posterior interosseous nerve

Abductor pollicis longus Extensor pollicis longus

Extensor indicis Extensor pollicis brevis

Dorsal tubercle of radius * * * *

22 Six synovial tendon sheaths

Extensor retinaculum

Intertendinous connections

23 Innervation for muscles in the poster compartment

Radial nerve Brachioradialis

Extensor carpi radialis longus

Extensor carpi radialis Recurrent brevis interosseous artery Deep branch Common Supinator interosseous Superficial branch artery Anterior Posterior interosseous artery interosseous artery Ulnar artery

24 Branches of deep branch of radial nerve

Recurrent interosseous artery Supinator

Posterior interosseous nerve

Posterior interosseous artery

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