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The Forearm

Anatomy of Muscle Compartments and Nerves

Carol A. Boles1, Srilatha Kannam2 and Anne B. Cardwell2

1 Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1088.
2 Rush-Presbyterian—St. Luke's Medical Center, Department of Radiology and Nuclear Medicine, 1653 W. Congress Pkwy., Chicago, IL 60612.




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  		Fig. 1. —Forearm compartments. ECRB = extensor carpi radialis brevis, ECRL = extensor carpi radialis longus, BR = brachioradialis, FCU = flexor carpi ulnaris, PL = palmaris longus, FCR = flexor carpi radialis, FDS = flexor digitorum superficialis, ED = extensor digitorum, EDM = extensor digiti minimi, ECU = extensor carpi ulnaris, FDP = flexor digitorum profundus, FPL = flexor pollicis longus, PT = pronator teres, S = supinator, APL = abductor pollicis longus, EPB = extensor pollicis brevis, EPL = extensor pollicis longus, EI = extensor indices, R = radius, U = ulna.

A, Drawing of proximal forearm. (See key.)

 


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  		Fig. 1. —Forearm compartments. ECRB = extensor carpi radialis brevis, ECRL = extensor carpi radialis longus, BR = brachioradialis, FCU = flexor carpi ulnaris, PL = palmaris longus, FCR = flexor carpi radialis, FDS = flexor digitorum superficialis, ED = extensor digitorum, EDM = extensor digiti minimi, ECU = extensor carpi ulnaris, FDP = flexor digitorum profundus, FPL = flexor pollicis longus, PT = pronator teres, S = supinator, APL = abductor pollicis longus, EPB = extensor pollicis brevis, EPL = extensor pollicis longus, EI = extensor indices, R = radius, U = ulna.

B, Corresponding MR image of healthy 32-year-old woman shows proximal forearm distal to radial tuberosity. Anterior interosseous nerve has already branched from median nerve. Radial nerve has divided. Deep radial nerve is within supinator muscle and not visible. Anconeus muscle is proximal to this level.

 



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  		Fig. 1. —Forearm compartments. ECRB = extensor carpi radialis brevis, ECRL = extensor carpi radialis longus, BR = brachioradialis, FCU = flexor carpi ulnaris, PL = palmaris longus, FCR = flexor carpi radialis, FDS = flexor digitorum superficialis, ED = extensor digitorum, EDM = extensor digiti minimi, ECU = extensor carpi ulnaris, FDP = flexor digitorum profundus, FPL = flexor pollicis longus, PT = pronator teres, S = supinator, APL = abductor pollicis longus, EPB = extensor pollicis brevis, EPL = extensor pollicis longus, EI = extensor indices, R = radius, U = ulna.

C, Drawing of mid forearm compartments. (See key.)

 


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  		Fig. 1. —Forearm compartments. ECRB = extensor carpi radialis brevis, ECRL = extensor carpi radialis longus, BR = brachioradialis, FCU = flexor carpi ulnaris, PL = palmaris longus, FCR = flexor carpi radialis, FDS = flexor digitorum superficialis, ED = extensor digitorum, EDM = extensor digiti minimi, ECU = extensor carpi ulnaris, FDP = flexor digitorum profundus, FPL = flexor pollicis longus, PT = pronator teres, S = supinator, APL = abductor pollicis longus, EPB = extensor pollicis brevis, EPL = extensor pollicis longus, EI = extensor indices, R = radius, U = ulna.

D, Corresponding MR image of healthy 32-year old woman.

 



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  		Fig. 1. (continued)—Forearm compartments. FCR = flexor carpi radialis, PL = palmaris longus, FDS = flexor digitorum superficialis, FCU = flexor carpi ulnaris, FPL = flexor pollicis longus, FDP = flexor digitorum profundus, PQ = pronator quadratus, R = radius, U = ulna, BR = brachioradialis, APL = abductor pollicis longus, ECRL = extensor carpi radialis longus, ECRB = extensor carpi radialis brevis, EPB = extensor pollicis brevis, EPL = extensor pollicis longus, EI = extensor indices, ED = extensor digitorum, ECU = extensor carpi ulnaris, EDM = extensor digiti minimi.

E, Drawing of distal forearm at junction of radial diaphysis and metaphysis.

 


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  		Fig. 1. (continued)—Forearm compartments. FCR = flexor carpi radialis, PL = palmaris longus, FDS = flexor digitorum superficialis, FCU = flexor carpi ulnaris, FPL = flexor pollicis longus, FDP = flexor digitorum profundus, PQ = pronator quadratus, R = radius, U = ulna, BR = brachioradialis, APL = abductor pollicis longus, ECRL = extensor carpi radialis longus, ECRB = extensor carpi radialis brevis, EPB = extensor pollicis brevis, EPL = extensor pollicis longus, EI = extensor indices, ED = extensor digitorum, ECU = extensor carpi ulnaris, EDM = extensor digiti minimi.

F, Corresponding MR image of healthy 32-year-old woman.

 


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  		Fig. 2. —Anatomic drawings of nerve—muscle relationships in forearm from anterior view.

A, Drawing shows course of radial nerve into forearm and division into superficial radial nerve and deep radial nerve (posterior interosseous nerve after passing deep in relation to supinator muscle).

 


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  		Fig. 2. —Anatomic drawings of nerve—muscle relationships in forearm from anterior view.

B, Drawing shows course of median nerve from arm into forearm and branching off anterior interosseous nerve at level of pronator teres.

 


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  		Fig. 3. —Serial axial images through forearm in 59-year-old woman with prior tumor resection and radiation therapy. Subsequent muscular atrophy allows excellent visualization of courses of nerves. BR = brachioradialis, B = brachialis, EC = extensor carpi radialis longus, P = pronator teres, h = humeral head of flexor carpi ulnaris, u = ulnar head of flexor carpi ulnaris, S = supinator, FS = flexor digitorum superficialis, FC = flexor carpi ulnaris, F = flexor digitorum profundus.

A, Radial nerve has divided into deep (wavy arrow) and superficial (long thin arrow) branches. Median nerve (white arrow) and brachial artery (short open arrow) are deep in relation to pronator teres. Shaded open arrow is ulnar nerve, and short thin arrow indicates bicipital aponeurosis.

 


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  		Fig. 3. —Serial axial images through forearm in 59-year-old woman with prior tumor resection and radiation therapy. Subsequent muscular atrophy allows excellent visualization of courses of nerves. BR = brachioradialis, B = brachialis, EC = extensor carpi radialis longus, P = pronator teres, h = humeral head of flexor carpi ulnaris, u = ulnar head of flexor carpi ulnaris, S = supinator, FS = flexor digitorum superficialis, FC = flexor carpi ulnaris, F = flexor digitorum profundus.

B, Deep radial nerve (wavy arrow) courses along extensor carpi radialis as it heads for supinator. Long thin arrow is superficial radial nerve. White arrow is median nerve; shaded open arrow is ulnar nerve.

 


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  		Fig. 3. —Serial axial images through forearm in 59-year-old woman with prior tumor resection and radiation therapy. Subsequent muscular atrophy allows excellent visualization of courses of nerves. BR = brachioradialis, B = brachialis, EC = extensor carpi radialis longus, P = pronator teres, h = humeral head of flexor carpi ulnaris, u = ulnar head of flexor carpi ulnaris, S = supinator, FS = flexor digitorum superficialis, FC = flexor carpi ulnaris, F = flexor digitorum profundus.

C, Deep radial nerve (wavy arrow) is within supinator. Superficial radial nerve (long thin arrow) joins radial artery (asterisk). Median nerve (white arrow) is between two heads of pronator teres. Short open arrow is brachial artery.

 


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  		Fig. 3. —Serial axial images through forearm in 59-year-old woman with prior tumor resection and radiation therapy. Subsequent muscular atrophy allows excellent visualization of courses of nerves. BR = brachioradialis, B = brachialis, EC = extensor carpi radialis longus, P = pronator teres, h = humeral head of flexor carpi ulnaris, u = ulnar head of flexor carpi ulnaris, S = supinator, FS = flexor digitorum superficialis, FC = flexor carpi ulnaris, F = flexor digitorum profundus.

D, Anterior interosseous nerve (arrowhead) dives toward interosseous membrane. Ulnar nerve (shaded open arrow) is located between flexor carpi ulnaris and flexor digitorum profundus. White arrow is median nerve, long thin arrow is superficial radial nerve, and wavy arrow is deep radial nerve.

 


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  		Fig. 4.—50-year-old healthy woman. Sagittal MR images through elbow, from radius to ulna, show nerves in proximal forearm. S = supinator.

A, Deep radial nerve (wavy arrow) enters supinator.

 


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  		Fig. 3. (continued)—Serial axial images through forearm in 59-year-old woman with prior tumor resection and radiation therapy. Subsequent muscular atrophy allows excellent visualization of courses of nerves. BR = brachioradialis, FS = flexor digitorum superficialis, FC = flexor carpi ulnaris, P = pronator teres, S = supinator, F = flexor digitorum profundus, EC = extensor carpi radialis longus.

E, Posterior interosseous nerve (straight thick arrow) has exited supinator. Median nerve (white arrow) heads toward flexor digitorum superficialis. As pronator inserts, ulnar artery (plus sign) joins ulnar nerve (shaded open arrow). Long thin arrow is superficial radial nerve; arrowhead is anterior interosseous nerve.

 


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  		Fig. 3. (continued)—Serial axial images through forearm in 59-year-old woman with prior tumor resection and radiation therapy. Subsequent muscular atrophy allows excellent visualization of courses of nerves. FS = flexor digitorum superficialis, FC = flexor carpi ulnaris, A = abductor pollicis longus, EC = extensor carpi radialis longus, PQ = pronator quadratus.

I, Anterior interosseous nerve (arrowhead) is deep in relation to pronator quadratus. Sensory remnant of posterior interosseous nerve (straight thick arrow) is now adjacent to interosseous membrane. White arrow is median nerve. Shaded open arrow is ulnar nerve, and long thin arrow is superficial radial nerve.

 


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  		Fig. 3. (continued)—Serial axial images through forearm in 59-year-old woman with prior tumor resection and radiation therapy. Subsequent muscular atrophy allows excellent visualization of courses of nerves. BR = brachioradialis, FS = flexor digitorum superficialis, FC = flexor carpi ulnaris, P = pronator teres, S = supinator, F = flexor digitorum profundus, EC = extensor carpi radialis longus.

F, Superficial radial nerve (long thin arrow) exits between brachioradialis and extensor carpi radialis longus tendons. Posterior interosseous nerve is not visible as discrete structure because its numerous branches innervate dorsal muscles (similar in appearance to filum terminale of spinal cord). Arrowhead is anterior interosseous nerve. White arrow is median nerve; shaded open arrow is ulnar nerve.

 


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  		Fig. 3. (continued)—Serial axial images through forearm in 59-year-old woman with prior tumor resection and radiation therapy. Subsequent muscular atrophy allows excellent visualization of courses of nerves. BR = brachioradialis, FS = flexor digitorum superficialis, FC = flexor carpi ulnaris, P = pronator teres, S = supinator, F = flexor digitorum profundus, EC = extensor carpi radialis longus.

G, Superficial radial nerve (long thin arrow) exits between brachioradialis and extensor carpi radialis longus tendons. Posterior interosseous nerve is not visible as discrete structure because its numerous branches innervate dorsal muscles (similar in appearance to filum terminale of spinal cord). Arrowhead is anterior interosseous nerve. White arrow is median nerve; shaded open arrow is ulnar nerve.

 


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  		Fig. 3. (continued)—Serial axial images through forearm in 59-year-old woman with prior tumor resection and radiation therapy. Subsequent muscular atrophy allows excellent visualization of courses of nerves. BR = brachioradialis, FS = flexor digitorum superficialis, FC = flexor carpi ulnaris, P = pronator teres, S = supinator, F = flexor digitorum profundus, EC = extensor carpi radialis longus.

H, Superficial radial nerve (long thin arrow) exits between brachioradialis and extensor carpi radialis longus tendons. Posterior interosseous nerve is not visible as discrete structure because its numerous branches innervate dorsal muscles (similar in appearance to filum terminale of spinal cord). Arrowhead is anterior interosseous nerve. White arrow is median nerve; shaded open arrow is ulnar nerve.

 


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  		Fig. 4. (continued)—50-year-old healthy woman. Sagittal MR images through elbow, from radius to ulna, show nerves in proximal forearm. F = flexor digitorum profundus, B = brachialis, P = pronator teres, h = humeral head of flexor carpi ulnaris, u = ulnar head of flexor carpi ulnaris, FC = flexor carpi ulnaris.

D, Median nerve (white arrow) and brachial artery (open arrow) in radial tunnel are deep in relation to lacertus fibrosis (bicipital aponeurosis) (short thin arrow).

 


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  		Fig. 2. —Anatomic drawings of nerve—muscle relationships in forearm from anterior view.

C, Drawing shows that bicipital aponeurosis has been resected. Note superficial head of pronator muscle has been cut and reflected. Also note path of median nerve between two heads of pronator muscle.

 


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  		Fig. 4. (continued)—50-year-old healthy woman. Sagittal MR images through elbow, from radius to ulna, show nerves in proximal forearm. F = flexor digitorum profundus, B = brachialis, P = pronator teres, h = humeral head of flexor carpi ulnaris, u = ulnar head of flexor carpi ulnaris, FC = flexor carpi ulnaris.

C, Anterior interosseous nerve and artery (arrowheads) are deep in relation to flexor digitorum profundus.

 


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  		Fig. 4. (continued)—50-year-old healthy woman. Sagittal MR images through elbow, from radius to ulna, show nerves in proximal forearm. F = flexor digitorum profundus, B = brachialis, P = pronator teres, h = humeral head of flexor carpi ulnaris, u = ulnar head of flexor carpi ulnaris, FC = flexor carpi ulnaris.

E, Ulnar nerve (shaded open arrow) is seen between two heads of flexor carpi ulnaris.

 


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  		Fig. 4.—50-year-old healthy woman. Sagittal MR images through elbow, from radius to ulna, show nerves in proximal forearm. S = supinator.

B, After exiting supinator, deep branch of radial nerve is called posterior interosseous nerve (straight thick arrow).

 

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