AJR 2000; 174:151-159
© American Roentgen Ray Society
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-PresbyterianSt. Luke's Medical Center, Department of Radiology and
Nuclear Medicine, 1653 W. Congress Pkwy., Chicago, IL 60612.
Received January 28, 1999;
accepted after revision June 11, 1999.
Address correspondence to C. A. Boles.
Introduction
Knowledge of the compartmental anatomy of the forearm can aid the
radiologist both in providing useful information to the surgeon and in
clarifying ambiguous clinical findings. The anatomy of the forearm is depicted
in several excellent atlases; however, its compartmental anatomy has not been
widely reviewed in the radiology literature. Division of the forearm into the
mobile wad, volar, and dorsal compartments provides a convenient and practical
way to review its important muscles, nerves, and vessels.
The radial, median, and ulnar nerves and their branches traverse the
forearm compartments. Compression or entrapment of these nerves may be caused
by adjacent masses but may also occur at specific transition zones along the
nerve path. We review the compartmental anatomy of the forearm and describe
the courses of the radial, median, and ulnar nerves as they traverse the
compartments.
Compartments of the Forearm
The antebrachial fascia is a continuation of the brachial fascia. The
antebrachial fascia surrounds the musculature of the forearm and divides it
into mobile wad, volar, and dorsal compartments. Fascia surrounds the
individual muscles and provides strong septal attachments to the radius, ulna,
and interosseous membrane. If the fascia is incomplete, some communication
between compartments may be permitted
[1].
Mobile Wad Compartment (Radial Group Forearm Muscles)
Muscles.The mobile wad compartment is composed of two wrist
extensors and a forearm flexor. The extensor carpi radialis brevis and
extensor carpi radialis longus extend and abduct the hand, and the
brachioradialis flexes the forearm
(Fig. 1A, Fig. 1B,
Fig. 1C,
Fig. 1D,
Fig. 1E,
Fig. 1F).


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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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Neurovascular structures.No major neurovascular structures
are located within this compartment. Proximally, the radial nerve, its two
main branches, and the radial artery lie between this compartment and the
volar compartment.
Volar Compartment
Muscles.The volar compartment contains the flexor and
pronator muscles. A transverse septum divides the muscles into deep and
superficial groups [2]. The
deep group consists of the flexor digitorum profundus and the flexor pollicis
longus, which flex the phalanges, and the pronator quadratus, which pronates
the forearm. An accessory slip of the flexor pollicis longus, Gantzer's
muscle, may be present as a large discrete muscle in 45% of individuals
[3]. All muscles of the deep
compartment originate on the radius or ulna. The superficial group contains
the flexor carpi ulnaris, palmaris longus, flexor carpi radialis, and flexor
digitorum superficialis, which flex the hand and wrist, and the pronator
teres, which pronates the forearm and aids in elbow flexion
(Fig. 1A,
Fig. 1B,
Fig. 1C,
Fig. 1D,
Fig. 1E,
Fig. 1F).
Neurovascular structures.Several nerves are located within
or traverse the volar compartment: the median nerve and its branch, the
anterior interosseous nerve, the ulnar nerve, and the deep branch of the
radial nerve. The major vessels of the forearm are also within this
compartment.
Dorsal Compartment
Muscles.The dorsal compartment, containing the wrist and
finger extensors, is also divided into deep and superficial muscle groups. The
deep compartment contains the supinator, which supinates the forearm as it
rotates the radius; abductor pollicis longus, which abducts and extends the
thumb; and the extensor pollicis brevis, extensor pollicis longus, and
extensor indices, which act to extend the phalanges. These three extensors
originate from a position distal to the supinator. The superficial compartment
contains muscles that extend the digits and hand: the extensor digitorum,
extensor digiti minimi, and extensor carpi ulnaris. The anconeus muscle is
located in this compartment. Functionally, the anconeus can be considered a
part of the long head of the triceps: it supports the elbow during abduction
and extension
(Fig. 1A,
Fig. 1B,
Fig. 1C,
Fig. 1D,
Fig. 1E, Fig. 1F).
Neurovascular structures.The posterior interosseous nerve,
which is a branch of the radial nerve, and the accompanying posterior
interosseous artery travel superficially to the extensor pollicis longus until
they terminate in the dorsal aspect of the wrist.
Courses of the Nerves
Radial Nerve
The radial nerve descends along the spiral groove of the humerus and into
the forearm via the radial tunnel (the space between the brachioradialis and
the brachialis). The tunnel is approximately 5 cm long and located 1 cm
lateral to the biceps tendon (Figs.
2A and 2B). Deep
palpation of the nerve is possible in the tunnel, with resultant discomfort
[4]. The radial nerve
innervates the anconeus, brachioradialis, and extensor carpi radialis longus
forearm muscles. In the radial tunnel, at the level of the radiocapitellar
joint, the nerve divides into two branches: the deep (motor) radial nerve and
the superficial (sensory) radial nerve. These branches initially lie adjacent
to the brachioradialis and extensor carpi radialis longus tendons of the
mobile wad compartment (Figs.
2A, 3A, and
3B)

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Fig. 2. Anatomic drawings of nervemuscle 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 nervemuscle 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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Deep Radial Nerve and Posterior Interosseous Nerve
The deep radial nerve innervates the extensor carpi radialis brevis and the
supinator. In approximately 70% of the population, the deep radial nerve then
passes into the volar compartment, through the supinator, and into the dorsal
compartment (Figs. 3C, 3D, and
4A). In the remaining 30%, the
nerve passes via the arcade of Frohse (proximal fibrous border of the
supinator) rather than through the belly of the supinator
[5]
(Fig. 2A). Now known as the
posterior interosseous nerve, the deep radial nerve travels with the posterior
interosseous artery between the superficial and deep compartments
(Figs. 3E and
4B).

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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. 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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Numerous branches supply the remaining muscles of the superficial and deep
dorsal compartments. Near the wrist, the posterior interosseous nerve's
residual sensory component dives deep in relation to the extensor pollicis
longus, to the interosseous membrane, and terminates in the dorsal aspect of
the wrist as a small gangliform enlargement
(Fig. 3I).

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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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Superficial Radial Nerve
After branching off the radial nerve, the superficial radial nerve
approaches the radial artery and travels with the artery as they pass the
insertion of the pronator teres (Fig.
3C). In the distal third of the forearm, the nerve separates from
the artery and passes through fascia between the tendons of the
brachioradialis and extensor carpi radialis, pierces the antebrachial fascia,
and becomes subcutaneous dorsally (Figs.
3F, 3G,
3H,
3I. The superficial radial
nerve has no motor function and provides sensory function to the dorsum of the
hand, the first web space, and the proximal phalanges of the radial three
digits.

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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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Median Nerve
The median nerve and the brachial artery enter the volar compartment in the
antecubital fossa. The median nerve travels under the bicipital aponeurosis,
or lacertus fibrosis, a strong membranous band that reaches inferiorly across
the antecubital fossa to join the deep fascia covering the flexor muscles
(Figs. 2B and
4D). The nerve passes between
the deep and superficial heads of the pronator teres and descends distally
(Figs. 2B,
2C, and
3A,
3B,
3C). It passes deep in
relation to the fibrous arch formed by the flexor digitorum superficialis and
is closely bound to the deep surface of this muscle by its fascial sheath
(Figs. 3D,
3E,
3F,
3G,
3H,
3I. The median nerve becomes
more superficial and enters the carpal tunnel at the wrist. The median nerve
innervates the pronator teres, the flexor carpi radialis, the palmaris longus,
and the flexor digitorum superficialis. It supplies branches to proximal
portions of the flexor pollicis longus and flexor digitorum profundus. The
brachial artery branches to form the radial and ulnar arteries, which travel
with the superficial radial nerve and the ulnar nerve, respectively.

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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 nervemuscle 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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Anterior Interosseous Nerve
The major branch of the median nerve is the anterior interosseous nerve. At
a point 5-8 cm distal to the lateral epicondyle, at the level of the deep head
of the pronator teres, the anterior interosseous nerve branches off and
travels with the anterior interosseous artery, anterior to the interosseous
membrane (Figs. 2C,
3D,
3E,
3F,
3G,
3H, and
4C). It dives deep in relation
to the pronator quadratus before terminating at the wrist
[3]
(Fig. 3I). The anterior
interosseous artery is a branch of the common interosseous artery, which is a
branch of the ulnar artery. The anterior interosseous nerve innervates the
flexor pollicis longus, the lateral portion of the flexor digitorum profundus,
and the pronator quadratus.

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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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Ulnar Nerve
The ulnar nerve enters the forearm between the medial epicondyle and the
ulnar head of the flexor carpi ulnaris and travels between the two heads of
the flexor carpi ulnaris in the superficial volar compartment
(Figs. 3A and
4E). It then courses between
the flexor carpi ulnaris and the flexor digitorum profundus, where it is
joined by the ulnar artery (Figs.
3D and 3E). In the
distal forearm, the ulnar nerve lies on the volar side of the pronator
quadratus (Fig. 3I), becomes
superficial and lateral to the flexor carpi ulnaris, and is on the volar side
of the flexor retinaculum where it crosses the wrist. The ulnar nerve provides
motor function to two muscles in the forearm: the flexor carpi ulnaris and the
medial portion of the 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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Conclusion
The forearm is anatomically divided into three compartments: the mobile
wad, the volar, and the dorsal compartments
(Tables 1 and
2). Tumor or infection may
initially be contained in a single compartment. Imaging of spread beyond a
compartment may affect treatment or prognosis. Knowledge of the course of the
major neurovascular structures through the compartments may help to establish
their involvement or displacement by tumor. As imaging technology improves, a
more detailed understanding of the anatomy of the forearm will become
increasingly important to the radiologist in the evaluation of tumor
resectability and nerve compression syndromes.
Acknowledgments
We thank Kristen Wienandt, medical illustrator and designer,
Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL, for her original
artwork, and Donna S. Garrison, Wake Forest University, Winston-Salem, NC, for
assistance in preparation of this manuscript.
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