:Forearm

The muscles in the anterior compartment of the

forearm are organised into three layers:

1.Superficial: flexor carpi ulnaris, palmaris longus,

flexor carpi radialis, pronator teres.

2.Intermediate: flexor digitorum superficialis.

3.Deep: flexor pollicis longus, flexor digitorum

profundus and pronator quadratus
This muscle group is associated with pronation of the forearm, flexion of the
wrist and flexion of the fingers.

They are mostly innervated by the median nerve (except for the flexor carpi
ulnaris and medial half of flexor digitorum profundus, which are innervated by
the ulnar nerve), and they receive arterial supply from the ulnar artery and
radial artery.

In this article, we shall look at the anatomy of the muscles in the anterior
compartment of the forearm – their attachments, actions, innervation and
clinical correlations.
 Superficial Compartment:

The superficial muscles in the anterior compartment are the

flexor carpi ulnaris, palmaris longus, flexor carpi radialis and
pronator teres.
They all originate from a common tendon, which arises from
the medial epicondyle of the humerus.
Flexor Carpi Ulnaris
•Attachments:
• The flexor carpi ulnaris has two origins. The
humeral head originates from the medial
epicondyle of the humerus with the other
superficial flexors, whilst the ulnar head
originates from the olecranon of the ulna.
• The muscle tendon passes into the wrist and
attaches to the pisiform bone, hook of
hamate, and base of the 5th metacarpal
•Actions: Flexion and adduction at the wrist.
•Innervation: Ulnar nerve.
Palmaris Longus
This muscle is absent in about 15% of the
population.
•Attachments: Originates from the medial
epicondyle, attaches to the flexor
retinaculum of the wrist.
•Actions: Flexion at the wrist.
•Innervation: Median nerve.
Flexor Carpi Radialis
•Attachments: Originates from
the medial epicondyle, attaches
to the base of metacarpals II
and III.
•Actions: Flexion and
abduction at the wrist.
•Innervation: Median nerve.
Pronator Teres
The lateral border of the pronator teres forms
the medial border of the cubital fossa, an
anatomical triangle located over the elbow.
•Attachments: It has two origins, one from the
medial epicondyle, and the other from the
coronoid process of the ulna. It attaches
laterally to the mid-shaft of the radius.
•Actions: Pronation of the forearm.
•Innervation: Median nerve.
 Intermediate Compartment

The flexor digitorum superficialis is the only muscle of the

intermediate compartment. It can sometimes be classed as a
superficial muscle, but in most individuals, it lies between the
deep and superficial muscle layers.

The muscle is a good anatomical landmark in the forearm –

the median nerve and ulnar artery pass between its two
heads, and then travel posteriorly.
•Attachments: It has two heads – one originates from the medial
epicondyle of the humerus, the other from the radius. The muscle
splits into four tendons at the wrist, which travel through the carpal
tunnel, and attach to the base of the middle phalanx of the four digits.
•Actions: Flexes the metacarpophalangeal joints and proximal
interphalangeal joints at the 4 fingers, and flexes at the wrist.
•Innervation: Median nerve.
 Deep Compartment
There are three muscles in the deep anterior forearm:
flexor digitorum profundus, flexor pollicis longus, and
pronator quadratus.
Flexor Digitorum Profundus
•Attachments: Originates from the ulna and associated interosseous membrane. At
the wrist, it splits into four tendons, that pass through the carpal tunnel and attach
to the distal phalanges of the four fingers.
•Actions: It is the only muscle that can flex the distal interphalangeal joints of the
fingers. It also flexes at metacarpophalangeal joints and at the wrist.
•Innervation: The medial half (acts on the little and ring fingers) is innervated by
the ulnar nerve. The lateral half (acts on the middle and index fingers) is innervated
by the anterior interosseous branch of the median nerve.
Flexor Pollicis Longus
This muscle lies laterally to the flexor digitorum profundus
•Attachments: Originates from the anterior surface of the radius and
surrounding interosseous membrane. Attaches to the base of the distal
phalanx of the thumb.
•Actions: Flexes the interphalangeal joint and metacarpophalangeal
joint of the thumb.
•Innervation: Median nerve (anterior interosseous branch).
Pronator Quadratus
A square shaped muscle found deep to the tendons of the flexor
digitorum profundus and flexor pollicis longus.
•Attachments: Originates from the anterior surface of the ulna and
attaches to the anterior surface of the radius.
•Actions: Pronates the forearm.
•Innervation: Median nerve (anterior interosseous branch).
The muscles in the posterior compartment of the forearm are commonly
known as the extensor muscles. The general function of these muscles is to
produce extension at the wrist and fingers. They are all innervated by the
radial nerve.
The muscles in this compartment are organised into two
layers; deep and superficial. These two layers are separated by a layer of
fascia.
In this article, we shall look at the anatomy of the muscles in the posterior
forearm – their attachments, actions and clinical relevance.
 Superficial Muscles
The superficial layer of the posterior forearm contains seven
muscles. Four of these muscles  share a common tendinous origin
at the lateral epicondyle.
Brachioradialis
The brachioradialis is a paradoxical muscle. Its origin and
innervation are characteristic of an extensor muscle, but it is
actually a flexor at the elbow.
The muscle is most visible when the forearm is half
pronated, and flexing at the elbow against resistance.
In the distal forearm, the radial artery and nerve are
sandwiched between the brachioradialis and the deep flexor
muscles.
•Attachments: Originates from the proximal aspect of the
lateral supracondylar ridge of humerus, and attaches to the
distal end of the radius, just before the radial styloid process.
•Actions: Flexes at the elbow.
•Innervation: Radial nerve.
Extensor Carpi Radialis Longus and Brevis
The extensor carpi radialis muscles are situated
on the lateral aspect of the posterior forearm.
Due to their position, they are able to produce
abduction as well as extension at the wrist.
•Attachments: The ECRL originates from the
lateral supracondylar ridge of the humerus,
while the ECRB originates from the lateral
epicondyle. Their tendons attach to metacarpal
bones II and III.
•Actions: Extends and abducts the wrist.
•Innervation: Radial nerve.
Extensor Digitorum Communis
The extensor digitorum is the main extensor of
the fingers. To test the function of the muscle,
the forearm is pronated, and the fingers
extended against resistance.
•Attachments: Originates from the lateral
epicondyle. The tendon continues into in the
distal part of the forearm, where it splits into
four, and inserts into the extensor hood of each
finger.
•Actions: Extension of the digits at the
interphalangeal and metacarpophalangeal joints.
•Innervation: Radial nerve (deep branch).
Extensor Digiti Minimi
The extensor digiti minimi is thought to
originate from the extensor digitorum muscle.
In some people, these two muscles are fused
together. Anatomically, the extensor digiti
minimi lies medially to the extensor digitorum.
•Attachments: Originates from the lateral
epicondyle of the humerus. It attaches, with the
extensor digitorum tendon, into the extensor
hood of the little finger.
•Actions: Extends the little finger, and
contributes to extension at the wrist.
•Innervation: Radial nerve (deep branch).
Extensor Carpi Ulnaris
The extensor carpi ulnaris is located on
the medial aspect of the posterior
forearm. Due to its position, it is able to
produce adduction as well as extension
at the wrist.
•Attachments: Originates from the
lateral epicondyle of the humerus, and
attaches to the base of metacarpal V.
•Actions: Extension and adduction of
wrist.
•Innervation: Radial nerve (deep
branch).
Anconeus
The anconeus is situated medially and
proximally in the extensor compartment of the
forearm. It is blended with the fibres of the
triceps brachii, and the two muscles can be
indistinguishable.
•Attachments: Originates from the lateral
epicondyle, and attaches to the posterior and
lateral part of the olecranon.
•Actions: Extends and stabilises the elbow
joint. Abducts the ulna during pronation of the
forearm.
•Innervation: Radial nerve.
By TeachMeSeries Ltd (2023)
 Deep Muscles

There are five muscles in the deep compartment of the

posterior forearm – the supinator, abductor pollicis longus,
extensor pollicis brevis, extensor pollicis longus and
extensor indicis.

With the exception of the supinator, these muscles act on the

thumb and the index finger.
Supinator
The supinator lies in the floor of the
cubital fossa. It has two heads, which the deep
branch of the radial nerve passes between.
•Attachments: It has two heads of origin. One
originates from the lateral epicondyle of the
humerus, the other from the posterior surface of
the ulna. They insert together into the posterior
surface of the radius.
•Actions: Supinates the forearm.
•Innervation: Radial nerve (deep branch).
Abductor Pollicis Longus
The abductor pollicis longus is situated
immediately distal to the supinator muscle. In
the hand, its tendon contributes to the lateral
border of the anatomical snuffbox.
•Attachments: Originates from the interosseous
membrane and the adjacent posterior surfaces
of the radius and ulna. It attaches to the lateral
side of the base of metacarpal I.
•Actions: Abducts the thumb.
•Innervation: Radial nerve (posterior
interosseous branch).
Extensor Pollicis Brevis
The extensor pollicis brevis can be found
medially and deep to the abductor pollicis
longus. In the hand, its tendon contributes to the
lateral border of the anatomical snuffbox.
•Attachments: Originates from the posterior
surface of the radius and interosseous membrane.
It attaches to the base of the proximal phalanx of
the thumb.
•Actions: Extends at the metacarpophalangeal
and carpometacarpal joints of the thumb.
•Innervation: Radial nerve (posterior
interosseous branch).
Extensor Pollicis Longus
The extensor pollicis longus muscle has a larger muscle
belly than the EPB. Its tendon travels medially to the dorsal
tubercle at the wrist, using the tubercle as a ‘pulley’ to
increase the force exerted.
The tendon of the extensor pollicis longus forms the medial
border of the anatomical snuffbox in the hand.
•Attachments: Originates from the posterior surface of the
ulna and interosseous membrane. It attaches to the distal
phalanx of the thumb.
•Actions: Extends all joints of the thumb: carpometacarpal,
metacarpophalangeal and interphalangeal.
•Innervation: Radial nerve (posterior interosseous branch).
Extensor Indicis Proprius
This muscle allows the index finger to be
independent of the other fingers during
extension.
•Attachments: Originates from the posterior
surface of the ulna and interosseous membrane,
distal to the extensor pollicis longus. Attaches
to the extensor hood of the index finger.
•Actions: Extends the index finger.
•Innervation: Radial nerve (posterior
interosseous branch).