Flexor Forearm And Hand Lab Loop - Anatomy Guy

Anatomy Guy Dissection SheetFlexor Forearm and HandDr. Craig GoodmurphyAnatomy GuyMajor Dissection ObjectivesSkin Removal of the Forearm and Hand1.2.3.Remove the skin from the forearm maintainingthe superficial veins and key cutaneous nervessuch as the dorsal ulnar, lateral antebrachial,medial antebrachial and superficial radialnervesContinue by removing the skin of the palm tothe palmar aponeurosis making cuts along themidline of the fingers and thumb down to thedigital sheathClean the antebrachial fascia starting at thedistal forearm and working backwards toexpose and mobilize superficial flexors of theforearm and the common flexor originMajor Dissection ObjectivesPalm & Forearm Flexor Muscles4.5.6.7.Slide a forceps under the middle of thepalmar aponeurosis and cut through beingcareful not to cut the underlying structures.Then remove the aponeurosisClean the antebrachial fascia starting fromthe distal forearm and work proximallyIdentify the common flexor attachment andgently mobilize the 5 superficial forearmflexor musclesClean and locate the three deep flexors andthe anterior interosseus artery and nerveEastern Virginia Medical School1

Anatomy Guy Dissection SheetFlexor Forearm and HandMajor Dissection ObjectivesNerves, Vessels and Carpal Tunnel8. Mobilize the ulnar nav under the FCU. Locatethe dorsal ulnar br. and the deep andsuperficial br. Follow the artery into the palmto the superficial palmar arch9. Trace the median nerve in the forearm andcarpal tunnel. After the carpal tunnel find therecurrent median into the thenar musclesand the cutaneous branches to the lateral 3.5digits10. Follow the radial artery to the wrist and floorof the snuff box11. Open the flexor retinaculum and identify thecontents of the carpal tunnelMajor Dissection ObjectivesPalmar HandMobilize the abductor, flexor and opponensmuscles of the thenar and hypothenarregionsClean the common palmer digital nav andfollow them as they distribute into the digitsCut the digital sheath to expose the flexordigitorum superficialis and profundustendons and locate the lumbrical musclesClean under the tendons to expose theinterosseus muscles and the adductorpollicis12.13.14.15.Pearls & ProblemsDon’t1.Do2.Don’t3.Don’t4.Do5.Cut the cutaneous nerves while skinningthe forearm use blunt dissectionRemove antibrachial fascia startingdistally and working proximally andremember not to over separate musclesRemove the skin of the fingers until theproper digital nerves and arteries havebeen found out to the distal phalanxGo deep or too proximal in the distalpalm cutsFree the tendons from the fibroustendon sheaths to allow for the deeperhand to be cleaned and mobilizedEastern Virginia Medical School2

Anatomy Guy Dissection SheetFlexor Forearm and HandCephalic v.Mediancubital v.Lateralantebrachial n.Basilic v.Superficialradial n.Remove the skin from theforearm maintaining thesuperficial veins and keycutaneous nerves such aslateral antebrachial,medial antebrachial andsuperficial radial nervesPalmer & Digital Skin RemovalContinue by removing the skinof the palm to the palmaraponeurosis making cuts alongthe midline of the fingers andthumb down to the digitalsheathNOTE: cuts are never blind!Start at the edge and extend thecuts so they end up like thisrather than starting by blindly.Blind cuts give poor results andclinically end up in court!Mobilize the 5 superficialflexors of the forearm andthe common flexor tendonFlexor Carpi RadialisPalmaris Longus(may not be present)Flexor DigitorumSuperficialisFlexor Carpi UlnarisEastern Virginia Medical School3

Anatomy Guy Dissection SheetFlexor Forearm and HandSlide a forceps under the middle of the palmaraponeurosis and cut through being careful not tocut the underlying structures. Then remove theaponeurosisBe cautious notto cut thesuperficialpalmar arch orMedian nerveClean and locate the three deep flexors andthe anterior interosseus artery and nerveFlexor Pollicis LongusFlexor Digitorum ProfundusAnteriorinterosseus navPronatorQuadratusMobilize the ulnar nav under the FCU. Locate thedorsal ulnar br. and the deep and superficial br.Follow the artery into the palm to the superficialpalmar archDorsal Ulnar n.Ulnar n.Superficial Ulnar n.Deep Ulnarn.Eastern Virginia Medical School4

Anatomy Guy Dissection SheetFlexor Forearm and HandTrace the median nerve through the forearm andinto the carpal tunnel. After the carpal tunnel findthe recurrent median into the thenar muscles andthe cutaneous branches to the lateral 3.5 digitsRecurrent median n.Median n.Follow the radial artery to the wrist and floorof the snuff boxSnuff boxwristEPLIndexEPBAPLRadial a.ThumbOpen the flexor retinaculum and identify thecontents of the carpal tunnelFlexor RetinaculumRecurrent median n.Flexor DigitorumSuperficialisEastern Virginia Medical School5

Anatomy Guy Dissection SheetFlexor Forearm and HandMobilize the abductor, flexor and opponensmuscles of the thenar and hypothenar regionsThenar Muscles1. Flexor Pollicis Brevis2. Abductor Pollicis3. Opponens PollicisHypothenar Muscles1. Flexor Digiti Minimi2. Abductor Digiti Minimi3. Opponens Digiti MinimiCut the digital sheath to expose the flexordigitorum superficialis and profundus tendonsand locate the lumbrical musclesFlexor DigitorumSuperficialis tendon(split so profundus tendonspass through)Flexor DigitorumProfundus tendonClean under the tendons to expose the lumbricalmuscles and the adductor pollicisAdductor pollicisLumbricales1stAdductor pollicisDorsal InterosseusDorsal Abduct /Palmer ADuct1st Palmer InterosseusEastern Virginia Medical School6

Anatomy Guy Dissection Sheet Flexor Forearm and Hand Eastern Virginia Medical School Major Dissection Objectives Nerves, Vessels and Carpal Tunnel 8. Mobilize the ulnar nav under the FCU. Locate the dorsal ulnar br. and the deep and superficial br. Follow the artery into the palm to the superficial palmar arch 9.