The importance of abductor pollicis longus in wrist motions: A physiological wrist simulator study

The abductor pollicis longus (APL) is one of the primary radial deviators of the wrist, owing to its insertion at the base of the first metacarpal and its large moment arm about the radioulnar deviation axis. Although it plays a vital role in surgical reconstructions of the wrist and hand, it is often neglected while simulating wrist motions in vitro. The aim of this study was to observe the effects of the absence of APL on the distribution of muscle forces during wrist motions. A validated physiological wrist simulator was used to replicate cyclic planar and complex wrist motions in cadaveric specimens by applying tensile loads to six wrist muscles – flexor carpi radialis (FCR), flexor carpi ulnaris, extensor carpi radialis longus (ECRL), extensor carpi radialis brevis, extensor carpi ulnaris (ECU) and APL. Resultant muscle forces for active wrist motions with and without actuating the APL were compared. The absence of APL resulted in higher forces in FCR and ECRL – the synergists of APL – and lower forces in ECU – the antagonist of APL. The altered distribution of wrist muscle forces observed in the absence of active APL control could significantly alter the efficacy of in vitro experiments conducted on wrist simulators, in particular when investigating those surgical reconstructions or rehabilitation of the wrist heavily reliant on the APL, such as treatments for basal thumb osteoarthritis.     

Composition and histotopography of receptors in antagonist muscles of the radial area of the human forearm

The m. extensor carpi radialis longus and m. flexor carpi in newborns are richly saturated in terminal sensitive apparatuses and are presented as peculiar reflexogenic zones. Quantity and topography of receptors in these zones are similar. Nevertheless, functionally different muscle areas (both in the extensor and flexor) are not equally supplied with the receptory apparatuses.     

Extensor carpi radialis longus muscle and the evolution of the first intermetacarpal ligament

The morphology and function of tendinous connections between the bases of the first and second metacarpal bone was studied in dissected specimens. The sample comprises 28 hands from eight species of cercopithecidae and pongidae and 23 human hands. Four types were identified: (1) No intermetacarpal connections were present. (2) The extensor carpi radialis longus tendon was divided at the carpus and the side branch inserted on the ulnar side of the base of the first metacarpal bone. (3) Part of the fibers of the extensor carpi radialis longus bypassed the insertion on the second metacarpal bone and continued to the base of the first metacarpal bone. A few proper intermetacarpal fibers were included. (4) An extracapsular, intermetacarpal ligament was present. Its fibers were mainly separated from the extensor carpi radialis longus. Type 1 is a general mammalian form. Type 2 is common in higher, non-human primates. Type 3 was found in 2 of the 23 human hands and otherwise among the anthropoid apes only. Type 4 is apomorph in man. Individual variations exist though. Type 3 and especially type 4 could check ab- and adductions and guide a circumduction in the first carpometacarpal joint.     

Radial half of extensor carpi radialis longus tendon as graft to elongate muscle tendon unit for correction of finger clawing

In 12 patients, the extensor carpi radialis longus muscle tendon unit was elongated using the radial half of the parent tendon so that it could reach the site of new insertion, the A1-A2 pulley of flexor sheath or lateral bands, after routing the transfer through the carpal tunnel. The tendon was of appropriate thickness and could be split into two halves to be used as a graft. Further splitting of the tendon into four tails was possible. The transferred slips retained adequate strength to activate the fingers after the operation. It is suggested that splitting of the extensor carpi radialis longus tendon to use one half as a tendon graft be considered in patients in whom extensor carpi radialis longus transfer is planned to correct finger clawing. This technique is simple, needs minor modification in the sequence of operative steps, reduces operating time, and saves the patient from postoperative discomfort, muscle herniation, and scarring at the donor site (usually the thigh).     

Wrist tendon moment arms: Quantification by imaging and experimental techniques

Subject-specific musculoskeletal models require accurate values of muscle moment arms. The aim of this study was to compare moment arms of wrist tendons obtained from non-invasive magnetic resonance imaging (MRI) to those obtained from an in vitro experimental approach. MRI was performed on ten upper limb cadaveric specimens to obtain the centrelines for the flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor carpi ulnaris (ECU), and abductor pollicis longus (APL) tendons. From these, the anatomical moment arms about each of the flexion-extension (FE) and radioulnar deviation (RUD) axes of the wrist were calculated. Specimens were mounted on a physiologic wrist simulator to obtain functional measurements of the moment arms using the tendon excursion method. No differences were observed between anatomical and functional values of the FE and RUD moment arms of FCR, ECRL and ECRB, and the RUD moment arm of ECU (p > .075). Scaling the anatomical moment arms relative to ECRB in FE and ECU in RUD reduced differences in the FE moment arm of FCU and the RUD moment arm of APL to less than 15% (p > .139). However, differences persisted in moment arms of FCU in RUD, and ECU and APL in FE (p < .008). This study shows that while measurements of moment arms of wrist tendons using imaging do not always conform to values obtained using in vitro experimental approaches, a stricter protocol could result in the acquisition of subject-specific moment arms to personalise musculoskeletal models.     

Fatigue effect on cross-talk in mechanomyography signals of extensor and flexor forearm muscles during maximal voluntary isometric contractions

Objective:This paper presents the analyses of the fatigue effect on the cross-talk in mechanomyography (MMG) signals of extensor and flexor forearm muscles during pre- and post-fatigue maximum voluntary isometric contraction (MVIC).Methods:Twenty male participants performed repetitive submaximal (60% MVIC) grip muscle contractions to induce muscle fatigue and the results were analyzed during the pre- and post-fatigue MVIC. MMG signals were recorded on the extensor digitorum (ED), extensor carpi radialis longus (ECRL), flexor digitorum superficialis (FDS) and flexor carpi radialis (FCR) muscles. The cross-correlation coefficient was used to quantify the cross-talk values in forearm muscle pairs (MP1, MP2, MP3, MP4, MP5 and MP6). In addition, the MMG RMS and MMG MPF were calculated to determine force production and muscle fatigue level, respectively.Results:The fatigue effect significantly increased the cross-talk values in forearm muscle pairs except for MP2 and MP6. While the MMG RMS and MMG MPF significantly decreased (p<0.05) based on the examination of the mean differences from pre- and post-fatigue MVIC.Conclusion:The presented results can be used as a reference for further investigation of cross-talk on the fatigue assessment of extensor and flexor muscles’ mechanic.     

Studies on the tendinous compartments of the extensor muscles on the back of the human hand and their tendon sheaths. I

In 47 dissected right and left hands of adults of both sexes, kept in a moist condition, significant practical-clinical investigations of the transitional zone between forearm and hand were undertaken. In particular it was sought to determine the characteristic sizes of the extensor retinaculum, the osteofibrous tunnels, the insertion tendons of the hand and finger extensor muscles, and their tendon sheaths. Together with the palmar carpal ligament, the 2 to 3 cm wide extensor retinaculum annularly surrounds the whole circumference of the carpus. It extends obliquely from radial-proximal to ulnar-distal and conducts the extensor tendons over the carpal articulations. According to recent studies, it is divided into a superficial and a deep fibrous layer. From the undermost surface, vertical and oblique septa run to the plane of the forearm and carpal bones. They separate the fibrous portion of the 6 tendinous compartments of the dorsum manus. In 8.5% of cases, an accessory and completely independent tunnel of the extensor pollicis brevis muscle exists in the material investigated, and in 2.2% of cases, there is an additional tunnel for the extensor carpi radialis muscle. Hence, one occasionally finds 8 separate osteofibrous gliding compartments for the extensor muscles in the dorsal hand region. The longest tunnel belongs, as a rule, to the extensor digiti minimi muscle, whilst the widest pertains to the extensor digitorum muscle. Within the tunnel and also proximal and distal to it, the extensor tendons are surrounded by synovial sheaths. Because of its wide encroachment on the dorsum of the hand, the insertion tendon of the extensor digiti minimi muscle possesses the longest tendon sheath, measuring 68.8 mm. The next longest sheath, that of the extensor pollicis longus muscle, which measures 56.2 mm, begins further proximal to the gap of the radiocarpal articulation. In 12.8% of cases, there are divided sheaths of the abductor pollicis longus and of the extensor pollicis brevis muscle. The tendon sheath of both extensor carpi radiales muscles is frequently divided into 2 compartments which, in 2/3 of cases, communicate. The compartment of the extensor carpi radialis brevis muscle, in 91.5% of cases, shares a window-like opening with the roof of the synovial vagina of the extensor pollicis longus muscle. The tendon sheath of the long extensor muscles of the fingers originates 5 mm proximal to the forearm border of the extensor retinaculum and has a communal recess. The IVth tendon sheath opens distally and splays out in a glove-like manner to some distal recesses.(ABSTRACT TRUNCATED AT 400 WORDS)     

Quantitative analyses of cross-sectional shape of the distal radius in three species of macaques

I conducted quantitative analyses of the cross-sectional shape of the distal radial shaft in three species of macaques, which differ in locomotor behavior: semi-terrestrial Japanese macaques (Macaca fuscata), arboreal long tailed macaques (M. fascicularis), and relatively terrestrial rhesus macaques (M. mulatta). I took CT scans of the distal radial shafts of a total of 180 specimens at the level of the inferior radio-ulnar articulation. From each CT image, the periosteal outline of the radius was traced automatically by a digital imaging technique. I determined five points (landmarks) on the outline by developing a standardized morphometric technique. Bone surface lengths were measured by using these landmarks and their soft tissue correlates were investigated. The results of this study were as follows: (1) Semi-terrestrial M. fuscata has features that are approximately intermediate between those of the other two species. M. fuscata has a relatively small groove for M. abductor pollicis longus and a large groove for Mm. extensor carpi radialis longus et brevis. These characters resemble those of M. fascicularis. On the other hand, the ulnar notch of M. fuscata is relatively large, a character which is similar to that of M. mulatta. Moreover, compared to the other two macaques, the surface of the flexor muscles of M. fuscata is intermediate in size. (2) The more terrestrial M. mulatta has a relatively large groove for M. abductor pollicis longus and a small groove for Mm. extensor carpi radialis longus et brevis. Moreover, M. mulatta has a relatively large ulnar notch and a small surface for the flexor muscles. (3) The arboreal M. fascicularis has similar features to those of M. fuscata for the first and second relative size index. However, in the ulnar notch, M. fascicularis has a peculiar character and the surface for the flexor muscles is relatively large compared to those of the other two species. These results can be interpreted in terms of positional habits and presumed functional demands. A form-functional study by Lemelin and Schmitt also corroborates the interpretations of the present study. Thus, the distal region of the forearm strongly reflects muscular development and joint resultant force, and is an important region for investigating locomotor adaptations in primates. The present study reveals the possibility of using this type of morphometric analysis for reconstructing the positional behavior of fossil primates.     

Anatomical partitioning of three multiarticular human muscles.

To examine neuromuscular partitioning within human muscles, the innervation patterns and muscle fiber architecture of the flexor carpi radialis (FCR), extensor carpi radialis longus (ECRL) and lateral gastrocnemius (LG) muscles were examined. Consistent patterns of innervation between specimens were found within each of the three muscles. The nerve to the FCR clearly innervates three major architectural divisions of the muscle. The ECRL is innervated by two different muscle nerves. Branches of these nerves innervate at least two distinct anatomical subvolumes. However, the subvolumes of the ECRL defined by muscle architecture are not totally congruent with those defined by the innervation pattern. In the LG, the single muscle nerve branches into two main divisions, and these subsequently divide into branches which supply the three heads. However, each head does not receive a completely private nerve. These results indicate that human muscles are partitioned in a manner roughly similar to the divisions of the same muscles in cats and rats, but with less congruency of architecture and innervation.     

Analysis of "Teno-uchi" maneuver in releasing Japanese-style bows based on muscle activities and forces acting on the bow

Since a Japanese-style bow has a very complicated shape and structure, an archer has to apply the "Teno-uchi" maneuver including horizontally twisting torque, or "Nejiri", and sagittally down-pushing torque, or "Uwa-oshi", to the restoring bow in order to hit the target. The purpose of this study was to investigate the biomechanical relationship between the muscular activities of the left forearm and the operation of "Teno-uchi" maneuver. Surface EMG of left forearm muscles and the two kinds of torque acting on the bow around the time of release were recorded in 10 experienced subjects during arrow shooting. The "Biku", an involuntary resignation from release happening in the shooting, was also examined. Close analyses of the results revealed that activation of the extensor carpi ulnaris and extensor digitorum muscles together with inhibition of the flexor carpi ulnaris muscle brought about "Nejiri", while activation of the extensor carpi ulnaris as well as flexor carpi ulnaris muscles and inhibition of the extensor carpi redialis longus and extensor digitorum muscles gave rise to "Uwa-oshi", thus causing activities of trade-off nature in the extensor digitorum and flexor carpi ulnaris muscles for the "Nejiri" and "Uwa-oshi. The trade-off activities were presumably actualized through time-sharing coordination between the muscles.     

A doubled flexor carpi radialis muscle

A doubled flexor carpi radialis muscle was observed in the right forearm of an embalmed adult male cadaver. The extra muscle took origin from intermuscular septa and inserted on the 3rd metacarpal. It shared the nerve supply and the synovial sheath of the regular muscle. The pertinent anatomical literature is reviewed.     

Localization of phospholamban in slow but not fast canine skeletal muscle fibers. An immunocytochemical and biochemical study

Phospholamban, originally described as a cardiac sarcoplasmic reticulum protein, was localized in cryostat sections of three adult canine skeletal muscles (gracilis, extensor carpi radialis, and superficial digitalis flexor) by immunofluorescence labeling with highly specific phospholamban antibodies. Only some myofibers were strongly labeled with phospholamban antibodies. The labeling of myofibers with phospholamban antibodies was compared to the distribution of Type I (slow) and Type II (fast) myofibers as determined by staining adjacent sections cytochemically for the alkali-stable myosin ATPase, a specific marker for Type II myofibers. All the skeletal myofibers labeled for phospholamban above background levels corresponded to Type I (slow) myofibers. The presence of phospholamban in microsomal fractions isolated from canine superficial digitalis flexor (89 +/- 3% Type I) and extensor carpi radialis skeletal muscle (14 +/- 6% Type I) was confirmed by immunoblotting. Antiserum to cardiac phospholamban bound to proteins of apparent Mr values of 25,000 (oligomeric phospholamban) and 5,000-6,000 (monomeric phospholamban) in sarcoplasmic reticulum vesicles from both muscles. Quantification of phospholamban in sarcoplasmic reticulum vesicles from cardic, slow, and fast skeletal muscle tissues following phosphorylation with [gamma-32P] ATP suggested that superficial digitalis flexor and extensor carpi radialis skeletal muscle contained about 16 and 3%, respectively, as much phospholamban as cardiac muscle per unit of sarcoplasmic reticulum. The presence of phospholamban in both Type I (slow) and cardiac muscle fibers supports the possibility that the Ca2+ fluxes across the sarcoplasmic reticulum in both fiber types are similarly regulated, and is consistent with the idea that the relaxant effect of catecholamines on slow skeletal muscle is mediated in part by phosphorylation of phospholamban.     

Forearm compartment syndrome: anatomical analysis of surgical approaches to the deep space

Forearm compartment syndrome is a surgical emergency that usually requires release of the superficial muscle compartments. In some clinical situations it is imperative to also explore the deep muscle compartments. There are no anatomical guides for surgical exploration of the deep compartments that would minimize collateral damage to surrounding vessels, nerves, and muscles. Surgical injury in the setting of ischemia, especially vascular injury, compounds the tissue damage that has already occurred. The authors evaluated four surgical approaches (three volar and one dorsal) to the deep forearm by performing detailed anatomical dissections on 10 embalmed and plastinated cadavers. They used a scoring system to rate the approaches for their ability to visualize the deep space without causing iatrogenic injury to superficial muscles, arteries, and nerves. In the volar forearm, an ulnar approach to the deep space is simple, causes the least iatrogenic surgical injury, and provides access to the deep volar forearm structures. The plane of dissection is between the flexor carpi ulnaris and the flexor digitorum superficialis. Dividing one or two distal segmental branches of the ulnar artery to the distal flexor digitorum superficialis exposes the pronator quadratus. Lifting the ulnar neurovascular bundle with the flexor digitorum superficialis in the middle third of the forearm exposes the flexor digitorum profundus and the flexor pollicis longus. This approach to the deep space requires no sharp dissection. In the dorsal forearm, a midline approach between the extensor digitorum communis and the extensor carpi radialis brevis is simple and safe.     

Sexually dimorphic muscles in the forelimb of the Japanese toad,Bufo japonicus

During the breeding season, male anurans display clasping behavior by holding females with their forelimbs. This behavior is peculiar to males, and may require specializations in forelimb musculature. The present study revealed that five kinds of forelimb muscles were heavier in the male Japanese toad than in the female: the flexor carpi radialis (FCR), the flexor antibrachii medialis caput superius (FAMsup), the abductor indicis longus (AIL), the extensor carpi radialis caput superius (ECRsup), and the flexor antibrachii lateralis superficialis caput superius (FALSsup). In addition, one breast muscle, the coracoradialis (CR), was also heavier in males than in females. A quantitative analysis of muscle fibers processed for myosin ATPase activity showed that, in such “sexually dimorphic muscles” of the female, both fast (twitch) and slow (tonic) muscle fibers were of smaller diameter than in other forelimb muscles of both sexes (all male muscles plus “nondimorphic muscles” of the female). Moreover, both types of fibers were less numerous than in the corresponding muscles of the male. These results suggest that the “sexually dimorphic muscles” are used especially for clasping by the male and are degenerative or subnormal in the female. Slow muscle fibers were neither peculiar to, nor abundant in, these clasping muscles, although they may well be necessary for tonic and prolonged contractions of the forelimb muscles during clasping. The mechanism of sexual dimorphism may be a direct action of androgens on clasping muscles or an indirect action on clasping muscles via the innervating motoneurons.     

Identifying tasks to elicit maximum voluntary contraction in the muscles of the forearm

Maximum voluntary contractions (MVCs) are often used for the normalisation of electromyography data to enable comparison of signal patterns within and between study participants. Recommendations regarding the types of tasks that are needed to collect MVCs for the muscles of the forearm have been made, specifically advocating the use of resisted moment tasks to get better estimates of forearm MVCs. However, a protocol detailing which specific tasks to employ has yet to be published. Furthermore, the effects of limb dominance on the collection of MVCs have not been considered previously. Muscle activity was monitored while 23 participants performed nine isometric, resisted tasks. The tasks that are likely to elicit MVC in the flexor carpi ulnaris, flexor carpi radialis, flexor digitorum superficialis, extensor carpi ulnaris, extensor carpi radialis, extensor digitorum communis, and pronator teres were identified. Thus, targeted protocols can be designed to mitigate against fatigue. Hand dominance had limited effect, with differences being found only in the finger flexors and extensors (p< 0.03). Thus, use of the contralateral flexor digitorum superficialis and extensor digitorum communis muscles to obtain baselines for activation levels and patterns may not be appropriate.     

Hand and foot remains from the Gran Dolina Early Pleistocene site (Sierra de Atapuerca, Spain).

We report here the study of the 22 hand and foot remains from the Early Pleistocene level TD6 of the Gran Dolina site at Sierra de Atapuerca (Burgos, Spain) recovered from 1994 to 1996. These remains are paratypes of Homo antecessor. All of the elements are briefly described and compared with other fossil hominids. The capitate has a constricted neck, well developed head, strong attachment for the ligamentum interosseum trapezoid-capitate, a palmarly placed trapezoid facet with a distinctive small dorsal trapezoid facet, a highly curved and oblique orientation of the second metacarpal facet, and a transversally oriented dorsodistal border. A hamate with a moderately projecting and lightly built hamulus; an inferred reduced styloid process on the third metacarpal base; a wide second metacarpal head; and middle phalanges with well marked insertions for the flexor digitorum superficialis muscle and wide heads. The morphology and dimensions of the pedal remains from TD6 are very similar to modern humans; but the base, proximal articular surface and shafts of the proximal hallucal phalanges are more rounded and the midshaft of the proximal toe phalanx is wider.     

Quantitative assessment of upper limb muscle fatigue depending on the conditions of repetitive task load

The aim of this study was to discriminate fatigue of upper limb muscles depending on the external load, through the development and analysis of a muscle fatigue index. Muscle fatigue is expressed by a fatigue index based on an amplitude parameter (calculated in the time domain) and a fatigue index based on a frequency parameter (a parameter calculated in the frequency domain). The fatigue index involves a regression function that describes changes in the EMG signal parameter, time elapsing before muscle fatigue and the probability of specific trends in changes in EMG parameters for the population under study.

The experimental study covered a group of 10 young men. During the study, they exerted force at a specific level and for a specific time in 12 load variants. During the study, EMG signals from four muscles of the upper limb were recorded (trapezius pars descendents, biceps brachii caput breve, extensor carpi radialis brevis, flexor carpi ulnaris). For each variant and for each examined muscles, the value of the fatigue index was calculated. Values of that index quantitatively expressed fatigue of a specific muscle in a specific load variant.

A statistical analysis indicated variation in the fatigue of the biceps brachii caput breve, extensor carpi radialis brevis, and flexor carpi ulnaris muscles depending on the external load (load variant) according to the task performed with the upper limb.

The study demonstrated usefulness of the fatigue index in expressing quantitatively muscle fatigue and in discriminating muscle fatigue depending on the external load.     

Changes of agonist and synergist muscles activity during a sustained submaximal brake-pulling gesture

We analyzed the time course of changes in muscle activity of the prime mover and synergist muscles during a sustained brake-pulling action and investigated the relationship between muscle activity and braking force fluctuation (FF). Thirty-two participants performed a continuous fatiguing protocol (CFP) at 30% of maximal voluntary contraction (MVC) until failure. Surface electromyography was used to analyze root mean square (RMS) values in the flexor digitorum superficialis (FD), flexor carpi radialis (FC), extensor digitorum communis (ED), extensor carpi radialis (EC), brachioradialis (BR), biceps brachii (BB), and triceps brachii (TB). The FF and RMS in all muscles increased progressively (P<0.01) during the CFP, with sharp increments at time limit particularly in FD and FC (P<0.001). The RMS of the FD and FC were comparable to the baseline MVC values at time limit, in comparison to the other muscles that did not reach such levels of activity (P<0.003). The three flexor/extensor ratios used to measure coactivation levels decreased significantly (P<0.001). In contrast to RMS, MVC was still depressed at the minute 10 of recovery. The results suggest that the time limit was mainly constrained by fatigue-related mechanisms of the FD and FC but not by those of other synergist and antagonist muscles.     

The effects of electromechanical wrist robot assistive system with neuromuscular electrical stimulation for stroke rehabilitation

An electromyography (EMG)-driven electromechanical robot system integrated with neuromuscular electrical stimulation (NMES) was developed for wrist training after stroke. The performance of the system in assisting wrist flexion/extension tracking was evaluated on five chronic stroke subjects, when the system provided five different schemes with or without NMES and robot assistance. The tracking performances were measured by range of motion (ROM) of the wrist and root mean squared error (RMSE). The performance is better when both NMES and robot assisted in the tracking than those with either NMES or robot only (P<0.05). The muscle co-contractions in the upper limb measured by EMG were reduced when NMES provided assistance (P<0.05). All subjects also attended a 20-session wrist training for evaluating the training effects (3-5 times/week). The results showed improvements on the voluntary motor functions in the hand, wrist and elbow functions after the training, as indicated by the clinical scores of Fugl-Meyer Assessment, Action Research Arm Test, Wolf Motor Function Test; and also showed reduced spasticity in the wrist and the elbow as measured by the Modified Ashworth Score of each subject. After the training, the co-contractions were reduced between the flexor carpi radialis and extensor carpi radialis, and between the biceps brachii and triceps brachii. Assistance from the robot helped improve the movement accuracy; and the NMES helped increase the muscle activation for the wrist joint and suppress the excessive muscular activities from the elbow joint. The NMES-robot assisted wrist training could improve the hand, wrist, and elbow functions.     

Vascular anatomy of the forearm muscles: a study of 50 dissections

This anatomic study is based on 50 adult cadaver upper extremities. The general disposition of the forearm arteries and muscles and the main anatomic variations encountered are specified. Constant existence of an "anterior oblique artery" satellite of the pronator teres was established. The median nerve artery was principally dedicated to the flexor digitorum superficialis and participated appreciably in the constitution of palmar arches in only one case. A supernumerary intermedial radial muscle was found only in two cases. The abductor pollicis longus and extensor pollicis brevis appeared as a single muscular and vascular unit in 84 percent of cases. All the arteries destined for muscles were reckoned whatever their caliber might be. Despite its limitations, this study confirms the very great number of the forearm muscular pedicles. Each forearm contained an average of 264 muscular vascular pedicles. The systematization of the origins and destinations of the 13,158 muscular pedicles is described in a numbered manner for each of the 20 normal forearm muscles and for each of the 12 studied arterial segments. The pronator teres was likely to be supplied by all the anterior arteries of the upper limb. The flexor carpi radialis had one or two dominant pedicles originated from the recurrens ulnaris anterior, recurrens ulnaris, or ulnaris-interossea communis arteries, and many transversal branches originated from the radial artery. The flexor carpi ulnaris was supplied in its proximal third by the recurrens ulnaris posterior artery and in its distal two-thirds by many branches of ulnar artery.(ABSTRACT TRUNCATED AT 250 WORDS)