KnotesFree Orthopaedic & FRCS notes, viva stations and higher order SBAs

Forearm muscle origins and insertions

High YieldHand & WristthinKbox SBA

Flexor-pronator compartment

The superficial flexor-pronator muscles arise predominantly from the common flexor origin at the medial epicondyle.

Pronator teres

  • Origin: medial epicondyle and coronoid process
  • Insertion: lateral surface of mid-radius
  • Action: pronation; assists elbow flexion
  • Nerve: median nerve

Flexor carpi radialis

  • Origin: medial epicondyle
  • Insertion: bases of second and third metacarpals
  • Action: wrist flexion and radial deviation
  • Nerve: median nerve

Palmaris longus

  • Origin: medial epicondyle
  • Insertion: palmar aponeurosis and flexor retinaculum
  • Action: weak wrist flexion; tensions palmar fascia
  • Nerve: median nerve

Flexor carpi ulnaris

  • Origin: medial epicondyle, olecranon and posterior ulna
  • Insertion: pisiform, hook of hamate and base of fifth metacarpal
  • Action: wrist flexion and ulnar deviation
  • Nerve: ulnar nerve

Flexor digitorum superficialis

  • Origin: humeroulnar and radial heads
  • Insertion: sides of middle phalanges of index to little fingers
  • Action: PIP flexion
  • Nerve: median nerve

Deep flexor compartment

Flexor digitorum profundus

  • Origin: proximal ulna and interosseous membrane
  • Insertion: bases of distal phalanges
  • Action: DIP flexion
  • Nerve: anterior interosseous nerve to index and middle; ulnar nerve to ring and little fingers

Flexor pollicis longus

  • Origin: anterior radius and interosseous membrane
  • Insertion: base of distal phalanx of thumb
  • Action: thumb IP flexion
  • Nerve: anterior interosseous nerve

Pronator quadratus

  • Origin: distal ulna
  • Insertion: distal radius
  • Action: pronation and distal radioulnar joint stabilisation
  • Nerve: anterior interosseous nerve

Extensor-supinator compartment

The common extensor origin is at the lateral epicondyle.

Superficial muscles include extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi and extensor carpi ulnaris. Deep muscles include supinator, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus and extensor indicis.

Clinical relevance

  • Lateral epicondylitis principally involves the common extensor origin, especially ECRB.
  • Medial epicondylitis involves the flexor-pronator origin.
  • Tendon transfers depend on understanding muscle excursion, strength and line of pull.

References

  1. Orthobullets. Forearm Anatomy.

Written/reviewed by Kishore Puthezhath

Professor of Orthopaedics and Consultant Paediatric Orthopaedic Surgeon

FRCS (Tr & Orth) revision resource

Reviewed: September 2026