1 Openings in the Base of the Skull and the structures that pass through them Openings in the Skull Bone of the Skull Anterior Cranial Fossa Structures Transmitted Perforations in the Cribriform plate Ethmoid Optic Canal Superior Orbital Fissure Middle Cranial Fossa Lesser wing of the Sphenoid Between lesser and greater wings of the Sphenoid Foramen Rotundum Foramen Ovale Greater wing of the Sphenoid Greater wing of the Sphenoid Foramen Spinosum Foramen Lacerum Greater wing of the Sphenoid Between petrous part of temporal and Sphenoid Posterior Cranial Fossa Occipital Foramen Magnum Olfactory nerves Hypoglossal Canal Jugular Foramen Occipital Between petrous part of temporal and condylar part of occipital Internal Acoustic Meatus Petrous part of temporal Optic nerve, ophthalmic artery Lacrimal, frontal, trochlear, oculomotor, nasociliary and abducent nerves; superior ophthalmic vein Maxillary Division of the Trigeminal Nerve Mandibular division of the Trigeminal Nerve Middle meningeal artery Internal carotid artery Medulla Oblongata, spinal part of accessory nerve, and right and left vertebral arteries Hypoglossal nerve Glossopharyngeal, vagus, and accessory nerves; sigmoid sinus becomes internal jugular vein Vestibulocochlear and facial nerves Muscles of the Eyeball and Eyelids Muscle Superior Rectus Inferior Rectus Medial Rectus Lateral Rectus Superior Oblique Inferior Oblique Sphincter Pupillae of Iris Dilatory Pupillae of Iris Ciliary Muscle Origin Insertion Innervation Extrinsic Muscles of Eyeball (Striated Skeletal Muscle) Tendinous ring on Superior surface of CNIII posterior wall of orbital eyeball just posterior to cavity corneoscleral junction Tendinous ring on Inferior surface of CNIII posterior wall of orbital eyeball just posterior to cavity corneoscleral junction Tendinous ring on Medial surface of eyeball CNIII posterior wall of orbital just posterior to cavity corneoscleral junction Tendinous ring on Lateral surface of eyeball CNVI posterior wall of orbital just posterior to cavity corneoscleral junction Posterior wall of orbital Passes through pulley CNIV cavity and is attached to superior surface of eyeball beneath superior rectus Floor of orbital cavity Lateral surface of eyeball CNIII deep to lateral rectus Intrinsic Muscles of Eyeball (Smooth Muscle) Parasympathetic via CNIII Sympathetic Parasympathetic via CNIII Action Raises cornea upward and medially Depresses cornea downward and medially Rotates eyeball so that cornea looks medially Rotates eyeball so that cornea looks laterally Rotates eyeball so that cornea looks downward and laterally Rotates eyeball so that cornea looks upward and laterally Constricts pupil Dilates pupil Controls shape of lens; in accommodation, makes lens more globular 2 Muscles of Eyelids Orbicularis Oculi Palpebral Part Orbital Part Levator Palpebrae Superioris Medial palpebral ligament Medial palpebral ligament and adjoining bone Back of orbital cavity Lateral palpebral raphe Facial nerve Loops return to origin Facial nerve Anterior surface and upper margin of superior tarsal plate Striated muscle oculomotor nerve, smooth muscle Sympathetic Closes eyelids and dilates lacrimal sac Throws skin around orbit into folds to protect eyeball Raises upper lid Muscles of the Head Muscle Occipitofrontalis Occipital belly Frontal belly Origin Insertion Muscle of Scalp Highest nuchal line of occipital bone Skin and superficial facia of eyebrows Epicranial aponeurosis Innervation Action Facial nerve Moves scalp on skull and raises eyebrows Facial nerve Facial nerve Facial nerve Closes eyelids and dilates lacrimal sac Throws skin around orbit into folds to protect eyeball Vertical wrinkles of forehead, as in frowning Compresses mobile nasal cartilages Widens nasal aperture Wrinkles skin of nose Compresses lips together Facial nerve Separate lips Outer surface of alveolar margins of maxilla, mandible and pterygomandibular ligament Deep fascia over Body of mandible and pectoralis major and angle of mouth deltoid Muscles of Mastication Zygomatic arch Lateral surface ramus of mandible Floor of temporal fossa Coronoid process of mandible Facial nerve Compresses cheeks and lips against teeth Depresses mandible and angle of mouth Greater wing of sphenoid and lateral pterygoid plate Tuberosity of maxilla and lateral pterygoid plate Mandibular division of trigeminal nerve Mandibular division of trigeminal nerve Muscles of Facial Expression Orbicularis Oculi Palpebral Part Medial palpebral ligament Lateral palpebral raphe Facial nerve Medial palpebral ligament and adjoining bone Loops return to origin Facial nerve Corrugator Supercilii Superciliary arch Skin of eyebrow Facial nerve Compressor Nasi Frontal process of maxilla Facial nerve Dilator Naris Procerus Orbicularis Oris Maxilla Nasal bone Maxilla, mandible and skin Aponeurosis of bridge of nose Ala of nose Skin between eyebrows Encircles oral orifice Dilator Muscles of Lips Orbital Part Levator Labii Superioris Alaeque Nasi Levator Labii Superioris Zygomaticus Minor Zygomaticus Major Levator Anguli Oris Risorius Depressor Anguli Oris Depressor Labii Inferioris Mentalis Buccinator Platysma Masseter Temporalis Lateral Pterygoid (two heads) Medial Pterygoid (two heads) Arise from bones and fascia around oral aperture and insert into substance of lips Neck of mandible and articular sac Medial surface of angle of mandible Facial nerve cervical branch Mandibular division of trigeminal nerve Mandibular division of trigeminal nerve Elevates mandible to occlude teeth Anterior and superior fibers elevate mandible; posterior fibers retract mandible Pulls neck of mandible forward Elevates mandible Muscles of Tongue Muscle Longitudinal Origin Median septum and submucosa Insertion Intrinsic Muscles Mucous membrane Innervation CNXII Alters shape of tongue CNXII Protrudes apex of tongue through mouth Depresses tongue Transverse Vertical Genioglossus Hyoglossus Styloglossus Palatoglossus Superior genial spine of mandible Body of greater cornu of hyoid bone Styloid process of temporal bone Palatine aponeurosis Extrinsic Muscles Blends with other muscles of tongue Blends with other muscles of tongue Blends with other muscles of tongue Side of tongue 3 Action CNXII CNXII Pharyngeal plexus Draws tongue upward and backward Pulls roots of tongue upward and backward, narrows oropharyngeal isthmus Muscles of the Neck Muscle Platysma SCM Digastric Posterior belly Origin Deep fascia over pectoralis major and deltoid Manubrium sterni and medial third of the clavicle Insertion Body of mandible and angle of mouth Innervation Facial nerve cervical branch Action Depresses mandible and angle of mouth Mastoid process of temporal bone and occipital bone Spinal part of accessory nerve and C2 and C3 Two muscles acting together extend head and flex neck; one muscle rotates head to opposite side Mastoid process of temporal bone Intermediate tendon is held to hyoid by fascial sling Facial nerve Depresses mandible or elevates hyoid bone Anterior belly Stylohyoid Mylohyoid Body of mandible Styloid process Mylohyoid line of body of mandible Geniohyoid Inferior mental spine of mandible Manubrium sterni and clavicle Manubrium sterni Sternohyoid Sternothyroid Thyrohyoid Omohyoid Inferior belly Oblique line on lamina of thyroid cartilage Body of hyoid bone Body of hyoid bone and fibrous raphe Nerve to mylohyoid Facial nerve Inferior alveolar nerve Body of hyoid bone First cervical nerve Body of Hyoid bone Ansa cervicalis; C1, 2 & 3 Ansa cervicalis; C1, 2 & 3 First cervical nerve Oblique line on lamina of thyroid cartilage Lower border of body of hyoid bone Elevates hyoid bone Elevates floor of mouth and hyoid bone or depresses mandible Elevates hyoid bone or depresses mandible Depresses hyoid bone Depresses larynx Depresses hyoid bone or elevates larynx Upper margin of scapula and suprascapular ligament Lower border of body of hyoid bone Transverse processes of 3rd, 4th 5th and 6th cervical vertebrae Intermediate tendon is held to clavicle and first rib by fascial sling Ansa cervicalis; C1, 2 & 3 Depresses hyoid bone First rib C4, 5 & 6 Scalenius Medius Transverse processes of upper six cervical vertebrae First rib Anterior rami of cervical nerves Scalenius Posterior Transverse process of lower cervical vertebrae Second rib Anterior rami of cervical nerves Elevates first rib; laterally flexes and rotates cervical part of vertebral column Elevates first rib; laterally flexes and rotates cervical part of vertebral column Elevates second rib; laterally flexes and rotates cervical part of vertebral column Superior belly Scalenius Anterior 4 Cranial Nerves Nerve Olfactory Components Sensory Optic Oculomotor Sensory Motor Trochlear Motor Trigeminal Ophthalmic division Sensory Maxillary division Sensory Mandibular division Motor Sensory Abducent Motor Facial Motor Sensory Secretomotor parasympathetic Vestibulocochlear Vestibular Cochlear Glossopharyngeal Sensory Sensory Motor Secretomotor parasympathetic Sensory Vagus Motor Sensory Accessory Cranial root Spinal root Hypoglossal Motor Motor Motor Function Smell Vision Lifts upper eyelid, turns eyeball upward, downward and medially; constricts pupil; accommodates eye Assists in turning eyeball downward and laterally Opening in Skull Openings in cribriform plate of ethmoid Optic canal Superior Orbital Fissure Superior Orbital fissure Cornea, skin of forehead, scalp, eyelids and nose; also mucous membrane of paranasal sinuses and nasal cavity Skin of face over maxilla and the upper lip; teeth of upper jaw; mucous membrane of nose, the maxillary air sinus, and palate Muscles of mastication, mylohyoid, anterior belly of digastrics, tensor veli palatini and tensor tympani Skin of cheek, skin over mandible, lower lip and side of head; teeth of lower jaw and temporomandibular joint; mucous membrane of mouth and anterior two thirds of tongue Lateral rectus muscle: turns eyeball laterally Muscles of face, cheek and scalp; stapedius muscle of middle ear; stylohyoid; and posterior belly of digastrics Taste from anterior two thirds of tongue, floor of mouth and palate Submandibular and sublingual salivary glands, lacrimal gland and glands of nose and palate Superior Orbital Fissure Position and movement of head Hearing Stylopharyngeus muscle; assists swallowing Parotid salivary gland Internal acoustic meatus General sensation and taste from posterior third of tongue and pharynx; carotid sinus and carotid body Constrictor muscles of phaynx and intrinsic muscles of larynx; involuntary muscle of trachea and bronchi, heart, alimentary tract from pharynx to splenix flexure of colon; liver and pancreas Taste from epiglottis and vallecula and afferent fibers from structures named above Muscles of soft palate, pharynx and larynx Sternocleidomastoid and trapezius muscles Muscles of tongue controlling its shape and movement (except palatoglossus) Foramen Rotundum Foramen Ovale Superior orbital fissure Internal acoustic meatus, facial canal stylomastoid foramen Jugular Foramen Jugular Foramen Jugular Foramen Hypoglossal Canal 5 Muscles Connecting the Upper Limb to the Thoracic Wall/ Muscles of the Pectoral Region (except Serratus Anterior) Muscle Pectoralis Major Insertion Lateral lip of the bicipital groove of humerus Pectoralis Minor Origin Clavicle, sternum and upper six costal cartilages 3rd, 4th and 5th ribs Subclavius First costal cartilage Clavicle Nerve to subclavius from upper trunk of brachial plexus Serratus Anterior Upper eight ribs Medial border and inferior angle of the scapula Long thoracic nerve Coracoid process of scapula Innervation Medial and lateral pectoral nerves form brachial plexus Medial pectoral nerve from brachial plexus Action Adducts arm and rotates it medially; clavicular fibers also flex arm Depresses point of shoulder; if the scapula is fixed, it elevates the ribs of origin Depresses the clavicle and steadies this bone during movements of the shoulder girdle Draws the scapula forward around the thoracic wall; rotates the scapula Muscles Connecting the Upper limb to the Vertebral Column/ Superficial (Appendicular) Group of Back Muscles Muscle Trapezius Latissimus Dorsi Levator Scapulae Rhomboid Minor Rhomboid Major Origin Occipital bone, ligamentum nuchae, spine of 7th cervical vertebra, spines of all thoracic vertebra Iliac crest, lumbar fascia, spines of lower six thoracic vertebrae, lower three or four ribs, and inferior angle of the scapula Transverse processes of first four cervical vertebrae Ligamentum nuchae and spines of 7th cervical vertebra and 1st thoracic vertebra 2nd to 5th thoracic spines Insertion Upper fibers into lateral third of clavicle; middle and lower fibers into acromion and spine of the scapula Innervation Spinal part of accessory nerve (motor) and C3 and C4 (sensory) Action Upper fibers elevate the scapula; middle fibers pull the scapula medially; lower fibers pull medial border of the scapula downward Extends, adducts and medially rotates the arm Floor of bicipital groove of humerus Thoracodorsal nerve Medial border of the scapula C3 and C4 and dorsal scapular nerve Raises medial border of the scapula Medial border of the scapula Dorsal scapular nerve Raises medial border of scapula upward and medially Medial border of scapula Dorsal scapular nerve Raises medial border of scapula upward and medially Muscles Connecting the Scapula to the Humerus Muscle Deltoid Origin Lateral third of clavicle, acromion, spine of scapula Insertion Middle of lateral surface of shaft of humerus Innervation Axillary nerve Supraspinatus Supraspinous fossa of scapula Spurascapular nerve Infraspinatus Infraspinous fossa Teres Major Lower third of lateral border of scapula Greater tuberosity of humerus; capsule of shoulder joint Greater tuberosity of humerus; capsule of shoulder joint Medial lip of bicipital groove of humerus Teres Minor Upper two thirds of lateral border of the scapula Subscapular fossa Greater tuberosity of the humerus; capsule of shoulder joint Lesser tuberosity of humerus Axillary nerve Subscapularis Action Abducts arm; anterior fibers flex and medially rotate arm; posterior fibers extend and laterally rotate arm Abducts arm and stabilizes shoulder joint Suprascapular nerve Laterally rotates arm and stabilizes shoulder joint Lower subscapular nerve Medially rotates and adducts arm and stabilizes shoulder joint Laterally rotates arm stabilizes shoulder joint Upper and lower subscapular nerves Medially rotates arm and stabilizes shoulder joint Muscles of the Arm Muscle Biceps Brachii Long head Short head Coracobrachialis Brachialis Triceps Long head Lateral head Medial head 6 Origin Insertion Anterior Compartment Innervation Supraglenoid tubercle of scapula Tuberosity of radius and bicipital aponeurosis into deep fascia of forearm Musculocutaneous nerve Supinator of forearm and flexor of elbow joint; weak flexor of shoulder joint Medial aspect of shaft of Musculocutaneous nerve humerus Coronoid process of Musculocutaneous nerve ulna Posterior Compartment Flexes arm and also weak adductor Flexor of elbow joint Coracoid process of scapula Coracoid process of scapula Front of lower half of humerus Action Infraglenoid tubercle of scapula Upper half of posterior surface of shaft of humerus Lower half of posterior surface of shaft of humerus Olecranon process of ulna Radial nerve Extensor of elbow joint Muscles of the Anterior Fascial Compartment of the Forearm Muscle Pronator Teres Humeral head Ulnar head Flexor Carpi Radialis Palmaris Longus Flexor Carpi Ulnaris Humeral head Ulnar head Flexor Digitorum Superficialis Humeroulnar head Radial head Origin Medial epicondyle of humerus Medial border of coronoid process of ulna Medial epicondyle of humerus Medial epicondyle of humerus Insertion Lateral aspect of the shaft of radius Bases of 2nd and 3rd metacarpal bones Flexor retinaculum and palmar aponeurosis Medial epicondyle of humerus Medial aspect of olecranon process and posterior border of ulna Pisiform bone, hook of the hamate, base at 5th metacarpal bone Medial epicondyle of humerus; medial border of coronoid process of ulna Oblique line on anterior surface of shaft of radius Middle phalanx of medial four fingers Flexor Pollicis Longus Flexor Digitorum Profundus Anterior surface of shaft of radius Anteromedial surface of shaft of ulna Distal phalanx of thumb Pronator Quadratus Anterior surface of shaft of ulna Anterior surface of shaft or radius Distal phalanges of medial four fingers Innervation Median nerve Median nerve Median nerve Action Pronation and flexion of forearm Flexes and abducts hand at wrist joint Flexes hand Ulnar nerve Flexes and adducts hand at wrist joint Median nerve Flexes middle phalanx of fingers and assists in flexing proximal phalanx and hand Anterior interosseus branch of median nerve Ulnar (medial half) and median (lateral half) nerves Anterior interosseus branch of median nerve Flexes distal phalanx of thumb Flexes distal phalanx of fingers; then assists in flexion of middle and proximal phalanges and wrist Pronates forearm Muscles of the Lateral Fascial Compartment of the Forearm Muscle Brachioradialis Origin Lateral supracondylar ridge of humerus Insertion Base of styloid process of radius Innervation Radial nerve Extensor Carpi Radialis Longus Lateral supracondylar ridge pf the humerus Posterior surface of base of 2nd metacarpal bone Radial nerve 7 Action Flexes forearm at elbow joint; rotates forearm to the midprone position Extends and abducts hand at wrist joint Muscles of the Posterior Fascial Compartment of the Forearm Muscle Extensor Carpi Radialis Brevis Origin Lateral epicondyle of humerus Extensor Digitorum Lateral epicondyle of humerus Extensor Digiti Minimi Lateral epicondyle of humerus Extensor Carpi Ulnaris Anconeus Lateral epicondyle of humerus Lateral epicondyle of humerus Supinator Abductor Pollicis Longus Extensor Pollicis Brevis Extensor Pollicis Longus Extensor Indicis Insertion Posterior surface of base of third metacarpal bone Middle and distal phalanges of medial four fingers Extensor expansion of little finger Innervation Deep branch of radial nerve Action Extends and abducts hand at wrist joint Deep branch of radial nerve Extends fingers and hand Deep branch of radial nerve Deep branch of radial nerve Radial nerve Lateral epicondyle of humerus Posterior surface of shaft of radius and ulna Posterior surface of shaft or radius Base of fifth metacarpal bone Lateral surface of olecranon process of ulna Neck and shaft of radius Base of first metacarpal bone Base of proximal phalanx of thumb Extends metacarpophalangeal joint of little finger Extends and adducts hand at wrist joint Extends elbow joint Posterior surface of shaft of ulna Posterior surface of shaft of ulna Base of distal phalanx of thumb Extensor expansion of index finger Deep branch of radial nerve Deep branch of radial nerve Deep branch of radial nerve Deep branch of radial nerve Deep branch of radial nerve Supination of forearm Extends and abducts thumb Extends metacarpophalangeal joint of thumb Extends distal phalanx of thumb Extends metacarpophalangeal joint of index finger Small Muscles of the Hand Muscle Palmaris Brevis Lumbricals (4) Interossei (8) Palmar (4) Dorsal (4) Abductor Pollicis Brevis Flexor Pollicis Brevis Origin Flexor retinaculum, palmar aponeurosis Tendons of flexor digitorum profundus Insertion Skin of palm First arises from base of 1st metacarpal; remaining three from anterior surface of shafts of 2nd, 4th and 5th metacarpals Contiguous sidesof shafts of metacarpal bones Proximal phalanges of thumb and index, ring and little fingers and dorsal extensor expansion of each finger Proximal phalanges of index, middle and ring fingers and dorsal extensor expansion Extensor expansion of medial four fingers Innervation Superficial branch of ulnar nerve 1st and 2nd (i.e. lateral two) median nerve; 3rd and 4th deep branch of ulnar nerve Action Corrugates skin to improve grip of palm Flexes metacarpophalangeal joints and extend interphalangeal joints of fingers except thumb Deep branch of ulnar nerve Palmar interossei adduct fingers toward center of third finger Deep branch of ulnar nerve Dorsal interossei abduct fingers from center of third finger; both palmar and dorsal flex metacarpophalangeal joints and extend interphalangeal joints Short Muscles of Thumb (Thenar Muscles; pollicis- thumb) Scaphoid, trapezium, Base of proximal Median nerve flexor retinaculum phalanx of thumb Flexor retinaculum Base of proximal Median nerve phalanx of thumb Abduction of thumb Flexes metacarpophalangeal joint of thumb Flexor retinaculum Adductor Pollicis Oblique head; 2nd and Deep branch of ulnar 3rd metacarpal bones; nerve transverse head; 3rd metacarpal bone Short Muscles of Little Finger (Hypothenar Muscles; digiti minimi- 5th digit) Pisiform bone Base of proximal Deep branch of ulnar Abducts little finger phalanx of little finger nerve Flexor retinaculum Base of proximal Deep branch of ulnar Flexes little finger phalanx of little finger nerve Abductor Digiti Minimi Flexor Digiti Minimi Opponens Digiti Minimi Flexor retinaculum Shaft of metacarpal bone of thumb Base of proximal phalanx of thumb Median nerve Medial border of 5th metacarpal bone Deep branch of ulnar nerve 8 Opponens Pollicis Pulls thumb medially and forward across palm Adduction of thumb Pulls 5th metacarpal forward as in cupping the palm Summary of the Branches of the Brachial Plexus and their Distribution Branches Distribution Roots Dorsal Scapular Nerve (C5) Rhomboid minor, rhomboid major, levator scapulae Long Thoracic Nerve (C5, 6, 7) Serratus anterior Upper Trunk Suprascapular Nerve (C5, 6) Supraspinatus and infraspinatus Nerve to Subclavius (C5, 6) Subclavius Lateral Cord Lateral Pectoral Nerve (C5, 6, 7) Pectoralis major Musculocutaneous Nerve (C5, 6, 7) Coracobrachialis, biceps brachii, brachialis; supplies skin along lateral border of forearm when it becomes the lateral cutaneous nerve of the forearm Lateral root of Median Nerve (C5, 6, 7) (See medial root of median nerve) Posterior Cord Upper Subscapular Nerve (C5, 6) Subscapularis Thoracodorsal Nerve (C6, 7, 8) Latissimus dorsi Lower Subscapular Nerve (C5, 6) Subscapularis and teres major Axillary Nerve (C5, 6) Deltoid and teres minor; upper and lateral cutaneous nerve of arm supplies skin over lower half of deltoid muscle Radial Nerve (C5, 6, 7, 8; T1) Triceps, anconeus, part of brachialis, ECRL; via deep radial nerve branch supplies extensor muscles of forearm: supinator, ECRB, ECU, ED, EDM, EI, AbPL, EPL, EPB; skin, lower lateral cutaneous nerve of arm, posterior cutaneous nerve of arm, and posterior cutaneous nerve of forearm; skin on lateral side of dorsum of hand and dorsal surface of lateral three and a half of fingers; articular branches to elbow, wrist and hand Medial Cord Medial Pectoral Nerve (C8; T1) Pectoralis major and pectoralis minor Medial Cutaneous Nerve of arm joined by intercostals Skin of medial side of arm brachial nerve from second intercostals nerve (C8; T1, 2) Medial Cutaneous Nerve of forearm (C8; T1) Skin of medial side of forearm Ulnar Nerve (C8; T1) FCU and medial half of FDP, FDM, ODM, AbDM, AdP, 3rd and 4th lumbricals, interossei, PB, skin of medial half of dorsum of hand and palm, skin of palmar and dorsal surfaces of medial one and a half fingers Medial root of Median Nerve (with lateral root) forms PT, FCR, PL, FDS, AbPB, FPB, OP, first two lumbricals (by way of Median Nerve (C5, 6, 7, 8; T1) anterior interosseus branch), FPL, FDP (lateral half), PQ, palmar cutaneous branch to lateral half of palm and digital branches to palmar surface of lateral three and a half fingers; articular branches to elbow, wrist and carpal joints 9 Muscles of the Gluteal Region Muscle Gluteus maximus Origin Outer surface of ilium, sacrum, coccyx, sacrotuberous ligament Gluteus medius Outer surface of ilium Insertion Iliotibial tract and gluteal tuberosity of femur Nerve Supply Inferior gluteal nerve Lateral surface of greater trochanter of femur Superior gluteal nerve Gluteus minimus Anterior surface of greater Superior gluteal nerve trochanter of femur Outer surface of ilium Tensor fasciae Iliac crest Iliotibial tract latae Piriformis Anterior surface of sacrum Upper border of greater trochanter of femur Obturator Inner surface of obturator Upper border of greater internus membrane trochanter of femur Gemellus Spine of ischium Upper border of greater superior trochanter of femur Gemellus Ischial tuberosity Upper border of greater inferior trochanter of femur Quadratus Lateral border of ischial Quadrate tubercle of femoris tuberosity femur Superior gluteal nerve Action Extends and laterally rotates hip joint; through iliotibial tract, it extends knee joint Abducts thigh at hip joint; tilts pelvis when walking to permit opposite leg to clear ground Abducts thigh at hip joint; tilts pelvis when walking to permit opposite leg to clear ground Assists gluteus maximus in extending the knee joint Lateral rotator of thigh at hip joint First and second sacral nerves Sacral plexus Lateral rotator of thigh at hip joint Sacral plexus Lateral rotator of thigh at hip joint Sacral plexus Lateral rotator of thigh at hip joint Sacral plexus Lateral rotator of thigh at hip joint Muscles of the Anterior Fascial Compartment of the Thigh Muscle Sartorius Origin Anterior superior iliac spine Insertion Upper medial surface of shaft of tibia Nerve Supply Femoral nerve Iliacus Iliac fossa of hip bone With psoas into lesser trochanter of femur Femoral nerve Psoas Transverse processes, With iliacus into lesser Lumbar plexus bodies, and intervertebral trochanter of femur discs of the 12th thoracic and five lumbar vertebrae Superior ramus of pubis Upper end of linea aspera Femoral nerve of shaft of femur Pectineus Quadriceps femoris Rectus femoris Vastus lateralis Vastus medialis Vastus intermedius Straight head: anterior Quadriceps tendon into Femoral nerve inferior iliac spine patella, then via ligamentum Reflected head: ilium above patellae into tubercle of acetabulum tibia Upper end and shaft of Quadriceps tendon into Femoral nerve femur patella, then via ligamentum patellae into tubercle of tibia Upper end and shaft of Quadriceps tendon into Femoral nerve femur patella, then via ligamentum patellae into tubercle of tibia Anterior and lateral Quadriceps tendon into Femoral nerve surfaces of shaft of femur patella, then via ligamentum patellae into tubercle of tibia Action Flexes, abducts, laterally rotates thigh at hip joint; flexes and medially rotates leg at knee joint Flexes thigh on trunk; if thigh is fixed, it flexes the trunk on the thigh as in sitting up from lying down Flexes thigh on trunk; if thigh is fixed, it flexes the trunk on thigh as in sitting up from lying down Flexes and adducts thigh at hip joint Extension of leg at knee joint; flexes thigh at hip joint Extension of leg at knee joint Extension of leg at knee joint; stabilizes patella Extension of leg at knee joint; articularis genus retracts synovial membrane Muscles of the Medial Fascial Compartment of the Thigh Muscle Gracilis Adductor longus Adductor brevis Adductor magnus Obturator externus Origin Inferior ramus of pubis, ramus of ischium Body of pubis, medial to pubic tubercle Inferior ramus of pubis Insertion Nerve Supply Upper part of shaft of tibia Obturator nerve on medial surface Posterior surface of shaft Obturator nerve of femur (linea aspera) Posterior surface of shaft Obturator nerve of femur (linea aspera) Inferior ramus of pubis, Posterior surface of shaft Adductor portion: ramus of ischium, ischial of femur, adductor tubercle obturator nerve tuberosity of femur Hamstring portion: sciatic nerve Outer surface of obturator Medial surface of greater Obturator nerve membrane and pubic and trochanter ischial rami 10 Action Adducts thigh at hip joint; flexes leg at knee joint Adducts thigh at hip joint and assists in lateral rotation Adducts thigh at hip joint and assists in lateral rotation Adducts thigh at hip joint and assists in lateral rotation; hamstring portion extends thigh at hip joint Laterally rotates thigh at hip joint Muscles of the Posterior Fascial Compartment of the Thigh Muscle Biceps femoris Semitendinosus Origin Long head: ischial tuberosity Insertion Head of fibula Short head: linea aspera, lateral supracondylar ridge of shaft of femur Ischial tuberosity Upper part of medial surface of shaft of tibia Semimembranosus Ischial tuberosity Medial condyle of tibia Adductor magnus Ischial tuberosity (hamstring portion) Adductor tubercle of femur Nerve Supply Action Long head: tibial Flexes and laterally rotates leg portion of sciatic nerve at knee joint; long head also extends thigh at hip joint Short head: common peroneal portion of sciatic nerve Tibial portion of sciatic Flexes and medially rotates leg nerve at knee joint; extends thigh at hip joint Tibial portion of sciatic Flexes and medially rotates leg nerve at knee joint; extends thigh at hip joint Tibial portion of sciatic Extends thigh at hip joint nerve Muscles of the Anterior Fascial Compartment of the Leg Muscle Origin Tibialis anterior Lateral surface of shaft of tibia and interosseous membrane Extensor digitorum longus Peroneus tertius Insertion Nerve Supply Medial cuneiform and base Deep peroneal nerve of first metatarsal bone Anterior surface of shaft of Extensor expansion of fibula lateral four toes Deep peroneal nerve Anterior surface of shaft of Base of fifth metatarsal fibula bone Deep peroneal nerve Extensor Anterior surface of shaft of Base of distal phalanx of hallucis longus fibula great toe Extensor digitorum brevis Calcaneum Deep peroneal nerve By four tendons into the Deep peroneal nerve proximal phalanx of big toe and long extensor tendons to second, third, and fourth toes Action Extendsb foot at ankle joint; inverts foot at subtalar and transverse tarsal joints; holds up medial longitudinall arch of foot Extends toes; extends foot at ankle joint Extends foot at ankle joint; everts foot at subtalar and transverse tarsal joints Extends big toe; extends foot at ankle joint; inverts foot at subtalar and transverse tarsal joints Muscles of the Lateral Fascial Compartment of the Leg Muscle Peroneus longus Origin Lateral surface of shaft of fibula Peroneus brevis Lateral surface of fibula shaft of fibula Insertion Nerve Supply Base of first metatarsal and Superficial peroneal the medial cuneiform nerve Base of fifth metatarsal bone Superficial peroneal nerve 11 Action Plantar flexes foot at ankle joint; everts foot at subtalar and transverse tarsal joints; supports lateral longitudinal and transverse arches of foot Plantar flexes foot at ankle joint; everts foot at subtalar and transverse tarsal joint; supports lateral longitudinal arch of foot Muscles of the Posterior Fascial Compartment of the Leg Muscle Origin Insertion Nerve Supply Superficial Group Via tendo calcaneus into Tibial nerve posterior surface of calcaneum Gastrocnemius Lateral head from lateral condyle of femur and medial head from above medial condyle Plantaris Lateral supracondylar ridge Posterior surface of of femur calcaneum Soleus Shafts of tibia and fibula Via tendo calcaneus into posterior surface of calcaneum Tibial nerve Tibial nerve Popliteus Lateral surface of lateral condyle of femur Deep Group Posterior surface of shaft Tibial nerve of tibia above soleal line Flexor digitorum longus Posterior surface of shaft of tibia Bases of distal phalanges of Tibial nerve lateral four toes Flexor hallucis Posterior surface of shaft longus of fibula Base of distal phalanx of big Tibial nerve toe Tibialis posterior Posterior surface of shafts Tuberosity of navicular of tibia and fibula and bone and other interosseous membrane neighboring bones Tibial nerve Action Plantar flexes foot at ankle joint; flexes knee joint Plantar flexes foot at ankle joint; flexes knee joint Together with gastrocnemius and plantaris is powerful plantar flexor of ankle joint; provides main propulsive force in walking and running Flexes leg at knee joint; unlocks knee joint by lateral rotation of femur on tibia and slackens ligaments of joint Flexes distal phalanges of lateral four toes; plantar flexes foot at ankle joint; supports medial and lateral longitudinal arches of foot Flexes distal phalanx of big toe; plantar flexes foot at ankle joint; supports medial longitudinal arch of foot Plantar flexes foot at ankle joint; inverts foot at subtalar and transverse tarsal joints; supports medial longitudinal arch of foot Muscles of the Sole of the Foot Muscle Abductor hallucis Flexor digitorum brevis Origin Medial tuberosity of calcaneum and flexor retinaculum Medial tubercle of calcaneum Insertion Nerve Supply First Layer Base of proximal phalanx of Medial plantar nerve big toe Four tendons to four Medial plantar nerve lateral toes— inserted into borders of middle phalanx; tendons perforated by those of flexor digitorum longus Abductor digiti Medial and lateral tubercles Base of proximal phalanx of Lateral plantar nerve minimi of calcaneum fifth toe Second Layer Quadratus Medial and lateral sides of Tendon of flexor digitorum Lateral plantar nerve plantae calcaneum longus Lumbricals (4) Tendons of flexor Dorsal extensor expansion; First lumbrical: medial digitorum longus bases of proximal phalanges plantar nerve; of lateral four toes remainder: lateral plantar nerve Flexor digitorum longus tendon Flexor hallucis longus tendon Third Layer Flexor hallucis Cuboid, lateral cuneiform, Medial tendon into medial Medial plantar nerve brevis tibialis posterior insertion side of base of proximal phalanx of big toe; lateral tendon into lateral side of base of proximal phalanx of big toe Adductor Oblique head bases of Lateral side of base of Deep branch lateral hallucis second, third, and fourth proximal phalanx of big toe plantar nerve metatarsal bones; transverse head from plantar ligaments Flexor digiti Base of fifth metatarsal Lateral side of base of Lateral plantar nerve minimi brevis bone proximal phalanx of little toe Fourth Layer Interossei Dorsal (4) Plantar (3) Peroneus longus tendon Tibialis posterior tendon Adjacent sides of metatarsal bones Bases of proximal Lateral plantar nerve phalanges first: medial side of second toe; remainder: lateral sides of second, third, and fourth toes also dorsal extensor expansion Inferior surfaces of third, Medial side of bases of Lateral plantar nerve fourth, and fifth metatarsal proximal phalanges of bones lateral three toes 12 Action Flexes and abducts big toe; braces medial longitudinal arch Flexes lateral four toes; braces medial and lateral longitudinal arches Flexes and abducts fifth toe; braces lateral longitudinal arch Assists flexor digitorum longus in flexing lateral four toes Extends toes at interphalangeal joints Flexes metatarsophalangeal joint of big toe; supports medial longitudinal arch Flexes metatarsophalangeal joint of big toe; holds together metatarsal bones Flexes metatarsophalangeal joint of little toe Abduction of toes; flexes metatarsophalangeal joints and extends interphalangeal joints Adduction of toes; flexes metatarsophalangeal joints and extends interphalangeal joints Muscle of the Dorsum of the Foot Muscle Extensor digitorum brevis Origin Anterior part of upper surface of the calcaneum and from the inferior extensor retinaculum Insertion Nerve Supply By four tendons into the Deep peroneal nerve proximal phalanx of big toe and long extensor tendons to second, third, and fourth toes 13 Action Extends toes Branches of the Sacral Plexus and Their Distribution Branches Superior gluteal nerve Inferior gluteal nerve Nerve to piriformis Nerve to obturator internus Nerve to quadratus femoris Perforating cutaneous nerve Posterior cutaneous nerve of thigh Sciatic nerve (L4, 5; S1, 2, 3) Tibial portion Common peroneal portion Pudendal nerve Distribution Gluteus medius, gluteus minimus, and tensor fasciae latae muscles Gluteus maximus muscle Piriformis muscle Obturator internus and superior gemellus muscles Quadratus femoris and inferior gemellus muscles Skin over medial aspect of buttock Skin over posterior surface of thigh and popliteal fossa, also over lower part of buttock, scrotum, or labium majus Hamstring muscles (semitendinosus, biceps femoris [long head], adductor magnus [hamstring part]), gastrocnemius, soleus, plantaris, popliteus, tibialis posterior, flexor digitorum longus, flexor hallucis longus, and via medial and lateral plantar branches to muscles of sole of foot; sural branch supplies skin on lateral side of leg and foot Biceps femoris muscle (short head) and via deep peroneal branch: tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus tertius, and extensor digitorum brevis muscles; skin over cleft between first and second toes. The superficial peroneal branch supplies the peroneus longus and brevis muscles and skin over lower third of anterior surface of leg and dorsum of foot Muscles of perineum including the external anal sphincter, mucous membrane of lower half of anal canal, perianal skin, skin of penis, scrotum, clitoris, and labia majora and minora Branches of the Lumbar Plexus and Their Distribution Branches Iliohypogastric nerve Ilioinguinal nerve Lateral cutaneous nerve of the thigh Genitofemoral nerve (L1, 2) Femoral nerve (L2, 3, 4) Obturator nerve (L2, 3, 4) Segmental branches Distribution External oblique, internal oblique, transversus abdominis muscles of anterior abdominal wall; skin over lower anterior abdominal wall and buttock External oblique, internal oblique, transversus abdominis muscles of anterior abdominal wall; skin of upper medial aspect of thigh; root of penis and scrotum in the male; mons pubis and labia majora in the female Skin of anterior and lateral surfaces of the thigh Cremaster muscle in scrotum in male; skin over anterior surface of thigh; nervous pathway for cremasteric reflex Iliacus, pectineus, sartorius, quadriceps femoris muscles, and intermediate cutaneous branches to the skin of the anterior surface of the thigh and by saphenous branch to the skin of the medial side of the leg and foot; articular branches to hip and knee joints Gracilis, adductor brevis, adductor longus, obturator externus, pectineus, adductor magnus (adductor portion), and skin on medial surface of thigh; articular branches to hip and knee joints Quadratus lumborum and psoas muscles 14 Back Muscles Connecting the Upper limb to the Vertebral Column/ Superficial (Appendicular) Group of Back Muscles *Trapezius *Latissimus Dorsi *Levator Scapulae *Rhomboid Major *Rhomboid Minor Intermediate (Respiratory) Group of Back Muscles Muscle Origin Insertion Serratus Posterior Lower portion of Upper border of Superior ligamentum nuchae, ribs 2 to 5 just spinous process of lateral to their C7 to T3 and angles supraspinous ligaments Serratus Posterior Spinous process of Lower border of Inferior T11 to L3 and ribs 9 to 12 just supraspinous lateral to their ligaments angles Innervation Anterior rami of upper thoracic nerves (T2 to T5) Action Elevates ribs 2 to 5 Anterior rami of lower thoracic nerves (T9 to T12) Depresses ribs 9 to 12 and may prevent lower ribs from being elevated when the diaphragm contracts Insertion Mastoid process, skull below lateral 1/3 of superior nuchal line Innervation Posterior rami middle cervical nerves Transverse processes of C1 to C3 Posterior rami middle cervical nerves Action Together- draw head backwards extending neck; individually- draw and rotate head to one side (turn face to same side) Together- extend neck; individuallydraw and rotate head to one side (turn face to same side) Deep Group of Back Muscles SpinoTransversales Muscles Muscle Origin Splenius Capitis Lower half of ligamentum nuchae, spinous processes of C7 to T4 Splenius Cervicis Spinous processes of T3 to T6 Erector Spinae Group of Back Muscles Muscle Origin Iliocostalis Lumborum Sacrum, spinous process of lumbar and lower two thoracic vertebrae and their supraspinous ligaments and the iliac crest Iliocostalis Thoracis Angles of the lower 6 ribs Iliocostalis Cervicis Longissimus Thoracis Longissimus Cervicis Longissimus Capitis Spinalis Thoracis Spinalis Cervicis Spinalis Capitis Angles of ribs 3 to 6 Blends with iliocostalis in lumbar region and is attached to transverse processes of lumbar vertebrae Transverse processes of upper 4 or 5 thoracic vertebrae Transverse processes of upper 4 or 5 thoracic vertebrae and articular processes of lower three or four cervical vertebrae Spinous processes of T10 or T11 to L2 Lower part of ligamentum nuchae and spinous processes of C7 (sometimes T1 to T2) Usually blends with semispinalis capitis Insertion Angles of the lower 6 or 7 ribs Angles of the upper 6 ribs and the transverse process of C7 Transverse processes of C4 to C6 Transverse processes of all thoracic vertebrae and just lateral to the tubercles of the lower 9 or 10 ribs Transverse processes of C2 to C6 Posterior margin of the mastoid process Spinous processes of T1 to T8 (varies) Spinous process of C2 (axis) With semispinalis capitis Transversospinales Group of Back Muscles Muscle Origin Semispinalis Thoracis Transverse processes of T2 to T10 Semispinalis Cervicis Semispinalis Capitis Multifidus Rotatores Lumborum Rotatores Thoracis Rotatores Cervicis Transverse processes of upper 5 or 6 thoracic vertebrae Transverse processes of T1 to T6 (or T7) and C7 and articular processes of C4 to C6 Sacrum, origin of erector spinae, PSIS, mammillary processes of lumbar vertebrae, transverse processes of thoracic vertebrae and articular processes of lower four cervical vertebrae Mammillary processes of lumbar vertebrae Transverse processes of thoracic vertebrae Articular processes of cervical vertebrae Segmental Back Muscles Muscle Origin Levatores Costarum Short paired muscles arising from transverse processes of C7 to T11 Interspinales Short paired muscles attached to the spinous process of contiguous vertebrae, one on each side of the interspinous ligament Intertransversarii Small muscles between the transverse processes of contiguous vertebrae Suboccipital Gorup of Back Muscles Muscle Origin Rectus Capitis Spinous process of Posterior Major axis (C2) Rectus Capitis Posterior Minor Posterior tubercle of atlas (C1) Obliquus Capitis Superior Transverse process of atlas (C1) Obliquus Capitis Inferior Spinous process of axis (C2) Insertion Spinous processes of upper 4 thoracic and lower 2 cervical vertebrae Spinous processes of C2 (axis) to C5 Medial area between the superior and inferior nuchal lines of occipital bone Base of spinous processes of all vertebrae from L5 to C2 Spinous processes of ;umbar vertebrae Spinous processes of thoracic vertebrae Spinous processes of cervical vertebrae Insertion The rib below vertebra of origin near tubercle Insertion Lateral portion of occipital bone below inferior nuchal line Medial portion of occipital bone below inferior nuchal line Occipital bone between superior and inferior nuchal lines Transverse process of atlas (C1) Action Contraction elevates rib Innervation Posterior ramus of C1 Posterior ramus of C1 Function Extension of head; rotation of face to same side as muscle Extension of head Posterior ramus of C1 Extension of head and bends it to same side Posterior ramus of C1 Rotation of face to same side 15 16 Thorax Muscles Connecting the Upper Limb to the Thoracic Wall/ Muscles of the Pectoral Region (except Serratus Anterior) *Pectoralis Major *Subclavius *Pectoralis Minor Muscles of the Thorax/ Thoracic Wall Muscle Origin External Intercostal Inferior margin of rib above Internal Intercostal Lateral edge of costal groove of rib above Innermost Intercostal Medial edge of costal groove of rib above Internal surface (near angle) of lower ribs Lower margins and internal surfaces of cocostal cartilages of 2nd to 6th ribs Subcostales Transversus Thoracis Diaphragm (most important muscle of respiration) Xiphoid process; lower six costal cartilages, first three lumbar vertebrae Levatores Costarum (12) Tip of transverse process of C7 and T1-11 vertebrae Serratus Posterior Superior Serratus Posterior Inferior Insertion Superior surface f rib below Innervation Intercostal nerves; T1-T11 Superior surface of rib below deep to the attachment of the related external intercostal Internal aspect of superior surface of rib below Internal surface of 2nd to 3rd rib below Intercostal nerves; T1-T11 Function Most active during inspiration; supports intercostals space; moves ribs superiorly Most active during expiration; supports intercostals space; moves ribs inferiorly Intercostal nerves; T1-T11 Acts with internal intercostals muscles Related intercostal nerves May depress ribs Inferior aspect of deep surface of body of sternum, xiphoid process and costal cartilages ribs 4-7 Central tendon Related intercostals nerves Depresses costal cartilages Phrenic nerve Rib below Posterior rami of thoracic spinal nerves Very important muscle of inspiration; increases vertical diameter of thorax by pulling central tendon downward; assists in raising lower ribs. Also used in abdominal straining and weight lifting Raises ribs and therefore inspiratory muscles (see Intermediate (Respiratory) Group of Back Muscles)
