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Muscle Anatomy Chart: Origins, Insertions, & Movements
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Region Surface Layer Muscle Pectoralis Major Pectoralis Minor Pectoral / (4) Origin Insertion Clavicular head: anterior surface of Intertubercular sulcus medial clavicle Sternocostal head: anterior surface of sternum; Superior 6 costal cartilages; aponeurosis of external oblique 3th-5th ribs Coracoid process of scapula / Serratus anterior Superfi cial Extrinsic Shoulde (originate r (11) d from trunk)(5) Costal surface of medial border of scapula Subclavius Junction btw 1st rib and cartilage Trapezius Skull Latissimus dorsi Clavicular head individually flexion Adduction Medial rotation Draws anteroinferiorly Stabilisation by draw anteroinferiorly against thoracic wall Upward rotation Stabilisation by draw anteroinferiorly against thoracic wall Allowing to raise >90 deg Anchor & Depression Middle fibre: Retraction Lower fibre: Draws inferiorly T7-T12 spinous process of vertebrae Intertubercular sulcus Extension Deep T2-T5 spinous process of vertebrae Target bones/ body part Upper arm Scapula Scapula Scapula Arm Inferior surface of the Clavicle middle third of clavicle Posterior surface of lateral Upper fibre: elevation & rotation Scapula third of clavicle during ABduction of arm Nuchal ligament Acromion process C7-T12 spinous process of vertebrae Spine of scapula Illiac crest Thoracolumbar fascia Inferior 3 ribs Levator scapulae C1-C4 transverse process of vertebrae Rhomboid Minor C7-T1 spinous process of vertebrae Rhomboid Major Movement Innervation Medial & lateral pectoral nerve Medial pectoral nerve Long thoracic nerve Nerve to subclavius Motor: accessory nerve Proprioceptor fibres from C3 &C4 spinal nerves Upper limb Thoracodorsal nerve Scapula Dorsal scapula nerve Scapula Dorsal scapula nerve Scapula Dorsal scapula nerve Adduction Medial rotation Medial border of scapula Elevation Medial border of the Retraction & rotation scapula, at the level of the spine of scapula Medial border of the Retraction & rotation scapula, between the scapula spine & inferior angle Remark Region Surface Layer Muscle Cont' Intrinsic Shoulde (6) r (11) / Insertion Movement Deltoid lateral third of the clavicle, the acromion & the spine of the scapula Deltoid tuberosity of the humerus Rotator Cuff Muscles (SITS)Supraspinatus Rotator Cuff Muscles Infraspinatus Rotator Cuff Muscles - Teres Minor Rotator Cuff Muscles Subscapularis Teres Major supraspinous fossa of the scapula Superior facet of greater tubercle of humerus Anterior (clavicular) fibres: flexion & medial rotation Middle (acromial) fibres: the major abductor (takes over from the supraspinatus which abducts the first 15 deg) Posterior (spinal) fibres: extension & lateral rotation Abduction 0-15 deg Arm Suprascapular nerve aids in 15-90 degrees Lateral rotation Deltoid Arm Suprascapular nerve Biceps Brachii Long head: from the supraglenoid tubercle of the scapula Innervation infraspinous fossa of the scapula Middle facet of greater tubercle of humerus posterior surface of the scapula, adjacent to its lateral border Inferior facet of Greater tubercle of the humerus Lateral rotation Arm Axillary nerve subscapular fossa, on the costal surface of the scapula Lesser tubercle of humerus Medial rotation Arm Upper and lower subscapular nerves posterior surface of the inferior angle of the scapula Medial lip of the intertubercular groove of the humerus Radial tuberosity (both head) Adduction, extension Medial rotation shoulder Arm Lower subscapular nerves Supination Forearm Musculocutaneous nerve Elbow, shoulder shoulder Arm Musculocutaneous nerve Brachialis anterior surfaces of the distal half humeral shaft Ulnar tuberosity Elbow Musculocutaneous nerve, with contributions from the radial nerve Triceps brachii Long head: Infraglenoid tubercle of scapula converge onto one tendon Extension & insert into the olecranon of the ulna Elbow Radial nerve Upper Anterior / Arm (4) (BBC 3) Lateral head – humerus, superior to the radial groove Medial head: humerus, inferior to the radial groove Flexion Remark Axillary nerve Short head: from the coracoid process the fascia of the forearm Flexion of the scapula via the bicipital aponeurosis (both head) coracoid process of the scapula Passes through the axilla Flexion & attaches the medial side Weak adduction of the humeral shaft, at the level of the deltoid tubercle Coracobrachialis Cont' Posterior Upper / (1) Arm (4) Target bones/ body part Arm Origin Not involve in supination as insert to ulnar (radius to move when supination/ pronation) Region Surface Layer Muscle Pronator teres (PT) Median nerve Palmar aspect of base of Flexion ABduction metacarpals II and III Wrist Median nerve Flexor retinaculum of the wrist pisiform, hamate, palmar aspect of base of 5th metarcarpal Flexion Wrist Median nerve Flexion Wrist Ulnar nerve Insertion Movement Coronoid process of the ulna Laterally to the mid-shaft of the radius Pronation Flexor Carpi Radialis (FCR) Superfi Palmaris Longus cial (PFPF (PL) Flexor Carpi 4) Ulnaris (FCU) Target bones/ body part Forearm Origin Medial epicondyle of humerus (common flexor origin) olecranon & posterior border of ulnar Flexor digitorium Medial epicondyle of the humerus superficialis (FDS) (common flexor origin) Interm ediate Forearm Anterior (1) (19) (7) Superior half of anterior Radius Flexor digitorium profundus (FDP) Proximal three quarters of medioanterior surface of the ulnar & interosseous membrane Deep (punch ing muscle s 3) Flexor pollicis longus (FPL) anterior radius & surrounding interosseous membrane Innervation Adduction splits into four tendons at the wrist, travel through the carpal tunnel, attaches to Palmar aspect of middle phalanges of the medial four digits Flexion metacarpophalang Median nerve eal joints & proximal interphalangeal joints at the 4 fingers wrist splits into four tendons at the wrist, travel through the carpal tunnel, attaches to the distal phalanges of the medial four digits Only muscle that Flexion distal Ulnar nerve: medial interphalangeal half (acts on the little joints of the fingers and ring fingers) Flexion Palmar aspect of base of the distal phalanx of the thumb Flexion metacarpophalang Median nerve eal joints & wrist (anterior interosseous branch): the lateral half (acts on the middle & index fingers) interphalangeal Median nerve joint & (anterior metacarpophalang interosseous branch) eal joint of the thumb Remark distal quarter of anterior surface of the distal quarter of anterior ulnar surface of the radius Pronation Target bones/ body part Forearm Brachioradialis proximal two thirds of the lateral supracondylar ridge of humerus Distal end of the lateral radius, just before the radial styloid process Flexion Elbow Radial nerve Extensor Carpi Radialis Longus (ECRL) Lateral supracondylar ridge of humerus Tendons attach to dorsal aspects of base of 2nd & 3rd metacarpal bones Wrist Radial nerve Region Surface Layer Muscle Pronator Cont' quadratus (PQ) Cont' Deep Anterior (punch (7) ing 3) Extensor Carpi Superfi Radialis Brevis cial (ECRB) (Beer Extensor lift break Digitorum dance Communis muscle Cont' unless Forearm atrophi (19) ed 7) Posterior Extensor Digiti (12) Minimi (EDM) Extensor Carpi Ulnaris (ECU) Anconeus Supinator Abductor Pollicis Longus (APL) Deep (5) Extensor Pollicis Longus (EPL) Origin Insertion Movement Innervation Median nerve (anterior interosseous branch) Extension & ABduction Lateral epicondyle of humerus (common extensor origin) Splits into 4 tendon at the Extension distal part of forearm, inserts into Dorsal aspect of the extensor hood of medial 4 digits Extensor digitorum tendon, Extension into the extensor hood of the little finger Dorsal aspect of base of Extension Adduction 5th metacarpal Posterolateral part of Extension, stabilisation Abduction during pronation of olecranon of ulnar forearm Posterior surface of the Supination Posterior surface of the ulna radius Proximal halves of posterior surfaces Lateral side of the base of Abduction of the radius & ulna, and adjacent 1st metacarpal interosseous membrane Middle third of posterior surface of the Dorsal aspect of base of Extension ulna & interosseous membrane distal phalanx of the thumb interphalangeal Radial nerve (deep joints (PIP & DIP) branch) & metacarpophalang eal joint of medial 4 digits Wrist and little finger Radial nerve (deep branch) Wrist Radial nerve (deep branch) Radial nerve Elbow Ulna Forearm thumb Radial nerve (deep branch) Radial nerve (posterior interosseous branch) all joints of the Radial nerve thumb: (posterior carpometacarpal, interosseous branch) metacarpophalang eal & interphalangeal Remark Region Surface Layer Muscle Cont'-2 Cont' Cont' Forearm Posterior Deep (19) (12) (5) Origin Extensor Pollicis Brevis (EPB) Distal third of posterior surface of the Dorsal aspect of base of Radius & interosseous membrane proximal phalanx of the thumb Extensor Indicis Proprius Distal third of Posterior surface of ulnar and interosseous membrane Opponens Pollicis Thenar (One for all 3) Hand (11/ 15 if count inteross Hypothe / nar (All ei sepratel for one 3) y) Short muscles (7) Insertion Flexor Pollicis Brevis Abductor Pollicis Brevis Abductor Digiti Minimi Flexor Digiti Minimi Brevis Opponens Digiti Minimi Lumbricals (4) tendon of the flexor digitorum profundus (Lateral 2 as unipennate muscles Medial 2 as bipennate muscles) Target bones/ Innervation Remark body part Carpometacarpal Radial nerve & (posterior metacarpophalang interosseous branch) eal joints of the thumb Index finger Radial nerve (posterior interosseous branch) Opposition = medial rotation & flexion the metacarpal on the trapezium Thumb Flexion metacarpophalang eal (MCP) joint of Deep head: innervated by the the thumb deep branch of the ulnar nerve Abduction thumb Medial aspect of base of the proximal phalanx of the little finger Abduction Little finger Flexion metacarpophalang eal (MCP) joint of Ulnar nerve little finger Medial aspect of 5th metacarpal opposition = rotation of metacarpal towards palm Flexion Little finger Lateral aspect of base of Palmar aspects of flexor retinaculum the proximal phalanx of & tubercles of scaphoid and trapezium the thumb hook of hamate & adjacent flexor retinaculum Extension Extensor hood of the index Extension finger Lateral aspect of the metacarpal of the thumb pisiform and the tendon of the flexor carpi ulnaris Movement Posterolateral aspect of extensor expansion of 2nd-5th digits Extension Median nerve Median nerve metacarpophalang Median nerve - the eal (MCP) joint of lateral two lumbricals 2nd-5th digits (of the index and middle fingers) Interphalangeal Ulnar nerve - the joint of 2nd-5th medial two digits lumbricals (of the little and ring fingers) Region Surface Layer Muscle Dorsal interossei (4) Cont' Short muscles (7) Cont' Hand (11/ 15 if count inteross ei sepratel y) / Origin Insertion Movement lateral & medial surfaces of metacarpals (as bipennate muscles) Medial aspect of extensor Abduction (DAB) hood and proximal phalanx of each finger Palmar interossei lateral & medial surfaces of Extensor hood and Adduction (PAD) (3) metacarpals (as unipennate muscles) proximal phalanx of 2nd (medial), 4th(lateral). 5th(lateral) digits Palmaris Brevis palmar aponeurosis and flexor Dermis of the skin on the Wrinkles (1) retinaculum medial margin of the hand Deepens Other (2) Adductor Pollicis (1) Transverse head: palmar aspect of Medial side of proximal 3th Metacarpal phalanx of the thumb Oblique head: palmar aspect of Capitate & adjacent areas base of 2nd & 3rd metacarpals Adduction Target bones/ Innervation body part metacarpophalang Ulnar nerve eal (MCP) joint metacarpophalang Ulnar nerve eal (MCP) joint the skin of the hypothenar eminence the curvature of the hand, improving grip thumb Ulnar nerve Ulnar nerve Remark Joints Location Articulating surface Joint cavity Joint capsule Ligaments Plane synovial joint Intrinsic: Acromioclavicular ligament – runs horizontally from the acromion to the lateral clavicle covers the joint capsule, reinforcing its superior aspect Movements Vasculature supply 1. Allows a degree of axial rotation 2. Anteroposterior movement Suprascapular Articular artery – arises branches of the from the subclavian artery suprascapular at the nerve thyrocervical trunk Extrinsic: Coracoclavicular ligament – collectively the conoid & trapezoid ligaments lined internally by a synovial membrane secretes synovial fluid into the cavity of the very strong structure, effectively joint suspending the weight of the upper limb from the clavicle Lateral end Acromi of the oclavic clavicle lined with ular articulates fibrocartilage (AC) with Joints Acromion of the scapula partially divided by an articular disc - a wedge of consists of a loose fibrocartilage suspended fibrous layer which from the upper part of encloses the two the capsule articular surfaces posterior aspect of the joint capsule is reinforced by fibres from the trapezius muscle Conoid ligament – runs vertically from the coracoid process of the scapula to the conoid tubercle of the clavicle Thoracoacromial artery – arises from the axillary artery Lateral pectoral nerves - both arise directly from the brachial plexus As no muscles act directly on the joint, all movement is passive, and is initiated by movement at other joints Veins of the joint follow the major arteries Trapezoid ligament – runs from the coracoid process of scapula to the trapezoid line of the clavicle Nerve supply Joint Articulating Location s surface Joint cavity lined with fibrocartilage the clavicle & the manubriu m of the Stern sternum, oclavi partially the only consists of cular divided by an the sternal connecti (SC) articular disc end of the on Joint clavicle, the between manubrium of the the sternum & upper limb & the part of the 1st costal axial skeleton cartilage Joint capsule Ligaments saddle synovial joint Sternoclavicular ligaments (anterior and posterior) strengthen the joint capsule anteriorly & posteriorly Movements Interclavicular ligamentspans the gap between the sternal ends of each clavicle Triaxial: & reinforces the joint capsule Elevation consists of a Depression fibrous outer layer superiorly Protraction & inner Retraction synovial membrane - produces synovial Costoclavicular ligament- Rotation (posterior) bind at the 1st rib & cartilage fluid inferiorly & to the anterior & to reduce friction posterior borders of the between the clavicle superiorly articulating structures a very strong ligament & is the main stabilising force for the joint, resisting elevation of the pectoral girdle Vasculature supply Nerve supply medial supraclavicul Internal thoracic ar artery nerve (C3, C4) suprascapular artery nerve to subclavius (C5, C6) Joints Location Articulating surface Bursae covered with hyaline cartilage synovial membrane synovial fluid filled sac produces synovial fluid acts as a cushion between to reduce tendons & other joint friction between the structures, reduce friction articular surfaces head of the humerus is much larger than the glenoid fossa, giving the joint a wide range of movement at the cost of inherent instability Subacromial bursa– located deep to the deltoid & acromion, & superficial to supraspinatus tendon & joint capsule, promoting free motion of the rotator cuff tendons Joint capsule Ligaments To reduce the disproportion in surfaces, the glenoid fossa is deepened by a fibrocartilage rim, called the glenoid labrum Subscapular bursa– located between the subscapularis tendon & the scapula, reduces wear & tear on the tendon during joint movement Vasculature supply Nerve supply Glenohumeral ligaments (superior, middle and inferior) – Extension – joint capsule is formed by these posterior deltoid ligaments connecting humerus to latissimus dorsi glenoid fossa teres major Act to stabilise the anterior aspect of the joint anterior & posterior circumflex humeral Axillary arteries nerves - branches of the axillary artery Flexion – pectoralis major anterior deltoid coracobrachialis (biceps brachii weakly assists in Supports the superior part of the joint forward flexion) branches of suprascapular suprascapular artery nerves Coracohumeral ligament – attaches the base of the coracoid process to the greater tubercle of humerus Transverse humeral ligament – spans the distance between the two tubercles of humerus the scapula & the Glenoh humerus, umeral major joint (GH) connecting Joint the upper limb to the trunk Movements Holds the tendon of the long head of extends from the the biceps in the intertubercular anatomical neck of the sulcus humerus to the border or ‘rim’ of the glenoid fossa lax, permitting greater Coracoclavicular ligament composed of the trapezoid & mobility conoid ligaments & runs from the clavicle to coracoid process of the scapula Adduction – pectoralis major latissimus dorsi teres major Abduction first 0-15 degrees - produced by the supraspinatus 15-90 degrees -middle fibres of the a branch of the deltoid thyrocervical trunk past 90 degrees - the scapula Maintain the alignment of the clavicle needs to be rotated to achieve in relation to the scapula abduction - by the trapezius and serratus anterior Coracoacromial ligament running between the acromion & coracoid process of scapula, forms the coraco-acromial arch, preventing superior displacement of humeral head Internal rotation – subscapularis, pectoralis major, latissimus dorsi, teres major & anterior deltoid External rotation – infraspinatus & Stability at the expense of space, narrowing space for supraspinatus & teres minor Biceps long head tendon lateral pectoral nerves Joints Location Elbow Joint Articulating surface Bursae Joint capsule Ligaments Movements Trochlear notch of the ulna & trochlea of the humerus Intratendinous – located within the tendon Hinge-type synovial joint of the triceps brachii Head of the radius & the capitulum of the humerus Subtendinous – between the olecranon & the tendon thickened medially & of the triceps brachii laterally to form collateral ligaments stabilise the flexing Subcutaneous and extending motion (olecranon) bursa – of the arm between the olecranon & the overlying connective tissue Ulnar collateral ligament - from the medial epicondyle & attaches to the coronoid process & olecranon of the ulna Bursae Ligaments Movements Annular radial ligament Movement is produced by head of the radius rotating within the annular ligament / Joints Location Articulating surface near the elbow, Proxim articulation Radial head is al between the held in place by radioul head of annular nar the radius & radial ligament joint the radial notch of the ulna Distal radioul near the nar wrist joint ulnar notch of the radius & the ulnar head Joint capsule / pivot synovial joint Vasculature supply Radial collateral ligament Extension – on the lateral side of the joint, triceps brachii extending from the lateral epicondyle & blending with anconeus the annular ligament of the radius median nerve Arterial supply from the cubital Flexion – anastomosis brachialis includes recurrent musculocutane biceps brachii ous nerve and collateral brachioradialis branches from the brachial & deep brachial arteries Pronation & supination do not radial nerves occur at the elbow – anteriorly & the they are produced at the nearby ulnar nerve radioulnar joints posteriorly Pronation: pronator quadratus & Forms a ‘collar’ around the joint, lined with a synovial membrane, pronator teres reducing friction during movement Supination: supinator & biceps brachii / Nerve supply Movement occur in Proximal radioulnar joint, Distal only passively moved, and mainly ONLY Radius do the movement Anconeus - Abduct ulna a bit when pronation Vasculature supply / Nerve supply / Joint Location s Wrist Joints Articulating surface Bursae Joint capsule Ligaments Movements Distally – proximal row of the carpal bones (except the pisiform) Palmar radiocarpal – ellipsoidal palmar side of the (condyloid) hand, passes from the radius to Flexion – flexor carpi ulnaris, flexor carpi radialis, with both rows of carpal bones, synovial joint, assistance from the flexor allowing for movement along two increasing stability, ensure the digitorum superficialis hand follows the forearm during axes supination Proximally – distal end of the radius & the articular disk fibrous outer layer attaches to the radius, ulna & the proximal row of the carpal bones / Dorsal radiocarpal – dorsum side of the Extension – extensor carpi hand, passes from the radius to radialis longus & brevis & both rows of carpal bones. extensor carpi ulnaris, with assistance from extensor increasing stability, ensure the digitorum hand follows the forearm during pronation / Ulnar collateral – from the ulnar styloid process to the triquetrum and pisiform Together, the carpal bones form a convex surface articulates with the concave surface of the radius & articular disk Works in union with the other collateral ligament to prevent synovial membrane, excessive lateral joint displacement secreting synovial fluid which lubricates the joint Radial collateral – from the radial styloid process to the scaphoid and trapezium, works in union with the other collateral ligament to prevent excessive lateral joint displacement Adduction – extensor carpi ulnaris & flexor carpi ulnaris Vasculature supply Nerve supply Median nerve – Anterior interosseous branch branches of dorsal and palmar carpal arches, which are derived from the ulnar and radial arteries Radial nerve – Posterior interosseous branch Ulnar nerve – deep and dorsal branches Abduction – abductor pollicis longus, flexor carpi radialis, extensor carpi radialis longus & brevis Nerve Root Trunk Brachial C5-6: plexusC5, C6, C7Superior Musculocutan C7: Middle eous Nerve Division Cord Branch Anterior Musculoc utaneous Lateral Motor function Brachialis Biceps brachii Coracobrachialis Teres minor Brachial C5, C6 PlexusAxillary Nerve Brachial C6 – T1 PlexusMedian Nerve Brachial PlexusUlnar Nerve C8, T1 Brachial C5 – T1 PlexusRadial Nerve Superior Posterior Posterior Axillary Deltoid muscles C6: Superior C7: Middle Anterior C8-T1: Inferior Inferior C5-C6: Superior C7: Middle C8-T1: Inferior Anterior C5-C7: Lateral C8-T1: Medial Median Ulnar Palmar cutaneous branch - lateral part of the palm Thenar muscles Digital cutaneous branch lateral 3.5 fingers on the palmar surface of the hand Muscles of the hand (apart from the thenar muscles and two lateral lumbricals) Flexor carpi ulnaris Medial half of flexor digitorum profundus Triceps brachii Posterior Posterior Radial Superior lateral cutaneous nerve of arm inferior region of the deltoid Most of the flexor muscles in the forearm Two lateral lumbricals associated with the index & middle fingers Medial Sensory function Lateral cutaneous branch of the forearm - lateral half of the anterior forearm & a small lateral portion of the posterior forearm Anterior & posterior surfaces of medial 1.5 fingers & associated palm area Posterior aspect of the arm & forearm Muscles in the posterior Posterolateral aspect of compartment of the hand the forearm Brachial Plexus-Apart from the five major branches of the brachial plexus, smaller nerves arise. They do so from all five parts of the brachial plexus. Nerve Root Dorsal scapular nerve / Long thoracic nerve Trunk Division Cord Suprascapula Lateral cord: r nerve Lateral pectoral nerve / Nerve to subclavius Medial cord: - Medial pectoral nerve - Medial cutaneous nerve of arm - Medial cutaneous nerve of forearm Posterior cord: - Superior subscapular nerve - Thoracodorsal nerve - Inferior subscapular nerve Branch / Region Part Layer Muscle Origin Insertion Movement Target bones/ body part Gluteus Maximus (main hip extensor) Superficial (tight Abductors and extenders) (4) Gluteal (9) / Gluteal surface of illium-posterior to Gluteal tuberosity of femur Extension posterior gluteal line Dorsal surface of sacrum & Coccyx Iliotibial tract-insert into lateral condyle of Lateral rotation tibia Gluteus Medius gluteal surface of the ilium btw Lateral surface of greater trochanter of ABduction & medial anterior and posterior gluteal lines femur Gluteus Minimus gluteal surface of the ilium btw Anterior surface of greater trochanter of rotation anterior and inferior gluteal lines femur During locomotion, it Tensor Fascia Lata anterior superior iliac spine (ASIS) at the junction of the middle and upper secures the pelvis, (IFL) third of the thigh, it inserts into the Anterior iliac crest anterior aspect of the Iliotibial tract-insert preventing pelvic drop of the opposite limb into lateral condyle of tibia Inferior gluteal nerve thigh Superior gluteal nerve makes muscle contraction more efficient in compressing deep veins, which ensures adequate venous return to the heart from the lower limbs a longitudinal thickening of the Movement – acts as an Compartmentalisation Muscular sheath – fascia lata, which is strengthened extensor, abductor & lateral rotator of – the deepest aspect of forms a sheath superoposteriorly ITT extends centrally to around the the hip, with an additional role by fibres from the gluteus maximus in providing lateral stabilisation to the form the lateral tensor fascia lata intermuscular septum of muscle knee joint located laterally in the thigh, the thigh & attaches to extending from the iliac tubercle to the femur the lateral tibial condyle tautens the iliotibial band and contraction within each compartment braces the knee, especially when centralises muscle weight and limits the opposite foot is lifted. outward expansion, when the fascia lata is pulled taut, it which in turn reduces forces muscles in the anterior & the overall force required for movement posterior compartments closer to at the hip joint towards the femur Iliotibial Tract (ITT) Related structures Piriformis Deep (Abductor, Lateral rotator) (5) Innervation anterior surface of the sacrum. Travels infero-laterally, through the greater sciatic foramen Obturator Internus Pubis & ischium at the obturator foramen. It travels through the lesser sciatic foramen Superior Gemellus Ischial spine Inferior Gemellus Ischial tuberosity Quadratus Femoris lateral border of ischial tuberosity Superior border of greater trochanter of femur Medial surface of greater trochanter of femur Quadrate tubercule on the intertrochanteric crest nerve to piriformis Lateral rotation; Abduction Lateral rotateExtended thigh nerve to obturator ABduct-Flexed thigh internus Lateral rotation Thigh nerve to quadratus femoris Region Surface Thigh (15) Anterior (knee extensor) (7) Layer Muscle Origin Insertion Movement Iliopsoas (main hip flexor) Psoas majorT12-L5 vertebrae; transverse process of all lumbar vertebrae Lesser trochanter of femur Flexion / Pectineus Sartorius (踢毽) Cont' Anterior (knee extensor) (7) Cont' Thigh (15) / pectineal line on the posterior side of the Adduction femur, just inferior to the lesser Flexion trochanter Anterior superior iliac spine (ASIS) Superior part of medial surface of tibia Quadriceps Femoris Anterior inferior iliac spine (AIIS) (main knee Ilium superior to acetabulum extensor) - Rectus Femoris Only quadriceps muscle across hip and knee joints Quadriceps Femoris intertrochanteric line and medial lip the patella via the quadriceps tendon - Vastus Medialis of the linea aspera 向內扯，確保Patella不向外移位 Quadriceps Femoris anterior & lateral surfaces of the - Vastus Intermedius femoral shaft Quadriceps Femoris-Vastus Lateralis Adductor Magnus Medial (thigh adductor) (5) iliacusiliac crest, illiac fossa of the pelvis Pectineal line on the anterior surface of the pelvis hip joint Innervation Psoas major anterior rami of L1-3 Iliacus - femoral nerve Femoral nerve may also receive a branch from the obturator nerve knee joint Knee thigh Femoral nerve Extension; Stabilisation knee; Patella Adductor part: flexion Hamstring part: extension both adduction thigh in hip joint Adductor part: obturator nerve thigh Hamstring part: tibial part of sciatic nerve Pectineal line and proximal part of linea aspera of femur Middle third of linea aspera of femur superior part of medial surface of tibia Adduction thigh leg posterior aspect of greater trochanter Flexion adduction Lateral rotation greater trochanter and the lateral lip of linea aspera adductor part: inferior pibic ramus adductor part: linea aspera of the femur & ramus of ischial ramus hamstring part: the ischial tuberosity hamstring part: the adductor tubercle & medial supracondylar line of the femur Adductor Brevis Pubic body & inferior Pubic ramus Adductor Longus Gracilis Pubic body inferior to pubic crest Pubic body & inferior Pubic ramus Obturator Externus Flexion, ABduction, lateral rotation Flexion Extension Flexion Target bones/ body part thigh in hip joint Margins of obturator foramen of pubis, obturator membrane oburator nerve Thigh Regio Surface n Layer Muscle Origin Insertion Biceps Femoris Long head: form a tendon, which ischial tuberosity of the pelvis inserts into the lateral head of the fibula Short head: linea aspera & lateral supracondylar line of femur Posterior (thigh Cont' 2 extensor & Thigh knee (15) flexor) (3) Semimembrano sus Semitendinosus / Leg (13) Anterior (Dorsiflexo r& toe extensor) (4) Lateral (foot plantarflex or) (2) extension Flexion Lateral rotation when flexed knee posterior part medial tibial condyle Ischial tuberosity Movement Superior part of medial surface of tibia Tibialis Anterior Lateral condyle & superior Inferomedial aspect of medial half of lateral surface of tibia cuneiform bone Extension Flexion Medial rotation when flexed Extension Flexion Medial rotation when flexed dorsiflexion Target bones/ Innervation body part thigh at hip joint long head: tibial part of the sciatic nerve leg short head: common fibular part of the sciatic nerve thigh leg thigh leg Ankle inversion Foot Extension lateral 4 toes Fibularis Tertius Inferior third of medial surface of fibula plantar aspect of base of 1st metatarsal bone dorsal aspect of Middle and distal phalanges of 4 lateral digits dorsal aspect of base of the distal phalanx of the great toe (Hallux) Dorsal aspect of base of 5th metatarsal Fibularis Longus head and superior 2/3 of lateral surface of fibula Fibularis Brevis inferolateral surface of the fibula Extensor Lateral condyle of tibia & Digitorum medial surface of the fibula Longus Extensor medial surface of the fibula Hallucis Longus tibial part of sciatic nerve dorsiflexion Extension Ankle Hallux dorsiflexion Ankle dorsiflexion eversion Foot plantar aspect of Base of 1st metatarsal & medial cuneiform Plantarflexion eversion Support Ankle Foot transverse & lateral arches tuberosity on lateral surface of 5th metatarsal Eversion foot deep fibular nerve Superficial fibula (peroneal) nerve Regio Surface n Layer Muscle Origin Gastrocnemius lateral head: lateral aspect of lateral femoral condyle Plantarflexion Target bones/ body part Ankle medial head: medial femoral condyle Flexion knee the soleal line of the tibia & Posterior surface of calcaneus superior quarter of posterior via calcaneal tendon surface of fibula Inferior end of lateral supracondylar line of femur Plantarflexion Ankle weak aids in Plantarflexion Ankle Superficial Soleus (3) Plantaris Insertion Movement Innervation weak aids in Flexion knee Cont' Leg (13) Popliteus Posterior (foot & toe Flexor) (7) Flexor Hallucis Longus Deep (4) lateral surface of lateral condyle of the femur & the posterior horn of the lateral meniscus posterior surface of tibia, superior to soleal line Inferior 2/3 of posterior surface of fibula plantar surface of distal phalanx Flexion of the hallux Hallux plantar surfaces of distal phalanges of lateral four digits Flexion lateral 4 toes Tuberosity of navicular bone Plantarflexion Ankle plantar aspects of 3 cuneiform bones inversion foot Flexor Digitorum Medial part of posterior Longus surface of tibia inferior to solea line Tibialis Posterior interosseous membrane between the tibia & fibula, & posterior surfaces of the two bones Femur will medial rotate when extend, need to lateral rotate a bit to unlock and flex plantar aspects of the bases of the 2nd-4th metatarsal bones ‘unlocking’ the knee Femur joint so that flexion can occur by allow lateral rotation of femur on fixed tibia Tibial nerve Regio Surface n Layer Dorsal aspect (aid digit / extensor) (2) Muscle Origin Extensor Digitorum Brevis Dorsal aspect of proximal phalanx of the great toe & the long Calcaneus, the interosseous extensor tendons of toes 2-4 talocalcaneal ligament & the inferior extensor retinaculum Dorsal aspect of base of proximal phalanx of hallux Extensor Hallucis Brevis Abductor Hallucis 1st layer (3) Foot (12) 2nd layer (2) medial side of base of the proximal phalanx of hallux Flexor Digitorum plantar aspect of middle medial tubercle of calcaneus phalanges of the lateral four Brevis & plantar aponeurosis digits Abductor Digiti Minimi Plantar aspect (10) flexor retinaculum Insertion Movement aids the extensor digitorum longus in extension Target bones/ Innervation body part medial four toes at the metatarsophala ngeal & interphalangeal Deep fibula nerve joints aids the extensor hallcis longus in extension ABduction Flexion Hallux at the metatarsophala ngeal joint Hallux Flexion lateral 4 digits at Medial plantar nerve the proximal interphalangeal joints little toe lateral side of base of the ABduction lateral tubercles of calcaneus proximal phalanx of the 5th digit Flexion Quadratus Plantae medial & lateral plantar surface of the calcaneus tendons of flexor digitorum longus Aids flexor digitorum lateral 4 digits longus in flexion Lumbricals (4) tendons of flexor digitorum longus Meidal aspect of extensor hoods Flexion of the lateral 4 digits Extension Lateral plantar nerve at the Medial one: metatarsophala medial plantar ngeal joints of nerve lateral 4 digits interphalangeal Lateral three: joints of lateral 4 lateral plantar digits nerve Regio Surface n Layer Origin Insertion Movement Flexor Hallucis Brevis plantar surfaces of the cuboid & lateral cuneiforms both sides of base of the proximal phalanx of hallux Flexion Adductor Hallucis oblique head: the bases of the 2nd, 3rd & 4th metatarsals lateral side of base of the proximal phalanx of hallux Adduction hallux aids in forming the transverse arch of the foot 3rd layer (3) Cont' Foot (12) Cont' Plantar aspect (10) 4th layer (2) Target bones/ Innervation body part proximal Medial plantar phalanx of the nerve great toe at the metatarsophala ngeal joint Muscle transverse head: plantar ligaments of the metatarsophalangeal joints Deep branch of lateral plantar nerve Flexor Digiti Minimi Brevis base of the 5th metatarsal Plantar aspect of base of the Flexion proximal phalanx of the 5th digit proximal phalanx of the little toe Plantar Interossei (3 muscles) Plantar aspects of medial side of metatarsals 3rd-5th shafts medial side of bases of 3rd-5th proximal phalanges Adduction 3rd-5th metatarsalphala ngeal joints Dorsal Interossei (4 muscles) Adjacent sides btw shafts of 1st: medial side of base of the metatarsal 1st-5th proximal phalanx of the 2nd digit 2nd-4th: lateral sides of base of the proximal phalanxes of 2nd4th digits Flexion 2nd-4th Lateral plantar metatarsalphala nerve ngeal joints ABduction Superficial branch of lateral plantar nerve Joints Articulating surface Joint capsule ball & socket synovial joint between the head of femur & acetabulum of the pelvis Hip Joint - its cavity is deepened by the presence of a fibrocartilaginous collaracetabular labrum enclosed by a joint capsule Nerve supply Movements Intra-capsular: Ligament of head of femur - relatively small structure, which runs from the acetabular fossa to the fovea of the femur Medial & lateral Degree to which flexion at the hip circumflex can occur depends on whether the Primary function of the femoral arteries hip joint - weight-bear - branches of knee is flexed – Innervated the profunda relaxes Stabilising Factors: femoris artery primarily the hamstring muscles & (deep femoral by the increases the range of flexion artery) 1. Acetabulum – sciatic, deep & encompasses femoral & nearly all of the femoral - anastomose obturator at the base of nerves head the femoral decreases the probability of the head neck to form same a ring, from slipping out of the nerves which smaller Extension at the hip joint is limited acetabulum innervate arteries arise to by the joint capsule & the (dislocation) the supply the hip Extra-capsular: iliofemoral ligament - become knee, joint itself 1. Iliofemoral ligament taut during extension to limit 2. Acetabular labrum which Arises from anterior inferior further movement a horseshoe shaped explains Medial iliac spine (AIIS) & Bifurates fibrocartilaginous ring why pain circumflex before inserting into the around the acetabulum femoral artery can be femoral intertrochanteric which - majority of the referred to line increases its depth arterial supply the knee the increase in depth from the -Y shaped appearance & Lateral provides a larger hip and prevent hyperextension of circumflex articular surface, vice versa hip joint iliopsoas femoral artery further improving the rectus femoris - penetrate Flexion stability of the joint The strongest of 3 sartorius through the ligaments pectineus thick iliofemoral - encloses a branch of the obturator artery (artery to head of femur), a minor source of arterial supply to the hip joint Acetabulum - a cup-like depression located on the inferolateral aspect of the pelvis Head of femurhemispherical & fits completely into the concavity of the acetabulum Function Vasculature supply Ligaments ligament Joints Articulating surface Both the acetabulum & head of femur are Hip covered in articular Joint (Con't) cartilage, which is thicker at the places of weight bearing Joint capsule / Ligaments Movements Function Vasculature supply Nerve supply gluteus maximus, Extensio semimembranosus, Extra-capsular: n semitendinosus & biceps femoris 2. Pubofemoral ligament - spans between the Damage to Stabilising Factors: superior pubic rami & the the medial femoral intertrochanteric circumflex line, reinforcing the adductors longus, brevis 3. iliofemoral, Adductio femoral capsule anteroinferiorly & magnus, pectineus & pubofemoral and n artery ischiofemoral gracilis ligaments can result in - a triangular shape & very strong - along with avascular prevents excessive the thickened abduction & extension necrosis joint capsule, provide a (AVN) of the (和ilio位置重疊但Pubo由 gluteus medius, gluteus large degree of stability femoral head 更medial開始-prevent Abductio minimus, piriformis & see above n aBduct) tensor fascia lata Artery to a unique spiral head of 3. Ischiofemoral orientation causing femur & the ligament them to become tighter biceps femoris, gluteus - spans between the body superior/infer when the joint is maximus, piriformis, Lateral of the ischium & the ior extended assisted by the rotation greater trochanter of the gluteal obturators, gemilli & femur, reinforcing the 4. Muscles & arteries quadratus femoris capsule posteriorly ligamentsprovide some work in a reciprocal additional - a spiral orientation & fashion at the hip joint supply prevents anterior fibres of gluteus hyperextension & holds Medial medius & minimus, the femoral head in the rotation tensor fascia lata acetabulum Joints Articulating surface Bursae 1. Suprapatellar bursa – an extension of the Consists of two articulations synovial cavity of the knee, – tibiofemoral & located between the patellofemoral quadriceps Joint surfaces are lined with femoris & the femur hyaline cartilage & are enclosed within a single joint cavity Knee Joint Joint capsule Ligaments Movements A hinge type synovial joint, which mainly allows for flexion and extension 1. Patellar ligament – a continuation of the quadriceps femoris tendon distal to the patella - attaches to the tibial tuberosity hamstrings, gracilis, Flexion sartorius & popliteus Menisci 2. Collateral ligaments – 2. Prepatellar bursa 1. Fibrocartilage two strap-like ligaments Tibiofemoral – – found between the structures act to stabilise the hinge motion Extensi quadriceps medial & lateral Femoral apex of the of the knee, preventing on femoris condyles articulate with tibial patella & the skin 2. To deepen the excessive medial or lateral condyles articular surface of the movement 3. Infrapatellar tibia, increase stability of weight-bearing component bursa – deep bursa the joint 2.1. Medial collateral ligament of knee joint lies between the tibia – & 3. To act as shock wide & flat ligament, found on **Tibial Medial condyle is the patella ligament; absorbers by increasing the medial side of the joint. larger, allow weight bearing surface area to further and medial rotate of femur superficial bursa dissipate forces Proximally: to the medial Lateral biceps when extend leg lies between the epicondyle of the femur rotation femoris patella ligament & 4. C shaped and the skin attached at both ends to Distally: attaches to the medial the intercondylar area of condyle of the tibia the tibia Vasculature supply Nerve supply Genicular anastomoses around the the knee femoral, tibial & supplied by common the genicular fibular branches of nerves the femoral & popliteal arteries Joint Articulating surface s Patellofemoral – anterior aspect of the distal femur articulates with the patella allows tendon of the quadriceps femoris to be inserted directly over knee increasing the efficiency of the muscle Bursae Joint capsule Ligaments Movements 2.2 Lateral collateral ligament – Medial meniscus is fixed thinner & rounder than the tibial collateral to the tibial collateral ligament & the Proximally: Lateral epicondyle of Medial the femur rotation joint capsule Distally: depression on the lateral surface of the fibular head Damage to the tibial Femoral lateral condyle has collateral ligament higher forward eminence to usually results in a avoid lateral dislocation of 4. medial meniscal tear patella Semimembranosus Vasculatur Nerve e supply supply semimembra nosus, semitendinos us, gracilis, sartorius & popliteus 3. Cruciate Ligaments – these two ligaments connect the femur & the tibia, cross each other bursa – 3.1 Anterior cruciate ligament – located posteriorly in Knee anterior intercondylar region of the the knee joint, tibia where it blends with the Joint between the medial meniscus (Con't) semimembranosus -->ascends to posteriorly to femur As the patella resides within muscle & the medial in the intercondylar fossa the quadriceps femoris P.S. Lateral and head of the Prevents anterior tendon, it provides a medial rotation can gastrocnemius dislocation of the tibia onto the femur fulcrum to increase power only occur when the of knee is flexed Lateral meniscus is 3.2 Posterior cruciate ligament (if the knee is not the knee extensor & smaller & does not have – Posterior intercondylar region of flexed, the any extra attachments, the tibia & serves as a stabilising medial/lateral rotation ascends anteriorly to the rendering it fairly structure that reduces occurs at the hip anteromedial mobile frictional forces placed on joint) femoral condyle. Prevents femoral condyles posterior dislocation of the tibia onto the femur see above see above Joint Articulating surface s Articulation between the head of the fibula & the lateral condyle of the tibia Joint capsule Ligaments A plane type synovial joint; where the bones to glide over one another to create movement Joint capsule receives additional support from: Proxi mal Tibiofi bular Capsule Support: Joint Articular surfaces of the proximal tibiofibular joint Biceps femoris – are lined with hyaline cartilage & contained within provides reinforcement a joint capsule as it inserts onto the fibular head articulation between the fibular notch of the distal tibia & the fibula Distal An example of a fibrous joint, where the joint Tibiofi surfaces are bular bound by tough, fibrous tissue Joint Interosseous membrane – a fibrous structure spanning the length of the tibia & fibula Anterior & posterior superior tibiofibular ligaments – span between the fibular head & lateral tibial condyle Vasculature supply 1. Inferior genicular arteries 2. Anterior tibial recurrent arteries Lateral collateral ligament of the knee joint Anterior & posterior inferior tibiofibular ligaments As it is a fibrous joint, the distal tibiofibular joint does not have a joint capsule Inferior transverse (only synovial joints tibiofibular ligament – have a joint capsule) a continuation of the posterior inferior tibiofibular ligament Nerve supply branches of the common fibular nerve the nerve to the popliteus (a branch of the tibial nerve) Branches of the fibular artery the anterior and posterior tibial arteries derived from the deep peroneal and tibial nerves Joint Articulating surface s Tibia & fibula are bound together by strong tibiofibular ligaments --> Together, they form a bracket shaped socket, covered in hyaline cartilage - this socket is known as a mortise Joint capsule Ligaments Medial Ligament (or deltoid ligament) Consists of four ligaments - fan out from the malleolus 1. Posterior tibiotalar ligament 2. Anterior tibiotalar ligament 3. Tibiocalcaneal ligament 4. Tibionavicular ligament Resist over-eversion of the foot Body of the talus fits snugly into the mortise formed by the bones of the leg Ankle Joint Articulating part of the talus is wedge shaped – it is broad anteriorly & narrow posteriorly Dorsiflexion – anterior part of the talus is held in the mortise & the joint is more stable Plantarflexion – posterior part of the talus is held in the mortise & the joint is less stable Lateral ligaments A hinge type synovial Originates from the lateral malleolus (distal fibula) joint, permitting dorsiflexion & plantarflexion of the foot Comprised of three distinct & separate ligaments: 1. Anterior talofibular – spans between the lateral malleolus & lateral aspect of the talus 2. Posterior talofibular – spans between the lateral malleolus & the posterior aspect of the talus 3. Calcaneofibular – spans between the lateral malleolus & the calcaneus Resists over-inversion of the foot Joint Articulating surface s Surfaces are covered by articular cartilage Subtal ar Joint Inferior surface of the body of the talus – the posterior talar articular surface Superior surface of the calcaneus – the posterior calcaneal articular facet Joint capsule Ligaments Capsule support: 1. Posterior talocalcaneal ligament A plane synovial joint 2. Medial talocalcaneal ligament 3. Lateral talocalcaneal ligament enclosed by a joint capsule Movements Vasculatur Nerve supply e supply The subtalar joint is formed on an oblique axis --> the chief site within the foot for generation of eversion and inversion movements posterior tibial arteries Capsule stability Intra-capsular 4. Interosseous talocalcaneal ligament acts to bind the talus & calcaneus together Produced by the muscles of the lateral compartment of the leg fibular lies within the sinus tarsi (a small & tibialis anterior muscle arteries cavity between the talus & respectively calcaneus) particularly strong - providing the majority of the ligamentous stability to the joint Plantar aspect of the joint medial or lateral plantar nerve Dorsal aspect of the joint - deep fibular nerve Lower Limb – Nerves Plexus Formed by anterior rami of the lumbar Lumbar Plexus spinal nerves L1, L2, L3 & L4 Receives contribution Combine together to form Peripheral nerves arised thoracic spinal nerve, T12 the six major peripheral nerves of the lumbar plexus Illiohypogatric N (L1) Illioinguinal N (L1) Genitofemoral N (L1-2) Lateral cutaneious nerve of thigh (L2-L3) Femoral N (L2-L4) Obturator N (L2-L4) Superior gluteal Inferior gluteal Sciatic nerve-fibular portion & tibial portion Posterior femoral Pudendal Sacral Plexus anterior rami of the sacral spinal nerves S1, S2, S3 & S4 lumbar spinal nerves L4 & L5 the five major peripheral nerves of the sacral plexus Nerve Root Motor function Sensory function Anterior thigh muscles that flex the hip joint (pectineus, iliacus, sartorius) Anterior cutaneous branchesanteromedial thigh extend the knee (quadriceps femoris: rectus femoris, vastus lateralis, vastus medialis & vastus intermedius) Saphenous nerve medial side of the leg & foot Muscles of the medial compartment of the thigh (obturator externus, adductor longus, adductor brevis, adductor magnus & gracilis) Cutaneous branches - skin of the medial thigh Muscles of the posterior thigh (biceps femoris, semimembranosus & semitendinosus) No direct sensory functions Femoral Nerve Obturator Nerve Sciatic Nerve Lumbar plexus L2-L4 Lumbar plexus L2-L4 Sacral plexus L4-S3 Hamstring portion of the adductor magnus (remaining portion of which is supplied by the obturator nerve) Indirectly innervates (via its terminal branches) all the muscles of the leg & foot Indirectly innervates (via its terminal branches) the skin of the lateral leg, heel, dorsal & plantar surfaces of the foot Posterior compartment of the leg & the majority of the intrinsic foot muscles Tibial Nerve L4-S3 Gastrocnemius Soleus Plantaris Popliteus Flexor Hallucis Longus Flexor Digitorum Longus Tibialis Posterior Skin of the posterolateral leg, lateral foot & plantar surface of the foot Short head of the biceps femoris directly Common Fibular Nerve Superficial Fibular Nerve L4–S2 Also supplies (via branches) the muscles in the lateral & anterior compartments of the leg Muscles in the lateral compartment of the leg L4-S1 Fibularis Longus Fibularis Brevis Skin of the lateral leg & the dorsum of the foot Majority of the skin over the dorsum of the foot, apart from the webbing between the hallux & the second digit Anterolateral aspect of the inferior third of the leg Muscles in the anterior compartment of the leg, as well as some of the intrinsic muscles of the foot Deep Fibular Nerve L4-S1 Tibialis Anterior Extensor Digitorum Longus Extensor Hallucis Longus Fibularis Tertius Extensor Digitorum Brevis Extensor Hallucis Brevis Supplies the triangular region of skin between the 1st & 2nd toes Region Part Muscle Origin Orbicularis oculi Movement Innervation 1. Skin of orbital 1. Medial orbital margin Margin 2. Lacrimal bone 2. Superior & inferior 3. Medial palpebral ligament tarsal plate Palpebral part: close eyelid gently Lacrimal part: involves in drainage of tears Orbital part: close eyelid tightly Facial nerve (temporal and zygomatic branches) Corrugator supercilii Superciliary arch, runs superolaterally skin of eyebrow draws the 2 eyebrows together, creating vertical wrinkles on the bridge of the nose Nasalis Both portions of muscles originated from maxilla Transverse part: an aponeurosis across the dorsum of the 2 parts work in opposition: nose Transverse part: compresses the nares Alar part: alar Alar part: open nares cartilage of the nasal skeleton Procerus Nasal bone Medial lower forehead Draws the eyebrows inferiorly to create the transverse wrinkles over the nose Depressor septi nasi Maxilla (above the medial incisor tooth) nasal septum Draws the nose inferiorly, open nares Orbicularis oris Maxilla and other cheek muscles Buccinator Maxilla and Mandible Orbital Nasal Head Oral Oralupper group Orallower group Head Middle scalene Posterior scalene Neck Skin and mucous membranes of the lips Runs inferomedially, blend with orbicularis oris, skin of the lips Levator labii Infraorbital margin (Maxilla Skin of upper lip superioris & Zygomatic) Levator anguli Canine fossa of maxilla Angle of mouth oris Zygomaticus Anterior aspect of zygomatic Blends with muscles minor bone of upper lip Zygomaticus Lateral aspect of zygomatic Angle of mouth major bone Risorius Parotid fascia Angle of mouth Depressor Middle portion of Olique line of mandible labii inferioris lower lip Depressor Anterolateral base of Angle of mouth aguli oris mandible Mentalis Incisive fossa of mandible Skin of chin Front belly of 1. skin of eyebrow Epicranial Occipitalfronta 2. muscles of forehead aponeurosis lis Occipital belly Supreme nuchal line of Epicranial of aponeurosis Occipitalfronta occipital bone lis Coronoid process & Temporalis Temporal fossa and fascia ramus of mandible Auricularis Cranial surface of Epicranial aponeurosis superior auricle Anterior scalene Neck Insertion Purses the lips Pulls the cheek inward against the teeth, prevent accumulation of food in that area Elevate, evert upper lip Facial nerve Elevates the angle of mouth Elevates the upper lip Elevates the angle of mouth Pull the angle of mouth laterally Depress, evert the lower lip Depress the angle of mouth Elevates, protrudes lower lips Elevates the eyebrows, wrinkles the skin of forehead Draws scalp backward Elevate, retract mandible Elevates and retract auricle Ipsilateral contraction: ipsilateral lateral Scalene tubercule on flexion of the neck Anterior rami the inner border of Bilateral contraction: anterior flexion of C5-C6 1st rib the necl Elevation of the 1st rib Ipsilateral contraction: ipsilateral lateral Posterior tubercle of the Anterior rami Scalene tubercule flexion of the neck tranverse process of C2-C7 C3-C8 Elevation of the 1st rib Ipsilateral contraction: ipsilateral lateral Posterior tubercle of the Anterior rami 2nd rib flexion of the neck tranverse process of C5-C7 C6-C8 Elevation of the 2nd rib Anterior tubercle of the transverse process of C3C6 Unilateral contraction: cervical spine: ipsilateral lateral flexion, Contralateral Sternal head: Superior part Lateral surface of the neck rotation Accessory of the anterior surface of mastoid process of nerve manubrium sterni temporal bone Bilateral contraction: Alantooccipital Sternocleidom (branches of joint & superior cervical vertebrae: astoid muscle cervical Clavicular head: Superior Lateral half of the head and neck extension; lower plexus C2surface of the medial third of nuchal line of cervical vertebrae: neck flexion C3) clavicle occipital bone Elevation of the manubrium of sternum & clavicle Platysma Pectoral fascia Inferior border of mandible and adjacent muscles Tense skin of neck, depress mandible Facial nerve Sternohyoid Manubrium of sternum Hyoid bone Depress hyoid bone Cervical plexus C1-C3 Joints Joint type Articulating surface Joint capsule Ligaments/ soft tissue Function of ligament Movement Remark s / External: Periosteum, Sharpey's fibres, Frontalis Internal: Dura mater / Immovable / With Coronal suture =Frontal fontanelle Immovable With Lambdoid suture=Occipital fontanelle / With Sagittal Immovable suture=Occipital fontanelle Fibrous jointSynarthrosis Coronal Suture 1. Fuse completely Frontal bone, 2 parietal around age of bones 20 2. Joints of potential weakness Sagittal suture Fibrous jointSynarthrosis 2 parietal bones / External: Periosteum, Sharpey's fibres, Epicranial aponeurosis Internal: Dura mater Lambdoid suture Fibrous jointSynarthrosis Occipital bones, 2 parietal bones / External: Periosteum, Sharpey's fibres, Epicranial aponeurosis Internal: Dura mater Squamous suture Fibrous jointSynarthrosis Temporal, 2 parietal bones / Temporoparietal fasica, Temporal fascia, Temporalis / Lateral ligament Temporal bone: Hinge/Ginglym 1. Mandibular fossa oarthrodial 2. Articular tubercle Temporoma joint (both (squamous part of ndibular sliding and temporal) Joint (TMJ) hinge)Head of mandible Diathrosis Location: Articular tubercle to mandibular neck Articular Sphenomandibular Location: discs ligament Sphenoid spine to mandible (fibrocartila ge) dividing cavity into 2 Stylomandibular ligament Location: Styloid process of the temporal bone to the jaw angle With Sagittal suture=Frontal fontanelle With Coronal Immovable suture=Sphenoidal fontanelle 1. Thickening the joint capsule 2. Acts to prevent posterior dislocation Protrusion Limit excessive translation of the condylar process (mouth opening) 1.Posterior temporalis 2. Masseter Retraction 3. Geniohyoid 4. Digastric Elevation 1. Thickening of the fascia of parotid gland 2. limit excessive protrusion of the jaw Lateral pterygoid assisted by medial pteryhoid 1. Temporalis 2. Massester 3. Medial pterygoid 1. Gravity - mostly If resistance Depression 2. Digastric 3. Geniohyoid 4. Mylohyoid Joints Joint type Articulating surface Joint capsule Ligaments/ soft tissue Function of ligament Anterior margin of the foramen magnum to upper border of the anterior arch Anterior atlantoof the atlas occipital ligament Movements Flexion rectus capitis anterior continuation of the anterior longintudinal ligament Atlantooccipital joint Condyloid jointDiathrosis Occipital condyles, 2 superior articular facets of the atlas 2 articular capsules / Posterior margin of the foramen magnum to upper border of the posterior arch of Posterior atlantothe atlas occipital ligament Continuation from the Ligamentum Flavum Rectus capitis posterior, assisted by - Sternocleidomastoid Extension - obliqus capitis superior - semispinalis capitis - splenius capitis Rectus capitis lateralis, assisted by assisted by lateral - trapezius flexion & - sternocleidomastoid of Rotation the same side (conjunct) - semispinalis capitis - splenius capitis Joints Joint type Articulating surface Joint capsule Ligaments/ soft tissue Anterior atlantoaxial ligament Function of ligament connects the tubercle on the anterior arch of the atlas to the anterior arch of the axis continuation of the Anterior longitudinal ligament Posterior atlantoaxial ligament Movements / Lower border of the posterior arch of the atlas to the upper edges of the lamina of the axis continuation of the Ligamentum flavum Medial Pivot jointAtlanto-axial Diathrosis joint posterior surface of the anterior arch of atlas, the front of the odontoid process thick & loose capsule covered with hyaline cartilage Alar ligaments Location: side of the dens/odontoid process to occipital condyles Limit extension, axial rotation, lateral bending Rotation Location: very strong, primary 1. small tubercle on the medial Transverse stabiliser for the upper surface of the lateral mass of the Ligament of the cervical spine, prevent Atlas Atlas/ anterior displacement 2. Upward to occipital bone; cruciform ligament of the C1 (atlas) over 3. Downward to posterior C2 (axis) surface of the body of the Axis Lateral Plane jointAtlanto-axial Diathrosis joint inferior articular surface of lateral mass for atlas, superior articular facet of thick & axis loose capsule covered with hyaline cartilage Apical ligament tip of the odontoid process on the Axis to foramen magnum accessory atlantoaxial ligament posterior aspect of the lateral mass of the atlas near its transverse ligament, to the posterior aspect of the body of the axis, near the base of the dens / rotational stability at the craniocervical junction 1. Sternocleidomastoid (SCM) muscle: Unilateral contraction: contralateral rotation 2. Obliquus capitis inferior 3. rectus capitis posterior 4. splenius capitis Joints Joint type Articulating surface Joint capsule Ligaments/ soft tissue Function of ligament Movements Rectus capitis posterior, assisted by - obliqus capitis superior - semispinalis capitis Extension - splenius capitis - Sternocleidomastoid - upper fibers of the trapezius Cervical Plane jointzygapophys Diathrosis eal joint Superior and inferior articular processes on adjacent vertebrae / covered in hyaline cartilage Accessory ligaments of the vertebral column: ligamenta flava interspinous ligaments connect adjacent laminae, and spinous processes / Flexion/ Lateral flexion adjacent vertebral bodies Cervical Cartilaginous Intervertebr jointal discs anarthrosis **C1&2 don't have it, as 1. C1 doesn’t have vertebral body 2. Give space to Dens and pivot joint Anterior longitudinal ligament Connects anterior surface of adjacent vertebral bodies / / Posterior longitudinal ligament 1. Anterior scalene (ipsilateral contraction: lateral flexion; Bilateral contraction: anterior flexion) 2. Middle & Posterior scalene: ipsilateral contraction: lateral flexion 3. SCM Ipsilateral contraction: lateral flexion Bilateral contraction: neck flexion 4. Rectus capitis anterior Connects posterior surface of adjacent vertebral bodies allows slight movement of the vertebrae Muscle External intercostals Internal intercostals Innermost intercostals Description Origin 11 pairs Lower border of the rib 1st-11th Run inferoanteriorly from rib ABOVE to rib below 向下向入 Continuous with the external oblique of the abdominal wall Flat muscles lie deep to external one Also run from rib ABOVE to rib below, BUT in opposite Lateral edge of the costal groove direction (Inferoposteriorly)向下向外 Continuous with the internal oblique of the abdominal wall The deepest of the intercostal muscles Similar structures to internal one Separated from the internal one by intercostal Medial edge of the costal groove neurovascualr bundle -> found in most lateral portion of the intercostal spaces Insertion Movement Superior border of the rib 2nd- Elevates the rib, increase the 12th thoracic volume Superior surface of the rib below Superior surface of the rib below Interosseous part: reduces the thoracic volume by depressing the ribcage Interchondral part: Elevates the ribs Transversus thoracis Continuous with transcersus abdomimnis inferiorly Posterior surface of the sternum Internal surface of the costal cartilages 2-6 Weakly depress the ribs Subcostals Found in the inferior portion of the thoracic wall Comprise of thin slips of muscle, which run from internal surface of one rib, to second and third rib below Direction of the fibres parallels that of the innermost intercostal Inferior border of lower ribs 7th10th, near the angle of the rib superior border of the rib 2 or 3 below share the action of internal intercostals Sternocleidomastoid Scalene groups X Pectoralis minor External intercostals Interchondral part of internal intercostals elevate sternum elevate upper ribs / Accessory Muscles of inspiration Principal Diaphragm Elevates ribs Dome descends, thus increases vertical dimension of thoracic cavity also elebates lower ribs Quiet breathing Passive, elastic recoil of the lungs, / rib cage and diaphragm Active breathing Internal intercostals (except interchondeal part which pulls ribs / down) Pulls ribs down Abdominals Compress abdominal contents thus pushing diaphragm up X Quratus lumborum (which pulls / ribs down) Muscles of expiration Innervation Intercostal nerves (T1-T11) Intercostal nerves (T2-T6) Intercostal nerves Muscle Part External oblique Interal oblique Pyramidlais Origin Insertion Movement iliac crest, pubic tubercle Contralateral rotation of torso In btw External oblique and Transversus abdominis inguinal ligament, iliac crest, lumbodorsal fascia, run superolaterallyperpendicular to external rib 10-12 Bilateral contractioncompresses thr abdomen, unilateralipsilateral rptation of torso Deepest flat muscles, deep to this muscle is a well formed fascia-transversalis fascia Inguinal ligamemnt, iliac crest, thoracolumbar fasica, costal cartilage 7-12 Pubic crest Conjoint tendon Linea alba Xiphoid process Compression of abdominal contents Linea alba Tense the lines alba Largest and most superficial Ribs 5-12, run FLAT muscle inferiormedially Lateral, Flat muscles Transversus abdominis Rectus abdominis Description Anterior, Vertical muscle Located medially, superficial to Transversus abdominis, Crest of the pubis covered by aponeurosis of internal & external olique A small triangular muscle, supperficially to the rectus abdominis Pubic crest, pubic symphysis Innervation Thoracoabdomin al nerves (T7T11) & subcostal nerve (T12) Thoracoabdomin al nerves (T7T11) subcostal nerve (T12) Branches of lumbar plexus Assistin the flat muscles in compressing the Xiphoid process Thoracoabdomin abdominal viscera Costal cartilage 5al nerves (T7Stabilises the 7 T11) perlvis during walking & depresses the ribs Subcostal nerve (T12) Muscle Part Description Origin Quadratus lumborum Posterior superficial to psoas major iliac crest iliolumbar ligament Psoas major imddidiately lateral to the lumbar vertebrae Trasnverse processes & vertebral bodies of T12-L5 Psoas minor Anterior to Psoas major Present in 60% population Vertebral bodies of T12-L1 / illiac fossa, angerior inferior iliac spine (AIIS) Posterior iliacus Insertion Movement Extension, lateral flexion of thevertebral Transverse column processes L1-L4 Fixes teh 12th rib inferior oder of the during inspiration 12th rib so that the contaction of diaphragm is not wasted Flexion of thigh Lesser trochanter lateral flexion of of femur the vertebral column Ridge on the superior ramus of Flexion of the vertebral column pubic bone Pectineal line Combine with tendon of the psoas major, Flexion & lateral inserting into the flexion of thigh lesser trochanter of femur Innervation Anterior rami of T12-L4 nerves Anterior rami of L1-L3 nerves Anterior rami of L1 Femoral nerve (L2-L4) Multifidus lumborum Posterior spine Superior vertebras, help stabilise the spine partly asises from the poeterior sacrum and the sacropsinour ligament, extension & lateral bending of th head & vertebral column Levator ani muslces A borad sheet of muscle composed of 3 separate paired musclesBubococcygeus Puborectalis iliococcygeus Innervated by anterior rmus of S4, branches of the pudendal nerve (roots S2-S4) Coccygeus Smaller & most poetsrior pelvic floow component (as levator ani muscles are situated anteriorly) originates from the ischial spines, travels to the lateral aspect of the sacrum & coccyx, along sacrospinous ligament innervated by anterior rami of S4-S5 Erector spinae Pelvic floor
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