Test 2 Material
MUSCLE
KNOW the ORIGIN, INSERTION, INNERVATION, and ACTION of a muscle
2-11-99
Terms of the day:
Tachycardia – fast HR
Ligation- the act of binding
Lymphopenia – lymphocytic l., a reduction in the # of lymphocytes in the circulating blood
Dysrhythmia – defective rhythm
Dyscrasia - A morbid general state resulting from the presence of abnormal material in the blood, usually applied to
diseases affecting blood cells or platelets.
Phlebotomy – venesection
Cardiomegaly – ht enlargement
Bradycardia – slow HR
Endarteretomy - Excision of diseased endothelial lining of an artery and also of occluding atheromatous deposits, so
as to leave a smooth lining.
Sclerosis – Induration. In neuropathy, induration of nervous and other structures by a hyperplasia of the interstitial
fibrous or glial connective tissue
Function of muscles
1. movement
2. heat production – shivering to raise body T
3. posture and body support
Characteristics of Skeletal Muscle
1. Irritability - muscles are sensitive to stimuli from nerve impulses
2. Contractility - muscle contracts when it receives the required stimulus from motor neuron
3. Extensibility – stretch beyond their normal resting state
4. Elasticity – recoil to original length (even a roast has recoil –poke thumb into it elasticity)
Muscle Attachments – there are 2 ways:
1. Tendons or sinews - a fibrous cord or band that connects a muscle to its boney attachment
2. Aponeurosis - broad flat tendinous sheath, attaches muscle to bone
Connective Tissue Covering of Skeletal Muscle
1. Endomysium - surrounds the individual muscle fibers ( = muscle cells )
2. Perimysium- surrounds fasciculi ( bundles of muscle cells )
3. Epimysium - surrounds entire muscle
4. Fascia - covers muscle and attaches to skin
Muscle Groups
1. Agonist - the primary mover of a joint ( agonist = flexed antagonist = relaxed )
2. Antagonist - actions opposite of agonist (antagonist = flexed  agonist = relaxed )
3. Synergist - muscles work together to accomplish a particular movement
4. Flexors - flex a joint ( biceps brachii of olecranon joint )
5. Extensors - extend a joint ( triceps brachii of olecranon joint )
Muscle Architecture and Fiber Arrangement – determines a muscle’s function
1. Parallel - straplike, good endurance, not strong; ie. sartorius m., rectus abdominis m.
2. Convergent - fan shaped, focuses force of contraction to a single point; gluteal mm.., deltoid
3. Sphincter - close body openings; Orbicularis oris m. (“pucker” m)
4. Pennate (“feather”) - fibers converge on a tendonous insertion, 3 types, uni, bi and multi pennate
Blood and Nerve Supply to a Skeletal Muscle
1. GSE ( General Somatic Efferent ) - motor neuron into skeletal muscle
2. GSA (General Somatic Afferent )- sensory neuron carries info from sk. Muscle ( pain, T, stretch ) Cell body in
the dorsal root ganglion is associated with mechano-proprioreceptors
3. Neuromuscular junction – or myoneural junction, where the nerve and the muscle synapse. Consists of the
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motor end plate ( where axon terminals contact sarcolemma ) and the cell membrane of a muscle fiber
 Neurotransmitter – ACH ( stored in synaptic vescicles at axon terminals, released by nerve impulse into the
neuromuscular cleft )
 Receptors - nicotinic
4. Motor Unit
 Consists of a single motor neuron and all of the muscle fibers it innervates. 1 motor neuron may innervate as
few as 2 or 3 muscle fibers ( fine control ) or as many as 200-300 muscle cells ( gross function )
 Recruitment of motor units ( grocery bag story ) – How many muscle fibers are needed to perform a certain
task?
5. Muscle Tone is a normal state of partial contraction, maintained by working out.
 Spasm – too much muscle tone, irritation, knots, subluxation, charley horse.
 Flaccid – not enough tone, from lack of use, subluxation?
Origin/Insertion
A. Origin of a muscle - the less movable of the two points of attachment of a muscle, that end which is attached
to the more fixed part of the skeleton. The place where the muscle originates.
B. Insertion of a muscle - the movable end, that end which moves in relation to the rest of the skeleton
Origin and insertion can flip flop sometimes, SCM example. Proximal and distal attachment is a better way.
You have to be given a function in order to determine the origin and insertion. A muscle only does one thing, so
origin and insertion cannot change.
Ask the origin of the muscle, give the function.
Naming of Muscles
1. Shape - trapezius m. ( ok way to name )
2. Location – pectoralis ( better way to name )
3. Attachment - sternocleidomastoid m. ( best way to name )
4. Size - maximus, minimus, etc.
5. Direction of fibers – rectus (= straight), oblique, etc
6. Muscle Action - flexor, extensor, etc.
7. Relative position – profundus (=deep), superficialis, etc.
Many muscles combine 2 or more of these ways, like Flexor carpe brachialis longus
Muscles of the Axial Skeleton p. 241 - 253
Muscles of Facial Expression
N 20
These muscles express emotions in humans much more so than in animals (Story: mom & dad in the den)
Innervation of facial muscles: CN VII except for 1 muscle
1. Epicranius frontalis m. (“surprise m”)- wrinkles forehead, raises eyebrows, blends into gala aponerotica
2. Orbicularis oculi m. - closes the eye, squints, sphincter m of the eye
3. Nasalis m. - widens the nostrils
4. Procerus m. (“serious m”)- pulls eyebrows medially and down
5. Orbicularis oris m. – (“pucker m”) surrounds the mouth
6. Levator labii superioris m. – (“Elvis m”)
7. Zygomaticus m. – (“smile m”)
8. Risorius m. – (“I made a what…? m”) draws angle of mouth laterally
9. Depressor anguli oris m. – (“frown m”)
10. Depressor labii inferioris m. – (“pout m”)
11. Levator palpebrae superioris m. - raises upper lid, Exception: N = CN III
N 78 & 115
Primary Muscles of Mastication
Innervation of the muscles is by Mandibular division (V3) of CN V
1. Temporalis m. – CN V3- well developed in dogs, crocodiles
O: temporal fossa, temporal lines
I: coronoid process of the mandible
A: elevates the mandible – closes the mouth
2. Masseter m. – CN V3 - pit bull
O: zygomatic arch
I: lateral portion of the ramus of the mandible
A: elevates the mandible – closes the mouth
3. Medial pterygoid m. – CN V3
O: sphenoid bone
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N 48
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I: medial aspect of the mandible
A: elevate the mandible and move mandible laterally
4. Lateral pterygoid m. – CN V3
O: sphenoid bone
I: anterior side of condylar process of mandible
A: protracts the mandible
Extrinsic Ocular Muscles
N 79
SO4, LR6, All else 3 – more than 1 ocular muscle has a single CN assigned to it, because vision is important for
survival. ( Horses run first, then figure out what scared them. Don’t sneak up on them. )
1. Superior oblique m. – CN IV - rotates pupil down and out, sees stuff sneaking up on you in the grass
2. Lateral rectus m. – CN VI - pulls pupil laterally – sees stuff sneaking up on you from the sides
3. Other rectus muscles – CN III
4. Inferior oblique m. - CN III - rotates pupil up and out
Extrinsic Muscles of the tongue p. 244, table 9.5
N 53
The extrinsic muscles of the tongue move the whole tongue, whereas the intrinsics change the shape of the tongue.
Name tells you where the muscle is going.
Innervation of most of them is by Hypoglossal Nerve, CN XII
1. Genioglossus m. - CN XII - ( “chin-tongue”)
O: mental spine of the mandible
I: undersurface of the tongue
A: depresses and protracts the tongue
2. Styloglossus m. - CN XII
O: styloid process of the temporal bone
I: lateral side and undersurface of the tongue
A: elevates and retracts the tongue
3. Hyoglossus m. - CN XII
O: body of the hyoid bone
I: side of the tongue
A: depresses the sides of the tongue
Muscles of the Neck P. 244 - 247, table 9.6
1. Platysma m. ( “plate”) - CN VII – superficial m of the neck, remnant of “cutaneous trunkus” that makes animals’
skin flick, (“shriek m”)
N 21
O: fascia of the neck
I: inferior border of the mandible
A: depresses the mandible ( opens the mouth ) and lower lip, tenses the skin of the anterior neck
2. Sternocleidomastoid m. - CN XI, spinal root of C 2, 3 – “Hippie, duck head m”
N 22
O: manubrium and clavicle
I: mastoid process of the temporal bone
A: flexes neck, extends head, turns head to one side by contracting the other side
3. Scalene mm. - cervical nerves
N 22, 25
 Anterior scalene m.
O: anterior tubercles of the transverse processes of C3-C6
I: medial aspect of rib 1
A: elevates first rib, flexes the neck
 Middle scalene m.
O: posterior aspect of TP C2-C7
I: on first rib
A: elevates the first rib, flexes the neck
 Posterior Scalene m.
O: posterior tubercles of the TPs C4-C6
I: on rib 2
A: elevates rib 2, flexes the neck
The brachial plexus runs between the anterior and middle scalene mm, it innervates the arm and forearm, therefore
rotation of C2 –C7 can cause problems with the arm.
4. Suprahyoid muscles
 Digastric m.
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O: anterior belly – CN V3 – inferior border of (anterior) mandible
posterior belly - CN VII – mastoid process of temporal bone
I: hyoid bone (HB)
A: opens mouth and elevates hyoid bone
 Mylohyoid m. - CN V
O: inferior border of the mandible
I: body of the hyoid bone
A: elevates the hyoid bone
 Stylohyoid m. - CN VII
O: styloid process of temporal bone
I: body of the hyoid bone
A: elevates the hyoid bone
5. Infrahyoid Muscles ( the name tells you from where to where these muscles go )
 Thyrohyoid m. - C1-3
C = cervical nerves
thyroid cartilage to greater cornu of hyoid bone
 Omohyoid m. - C1-3 (omo- - indicates relationship to shoulder )
superior border scapula to body of hyoid bone
 Sternohyoid m. - C1-3
manubrium of sternum to body of hyoid bone
 Sternothyroid m. - C1-3
Deep to the above muscles
Manubrium of sternum to thyroid cartilage
N 22, 23, 47
Terms of the day
2/16/99
Hematoma, Sphygmomanometer, hemostasis, stethoscope, cardiac tamponade, cholelithiasis, dysphagia,
dyspepsia.
Sialorrhea - hygrostomia; ptyalism; salivation; sialorrhea; sialosis;an excess secretion of saliva.
Xerostomia - A dryness of the mouth, having a varied etiology, resulting from diminished or arrested salivation .
Muscles of Respiration
N 181
1. Diaphragm m. - phrenic nerve, C3, 4, 5 (“C3, 4, 5 keep the diaphragm alive.”) ( Beef fajitas are made of skirt
steak which is nothing but diaphragm. ) Know in general where the d. inserts and attaches.
posterior aspect of xyphoid process, lower 6 ribs, right crus attaches to sides of 1st 3 lumbar vertebrae and
associated IVD’s and the left crus attaches to sides of bodies of first 2 lumbar vertebrae and IVD’s.
2. External intercostal mm. - elevate ribs, increasing width of thoracic cavity for inspiration, thereby increasing the
volume of the thoracic cavity and creating negative pressure, drawing air in.
3. Internal intercostal mm. - two parts
• interchondral part - elevates the ribs for inspiration. In quiet breathing, expiration is a passive process due to
the recoil of these muscles.
N 183
• intercostal part - decreases width of thoracic cavity for active (forced) expiration. Asthmatics have well
developed internal intercostals to help them force the air out.
Muscles of the Abdominal Wall p. 248-250, Table 9.7
N 232, 235
Know the general O/I’s, what do these muscles do, and how do their fibers run.
There are 4 muscles in this set that form a sheet of the abdominal wall. Their function is to protect, support, and
compress the visceral organs, as well as to protect the spine during lifting.
• linea alba – an attachment for the internal & external obliques and the transverse abdominal muscles,
between the xyphoid and the pubis
• tendinous inscriptions –give the stomach a washboard appearance. Purpose is to give strength to the muscles
1. Rectus abdominis m. – most superficial of the abdominal muscles
O: pubic crest and symphysis pubis
I: costal cartilage of ribs 5-7 and xyphoid process
A: flexes vertebral column
• arcuate line – ASIS to ASIS. Termination of posterior rectus sheath, below the arcuate line there is no
posterior rectus sheath. 1/2 way between umbilicus and pubis at level of iliac crest.
N 234
2. External abdominal oblique m. EAO This is the strongest and 2nd most superficial of the abdominal muscles.
Fibers run inferiorly and medially.
N 232
O: lower 8 ribs ( ribs 3-10 )
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3.
4.
5.
6.
7.
I: iliac crest and linea alba
A: compresses abdominal contents, lateral rotation, draws thorax downward
Internal abdominal oblique m. IAO Deep to the EAO, fibers run at right angles to the external o., this crossing
of fibers gives it strength.
O: iliac crest, inguinal ligament, fascia of back
I: linea alba and costal cartilage of last three ribs (vertebrochondrals: 8, 9, 10 )
A: same as EAO
Transverse abdominis m. Deepest of the 4 abdominal muscles superior to the arcuate line.
O: iliac crest, inguinal ligament, lumbar fascia, costal cartilage of last 6 ribs ( 5 – 10 )
I: xyphoid process, linea alba, pubis
A: compresses the abdominal contents
Inguinal ligament - ASIS to pubic tubercle, fallopian ligament; Poupart's ligament;a fibrous band formed by the
inferior border of the aponeurosis of the external, inferior aspect of external abdominal oblique muscle. This is CT
in make up, a thickened aspect of the EAO.
N 245
Cremaster m. - raises and lowers the testicles, slip off of the IAO muscle as the testicles travel through it shortly
before a male infant is born. ( Story: Mike Shiley, Dr. G’s teacher at Purdue: “What is the most important muscle
to a male dog jumping a barbed wire fence?” )
Quadratus lumborum m. - posterior aspect of the abdominal muscles, bike riders spasm.
N 181
O: iliac crest, lower 3 lumbar vertebrae
I: 12th rib and upper 4 lumbar vertebrae
A: lateral flexion of vertebral column
Muscles of the Pelvic Diaphragm
Know these muscles in general
1. Levator ani m.
ischial spine to coccyx
2. Coccygeus m.
ischial spine to sacrum and coccyx
3. Bulbospongiosus m. – constricts vaginal opening, helps expel urine in the male
central tendon in perineum to base of penis or clitoris
4. Ischiocavernosus m.
ischial tuberosity - penis or clitoris, aids in erection
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N 335/ 336
N 355
Muscles of the Back
1. Superficial - Extrinsic Back Muscles ( see below )
• involved with movement of the pectoral girdle and humerus at the shoulder joint
2. Intermediate Extrinsic Back Muscles, these are also secondary respiratory muscles
• Serratus posterior superior m. / or \ fibers run inferior-laterally and superior-medially
• Serratus posterior inferior m. \ or / fibers run inferior-medially and superor-laterally
3. Deep - Intrinsic Back Muscles - deep to the Serratus muscles.
A. Superficial intrinsic group - Splenius mm - fibers run superior-laterally ( or inferior-medially )
Limited to cervical area!
B. Intermediate intrinsic group - Erector Spinae mm. 3 columns, fibers run vertically
1. Iliocostalis – ribs…
2+ segments away
2. Longissimus – TPTP
2+ segments away
3. Spinalis – SPSP
2+ segments away
C. Deep intrinsic group-
1. Transversospinalis mm.
2. Interspinalis mm.
3. Intertransversarii mm.
Muscles
Serratus posterior superior
Serratus posterior inferior
Splenius mm
Erectors or Intertransversarii/spinalis
Rotatores, Multifidi, & Semispinales
N 160-164
a. Rotatores
TPSP 1or 2 up
b. Multifidus
TPSP 3 or 4 up
c. Semispinalis TPSP 5+ up
1 segment up
1 segment up
fibers run
Inferior laterally and superior-medially
inferior-medially and superior laterally
superior-laterally (SP occ/post tub.TP)
Vertically (ribrib, TPTP, SPSP)
superior-medially ( TP  SP )
1. Extrinsic Back Muscles – superficial p. 253-254, Table 9.10
Muscles which act on the Pectoral Girdle ( scapula, humerus, and shoulder joint )
1) Trapezius m.
O: medial 1/3 of the superior nuchal line, EOP, ligamentum nuchae, spinous processes of C7-T12
I: lateral 1/3 of the clavicle, acromion, spine of scapula
A: 3 primary functions: superior fibers elevate scapula, inferior fibers depress and middle fibers retract (adduct)
scapula, hyperextends the neck and braces the shoulder and stabilizes it.
I: spinal roots of the accessory nerve CN XI, ventral rami of C3 and C4
2)
Latissimus dorsi m. –“wide back muscle”, overlapped by trapezius
N 395
O: SP’s of T6 to sacrumiliac crest, inferior 4 ribs, inferior angle of scapula (test )( overlaps T6-12 w/ O of traps)
I: crest of lesser tubercle of humerus and floor of intertubercular groove
A: extends, adduct, and medially rotates humerus at shoulder, retracts (adducts) the scapula (pulls it posteriorly),
“rowing, chopping wood, pull up muscle”
I: thoracodorsal nerve (C 6, 7, 8)
3)
Levator scapulae m. – origin and insertion can flip flop!
O: TP’s of C1-C4
I: superior portion of the medial border of the scapula
A: elevate scapula, flex neck
I: dorsal scapular n. (C5)
4) Rhomboid major m. – “manly muscle” – located inferior to the minor
O: SP’s of T2-T5
I: medial border of scapula
A: elevate and retract (adduct) scapula
I: dorsal scapular n. (C5)
5) Rhomboid minor - superior to major
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O: SP’s of C7and T1
I: , A: and I; same as major
6)
Serratus anterior m. – Boxer’s or Bells muscle, holds scapula tight to thorax
O: external surface of the first 8-9 ribs
I: anterior surface of vertebral border of scapula
A: pulls scapula forward (protracts) and down (depress)
I: long thoracic n. ( Bell’s nerve ) (C5,6,7)
7)
Subclavius m. – ( test )
O: first rib
I: groove for the subclavius m. on clavicle
A: pulls clavicle downward (depress)
I: subclavian n. (C5,6)
N 177
KNOW N 393
3. Intrinsic Back muscles
A. Superficial Intrinsic Muscle Group - limited to cervical area
N 161
Deep to the trapezius. Splenius from splenion – “bandage” acts like a strap to hold the deeper muscles in place.
Innervated by the dorsal rami of the spinal nerves. Fibers run superior and lateral
1. Splenius capitis m.
O: lower 1/2 of nuchal ligament, SP’s of C7 to T4
I: lateral aspect superior nuchal line and mastoid process
A: extend and laterally flex head and neck, slight rotation
2. Splenius cervicis m.
O: spinous processes of T3 to T6
I: posterior tubercles of TP’s of C1 to C3 (C4 in some people)
A: laterally flex neck and extend neck when both sides contract
B. Intermediate Intrinsic Group – lateral to medial: I Love Spines
2 or more segments away
N 161
3 Columns - extend and laterally flex the spine and hold it erect
1) Iliocostalis mm. – ilium to ribs, most lateral
a. Iliocostalis lumborum m.
O: posterior medial crest of ilium, thoracolumbar fascia, middle crest of sacrum
I: lower six ribs
b. Iliocostalis thoracis m.
O: lower six ribs
I: upper six ribs
c. Iliocostalis cervicis m.
O: angles of ribs 3-6
I: transverse processes of C4-C6
2) Longissimus mm. – TPTP - medial column
a. Longissimus capitis m.
O: articular process of C5 - C7, TP’s of T1-T5
I: mastoid process of the temporal bone
b. Longissimus cervicis m.
O: TP’s of upper 4 thoracic vertebrae
I: TP’s of C2-C6
c. Longissimus thoracis m.
O: spinous processes and supraspinal ligament of lumbar (L1-5) and T11 and T12 vertebrae, medial
aspect of iliac crest, sacrum, and thoracolumbar fascia
I: TP’s of all thoracic vertebrae and lower 9 ribs
3) Spinalis mm. - SP  SP – most medial
a. Spinalis capitis
b. Spinalis cervicis
c. Spinalis thoracis m. – most definitive
O: spinous process of upper lumbar and lower thoracic vert.
I: spinous processes of upper thoracic vert.
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C. Deep Intrinsic Group TPSP
1. Transversospinalis mm. All these are from T10 superiorly, 3 groups:
a. Rotatores mm.- deep to multifidus, each one has a single origin, extend from L5 to T2, best developed
in the thoracic region
Rotatores brevus – TPSP of the vertebra immediately above
Rotatores longus - TPSP of 2nd vertebra above
b. Multifidus mm. - thickest in the lumbar region, ends in the cervical region, basically one single muscle
O: TP’s from L5 to T1, lamina of vertebrae from S4 to C2, and articular processes from C6 to C4
Multifidous brevus - TPSP of 3rd vertebra above
Multifidous longus – TPSP of 4th vertebra above
c. 1. Semispinalis capitis m. – has a tendinous inscription on its belly , TPSP of 5+ vertebra above
O: transverse processes of C4-T6 (C7-T7)
I: superior nuchal line of occipital bone
2. Semispinalis cervicis m. TPSP of 5+ vertebra above
O: TP’s of T1-T6
I: SP’s of C2-C5
3. Semispinalis thoracis m. TPSP of 5+ vertebra above
O: TP’s of T6-T10
I: SP’s of C6- T4
d. Interspinalis mm. – between the spines, well developed in the cervical region from C2 to T1, relatively
lacking in the thoracic region and then well developed in the lumbar region
O: spinous process SP to next SP
I: spinous process
e. Intertransversarii mm.
O: transverse process TP to next TP
I: transverse process
Muscles of the Suboccipital Triangle ( SOT ) right beneath atlas and axis
N 164
The SOT is a triangle bounded by the obliquus inferior, obliquus superior, and the rectus capitis posterior major mm
1. Rectus capitis posterior major m. (/)
O: spinous process of the C2 ( axis, epistropheus )
I: inferior nuchal line of the occipital bone
A: extend and rotate head
I: suboccipital nerve, dorsal ramus of C1
2. Rectus capitis posterior minor m. – superior and medial to the Rectus a. p. major
O: posterior tubercle of the atlas
I: medial portion of inferior nuchal line of occipital bone
3. Obliquus capitis superior m. (\) – extends the head
O: transverse process of the atlas
I: occipital bone between sup.and inferior nuchal lines
4. Obliquus capitis inferior m. (_) – only one in this group that does not originate on the occipital bone
O: spinous process of the axis
I: transverse process of the atlas
A: extend and rotate the atlantoaxial joint
Structures associated with the SOT ( test question )
• Vertebral artery – within the confines of the SOT
• Suboccipital nerve - dorsal ramus of C1- within the confines of the SOT
• Greater Occipital nerve - dorsal ramus of C2 , exits below the SOT
N 164
Terms of the day:
Ascites, hematoma, diplopia, dysentery, bulimia, cirrhosis, myopia, dysentery
Chalazion – tarsal cyst
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Blepharospasm – eye twitch, spasmodic winking
Keratoconjunctivitis – inflammation of the conjunctiva and the cornea
Muscles which move the Humerus at the Shoulder Joint
N 397/398
p. 254 - 257, Table 9.10
1. Deltoid m. – multipennate convergent
O: semicircular, lat. 1/3 of clavicle, acromion, spine of scapula (directly beneath insertion of trapezius)
I: deltoid tuberosity of humerus
A: abduct, extend, flex, medially and laterally rotate the humerus at the shoulder joint
I: axillary n. (C5,6)
2. Supraspinatus m.
O: supraspinous fossa of the scapula
I: superior aspect of greater tubercle of humerus
A: abducts humerus to 90 degrees, weaker lateral rotator, part of rotator cuff group
I: suprascapular n. (C5,6)
3. Infraspinatus m.
O: infraspinous fossa of scapula
I: greater tubercle of humerus, below supraspinatus
A: lateral rotator of humerus
I: suprascapular n. (C5,6)
Note:
lateral rotators are on posterior aspect
medial rotators are on the anterior aspect
4. Teres minor m.
O: middle 1/2 of the lateral border of scapula, passes posterior to the long head of triceps
I: greater tubercle of humerus, below infraspinatus
A: lateral rotator of humerus
I: axillary n. (C5,6)
5. Teres major m.
O: lower 1/3 of lateral border of scapula, passes anterior to the long head of triceps and around medial side of
humerus with latissimus dorsi m.
I: lesser tubercle, medial aspect of intertubercular groove
A: extend shoulder, adduct and medially rotate humerus
I: lower subscapular n. (C5,6)
6. Subscapularis m. – adds anterior stability to the shoulder joint
O: subscapular fossa
I: lesser tubercle of humerus
A: medial rotator of humerus
I: upper and lower subscapular n. (C5,6)
7. Pectoralis major m.
O: clavicular head - anterior surface med. 1/3 clavicle
sternal head - manubrium and body of sternum
abdominal head - costal cartilages of ribs 2-6
I: lateral lip of intertubercular groove
A: flexes, adducts and rotates humerus medially
I: medial (C8, T1) and lateral (C5,6,7) pectoral nerves
N 395
8. Pectoralis minor m.
O: superior margin, ext. surface sternal ends of ribs 3,4,5
I: coracoid process of scapula
A: pulls scapula forward (protracts) and down (depress)
I: medial pectoral n. (C8, T1)
N 393
9. Coracobrachialis m.
O: coracoid process of scapula – contralateral to insertion of deltoid m.
I: middle 1/3 of medial aspect of shaft of humerus
A: flexes and adducts humerus at shoulder
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I: musculocutaneous n. (C5,6,7)
Triangle of auscultation
•
•
N 395
Borders
• Latissimus dorsi (_)
• rhomboid major m./vertebral border of scapula (/)
• trapezius m. (\)
thinnest region between skin and thoracic wall
Rotator cuff muscles
•
•
these muscles are rotators of the humerus
SITS
• supraspinatus m.
• infraspinatus m.
• teres minor m.
• subscapularis m.
Quadrangle space
•
•
N 397
Borders
• teres major m. – tendonous insertion
• lateral head of the triceps brachii m.
• teres minor m. – tendonous insertion
• long head of the triceps brachii m. – tendonous origin
(know ) axillary nerve and posterior circumflex humeral artery from w/I this space  deltoid and teres
Triangular Space
• scapular circumflex vessels turn around subscapularis
• Borders
• teres minor m.
• teres major m.
• long head of the triceps brachii m.
Triangular interval
• can see deep brachial artery and radial nerve
• Borders
• lateral head of triceps brachii m
• long head of triceps brachii m.
• teres major m.
Muscles which move the Forearm at the Elbow
p. 257 - 258, Table 9.11
KNOW 420/421
1. Biceps brachii m.
N 400
O: long head - supraglenoid tubercle of scapula
short head - coracoid process of scapula
I: radial tuberosity, blends into fascia of medial forearm ( helps with pronation, that’s why tightening a screw is
A: flex elbow and supinate forearm
easier for a R hander, and loosening
I: musculocutaneous n. (C5,6,7)
a screw is easier for a L hander )
2. Brachialis m.
O: anterior body of the humerus
I: coronoid process of ulna, ulnar tuberosity
A: flexes the elbow joint
Marie Paas
N 403
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I: musculocutaneous (C5,6,7) and radial (C5,6,7,8,T1) nerves
3. Brachioradialis m. – bulk of this muscle is on the forearm, often involved in tennis elbow
O: lateral supracondylar crest of humerus
I: distal aspect of radius, proximal to styloid process
A: flexes the elbow joint
I: radial n. (C5,6,7,8,T1)
4. Triceps brachii m.
O: long head - infraglenoid tubercle
lateral head - posterior lateral aspect of humerus, proximal to radial groove
medial head - posterior medial aspect of humerus, distal to radial groove
I: olecranon of ulna
A: extend elbow, long head will extend and adduct arm because it crosses the shoulder
I: radial n. (C5,6,7,8,T1)
5. Anconeus m.
O: lateral epicondyle of the humerus and posterior border of the ulna
I: olecranon of the ulna
A: extends elbow and abducts ulna during pronation
I: radial n. (C5,6,7,8,T1)
Muscles of the Forearm that move the Carpus and Digits
p. 258 - 263, Table 9.12
Flexors originate from the medial epicondyle, extensors from the lateral epicondyle of the humerus
18 total muscles divided into:
1) Rotators of the radius on the ulna
2) Flexors of the carpus and digits - anterior compartment
3) Extensors of the carpus and digits - posterior compartment
1) Rotators of the Radius on the Ulna
1. Pronators
N 410
A. Pronator teres m. – P.T. syndrome mimics carpal tunnel s. , due to pressure on median nerve
O: medial epicondyle of humerus, coronoid process ulna
I: medial and lateral surface of radius
A: pronate forearm and flex elbow
I: median n. (C5,6,7,8,T1)
B. Pronator quadratus m.
O: distal aspect of anterior ulna
I: distal aspect of anterior radius
A: pronates forearm
I: median n. (C5,6,7,8,T1)
2. Supinators
A. Supinator m. – wraps around the radius
O: lateral epicondyle of humerus, lateral collateral ligament of elbow, annular ligament of proximal
radioulnar joint, proximal posterior and lateral ulna
I: lateral posterior and anterior surfaces of proximal 1/3 of radius
A: supinates forearm
I: radial n. (C5,6,7,8,T1)
B. Biceps brachii m.
2) Flexors of the Carpus and Digits
p. 260 - 261, table 9.12
1. Flexor carpi radialis m.
O: medial epicondyle of humerus
I: base of Mc 2 and 3
Marie Paas
N 414
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A: flex and abducts hand at the carpus
I: median n. (C5,6,7,8,T1)
2. Palmaris longus m. –13% of people don’t have this muscle
O: medial epicondyle of humerus
I: palmar aponeurosis
A: flex carpus
I: median n. (C5,6,7,8,T1)
3. Flexor carpi ulnaris m.
O: humeral head - medial epicondyle of humerus
ulnar head - olecranon and posterior border of ulna
I: pisiform bone, hamulus of hamate bone, Mc5
A: flex and adduct the hand at the carpus
I: ulnar n. (C8,T1)
N 415
3) Flexors of the digits
1. Flexor digitorum superficialis m.
O: humeroulnar head - medial epicondyle, coronoid process of ulna, ulnar collateral ligament
radial head - superior 1/2 anterior surface of radius
I: palmar aspect of middle phalanx of digits 2-5 (= 4 tendons), proximal aspect, lateral tubercles
A: flex carpus, flex digits at Metacarpophalangeal joint and the proximal interphalangeal joint
I: median n. (C5,6,7,8,T1)
2. Flexor digitorum profundus m.
O: proximal 2/3’s of ulna and interosseous membrane
I: tendons pass thru the tendons of insertion of the FDS to insert on bases of distal phalanges of digits 2-5
A: flex carpus, Metacarpophalangeal joints, and interphalangeal joints. Only one to flex distal
interphalangeal joint, makes a fist.
I: median (C5,6,7,8,T1) and ulnar (C8,T1) nerves
3. Flexor pollicis longus m.
O: body of radius, interosseous membrane and coronoid process of ulna
I: base of distal phalanx of thumb
A: flexes interphalangeal joint of thumb
I: median n. (C5,6,7,8,T1)
Extensors of the Carpus and Digits
p. 261 - 263, table 9.12
N 411
1. Extensor carpi radialis longus m.
O: lateral supracondylar ridge of humerus
I: posterior aspect base of Mc2
A: extends and abducts the wrist
I: radial nerve (C5,6,7,8,T1)
2. Extensor carpi radialis brevis m.
O: lateral epicondyle of the humerus
I: posterior aspect base of Mc3
A: extends and abducts the wrist
I: radial n.
3. Extensor carpi ulnaris m.
O: lateral epicondyle of humerus and olecranon
I: lateral aspect of base of Mc5
A: extend and adduct hand at carpus
I: radial n.
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4. Extensor digitorum communis m.
O: lateral epicondyle of humerus
I: posterior surfaces of the bases of the middle and the distal phalanges of digits 2-5
A: extend the carpus and digits
I: radial n.
5. Extensor digiti minimi m. – extra muscle just to move the pinky
O: lateral epicondyle of the humerus
I: base of middle and distal phalanges of digit 5
A: extend carpus and fifth digit
I: radial n.
6. Extensor indicus m. – extra muscle just to move the index finger
O: ulna and interosseous membrane
I: joins the tendon of extensor digitorum to index finger
A: extends carpus and index finger (2nd digit)
I: radial n.
7. Extensor pollicis longus m. – thumbs up sign
O: middle of body of ulna lateral side and interosseous membrane (posterior), distal to abductor pollicis longus
I: base of distal phalanx of the thumb
A: extends joints of thumb, abducts hand at carpus
I: radial n.
8. Extensor pollicis brevis m.
O: posterior surface of radius and interosseous membrane distal to abductor pollicis longus
I: base of proximal phalanx of thumb
A: extends (abducts) carpus and metacarpophalangeal joint of the thumb
I: radial n.
9. Abductor pollicis longus m.
O: posterior surface of the radius and ulna and interosseous membrane
I: base of Mc1
A: abducts carpus and Mc1
I: radial n.
Anatomic snuff box
•
•
N 436
Borders - tendons of insertion of the:
• abductor pollicis longus m. - laterally
• extensor pollicis brevis m. - laterally
• extensor pollicis longus m. - medially
Significance - trapezium sits at base, radial artery is visualized. In chiropractic, the pisiform goes into it, then
the other pisiform delivers the thrust
Intrinsic Muscles of the Hand
p. 263-265, Table 9.13
Thenar Muscles
Innervated by the Median Nerve
Thenar - fleshy mass on the lateral side of the palm
1. Abductor pollicis brevis m.
O: flexor retinaculum, scaphoid and trapezium bones
I: proximal phalanx of the thumb
A: abducts the joints of the thumb
2. Flexor pollicis brevis m.
O: flexor retinaculum and trapezium bone
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I: proximal phalanx of the thumb
A: flexes metacarpophalangeal joint of thumb
3. Opponens pollicis m.
O: trapezium and flexor retinaculum
I: Mc1
A: opposes joints of the thumb
I: median n.
Terms of the day
Nystagmus, Ophthalmoscope, Otorrhea, Brontophobia, Miosis, Myringotomy
Mydriasis – dilation of the pupil
Nyctalopia – night blindness
Presbyopia – loss of accommodation due to age
2-23-99
Intermediate Muscles of the Hand
Table 9.13
1. Adductor pollicis m.
O: oblique head - capitate bone
transverse head - Mc2 and 3
I: proximal phalanx of the thumb
A: adducts thumb
I: ulnar n. (C8,T1)
N 434
2. Lumbricalis
O: tendons of the flexor digitorum profundus m.
I: extensor (posterior) surface of digits 2-5
A: flexes digits at the metacarpophalangeal jt. And extends digits at the interphalangeal jt.
I: median and ulnar nerves
3. Palmar interossei mm.
O: medial side of Mc2 and lateral sides of Mc 4,5
I: proximal phalanges of digits 2, 4 and 5 and the tendon of extensor communis m.
A: adducts fingers toward middle finger at McP joint
I: ulnar n.
4. Dorsal interossei mm.
O: adjacent sides of Mc bones
I: proximal phalanges of digits 2 & 3 (lateral sides) and the proximal phalanges of digits 3 & 4 (medial sides) and
extensor communis tendon
A: abducts fingers away from middle finger at metacarpophalangeal joint
I: ulnar n.
Hypothenar Muscles
Innervated by the ulnar nerve
1. Abductor digiti minimi m.
O: pisiform and tendon of flexor carpi ulnaris m.
I: proximal phalanx of digit 5
A: abducts little finger
2. Flexor digiti minimi m.
O: flexor retinaculum and hamulus of the hamate bone
I: proximal phalanx of digit 5
A: flexes joints of little finger
3. Opponens digiti minimi m.
O: flexor retinaculum and hamulus of the hamate bone
I: distal aspect of Mc5
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A: opposes little finger, pulls it across the palm
Muscles that move the Thigh at the Hip Joint
p. 265 - 268, Table 9.15
Anterior Muscles ( = flexors )
p. 265 - table 9.14
1. Iliacus m.
O: iliac fossa
I: lesser trochanter of the femur
A: flex thigh, rotate hip laterally, flex spine if the thigh is stationary, then O/I flip flop
I: femoral n. (L2,3,4)
N 456
N 462
2. Psoas major m.
O: transverse processes of all lumbar vertebrae
I: lesser trochanter of femur
A: flex thigh and rotate hip laterally, flex spine
I: spinal nerves L2 and L3
These 2 muscles join below the inguinal ligament  iliopsoas. The lumbar plexus is embedded in its belly.
Posterior and Lateral Muscles
N 460
p. 266 - 267, table 9.14
1. Gluteus maximus m.
O: iliac crest, sacrum, sacrotuberous ligament, aponeurosis of lumbar region
I: gluteal tuberosity and iliotibial tract
A: extend and rotate the thigh laterally, primary extensor of the thigh ( in some people the hamstring is primary)
I: inferior gluteal n. (L5,S1,S2)
2. Gluteus medius m.
O: lateral surface of the ilium
I: greater trochanter of femur
A: abduct and rotate thigh medially
I: superior gluteal n. (L4,5,S1)
3. Gluteus minimus m.
O: lateral surface of the ilium
I: greater trochanter of the femur
A: abduct and medially rotate the thigh
I: superior gluteal n. (L4,5,S1)
4. Tensor fasciae latae m.
O: anterior border of ilium and iliac crest, ASIS
I: blends into iliotibial tract, Gerdy’s tubercle
A: abducts thigh at hip joint
I: superior gluteal n.
5. Piriformis m. – Elvis muscle or boy dog muscle or the “why we are here”  muscle
O: anterior surface of sacrum between S2 and S4
I: superior border of the greater trochanter
A: laterally rotate, extend thigh, abduct flexed thigh
I: branches of the sacral plexus
SCIATIC NERVE
Actually composed of 2 nerves, the tibial and the common peroneal, this is the largest nerve in the body. It emerges
below the inferior border of the piriformis m., typically between the piriformis and the glemellus. ( The posterior sup
iliac spine makes the dimples on the buttocks, draw a line to the greater trochanter, go 2 fingers below the middle of
that line and poke a finger in that area  sciatic nerve ).
Know the order of these mm, no details
6. Superior gemellus m. – some people do not have this muscle
Marie Paas
39
N 461
Anatomy TRI 1
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O: ischial spine
I: trochanteric fossa
A: laterally rotate, extend thigh, abduct flexed thigh
I: branches of the sacral plexus
7. Obturator internus m.
O: posterior (outer) surface of the obturator membrane and ischium
I: trochanteric fossa
A: laterally rotate, extend thigh, abduct flexed thigh
I: branches of the sacral plexus
8. Inferior gemellus m.
O: ischial tuberosity (superior aspect)
I: trochanteric fossa
A: laterally rotate, extend thigh, abduct flexed thigh
I: branches of the sacral plexus
9. Quadratus femoris m.
O: lateral border of the ischial tuberosity
I: inferior aspect of the intertrochanteric crest
A: lateral rotator of the thigh
I: branches of the sacral plexus
Medial Muscles ( adductors )
p. 268-269, table 9.15
These mostly originate on the pubic bone
1. Gracilis m. - most superficial and most medial ( not on lab practical )
O: inferior edge of the symphysis pubis
I: proximal medial surface of the tibia
A: adducts thigh, flexes leg at the knee and rotates thigh medially
I: obturator n. (L2,3,4)
N 458
2. Pectineus m.
O: pectineal line of the pubis
I: distal to lesser trochanter of femur
A: adducts, flexes, laterally rotates thigh
I: femoral n. (L2,3,4) and obturator n. (L2,3,4)
3. Adductor longus m.
O: body of the pubis below pubic crest
I: linea aspera of femur
A: adducts, flexes and laterally rotates thigh
I: obturator n.
4. Adductor brevis m.
O: inferior ramus of the pubis
I: linea aspera and pectineal line (below lesser trochanter)
A: adducts, flexes and laterally rotates thigh
I: obturator n.
5. Adductor magnus m.
O: inferior ramus of pubis and ischium and ischial tuberosity
I: gluteal tuberosity, linea aspera, adductor tubercle
A: adducts, flexes and laterally rotates thigh
I: obturator n. and tibial nerve (L4,5,S1,2,3)
Muscles of the Thigh that move the Knee Joint
p. 268 - 273, Table 9.17
Anterior Thigh Muscles that Move the Knee Joint – innervated by the femoral nerve
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P. 268 - 271, table 9.16
1. Sartorius m.
O: ASIS
I: anterior superior medial aspect of the tibia at the pes anserinus (along with the gracilis m. and the
semitendinosus m.)
A: flexes, abducts and laterally rotates thigh, flexes leg at knee joint
I: femoral nerve (L2,3,4)
2. Quadriceps femoris mm. – ( these mm. exert a force of up to 800lb per square inch )
N 458
Femoral nerve (L2,3,4) ( femoral n paralysis – affected knee locked, both nn paralyzed – need help walking )
All components insert on the patella and via patellar ligament to tibial tuberosity and all extend the
knee
A. Rectus femoris m. O: AIIS, lip of the acetabulum
I: base of the patella, patellar ligament to tibial tuberosity
A: extend knee because it crosses the knee, flex the thigh
Note – Van de Graff wrong on O
B. Vastus lateralis m.
O: greater trochanter, lateral lip of linea aspera of femur
C. Vastus medialis
O: intertrochanteric line and medial lip of the linea aspera
D. Vastus intermedius m.
O: anterior and lateral surface of the femur
Posterior Thigh Muscles that move the Knee Joint
N 456
p. 272 - 273, table 9.17
1-3 are also called Hamstring mm – called hamstring, because the tendons of these mm were used to hang hams
on. All 3 originate from the ischial tuberosity, all extend the thigh and flex the knee.
1. Biceps femoris m.
O: long head - ischial tuberosity
short head - lateral lip of distal 1/2 of linea aspera
I: head of the fibula (lateral epicondyle of tibia)
A: long head - flex knee, extend and laterally rotate thigh
short head - flex knee
I: long head - tibial n. (L4,5,S1,2,3)
short head - common peroneal n. (L4,5,S1,2)
2. Semitendinosus m.
O: ischial tuberosity
I: proximal portion of the medial aspect of the tibia
A: extend and medially rotate thigh, flex knee
I: tibial nerve
How to remember which is where: Teddy sleeps on Mary – tendinosus superficial to membranosus
3. Semimembranosus m.
O: ischial tuberosity
I: medial condyle of the tibia
A: extend and medially rotate thigh, flex knee
I: tibial n.
Pes anserinus
N 456
• The combined tendonous expansions of the semitendinosus m., gracilis m., and the sartorius where they
insert on the medial aspect of the tibial tuberosity
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Muscles of the Leg that move the Joints of the Ankle, Foot and Toes
p. 273 - 276, table 9.18
Anterior Crural Muscles
Deep peroneal (fibular) nerve of common peroneal nerve
(L4,5,S1,2)
N 480
1. Tibialis anterior m. – this m rubs on the tibia, inflammation of the tendinous sheath = shin splints
O: lateral condyle and superior 1/2 of the lateral tibia
I: base of Mt1 and inferior surface of medial cuneiform
A: dorsiflex and invert the foot
N 484
2. Extensor hallucis longus m.
O: anterior surface of fibula and interosseous membrane
I: dorsal aspect of base of distal phalanx of first digit
A: extend first digit, dorsiflex foot, invert foot
3. Extensor digitorum longus m.
O: lateral epicondyle of tibia, superior 3/4 of anterior surface of fibula and interosseous membrane
I: middle of distal phalanges of digits 2-5
A: extend digits 2-5 and dorsiflex the foot
4. Peroneus (fibularis) tertius m.
O: inferior 1/3 of anterior surface of fibula and interosseous membrane
I: dorsal surface of the base of Mt 5
A: dorsiflex and evert foot
Lateral Crural Muscles
Superficial peroneal (fibular) nerve of common peroneal nerve
(L4,5,S1,2)
1. Peroneus longus m.
O: head and superior 2/3 of the body of the fibula, lateral epicondyle of tibia
I: base of Mt1 and medial cuneiform bone ( same I as tibialis anterior )
A: evert and plantar flex foot
N 480
N 486
2. Peroneus brevis m.
O: inferior 2/3 of the lateral surface of the fibula
I: tuberosity of the fifth metatarsal – can be torn
A: plantar flex and evert the foot
Posterior Crural Muscles
Tibial division of the Sciatic Nerve
(L4,5,S1,2,3)
1. Gastrocnemius m. – medial and lateral head
O: medial and lateral epicondyles of the femur
or calcaneal tendon
I: posterior surface of the tuberosity of the calcaneus via the tendo calcaneus ( Achilles’ tendon ) Hobbling = the
A: plantar flex foot, flex knee – since it crosses the knee joint
cutting of A’s tendon to prevent
POWs from escaping!
2. Soleus m.
O: posterior aspect of proximal 1/4 of fibula and medial tibia
I: posterior surface of the tuberosity of the calcaneus via the tendo calcaneus
A: plantar flex the foot at the ankle
Triceps surae (calf ) - two heads of gastrocnemius and soleus mm.
3. Plantaris m. – has a very long, long tendon which adds to the formation of the calcaneal tendon
O: lateral supracondylar ridge of femur and oblique popliteal ligament
I: attaches to tendo calcaneus and then to calcaneus bone
A: plantar flex foot, flex knee
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4. Popliteus m.
O: lateral epicondyle of femur and lateral meniscus
I: superior posterior aspect of tibia
A: flex and medially rotate leg at knee joint, unlocks the knee
5. Flexor hallucis longus m.
O: inferior 2/3 of the posterior surface of the fibula and interosseous membrane
I: base of distal phalanx of first digit
A: flex big toe and plantar flex the foot
6. Flexor digitorum longus m.
O: medial portion of posterior surface of tibia
I: base of distal phalanges of digits 2-5
A: flex digits 2-5 and plantar flex the foot
7. Tibialis posterior m.
O: posterior surface of tibia and fibula and interosseous membrane
I: navicular bone, cuboid bone, all 3 cuneiform bones, and bases of Mt 2, 3, and 4
A: plantar flex and inverts foot ( anterior and posterior both ), supports the arches
N 483
Femoral triangle
Borders:
Inguinal ligament – superior
Sartorius m. - lateral
Adductor longus m. - medial
N 466
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What muscles attach to the mastoid process?
Longissimus capitus
Digastric
SCM
Splenius capitis
What mm attach to the atlas?
Levator scapulae
Rectus capitis posterior minor
Splenius cervicis
Obliquus capitis inferior
Obliquus capitis superior
(Rectus capitis lateralis)
(Rectus capitis anterior)
(Longus Colli)
What mm attach to the axis C2
Levator scapulae
Mulitifidus
Obliquus capitis inferior m
Rectus capitis posterior major m. (/)
Splenius cervicis
Spinalis Cervicis
(Longus Colli)
What muscles insert to the superior nuchal line?
Trapezius
Splenius capitis
Semispinalis capitis
MM that atach to ( origin OR insertion ) the iliac crest
EAO
IAO
Transverse Abdominis
Quadratis Lumborum
MM that atach to the coracoid process:
Brachialis brevus
Pectoralis minor
Coracobrachialis
Dual innervation muscles
Brachialis – musculocutaneous and radial nerves
Flexor digitorum profundus – median and ulnar nerve
Pectineus – femoral and obturator
Biceos femoris – longus: tibial; brevus: common peroneal
Adductor magnus – tibial and obturator
What muscles flex the elbow?
Pronator teres
Brachialis
Brachioradialis
***Muscles that attach to the occipital bone?
Trapezius
Semispinalis capitis
Rectus capitis posterior major
Rectus capitis posterior minor
Obliquus capitis superior
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Muscles that attach to the zygomatic arch?
Masseter
***What actions do you see with the trapezius muscle?
superior fibers elevate scapula
inferior fibers depress scapula
middle fibers retract (adduct) scapula
hyperextends the neck
braces the shoulder and stabilizes it
Muscles that act on the scapula their specific actions:
Muscle
elevates scapula
depresses
Latissimus dorsi
Levator scapulae
X
Rhomboids
X
Trapezius
X
X
Serratus anterior
X
Pectoralis minor
X
protracts (abducts)
retracts (adducts)
X
X
X
X
X
Muscles that rotate the humerus at the shoulder joint
Supraspinatus
Latissimus
Teres major
Deltoid
Latisimus dorsi
Pectoralis major
Infraspinatus
Subscapularis
Teres minor
Muscles that attach to the clavicle
Deltoid
Pectoralis major
Sternocleidomastoid
Subclavius
Trapezius
Muscles that attach to the coracoid process of the scapula
Biceps brachii
Coracobrachialis
Pectoralis minor
Muscles that insert on the distal phalanges
Hands:
Flexor digitorum profundus
Extensor digitorum communis
Extensor digiti minimi
Extensor indicus
Flexor pollicus longus
Extensor pollicus brevus
Feet:
Extensor hallucis longus
Extensor digitorum longus
Flexor hallucis longus
Flexor digitorum longus
Muscles that insert on metacarpal bones
Muscles that act on the metatarsal bones
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