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