The A to Z of Skeletal Muscles

A-Z Skeletal Muscles14:A to Z Book 7/05/10 11:01 AM Page A

The A to Z of Skeletal Muscles

Dr A. L. Neill BSc MSc MBBS PhD FACBS [email protected]

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A-Z Skeletal Muscles14:A to Z Book 7/05/10 11:01 AM Page C

A-Z Skeletal Muscles14:A to Z Book 7/05/10 11:01 AM Page 1


Introduction

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This is the fourth revision of the first A to Z book, and many things have changed. The clinical aspects of muscle grouping and testing has been expanded, due to strong feedback, but the listing of the muscles and their illustration are largely unchanged. There are now 7 in the A to Z series of pocket-sized medical reference books (see the back of the book for details) - 2 considering organs of the body, and also 2 posters on medical education on with supportive website, where all the A to Z material can be accessed as well as additional material: www.aspenpharma.com.au/atlas/student.htm Any corrections b/n reprints are placed on this site so that the latest version and comments re any of the A to Z books may be viewed as soon as possible. As usual the A to Zs get better if there is feedback – please send us your comments and suggestions.

Acknowledgement

Thank you ASPENpharmacare Australia for your support & assistance in this valuable project, particularly Mr. Greg Lan CEO of Aspenpharmacare Australia, Rob Koster, Richard Clements and Ante Mihaljevic of TM Graphic Design & everyone who provided valuable feedback.

Dedication

To AA and ZZ I love you.

How to use this book

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The structure of the A to Z books grows and develops with each publication, but the principle of listing structures in an alphabetical manner as far as possible and hence making the book its own index for easy retrieval has been maintained. However this is now done after first dividing the material into a number of main topics for example muscle groups acting on significant joints, examination, palpation and testing of muscle groups prior to the main listing of each and every muscle - excluding some of the detailed Head and Neck muscles which can be found in the A to Z of the Head & Neck.

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Features are named using in the most familiar terms and those agreed upon by anatomical nomenclature convention avoiding eponymous terms wherever possible but as with all anatomical studies sometimes several terms are used to name the same feature. Wherever this is common and to save confusion reference is made to each term. Similarly between disciplines such as radiology and osteology as well as anatomy the same view may be described several different ways, so when this is also common and to provide clarity these terms are mentioned. In some cases with complex muscles - several views of the same muscle are also supplied.

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The text under each muscle in the main listing consists of basic minimal information such as the : Origin (O), Insertion (I), Action (A), Blood Supply (BS), Nerve Supply (NS), Nerve Root origin (NR) and functional tests (T). The test section is by no means complete, although in this edition it has been added to in the front of the book with illustrations of testing of major muscle groups. It is also expanded in the A to Z of Peripheral Nerves and will be further explored in the A to Z of muscle and PN testing. Capitalization is used to demonstrate the muscles and bones and important components. It is hoped that this will prove a valuable resource for those working on muscle examination exercise and recovery in whatever field. Any suggestions on format or inclusions will be gratefully received This book is cross-referenced with all the other A to Zs Thank you

Amanda Neill

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BSc MSc MBBS PhD FACBS ISBN 978 0 9806959 6 0

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Table of contents

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Introduction Acknowledgement Dedication How to use this Book Table of Contents Abbreviations Common Terms Used in the Study & Examination of Skeletal Muscles, Nerves & Bones Structure & Substructure of Skeletal Muscles Definition of Tendons & Ligaments Neuro-Muscular Junction Neuro-Muscular Spindle Neuro-Tendinous Spindle Anatomical Planes & Relations Anatomical Movements Classification, Naming & Examination of Muscles Myotomes Muscle Innervation at the Spinal Cord level Segmental Motor Nerve Diagram Summaries Of Skeletal Muscle Groups Examination of Skeletal Muscles - major groups Index - Alphabetical Listing Of Muscles

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5 11 10 13 15 15 17 19 25 27 28 33 35 61 69

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LL lig A = actions /movements of LP a joint Lt. aa = anastomosis or anastomoses MC adj. = adjective aka = also known as MCP ALL = anterior longitudinal ligament med alt. = alternative MT ant. = anterior N art. = articulation (joint w/o the NR additional support structures) NS AS = Alternative Spelling, generally referring to the diff. b/n NT British & American spelling O ASIS = anterior superior iliac spine P (of hip bone) b/n = between pl. BP = brachial plexus PLL BS = Blood Supply C = cervical PN c.f. = compared to post. CN = cranial nerve R CNS = central nervous system ROM Co = coccygeal S CP = cervical plexus sing. collat. = collateral SC CSF = Cerebrospinal fluid SN CT = connective tissue SP e.g. = example EC = extracellular (outside the cell) SS ES = Erector Spinae group of T muscles TOS ext. = extensor (as in muscle to TP extend across a joint) UL Gk. = Greek VB I = insertion VC IC = intercarpal / intercarpo - (b/n w/n wrist) w/o IMC = intermetacarpal wrt IP = interphalangeal (b/n fingers / & toes) IT = intertarsal / intertarso jt(s) = joints = articulations L = lumbar / left

= lower limb = ligament = lumbar plexus = Latin = metacarpal / metacarpo(hand) = metacarpo-phalangeal = medial = metatarsal / metatarso (foot) = nerve = nerve root origin = nervous supply / nerve system = nervous tissue = origin = phalangeal / phalanges / phalango= plural = posterior longitudinal ligament = peripheral nerve = posterior = right / resistance = range of motion = sacral = singular = spinal cord = spinal nerve = spinous process / sacral plexus = signs and symptoms = TEST / thoracic = thoracic outlet syndrome = transverse process = upper limb, arm = vertebral body = vertebral column = within = without = with respect to = and

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Abbreviations

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Ala Ankle Ante Aperture Aponeurosis

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Common terms in the Study and Examination of Skeletal Muscles, Nerves and Bones

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wing used for winglike process e.g. on the hip bone bend ie the “bend” b/n the leg and foot before - in front of an opening or space between bones or within a bone expanded end of a tendon - sheet of fibrous tissue allowing for muscle insertion Appendicular (skeleton) that which is not axial i.e. the upper and lower limbs Areolar air filled bone - tooth socket Articulation joint, which is a point of contact b/n 2 opposing bones Axial (skeleton) refers to the head & trunk (vertebrae, ribs & sternum) of the body. Basilar relating to the base or bottom of structures Basocranium base of the skull Brachi pertaining to the arm (upper arm) Brevis short Buccal relating to the cheek Canal tunnel / extended foramen Capitus/Caput relating to the head Carpi/Carporelating to the wrist Carotid “to put to sleep” related to the carotid BVs in the neck which when compressed can put a person to sleep Cavity/Cavernous an open area or sinus w/n a bone or formed by 2 or more bones - used interchangeably with fossa. Cephalic/Cephalopertaining to the head Cervical/Cerivcopertaining to the neck Cilli/Cillia pertaining to the eyelash / hair Colles referring to the “collar” or neck Cochlea a snail, snaillike relating to the organ of Corti in the ear Condyle a rounded enlargement / process possessing an articulating (joint) surface. Cornu a horn as on the Hyoid bone Corona a crown. adj.- coronary, coronoid or coronal; hence a coronal plane is parallel to the main arch of a crown which passes from ear to ear (c.f. coronal suture). Costa / Costal referring to the ribs Cranium / Cranus the cranium of the skull comprises all of the bones of the skull except for the mandible, referring to the skull generally excluding the facial bones Crest prominent sharp thin ridge of bone formed by the attachment of muscles particularly powerful ones eg Temporalis / Sagittal crest Cuneate / Cuneus a wedge / wedge-shaped Cutus referring to skin, hence cutaneous branches of Ns go to the skin Deltoid D-Shaped

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Dens / Dentine / Dentate a tooth, relating to teeth, denticulate having tooth-like projections (see odontoid) Depression a concavity on a surface Diaphragm a partition or separating wall Diaphysis the body of a long bone. In the young this is the region between the growth plates. Digit / Digitorum relating to the fingers or toes Dislocation a displacement of anything particularly bone (also called luxation) Distal further away from the core opposite to Proximal Dorsal / Dorsi relating to the back or the back of something e.g. the hand Elbow any bend in the arm referring to the elbow b/n arm and forearm Eminence a smooth projection on a bone. Epion top of Epiphysis the end of a long bone beyond the growth plate (epiphyseal plate) - 2 epiphyses to each long bone. Facet a face, a small bony surface (occlusal facet on the chewing surfaces of the teeth) seen in planar joints. Femoris pertaining to the thigh Fissure a narrow slit or gap from cleft. Foramen a natural hole in a bone usually for the transmission of blood vessels and/or nerves. (pl. foramina). Fornix an arch Fossa a pit, depression, or concavity, on a bone, or from several bones as in temporomandibular fossa - more like a “bowl” than a cavity Fovea a small pit (usually smaller than a fossa) - as in the fovea of the occlusal surface of the molar tooth. Fracture break # particularly of bone Genio/Genu pertaining to the knee Geneio pertaining to the chin adj. geneio Glossus / Glosso pertaining to the tongue Gluteal / Gluteus pertaining to the buttocks Groove long pit or furrow, as on the Humerus Hamus a hook hence the term used for bones which “hook around other bones or where other structures are able to attach by hooking - hamulus = a small hook. Hyoid U-shaped Incisura a notch. Inter between (b/n) Intra within (w/n) Lacerum something lacerated, mangled or torn eg foramen lacerum small sharp hole at the base of the skull often ripping tissue in trauma. Lacrimal related to tears and tear drops. (noun lacrima) Lamina a plate as in the lamina of the vertebra a plate of bone connecting the vertical & transverse spines (pl. laminae) © A. L. Neill

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Locus Longus Lumbar Magnum Mandible Mastoid Maxilla Meatus

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Medulla Mental Metaphysis MyloNotch Nucha Oblique / Obliquuis

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Lingual Lip

Occiput

deficit or injury - lack of function arising from pathology fibrous tissue joining bone to bone a line as in the nuchal lines of the Occiput, linea aspera of the Femur pertaining to the tongue projection over the usual margin - e.g. the Glenoid lip (often pathological) a place (c.f. location, locate, dislocate). long back - generally the lower part of the back (lumbago) large pl magna from the verb to chew, hence, the movable lower jaw; adj.- mandibular. a breast or teat shape - mastoid process of the Temporal bone. the jaw-bone; now used only for the upper jaw; adj.maxillary. a short passage; adj.- meatal as in external acoustic meatus connecting the outer ear with the middle ear. middle relating to the chin (mentum = chin not mens = mind) the slightly expanded end of the shaft of a bone. relating to the molar teeth (from grinding as in a mill) an indentation in the margin of a structure. the nape or back of the neck adj.- nuchal. pertaining to a slope or slant e.g. muscles slanting downwards etc the prominent convexity of the back of the head Occiput = Occipital bone adj. occipital an eye / relating to an eye relating to teeth, toothlike see Dens pertaining to the shoulder a circle; the name given to the bony socket in which the eyeball rotates; adj - orbital. an opening. relating to the mouth a bone / bonelike, referring to bone a door, an opening, an orifice. Oval shaped a roof adj.- palatal or platatine. referring to the palm of the hand - anterior in the anatomical position pertaining to the eyebrow pertaining to the outer wall of a cavity from paries, a wall pertaining to a region beside or near the ear a part of referring to the anterior wall of the chest / breast resembling a feather referring to the lower leg adj. - peroneal

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Lesion Ligament Linea

Oculus / Ocular Odontoid OmoOrbit

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Orifice Oris / Ora Os / Osseus / Ossei Ostium Ovale Palate Palm / Palmar Palpebra Parietal Parotid Pars Pectus/ Pectorial Pennate Peroneus 7

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Prominens Prone Pterygoid Pubis/Pubic Quadratus Radial/Radialis Recess

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Rectus Rhomboid Ridge Risorius Root

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Piriform Plantae Process

small bones of the fingers or toes - 3/finger (2/thumb 2/big toe) pear shaped referring to the sole of the foot adj - plantar a general term describing any marked projection or prominence as in the mandibular process. a projection to place face down, or lie on the anterior surface (opposite supine) wing-shaped “hairy”, pertaining to the hairy part of the hip square or rectangular shaped pertaining to the radial or lateral bone of the forearm a secluded area or pocket; a small cavity set apart from a main cavity. straight - erect rhomboid shaped (squashed, leaning square) elevated bony growth often roughened. laughter, smile the segments of origin as in Nerve Root (NR) of the Peripheral Nerve made up from several points of exit from the SC round an arrow; the sagittal suture is notched posteriorly, making it look like an arrow by the lambdoid sutures. pertaining to a tube uneven, one side very different to the other grainlike S-shaped, from the letter Sigma which is S in Greek. a space usually within a bone lined with mucous membrane, such as the frontal and maxillary sinuses in the head, (also, a modified BV usually vein with an enlarged lumen for blood storage and containing no or little muscle in its wall). Sinuses may contain air, venous or arterial blood, lymph or serous fluid depending upon location and health of the subject adj.- sinusoid. the skull refers to all of the bones that comprise the head. a thorn - descriptive of a sharp, slender process / protrusion. adj. - spinous refers to the facial bones of the skull - most muscles to this region are innervated by the Facial (CN VII) and Trigeminal (CN V) nerves. partial dislocation of bone, generally in the VC, used account for any mechanical impediment to N function long wide groove often due to a BV indentation to place face up or to lie on posterior surface (opposite prone)

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Phalanx/Phalanges

Rotundum Sagittal Salpingo Scalene Sesamoid Sigmoid Sinus

Skull

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Spine

Splanchocranium

Subluxation to Sulcus Supine © A. L. Neill

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Stylos Symphysis Tarsus / Tarsal Temporal Tendon

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Tensor

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Tentorium Teres Thenar Thorax Trabecula

Trapezoid Trochanter Trochlear Trunk

Tubercle Tuberculum Tuberosity

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Tympanic Uncus Vagina

the saw-like edge of a cranial bone that serves as joint between bones of the skull. an instrument for writing hence adj. - styloid a pencil-like structure. a joint or a growth with bone-cartilage-bone connection e.g. in pubic symphysis pertaining to the Tarsal bone and the bones distal to it in the foot (not the toes - phalanges) refers to time and the fact that grey hair (marking the passage of time) often appears first at the site of the temporal bone. fibrous end of a skeletal muscle facilitating attachment to bone (as opposed to ligament joining bone to bone) to stretch (i.e. muscle to stretch so that a structure is “tense”) a tent. round shape relating to the palm as in thenar eminence referring to the chest region - anterior the area b/n the neck and the abdomen a “little” beam i.e. supporting structure or strut pl. trabeculae trapezius or kite shape small wheel or disc-shaped as the disc shape of the trochanters of the Femur pulley that part of the bone/ligament which pulls bones in another direction e.g. in the elbow and ankle the area b/n the thorax and the pelvis anterior and posterior - core muscles generally surround the trunk, relatively undefined (also referring to large groups of N fibres organizing to supply a particular region as in the trunks of the BP) a small process or bump, an eminence.. a very small prominence, process or bump. a large rounded process or eminence, a swelling or large rough prominence often associated with a tendon or ligament attachment. pertaining to a drum a hook adj. - uncinate. a sheath; hence, invagination is the acquisition of a sheath by pushing inwards into a structure, and evagination is similar but produced by pushing outwards adj. - vaginal. pertaining to a veil pertaining to the sole (foot) or palm (hand) a yoke, hence, the bone joining the maxillary, frontal, temporal & sphenoid bones also referring to the "H" shape of the bone. adj zygomatic.

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Suture

Velum / Veli Volar Zygoma

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Definition of Ligament and Tendon Ligament (2)= CT band which joins the muscle (1) to the bone also used to describe any non-specific thickening of CT in organs and other structures - may incorrectly be used in this sense interchangeably with Tendon Tendon (3)= - CT band which joins 2 bones over a joint or 2 boney points - used for joint stabilization

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to limit the ROM of the joint as in the Knee

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muscle eg. Biceps epimysium - CT surrounding a whole muscle perimysium - CT surrounding a muscle fascicle endomysium - CT surrounding each muscle fibre muscle fibre nucleus (note the muscle cell is multinucleated) sarcolemma - membrane around each myofibril myofibril sarcomere basic contractile unit of the muscle myosin filament actin filament

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Structure and Substructure of Skeletal muscles

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A band - myosin to myosin filaments H band - myosin only segments minimum in contraction I band - actin only segment maximum in relaxation Z line - line of attachment of the actin filaments

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Neuromuscular Junction – longitudinal

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Nerve end attaching to Skeletal muscle

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1 axon - sheathed 2 mylein sheath – multiple lipid layers 3 Schwann cell 4 axonlemma – axon membrane 5 pre-synaptic vesicles 6 axon – unsheathed / naked 7 presynaptic membrane 8 junctional folds (in sarcolemma) 9 synaptic cleft (~20nm) 10 mitochondria 11 sarcolemma 12 myofilaments in muscle fibre

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Neuro-Muscular Spindle –

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feedback loop to stop overextension in Skeletal muscle

Neuro-Tendinous Spindle – feedback loop to tendon

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1 capsule of spindle 2 myelinated motor fibres 3 myelinated sensory fibres 4 unmyelinated motor fibres 5 annualospiral fibre endings 6 bag of nuclei in intrafusal muscle 7 motor end plates 8 muscle fibres i = intrafusal e = extrafusal 9 skeletal muscle nuclei 10 tendon fibres i = intrafusal e = extrafusal 11 naked axons 12 nuclei in tendon

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This is the anatomical position.

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Anatomical Planes and Relations

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A = Anterior Aspect from the front Posterior Aspect from the back used interchangeably with ventral and dorsal respectively B= Lateral Aspect from either side C = Transverse / Horizontal plane D= Midsagittal plane = Median plane; trunk moving away from this plane = lateral flexion or lateral movement moving into this plane medial movement; limbs moving away from this direction = abduction; limbs moving closer to this plane = adduction E = Coronal plane F = Median

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arm abduction -away from median plane / adduction-towards the median plane -shoulder movement

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arm extension in sagittal plane / shoulder movement

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Anatomical Movements

shoulder extension in the sagittal plane

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shoulder abduction in the coronal plane (with elbow flexion)

shoulder elevation - reverse movement shoulder depression shoulder movement 19

wrist extension wrist flexion

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back extension / hyperextension note the back muscles are contracting

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hip flexion / with back and shoulder extension

back rotation

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back lateral flexion shoulder extension and elbow flexion 20


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neck flexion

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neck extension/hyper-extension

lateral flexion

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lateral rotation

note: extension of the neck is in the normal anatomical position

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arm/shoulder movements in the coronal plane commencing from adduction abduction to extension

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shoulder/scapula movements in the horizontal plane

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Hip extension

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Hip flexion

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Hip abduction

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Hip lateral and medial rotation

Knee flexion

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Hip adduction

Hip circumduction

Knee extension

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Foot dorsiflexion

Foot plantar flexion

Foot inversion

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Foot normal position

Fingers extension

Fingers flexion

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Forearm pronation Forearm supination

Fingers abduction

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Fingers adduction

Hand deviation radial/laterally ulna/medially

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Classification, Naming & Examination of Muscles

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There are 3 types of muscle tissue and this book discusses only one of them SKELETAL MUSCLE. The other 2 are smooth muscle (for the gut and other areas of involuntary movement) and cardiac muscle (for the heart).

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SKELETAL muscle is defined as muscle which is “striated” or striped, indicating and ordered cell structure, of myosin and actin filaments, and is generally under voluntary control, which has an action on the skeleton or bones in the body. In its relaxed form the muscle is at its maximum length and this is generally how the tissue is found. Stimulation generally causes contraction and a shortening and thickening of the tissue. As it is attached to a minimum of 2 points, the Origin (O) and the insertion (I) - although these may be arbitrarily named - this “contraction” brings these 2 points closer together. To reverse this, another muscle must be attached to 2 different points which when they move together cause a reversal of the position of the 2 or more affected bones, hence for each muscle there is an antagonist (opposing muscle) and in many situations a synergist (a muscle which enhances the original movement). There are a few exceptions to this, for example SPHINCTERS are circular groups of muscle fibres which upon contraction close the circle they have formed and may not be attached to bones at all. Their function is to prevent leakage or passage of material from one area to another. Many of the MUSCLES OF FACIAL EXPRESSION are inserted into the deep fascia of the skin and hence change the soft tissues of the face but do not affect the bones underneath. We as humans have a great deal of these muscles, and they may be shifted or injured in many cosmetic procedures because of this structure.

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Muscle are shaped to allow their contraction to occur in the most efficient manner, for example sheets of muscles cover expanses of tissue to contain them, as in the OBLIQUES to contain and move bulky abdominal contents, or DIAPHRAGMS to separate as well as move large anatomical regions around, while TERES muscles are small, cordlike, focused groups of fibres for very specific movements. Generally the smaller the muscles the deeper they are placed so larger and more powerful muscles ones can cover them, for example the GLUTEAL and ADDUCTOR group of muscles in the leg and buttocks. Smaller muscles generally have more specific actions, are more resilient but are weaker, they contract and relax repeatedly for example, to maintain posture or balance, as in the ROTATORES. Larger, longer muscles by definition cannot be as precise but have larger ranges of motion and more power and are placed more superficially - closer to the surface, as in ERECTOR SPINAE.

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Fibrous tissue inserts give the muscle more strength but less ability to move, as in RECTUS ABDOMINUS versus TRAPEZIUS, but it is these large surface/superficial muscles whose shape can be changed and defined by gross movement exercises.

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Muscles are named using many different criteria singly or in combination: for example they may be named according to their action –Supinator, Pronator and size – Adductor Magnus, Adductor Longus, Adductor Brevis; their shape and location- Biceps Brachii, Triceps Brachii, Quadratus Lumborum, Interossei, Intercostals; the direction of their muscle fibres and anatomical layer Obliquus Externus Abdominus, Obliquus Internus Abdominus and there does not seem to be a consistent pattern in this naming - only that from the name it is often possible to determine their site, action &/or shape and this helps when memorizing these muscles.

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Between each muscle group is a fascial layer to transport in the BVs and the Nerves but there is considerable variation in individuals so that in some cases some anatomists have named the same muscle in several ways. The commonest has been used here but the alternatives listed if it is thought there may be confusion this for example ROTATORES has been listed as a single muscle group but may in some books be divided into 2 ROTATORES LONGUS and BREVIS, similarly with PSOAS which can be PSOAS MAJOR and MINOR, but not with PECTORALIS MAJOR and MINOR, 2 distinct muscles. Wherever this occurs it is mentioned in the text, particularly if there is a functional difference in the 2 muscles.

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Testing of a muscle is often impossible to do singly and they must be tested as an anatomical and functional group. The tests are generally graded 1-5, with 5 being the strongest and 3 being the point where when appropriate the muscle can overcome Gravity often a natural form of resistance to the muscle action. This level of testing muscles is not dealt with in this book and will be discussed in the A to Z of Muscle and Sensory testing to follow - it is also examined in some detail in the A to Z of Peripheral Nerves - however testing of the primary action of most muscles is listed on each page as a guide to the practitioner for basic testing and grouping of muscles. Please use this testing section as a guide only.

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Myotomes

C1,2

neck and upper VC muscles

C3-5

diaphragm

C5

shoulder and upper arm

C6

wrist extension

C7

extension of the elbow

C8

finger movement

T1

finger abduction

T1-12 chest and abdominal muscles hip flexion

L3

knee extension

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Each muscle is supplied by a particular NR or segment of the SC and the muscles supplied by the same NR belong to the same MYOTOME. These are briefly grouped as follows.

L4

foot dorsiflexion

L5

toe movement

S1

plantar flexion of the foot

S2-5

organs of the pelvis and perineum including bladder and bowel and genitals

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These muscles are listed in detail in the following table.

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Muscle innervation at the SC level Muscle

C1

Longus Capitus Olquuis Capitus Superior Rectus Capitus Anterior Rectus Capitus Major Rectus Capitus Minor Semispinalis Capitus Trapezius

Neck Neck - head Neck - head Neck - head Neck - head Neck - head Back

C2

Longus Capitus Longus Colli Rectus Capitus Anterior Semispinalis Capitus Sternocleidomastoid Trapezius

Neck Neck - head Neck - head Neck - head Neck - head Back

C3

Levator Scapulae Longus Capitus Longus Colli Semispinalis Capitus Rhomboideus Major Rhomboideus Minor Sternocleidomastoid Trapezius

Neck - shoulder Neck Neck - head Neck - head Back - shoulder Back - shoulder Neck - head Back

C4

Iliocostalis Cervicis Levator Scapulae Longus Capitus Longus Colli Rhomboideus Major Rhomboideus Minor Sternocleidomastoid Trapezius

Neck - chest Neck - shoulder Neck Neck - head Back - shoulder Back - shoulder Neck - head Back

C5

Brachialis Brachioradialis Biceps Brachii Deltoid Iliocostalis Cervicis Infraspinatus Levator Scapulae Longus Capitus Longus Colli Pectoralis Major Rhomboideus Major Rhomboideus Minor Scalenus Ant. Medial &Post. Semispinalis Capitus Semispinalis Cervicus Serratus Anterior Sternocleidomastoid Subscapularis Supraspinatus

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Location

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SC level

Arm Arm Arm Shoulder - arm Neck - chest Neck - shoulder Neck - shoulder Neck Neck - head Chest - arm Back - shoulder Back - shoulder Neck Neck - head Neck Chest Neck - head Shoulder Shoulder

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Abductor Pollicis Longus Brachialis Brachioradialis Biceps Brachii Coracobrachialis Deltoid Extensor Carpi Radialis Brevis Extensor Carpi Radialis Longus Extensor Carpi Ulnaris Extensor Digitorum Extensor Digiti Minimi Extensor Indicis Extensor Pollicis Brevis Extensor Pollicis Longus Flexor Carpi Radialis Iliocostalis Cervicis Infraspinatus Latissimus Dorsi Longus Colli Pectoralis Major Pronator Teres Scalenus Anterior Scalenus Medial Scalenus Posterior Semispinalis Capitus Semispinalis Cervicus Serratus Anterior Subscapularis Supinator Supraspinatus Teres Major Trapezius

Hand - thumb Arm Arm Arm Arm - elbow Shoulder - arm Forearm - wrist Forearm - wrist forearm - wrist Hand - fingers Hand - little finger Hand - index finger Hand - thumb Hand - thumb Wrist Neck - chest Neck - shoulder Back - arm Neck - head Chest - arm Forearm - wrist Neck - head Neck - head Neck - head Neck - head Neck Chest - arm Scapula - shoulder Forearm - wrist Neck -shoulder Arm - chest Back

Abductor Pollicis Longus Anconeus Brachialis Brachioradialis Coracobrachialis Extensor Carpi Radialis Brevis Extensor Carpi Radialis Longus Extensor Carpi Ulnaris Extensor Digitorum Extensor Digiti Minimi Extensor Indicis Extensor Pollicis Brevis Extensor Pollicis Longus Flexor Carpi Radialis Flexor Digitorum Iliocostalis Cervicis Infraspinatus Latissimus Dorsi Longus Colli

Hand - thumb Elbow - Arm - Forearm Arm Arm Arm - elbow Forearm - wrist Forearm - wrist forearm - wrist Hand - fingers Hand - little finger Hand - index finger Hand - thumb Hand - thumb Wrist Hand - fingers Neck - chest Neck - shoulder Back - arm Head - neck

©D

C7

rA ma na

da

C6

Arm - back Arm - back Back

Ne ill

Teres Major Teres Minor Trapezius

29

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Abductor Digiti Minimi Abductor Pollicus Brevis Abductor pollicus Longus Adductor Pollicus Anconeus Dorsal Interossei Extensor Carpi Ulnaris Extensor Digitorum Extensor Digiti Minimi Extensor Indicis Extensor Pollicis Longus Flexor Carpi Ulnaris Flexor Pollicus Brevis Flexor Pollicus Longus Iliocostalis Cervicus +Thoracis Lumbricals Opponens Pollicis Palmar Interossei Pectoralis Major Pronator Quadratus

Hand - little finger Hand - thumb Hand - thumb Hand - thumb Elbow Hand - fingers Wrist Hand - fingers Hand - little finger Hand - index finger Hand - thumb Wrist Hand - thumb Hand - thumb

Hand - fingers Hand - thumb Hand - fingers Thorax - chest Hand

Abductor Digiti Minimi Abductor Pollicus Brevis Adductor Pollicus Dorsal Interossei Flexor Carpi Ulnaris Flexor Ddigitorum Profundus Flexor Digitorum Superficialis Flexor Pollicus Brevis Flexor Pollicus Longus Lumbricals Opponens Digiti minimi Opponens Pollicis Palmar Interossei Pectoralis Major Pronator Quadratus

Hand - little finger Hand - thumb Hand - thumb Hand - fingers Wrist Hand - fingers Hand - fingers Hand - thumb Hand - thumb Hand - fingers Hand - little finger Hand - thumb Hand - fingers Thorax - chest Hand

Adductor Brevis Adductor Longus Adductor Magnus Gracilis Iliacus Pectineus Rectus Femoris

Hip - thigh Hip - thigh Hip - thigh Hip - thigh Hip - thigh Hip Hip - thigh - knee

Ne ill

Chest - arm Forearm - wrist Neck - head Neck Chest - arm Scapula - shoulder Forearm - wrist Neck - shoulder Arm - chest Back Arm - elbow

rA ma na

da

C8

Pectoralis Major Pronator Teres Scalenus Anterior Semispinalis Cervicus Serratus Anterior Subscapularis Supinator Supraspinatus Teres Major Trapezius Triceps Brachii

©D

T1

L2

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31

Hip - thigh Hip - thigh Hip - thigh Hip - thigh Hip - thigh Hip Hip - thigh - knee Hip - thigh - knee

Hip - thigh - knee Hip - thigh - knee

Adductor Brevis Adductor Longus Adductor Magnus Extensor digitorum Brevis Extensor Digitorum Longus Extensor Hallucis Longus Gemellus Inferior Gluteus Medius Gluteus Minimus Gracilis Iliacus Obturator Externus Pectineus Peroneus Brevis Peroneus Longus Popliteal Quadratus Femoris Rectus Femoris Tibialis Anterior Vastus Intermedius Vastus Lateralis Vastus Medialis

Hip - thigh Hip - thigh Hip - thigh Foot - toes Foot - toes Foot - big toe Hip Hip Hip Hip - thigh Hip - thigh Hip - pelvis Hip Leg - ankle Leg - ankle Knee Hip - thigh - knee Hip - thigh - knee Leg - ankle Hip - thigh - knee Hip - thigh - knee Hip - thigh - knee

Biceps Femoris Extensor Digitorum Brevis Extensor Digitorum Longus Extensor Hallucis Longus Flexor Digitorum Brevis Flexor Digitorum Longus Flexor Hallucis Longus Gemellus Inferior Gemellus Superior Gluteus Maximus Gluteus Medius Gluteus Minimus Lumbrical (first) Obturator Externus Oburator Internus Pectineus

Hip - thigh Foot - toes Foot -toes Foot - big toe Foot - toes Foot - toes Foot - big toe Hip Hip Hip Hip Hip Toe Hip - pelvis Hip - pelvis Hip

©D

L5

Hip - thigh - knee Hip - thigh - knee

da

L4

Adductor Brevis Adductor Longus Adductor Magnus Gracilis IIiacus Pectineus Rectus Femoris Sartorius Vastus Intermedius Vastus Lateralis Vastus Medialis

rA ma na

L3

Hip - thigh - knee

Ne ill

Sartorius Vastus Intermedius Vastus Lateralis Vastus Medialis

© A. L. Neill



Biceps Femoris Extensor Digitorum Longus Extensor Hallucis Longus Flexor Digitorum Brevis Flexor Digitorum Longus Flexor Hallucis Longus Gastrocnemius Gemellus Inferior Gemellus Superior Gluteus Maximus Gluteus Medius Gluteus Minimus Lumbrical (first) Obturator Externus Oburator Internus Pectineus Peroneus Brevis Peroneus Longus Piriformis Quadratus Femoris Semimembranous Semitendinous Tensor fascia Lata Tibialis Anterior Tibialis Posterior

Hip - thigh Foot - toes Foot - big toe Foot - toes Foot - toes Foot - big toe Knee - leg Hip Hip Hip Hip Hip Toe Hip - pelvis Hip - pelvis Hip Leg - ankle Leg - ankle Hip Hip - thigh - knee Hip - thigh - knee Hip - thigh - knee Hip - leg Leg - ankle Leg - ankle

Biceps Femoris Flexor Hallucis Longus Gastrocnemius Gemellus Superior Gluteus Maximus Lumbricals (2-4) Oburator Internus Piriformis Semimembranous Semitendinous Soleus Lumbricals (2-4)

Hip - thigh Foot - big toe Knee - leg Hip Hip Toes Hip - pelvis Hip Hip - thigh - knee Hip - thigh - knee Foot - toes Toes

rA ma na

da

S1 S1

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S2

S3

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Leg - ankle Leg - ankle Knee Hip - thigh - knee Hip - thigh - knee Hip - thigh - knee Hip - leg Leg - ankle Leg - ankle

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Peroneus Brevis Peroneus Longus Popliteal Quadratus Femoris Semimembranous Semitendinous Tensor fascia Lata Tibialis Anterior Tibialis Posterior

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Segmental Motor Diagram

Head, upper neck and face supplied by CNs C1

neck

C2

infrahyoid

C3 C4 C5 C6

Biceps

da

C7

Triceps

C8 T1

T3 T4 T5 T6 T7 T8 T9 T10

Transverse thoracis

Intercostals

Abdominal obliques

SPI

Hip flexion

QL

©D

T11 T12 L1 L2 L3 L4 L5 S1 S2 S3 S4 S5

SPS

rA ma na

T2

33

upper limbs

shoulder

Pelvis

Lower limbs

Perineal muscles

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©D

rA ma na

da

Ne ill


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Muscles of the arm Muscles of the arm and shoulder

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Summaries of Skeletal Muscle Groups

External Rotators = Lateral Rotators

rA ma na

Infraspinatus Teres Minor

da

Deltoid Rotator Cuff muscles Subscapularis, Supraspinatus, Infraspinatus, Teres Major & Minor NS from the BP – C5-7 BS from the axillary artery & branches

Internal Rotators = External Rotators

©D

Latissimus Dorsi Teres Minor

35

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Ne ill

Muscles connecting the arm with the VC Levator Scapulae Rhomboids Major & Minor Trapezius Latissimus Dorsi NS segmental (C2-T12) BS from dorsal branches of the aorta

Muscles connecting the arm with the chest wall Pectoralis Major & Minor Serratus Anterior Subclavius

da

segmental NS and BS from the axillary and long thoracic

rA ma na

Muscles in the anterior compartment of the arm - flexors Biceps Brachii Coracobrachialis Brachialis NS musculocutaneous (C5-6) BS brachial

©D

Muscles in the posterior compartment - extensors Triceps Brachii NS radial (C7-8) BS profunda brachii and branches

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superficial Pronator Teres Palmaris Longus Flexor Carpi Radialis Flexor Carpi Ulnaris intermediate Flexor Digitorum Superficialis deep Flexor Pollicis Longus Flexor Digitorum Profundus Pronator Quadratus

da

anterior

Ne ill

Muscles of the forearm

NS median and ulnar Ns - BS radial branches

superficial Extensor Digitorum Extensor Digiti Minimi Extensor Carpi Ulnaris Anconeus deep Supinator Abductor Pollicis Longus Extensor Pollicis Longus & Brevis Extensor Indicis

rA ma na

posterior

©D

NS radial (C7-C8) BS radial and interosseous branches

37

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Intrinsic muscles of the hand THENAR EMINENCE (Side of the thumb) Muscles:

Abductor Pollicus Brevis Flexor Pollicus Brevis Opponens Pollicus

NS: median, C8 BS: median, medial of Superfical and Deep Palmer anastomoses

da

HYPOTHENAR EMINENCE (Side of the little finger) Muscles: Abductor Digiti Minimi Flexor Digiti Minimi Oppons Digiti Minimi

rA ma na

NS: ulnar, T1 BS: ulnar, lateral of Superfical and Deep Palmer anastomoses OTHER Muscles:

Adductor Pollicus Lumbricals (4) Interossei (7-8) Palmar and Dorsal

©D

BS: ulnar and radial, palmar anastomoses and digital branches

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Muscles of the Hip and Buttocks (Gluteal region) Gluteus Maximus, Medius, Minimus

Medial – Internal Rotators 7 Gluteus Minimus 8 Tensor Fascia Lata (part of the ITB)

rA ma na

NS local L4-S2 BS superior gluteal

da

Lateral – External Rotators 1 Obturator Externus 2 Obturator Internus 3 Gemellus Inferior 4 Quadratus Femoris 5 Gemellus Superior 6 Piriformis

6 5

1

4

2

©D

7

39

8

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Muscles:

NS: local, L4-S2 BS: superior gluteal

Ne ill

Muscles of the gluteal region Gluteus Maximus Medius and Minimus Piriformis Superior and Inferior Gemellus Obturator Internus Quadratus Femoris

da

Muscles and muscle layers of the chest and abdomen

rA ma na

superficial Pectoralis Major & Minor Serratus Anterior & Posterior Rectus Abdominus middle External & Internal Intercostals External & Internal Obliques deep Innermost Intercostals Levator Costi Longus & Brevis Tranversus Thoracics Transverses Abdominus Quadratus Lumborum

©D

NS segmental (C3-L2) BS from C3-L2

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Muscles of the Hip and Thigh anterior compartment muscles - hip flexors / knee extensors Sartorius Iliopsoas Pectineus Quadriceps Femoris = Vastus Intermedius + V. Lateralis V. Medialis + Rectoris Femoris (deep)

da

NS femoral N (L2-5) BS femoral

rA ma na

posterior compartment muscles - hip extensors /knee flexors Hamstrings = Semimembranous + Semitendinous + Biceps Femoris Adductor Magnus NS sciatic N (L2-S2) BS profunda femoris

medial compartment muscles - hip adductors Gracilis Adductor Magnus, Longus, Brevis Obturator Externus Pectineus

©D

NS obturator N (L2-4) BS obturator, profunda femoris

lateral compartment - abductor (not really a compartment) Tensor Fascia Lata - part of the Iliotibial tract NS superior gluteal (L4-S1) BS superior gluteal, lateral femoral circumflex

41

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Muscles of the leg anterior compartment muscles - dorsi-flexors of the ankle, extensors of the toes Extensor Digitorum Longus Extensor Hallicus Longus Peroneus Tertius Tibialis Anterior

rA ma na

da

NS deep peroneal N (L5-S1) BS anterior tibial

lateral compartment muscles - evertors Peroneus Brevis. Longus NS superficial peroneal N (S1-2) BS peroneal

posterior compartment muscles - plantar-flexors

©D

superficial Gastrocnemius, Plantaris, Soleus deep Extensor Digitorum Longus Flexor Hallicus Longus, Popliteus Tibialis Posterior

NS tibial N (L4-S3) BS posterior tibial

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Intrinsic muscles of the sole of the foot

Dorsal surface of the foot - dorsi-flexors Extensor Digitorum Brevis Extensor Hallicus Brevis and Dorsal Interossei (intrinsic muscles of the foot) and the tendons of the Longus Extensors cross over this surface (not shown).

rA ma na

da

NS deep peroneal N (S1-2) BS dorsalis pedis

©D

Plantar surface superficial layer - closest to the surface of the sole of the foot Abductor Hallicus Flexor Digitorum Brevis Abductor Digiti Minimi

43

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third layer

da

Ne ill

second layer Quadratus Plantae Lumbricals and tendons of the Flexors of the toes and big toe

rA ma na

Flexor Hallicus Brevis Adductor Hallicus Flexor Digiti Minimi

fourth and deepest layer of the sole - closet to the bones Interossei Tendons of Peroneus Longus and Tibialis Posterior

©D

NS lateral plantar (S1-3) BS lateral plantar

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Muscles and muscle layers of the Back and Neck NECK - has 2 major groups of muscles 1

those concerned with the neck movement i.e. movement of the cervical spine and head; 2 those concerned with the anterior neck structures. These muscles are dealt with in the laryngeal, pharyngeal and other related structures. Other muscles are concerned with the anterior regions of the head and are mentioned here.

rA ma na

da

deep posterior - suboccipital muscles - extensors (see the next page included with the back muscles) / hyperextensors / rotators and stabilizers Rectus Capitus Posterior - Major and Minor Obliquuis Capitus muscles Cervical and Cephalic / Capitus regions of the muscles of the VC NS segmental - dorsal rami of the related SNs BS dorsal branches of the carotids

deep anterior - prevertebral A flexors, rotators and stabilizers Rectus Capitus Anterior and Lateral Longus Colli and Capitus NS segmental - ventral rami of related SNs BS branches of carotids and other local vessels

©D

anterior - flexors, rotators B Scalenii muscles NS segmental anterior branches of the ventral rami BS superficial cervical

45

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rA ma na

da

A

Ne ill


©D

B

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1 2

Ne ill

BACK - has 2 major groups of muscles those which are intrinsic to the VC basically segmental muscles concerned with movements and stability of the VC particularly the deepest layers - connected with the movement of the neck etc. those which use the VC as an immoveable post and move structures around the back extrinsic concerned with the anterior neck structures.

EXTRINSIC

da

muscles which move the shoulder and arm Trapezius, Latissimus Dorsi, Rhomboids Levator Scapulae muscles which move the rib cage Serratus Posterior inferior and superior

NS segmental - ventral rami of related SNs BS branches of carotids and other local vessels

rA ma na

INTRINSIC

most superficial Erector Spinae - ES divided into a number of muscle groups with regional distinctions medial lateral Spinalis Iliocostalis Longissimus Iliocostalis - Lumborum, Thoracis, Cervicus Longissimus - Thoracis, Cervicus, Capitus Spinalis - Thoracis, Cervicus, Capitus

©D

O & I listed individually in the text as a group O along the VC, Sacrum and Ribs I into the VC and Ribs A listed individually A as a group the ES extends and rotates the VC NS - segmental spinal roots generally the dorsal rami but may alos have innervation from the dorsal branches of the ventral rami branches (C1L5) - cervical and capitus regions act upon the neck BS - segmental dorsal branches of the descending aorta, lumbar and sacral arteries T - to stand up from touching toes w/o help - from upright position bend to one side and the other w/o help

47

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rA ma na

da

Ne ill


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Muscles of the Perineum (only female anatomy shown)

Ne ill

The summary below is brief and only an overview of these muscles for completeness of this muscle book. They are discussed in individual detail in the A to Z of the Pelvis and Perineum and the A to Z of Surface Anatomy.

rA ma na

da

Anterior - urogenital triangle bordered by the pubic arch and ischeal tuberosities and overlaid by the structures of the Vulva. Bulbospongiosus surrounding the urethra and vagina combined and compressing their orifices during coitus Ischiocavernosus encasing glandular tissue which contacts in coitus to expel the contents Sphincter Urethrae = Urethral Sphincter sphincter hence circular muscle inserting all around natural position - constricted rather than relaxed Transverse Perineal - Profundus between the perineal fascae, Superficialis these muscles overlie each other with the perineal diaphragm in b/n Superficialis - inferior to Profundus hence closer to the skin NS pudendal (S2-4) BS pudendal

Posterior - anal triangle bordered by the ischeal tuberosities and the coccyx Coccygeus from the isheal spine tom the coccyx Levator Ani = Pubococcygeus + Iliococcygeus Sphincter Ani = External Anal Sphincter Ischiococcygeus sphincter hence circular muscle inserting all around natural position - constricted rather than relaxed

©D

A muscles of this region act to support the pelvic contents and the perineum and are intimately related so that damage to any of this basin of tissue will have profound effects on the functional capacities of the others. NS pudendal and Ns from SP (S2-4) BS internal iliacs

49

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rA ma na

da

Ne ill


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Ne ill

The summaries below are brief and only an overview of these muscles for completeness of this muscle book. They are discussed in individual detail in the A to Z of the Head and Neck.

Muscles of the Eye - note all 6 of these muscles act “in concert” in eye movement and depend upon the fixation and focus of the eye

Extrinsic

da

Muscles responsible for movement of the upper eyelid Levator Palpebrae Superioris NS occulomotor N (CNIII) BS supraorbital, branches of ophthalmic

rA ma na

Muscles responsible for movement of the eyeball Recti muscles - Inferior /Superior, Medial/Lateral. These muscles are straight and are responsible for one movement up/down, in/out Oblique muscles - Inferior, Superior These muscles are attached via a trochlea or pulley and movements therefore vary on eye position and are diagonal up and out/ down and in All are attached to the scleral surface, the Recti via the optic canal on the common annular tendon, and the Obliques via bones in the optic cavity NS oculomotor N (CNIII) - except Lateral Rectus - abducent N (CNVI) and Superior Oblique - trochlea N (CNIV) BS ophthalmic and branches of internal carotid

Intrinsic

These muscles are responsible for moving structures within the eyeball and are not shown.

©D

NS oculomotor N (CNIII) also branches from the autonomic NS BS ophthalmic and branches of internal carotid Ciliaris, Dilator Pupillae, Sphincter Pupillae

51

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rA ma na

da

Ne ill


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Expression

Ne ill

Muscles of the Face

rA ma na

da

Buccinator see individual listing Corrugator Supercili see individual listing Depressor Anguli Oris, see individual listing Depressor Labii Inferioris, see individual listing Depressor Septi see individual listing Frontalis (of Occipitofrontalis), see individual listing Incisivus Labii Superioris & Inferioris These muscles insert into the other muscles of the mouth and assist Orbicularis Oris in protruding the lips Levator Anguli Oris (Caninus), Levator Labii Superioris Levator Labii Superioris alaeque nasi These muscles evert the upper lips medially and laterally assisting Orbicularis Oris and the Zygomaticus muscles Mentalis see individual listing Nasalis (compressor & dilator) These muscles change the aperature of the nares (nostrils) assisting Depressor Septi Orbicularis Oculi see individual listing Orbicularis Oris see individual listing Platysma see individual listing Procerus This muscle depresses the medial end of the eyebrow assisting both Orbicularis Oculi and Corrugator Supercili Risorius see individual listing Zygomaticus Major & Minor see individual listing NS facial N (CNVII) BS facial These muscles are often involved in cosmetic surgery and their function may be compromised by incisions at the level of the deep fascia.

©D

Mastication

Masseter, see individual listing Pterygoids Lateral, Medial see individual listing Temporalis see individual listing All are attached to the Mandible - Jaw bone and part of the Splanchnocranium

NS trigeminal N (CNV) BS trigeminal and facial branches 53

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rA ma na

da

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- superficial anterior neck muscles - muscles of the Anterior Triangle - strap muscles Digastricus - see individual muscle listing Geniohyoid Mylohyoid

Ne ill

Muscles of the Thyroid & Hyoid

Omohyoid Sternohyoid Sternothyoid

da

These muscles elevate and position the Hyoid and the floor of the mouth to facilitate swallowing and occlusion of the Larynx NS hypoglossal and C1 of ansa cervicalis BS facial branches

rA ma na

These muscles depress the Hyoid after swallowing NS ansa cervicalsis C1-3 BS thyroid vessels Stylohyoid Thyrohyoid

These muscles are involved in support of swallowing - Thyrohyoid both lowers and elevates the Hyoid NS ansa cervicalis C1-3 BS facial and thyroid vessels

©D

As a group, these muscles define the neck line and shape, are involved in swallowing and sound production may be tightened in cosmetic surgery - they may attach to the Hyoid, Sternum and other bones in the region as a “through” bones - i.e. they have fascial slings to support them and separate them into 2 muscle bellies.

55

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rA ma na

da

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Muscles of the Larynx and Pharynx Salpingopharyngeus - attaches to the inferior of the auditory tube and blends with Palatopharyngeus to raise the pharyngeal wall close off the auditory tube for swallowing

Palatopharyngeus - attaches to the Thyroid cartilages and the Palate to bring the pharynx forward allowing food to leave the mouth and enter the pharynx Stylopharyngeaus - attaches to the styloid process and the constrictors to elevate and dilate the pharynx in the early stages of swallowing

da

Pharygneal Constrictors - superior, middle, inferior - attach to the Medial Pterygoid plate, Hyoid and Thyroid cartilages and blend in with each other and the posterior root of the tongue in order to commence swallowing and the resultant peristaltic movement -

rA ma na

NS vagus (CNX) and branches of ansa cervicalis (C1-3) BS maxillary, facial

Note in CVAs - strokes these muscles under voluntary control and are involved in the early stages of swallowing - so may be affected greatly limiting the person’s capacity to swallow

©D

Cricothyroid - attached to the laryngeal cartilages Arytenoids muscles attached to the arytenoids cartilages at the back of the vocal cords responsible for altering the shape and angle of these cartilages Cricoarytenoids - posterior and lateral, Thyroarytenoid, Transverse arytenoids, Vocalis - also attached to the arytenoids cartilages for voice regulation. NS for most of these muscles comes from the vagus (CNX) BS from the thyroid vessels and branches of the carotids

57

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rA ma na

da

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Muscles of the Soft Palate Levator Veli Palatini - attaches to the inferior surface of the Temporal bone to lift the soft palate and separate the naso and oropharynx

Muscularis Uvulae - attaches to the posterior spine of the Palatine bone and the Uvula to elevate it

Palatoglossus - attaches to the oral surface of the Palate to the side of the tongue to allow the tongue to rise and shut off the mouth from the oropharynx

da

Tensor Veli Palatini - attaches to the side of the auditory tube and medial of the spine of the Sphenoid bone to the hard palate to close both the naso and oropharynx NS mainly from glossopharyngeal N (CN IX) BS facial palatine vessels and branches

©D

rA ma na

It is changes in these muscles which may result in snoring and sleep apnea.

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Extrinsic

Ne ill

Muscles of the Tongue Genioglossus - attaches to the Hyoid, Pharyngeal constrictors, Hypoglossus and intrinsic Lingualis muscles to protrude tongue (poke out the tongue) depress the centre and raise the sides (make a tunnel with the tongue) Hyoglossus - attaches to the front and horns of the Hyoid, side of the tongue and intrinsic Lingualis muscles in order to depress the tongue (as in say AHHHHH…)

Intrinsic

da

Styloglossus - attaches to the styloid process, and blends with the Hypoglossus, Stylohyoid

rA ma na

Linguali muscles - superior, inferior, transverse and vertical attach w/in the tongue to change its shape for speech, in mastication and swallowing

©D

NS lingual, sublingual and hypoglossal (CNXII) Ns BS lingual, sublingual and external carotid

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Examination of Skeletal Muscles - major groups note detailed examinations of individual muscles are listed in the A to Z of Sensory and Muscles testing as well as general testing listed after each muscle in the text. ROM and a selection of strength tests of major movements are included here

Hx - questions for individual joint examination

1 functional limitation 2 SS -limited to one or more joints 3 onset - acute - related to a specific incident - chronic - slow progressive increase of pain or reduced ROM 4 description of the causative agent if known e.g. accident 5 any prior MSS history of that joint or others 6 Systemic problems

da

Ex - for participation in sport/training activities MSS

for this examination unless otherwise indicated the patient standing - facing the clinician in the anatomical position - included are several tests with the patient in alternative positions for specific testing

CERVICAL SPINE / NECK - ROM tests the following groups of muscles

rA ma na

Scalenes/Colles/Trapezius upper fibres/Cervicis regions of ES and deep muscles of the VC/Sternocleidomastoid patient looks at the roof ± R patient looks at the floor ± R patient looks over each shoulder ± R head bends towards the shoulder - sideways ± R (shoulders kept still)

extension flexion horizontal rotation lateral flexion

SHOULDER (SCAPULA) - ROM tests the following groups of muscles Levator Scapulae/Rhomboids/Serratus Anterior/Spinati muscles/Trapezius/Deltoid observe symmetry of shoulder particularly the Acromioclavicular jt shrug shoulders ± R elevation drop shoulders depression straighten shoulders - trying to meet shoulder blades lateral rotation contract shoulders - withdrawing chest medial rotation abduct shoulders to 90o (flexed arm) ± R abduction

©D

Strength tests - Shoulder

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SHOULDER + ARM - ROM tests the following groups of muscles

Ne ill

Pectorals/Latisimus Dorsi/Trapezius/Scapular muscles

rA ma na

full ROM of the shoulder, scapula and upper limb

da

scratch back with each hand from over and under the shoulder or have hands meet at the back from over and under the shoulder external rotation + abduction internal rotation + adduction move extended abducted arms as high as possible ± R vertical adduction move extended abducted arms into the sagittal plane ± R horizontal adduction move extended abducted arms out of the sagittal plane ± R horizontal abduction with bent arms keep them close to the body against R adduction

UPPER LIMB + HAND - ROM tests the following groups of muscles

Brachii muscles/Brachioradialis/Flexors & Extensors of upper limb, hand & digits/Supinators/Pronators/Carpi muscles/Intrinsic muscles of the hand flex/extend elbows ± R turn wrist in and out ± R bend and straighten wrist ± R move extended wrist towards the body ± R

move extended wrist away from the body ± R spread extended fingers ± R close extended open fingers ± R oppose fingers and thumb make a fist ± R extend hand and fingers ± R

pronation/supination flexion/extension ulnar deviation = medial flexion radial deviation = lateral flexion abduction adduction opposition flexion extension

©D

Strength tests - Shoulder

testing elbow extension / flexion

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The A to Z of Skeletal Muscles Testing pronation and supination

Wrist

testing extension flexion

rA ma na

Fist

da

Ne ill

Forearm

note the normal fist has all fingers pointing to the scaphoid tubercle normal flaxion of the IP joints

thumb adduction opposition

©D

Thumb

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BACK ABDOMEN - ROM tests the following groups of mscles

Ne ill

ES, deep muscles of the back, Latissimus Dorsi, Quadratus Lumborum, Obliques, Gluteal muscles, Rectus Abdominus observe posture, shoulder and neck symmetry, spinal curvature observe for balance on one leg bend from side to side while facing the front lateral flexion bend back as far as possible hyperextension twist from the hips to the left & right rotation supine patient - touch toes and back extension/flexion (back/abdomen)

Strength tests - Abdomen

rA ma na

da

testing abdominal flexion - abdominal rotation

HIP + THIGH - ROM tests the following muscles

Gluteal muscles/Iliopsoas /Obturators/Quadriceps/Hamstrings/ Adductors/Abductors observe symmetry of the hips and stance turn leg inwards/outwards standing patient - touch toes with straight legs

lift the extended leg forwards/backwards lift the extended leg sideways with the sitting patient keep legs together against R

medial/lateral rotation extension/flexion (back) & hamstring tightness flexion/extension (hip) lateral flexion (hip) adduction

Hip

©D

test flexion

© A. L. Neill

extension 64


rA ma na

adduction

da

test abduction

Ne ill


test lateral / external rotation

medial / internal rotation

LOWER LIMB + KNEE + FOOT - ROM tests the following groups of muscles

©D

Gluteal muscles/Iliopsoas/Quadriceps/Hamstrings/Adductors/Abductors/Peroneal muscles/Soleus/Intrinsic muscles of the foot

observe for knee & ankle symmetry - looking for effusions &/or deformities bend and straighten legs with erect posture flexion/extension (knee & ankle) spread toes abduction (toes) point toes plantar flexion (ankle) duckwalk with buttocks on heals - this tests all lower limb and hip ROM point feet outwards/inwards eversion/inversion (foot) 65

© A. L. Neill



Ne ill

Strength tests - Knee

flexion

da

testing extension

rA ma na

Ankle

testing dorsiflexion

plantar flexion

©D

Toes

testing extension

© A. L. Neill

flexion

66



Skeletal Muscle Groups

Ne ill

Skeletal Muscle Groupings

da

Muscles of the face, head and neck Muscles of the trunk

rA ma na

Muscles of the back and spine

Muscles of the chest, shoulder, forearm and hand Muscles of the hip, thigh, leg and foot Muscles of the pelvis and perineum

©D

Please use this colour coding as a guide only for muscle positions and placements; double colour codes may be used for muscles which cover 2 anatomical regions.

67

© A. L. Neill



©D

rA ma na

da

Ne ill

Skeletal Muscle Groupings

© A. L. Neill

68



Ne ill

Index of Muscles A

63 64 65 66 67 68 69 70 71 72 73

da

Abductor Digiti Minimi (foot) Abductor Digiti Minimi (hand) Abductor Hallicus Abductor Pollicus Brevis Abductor Pollicus Longus Adductor Brevis Adductor Hallicus Adductor Longus Adductor Magnus Adductor Pollicus Anconeus Aryepiglotticus see the muscles of the Larynx Arytenoids - Oblique, Transverse - see the muscles of the Larynx Auricularis = Extrinsic Auricular Muscles

B

74

C

rA ma na

Biceps Brachii Biceps Femoris Brachialis Brachioradialis Buccinator Bulbospongiosus - see the muscles of the Perineum

75 76 77 78 79

Ciliaris see the muscles of the eye Coccygeus = Ischeococcygeus - see the muscles of the Perineum Coracobrachialis Corrugator Supercilii Cremaster Cricothyroid - see the Thyro/Hyoid muscles

D

©D

Deltoid Depressor - Anguli Oris, Labii Inferioris, Septi Diaphragm Digastricus Dilator pupillae - see the muscles of the eye Dorsal Interossei - (foot) Dorsal Interossei - (hand)

E

83 84, 85, 86 87 88 89 90

Epicranius = Frontalis + Occipitalis Erector Spinae (ES) - Iliocostalis, Longissimus, Spinalis - see muscles of the Back - muscles are also each listed separately Extensor Carpi Radialis Brevis Extensor Carpi Radialis Longus

69

80 81 82

91 92 93

© A. L. Neill



94 95 96 97 98 99, 100 101 102, 103

F

da

Ne ill

Extensor Carpis Ulnaris Extensor Digiti Minimi Extensor Digitorum Extensor Digitorum Brevis Extensor Digitorum Longus Extensor Hallicus Brevis, Longus Extensor Indicis Extensor Pollicis Brevis, Longus External Anal Sphincter - see Sphincter Ani External Intercostals - see Intercostals External Obliques - see Obliquuis Abdominus Externus Extrinsic Auricular Muscles - see Auricularis Extrinsic Ocular Muscles - see the muscles of the eye

rA ma na

Flexor Carpi Radialis Flexor Carpi Ulnaris Flexor Digiti Minimi Brevis (foot) Flexor Digiti Minimi Brevis (hand) Flexor Digitorum Brevis Flexor Digitorum Longus Flexor Digitorum Profundus Flexor Digitorum Superficialis Flexor Hallicus Brevis, Longus Flexor Pollicus Brevis, Longus Frontalis - see Epicranus

104 105 106 107 108 109 110 111 112, 113 114, 115

G

Gastrocnemius 116 Gemellus Inferior, Superior 117 Genioglossus - see the summary of the Tongue Muscles Geniohyoid - see the summary of the muscles of the Hyoid Gluteus Maximus, Medius, Minimus 118, 119, 120 Gracillis 121

H

Hyoid muscles - Geniohyoid, Mylohyoid, Omohyoid, Sternohyoid - see the muscles of the Thyro / Hyoid Hypoglossus - see the Tongue Muscles

I

©D

Iliacus Iliocostalis- Lumborum, Thoracis, Cervicis - part of ES Iliopsoas = Iliacus + Psoas - see Iliacus and Psoas Incisivus Labii - Inferior, Superior - see the muscles of the face Inferior Lingualis - see the muscles of the Tongue Inferior Oblique - see the muscles of the Eye Inferior Pharyngeal Constrictor - see Pharyngeal Constrictors Inferior Rectus - see the muscles of the Eye Infraspinatus

© A. L. Neill

122 123

125 70



Ne ill

Innermost Intercostals = Intercostalis Intimi see Intercostals Internal intercostals - see Intercostals Internal Obliques - see Obliquuis Abdominus Internus Intercostals - External, Internal 126 Interossei - Dorsal, Palmer (hand), Dorsal, Plantar (foot) also see individual listings of these muscles Interspinalis 127, 128 Intertransversarii 129. 130 Intrinsic Auricular Muscles - Stapedius Intrinsic Ocular Muscles - Ciliarus, Recti muscles, Sphincter Pupillae - see the muscles of the eye Ischiocavernosus - see the muscles of the Perineum

L

M

rA ma na

da

Lateral Cricoarytenoid - see the muscles of the Larynx Latissimus Dorsi 131 Levator Ani Levator Palpabrae Superioris - see the muscles of the Eye Levator Anguli Oris - see the muscles of the face Levator Costi - Brevis, Longus 132, 133 Levator Labii - Superioris, Superioris, Nasi - see the muscles of the face Levator Scapulae 134 Levator Veli Palatini - see the Soft Palate Muscles Lingualis - Inferior, Transverse & Vertical - see Tongue Muscles Longissimus - Thoracis, Cervicus, Capitus - part of ES 135, 136 Longus Capitus, Colli 137, 138 Lumbricals (foot) 139 Lumbricals (hand) 140 Masseter Mentalis Middle Pharyngeal Constrictor - see Pharyngeal Constrictors Multifidus Muscularis Uvulae - see the Soft Palate Muscles Mylohyoid - see the Thyro / Hyoid Muscles

N

141 142 143, 144

Nasalis - see the muscles of the Face

O

©D

Oblique muscles - superior / inferior - see the muscles of the Eye Obliquuis Abdominus - External, Internal 145, 146, 147, 148 Oblique Capitus Inferior, Superior 149 Obturator Externus, Internus 150, 151 Occipitalis - see Epicranus Occipito - Frontalis = Epicranus Omohyoid - see the Hyoid muscles Opponens Digiti Minimi 152 Opponens Pollicus 153 Orbicularis Oculi, Oris 154, 155

71

© A. L. Neill



P

rA ma na

da

Ne ill

Palatoglossus - see the Soft Palate Muscles Palmer Interossei - see also Interossei 156 Palmaris Brevis, Longus 157, 158 Pectineus 159 Pectoralis Major, Minor 160, 161 Peroneus Brevis, Longus, Tertius 162, 163, 164 Pharyngeal Constrictors - Superior, Middle, Inferior Pharyngeal Muscles - Constrictors, Palatopharyngeus, Stylopharyngeus, Salpingopharyngeus - see the muscle of the Soft Palate Piriformis 165 Plantar Interossei - see Interossei 166 Plantaris 167 Platysma 168 Popliteus 169 Posterior Cricoarytenoid - see the muscles of the Larynx Procerus - see the muscles of the Face Pronator Quadratus 170 Pronator Teres 171 Psoas Major, Minor 172 Pterygoid Lateral, Medial 173 Pyramidalis 174

Q

Quadratus Femoris Quadratus Lumborum Quadratus Plantae

175 176 177

R

Recti muscles - medial / lateral - superior / inferior - see the muscles of the Eye Rectus Abdominus 178 Rectus Capitus, Anterior, Lateralis 179 Rectus Capitus Posterior Major, Minor 180 Rectus Femoris 181 Rhomboideus Major, Minor (Rhomboid = USA) 182, 183 Risorius (also in the Muscles of the face) 184 Rotatores - Brevis, Longus 185

S

©D

Salipingopharyngeus - see the Pharyngeal Muscles Sartorius 186 Scaleni - Anterior, Medial, Posterior 187 Semimembranous 188 Semispinalis - Capitus, Cervicis, Thoracis 189, 190 Semitendinous 191 Serratus Anterior 192 Serratus Posterior - inferior, superior 193 Soft Palate Muscles - Musculus Uvulae, Palatoglossus, Levator & Tensor Veli Patalini - see the muscles of the Soft Palate

© A. L. Neill

72



194 195

da

Ne ill

Soleus Sphincter Ani (External Anal Sphincter) Sphincter Pupillae see Intrinsic Ocular Muscles Sphincter Urethrae (Urethral Sphincter) Spinalis - Capitus, Cervicis, Thoracis - part of ES Splenii Capitus, Cervicis Stapedius - see Intrinsic Auricular Muscles Sternocleidomastoid Sternohyoid - see Thyro / Hyoid Muscles Sternothyoid - see Thyro / Hyoid Muscle Stylohyoid - see Thyro / Hyoid Muscles Stylopharyngeus - see Pharyngeal Muscles Subclavius Subcostales Subscapularis Supinator Superior Pharyngeal Constrictor - see Pharyngeal Constrictors Supraspinatus

T

196 197, 198 199

200

201 202 203 204 205

U

rA ma na

Temporalis 206 Tensor Fascia Lata 207 Tensor Veli Palatini - see the Soft Palate Muscles Teres Major, Minor 208, 209 Thyrohyoid - see Thyro / Hyoid Muscles Tibialis Anterior, Posterior 210, 211 Tongue Muscles - Genioglossus, Hyoglossus, Styloglossus, Inferior, Transverse & Vertical Lingualis Transversus Abdominus 212 Transversus Perinei - Profundus, Superficialis Trapezius 213, 214 Triceps Brachii 215 Urethral Sphincter - see Sphincter Urethrae

V

Vastus Intermedius, Lateralis, Medialis

Z

219

©D

Zygomaticus Major, Minor

216, 217, 218

73

© A. L. Neill


©D

rA ma na

da

Ne ill


© A. L. Neill

74



A

Abductor Digiti Minimi (foot)

rA ma na

da

Ne ill

most superficial layer of the sole of the foot

©D

O - medial & lateral process of Calcaneal tuberosity - Plantar Aponeurosis I - lateral base Phalanx 1 Digit 5 A - abduction NS - lateral plantar N (L4-5) BS - lateral plantar T - abduction against R

75

© A. L. Neill



Abductor Digiti Minimi (hand)

A

©D

rA ma na

da

Ne ill

Hypothenar eminence

© A. L. Neill

O - Pisiform - tendon of Flexor Carpi Ulnaris I - ulnar side Phalanx 1 Digit 5 A - abduction NS - ulnar N (C8-T1) BS - ulnar T - abduction against R

76



A

Abductor Hallicus

rA ma na

da

Ne ill

most superficial layer of the sole of the foot

©D

O - medial process of Calcaneal tuberosity - Plantar Aponeurosis / Flexor Retinaculum I - medial base Phalanx 1 Digit 1 A - abduction NS - medial plantar N (L4-5) BS - medial plantar T - abduction against R

77

© A. L. Neill



Abductor Pollicus Brevis

A

rA ma na

da

Ne ill

part of the thenar eminence

©D

O - ridge of Trapezium - Flexor Retinaculum - Scaphoid I - lateral Phalanx 1 Digit 1 A - abduction / anterior movement of thumb NS - median N (C7-T1) BS - radial T - abduction against R - at MCP

© A. L. Neill

78



Abductor Pollicus Longus

rA ma na

da

Ne ill

A

©D

O I A NS BS T -

79

posterior Radius posterior Ulna interosseus membrane lateral base of MC 1 abduction of hand and thumb radial N (C6-7) radial / ulnar abduction against R - at MCP

© A. L. Neill



Adductor Brevis

A

rA ma na

da

Ne ill

part of the medial compartment of the thigh

©D

O - inferior pubic ramis of hip I - upper medial lip of linea aspera (Femur) A - adduction / hip flexion NS - obturator N (L2-4) BS - obturator T - adduct legs against R in the supine patient

© A. L. Neill

80



A

Adductor Hallicus

rA ma na

da

Ne ill

part of the third layer of the sole of the foot

©D

O - oblique head - base MTs 2-4 - transverse head - sheath/tendon of Peroneus Longus - plantar MCPs of Digits 3-5 I - lateral base of Phalanx 1 Digit 1 A - adduction NS - lateral plantar N (deep branch) (L4-5) BS - 1st plantar MT T - separate big toe against R

81

© A. L. Neill



Adductor Longus

A

rA ma na

da

Ne ill


©D

O - pubic symphysis of hip I - middle medial lip of linea aspera (Femur) A - adduction / hip flexion NS - obturator N (L2-4) BS - obturator T - adduct legs against R in the supine patient

© A. L. Neill

82



A

Adductor Magnus

rA ma na

da

Ne ill


©D

O - pubic symphysis, ischeal ramus of hip I - linea aspera, adductor tubercle (Femur) A - adduction / hip flexion & extension NS - obturator N + sciatic N (L2-4) BS - obturator, medial circumflex, femoral T - adduct legs against R in the supine patient

83

© A. L. Neill



A

rA ma na

da

Ne ill

Adductor Pollicus

©D

O - transverse head of MC 3 - Capitate (oblique head) - Trapezium - Trapezoid I - lateral base of Phalanx 1 Digit 1 A - adduction of thumb NS - ulnar N (deep branch) (C8-T1) BS - deep palmar arch T - close hand against R to the thumb

© A. L. Neill

84



A

rA ma na

da

Ne ill

Anconeus

posterior lateral condyle - Capitulum (Humerus) posterior Olecranon process (Ulna) elbow extension radial N (C7-8) brachial (deep branch) extend elbow against R

©D

O I A NS BS T -

Aryepiglotticus - see Muscles of the Larynx Arytenoids - Oblique, Transverse - see Muscles of the Larynx

85

© A. L. Neill



Auricularis

A

rA ma na

da

Ne ill

anterior, superior, posterior = Extrinsic muscles of the Ear (present in 30%)

©D

O - ant. Epicranial Aponeurosis - post. Mastoid process of Temporalis - sup. Epicranial Aponeurosis I - ant. root of Auricle - post. root of Auricle - sup. root of Auricle A - moves ear Pinna NS - facial N (CN VII) BS - facial / temporal T - present if there is movement of the ear

© A. L. Neill

86



Biceps Brachii

rA ma na

da

Ne ill

B

©D

O - long head superior lip of Glenoid fossa (Scapula) - short head Coracoid process (Scapula) I - tuberosity (Radius) A - flexion (shoulder & elbow) - supination (hand & forearm) NS - musculocutaneous N (C5-6) BS - brachial (deep branch) T - flex elbow against R - elbow placed on table at 90º

87

© A. L. Neill



B

rA ma na

da

Ne ill

Biceps Femoris

©D

O - ischeal tuberosity (hip) - linea aspera (Femur) I - head of Fibula A - extension (hip) - flexion (knee) - rotation (flexed knee) NS - sciatic N (L5-S2) BS - deep femoral - popliteal T - extend hip against R - flex knee against R - in the prone patient

© A. L. Neill

88



Brachialis

rA ma na

da

Ne ill

B

©D

O - lower ½ of the Humerus I - coronoid process (Ulna) A - flexion (elbow) NS - musculocutaneous N (C5-6) BS - brachial (deep branch) - radial recurrent T - flex elbow against R - elbow placed on table at 90º

89

© A. L. Neill



B

rA ma na

da

Ne ill

Brachioradialis

©D

O - lateral supracondylar ridge (Humerus) I - styloid process (Radius) A - flexion (elbow) - pronation (forearm) NS - radial N (C5-6) BS - radial recurrent T - flex elbow against R - elbow placed on table at 90º

© A. L. Neill

90



Buccinator

B

- lateral – outer surface of alveolar process of Maxilla - lateral surface (Mandible) I - deep part of the muscles of the lips - deep fascia of the face A - compresses cheeks - draws down angle of the mouth NS - facial N (CN VII) BS - facial T - ask patient to blow as if playing the saxaphone.

©D

O

rA ma na

da

Ne ill

part of the muscles of mastication

Bulbospongiosus - see Muscles of the Perineum Ciliaris - see Muscles of the Eye Coccygeus = Ischeococcygeus - see the muscles of the Perineum

91

© A. L. Neill



C

rA ma na

da

Ne ill

Coracobrachialis

©D

O - corocoid process (Scapula) I - midshaft of the Humerus A - adduction (arm & shoulder) NS - musculocutaneous N (C6-7) BS - brachial T - moving extended arm supported on a table to the midline against R

© A. L. Neill

92



Corrugator Supercilii

Ne ill

part of the muscles of facial expression

rA ma na

da

C

©D

O - glabella (Frontalis) - medial suprorbital margin (Frontalis) I - deep fascia of the skin in the midpoint of the orbital arch A - pulls brows down and medially frowning NS - facial N, supraorbital supratrochlear branches (CN VII) BS - facial opthalmic artery T - ability to wrinkle brow

93

© A. L. Neill



Cremaster C

rA ma na

da

Ne ill

part of the muscles of the perineum

©D

O - inguinal ligament I - pubic tubercle (hip) A - pulls testis to the body /regulates temperature of the testis NS - genitofemoral, genital branch (L1-2) BS - genitofemoral, genital branch T - testis jumps up when the thigh is stroked - labia majora twitches

© A. L. Neill

94



Ne ill

Deltoid

lateral 1/3 of anterior surface of Clavicle acromion process (Scapula) posterior spine (Scapula) deltoid tuberosity (Humerus) anterior - shoulder flexion, adduction, medial rotation abduction >90º, horizontal swing to midline - middle - shoulder abduction >90º - posterior - shoulder extension, adduction, lateral rotation abduction >90º horizontal swing to midline, NS - axillary N (C5-6) BS - thoracoacromial T - moving shoulder in most directions against R - the supine patient will eliminate the influence of gravity

©D

O I A -

rA ma na

da

D

95

© A. L. Neill



Depressor Anguli Oris D

rA ma na

da

Ne ill


©D

O - oblique lines (Mandible) I - deep fascia - at the corner of the lips A - turns the corners of the lips down as in frowning NS - facial N, mandibular branch (CN VII) BS - facial - maxillary branch + inferior labial branch T - ability to turn down the corners of the mouth as in frowning

© A. L. Neill

96



Depressor Labii Inferioris

Ne ill


rA ma na

da

D

©D

O - anterior-medial surfaces of Mandible I - deep fascia medial to the corners of the lips A - pulls lips down and back (with Platysma) NS - facial N, superior buccal & mandibular branches (CN VII) BS - facial - labial branches T - ability to draw back lips and tighten neck (Platysma)

97

© A. L. Neill



Depressor Septi D

rA ma na

da

Ne ill


©D

O - anterior - medial surfaces of Maxilla I - deep fascia at the base of the nose A - pulls nostrils inwards and lips up NS - facial N, maxillary branch (CN VII) BS - facial - maxillary, superior buccal branches T - ask patient to wrinkle nose

© A. L. Neill

98



Ne ill

Diaphragm

rA ma na

da

D

©D

O - xiphoid process (Sternum) - ribs 7-12 - lumbar vertebrae L1-2 I - central tendon A - forced inspiration - pulls down central tendon and expands volume NS - phrenic (C3-5) - accessary phrenic, cervical plexus BS - superior, inferior phrenic, mamillary & long thoracic T - ask patient to force inspiration and note abdomen increase

99

© A. L. Neill



Digastricus D

rA ma na

da

Ne ill

part of the muscles of the Hyoid (anterior neck 2 muscle bellies passing through a fibrous loop)

anterior - inner side (lingular) of jaw (Mandible) posterior - mastoid notch (Temporal bone) slides through the Hyoid tendon / ligament elevates, retracts and protracts Hyoid depresses Mandible anterior - trigeminal N (CN V) posterior - facial N (CN VII) facial mandibular branch superior cervical open jaw against R note movement of Hyoid on swallowing

©D

O I A NS BS T -

© A. L. Neill

100



Ne ill

Dorsal Interossei (foot)

rA ma na

da

D

©D

O - 2 heads to adjacent MTs 2-5 I - base Phalanx 1 Digits 2-5 A - abduction NS - lateral plantar (superficial peroneal) (L4-S2) BS - lateral plantar

101

© A. L. Neill



D

rA ma na

da

Ne ill

Dorsal Interossei (hand)

©D

O - 2 heads to adjacent MCs 2-5 I - base Phalanx 1 Digits 2-5 A - abduction of fingers from and axis through middle finger - flexion of proximal PIPs - extension of middle and distal PIPs (fingers in a tent) NS - ulnar N (C8-T1) BS - deep palmer arch T - open fingers against R - straighten 1st jt of fingers and straighten out their ends

© A. L. Neill

102



Ne ill

Epicranius = Frontalis + Occipitalis = Occipito-Frontalis

rA ma na

da

E

Frontalis

O - skull aponeurosis I - superficial fascia superior to brow A - raises eyebrows / wrinkles forehead NS - facial N temporal branches (CN VII) BS - supraorbital supratrochlear branches of opthalmic artery

Occipitalis

©D

O - Occipital bone - mastoid process (Temporalis) I - skull aponeurosis A - draws scalp back NS - facial N postauricular branch BS - facial Erector Spinae (ES) - Iliocostalis, Longissimus, Spinalis - see muscles of the Back - muscles are also each listed separately

103

© A. L. Neill



E

rA ma na

da

Ne ill

Extensor Carpi Radialis Brevis

©D

O - lateral epicondyle (Humerus) I - dorsal base of MC 3 A - extension (wrist) - radial deviation of hand NS - radial N (C6-8) BS - radial - radial recurrent T - lift hand from table against R - move flat hand towards thumb against R

© A. L. Neill

104



Ne ill

Extensor Carpi Radialis Longus

rA ma na

da

E

©D

O - lateral supracondylar ridge (Humerus) I - dorsal base of MC 2 A - extension (wrist) NS - radial N (C6-8) BS - radial, radial recurrent - posterior interosseus T - lift hand from table against R

105

© A. L. Neill



E

rA ma na

da

Ne ill

Extensor Carpis Ulnaris

©D

O - lateral epicondyle (Humerus) - interosseus membrane from posterior surface I - medial base of MC5 A - extension (wrist) - lateral deviation of hand NS - radial N (C6-8) BS - ulnar T - lift hand from table against R

© A. L. Neill

106



Ne ill

Extensor Digiti Minimi

rA ma na

da

E

©D

O - lateral epicondyle (Humerus) I - dorsal Phalanx 1, Digit 5 via Extensor Digitorum tendon A - extension (forearm, hand & Digit 5) - abduction (Digit 5) NS - radial N, deep radial N (posterior interosseus N) (C7-8) BS - ulnar T - abduct little finger against R

107

© A. L. Neill



E

rA ma na

da

Ne ill

Extensor Digitorum

©D

O - lateral epicondyle (Humerus) I - 4 tendons arise and are attached to dorsal base of Phalanges 2-3 & Digits 2-5 A - extension (forearm, hand & Digits2-5) NS - radial N, deep radial N (posterior interosseus N) (C7-8) BS - ulnar T - extend hand from fist against R

© A. L. Neill

108



Ne ill

Extensor Digitorum Brevis

rA ma na

da

E

©D

O - superio-lateral surface of Calcaneus - inferior retinaculum I - 4 tendons arise and are attached to dorsal base of Phalanx 1 & Digits 2-4 A - extension (Digits1-4) NS - deep peroneal N (L5-S1) BS - dorsalis pedis - lateral tarsal T - lift toes with foot on floor from upright patient

109

© A. L. Neill



E

rA ma na

da

Ne ill

Extensor Digitorum Longus

©D

O - anterior surfaces of Tibia & Fibula - interosseus membrane I - 4 tendons arise and are attached to dorsal base of Phalanges & Digits 2-5 A - extension (Digits1-4) - dorsiflexion of the ankle NS - deep peroneal N, anterior tibial N (L4-S1) BS - anterior tibial T - lift foot and toes with heel on floor from upright patient - walk / stand on heels

© A. L. Neill

110



Ne ill

Extensor Hallicus Brevis

rA ma na

da

E

©D

O - superio-lateral surface of Calcaneus - inferior retinaculum I - dorsal base of Phalanx 1 & Digit 1 A - extension (Digit1) NS - deep peroneal N (S1-2) BS - dorsalis pedis - medial tarsal T - uncurl big toe against R

111

© A. L. Neill



rA ma na

da

Ne ill

Extensor Hallicus Longus

©D

O - anterior Fibula I - Phalanx 2 & Digit 1 A - extension (Digit 1) - dorsiflexion (ankle) NS - deep peroneal N (S1-2) BS - dorsalis pedis - anterior tibial T - lift big toe from floor from upright patient - extend big toe

© A. L. Neill

112

E



Ne ill

Extensor Indicis

rA ma na

da

E

©D

O - dorsal distal ½ of Ulna - posterior distal surface of interosseus membrane I - dorsal base of Phalanges 2-3 & Digit 2 via extensor digitorum tendon A - extension (hand & Digit 2) NS - radial N (C7-T1) BS - ulnar T - extend curled hand & index finger

113

© A. L. Neill



E

rA ma na

da

Ne ill

Extensor Pollicis Brevis

©D

O - dorsal surface of Radius I - dorsal base of Phalanx 1 & Digit 1 A - extension and abduction (hand & thumb) NS - radial N, deep radial (= posterior interosseus N) (C6-7) BS - ulnar T - open curled thumb against R

© A. L. Neill

114



Ne ill

Extensor Pollicis Longus

rA ma na

da

E

©D

O - dorso-lateral surface in the middle 1/3 of Ulna - interosseus membrane I - dorsal base of Phalanx 2 & Digit 1 A - extension and abduction (hand & thumb) NS - radial N, deep radial (= posterior interosseus N) (C6-7) BS - ulnar T - open curled thumb against R External Anal Sphincter - see Sphincter Ani External Intercostals - see Intercostals External Obliques - see Obliquuis Abdominus Externus Extrinsic Auricular Muscles - see Auricularis Extrinsic Ocular muscles - see the muscles of the Eye

115

© A. L. Neill



rA ma na

da

Ne ill

Flexor Carpi Radialis

©D

O - medial condyle (Humerus) I - dorsal base of MC 2-3 A - flexion (forearm & hand) NS - median N (C6-7) BS - radial, radial recurrent T - lift up forearm lying flat on a table against R

© A. L. Neill

116

F



Ne ill

Flexor Carpi Ulnaris

rA ma na

da

F

©D

O - medial condyle (Humerus) - proximal posterior (Ulna) I - Pisiform - base of MC 5 A - flexion (forearm & hand) NS - ulnar N (C7-8) BS - posterior ulnar recurrent T - lift up forearm lying flat on a table against R

117

© A. L. Neill



F

rA ma na

da

Ne ill

Flexor Digiti Minimi Brevis (foot)

©D

O - base MT 5, sheath of Peroneus Longus I - base of Phalanx 1 & Digit 5 A - flexion (foot & little toe) NS - lateral plantar N (L4-5) BS - lateral plantar T - curl up little toe

© A. L. Neill

118



Flexor Digiti Minimi Brevis (hand)

Ne ill

Hypothenar eminence

rA ma na

da

F

©D

O - flexor retinaculum - Hamulus & Hamate I - ulnar side of Phalanx 1, Digit 5 A - flexion of little finger NS - ulnar N, (C8-T1) BS - ulnar T - flex little finger against R

119

© A. L. Neill



Flexor Digitorum Brevis (foot)

F

rA ma na

da

Ne ill

first layer of the sole of the foot

©D

O - base MT 5, sheath of Peroneus Longus I - base of Phalanx 1 & Digit 5 A - flexion (foot & little toe) NS - lateral plantar N (L4-5) BS - lateral plantar T - curl up little toe

© A. L. Neill

120



Flexor Digitorum Longus (foot)

Ne ill

second layer of the muscles of the sole of the foot

rA ma na

da

F

©D

O - posterior Tibia I - base of Phalanx 3 & Digits 2-5 A - flexion & plantar flexion of the foot NS - posterior tibial N (S2-3) BS - posterior tibial T - push toes into hand on the prone patient with feet over the end. ie plantar flex against R

121

© A. L. Neill



F

rA ma na

da

Ne ill

Flexor Digitorum Profundus (hand)

©D

O - proximal 2/3 on anterior surface of Ulna - coronoid process (Ulna) I - ulnar side of Phalanx 3, Digits 2-5 A - flexion of hand & fingers 2-5 NS - median & ulnar Ns, (C8-T1) BS - ulnar T - flex fingers against R

© A. L. Neill

122



Ne ill

Flexor Digitorum Superficialis (hand)

rA ma na

da

F

©D

O - medial epicondyle (Humerus) - anterior onlique line (Radius) - coronoid process (Ulna) I - Phalanx 2, Digits 2-5 A - flexion (forearm, hand and fingers 2-5) NS - median N, (C7-8) BS - ulnar, radial T - flex fingers against R

123

© A. L. Neill



Flexor Hallucis Brevis (foot)

F

rA ma na

da

Ne ill

third layer of the sole of the foot

©D

O - plantar surface of the Cuboid - lateral Cuniform - Tibialis Posterior tendon I - both sides of Phalanx 1 & Digit 1 A - flexion (big toe) NS - 1st plantar digital N (L4-S3) BS - medial plantar T - curl up big toe

© A. L. Neill

124



Flexor Hallucis Longus (foot)

Ne ill

second layer of the sole of the foot

rA ma na

da

F

©D

O - lower posterior Fibula I - base of Phalanx 2 & Digit 1 A - flexion & plantarflexion of the foot - inversion of the foot - medial stabilization of the ankle - support for longitudinal ligament of arch NS - posterior tibial N (S2-3) BS - posterior tibial - peroneal T - plantarflex foot against R - flex big toe against R

125

© A. L. Neill



F

©D

rA ma na

da

Ne ill

Flexor Pollicis Brevis

© A. L. Neill

O - flexor retinaculum - Trapezium ridge I - lateral base of Phalanx 1, Digit 1 A - flexion of thumb NS - median & ulnar Ns (C6-T1) BS - radial - palmar digital branches T - flex thumb against R

126



Ne ill

Flexor Pollicis Longus

rA ma na

da

F

©D

O - anterior surface of middle 1/2 of Radius - interosseus membrane (b/n Radius & Ulna) - coronoid process (Ulna) I - Phalanx 2, Digit 1 A - flexion (hand & thumb) NS - median N, (C8-T1) BS - ulnar T - flex hand and thumb against R Frontalis - see Epicranius

127

© A. L. Neill



G

rA ma na

da

Ne ill

Gastrocnemius

©D

O - posterior condyles (Femur) via 2 heads medial & lateral I - Archille’s tendon to tuberosity of Calcaneus A - knee flexion - plantar flexion and inversion of the foot NS - tibial N (S1-2) BS - popliteal T - flex knee against R

© A. L. Neill

128



G

Inferior

da

Ne ill

Gemellus

rA ma na

O - ischeal tuberosity (hip) I - medial surface of the greater trochanter (Femur) A - lateral rotation NS - N to Quadratus Femoris branch of (L4-S1) BS - inferior gluteal T - rotate hip against R

Superior

©D

O - ischeal spine (hip) I - medial surface of the greater trochanter (Femur) A - lateral rotation NS - N to Obturator Internus, SP (L4-S1) BS - inferior gluteal T - rotate hip against R Genioglossus - see Tongue Muscles Geniohyoid - see Thyro / Hyoid Muscles

129

© A. L. Neill



G

rA ma na

da

Ne ill

Gluteus Maximus

©D

O - posterior crest of the Ileum (hip) - Sacrum & Coccyx I - greater trochanter (Femur) - Tensor Fascia Lata - linea aspera (Femur) A - lateral rotation (hip) - extension (thigh) NS - inferior gluteal N (L5-S2) - angiococcygeal Ns dorsal sacral Ns (S1-5) BS - superior gluteal T - extend leg against R or in the standing patient

© A. L. Neill

130



Ne ill

Gluteus Medius

rA ma na

da

G

©D

O - posterior crest of the Ileum b/n upper 2 gluteal lines (hip) I - lateral surface of the greater trochanter (Femur) A - abduction (Femur) - medial rotator (hip) NS - superior gluteal N (L5-S1) BS - superior gluteal T - extend leg against R or in the standing patient

131

© A. L. Neill



G

rA ma na

da

Ne ill

Gluteus Minimus

©D

O - posterior crest of the Ileum b/n upper 2 gluteal lines (hip) - margin of sciatic notch I - anterolateral border of the greater trochanter (Femur) A - abduction (hip) - pelvic stabilizer NS - superior gluteal N (L5-S1) BS - superior gluteal T - extend leg against R or in the standing patient - test balance on one leg

© A. L. Neill

132



Ne ill

Gracillis

rA ma na

da

G

©D

O - pubic symphysis (hip) I - anteromedial surface of the Tibia A - flexion (hip) - adduction (hip) NS - obturator N (L2-4) BS - deep femoral - obturator - medial femoral circumflex T - flex hip against R

Hyoid muscles - Geniohyoid, Mylohyoid, Omohyoid, Sternohyoid - see individual listings and the Thyro /Hyoid muscles Hypoglossus - see Tongue Muscles

133

© A. L. Neill



Iliacus

da

Ne ill

part of Iliopsoas

rA ma na

I

©D

O - iliac fossa (hip) I - lesser trochanter (Femur) A - flexion (hip) from supine position - anterior pelvic tilt (hip) NS - femoral N (L2-3) BS - deep femoral - obturator - medial femoral circumflex T - flex hip in the supine patient

© A. L. Neill

134



da

part of the ES

Ne ill

Iliocostalis

©D

rA ma na

I

135

© A. L. Neill



Cervicis

Ne ill

Iliocostalis

Thoracis

da

O - angles of ribs 3-6 I - TPs of cervical VBs 4-6 A - bilateral action - extension of cervical VC - unilateral action - lateral flexion of cervical VC NS - segmental doral branches of SNs BS - segmental dorsal branches of the carotids T - extend neck against R and laterally flex against R

I

rA ma na

O - angles of ribs 6-12 I - TP of cervical VB C7 - angles of ribs 1-6 A - bilateral action - forceful contraction of the ribs for inspiration - unilateral action - lat. flexion of VC (largely stopped by the ribs) NS - segmental dorsal branches of SNs BS - segmental dorsal branches of descending aorta T - ask patient to inspire forcefully

Lumborum

O - sacral crest and medial parts of the iliac crests I - angles of ribs 3-6 lateral to Thoracis A - bilateral forced inspiration, extension of the VC - unilateral lateral flexion of the VC NS - segmental dorsal branches of SNs BS - segmental dorsal branches of descending aorta, iliacs, lumbar and sacral vessels

©D

Iliopsoas = Iliacus + Psoas - see Iliacus and Psoas Iliotibial Tract - see Tensor Fascia Lata Incisivus Labii - Inferior, Superior - see the muscles of the Face Inferior Lingualis - see the muscles of the Tongue Inferior Oblique - see the muscles of the Eye Inferior Pharyngeal Constrictor - see Pharyngeal Constrictors Inferior rectus - see the muscles of the Eye

© A. L. Neill

136



Infraspinatus

da

Ne ill

part of the shoulder girdle - rotator cuff muscles

rA ma na

I

O - medial 2/3 of infraspinous fossa (Scapula) I - greater tuberosity (Humerus) A - lateral rotation - horizontal abduction (shoulder) NS - suprascapular N (C4-6) BS - suprascapular - transverse cervical - scapular cirumflex T - with anterior horizontal arm move around against R

©D

Innermost Intercostals - see Intercostals Internal intercostals - see Intercostals Internal Obliques - see Obliquuis Abdominus Internus

137

© A. L. Neill



Intercostals

Ne ill

as a group the muscles b/n ribs

External

I

rA ma na

da

O - costal groove of the rib I - superior surface of the rib below A - draws adjacent ribs up and closer together - increases thoracic volume with contracted Diaphragm NS - segmental - anterior branches of SNs (T1-12) BS - internal thoracic - intercostal branches T - movement of rib cage with breathing

©D

Internal

O - inferior border of the rib I - superior surface of the rib below A - draws adjacent ribs down and closer together - decreases thoracic volume with relaxed Diaphragm - flexion of the thorax NS - segmental - anterior branches of SNs (T1-12) BS - internal thoracic - intercostal branches T - movement of rib cage with breathing

Intimi = Innermost Intercostals - see Intercostals

© A. L. Neill

138



Interspinalis

da

Ne ill

cervical, thoracic and lumbar

©D

rA ma na

I

139

© A. L. Neill


Ne ill


da

O - cervical SP of C3-7 - thoracic SP of T2-12 - lumbar SP L2-5 I - SP of the immediate VB above A - draws adjacent VBs together extending the VC NS - segmental - dorsal branches of relative SNs (C1-L5) BS - cervical - branches of the internal carotid - thoracic - dorsal branches of the decending aorta - lumbar - dorsal branches of the iliacs

rA ma na

I

©D

Interossei - Muscles groups - Dorsal, Palmer (hand), Dorsal, Plantar (foot) - see individual listings of these muscles O & I listed individually - as a group these muscles lie b/n the MT or the MC bones of the hands or feet. A listed individually - as a group they assist in abduction (dorsal) /adduction (plantar, palmar) of the toes /fingers of the foot or hand. NS the digital branches of the Ns supplying the hand or foot BS the digital branches of the BVs supplying the hand or foot coming from arches in the hand or foot

© A. L. Neill

140



da

Ne ill

Intertranversarii

©D

rA ma na

I

141

© A. L. Neill


Ne ill


da

cervical - TP of C1-T1 on the anterior & posterior surfaces thoracic - TP of T11- L1 on the posterior surface only lumbar - TP on the lateral surface and mamillary bodies of L1-5 TP of the immediate VB above on the same surface draws adjacent VBs together extending the VC segmental - ventral branches of relative SNs cervical - branches of the internal carotid thoracic - dorsal branches of the decending aorta lumbar - dorsal branches of the iliacs

I

rA ma na

O I A NS BS -

©D

Intrinsic Auricular Muscles - Stapedius Intrinsic Ocular Muscles - Ciliarus, Recti, Sphincter Pupillae see the muscles of the Eye Ischiocavernosus - see the muscles of the Perineum Lateral Cricoarytenoid - see the muscles of the Larynx

© A. L. Neill

142



L

rA ma na

da

Ne ill

Latissimus Dorsi

©D

O - spines of T7-L5 - sacrum - iliac crest - ribs 10-12 I - floor of the bicipital groove (Humerus) A - extension (arm) - adduction and horizontal abduction (arm) NS - thoracodorsal N (C6-8) BS - transverse cervical - subscapluar T - extend arm against R Levator Ani - see the muscles of the Pelvis and Perineum Levator Anguli Oris - see the muscles of the Face Levator Palpabrae Superioris - see the muscles of the Eye

143

© A. L. Neill



rA ma na

da

Brevis

Ne ill

Levator Costi

©D

L

O - TP of C7-T11 I - outer surface of the rib immediately inferior b/n tubercle and angle A - elevate ribs in inspiration - extend and laterally flex VC in thoracic region NS - segmental dorsal branches of the corresponding SNs (C7-T11) BS - segmental dorsal branches of the descending aorta

© A. L. Neill

144



©D

L

rA ma na

da

Longus

Ne ill

Levator Costi

O - TP of T7-T10 I - outer surface of the ribs 2-3 below b/n tubercle and angle A - elevate ribs in inspiration - extend and laterally flex VC in thoracic region - rotation of the VC NS - segmental dorsal branches of the corresponding SNs (T7-T11) BS - segmental dorsal branches of the descending aorta

145

© A. L. Neill



rA ma na

da

Ne ill

Levator Scapulae

L

©D

O - TP of C1-4 (5) I - medial border of Scapula to the spine A - elevate (shoulders) unilateral or bilateral - lateral flexion, medial rotation (neck) unilateral NS - dorsal scapular N (C5) - dorsal branches of the SNs (C3-4) - N to Levator Scapulae BS - segmental dorsal branches of the descending aorta Levator Veli Palatini - see the Soft Palate Muscles Lingualis - Inferior, Transverse & Vertical - see the Tongue Muscles

© A. L. Neill

146



Ne ill

Longissimus

©D

L

rA ma na

da

Capitus, Cerivcis & Thoracis - part of ES

147

© A. L. Neill


da

Ne ill


L

©D

rA ma na

O - Capitus - TP of C1-5 Cervicis -TP of C1-5 Thoracis - TP of T1-5 I - Capitus - mastoid process (Temporalis) Cervicis - TP of C2-6 Thoracis - TP of T1-12 A - extension and rotation of the VC NS - segmental spinal roots generally the dorsal branches (C1-L5) BS - segmental dorsal branches of the ascending cervical BVs, descending aorta and lumbar arteries T - to stand up from touching toes w/o help - from upright position bend to one side and the other w/o help

© A. L. Neill

148



L

rA ma na

da

Ne ill

Longus Capitus

©D

O - TP of C3-7 I - anterior surface of Occiput A - flexion neck (bilaterally action) - rotation of neck (unilateral action) NS - N to Longus Capitus (C1-C3) BS - vertebral - maybe damaged in Whiplash accidents T - flexion of Neck against R - rotation of neck against R

149

© A. L. Neill



rA ma na

da

Ne ill

Longus Colli

L

©D

O - TP and anterior surface of C1-T3 I - anterior arch of Atlas (C1) A - flexion neck (bilaterally action) - rotation of neck (unilateral action) NS - N to Longus Colli (C1-C3) BS - vertebral - maybe damaged in Whiplash accidents T - flexion of Neck against R - rotation of neck against R

© A. L. Neill

150



Lumbricals (foot)

L

rA ma na

da

Ne ill

second layer of the soul of the foot

©D

O - tendon of Flexor Digitorum Longus I - dorsal surface of proximal Phalanges A - flexion of toes (not big toe) NS - medial plantar N (L4-5) - deep lateral plantar N (S1-2) BS - plantar metatarsal T - to curl up toes

151

© A. L. Neill



rA ma na

da

Ne ill

Lumbricals (hand)

L

©D

O - tendon of Flexor Digitorum Profundus to the palm I - lateral surface of Phalanx 1 Digits 2-5 - Extensor Digitorum tendons A - flexion of fingers (not thumb) NS - median & ulnar Ns (C8-T1) BS - palmar arches deep and superficial T - to curl up fingers

© A. L. Neill

152



Masseter

M

rA ma na

da

Ne ill


©D

O - zygomatic arch (Maxilla) I - Mandible A - closes jaw - clenches teeth - protraction and retraction of jaw NS - trigeminal N - mandibular branch (CN V) BS - maxillary, facial, transverse facial T - to clench teeth and move jaw in and out

153

© A. L. Neill



Mentalis

rA ma na

da

Ne ill


M

©D

O - Mandible I - deep fascia of the skin of the chin A - protrudes lips - raises bottom lip NS - facial N - mandibular branch (CN VII) BS - facial - mandibular branch T - to lift up bottom lip

© A. L. Neill

154



Multifidus Capitus, Cervicis & Thoracis

©D

M

rA ma na

da

Ne ill

part of deep spinal muscle layer

155

© A. L. Neill


Ne ill


rA ma na

da

O - Capitus articular processes (zygoapophyseal) of C1-7 - Cervicis TP and intertranverse ligament T1-12 - Thoracis TP and mamillary bodies of L1-5 - posterior foraminae of Sacrum I - SP of 2-3 VB above A - extension and rotation of the VC - stability of the VC NS - segmental spinal roots generally the dorsal branches (C1-L5) BS - segmental dorsal branches of the ascending cervical BVs, descending aorta and lumbar arteries T - to stand up from touching toes w/o help - from upright position bend to one side and the other w/o help

M

©D

Muscularis Uvulae - see Soft Palate Muscles Mylohyoid - see Thyro / Hyoid Muscles Nasalis - see the muscles of the Face Oblique muscles of the eye - superior / inferior see the muscles of the Eye

© A. L. Neill

156



Obliquus Abdominus - Externus

©D

O

rA ma na

da

Ne ill

External Oblique

157

© A. L. Neill


Ne ill


O

©D

rA ma na

da

External (outer layer of abdominal muscles) O - ribs 2 - 12 - interdigitates with Serratus Anterior I - abdominal aponeurosis to linea alba (direction hands in front pockets) - iliac crest (hip) - inguinal ligament A - bilateral flexion of VC forced expiration, coughing compression of abdominal contents assistance in defaecation assisting the lumbar muscles for stability of the VC - unilateral rotation to opposite side NS - segmental T8-12 - iliohypogatric, ilioinguinal Ns BS - segmental intercostals - ilioinguinal, iliohypogastric T - to suck in stomach / abdomen

© A. L. Neill

158



Obliquus Abdominis - Internus

©D

O

rA ma na

da

Ne ill

Internal Oblique

159

© A. L. Neill


Ne ill


O

©D

rA ma na

da

Internal (middle layer of abdominal muscles) O - Iliac crest (hip) - inguinal ligament, lumbar fascia I - abdominal aponeurosis (direction hands in back pockets) - lower ribs (8-12) A - bilateral flexion of VC forced expiration, coughing compression of abdominal contents assistance in defaecation assisting the lumbar muscles for stability of the VC - unilateral rotation to opposite side NS - segmental T8-12 - iliohypogatric, ilioinguinal Ns BS - segmental intercostals - ilioinguinal, iliohypogastric T - to suck in stomach /abdomen

© A. L. Neill

160



Inferior

da

Ne ill

Oblquuis Capitis

O

rA ma na

O - SP of C2 Axis I - TP of C1 Atlas A - rotates head NS - suboccipital N (C2) and dorsal rami of C1-2 BS - vertebral

Superior

©D

O - TP of C1 Atlas I - base of skull (Occiput) A - extends head - lateral flexion of head NS - suboccipital N (C2) and dorsal rami of C1-2 BS - ascending cervical T - test movements of the head ± R

161

© A. L. Neill



rA ma na

da

Ne ill

Obturator Externus

O

©D

O - inferior pubic ramus and ischeal ramus (hip) - obturator membrane I - trochanteric fossa (Femur) A - lateral rotation NS - obturator N (L3-4) BS - obturator - medial femoral circumflex

© A. L. Neill

162



O

rA ma na

da

Ne ill

Obturator Internus

©D

O - internal pelvic surface - obturator membrane through sciatic notch I - anterior surface of medial greater trochanter (Femur) A - lateral rotation (hip) - extension & abduction from flexed hip NS - N to Obturator Internus (L5-S2) BS - superior gluteal T - test movements of the flexed hip to R Occipitalis see Epicranius Omohyoid see Thyro / Hyoid muscles

163

© A. L. Neill



Opponens Digiti Minimi

rA ma na

da

Ne ill

Hypothenar eminence

O

©D

O - flexor retinaculum - Hamulus, Hamate I - ulnar side of MC 5 A - flexion and apposition to thumb of little finger NS - ulnar N deep branch (C8-T!) BS - ulnar T - oppose thumb and little finger with R to little finger

© A. L. Neill

164



Opponens Pollicis

O

rA ma na

da

Ne ill

Thenar eminence

©D

O - Trapezium (ridge) - flexor retinaculum I - along the side of MC 1 A - flexion and apposition of thumb - adduction and medial rotation (thumb) NS - median (C7-8) BS - radial T - oppose thumb and little finger with R to thumb

165

© A. L. Neill



Orbicularis Oculi

rA ma na

da

Ne ill


O

©D

O - Frontalis, medial margin of Maxilla, Lacrimal bone I - inserts into deep fascia of the orbit on all sides A - closure of eyelids tightly and as in normal blinking drainage of tear ducts NS - facial N (CNVII) BS - facial T - ability to tightly close eyes

© A. L. Neill

166



Orbicularis Oris

O

rA ma na

da

Ne ill


©D

O - Maxilla, I - deep fascia of skin and muscles around the mouth decussates extensively with the other muscles in this region A - closure, pursing and protrusion of lips - assists in the actions of other muscles here NS - facial N (CN VII) BS - facial T - test movements of the mouth note other muscles act in synergy

167

© A. L. Neill



rA ma na

da

Ne ill

Palmar Interossei

P

©D

O - MCs 1-5 I - medial side of the base of the proximal Phalanges 1-2 - lateral side of the base of the proximal Phalanges 3-5 A - adduction to the middle finger NS - ulnar N (C8-T1) BS - deep palmer arch T - close open fingers against R

© A. L. Neill

168



P

rA ma na

da

Ne ill

Palmaris Brevis (hand)

©D

O - flexor retinaculum - palmar aponeurosis I - superficial fascia A - closure of hand NS - ulnar N (C8) BS - superficial palmar arch T - close open hand against R

169

© A. L. Neill



rA ma na

da

Ne ill

Palmaris Longus (arm)

P

©D

O - medial epicondyle (Humerus) I - flexor retinaculum - palmar aponeurosis A - flexion of hand NS - median N (C6-8) BS - posterior ulnar recurrent - superficial palmar arch T - flex hand against R

© A. L. Neill

170



P

rA ma na

da

Ne ill

Pectineus

©D

O - pubic crest & tubercle (hip) I - upper ½ linea aspera (Femur) A - adduction, flexion, lateral rotation (hip) NS - femoral N (L2-4), obturator and accessory obturator Ns (L3-4) BS - media femoral circumflex, obturator

171

© A. L. Neill



rA ma na

da

Ne ill

Pectoralis Major

base of the breast tissue main muscle of the chest

P

©D

O - medial 2/3 of the anterior clavicle - ½ width of the anterior surface of the Sternum - anterior surface of the cartilages of ribs 1- 6 - tendon twists over - so the clavicular fibres insert below the sternal & costal fibres I - lateral lip of bicipital groove (Humerus) A - fixed Sternum/chest - adduction, horizontal adduction, medial rotation (Humerus) - abduction > 90º - fixed Humerus/arm (as in holding onto a fixed structure) - accessory muscle of respiration - inspiration (eg in asthma) NS - medial & lateral pectoral N (C5-8) BS - thoracoacromial T - horizontal adduction and adduction against R - arm placed on a table moved over the surface 180º across the table to eliminate gravity This muscle may be removed in a mastectomy if there is invasion to the deep fascia

© A. L. Neill

172



P

rA ma na

da

Ne ill

Pectoralis Minor

deep to Major

anterior surface of ribs 3-5 coracoid process (Scapula) depression, flexion, medial rotation (shoulder) abduction > 90º (Humerus) fixed Humerus/arm (as in holding onto a fixed structure) accessory muscle of respiration - inspiration (eg in asthma) NS - medial & lateral pectoral N (C5-T1) BS - thoracoacromial T - ability to pull their shoulders down

©D

O A -

173

© A. L. Neill



Peroneus Brevis

rA ma na

da

Ne ill

b/n Longus and Tertius

P

©D

O - lower lateral surface of Fibula I - moves beneath the foot to the base of MT1 & Cuniform1 (big toe) A - plantar flexion (ankle) - eversion (foot) NS - superficial peroneal N (L5-S2) BS - peroneal T - plantar flex and evert against R

© A. L. Neill

174



Peroneus Longus

P

rA ma na

da

Ne ill

most superficial

©D

O - head, lateral surface of the Fibula I - base of MT 5 A - plantar flexion (ankle) - eversion (foot) NS - superficial peroneal N (L5-S1) BS - peroneal T - plantar flex and evert against R

175

© A. L. Neill



Peroneus Tertius

rA ma na

da

Ne ill

deepest

P

©D

O - lower anterior of the Fibula I - base of MT 5 A - dorsi flexion (ankle) - eversion (foot) NS - anterior tibial, deep peroneal N (L5-S1) BS - anterior tibial T - plantar flex and evert against R

© A. L. Neill

176



P

rA ma na

da

Ne ill

Piriformis

©D

O - anterior surface of Sacrum - sacrotuberous ligament - through the greater sciatic notch I - superior medial surface of greater trochanter A - lateral rotation, abduction extension (hip) NS - inferior gluteal N (L5-S2) - N to Piriformis from SP (S1-2) BS - superior & inferior gluteal, internal pudendal Important landmark for the emergence of the Sciatic N

177

© A. L. Neill



Plantar Interossei

rA ma na

da

Ne ill

fourth and deepest layer of the soul

- medial surface of MTs 3-5 - medial surface of base Phalanx 1 Digits 3-5 - adduction - lateral plantar (superficial peroneal) N (S2-3) - lateral plantar

©D

O I A NS BS

P

© A. L. Neill

178



P

rA ma na

da

Ne ill

Plantaris

©D

O - posterior surface of lateral condyle (Femur) I - Calcaneal tuberosity via Achilles’ tendon A - flexion (knee) - dorsiflexion (ankle) NS - medial popliteal/tibial N (L4-S1) BS - popliteal T - dorsiflex ankle against R

179

© A. L. Neill



Platysma

rA ma na

da

Ne ill


P

©D

O - superficial fascia of the upper chest I - superficial fascia of the chin and jaw up to the lower lips A - moves the skin from lower jaw to chest NS - facial N cervical branch (CN VII) BS - facial, inferior alveolar, laryngeal T - ability to tighten neck and jaw

© A. L. Neill

180



P

rA ma na

da

Ne ill

Popliteus

©D

O - lateral epicondyle (Femur) I - proximal posterior surface of Tibia A - flexion (knee) - medial rotation of the flexed knee NS - medial popliteal/tibial N (L4-S1) BS - popliteal T - with flexed knee rotate inwards against R Procerus - see the summary of the muscles of the Face

181

© A. L. Neill



rA ma na

da

Ne ill

Pronator Quadratus

P

©D

O - anterior surface of the distal ¼ of the Ulna I - anterior surface of the distal ¼ of the Radius A - pronation NS - median N anterior interosseus branch (C8-T1) BS - ulnar T - lay arm on bench pronate against R

© A. L. Neill

182



P

rA ma na

da

Ne ill

Pronator Teres

©D

O - medial epicondyle (Humerus) - supracondylar ridge (Humerus) - coronoid process (Ulna) I - lateral surface (Radius) A - pronation, flexion (forearm) NS - median N anterior interosseus branch (C6-7) BS - anterior ulnar recurrent T - lay extended arm on bench pronate and flex against R

183

© A. L. Neill



Psoas

rA ma na

da

Ne ill

Iliopsoas = Iliacus + Psoas Major

Major

completely overlays Minor and merges with Iliacus O I A NS BS T -

P

bodies and TP of T12, L1-5 lesser trochanter (Femur) flexion of hip and lower back femoral N and LP (L1-3) iliolimbar ability to raise straight legs (R=gravity)

©D

Minor

absent in 30% of patients O - bodies and TP of L2-5 I - lesser trochanter (Femur) A - flexion of hip and lower back NS - femoral N and LP (L1-3) BS - iliolimbar T - ability to straight legs (R=gravity)

© A. L. Neill

184



Pterygoid

Lateral

da

Ne ill


P

rA ma na

O - superior, inferior heads, greater wing and lateral surface of the lateral pterygoid plate of Sphenoid I - temporomandibular joint A - opens jaw / Mandible - moves Mandible from side to side NS - trigeminal N (CN V) BS - maxillary branches T - open jaw against R

Medial

©D

O - lateral plate of Sphenoid - lateral pterygoid plate - Palatine bones, Maxilla I - Mandible A - closes jaw / Mandible - moves Mandible back and clenches teeth NS - trigeminal N (CN V) BS - maxillary and its branches T - ability to clench teeth and pull jaw back

185

© A. L. Neill



rA ma na

da

Ne ill

Pyramidalis

P

©D

O - anterior surface of Pubic Symphysis and Pubis (pelvic ring) I - linea alba (part of the deep fascia of the abdomen) ½ way to the umbilicus A - compresses abdomen, supports contents - assists in defeacation, and forced expiration NS - subcostal N (T12) BS - ilioinguinal, iliohypogastric T - tighten abdomen and observe lower muscles

© A. L. Neill

186



Q

rA ma na

da

Ne ill

Quadratus Femoris

©D

O - ischeal tubersoity (hip) I - quadrate tubercle on intertrochanteric crest (Femur) A - lateral rotation (Femur) NS - N to Quadratus Femoris from SP (L4-S1) BS - medial femoral circumflex T - sitting on the floor legs flexed & abducted rotate legs outwards

187

© A. L. Neill



rA ma na

da

Ne ill

Quadratus Lumborum

Q

©D

O - posterior crest of Ileum (hip) I - rib 12, TP of L1-5 A - bilateral = lumbar extension (lower back) - unilateral = lateral flexion (lower back) - augments action of Diaphragm, - supports lower back - supports abdominal & pelvic contents (core muscle) NS - subcostal N, LP (T12-L3) BS - lumbar vessels T - erect standing patient bends to the side - hyperextension of lower back - care needed with some patients

© A. L. Neill

188



Quadratus Plantae

Q

rA ma na

da

Ne ill

2nd layer soul of the foot

©D

O - 2 heads medial, lateral - medial medial inferior surface of Calcaneus - lateral lateral surface Calcaneus, long plantar ligament I - tendon of Flexor Digitorum Longus A - plantar flexion NS - lateral plantar N (L4-S2) BS - lateral plantar T - foot, plantar flexion against R - observation of arch and changes with flexion

189

© A. L. Neill



Rectus Abdominis

rA ma na

da

Ne ill

Segmental muscles 4-5 divisions - often asymmetric

R

©D

O - anterior surface of Pubic Symphysis and crest of Pubis (hips pelvic ring) I - xiphoid process (Sternum) - costal cartilages ribs 5-7 A - bilateral - lateral flexion and flexion of trunk/abdomen, supports contents - assists in defeacation - unilateral - rotation of abdomen NS - subcostal N (T12), lower intercostal Ns (T5-12) BS - inferior epigastric, lower intercostals T - tense and bend abdomen - sit ups

© A. L. Neill

190



Anterior

da

Ne ill

Rectus Capitis

©D

R

rA ma na

O - TP of Atlas (C1) I - Occiput - inferior surface of basilar part A - flexion (head) NS - N to Rectus Capitus part of CP (C2-3), suboccipital N (C1) BS - vertebral T - flex head against R

Lateralis O - TP of Atlas (C1) I - Occiput - jugular process A - lateral flexion (head) unilateral action NS - N to Rectus Lateralis (C1-3) part of CP BS - vertebral T - laterally flex head against R

191

© A. L. Neill



da

Ne ill

Rectus Capitis

Posterior - Major

©D

rA ma na

O - SP of Axis (C2) I - Occiput - lateral ½ of inferior nuchal line A - bilateral extension (head) - unilateral ipsi-rotation - (to the same side) NS - suboccipital N (C1) BS - vertebral, occipital T - extend head against R

© A. L. Neill

R

Posterior - Minor O - posterior arch of Atlas (C1) I - Occiput - medial ½ of the inferior nuchal line A - extension (head) NS - suboccipital N (C1) BS - vertebral, occipital T - extend head against R 192



©D

R

rA ma na

da

Ne ill

Rectus Femoris

O - ASIS (hip) I - quadratus tendon through to tibial tuberosity A - flexion (hip) - stabilizes the hip - extension (knee) NS - femoral N (L2-4) BS - lateral femoral circumflex T - sitting patient extend knee against R

193

© A. L. Neill



rA ma na

da

Ne ill

Rhomboideus Major (Major Rhomboid)

R

©D

O - SP of C7-T5 I - inferior angle of medial border and spine of Scapula A - elevation, medial rotation (shoulders/shoulder blade) - adduction (arm via shoulder blade) NS - dorsal scapular N (C4-5) BS - transverse cervical

© A. L. Neill

194



R

rA ma na

da

Ne ill

Rhomboideus Minor

©D

O - SP of C7-T1 I - inferior angle of medial border and spine of Scapula A - elevation, medial rotation (shoulders/shoulder blade) - adduction (arm via shoulder blade) NS - dorsal scapular N (C4) BS - transverse cervical

195

© A. L. Neill



rA ma na

da

Ne ill

Risorius

R

©D

O - deep fascia of the face superficial to Masseter I - skin at the angle of the mouth A - grinning (variable) NS - facial N (CN VII) BS - facial - transverse branch T - ability to smile "wryly"

© A. L. Neill

196



Rotatores

R

rA ma na

da

Ne ill

part of the deepest layer of muscles of the Spine - VC series of small muscles extending from Atlas to Sacrum Longus completely overlays Brevis

©D

O&I - Longus - SP to lamina of the VB 2 above - Brevis - SP to lamina of the VB 1 above A - bilateral - extension of the VC - unilateral - rotation of the VC at the level of individual VBs NS - segmental dorsal rami of the SNs BS - segmental dorsal branches of the local vessels eg intercostals, iliolumbar etc Salpingopharyngeus - see the Pharyngeal Muscles

197

© A. L. Neill



Sartorius

rA ma na

da

Ne ill

part of anterior compartment of the thigh

S

©D

O - ASIS of hip I - anteriomedial surface of Tibia A - flexion (hip and knee) - abduction & lateral rotation (hip) NS - femoral N (L4-5) BS - femoral T - patient lying on the side with flexed hip and extended leg from here ability to flex knee against R (gravity eliminated)

© A. L. Neill

198



Scalenus Anterior, Medial & Posterior

O I A NS -

Anterior TP of C3-7 Medial TP of C3-7 Posterior TP of C5-7 Anterior anteromedial surface of rib 1 Medial lateral to the anterior muscle rib 1 Posterior rib 2 inferior to the Clavicle elevation of the ribs for unilateral action ll muscles in forced inspiration bilateral - flexion (neck) unilateral - rotation & lateral flexion of the neck segmental - SNs anterior branches (C4-7 anterior & lateral C6-8 posterior) supraclavicular branches of the BP Ns (C4-8) N to Longus Colli and N to Scaleni muscles BS - superficial cervical T - flex neck against R - laterally flex neck against R

©D

S

rA ma na

da

Ne ill

Scalene muscles

199

© A. L. Neill



Semimembranosus

rA ma na

da

Ne ill

part of Hamstrings - posterior compartment of the thigh

S

©D

O - ischeal tuberosity (hip) I - posterior surface of the medial condyle (Tibia) A - extension (hip) - flexion (knee) - lateral rotation (flexed knee) NS - sciatic N (L5-S2) BS - deep femoral T - patient lying on the side with flexed hip and extended leg ability to draw up both hip and knee against R (gravity eliminated)

© A. L. Neill

200



Semispinalis

©D

S

rA ma na

da

Ne ill

part of the deep muscles of the spine / neck more lateral than Spinalis

201

© A. L. Neill


Capitis

Ne ill


Cervicis

da

O - TP of C4-7 I - superior & inferior nuchal lines (Occiput) A - bilateral extension (head) - unilateral rotation (head) NS - suboccipital N - dorsal rami (C1)

rA ma na

O - TP of T1-6 I - SP of C1-5 A - bilateral extension (neck) - unilateral rotation (head) NS - dorsal rami of the segmental SNs (C2-T5)

Thoracis

©D

O - TP of T6-10 I - SP of C6-T4 A - bilateral extension (thorax) - unilateral rotation (thorax) NS - dorsal branches of the segmental SNs (C5-T11) BS - segmental branches from local BVs T - ability to extend back in a prone position and extend and rotate neck

© A. L. Neill

202



Semitendinosus

S

rA ma na

da

Ne ill

part of Hamstrings - posterior compartment of the thigh

©D

O - ischeal tuberosity (hip) I - medial surface of the proximal shaft of the Tibia A - flexion (knee) - medial rotation (flexed knee) NS - sciatic N (L5-S2) BS - deep femoral T - ability of the standing patient to rotate knee inwards

203

© A. L. Neill



rA ma na

da

Ne ill

Serratus Anterior

S

- lateral surface of ribs 1-9 - costal surface of the vertebral boarder of the Scapula - abduction (Scapula - shoulder) - lateral rotation (shoulder - pulling shoulders back - fixed upper limb accessory breathing muscle - inspiration - protraction (drawing shoulders down) NS - long thoracic (C5-7) BS - lateral thoracic T - ability to pull down shoulders and arms

©D

O I A

© A. L. Neill

204



da

Ne ill

Serratus Posterior

S

rA ma na

Inferior O - SP of T11-L3 I - lateral surface of ribs 8-12 A - pulls ribs downwards (for expiration) NS - lower intercostal Ns, subcostal N (T7-12) BS - intercostals, iliohypogastric T - forced expiration w/o assistance from accessory muscles observe lower rib movement

©D

Superior O - ligamentum nuchae - SP of C1-T3 I - lateral surface to angle of ribs 2-5 A - pulls ribs upwards (for inspiration) NS - upper intercostal Ns (T1-4) BS - intercostal BVs T - observation of the upper ribs in inspiration

205

© A. L. Neill



rA ma na

da

Ne ill

Soleus

©D

O I A NS BS T -

© A. L. Neill

S

upper shaft, posterior surface (Tibia & Fibula) Achille’s tendon to tuberosity of Calcaneus plantar flexion (foot) medial popliteal, tibial N (S1-2) posterior tibial peroneal popliteal ability of the standing patient to go on their toes

206



Sphincter Ani - External Anal Sphincter

O - submuscosa of the rectum extending to deep fascia of the skin I - peroneal body - fibres of Levator Ani A - relaxation causes release of rectal contents NS - inferior rectal Ns from SP (S2-4) - pudendal N (S2-4) BS - inferior rectal vessels - haemorrhoidal vessels T - faecal continence

©D

S

rA ma na

da

Ne ill

sphincter hence circular muscle inserting all around natural position - constricted rather than relaxed

207

© A. L. Neill



Sphincter Urethrae - Urethral Sphincter

rA ma na

da

Ne ill

sphincter hence circular muscle inserting all around natural position - constricted rather than relaxed

S

©D

O - submuscosa of the urethra I - peroneal diaphragm - in females - anterior wall of the vagina A - relaxation causes release of bladder contents NS - pudendal N (S2-4) BS - inferior vaginal vessels - branches from internal iliacs - pudendal vessels T - urinary continence

© A. L. Neill

208



Spinalis

©D

S

rA ma na

da

Ne ill

part of ES more medial than and superficial to Semispinalis

209

© A. L. Neill


Ne ill


Capitus

rA ma na

Cervicis

da

O - TP of C4-7 I - superior nuchal lines (Occiput) A - bilateral extension (head and upper VC) - unilateral rotation (head and neck) NS - dorsal branches of SN - dorsal rami (C1-8)

O - ligamentum nuchae - SP of C7 I - SP of C1 A - bilateral extension (upper VC) - unilateral stabilization (neck) NS - dorsal rami of the segmental SNs (C2-8)

Spinalis Thoracis

S

©D

O - TP of T11-L2 I - SP of T1-8 A - bilateral extension (thorax) - unilateral stabilization of thorax NS - dorsal branches of the segmental SNs (T9-L2) BS - segmental branches from local BVs T - ability to extend back in a prone position and extend neck

© A. L. Neill

210



Splenius

rA ma na

da

Ne ill

superficial to Spinalis

Capitus

S

O - TP of T1-3 I - superior nuchal lines (Occiput) - lateral mastoid process (Temporal bone) A - bilateral hyperextension, extension (head and neck) - stabilization (head) - unilateral rotation (head and neck) NS - dorsal branches of SN - dorsal rami (C1-2) - suboccipital N, greater occipital N (C1-2)

©D

Cervicis

O - ligamentum nuchae and TP of C1-3 I - SP and interspinous ligaments of T1-4 A - bilateral extension, hyperextension (neck and upper VC) - unilateral stabilization (neck) NS - dorsal rami of the segmental SNs (C3-8) BS - branches of the internal carotids T - ability to hyper-extend the head and neck

211

© A. L. Neill



rA ma na

da

Ne ill

Sternocleidomastoid

S

©D

O - Manubrium (breastbone) - anterior surface of medial 1/3 of the Clavicle I - mastoid process (Temporal bone) A - bilateral flexion (head and neck) - unilateral rotation (head and neck) NS - accessory N (CN XI) - N to Sternocleidomastoid (ventral rami of SNs C1-2) BS - superficial cervical T - turn head against R - flex head against R Sternohyoid - see Thyro / Hyoid Muscles Sternothyoid - see Thyro / Hyoid Muscle Stylopharyngeus - see Pharyngeal Muscles

© A. L. Neill

212



S

rA ma na

da

Ne ill

Subclavius

©D

O - anterosuperior surface of rib 1 I - inferior groove on the Clavicle A - depression of Clavicle - stabilizer of sternoclavicular joint NS - N to Subclavius (C5-6) from branches of BP BS - superficial cervical - thoracoacromial

213

© A. L. Neill



rA ma na

da

Ne ill

Subcostales

S

©D

O - angle of the ribs 1-10 I - medial end of 2-3 ribs inferior - below A - forced expiration NS - intercostal Ns T1-12 BS - intercostal BVs T - observe the extent of unassisted forced expiration

© A. L. Neill

214



S

rA ma na

da

Ne ill

Subscapularis

©D

O - subscapular fossa (Scapula) I - lesser tuberosity (Humerus) A - medial rotation (arm) - adduction NS - upper and lower subscapular Ns (C5-7) BS - lateral thoracic - subscapular T - turn arm inwards against R

215

© A. L. Neill



rA ma na

da

Ne ill

Supinator

S

©D

O - lateral epicondyle (Humerus) - collateral radial ligament - annular ligament - crest (Ulna) I - proximal 1/3 of Radius A - supination (forearm) - medial rotation (arm) NS - radial N, deep radial & posterior interosseus branches (C5-6) BS - radial T - supination of forearm against R Superior Pharyngeal Constrictor - see Pharyngeal Constrictors

© A. L. Neill

216



Supraspinatus

S

rA ma na

da

Ne ill

Part of the rotator cuff muscles of the shoulder

©D

O - supraspinous fossa (Scapula) I - greater tuberosity (Humerus) - shoulder joint capsule A - draws head of Humerus up into the shoulder - abduction > 180º (arm) - stabilizer of shoulder joint NS - suprascapular N (C4-6) BS - suprascapular - axillary T - hyperextension of arm > 180º against R

217

© A. L. Neill



rA ma na

da

Ne ill

Temporalis

T

©D

O - temporal fossa of the Frontal, Parietal and Temporal bone I - coronoid process and ramus (Mandible) A - closes jaw - retracts Mandible - clenches teeth NS - trigeminal N (CNV) BS - maxillary - middle & superior temporals T - test strength of closed jaw or close against R (with care)

© A. L. Neill

218



Tensor Fascia Lata

O - anterior iliac crest (Ileum –hip) I - iliotibial tract A - flexion, abduction & medial rotation (Femur on hip) NS - superior gluteal (L4-S1) BS - superior gluteal - lateral femoral circumflex T - patient to abduct leg when standing R = gravity - supine patient to abduct leg against R

©D

T

rA ma na

da

Ne ill

part of the Iliotibial tract - lateral compartment of the thigh

Tensor Veli Palatini - see Soft Palate Muscles

219

© A. L. Neill



rA ma na

da

Ne ill

Teres Major

T

©D

O - lower posterio-lateral border of Scapula I - medial lip of the bicipital groove (Humerus) A - extension, medial rotation (shoulder) - horizontal abduction (shoulder) NS - lower subscapular N (C5-7) BS - scapular circumflex

© A. L. Neill

220



O - lower posterio-lateral border of Scapula I - inferior surface of greater tuberosity (Humerus) A - lateral rotation (shoulder) - horizontal abduction (shoulder) NS - axillary N (C4-5) BS - scapular circumflex T - patient with arm resting on table move in an horizontal arc away from sagittal plane against R

©D

T

rA ma na

da

Ne ill

Teres Minor

Thyrohyoid - see Thyro / Hyoid Muscles

221

© A. L. Neill



©D

rA ma na

da

Ne ill

Tibialis Anterior

© A. L. Neill

T

O - lateral tibial surface I - base of MT 1 A - dorsiflexion (ankle) - inversion (foot) NS - anterior tibial N, deep peroneal N (L4-S1) BS - anterior tibial T - invert foot against R - dorsiflex foot against R 222



O - posterior surface of Tibia & Fibula I - inferior surfaces of the Tarsal bones - base of MTs 2-3 A - plantar flexion (ankle) - inversion (foot) NS - posterior tibial N (L4-S1) BS - peroneal T - invert foot against R - plantarflex foot against R

©D

T

rA ma na

da

Ne ill

Tibialis Posterior

223

© A. L. Neill



Transversus Abdominis

rA ma na

da

Ne ill

deepest layer of the abdominal wall

O

T

©D

- costal cartilages of lower ribs (7-12) - lumbar fascia - crest of Ileum (hip) I - linea alba A - compresses abdomen - helps with defeacation - helps with forced expiration - diaphragm - stabilizes VC - core muscle NS - segmental intercostal Ns (T7-12) - iliohypogastric, ilioinguinal & subcostal Ns (T12-L1) BS - iliolumbar - deep iliac circumflex T - ability to pull in the waist Transverse Perineal - Profundus, Superficialis - see the muscles of the Pelvis and Perineum

© A. L. Neill

224



Trapezius upper, middle, lower

©D

T

rA ma na

da

Ne ill

Most superficial muscle of the back

225

© A. L. Neill


da

Ne ill


T

©D

rA ma na

O - external occipital protuberance (skull) - medial 1/3 superior nuchal line (Occiput) - ligamentum nuchae - SP of C7, T1-12 & their supra-, inter-, spinous ligaments I - lateral 1/3 of the Clavicle - medial border of acromion (Scapula) - spine of Scapula A - elevation, upward rotation - upper fibres (Scapula) - extension, adduction - middle fibres (Scapula) - depression, downward rotation - lower fibres (Scapula) NS - accessory N (CN XI) - upper, middle fibres - ventral rami of C3-4 = N to Trapezius - upper, middle fibres - dorsal roots C1-5 - lower fibres BS - transverse cervical - segmental - dorsal branches of intercostals T - elevation of shoulder blades - upper, middle fibres (against R) - depression of shoulder blades - lower fibres

© A. L. Neill

226



Triceps Brachii

T

rA ma na

da

Ne ill

3 headed muscle - long, lateral & medial heads

long - infraglenoid tubercle (Scapula) lateral - lateral posterior surface of Humerus medial - posterior surface of Humerus olecranon (Ulna) extension (elbow) extension (Scapula) radial N (C6-8) deep brachial extension or arm against R (in standing patient R=gravity)

©D

O I A NS BS T -

227

© A. L. Neill



rA ma na

da

Ne ill

Vastus Intermedius

©D

O - anterior surface of Femur I - tibial tuberosity A - extension (knee) NS - femoral N (L2-4) BS - femoral, lateral femoral circumflex T - extension of knee in sitting patient BS - ulnar T - ability to extend the knee in the sitting patient

© A. L. Neill

V

228



O - lateral lip of linea aspera (Femur) I - tibial tuberosity A - extension (knee) NS - femoral N (L2-4) BS - femoral, lateral femoral circumflex T - extension of knee in sitting patient

©D

V

rA ma na

da

Ne ill

Vastus Lateralis

229

© A. L. Neill



©D

rA ma na

da

Ne ill

Vastus Medialis

O - medial lip pf linea aspera (Femur) I - tibial tuberosity A - extension (knee) NS - femoral N (L2-4) BS - femoral T - extension of knee in sitting patient

© A. L. Neill

V

230



Zygomaticus

Major

- Zygoma - cheekbone - deep fascia at the angle of the mouth - draws mouth back smiling/laughing - Major - facial N (CNV) - facial - smile

rA ma na

O I A NS BS T

da

Ne ill

part of muscles of facial expression

©D

Minor

O - Zygoma – cheekbone - deep fascia of the upper lip A - maintains nasolabial furrow - philtum NS - facial N (CNV) BS - facial often lost in cosmetic surgery i.e. no skin crease from nose to lips

Z

231

© A. L. Neill


©D

Grap ere hic Desig n by Left Hemisph

rA ma na

da

Ne ill


© A. L. Neill

232



©D

rA ma na

da

Ne ill

Notes...

233

© A. L. Neill


THE A TO Z SKELETAL MUSCLES

Ne ill

ISBN 978-0-9806959-0-8 Origins, insertions, actions, blood supply & nerve supply for all muscles are listed alphabetically with separate illustrations of each individual muscle; separate listing of all major muscle groups; regional index of the muscle along the side (i.e. where does this muscle come from) and cross referencing with common muscle names. GREAT FOR THE SPORTS THERAPIST, THE MASSAGE THERAPIST, THE PERSONAL TRAINER CHIROPRACTOR AND THE PHYSIOTHERAPIST.

THE A TO Z OF THE HEART

da

ISBN 978-0-9806840-6-3

The heart is illustrated from all points of view as a whole organ, along with the structures of the components of the CVS, including the lymphatic system.

rA ma na

Included and arranged alphabetically is the BS of all the major organs, any special features and relationship b/n the function and the structure.

THE A TO Z OF THE BONES, JOINTS & LIGAMENTS AND THE BACK ISBN 1 74138 167 5

All bones, their joints, movements, ligaments, relations, BS & NS are listed alphabetically. Each major joint is discussed in detail - shown with & w/o their additional supportive structures. Regional listing and cross referencing. A special section discusses the BACK, common problems with posture, pathology, examination techniques and overall structure. GREAT FOR THE FORENSIC EXPERT, THE ANTHROPOLOGIST THE MEDICAL PRACTITIONER, ORTHOPAEDIC SURGEON AND TRAINEE RADIOGRAPHER AND RADIOLOGIST

THE A TO Z OF THE BONES OF THE SKULL

©D

ISBN 1741381675

All skull bones are listed alphabetically. The TMJ is shown in detail with related structures; radiology of the skull using the common clinical planes are shown with line drawing explanations of the features. an examination of all cavities, joints and anthropological markers, are also included. GREAT FOR THE FORENSIC EXPERT, THE ANTHROPOLOGIST THE MEDICAL PRACTITIONER, ORTHOPAEDIC SURGEON AND TRAINEEE RADIOGRAPHER AND RADIOLOGIST


THE A TO Z OF THE HEAD & NECK

Ne ill

ISBN 978-0-9806840-0-1 All bones of the skull and cervical spine are illustrated individually from several aspects, including teeth charts and nomenclature. The skull as a whole is demonstrated and common radiographical images explained, an examination of all cavities, joints and anthropological markers, are included. All the muscles of the Head & Neck are individually listed and illustrated along with their BS & NS. Overviews of the cutaneous nerves, anastomoses of the arteries and the supf and deep venous systems of the region, lymphatic drainage and clinical ramifications are illustrated. Great for the ANTHROPOLOGIST/DENTIST/ARTIST/FORENSIC SCIENTIST!!

THE A TO Z OF PERIPHERAL NERVES ISBN 978-0-9806959-2-2

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All peripheral nerves, their pathways, branches, alternative names and nerve root origins, including functional deficits, likely aetiology of the trauma and examination techniques to illicit pathology deficits. There is also cross referencing, regions indexing and an examination guide. USEFUL IN REHABILITATION AND EXAMINATION FOR WORKERS COMPENSATION, THIS BOOK LISTS DEFICITIS AND TESTING OF NEUROLOGICAL FUNCTION.

THE A TO Z OF THE BRAIN ISBN 978-0-9806840-2-5

The brain is illustrated as a whole organ with BS NS coverings special features and then dissected and individual structures w/in it listed alphabetically and illustrated cross referenced with their many names. The Cranial Nerves origins pathways and interactions are illustrated and a full cranial nerve clinical examination illustrated and explained. Clinical tables of coma assessment, headache classification and other complex neurological concepts are included along with a comprehensive neurological glossary.

A TO Z POSTER INFECTIONS OF THE SKIN ISBN 978-0-9806959-1-5

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This A3 size poster examines the pyogenic bacterial infections of the skin in a new and unique way - listing the various pathological presentations of these infections layer by layer and their clinical ramifications. It along with other skin posters of malignancies and other skin conditions in the series will be incorporated into the A to Z of the skin a coming title of the A to Zs. The A to Z collection may be ordered from the Coop bookshop or directly from Anatomy Update 0410018681 / [email protected] Special rates for students and libraries.



The A to Zs Dr. A. L. NEILL BSc MSc MBBS PhD FACBS [email protected] www.amandasatoz.com 0414 248 747 ISBN 978 0 9806959 6 0 Aspen Pharmacare Australia Pty Ltd 34-36 Chandos Street, St Leonards NSW 2065 ABN 51 096 236 985

The A to Z of Skeletal Muscles

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