muscles of lowerlimb
TRANSCRIPT
MUSCLES OF LOWER LIMB
Dr .BALRAJ NAIDU PG IN MS (ORTHO)GANDHI MEDICAL COLLEGE
BY
GLUTEUS MAXIMUS
• ORIGIN: ILIAC CREST ILIUM SACRUM COCCYX SACRO TUBEOUS LIGAMENTS POSTERIOR GLUTEAL LINE FACIA COVERING G.MEDIUS
• INSERTION: GLUTEAL TUBEROSITY ( greater part of muscle inserted into ilio tibial tract)• NERVE SUPPLY :INFERIOR GLUTEAL NERVE• ACTION : Chief EXTENSOR OF THIGH ER & ABDUCTION OF THIGH With TFL Stabilises knee through IBT
Clinical Anatomy
GLUTEUS MEDIUS
ORIGIN : ILIUM…Gluteal surface B/w ant & post gluteal lineINSERTION : GREATER TROCHANTER on lat surfN/S : SUPERIOR GLUTEAL NERVEACTION : INTERNAL TOTATION OF HIP ABDUCTION OF THIGH
GlUTEUS MINIMUS
ORIGIN : ILIUM b/w anterior and inferior gluteal lineINSERTION : Greater trochanter lat surface N/S : Superior gluteal nerve ACTION : INTERNAL TOTATION OF HIP ABDUCTION OF THIGH
TENSOR FACIA LATA
• ORIGIN Iliac Crest :-anterior 5cm of outer lip• INSERTION 3-5cm below gluteal tuberosity• N/S Superior gluteal nerve L4,L5,S1• ACTION TFL Stabilises knee through ITT
Clinical significance of G.Med ,Min
SHORT EXTERNAL ROTATORS OF HIP
PIRIFORMIS
ORIGIN : S2,S3,S4 pelvic surface by 3 digitations Greater sciatic notch upper part INSERTION : GT apex N/S : Ventral rami of S1,S2 ACTION : ER of thigh at hip joint
GEMELLI SUPERIOR
ORIGIN : Lesser sciatic notch upper part
INSERTION : GT medial surface tendon blend with tendon obturator internus
N/S : Nerve to obturator internus L5,S1,S2
ACTION : ER of thigh
GEMELLI INFERIOR
ORIGIN : Lesser sciatic notch upper partINSERTION : GTMedial surface tendon blends with tendon of obturator internus.N/S : Nerve to Quadratus femoris L4,L5,S1ACTION : ER of thigh
OBTURATOR INTERNUS
ORIGIN : Ilium :- Below pelvis brim Ischium :- pelvic surface of body Ischial tuberosity Ischio pubic rami Obturator membrane :- pelvic surfacINSERION : GT medial surface N/S : Nerve to obturator internus L3,S1,S2ACTION : ER of thigh
OBTURATOR EXTERNUS
ORIGIN : Obturator membrane :-outer surface Obturator foramen :- outer surfaceINSERTION : GT medial surface N/S : Obturator nerve posterior division L2,L3,L4ACTION : ER of thigh
QUADRATUS FEMORIS
ORIGIN : Ischial tuberosityINSERTION : Quadrate tubercleN/S : Nerve to Quadratus femoris L4,L5,S1ACTION : ER of thigh accessory function MR , ABDUCTION EXTENSOR of knee
SARTORIUS
ORIGIN : ASIS INSERTION : Tibia :- upper part of medial surface shaft of tibia infront of Gracilis and SEMI TEND N/S : Femoral nerveACTION : EXTERNAL ROTATION and ABDUCTION OF THIGH FLEXION OF LEG AT KNEE
QUADRICEPS FEMORIS
RECTUS FEMORIS
ORIGIN : Straight head :- AIIS Reflected head :- acetabulum margin capsule of hip jt INSERTION : Patella : - bone N/S : Femoral nerveACTION : EXTENSION OF KNEE
VASTUS LATERALIS
ORIGIN : GREATER TROCHANTER Anterior and Inferior border
Inner trochanter :- upper part Gluteal tuberosity :- lateral lip Linea aspera :- lateral lip U 1/3 INSERTION : Patella :- bone N/S : Femoral nerve ACTION : EXTENSION OF KNEE
VASTUS MEDIALIS
ORIGIN : Inter trochanteric line lower part linea aspera :- medial lip Spiral line Medial supra condylar line :- U ¼INSERTION : Patella :- bone N/S : Femoral nerve ACTION : EXTENSION OF KNEE
VASTUS INTERMEDIUS
ORIGIN : Shaft of femur U3/4 Anterior and lateral surface INSERTION : Patella :- boneN/S : Femoral nerve ACTION : EXTENSION OF KNEE
HAMSTRING MUSCLES
BICEPS FEMORIS
LONG HEAD : Ischial tuberosity with semi tendonosis sacro tuberal ligamentSHORT HEAD : Linea aspera lateral lip B/w vastus lateralis and adductor magnus lateral supracondylar line Lateral intermuscular septumINSERTION : Head of fibula N/S : Long head :- tibial part of sacral nerve L5,S1,S2 : Short hand :- common peroneal nerve of sacral nerve ACTION : LONG HEAD:- Chief flexor of knee Lateral rotation of leg in semiflexed knee : SHORT HEAD :- Weak extension of hip
SEMI TENDANOSIS
ORIGIN : Ischial tuberosity with long head of biceps INSERTION : Tibia :- upper part of medial shaft of tibia behind sartorius , gracilis N/S : Tibial part sacral nerve L5,S1,S2ACTION : : Chief flexor of knee Lateral rotation of
leg in semiflexed knee Weak extension of hip
SEMI MEMBRINOSUS
ORGIN : Ischial tuberosityINSERTION : Tibia :- medial condyle of posterior
surface N/S : Tibial part of L5,S1,S2 ACTION :
Chief flexor of knee Lateral rotation of leg in semiflexed knee Weak extension of hip
ADDUCTOR MAGNUS
ORIGIN : Ischium :- Ischial tuberosity ischium Pubis :- Inferior pubic ramiINSERTION : Gluteal tuberosity Linea aspera Medial supra condylar line Adductor tubercleN/S : HAMSTRING Part By tibial Part of siactic nerve ADDUCTOR Part By OBTURATOR nerve posterior division
ACTION : EXTENTION at Hip FLEXION at Knee
CLINICAL TESTING OF HAMSTRINGS
ER OF HIP
MEDIAL COMPARTMENT OF THIGH
ADDUCTOR LONGUS
ADDUCTOR BREVIS
ADDUCTOR MAGNUS
ADDUCTOR LONGUSORIGIN : Pubis :body of pubis in the angle b/w pubic symphysis and pubic crest INSERTION : Linea aspera :- M/3 shaft b/w VM, AM,ABN/S : Obturator nerve – anterior
ACTION : Adductor of thigh
ADDUCTOR BREVISORIGIN : Pubis :- . body of pubis .Inferior pubic rami b/w gracilis and obturator externus Ischium :- . Outer surface of ramus of ischium b/w gracilis and adductor magnus .
INSERTION : line extending from lesser trochanter to upper part of linea aspera behind upper part of adductor longusN/S : OBTURATOR NERVE ANT DIV
ACTION : ADDUCTION Of Thigh
ADDUCTOR MAGNUSORIGIN : Ischium :-Ischial tuberosity Ramus of ischium Pubis :- Inferior pubic ramus
INSERTION : Gluteal tuberosity lInea aspera Medial supracondylar line Adductor tubercle
N/S : Adductor part :- obtuator nerve – posterior division : Hamstring part :- Tibial part of sciatic nerve
ACTION : Adductor magnus :- lower part helps in extension of hip , flexon of knee
Clinical testing of adductors
GracilisORIGIN : Pubis :- Medial margin of lower half of body of pubis Inferior pubic rami Ischium :- Rami of ischium INSERTION : Tibia :- upper part , medial surface infront of STN/S : Obturator nerve – Anterior
ACTION : Flexion and medial rotation of thigh Weak adduction of thigh
PECTINEUS
ORIGIN : Pubis :- Superior pubic rami Pectin pubis Fascia Over Pectineus
INSERTION : Line extended from lesser trochanter to linea aspera
N/S : Anterior fibre : Femoral N Posterior fibre : Obturator N
ACTION : Adductor and flexon of thigh
MUSCLE OF POSTERIOR ABDOMINAL WALL
PSOAS MAJOR
PSOAS MINOR
ILIACUS
QUADRATUS LUMBORUM
PSOAS MAJOR
ORIGIN : All lumar vertebra L1-L5 from anteior surface and lower border of transverse process L1-L5 By 5lips one each from bodies of adjacent vertebra intravertebral disc of T12-L5 INSERTON : Lesser trochanter of femur muscle pass behind the inguinal ligament nd infront of hip joint to enter into thigh It ends in a tendon which receives fibres of iliacus on its lateal side
N/S : Branch of roots of spinal nerve L2,L3,L4
ACTON :- Ileao-psos – power of flexor of hip
PSOAS MINOR
ORIGIN : Sides of bodies of T12 and L1INSERETION : PECTIN PUBIS ILIO PUBIC EMINENCEN/S : Br of L1ACTION : Weak Flexor Of HIP
ILIACUS
ORIGIN : ILIAC CREST Inner lip ILIAC FOSSA SACRUMINSERTION : Lesser TrochanterN/S : Br of FEMORAL NERVEACTION : Flexion of Hip
QUADRATUS LUMBORUMORIGIN : L5 Transverse process belowINSERTION : L1 – L4 Transverse process above 12th RIBN/S : SPINAL NERVES T12 – L4ACTION : EXTENTION OF LUMBAR VERTEBRAE FLEXION OF 12TH RIB during inspiration
CLINICAL TESTING OF MUSCLES
Muscles producing movements at hip joint
Movement Chief muscles Accessory muscles
Flexion Psoas major and iliacus Pectinius,rectus femoris,and sartorius,adductors(mainly adductor longus )participate in early stagesExtension Gluteus maximus and ---------------------------- Hamstrings Adduction Adductor longus,brevis,magnus Pectinius and gracilis
Abduction Glutei medius and minimus Tensor fascia lata and sartorius
Medial rotation TFL,anterior fibres of G.Med,G.Min ------------------------------ Lateral rotation 2obturators,2gemelli,and quadratus Piriformis,gluteus maximus, femoris sartorius
Muscles producing movement at knee joint
Movement Principal muscles Accessory muscles
Flexion Biceps femoris Gracilis Semitendinosus Sartorius Semimembranosus Popliteus
Extension Quadriceps femoris TFL
Medial rotation PopliteusOf flexed leg Semimembranosus Sartorius Semitendinosus Gracilis
Lateral rotation Biceps femoris ------------------------Of flexed leg
MUSCLES OF ANTERIOR COMPARTMENT OF LEG
TIBIALIS ANTERIOR
EXTENSOR HALLUCIS LONGUS
EXTENSOR DIGITORUM LONGUS
PERONEUS TERTIUS
EXTENSOR DIGITORUM BREVIS
TIBIALIS ANTERIORORIGIN : Tibia :- lateral condyle U2/3 lateral surface of shaft Inter osseous membrane
INSERTION : Medial cuneiform :- infro medial surface 1st MT :- Base
N/S : Deep peroneal nerve ACTION : Dorsiflexion at foot Inverter of foot Maintain medial longitudinal arch of foot
EXT HALLUCIS LONGUS
ORIGIN : Fibula :-middle 2/4 shaft post surface
INSERTION : Distal phalynx of great toe :-Dorsal surfaceN/S : Deep peroneal nerve ACTION : Dorsi flexion of foot Extensin of MTP , Keep leg verticle while walking on uneven ground
EXTENSOR DIGITORIUM LONGUS ORIGIN : Tibia :- Lateral condyle Fibula :- U ¼ whole side Middle :- anterior half Interosseous membraneINSERTION : Middle and distal phalanges of 2nd and 5th toe Muscle divide into 4 tendons for 2ndto 5th toe Each tendon is joined on lateral side by tendon of ext digitobrevis and form dorsal digital expantion
N/S : Deep peroneal nerve
ACTION : Dorsiflexion of foot Extends MTP ,IP5 of 2nd and 5th toe
PERONEUS TERTIUS
ORIGIN : Fibula :- L/4 medial surface shaft
INSERTION : 5th MT – medial surface of dorsal surface
N/S : Deep peroneal nerve ACTION : Dorsiflexion and inverter of foot
EXTENSOR DIGITORIUM BREVIS
N/S : Deep peroneal nerve
ACTION : EHB :- Extends MTP of great toe Other extends MTP ,IP5 OF 2ND ,3RD,4TH toes
ORIGIN : Calcaneus anterior surface INSERTION : Proximal phalynx of 1st – 4th toes Muscle divides into 4 tendons for medial 4th toe medial most part of muscle called as extensor hallucis brevis Lateral 3 tendons join lateral side of EDL for dorsal digital expansion of 2nd ,3RD ,4th
toe
2 MUSCLES OF LATERAL SIDE OF LEG
PERONEUS LONGUS
PERONEUS BREVIS
PERONEUS LONGUS
ORIGIN : Fibula :- Head of fibula Lateral surface of shaft Medial 1/3 of fibula INSERTION : Medial cuneaform same as T.ant 1st MT N/S : Superior peroneal nerveACTION : Evertor of foot Maintains lateral longitdinal transerve arch
PERONEUS BREVIS
• ORIGIN : Fibula :- L/3 Lateral surface of shaft
• INSERTION : 5th MT
• N/S : Superficial peroneal nerve
• ACTION : Evertor of foot
MUSCLES OF MEDIAL SIDE OF LEG
• SARTORIUS • GRACILIS• SEMITENDANOSUS
SUPERFICIAL MUSCLES OF BACK OF LEG
. GASTROCNEMIUS
. SOLEUS
. PLANTARIS
GASTROCNEMIUSORIGIN : Medial Head :- medial condyle of femur popliteal surface of femur capsule of knee joint Lateral head :- lateral condyle of femur lateral supracondylar line capsule of kneeINSERTION : Calcaneous :- Tendons of gastrocnemius fuses with soleus for tendon achilis inserted on M/3 of posteior surface of calcaneous
N/S : Tibial nerve S1,S2 ACTION : Plantar flexion foot imp for walking Flexor of knee
SOLEUSORIGIN : Tibia :- soleal line and m/3 of post surface of shaft Fibula :- Base of head U/4 post surface of shaft INSERTION : Calcaneous:- Tendon of gastorcnemus fuses with tendon of soleus form tendon achillis inserted on M/3 of posteior surface of calcaneousN/S : Tibial nerve S1/S2ACTION : PLANOR FLEXION OF FOOT
PLANTARISORIGIN : FEMUR : Lateral condyle Oblique popliteal line INSERTION : Calcaneous:- posteior surface of calcaneum medial to TAN/S : Tibial nerve S1/S2ACTION : Plantar is rudimentary Accessory to gastrocnemeus Importance of
DEEP MUSCLES OF BACK OF LEG
. POPLITEUS
. FLEXOR HALLUCIS LONGUS
. FLEXOR DIGITORUM LONGUS
. TIBIALIS POSTERIOR
POPLITEUS
ORIGIN : Femur :- Lateral condyle Lateral meniscusINSERTION : Tibia :- post surface shaft of tibia above soleal lineN/S : Tibial nerve ACTION : Unlocking of knee by lateral rotations of femur on tibia bigining of flexion
FlEXOR HALLUCIS LONGUS
ORIGIN : Fibula :- lower ¾ post surface
INSERTION : Distal phalynx of big toe
N/S : Tibial nerve ACTION : Flexion of distal phalnx of great toe
FLEXOR DIGITORIUM LONGUS
ORIGIN : Tibia :-U/3post surface below soleal lineINSERTION : Distal phalanx of 2nd -5th toe Muscle divides into 4 tendons for lateral 4 toes N/S : Tibial nerveACTOIN : Flexor of digital phalanx 2-5th toes Plantar flexon of foot at ankle
TIBIALIS POSTERIORORIGIN : Tibia :- u2/3 posterior surface below soleal line Fibula :- Posterior surface of fibula INSERTION : Tuberosity of navicular bone and tarsal bones except talus Insert extends to 2nd ,3rd,4th,MT at baseN/S : Tibial nerve ACTION : Plantar flexion at ankle Inversion at foot at subtalar joint Maintains medial longitudinal arch
Muscles producing movements at ankle joint
Movement Principal muscles Accesory muscles
Dorsiflexion Tibialis anterior Extensor digitorum longus Extensor hallucis longus
Peroneus longus
Plantarflexion Gastrocnemius Plantaris Soleus Tibialis posterior Flexor hallucis longus Flexor digitorum longus
Muscles producing movement of inversion and eversion
Movement Principal muscles Accesssory muscles
Inversion Tibialis anterior Flexor hallucis longus Tibialis posterior Flexor digitorum longus
Eversion Peroneus longus Peroneus tertius Peroneus brevis
3 MUSCLES OF 1ST LAYER of Sole
FLEXOR DIGITORUM BREVIS
ABDUCTOR HALLUCIS
ABDUCTOR DIGITI MINIMI
FLEXOR DIGITORIUM BREVISORIGIN : Calcaneous :- medial tubercle Plantar aponeurosis Intermuscular septa
INSERTION : Middle phalanx of 2nd -5th toe Muscle ends in 4 tendons 2-5th DP opp bone of proximal phalanx each tendon divides in to 2 slips
N/S : Medial plantar nerve
ACTION : Flexion of toes at MTP ,IP5
ABDUCTOR HALLUCIS
ORIGIN : Calcaneous :- medial tubercle Flexor retinaculum Intermuscular sept
INSERTION : Medial side of proximal phalanx of 1st toe Tendon of abductor hallucis fuses with
tendon of flexor hallucis brevis
N/S : Medial plantar nerve
ACTION : Abductor of great toe
ABDUCTOR DIGITI MINIMIORIGIN : Calcaneus FR Inter muscular septaINSERTION : Lateral side of Proximal phalanx of 5th toe Tendon fuses with tendon of flexor digiti mini brevis inserted into lateral side of pp of 5th toeN/S : Medial plantar nerve
ACTION : Abductor of LT
4MUSCLES OF 2ND LAYER
• FLEXOR DIGITORIUM LONGUS
. FLEXOR DIGITORIUM ACCESSORIUS
. LUMBRICLES
. FLEXOR HALLUCIS LONGUS
FLEXOR DIGITORUM LONGUSORIGIN : Tibia : u/3 posterior surface tibia below soleal line INSERTION : distal phalanx of 2nd to 5th toe
N/S : Tibial nerve ACTOIN : Plantar flexion of ankle 2nd to 5th toe
FLEXOR DIGITORUM ACCESSORI
ORIGIN : Medial head :- calcanium Lateral head :- calcaniumINSERTION : Distal phalanx of 2nd to 5th toe Muscle fibres insert on to lateral side of tendons of FDL N/S : Lateral plantar nerve ACTION : plantar felxion of ankle of 2nd -5th toe
LUMBRICLESORIGIN : 1ST :-medial side of 1st FDL OF 2ND toe 2nd :-adjacent side of tendon of 1st and 2nd FDL 3RD :-adjacent side of tendon of 2nd and 3rd FDL 4TH :-Adjacent side of tendon of 3rd and 4th FDL INSERTION : MTP of lateral four toes dorsally for insertion into extensor expansion
N/S : 1st :- Medial plantar nerve 2nd -4th :- lateral plantar nerve
ACTION : Extension of IPJ Toes dosent buckle while walking
FLEXOR HALLUCIS LONGUSORIGIN : Fibula :- L3/4 post surface
INSERTION : Distal phalanx of 1st toe
N/S : Tibial nerve
ACTION : Plantar flexion of big toe ,Ankle
Maintaines Median long arch
3 MUSCLES OF 3RD LAYER
. FLEXOR HALLUCIS BREVIS
. ADDUCTOR HALLUCIS
. FLEXOR DIGITI MINIMI BREVIS
FLEXOR HALLUCIS BREVIS ORIGIN : Arises by ‘Y’ shaped tendon Medial limb :- direct conitnuation of tibialis posterior Lateral limb:- cuboidINSERTION : Proximal phalanx of GT muscle divides into medial and lateral part each tendon inserted into corresponding sides N/S : Medial plantar nerve ACTION : Flexor of pp at GT
ADDCUTOR HALLUCISORIGIN : Oblique head :- 2nd 3rd MT sheath of peroneus longus Transerve head :-long plantar ligaments of MTP joints of 3rd 4th 5th joints Deep MT ligaments INSERTION : Lateral side of proxiaml phalanx of GT Common with lateral tendon of flexor hallucis brevisN/S : Deep lateral plantar nerve
ACTION : Addcutor of GT
FLEXOR DIGITI MINI BREVIS
ORIGIN : 5MT Tendon of peroneus longus
INSERTION : lateral side of proximal phalan of LT N/S : Superficial lateral plantar nerve
ACTION : Flexor of pp of LT
4 MUSCLES OF 4TH LAYER
• DORSAL INTEROSSEI
• PLANTOR INTEROSSEI
• TIBIALIS POSTERIOR
• PERONEUS LONGUS
DORSAL INTEROSSEIORIGIN : ALL MT :- adjacent sides INSERSTION : Proximal phalanx of 2nd to 5th toe 1ST :- medial side of pp 2nd toe 2ND :-lateral side of pp 3rd toe 3rd :- lateral side of pp 4th toe 4th :- lateral side of pp 5th toe N/S : lateral plantar NerveACTION : DAB
PLANTAR INTEROSSEI
ORIGIN : 3rd ,4th,5th,MT :- medial side INSERTION : Proximal phalanx 3rd ,4th,5th,N/S : lateral plantar Nerve ACTION : PAD
TIBIALIS POSTERIORORIGIN : Tibia :- u2/3 posterior surface below soleal line Fibula :- Posterior surface of fibula INSERTION : Tuberosity of navicular bone and tarsal bone except talus Insert extends to 2nd ,3rd,4th,MT at baseN/S : Tibial nerve ACTION : Plantar flexion at ankle Inversion at foot at subtalar joint Maintains medial longitudinal arch
PERONEUS LONGUS
ORIGIN : Fibula :- Head of fibula Lateral surface of shaft Medial 1/3 of fibula INSERTION : Medial cuneaform same as T.ant 1st MT N/S : Superior peroneal nerveACTION : Evertor of foot Maintains lateral longitdinal
transverse arch
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