Class 6 Ap1 Muscles
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Class 6 Ap1 Muscles

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Class 6 Ap1 Muscles Class 6 Ap1 Muscles Presentation Transcript

  • Muscles of the Pelvis and Thigh
  • Review Week 5
  • Latissimus Dorsi
    • P: SPs of T7-L5, posterior sacrum, and the posterior iliac crest
    • D: Medial lip of bicipital groove of the humerus
    • Medially rotates the arm at the shoulder joint
    • Adducts the arm at the shoulder joint
    • Extends the arm at the shoulder joint
    • Anteriorly tilts the pelvis at the lumbosacral joint
  • Rhomboid Major and Minor
    • P: SPs of C7-T5
    • D: Medial border of the scapula from the root of the spine of the scapula to the inferior angle of the scapula
    • Retracts (Adducts) the scapula at the scapulocostal joint
    • Elevates the scapula
  • Serratus Anterior
    • O: Ribs 1-9
    • I: Anterior surface of the entire medial border of the scapula
    • Protracts (abducts) the scapula at the scapulocostal joint
    • Upwardly rotates the scapula at the scapulocostal joint
  • Serratus Posterior Superior
    • 1. Elevates ribs #2-5 at the sternocostal and costospinal joints
  • Serratus Posterior Inferior
    • 1. Depresses ribs #9-12 at the sternocostal and costospinal joints
  • Erector Spinae Group
    • O: Pelvis
    • I: Spine, ribcage, and head
    • Extends the trunk, neck, and the head at the spinal joints
    • Laterally flexes the trunk, neck, and head at the spinal joints
    • Ipsilaterally rotates the trunk, neck, and head at the spinal joints
    • Anteriorly tilts the pelvis at the lumbosacral joint
  • Transversospinalis Group
    • O: Pelvis
    • I: Spine and the head
    • Extends the trunk, neck, and head at the spinal joints
    • Laterally flexes the trunk, neck, and head at the spinal joints
    • Contralaterally rotates the trunk and the neck at the spinal joints
    • Anteriorly tilts the pelvis at the lumboscaral joint
  • Quadratus Lumborum
    • P: 12 th rib and the TPs of L1-L4
    • D: Posterior Iliac crest
    • Elevates the pelvis at the lumbosacral joint
    • Anteriorly tilts the pelvis at the lumbosacral joint
    • Laterally flexes the trunk at the spinal joints
    • Extends the trunk at the spinal joints
  • Pectoralis Major
    • P: Medial clavicle, sternum, and the costal cartilages of ribs 1-7
    • D: Lateral lip of the bicipital groove of the humerus
    • 1. Adducts the arm at the shoulder joint
    • 2. Medially rotates the arm at the shoulder joint
    • 3. Flexes the arm at the shoulder joint (clavicular head)
  • Pectoralis Minor
    • P: Ribs 3-5
    • D: Coracoid process of the scapula
    • Protracts (abducts) the scapula at the scapulocostal joint
    • Depresses the scapula at the scapulocostal joint
    • Elevates ribs 3-5 at the sternocostal and costospinal joints
  • Diaphragm
    • Increases the volume of the Thoracic Cavity (inspiration)
  • RectusAbdominis
    • P: Pubis
    • D: Xiphoid process and the cartilage of ribs 5-7
    • Flexes the trunk at the spinal joints
    • Posteriorly tilts the pelvis at the lumbosacral joint
  • External Oblique
    • P: Anterior iliac crest, pubic bone, and the abdominal aponeurosis
    • D: Lower 8 ribs (5-12)
    • Flexes the trunk at the spinal joints
    • Laterally flexes the trunk at the spinal joints
    • Contralateral rotates the trunk at the spinal joints
    • Posteriorly tilts the pelvis at the lumbosacral joints
  • Internal Oblique
    • O: Inquinal ligament, iliac crest, and the thoracolumbar fascia
    • I: Lower three ribs (10-12) and the abdominal aponeurosis
    • Flexes the trunk at the spinal joints
    • Laterally flexes the trunk at the spinal joints
    • Ipsilaterally rotates the trunk at the spinal joints
    • Posteriorly tilts the pelvis at the lumbosacral joints
  • Transverse Abdominis
    • Compresses the abdominal contents
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  • Psoas Major
    • P: Anterolateral lumbar spine
    • D: Lesser trochanter of the femur
    • Flexes the thigh at the hip joint
    • Laterally rotates the thigh at the hip joint
    • Flexes the trunk at the spinal joints
    • Laterally flexes the trunk at the spinal joints
    • Anteriorly tilts the pelvis at the hip joints
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  • Iliacus
    • P: Internal Ilium
    • D: Lesser trochanter of the femur
    • Flexes the thigh at the hip joint
    • Laterally rotates the thigh at the hip joint
    • Anteriorly tilts the pelvis at the hip joints
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  • Psoas Minor
    • Flexes the trunk at the spinal joints
    • Posteriorly tilts the pelvis at the lumbosacral joint
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  • Gluteus Maximus
    • P: Posterior iliac crest, posterolateral sacrum, and the coccyx
    • D: Iliotibial band (ITB) and gluteal tuberosity of the femur
    • Extends the thigh at the hip joint
    • Laterally rotates the thigh at the hip joint
    • Abducts the thigh at the hip joint (upper 1/3)
    • Adducts the thigh at the hip joint (lower 2/3)
    • Posteriorly tilts the pelvis at the hip joint
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  • Gluteus Medius
    • P: External Ilium
    • D: Greater trochanter of the femur
    • Abducts the thigh at the hip joint (entire muscle)
    • Flexes the thigh at the hip joint (anterior fibers)
    • Medially rotates the thigh at the hip joint (anterior fibers)
    • Extends the thigh at the hip joint (posterior fibers)
    • Laterally rotates the thigh at the hip joint (posterior fibers)
    • Posteriorly tilts the pelvis at the hip joint (posterior fibers)
    • Anteriorly tilts the pelvis at the hip joint (anterior fibers)
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  • Gluteus Minimus
    • P: External Ilium
    • D: Greater trochanter of the femur
    • Abducts the thigh at the hip joint (entire muscle)
    • Flexes the thigh at the hip joint (anterior fibers)
    • Medially rotates the thigh at the hip joint (anterior fibers)
    • Extends the thigh at the hip joint (posterior fibers)
    • Laterally rotates the thigh at the hip joint (posterior fibers)
    • Posteriorly tilts the pelvis at the hip joint (posterior fibers)
    • Anteriorly tilts the pelvis at the hip joint (anterior fibers)
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  • Deep Lateral Rotators of the Thigh
    • Piriformis
    • Superior Gemellus
    • Obturator Internus
    • Inferior Gemellus
    • Obturator Externus
    • Quadratus Femoris
  • Piriformis
    • P: Anterior sacrum
    • D: Greater trochanter of the femur
    • 1. Laterally rotates the thigh at the hip joint
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  • Tensor Fasciae Latae (TFL)
    • P: Anterior Superior Iliac Spine
    • D: Iliotibial band (ITB)
    • Flexes the thigh at the hip joint
    • Abducts the thigh at the hip joint
    • Medially rotates the thigh at the hip joint
    • Anteriorly tilts the pelvis at the hip joint
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  • Sartorius
    • P: Anterior superior iliac spine (ASIS)
    • D: Pes Anserine Tendon (at the proximal anteromedial tibia)
    • Flexes the thigh at the hip joint
    • Abducts the thigh at the hip joint
    • Laterally rotates the thigh at the hip joint
    • Flexes the leg at the knee joint
    • Anteriorly tilts the pelvis at the hip joint
  • Pes Anserine
    • The three muscles that attach here are from anterior to posterior:
    • Sartorius
    • Gracilis
    • Semitendinosus
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  • Rectus Femoris
    • P: Anterior Inferior iliac spine (AIIS)
    • D: Tibial Tuberosity
    • Extends the leg at the knee joint
    • Flexes the thigh at the hip joint
    • Anteriorly tilts the pelvis at the hip joint
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  • Vastus Lateralis
    • P: Linea Aspera of the femur
    • D: Tibial tuberostiy
    • 1. Extends the leg at the knee joint
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  • Vastus Medialis
    • P: Linea Aspera of the femur
    • D: Tibial tuberosity
    • 1. Extends the leg at the knee joint
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  • Vastus Intermedius
    • P: Anterior shaft and the linea aspera of the femur
    • D: Tibial tuberosity
    • 1. Extends the leg at the knee joint
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  • Pectineus
    • P: Pubis
    • D: Proximal posterior shaft of the femur
    • Adducts the thigh at the hip joint
    • Flexes the thigh at the hip joint
    • Anteriorly tilts the pelvis at the hip joint
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  • Adductor Longus
    • P: Pubis
    • D: Linea aspera of the femur
    • Adducts the thigh at the hip joint
    • Flexes the thigh at the hip joint
    • Anteriorly tilts the pelvis at the hip joint
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  • Gracilis
    • P: Pubis
    • D: Pes anserine tendon (at the proximal anteromedial tibia)
    • Adducts the thigh at the hip joint
    • Flexes the thigh at the hip joint
    • Flexes the leg at the knee joint
    • Anteriorly tilts the pelvis at the hip joint
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  • Adductor Brevis
    • P: Pubis
    • D: Linea aspera of the femur
    • Adducts the thigh at the hip joint
    • Flexes the thigh at the hip joint
    • Anteriorly tilts the pelvis at the hip joint
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  • Adductor Magnus
    • P: Pubis and Ischium
    • D: Linea aspera of the femur
    • Adducts the thigh at the hip joint
    • Extends the thigh at the hip joint
    • Posteriorly tilts the pelvis at the hip joint
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  • Biceps Femoris
    • P: Long head: Ischial tuberosity
    • Short head: Linea aspera
    • D: Head of the fibula
    • Flexes the leg at the knee joint (entire muscle)
    • Extends the thigh at the hip joint (long head)
    • Posteriorly tilts the pelvis at the hip joint (long head)
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  • Semitendinosus
    • P: Ischial tuberosity
    • D: Pes Anserine tendon
    • Flexes the leg at the knee joint
    • Extends the thigh at the hip joint
    • Poseteriorly tilts the pelvis at the hip joint
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  • Semimembranosus
    • P: Ischial tuberosity
    • D: Medial condyle of the tibia
    • Flexes the leg at the knee joint
    • Extends the thigh at the hip joint
    • Posteriorly tilts the pelvis at the hip joint
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    • Have client supine with pillow under knees
    • Place palpating hand on the abdomen between the iliac crest and the 12 th rib and palpate deeply with even pressure toward the psoas major. GO SLOW
    • Ask the client to slowly flex the thigh at the hip joint and feel for contraction of the psoas major
    • The distal tendon of the psaos major is palpable in the proximal anterior thigh between the pectineus and the sartorius
    • Have client supine with a pillow under the knees. Have the knee flexed and slightly laterally rotated
    • Place palpating hand on the anterior iliac crest and palpate into the iliac fossa with your finger tips. Most of the iliacus is not palpable
    • Ask the client to actively flex the thigh at the hip joint and feel for the contraction of the iliacus
    • Have client supine
    • Place palpating hand just distal and slightly medial to the ASIS
    • Ask client to actively flex and laterally rotate the thigh at the hip joint and feel for the contraction of the sartorius
    • Continue palpating the sartorius from the ASIS to the pes anserine tendon
    • To further bring out the muscle give the client resistance
    • Have client supine
    • Place palpating hand just distal and slightly lateral to the ASIS
    • Have client actively hold the thigh in a position of flexion and medial rotation at the hip joint
    • Resist the client from further flexion of the thigh at the hip joint and feel for the contraction of the TFL
    • Continue palpating the TFL distally and slightly posteriorly toward ITB attachment
    • Have client supine with a pillow under their knees
    • Place palpating hand just proximal to the patella
    • Resist the client from actively extending the leg at the knee joint and feel for the contraction of the rectus femoris
    • Continue palpating the muscle toward the ASIS
    • To palpate the proximal attachment passively flex the thigh at the hip joint and palpate slightly distal to the ASIS
    • Have client supine
    • Place palpating hand just distal to the greater trochanter
    • Ask the client to contract the quadriceps femoris group and feel for contraction of the vastus lateralis
    • Continue palpating distally toward the patella
    • Have client supine
    • Place palpating hand just proximal and medial to the patella
    • Ask the client to contract the quadriceps femoris group and feel for the contraction of the vastus medialis
    • Continue palpating the vastus medialis proximally as far as possible
    • The vastus medialis is best palpated medially in the distal 1/3 of the thigh
    • Deep and difficult to palpate
    • Have client supine
    • Place palpating hand just proximal to the patella
    • If the rectus femoris can be lifted and/or moved aside, the distal vastus intermedius may be palpated deep to the rectus femoris when approached from either the medial or lateral side
    • To feel the vastus intermedius deep to the rectus femoris, make sure that the direction of your pressure is directed toward the middle of the femur
    • Have the client supine with the their knee resting on a pillow or your inferior thigh
    • Palpate the medial thigh for the “guitar string” muscle. This is the gracilis
    • Ask the client to flex the leg at the knee joint against resistance of the table and only the gracilis will contract
    • Once located continue palpating medially toward the pubic attachment and distally to the pes anserine attachment. Ask the client to adduct the thigh at the hip joint to distinguish it from the semitendinosus
    • Have the client supine with their thigh flexed at the hip joint and slightly laterally rotated resting their thigh on a pillow or your inferior leg
    • Place palpating hand on the proximal anteromedial thigh
    • Ask the client to actively adduct the thigh at the hip joint
    • Follow the adductor longus’ tendon proximally toward the pubis
    • The tendon will be just lateral to the attachment of the gracilis
    • Have the client supine
    • Place palpating hand just lateral to the pubic tubercle and feel for the pectineus
    • Continue palpating just lateral and slightly proximal to the adductor longus
    • To further bring out the pectineus ask the client to actively adduct the thigh at the hip joint
    • The biceps femoris is superficial for most of its course in the posterolateral thigh and is easy to palpate
    • Have the client prone with the leg partially flexed at the knee joint
    • Place palpating hand on the distal posterolateral thigh
    • Resist the client from performing further flexion of the leg at the knee joint and feel for the distal tendon of the biceps femoris
    • Continue palpating the biceps femoris toward the ischial tuberosity
    • The semitendinosus is superficial for most of its course in the posteromedial thigh and is easy to palpate
    • Have the client prone with the leg partially flexed at the knee joint
    • Place palpating hand on the posteromedial thigh
    • Further resist flexion of the leg at the knee joint and feel for the distal tendon of the semitendinosus
    • Continue palpating the muscle proximally toward the ischial tuberosity. Its attachment is just medial to the long head of the biceps femoris
    • Best palpated distally in the posterior thigh, medial to the belly of the semitendinosus, and on either side of the distal tendon of the semitendinosus
    • Have the client prone with the leg partially flexed at the knee joint
    • Place palpating hand on the distal posteromedial thigh
    • Resist the client from performing further flexion of the leg at the knee joint and feel for contraction of the semimembranosus
    • The proximal attachment on the ischial tuberosity is lateral to the attachment of the long head of the biceps femoris
    • Have the client prone
    • Find the ischial tuberosity attachment and proximal belly of the hamstrings by having the client flex the leg at the knee joint against your resistance.
    • Locate the medial border of the hamstrings in the proximal thigh.
    • Palpate just anteromedial to the medial border of the hamstrings for the adductor magnus. This will feel like a natural depressionin the thigh
    • Continue palpating proximally to the attachment on the ischial tuberosity
    • Have client prone
    • Follow palpation of the Adductor Magnus
    • The tendon of the adductor brevis is just medial to the attachment of the adductor magnus on the pubic bone
    • Have client prone
    • Place palpating hand just lateral to the sacrum at a point mid way between the PSIS and the apex of the sacrum
    • Have client flex the leg at the knee joint to 90 degrees
    • Have client laterally rotate the thigh at the hip joint against resistance and feel for contraction of the piriformis
    • Continue palpating laterally to the greater trochanter of the femur
    • Have client lay prone
    • Place palpating hand on the lateral sacrum
    • Palpate the gluteus maximus from its medial attachment (lateral sacrum) to its lateral attachment (ITB)
    • Have the client actively extend and laterally rotate the thigh at the hip joint to further bring out the muscle.
    • The gluteus maximus does not cover the entire buttocks; the gluteus medius is just inferior to most of the posterior iliac crest
    • Have client side lying
    • Middle portion: Place palpating hand between the iliac crest and the greater trochanter of the femur. Ask client to abduct the thigh at the hip joint
    • Anterior portion: Place palpating hand just posterior and inferior to the ASIS and feel for the anterior fibers. Ask client to flex and medially rotate the thigh at the hip joint.
    • Posterior portion: Palpate just deep to the superolateral portion of the gluteus maximus and have the client extend and laterally rotate the thigh at the hip joint.
    • Distinguishing gluteus medius from glut max and piriformis can be difficult
    • It is difficult to differentiate the gluteus medius from the gluteus minimus because the gluteus medius entirely overlies the gluteus minimus and they have identical actions
    • Do the same procedure for gluteus medius and palpate deeper